Patent Publication Number: US-2015088144-A1

Title: Surgical tool

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a divisional of co-pending U.S. patent application Ser. No. 13/561,839, filed Jul. 30, 2012, the entirety of which is herein incorporated by reference. 
    
    
     FIELD OF DISCLOSURE 
     The present disclosure relates to surgical devices, and more particularly to a surgical tool and related method useable for orthopedic procedures including joint repair involving distraction and compression. 
     BACKGROUND 
     Surgical joint repair procedures sometimes involve the distraction or spreading of bone joints to temporarily hold the joint open which allows the surgeon to gain access to opposing joint surfaces and anatomical features such as cartilage lying therebetween. In some cases, this involves first inserting K-wires (Kirschner wires) through the bones adjacent to the joint. The loose wire ends are then attached to working ends of a surgical tool such as a distractor which operates in scissor-like fashion. The distractor is operated to distract and hold the joint open during completion of whatever surgical repair is needed. When the surgeon is finished, the K-wires are detached from the distractor which is removed. A different tool such as a compressor is then attached to the K-wire ends and the joint is compressed or closed using the tool. This tool switchover may be cumbersome and increases the surgical procedure time. 
     Accordingly, improved surgical tools and method are desirable for joint distraction and compression. 
     SUMMARY 
     A surgical tool is disclosed which in one embodiment advantageously includes both a distraction operating configuration or mode and a compression operating configuration or mode. The tool is transformable between both operating configurations in-situ during the surgical joint repair or other procedure without detachment from the patient or bone fixation elements such as K-wires. 
     According to one embodiment, a surgical tool includes a body including a distal working portion and a proximal operating portion pivotally coupled to the working portion. The working portion includes a pair of elongated working members each having a distal end configured for engaging a fixation element securable to a bone segment. The working members are movably coupled together and configured for motion in an opening or spreading distraction direction and a closing compression direction with respect to each other. The operating portion includes a pair of elongated handles pivotally coupled together and configured for opening and closing movement with respect to each other. The operating portion is configured so that moving the handles apart in an opening direction moves the working members together in the closing compression direction, and moving the handles together in a closing direction handles moves the working members apart in the opening distraction direction. An elongated toothed ratchet member is arranged across the handles and pivotally coupled to one of the handles. The ratchet member is engageable with a pawl disposed on the other handle. The ratchet member is rotatable, with respect to the handles, between two different operating positions. When the ratchet member is in a first operating position engaged with the pawl, the handles are movable in the closing direction and prevented from movement in the opening direction by the ratchet bar, and when the ratchet mechanism is in a second operating position engaged with the pawl, the handles are movable in the opening direction and prevented from movement in the closing direction by the ratchet bar. Through rotation of the ratchet member, it is possible to change operating configurations of the tool from a compression tool to a distraction tool, and vice versa. 
     According to another embodiment, a surgical tool for distraction and compression operation includes a first handle having a proximal and distal ends, a second handle having proximal and distal ends, the first handle being pivotally coupled to the second handle for relative opening and closing movement, a first lateral arm pivotally coupled to the first handle, and a second lateral arm pivotally coupled to the second handle. The first and second lateral arms are movably coupled together for relative opening and closing movement. The tool further includes a pawl disposed on the second handle and an elongated ratchet member arranged across the handles and pivotally coupled to the first handle. The ratchet member is rotatable with respect to the handles. The ratchet member has a first tooth rack comprising a plurality of teeth angled in a first direction and a second gear rack comprising a plurality of teeth angled in a second direction opposite the first direction. The first and second tooth racks are selectively and alternatingly engageable with the pawl by rotating the ratchet member. 
     According to another aspect of the present disclosure, an exemplary method for operating the surgical tool is provided. In one embodiment, the method includes: providing a tool comprising a pair of handles pivotally coupled for grasping, a pair of working members operably coupled to the handles and configured to engage a fixation element securable to a bone segment, and a toothed ratchet member arranged between the handles and being configured to engage a pawl disposed on one handle and having a first end pivotally coupled to one of the handles; engaging a first tooth rack disposed on a first side of the ratchet member with the pawl; rotating the ratchet member; and engaging a second tooth rack disposed on a second side of the ratchet member with the pawl. In one embodiment, the first tooth rack and second tooth rack are arranged 180 degrees apart on the ratchet member. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       These and other features and advantages of the present invention will be more fully disclosed in, or rendered obvious by the following detailed description of the preferred embodiments of the invention, which are to be considered together with the accompanying drawings wherein like numbers refer to like parts and further wherein: 
         FIG. 1  is a front perspective view of one exemplary embodiment of an improved surgical tool configured for compression and distraction operation; 
         FIG. 2  is a front elevation view thereof showing working members in a closed position and handles in an open position; 
         FIG. 3  is a rear elevation view thereof; 
         FIG. 4  is front elevation view thereof showing working members in an open position handles in a closed position; 
         FIG. 5  is an enlarged front view of the proximal ends of the handles and tooth ratchet member of  FIG. 1 ; 
         FIG. 6  is an enlarged cross-sectional side view of the lower left portion of the tool (with reference to  FIG. 1 ) with locking knob in a blocking operating position; 
         FIG. 7  is an enlarged cross-sectional side view of the lower right portion of the tool (with reference to  FIG. 1 ) with the anti-rotation projection on ratchet member in a locked operating position; 
         FIG. 8  is an enlarged cross-sectional side view of the lower left portion of the tool (with reference to  FIG. 1 ) with locking knob in an unblocking operating position; 
         FIG. 9  is an enlarged cross-sectional side view of the lower right portion of the tool (with reference to  FIG. 1 ) with the anti-rotation projection on ratchet member in an unlocked operating position allowing axial rotation of the ratchet member; 
         FIG. 10  is an enlarged cross-section side view thereof showing rotation of the ratchet member; 
         FIG. 11  is an enlarged cross-section side view thereof showing pivoting of the ratchet member with respect to the handle; 
         FIG. 12  is a cross-sectional view taken through the ratchet member along line  12 - 12  in  FIG. 5 ; 
         FIG. 13  is a perspective view of a collet sleeve useable to form clamping ends in the surgical tool of  FIG. 1 ; and 
         FIG. 14  is a front elevation view of an alternative embodiment of an improved surgical tool configured for compression and distraction operation. 
     
    
    
     DETAILED DESCRIPTION 
     This description of preferred 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 of the invention 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. The term “operatively or operably connected” is such an attachment, coupling or connection that allows the pertinent structures to operate as intended by virtue of that relationship. 
       FIGS. 1-4  show an embodiment of a surgical tool  100  according to the present disclosure that is operable to perform both distraction and compression of a bone joint via a movable operating mode switch. Tool  100  has a body defining a longitudinal tool axis LA and generally includes a distal working portion  102 , a proximal operating portion  104  movably coupled to the working portion, and the operating mode control switch disposed on the operating portion. In one embodiment, the operating mode switch is an elongated toothed ratchet member  130 . Ratchet member  130  is configured and operable to control and limit/restrict the movement of the operating portion  104  as further described herein. 
     Working portion  102  includes a pair of laterally arranged and adjacent working members such as axially elongated arms  110 . Arms  110  each include a working distal end  112  configured to engage a bone-fastener such as a K-wire and an opposite proximal end  114  (see  FIGS. 1-4 .) Arms  110  are configured and structured to act as structural members capable of applying a force to an object such as without limitation a bone-fastener that may be secured to a bone segment. In one embodiment, arms  110  may have a generally rectilinear configuration overall (best shown in  FIG. 1 ) with a square or rectangular cross-sectional shape, and in some embodiments define an axially extending internal passageway  119 . Other suitable configurations of arms  110  may alternatively be provided and are contemplated. 
     In one potential application, tool  100  may be used in conjunction with bone joint repair surgery and is operable for distraction of the joint (i.e. spreading) and compression of the joint in two different user selectable operating modes, as further described herein. With continuing reference to  FIGS. 1-4 , working distal ends  112  of arms  110  are configured to engage a bone fixation element as noted above such as without limitation a bone fastener or K-wire (Kirschner wire) in some embodiments which is securable to a bone segment. In one embodiment, distal ends  112  include a hole  116  configured to temporarily receive therethrough and engage a portion of a K-wire. In one embodiment, distal ends  112  include cylindrical locking members  111  such as collets which define holes  116  and are operable to apply a clamping force on the K-wire or bone fastener. Locking members  111  are operable to tighten against a K-wire or shaft of another bone fastener. 
     In one embodiment, as shown in  FIGS. 1 and 13 , locking members  111  include an outer hollow cylindrical collar  190  and inner hollow sleeve  192  configured and dimensioned for insertion into the collar. Sleeve  192  includes a distal end  191  and proximal end  196  configured for grasping by the fingers and/or a tool such as a wrench, socket, or insertable key. In one embodiment, as shown in  FIG. 13 , proximal end  196  may include a knurled or other textured surface configured as a knob and/or a tool engagement element configured to engage a tool for rotating sleeve  192 . In some embodiments, tool engagement element can be configured as a square (shown) or other shaped polygonal protrusion (e.g. hexagon, decagon, octagon, etc.) or a suitably configured polygonal recess or socket (e.g. hexagon, square, etc.) to engage a complementary configured tool or key insertable therein. Inner sleeve  192  further includes a threaded portion  198  configured to engage a mating threaded portion inside a passageway extending completely through outer collar  190  (not shown). Distal end  191  includes a plurality of radially spaced apart kerfs or slits  194  extending axially from the distal end towards the proximal end  196  for a distance to a point terminating before threaded portion  198 . As commonly found in collet-type clamping devices or chucks, the distal end  191  portion of sleeve  192  adjacent at least part of the slits  194  is tapered and flared slightly outwards to function as a chuck for clamping a K-wire or other bone fastener. In operation, the K-wires are inserted through inner sleeve  192 . As the inner sleeve  192  is inserted and screwed into the outer collar  190  via the knurled surface or tooling protrusion, the outwardly flared tapered distal end  191  adjacent slots  194  engages the inside surfaces of the passageway in outer collar and are compressed inwards by the interaction thereby pinching around and clamping the K-wire. 
     In alternative embodiments, distal ends  112  of lateral arms  110  may each be a non-clamping design which is configured to merely engage, but not rigidly clamp the K-wires in holes  116 . The K-wires would be merely inserted through plain holes  116  which can be drilled or otherwise formed into the ends  112 . 
     As best shown in  FIG. 4 , working portion  102  is configured so that arms  110  are movably coupled together for movement in unison. In one embodiment, this is provided by an openable/closeable motion control brace  118  comprised of a pair of cross supports  120  which are pivotally connected together proximate to their midpoints by pivot pin  122  which defines a pivot point. Control brace  118  is configured such that the motion of one arm  110  controls the motion of the interconnected opposing arm  110  via movement of and interaction with the brace. Each cross support  120  has a proximal end  121  which is pivotally pinned by pin  124  to arm  110  and a distal end  123  which is slidably engaged with arm  110  via a guide protrusion  128  that is received in an axially elongated slot  126  as shown in  FIGS. 1-4 . In one embodiment, protrusion  128  is cylindrical in shape with a circular cross section. End  121  is fixed in axial position with respect to arm  110  albeit pivotally movable about pin  124 . Opposing end  123  is axially movable in a longitudinal direction along arm  110  within the range provided by slot  126 . Protrusion  128  both guides and limits the range of axial movement possible by distal end  123  of cross support  120  depending on the length of slot  126  provided. In one embodiment, protrusion  128  is disposed at about 90 degrees or perpendicular to each cross support  120  which may be substantially flattened in shape having a thickness (i.e. measured perpendicular to the plane of the paper in  FIG. 4 ) that is less than the lateral width and length of each support. 
     Motion control brace  118  is expandable and contractable via movement of the lateral arms  110  together or apart, as shown for example in  FIGS. 2 and 4 . Ends  121  and  123  of each cross support  120  and varying portions of each support are received in passageway  119  in each lateral arm  110 . The passageway  119  provides a space for allowing the control brace  118  to be almost completely nested inside arms  110  when the brace is fully contracted as shown in  FIGS. 1 and 3 . In  FIG. 4 , only the ends  121 ,  123  and adjacent portion of each cross support  120  are nested inside passageway  119  of the arms  110 . 
     Motion control brace  118  advantageously restricts the movement of lateral arms  110  of working portion  102  to linear motion with respect to each other in a direction that is transverse to longitudinal axis. As further described herein, this embodiment ensures that spreading/distraction and compression of a bone joint occurs laterally across the joint and substantially parallel to the length of the mating bones (see, e.g.  FIG. 1 ) to prevent oblique displacement of bone segments on opposing sides of the joint when tool  100  is engaged with the fixation elements which are properly positioned and implanted in the bone segments. 
     In operation, referring to the present embodiment shown in  FIGS. 1-4 , lateral arms  110  are moveable together relative to one another in a closing or inward compressing direction toward each other (see, e.g.  FIGS. 2 and 3 ) and an opposing opening or outward distraction direction apart or away from each other (see, e.g.  FIG. 4 ). During this closing or converging motion and opening or diverging motion, arms  110  and concomitantly their respective opposing faces or surfaces on the inside of each arm remain substantially parallel in alignment to each other in one embodiment as shown. 
     Referring to  FIGS. 1-4 , proximal ends  114  of lateral arms  110  are pivotally connected to distal ends  101  of handles  106 A,  106 B of the operating portion  104  via pivots  113  which in some embodiments may be fasteners or pins (not shown). In one, the connection may include a tongue  115  formed on arms  110  disposed between a pair of spaced apart ears  117  formed on handles  106 A,  106 B (see  FIG. 1 ), or vice versa. Handles  106  are laterally disposed in relation to each other and pivotally connected via pivot  105  which may be a fastener or pin (not shown). In one embodiment, pivot  105  is disposed between handles  106 A,  106 B and disposed closer to distal ends  101  of handles  106 A,  106 B than proximal ends  103 . Handles  106 A,  106 B are configured for opening and closing movement with respect to each other from an open operating position shown in  FIGS. 1-3  to a closed operating position shown in  FIG. 4 . The operating portion  104  is configured so that moving the handles  106 A,  106 B apart in an opening direction moves the lateral arms  110  together in a closing compression direction, and moving the handles together in a closing direction handles moves the lateral arms apart in an opening distraction direction. 
     In one embodiment, referring to  FIGS. 1-4 , operating portion  104  has a distal portion  107  defined between pivot  105  and distal ends  104  and a proximal portion  107  defined between pivot  105  and proximal ends  103 . Moving operating handles  106 A,  106 B between the open operating position (see, e.g.  FIGS. 1-3 ) and closed operating position (see, e.g.  FIG. 4 ) moves distal ends  104  together and apart respectively, which in turn concomitantly moves lateral arms  110  together and apart. Due to operation and the location of the pivot  105 , the proximal ends  103  of handles  106 A,  106 B moves in an opposite lateral or transverse direction than distal ends  101  when the handles are squeezed close or pulled part by the user. 
       FIGS. 5-11  show proximal ends  103  of operating portion  104  and toothed ratchet member  130  in closer detail. Ratchet member  130  has one end  132  pivotally connected to proximal end  103  of one handle  106 B and an opposing free end  134  disposed near and engageable with proximal end  103  of the other opposing handle  106 A. 
     Toothed ratchet member  130  includes hollow outer toothed ratchet bar  150  and inner control rod  160  disposed within an axially elongated cavity  151  (see  FIG. 6 ) in the ratchet bar. In one embodiment, ratchet bar  150  is both axially movable on the control rod  160  and rotatably movable with respect to the control rod without rotating the control rod for changing the position of the ratchet bar from a distraction operating position or mode to a compression operating position or mode, as further described herein. Control rod  160  is axially concentrically aligned with the centerline CL of the ratchet bar  150  in one embodiment as shown. Both ratchet bar  150  and control rod  160  each have a greater length than width, and are generally oriented transverse to the longitudinal axis of tool  100 . 
     Referring initially to  FIGS. 6 and 7 , control rod  160  is elongated having a circular cross-sectional shape (see  FIG. 12 ) and includes a first end  161  coupled to handle  106 B and second end  162 . In one embodiment, end  161  is enlarged in size with respect to portions of control rod  160  disposed between the ends and is configured as a rectilinear or block-shaped tab that is insertable between spaced apart ears  139  of a mounting protrusion  136  disposed on handle  106 B. In one embodiment, tabular shaped end  161  is cross pinned via pin  137  to ears  139  of protrusion  136  as shown for pivotal upward/downward movement of the control rod  160  and concomitantly ratchet member  130  with respect to handle  106 B. 
     In one embodiment, tabular end  161  may include an angled end surface  138  disposed at an angle A1 to the top/bottom surfaces of the end as shown in  FIG. 7 . End surface  138  is acted on by an engaging biasing member  140  such as without limitation a flat spring as shown in some embodiments. Other suitable spring types and shapes may be used. Spring  140  is mounted to handle  106 B via a fastening member  142  which may be a threaded fastener (shown) or alternatively a pin (not shown) in other embodiments. Fastening member  142  may be disposed near an upper distal end  146  of the spring  140  which has an opposite proximal end  144  that acts laterally against end surface  138  of control rod  160  so that the opposing end  162  (and ratchet member  130 ) is biased and urged in an upward generally longitudinal direction toward and abuttingly against the end  103  of opposing handle  106 A (see directional arrow  FIG. 5 ). Spring  140 , which is normally flat in configuration, is pre-tensioned and flexed into a slightly bent configuration when mounted to handle  106  as shown due to combination of the outwardly flared shape of the handle and angled end surface  132  of ratchet bar  130 . In one embodiment, proximal end  144  of spring  140  is received between ears  139  of protrusion  136  and captured between end surface  138  and handle  106 B (see, e.g.  FIGS. 5 and 7 ). 
     The opposite free end  162  of control rod  160  has an externally threaded portion  163  as shown in  FIGS. 6 and 8 . An internally threaded locking knob  164  threadably and rotatably engages threaded portion  163  and is axially movable in position on control rod  160  in two different opposite axial directions upon respectively rotating the knob in opposing rotational directions (compare  FIGS. 6 and 8 ). Locking knob  164  includes an axially extending through passageway  168  of which at least part is a threaded portion  165  to engage threaded portion  163  of control rod  160 . A cavity  167  is formed in one end of the knob  164  proximate to handle  106 B which is configured to hold a spring  166  that acts between the knob and end  152  of ratchet bar  150  to bias the ratchet bar towards handle  106 B. In one embodiment, spring  166  may be a helical spring; however, other suitable types of springs may be used. An end flange  169  is disposed on end  162  of control rod  160  to prevent the locking knob  164  from rotating off the end of the rod. 
     Locking knob  164  has an axial range of movement on control rod  160  from a first blocking position abuttingly engaged with ratchet bar  150  (see  FIG. 6 ) to a second unblocking position abuttingly engaged with or proximate to flange  169  (see  FIG. 8 ). Knob  164  is axially moveable between these positions by rotating or turning the knob in two different opposing directions. In some embodiments, as shown, locking knob  164  may have an outer knurled or other textured surface to facilitate gripping and turning the knob particularly when wearing surgical gloves. 
     Referring to  FIGS. 5-12 , ratchet bar  150  is elongated having a generally rectilinear cross-sectional shape including a opposing lateral sides  156 , a top side  157 , and a bottom side  158  (see  FIG. 12 ). Ratchet bar  150  further includes a first end  153  slidably and abuttingly engageable with tabular end  161  of control rod  160  and second end  152  slidably and abutting engageable with locking knob  164 . Ends  152  and  153  of the ratchet bar  150  each defines an opening that communicate with cavity  151  to allow the ratchet bar to be slid axially along the control rod  160 . 
     Ratchet bar end  153  and control rod tabular end  161  are mutually and complementary configured to provide an anti-rotation feature for the ratchet bar  150  wherein the ratchet bar is not rotatable on control rod  160  when ends  153  and  161  are engaged. In one possible embodiment, as shown in  FIGS. 7 and 9 , end  153  of ratchet bar  150  defines a V-shaped locking projection  154  and end  161  of control rod  160  defines a mating V-shaped locking recess  155  into which the projection is axially insertable and engageable to prevent rotation of the ratchet bar with respect to the control rod. Mating angled surfaces  154   a  and  155   a  of the ratchet bar  160  and control rod  160  respectively prevent twisting or rotation of the ratchet bar thereby defining a locked position. In other possible embodiments, tabular end  161  of control rod  160  may alternatively be provided with a V-shaped projection and end  153  of ratchet bar  150  may be provided with a V-shaped recess instead. Either arrangement may be used. 
     It will be appreciated that numerous other possible combinations of complementary configured mating projection and recess shapes may alternatively be used beyond just V-shapes so long as ratchet bar  150  is not rotatable when ends  153  and  161  are mutually engaged. 
     In some embodiments, axially elongated slot-shaped windows  133  may be provided in lateral sides  156  of ratchet bar  150  lighten the weight of surgical tool  100  (see, e.g.  FIGS. 5 and 6 ). 
     With continuing reference to  FIGS. 5-12 , ratchet bar  150  includes at least a pair of tooth racks  170 ,  171  disposed on the sides of the ratchet bar. In one embodiment, tooth racks  170 ,  171  are arranged 180 degrees apart on opposite sides of the ratchet bar. In one embodiment, as shown, tooth rack  170  may be disposed on the top side  157  of ratchet bar  150  and tooth rack  171  may be disposed on the bottom side  158 . Tooth rack  170  defines a plurality of axially arranged ratchet teeth  172  angled in a first axial direction or orientation (see, e.g.  FIG. 6 ). In this embodiment, each tooth  172  comprises a vertical abutment surface and an angled or sloped sliding surface which faces towards handle  106 A (i.e. towards the left in  FIG. 6 ). Tooth rack  171  defines a plurality of axially arranged ratchet teeth  173  angled in a second opposite axial direction or orientation to ratchet teeth  172  (see, e.g.  FIG. 6 ). In this embodiment, each tooth  173  comprises a vertical abutment surface and an angled or sloped sliding surface which faces towards handle  106 B (i.e. towards the right in  FIG. 6 ). 
     Tooth racks  170 ,  171  are configured to selectively engage a pawl  174  disposed on end  103  of handle  106 A (see, e.g.  FIGS. 5-11 ). Pawl  174  is configured with a convex pointed free end that is positioned to both slidably and abuttingly engage tooth racks  170 ,  171  in a ratcheting manner wherein depending on which tooth rack is presented to and engaged with pawl, the pawl is allowed to move in a single axial direction towards either handle  106 A or  106 B only as further described herein. Either tooth rack  170  or  171  may be selectively engaged with pawl  174  by rotating the ratchet bar  150  between a compression operating position or a distraction operating position. The upwards or top facing tooth rack  170  or  171  may be considered in an active ratcheting position whereas the downwards or bottom facing tooth rack may be considered in an inactive position. 
     Exemplary and non-limiting methods for operating the tool  100  and changing operational modes between a distraction mode and compression mode will now be described. 
     FIGS.  2  and  5 - 7  show tool  100  in a distraction operating mode. Although the method will now be described for convenience only with reference to distraction/compression of a bone joint (e.g. ankle, knee, etc.), the tool  100  may be used in other applications where distraction and compression of portions of one or more bones may be desired such as in fracture fixation. 
     Initially, the user who may be a surgeon secures the distal ends  111  to bone fixation elements  200  such as K-wires already mounted in bone on opposing sides of a closed joint in normal position as shown in  FIG. 1 . In embodiment of surgical tool  100  provided with locking members  111 , the K-wires are clamped to the distal end  112  of tool  100  by tightening the locking members in a manner already described herein with respect to operation of the collet device. In alternative embodiments, the surgeon might choose to first put one K-wire into the bone and clamp distal end  112  thereto using one locking member  111 , and then use the remaining open hole  116  on the other locking member  111  as a drill guide for inserting the second K-wire into the adjacent bone. In either case, the joint is now ready to be distracted or opened to provide access to interior portions of the bone joint such as to repair or remove cartilage in some possible applications. The locking knob  164  is in the blocking position, shown for example in  FIGS. 5 and 6 , wherein the ratchet bar  150  cannot be axially moved out of the locked position also shown in  FIGS. 5 and 6 . 
     As more clearly shown in  FIGS. 5 and 6  in greater detail, tooth rack  170  is on top of ratchet bar  150  in the active position engageable with pawl  174  and tooth rack  171  is on bottom and in the inactive position not engageable with the pawl. The angled surfaces of the teeth  172  are facing towards handle  106 A, meaning that the pawl  174  can ride on and slide over the teeth in a first axial direction towards handle  106 B when the handles are squeezed together with inward force F1 in a closing motion as shown in  FIG. 4 . The lateral arms  110  connected to distal ends  101  of the handles simultaneously move apart with a force F2 for distraction of the bone joint via engagement with fixation elements  200  secured in the bone on opposite sides of the joint. A distraction position of tool  100  is shown in  FIG. 4 . It should be noted that the pawl  174  is prevented from moving in a second opposite axial direction towards handle  106 A by engagement with the vertical abutment surface of the teeth  173  in the usual one-way ratcheting manner. 
     After the surgeon completes the procedure on the joint, the joint is next reclosed or compressed. Heretofore, it was necessary to uncouple and completely remove a separate distraction tool from the bone used to open the joint so that a different compression tool could be mounted to the bone fixation elements to then perform compression of the joint. This procedure is cumbersome and prolongs the duration of operating procedure. Advantageously, in embodiments according to the present disclosure, the surgeon can leave surgical tool  100  in place and coupled to the bone, and merely switch operating modes between distraction and compression to complete both opening and closure of the bone joint. 
     The method for switching operating modes of tool  100  will now be described. Referring to  FIG. 8 , the method starts with first rotating and unscrewing the locking knob  164  which is initially in the blocking position shown in  FIG. 6 . This causes the knob to travel axially towards handle  106 A (see directional arrows). Spring  166 , previously fully compressed as shown in  FIG. 6 , gradually expands with movement of the knob towards handle  106 A as can be seen in  FIG. 8 . The knob  164  can be rotated towards flanged end  162  of control rod  160  for an axial distance until one end of the knob abuts flange  169 . Knob  164  is now in the unblocking position shown in  FIG. 8  allowing axial movement of the ratchet bar  150  with respect to the control rod  160  as further described herein. 
     It should be noted in  FIG. 8  that a gap G1 is formed between end  152  of ratchet bar  150  and the end of knob  164  opposite that abutting flanged end  162  of control rod  160 . Spring  166 , acting on end  152  of ratchet bar  150 , urges opposite end  153  of the ratchet bar against tabular end  161  of control rod  160 , wherein mating locking angled surfaces  154   a  and  155   a  of the ratchet bar  160  and control rod  160  are mutually engaged as shown in  FIG. 7 . 
     Next, with gap G1 being formed as shown in  FIG. 8 , the surgeon axially slides ratchet bar  150  towards handle  106 A as illustrated in  FIG. 9  (see directional arrows) from the locked position (see  FIG. 7 ) to the unlocked position (see  FIG. 9 ). This compresses spring  166  with end  152  of the ratchet bar  150 , thereby closing gap G1 and forming a second gap G2 at the opposite end  153  between angled surfaces  154   a  and  155   b  as shown. 
     With the creation of gap G2, the surgeon next axially rotates ratchet bar  150  in relation to the control rod  160  (and handles  106 A,  106 B). The control rod  160  remains in a stationary fixed rotational position during rotation of the ratchet bar  150  because the control rod end  161  is pinned to protrusion  136  on handle  106 B. In one embodiment, the ratchet bar  150  is rotated 180 degrees. Rotation of the ratchet bar  150  transposes tooth rack  170  previously on top of ratchet bar  150  in position with tooth rack  171  which is now presented to pawl  174 , thereby switching operating modes of tool  100  from distraction to compression as shown in  FIG. 10  (see directional arrows). Since the angled surfaces of teeth  173  faced towards handle  106 B now, pawl  174  can axially move only towards handle  106 A when the handles are pulled apart with a force F3 to compress the bone joint. In order to provide sufficient clearance between the pawl  174  and tooth rack  170  before rotating the ratchet bar  150 , the end  134  of the ratchet member  130  may first be pulled downward and pivoted about pin  137  on handle  106 B as shown in  FIG. 11  (see directional arrows) against the upward biasing force of biasing member  140  thereby further compressing the spring. This will completely disengage the tooth rack  170  from pawl  174 . 
     After tooth rack  171  is rotated to the top active position, ratchet bar  150  is released. Spring  166  urges and returns the ratchet bar  150  towards handle  106 B thereby engaging again angled locking surfaces  154   a  and  155   a  (see, e.g.  FIG. 11 ) to prevent rotation of the ratchet bar. Locking knob  164  is then rotated in an opposite direction from before thereby axially moving the knob from the unblocking position (see  FIG. 8 ) to the blocking position (see  FIG. 6 ). Upon pulling the handles  106 A,  106   b  apart with force F3, the lateral arms  110  connected to distal ends  101  of the handles simultaneously move together with a force F4 for compression of the bone joint via engagement with fixation elements  200  secured in the bone on opposite sides of the joint. A compression position of tool  100  is shown in  FIGS. 2 and 3 . It should be noted that the pawl  174  is prevented from moving in an axial direction towards handle  106 B by engagement with the vertical abutment surface of the teeth  173  in the usual one-way ratcheting manner. 
     Surgical tool  100  may be made of any suitable surgical grade materials including metals, non-metals, and combinations thereof for various components. In one embodiment, tool  100  is made of stainless steel. Biasing members  140  and  166  may be made of any suitable spring steel approved for surgical device applications. 
       FIG. 14  shows an alternative embodiment of a combined compression-distraction surgical tool  300  having a single pivot  105  that pivotally connects opposing handles  106 A and  106 B. The construction and arrangement of the elements of tool  300  is generally similar to surgical tool  100  already described herein. In tool  300 , however, distal working portion  102  of tool  300  is defined by rigid portions of the distal ends  101  of the handles  106 A,  106 B lying above pivot  105  which are each constructed as an integral unitary structural part of the lower portions of each handle, as opposed to separate arms  111  each pivotally connected to distal ends of handles  106 A,  106 B (see, e.g.  FIG. 1 ). In surgical tool  300 , the working distal ends  112  of the tool configured to engage bone fasteners are instead defined by the distal ends  101  of handles  106 A,  106 B themselves which are extended in length and configured to engage a bone fastener. The distal ends  101  may therefore include cylindrical locking members  111  that define holes  116  to clampingly engage bone fasteners such as K-wires, or alternatively plain holes  116  are defined in distal ends of the handles for non-clamping engagement with the fasteners. In operation, the distal ends  101  and holes  116  therein of tool  300  will travel in a slightly arcuate path with respect to each other and pivot  105  upon opening and closing the handles, whereas the distal ends  112  of arms  110  will travel in a substantially linear path with respect to each other and pivot  105  due to motion control brace  120  (see  FIGS. 3 and 4 ). Accordingly, surgical tool  100  provides substantially linear or straight line separation of a bone joint which in some surgical situations may be desirable. 
     The operating mode of surgical tool  300  can be switched between compression and distraction in essentially the same manner as tool  100  using toothed ratchet member  130 , as previously described herein. 
     Although the surgical device and method 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 surgical device and method, which may be made by those skilled in the art without departing from the scope and range of equivalents of the device and method.