Patent Publication Number: US-2007123857-A1

Title: Orthopaedic joint, device and associated method

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
      Cross reference is made to the following applications: DEP5427 titled, “SUPPORT FOR LOCATING INSTRUUMENT GUIDES”, DEP5597USNP titled, “METHOD OF RESECTING BONE”, DEP5368USNP titled “TRAUMA JOINT, EXTERNAL FIXATOR AND ASSOCIATED METHOD” and DEP5558USNP titled “ORTHOPAEDIC INSTRUMENT JOINT, INSTRUMENT AND ASSOCIATED METHOD” filed concurrently herewith which are incorporated herein by reference.  
     TECHNICAL FIELD OF THE INVENTION  
      The present invention relates generally to the field of orthopaedics, and more particularly, to a device for use in treating orthopaedic trauma.  
     BACKGROUND OF THE INVENTION  
      The skeletal system includes many long bones that extend from the human torso. These long bones include the femur, fibula, tibia, humerus, radius and ulna. These long bones are particularly exposed to trauma from accidents, and as such often are fractured during such trauma and may be subject to complex devastating fractures.  
      Automobile accidents, for instance, are a common cause of trauma to long bones. In particular, the femur  
      Often the distal end or proximal portions of the long bone, for example, the femur and the tibia, are fractured into several components and must be realigned. Mechanical devices, commonly in the forms of pins, plates, screws, nails, wires and external devices are commonly used to attach fractured long bones. The pins, plates, wires, nails and screws are typically made of a durable material compatible to the human body, for example titanium, stainless steel or cobalt chromium.  
      Fractures of the long bone are typically secured into position by at least one of three possible techniques.  
      The first method is the use of intramedullary nails that are positioned in the intramedullary canal of those portions of the fractured bone.  
      The first method is the use of intramedullary nails that are positioned in the intramedullary canal of those portions of the fractured bone.  
      A second method of repairing fractured bones is the use of internal bone plates that are positioned under the soft tissue and on the exterior of the bone and bridges the fractured portion of the bone.  
      Another method of securing fractured bones in position is the use of external fixators. These external fixators have at least two general categories. In one category the fixator is generally linear with a first portion of the fixator to connect to a first fracture segment of the bone and a second fracture segment of the fixator to connect to the second fracture segment of the bone. A first series of bone screws or pins are first connected to the fixator and then into the first portion of the bone. Then a second series of screws or pins are connected to the fixator and then to the second fracture segment of the bone, thereby securing the first portion fracture segment of the bone to the second portion of the bone. These types of fixators use screws and pins that are connected to rigid internal frames and rely on the rigidity of the frame to assure that the fixation is secure. One such linear fixator is sold by DePuy Orthopaedics, Inc., Warsaw, Ind. and marketed as the DePuy ACE Align® Fixator.  
      Rigid pins are placed into the proximal portion of the fractured bone and pins are placed into the distal portion of the fractured bone. The linear fixator is then attached to the two sets of pins bridging the fracture site and holding the two bone segments in place.  
      A second method of external fixation is through the use of a ring type fixator that uses a series of spaced apart rings to secure the bone. For example, an upper ring and a lower ring are spaced apart by rods. A plurality of wires is placed through the long bone and is connected on each end of the long bone by the ring. The wires are then tensioned much as a spoke in a bicycle are tightened, thereby providing for a rigid structure to support the first fracture segment portion of the bone. Similarly, a plurality of wires are positioned through the second fracture segment of the bone and are secured to and tensioned by the lower ring to provide a rigid fixation of the second fracture segment of the bone bridging the fracture site.  
      Such external fixators that utilize the tension wire approach may also be used with rigid pins in combination with the wires.  
      When utilizing either pins or wires for the external fixator, it is desirable that the wires are as small in diameter as possible to minimize the damage to soft tissue and to the bone during the fixation process. Further, it is important that the wires and pins move through the body and particularly through the bone in a generally linear fashion, such that when tightened the wires do not cause undue stresses on the soft tissues, and, particularly, the bone. The wires and pins typically have a cutting edge on the leading portion of the pin or wire to assist in the movement of the pin or wire through the soft tissue and bone of the patient. The pins or wires are typically mounted to a power rotational tool that is utilized to drill the pin or wire through the body.  
      In the orthopedic reconstruction of a patient&#39;s bone and/or joint, particularly with respect to bone repair thereof, it is necessary to keep the repaired bone and/or joint in an immobilized and stable state during the healing process. This is accomplished by using a frame construct that typically includes many different fixation components. The various fixation components are utilized to build a fixation device for immobilizing the bone and/or joint. One such fixation component may be an immobilization platform or platform construct.  
      In the area of the foot and/or ankle, what is known as a foot frame is generally utilized. Current foot frames are typically of an open U-ring type. The open U-rings may comprise a single “horseshoe-shaped” frame or may include myriad pieces that must be assembled during and for use (known as a modular foot frame).  
      During the particular surgery, one or more wires, pins, or half pins as they are known in the art are implanted through particular bones of the bone/joint (e.g. the foot and/or ankle). These wires, olive wires, pins, or half pins (collectively, wires) are utilized to immobilize and/or apply compression to the particular and/or surrounding bones in order to create a proper healing environment. The wires themselves need to be externally fixed in order to create a desired compression result on the bone(s) and/or joint(s). This is currently accomplished by tying the wires to wire/rod nuts on the various components of the open U-ring foot frame. These systems, however, suffer problems with respect to being able to achieve the desired compression results, e.g. the ability to adequately externally fix the wires and provide controlled compression. This can lead to instability problems. Moreover, it is difficult to achieve accurate in-plane compression with current fixation devices.  
      In order to resolve these problems, the prior art bends the transverse wires from the ankle/foot, then tensions the bent wires to achieve compression. This is known as walking the wires. The bent and tensioned wires are then attached to the open U-frame. Tensioning bent wires, however, does not provide a controlled or measurable amount of compression on the desired area of the ankle/foot.  
      With respect to orthopaedic surgery and particularly with respect to the foot and/or ankle, the surgical area (ankle/foot area) is exposed. It is, thus, necessary in some respects to protect the particular area (ankle/foot). Prior art fixation devices utilize an additional ring positioned inferior to the foot frame to protect the bottom of the foot. This technique is time consuming and costly.  
      Osteoarthritis and rheumatoid arthritis are common afflictions of the joints of the human body. The ankle is one of the many joints, which may be susceptible to osteoarthritis. Arthrodesis has been an accepted treatment for painful osteoarthritis and rheumatoid arthritis of the ankle and the subtalor joints for many years. In the most common of arthrodesis, the talus, tibia and calcaneus are fused together. Such a procedure is commonly known as an ankle fusion. Another less common treatment for arthritis of the ankle is total ankle arthroplasty. Total ankle arthroplasty can be described in greater detail in U.S. Pat. No. 5,326,365 to Alvine, hereby incorporated by reference in its entirety.  
      A portion of the ankle fusion procedure is to resect the distal tibia and the proximal talus. The resected surface of the distal tibia and the proximal talus are then fused together. The tibia and talus may be fused together using any of a combination of bone plates, bone screws, and intramedullary nails. To perform the tibia and talus resections, the ankle joint is distracted approximately one centimeter. While in this distracted condition, the tibia and talus are resected. The joint is then relaxed and then the tibia and talus are fused.  
      The resection of the tibia and talus are typically performed utilizing a saw blade that is held in the surgeon&#39;s hand and the resection is performed free hand. The free-hand resection of the tibia and talus has several problems. One problem with the current free-hand method of resection is the danger of over resection of the joint surfaces. If too great a resection is performed, the ankle joint height is compromised. The patient then may have a resected leg length that is unacceptably shorter than the unfused leg length. Another problem with the present free-hand method of resecting the tibia and talus is that fore and hind foot alignment may be inaccurate. Alignment is very important because a fused ankle has only a limited degree of flexion. Excessive dorsal flexion or plantar flexion may cause gait problems or patient pain.  
      In utilizing external fixators, the position of the pins, which engage the bones, is often critical. Thus, in prior art, fixation devices have included a locking mechanism to provide for an articulating adjustment between a first portion and a second portion of the fixator device. To provide for sufficient adjustment of the different portions of the fixator device a plurality of, for example two or more, separate locking mechanisms are utilized to provide for the amount of adjustment required to provide for the proper positioning of the pins related to an external fixator.  
      For example, some external fixators are particularly troublesome to properly adjust the position of the first set of fixator pins with respect to the second set of fixator pins. One such application is related to external fixators for foot positioners. For proper foot positioning for an external fixator, the posterior and anterior positioning, inversion and eversion, as well as dorsal and planar flexion must be properly positioned for proper bone resection for ankle fusion or for total ankle arthroplasty. The proper positioning of the feet with respect to the tibia can be quite troublesome. In fact, many adjustments may be necessary for the various locking mechanisms to establish the proper positioning of the bones in the feet.  
      Attempts have been made in the prior art to provide for the adjustment of the various positions of an external fixator. Such distraction advice includes a series of locked ball joints to provide for the motion. Such distractors require three, four or more adjustments to lock the ball joints.  
      U.S. Pat. No. 6,036,691 provides two separate cam locks for two separate ball joints. The distal member of the foot positioner allows dorsal and planar flexion but does not provide for inversion and eversion.  
      Another prior art patent, U.S. Pat. No. 6,461358 B1 also attempts to provide for positioning of the foot.  
      Distractors may also be included in an external fixator. Such distractors are often used for external fixators for preparation of ankle fusion or total ankle arthroplasty. Resection cuts are performed with the use of the distractor device to provide for proper leg length.  
     SUMMARY OF THE INVENTION  
      The present invention serves as an external fixator for use in the distraction of the ankle. The present invention may also be used as an external fixator for use in distractions of other portions of the skeleton. The present invention may also serve as a portion of an external fixator for use with cutting blocks to provide for resection cuts of bone for use, for example, in preparing bones for orthopedic implants.  
      The proximal member of the external fixator consists of a body that is attached to the tibia with pins and contains a distraction device that translates the medial and distal members. One embodiment includes a proximal member attached to a medial member with a lockable ball joint. The distal member attaches to the opposed end of the medial member with a lockable ball joint.  
      The present invention may include a locking cam mechanism that locks the proximal and distal member of the ball joint simultaneously. To provide for radiological measurements, the distal member may be composed of a radiolucent material that is fixed to the ankle with pins. The distal member allows for inversion and eversion of the anklebone segments along with dorsal and planar flexion.  
      The locking fixation device of the present invention provides for a single locking mechanism for two distinct ball joints. The mechanism allows the surgeon to lock the distraction device with a single mechanism instead of locking with several different modifications. The use of a single mechanism saves the surgeon time by reducing the number of adjustments required to properly position, for example, the foot. The distal member of the foot positioner allows the position of the pins or wires to be fully customized for the proper orientation of the foot. The fixation device includes posterior and anterior movement of the wire clamps along with dorsal and planar reflection. The distal member also allows rotation of the wire clamp assembly inversely and eversely. This allows the wires and foot to be adjusted any way the surgeon wants to position it.  
      The foot positioner of the present invention includes a locking articulation member, which locks two spherical members simultaneously. The locking articulation joint includes a cam that translates two bearings in opposite direction to lock two separate spherical members. The actuator or cam rotates in a slit or channel that allows both spherical members to be locked with an equal amount of force. The actuator allows translation of the bearing with a line-to-line action that prevents binding of the bearings while locking.  
      The cam lock feature of the present invention provides enhanced performance and reduced time required to lock the external fixator. The distal portions of the foot positioner are composed of carbon fiber bars and nylon wire clamps. The carbon fiber bars and nylon wire clamps are available as part of the TempFix® External Fixator product line available from DePuy Orthopaedics, Inc. The carbon fiber bars are connected to aluminum rotating clamps that are tightened using bolts. The bolts can be loosened to allow rotation of the wire clamp assemblies in any orientation required by the surgeon. The wire clamps can be moved along the carbon fiber bar to be customized for every individual angle.  
      The articulating joint for use in the external fixating device of the present invention includes a body. The body includes a central cavity and opposed caps. As an actuator rotates in a slitted hole formed in the body, the actuator translates two pistons. The actuator is rotated until the pistons push into the articulating members. The articulating members are locked when they press against the caps. This occurs on both sides of the actuating joints simultaneously.  
      The actuator includes a shaft that is fitted loosely in a slit. The slit in the body allows the actuator to rotate and lock with an equal amount of force. The purpose of the slit is to allow for any differences in tolerances so that both articulating members lock simultaneously every time. The actuator includes a cam, which cooperates with a piston. The cam includes a rounded cut out that follows an elliptical path. The cam is designed to fit with the spherical radius of the piston. The cam and spherical radius on the piston allows the piston to be translated without binding.  
      The distal portion of the foot positioner allows several different adjustments to allow for any type of orientation of the foot. It incorporates the same ideas as that of the TempFix® External Fixation Platform available from DePuy Orthopaedics, Inc. The wire clamps of the foot positioner can be moved along the vertical carbon fiber bar allowing proper placement of the pins in the ankle. The bar clamp may be tightened by a bolt to allow inversion and eversion by allowing the bar to rotate about the bar clamp. A bar end clamp that mates with a bar clamp is connected by the use of a bolt. Loosening the bolt allows dorsal and planar flexion of the ankle. All of these adjustments allow positioning of the pins and orientation of the foot in any possible position.  
      According to one embodiment of the present invention, there is provided a device for use in an external fixator for use in trauma surgery for rigidly connecting a first object to a second object. The device includes a body and a first articulating member for connecting the device to the first object. The first articulating member is lockable and un-lockable to the body to selectively provide articulation with and rigid connection to the body. The device further includes a second articulating member for connecting the device to the second object. The second articulating member is lockable and un-lockable to the body to selectively provide articulation with and rigid connection to the body. The body, the first articulating member and the second articulating member are adapted for simultaneous locking and unlocking to each other.  
      According to another embodiment of the present invention there is provided a device for use in an instrument for use in preparing bone for receiving an orthopaedic implant for use in orthopaedic surgery for rigidly connecting a first object to a second object. The device includes a body and a first articulating member for connecting the device to the first object. The first articulating member is lockable and un-lockable to the body to selectively provide articulation with and rigid connection to the body. The device further includes a second articulating member for connecting the device to the second object. The second articulating member is lockable and un-lockable to the body to selectively provide articulation with and rigid connection to the body. The body, the first articulating member and the second articulating member are adapted for simultaneous locking and unlocking to each other.  
      According to another embodiment of the present invention there is provided an articulating joint for rigidly connecting a first object to a second object for use in orthopedics. The joint includes a body and a first articulating member being one of pivotably and rigidly connected to the body. The first articulating member is connected to the first object. The joint also includes a second articulating member being selectively one of pivotably connected to and rigidly connected to the body. The second articulating member is connectable to the second object. The first and second articulating members are adapted for simultaneous locking and unlocking to each other.  
      According to another embodiment of the present invention there is provided an external fixator for use in trauma surgery for rigidly connecting a first portion of bone to a second portion of bone. The fixator includes a body and a first articulating member for connecting the device to the first object. The first articulating member is lockable and un-lockable to the body to selectively provide articulation with and rigid connection to the body. The device further includes a second articulating member for connecting the device to the second object. The second articulating member is lockable and un-lockable to the body to selectively provide articulation with and rigid connection to the body. The body, the first articulating second and the second articulating member are adapted for simultaneous locking and unlocking to each other.  
      According to another embodiment of the present invention there is a method for performing orthopaedic surgery. The method includes the steps of providing a cutting block for attachment to a bone. The cutting block includes an articulating joint for rigidly connecting the cutting block to the bone. The joint includes a body and a first articulating member that is selectively pivotably connected to or rigidly connected to the body. The first articulating member is connectable to the first object. The joint also includes a second articulating member that is selectively pivotably connected to or rigidly connected to the body. The second articulating member is connectable to the second object, the first and second articulating member being adapted for simultaneous locking and unlocking to each other. The method also includes the steps of securing the cutting block to the bone, unlocking the articulating joint, and aligning the cutting block to provide an accurate cutting of the bone. The method further includes the steps of locking the articulation joint and cutting the bone.  
      According to another embodiment of the present invention there is provided a method for rigidly securing a first portion of bone to a second portion of bone during trauma surgery. The method includes the steps of providing an external fixator for attachment to the first portion of bone and to the second portion of bone. The external fixator includes an articulating joint for rigidly connecting the external fixator to the first portion of bone and to the second portion of bone. The joint includes a body, a first articulating member that is selectively either pivotably connected to or rigidly connected to the body. The first articulating member is connectable to the first object. The joint also includes a second articulating member that is selectively either pivotably connected to or rigidly connected to the body. The second articulating member is connectable to the second object. The first and second articulating member are adapted for simultaneous locking and unlocking to each other. The method also includes the steps of securing the external fixator to the first portion of bone and unlocking the articulating joint. The method further includes the step of aligning the first portion of bone and the second portion of bone to provide proper orthopaedic alignment. The method also includes the steps of securing the external fixator to the second portion of bone and locking the articulation joint.  
      According to yet another embodiment of the present invention there is provided a method for rigidly securing a first portion of bone to a second portion of bone during orthopaedic surgery. The method includes the step of providing a device for attachment to a bone. The device includes an articulating joint for rigidly connecting the device to the first portion of bone and to the second portion of bone. The articulating joint includes a body and a first articulating member. The first articulating member is selectively one of pivotably connected to and rigidly connected to the body. The first articulating member is connectable to the first object. The articulating joint also includes a second articulating member. The second articulating member is selectively pivotably connected to or rigidly connected to the body. The second articulating member is connectable to the second object. The first articulating member and second articulating member are adapted for simultaneous locking and unlocking to each other. The method also includes the steps of securing the device to the first portion of bone, unlocking the articulating joint, aligning the first portion of bone and the second portion of bone to provide proper orthopaedic alignment, securing the device to the second portion of bone, and locking the articulation joint.  
      According to yet another embodiment of the present invention there is provided a device for securing a first bone portion to a second portion. The device includes a first object for securement to the first bone portion and a second object for securement to the second bone portion. The device further includes an articulating joint for rigidly connecting the first object to the second object. The articulating joint has a first articulating member that is selectively pivotably connected to or rigidly connected to the body. The first articulating member is connectable to the first object. The articulating joint also has a second articulating member that is selectively pivotably connected to or rigidly connected to the body. The second articulating member is connectable to the second object. The first articulating member and second articulating member are adapted for simultaneous locking and unlocking to each other.  
      The technical advantages of the present invention include the ability to permit two ball joints to be locked simultaneously. For example, according to one aspect of the present invention an articulating joint for rigidly connecting a first object to a second object for use in orthopedics is provided. The joint includes a body and a first and second articulating member. The first articulating member is selectively pivotably connected or rigidly connected to the body. The first articulating member is connectable to the first object. The second articulating member is selectively pivotably connected or rigidly connected to the body. The second articulating member is connectable to the second object. The first articulating member and the second articulating member are adapted for simultaneous locking and unlocking to each other. Thus, the present invention provides for two ball joints to be locked simultaneously.  
      The technical advantages of the present invention further include the ability to save the surgeon time in utilizing external fixators. For example, according to another aspect of the present invention, a device for use in an external fixator for use in trauma surgery for connecting a first object to a second object is provided. The device includes a body, as well as first and second articulating members. The first articulating member connects the device to the second object and is lockable and un-lockable to the body to selectively provide articulation with and rigid connection to the body. The second articulating member is used to connect the device to the second object. The second articulating member is lockable and un-lockable to the body to selectively provide articulation with and rigid connection to the body. The body and the first and second articulating members are adapted for simultaneously locking and unlocking to each other. Thus, the present invention provides for the saving of surgeons&#39; time by permitting two ball joints to be simultaneously locked.  
      The technical advantages of the present invention further include the ability to reduce the number of adjustments required. For example, according to yet another aspect of the present invention, a device for use in an instrument for preparing bone is provided. The device includes a body and first and second articulating members. The first articulating member is used to connect the device to the first object. The first articulating member is lockable and un-lockable to selectively provide articulation with the body. The second articulating member is used to connect the device to the second object. The second articulating member is lockable and un-lockable to the body to provide articulation with and rigid connection to the body. The body, the first articulating member and the second articulating member are adapted for simultaneously locking and unlocking to each other. Thus, the present invention provides for a reduction in the number of adjustments required in that the two separate joints can be simultaneously locked and thereby the surgeon can place the bone pins in the proper position by having more ability to properly orient the external fixator holding the pins.  
      The technical advantages of the present invention also include the ability to provide another form of rotation with the foot positioner. For example, according to yet another aspect of the present invention, a device for use as an external fixator for use in trauma surgery for connecting the tibia to the bones of the foot include a body, and first and second articulating members. The first articulating member is used to connect the device to the first object. The first articulating member is lockable and un-lockable to the body to provide articulation with and rigid connection to the body. The second articulating member is used to connect the device to the second object and is lockable and un-lockable to the body to selectively provide articulation with and rigid connection to the body. The body and the first and second articulating members are adapted for simultaneously locking and unlocking to each other. Thus, the present invention provides another form of rotation with a foot positioner by permitting the surgeon to orient the foot in any direction by utilizing the two ball joints and then locking them together simultaneously.  
      The technical advantages of the present invention further include the ability to permit inversion and eversion rotation simultaneously with the ability to permit the positioning of the dorsal and plantar flexion. For example, according to yet another aspect of the present invention, a device for use in an external fixator for use in trauma surgery for performing an ankle fusion or ankle arthroplasty is provided. The device includes a body as well as first and second articulating members. The articulating members are selectively positioned in a locked and unlocked position with the first and second articulating members being adapted for simultaneously locking and unlocking to each other. The surgeon may adjust the foot positioner in any orientation including inversion and eversion, as well as dorsal and planar flexion easily and then lock the foot positioner in that position by utilizing the locking device with the two articulating members.  
      Other technical advantages of the present invention will be readily apparent to one skilled in the art from the following figures, descriptions and claims.  
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       FIG. 1  is a perspective view of an articulating joint for rigidly connecting a first object to a second object for use in orthopaedics in accordance to an embodiment of the present invention;  
       FIG. 2  is a plan view, partially in cross section, of the articulating joint of  FIG. 1 ;  
       FIG. 2A  is a partial plan view, partially in cross section, of the actuator of the articulating joint of  FIG. 1 ;  
       FIG. 2B  is a partial plan view, partially in cross section, of the actuator of the articulating joint of  FIG. 1 ;  
       FIG. 2C  is a partial plan view of another embodiment of the present invention in the form of an actuator with a circular opening;  
       FIG. 3  is a partial cross sectional view of the articulating joint of  FIG. 1 ;  
       FIG. 3A  is a partial plan view, partially in cross-section of another embodiment of the present invention in the form of an actuator with a wedge shape;  
       FIG. 4  is a partial plan view, partially in cross section, of the actuator of another embodiment of the articulating joint the present invention showing a body with a circular body transverse opening;  
       FIG. 5  is a partial plan view, partially in cross section, of the actuator of another embodiment of the articulating joint the present invention showing an actuator with a wedge;  
       FIG. 6  is a plan view of a fixator incorporating an articulating joint for rigidly connecting a first object to a second object for use in orthopedics in accordance with yet another embodiment of the present invention;  
       FIG. 7  is a plan view of the articulating joint of the fixator of  FIG. 6 ;  
       FIG. 8  is a cross-sectional of  FIG. 7  along the line  8 - 8  in the direction of the arrows;  
       FIG. 9  is a plan view of the body of the articulating joint of  FIG. 7 ;  
       FIG. 10  is a top view of the body of  FIG. 8  of the articulating joint of  FIG. 7 ;  
       FIG. 11  is a plan view of the articulating member of the articulating joint of  FIG. 7 ;  
       FIG. 12  is a cross-sectional view of  FIG. 11  along the line  12 - 12  in the direction of the arrows;  
       FIG. 13  is a plan view of the piston of the articulating joint of  FIG. 7 ;  
       FIG. 14  is a cross-sectional view of  FIG. 13  along the line  14 - 14  in the direction of the arrows;  
       FIG. 15  is a bottom view of the piston of  FIG. 12  of the articulating joint of  FIG. 7 ;  
       FIG. 16  is a plan view of the cam of the articulating joint of  FIG. 7 ;  
       FIG. 17  is a cross-sectional view of  FIG. 16  along the line  17 - 17  in the direction of the arrows;  
       FIG. 18  is a side view of the cam of  FIG. 16  of the articulating joint of  FIG. 7 ;  
       FIG. 19  is a plan view of an external fixator for use in ankle fusion shown with an ankle fusion cutting guide in position on the body of a patient in accordance to yet another embodiment of the present invention;  
       FIG. 20  is a partial plan view of the external fixator of  FIG. 19  showing the portion of the fixator around the foot in greater detail;  
       FIG. 21  is a partial plan view of an external fixator of another embodiment of the device of the present invention having a U-shaped bar portion surrounding the foot;  
       FIG. 22  is a partial perspective view of the external fixator of  FIG. 19  showing the portion of the fixator around the actuating joint and the distractor in greater detail;  
       FIG. 23  is a plan view of the distractor pin of the distractor of the external fixator of  FIG. 22 ;  
       FIG. 23A  is a cross-sectional view of  FIG. 23  along the line  23 A- 23 A in the direction of the arrows;  
       FIG. 24  is a plan view of the distractor screw of the distractor of the external fixator of  FIG. 22   
       FIG. 25  is an enlarged partial perspective view of the external fixator of  FIG. 22 ;  
       FIG. 26  is another further enlarged partial perspective view of the external fixator of  FIG. 22 ;  
       FIG. 27  is a plan view of the connector of the external fixator of  FIG. 22 ;  
       FIG. 28  is an end view of the connector of the external fixator of  FIG. 22 ;  
       FIG. 29  is a plan view of the bar of the external fixator of  FIG. 22 ;  
       FIG. 30  is a partial plan view of an external fixator of another embodiment of the device of the present invention having a bar with pins protruding transversely through the bar;  
       FIG. 31  is a plan view of the bar/periphery half of the bar clamp of the external fixator of  FIG. 22 ;  
       FIG. 32  is a side view of the bar/periphery half of  FIG. 31 ;  
       FIG. 33  is an end view of the bar/periphery half of  FIG. 31 ;  
       FIG. 34  is a plan view of the bar end half of the bar clamp of the external fixator of  FIG. 22 ;  
       FIG. 35  is a side view of the bar end half of  FIG. 34 ;  
       FIG. 36  is a plan view of the bar clamp half of the bar-pin clamp of the external fixator of  FIG. 22 ;  
       FIG. 37  is a side view of the bar clamp half of  FIG. 36 ;  
       FIG. 38  is a perspective view of the pin clamp half of the bar-pin clamp of the external fixator of  FIG. 22 ;  
       FIG. 39  is a perspective view of a spacer for use with the pin clamp half of the bar-pin clamp of the external fixator of  FIG. 22 ;  
       FIG. 40  is a plan view of a fused ankle that may be prepared with the external fixator of  FIG. 19 ;  
       FIG. 41  is a plan view of an external fixator for use in ankle arthroplasty shown with an ankle arthroplasty cutting guide in position on the body of a patient in accordance to yet another embodiment of the present invention;  
       FIG. 42  is a plan view of an ankle implant for use in an ankle that may be prepared with the external fixator of  FIG. 41 ;  
       FIG. 43  is a plan view of an external fixator for use around the knee of a patient in accordance to yet another embodiment of the present invention;  
       FIG. 44  is a plan view of an external fixator for use around the elbow of a patient in accordance to yet another embodiment of the present invention;  
       FIG. 45  is a plan view of an external fixator for use in knee arthroplasty shown with a tibial knee arthroplasty cutting guide in position on the body of a patient in accordance to yet another embodiment of the present invention;  
       FIG. 46  is a plan view of an external fixator for use in knee arthroplasty shown with a femoral knee arthroplasty cutting guide in position on the body of a patient in accordance to yet another embodiment of the present invention;  
       FIG. 47  is a plan view of an external fixator for use in knee arthroplasty shown with a femoral hip arthroplasty cutting guide in position on the body of a patient in accordance to yet another embodiment of the present invention;  
       FIG. 48  is a perspective view of an articulating joint for rigidly connecting a first object to a second object for use in orthopaedics in accordance to yet another embodiment of the present invention having a telescoping two piece body;  
       FIG. 49  is a plan view, partially in cross section, of the articulating joint of  FIG. 48 , with the joint in the locked position;  
       FIG. 50  is a plan view, partially in cross section, of the articulating joint of  FIG. 48 , with the joint in the unlocked position;  
       FIG. 51  is a partial plan view, partially in cross section, of the articulating joint of  FIG. 48  showing the articulating member and the body in greater detail;  
       FIG. 52  is a plan view, partially in cross section, of an articulating joint for rigidly connecting a first object to a second object for use in orthopaedics in accordance with a further embodiment of the present invention having a ratchet mechanism;  
       FIG. 52A  is a cross-sectional view of  FIG. 52  along the line  52 A- 52 A in the direction of the arrows;  
       FIG. 52B  is a cross-sectional view of  FIG. 52  along the line  52 B- 52 B in the direction of the arrows;  
       FIG. 53  is a plan view, partially in cross section, of an articulating joint for rigidly connecting a first object to a second object for use in orthopedics in accordance with a further embodiment of the present invention having cylindrical articulating portions of the articulating members;  
       FIG. 54  is a top view, partially in cross-section, of the joint of  FIG. 53 ;  
       FIG. 55  is a partial top view, partially in cross-section, of the joint of  FIG. 53 ;  
       FIG. 56  is a flow chart for a method of performing trauma surgery in accordance to yet another embodiment of the present invention; and  
       FIG. 57  is a flow chart for a method for performing orthopaedic surgery in accordance to another embodiment of the present invention. 
    
    
      Corresponding reference characters indicate corresponding parts throughout the several views. Like reference characters tend to indicate like parts throughout the several views.  
     DETAILED DESCRIPTION OF THE INVENTION  
      Embodiments of the present invention and the advantages thereof are best understood by referring to the following descriptions and drawings, wherein like numerals are used for like and corresponding parts of the drawings.  
      According to the present invention and referring now to  FIG. 1  an articulating joint  10  is shown for rigidly connecting a first object  12  to a second object  14  for use in orthopedics. The articulating joint  10  includes a body  16  as well as a first articulating member  18 . The first articulating member  18  is selectively either pivotably connected to or rigidly connected to the body  16 . The first articulating member  18  is connectable to the first object  12 .  
      The articulating joint  10  further includes a second articulating member  20 . The second articulating member  20  is selectively either pivotably connected to or rigidly connected to the body  16 . The second articulating member  20  is connectable to the second object  14 . The first articulating member  18  and the second articulating member  20  are adapted for simultaneously locking and unlocking to each other.  
      The articulating joint  10  as shown in  FIG. 1  may further include an actuator  22 . The actuator is operably connected to the first articulating member  18  and to the second articulating member  20 . The actuator  22  simultaneously locks and unlocks the first articulating member  18  and the second articulating member  20 .  
      Referring now to  FIG. 2 , the articulating joint  10  is shown in greater detail. The articulating joint  10  includes the body  16 . The body  16  may have any suitable shape capable of supporting the actuator  22  and for assisting to transfer motion from the actuator  22  to the first articulating member  18  as well as to the second articulating member  20 .  
      For example and as shown in  FIG. 2 , the body  16  may be in the form of a generally tubular cylindrical member. The body  16  may include a generally cylindrical outer periphery  24  and a generally cylindrical bore  26 . Bore  26  may as shown in  FIG. 2  be concentric with outer periphery  24 .  
      As shown in  FIG. 2 , the actuator  22  is mounted to the body  16 . For example and as shown in  FIG. 2 , the body  16  may include a body transverse opening  28  through which shaft  30  of the actuator  22  is rotatably fitted. Preferably, to accommodate component tolerances and the resultant tolerance stack of the components of the articulating joint  10 , the body transverse opening  28  may be sized to provide additional clearance between the body transverse opening  28  and the shaft  30 . The clearance accommodates the tolerances so that the shaft  30  is not limited in its motion axially by the body  16 .  
      For example and as shown in  FIG. 2 , the body transverse opening  28  may be oval. For example and as shown in  FIG. 2 , the body transverse opening  28  may be defined by an opening length L which is substantially greater than the opening width W. The opening length L is made sufficiently larger than diameter D of the shaft  30  such that the shaft  30  does not impinge upon the body  16 .  
      The actuator  22  includes a feature  32  in the form of, for example, a cam for transferring force from the shaft  30  to the articulating members  18  and  20 . The actuator  22  may, as shown in  FIG. 1  further include a handle  34  for locking and releasing the articulating joint  10 .  
      It should be appreciated that the body  16  may fully restrain the articulating members  18  and  20 . It should also be appreciated that the joint  10  may, for simplicity, include restraining features in addition to the body  16 . For example, the articulating joint  10  may further include a first cap  36  and an opposed second cap  38 . Caps  36  and  38  may have any suitable shape capable of containing the articulating members  18  and  20  within the joint  10 . For example and as shown in  FIG. 2 , the first cap  36  includes a concave inner-periphery  40  for cooperation with spherically shaped portion  42  of the first articulating member  18 . The first cap  36  further defines a first cap member opening  44  for permitting stem portion  46  of the first articulating member  18  to pass therethrough.  
      The first cap  36  further defines the first cap body opening  48  for receiving the body  16 . The first cap  36  may be secured to the body  16  in any suitable way, for example, by a series of pins, a groove and lip, or, as shown in  FIG. 2 , by internal threads  50  formed on the first cap  36  adjacent the first cap body opening  48 . The internal threads  50  of the first cap  36  matingly engage external threads  52  formed on first hub  54  of the body  16 .  
      The second cap  38  is similar to the first cap  36  and includes a concave inner-periphery  56  for cooperation with spherically shaped portion  58  of the second articulating member  20 . The second cap  38  includes a second cap member opening  60  for passage of the stem portion  62  of the second articulating member  20 . The inner periphery  56  of the second cap  38  includes internal threads  64 , which mate with external threads  66  formed on hub  68  of the body  16 .  
      The articulating joint  10  of the present invention may include a number of design alternatives to transfer the motion from the actuator  22  to the articulating members  18  and  20 . For example, the articulating joint  10  may include a first piston  70  for positioning within the bore  26  of the body  16  as well as a second piston  72  likewise positioned in the bore  26  of the body  16 . The pistons  70  and  72  serve to transfer motion from the cam  32  to the articulating members  18  and  20  respectively. For example and as shown in  FIG. 2 , as the cam  32  is rotated in the direction of arrow  74 , the cam  32  moves from first position  76  to second position  78  as shown in phantom.  
      As the cam  32  moves from first position  76  to second position  78 , the cam serves to advance the first piston  70  and second piston  72  in opposed directions in the directions of arrows  80 . In particular, the first piston  70  advances from first position  82  (as shown in solid) to second position  84  (as shown in phantom). Similarly the second piston  72  advances from first position  86  (as shown in solid) to second position  88  (as shown in phantom).  
      When the first piston  70  and the second piston  72  are in their second positions, the outer face  90  of the first piston  70  becomes in locking engagement with the spherically shaped portion  42  of the first articulating member  18  locking it into position. Similarly and simultaneously, the second piston  72 , when in its second position  88 , provides for outer face  92  of the second piston  72  to be in locked engagement with spherically shaped portion  58  of the second articulating member  20 . Thereby, the second piston  72  locks the second articulating member  20 . Thus, the articulating joint  10  of the present invention provides for simultaneous locking of the first articulating member  18  and the second articulating member  20  with respect to the body  16  by the actuation of the actuator  22 .  
      The outer face  90  of the first piston  70  and the outer face  92  of the second piston  72  may have, for example, concave surfaces to mate with the spherically shaped portions  42  and  58  of the first articulating member  18  and second articulating member  20 , respectively. The concave surfaces provide for increased contact and superior locking of the articulating members  18  and  20 .  
      Referring now to  FIGS. 2A and 2B , the actuator  22  is shown in greater detail. As shown in  FIG. 2A , the actuator  22  includes the shaft  30 , which is slidably positioned in body transverse opening  28 , which is positioned normal to outer periphery  24  of the body  16 . The shaft  30  may be secured to the body  16  by a pair of fasteners  94  secured to the outer periphery  24  of the body  16 , as well as to the shaft  30 . Inner faces  96  and  98  of the first piston  70  and second piston  72 , respectively, may as shown in  FIG. 2A  be convex to provide for a smooth movement of the cam  32  with respect to the pistons  70  and  72 .  
      Referring now to  FIG. 2B , the body transverse opening  28  may be defined by a width W closely conforming to the shaft  30  as well as a length L which is substantially larger than the width W and provides for variations in the accuracy of the components and their resulting tolerance stack so that the first piston  70  and the second piston  72  engage simultaneously with the first articulating member  18  and the second articulating member  20 , respectively.  
      Referring now to  FIG. 2C , yet another embodiment of the present invention is shown as articulating joint  10 C. The articulating joint  10 C is similar to the articulating joint  10  of  FIG. 2  except that the articulating joint  10 C includes an opening  28 A in the body  16 A of the joint  10 A that is circular rather than elongate or oval. The opening  28 A in the body  16 A as shown in  FIG. 2C  is substantially larger than the shaft  30 A such that the variations in tolerance may still permit the articulating members to simultaneously lock.  
      Referring now to  FIG. 3 , the first end of the articulating joint  10  is shown in greater detail. As shown in  FIG. 3 , the first cap  36  extends from body  16  and is threadably connected to the body  16  by internal threads  50  formed in the first cap  36 , which mate with external threads  52  formed on the body  16 . First piston  70  is slidably fitted in bore  26  of the body  16  and engages the spherically shaped portion  42  of the first articulating member  18 .  
      Preferably and as shown in  FIG. 3 , outer face  90  of piston  70  has a concave shape to mate with the spherically shaped portion  42  of the first articulating member  18 . The spherically shaped portion  42  of the first articulating member  18  also matingly fits with inner-periphery  40  of the first cap  36 . The inner-periphery  40  of the first cap  36  may, as is shown in  FIG. 3 , have a concave shape, for example, a spherical shape. The first articulating member  18  also includes stem portion  46  that extends from the spherically shaped portion  42  and passes through first cap opening  44  formed in the first cap  36 .  
      For example, and as shown in  FIG. 3 , the spherically shaped portion  42  of the first articulating member  18  is defined by a radius RA extending from origin  31 . Similarly, the outer face  90  of piston  70  is defined by radius RP extending from the origin  31 . Similarly, the inner-periphery  40  of the cap  36  is defined by radius RB extending from origin  31 . As shown in  FIG. 3 , the radius RA of the spherically shaped portion  42  of the first articulating portion  18  is slightly smaller than the radii RP and RB of the piston  70  and cap  36  respectively.  
      According to the present invention the articulating joint  10  is connectable to the first object  12  as well as the second object  14  (see  FIG. 2 ). The objects  12  and  14  may be connected to the articulating joint in any suitable manner. For example and as shown in  FIG. 3 , the articulating joint  10  may include a first connector  35  for securing the first object  12  to stem portion  46  of the first articulating member  18  of the articulating joint  10 . The first connector  35  may include a body  39  defining a first bore  43  matingly fitted with the stem portion  46  of the first articulating member  18  as well as a second bore  47  for connection with the first object  12 .  
      Referring again to  FIG. 2 , the articulating joint  10  includes a second connector  51  for securing the stem portion  62  of the second articulating member  20  to the second object  14 . Second connector  51  may as shown in  FIG. 2  be similar or even identical to the first connector  35 .  
      Referring now to  FIG. 3A , another embodiment of the present invention is shown as articulating joint  10 B. The articulating joint  10 B includes an actuator  22 B, which is different than the actuator  22  of the articulating joint  10 . For example, as is shown in  FIG. 3A , the actuator  22 B includes a wedge  32 B, which replaces the cam  32 B of the actuator  22  of the articulating joint  10  of  FIG. 2 . The wedge  32 B extends from shaft  30 B, which is positioned in elongated opening  28 B formed in body  16 B of the articulating joint  10 B. As the actuator  22 B is advanced in the direction of arrow  74 B, the wedge  32 B engages with first piston  70 B with second piston  72 B to engage the articulating members and thereby simultaneously lock the articulating members.  
      Referring now to  FIGS. 4 and 5  the first connector  35  is shown in greater detail. While the first connector  35  may have any suitable size and shape, the first connector  35 , as shown in  FIGS. 4 and 5 , includes the body  39 , which has a generally hollow cylindrical shape. The body  39  of the first connector  35  may, as shown in  FIGS. 4 and 5  include the first opening  43  and the second opening  47 . The first opening  43  and the second opening  47  may, for simplicity, be concentric to each other and be generally cylindrical.  
      Referring now to  FIG. 4 , the body  39  may define a transverse aperture  53  for passage of a fastener in the form of bolt  59 . The bolt  59  serves to compress the body  39  to secure the body  39  to the stem portion  46  of the first articulating member  18  as well as to the first object  12 .  
      Referring now to  FIG. 5 , to permit the body  39  to compress against the stem portion  46  and the second object  12 , the body  39  preferably includes a slit  63  extending from the opening  43  through the body  39  radially. The slit serves to provide for compression of the body  39 .  
      The components of the articulating joint  10  of  FIGS. 1-5  are preferably made of any suitable durable material that may be sterilized by commercially available sterilization techniques. For example, the components of the articulating joint  10  of the present invention may be made from a metal, a plastic, or a composite material. If made of a metal, light materials, for example aluminum, may be well suited. Composite materials, for example a carbon fiber reinforced plastic material may be well suited for components of the articulating joint  10 .  
      Referring now to  FIGS. 6 through 18 , another embodiment of the present invention is shown as device  110  in the form of an actuating joint for use in trauma surgery for rigidly connecting first object  112  to second object  114 .  
      As shown in  FIG. 6 , an external fixator  100  is utilized to fixably secure a first bone in the form of, for example, tibia  2  to a second bone, for example bones in the foot  4 . The external device  100  includes a device  110  in the form of the actuating joint. Extending proximally from the actuating joint  110  is a first connector  135 , which fixedly connects the actuating joint  110  to distractor  102 .  
      The distractor  102  may be an optional part of the external fixator  100 . The distractor  102  is utilized to distract or to draw the tibia  2  away from the foot  4 . The distractor  102  serves to support a pin or, as shown in  FIG. 6 , a pair of spaced-apart pins or wires  104 . The wires or pins  104  are inserted into tibia  2  and are used to fixedly attach the tibia  2  to the distractor  102 .  
      Extending distally from the actuating joint  110  is a second connector  51  used to connect the device  110  to rod  106 . A slit rod/pin clamp  108  is fixedly securable to the rod  106  and supports pins  104 , which are secured to the bones in the foot  4 .  
      Referring now to  FIG. 7 , the articulating joint  110  is shown in greater detail. The articulating joint  110  may be used in the external fixator  100  for use in trauma surgery. For example, the articulating joint  110  may be a part of the fixator  100  for rigidly connecting a first object  112  to a second object  114 . The articulating joint  110  of  FIG. 7  is similar to the articulating joint  10  of  FIG. 2 . The articulating joint  110  includes a body  116  as well as a first articulating member  118  and a second articulating member  120 .  
      The first articulating member  118  is utilized for connecting the articulating joint  110  to the first object  112 . The first articulating member  118  is lockable and unlockable to the body  116  to selectively provide articulation with and rigid connection to the body  116 .  
      The second articulating member  120  is utilized to connect the articulating joint  110  to the second object  114 . The second articulating member  120  is lockable and unlockable to the body  116  to selectively provide articulation with and rigid connection to the body  116 . The body  116 , the first articulating member  118  and the second articulating member  120  are adapted to simultaneously lock and unlock to each other.  
      The articulating joint  110  may further include an actuator  122 , which is operably connected to the first articulating member  118  and a second articulating member  120 . The actuator  122  is utilized for simultaneously locking and unlocking of the first articulating member  118  and the second articulating member  120 .  
      Referring now to  FIG. 8 , the articulating joint  110  is shown in greater detail. The body  116  of the articulating joint  110  may be of any suitable shape. The joint  110  may, as shown in  FIG. 8 , have a generally cylindrical body defining a cylindrical outer periphery  124  and a cylindrical bore  126  which may as shown in  FIG. 8  be generally concentric with the outer periphery  124 . The body  116  may further include a body transverse opening  128  formed in the body  116  for receiving the actuator  122 .  
      The bore  126  of the body  116  is utilized to contain and guide the first articulating member  118  and the second articulating member  120 . The bore  126  further contains a first piston  170  positioned between the actuator  122  and the first articulating member  118  as well as a second piston  172  positioned between the actuator  122  and the second articulating member  120 .  
      The articulating joint  110  further includes a first cap  136  for securing the first piston  170  between cam  132  and the first articulating member  118 . The first cap  136  also serves to constrain the first articulating member  118 . Similarly, the articulating joint  110  further includes a second cap  138  secured to the body  116 . The second cap  138  is utilized to secure the second articulating member  120  to the body  116  as well as to secure the second piston  172  between the second articulating member  120  and the cam  132 .  
      The first cap  136  and the second cap  138  may be secured to the body  116  in any suitable fashion. For example and as shown in  FIG. 8 , the first cap  136  includes internal threads  150 , which mate with external threads  152  formed on the body  116 . Similarly, the second cap  138  includes internal threads  164 , which threadably engage with external threads  166  formed on the body  116 .  
      The articulating joint  110  is utilized to selectively lock and unlock the first articulating member  118  and the second articulating member  120  in any suitable fashion. For example, and as shown in  FIG. 8 , the articulating joint  110  includes the actuator  122 , which may be used to actuate or selectively lock and unlock the first and second articulating members,  118  and  120 , respectively. For example, and as shown in  FIG. 8 , the actuator  122  includes a handle  134  which may be rotated in the direction of arrow  174  to rotate the cam  132  extending from shaft  130  rotatably fitted through body transverse opening  128 .  
      As the cam  132  rotates in the direction of arrow  174 , the cam  132  contacts the first piston internal face  196  of the first piston  170  advancing it in the direction of arrow  180 . Similarly, as the cam  132  is rotated, the cam contacts the second piston internal face  198  of the second piston  172  advancing it in the direction of arrow  181 .  
      The first piston  170  as it advances in the direction of arrow  180  includes a concave outer face  190 , which cooperates with spherically shaped portion  142  of the first articulating member  118  to advance the first articulating member  118  in the direction of arrow  180 . As the first articulating member  118  advances in the direction of arrow  180 , it contacts concave interior periphery  140  of the body  116  thereby locking the first articulating member  118 .  
      Similarly, as the second piston  172  advances in the direction of arrow  181  outer face  192  of the piston  172  contacts spherically shaped portion  158  of the second articulating member  120  causing the second articulating member  120  to advance in the direction of arrow  181 . As the spherically shaped portion  158  of the second articulating member  120  advances in the direction of arrow  181  the spherical shaped portion  158  engages with interior periphery  156  of the body  116  thereby locking the second articulating member  120  to the body  116 .  
      The locking of the first articulating member  118  and the second articulating member  120  is accomplished simultaneously by the rotation of the handle  134  in the direction of arrow  174  by providing sufficient clearance between the shaft  130  and the body transverse opening  128  that neither the first articulating member  118  nor the second articulating member  120  are locked until all of the first articulating member  118 , first piston  170 , cam  132 , second piston  172 , and second articulating member  120  are all in mating engagement. Only then are the components subsequently locked to each other within the bore  126  of the body  116 .  
      Extending outwardly from the first cap  136  is stem portion  146  of the first articulating member  118 . The stem portion  146  is used to transfer the articulation and rigidity to the first object  112 . Similarly, second stem portion  162  of the second articulating member  120  extends outwardly from the second cap  138  and is utilized to permit articulation and support to second object  114 .  
      The first stem portion  146  and the second stem portion  162  may be operably connected to the first object  112  and the second object  114 , respectively in any suitable manner. For example and as shown in  FIG. 8 , the first stem portion  146  may be secured to the first object  112  by a first connector  135  which is substantially similar to first connector  35  of the articulating joint  10  of  FIGS. 4 and 5 . Similarly, the second stem portion  160  may be secured to second object  114  by means of second connector  151 , which is substantially similar to second connector  51  of  FIG. 2 . The first connector  135  and the second connector  151  may, for simplicity, be identical to each other.  
      Referring now to  FIGS. 9 and 10 , body  116  of the articulating joint  110  is shown in greater detail. The body  116 , as shown in  FIGS. 9 and 10 , includes the generally cylindrical outer periphery  124  as well as a generally cylindrical body bore  126 , which may, as shown in  FIGS. 9 and 10 , be concentric with the outer periphery  124 . The body  116  includes first external threads  152  and second external threads  166  formed on outer periphery  124  of the body  116 .  
      To receive the actuator  122 , the body  116  may include the transverse aperture  128  formed in the body  116 . The aperture  128  may, as shown in  FIG. 9 , be generally oval. Alternatively, the aperture  128  may be cylindrical.  
      The body  116  may further include opposed parallel flats  117  positioned around the aperture  128 . The flats  117  may serve to cooperate with the actuator  122 .  
      Referring now to  FIGS. 11 and 12 , one of the articulating members, for example first articulating member  118  of the articulating joint  110  is shown in greater detail. The first articulating member  118  may, as is shown in  FIGS. 11 and 12 , include an articulating portion  142 , which may be as is shown in  FIGS. 11 and 12  have a generally spherical periphery. Extending from the actuating or spherical portion  142  may, as shown in  FIGS. 11 and 12 , be a stem portion  146 . As shown in  FIGS. 11 and 12 , the stem portion  146  is generally cylindrical. It should be appreciated that the stem portion  146  may have any suitable shape, for example, a polygonal, for example triangular, rectangular or hexagonal for mating with the connector, for example connector  135 . It should be appreciated that the second articulating member  120  may have a size and shape similar or identical to the first articulating member  118 .  
      Referring now to  FIGS. 13, 14  and  15 , a piston for example the first piston  170  of the articulating joint  110  is shown in greater detail. First piston  170  includes an interior face  196 , which serves as a follower for the cam  132  of  FIG. 8 . Since the piston interior face  196  serves as a follower, the interior face  196  may as shown in  FIGS. 13 and 14  have a arcuate, for example a convex surface. The convex surface serves to assist in providing smooth motion with the first piston  170  with cam  132 . The first piston  170  further includes an outer periphery  171 , which serves as the sliding surface for cooperation with the bore  126  of the body  116  of the articulating joint  110  of  FIG. 8 . The outer periphery  171  preferably has a shape or contour similar to that of the bore  126 .  
      The first piston  170  further includes an outer face  190  opposed to the interior face  196 . The first outer face  190  serves to articulate with the first articulating member  118  of  FIGS. 11 and 12 . Since the first outer face  190  articulates with the spherical portion  142  of the first articulating member  118 , first outer face  190  is preferably arcuate. For example, the first outer face  190  may be concave. For example and as shown in  FIG. 14 , the first outer face  190  may be in the form of a portion of a sphere.  
      Referring now to  FIGS. 16, 17  and  18 , the actuator  122  of the articulating joint  110  is shown in greater detail. The actuator  122  includes the shaft  130 . The shaft  130  may have any suitable shape and may, for simplicity and as shown in FIGS.  16  to  18 , have a generally cylindrical shape. It should be appreciated that the shaft  130  may be of any other shape, for example that of a polygon or any irregular shape.  
      The actuator  122  may as shown in  FIGS. 17 and 18  further include a handle  134  extending from the shaft  130  in a direction transverse to the shaft  130 . The handle  134  may have any shape and may for simplicity have a generally uniform cross-section, for example, a generally rectangular cross-section. The handle  134  may extend out sufficiently to provide the mechanical advantage necessary to lock and unlock the actuator  122 .  
      The actuator  122  further includes cam  132 . The cam  132  may have any suitable shape and may, as shown in  FIGS. 16, 17 , and  18 , be a portion of the periphery of the shaft  130 . The cam  132  may, as shown in  FIGS. 16 and 18 , be generally centrally located within the length of the shaft  130 . The cam  132  as shown in  FIG. 17  may have an oval or elliptical cross-section so that as the handle  134  is rotated the cam  132  may serve to advance the pistons  170  and  172  (see  FIG. 8 ). The cam  132  may have a concave shape as shown in  FIGS. 16 and 18  to provide a self centering feature between the cam  132  and the convex inner-faces  196  and  198  of the pistons  170  and  172 , respectively.  
      Referring now to  FIG. 18 , the actuator  122  may further include a locking feature in the form of external threads  193  formed on the shaft  130  opposed to the handle  134 . The external threads  193  may be used to cooperate with a fastener for example, nut  194 , shown in phantom.  
      The articulating joint  110  and other components of the external fixator  100  of  FIGS. 6-18  may be made of any suitable durable material that may be sterilized by commercially available techniques. For example the external fixator  100  and the articulating joint  110  may be made of a metal, a plastic, or a composite material. If made of a metal the articulating joint  110  is preferably made of a durable lightweight material, for example aluminum or a metal alloy, for example a cobalt chromium alloy. If the components of the articulating joint  110  are made of a plastic, the components of the articulating joint  110  are made of a durable high-strength plastic. The components of the articulating joint  110  may likewise be made of a composite material for example a carbon fiber reinforced plastic. The components to the external fixator  100  for example, the bars, may be suited for the use of carbon fiber composite materials.  
      Referring now to  FIG. 19 , yet another embodiment of the present invention is shown as external fixator  200 . As shown in  FIG. 19 , the external fixator  200  includes an articulation joint  210  somewhat similar to the articulation joint  110  of  FIGS. 6-18 . In fact, the articulating joint  210  may be substantially identical to articulation joint  110  of  FIGS. 6-18 .  
      The external fixator  200  may further include a distractor  202  for use to distract the bone for example the tibia  2  from the foot  4 . Wires  204  extend from distractor  202  and secure the distractor  202  to the tibia  2 .  
      The external fixator  200  further includes a first connector  235  extending from the articulation joint  210  and opposed to the distractor  202 . A carbon fiber bar  206  extends from the first connector  205 . The carbon fiber bar  206  is connected to bar/end, bar clamp  207 .  
      A second carbon fiber bar  206  extends from the bar/end bar clamp  207 . The pair of bar/periphery pin clamps  208  extends in opposed direction from the bar/end, bar clamp  207  and are secured to the second carbon fiber bar  206 . A series of pins  204  extend from both bar/periphery pin clamps  208  and are secured to the bones in the foot  4 .  
      As shown in  FIG. 19 , a jig  201  may be used in conjunction with external fixator  200  to perform ankle fusion surgery on a patient. The jig  201  is shown in position on a leg  209  of the patient. As shown in  FIG. 19 , during an operation performing an ankle fusion utilizing the guide and external fixator of the present invention, an incision is made in the skin between the tibia  2  and the talus  213 .  
      As shown in  FIG. 19 , the distractor  202  may be utilized or a standard ankle distractor, which is available for example, commercially from OrthoFix International NZ, Huntersville, N.C., is used to distract the ankle joint.  
      The ankle distractor is, for example, secured to the patient by the pins  204  which are placed in the tibia  2  and distraction pins  204  which are placed in the patient&#39;s talus  213  and calcaneous  219 . The ankle distractor  202  is actuated to separate the tibia  2  from the talus  213  a distance of, for example, one centimeter.  
      As shown in  FIG. 19 , the jig  201  may include a rough adjustment mechanism  223 A, which permits a cutting guide  203  to be raised and lowered vertically to roughly position the guide  203  in a location between the tibia  2  and the talus  213 .  
      As shown in  FIG. 19 , the jig  201  may also include a fine-tuning adjustment mechanism  223 B, which provides for precise adjustment of the guide  203  so that it may be precisely positioned between the tibia  2  and the talus  213 .  
      Preferably, as shown in  FIG. 19 , the guide  203  may further include a posterior face, which preferably is positioned adjacent the interior face of the tibia  2  and adjacent the interior face of the talus  213 .  
      When the guide  203  is properly positioned relative to the tibia  2  and the talus  213 , the pins  204  are positioned in holes of the guide  203  to securely hold the guide  203  in position for the resection.  
      Referring now to  FIG. 20 , the distractor  202  and other portions of the external fixator  200  are shown in greater detail. As shown in  FIG. 20 , the articulating joint  210  is shown extending distally from the distractor  202 . The connector  235  extends distally from the articulating joint  210 . The vertical bar  206  extends vertically downward from the connector  235  and attaches to the bar/end, bar clamp  207 . The horizontal bar  206  is secured to the bar/end, bar clamp  207  and is used to support the bar/periphery pin clamp  208 . The bar/periphery pin clamp(s)  208  are used to secure pins  204  to the foot  4 .  
      The pins  204  may be secured to the foot  4  in any suitable location. For example and as shown in  FIG. 20 , the pins  204  are secured to calcaneous  219  as well as navicular  225 . It should be appreciated that other locations of the foot  4  may be used. For example and referring again to  FIG. 19 , the pins  204  may be secured to the calcaneous  219  as well as to the talus  213 .  
      Referring now to  FIG. 21  yet another embodiment of the present invention is shown as external fixator  200 A. The external fixator  200 A includes a distractor  202 A similar to distractor  202  of  FIG. 19  as well as an articulating joint  210 A connected to the distractor  202 A extending from the distractor  202 A. The articulating joint  210 A may be similar to the articulating joint  210  of  FIG. 19 . The external fixator  200 A may further include a connector  235 A connecting the articulating joint  210 A to vertical bar  206 A similar to the bar  206  of  FIG. 20 .  
      The external fixator  200 A may further include a bar-end bar clamp  207 A to connect the vertical bar  206 A to arcuate bar  229 A. A series of bar pin clamps  208 A are located on the arcuate bar  229 A and connect with various portions of the foot  4  with support pins  204 A.  
      Referring now to  FIG. 22 , the external fixator  200  is shown in greater detail. The external fixator  200  includes the distractor  202 . The distractor  202  may as shown in  FIG. 22  include a body  205 . The distractor  202  may further include a pair of fasteners in the form of screws  211  which may be threadably secured to the body  205 . The screws  211  may be adapted for securing the pins  204 .  
      The distractor  202  is operably connected to the articulating joint  210 . For example, as shown in  FIG. 22 , the articulating joint  210  may include the first articulating member  218  for connection with the distractor  202 . The first articulating member  218  may be integral with distractor pin  215 . The distractor pin  215  may alternatively be a separate component from the first articulating member  218  and coupled thereto.  
      The distraction pin  215  is slidable fitted within the body  205  of the distractor  202 . A distraction screw  221  is threadably fitted to the distraction pin  215 . Distraction screw  221  includes a handle  227  which when rotated causes the distraction pin  215  and the first articulating member  218  to cause the external fixator  200  to distract.  
      The articulating joint  210  includes a handle  234 , which rotated causes the first articulating member  218  and the second articulating member  220  to simultaneously lock with the body  205 . The second articulating member  220  of the articulating joint  210  is connected to, for example, first connector  235 . The first connector  235  connects the second articulating member  220  to vertical bar  206 . The vertical bar  206  is connected to the bar/end bar clamp  207 . The bar end/bar clamp  207  is slidably fitted to horizontal bar  229 . Bar/pin clamps  208  are slidably fitted along horizontal bar  229  and receive pins  204  for cooperation with the foot  4 .  
      Referring now to  FIGS. 23 and 23 A, the distractor pin  215  is shown in greater detail. As shown in  FIG. 23 , the distractor pin  215  may be integral with first articulating member  218 . The pin  215  may include a cavity  215 A in which integral threads  217 A are formed.  
      As shown in  FIG. 23A , the pin  215  may have a rectangular or square cross-section for cooperation with the body  205  of the distractor  202  to permit translation and prevent rotation of the pin  215  when the screw  221  is rotated.  
      Referring now to  FIG. 24 , the distractor screw  221  is shown in greater detail. The screw  221  includes handle  227  for rotating the screw  221 . The screw includes external threads  219 A for cooperation with internal threads  217 A of the pin  215 .  
      Referring now to  FIG. 25 , the distal portion of the external fixator  200  is shown in greater detail. The first articulating member  218  of the articulating joint  210  is connected to first connector  235 , which is connected to the vertical bar  206 . The bar/end, bar clamp  207  is connected to the vertical bar  206 . The bar/end, bar clamp  207  is connected to the horizontal bar  229  which receives the bar/periphery pin clamps  208 , which support the pins  204 .  
      Referring now to  FIG. 26 , the bars and clamps of the external fixator are shown in greater detail. The bar/end, bar clamp  207  includes a bar end half  233 , which cooperates with the vertical bar  206  and a bar/periphery clamp half  237  which cooperates with the horizontal bar  229 . The bar/periphery pin clamp  208  includes a bar/periphery clamp half  241  and a pin clamp half  245 .  
      Referring now to  FIG. 27 , the first connector  235  is shown in greater detail. The first connector  235  includes a body  239 , which defines the actuating member bore  243  and the bar bore  247 . For simplicity, the bar bore  247  may be concentric with the articulating member bore  243 . The articulating member bore  243  cooperates with the first articulating member  218  and the bar bore  247  cooperates with the bar  204 . The body  239  includes a radial slit  257 , which permits the bar bore  247  and the articulating member bore  243  to become smaller when bolt  259  is utilized to reduce the width of the slit  257 .  
      Referring now to  FIG. 29 , the horizontal bar  229  is shown in greater detail. The horizontal bar  229  may, for simplicity, be rectangular or in the form of a cylindrical bar. For example, as shown in  FIG. 29 , the bar  229  is in the form of a solid cylindrical bar.  
      Referring now to  FIG. 30 , another embodiment of the present invention is shown as external fixator  200 A, which is similar to the fixator  200  of  FIGS. 19-30 , except that the external fixator  200 A includes a horizontal bar  229 A, which is different than the horizontal bar  229  of  FIG. 29  in that the bar  229 A includes a series of cross-holes or openings  261 A for receiving pins  204 A. The openings  261 A provide for a variety of positions for engagement of the pins  204 A to the bone. Slits  257  may be positioned between the openings  261  to permit a fastener  267 A to secure the pins  204 A in the openings  261 A.  
      Referring now to  FIGS. 31, 32  and  33 , the bar/periphery clamp half  237  of the bar end/bar clamp  207  is shown in greater detail. The bar/periphery clamp half  237  includes a bar opening  269  for receiving the bar  229  (see  FIG. 26 ) and a bar fastener opening  271  perpendicular to the bar opening  269 . The bar/periphery clamp half  237  further includes a clamp fastener opening  273  for connecting the bar/periphery clamp half  237  to the bar end/bar clamp half  233 . The bar/periphery clamp half  237  further includes teeth  275  for cooperation with teeth on the bar end/bar clamp half  233 .  
      Referring now to  FIGS. 34 and 35 , the bar/end bar clamp half  233  of the bar end/bar clamp  207  is shown in greater detail. The bar/end clamp half  233  includes a clamp fastener opening  277  for cooperation with the bar/periphery clamp half  237 . The bar/end bar clamp half  233  further includes teeth  279  for cooperation with the teeth  275  of the bar/periphery clamp half  237 . The bar end clamp half  233  further includes a bar-end pin  283  for securing the bar end clamp half  233  to the vertical bar  204  (see  FIG. 25 ).  
      Referring now to  FIGS. 36 and 37 , the bar/periphery clamp half  241  of the bar/periphery pin clamp  280  is shown in greater detail. The bar/periphery clamp half  241  includes a bar opening  285  for cooperation with the bar  229  of  FIG. 26 . The bar/periphery clamp half  241  further includes a clamp-fastening opening  287  for connecting the bar/periphery clamp half  241  with the pin clamp half  245 . The bar/periphery clamp half  241  further includes a bar fastening opening  289  for securing the bar  229  with the bar/periphery clamp half  241  with a fastener (not shown). The bar/periphery clamp half  241  may further include teeth  291  which cooperate with the pin clamp half  245 .  
      The components of the external fixator  200  may be made of any suitable durable material, for example the components of the external fixator  200  may be made of a plastic, a metal, or a composite. If made of a metal, the components of the external fixator  200  may be made of any metal that may be sterilized by any commercially available sterilizing technique. For example, the metal components of the external fixator  200  may be made of a cobalt chromium alloy, a stainless steel alloy, or a titanium alloy. The materials of the external fixator may be made of, for example, a composite. For example, the composite material may be a carbon fiber material. The use of a carbon fiber material may reduce the weight of the external fixator. The composite material preferably is made of a sterilizable material that may be sterilized by any commercially available sterilization technique.  
      The materials of the external fixator  200  may, for example, be made of a plastic. If made of a plastic, the materials of the external fixator  200  should be durable and be sterilizable by commercially available techniques.  
      The bars, for example the vertical bar  206  and the horizontal bar  229 , are well suited for the use with carbon fiber composite materials. The articulating joint  210  and the distractor  202  are adaptable for use with metal components. The clamps may be made with any suitable material, for example plastic, composites, or metals. Aluminum, because of its weight and strength, may be well suited for external fixators.  
      The pins  204  used in the external fixator  200  are preferably made of a material that is compatible with the human anatomy. For example, the pins  204  may be made of a metal. For example, the pins may be made of a chromium alloy, a stainless steel alloy, or a titanium alloy.  
      Referring now to  FIGS. 38 and 39 , the pin clamp half  245  of the bar/periphery pin clamp  208  is shown in greater detail. The pin clamp half  245  may be made of any suitable durable material that is sterilizable by commercially available techniques. For example, the pin clamp half  245  may be made of a plastic or a carbon fiber reinforced plastic. Alternately, the pin clamp half  245  may be made of a metal. If made of a metal the pin clamp half  245  is preferably made of a strong lightweight material, for example, aluminum. The pin clamp half  245  may be made of a plastic, for example, a nylon or another plastic. The pin clamp half  245  if made of plastic may include a living hinge  295  for assisting in clamping the wires  204 . The pin clamp half  245  may include a pin opening  297  for receiving the pin  204  and a clamp fastening hole  299  for cooperation with the bar/periphery clamp half  241 . The pin clamp half  245  may further include teeth  296  for engaging with the teeth  291  of the bar/periphery clamp half  241 .  
      As shown in  FIG. 39 , the bar/periphery pin clamp  208  may further include a pin clamp spacer  254  positioning between the pin clamp half  245  and the bar/periphery clamp half  241  for changing the position of the pins  204  in the bone.  
      Referring now to  FIG. 40 , an implant ankle fusion set  300  is shown for use with the external fixator  200  and the jig  201  of the present invention as shown in  FIG. 19 . The ankle fusion implant  300  includes a lateral ankle fusion plate  302  and a medial ankle fusion plate  304 . The ankle fusion plates  302  and  304  are secured to the body with screws  306  which are fitted into openings  308  in the ankle fusion plates  302  and  304 .  
      The lateral ankle fusing plate  302  is secured to the body, for example, tibia  2 , talus  13  and calcaneous  19 .  
      The medial ankle fusion plate  304  may be connected to the tibia  2 , the talus  13  and the calcaneous  19 . The lateral ankle fusing plate  302  or the medial ankle fusion plate  304  or both may be connected to the fibula  5 . As shown in  FIG. 40 , the medial ankle fusion plate  304  is connected to the fibula  5 .  
      Referring now to  FIG. 40 , the ankle fusion implant set  300  may be made of any suitable durable material that are implantable in the human body, for example the ankle fusion implant sets may be made of a metal, for example cobalt chromium alloy, stainless steel alloy, or titanium alloy.  
      Referring now to  FIG. 41  yet another embodiment of the present invention is shown as external fixator  400  for use with jig  401  to perform a total ankle arthroplasty.  
      The external fixator  400  includes distractor  402 , which is secured by wires  404  to, for example, the tibia  2 . The external fixator  400  further includes the articulating joint  210 , which is connected to the distractor  202 . The articulating joint  210  is connected by first connector  405  to carbon fiber bars  406  and to bar end/bar clamp  407 . The bar end/bar clamp  407  is secured to horizontal bar  429 . Bar/periphery pin clamps  408  are secured to the horizontal bar  429  and are used to position pins  404  to the foot  4 .  
      The jig  401  includes a clamp  406  for securing resection guide  403  to the tibia  2 . The resection guide  403  is used to resect the distal tibia  2  and the proximal talus  13 . The jig  401  may be utilized for either a total ankle arthroplasty or an ankle fusion. For a patient in which total ankle arthroplasty is planned, the jig  401  may be utilized to support a resection guide  403  which is used to prepare the talus  13  and the tibia  2  for the resection cuts necessary to implant a total ankle implant.  
      The resection guide  403  is similar to the resection guide  203  of  FIG. 19  and may include slits for performing the cuts on the tibia  2  as well as slits for performing the resection of the talus  13 . The resection guide  403  may be secured, for example, to the tibia  2 . The resection guide  403  may be made of any suitable durable material, for example, a metal, a cobalt chromium alloy, a stainless steel alloy, or a titanium alloy.  
      The jig  401  may be mounted with clamp  406  to the patient. An incision may be made in the patient and the tibia  2  and the talus  13  as well as adjacent soft tissues examined to determine whether or not a total ankle arthroplasty is advised. If the patient is a suitable candidate for total ankle arthroplasty, the resection guide  403  is mounted onto the jig  401 . Conversely, if a total ankle arthroplasty is not well suited for the patient and an ankle fusion is more suited for the patient, the resection guide  203  of  FIG. 19  may be utilized with the jig  201 .  
      The external fixator  400  of  FIG. 41  may be made of any suitable durable material and may, for example, be made of any materials similar to that of external fixator  200  of  FIG. 19 .  
      Referring now to  FIG. 42 , a total ankle implant  440  is shown in position on the patient with a portion of the total ankle implant  440  shown in position in the tibia  2  and another portion of the total ankle implant  440  positioned in the talus  13 . The total ankle implant  440  is shown and explained in greater detail in U.S. Pat. No. 5,326,365 to Alvine, hereby incorporated in its entirety by reference.  
      Referring now to  FIG. 43 , another embodiment of the present invention is shown as external fixator  500 . The external fixator  500  is for use in fixedly positioning the femur  4  with respect to the tibia  2 . The external fixator  500  as shown in  FIG. 43  may include a pair of spaced apart bar pin clamps  508  for securing pins  504  to the femur  4 . The bar pin clamps  504  are secured to femur bar  506 , which is positioned spaced apart and generally parallel to the femur  4 . A distractor  502  may optionally be positioned between the bar  506  and the articulating joint  510 .  
      A first connector  535  may be utilized to connect the articulating joint  510  to the distractor  502 . A second connector  551  may be positioned between the articulating joint  510  and tibia bar  529 . A pair of spaced apart bar pin clamps  508  are slidably positioned on the tibia bar  529  and are used to secure pins  504  to the tibia  2 . The articulating joint  510  may be used to selectively lock or position the femur  4  with respect to the tibia  2 .  
      Referring now to  FIG. 44 , yet another embodiment of the present invention is shown as external fixator  600 . The external fixator  600  may include a pair of spaced apart bar pin clamps  608 , which are slidably positioned on humeral bar  606 . The bar pin clamps  608  are used to secure pins  604 , which are positioned in humerus  17 . A distractor  602  may be positioned along the humeral bar  606  and may be connected to first connector  635 , which may be positioned between the distractor  602  and articulating joint  610 .  
      The articulating joint  610  may be connected to ulnar bar  629  by means of, for example, second connector  651 . The ulnar bar  629  is used to support bar pin clamps  608 , which are used to fixedly position pins  604  for securement to the ulna  21 . The articulating joint  610  is used to selectively lock and unlock the external fixator  610  to lockably position the humerus  17  with respect to the ulna  21  in any of many selectable positions.  
      Referring now to  FIGS. 43 and 44 , the external fixator  500  of  FIG. 43  and the external fixator  600  of  FIG. 44  may be made of any suitable durable material that is sterilizable from any commonly known technique. For example, the components of the external fixator  500 , as well as the external fixator  600 , may be made of for example a metal, a plastic, or a composite. The pins used to secure the fixators to bone are preferably made of a material that is compatible with the human body. The pins  504  may, for example, be made of a metal, a cobalt chromium alloy, titanium alloy or stainless steel.  
      Referring now to  FIGS. 45-47 , the external fixator and articulating joint of the present invention may be used with a resection guide and optionally with a Computer Aided Surgery Array  714  to assist in performing arthroplasty. For example and referring now to  FIG. 45 , another embodiment of the present invention is shown as instrument  700 . Instrument  700  is utilized to perform knee surgery, for example to prepare a resected surface  712  of the tibia  2 .  
      The instrument  700  includes an external fixator  702 , including a pair of spaced apart bar pin clamps  708 , which are slidably fitted on bar  706 . The bar pin clamps  708  are used to secure pins  704  for positioning in the tibia  2 . The bar  706  is fixably positioned by first connector  735  to articulating joint  710 . A second connector  751  is used to secure the articulating joint  710  to cutting block  703 . The cutting block  703  may be selectably positioned utilizing the articulating joint  710  to properly align the cutting block with respect to the tibia  2 .  
      A Computer Assisted Surgery (CAS) Array  714  may be utilized in conjunction with the instrument  700  for properly positioning the cutting block  703 . The Computer Aided Surgery Array  714  will display the proper position of the cutting block  703 . It should be appreciated that once the cutting block  703  is in the proper position the articulating joint  710  may be used to fixedly secure the cutting block  703  in that position to perform the cuts necessary to obtain the resected surface  712 . The cutting block  703  may include a solitary or multiple guide slits  716  for cooperation with blade  718 .  
      Referring now to  FIG. 46 , another embodiment of the present invention is shown as instrument  800  for use in preparing distal end  9  of the femur  4 . The instrument  800  includes a series of spaced apart bar pin clamps  808  fixedly spacedly connected to bar  806 . The bar pin clamps  808  are used to secure pins  804  to the femur  4 . The bar  806  is secured by first connector  835  to articulating joint  810 .  
      The articulating joint  810  is connected by second connector  851  to cutting block  803 . The articulating joint  810  may be used to selectively lockably position the cutting block  803 . The cutting block  803  may be used to perform a single or preferably multiple cuts on the distal end of the femur  4 . The cuts are for preparing the knee for the femoral component of a knee prosthesis. The block  803  may include a plurality of slots  816  for preparing the resected surfaces. For example, the block  803  may be used to prepare first resection surface  812  and second resection surface  813 .  
      The instrument  800  may further include a Computer-Aided Surgery Array  814  for use to determine the optimal position of the cutting block  803 . Once the ideal position of the cutting block  803  is determined with the use of a Computer Aided Surgery Array  814 , the cutting block  803  may be fixedly positioned in that position by use of the articulating joint  810 . Once the ideal position of the cutting block  803  is locked into position, a blade  818  may be used in cooperation with the slits  816  to resect, for example, first surface  812 .  
      Referring now to  FIG. 47 , yet another embodiment of the present invention is shown as instrument  900 . Instrument  900  is used to prepare resected surface  912  of the femur  4  for use in preparation for hip arthroplasty. The instrument  900  is in the form of an external fixator and includes a pair of spaced apart bar pin clamps  908 , which are slidably positioned along bar  906 . The bar pin clamps  908  are used to secure pins  904  to the femur  4 . A first connector  935  is used to connect the bar  906  to the articulating joint  910 . A second connector  951  is used to secure the articulating joint  910  to cutting block  903 .  
      The cutting block  903  includes a slot  916  for receiving blade  918 . A Computer Aided Surgery Array  914  may be secured to the cutting block  903 . The Computer Aided Surgery Array  914  may be connected to computer-aided surgery equipment such that the ideal position of the cutting block  903  may be determined by use of the Computer Aided Surgery Array  914 .  
      Once the proper position of the cutting block  903  is determined, the articulating joint  910  may be utilized to fixedly secure the cutting block  903  to the femur  4 . Once the cutting block  903  is in its proper position, blade  918  may be used with the cutting block  903  to slide the blade  918  into the slit  916  to prepare resected surface  912  of the femur  4 .  
      Referring now to  FIGS. 45-47 , the instrument sets  700 ,  800  and  900  may be made of any suitable durable material that may be readily sterilizable. For example the instruments  700 ,  800  or  900  may be made of a plastic, a metal, a composite material, or any combination of these materials.  
      Referring now to  FIGS. 48-51  yet another embodiment of the present invention is shown as articulating joint  1010 . The articulating joint  1010  may be similar to the articulating joint  100  of  FIGS. 6-18 , but includes some modifications from the joint  100 . The articulating joint  1010  includes a first cup-shaped portion  1036 , which telescopes with second cup-shaped portion  1038 . A solitary piston  1070  is utilized to assist in locking and unlocking the articulating joint  1010 .  
      Referring now to  FIG. 48 , the articulating joint  1010  includes a body  1016  defined by the first and second cup-shaped portions  1036  and  1038 , which telescopically cooperates with the first cup-shaped portion  1036 . The first cup-shaped portion  1036  cooperates with first articulating member  1018 . A first connector  1035  connects the first articulating member  1018  to first object  1012 . The articulating joint  1010  further includes a second articulating member  1020 , which cooperates with the second cup portion  1038 . A second connector  1051  is utilized to connect the second articulating member  1020  to second object  1014 .  
      Referring now to  FIG. 49 , the articulating joint  1010  is shown in greater detail. As shown in  FIG. 49 , the body  1016  includes the first cup-shaped portion  1036  as well as the second cup-shaped portion  1038 . The first cup-shaped portion  1036  is slidably fitted over piston  1070 . The piston  1070 , for simplicity, may have a general cylindrical shape.  
      The first cup-shaped portion  1036 , as shown in  FIG. 49 , has a general cylindrical hollow shape and is slidably fitted over the piston  1070 . The second cup-shaped portion  1038  is likewise slidably positioned over the piston  1070  and includes a portion of its inner-periphery that is slidably positioned over the outer periphery of the first cup-shaped portion  1036 .  
      The first articulating member  1018  is constrained between the first cup-shaped portion  1036  and the piston  1070 . Similarly, the second articulating member  1020  is constrained between the second cup-shaped portion  1038  and the piston  1070 . A cam  1032  is utilized to advance and separate the first cup-shaped portion  1036  to the second cup-shaped portion  1038 , thereby selectively locking and unlocking the articulating joint  1010 .  
      Referring now to  FIGS. 50 and 51  the articulating joint  1010  is shown in an unlocked position. It should be appreciated that  FIG. 49  shows the articulating joint  1010  in a locked position.  
      It should be appreciated that the first cup-shaped portion  1036  and the second cup-shaped portion  1038  may be selectively separated and brought together to selectively lock and unlock the articulating joint  1010  in any suitable fashion.  
      For example, and as shown in  FIG. 51  the first cup-shaped portion  1036  may include a inner-periphery  1040 , which has a concave periphery to cooperate with convex spherical portion  1042  of first articulating member  1018 . The first articulating member  1018  further includes stem portion  1046  which extends from the convex spherical portion  1042  and which is secured to connector  1035 . The first cup-shaped portion  1036  further includes a slot  1028  for cooperation with cam  1032 .  
      Referring again to  FIGS. 50 and 51  similarly, the second cup-shaped portion  1038  includes an inner periphery  1056 , which is partially concave, for example, spherical, for mating with convex spherical portion  1058  of the second articulating member  1020 . The second cup-shaped portion  1038  further includes a generally rectangular slot  1029  having a shape similar to the slot  1028  of the first cup-shaped portion  1036 .  
      The piston  1070  has a generally solid cylindrical shape with a first concave face  1090  for cooperation with convex spherical portion  1042  of the first articulating member  1018 . The piston  1070  further includes an opposed second convex face  1092  for mating cooperation with convex spherical portion  1058  of the second articulating member  1020 . The piston  1070  further includes an elongated slit  1048  for cooperation with shaft  1050  connected to the cam  1032 .  
      It should be appreciated that slot  1028  is formed in opposed sides of the first cup-shaped portion  1036 . Similarly, the second slot  1029  is formed in both opposed surfaces of the second cup-shaped portion  1038 . Thus, it should be appreciated that the cam  1032  is in the form of two opposed cams  1032  each fitting into a pair of the slots  1028  and  1029 .  
      Referring now to  FIGS. 49 and 50 , it should be appreciated that as the cam  1032  is rotated in the direction of arrow  1055 , the outer tips  1057  of the cam  1032  engages opposing faces  1059  formed from the slots  1028  and  1029  causing the first cup-shaped portion  1036  and the second cup-shaped portion  1038  to move in the direction of arrows  1061  causing the piston  1070  to cooperate with the cup-shaped portion  1036  and the second cup-shaped portion  1038  to lock the first articulating member  1018  and the second articulating member  1020  in a fixed position.  
      Referring now to  FIGS. 52, 52A  and  52 B, yet another embodiment of the present invention is shown as articulating joint  1110 . The articulating joint  1110  is similar to the articulating joint  100  of  FIGS. 6-18 , except that the cam of the articulating joint  100  of  FIGS. 6-18  has been replaced by a ratchet and lever mechanism.  
      The articulating joint  1110  of  FIGS. 50, 51   52 A and  52 B include a body  1116  to which a first cup-shaped portion  1136  and a second cup-shaped portion  1138  are, for example, threadedly connected. A first piston  1170  and a second piston  1172  are slidably positioned in cavity  1126  formed in the body  1116  of the articulating joint  1110 . The pistons  1170  and  1172  are urged in the direction of arrows  1173  to lock the articulating joint  1110 . A first articulating member  1118  is positioned between the first piston  1170  and the first cup-shaped portion  1136 .  
      The first articulating member  1118  is fixedly connected to first object  1112  by, for example, first connector  1135 . Similarly, a second articulating member  1120  is constrained between second piston  1172  and the second cup-shaped portion  1138 . The second articulating member  1120  is fixedly connected to second object  1114  by second connector  1151 .  
      The articulating joint  1110  of  FIG. 52  is different than the articulating joint  10  of  FIG. 1  in that the articulating joint  1110  of  FIG. 52  includes an actuator  1122  in the form of a ratchet, pawl, and lever mechanism. The actuator  1122  includes a ratchet  1132 , which is connected by first lever  1133  to first piston  1170  and by second lever  1133 A to second piston  1172 .  
      A pawl  1137  is pivotably connected to body  1116 . Teeth  1139  formed on ratchet  1132  engage the pawl  1137 . As the pawl  1137  is advanced in the direction of arrow  1179  the actuator  1122  is released, permitting the articulating joint  1110  to move freely. Extending from the ratchet  1132  is a handle  1134  that may be rotated to actuate or lock the articulating joint  1110 . By rotating the handle  1134  in the direction of arrow  1141  the articulating joint  1110  may be locked.  
      The cavity  1126  of the body  1116  of the articulating joint  1110  may, for example, have a generally rectangular or square shape. Such shape makes possible or eases the use of the actuator  1122  including the ratchet  1132 .  
      Referring now to  FIGS. 52A and 52B , the actuator  1122  is shown in greater detail. The body  1116  of the articulating joint  1110  as shown in  FIG. 52A  has the cavity  1126  having a generally rectangular shape. The pistons  1170  and  1172  have a generally rectangular shape and are slidably fitted in the cavity  1126 . As shown in  FIG. 52A , the pistons  1170  and  1172  are slidably fitted within the rectangular cross-shaped cavity  1126 . The ratchet  1132  may be positioned in the cavity  1126  and may include a portion, which extends beyond the cavity. For example, the pawl  1137  may extend outside the body  1116  so that the pawl  1137  may be actuated or released and so that the handle  1134  may be actuated with the articulating joint  1110 .  
      Referring now to  FIGS. 53 and 54 , yet another embodiment of the present invention is shown as articulating joint  1210 . The articulating joint  1210  is similar to the articulating joint  10  of  FIG. 1  except that the articulating joint  1210  includes first articulating member  1218  and a second articulating member  1220  which include portions that are in the form of cylinders rather than spheres.  
      For example and as shown in  FIG. 54 , the first articulating member  1218  is lockably positioned between first cap  1236  and first piston  1270 . The articulating joint  1210  includes a body  1216  to which the first cap  1236  and the second cap  1238  are, for example, rotatably connected.  
      The body  1216  forms a longitudinal cavity  1226 , which may be rectangular or have a circular cross-section. The cavity  1226  is formed to slidably receive first piston  1270  and second piston  1272 . Cam  1232  is rotatably connected to the body  1216  and is utilized to advance first piston  1270  and the second piston  1272  in the direction of arrows  1273 . The pistons  1270  and  1272  lock the first articulating member  1218  and the second articulating member  1220  to the first cup  1236  and the second cup  1238  respectively with respect to the body  1216 . The articulating joint  1210  is thereby locked or fixed.  
      As shown in  FIGS. 53 and 54 , the first articulating member  1218  includes a cylindrical portion  1242  which mates with a cylindrical concave inner-periphery  1242  of the first cup  1236 . Similarly, the second articulating member  1220  includes a cylindrical portion  1256 , which matingly fits with cylindrical concave periphery  1241  formed in the second cup  1238 .  
      Referring now to  FIG. 55 , the second cup  1238  includes, for example, a groove  1259  to which a lip  1261  formed on the body  1260  matingly fit. The lip  1261  and the groove  1259  cooperate to permit the second cup  1238  to rotate with respect to the body  1216 . It should be appreciated that the first cup  1236 , likewise, is configured to prevent rotation of the second cup  1236  with respect to the body  1216 .  
      Referring again to  FIG. 54 , as handle  1234  is rotated in the direction of arrow  1225 , the cam  1232  advances toward pistons  1270  and  1272  to advance the pistons  1270  and  1272  into locking contact with the first and second articulating members  1218  and  1220 .  
      Referring now to  FIG. 54 , the cam  1232  thus moves from first position  1261  (shown in phantom) to second position  1263  shown in solid. The articulating joint  1210  as shown with the cam  1232  in the second position  1263  is in a locked configuration.  
      Referring now to  FIG. 56 , yet another embodiment of the present invention is shown as surgical method or surgical procedure  1300 . The surgical procedure may be used for performing arthroplasty surgery. The method  1300  includes a first step  1310  of providing a cutting block for attachment to a bone. The joint includes a body. A first articulating member may be selectively one of pivotably connected to and rigidly connected to the body.  
      The first articulating member is connectable to the first object and a second articulating member. The second articulating member is selectively one of pivotably and connected to and rigidly connected to the body. The second articulating member is connectable to the second object. The first articulating joint and the second articulating joint are adapted for simultaneously locking and unlocking to each other. The method  1300  further includes a second step  1312  of securing the cutting block to the bone.  
      The method  1300  further includes a third step  1314  of unlocking the articulating joint and a fourth step  1316  of aligning the cutting block to provide an accurate cutting of the bone. The method  1300  further includes a fifth step  1318  of locking the articulating joint and a sixth step  1320  of cutting the bone.  
      Referring now to  FIG. 57 , yet another embodiment of the present invention is shown as surgical procedure or surgical method  1400 . The method  1400  is utilized for rigidly securing a first portion of bone to a second portion of bone during trauma surgery. The method  1400  includes a first step  1410  of providing an external fixator for attachment to the bone.  
      The external fixator includes an articulating joint for rigidly connecting the external fixator to the first portion of bone and to the second portion of bone. The external fixator also includes a body and a first articulating member, which is selectively one of pivotably connected to and rigidly connected to the body. The first articulating member is connectable to the first object.  
      The external fixator further includes a second articulating member. The second articulating member is selectively one of pivotably connected to and rigidly connected to the body. The second articulating member is connectable to the second object. The first articulating joint and the second articulating joint are adapted for simultaneously locking and unlocking to each other.  
      The method  1400  further includes a second step  1412  of securing the external fixator to the first portion of bone and a third step  1414  of unlocking the articulating joint. The method  1400  further includes a fourth step  1416  of aligning the first portion of bone and the second portion of bone to provide proper orthopedic alignment. The method  1400  further includes a fifth step  1418  of securing the external fixator to the second portion of bone and a sixth step  1420  of unlocking the articulating joint.  
      Although the present invention and its advantages have been described in detail, it should be understood that various changes, substitutions, and alterations can be made therein without departing from the spirit and scope of the present invention as defined by the appended claims.