Abstract:
A method for performing an open wedge osteotomy, the method comprising:
       forming a cut in a bone;   manipulating the portions of the bone adjacent to the cut so as to open the cut into a wedge-like opening;   providing an osteotomy implant, wherein the osteotomy implant comprises:
           an elongated body characterized by a distal end and proximal end, the elongated body having a screw thread thereon;   
           positioning at least the distal end of the elongated body into the wedge-like opening so that the screw thread engages the surrounding bone; and   threadingly advancing the elongated body into the wedge-like opening until the portions of the bone assume the desired positioning, with the elongated body stabilizing the bone portions in this position.

Description:
REFERENCE TO PENDING PRIOR PATENT APPLICATION 
       [0001]    This patent application claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 60/963,720, filed Aug. 7, 2007 by Justin L. Horacek for DESCRIPTION OF A BONE FUSION IMPLANT AND VARIATIONS THEREOF (Attorney&#39;s Docket No. NOVAK-25 PROV), which patent application is hereby incorporated herein by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    This invention relates to surgical methods and apparatus in general, and more particularly to surgical methods and apparatus for performing open wedge osteotomies of the knee. 
       BACKGROUND OF THE INVENTION 
       [0003]    Osteotomies of the knee are an important technique for treating knee osteoarthritis. In essence, knee osteotomies adjust the geometry of the knee joint so as to transfer weight bearing load from arthritic portions of the joint to relatively unaffected portions of the joint. 
         [0004]    Knee osteotomies are also an important technique for addressing abnormal knee geometries, e.g., due to birth defect, injury, etc. 
         [0005]    Most knee osteotomies are designed to modify the geometry of the tibia, so as to adjust the manner in which load is transferred across the knee joint. 
         [0006]    There are essentially two ways in which to adjust the orientation of the tibia: (i) the so-called “closed wedge” technique; and (ii) the so-called “open wedge” technique. 
         [0007]    With the closed wedge technique, a wedge of bone is removed from the upper portion of the tibia, and then the tibia is manipulated so as to close the resulting gap, whereby to re-orient the lower portion of the tibia relative to the tibial plateau and hence adjust the manner in which load is transferred from the femur to the tibia. 
         [0008]    With the open wedge technique, a cut is made into the upper portion of the tibia, the tibia is manipulated so as to open a wedge-like opening in the bone, and then the bone is secured in this position (e.g., by screwing metal plates to the bone or by inserting a wedge-shaped implant into the opening in the bone), whereby to re-orient the lower portion of the tibia relative to the tibial plateau and hence adjust the manner in which load is transferred from the femur to the tibia. 
         [0009]    While both closed wedge osteotomies and open wedge osteotomies provide substantial benefits to the patient, they are procedurally challenging for the surgeon. 
         [0010]    Among other things, with respect to open wedge osteotomies, it can be difficult to properly stabilize the upper and lower portions of the tibia relative to one another, and to properly maintain them in this position, while healing occurs. 
         [0011]    In addition, with open wedge osteotomies, the wedge-shaped implants are generally anatomically-specific, in the sense that the size of the implant must be matched to the size of the anatomy and the degree of correction desired. This can present inventory issues. 
         [0012]    And, with open wedge osteotomies, the wedge-shaped implants are generally procedure-specific, in the sense that an antero-medial approach may require one configuration for the implant, a lateral approach may require another configuration for the implant, etc. Again, this can present inventory issues. 
         [0013]    In addition to the foregoing, open wedge osteotomies may also be performed on locations other than the high tibia. By way of example but not limitation, an open wedge knee osteotomy may be performed on the low femur. By way of further example but not limitation, an open wedge osteotomy may be performed on a joint other than the knee, e.g., an open wedge osteotomy may be performed on the elbow. Again, these open wedge osteotomies may be stabilized with metal plates, wedge-shaped implants, etc. And again, these open wedge osteotomies generally suffer from the aforementioned issues of proper stabilization, size specificity, procedure specificity, etc. 
         [0014]    The present invention is directed to open wedge osteotomies in general, both for the knee and for other joints, and is intended to provide a new and improved osteotomy implant which addresses the foregoing issues with the prior art. 
       SUMMARY OF THE INVENTION 
       [0015]    The present invention comprises a novel method and apparatus for performing an open wedge osteotomy. More particularly, the present invention comprises the provision and use of a novel method for performing an open wedge osteotomy, the method comprising: 
         [0016]    forming a cut in a bone; 
         [0017]    manipulating the portions of the bone adjacent to the cut so as to open the cut into a wedge-like opening; 
         [0018]    providing an osteotomy implant, wherein the osteotomy implant comprises:
       an elongated body characterized by a distal end and proximal end, the elongated body having a screw thread thereon;       
 
         [0020]    positioning at least the distal end of the elongated body into the wedge-like opening so that the screw thread engages the surrounding bone; and 
         [0021]    threadingly advancing the elongated body into the wedge-like opening until the portions of the bone assume the desired positioning, with the elongated body stabilizing the bone portions in this position. 
         [0022]    In another form of the present invention, there is provided a method for performing an open wedge osteotomy, the method comprising: 
         [0023]    forming a cut in a bone; 
         [0024]    manipulating the portions of the bone adjacent to the cut so as to open the cut into a wedge-like opening; 
         [0025]    providing an osteotomy implant, wherein the osteotomy implant comprises:
       an elongated body characterized by a distal end and proximal end, the elongated body having a bone anchoring mechanism associated therewith;       
 
         [0027]    positioning at least the distal end of the elongated body into the wedge-like opening so that it engages the surrounding bone; and 
         [0028]    advancing the elongated body into the wedge-like opening until the portions of the bone assume the desired positioning, with the bone anchoring mechanism preventing retraction of the elongated body from the wedge-like opening and with the elongated body stabilizing the bone portions in this position. 
         [0029]    In another form of the present invention, there is provided apparatus for performing an open wedge osteotomy, the apparatus comprising: 
         [0030]    an osteotomy implant for disposition in a wedge-shaped opening created in the bone, the osteotomy implant comprising:
       an elongated body characterized by a distal end and a proximal end, and having a screw thread for engaging the surrounding bone; and   an osteotomy plate for covering at least a portion of the entrance of the wedge-like opening.       
 
         [0033]    In another form of the present invention, there is provided apparatus for performing an open wedge osteotomy, the apparatus comprising: 
         [0034]    an osteotomy implant for disposition in a wedge-shaped opening created in the bone, the osteotomy implant comprising:
       an elongated body characterized by a distal end and a proximal end, and having a bone anchoring mechanism associated therewith for engaging the surrounding bone, with the bone anchoring mechanism preventing retraction of the elongated body from the wedge-like opening; and   an osteotomy plate for covering at least a portion of the entrance of the wedge-like opening.       
 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0037]    These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts, and further wherein: 
           [0038]      FIGS. 1 and 2  are schematic views showing a first novel osteotomy implant formed in accordance with the present invention; 
           [0039]      FIGS. 3 and 4  are schematic views showing a traditional osteotomy cut procedure to create a wedge-like opening in the bone; 
           [0040]      FIG. 5  is a schematic view showing a bore formed along the wedge-like opening; 
           [0041]      FIGS. 6 and 7  are schematic views showing the osteotomy implant of  FIGS. 1 and 2  positioned within an osteotomy cut formed in the tibia; 
           [0042]      FIGS. 8 and 9  are schematic views showing a second novel osteotomy implant formed in accordance with the present invention; 
           [0043]      FIGS. 10 and 11  are schematic views showing the osteotomy implant of  FIGS. 8 and 9  positioned within an osteotomy cut formed in the tibia; 
           [0044]      FIGS. 12 and 13  are schematic views showing a third novel osteotomy implant formed in accordance with the present invention; 
           [0045]      FIGS. 14 and 15  are schematic views showing the osteotomy implant of  FIGS. 12 and 13  positioned within an osteotomy cut formed in the tibia; 
           [0046]      FIGS. 16 and 17  are schematic views showing a fourth novel osteotomy implant formed in accordance with the present invention; 
           [0047]      FIGS. 18 and 19  are schematic views showing the osteotomy implant of  FIGS. 16 and 17  positioned within an osteotomy cut formed in the tibia; 
           [0048]      FIG. 20  is a schematic view showing a fifth novel osteotomy implant formed in accordance with the present invention; 
           [0049]      FIGS. 21 and 22  are schematic views showing the osteotomy implant of  FIG. 20  positioned within an osteotomy cut formed in the tibia; 
           [0050]      FIGS. 23 and 24  are schematic views showing a sixth osteotomy implant, including an osteotomy plate, formed in accordance with the present invention; 
           [0051]      FIGS. 25 and 26  are schematic views showing the osteotomy implant and osteotomy plate of  FIGS. 23 and 24  positioned within an osteotomy cut formed in the tibia; 
           [0052]      FIGS. 27 and 28  are schematic views showing a seventh osteotomy implant, including an osteotomy plate, formed in accordance with the present invention; 
           [0053]      FIG. 29  is a schematic view showing the osteotomy implant and osteotomy plate of  FIGS. 27 and 28  positioned within an osteotomy cut formed in the tibia; 
           [0054]      FIGS. 30 and 31  are schematic views showing an eighth novel osteotomy implant, including an osteotomy plate, formed in accordance with the present invention; 
           [0055]      FIG. 32  is a schematic view showing a ninth novel osteotomy implant, including an osteotomy plate, formed in accordance with the present invention; 
           [0056]      FIG. 33  is a schematic view showing the implant and osteotomy plate of  FIG. 32  positioned within an osteotomy cut formed in the tibia; 
           [0057]      FIG. 34  is a schematic view showing a tenth novel osteotomy implant formed in accordance with the present invention; 
           [0058]      FIGS. 35 and 36  are schematic views showing the implant of  FIG. 34  positioned within an osteotomy cut formed in the tibia; 
           [0059]      FIGS. 37-39  are schematic views showing a pair of novel osteotomy implants positioned within an osteotomy cut formed in the tibia; 
           [0060]      FIG. 40  is a schematic view showing an eleventh novel osteotomy implant formed in accordance with the present invention; 
           [0061]      FIG. 41  is a schematic view showing a twelfth novel osteotomy implant formed in accordance with the present invention; and 
           [0062]      FIG. 42  is a schematic view showing a thirteenth novel osteotomy implant formed in accordance with the present invention. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0063]    The present invention provides a novel osteotomy implant for use in an open wedge osteotomy. More particularly, after a cut has been made in the bone, and after the bone is manipulated so as to open a wedge-like opening in the bone, the osteotomy implant is disposed in the wedge-like opening in the bone so as to stabilize the bone portions in a desired (i.e., corrected) position. Significantly, the novel osteotomy implant may be used in substantially any open wedge osteotomy, e.g., a knee osteotomy, an elbow osteotomy, etc., and the novel osteotomy implant may be used with substantially any bone, e.g., the high tibia, the low femur, etc. For clarity of illustration, the novel osteotomy implant may hereinafter be discussed in the context of an open wedge, high tibial osteotomy, however, it should be appreciated that this is solely for the sake of illustration and should not be construed as a limitation of the present invention. 
         [0064]    Looking now at  FIGS. 1 and 2 , there is shown a novel osteotomy implant  105  intended to be deployed in an open wedge osteotomy so as to stabilize the bone portions in a desired (i.e., corrected) position. Osteotomy implant  105  generally comprises an elongated body  110  having a distal end  115  and a proximal end  120 . Elongated body  110  is preferably tapered, increasing in diameter as it extends distal to proximal. Elongated body  110  comprises a screw thread  125  for engaging bone. Proximal end  120  may be provided with a recess  130  for mating with a driver (not shown) for turning osteotomy implant  105  into bone, as will hereinafter be discussed. In this respect, it should be appreciated that recess  130  may have substantially any geometry appropriate for transferring rotation from the drive to the osteotomy implant  105 , e.g., it may have the square configuration shown in  FIG. 1 , or it may have a hex geometry, an ovoid geometry, or substantially any other non-circular geometry, etc. 
         [0065]    In use, osteotomy implant  105  is intended to be deployed in an open wedge osteotomy so as to secure the bone in a corrected position. More particularly, and looking now at  FIG. 3 , there is shown a knee joint J upon which an open wedge osteotomy is to be performed. Knee joint J generally comprises a tibia T and a femur F. In accordance with the present invention, the open wedge osteotomy is effected by first making a cut C into the upper tibia, and then manipulating the lower portion of the tibia so as to open a wedge-like opening W ( FIG. 4 ) in the bone, with the wedge-like opening W being configured so as to adjust the manner in which load is transferred from the femur to the tibia. In this respect, it should be appreciated that a variety of methods are well known in the art for determining the degree of correction necessary to correctly re-align the weight-bearing axis of the knee. 
         [0066]    Furthermore, cut C and wedge-like opening W may be formed in a variety of ways well known in the art. 
         [0067]    In order to prepare the tibia to receive the osteotomy implant, a bore B is preferably formed in the tibia by over-drilling wedge-like opening W ( FIG. 5 ). Bore B is preferably sized so to be just slightly larger than the diameter of the distal end of the osteotomy implant, and just slightly smaller than the diameter of the proximal end of the osteotomy implant, in order that the implant may be easily inserted into bore B and make a gripping engagement with tibia T. 
         [0068]    Looking next at  FIGS. 6 and 7 , osteotomy implant  105  is deployed in wedge-like opening W by fitting an appropriate driver (not shown) into recess  130 , placing the distal end of osteotomy implant  105  into bore B, and then turning osteotomy implant  105  with the driver so as to threadingly advance osteotomy implant  105  into wedge-like opening W. As this occurs, threads  125  engage the bone on either side of wedge-like opening W and stabilize the bone portions in position relative to the osteotomy implant and, hence, in position relative to one another. 
         [0069]    In this respect it will be appreciated that, by forming osteotomy implant  105  with a tapered configuration, insertion of osteotomy implant  105  into bore B is facilitated. 
         [0070]    Significantly, as osteotomy implant  105  advances into bore B, it effectively “jacks open” wedge-like opening W, since the proximal end of osteotomy implant  105  is oversized relative to bore B. Thus, a surgeon can achieve a desired degree of correction simply by advancing osteotomy implant  105  an appropriate distance into wedge-like opening W. As a result, a single size of osteotomy implant  105  can be used effectively on a wide range of different anatomy sizes to achieve a wide range of different angle corrections. 
         [0071]    If desired, bore B may be omitted entirely, and osteotomy implant  105  inserted directly into wedge-like opening W, with screw threads  125  of the osteotomy implant engaging the adjacent bone surfaces. 
         [0072]    Looking next at  FIGS. 8-11 , there is shown a second novel osteotomy implant  205  formed in accordance with the present invention. Osteotomy implant  205  is generally similar to osteotomy implant  105  in that it also comprises an elongated body  210  having a distal end  215  and a proximal end  220 , and elongated body  210  comprises a screw thread  225  for engaging bone. However, with second osteotomy implant  205 , elongated body  210  is not tapered, instead having the geometry of a threaded cylinder. However, the distal end of elongated body  210  is beveled so as to facilitate insertion into bore B (or, in the case where bore B is not provided, directly into wedge-like opening W). Furthermore, osteotomy implant  205  has its recess  230  in the form of a Philips-type geometry. 
         [0073]    As shown in  FIGS. 10-11 , osteotomy implant  205  is used in a manner which is similar to that of osteotomy implant  105 . 
         [0074]    Looking next at  FIGS. 12-15 , there is shown a third novel osteotomy implant  305  formed in accordance with the present invention. Osteotomy implant  305  is generally similar to osteotomy implant  105  in that it also comprises an elongated body  310  having a distal end  315  and a proximal end  320 . However, with third osteotomy implant  305 , elongated body  310  is provided with ribs  325  instead of threads and, like osteotomy implant  205 , is not tapered, instead having the geometry of a ribbed cylinder. 
         [0075]    Osteotomy implant  305  is used in a manner which is similar to that of osteotomy implant  105 , in the sense that it is advanced an appropriate distance into wedge-like opening W so as to stabilize the bone portions with the desired positioning. However, with osteotomy implant  305 , the implant is deployed by driving it forward (e.g., by tapping with a hammer) into wedge-like opening W, rather than by rotatably advancing the implant via screw threads  125 . Ribs  325  help stabilize osteotomy implant  305  against retraction out of wedge-like opening W and facilitate osteointegration of the osteotomy implant  305  with the surrounding bone. 
         [0076]    Looking next at  FIGS. 16-19 , there is shown a fourth novel osteotomy implant  405  formed in accordance with the present invention. Osteotomy implant  405  is generally similar to osteotomy implant  105  in that it also comprises an elongated body  410  having a distal end  415  and a proximal end  420 . However, with fourth osteotomy implant  405 , elongated body  410  is not provided with threads or ribs and, like osteotomy implant  205 , is not tapered. Instead, osteotomy implant  405  comprises a generally cylindrical body having a beveled distal end. Furthermore, elongated body  410  is provided with one or more crossbores  430  for receiving a toe screw or toe pin  432  (not shown in  FIGS. 16 and 17 , but shown in  FIGS. 18 and 19 ) therethrough, for anchoring osteotomy implant  405  to the bone, as will hereinafter be discussed. 
         [0077]    Osteotomy implant  405  is used in a manner which is similar to that of osteotomy implant  105 , in the sense that it is advanced an appropriate distance into wedge-like opening W so as to stabilize the bone portions with the desired positioning. However, with osteotomy implant  405 , the osteotomy implant is deployed by driving it forward into wedge-like opening W, rather than by rotatably advancing the implant via screw threads. Once osteotomy implant  405  has been inserted to the appropriate depth within wedge-like opening W, toe screw(s) or toe pin(s)  432  are passed through crossbore(s)  430  and into the adjacent bone. The provision of crossbore(s)  430  and toe screw(s) or toe pin(s)  432  help stabilize osteotomy implant  405  against retraction out of wedge-like opening W. 
         [0078]    Looking next at  FIGS. 20-22 , there is shown a fifth novel osteotomy implant  505  formed in accordance with the present invention. Osteotomy implant  505  is generally similar to osteotomy implant  105  in that it also comprises an elongated body  510  having a distal end  515  and a proximal end  520 , and elongated body comprises a screw thread  525 . However, with fifth osteotomy implant  505 , elongated body  510  is provided with one or more crossbore(s)  530  for receiving a toe screw or a toe pin  532  (not shown in  FIG. 20 , but shown in  FIGS. 21 and 22 ) therethrough, for anchoring osteotomy implant  505  to the bone, as will hereinafter be discussed. 
         [0079]    Osteotomy implant  505  is used in a manner which is similar to that of osteotomy implant  105 , in the sense that it is advanced an appropriate distance into wedge-like opening W so as to stabilize the bone portions with the desired positioning. However, unlike osteotomy implant  105 , when osteotomy implant  505  has been advanced an appropriate distance within wedge-like opening W, toe screw(s) or toe pin(s)  532  are passed through crossbore(s)  530  and into the adjacent bone. The provision of crossbore(s)  530  and toe screw(s) or toe pin(s)  532  help stabilize osteotomy implant  505  against retraction out of wedge-like opening W. 
         [0080]    Looking next at  FIGS. 23-26 , there is shown a sixth novel osteotomy implant  605  formed in accordance with the present invention. Osteotomy implant  605  is generally similar to osteotomy implant  105  in that it also comprises an elongated body  610  having a distal end  615  and a proximal end  620 , and elongated body  610  comprises a screw thread  625  for engaging bone. However, osteotomy implant  605  also includes the provision of an osteotomy plate  640  for securing to the exterior surface of the bone adjacent to wedge-like opening W, in order to “cap” the opening and prevent osteotomy implant  605  from retracting out of wedge-like opening W. Osteotomy plate  640  is provided with two screw holes  645  extending therethrough for receiving bone screws  650 . 
         [0081]    Osteotomy implant  605  is used in a manner which is similar to that of osteotomy implant  105  except, however, after osteotomy implant  605  has been advanced an appropriate distance within wedge-like opening W, osteotomy plate  640  is positioned along the exterior surface of the bone, adjacent to wedge-like opening W. It should be appreciated that in some instances, osteotomy plate  640  will directly engage the proximal end of osteotomy implant  605 . In other instances, osteotomy implant  605  may be advanced so far into wedge-like opening W as to prevent osteotomy plate  640  from directly engaging osteotomy implant  605 . In either case, osteotomy plate  640  is then secured to the exterior surface of the bone adjacent wedge-like opening W using bone screws  650 . The provision of osteotomy plate  640  and bone screws  650  help stabilize osteotomy implant  605  against retraction out of wedge-like opening W. In addition osteotomy plate  640  can also help carry load between the two bone portions. 
         [0082]    It should be appreciated that bone screws  650  may be configured to advance directly into virgin bone or, if desired, bores for receiving bone screws  650  may be pre-drilled into the bone. 
         [0083]    Looking next at  FIGS. 27-29 , there is shown a seventh novel osteotomy implant  705  formed in accordance with the present invention. Osteotomy implant  705  is generally similar to osteotomy implant  605  in that it comprises an elongated body  710  having a distal end  715  and a proximal end  720 , and elongated body  710  comprises a screw thread  725  for engaging bone. Also, like osteotomy implant  605 , osteotomy implant  705  includes the provision of an osteotomy plate  740  for securing to the exterior surface of the bone adjacent to wedge-like opening W, in order to “cap” the opening and prevent osteotomy implant  705  from retracting out of wedge-like opening W. Osteotomy plate  740  is generally similar to osteotomy plate  640  in that it comprises a planar structure which is provided with two screw holes  745  extending therethrough for receiving bone screws  750 . However, osteotomy plate  750  also comprises a rim  755  on its distal face for receiving the proximal end of osteotomy implant  705 , as will hereinafter be discussed. 
         [0084]    Osteotomy implant  705  is used in a manner which is similar to that of osteotomy implant  105 . Once osteotomy implant  705  has been inserted to the appropriate depth within wedge-like opening W, osteotomy plate  740  is positioned against the exterior surface of the bone adjacent the wedge-like opening W, with rim  755  extending into wedge-like opening W. It should be appreciated that in some instances, osteotomy plate  740  will directly engage the proximal end of osteotomy implant  705 , with rim  755  receiving the proximal end of osteotomy implant  705 . In other instances, osteotomy implant  705  may be advanced so far into wedge-like opening W as to prevent osteotomy plate  740  from directly engaging osteotomy implant  705 . In either case, osteotomy plate  740  is then secured to the exterior surface of the bone adjacent wedge-like opening W using bone screws  750 . The provision of osteotomy plate  740  (with rim  755 ) and bone screws  750  help stabilize osteotomy implant  705  against retraction out of wedge-like opening W. In addition osteotomy plate  740  can also help carry load between the two bone portions. 
         [0085]    It should be appreciated that osteotomy plate  740  may also be used in conjunction with a ribbed implant, such as implant  205 , etc. 
         [0086]    Looking next at  FIGS. 30 and 31 , there is shown an eighth novel osteotomy implant  805  formed in accordance with the present invention. Osteotomy implant  805  is generally similar to osteotomy implant  705  in that it comprises an elongated body  810  having a distal end  815  and a proximal end  820 , and elongated body  810  comprises a screw thread  825  for engaging bone. Also, like osteotomy implant  705 , osteotomy implant  805  includes the provision of an osteotomy plate  840 . Osteotomy plate  840  is generally similar to osteotomy plate  740  in that it comprises a planar structure which is provided with two screw holes  845  extending therethrough for receiving bone screws  850 . However, in place of rim  755 , osteotomy plate  840  comprises a projection  855  for mating with recess  830  formed in the proximal end of osteotomy implant  805 , as will hereinafter be discussed. 
         [0087]    Osteotomy implant  805  is used in a manner which is similar to that of osteotomy implant  105 . Once osteotomy implant  805  has been inserted to the appropriate depth within wedge-like opening W, osteotomy plate  840  is positioned against the exterior of wedge-like opening W with projection  855  seated in recess  830  formed in the proximal end of implant  805 . Osteotomy plate  840  is then secured to the bone in a manner similar to that of osteotomy plate  740 . The provision of osteotomy plate  840  (with rim  855 ) and bone screws  850  help stabilize osteotomy implant  805  against retraction out of wedge-like opening W. In addition osteotomy plate  840  can also help carry load between the two bone portions. 
         [0088]    It should be appreciated that osteotomy plate  840  may also be used in conjunction with a ribbed implant, such as implant  205 , etc. 
         [0089]    Looking next at  FIGS. 32 and 33 , there is shown a ninth novel osteotomy implant  905  formed in accordance with the present invention. Osteotomy implant  905  is similar to osteotomy implant  705  in that it comprises an elongated body  910  having a distal end  915  and a proximal end  920 , and elongated body  910  comprises a screw thread  925  for engaging bone. Also, like osteotomy implant  705 , osteotomy implant  905  includes the provision of an osteotomy plate  940 . Osteotomy plate  940  is generally similar to osteotomy plate  740  in that it is provided with a rim  955  for mating with proximal end of osteotomy implant  905 . However, osteotomy plate  940  is provided with three screw holes  945  extending therethrough in place of the two screw holes  745  formed in osteotomy plate  740 , and three bone screws  950 . 
         [0090]    Osteomtomy implant  905  and osteotomy plate  940  are used in a manner which is similar to that of osteotomy implant  705  and osteotomy plate  740 , but using two bone screws  950  to secure osteotomy plate  940  to the exterior of the bone and one bone screw  950  to secure osteotomy plate  940  to osteotomy implant  905  via bore  952  ( FIG. 32 ). The provision of osteotomy plate  940  (with rim  955 ) and bone screws  950  help stabilize osteotomy implant  905  against retraction out of wedge-like opening W. In addition, osteotomy plate  940  can also help carry load between the two bone portions. 
         [0091]    It should be appreciated that osteotomy plate  940  may also be used in conjunction with a ribbed implant, such as implant  205 , etc. 
         [0092]    Looking next at  FIGS. 34-36 , there is shown a tenth novel osteotomy implant  1005  formed in accordance with the present invention. Osteotomy implant  1005  generally comprises an elongated body  1010  having a distal end  1015  and a proximal end  1020 . Elongated body  1010  is formed with a smooth exterior, but may also be formed with a threaded or ribbed exterior (not shown). Similarly, elongated body  1010  may be formed with a tapered geometry or with a non-tapered geometry. 
         [0093]    Osteotomy implant  1005  is positioned in wedge-like opening W in substantially the same manner as osteotomy implant  205 , by using an appropriate inserter. Once osteotomy implant  1005  has been inserted to the appropriate depth within wedge-like opening W, osteotomy implant  1005  may be secured in position using toe pins, osteotomy plates, and/or bone screws, etc. 
         [0094]    Looking next at  FIGS. 37-39 , two or more osteotomy implants  1005  may be disposed in wedge-like opening W in order to achieve the desired angle of correction. It should be appreciated that the two or more osteotomy implants  1005  may be disposed in wedge-like opening W in a side-by-side fashion ( FIGS. 37-39 ) or in a serial fashion (not shown) depending on the approach and desired degree of correction. 
         [0095]    It should also be appreciated that two or more osteotomy implants  1005  having different geometries, surfaces and/or tapered configurations may also be used in combination with one another. 
         [0096]    Looking next at  FIG. 40 , there is shown an eleventh novel osteotomy implant  1105  formed in accordance with the present invention. Osteotomy implant  1105  generally comprises an elongated body  1110  having a distal end  1115  and a proximal end  1120 . Elongated body  1110  comprises a screw thread  1125  for engaging bone. Elongated body  1110  is provided with a center longitudinal fenestration  1160  to allow for increased bone growth into and through the implant during bone healing. It should be appreciated that osteotomy implant  1105  may be provided with a beveled distal end so as to facilitate insertion into bore B (or, in the case where no bore B is provided, directly into wedge-like opening W). 
         [0097]    Osteotomy implant  1105  is positioned in wedge-like opening W in substantially the same manner as osteotomy implant  105 , and by using an appropriate driver or inserter. 
         [0098]    Looking next at  FIG. 41 , there is shown a twelfth novel osteotomy implant  1205  formed in accordance with the present invention. Osteotomy implant  1205  generally comprises an elongated body  1210  having a distal end  1215  and a proximal end  1220 . Elongated body  1210  comprises a screw thread  1225  for engaging bone. Elongated body  1210  is provided with a beveled distal end so as to facilitate insertion into bore B (or, in the case where no bore B is provided, directly into wedge-like opening W). Elongated body  1210  is also provided with a plurality of sidewall fenestrations  1260  for increased bone growth into and through the implant during bone healing. 
         [0099]    Osteotomy implant  1205  is positioned in wedge-like opening W in substantially the same manner as osteotomy implant  105 , and by using an appropriate driver or inserter. 
         [0100]    Looking next at  FIG. 42 , there is shown a thirteenth novel osteotomy implant  1305  formed in accordance with the present invention. Osteotomy implant  1305  generally comprises an elongated body  1310  having a distal end  1315  and a proximal end  1320 . Elongated body  1310  comprises a screw thread  1325  for engaging bone. Elongated body  1310  is provided with a beveled distal end so as to facilitate insertion into bore B (or, in the case where no bore B is provided, directly into wedge-like opening W). Elongated body  1310  is also provided with an elongated sidewall fenestration  1360  for increased bone growth into and through the implant during bone healing. 
         [0101]    Osteotomy implant  1305  is positioned in wedge-like opening W in substantially the same manner as osteotomy implant  105 , and by using an appropriate driver or inserter. 
         [0102]    It should be appreciated that osteotomy implants  1105 ,  1205  and  1305  may all be used in combination with the toe pins, osteotomy plates and/or bone screws of the present invention, as well as with other toe pins, plates and bone screws well known in the art. 
         [0103]    It should also be appreciated that the novel implants of the present invention may be formed out of plastic, metal, bone, bioabsorbable material, etc. 
         [0104]    Significantly, it should be noted that the novel implants formed in accordance with the present invention provide surgeons with increased flexibility in performing an osteotomy procedure. Although the implants have been shown in use during a high tibial osteotomy, it will be appreciated that the implants could also be used in femoral osteotomy procedures, or in osteotomy procedures conducted on other bones. 
         [0105]    Similarly, the novel implants may be used in a variety of approaches, angles, etc. Because the implants are formed with a generally symmetrical, non-anatomically-specific configuration, they can be deployed in a variety of ways. By way of example but not limitation, the implants may be used in an antero-medial approach, lateral approach, etc. Likewise, the implants of the present invention may be used in conjunction with an osteotomy cut formed using an apex pin in accordance with the methods of U.S. patent application Ser. No. 11/644,218, filed Dec. 22, 2006 by Kelly G. Ammann et al. for METHOD AND APPARATUS FOR PERFORMING AN OPENING WEDGE, HIGH TIBIAL OSTEOTOMY (Attorney&#39;s Docket No. NOVAK-11), which patent application is hereby incorporated herein by reference. 
         [0106]    Lastly, the novel implants of the present invention are “one-size-fits-all”, in the sense that a single implant can be advanced (or withdrawn) to an appropriate depth within the wedge-like opening so as to stabilize the bone portions with the desired degree of correction for each individual patient. This greatly reduces the need to inventory trial implants as well as different-shaped and different-sized osteotomy implants to account for variations in patient anatomy. 
       Anterio-Lateral Osteotomies 
       [0107]    In the foregoing description, the present invention is discussed in the context of performing an open wedge osteotomy using an antero-medial approach so as to effect a medial opening wedge osteotomy. Of course, it should be appreciated that the present invention may also be used in antero-lateral approaches so as to effect a lateral opening wedge osteotomy, or in other approaches which will be well known to those skilled in the art. 
         [0108]    Open wedge osteotomies can also be performed on the lower end of the femur (e.g., a so-called “open wedge, low femoral osteotomy”) and/or on other bones. 
         [0109]    The present invention may also be used in other types of osteomies, e.g., elbow, ankle, etc. 
       Modifications 
       [0110]    It will be understood that many changes in the details, materials, steps and arrangements of parts, which have been herein described and illustrated in order to explain the nature of the invention, may be made by those skilled in the art without departing from the principles and scope of the present invention.