Abstract:
An implant is disclosed including an elongate threaded portion and a blade extending from the elongate threaded portion. The blade having a taper terminating at a point and a biasable cantilever formed in a central portion of said blade and with a free end that protrudes from at least one surfaces when the cantilever is unbiased.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a Continuation-in-Part of pending patent application Ser. No. 13/086,136, filed Apr. 13, 2011, which claims priority to U.S. Provisional Patent Application Ser. No. 61/350,665, filed on Jun. 2, 2010, the entirety of which are herein incorporated by reference. 
     
    
     FIELD OF DISCLOSURE 
       [0002]    The disclosed system and method relate implants. More specifically, the disclosed system and method relate to installing an implant for treating hammer toe. 
       BACKGROUND 
       [0003]    Hammer toe is a deformity of the toe that affects the alignment of the bones adjacent to the proximal interphalangeal (PIP) joint. Hammer toe can cause pain and can lead to difficulty in walking or wearing shoes. A hammer toe can often result in an open sore or wound on the foot. In some instances, surgery may be required to correct the deformity by fusing one or both of the PIP and distal interphalangeal (DIP) joints. 
         [0004]    The most common corrective surgery includes the placement of a pin or rod in the distal, middle, and proximal phalanxes of the foot to fuse the PIP and DIP joints. The pin or rod is cut at the tip of the toe, externally of the body. A plastic or polymeric ball is placed over the exposed end of the rod, which remains in the foot of the patient until the PIP and/or DIP joints are fused in approximately 6 to 12 weeks. This conventional treatment has several drawbacks such as preventing the patient from wearing closed toe shoes while the rod or pin is in place, and the plastic or polymeric ball may snag a bed sheet or other object due to it extending from the tip of the toe resulting in substantial pain for the patient. 
         [0005]    Another conventional implant includes a pair of threaded members that are disposed within adjacent bones of a patient&#39;s foot. The implants are then coupled to one another through male-female connection mechanism, which is difficult to install in situ and has a tendency to separate. 
         [0006]    Yet another conventional implant has body including an oval head and a pair of feet, which are initially compressed. The implant is formed from nitinol and is refrigerated until it is ready to be installed. The head and feet of the implant expand due to the rising temperature of the implant to provide an outward force on the surrounding bone when installed. However, the temperature sensitive material may result in the implant deploying or expanding prior to being installed, which requires a new implant to be used. 
         [0007]    Accordingly, an improved implant for treating hammer toe is desirable. 
       SUMMARY 
       [0008]    An implant is disclosed including an elongate threaded portion and a blade extending from the elongate threaded portion. The blade has a taper terminating at a point and a biasable cantilever formed in a central portion and having a free end that protrudes from at least one surface when said cantilever is unbiased. 
         [0009]    A method is also disclosed in which an incision is formed to gain access to a joint between first and second bones. The first and second bones are flexed such that the bones are disposed at an angle from one another. A threaded portion of an implant is advanced into the first bone. The implant includes a blade portion extending from the elongate threaded portion. The second bone is repositioned such that a middle of the second bone is approximately aligned with the blade portion of the implant. The second bone is forced into engagement with the blade portion of the implant. 
         [0010]    A surgical assembly is disclosed comprising an implant having an elongate body and a driving assembly. The implant includes a threaded end and a blade end extending from the threaded end. The blade end tapers along its thickness and its width to a point and includes a plurality of serrated edges and a biasable cantilever formed in a central portion and having a free end that protrudes from at least one surface when said cantilever is unbiased. The driving assembly includes a handle, a driving rod extending from the handle, and an adapter coupled to an end of the driving rod. The adapter has a body defining a slot at one end that is sized and configured to receive the blade end of the implant. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0011]    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: 
           [0012]      FIG. 1  is an isometric view of one example of an improved hammer toe implant; 
           [0013]      FIG. 2  is a side view of the hammer toe implant illustrated in  FIG. 1 ; 
           [0014]      FIG. 3  is a sectional view of the hammer toe implant taken along line  3 - 3  in  FIG. 2 ; 
           [0015]      FIG. 3A  is an isometric view of another example of an improved hammer toe implant; 
           [0016]      FIG. 3B  is a plan view of the improved hammer toe implant shown in  FIG. 3A ; 
           [0017]      FIG. 3C  is a side view of the improved hammer toe implant shown in  FIG. 3A ; 
           [0018]      FIG. 3D  is an isometric view of a further example of improved hammer toe implant according to the invention; 
           [0019]      FIG. 3E  is a plan view of the improved hammer toe implant shown in  FIG. 3A ; 
           [0020]      FIG. 3F  is a side view of the improved hammer toe implant shown in  FIG. 3A ; 
           [0021]      FIG. 4  is an end on view of the hammer toe implant taken along line  4 - 4  in  FIG. 2 ; 
           [0022]      FIG. 5  is a top view of another example of a hammer toe implant; 
           [0023]      FIG. 6  is a side view of the hammer toe implant illustrated in  FIG. 5 ; 
           [0024]      FIG. 7  is a side view of one example of a driving adapter for use with the hammer toe implants illustrated in  FIGS. 1 and 6 ; 
           [0025]      FIG. 8  is an end view of the driving adapter illustrated in  FIG. 7 ; 
           [0026]      FIG. 9  is a side view of another example of a driving adapter for use with the hammer toe implants illustrated in  FIGS. 1 and 6 ; 
           [0027]      FIG. 10  is an end view of the driving adapter illustrated in  FIG. 9 ; 
           [0028]      FIG. 11  is an assembly view of a hammer toe implant engaged by a driving adapter; 
           [0029]      FIGS. 12A and 12B  illustrate the middle and proximal phalanxes of a foot being resected; 
           [0030]      FIG. 13  illustrates a hammer toe implant being driven into a proximal phalanx; 
           [0031]      FIG. 14  illustrates a middle phalanx being drilled or broached; 
           [0032]      FIG. 15  illustrates a blade of a hammer toe implant extending from the proximal phalanx with the middle phalanx having been drilled or broached; 
           [0033]      FIG. 16  illustrates a hammer toe implant installed in the middle and proximal phalanxes; 
           [0034]      FIG. 17  illustrates another example of a driving assembly for installing an implant; 
           [0035]      FIG. 18  illustrates side view of the driving assembly illustrated in  FIG. 17 ; 
           [0036]      FIG. 19  is an isometric view of an adapter of the driving assembly illustrated in  FIG. 17 ; 
           [0037]      FIG. 20  is an end view of the adapter illustrated in  FIG. 19 ; 
           [0038]      FIG. 21  is a cross-sectional view of the adapter taken along line  21 - 21  in  FIG. 20 ; 
           [0039]      FIG. 22  is a cross-sectional view of the adapter taken along line  22 - 22  in  FIG. 20 ; 
           [0040]      FIG. 23  is a plan view of the driving rod of the driving assembly illustrated in  FIG. 17 ; 
           [0041]      FIG. 24  is a cross-sectional view of the driving rod taken along line  24 - 24  in  FIG. 23 ; 
           [0042]      FIG. 25  is a cross-sectional view of the fin of the driving rod taken along line  25 - 25  in  FIG. 23 ; 
           [0043]      FIG. 26  is a plan view of driving assembly illustrated in  FIG. 17  without the o-ring; 
           [0044]      FIG. 27  is a cross-sectional view of the handle taken along line  27 - 27  in  FIG. 26 ; 
           [0045]      FIGS. 28A and 28B  illustrate the middle and proximal phalanxes of a foot being resected; 
           [0046]      FIGS. 29A and 29B  illustrate an implant coupled to the adapter of the driving assembly illustrated in  FIG. 17 ; 
           [0047]      FIG. 30  illustrates a hammer toe implant being driven into a proximal phalanx; 
           [0048]      FIG. 31  illustrates a middle phalanx being drilled or broached; 
           [0049]      FIG. 32  illustrates a blade of a hammer toe implant extending from the proximal phalanx with the middle phalanx having been drilled or broached; and 
           [0050]      FIG. 33  illustrates a hammer toe implant installed in the middle and proximal phalanxes. 
       
    
    
     DETAILED DESCRIPTION 
       [0051]    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 connected” is such an attachment, coupling or connection that allows the pertinent structures to operate as intended by virtue of that relationship. 
         [0052]      FIG. 1  illustrates one example of an implant  100  for treating hammer toe. As shown in  FIG. 1 , implant  100  includes a threaded portion  102  and a blade portion  104 , which are connected together at an engagement portion  106 . Implant  100  may have a substantially linear geometry having an overall length of approximately 19 mm (approximately 0.75 inches). In some embodiments, such as the one illustrated in  FIGS. 5 and 6 , blade portion  104  may be disposed at angle with respect to a longitudinal axis defined by the threaded portion  102 . The angle may be between zero and 45 degrees, and more particularly between approximately five and fifteen degrees, although one skilled in the art will understand that implant  100  may have other dimensions and be provided in different sizes. For example, implant  100  may be provided in lengths of 16 mm and 22 mm, to name a few potential lengths. 
         [0053]    Threaded portion  102  may include a plurality of threads  108  disposed along its entire length, which may be approximately 13 mm (approximately 0.5 inches). The tip  110  of threaded portion  102  may be pointed to facilitate the advancement of threads  108  into bone. Threads  108  may have a maximum outer diameter of approximately 2 mm (approximately 0.08 inches), although one skilled in the art will understand that thread portion  102  may have other dimensions and be configured to be received within a phalanx bone of a person. For example, threads may have an outer diameter of approximately 2.4 mm and 1.6 mm, to name a few potential possibilities. 
         [0054]    As best seen in  FIG. 3 , blade portion  104  includes a plurality of serrated edges  112  on its top and bottom sides  114 ,  116 . Blade portion  104  may have a width that is greater than its thickness as best seen in  FIGS. 2 and 4 . For example, blade portion  104  may have a width of approximately 0.4 centimeters (approximately 0.16 inches) and a thickness of approximately 0.1 centimeters (approximately 0.04 inches) each of which taper to point  118 . Blade portion  104  may have a substantially rectangular cross-sectional area as illustrated in  FIG. 4 , although one skilled in the art will understand that blade portion  104  may have other cross-sectional geometries. Engagement portion  106  may include a pair of protrusions  120  extending from opposite sides of implant  100  and having rounded outer edges  122 . The sides  124  of protrusions  120  may be substantially parallel with each other as shown in  FIG. 4 . 
         [0055]    Referring to  FIGS. 3A-3F , one embodiment of the invention provides an implant  125  that includes an alternative blade portion  130  that includes a plurality of serrations  132  formed along edges  134 ,  136 , a top surface  138 , and a bottom surface  140 . Blade portion  130  often has a width that is greater than its thickness. A cantilever  142  is formed in blade portion  130  between edges  134 ,  136 . Cantilever  142  includes a free end and a clamped end  145  that is located in spaced relation to the free end. The free end of cantilever  142  is often formed so as to have a chamfer  147  ( FIG. 3F ) along a top edge. In some embodiments, clamped end  145  is located within blade portion  130  adjacent to engagement portion  106  ( FIGS. 3A-3B ). In these embodiments, the free end of cantilever  142  is located in spaced relation to engagement portion  106 . In other embodiments, clamped end  145  is located within blade portion  130  in spaced relation to engagement portion  106 , but with free end  147  being located adjacent to engagement portion  106  ( FIGS. 3D-3F ). In most embodiments, cantilever  142  will be pre-loaded such that chamfered free end  147  will stand proud of either top surface  138  or bottom surface  140  often by a distance approximating the thickness of blade portion  130 . In this arrangement, cantilever  142  is inclined at about a 2° angle relative to top surface  138  or bottom surface  140 . Often, chamfered free end  147  of cantilever  142  will rise above top surface  138  so that cantilever  142  will form an angle of approximately 2°-4° with respect to top surface  138 . For example, blade portion  130  may have a width of approximately 0.4 centimeters (approximately 0.16 inches) and a thickness of approximately 0.1 centimeters (approximately 0.04 inches) each of which taper to point  150 . Blade portion  130  may have a substantially rectangular cross-sectional area, although one skilled in the art will understand that blade portion  130  may have other cross-sectional geometries. For example, in some embodiments, blade portion  130  may taper along its width and thickness to point  150 . 
         [0056]    Implants  100  and  125  are both configured to be installed using a driving adapter  200  such as the one illustrated in  FIGS. 7-10 . The driving adapter  200  has an elongate body  202  having a proximal end  204  and a distal end  206 . Body  202  of driving adapter  200  may have a circular cross-sectional geometry, although one skilled in the art will understand that body  202  may have other cross-sectional geometries including, but not limited to, triangular, rectangular, pentagonal, and hexagonal to name a few. 
         [0057]    Proximal end  204  may be substantially solid and have a rounded tip  208 . Distal end  206  may define a slot  210  sized and configured to receive blade portion  104 , 130  of implants  100 ,  125 , respectively. Slot  210  may have a rectangular cross-sectional geometry and have a depth that is sufficient to receive the entire blade portion  104  of implant  100  such that distal edges  212  of slot  210  contact protrusions  120  of engagement portion  106 . However, one skilled in the art will understand that slot  210  may have other cross-sectional geometries and dimensions. Slot  210  may extend through side walls  214  of body  202  as shown in  FIGS. 7 and 8 , or side walls  214  may completely enclose slot  210  as shown in  FIGS. 9 and 10 . 
         [0058]    If the driving adapter  200  is to be used with an implant  100  having a substantially linear lengthwise geometry such as the implants  100 ,  125  illustrated in  FIGS. 1-5 , then slot  210  may extend in a direction that is substantially parallel to an axis defined by body  202  of driving adapter  200 . If driving adapter  200  is to be used with an implant  100  having a blade portion  104  that extends at an angle with respect to an axis defined by elongate threaded portion  102  such as the implant illustrated in  FIGS. 5 and 6 , then slot  210  may extend from distal edges  212  at an angle with respect to an axis defined by the length of body  202  such that elongate threaded portion  102  of implant  100  is linearly aligned with body  202  of driving adapter  200  as shown in  FIG. 11 . For example, if blade portion  104  of implant  100  extends at a ten degree angle with respect to an axis defined by elongate threaded portion  102 , then slot  210  of driving adapter  200  may extend at a ten degree angle with respect to a longitudinal axis defined by body  202  such that threaded portion  102  of implant  100  and body  202  of driving adapter  200  are substantially linearly aligned. 
         [0059]    A method for installing implants  100 ,  125  in the proximal interphelangeal joint (PIP)  300  is described with reference to  FIGS. 12A-16 . However, one skilled in the art will understand that the technique for installing implants  100 ,  125  may be applied to other joints such as, for example, the distal interphelangeal (DIP) joint between middle phalanx  304  and distal phalanx  306 . As shown in  FIGS. 12A and 12B , an incision is made to open the PIP joint  300  and a cutting tool  400  having a blade  402  may be used to resect adjacent faces of proximal phalanx  302  and middle phalanx  304 . The resected surfaces of proximal phalanx  302  and middle phalanx  304  may be debrided as understood by one skilled in the art. 
         [0060]    Blade portions  104 ,  130  of implants  100 ,  125  may be disposed within slot  210  of driving adapter  200  as shown in  FIG. 11 , and the body  202  of driving adapter  200  may be secured in a chuck  412  of a drill  410  or other driving instrument as shown in  FIG. 13 . Drill  410  or other driving instrument is used to drive the threaded portion  102  of implants  100 ,  125  into the resected surface of proximal phalanx  302 . With the threaded portion  104 ,  130  of implants  100 ,  125  disposed within proximal phalanx  302 , driving adapter  200  may be disengaged from blade portion  104 ,  130  of implants  100 ,  125 . 
         [0061]    Middle phalanx  304  may be predrilled or broached using drill  410  to create a hole  308  as shown in  FIGS. 14 and 15 . The predrilled or broached middle phalanx  304  is then repositioned such that the predrilled hole or broach  308  aligns with the blade portion  104  of implant  100 . The middle phalanx  304  is then pressed into engagement with the blade portion  104  as shown in  FIG. 16 . Serrated edges  112  of blade portion  104  help to maintain the engagement between middle phalanx  304  and blade portion  104  of implant  100 . 
         [0062]    A further method for installing implant  125  in the proximal interphelangeal joint (PIP)  300  is substantially similar to the method used in connection with implant  100  and illustrated in  FIGS. 12A-16  and  28 A- 33 , utilizing tooling as shown in  FIGS. 17-27 . More particularly, an incision is made to open the PIP joint  300  with a cutting tool  400  having a blade  402  used to resect adjacent faces of proximal phalanx  302  and middle phalanx  304 . Blade portion  130  of implant  125  may also be disposed within slot  210  of driving adapter  200 , and the body  202  of driving adapter  200  may be secured in a chuck  412  of a drill  410  or other driving instrument. Drill  410  or other driving instrument is used to drive the threaded portion  102  of implant  125  into the resected surface of proximal phalanx  302 . With the threaded portion  102  of implant  125  disposed within proximal phalanx  302 , driving adapter  200  may be disengaged from blade portions  104 ,  130  of implants  100 ,  125 . Middle phalanx  304  may be predrilled or broached using drill  410  to create a hole  308 . The predrilled or broached middle phalanx  304  is then repositioned such that the predrilled hole or broach  308  aligns with the blade portions  104 ,  130  of implants  100 ,  125 . The middle phalanx  304  is then pressed into engagement with the blade portion  130 . Serrated edges  112  of blade portion  130  help to maintain the engagement between middle phalanx  304  and blade portion  130  of implant  125 . Advantageously, as blade portion  130  enters predrilled hole or broach  308  of middle phalanx  304  cantilever  142  is biased toward blade portion  130  by the edge of middle phalanx  304  that defines predrilled hole  308 . In one embodiment, the chamfered free end  147  of cantilever  142  engages the edge of middle phalanx  304  so as to cam cantilever  142  into biased relation with the bone, but without over stressing and damaging middle phalanx  304 . Once fully inserted into middle phalanx  304 , cantilever  142  provides additional resistance to removal of implant  125  from hole  308 . 
         [0063]      FIGS. 17-27  illustrate another embodiment of a driver assembly  500  for installing an implant into bone. As shown in  FIGS. 17 and 18 , driver assembly  500  includes an adapter  502  coupled to a driving rod  516  onto which a handle  534  is over-molded or otherwise coupled. Adapter  502  includes a body  504  with a substantially rectangular side profile comprising side walls  506 - 1 ,  506 - 2 ,  506 - 3 , and  506 - 4  (collectively referred to as “side walls  506 ”) and a pair of end walls  508 - 1 ,  508 - 2  (collectively referred to as “end walls  508 ”) having a substantially square geometry as best seen in  FIGS. 19-22 . 
         [0064]    Body  504  defines a recess  510  along the length of side walls  506 . Recess  510  is dimensioned such that an o-ring  544  ( FIGS. 17 and 18 ) may be received therein. Additionally, recess  510  is located along side walls  506  at a distance from end walls  508  such that recess  510  is aligned with a valley  126  of serrated edges  112  along the top and bottom sides  114 ,  116  of blade portion  104 . 
         [0065]    End wall  508 - 1  defines an aperture  512  having a geometry that complements the cross-sectional geometry of blade portion  104  of implant  100 . For example, if implant  100  has a straight blade portion  104  as illustrated in  FIG. 2 , then aperture  512  may extend approximately parallel to the lengthwise direction of side walls  506 . If the blade portion  104  of implant  100  is angled as illustrated in  FIG. 6 , then aperture  512  may extend from wall  508 - 1  at an angle relative to the plane defined by side wall  506 - 2  or  506 - 4  as will be understood by one skilled in the art. In some embodiments, aperture  512  has a depth that is greater than or equal to a length of blade portion  104  such that blade portion  104  may be received within body  504  and engagement portion  106  abuts end wall  508 - 1 . Similarly, end wall  508 - 2  defines an aperture  514  that is sized and configured to receive an end of elongate driving rod  516  therein. 
         [0066]    As best seen in  FIGS. 23-25 , driving rod  516  includes a fin  518  disposed at a first end  520 . Fin  518  disposed at end  20  of driving rod  516  has a rectangular shape and is sized and configured to be received within aperture  512  of adapter  502 . Fin  518  defines a slot  522 , which is sized and configured to receive a pin (not shown) for cross-pinning driving rod  516  to adapter  502 . In some embodiments, end  520  may have other cross-sectional geometries including, but not limited to, triangular, square, and pentagonal, to name a few possibilities, that are configured to be received within aperture  512 . Adapter  502  may be over-molded onto the end of driving rod  516 . However, one skilled in the art will understand that adapter  502  may be cross-pinned or otherwise coupled to driving rod  516 . 
         [0067]    The opposite end  524  of driving rod  516  defines a pair of flats  526 ,  528 , which are disposed on opposite sides of driving rod  516 . As best seen in  FIG. 23 , flat  526  extends from tip  530  and is linearly spaced from flat  528 , which is disposed at a greater distance from tip  530  than flat  526 . However, one skilled in the art will understand that flats  526 ,  528  may be disposed at other positions along driving rod  516 . Flats  526 ,  528  are configured to provide a contact surface for coupling to handle  532 , which may be over-molded onto driving rod  516 , such that rotation of handle  532  is translated to driving rod  516 . 
         [0068]    Turning now to  FIGS. 26 and 27 , handle  532  has an elongate body  534  that includes a plurality of ribs  536  that extend in a longitudinal direction along body  534  to provide a gripping surface for a user. As best seen in  FIGS. 17 and 22 , a smooth surface  538  interrupts circumferential ridges  540 , which are disposed adjacent to proximal end  542  also for providing a gripping surface for a user. 
         [0069]    Driver assembly  500  may be provided in a kit with a first adapter  502  for use with a straight implant  100  and a second adapter for use with an angled implant  100 . A plurality of implants  100  of different sizes may also be provided in the kit. The kit may be used in an operation similar to the operation described above with respect to  FIGS. 12A-16 . 
         [0070]    For example and referring to  FIGS. 28A-33 , an incision is made to open the PIP joint  300  and a cutting tool  400  having a blade  402  may be used to resect adjacent faces of proximal phalanx  302  and middle phalanx  304  as illustrated in  FIGS. 28A and 28B . The resected surfaces of proximal phalanx  302  and middle phalanx  304  may be debrided as understood by one skilled in the art. 
         [0071]    Blade portion  104  of implant  100  is disposed within aperture  512  of adapter  502  as shown in  FIGS. 29A and 29B . With blade portion  104  disposed within aperture  512 , an o-ring  544  ( FIGS. 17 and 18 ) is placed in recess  510  defined by adapter  502  and within a valley  126  of serrated edges  112  along the top and bottom sides  114 ,  116  of blade portion  104 . O-ring  544  secures implant  100  to adapter  502  such that implant does not move axially out of aperture  512 . 
         [0072]    Once implant  100  is secured to adapter  502 , the surgeon uses handle  534  to manually drive threaded portion  102  of implant  100  into the resected surface of proximal phalanx  302  as illustrated in  FIG. 30 . Implant  100  is driven into proximal phalanx  302  until engagement portion  106  abuts proximal phalanx  302 . Implant  100  is decoupled from adapter  502  by axially pulling handle  534  away from implant  100  with sufficient force to flex o-ring  544  and separate adapter  502  from implant  100 . 
         [0073]    Middle phalanx  304  may be predrilled or broached using drill  410  to create a hole  308  as shown in  FIGS. 31 and 32 . The predrilled or broached middle phalanx  304  is then repositioned such that the predrilled hole or broach  308  aligns with the blade portion  104  of implant  100 . The middle phalanx  304  is then pressed into engagement with the blade portion  104  as shown in  FIG. 33 . Serrated edges  112  of blade portion  104  help to maintain the engagement between middle phalanx  304  and blade portion  104  of implant  100 . 
         [0074]    The implant described above may advantageously be installed through a small incision as described above. Additionally, the improved implant is completely disposed within a toe of a patient, which prevents the implant from being caught on bed sheets or other objects like the conventional pins. 
         [0075]    Although the invention has been described in terms of exemplary embodiments, it is not limited thereto. Rather, the appended claims should be construed broadly, to include other variants and embodiments of the invention, which may be made by those skilled in the art without departing from the scope and range of equivalents of the invention.