Proximal Humerus Fixation Plate and Method of Placing the Same

Abstract

The present invention relates to a fixation plate (2) for fixation to the proximal humerus. The fixation plate includes a head portion (3) for distal attachment to a footplate on the greater tuberosity (26) of the humerus (25). The head portion has internally threaded first screw holes (5) for angularly stabilized screws (24) and a plurality of suture holes (7). Two of the first screw holes located farthest from the shank portion (4) serve as upper screw holes (11) for down-threading screws (29). One of the suture holes (7) is a fixation suture hole (10) for securing thereto, by sutures (28), a bone fixation element (9) attached to the top (31) of the humeral head (32) and a shank portion (4) adjacent to the head portion (3) at its lower end for attachment to the humeral shaft (27). The present invention further relates to a set of such a fixation plate (2) and side arm (16) and a method for treating shoulder fractures using such a fixation plate (2).

Description

[Technical field]

[0001] The present invention relates to a fixation plate for fixation to a proximal humerus, the fixation plate having a head portion and a stem portion inferiorly adjacent the head portion, the head portion being designed to be attached distally to a foot plate of the greater tuberosity of the humerus, for that, a first screw hole for inserting an angularly stable screw; and and a suture hole for inserting a suture therein; The stem is designed to be attached to the humerus shaft, To that end, the fixation plate is provided with a second screw hole for inserting a fixation screw therein. [Background technology]

[0002] Such fixation plates are used to treat shoulder fractures.

[0003] Examples of such fixation plates are described and depicted in WO 2005 / 072285 A2, US 2012 / 0179208 A1, US 2006 / 0235402 A1, WO 2014 / 110421 A1, US 2018 / 0000496 A1, US 2016 / 0287297 A1 DE 10 2005 0743 281 A1, US 2016 / 0166297 A1 and US 9,526,544 B1.

[0004] In certain shoulder fractures, a fixation plate is attached to the proximal humerus.

[0005] The shank of the fixation plate herein includes the second screw holes for securing the shank to the humeral shaft, and one or more of these second screw holes may be elongated and at least partially internally threaded and / or at least partially non-internally threaded.

[0006] The head portion includes the first screw hole having internal threads for receiving an angularly stable screw.

[0007] To further strengthen the structure of the fixation plate on the humerus, sutures are typically pulled through the tendons around the humeral head and secured to the fixation plate via suture holes, which for this purpose are typically located at the edge of the fixation plate.

[0008] Despite these well-developed fixation systems, there are a number of significant complications associated with the surgical procedures in which these fixation plates are used.

[0009] The first such complication is postoperative humeral head retroversion, which the fixation plate is unable to prevent.

[0010] A second such complication is the gradual subsidence of the humeral head on the screw, causing the threaded end of the humeral head screw to perforate through the articular surface, which can lead to destruction of the joint.

[0011] These complications occur primarily in older people, whose weaker bones give the screws a weaker grip.

[0012] Problems with known surgical techniques using known fixation plates are described, for example, in Jonathan Barlow et al, Locking plate fixation of proximal humerus fractures in patients older than 60 years continues with a high complication rate, J Shoulder Elbow Surg (2020) 29, 1689-1694. Summary of the Invention

[0013] It is an object of the present invention to provide a proximal humerus fixation plate, set and method that can limit the aforementioned complications.

[0014] This object of the present invention is achieved by providing a fixation plate having a head portion and a stem portion adjacent to and below the head portion, The head is designed to be attached distal to the footplate on the greater tuberosity of the humerus, a first screw hole having a thread for receiving an angularly stable screw; and suture holes for inserting sutures, one of which is provided as a fixation suture hole for fixing a bone fixation element attached to the apex of the humerus head by a suture, and the first two screw holes located furthest from the shaft are provided as upper screw holes for inserting downward screws therein; The shaft is designed to be attached to the humeral shaft and is therefore provided with a second screw hole for the insertion of a fixation screw.

[0015] The fixation plate together with the angularly stable screw, fixation screw, sutures and bone fixation elements form a proximal humerus fixation system.

[0016] The terms superior, inferior, horizontal and vertical are used in reference to the fixation plate as viewed from the perspective of a person standing with the corresponding arm hanging down at the location of the fixation plate where the fixation plate would typically be attached to the humerus.

[0017] The vertical plane here corresponds substantially to the plane along which the shank mainly extends and substantially coincides with the ideal bearing plane of the shank relative to the humeral shaft.

[0018] The horizontal plane extends transversely to such vertical plane and substantially transversely to the shaft portion.

[0019] A down-thread is a thread that, when its start point is threaded away from the horizontal plane, always ends up below this plane so that its start point is at its lowest point, thus forming a downward angle with the horizontal plane.

[0020] An upward thread is a thread that, when its start point is threaded away from a horizontal plane, always threads further above this plane so that its start point is located at the highest point above the horizontal plane, and thus forms an upward angle with said horizontal plane.

[0021] Said bone anchoring element is known and implemented in various embodiments. It is typically attached to an inserter. The bone anchor element here typically engages firmly into the bone and engages under the subchondral bone. Such bone anchoring elements are known, for example, in the form of screws or wedges, or screws wrapped around a knot. In various possible embodiments, the bone anchor element is always attached in the bone as a barb. The anchor is attached subchondrally from the tendon insertion site, drilling a minimal hole in the cartilage. This hole is kept as small as possible by limiting the size of the bone anchor element.

[0022] Such bone anchoring elements are provided with the necessary sutures for their fixation. Once the bone anchoring element is placed on the top of the humerus, the sutures are guided through the insertions of the supraspinatus and infraspinatus tendons and secured into the fixation suture holes.

[0023] Conventionally, the sutures for fixing the fixation plate are placed in the tendons around the humeral head. According to the present invention, a bone fixation member is provided that can be fixed to the bone of the humeral head and sutured to the fixation plate. In this way, tilting of the humeral head can be better avoided.

[0024] In the prior art, the risk of screw perforation is greatest for the most proximal angularly stable screw. In accordance with the present invention, it is now provided to orient these two or more proximal angularly stable screws atypically downwards to also reinforce the calcaneus. This also avoids the screws perforating the articular surface. Also, as in the prior art, additional angularly stable screws can be provided to reach the calcaneus from a horizontal or downward position.

[0025] In a preferred embodiment, anchoring suture holes are provided for adjustably placing sutures therein.

[0026] By allowing the suture to be adjustably inserted into the fixed suture hole, the suture can be attached in a more controllable manner.

[0027] In a specific embodiment, the fixation suture holes of the fixation plates of the present invention may include tunnel-like cavities through which sutures can be inserted, and the fixation plates may include adjustment means for adjustably securing the sutures in the tunnel-like cavities.

[0028] Thus, for example, the fixation plate may be provided with threaded holes that open into the tunnel cavities for adjustably securing the sutures in the tunnel cavities with set screws, and the fixation plate may be provided with a set that includes set screws that can be inserted into the threaded holes to adjustably secure the sutures in the tunnel cavities.

[0029] Alternatively, for example, a bayonet or eccentric system may be provided for adjustably securing the suture within such a tunnel-like cavity.

[0030] The fixed suture holes are further preferably provided for releasable placement of suture material therein such that the suture material can be reversibly placed into the fixed suture holes.

[0031] The fixation suture hole is preferably located in the center of the head.

[0032] More specifically, the fixation suture hole preferably defines a tunnel-like cavity having a first entry opening centrally opening at the upper edge of the fixation plate and a second entry opening centrally opening at the head of the fixation plate, and the screw hole for the set screw is preferably located centrally between the two entry openings in the head and here opens into the tunnel-like cavity.

[0033] Two types of screw holes for angularly stable screws are known.

[0034] The first type concerns screw holes in which angularly stable screws are variably and adjustably positioned, where the angle can typically be adjusted up to 15° in each direction.

[0035] The second type involves screw holes in which the angularly stable screws can only be placed at certain fixed angles.

[0036] To manufacture said upper screw holes of the fixation plate according to the invention, in principle both types of screw holes can be used. However, preferably, these upper screw holes are designed according to the second said type. The advantages of angularly stable screws do not actually offset the high manufacturing costs. Such variable angle stable screws may also be less reliable. Thus, there is a risk of collision, and when inserting the first variable angle stable screw, its exact position is not known precisely enough and when drilling the screw hole for the next screw to be inserted, the already inserted screw may be touched. The drill may be damaged and even broken. Another disadvantage is the need to drill a second path in case of a collision.

[0037] The internal threads of each of the two or more upper threaded holes preferably have a longitudinal axis that is disposed at a downward angle relative to the horizontal plane between 10° and 35°, more preferably between 15° and 25°, even more preferably between 15° and 20°, and even more preferably, this angle amounts to about 16°.

[0038] This downward angle is provided to ensure that the most proximal screw can reach the heel as optimally as possible.

[0039] The two or more upper screw holes further preferably each comprise a second internal thread comprising a second longitudinal axis disposed at an upward angle relative to the horizontal plane between 10° and 35°, preferably between 15° and 25°, more preferably between 20° and 25°, and further preferably this angle amounts to about 24°.

[0040] When the upper screw hole has both the first and second internal threads, the same fixation plate can be used in surgeries where there is a risk of the above complications, so that the most proximal screw can be directed downward to avoid these complications, and in surgeries where these complications are not anticipated and the most proximal screw can be directed upward in the traditional manner.

[0041] The internal thread is preferably configured to converge conically.

[0042] In a particularly preferred embodiment, the two or more upper threaded holes are each designed substantially in the shape of a figure of eight with an upper inlet opening and a lower inlet opening, the upper inlet opening being provided with a first said internal thread groove and the lower inlet opening being provided with a second internal thread groove, or vice versa, whereby the upper inlet opening is provided with the second internal thread and the lower inlet opening is provided with the first internal thread groove.

[0043] The object of the invention is further achieved by providing a set of a fixation plate according to the invention and a side arm releasably attached to the head portion and provided with a second fixation suture hole for fixing the side arm medially from the small foot plate by means of sutures and a second bone fixation element.

[0044] The side arm here bridges the ligament groove and projects beyond the medial edge of the ligament groove. The biceps tendon, located in the bicipital groove, is left undisturbed. In some cases, the side arm can also end above the ligament groove, as long as there is no impingement between the suture and the ligament tendon.

[0045] The side arm preferably has only one of said anchoring suture holes, which are provided here for anchoring a suture material, typically a suture, thereto, and which is preferably of minimal design to perform this function.

[0046] The second fixation hole may be provided in a manner similar to the fixation hole provided in the head portion of the fixation plate described above, and is also preferably designed for adjustably inserting suture material therethrough.

[0047] The side arms may be attached either to the front of the stationary plate or to the rear of the stationary plate.

[0048] The side arm preferably includes a fastener for fastening the side arm to the head portion.

[0049] More specifically, the fixing plate may have a recess in its head portion in which the fixing body is disposed to fix the fixing body to the head portion.

[0050] Preferably, the side arm is designed symmetrically, which is first attached with a first upright side projecting against the fixation plate and can be twisted by 180° with a second upright side projecting against the fixation plate. In this way, the same side arm can be used both for treating shoulder fractures of the left shoulder and for treating shoulder fractures of the right shoulder. Preferably, the fixation plate comprises said recesses corresponding to each of the upright sides.

[0051] Alternatively or additionally, the locking body may be provided to extend across the full width of the head portion.

[0052] More specifically, the fixing body may comprise a mounting pin which can be inserted into said suture hole in the head portion configured as a mounting hole in order to fix the fixing body to the head portion.

[0053] More specifically, the fixation body may be provided with one or more fixing screw holes and the head with one or more corresponding fixing screw holes for fixing the fixation body to the head by means of one or more fixing screws. If the fixation body extends over the full width of the head, for example, such fixing screw holes of the head may be more specifically provided on opposite side edges of the head, so that the fixation body is placed on the head and attached on both sides of said head.

[0054] In certain embodiments, the side arms may be height adjustable attached to the fixed plate.

[0055] The above-mentioned second bone anchoring element and the above-mentioned side arms are also useful in cases where the fixation plates according to the prior art do not have upper screw holes for inserting downwardly directed screws therein. They can also be useful in fixation systems where the head of the fixation plate does not have the first said bone anchoring element and fixation suture holes.

[0056] On the side remote from the head, the shank of the fixing plate according to the invention is preferably provided with an end which is designed concavely so as to form a centrally free cavity below the shank.

[0057] The concave design of this end minimizes impingement with the tendon insertion site located there, so that only a minimal amount of tendon needs to be disinserted to place the fixation plate, if necessary. In this way, the end acts as a lugen into which as much of the deltoid tendon can be inserted as needed. This is in contrast to current methods, where a separate lugen is used to disinsert and then attach the plate. With the appropriate end, the fixation plate can be designed to be shorter than existing fixation plates, thus avoiding this step and requiring less insertion.

[0058] Such a concave end is also beneficial in prior art fixation plates in which upper screw holes are not provided for inserting downwardly directed screws therein, and in fixation systems in which the fixation plate is not provided with the aforementioned bone fixation elements and fixation suture holes.

[0059] Preferably, at least one screw hole in the stem of the fixation plate according to the invention is formed as a slot, which allows the insertion of a first fixation screw and, if necessary, a more accurate positioning of the fixation plate relative to the humerus.

[0060] The screw holes of the shank are further preferably staggered relative to one another, i.e., they are not positioned on one vertical line above one another, but are at least partially offset relative to this vertical line. In this way, the shank can be securely attached to the humeral shaft without the shaft beginning to split.

[0061] The present invention will now be described in more detail with reference to the following detailed description of several embodiments of a proximal humerus fixation system with a fixation plate and method according to the invention, the purpose of which is solely to provide a clear example and to show further advantages and features of the present invention, and therefore should not be interpreted in any way as a limitation of the application area of ​​the present invention or the patent rights described in the claims.

[0062] In this detailed description, reference will be made by way of reference characters to the accompanying drawings, in which: [Brief description of the drawings]

[0063] [Figure 1] FIG. 1 is a front view of a fixation system according to the invention attached to the humerus. [Diagram 2] FIG. 2 is a lateral view of the fixation system and the humerus of FIG. [Diagram 3]FIG. 3 shows the fixation device and humerus of FIG. 1 in a longitudinal section taken through the center of the humerus and fixation plate. [Figure 4] FIG. 4 shows a separate longitudinal section of the fixation plate of the fixation system from FIG. [Diagram 5] FIG. 5 shows the fixing plate of the fixing system from FIG. 1 separately in rear view. [Figure 6] FIG. 6 is a side view of the fixation plate of the fixation system from FIG. 1 with angularly stable screws inserted into the upper screw holes. [Figure 7] FIG. 7 shows a top view of the fixation system and the humerus of FIG. [Figure 8] FIG. 8 shows the fixation system of FIG. 1 and the humerus in a cross-section through the side arm. [Figure 9] FIG. 9 shows a side arm of the fastening system from FIG. 1 in separate perspective view. [Figure 10] FIG. 10 shows the side arms of the fastening system from FIG. 1 separately in a top view. [Figure 11] FIG. 11 shows the side arms of the fastening system from FIG. 1 in separate front view. [Figure 12] FIG. 12 shows separately a second embodiment of a side arm from the fastening system from FIG. 14 in a perspective view from the left side. [Figure 13] FIG. 13 is a rear perspective view of the side arm from FIG. [Figure 14] FIG. 14 shows a second embodiment of a fastening system according to the invention from a left front view. [Figure 15] FIG. 15 shows the fixation plate from the fixation system from FIG. 14 separately in a front perspective view. [Figure 16] FIG. 16 shows the fastening system from FIG. 14 from a rear left perspective. [Figure 17] FIG. 17 shows part of the fastening system of FIG. 14 in an exploded state at head level. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0064] The illustrated proximal humerus fixation system (1) includes a fixation plate (2) with a side arm (16) releasably attached thereto, bone fixation elements (9, 33), screws (24, 35), and sutures (28).

[0065] The fixed plate (2) also has a head portion (3) and a stem portion (4) adjacent the head portion (3) at its bottom.

[0066] As can be seen from Figures 1 to 3, the stem (4) is designed to be attached to a humeral shaft (27).

[0067] For this purpose, in each case the shank (4) is provided with a number of screw holes (8) for inserting fixing screws (35) therein. Such insertion of fixing screws (35) is known from the prior art and is illustrated in the second embodiment. The centrally arranged screw hole (23) is here configured elongated in order to allow a certain amount of play of the fixation plate (2) relative to the humerus (25) even when a first fixation screw (35) is arranged therein. The fixation plate (2) can thus be positioned more precisely relative to the humerus (25) if necessary, before inserting further screws (35) in the further screw holes (8) of the shank (4). These screw holes (8) can furthermore be designed similarly to the screw holes of the shanks of fixation plates according to the prior art. As can be seen more clearly from FIG. 5, the screw holes (8) are not arranged in a row, but they are offset relative to the vertical. In this way, several fixation screws (35) can be arranged on top of each other without splitting the humerus shaft (27).

[0068] On its side facing away from the head (3), the stem (4) also has a concavely designed edge (22) in such a way that a free cavity is formed centrally below the stem (4), this cavity opening towards the rear side of the fixation plate (2) and preferably running transversely to the stem (4). The application of the fixation plate (2) to the humerus is prevented as little as possible by the tendon insertions present there. Fixation plates according to the prior art can likewise be provided with such concave edges in order to ensure that only a minimum of tendons need to be cut off in order to be able to apply the fixation plate.

[0069] The head portion (3) of the depicted fixation plate (2) is designed to be mounted just distal to the foot plate at the greater tuberosity (26), as seen in Figures 1-3. Thus, the head portion (3) can be mounted approximately 5-7 mm distal to the foot plate. To this end, the head portion (3) is provided with a number of screw holes (5) for the insertion of angularly stabilizing screws (24) therein.

[0070] The two most proximal threaded holes (11) are configured in a figure-8 shape and include an upper inlet opening (12) and a lower inlet opening (23). The upper inlet opening (12) includes a first internal thread having a first longitudinal axis (A) disposed at a downward angle (α) of approximately 16° relative to the horizontal plane (X) as seen in Figure 6. The lower inlet opening (13) includes a second internal thread having a second longitudinal axis (B) disposed at an upward angle (β) of approximately 24° relative to the horizontal plane (X) as seen in Figure 6.

[0071] The horizontal plane (X) corresponds substantially to the plane in which the shank (4) primarily extends and is disposed transversely to a vertical plane (Y) which substantially coincides with the ideal bearing plane of the shank (4) on the humeral shaft (27).

[0072] 1-3 and 6-8 each show, for illustrative purposes, a downwardly directed screw (29) placed in one of the most proximal screw holes (11) and an upwardly directed screw (30) placed in the other most proximal screw hole (11). In practice, typically, either a downward thread (29) or an upward thread (30) as shown in FIGS. 14 and 16-17 will be placed in both of the most proximal screw holes (11).

[0073] In an alternative embodiment, separate screw holes for downwardly directed screws and separate screw holes for upwardly directed screws may also be provided instead of the figure-of-eight shaped screw holes (11). As a further alternative, only two or more proximal screw holes may be provided for downwardly directed screws, in which case this fixation plate would be used only for procedures in which the above-mentioned complications are a concern, while an alternative fixation plate having only proximal screw holes for upwardly directed screws would be used for procedures in which these complications are not anticipated.

[0074] The depicted fixation plate (2) can be attached to both the left and right humerus of a human body, or, as in the prior art, it is also possible to manufacture fixation plates (2) for the fixation system (1) according to the invention that are only designed to be applied to the left humerus or only designed to be applied to the right humerus.

[0075] Similar to the screw holes (5, 8), the fixation plate (2) also has a number of suture holes (7) in which sutures (28) can be placed.

[0076] A number of suture holes (7) are provided for passing sutures, as in the prior art, which are pulled through the tendons around the humeral head to secure the fixation plate (2).

[0077] The fixation plate (2) is provided in its center with a fixation suture hole (10). This fixation suture hole (10) is designed as a tunnel with a first inlet opening (40) at the upper edge of the head part (3) and a second inlet opening (41) in the center of the head part (3). In the center between these two inlet openings (40, 41) there is a threaded hole (15) which opens into the tunnel-like cavity (14) of the fixation suture hole (10). Through the inlet openings (40, 41) a suture thread (28) can be introduced into the tunnel-like cavity (14), as can be seen in Figures 3, 14 and 17. A set screw (47) in the threaded hole (15) allows the suture thread (28) to be adjustably and reversibly fixed in the tunnel-like cavity (14).

[0078] The first bone fixation element (9) of the bone fixation elements (9, 33) of the depicted fixation system (1) is in each case provided for subchondral fixation at the top (31) of the humeral head (32) medially from the crural plate of the greater tuberosity, where the supraspinatus tendon (36) and the infraspinatus tendon (36) are inserted. Sutures (28) are attached to this first bone fixation element (9), inserted through the supraspinatus and infraspinatus tendons (36) and secured in the previous fixation suture holes (10).

[0079] The second bone fixation element (33) of the bone fixation elements (9, (33) of the depicted fixation system (1) is in each case designed to be fixed subchondrally, medially from the small footplate, where the subscapularis tendon is inserted. The sutures (28) are attached to this bone fixation element (33), inserted from the subscapularis tendon insertion (37) and fixed in the second fixation suture hole (17) of the side arm (16).

[0080] The side arm (16) is for this purpose releasably attached to the head portion (3) of the fixation plate (2) and thus bridges the bicipital groove (45) so as to leave the biceps tendon unobstructed. In the depicted embodiment, the side arm (16) is attached anteriorly to the fixation plate (2). In alternative embodiments, this side arm (16) may be attached posteriorly to the fixation plate (2).

[0081] In either case, the side arm (16) is provided with a tunnel-like cavity (17) having two entry openings (42, 43) for the insertion of the suture (28). A screw hole (44) is disposed transversely to the tunnel-like cavity (17) and opens into the tunnel-like cavity (17). Through the entry openings (42, 43), the suture (28) can be introduced into the tunnel-like cavity (17), as seen in Figures 8, 14, 16 and 17. A set screw (48) in the screw hole (44) allows the suture (28) to be adjustably and reversibly fixed in the tunnel-like cavity (17).

[0082] For releasable attachment of the side arm to the head part (3), this side arm (16) is in each case provided with a locking body (18).

[0083] In the first embodiment depicted, this fastener (18) extends across the entire width of the head portion (3) and is attached to either side of this head portion (3).

[0084] In the illustrated second embodiment, the front face of the head portion (3) is provided with recesses (50) on both sides corresponding to the fixed body (18), in which the fixed body (18) can be placed and fixed to the fixed plate (2). In this embodiment, the side arm (16) is designed symmetrically so that it can be attached to the fixed plate (2) on the left side as shown, or rotated 180° to the right side relative to the fixed plate (2).

[0085] To attach the fixation body (18) to the fixation plate (2), this fixation body (18) in both embodiments is provided with a mounting pin (20) which can be inserted into the suture hole (7) configured as a mounting hole (35).

[0086] In addition, both the fixed body (18) and the head portion (3) may be provided with one or more corresponding fixing screw holes (38, 39), through which one or more screws can be introduced for screwing the fixed body (18) to the head portion (3).

[0087] In the first embodiment, the fixing screw holes (39) of the head part (3) are here provided on the opposite side edge of the head part (3). In the second embodiment, such fixing screw holes (39) are provided in each of the recesses (50).

[0088] In the first embodiment, the fixator (18) is provided with a notch (21) to allow for unhindered insertion of the proximal most angularly stable screw (24) at the head portion (3).

[0089] The bone anchoring element (9) may take any form known from the prior art. One example of such a suitable bone anchoring element is known under the name Lupine® DePuy Synthes.

Claims

1. A fixation plate (2) for fixation to a proximal part of a humerus (25), comprising: A head portion (3) and a stem portion (4) adjacent to the head portion (3) at the bottom, said head portion (3) being adapted to be attached distally to the crus plate of the greater tuberosity (26) of the humerus (25); a plurality of first screw holes (5) having internal threads for inserting angularly stable screws (24); a plurality of first suture holes (7) for inserting first suture materials (28); said stem (4) is designed to be attached to the shaft (27) of said humerus, for which purpose a second screw hole (8) is provided for the insertion of a fixation screw (35); one of the first suture holes (7) is provided as a fixation suture hole (10) for fixing a bone fixation element (9) attached to the top (31) of the humeral head (32) with a first suture (28); The two first screw holes (5) located furthest from the shaft portion (4) are provided as upper screw holes (11) for inserting first screws (29) downwardly with respect to a horizontal plane (X); The fixation suture hole (10) has a tunnel-like cavity (14) into which the first suture material (28) can be inserted, A fixation plate (2) including a set screw (15) for fixing the first suture (28) within the tunnel cavity (14).

2. A fixation plate (2) as described in claim 1, wherein the fixation suture hole (10) is provided for positioning the first suture material (28).

3. A fixing plate (2) as described in claim 1 or 2, wherein the fixing suture hole (10) is positioned in the horizontal center of the head portion (3).

4. The upper screw hole (11) has a first internal screw groove, The fixation plate (2) according to any one of claims 1 to 3, wherein the first internal thread groove includes a first longitudinal axis (A) disposed at a downward angle (α) between 10° and 35° with respect to the horizontal plane (X).

5. The upper screw hole (11) has a second internal screw groove, 5. The fixation plate (2) according to claim 4, wherein the second internal thread groove includes a second longitudinal axis (B) disposed at an upward angle (β) between 10° and 35° with respect to the horizontal plane (X).

6. Each of the upper screw holes (11) is substantially designed in an eight-shape having an upper inlet opening (12) and a lower inlet opening (13); The upper inlet opening (12) is provided with the first internal thread groove, 6. The fixing plate (2) according to claim 4 or 5, wherein the lower inlet opening (13) is provided with the second internal thread.

7. A fixing plate (2) as described in any of claims 1 to 6, wherein, on the side away from the head portion (3), the shaft portion (4) has an edge portion (22) that is recessed so as to form a centrally located free cavity below the shaft portion (4).

8. A side arm (16) having a second fixed suture hole (17) and attached to the head portion (3), The fixation plate (2) according to any one of claims 1 to 7, wherein the side arm (16) is fixed subchondrally from the smaller foot plate (34) towards the medial side by a second suture (28) and a second bone fixation element (33).

9. A fixation plate (2) as described in claim 8, wherein the second fixation suture hole (17) is designed to insert the second suture material (28).

10. A fixing plate (2) as described in claim 8 or 9, wherein the side arm (16) is provided with a fixing body (18) for fixing to the head portion (3).

11. A fixing plate (2) as described in Claim 10, wherein the head portion (3) is provided with a recess (50) in which the fixing body (18) can be positioned in order to fix the fixing body (18) to the head portion (3).

12. A fixing plate (2) as described in claim 10 or 11, provided with an attachment pin (20) insertable into the first suture hole (7) of the head portion (3) configured as an attachment hole (35) for fixing the fixing body (18) to the head portion (3).

13. A fixing plate (2) as described in any of claims 8 to 11, wherein the side arm (16) is attached to the fixing plate (2) in a height-adjustable manner.

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