Patent Publication Number: US-2023157712-A1

Title: Drill alignment guide

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 17/243,869, filed Apr. 29, 2021, which is a divisional application of U.S. patent application Ser. No. 16/136,843, filed Sep. 20, 2018 (now U.S. Pat. No. 11,020,130), the entire contents of which is incorporated herein by reference. 
    
    
     FIELD OF DISCLOSURE 
     The present disclosure relates to a targeting guide that can be used to provide an accurate trajectory for placement of a bone screw along a longitudinal axis of a bone. 
     BACKGROUND 
     A successful treatment of bone fractures often depend on accurate placement of k-wires or bone screws for reducing or compressing the fracture. Often, a surgeon must visually estimate the trajectory of a drill bit for drilling a hole along a long axis of a bone to prepare for a k-wire or a bone screw. When these bones are inside the patient&#39;s body such as a hand or a foot, visually estimating the trajectory is difficult. Thus, a drill alignment or a targeting guide that can facilitate such procedure is desired. 
     SUMMARY 
     Disclosed herein is a surgical drill alignment guide that can be used to provide an accurate trajectory for placement of a bone screw along the long axis of a bone. One example of such application is for providing an accurate trajectory for placement of a bone screw along a fifth metatarsal bone for treating a Jones fracture. 
     In some embodiments, the surgical drill alignment guide assembly comprises a first alignment arm having a first end, a second end, and a longitudinal axis extending from the first end to the second end, the first end of the first alignment arm having a first through hole for receiving a first wire, and at least one second through hole provided between the first end and the second end for receiving a second wire. 
     The first through hole extends through the first end of the first alignment arm in an orthogonal orientation to and intersecting the longitudinal axis of the first alignment arm. The at least one second through hole extends through the first alignment arm in an orthogonal orientation to the longitudinal axis of the first alignment arm. 
     A second alignment arm has a first end, a second end, and a longitudinal axis extending between the first end and the second end. The first end of the second alignment arm is attached to the first end of the first alignment arm, wherein the second alignment arm is oriented so that its longitudinal axis is in parallel relation to the longitudinal axis of the first alignment arm. A drill guide is attached to the first alignment arm between the second end and the at least one second through hole. The drill guide comprises an arm having a hollow shaft that extends therethrough for receiving and guiding a drill bit or a k-wire. The hollow shaft extends in parallel relation to the longitudinal axis of the first alignment arm and the longitudinal axis of the second alignment arm. The hollow shaft is in-plane with the first alignment arm&#39;s longitudinal axis in a first plane, and in-plane with the second alignment arm&#39;s longitudinal axis in a second plane, wherein the first plane and the second plane are orthogonal to each other. 
     A method of using the drill alignment guide assembly is also disclosed. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The inventive surgical drill alignment guide assembly of the present disclosure will be described in more detail in conjunction with the following drawing figures. The structures in the drawing figures are illustrated schematically and are not intended to show actual dimensions. 
         FIG.  1 A  is an isometric view of a surgical drill alignment guide assembly according to an embodiment of the present disclosure. 
         FIG.  1 B  is an isometric view of a surgical drill alignment guide assembly according to another embodiment of the present disclosure. 
         FIG.  2 A  is a top-down view of the surgical drill alignment guide assembly of  FIG.  1 A . 
         FIG.  2 B  is a top-down view of the surgical drill alignment guide assembly of  FIG.  1 B . 
         FIG.  3 A  is a sectional view of the surgical drill alignment guide assembly of  FIGS.  1 A and  2 A , taken through the sectional line D-D marked in  FIG.  2 A . 
         FIG.  3 B  is a sectional view of the surgical drill alignment guide assembly of  FIGS.  1 B and  2 B , taken through the sectional line DD-DD marked in  FIG.  2 B . 
         FIG.  4 A  is a side view of the surgical drill alignment guide assembly of  FIGS.  1 A and  2 A . 
         FIG.  4 B  is a side view of the surgical drill alignment guide assembly of  FIGS.  1 B and  2 B . 
         FIG.  5 A  is a sectional view of the surgical drill alignment guide assembly taken through the sectional line B-B marked in  FIG.  4 A . 
         FIG.  5 B  is a sectional view of the surgical drill alignment guide assembly taken through the sectional line BB-BB marked in  FIG.  4 B . 
         FIG.  6    is a perspective view of the surgical drill alignment guide assembly of  FIG.  1 A  in its installed position with respect to a human right foot showing the alignment guide assembly&#39;s arrangement with the fifth metatarsal bone. 
         FIG.  7    is a perspective view of the surgical drill alignment guide assembly of  FIG.  1 B  in its installed position with respect to a human right foot showing the alignment guide assembly&#39;s arrangement with the fifth metatarsal bone. 
         FIG.  8    is an illustration showing the spatial relationship among the fifth metatarsal bone B 1 , the first wire W 1 , the longitudinal axis AA of the first alignment arm  10 , and the first alignment plane P 1  defined by the first wire W 1  and the long axis A of the fifth metatarsal bone B 1 , according to the present disclosure. 
         FIG.  9    is an illustration showing the spatial relationship among the fifth metatarsal bone B 1 , the long axis A of the fifth metatarsal bone B 1 , the longitudinal axis AAA of the second alignment arm  20 , and the second alignment plane P 2  according to the present disclosure. 
         FIG.  10    is an illustration showing the components of  FIGS.  8  and  9    and showing the orthogonal relationship between the first alignment plane P 1  and the second alignment plane P 2  according to the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     This description of the exemplary embodiments is intended to be read in connection with the accompanying drawings, which are to be considered part of the entire written description. The drawing figures are not necessarily to scale and certain features may be shown exaggerated in scale or in somewhat schematic form in the interest of clarity and conciseness. In the description, relative terms such as “horizontal,” “vertical,” “up,” “down,” “top” and “bottom” as well as derivatives thereof (e.g., “horizontally,” “downwardly,” “upwardly,” etc.) should be construed to refer to the orientation as then described or as shown in the drawing figure under discussion. These relative terms are for convenience of description and normally are not intended to require a particular orientation. Terms including “inwardly” versus “outwardly,” “longitudinal” versus “lateral” and the like are to be interpreted relative to one another or relative to an axis of elongation, or an axis or center of rotation, as appropriate. Terms concerning attachments, coupling and the like, such as “connected” and “interconnected,” refer to a relationship wherein structures are secured or attached to one another either directly or indirectly through intervening structures, as well as both movable or rigid attachments or relationships, unless expressly described otherwise. When only a single machine is illustrated, the term “machine” shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein. The term “operatively connected” is such an attachment, coupling or connection that allows the pertinent structures to operate as intended by virtue of that relationship. In the claims, means-plus-function clauses, if used, are intended to cover the structures described, suggested, or rendered obvious by the written description or drawings for performing the recited function, including not only structural equivalents but also equivalent structures. 
     Referring to  FIG.  1 A , a surgical drill alignment guide assembly  100  for aligning a drill guide  30  along a longitudinal axis A of a fifth metatarsal bone is disclosed. The drill alignment guide assembly  100  comprises a first alignment arm  10 , a second alignment arm  20 , and a drill guide  30 . 
     The first alignment arm  10  has a first end  11 , a second end  13 , and a longitudinal axis AA extending from the first end  11  to the second end  13 . The second alignment arm  20  has a first end  21 , a second end  22 , and a longitudinal axis AAA extending from the first end  21  to the second end  22 . 
     The second alignment arm  20  is attached to the first alignment arm near or at the first end  11  of the first alignment arm  10 . The second alignment arm  20  is oriented so that its longitudinal axis AAA is in parallel relation to the longitudinal axis AA of the first alignment arm  10 . Because of this arrangement, when the longitudinal axis AA of the first alignment arm is aligned parallel to the longitudinal axis A of the fifth metatarsal bone B 1 , the second alignment arm&#39;s longitudinal axis AAA is also aligned parallel to the longitudinal axis A of the fifth metatarsal bone B 1 . 
     The first end  11  of the first alignment arm  10  is configured to attach to a first wire W 1  that is placed into a distal portion of the fifth metatarsal bone perpendicular to the longitudinal axis A of the fifth metatarsal bone. In some embodiments, the first alignment arm  10  is configured so that the attachment between the first alignment arm  10  and the first wire W 1  can be releasably locked so that the position of the first alignment arm  10  along the length of the first wire W 1  can be fixed then unlocked when the drill alignment procedure is completed. 
     As shown in  FIG.  1 A , the first end  11  of the first alignment arm  10  is provided with a through hole  16  that extends through the full thickness of the first alignment arm  10  for receiving the first wire W 1 . Preferably, the through hole  16  extends through the first alignment arm  10  straight and oriented orthogonal to the longitudinal axis AA of the first alignment arm  10 . In use, the first wire W 1  would be inserted into the distal end of the fifth metatarsal bone from the lateral side of the patient&#39;s foot such that the first wire W 1  is substantially perpendicular to the long axis A of the fifth metatarsal bone. The through hole  16  extends through the first alignment arm  10  straight and oriented orthogonal to the longitudinal axis AA of the first alignment arm  10 . This ensures that when the alignment guide  100  is attached to the first wire W 1  by fitting the through hole  16  over the first wire W 1 , the first wire W 1  and the longitudinal axis AA of the first alignment arm  10  are orthogonal to each other. 
     The first alignment arm  10  is configured and adapted to be able to lock the first wire W 1  in place in the through hole  16 . There are many known locking mechanisms that can be employed here such as a CAM locking mechanism or a set screw arrangement. In the example illustrated in  FIGS.  1 A,  3 A, and  6   , the through hole  16  is provided with a setscrew  41  for locking the first wire W 1  extending through the through hole  16 . As shown in the cross-sectional view in  FIG.  3 A , the setscrew  41  threads into the first end  11  of the first alignment arm  10  orthogonal to the through hole  16 . Thus, the first wire W 1  extending through the through hole  16  can be locked in position by tightening the setscrew  41  against the first wire W 1 . 
     The first alignment arm  10  is also provided with at least one second through hole  18 A for receiving a second wire W 2  that gets placed into a mid-foot bone B 2  that is associated with the fifth metatarsal bone B 1 . Like the first through hole  16 , the second through hole  18 A also extends through the thickness of the first alignment arm  10  oriented perpendicular to the longitudinal axis AA of the first alignment arm  10 . This ensures that a second wire W 2  inserted through the second through hole  18 A is parallel to the first wire W 1  and, in turn, also orthogonal to the long axis A of the fifth metatarsal bone B 1 . In some embodiments, the first alignment arm  10  is configured to lock the position of the second wire W 2  placed through the second through hole  18 A. The second wire W 2  is for a fixing the orientation of the drill alignment guide assembly  100  to the patient&#39;s mid-foot bone B 2 , so the second through hole  18 A is located at an appropriate distance from the first through hole  16  so that the position of the second through hole  18 A reaches the patient&#39;s mid-foot bone B 2 . 
     In some embodiments, a plurality of second through holes  18 A are provided as shown in  FIGS.  1 A and  1 B  in order to provide a more robust functionality to the drill alignment guide  100  in terms of its ability to accommodate a wide range of patient&#39;s foot sizes. The plurality of second through holes  18 A are provided side by side along a portion of the first alignment arm  10  as shown so that a variety of choices are available for the distance between the first through hole  16  and the second through hole  18 A to accommodate fifth metatarsal bones of different lengths. 
     The surgical drill alignment guide  100  can be configured to lock the second wire W 2  extending through the second through hole  18 A. There are many known locking mechanisms that can be employed here such as a CAM locking mechanism or a set screw arrangement. In the example illustrated here, the first alignment arm  10  is provided with a second set screw  42  for locking the second wire W 2  extending through a through hole  18 A. As shown in the cross-sectional view in  FIG.  3 A , the setscrew  42  threads into the first alignment arm  10  orthogonal to the through hole  18 A. Thus, the second wire W 2  extending through the through hole  18 A can be locked in position by tightening the setscrew  42  against the second wire W 2 . Where there are more than one second through hole  18 A, each of the second though hole  18 A will be provided with a second set screw  42 . 
     Referring to  FIGS.  3 A,  3 B , the first alignment arm  10  also has a radio-opaque alignment wire  5  provided along the longitudinal axis AA of the first alignment arm so that the alignment wire  5  can be used to check the alignment of the first alignment arm  10  under a fluoroscope. 
     The second alignment arm  20  has a first end  21  and a second end  22 , and a longitudinal axis AAA extending between the first end and the second end. The second alignment arm  20  is disposed in parallel relation to and attached to the first alignment arm  10 , whereby the longitudinal axis AAA is in parallel relation to the longitudinal axis AA of the first alignment arm  10 . Thus, when the longitudinal axis AA of the first alignment arm  10  is positioned in an alignment parallel to the longitudinal axis A of the fifth metatarsal bone B 1 , the longitudinal axis AAA of the second alignment arm  20  is also in parallel relationship to the longitudinal axis A of the fifth metatarsal bone B 1 . 
     In some embodiments, the second alignment arm  20  is attached to the first alignment arm  10  by a hinge joint  23 A. In the example shown in  FIGS.  1 A and  1 B , the first alignment arm  10  has a vertical connecting arm  12  and the second alignment arm  20  is connected to the extension section  12  by the hinge joint  23 A. The hinge joint  23 A is configured to allow the second alignment arm  20  to turn 180° about the hinge joint from the position shown in  FIGS.  1 A and  1 B  to the position shown in  FIG.  6   . This allows the surgical drill alignment guide assembly  100  to be used on either the left foot or the right foot. For example, in  FIG.  6   , the surgical drill alignment guide assembly  100  is installed on the patient&#39;s right foot aligning the drill guide  30  with the fifth metatarsal bone B 1  on the right foot. In this configuration, one can see that the second alignment arm  20  has been flipped over 180° about the hinge  23 A from the configuration shown in  FIG.  1 A . The drill guide  30  is also connected to the first alignment arm  10  from the opposite side than the configuration shown in  FIG.  1 A . 
     The same ability to be used either on the left foot or the right foot is applicable to the embodiments of the drill alignment guide assembly shown in  FIG.  1 B  and  FIG.  7   . In  FIG.  1 B  and  FIG.  7   , the drill guide  30  and the second end  13  of the first alignment arm  10  are configured so that the drill guide  30  attaches to the first alignment arm  10  by fitting its stem  32  through the slot  14 B in a vertical direction rather than the sideways engagement in the embodiments of  FIG.  1 A  and  FIG.  6   . 
     The vertical connecting arm  12  positions the second alignment arm  20  a distance Y above the longitudinal axis AA of the first alignment arm  10 . The distance Y is a distance that is sufficiently large to allow the second alignment arm  20  to be positioned above the patient&#39;s fifth metatarsal bone without contacting or interfering with the patient&#39;s foot. 
     In the embodiments illustrated in  FIGS.  1 A and  1 B , the vertical connecting arm  12  extends from the first end  11  of the first alignment arm  10 . However, the vertical connecting arm  12  can be connected to the first alignment arm  10  anywhere on the first alignment arm  10  as long as the second alignment arm  20  can be positioned above the fifth metatarsal bone B 1  somewhere along the length of the fifth metatarsal bone B 1  on the dorsal side of the patient&#39;s foot or below the fifth metatarsal bone B 1  somewhere along the length of the fifth metatarsal bone B 1  on the anterior side of the patient&#39;s foot. Whether the alignment procedure is carried out from the dorsal side or the plantar side of the patient&#39;s foot is at the discretion and preference of the surgeon but the drill alignment guide assembly  100  of the present disclosure is configured to be used in either direction. 
     The second alignment arm  20  is connected to the vertical connecting arm  12  by a connecting portion  23 . The connecting portion  23  extends away from the vertical connecting arm  12  so that the longitudinal axis AAA of the second alignment arm  20  is at a distance X from the vertical plane D 1  defined through the center of the vertical connecting arm  12  and the longitudinal axis AA of the first alignment arm  10 . The center of the vertical connecting arm  12  here refers to the middle of the thickness of the vertical connecting arm  12 . 
     Referring to  FIGS.  1 A,  1 B,  2 A, and  2 B , the drill guide  30  is attached to the first alignment arm  10  between the second end  13  and the at least one second through holes  18 A. The drill guide  30  comprises an arm  34  having a hollow shaft  35  for receiving and guiding a drill bit or a k-wire. The hollow shaft  35  extends through the length of the drill guide arm  34  in parallel relation to the longitudinal axis AA of the first alignment arm  10  and the longitudinal axis AAA of the second alignment arm  20 . 
     In some embodiments, the drill guide  30  is slidably attached to the first alignment arm  10  so that the drill guide  30  can be moved along the longitudinal axis AA of the first alignment arm  10  and locate it at a desired position along the first alignment arm  10 . The connection between the drill guide  30  and the first alignment arm is configured to be able to lock the drill guide  30  at a desired position. 
     The drill guide  30  can be attached to the first alignment arm  10  in any suitable configuration. The example in  FIGS.  1 A,  2 A,  3 A,  4 A,  5 A, and  6    show an embodiment where the drill guide  30  is attached to the first alignment arm  10  in a slidable manner through a slot  14  that is accessible from the side of the first alignment arm  10 . The drill guide  30  has a stem portion  31  (labeled in  FIG.  2 A ) that extends through the slot  14  and has a male threaded portion  32  onto which a female threaded nut  43  engages to lock the drill guide  30  in place. The stem portion  31  is configured to position the hollow shaft  35  of the drill guide  30  at the distance X from the longitudinal axis AA of the first alignment arm  10 . 
     In this example, the stem portion  31  is provided with bump stoppers  33  to maintain the fixed distance X. (See  FIG.  1 A ). Here, the distance X between the hollow shaft  35  and the longitudinal axis AA, we are referring to the distance between the central axis of the hollow shaft  35  (having a cylindrical shape) and the longitudinal axis AA. This ensures that the second alignment arm  20  can be used to align the drill guide  30  to the long axis A of the fifth metatarsal bone B 1 . The attachment between the drill guide  30  and the first alignment arm  10  is configured so that the hollow shaft  35  of the drill guide  30  is in parallel relation with the longitudinal axis AA of the first alignment arm  10  and also in the plane P 1  defined by the longitudinal axis AA and the first wire W 1  extending through the through hole  16 . (See  FIG.  8   ). 
       FIGS.  1 B,  2 B,  3 B,  4 B,  5 B, and  7    show an embodiment where the drill guide  30  is attached to the first alignment arm  10  in a slidable manner through a slot  14 B that is accessible from the top side of the first alignment arm  10 . In this embodiment, the drill guide  30  has a stem portion  31  (labeled in  FIG.  2 B ) that extends under the slot  14 B and has a male threaded portion  32  that extends through the slot  14 B onto which a female threaded nut  43  engages to lock the drill guide  30  in place. The stem portion  31  has an appropriate length to maintain the hollow shaft  35  at the distance X from the longitudinal axis AA of the first alignment arm  10 . In this example the stem portion  31  extends under the slot  14 B. Although the stem portion  31  extends under the slot  14 B, the stem portion  31  is configured to maintain the hollow shaft  35  in the same plane P 1  defined by the longitudinal axis AA and the first wire W 1  extending through the through hole  16 . (See  FIG.  8   ). In the particular example shown in  FIGS.  1 B and  4 B , the stem portion  31  has a jog  31 A (labeled in  FIG.  4 B ) that extends the stem portion  31  under the slot  14 B. 
     In some embodiments of the surgical drill alignment guide assembly, the second alignment arm  20  has an alignment wire  25  provided therein and extends along the second alignment arm&#39;s longitudinal axis AAA. The alignment wire  25  is radio-opaque so that it is visible under fluoroscopy for checking the alignment of second alignment arm  20 . Because the alignment wire  25  is positioned along the longitudinal axis AAA, the alignment wire  25  represents the longitudinal axis AAA under the fluoroscope. 
     In some embodiments, the drill guide  30  is attached to the second alignment arm  20 . Regardless of whether the drill guide  30  is attached to the first alignment arm  10  or the second alignment arm  20 , the drill guide  30  and the second alignment arm  20  are arranged so that the hollow shaft  35  is in the same plane as the longitudinal axis AAA of the second alignment arm  20 , represented by the alignment wire  25  and in the same plane as the longitudinal axis AA of the first alignment arm  10 , represented by the alignment wire  5 . 
     As shown in  FIGS.  1 A and  1 B , the first alignment arm  10  and the second alignment arm  20  are arranged so that the longitudinal axis AAA is placed at a distance X from a plane D 2  that contains the longitudinal axis AA of the first alignment arm  10 . The structure of the drill guide  30  is configured so that the hollow shaft  35  is also placed at the distance X from the plane D 2  and the hollow shaft  35  is in a plane D 1  that is orthogonal to the plane D 2  and intersects the plane D 2  along the longitudinal axis AA. This means that the longitudinal axis AAA of the second alignment arm  20  and the hollow shaft  35  are both lie in a plane D 3  that is parallel to the plane D 2  and orthogonal to the plane D 1 . Since the hollow shaft  35  has a cylindrical shape, when the present disclosure refers to the position of the hollow shaft  35 , it is referring to the position of the longitudinal axis of the hollow shaft  35 . This configuration among the first alignment arm  10 , the second alignment arm  20 , and the drill guide  30 , enables a surgeon to use the surgical drill alignment guide assembly  100  to drill along the long axis A of a fifth metatarsal bone of a patient. 
     Referring to  FIGS.  8 - 10   , in order to assist in describing the spatial alignment of the surgical drill alignment guide assembly  100  with the long axis A of a fifth metatarsal bone B 1 , we first define two alignment planes P 1  and P 2  that are orthogonal to each other. Referring to  FIG.  8   , the first alignment plane P 1  is a plane that is defined by the long axis A of the fifth metatarsal bone B 1  and the first wire W 1  that is placed into the distal end of the fifth metatarsal bone B 1  where the first wire W 1  is substantially orthogonal to the long axis A of the fifth metatarsal bone B 1 . In other words, the long axis A and the first wire W 1  lie in the first alignment plane P 1 . Referring to  FIGS.  9  and  10   , the second alignment plane P 2  is orthogonal to the first plane P 1  and intersects the first alignment plane P 1  along the long axis A of the fifth metatarsal bone B 1 . In other words, the long axis A of the bone B 1  lies in both planes P 1  and P 2 . 
     Because the hollow shaft  35  is in the same first alignment plane P 1  as the longitudinal axis AA of the first alignment arm  10 , the hollow shaft  35  and the alignment wire  5  (of the first alignment arm  10 ) are in the same first plane P 1 . It should be noted that  FIG.  10    does not show the alignment wire  5 . However, the longitudinal axis AA of the first alignment arm  10  represents the location of the alignment wire  5  with respect to the first plane P 1  because the alignment wire  5  is provided in the first alignment arm  10  along the first alignment arm&#39;s longitudinal axis AA, 
     Some methods for using the drill alignment guide is also disclosed. In some embodiments, the method comprises the following steps. (a) The first wire W 1  is inserted into a distal portion of a first bone B 1  of a patient&#39;s foot or a hand with the first wire W 1  oriented substantially orthogonal to the long axis A of the first bone B 1 . The point of entry for the first wire W 1  is visually determined by the surgeon. The first wire W 1  can either intersect and extends through the long axis A or extends along a trajectory that intersects the long axis A but does not go through the long axis A depending on the particular situation of the bone fracture or injury being attended to. The first wire W 1  and the long axis A of the first bone B 1  together defines the first alignment plane P 1 . The first alignment plane P 1  is shown in  FIG.  8   . In other words, both the long axis A and the first wire W 1  are in-plane in P 1 . 
     (b) Next, the first alignment arm  10  is slid over the first wire W 1  through the first through hole  16  that is provided at the first end  11  of the first alignment arm  10 . As described above in reference to  FIG.  1 A , the drill alignment guide assembly  100  is configured so that the first through hole  16  extends through the first alignment arm  10 &#39;s longitudinal axis AA in a direction that is orthogonal to the longitudinal axis AA, the longitudinal axis AA reside in the plane D 2 . Therefore, once the first alignment arm  10  is slid over the first wire W 1 , the configuration of the drill alignment guide assembly  100  dictates that the planes D 2  and D 3  (shown in  FIG.  1 A ) of the drill alignment guide assembly  100  are parallel to the second alignment plane P 2  shown in  FIG.  9   . 
     (c) Next, an incision is made in the patient&#39;s foot or a hand near the proximal end of the first bone B 1  and the drill guide  30  is moved into a position so that the tip  37  of the drill guide is contacting the proximal end of the first bone B 1 . For example, when used on a patient&#39;s foot for aligning to a fifth metatarsal bone, the drill guide  30  would be contacting the proximal end of the fifth metatarsal bone as appropriate. This example position is illustrated in  FIGS.  6  and  7   . 
     (d) Next, the surgeon aligns the second alignment arm  20  to the long axis A of the first bone B 1  under fluoroscopy so that the second alignment arm&#39;s longitudinal axis AAA and the first bone B 1 &#39;s long axis A are in-plane in the second alignment plane P 2 . This aligning is accomplished by sliding the drill alignment guide assembly  100  along the first wire W 1  in the directions illustrated with the arrows S in  FIG.  10   . The radio-opaque alignment wire  25  in the second alignment arm  20  is useful in this step because the alignment wire  25  representing the longitudinal axis AAA of the second alignment arm  20  is visible in fluoroscopy. Preferably, while viewing through a fluoroscope, the parallax cue  27  provided on the second alignment arm  20  is utilized to ensure that the surgeon is looking in-plane with the second alignment plane P 2 . In this method embodiment, because the drill guide  30  was placed in the proximity of the proximal end of the first bone B 1 , the second alignment arm  20  is already substantially close to the desired alignment position. Thus, only minor adjustments would be necessary to align the second alignment arm  20  to the long axis A of the first bone B 1 , 
     (e) Once the second alignment arm  20  is in alignment with the long axis A, the surgeon inserts a second wire W 2  through the at least one second through hole  18 A of the first alignment arm and into a second bone B 2  of the patient. This arrangement is shown in  FIGS.  6  and  7   . This secures the parallel alignment relationship between the longitudinal axis AA of the first alignment arm  10  and the long axis A of the first bone B 1 . 
     (f) Next, the surgeon visually aligns the longitudinal axis AA of the first alignment arm  10  with the long axis A of the first bone B 1  in the first alignment plane P 1  by adjusting the orientation of the first alignment arm  10  by pivoting the first alignment arm  10  about the first wire W 1  in the directions R as shown in  FIG.  8   . In  FIG.  8   , the pivoting of the first alignment arm&#39;s longitudinal axis AA about the first wire W 1  is illustrated by the directional arrows R. 
     (g) Then, the surgeon confirms the alignment between the first alignment arm  10  and the long axis A of the first bone B 1  by fluoroscopy. This is accomplished by viewing through a fluoroscope along the first alignment plane P 1  to ensure that the longitudinal axis AA of the first alignment arm  10  is parallel to the long axis A of the first bone B 1  in the first alignment plane P 1 . Preferably, while viewing through a fluoroscope, the parallax cue  17  provided on the first alignment arm  10  is utilized to ensure that the surgeon is looking in-plane with the first alignment plane P 1 . 
     (h) If the longitudinal axis AA is not parallel to the long axis A, the step (f) is repeated until the first alignment arm  10  is aligned with the long axis A. When the parallel relationship between the longitudinal axis AA and the long axis A is achieved, the longitudinal axis AA and the long axis A are in-plane in the first alignment plane P 1 . 
     (i) At this point, the drill guide  30  is properly aligned to the long axis A of the first bone B 1 , i.e., aligned in both the first alignment plane P 1  and the second alignment plane P 2 . Thus, a k-wire can be drilled through the hollow shaft  35  of the drill guide  30  and into the first bone B 1  along its long axis A. 
     In some embodiments of the procedure, the first bone is a fifth metatarsal bone and the second bone is a mid-foot bone. 
     During this procedure, the surgeon has the option of locking the first alignment arm  10  to the first wire W 1  sometime after the step (h) so that the arrangement of the first wire W 1  and the first alignment arm  10  is secured. The surgeon has the option of locking the first alignment arm  10  to the second wire W 2  sometime after the step (h) so that the arrangement of the second wire W 2  and the first alignment arm  10  is secured. In other embodiments, the surgeon has the option of locking the first alignment arm  10  to the first wire W 1  and the second wire W 2  sometime after the step (h) so that the arrangement of the first wire W 1 , the second wire W 2 , and the first alignment arm  10  is secured. 
     As mentioned above, the configuration of the drill alignment guide  100  is such that it can be oriented so that the alignment procedure described above can be conducted with the second alignment arm  20  positioned on any side of the patient&#39;s body portion being operated on. For example, if the drill alignment guide assembly  100  is being used on a foot, the second alignment arm  20  can be positioned on the dorsal side of the patient&#39;s foot or on the plantar side of the patient&#39;s foot. Thus, at this point in the procedure, depending on whether the surgeon chose the dorsal side or the plantar side, the visual alignment of the second alignment arm  20  to the long axis A is conducted while viewing the second alignment arm  20  from the dorsal side or from the plantar side. 
     A method of using the drill alignment guide assembly  100  according to some other embodiments will now be described. The method comprises the following steps. (aa) The first wire W 1  is inserted into a distal portion of a first bone B 1  of a patient&#39;s foot or a hand with the first wire W 1  oriented substantially orthogonal to the long axis A of the first bone B 1 . The point of entry for the first wire W 1  is visually determined by the surgeon. The first wire W 1  can either intersect and extends through the long axis A or extends along a trajectory that intersects the long axis A but does not go through the long axis A depending on the particular situation of the bone fracture or injury being attended to. The first wire W 1  and the long axis A of the first bone B 1  together defines the first alignment plane P 1 . The first alignment plane P 1  is shown in  FIG.  8   . In other words, both the long axis A and the first wire W 1  are in-plane in P 1 . 
     (bb) Next, the first alignment arm  10  is slid over the first wire W 1  through the first through hole  16  that is provided at the first end  11  of the first alignment arm  10 . As described above in reference to  FIG.  1 A , because the first through hole  16  extends through the first alignment arm  10 &#39;s longitudinal axis AA in a direction that is orthogonal to the longitudinal axis AA, the configuration of the alignment guide assembly  100  dictates that the longitudinal axis AA reside in the plane D 2  and that the plane D 2  and the second alignment plane P 2  (See  FIG.  9   ) are now parallel to each other. while sharing the first wire W 1  as the pivot. 
     (cc) Next, the surgeon visually aligns the first alignment arm  10  with the long axis A of the first bone B 1  by pivoting the first alignment arm  10  about the first wire W 1  in the directions shown by the arrows R shown in  FIG.  8   , until the first alignment arm&#39;s longitudinal axis AA and the first bone&#39;s long axis A are in-plane in the first alignment plane P 1 . In  FIG.  8   , the pivoting of the longitudinal axis AA about the first wire W 1  is illustrated. 
     (dd) Then, the surgeon confirms the alignment between the first alignment arm  10  and the long axis A of the first bone B 1  by fluoroscopy. This is accomplished by viewing through a fluoroscope along the first alignment plane P 1  to ensure that the longitudinal axis AA of the first alignment arm  10  is parallel to the long axis A of the first bone B 1 . Preferably, while viewing through a fluoroscope, the parallax cue  17  provided on the first alignment arm  10  is utilized to ensure that the surgeon is looking in-plane with the first alignment plane P 1 . 
     (ee) If the longitudinal axis AA is not parallel to the long axis A, the steps (cc) and (dd) are repeated until the first alignment arm  10  is aligned with the long axis A. When the parallel relationship between the longitudinal axis AA and the long axis A is achieved, the longitudinal axis AA and the long axis A are in-plane in the first alignment plane P 1 . 
     (ff) Once the first alignment arm  10  is in alignment with the long axis A, the surgeon inserts a second wire W 2  through the at least one second through hole  18 A of the first alignment arm and into a second bone B 2  of the patient. This arrangement is shown in  FIGS.  6  and  7   . This is to secure the parallel alignment relationship between the longitudinal axis AA of the first alignment arm  10  and the long axis A. 
     (gg) Next, the surgeon visually aligns the second alignment arm  20  to the long axis A of the first bone B 1  by sliding the whole drill alignment guide assembly  100  along the lengths of the first and second wires W 1  and W 2  while looking down at the second alignment arm  20 . This alignment step is for positioning the longitudinal axis AAA of the second alignment arm  20  in the second alignment plane P 2 . In  FIG.  10   , the sliding motion of the drill alignment guide assembly  100  is illustrated with the arrows S. 
     As mentioned above, the configuration of the drill alignment guide  100  is such that it can be oriented so that the alignment procedure described above can be conducted with the second alignment arm  20  positioned on any side of the patient&#39;s body portion being operated on. For example, if the drill alignment guide  100  is being used on a foot, the second alignment arm  20  can be positioned on the dorsal side of the patient&#39;s foot or on the plantar side of the patient&#39;s foot. Thus, at this point in the procedure, depending on whether the surgeon chose the dorsal side or the plantar side, the visual alignment of the second alignment arm  20  to the long axis A is conducted while viewing the second alignment arm  20  from the dorsal side or from the plantar side. 
     (hh) Next, the alignment between the second alignment arm  20  and the long axis A of the first bone B 1  is verified using fluoroscopy. The radio-opaque alignment wire  25  in the second alignment arm  20  is useful in this step because the alignment wire  25  is visible in fluoroscopy. Preferably, while viewing through a fluoroscope, the parallax cue  27  provided on the second alignment arm  20  is utilized to ensure that the surgeon is looking in-plane with the second alignment plane P 2 . 
     (ii) If the alignment is not as desired and needs adjusting, the steps (gg) and (hh) are repeated until the second alignment arm  20  is aligned with the long axis A of the first bone B 1 . 
     (jj) Next, an incision is made in the patient&#39;s foot or a hand near the proximal end of the first bone B 1  and the drill guide  30  is moved into a position so that the tip  37  of the drill guide is contacting the proximal end of the first bone B 1 . For example, when used on a patient&#39;s foot for aligning to a fifth metatarsal bone, the drill guide  30  would be contacting the proximal end of the fifth metatarsal bone as appropriate. This example position is illustrated in  FIGS.  6  and  7   . Because the hollow shaft  35  of the drill guide  30  is in-plane with the longitudinal axis AA in the plane D 1  and in-plane with the longitudinal axis AAA, the hollow shaft  35  will be in axial alignment with the long axis A of the first bone B 1 . 
     During this procedure, the surgeon has the option of locking the first alignment arm  10  to the first wire W 1  sometime after the step (ii) so that the arrangement of the first wire W 1  and the first alignment arm  10  is secured. The surgeon has the option of locking the first alignment arm  10  to the second wire W 2  sometime after the step (ii) so that the arrangement of the second wire W 2  and the first alignment arm  10  is secured. In other embodiments, the surgeon has the option of locking the first alignment arm  10  to the first wire W 1  and the second wire W 2  sometime after the step (ii) so that the arrangement of the first wire W 1 , the second wire W 2 , and the first alignment arm  10  is secured. 
     At this point, the long axis A, the longitudinal axis AA, and the longitudinal axis AAA are in the desired alignment relative to each other. This alignment is illustrated in  FIG.  10    where the longitudinal axis AA and the long axis A are in-plane in the first alignment plane P 1  and the longitudinal axis AAA and the long axis A are in-plane in the second alignment plane P 2 . 
     The method can further comprise a step of locking the drill guide  30  in place. In the examples illustrated here, the drill guide  30  can be locked in place by tightening the locking nut  43 . After the drill guide  30  is locked in place a k-wire is inserted or thrown through the hollow shaft  35  of the drill guide  30  and into the first bone B 1  following the trajectory set by the drill guide  30 . Then, a drill bit is inserted through the hollow shaft  35  over the k-wire for drilling into the first bone. 
     In some embodiments, the first bone B 1  is a fifth metatarsal bone of a patient and the second bone B 2  is a mid-foot bone associated with the fifth metatarsal bone. In some embodiments, the first bone B 1  is a first metatarsal bone of a patient and the second bone B 2  is a mid-foot bone associated with the first metatarsal bone. 
     According to some other embodiments of the method, the second alignment arm  20  can be aligned with the long axis A of the first bone B 1  first. Then, the first alignment arm  10  can be aligned with the long axis A of the first bone B 1  before the second wire W 2  is secured to the second bone B 2 . Accordingly, this alternate method comprises: (aaa) inserting the first wire into a first bone of a patient (the first wire can be inserted either into the distal portion or into the proximal portion of the first bone) wherein the first wire is substantially orthogonal to the first bone&#39;s long axis; (bbb) sliding the first alignment arm over the first wire through the first through hole; (ccc) aligning the second alignment arm to the long axis of the first bone so that the second alignment arm&#39;s longitudinal axis and the first bone&#39;s long axis are in-plane in the second alignment plane; (ddd) confirming the alignment between the second alignment arm and the long axis of the first bone by fluoroscopy; (eee) repeating (ccc) and (ddd) if necessary, until the second alignment arm is aligned with the long axis of the first bone; (fff) aligning the first alignment arm to the long axis of the first bone so that the first alignment arm&#39;s longitudinal axis and the first bone&#39;s long axis are in-plane in the first alignment plane; (ggg) confirming the alignment between the first alignment arm and the long axis of the first bone by fluoroscopy; (hhh) repeating (fff) and (ggg) if necessary, until the first alignment arm is aligned with the long axis; (iii) inserting the second wire through the at least one second through hole of the first alignment arm and into a second bone of the patient; (jjj) locking the first alignment arm to the first wire so that the arrangement of the first wire and the first alignment arm is fixed; (kkk) locking the first alignment arm to the second wire so that the arrangement of the second wire and the first alignment arm is fixed; and (lll) moving the drill guide into place so that the hollow shaft of the drill guide is alignment with the long axis of the first bone. In some embodiments of this procedure, the steps (jjj) and (kkk) can be optional and the surgeon can opt to perform the steps (jjj) and (kkk) individually sometime after the step (iii) or perform the steps (jjj) and (kkk) together sometime after step (iii). In steps (ddd) and (ggg) in this embodiment, while viewing through a fluoroscope, the parallax cue  17  provided on the first alignment arm  10  and the parallax cue  27  provided on the second alignment arm  20  are utilized to ensure that the surgeon is looking in-plane with the associated first alignment plane P 1  and the second alignment plane P 2 . 
     Although the devices, kits, systems, and methods have been described in terms of exemplary embodiments, they are not limited thereto. Rather, the appended claims should be construed broadly, to include other variants and embodiments of the devices, kits, systems, and methods, which may be made by those skilled in the art without departing from the scope and range of equivalents of the devices, kits, systems, and methods.