Kit, plate, insert, and method for treating a clavicle

Abstract

43 Abstract The invention relates to a kit comprising at least one insert (10, 20) and a plate (1) for the treatment of a bone, in partic- ular a clavicle (B). The plate (1) has a receptacle (6) for the 5 insert (10, 20). The insert (10, 20) has an outer contour (C'') and / or the receptacle (6) has an inner contour (C'), the outer contour (C'') and the inner contour (C') being adapted to one another in such a way that the insert (10, 20) inserted into the receptacle (6) can be pivoted about an axis which runs essen-10 tially parallel to a plate upper side (O).. (Fig. 3a) Abstract 5 10 . 20 26 20 52 15 01 J ul 2 02 6 0 1 J u l 2 0 2 6 A b s t r a c t 2 0 2 6 2 0 5 2 1 5

Description

10 Fig. 1a shows a clavicle plate 1 in perspective view. The plate 1 is curved along a longitudinal direction (L) to conform to the shape of a human clavicle. The plate has nine round screw holes 7. In addition, the plate 1 has an elongated hole 8 arranged 15 substantially along the longitudinal direction (L). The elongated hole 8 is suitable for receiving a conventional bone screw. Furthermore, the plate 1 comprises a receptacle 6 for an insert (10, 20 in the following figures). The receptacle has a contour C', which is partially rounded. In the present case, the round- 20 ing is designed as a circular arc-shaped cross-section in a plane P1 perpendicular to the longitudinal direction (L) (see Fig. 1b). The plate has recesses 2',2'' on its top side. In the plate 25 shown here, some recesses 2' are arranged along the longitudinal direction midway between two screw holes 7,8 each. Seen in a direction perpendicular to the longitudinal direction (L), these recesses 2' are arranged midway between the plate edges. Further recesses 2'' are arranged in the vicinity of screw holes 7, but 30 not midway in relation to the longitudinal direction (L) or in a direction perpendicular to the longitudinal direction. 2026205215   01 Jul 2026 The recesses have a circular shape. The diameter of the recesses 2',2'' in the plane O (see Fig. 1c) is 1 mm. The thickness D of plate 1 varies along the longitudinal direction (L). It is smaller at the ends of the plate 1 and increases along the lon- 5 gitudinal direction (L), reaching a maximum in the area of the receptacle 6. The plate 1 further comprises two tabs 5, each of which is connected to the plate 1 via a bridge 4. The tabs 5 are annular in 10 shape and are therefore suitable for receiving a screw. The bridges 4 have a rectangular cross-sectional profile. They can therefore be bent only insignificantly in a direction parallel to the longitudinal direction (L) and only with great force. Perpendicular to the longitudinal direction (L), however, the 15 bridges 4 are bendable. In the embodiment shown, the tabs 5 are arranged such that a screw inserted into the tab 5 is substantially perpendicular to the longitudinal direction (L) and parallel to the plate surface. However, by bending the bridges 4, it can be achieved that an inserted screw would be arranged at 20 an angle not equal to 0° to the plate surface. Due to the insignificant bendability in the direction of the longitudinal direction (L), screws inserted into the tabs 5 remain stable against transverse forces even when the bridges 4 are bent. The plate is made of titanium or a titanium alloy. 25 Fig. 1b shows a cross-sectional view of the plate 1 of Fig. 1a along the plane P1. The receptacle 6 intersects the plane P1. In cross-section, the plate has a straight bottom side U and a top side O running parallel thereto. As already explained in connec-30 tion with Fig. 1a, the plate thickness D along the longitudinal direction L is not constant. The top side O and the bottom side U are partially arranged at an angle to each other in the direction of the longitudinal direction L (see Fig. 1a, left of plane 2026205215   01 Jul 2026 P1). The receptacle 6 is partially rounded in shape and includes recesses 23 whose surface is concavely curved and has a radius of curvature of about 3.5 mm. The recesses connect the side wall of the receptacle 6 to the top side O and are arranged at an an-5 gle of about 45° on both sides. Rounded edges E', E'' are also arranged on the top of the plate. Fig. 1c shows a cross-sectional view of the plate 1 of Fig. 1a along the plane P2. A recess 2' is arranged on the top side O 10 midway between the edges E', E''. The recess 2' is designed as a truncated cone so that it has a trapezoidal cross-section. The depth of the recess is 0.3 mm. The diameter of the base surface of the cone in the plane O is 1 mm, as mentioned above. The recessed surface of the recess has a diameter of 0.6 mm. 15 Fig. 2 shows an alternative embodiment of a clavicle plate 1, which is similar to the plate 1 shown in Fig. 1a. Unlike the plate 1 shown in Fig. 1a, the present plate shown does not have tabs (4 in Fig. 1a) or bridges (5 in Fig. 1a). 20 Fig. 3a shows the clavicle plate of Fig. 1a with screws 3 inserted in the screw holes 7 in a perspective view. In the present embodiment shown, the screw holes are of variable angle design so that the screws can each be oriented in an angular 25 range. Such variable-angle holes are disclosed, for example, in WO 2006 / 099766. Alternatively, however, it would also be possible to design the screw holes as conventional, essentially cylindrical bores with an internal thread. In this case, the orientation of the screws 3 would correspond substantially to the 30 orientation of a longitudinal axis of the holes. Furthermore, a non-angularly stable screw 3' is inserted in the oblong hole 8. The screw head thereof is displaceably mounted in oblong hole 8, so that relative to screw 3' the plate can be displaced along 2026205215   01 Jul 2026 oblong hole 8. A screw 3 is inserted in each of the tabs 5. The tabs 5 are each connected to the plate via a bridge 4 and have not been bent compared to the embodiment shown in 1. Therefore, in the embodiment shown, the screws are oriented parallel to the 5 underside U of the clavicle plate 1. Fig. 3b shows a bottom view of the clavicle plate 1 from Fig. 3a. The transverse screws from the tabs pass between the other screw axes without touching them. These transverse screws allow 10 a reduction of the risk of screw break-out in poor quality bone. Fig. 4 shows the clavicle plate 1 of Fig. 2a with screws 3 inserted in the screw holes in an oblique view. The screw holes 7 are designed here for variable-angle receptacle of screws and as shown, for example, in WO 2006 / 099766. The screws 3 can be 15 screwed in at an angle range of + / -15° relative to a neutral position. Of course, one or more screw holes 7 could alternatively be shaped in a non-variable angle. The screw 3' in the oblong hole 8 is displaceably mounted and not angularly stable so that it can be displaced along the longitudinal direction of the 20 plate. Figures 5a-5d show a method of using an insert 10 with a clavicle plate 1 as shown in Fig. 2a. Of course, the same procedure could be performed with other embodiments of the clavicle plate 25 and / or other than the insert 10 shown here and / or on a different bone. Furthermore, the plate 1 is shown without bone for overview purposes (see Figures 20a+20b). However, the procedure could of course be performed after the screws 3 have been screwed into a bone. 30 Fig. 5a shows how a thread 9 is first fed through the receptacle 6. The thread 9 can be made of UHMWPE. The thread 9 has two free ends F, which are guided through the receptacle 6 from the un- derside U of the plate. 2026205215   01 Jul 2026 Fig. 5b shows how the thread 9 is then guided through an insert 10. The insert 10 is adapted for fixing to a thread 9 and has a sunk strut (not visible) and a rounded outer contour C'' for 5 this purpose. The insert 10 is connected to a holder 12 via a predetermined breaking point 13 (see Figures 6a-6c). The holder has two markings 16 which, on the one hand, indicate to the user which side of the insert 10 should point in the same direction as the top of the plate O when inserted and, on the other hand, 10 has a serial number. The latter can be retained during treatment and thus enables easier documentation of the treatment. This reduces the error rate and thus increases the safety of the treatment. The thread 9 is passed through the insert 10 with one end F on each side of the strut (see, for example, Figures 6a+6b). 15 Fig. 5c shows how the insert 10 is guided into the receptacle 6 of the clavicle plate with the aid of the retainer 12. The retainer 12 can be removed from the insert 10 by breaking the predetermined breaking point 13 by bending. The retainer 12 can be 20 stored after removal and allows the inserted insert to be identified at a later time via the marking 16, which includes a serial number. In the present case, the inner contour C' of the receptacle 6 is partially shaped and the outer contour C'' of the insert 10 is shaped entirely circular-cylindrical in cross-25 section, whereby the insert 1 can be pivoted in the receptacle 6 about the axis of the insert 1 and / or the receptacle 6. Fig. 5d shows how the thread 9 is finally attached to the insert 10 by a knot 15. It is also conceivable to use several knots. If 30 the suture 9 is attached to a coracoid, for example via a further knot or via a loop, this is connected via the insert 10 of the clavicle plate 1 so that the distance between the coracoid and the clavicle is kept constant and physiologically correct. 2026205215   01 Jul 2026 Fig. 6a shows a bottom view of an insert 10 as it can be used in the process according to Figs. 5a-5d. The insert 10 is adapted for fixing with a thread and therefore has a strut 14, which is 5 sunk and forms two openings 11 through which a thread 9 can be passed so that it can be connected to the strut 14 by means of a knot or loop. The insert 10 is connected to a holder 12 via a predetermined breaking point 13. The insert 10 is made of a titanium alloy and is integrally connected to the holder 12. 10 Fig. 6b shows the insert of Fig. 6a in a perspective view. The holder 12 has two markings. On the one hand, a marking with "TOP" indicates that this side should point in the same direction as the top side of the plate 1 when inserted into a recep-15 tacle 6 of a clavicle plate 1. On the other hand, a second marking 16, for example in the form of a serial number or a bar code, is provided, which serves to identify the insert 10 before, during, and after its use. 20 Fig. 6c shows the insert 10 of Figs. 6a and 6b in a side view. Fig. 6d shows the insert 10 of Figs. 6a-6c in the same side view as in Fig. 6c. The predetermined breaking point 13 is broken, so that the insert 10 and the holder are no longer connected to 25 each other. Fig. 6e shows the insert of Fig. 6c in a cross-sectional view along a longitudinal axis of the insert 10 and the holder 12. The strut 14 is sunk and forms two openings 11 through which a 30 thread 9 can be passed. Fig. 7 schematically shows the holding of a clavicle plate 1 by means of a tool 17. The tool 17 in the present case is a surgi- 2026205215   01 Jul 2026 cal plier comprising a handle 30',30'' which can be gripped with two fingers. The pliers 17 further comprise a locking ratchet 31 and at least one tip 32. The tip 32 can be inserted into a recess 2' and is therefore prevented from moving relative to the 5 plate 1 by means of a positive fit. Furthermore, by means of the locking louvers 31, the opening of the pliers can be locked in this position so that the plate is temporarily fixed and a user, e.g. a physician, does not have to hold the pliers for further treatment. This leaves his hands free, for example, to screw a 10 bone screw 3 through a screw hole 7 into the bone by means of a screwdriver 18. Fig. 8a shows a top view of the tip 32 of a tool 17 inserted 6 into the recess 2' as shown in Fig. 7. Since the pliers are 15 placed in the recess 2' between plate holes, a bone screw can be screwed into these plate holes without any problems. Fig. 8b shows a cross-sectional view of the tool 17 and the plate 1 along the plane P3 of Fig. 8a. The tool includes two 20 tips 32 that are substantially identical in design. Thus, the tool 17 can be inserted into a recess 2' with both tips 32. Alternatively, it would also be possible to implement one side of the tool with a different end. For example, a shallow gripper could be used to allow tissue to be gripped while reducing inju- 25 ry to that tissue. Fig. 8c shows a method not according to the invention for holding a plate 1 with a tool. Here, a tip 32 of the tool is inserted into a screw hole 7 to temporarily fix the plate 1. It is 30 true that this restricts the movement of the plate 1 relative to the tool 17. However, some movement is still possible because the screw hole 7 has a size and shape not adapted to the tool 2026205215   01 Jul 2026 17. Furthermore, no screw 3 can be inserted into the used screw hole 7, at least temporarily. Fig. 8d shows another method not according to the invention for 5 holding a plate 1 with a tool. Here, the tip 32 is placed on the top of the plate O. The plate 1 and the tool 17 are connected only by a frictional connection. The plate 1 can therefore easily slip. In addition, the tip 32 and the plate can become damaged, e.g. scratched. 10 Fig. 9a shows a second embodiment of an insert 20 in a top view. The insert is adapted to receive a screw. For this purpose, it has an opening 21 into which a screw can be inserted. The insert 20 is connected to a holder 12 via a predetermined breaking 15 point 13, which has two markings 16. The holder 12 corresponds essentially to the holder of Fig. 6a. Fig. 9b shows the insert 20 of Fig. 9b in perspective view. The opening 21 for the receptacle of a screw is designed here with-20 out a thread. However, it would of course be conceivable that the opening has an internal thread or another contour for the angularly stable receptacle of a screw, in particular a receptacle according to WO 2006 / 099766. The opening has an essentially cylindrical shape and is also designed as a blind hole 24. 25 Fig. 9c shows the insert of Figs. 9a and 9b in a side view. The blind hole 24 is shaped in such a way that the insert 20 has depressions in a side view. Fig. 9d shows the insert 20 of Figs. 9a-9c, where the predeter-30 mined breaking point 13 has been broken and the holder 12 is therefore separated from the insert 20. 2026205215   01 Jul 2026 Fig. 9e shows the insert of Figures 9a-9d in a cross-sectional view along the longitudinal axis of the holder 12 and the insert 20. 5 Figures 10a-10e schematically show a method of using the insert 20 of Figures 9a-9e for use with a screw 3' with a clavicle plate 1 as shown in Fig. 2a. Of course, the same procedure could be performed with other embodiments of the clavicle plate 1 and / or the insert 20 than shown herein and / or on other bones 10 than shown herein. Furthermore, the plate 1 is shown without bone for overview purposes (see Figures 20a+20b). The procedure is typically performed after the screws 3 have been screwed into a bone. 15 Fig. 10a shows the plate 1 with screws 3 screwed into the screw holes 7,8. The insert 20 is essentially the same as in Figs. 9a-9e. Fig. 10b shows how the insert 20 is inserted into a receptacle 6 20 provided for this purpose. The marking 16 indicates how the insert must be oriented, i.e. with the marking "TOP" 16 pointing in the same direction as the top side O of the plate 1. However, it is possible to swivel the insert 20 in the receptacle 6. In this case, the opening 21 can be oriented so that a screw 3 in-25 serted into it can be screwed into a bone at a desired angle. By bending the holder 12 away, the predetermined breaking point 13 can be broken and the insert 20 is thus separated from the holder 12. Fig. 10c shows how a screw 3' is inserted into the opening 21 of 30 the insert 20. Fig. 10d shows how the screw 3' has been fully inserted into the opening 21 of the insert 20. 2026205215   01 Jul 2026 Fig. 10e shows a cross-section of the insert 20, the screw 3' and the plate 1 of Fig. 10d in the plane P4. The screw 3' is oriented at an angle to the plate 1 because the insert 20 has 5 been pivoted in the receptacle 6. The opening 21 of the insert 20 is designed in such a way that the screw 3' has clearance in the opening 21 and could also be pivoted relative to the opening 21 and the insert 20 if required. This is also achieved in particular by the opening having a larger diameter than the shaft 10 of the screw 3'. Fig. 11a shows various receptacles L1,L2,L3,L4,L5,L6,L7,L8. These are not shown in a clavicle plate 1 for better illustration and overview. However, any of the receptacles 15  L1,L2,L3,L4,L5,L6,L7,L8 shown could be combined with any of the clavicle plates 1 described herein, particularly those of Figures 1a and 2a, and are suitable for receiving an insert 10,20. The receptacles L1,L2,L3,L4,L5,L6,L7,L8 are shown below in a plan view. Directly above, a cross-section of each receptacle 20  L1,L2,L3,L4,L5,L6,L7,L8 is shown in the plane P5. All recepta cles L1,L2,L3,L4,L5,L6,L7,L8 are each rounded at two end sections B'. A middle section B'', on the other hand, has a straight section in plan view, in particular with two mirror-symmetrical side walls. 25 All receptacles L1,L2,L3,L4,L5,L6,L7,L8 have in common that an inner wall I tapers at least partially from a top side to a bottom side. In addition, the end section B' is rounded and the middle section B'' is straight in plan view with mirror- 30 symmetrical side surfaces. The receptacle L1 has a trapezoidal cross section in the central region B''. The inner walls I in the central region B' are 2026205215   01 Jul 2026 shaped as straight surfaces which are at an angle to each other so that they taper from the top side O to the bottom side U. The inner walls I in the central region B'' are shaped as straight surfaces which are at an angle to each other so that they taper 5 from the top side O to the bottom side U. The receptacle L1 is thus shaped like a prism in the central region B''. Receptacle L2 is not shaped in a tapered manner in the area adjacent to the underside U. Instead, the inner walls I in the 10 central area B'' are partially shaped parallel to each other (in the area adjacent to the underside U). Directly above this, in the region adjacent to the top side O, the receptacle has essentially the same shape as the receptacle L1. 15 Receptacle L3 has a partially spherical and a partially cylindrical inner surface I. The radius of curvature of the spherical inner surface I corresponds to the radius of curvature of the outer contour C'' of insert 1 (see Fig. 11b). 20 Receptacle L4 has a cross-section corresponding to two rectangles. The rectangle on the top side O is wider. The two areas with different widths are separated by a boundary surface parallel to the top side O. The two rectangles are arranged on the same side. 25 Receptacle L5 is similar to receptacle L4, but the two areas of different width are separated by an interface that is not shaped parallel to the top side O. 30 Receptacle L6 is similar to receptacle L3. However, the radius of curvature of the spherical inner surface I is different from the radius of curvature of the outer contour C'' of the insert. 2026205215   01 Jul 2026 Receptacle L7 is similar to receptacles L4 and L5, with the two areas of different width separated by an elliptical section. The shapes of the cross-sections shown here are only exemplary and could also have other shapes. In particular, hyperbolic, 5 parabolic and / or multi-stepped designs are conceivable. Fig. 11b shows receptacles L1,L2,L3,L4,L5,L6,L7,L8 of Fig. 11a with an inserted insert 20 for receiving a screw. The exemplary insert 20 shown corresponds to the insert 20 of Fig. 9a, but any 10 of the inserts 10,20 described here is suitable for receptacle in any of the receptacles 6, L1, L2, L3, L4, L5, L6, L7, L8 shown. The outer contour C'' of the inserts 20 is shaped in a rounded manner. The cross-section of the insert 20 perpendicular to its longitudinal axis is a segment of a circle, as the insert 15  20 comprises a milled-off portion 37 which is substantially straight. The rounded outer contour C' of the insert 20 is therefore adapted to all of the shown inner contours C'' such that the insert 20 can be pivoted in a plane perpendicular to the longitudinal axis of the insert 20 and the receptacle 20  L1,L2,L3,L4,L5,L6,L7,L8. In addition, the insert is slidable along the longitudinal axis of the receptacle 6 and cannot slip through the receptacle. Alternatively, an insert 10,20 with a different shape, for exam-25 ple an angular shape, could be inserted into the receptacles L3, L6, L7 shown in Figures 11a and 11b. The pivotability would be ensured thanks to the partially rounded inner contour C' of the receptacle L3, L6, L7. 30 Figures 12a-12l show various inserts 10 for thread fixation, which are suitable for receptacle in a screw hole 7 according to WO 2006 / 099766. The use of the inserts shown in Figures 12a-12l therefore does not require a specifically adapted receptacle 6. 2026205215   01 Jul 2026 The inserts 10 shown in Figures 12a-12l are adapted to be screwed into a conventional screw hole of a plate. For this purpose, they have a locking area according to WO 2006 / 099766 and a receptacle for a tool. Preferably, the receptacle is designed as 5 a Torx drive. The insert 10 is adapted for holding a thread and preferably has at least one bore and / or a head with an undercut for this purpose. Preferably, the interlocking region is shaped such that, when screwed in, there is at least one region with a distance to the inner shape of a screw hole through which a 10 thread can be guided. Preferably, the head has at least one recess through which a thread can be guided. In particular, such an insert makes it possible to fix a thread by means of a knot, so that the knot is arranged sunk in a screw hole. 15 Fig. 12a shows an embodiment of an insert 10 with an locking area 19 for receiving into a variable-angle screw hole 7 as shown in WO 2006 / 099766. The insert 10 can therefore be inserted into a screw hole at different angles. It comprises a head portion 22, and a neck portion 25 adjacent thereto, which comprises a 20 centering collar to which a thread can be attached and which is connected to the interlocking portion 19 via a circular cylindrical section. In this embodiment, the thread is guided over the plate edge. The insert shown here has a centering collar 39 on the underside. This allows the insert to align itself in a 25 hole according to the hole axis and runs less risk of being tipped off when the thread is pulled. Fig. 12b shows an insert 10 similar to the insert 10 shown in Fig. 12a. The neck area is spherical in this case. In this ver-30 sion, the thread is guided over the plate edge. In contrast to the design shown in Fig. 12a, the insert shown here does not have a centering collar. 2026205215   01 Jul 2026 Fig. 12c shows another embodiment of an insert 10 for thread fixation. It includes a head portion 22 and a curved neck portion 25 directly adjacent to the interlocking portion 19. Thus, the insert 10 shown lacks a circular cylindrical portion (see 5 Figures 12a and 12b), allowing a thread held at the neck portion 25 to be sunk into a screw hole 7 if necessary. The head portion 22 includes six indentations 26 through which the thread can be passed, particularly when the insert is sunk. In this embodiment, the thread can be guided over the edge of the plate. 10 Fig. 12d shows an insert 10 similar to that shown in Fig. 12c. The head portion 22 includes four indentations and a slot 27. The insert is pierced, i.e., the suture can be passed through the bone. The slot 27 allows the suture to pass to the side of 15 the screwdriver blade when the insert is screwed into the plate hole, and allows the suture to be subsequently secured to the neck of the insert. Fig. 12e shows an insert 10 that is similar to the insert 10 20 shown in Fig. 12 and further comprises two bores 28. The two holes are symmetrical with respect to the plane P6 and run parallel to the plane P6 in the interlocking area 19. In the neck portion 25, the holes 28 are perpendicular to the holes in the interlocking portion 19, making this insert 10 suitable for re- 25 ceiving a thread through one hole 28 so that it can be wrapped around the neck portion 25 and exited through the other hole 28. Likewise, this arrangement allows for the insertion of a screwdriver blade. 30 Fig. 12f shows an insert 10 used for the non-locking variable angle arrangement in a screw hole 7 (as shown in WO 2006 / 099766). Thread fixation can be performed by passing a thread laterally past the insert 10 between two interlocking 2026205215   01 Jul 2026 sections 29. By anchoring the insert 10 in a plate (not shown) by means of the interlocking section 19, the thread is held laterally and can be held above the insert, for example by a knot. Fig. 12g shows an insert 10 similar to the one shown in Fig. 5   12f. This insert 10 additionally comprises a collar 30 for bet ter gripping of the insert during production on a machine. Fig. 12h shows an insert 10 similar to the one shown in Fig. 12g. This insert additionally has a recess 31 at the collar 20, which allows a thread to be inserted into a screw hole 7 after 10 screwing and thus to be guided into the section 29 between the interlocking areas without causing injury. Fig. 12i shows an insert 10 similar to the one shown in Fig. 12f. It additionally includes a milled recess 38 in the inter-15 locking area 19 for better gripping during production on a machine. Fig. 12j shows a further embodiment of an insert 10 that can be inserted into a conventional screw hole 7 for thread fixation. 20 This is connected to a holder 12 via a predetermined breaking point 13. This is formed by laser cutting as a cutout from a metal sheet and further comprises a marking 16 which serves to orient the insert 10 in a screw hole 7. 25 Fig. 12k shows an insert 10 that is designed essentially like the insert 10 shown in Fig. 12i. It additionally comprises a holder 12 which can be bent away from the insert 10 for separation. 30 Fig. 12l shows an insert 10 similar to that shown in Fig. 12j. The holder 12,12' comprises two parts, each of which is connected to the insert 10 via a predetermined breaking point 13,13'. 2026205215   01 Jul 2026 The two-piece holder 12,12' is formed from a sheet by laser cutting. The insert in Fig. 12l has two holders. Together, the holders 5 form a guide for a thread that can preferably be held on the insert. Both holders are connected to the insert via a predetermined breaking point so that they can be broken independently of each other. Preferably, the insert has a recess in which a thread can be received. Particularly preferably, the thread in 10 the recess cannot be removed without force. Fig. 13 schematically shows the use of inserts 10 of Fig. 12 for suture fixation in a conventional screw hole 7 in a clavicle plate. 15 The clavicle plate 1 includes oblong hole 8 in addition to multiple screw holes 7. The insert 10 of Fig. 12f is inserted at a position X. Alterna-20 tively, an insert of Figs. 12g-12l could be used analogously. This anchors two threads 9,9', each inserted from one side as a thread loop into the plate hole. After screwing in the insert, they are protected against loss and the thread 9 is guided over the plate edge where it can be knotted, for example. The thread 25   9' is fixed in the plate hole in the same way, but in the oppo site direction, and is therefore not guided over the plate edge. Alternatively, the threads 9,9' could be guided through the bone, protected against loss by means of an insert in the plate hole and knotted over the insert. 30 At a position Y, the insert 10 of Fig. 12a is inserted. The thread 9'' comprises a loop which is anchored in the neck area 25 of the insert 10. For a better overview, the insert 10 is 2026205215   01 Jul 2026 shown in a not completely screwed-in state. By screwing it in further, the thread 9'' can be pressed against the top of the plate O. The thread 9 is guided over the top of the plate O and one edge of the plate 1. 5 The insert 10 of Fig. 12c is screwed in at position Z. For a better overview, this insert is shown without thread. Figures 14a-14h schematically show a method of using the insert 10 of Fig. 12l. 10 Fig. 14a shows two threads 9 that are fed along the first section of the one-piece holder 12,12', which comprises two cutoffs, through one insertion slot each to the side of the insert 10. The respective insertion slot is formed between the two 15 pieces of the holder 12,12'. At this point, the sutures 9 may have already been held to a bone and passed through the clavicle and a clavicle plate (not shown). Fig. 14b shows how the threads 9 are guided closer to the insert 20   10. Fig. 14c shows how the insert is placed against the clavicle plate 1 so that the insert 10 is positioned over the desired screw hole 7. The threads 9 are tightened so that they snap into 25 the insert 10. The insert 10 is positioned so that the marking 16 points upward (in a direction from the bottom of the plate to the top of the plate O). Fig. 14d shows how a blade 18 of a screwdriver is inserted into 30 the insert. Fig. 14e shows how the first piece 12 of the holder is broken at the predetermined breaking point 13 and removed. 2026205215   01 Jul 2026 Fig. 14f shows how the second piece 12' of the holder is also broken off at the other predetermined breaking point 13' and removed. The insert 10 can be held in this state with the aid of 5 the blade 18. Fig. 14g shows how the insert 10 is screwed into the desired screw hole using the blade 18. 10 Fig. 14h shows the plate 1 with the insert 10 screwed in, whereby the threads 9 are guided laterally past the insert. These could, for example, be held above the insert by means of a knot (not shown). 15 Fig. 15 shows another embodiment of an insert 10 for thread fixation in a conventional screw hole. This comprises a holder 12 which is connected to the insert 10 via a predetermined breaking point 13. It is shaped to be pressed into a screw hole along a longitudinal axis of the holder. 20 Figures 16a-16d schematically show a method of using the insert 10 of Fig. 15. Fig. 16a shows how, in a first step, two threads 9 are passed 25 through a screw hole 7. Fig. 16b shows how the insert 10 is guided between the two threads towards the screw hole 7. 30 Fig. 16c shows the pressing-in of the insert 10 into the screw hole 7, whereby it is fixed rotationally securely in this screw hole 7. During pressing-in, the insert 10 is compressed and the insert then holds frictionally in the plate hole 7. The stage 2026205215   01 Jul 2026 shown here is particularly suitable for removing the retainer 12 by breaking the predetermined breaking point 13. Fig. 16d shows the plate 1 with the inserted insert 10 after re-5 moval of the holder. The two threads 9 can be tied together by a knot above the insert 10 and therefore wrap around the insert 10 in such a way that the threads 9 are retained on the insert 10. At the same time, the pull of the threads prevents the insert from sliding out of the plate hole. 10 Fig. 17a shows a further embodiment of an insert 10 for thread fixation in a side view, top view and perspective view. The insert shown is adapted for use in a specially designed receptacle (for example 6 in Fig. 1a). The insert 10 includes a retainer 12 15 connected to the insert 10 by a predetermined breaking point. The insert is substantially flat in design and has a partially rounded shape. The insert 10 has two holes 11 through which a thread can be passed. At the predetermined breaking point 13, the insert has a recess 35 in the direction of the holes 11. As 20 a result, any irregularities on the surface resulting from breaking of the predetermined breaking point 13 are recessed and do not come into contact with the receptacle for the insert 10. Fig. 17b shows another variant of an insert 10, which is de- 25 signed without a holder. However, it would be conceivable to equip this insert with a holder connected, for example, via a predetermined breaking point. The insert 10 shown is similar to the one shown in Fig. 17a. In addition to the aforementioned missing holder, this insert also has a lateral recess 34 com- 30 pared to the one shown in Fig. 17a, at which the insert can be gripped by means of a tool (tweezers or other holding instrument). 2026205215   01 Jul 2026 Fig. 18a shows a further embodiment of an insert 10 for thread fixation in a bottom view. The insert 10 is similar to the insert 10 of Figures 6a-6e. However, it includes spherical sections 36', 36'' at the ends. A spherical section 36'' is con-5 nected to a support via a predetermined breaking point 13. A strut 14 forms two openings 11 through which a thread (not shown) can be passed. The strut 14 is flush with the surface of the insert 10 on the underside. The insert also has no flattening on the upper side. 10 Fig. 18b shows the insert 10 of Fig. 18a in a perspective view. Fig. 18c shows the insert of Fig. 18a in a side view. Fig. 18d shows the insert of Fig. 18a in a cross-sectional view 15 in a plane parallel to a longitudinal axis of the insert 10 and the holder 12. The strut 14 is sunk and forms two openings 11 through which a thread 9 can be passed. Fig. 18e shows a detailed view of the insert 10 of Fig. 18a. 20 Fig. 18f shows a cross-section of the insert 10 of Fig. 18a in the plane P7 (see Fig. 18e) with one of the openings 11 for the passage of a thread. The opening 11 is substantially cylindrical in shape. The insert 10 has a substantially circular cross-25 section. However, it would also be conceivable to shape the insert 10 straight on one side so that the cross-section has the shape of a segment of a circle (as is the case, for example, with the insert of Figures 6a-6e). 30 Fig. 18g shows a cross-section of the insert 10 of Fig. 18e in the plane P8 passing through the strut 14. The strut 14 is shaped flush with the outside of the insert 10 and sunk. 2026205215   01 Jul 2026 Fig. 19a shows another variant of an insert 20 for fixing a screw. It comprises an opening 21, which is designed here without a thread and which is adapted for the receptacle of a screw. It is connected to a holder 12 via a predetermined breaking 5 point 13. Fig. 19b shows the insert 20 of Fig. 19a in a perspective view. The insert 20 is similar to that of Figs. 9a-9e. However, like the insert 10 of Figs. 18a-18g, it has a substantially circular 10 cross-section in a plane perpendicular to a longitudinal axis of the holder 12 and the insert 20. Likewise, the insert does not have a flattening on its top side. The opening 21 is shaped with a recess 24 on its top side, such that the opening 21 is shaped as a countersunk hole for a screw. 15 Fig. 19c shows the insert 20 of Fig. 19a in a side view. Fig. 19d shows the insert 20 of Fig. 19a in a cross-sectional view in a plane perpendicular to the longitudinal axis of the 20 holder 12 and the insert 20. Fig. 20a shows the clavicle plate 1 of Fig. 1a in a condition screwed to a human clavicle B. The plate 1 is fixed with nine screws 3 in screw holes 7. In addition, two screws 3 are fixed 25 to the bone via a tab 5 each, and another screw 3' is fixed via an oblong hole 8. The treatment shown here was performed without the use of an insert 10,20. However, it would be conceivable to insert an insert 10 into the receptacle 6 adapted for this purpose and to fix a suture or to screw a further screw 3 into the 30 bone B via an insert 20. Fig. 20b shows the clavicle plate 1 of Fig. 20a, with bone B shown transparent for clarity. 2026205215   01 Jul 2026 Throughout this specification and claims which follow, unless the context requires otherwise, the word “comprise,” and variations such as “comprises” or “comprising,” will be understood to 5 imply the inclusion of a stated integer or group of integers or steps but not the exclusion of any other integer or group of integers. The reference in this specification to any prior publication (or 10 information derived from it), or to any matter which is known, is not, and should not be taken as an acknowledgment or admission or any form of suggestion that that prior publication (or information derived from it) or known matter forms part of the common general knowledge in the field of endeavour to which this 15 specification relates.

Claims

2026205215   01 Jul 2026Patent Claims1. Plate (1), in particular for the treatment of the clavicle (B), with at least one screw hole (7) for receiving a bone screw (3), wherein the plate (1) has at least one overhang-5        ing tab (5) at one end region.

2. Plate (1) according to claim 1, wherein the at least one tab (5) is connected to the plate (1) via at least one bendable bridge (4) and wherein the tab (5) has a receiving opening 10        for a bone screw (3).

3. Plate according to claim 1 or 2, wherein the at least one tab (5) is substantially annular in shape.15   4. Plate according to claim 2 or 3, wherein the bridge (4) hasa substantially rectangular cross-sectional profile.

5. Plate (1) according to any one of claims 2 - 4, wherein the bridge (4) can be bent only insignificantly in a direction 20        parallel to a longitudinal direction (L).

6. Plate (1) according to any one of claims 2 - 5, wherein the bridge (4) is bendable in a direction perpendicular to the longitudinal direction (L).

257. Plate (1) according to any one of claims 2 - 6, wherein the plate has, in the region of at least one screw hole (7), a greater plate thickness than in the region of the at least 30        one bendable bridge (4).

8. Plate (1) according to any one of claims 1 or 7, wherein the tab (5) is shaped such that an angle between a longitudinal2026205215   01 Jul 2026axis of the receiving opening for a bone screw (3) and a normal to the surface of the plate (1) is at most 150°, preferably at most 120°, particularly preferably at most 90°.

59. The plate (1) according to any preceding claims, wherein the at least one tab (5) is arranged such that a screw inserted into the tab (5) is substantially perpendicular to the longitudinal direction (L) of the plate (1) and parallel to10        the plate surface.

10. The plate (1) according to any preceding claim, wherein the plate (1) comprises at least two overhanging tabs (5) in the end region.1511. The plate (1) according to any preceding claim, wherein the at least one tab (5) is connected to the plate (1) by two or more bridges (4).20   12. The plate (1) according to any preceding claim, wherein theopening for the bone screw (3) of the at least one overhanging tab (5) is spaced apart from the at least one screw hole (7) of the plate along the longitudinal direction (L) of the plate (1).2513. The plate (1) according to claim 12, wherein the opening of the at least one overhanging tab (5) is arranged between at least one first screw hole of the plate and at least one second screw hole of the plate (1) in the longitudinal di-30        rection of the plate (1).

14. The plate (1) according to any preceding claim, wherein the plate (1) is at least partially curved, as viewed in a plan2026205215   01 Jul 2026view, and the at least one overhanging tab (5) is arrangedon a concave side of the plate.

15. The plate (1) according to any preceding claim, wherein the5        plate (1) is shaped and sized to be placed and fastened toa terminal region of a clavicle.

16. The plate (1) according to any preceding claim, wherein awidth of the plate, as viewed in a plan view, increases to-10        wards the end region.

17. Plate (1) according to any of the claims 1, 2, 7 or 8 for the treatment of a bone (B), in particular for the treatment of the clavicle (B), having at least one screw hole15 (7) for receiving a bone screw (3), further comprising a top side (O) and a bottom side (U), the bottom side (U) of the plate (1) being adapted in its shape to be in contact with a bone (B), the plate (1) having on its top side (O)at least one recess (2) which does not penetrate the plate20        (1) and which is adapted for temporarily receiving a tool(17).

18. Plate (1) according to claim 17, wherein the at least one recess (2) is located, with respect to the longitudinal di-25        rection (L) of the plate (1), between screw holes (7),preferably midway between screw holes (7).

19. A plate (1) according to any one of claims 17 or 18, wherein the at least one recess (2) is arranged on the plate sur-30        face in a transverse direction perpendicular to the longitudinal direction (L) substantially central to an outer boundary of the plate (1).2026205215   01 Jul 202620. A plate (1) according to any one of claims 17 to 19, wherein the recess (2) has a longitudinal axis and is shaped substantially rotationally symmetrical with respect to the longitudinal axis.5

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