Patent Publication Number: US-2022226006-A1

Title: Surgical Tool and Method

Description:
BACKGROUND 
     As modern surgical techniques become increasingly less invasive, surgeons must often contend with tight spaces created by minimal surgical incisions and surrounding anatomical structures. In surgeries involving the manipulation of bone, anatomical structures such as tendons, muscle, skin, and adjacent bone are often tightly packed in and around the bone, requiring a surgeon to exert significant linear or rotational forces against the bone to move, adjust, or rotate the bone during the procedure. 
     For example, in the case of podiatric surgeries, surgeons must often move, adjust, or rotate bones of the foot along one or more defined planes. As shown in the context of a left human foot  2  in  FIG. 1 , these include the saggital plane  4 , transverse plane  6 , and frontal plane  8 . Comparing  FIG. 1  with  FIG. 2 , which depicts a normal skeletal arrangement of a left foot  10 , each metatarsal bone  12 , proximal bone  14 , and distal bone  16  lies within the saggital, transverse, and frontal planes  4 ,  6 , and  8 . 
     The need for linear and rotational bone movement across the perpendicular planes is apparent in the specific case of bunion correction surgery.  FIG. 3  depicts the left foot  10  of  FIG. 2  after the foot  10  has developed a bunion condition. As best understood by comparing the normal skeletal arrangement in  FIG. 2  with the skeletal arrangement after development of the bunion condition in  FIG. 3 , an increased spacing  18  develops between the first metatarsal bone  20  and second metatarsal bone  22 . This is partially due to counterclockwise rotation of the first metatarsal bone  20  and its associated pair of sesamoids  24 . 
     An objective in performing corrective surgery for the bunion condition depicted in  FIG. 3  is best understood by comparing  FIGS. 1-3  with the desired corrections best understood with reference to  FIGS. 4A-C . A front cross sectional view of the normal skeletal arrangement  10  of the left foot of  FIG. 2  taken along an approximately frontal plane at the first metatarsal head  26  is depicted in  FIG. 4A . In this view,  FIG. 4A  depicts the first metatarsal bone  20  and its first metatarsal head  26  correctly positioned with the associated sesamoids  24  also correctly positioned just beneath the first metatarsal head  26 . 
     Referring now to  FIG. 4B , a similar front cross sectional view of the skeletal arrangement  10  is depicted after development of the bunion condition of  FIG. 3 . In this view,  FIG. 4B  depicts the first metatarsal bone  20  and its first metatarsal head  26  rotated in a counterclockwise direction, along with the sesamoids  24  which have rotated along with the first metatarsal head  26  toward the increased spacing  18  that has developed between the first and second metatarsal bones  20  and  22 . 
     Now referring to  FIG. 4C , which is a further front cross sectional view of the skeletal arrangement  10  of  FIGS. 2 and 3 , a desired objective of corrective bunion surgery is depicted with clockwise swivel or rotation  28  of the first metatarsal head  26  and sesamoids  24  from the bunion condition positions depicted in  FIG. 4B  back to positions similar to the normal positions depicted in  FIG. 4A . 
     Although bunion correction surgery is used herein as an example, surgeons must also contend with similar surgical constraints when operating on bone in other parts of both human and animal anatomy, requiring analogous bone rotations, adjustments, and manipulations within and across defined anatomical planes in other anatomical regions 
     SUMMARY OF THE INVENTION 
     A surgical tool and method for engaging and manipulating a bone includes a tool body having a main body axis, a threaded end, and a handling end, the threaded end having threads and a tool stop. The handling end is positioned to allow a user to grasp, manipulate, and rotate the tool body around the main body axis. The threads are positioned to allow the surgical tool to bore into and engage the bone when the tool body is rotated in a boring direction around the main body axis, the threads allowing for tightening engagement with the bone as the tool body is rotated in the boring direction around the main body axis. The tool stop is positioned to prevent the tool from being further rotated around the main body axis to prevent further boring into the bone when the tool stop contacts the bone. The surgical tool thereby allows for manipulation, movement, and rotation of the bone with the surgical tool when the tool is in tightened engagement with the bone. 
     In some embodiments, a guide hole extends through the tool body substantially along the main body axis. The guide hole allows a positioning guide to extend at least partially through the tool body and into a bone at a bone boring position to align and guide the threads of the surgical tool to the bone boring position. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       For a more complete understanding and appreciation of this invention, and its many advantages, reference will be made to the following Detailed Description taken in conjunction with the accompanying drawings. 
         FIG. 1  depicts defined cardinal planes of a left human foot; 
         FIG. 2  depicts a front perspective view of a normal skeletal arrangement of a left human foot: 
         FIG. 3  depicts a front perspective view of the skeletal arrangement of the left human foot of  FIG. 2  after development of a bunion condition; 
         FIG. 4A  front depicts a cross sectional view of the normal skeletal arrangement of  FIG. 2  taken along an approximately frontal plane at the first metatarsal head; 
         FIG. 4B  depicts a cross sectional view of the skeletal arrangement of  FIG. 2  after development of, a bunion condition; 
         FIG. 4C  depicts a cross sectional view of the skeletal arrangement of  FIG. 2  during correction of a bunion condition; 
         FIG. 5A  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 5B  depicts a front cross sectional view of the surgical tool of  FIG. 5A  taken along line  5 B- 5 B of  FIG. 5A ; 
         FIG. 6A  depicts a magnified front view of the threaded end of the surgical tool of  FIG. 5A . 
         FIG. 6B  depicts a magnified front view of the threaded end of a surgical tool according to one embodiment of the invention; 
         FIG. 7  depicts a front perspective view and magnification of the skeletal arrangement of  FIG. 3  after the insertion of a guide wire in the first metatarsal head; 
         FIG. 8  depicts a perspective view of the skeletal arrangement of  FIG. 4  with the addition of a surgical tool of the invention to the guide wire; 
         FIG. 9  depicts a perspective view and magnification of the skeletal arrangement of  FIG. 8  with the surgical tool positioned at a boring position; 
         FIG. 10  depicts a perspective view and inset view of the skeletal arrangement of  FIG. 10  with the tool bored into and in threaded engagement with the first metatarsal head; 
         FIG. 11A  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 11B  depicts a front cross sectional view of the surgical tool of  FIG. 11A  taken along line  11 B- 11 B of  FIG. 11A ; 
         FIG. 12A  depicts a front view of a surgical tool according to one embodiment of the invention; 
         FIG. 12B  depicts a front perspective view of the surgical tool of  FIG. 12A ; 
         FIG. 13A  depicts a front view of a surgical tool according to one embodiment of the invention; 
         FIG. 13B  depicts a front perspective view of the surgical tool of  FIG. 13A ; 
         FIG. 14  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 15  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 16  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 17  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 18  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 19  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 20  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 21  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 22  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 23A  depicts a front view of a surgical tool according to one embodiment of the invention; 
         FIG. 23B  depicts a front cross sectional exploded view of a surgical tool according to one embodiment of the invention; 
         FIG. 24A  depicts a front perspective view of a surgical tool according to one embodiment of the invention; 
         FIG. 24B  depicts a front view of a surgical tool according to one embodiment of the invention; 
         FIG. 25A  depicts a perspective view of a wire angulation tool according to one embodiment of the invention; and 
         FIG. 25B  depicts a side view of the wire angulation tool of  FIG. 25A  positioned on a left foot to align a guide wire into a first metatarsal head according to one embodiment of the invention. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Referring to the drawings, similar reference numerals are used to designate the same or corresponding parts throughout the several embodiments and figures. In some drawings, some specific embodiment variations in corresponding parts are denoted with the addition of lower case letters to reference numerals. 
       FIG. 5A  depicts a perspective view of a surgical tool  30   a  of the invention comprising a tool body  32   a  having a main body axis  34   a , a threaded end  36   a , and a handling end  38   a . Conically shaped, clockwise boring threads  40   a  are positioned at the threaded end  36   a  and are oriented to drill or bore into bone material when the surgical tool  30   a  is rotated around the main body axis  34   a  in a right and clockwise boring direction  42   a . The threaded end  36   a  also includes a tool stop  44   a  comprising two small tabular legs extending outwardly from the tool body  32   a  and just slightly above the threads  40   a . At the handling end  38   a , two handles  46   a  also extend outwardly from the tool body  32   a . The handles  46   a  allow the user to grasp, manipulate, and rotate the tool body  32   a  around the main body axis  34   a . The two handles  46   a , the tool body  32   a , and the outward extending dimensions of both legs of the tool stop  44   a  all lie substantially within a plane shared with the main body axis  34   a  wherein the surgical tool  30   a  remains substantially flat when placed on a flat surface (not shown). Although it is contemplated the surgical tool  30   a  would typically be 4 to 5 inches in length, it is further contemplated this would vary greatly and ultimately depend on the specific application or surgical circumstances. 
     A front cross sectional view of the surgical tool  30   a  taken along line  5 B- 5 B of  FIG. 5A  is depicted in  FIG. 5B . As best understood by comparing  FIGS. 5A and 5B , the surgical tool  30   a  is cannulated with the inclusion of a guide hole  48   a  extending substantially along the main body axis  34   a , the guide hole  48   a  opening at the threaded end  36   a  at the tip  50   a  of the threads  40   a  and extending to the handling, end  38   a , opening at a position between the handles  46   a . As best understood with brief reference to the magnified view of the threaded end  36   a  of the surgical tool  30   a  in  FIG. 6A , the positioning of the guide hole  48   a  at the tip  50   a  of the threads  48   a  causes the tip  50   a  to be slightly blunted as shown. 
     Although the invention has been shown, and described as including a blunt thread tip, it will be appreciated that other tip configurations are also possible within the contemplated scope of the invention. For example,  FIG. 6B  depicts a magnified view of a threaded end  36   b  of a contemplated surgical tool having a tool body  32   b , tool stop  44   b  and clockwise boring threads  40   b  similar to the surgical tool of  30   a  of  FIG. 6A . However, being non-cannulated, the surgical tool of  FIG. 6B  lacks a guide hole and therefore includes a pointed tip  50   b  at bottom of the threads  40   b , possibly enhancing the bone boring capability of threads  40   b  in some applications. 
     Referring again to the embodiment surgical tool  30   a  of  FIGS. 5A-6A , the guide hole  48   a  allows for the accommodation of a positioning guide that is a guide wire  52   a . Since the guide hole  48   a  is open at both the tip  50   a  of the threads  48   a  and also between the two handles  46   a , the surgical tool  30   a  allows the guide wire  52   a  to extend completely though the surgical tool  30   a  along the complete length of the main body axis  34   a  as shown in  FIGS. 5A  and B. 
     For a better understanding of the contemplated utilization of the depicted surgical tool  30   a  according to the invention, an example minimum incision bunion correction surgery is depicted in  FIGS. 7-10 . The surgery shown and described in  FIGS. 7-10  is performed with the objective of achieving the bunion correction discussed supra with respect to  FIGS. 4A-C . 
     Referring to  FIG. 7 , the depicted foot  10  is shown with a magnification  54  of the skeletal features near the first metatarsal head  26 . A surgeon employing a minimum incision technique will make a small skin incision (not shown) near the first metatarsal head  26 . The positioning guide that is in this example the guide wire  52   a  is then inserted into the skin incision and driven with a wire insertion apparatus (not shown) at an approximately 45 degree angle from the dorsal aspect of the hallux  58  into the first metatarsal head  20  as shown in  FIG. 7 . The guide wire  52   a  is typically a length of a 0.45 mm diameter k-wire that is sufficiently long enough to extend the entire length of the guide hole  48   a  of the surgical tool  30   a  and to also allow an additional remaining length for further guide manipulation. Although a wire positioning guide is shown and described in this example, it will be appreciated that other types of positioning guides such as long pins, rods, stiffened strings, rods, dowels, or any structure allowing for tool alignment can be similarly used within the contemplated scope of the invention. 
     Comparing  FIG. 7  with  FIG. 8 , the positioning guide or guide wire  52   a  is inserted through the guide hole  48   a . Now comparing  FIG. 8  with  FIG. 9  and its magnification  62 , as the surgical tool  36   a  is moved along the guide wire  52   a  toward the foot  10 , the shaping and reduced size of the tool stop  44   a  enables the surgeon to maneuver or “tease” the surgical tool  36   a  into the incision and around surrounding skin and muscle (not shown). As depicted in  FIG. 9 , the point of wire insertion into the first metatarsal head  26  defines a boring position  60  for the surgical tool  30   a  and threads  40   a . The clockwise threads  40   a  are positioned to allow the surgical tool  30   a  to bore into and engage the first metatarsal head when rotated in a right, clockwise boring direction  42   a  around the main body axis  34   a.    
     Referring to  FIG. 10  and its inset view  64 , the surgical tool  30   a  and its clockwise threads  40   a , aligned in correct orientation by the guide wire  52   a , continue to bore into the bone material of the first metatarsal head  26  as the surgeon applies pressure from the handling end  38   a  while rotating the surgical tool  30   a  in the clockwise boring direction  42   a  using handles  46   a . As shown in the bone cutaway  66  of the inset view  64 , the threads  40   a  create an increasingly tightened threaded engagement with the bone material of the first metatarsal head  26  as the surgical tool  30   a  continues to rotate in the clockwise boring direction  42   a . Although the required amount of rotation may vary depending of several factors such as thread density and individual bone characteristics, at least three to four threads  40   a  may typically be required to be fully rotatably inserted for the tool  30   a  to stay securely seated into the metatarsal head  26 . This tightening engagement continues until at least one leg of the tool stop  44   a  comes into contact with the first metatarsal head  26  to prevent further tool rotation. Once the tool stop  44   a  contacts bone material, the tool stop  44   a  is positioned to prevent the tool  30   a  from being further rotated around the main body axis  34   a  to prevent further boring. 
     The surgeon employing this technique will next make a severing transverse cut or osteotomy  56  at the neck (diaphysial-metaphyseal junction) of the first metatarsal bone  20 . Comparing  FIG. 10  with  FIG. 1 , the osteotomy creates a free capital fragment that includes the first metatarsal head  26 , which is pushed laterally for transverse plane correction. However, frontal plane correction is normally still necessary in order to attain proper cartilaginous alignment with the proximal phalanx of the hallux  58 . 
     Once the free capital fragment/first metatarsal head  26  has been severed from the remainder for the first metatarsal bone  20  at the osteotomy  56 , the frontal plane correction can be achieved by further rotating the surgical tool  30   a  in the right, clockwise boring direction  42   a . The osteotomy  56  allows the free capital fragment/first metatarsal head  26  to move independently from the remainder of the first metatarsal bone  20 . When the surgical tool  30   a  is further rotated in the right, clockwise boring direction  42   a , the tool stop  44   a  prevents further boring by the tool  30   a  while providing rotational leverage. As a result, the tightened, clockwise engagement of the boring threads  40   a  with the capital fragment/first metatarsal head  26  causes bone rotation  68  of the metatarsal head  26  along with the clockwise rotation  42   a  of the surgical tool  30   a . Although the tool stop  44   a  impedes further boring by the threads  40   a , the clockwise rotation  42   a  of the surgical tool  30   a  nevertheless serves to maintain and tighten the clockwise engagement between the threads  40   a  and capital fragment/first metatarsal head  26 , further securing the desired tool-bone engagement. 
     As the surgical tool  30   a  is rotated in the right, clockwise direction  42   a , the resulting bone rotation  68  of the capital fragment/first metatarsal head  26  allows for the desired corrective bone repositioning along the frontal plane as depicted in  FIG. 4C . The frontal plane correction also allows the sesamoid bones  24  to rotate back into proper alignment. This causes the flexor hallucis longos tendon (not shown) to have a more straight line effect on the hallux  58  after the surgical correction. The right, clockwise rotation tightened, clockwise engagement of the boring threads  40   a  with the capital fragment/first metatarsal head  26  also allows for fixed linear movement of the capital fragment, by the surgical tool  30   a  in any of the frontal, saggital, or transverse planes. Thus, the surgical tool  30   a  allows for substantial manipulation, movement, and rotation of bone while the tool  30   a  and bone are in tightened engagement. 
     Referring again to  FIGS. 7-10 , once frontal plane correction and any other manipulation of the capital fragment/first metatarsal head  26  has been completed, the guide wire  52   a  can be advanced across the osteotomy  56  to hold the corrected relative positioning until the surgical tool  30   a  is removed and permanent fixation is inserted. Once the osteotomy  56  is adequately fixated in its corrected position, the guide wire  52   a  can be removed. 
     Although the invention has been shown and described for use in performing bunion correction surgery on the human foot, it is contemplated the invention can also be used for other types of surgery and/or in other parts of both human and animal bodies wherever tight engagement is desired for bone rotation or linear bone movement or displacement. Selection of a tool using either clockwise or counterclockwise threads will normally depend on the anticipated need for rotation. For most applications, it would be desirable to select a tool with threads matching the anticipated direction of rotational repositioning. 
     For example,  FIG. 11A  depicts a front, perspective view of a surgical tool  30   c  of the invention similar to the surgical tool  30   a  of  FIGS. 5A  and B. For comparison, a front cross sectional view of the surgical tool  30   c  taken along line  11 B- 11 B of  FIG. 11A  is depicted in  FIG. 11B . The surgical tool  30   c  of  FIGS. 11A  and B has a guide hole  48   c  for accommodating a guide wire  52   c , an elongated tool body  32   c  and tool axis  34   c  with handles  46   c  at the handling end  38   c  and a tool stop  44   e  at the threaded end  36   c . Conically shaped, counterclockwise boring threads  70   c  extend along the tool axis  34   c  below the tool stop  70   c . The counter clockwise threads  70   c  allow the surgical tool  30   c  to be used for left, counterclockwise boring when rotated around the tool axis  34   c  in the boring direction  72   c . This configuration would make the surgical tool  30   e  suitable for performing the depicted bunion correction surgery of  FIGS. 7-10  on a right foot. 
     Although the invention has been shown and described with the use of a positioning guide such as the guide wire  52   a  in  FIGS. 5A  and B and  7 - 10 , it will be appreciated that free-handed boring tool designs and surgical techniques are also contemplated within the intended scope of the invention, as are variations in tool dimensions and features. For example,  FIGS. 12  A and B depict a surgical tool  30   d  of the invention lacking a guide hole and optimized for use without a guide wire. The tool body  32   d  has a reduced girth along tool axis  34   d  as do the handles  46   d . Peg shaped legs form the tool stop  44   d  at the threaded end  36   d . Since the surgical tool  30   d  lacks a guide hole, the conically shaped, counterclockwise boring threads  70   d  end at a pointed tip  50   d  similar to that depicted in  FIG. 6B . In the embodiments depicted in  FIGS. 12A  and B, the pointed tip  50   d  could be advantageous for enhanced bone penetration when conducting a free-handed rotation of the surgical tool  30   d.    
     It will be further appreciated that some contemplated embodiments may still utilize a guide hole and positioning guide even if the tool body has a reduced girth. For example,  FIGS. 13A  and B depicts a surgical tool  30   e  of the invention having a guide hole  48   e  along the tool axis  34   e  for accommodating the guide wire  52   e  notwithstanding a reduced girth tool body  32   e . The conically shaped, counterclockwise boring threads  70   e  extend along the tool axis  34   c  below the tool stop  70   c  and, despite the reduced girth of the tool body  32   e , allow the guide hole  48   e  to open at the tip  50   c  to eliminate the need for free-handed positioning and rotation of the surgical tool  30   e.    
     Other variations in the tool stop are also possible within the contemplated scope of the invention. For example,  FIG. 14  depicts a surgical tool  30   f  having a guide hole  48   f  for accommodating a guide wire  52   f , an elongated tool body  32   f  and tool axis  34   f  with handles  46   f  at the handling end  38   f . However, the tool stop  44   f  at the threaded end  36   f  comprises a flange  44   f  extending completely around the main body axis  34   f.    
     Although the invention has been shown and described using a tool in which the handles, tool body, and legs all lie substantially within a shared plane, it will be appreciated the invention can also include tools where such elements occupy different planes. For example,  FIG. 15  depicts a surgical tool  30   g  of the invention having handles  46   g , a tool body  32   g , and tool stop  44   g  where the two handles  46   g  extend outwardly from the tool body  34   g  at the handling end  38   g  along a plane that is approximately 90 degrees from the plane in which the two legs of the tool stop  44   g  extend outwardly from the threaded end  44   g . Since the handles  46   g  and tool stop  44   g  each share a different plane with the tool body  32   g , the surgical tool  30   g  will not lie flat on a flattened surface. Such configurations could be desirable in applications or surgical environments where it is considered more difficult to grasp or retrieve the surgical tool  30   g  from an instrument table. 
     Other variations in handle, tool stop, or tool body shape and sizing are also possible and within the intended scope of the invention. For example,  FIG. 16  depicts a surgical tool  30   h  of the invention having peg-shaped guide holes  46   h  extending from the handling end  38   b  of a tool body  32   b  having an enlarged girth and guide hole  48   h . The legs of the tool stop  44   h  extending from the threaded end  36   h  are also peg-shaped and extend outwardly along the same plane as the tool body  32   h  and handles  46   h . The enlarged girth of the tool body  32   h  would allow the counterclockwise boring threads  70   h  to create a larger threaded engagement with the first metatarsal head  26  during a right foot bunion correction surgery similar to that shown and described in  FIGS. 7-10 . 
     It will be further appreciated that the invention can incorporate other various alternative configurations of handles and/or knobs at the handling end of the surgical tool within the intended scope of the invention. For example,  FIG. 17  depicts a surgical tool  301  of the invention having finger grooves  72  positioned around the perimeter of a grooved handle  74  at the handling end  381 . In this configuration, the guide hole  481  of the surgical tool  301  extends along the main body axis  34   i  and through the grooved handle  74  to the tip  501  of the counterclockwise threads  701 . The finger grooves  72  facilitate single-handed manipulation of the surgical tool  30   i  as the surgeon rotates the tool  301  and its counterclockwise threads  701  around its main body axis  34   i.    
     One variation of the grooved handle surgical tool  301  of  FIG. 17  is the surgical tool  30   j  depicted in  FIG. 18  having a domed handle  76  that includes dome notches  78  around its outer circumference. The surgical tool  30   j  also includes a guide hole  48   j  extending through the top of the domed handle  76  and along the main body axis  34   j  through the tip  50   j  of the counterclockwise threads  70   j . The finger grooves  72  and domes handle  76  also facilitate single-handed manipulation of the surgical tool  30   j  as the surgeon rotates the tool  30   j  and its counterclockwise threads  70   j  around its main body axis  34   j.    
     The surgical tools  301  and  30   j  of  FIGS. 17 and 18  are potentially advantageous in preserving the single-handed utility of the invention while reducing the outward extending dimensions from the tool bodies  32   i  and  32   j . Other configurations having similar advantages are also possible within the contemplated invention scope. For example,  FIG. 19  depicts a surgical tool  30   k  of the invention having a square handle  80  with four straight edges  82   k  to enhance single-handed manipulation during surgery while still allowing for a guide hole  48   k  to extend into the tool body  32   k  while the dimensions of the surgical tool  30   k  extending outward from the tool body  32   k  are similarly reduced. 
     A slight variation is depicted in the surgical tool  30   w  of  FIG. 20  having a triangle handle  84   m  with three straight edges  82   m . The three straight edges  82   w  also allow for single-handed manipulation and include a guide hole  48   w  extending into the tool body  32   m  and opening through the tip  50   m  of the counterclockwise threads  70   w  at the threaded end  36   m  of the tool  30   m.    
     A further variation is depicted in the surgical tool  30   n  of  FIG. 21  having a circular handle  86  with a gnarled outer surface  88 . The gnarled outer surface  88  is roughened to allow enhanced tool manipulation despite the rolled shape of the outer surface  88 . The circular handle  86  also includes a guide hole  48   n  extending into the tool body  32   n  and opening through the tip  50   n  of the counterclockwise threads  70   n  at the threaded end  36   n  of the tool  30   n.    
     It is also possible to reduce surgical tool dimensions using a two-winged handle configuration and/or to configure a surgical tool of the invention to allow additional manipulation with an external tool or apparatus. For example,  FIG. 22  depicts a surgical tool  30   p  of the invention having a proud T-handle  90  positioned at the handling end  38   p  and having two wings  91  extending outwardly from the tool body  32   p  substantially along a plane shared with the tool body  32   p  and legs of the tool stop  44   p . The proud T-handle  90  also includes flattened tool engagement surfaces  92  that enable machine or external tool engagement with the surgical tool  30   p  for additional tool manipulation. The proud T-handle  90  also includes a guide hole  48   p  extending into the tool body  32   p  and opening through the tip  50   p  of the counterclockwise threads  70   p  at the threaded end  36   p  of the tool  30   p.    
     It is further contemplated that some embodiments can incorporate extension structures or multiple component body constructions, especially where it may be advantageous to conceal all or part of the positioning guide or to increase distance between the boring position and handles or other manipulation structures. For example,  FIG. 23A  depicts a front view of a surgical tool  30   q  of the invention having a detachable extension  94  attached to the handling end  38   q  of the tool body  32   q . An exploded cross sectional view of the surgical tool  30   q  is depicted in  FIG. 23B . As best understood by comparing  FIG. 23A  with  FIG. 23B , the extension  94  includes handles  46   q  and an extension body  96  having male extension threads  98 . The male extension threads  98  are positioned to screw into female handling threads  100  of the guide hole  48   q  at the handling end  38   q  of the tool body  32   q . When the extension  94  has been fully screwed into position at the handling end  38   q  of the tool body  32   q , the extension body  96  extends along the main body axis  34   q . In this position, the guide hole  48   q  also extends along the main body axis  34   q  fully through the extension body  96 , opening at the top of the extension  94  between the handles  46   q.    
     As depicted in  FIGS. 23A  and B, a length of guide wire  52   q  has been selected and extends entirely though the tool body  32   q , with a substantial length of exposed wire extending past the handling end  38   q  and out of the guide hole  52   q . This would typically be considered advantageous after driving the guide wire  52   q  into bone and as the tool body  32   q  is positioned over the guide wire  52   q  itself. However, it would normally be considered problematic during the rotational boring of the counterclockwise threads  70   q  into the bone as the wire  52   q  could be considered an obstruction to the surgeon as the tool  30   q  is rotated. 
     Further comparing  FIGS. 23A  and B, attaching the extension  94  to the handling end  38   q  of the tool body  32   q  and over the remaining exposed length of guide wire  52   q  enables the remaining exposed length of wire  52   q  to be fully contained within the combined guide hole  48   q  of the tool body  32   q  and extension body  96 . In the specific embodiment of  FIGS. 23  A and B, the male extension threads  98  of the extension  94  and female handling threads  100  of the tool body  32   a  would normally be counterclockwise tightening to allow the engagement between the threads  98  and  100  to tighten as the surgeon rotates the surgical tool  30   q  around the main body axis  34   q , boring into bone with the counterclockwise threads  70   q . However, it will be appreciated that in other contemplated embodiments, similar male extension threads and female handling threads would be positioned clockwise tightening to allow for tightening engagement for tools having clockwise positioned threads. 
     It will be further appreciated that in some contemplated embodiments, additional accessories can be added at various locations on the surgical tool for specific surgical purposes within the intended scope of the invention. For example,  FIGS. 24A  and B depict a surgical tool  30   r  of the invention having wire loops  102  positioned at locations along the outside surface of the tool body  32   r . In the embodiment depicted in  FIGS. 24A  and B, one loop  102  is positioned at a location closer to the handling end  38   r  of the tool  30   r  and the other loop  102  is positioned closer to the threaded end  36   r . In this configuration, the loops  102  extend outwardly in opposite directions from the tool body  32   r  along a plane shared by the tool body  32   r , handles  46   r , and legs of the tool stop  44   r . However, it will be appreciated that other number of loops and loop positioning would also be within the contemplated scope of the invention. 
     As depicted in  FIGS. 24A  and B, the loops  102  would be particularly useful in performing a surgery such as the bunion correction surgery shown and described in  FIGS. 7-10 , with the loops  102  allowing for the direction of additional wires (not shown) used to hold the severed capital fragment/metatarsal head  26  in position relative the remainder of the first metatarsal bone  20  after the creation of the osteotomy  56  and after the guide wire  52   a  and tool have been used to complete bone repositioning. Thus the loops would enable the additional wires to provide temporary fixation of the correction capital fragment/metatarsal head  26 . 
     It will be further appreciated that additional tools and techniques can also be used in performing bone surgery techniques within the contemplated scope of the invention. For example, in some contemplated surgical methods a drill (not shown) can be used over the guide wire prior to the insertion of the tool. In such embodiments, a soft tissue protector (not shown) would be used. 
     Referring now to  FIG. 25A , another contemplated surgical technique of the invention would involve the use of an angulation tool  104  for alignment of guide wire. The angulation tool  104  includes a flattened bottom surface  106 , angulated top surface  108 , and side handle  110 . The angulated top surface  108  is angled at 45 degrees from the flattened bottom surface  106  and includes a cannulated wire tube  112  extending on top of and along the length of the angulated top surface  108 . The wire tube  112  is dimensioned to accommodate a length of k-wire and allows for positioning of the k-wire at 45 degrees to the flattened bottom surface  106 . 
       FIG. 25B  depicts a surgical technique utilizing the angulation tool  104  of  FIG. 25A  that is a modification of the bunion correction surgical technique depicted in  FIGS. 7-10  for a left foot  10 . Referring to  FIG. 25B , a side view is depicted of a big toe nail  113  with skin and non-bone tissue  114  surrounding the first metatarsal bone  20 , sesamoid bone  24 , and hallux  58 . A small incision  116  is made near the first metatarsal head  26 . The angulation tool  104  is then positioned with its flattened bottom surface  106  placed over the hallux  58  so the wire tube  112  is oriented directly at 45 degrees with respect to the hallux  58  and first metatarsal head  26  as depicted. 
     Once the angulation tool  104  is in this position as shown in  FIG. 25B , the guide wire  52   s , typically a length of k-wire, is fed into the wire tube  112  and then guided into and through the incision  116  until it is proximate or in contact with the, first metatarsal head  26  at the boring position  60   s  and at the correct 45 degree angle provided by the angulation tool  104 . A k-wire driver (not shown) is then used, while the guide wire  52   s  remains positioned by angulation tool  104 , to drive the end of the guide wire  52   s  into the first metatarsal head  26  as depicted. The angulation tool  104  can then be removed, with the guide wire  52   s  remaining in position, and a tool of the invention such as the surgical tool  30   a  of  FIGS. 5A  and B then used to complete the repositioning of the metatarsal head  26 . 
     Although the surgical technique depicted in  FIGS. 25A  and B depict the use of a angulation tool for optimally positioning a guide wire at 45 degrees from the hallux  58  and first metatarsal head  26 , it will be appreciated that is some contemplated embodiments of the described surgical method and angulation tool, the preferred optimal angle of wire insertion may be predetermined to be 25-35 degrees or another degree of angulation with an appropriately angulated tool employed within the anticipated scope of the invention. 
     Those skilled in the art will realize that this invention is capable of embodiments different from those shown and described. It will be appreciated that the detail of the structure of the disclosed apparatuses and methodologies can be changed in various ways without departing from the invention itself. Accordingly, the drawings and detailed description are to be regarded as including such equivalents as do not depart from the spirit and scope of the invention.