Abstract:
An intramedullary fixation device having a distal section; a proximal section; a connecting member for adjustably securing the distal and proximal sections end to end along a longitudinal axis; means for securing the proximal section to a first bone; and means for securing the distal section to a least one different bone. The connecting member is rotated to provide compression across a bone arthrodesis site to be stabilized and fused. Also described is a method of utilizing the intramedullary fixation device with an outrigger assembly.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation-in-part from and claims priority to U.S. patent application Ser. No. 12/500,473, filed on Jul. 9, 2009, entitled “ANKLE ARTHRODESIS NAIL AND OUTRIGGER ASSEMBLY,” which claims priority to U.S. Provisional Application No. 61/079,132, filed on Jul. 9, 2008, entitled “ARTHRODESIS NAIL OUTRIGGER ASSEMBLY” and to U.S. Provisional Application No. 61/079,130 filed on Jul. 9, 2008, entitled “ANKLE ARTHRODESIS NAIL AND OUTRIGGER ASSEMBLY,” all of which are incorporated herein by reference in their entirety as if set forth in full. 
     
    
     FIELD OF THE EMBODIMENTS 
       [0002]    Embodiments of the present invention relate to surgical and bone fusion devices and systems in general, and more particularly to an improved arthrodesis nail that enables the bone fusion site to be sufficiently compression prior to fusion, and more particularly still tea an improved outrigger assembly and method for implanting an arthrodesis nail. 
       BACKGROUND 
       [0003]    The lower limbs of the human body, namely the femur (thigh bone), the tibia (shinbone), and fibula, are designed to bear the weight of the body and to provide the body with sufficient stability. The femur courses medially from its proximal end connected to the hip bone to its distal end connected to the knee, placing the knee joints closer to the body&#39;s center of gravity and thus giving the body better balance while walking or standing. The tibia and fibula, which are connected together by an interosseous membrane, extend in parallel from the knee to ankle, with the tibia being larger and located medially in relation to the fibula. The tibia articulates proximally with the femur, forming the hinge joint of the knee, and distally with the talus bone of the foot at the ankle, and as such receives most of the body&#39;s weight and transmits it to the foot, while the fibula, which articulates proximally and distally with the lateral aspects of the tibia, is a non-weight bearing bone and generally provides stability for the ankle joint. The shaft of the tibia is generally triangular in cross section, and its distal end is blunt where it articulates with the talus. Situated medially to such distal tibia end is the medial malleolus, and a fibular notch is provided on the lateral surface of the tibia opposite the medial malleolus. 
         [0004]    The foot skeleton is made up of the tarsus, metatarsus, and phalanges bones, with the tarsus bones forming the proximal or heel end of the foot, the metatarsus bones forming the bases of the toes, and the phalanges being the toe bones. The tarsal bones include the talus, calcaneus, lateral cuboid, medial navicular, and medial, intermediate, and lateral cuneiform bones. The talus articulates with the tibia and fibula superiorly and is located on the upper surface of the calcaneus bone, which forms the heel and with the part that touches the ground the tuber calcanei, and such bones support most of the weight of the body, although some weight is distributed to the heads of the metatarsals by the arching of the foot. In some patients the ankle joint or interconnection of the lower end of the tibia, the fibula, and the talus (spaced apart by articular cartilage and held together by various ligaments) can become worn or injured due to a degenerative condition or deformity, or a fracture, subluxation, or other traumatic event. In order to stabilize the ankle joint and control the often severe pain caused by such conditions, an arthrodesis procedure may be necessary to fuse and therefore permanently immobilize the ankle joint, fusing the distal end of the tibia with the talus. Where both the tibi-talar and talocalcaneal joints are damaged, such as in some patients having severe osteoporosis, the calcaneus bone will also be fused with the ankle. Such tibiotalacalcaneal arthrodesis procedures today are typically accomplished by permanent intramedullary nailing, wherein after the ankle bone surfaces have been prepared a rigid nail or rod is inserted in a hole drilled upwardly through the calcaneus and talus bones and into the medullary canal of the tibia. Screws are passed laterally through holes drilled in the tibia to hold the proximal end of the nail in place in the tibia, and into the nail through holes drilled in the calcaneus and talus bones. A limitation of known intramedullary or tibio-calcaneal arthrodesis nailing systems is in obtaining sufficient compression across the arthrodesis site so that a proper fusion is accomplished. 
         [0005]    Embodiments of the invention provide both an arthrodesis implant which is simple, easy to install and effective, as well as an arthrodesis outrigger assembly for use with such implant which is effective during an arthrodesis operation for proper alignment and implantation of the arthrodesis implant. 
         [0006]    Alternate embodiments also provide an arthrodesis implant which can be relatively easily implanted in the foot and ankle and quickly, easily and effectively secured in place. 
         [0007]    Alternate embodiments also provide an arthrodesis prosthesis which is formed in two main sections which are adjustably secured together by an intervening rotatable adapter effective from the bottom of the arthrodesis prosthesis to compress or place tension on the leg and ankle bones to be fused. 
         [0008]    Alternate embodiments also provide an arthrodesis implant which is formed in two main sections adjustably secured together by a central rotating fitting which in combination with an external compression disc are used to provide tension from and through the foot bone to provide compression of the bones in an arthrodesis site prior to insertion of retaining screws used to immobilize the foot bones after which the compression disc can be removed. 
         [0009]    Alternate embodiments also provide an improved arthrodesis nail outrigger assembly adapted for guiding an arthrodesis tool into the foot and leg bones applying an external compression disc and retaining screws after which the outrigger assembly can be removed. 
         [0010]    Alternate embodiments also provide an arthrodesis nail outrigger assembly wherein the outrigger assembly can be adjustably rotated around an arthrodesis with respect to a stationary intramedullary nail device. 
         [0011]    Alternate embodiments also provide an arthrodesis nail outrigger assembly having a cannulated nail mounting shaft arrangement to allow for compression of a two-sectioned intramedullary nail device, resulting in a more tightly compressed and stable tibio-calcaneal arthrodesis. 
         [0012]    Objects and advantages of embodiments of the invention will become clear upon review of the following detailed description in conjunction with the appended drawings. 
       SUMMARY 
       [0013]    In a preferred embodiment, an intramedullary fastener or nail is provided, wherein the nail is formed in two sections that are adjustably joined together by an internal bolt member that can be rotated to decrease the total length of the combined nail. Accordingly, the device is capable of providing compression across an arthrodesis site in a tibio-calcaneal arthrodesis nailing procedure. After the nail has been inserted upwardly through holes drilled in the calcaneus and talus bones and tibia, using an outrigger assembly the nail may be secured to the tibia. After this the outrigger assembly, in combination with a compression disc provided at the distal end of the nail, can rotate the internal bolt member causing the distal or lower section of the nail and compression disc to move upwardly toward the proximal or upper section, thus providing compression of the calcaneus and talus bones with the tibia so that any spaces between the joints are closed prior to securing the bones in such position. In an alternate embodiment, at improved outrigger assembly is also provided that enables the outrigger handle to be rotated and secured at ninety-degree angles with respect to the stationary intramedullary nail. The outrigger assembly provides stability and ease of use. The outrigger assembly can include a cannulated nail mounting shaft that enables a compression driver to be inserted through the shaft upwardly into the nail to adjust the position of the belt member and provide the desired amount of compression across the arthrodesis site. In addition the amount of compression across the arthrodesis site can be adjusted at a later date via a minimally invasive procedure. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]      FIG. 1  is a partial cross-sectional view an embodiment of the intramedullary fixation device along its longitudinal axis in an uncompressed configuration. 
           [0015]      FIG. 2  is a side view of an embodiment of the intramedullary fixation device as applied to an ankle joint in an uncompressed configuration. 
           [0016]      FIG. 3  is a side view of the fixation device shown in  FIG. 2  as applied to an ankle joint in a fully compressed configuration. 
           [0017]      FIG. 4A  is a top view of an embodiment of a compression disc used with embodiments of the intramedullary fixation device. 
           [0018]      FIG. 4B  is a side view of embodiments of the intramedullary fixation device and the compression disc as applied to an ankle joint in an uncompressed configuration. 
           [0019]      FIG. 5A  is a side view of an embodiment of the proximal section of the intramedullary fixation device. 
           [0020]      FIG. 5B  is a cross-sectional view of the proximal section of an embodiment of the intramedullary fixation device of  FIG. 5A . 
           [0021]      FIG. 6A  is a side view of an embodiment of the distal section of the intramedullary fixation device. 
           [0022]      FIG. 6B  is a view of an embodiment of the distal section of the intramedullary fixation device taken along the line B in  FIG. 6A . 
           [0023]      FIG. 6C  is a view of an embodiment of the distal section of the intramedullary fixation device taken along the line C in  FIG. 6A . 
           [0024]      FIG. 7  is a side view of an embodiment of the compression bolt member of the intramedullary fixation device. 
           [0025]      FIG. 8A  is a side view of an embodiment of the bolt retainer member. 
           [0026]      FIG. 8B  is a cross-sectional view of the bolt retainer member shown in  FIG. 8A . 
           [0027]      FIG. 9  is a cross-sectional view of an embodiment of the intramedullary fixation device as shown in  FIG. 1  in a compressed configuration. 
           [0028]      FIG. 10A  is a side view of an embodiment of the intramedullary fixation device in an uncompressed configuration. 
           [0029]      FIG. 10B  is a side view of an alternative embodiment of the intramedullary fixation device. 
           [0030]      FIG. 11  is a proximal end view of an embodiment of a section of the intramedullary fixation device. 
           [0031]      FIG. 12  is a perspective view from the side of an embodiment of the outrigger assembly and intramedullary fixation device. 
           [0032]      FIG. 13  is a side view of an embodiment of the outrigger assembly and intramedullary fixation device. 
           [0033]      FIG. 14  is a perspective view from the top of an embodiment of the outrigger assembly and intramedullary fixation device. 
           [0034]      FIG. 15  is an exploded view from the side of an embodiment of the outrigger assembly. 
           [0035]      FIG. 16  is an exploded view from the top of an embodiment of the outrigger assembly. 
           [0036]      FIG. 17  is a cross-sectional view from the side of an embodiment of the outrigger assembly. 
           [0037]      FIG. 18  is a side view of an embodiment of the intramedullary fixation device as applied to an fifth metatarsal fracture in an uncompressed configuration. 
           [0038]      FIG. 19  is a side view of an embodiment of the intramedullary fixation device as applied to an long bone fracture in an uncompressed configuration. 
           [0039]      FIG. 20  is a side view of an embodiment of the intramedullary fixation device as applied to subtalar joint fusion in an uncompressed configuration. 
       
    
    
     DETAILED DESCRIPTION 
       [0040]    This description is not intended to be understood in a limiting sense, but to be embodiments of the invention presented solely for illustration thereof, and by reference to, in connection with the following description and the accompanying drawings, one skilled in the art may be advised of advantages and construction of embodiments of the invention. Embodiments of the invention are intended to cover alternatives, modifications, and equivalents, which may be included within the spirit and scope of the invention as defined by the appended claims. 
         [0041]      FIGS. 1-11  illustrate embodiments of the intramedullary fixation device,  FIGS. 12-14  and  17  illustrate embodiments of the combination intramedullary fixation device and outrigger assembly, and  FIGS. 15-16  illustrate embodiments of the outrigger assembly alone Referring to  FIG. 1 , there is shown an embodiment of the intramedullary fixation device  12  for stabilizing the position of and fusing together the tibia T (shin bone) relative to the talus A (adjoining ankle) and calcaneus C (heel) bones, and which is to be inserted through the bottom of the foot into the medullary canal of the tibia. Intramedullary nail  12  is comprised of two main sections, referred to generally herein as proximal section  14  and distal section  16 . In addition, compression bolt  18  (see  FIG. 7 ) can be used to join proximal section  14  to distal section  16 , and provide the required tension or compression of the ankle joint on installed, as will also be described in detail below. In addition, alignment outrigger device  20  ( FIG. 16 ) is provided, which can be used to precisely position nail  12  in the tibia T and fixed to the talus A and calcaneus C bones. Also shown in  FIG. 16  is compression driver  24 , which is used to adjust compression bolt  18 . 
         [0042]    Proximal  14  and distal  16  sections of intramedullary nail  12  generally have a rounded or circular shape, and are preferably made of surgical stainless steel or surgical stainless titanium, and correspond generally to the shape of the tibia medullary canal. Referring more particularly now to  FIG. 5A , proximal section  14  of nail  12  has a forward end  25  and a rearward tad  26 , and is slightly tapered along its longitudinal axis  23  from rearward end  26  to forward end  25 , the outer surface of which end is preferably smooth and rounded. Through-holes  28  can be formed in the nail  12  extend perpendicular to longitudinal axis  23 , and may be spaced apart in the shaft of proximal section  14  near forward end  25 . Support screws  30  (see  FIG. 1 ) can be passed through the holes  28  to secure proximal section  14  of nail  12  to the tibia bone in position in the tibia medullary canal. The screws  30  may have different lengths and sizes as required and known to those skilled in the art. The proximal section  14  of the nail  12  may further include a bore  32  that extends inwardly from the rearward end  26  of proximal section  14  along the longitudinal axis  23 , forming non-threaded sleeve area  34  adjacent rearward end  26 , a short non threaded section  35  adjacent sleeve area  34  and having a smaller diameter than sleeve area  34 , with inwardly extending circumferential bearing surface  37  formed between areas  34  and  35 . An internal screw threaded area  36  for receiving compression bolt  18  can be formed by extending inwardly from short section  35 . See also  FIGS. 1 and 9 . In addition, at least one alignment tab  38  is provided in sleeve area  34 . 
         [0043]    As shown in  FIG. 6A , distal section  16  of nail  12  has an upper end  40  and a lower end  41 , and is preferably slightly tapered from lower end  41  to upper end  40  along its longitudinal axis  42 . A plurality of holes  44  can be situated in distal section  16  near lower end  41  extending perpendicular to longitudinal axis  42  and spaced apart a predetermined distance, for receiving screws  30  passed through the talus and calcaneus bones. Situated on the upper end  40  of distal section  16  is arm  46  having a reduced outer diameter and being sized to be slidingly received in sleeve  34  of bore  32  in proximal section  14 . A bore  48  extends through distal section  16  from upper end  40  to lower end  41 , which bore  48  has a smaller diameter section  49  adjacent upper end  40  and arm  46 , and a larger diameter section  50 , with inwardly extending bearing surface or end wall  51  between such sections. The bore  48  is also variable in  FIGS. 1 and 9 . Threads  52  are provided in the inner walls of larger diameter section  50  of bore  48  adjacent lower end  41 , while a plurality of spaced apart rectangular notches  54  are formed in lower end  41  (See  FIGS. 6C and 11 ). The upper end  40  of distal section  16  includes two longitudinally-oriented notches  56 . According to one embodiment, these notches are placed orthogonally with respect to each other and are aligned with or are orthogonal to the holes  44 . The notches  56  are designed to mate with tab  38  in the rearward end of the proximal section  14  of the nail  12  as shown  FIG. 5B . By providing two notches  56  in the upper end  40  of the distal section  16 , the distal section can be oriented such that its holes  28  are either aligned with the holes  44  in the distal section  16 , or placed orthogonal to holes  44 . In this manner, the nail device  12  can be configured such that the nails can be applied uniformly in a medial-lateral (M-L) or anterior-posterior (A-P) direction, or distal nails and proximal nails can be alternated between an M-L, and A-P alignment (i.e., orthogonally), as shown in  FIG. 10B . 
         [0044]    Bore  48  is sized to receive compression bolt  18 , shown in  FIG. 7 , which bolt has a reduced diameter section  60  and a larger diameter head section  62 , forming an outwardly extending bearing surface  63  between sections  60  and  62 . Reduced diameter section  60  includes a threaded section  64 , a non-threaded shall section  66 , a shallow notch  67  situated between such sections, and head section  68 . A socket  70  is provided in the end surface of enlarged diameter section  62  to facilitate rotating bolt  18  in either a clockwise or counterclockwise direction using a driving device  24  as described in more detail below. As shown in  FIGS. 1 and 9 , head section  62  of compression bolt  18  is sired to be received in bore  50  of distal section  16  of nail  12 , while at the same time reduced diameter section  60  of bolt  18  is passed through bore sections  50 , with threaded section  64  extending outwardly through forward end  40  while shaft section  66  remains in bore  49  in arm  46 . When arm  46  is inserted in sleeve  34 , male threaded section  64  can be received on the female threads in bore section  36 , and when rotated on the threads arm  46  is pulled towards sleeve  34  until hearing surface  63  of head section  62  engages against beating surface  51  in bore  50 . Compression bolt  18  can be adjustably secured to proximal section  14  by clip  72 , shown in  FIG. 8 , which clip is secured around the outer surface of bolt  18  in slot  67 , to prevent threaded section  64  from being moved out of bore  32  past sleeve section  34 . 
         [0045]    Embodiments of the invention also includes an improved outrigger assembly  20 , shown alone in  FIGS. 15-16 , and with nail  12  attached in  FIGS. 12-14  and  17 . The outrigger assembly  20  is used to position and align the intramedullary fixation device  12  while it is being inserted and secured in the patient&#39;s tibia medullary canal, and also while a compressive force is applied across the arthrodesis site. Outrigger assembly  20  includes an alignment beam  80  that can be detachably and adjustably secured to handle  82  in a slot  83  along one side edge of handle  82  so that the beam extends outwardly from the handle. A nail engaging shaft  84  can be secured to handle  82  in an aperture  85  along the opposite side edge of the handle, so that which nail  12  is engaged with shaft  84 , the nail  12  is spaced apart from and in parallel with beam  80 . Outrigger assembly  20  is preferably made of carbon fiber, which is radiolucent and thus does not appear in x-rays, although other materials such as surgical stainless steel may be used. 
         [0046]    Beam  80  can be secured in slot  83  by two different locking mechanisms on opposite sides of the slot. The first of these is a threaded pin  86  which is threadably secured in an aperture  87  in handle  82 . A aperture  87  extends laterally between the outer side surface of handle  82  and slot  83 . Thus, when pin  86  is inserted and tightened in aperture  87  with beam  80  in slot  83 , its forward end extends through aperture  87  and presses against the side surface of beam  80 , preferably in one of several notches  88  (see  FIG. 17 ) in the corresponding side surface of beam  80 , to hold it in place in slot  83 . The second locking mechanism is pinstop  89 , which engages with beam  80  provided on the opposite side of slot  83  in handle  82 . As shown in the cross sectional view in  FIG. 17 , an angled aperture  90  is provided in handle  82  having a larger diameter end section  92 , a reduced diameter center section  94 , and second reduced diameter section  9  terminating at slot  83 . In addition, a transverse slot  98  can be cut a out in handle  82  extending through reduced diameter center section  94 . Aperture  90  can receive a lock shaft  100  having a head section  102 , a non-threaded shaft section  104 , a threaded shaft section  106 , and a forward non-threaded pin section  108 . Head section  102  is sized to be received in end section  92  of aperture  90 , shaft sections  104  and  106  are sized to be received in center section  94  of aperture  90 , and pin section  108  is sized to be received in section  96  of aperture  90 . Lock spring  110  is placed around non-threaded shaft section  104 , while adjustor knob  112  is secured over threaded shaft section  106  in transverse slot  98 , such that taming knob  112  causes lock shaft  100  to move either forwardly or rearwardly in aperture  90 , with the forward end of pin section  108  extending into one of several similarly angle apertures  114  in beam  80 , thereby locking beam  80  in place. Notches  116  aligned with apertures  114  are also provided in beam  80 , which when aligned properly with handle  82  engage teeth  117  on the inner surface of slot  83  adjacent second reduced diameter section  96  of aperture  90 . Thus, the tension on beam  80  can be adjusted on one side by rotating knob  112 , and on the other side using threaded pin  86  to ensure that such tension is generally equal and further than beam  80  is locked in place. 
         [0047]    The intramedullary fixation device mounting shaft  84  may include a bottom section  118  that is generally square or rectangular and fits in aperture  85  in handle  82 . The mounting shaft  84  also includes a slide lock receiving section  120 , adjacent to bottom section  118 , a short conical section  122  adjacent to slide lock receiving section  120 , a second short enlarged diameter section  124  adjacent conical section  122 , and a shaft section  126  for engaging with nail  12 . A Cavity  128  may extend through the nail mounting shaft  84 , and alignment tabs  130  that engage with notches  54  in the outer end  41  of distal section  16  of nail  12 . The alignment tabs  130  also engaged with notches  154  on compression disc  150 , shown in  FIG. 4 . The alignment tabs  130  can be provided on the outer end of shaft section  126 . Another slot  134  and associated notch  135  (see  FIG. 17 ) are provided in the side surface of handle  82  adjacent aperture  85 , in which slide lock device  136  can be inserted. Slide lock device  136  has a head or button section  138 , a rectangular shaft section  140  having a lateral through-hole  142 , and a pin section  144  extending forwardly from shaft section  140 , around which pin  144  coil spring  146  may be secured. When bottom section  118  of nail mounting shaft  84  is inserted in aperture  85 , the slide lock device  136  can be inserted in aperture  134  unfit lateral hole  142  is aligned with aperture  85 . Bottom section  118  may therefore be passed through lateral hole  142 , and slide lock receiving section  120 , which section has a width that is slightly greater than the width of shaft section  140 , is aligned in hole  142 . Slide lock device  136  can serve as a position stop locking device, as spring  146  causes shaft section  140  to press against the side surface of slide lock receiving section  120 , thereby locking nail receiving shaft  84  in place secured to handle  82 . When button  138  on slide lock device  136  is pressed inwardly, shaft  84  is released and outrigger assembly  20  can be swiveled or rotated with respect to shaft  84  and nail  12  in a three hundred sixty degree range around shaft  84  and nail  12 . The outrigger assembly  20  can also be stopped and locked at ninety degree intervals. Such unique feature enables the outrigger assembly to be rotated to different positions or angles around a patient&#39;s legs as desired, with the nail  12  remaining stationary or fixed to the patient&#39;s tibia. This may be desired in some cases where the outrigger assembly is in the surgeon&#39;s way while another step or task is being performed, and allows the assembly to be moved out of the way and then back again after a task has been completed, or where the outrigger assembly must be moved in order to complete the operation. 
         [0048]    Nail  12  can be secured to outrigger assembly  20  as follows. The alignment between the proximal section  14  and distal section  16  in either the M-L or A-P orientation is determined by the surgeon and the notches  56  are mated with tab  38  for the desired alignment. To change alignment, the compression driver  24  facilitates the removal of the proximal section  14  from bolt  18  via socket  70 . The proximal section  14 , using notches  56  and tab  38 , can be re-oriented and the compression driver  24  tightens the proximal section back on bolt  18  via socket  70 . The notches  54  in the lower end  41  of distal section  16  of intramedullary fixation device or nail assembly  12  can be aligned in the desired position with tabs  130  on the outer end of shaft section  12 $ of nail mounting shaft  84 . In addition, compression disc  150 , shown in  FIG. 4A , can be positioned between lower end  41  of nail  12  and tabs  130  so that it will be held between the lower end of the nail and forward end of shaft section  126 . As shown in  FIG. 4A , disc  150  has an aperture  152  through its center area, to accommodate shaft section  126  passing through such aperture. The purpose of disc  150  is to prevent the lower end of nail  12  from pulling upwardly into the calcaneus or heel bone when the bolt  18  is rotated to bring the distal section  16  of nail  12  upwardly to proximal section  14 . Rather, with compression disc  150  abutting against the bottom surface of the patient&#39;s heel, the upward movement of distal section  16  will cause the spaces between the lower end of the tibia and top surface of the talus, as well as between the bottom surface of the talus and top surface of the calcaneus, to shrink and eventually be eliminated, as shown in  FIGS. 2 and 3 , and resulting in a desirably compressed ankle joint, In a preferred embodiment, the compression disc  150  is placed against the heel bone internal to the body. In an alternate embodiment, the compression disc  150  is placed against the heel bone external to the body. 
         [0049]    Once alignment tabs  130  on the outer end of shaft  84  have been engaged with notches  54  on the lower end  41  of nail  12 , with compression disc  150  inserted in-between, then nail attachment device  160  can be used to secure nail  12  to shaft  84 . As illustrated in  FIG. 17 , device  160  may comprise a knob  162  attached to one end of an elongated shaft  164  having male threads  166  on its opposite end. Shaft  164  is sized to be slidably received in cavity  128  in nail mounting shaft  84 . In addition, a cavity  168  extends through shaft  164  from end to end. Male threads  166  can be engaged with female threads  52  on the lower end of distal section  16  of fixation device  12 , thus causing nail  12  to be tightly secured to mounting shaft.  84 . Note also that compression bolt  18  can be pre-positioned in proximal and distal sections  14  and  16 , so that the nail  12  is in an uncompressed state. After a hole has been is drilled upwardly through the bottom of the calcaneal bone C, talus A (if not so eroded or degraded that it no longer separates the tibia from the calcaneal bone) and into the medullary canal, the tibea T and cleaned out appropriately using techniques known to those skilled in the art, the forward end  25  of proximal section  14  of nail  12  can be inserted upwardly into such hole into the tibia, also in the known manner. Screw holes  170  are provided in the distal end of beam  80 , which during use of outrigger assembly  20 , can be aligned with holes  28  in proximal section  14  of nail  12 . Similarly, similarly screw holes  172  in beam  80  can be aligned with holes  44  in distal section  16  of nail  12 . Use of the outrigger assembly  20  with beam  80  assists the positioning and alignment of screws  30  with the tibia, talus, and calcaneus during insertion. Using outrigger assembly  20 , holes can be then drilled into the tibia, which holes are aligned with holes  28  in nail  12 , and been screws  30  can be inserted in such holes to secure proximal section  14  of nail  12  in position in the tibia. Then, compression driver  24  can be used rotate bolt  18 , which movement causes distal section  16  to move upwardly towards proximal section  14 . As shown in  FIG. 16 , compression driver  24  may include a handle section  180 , a shaft or blade section  182  and a tip  184  which is designed to match and be received in socket  70  in the end of bolt  18 . Blade section  182  is sized to glidingly fit through cavity  168  in nail attachment device  160 , and is long enough so that tip  184  can be engaged with socket  70  in bolt  18 . Bolt  18  can be turned so that threaded shaft section  64  is moved upwardly into threaded section  36  of proximal section  14  of nail  12 , thus causing distal section  16  to slowly move upwardly toward proximal section  14 . As indicated above and illustrated in  FIGS. 3 and 4B , such movement causes the calcaneus and talus bones to also be forced to moved upwardly toward the lower end of the tibia. Eventually, by continuing to rotate driver  24  to turn bolt  18 , an adequate amount of compression of the ankle joint can be accomplished, after which driver  24  may be removed from cavity  168  in mounting abaft  84 . Then, the surgeon may secure the talus and calcaneus bones in such a compressed position against the lower end of the tibia by drilling the appropriate holes in the talus and calcaneus through apertures  172  in beam  80  of outrigger assembly  20 , and the inserting screws through such holes and into holes  44  in distal section  16  of nail  12 . Once properly secured, nail attachment device  160  can be removed from the lower end  41  of nail  12 , and compression plate  150  can also be coincidently removed. Preferably a suitable screw threaded cap can be placed over the lower end of nail  12  on threads  52 . 
         [0050]      FIGS. 2-3  are exemplary embodiments of uses for the intramedullary fixation device for use in ankle arthrodesis.  FIG. 2  is a side view of the nail  12  in a non-compressed state in position within the tibia (T), talus (A) and calcaneus (C) bones. In  FIG. 3  the nail  12  of  FIG. 2  is in a compressed state.  FIG. 4B  is another view the nail of  FIG. 2  in a non-compressed state along with the compression disc  150  being placed against the calcaneus hone.  FIGS. 2 and 4  also show the direction of compression being applied. 
         [0051]      FIGS. 18-20  are exemplary alternate embodiments of uses for the intramedullary fixation device.  FIG. 18  is a side view of the intramedullary fixation device as applied to a fifth metatarsal fracture in an uncompressed configuration. The proximal portion  14  of nail  12  can he secured to a first portion of a metatarsal bone and the distal portion  16  of nail  12  can be secured to a second portion of the metatarsal bone. The direction of compression is also shown. A compression disc  150  can also be used and placed to provide a compressive force on the bones during compression of the nail  12  but prior to the distal portion  16  being affixed to the second portion of the metatarsal bone. The compression disc  150  may be placed internal or external to the body. 
         [0052]      FIG. 19  is a side view of the intramedullary fixation device as applied to a long bone fracture in an uncompressed configuration. The proximal portion  14  of nail  12  is secured to a first portion of a long bone and the distal portion  16  of nail  12  is secured to a second portion of the long bone. The direction of compression is also shown. The long bone may be any bone having a fracture that would benefit from the compressive forces of nail  12  being applied thereupon. Examples of a long bone include the tibia and femur. A compression disc  150  can also be used and placed to provide a compressive force on the bones during compression of the nail  12  but prior to the distal portion  16  being affixed to the second portion of the long bone. The compression disc  150  may be placed internal or external to the body. 
         [0053]      FIG. 20  is a side view of the intramedullary fixation device as applied to subtalar joint fusion in an uncompressed configuration. The proximal portion  14  of nail  12  is secured to the talus (A) and the distal portion  16  of nail  12  is secured to the calcaneus (C) bones. The direction of compression is also shown. A compression disc  150  can also be used and placed to provide a compressive force on the bones during compression of the nail  12  but prior to the distal portion  16  being affixed to the second portion of the calcaneus bone. The compression disc  150  may be placed internal or external to the body. 
         [0054]    While many embodiments of the present invention have been described at some length and with some particularity with respect to the several described embodiments, it is not intended that it should be limited to any such particulars or embodiments or any particular embodiment, but it is to be construed with references to the appended claims so as to provide the broadest possible interpretation of such claims in view of the prior art and, therefore, to effectively encompass the intended scope of the invention.