Device for treating fracture

Abstract

The invention relates to a device for treating a fracture, in particular a fracture of the femoral neck, comprising a nail (1) which can be inserted into an intramedullary canal of a bone, in particular of a femoral shaft (2), where the nail (1) comprises a hole (3) aligned substantially transversely to a longitudinal axis (4) of the nail (1), where the device is provided with coupling means (in particular a bone screw (5)), the coupling device can be inserted into the hole (3) in such a way that the coupling device protrudes beyond both sides of the hole (3) and can be moved within the hole (3) along a transverse axis (21) in a lateral direction (6) and in a medial direction (7) opposite the lateral direction (6) and can be fixed in place at the end of a bone part, in particular a femoral head (8), especially, fixation in place is achieved through threads arranged on the connecting device. In order to achieve an adjustable ability to move the femoral head (8) relative to the femoral shaft, according to the invention an adjusting device is provided which can be fixed in place in different positions relative to the nail (1), in particular by means of threads in the adjusting device and in the nail (1), and wherein the adjusting device comprises a first stop surface (9), the first stop surface (9) limits the mobility of the coupling means in the lateral direction (6) when the coupling means and the adjusting means are provided on the staple (1), such that by changing the position of the adjusting means relative to the staple (1), the lateral end position to which the coupling means can be moved relative to the staple (1) in the lateral direction (6) can be changed. The invention also relates to a method of treating a fracture of the femoral neck, in which a nail (1) is introduced into the intramedullary canal of the femoral shaft (2) and then a coupling device is introduced into the nail (1), which coupling device is fixed in place in the femoral head (8).

Description

[0001] The present invention relates to a device for treating fractures, in particular a device for treating fractures of the proximal femur (e.g. fractures of the femoral neck), for example, the device comprises a nail capable of being inserted into the intramedullary canal of a bone (in particular the intramedullary canal of a femoral shaft), wherein the nail comprises a hole aligned substantially transversely to the longitudinal axis of the nail, wherein a connecting device (in particular a bone screw) is provided, the connecting device being insertable into the hole so that the connecting device protrudes beyond both sides of the hole and being capable of moving in the hole along the transverse axis in a lateral direction and in a medial direction opposite to the lateral direction, and the connecting device being fixable at the end of a bone portion (in particular a femoral head), in particular by being fixed by a thread provided on the connecting device.

[0002] The invention also relates to a method for treating fractures of the femoral neck, wherein a nail is introduced into the intramedullary canal of the femoral shaft and then a coupling device is introduced into the nail, which coupling device is fixed in place in the femoral head.

[0003] Devices and methods of the type mentioned at the outset are known in the prior art, in particular for treating fractures of the femoral neck.

[0004] The key to rapid healing therefore lies in a certain mobility between the femoral head and the femoral shaft, for which, for example, a device known from document US 8,172,841 B2 allows a certain mobility of the coupling device relative to the nail. According to the document, this mobility is achieved by a grub screw arranged at the distal end of the nail, which slides in a groove of the coupling device.

[0005] However, it has been shown that optimal recovery is not possible for all patients using this type of equipment.

[0006] The present invention solves this problem. The object of the invention is to provide a device of the type mentioned at the outset which can be better adapted to the needs of individual patients. Furthermore, a method of this type should be specified.

[0007] According to the present invention, the first object is achieved by the device described at the beginning of the article, in which an adjustment device is provided, which can be fixed in place at different positions relative to the nail, in particular, the fixation is achieved by the adjustment device and the thread in the nail, and the adjustment device includes a first stop surface, when the connecting device and the adjustment device are arranged on the nail, the first stop surface limits the ability of the connecting device to move in the lateral direction, so that by changing the position of the adjustment device relative to the nail, the lateral end position to which the connecting device can move in the lateral direction relative to the nail can be changed.

[0008] In the course of the invention it was found that the same mobility of the coupling device relative to the nail, or the clearance between the coupling device and the nail in the lateral direction, is not equally beneficial for all patients, but rather different amplitudes of the coupling device relative to the nail can be advantageous depending on the patient's specific parameters, in particular such as height, weight, bone density, fracture type, etc. According to the invention, this adaptability of the mobility or the clearance, which promotes healing, is achieved in a particularly structurally simple manner by means of an adjustment device, which can be fixed in place at different positions relative to the nail, which restricts the mobility of the coupling device in the lateral direction in a form-fitting manner by means of a first stop surface.

[0009] Coupling device can be connected to femoral head by the threaded connection that is arranged on end usually, and for this purpose, coupling device is embodied as bone screw usually.Yet coupling device can also adopt any other suitable mode to implement, so that can be connected to bone part, bone part such as femoral head.

[0010] Furthermore, it will be appreciated that the device according to the invention may also be used to treat fractures other than fractures of the femoral neck, and in particular may also be used to treat fractures of the proximal femur region.

[0011] The transverse axis is typically generally transverse to the longitudinal axis of the nail, and typically forms an angle with the longitudinal axis of the nail that is the angle between the axis of the femoral neck and the axis of the femoral shaft, such as 110° to 140°.

[0012] The adjusting device can preferably be screwed into the nail, i.e. preferably away from the coupling device, and for example preferably at a slight angle to the transverse axis. Therefore, by changing the screw-in depth of the adjusting device (usually embodied as an adjusting screw), the clearance of the coupling device relative to the nail can be easily changed.

[0013] The first stop surface can be formed by only a single surface. However, it can also be provided that the first stop surface is formed by a plurality of stop surfaces acting in parallel, so that the movement capacity is limited in a particularly effective manner. For example, it has been shown that when only a single first stop surface is used, there is a risk that the adjusting device slides along the coupling device, so that the movement is less restricted than expected. In particular, it can be provided that the first stop surface is formed by two or three stops acting in parallel, for example a first stop, a second stop and a third stop. Thus, the first stop can be arranged, for example, at a lateral end of the adjusting device, the second stop can be arranged, for example, at the substantial center of the adjusting device, and the third stop can be arranged in the inner end region of the adjusting device.

[0014] It may be advantageous if the first stop surface is at least partially formed by a shoulder or a collar in the region of a lateral end of the adjusting device, in particular by an adjusting screw collar. The collar may be embodied as an adjusting screw collar and may be positioned at a lateral end of the adjusting screw, for example in order to abut against the coupling device at a predetermined relative position of the coupling device and the adjusting device and thus prevent further movement of the coupling device relative to the adjusting device in a lateral direction.

[0015] Preferably, the first stop surface is at least partially formed by a portion of a thread of the adjusting device, which can be fixed in place relative to the nail using the thread. In particular, the inner end of the thread can be used as a stop for the corresponding surface of the coupling device to limit the movement of the coupling device in the lateral direction.

[0016] The first stop surface is at least partially formed by a portion of the thread of the coupling device, with which the coupling device can be fixed in place at the end of the bone part, which has proven effective. Thus, the thread of the coupling device can be used as a stop, for example, the lateral end of the thread abuts against the adjustment device at a predetermined relative position of the adjustment device and the coupling device, thereby limiting further movement of the coupling device in the lateral direction.

[0017] The adjusting device is preferably connected to the nail by a thread, wherein a thread lock that increases the friction in the thread is provided, thereby preventing the adjusting device from loosening, and the thread lock is particularly a plastic part. Thus, accidental loosening of the adjusting device can be prevented in a simple manner.

[0018] In order to easily prevent errors during the insertion of the device due to over-screwing, the adjustment device can preferably only be screwed into the nail to a predetermined position, wherein this is structurally achieved in particular with a wrench, which is preferably a hexagonal wrench, which no longer comes into any contact with the corresponding counterpart in the adjustment device, in particular the hexagonal groove, starting from the predetermined position of the adjustment device.

[0019] It may be advantageous if the adjustment device comprises a second stop surface which limits the ability of the coupling device to move in the medial direction when the coupling device and the adjustment device are arranged on the nail.

[0020] Furthermore, it can be arranged that the adjustment device is angled with the coupling device so that an inclined surface appears, which defines the mobility of the coupling device by this angle. Thus, the mobility of the coupling device in the transverse direction relative to the nail can be structurally changed by the angle between the adjustment device and the coupling device, and the mobility of the coupling device in the transverse direction relative to the nail can be structurally changed by the position of the adjustment device relative to the nail or the screw-in depth while the operation is still in progress. The angle is, for example, 0.8° to 2°.

[0021] Alternatively, it can of course also be provided that the medial end position of the coupling device relative to the nail is formed by a stop on the nail, which prevents the coupling device from moving further in the medial direction starting from a certain position. To this end, a hoop or a shoulder can be provided, for example, at the lateral end of the coupling device extending laterally from the nail, which hoop or shoulder is larger than the diameter of the hole in the nail through which the coupling device is guided through the nail, so that starting from a predetermined position, the lateral hoop or lateral shoulder abuts against the nail, thereby forming a stop to prevent the coupling device from moving further in the medial direction.

[0022] The position of the adjusting device relative to the nail is preferably arranged to be changeable along the adjusting direction, in particular along a straight line. This can be achieved in a simple manner, in particular when the adjusting device is implemented as having an external thread and the nail is implemented as having a corresponding internal thread, wherein the axis extends along the adjusting direction.

[0023] The first stop surface and the second stop surface are preferably arranged to align the adjustment direction at different angles, so that when the position of the adjustment device relative to the nail changes, the amplitude of the lateral end position that can change is greater than the amplitude of the medial end position that can change. Therefore, by changing the position of the adjustment device relative to the nail, not only the position of the gap of the connecting device relative to the nail can be changed, but also the size of the gap can be changed. The position of the second stop surface can also be arranged not to change with the position of the adjustment device. This is particularly applicable when the adjustment device is implemented as an adjustment screw when the second stop surface is composed of a cylindrical envelope surface of the adjustment device. In this case, only the size of the gap and the position of the first stop surface change with the position of the adjustment device or the screw-in depth of the adjustment screw.

[0024] Particularly preferably, the position of the adjustment device relative to the nail can be changed along an adjustment direction, wherein the adjustment direction forms an angle of 0.1° to 15°, in particular 0.8° to 2° with the transverse direction, wherein the adjustment direction and the transverse direction are preferably located in the same plane.

[0025] In this way, a design is achieved in a particularly structurally simple manner, in which a change in the position of the adjusting device relative to the pin has different effects on the position of the first stop surface on the one hand and on the position of the second stop surface on the other hand. Thus, the first stop surface can be formed, for example, by a surface of the adjusting device substantially perpendicular to the adjustment direction, in particular by a thread flank of the adjusting device in the form of an adjusting screw, while the second stop surface can be formed, for example, by a cylindrical surface extending rotationally symmetrically to the adjustment direction, in particular by a conical or cylindrical surface extending concentrically to the adjustment direction, or by an outer surface of the adjusting device in the form of an adjusting screw. When the angle between the adjustment direction and the transverse direction is correspondingly small, a change in the position of the adjusting device in the adjustment direction has approximately the same effect on the position of the first stop surface, while having little or no effect on the position of the second stop surface.

[0026] For example, in a case where the second stop surface is formed by a cylindrical surface of an adjusting device that is concentric with the adjusting direction, the adjusting direction is angled with the transverse direction, and a groove corresponding to the adjusting device is arranged in the connecting device at a corresponding angle, the position of the second stop surface is limited only by the angle, but, unlike the first stop surface, the position of the second stop surface does not change when the screw-in depth of the adjusting device changes, wherein the first stop surface is formed by a surface or a threaded side of the adjusting device, which can be implemented as an adjusting screw.

[0027] The adjusting device is usually implemented with a length greater than the length of the hole, so that the adjusting device can be connected to the nail at a position protruding beyond both sides of the hole, wherein the first stop surface is arranged on the inner side of the nail. The adjusting device usually extends through the entire hole, for example at the opening of the hole. The opening can also coincide with the hole, through which the adjusting device protrudes through the nail, and through which the coupling device protrudes through the nail. Therefore, the corresponding hole can be implemented with a thread for the adjusting device at the distal region.

[0028] The coupling device and the adjustment device are usually embodied in a substantially elongated shape, preferably in a substantially cylindrical shape, in particular since the corresponding hole in the femoral head also generally has a cylindrical cross section.

[0029] It is advantageous if the coupling device comprises a groove interacting with the adjusting device and extending along the coupling device, so that when the coupling device and the adjusting device are connected to the nail, the adjusting device limits the rotation of the coupling device about the transverse axis, preferably prevents the rotation of the coupling device about the transverse axis. This is particularly advantageous because during the fracture healing of the femoral neck, the femoral neck is usually subjected to certain stresses and torsional loads usually act on the femoral neck, which loads may cause the coupling device to rotate undesirably relative to the nail. If a corresponding groove is provided, which interacts with the adjusting device, so that the adjusting device engages in the groove, thereby preventing the coupling device from rotating relative to the nail, such a rotation about the transverse axis can be effectively prevented.

[0030] In order to achieve a simple structure on the one hand and a particularly good contact between the adjusting device and the coupling device on the other hand, it is advantageous if the hole is designed to receive the coupling device in the proximal region and the adjusting device in the distal region. It should be understood that in this case, the expressions distal, proximal, lateral and medial refer to the intended arrangement of the device on the human bone (usually the femur), respectively. If used as intended, the adjusting device is arranged below or at the distal end of the coupling device.

[0031] It is advantageous if the coupling device comprises a through hole protruding from the lateral end to the medial end, into which a Kirschner wire can be inserted. Thus, the coupling device can be introduced into the femoral neck in a particularly precise manner, wherein initially only one hole with a small diameter is introduced into the femoral neck, then the Kirschner wire is introduced into the hole with the small diameter, and subsequently the Kirschner wire is introduced as a guide into a hole with a larger diameter that substantially corresponds to the diameter of the coupling device, wherein the Kirschner wire serves as a guide for the larger drill bit, after which the larger drill bit is removed and the coupling device is introduced into the femoral neck again by means of the Kirschner wire as a guide.

[0032] It is particularly advantageous if a hollow introduction device is provided, which can be connected to the nail instead of the adjustment device, in particular can be inserted into the hole of the nail instead of the adjustment device, so that when the bone nail is arranged in the femoral shaft and the introduction device is connected to the nail, bone cement or other reinforcing materials can be introduced into the area of ​​the femoral head through the hollow introduction device. Usually, the bone cement or other reinforcing materials are introduced through a sleeve, which is detachably and temporarily introduced into the sleeve of the introduction device, and the sleeve can be implemented as a through hole passing through the introduction device. Usually, the device also includes a sleeve of this type, which corresponds to the hollow introduction device.

[0033] Of course, in addition to temporarily introducing a sleeve into the introduction device so as to introduce bone cement or other reinforcing materials into the first bone hole through the introduction device, the introduction device itself can also be implemented as a sleeve, so that the bone cement or other reinforcing materials are directly introduced into the first bone hole through the hole in the introduction device, and an additional separate sleeve is omitted.

[0034] It should be understood that in addition to bone cement, any other suitable reinforcing material may also be used. Therefore, for the purpose of this application, the term bone cement also includes other suitable materials.

[0035] Therefore, such a method can be realized, wherein, coupling device is introduced into femoral neck in two stages, that is, first only reach the end position of distance in femoral neck such as 20mm to 40mm, particularly about 30mm position, then by hollow introduction device (usually using sleeve tube), bone cement is introduced into the end area of ​​femoral neck, then coupling device is moved to the end position in femoral neck, thereby move the bone cement positioned at the end position, make bone cement be distributed in bone.This is particularly advantageous for the patient suffering from late stage osteoporosis, because bone cement can be distributed in porous bone, thereby stabilizing bone.Particularly preferably, only when coupling device is introduced into femoral neck completely until the end position, and usually also only when bone cement is completely solidified, just remove kirschner wire again.Thus, reliably prevent bone cement from being advanced into joint capsule, and bone cement is not allowed to be advanced into joint capsule under any circumstances. However, if the K-wire is removed prematurely (particularly because of the risk of puncturing the femoral head during its introduction into the femoral head), a full-length opening through the joint capsule may be created. In other words, the K-wire may thus effectively close a possible opening into the joint capsule during the introduction of bone cement, thereby preventing unintended penetration of bone cement into the joint capsule.

[0036] Preferably, the coupling device includes a thread at its end, by means of which the coupling device can be fixed in place on the femoral head. In order for the coupling device to interact with the adjusting device, the coupling device generally also includes a contact surface corresponding to the adjusting device, which contact surface can also be implemented as a groove at the same time to prevent the rotation caused by the adjusting device. The corresponding contact surface must generally be arranged on a side of the adjusting device arranged relative to the coupling device, generally arranged at the distal end. However, in order to ensure that the possible screw-in depth has a high variability, at least two corresponding contact surfaces distributed on the circumference of the coupling device are preferably provided. For example, when the pitch is 3.2mm, the coupling device can not only be introduced into the femoral head with a step-in depth of 3.2mm, but can also have two contact surfaces arranged to be evenly distributed on the circumference, for example, the femoral head is introduced with a step-in depth of 1.6mm.

[0037] The adjusting device generally comprises a substantially cylindrical or conical outer profile with a thread, wherein the adjusting device can be screwed into the nail by a thread at a position generally located at the distal end relative to the coupling device. The length of the adjusting device is generally greater than the length of the opening in the nail, and the adjusting device is guided through the nail by this opening so that the adjusting device generally protrudes beyond the two sides of the nail. The adjusting device can also be arranged to be almost as long as the coupling device, so that the adjusting device can extend into the region of the femoral head from the lateral side of the nail like this. Thus, the coupling device can be stabilized, and the rotation of the coupling device around the transverse axis and the rotation of the femoral head fragment around the coupling device can be effectively prevented.

[0038] According to the invention, another object is achieved by a method of the type described at the outset, wherein an adjustment device is connected to the nail, which adjustment device limits the ability of the coupling device to move relative to the nail along a transverse axis. Typically, the device according to the invention is used in a method of this type. The transverse axis is typically substantially transverse to the longitudinal axis of the nail, typically at an angle to the longitudinal axis of the nail, the angle being the angle between the axis of the femoral neck and the axis of the femoral shaft, for example an angle of 110° to 140°.

[0039] It is advantageous if first a first Kirschner wire is introduced into the femoral neck along the transverse axis up to the femoral head, the diameter of the first Kirschner wire being smaller than the diameter of the coupling device, then a first bone hole for the coupling device is introduced into the femoral neck, wherein the first Kirschner wire serves as a guide, and the coupling device is subsequently introduced into the femoral neck via the nail. This ensures that the coupling device is introduced into the femoral neck particularly accurately, in particular because the diameter of the hole required for the Kirschner wire is very small, for example 1.5 mm, and such a hole can be introduced with high precision. Usually, the hole is introduced for this purpose via a Kirschner wire, so that the Kirschner wire is initially used as a drill and subsequently as a guide for a larger bone hole and the coupling device.

[0040] Typically, the K-wire also serves as a guide for introducing the coupling device into the femoral neck or femoral head.

[0041] Particularly preferably, once the coupling device is completely introduced into the femoral neck, the Kirschner wire is removed. Therefore, after the coupling device is finally positioned at the femoral neck, the Kirschner wire can only be removed in the transverse direction.

[0042] Particularly in the case of fractures in the base region of the femoral neck, it is advantageous to introduce a second K-wire into the femoral head in an axially offset manner in order to prevent a rotation of the femoral head during drilling or screwing in the coupling device.

[0043] Especially for osteoporosis patients, if initially only coupling device is introduced into the first bone hole until the middle position, then bone cement is introduced into the end area of ​​the first bone hole, then coupling device is fully introduced into the first bone hole, wherein the bone cement located at the end area is distributed in the femoral head, which can be advantageous. Finally coupling device is introduced into the end area to cause the distribution of bone cement, wherein coupling device is used as the plunger for distributing bone cement. Therefore, coupling device can be temporarily fixed to the end position before about 30mm in the first step, for example, bone cement is introduced thereafter, then coupling device is further moved 30mm along the medial direction, enters the final end position. After the bone cement solidifies, the Kirschner wire can be taken out. If the femoral head is pierced in the process of inserting the Kirschner wire into the femoral head, because the Kirschner wire is located in the femoral head, therefore in the bone cement solidification process, this just prevents the bone cement from entering the joint capsule from the femoral head by the through opening that may be produced unintentionally.

[0044] Particularly preferably, the bone cement is introduced into the end region of the first bone hole by means of a hollow introduction device, the introduction device is guided through the nail through the opening, the adjustment device can be guided through the nail through the opening, and after the introduction of the bone cement, the introduction device is removed from the nail and the adjustment device is subsequently inserted into the opening, in particular screwed into the opening. As described above, the opening can coincide with the hole, so that in the case of a hole that is embodied as an elongated hole, the coupling device is arranged in the upper part or proximal region of the hole, and the adjustment device is arranged in the lower part or distal region of the hole.

[0045] In order to introduce the adjustment device, which can also extend into the area of ​​the femoral head, a second bone hole is usually introduced into the femoral neck, usually also from the lateral side of the femur. For this purpose, preferably at the distal end of the area where the coupling device can be connected to the nail, a second Kirschner wire is introduced, in particular at an angle of 0.1° to 15° to the first Kirschner wire, in particular at an angle of 0.8° to 2°, and then the second bone hole is introduced into the femoral neck, wherein the second Kirschner wire serves as a guide, and then the second Kirschner wire is removed and the adjustment device is then introduced into the second bone hole, the adjustment device protruding beyond the sides of the nail.

[0046] Additional features, advantages and effects of the present invention are derived from the following exemplary embodiments. In the referenced drawings:

[0047] Figures 1 to 3 shows a cross-sectional view of the device according to the invention and different operating states;

[0048] Figures 4 to 6 shows a detailed view of a further device according to the invention;

[0049] Figures 7 to 14 The different process steps for carrying out the method of the present invention are shown;

[0050] Fig.15 A further device according to the invention is shown;

[0051] Figures 16 to 26 Different process steps in a further method according to the invention are shown;

[0052] Figure 27 to Figure 29 A detailed view of the device according to the invention is shown in schematic form;

[0053] Fig.30 and Fig.31 A detailed view of a further device according to the invention is shown.

[0054] Figures 1 to 3 The device according to the invention is shown in different working conditions. The device comprises a bone nail, which is only partially shown, which can be arranged along a longitudinal axis 4 in the intramedullary canal of the femur, which starts at the upper end or the proximal end of the femur. In addition, the device comprises a coupling device, which is embodied here as a bone screw 5, which is arranged in the hole 3 of the nail 1 in order to connect the femoral shaft 2 to the femoral head 8 that has been broken. For this purpose, a thread is provided at the medial end 14 of the bone screw 5, which thread can be screwed into the femoral head 8. Thereby, the hole 3 and the bone screw 5 are aligned so that the bone screw 5 can be connected to the nail 1 along a transverse axis 21, which is aligned transversely to the longitudinal axis 4 of the nail 1, and which is generally at an angle of about 130° to the longitudinal axis 4 of the nail 1, so that the transverse axis 21 extends approximately along the femoral neck and the nail 1 extends substantially along the femoral shaft 2.

[0055] The bone screw 5 is not screwed together with the nail 1, but is connected to the nail 1 in a manner that it can move along the transverse axis 21, so that particularly good healing can be achieved. In addition, an adjustment device is provided in the device according to the invention, which is implemented as an adjustment screw 20 in this case, which can be screwed together with the nail 1 (that is, screwed together in an opening), which is arranged in this case in the lower area of ​​the hole 3 through which the bone screw 5 passes through the nail 1.

[0056] Here, the adjusting screw 20 limits the mobility of the bone screw 5 relative to the nail 1, depending on the screw-in depth. For this purpose, on the one hand, a first stop surface 9 is provided, which limits the mobility of the bone screw 5 in the lateral direction 6. The first stop surface 9 on the adjusting screw 20 thus forms a lateral end position of the bone screw 5 and is oriented essentially perpendicularly to the axis or adjustment direction 11 of the adjusting screw 20. The first stop surface 9 on the adjusting screw 20 can be formed, for example, by a thread flank.

[0057] Furthermore, a second stop surface 10 is provided on the adjustment screw 20, which limits the mobility of the bone screw 5 in the medial direction 7. The second stop surface 10 is arranged on the circumferential surface of the adjustment screw 20, so that the second stop surface 10 is oriented substantially perpendicular to the first stop surface 9 and substantially coaxially with the adjustment direction 11. The second stop surface 10 is formed by an angle α of about 1.2° between the adjustment direction 11 and the transverse direction.

[0058] exist Figure 1 , the position of the adjusting screw 20 is shown, wherein the adjusting screw 20 is completely screwed into the nail 1 so that the bone screw 5 cannot move relative to the nail 1, but the bone screw 5 abuts against both the first stop surface 9 and the second stop surface 10 on the adjusting screw 20.

[0059] Figure 2 and Figure 3 A further working position is shown, in which, compared to Figure 1 ,exist Figure 2 The central adjustment screw 20 has been slightly unscrewed from the nail 1 in the lateral direction 6 , so that the bone screw 5 has a mobility or clearance 17 relative to the adjustment screw 20 or relative to the nail 1 in the lateral direction 6 and in the opposite medial direction 7 .

[0060] Figure 3 A further working position is shown, in which, compared to Figure 2 , the adjusting screw 20 has been further screwed out of the nail 1 in the lateral direction 6, so that the gap 17 of the bone screw 5 is larger than Figure 2 The gap is larger in the working position shown.

[0061] The mobility of the bone screw 5 relative to the bone nail is thus limited in the lateral direction 6 by the adjustment screw 20 using a first stop surface 9, which in this case is arranged at the medial end 14 of the adjustment screw 20. The second stop surface 10 on the adjustment screw 20 is formed by the substantially cylindrical outer surface of the adjustment screw 20 and serves to limit the mobility of the bone screw 5 in the medial direction 7 of the transverse axis 21. This is due to the fact that the adjustment axis of the adjustment screw 20 is at an angle α to the transverse axis 21, so that a movement of the adjustment screw 20 in the adjustment direction 11 has a different effect on the position of the first contact surface and the second contact surface. Thus, with the movement of the adjustment screw 20 in the adjustment direction 11, not only the position of the stop surface is moved, but also the gap 17 of the bone screw 5 relative to the nail 1 and relative to the adjustment screw 20 is changed. Thus, the angles and dimensions of the bone screw and the adjustment screw can also be selected so that the position of the second stop surface or the medial end of the bone screw relative to the nail does not change due to a change in the position of the adjustment screw, but rather a change in the screw-in depth only affects the position of the first stop surface.

[0062] Figures 4 to 6 A further exemplary embodiment of a coupling device and an adjusting device of the device according to the invention is shown. Here, too, the coupling device is embodied as a bone screw 5 with an inner thread, and the adjusting device is embodied as an adjusting screw 20, respectively. In particular Figure 4 In the figure, a groove 12 corresponding to the first and second contact surface of the adjusting screw 20 can also be seen on the bone screw 5 in the longitudinal direction, which groove 12 on the one hand provides a contact surface corresponding to the first and second contact surface on the bone screw 5 and on the other hand prevents the bone screw 5 from rotating about the transverse axis 21 when the adjusting screw 20 is arranged in the region of this contact surface. To this end, the groove 12 corresponds to the adjusting screw 20 and is preferably approximately parallel to the adjustment direction 11 in the working position. Therefore, the groove 12 usually forms an angle α of, for example, 1.2° with the transverse direction 21.

[0063] The corresponding groove 12 generally comprises a surface corresponding to the first stop surface 9 and the second stop surface 10, and the groove 12 may be arranged at only one place on the bone screw 5, generally approximately along the axis or transverse axis 21 of the bone screw 5. However, preferably, the groove 12 is arranged at multiple places (at least two places), so that the groove 12 is distributed on the circumference of the bone screw 5, such as Figure 5 and Figure 6 As shown, in particular, because there are thus multiple possibilities for screwing the bone screw 5 into the nail 1. Thus, for example, for a thread pitch of 3.2 mm, a screw-in depth of 1.6 mm can be achieved if the corresponding grooves 12 are arranged in two relative positions distributed on the circumference, in particular because one of the grooves 12 is advantageously arranged in the working position at a position corresponding to the adjusting screw 20.

[0064] like Figure 5 and Figure 6 As shown, the transverse axis 21 and the adjustment axis are at an angle α to each other, thereby forming an inclined surface, which has the result that a movement of the adjustment device 20 in the adjustment direction 11 has a different effect on the first stop surface 9 and the second stop surface 10 respectively.

[0065] like Figure 5 and Figure 6 As shown, the adjusting screw 20 may also be implemented as a long screw extending into the region of the femoral head 8 to effectively prevent the femoral head 8 from rotating around the bone screw 5 when subjected to stress.

[0066] like Figures 4 to 6 According to these embodiments, the bone screw 5 comprises a hoop 18 at the lateral end 13, respectively, which can serve as a stop and can define the medial end position of the bone screw 5 by interaction with the adjustment screw 20 and / or the nail 1. However, this hoop 18 can also be omitted, in particular because the medial migration can also be defined by the interaction of the bone screw 5 and the adjustment screw 20.

[0067] Figures 7 to 14 The different steps of the method for treating femoral fracture according to the present invention are shown. Figure 7 and Figure 8 As shown, a small diameter drill is first used to introduce a Kirschner wire hole into the femoral neck 22, and then the Kirschner wire 15 is placed in the hole. For this purpose, the Kirschner wire itself is usually implemented as a drill, so that the Kirschner wire can be used to introduce the Kirschner wire hole, and then the Kirschner wire 15 remains in the bone. The Kirschner wire 15 is then used to guide a drill with a larger diameter so that a first bone hole 23 for the coupling device (also implemented as a bone screw 5 in this case) and a second bone hole 24 for the adjustment device (also implemented as an adjustment screw 20 in this case) can be introduced in a precise manner.

[0068] Figure 7 The first K-wire is shown after its introduction. Figure 8 The figure shows the situation where the second K-wire 15 has been completely introduced. Fig. 9 A method step is shown in which a first bone hole 23 for a bone screw 5 is introduced into the femoral neck 22, wherein the drill is designed to be cannulated and is guided by a corresponding K-wire 15. Additional positioning aids can also be provided for this purpose, for example by means of X-rays or the like.

[0069] Fig.10 The first bone hole 23 is shown to have been formed, but the second bone hole 24 has not yet been formed. It can be seen that even after the first bone hole 23 is drilled, the Kirschner wire 15 still remains in the first bone hole 23.

[0070] Fig.11A method step is shown in which a second bone hole 24 is drilled again using the K-wire 15 as a guide.

[0071] In addition to using the K-wire 15 as a guide, the second bone hole 24 may be introduced using a solid drill bit instead of using the K-wire 15 (ie, without using a guide).

[0072] Fig.12 A method step is shown, in which the second bone hole 24 has also been completed and the bone screw 5 is introduced into the first bone hole 23, i.e. also via the Kirschner wire 15, wherein the Kirschner wire 15 serves as a guide for the bone screw 5. For this purpose, the bone screw 5 comprises a central through hole 19 extending from the medial end 14 to the lateral end 13. Therefore, the Kirschner wire 15 can only be removed after the bone screw 5 has been completely introduced into the first bone hole 23. Then, the second Kirschner wire 15 is also removed, as shown in FIG. Fig.13 shown.

[0073] Finally, the adjusting screw 20 is introduced, as Fig.14 The movement capability of the bone screw 5 relative to the nail 1 can be influenced by the position of the adjustment screw 20 along the adjustment direction 11 , which can be changed by the threads on the adjustment screw 20 and the nail 1 .

[0074] Fig.15 An alternative embodiment is shown in which a long adjustment screw 20 is provided that protrudes into the region of the femoral head 8. In this type of embodiment, rotation of the femoral head 8 around the bone screw 5 can be effectively prevented. Thus, the adjustment screw 20 also serves as an anti-rotation mechanism of the femoral head 8 relative to the femoral shaft 2.

[0075] Figures 16 to 26 Another method of treating a femoral fracture according to the invention is shown, in which bone cement 26 is also introduced into the femoral head 8 .

[0076] like Fig.16 and Fig.17 As shown, for this purpose, a first bone hole 23 is again introduced into the femoral neck 22, wherein in this case, a K-wire 15 is again previously introduced, which then serves as a guide for a larger drill.

[0077] The method described here relates to the treatment of femoral fractures in osteoporotic patients, for which bone cement 26 is injected before the bone screw 5 and the adjusting screw 20 are finally introduced into the end region of the femoral head 8. For this purpose, a method as shown in FIG. Figures 18 to 23The introduction device 16 is shown. The introduction device 16 is introduced into the femoral neck 22 through the opening of the nail 1 and into the second bone hole 24, through which the adjustment screw 20 can be introduced alternatively and subsequently through the nail 1. In this case, the opening is also part of the hole 3 through which the bone screw 5 is guided through the nail 1.

[0078] Thus, the introduction device 16 shown comprises, at least in the region where the device contacts the nail 1, an outer contour corresponding to the adjustment screw 20, but without a thread, although of course it could also be designed with a thread. Furthermore, the introduction device 16 is hollow, so that once the device is positioned below the bone screw 5, the bone cement 26 can be introduced into the end region of the first bone hole 23 through the hollow portion by means of the cannula 25. For this purpose, the bone screw 5 is not initially introduced completely into the first bone hole 23, but rather as Figures 19 to 22 As shown, the bone screw 5 is only introduced to the introduction position, which is, for example, 30 mm from the end position. Fig.23 This end position is only reached during the method steps shown.

[0079] When bone screw 5 is kept Figures 19 to 22 In the illustrated introduction position, the bone cement 26 is introduced into the end region of the first bone hole 23 or into the region of the femoral head 8 via a cannula 25 inserted into the introduction device 16 .

[0080] As an alternative to temporarily inserting the cannula 25 into the introduction device 16 , the introduction device 16 itself can also be embodied as a cannula 25 .

[0081] exist Fig. 20 In FIG. 2 , the sleeve 25 is introduced into the sleeve of the insertion device 16 which is designed as a hole, and in FIG. Fig.21 FIG. 8 shows bone cement 26 being introduced into the femoral head 8 through the cannula 25 . Fig. 22 Removal of the cannula 25 is shown with the introducing device 16 still retained in the second bone hole 24 .

[0082] Subsequently (i.e., before the bone cement 26 solidifies), the bone screw 5 is completely screwed into the end position in the first bone hole 23, wherein the bone cement 26 located at the end position and not yet solidified is distributed in the femoral head 8, as shown in FIG. Fig.23 shown.

[0083] Then, if Fig.24 As shown, the introducing device 16 is removed from the second bone hole 24 and the hole 3 of the nail 1 .

[0084] like Fig.25As shown, the adjusting screw 20 is then screwed into the nail 1, and the adjusting screw 20 is located distally or below the bone screw 5. Finally, once the bone cement 26 solidifies, the Kirschner wire 15 is removed from the bone screw 5, wherein the Kirschner wire 15 guides the bone screw 5 during the introduction process. Fig.26 This position is shown, which indicates that the device for treating fractures has been fully introduced. The adjustment screw 20 shown extends into the region of the femoral head 8, so that the screw can not only set the gap 17 of the bone screw 5 and prevent the bone screw 5 from rotating about the transverse axis 21, but also inhibit the femoral head 8 from rotating about the transverse axis 21, thereby preventing the threaded connection between the femoral head 8 and the bone screw 5 from loosening.

[0085] By removing the Kirschner wire 15 from the first bone hole 23 only after the bone cement 26 has solidified, when the femoral head 8 is accidentally punctured during the introduction of the Kirschner wire 15, the liquid bone cement 26 can be effectively prevented from penetrating into the joint capsule before solidification, especially because the Kirschner wire 15 seals the opening that may be accidentally created in the femoral head 8.

[0086] In this embodiment, a collar 18 may also be provided at the lateral end 13 of the bone screw 5 in order to define the medial end position by form-fitting with the nail 1 and / or the adjustment screw 20 or the stopper.

[0087] The device according to the invention is particularly effective in treating femoral fractures, particularly because the mobility of the bone screw 5 relative to the nail 1 and thus the mobility of the femoral head 8 relative to the femoral shaft can be easily varied while the operation is still in progress, so that the mobility can be particularly well adapted to the individual patient.

[0088] Figure 27 to Figure 29 The interaction of the bone screw 5 and the adjusting screw 20 in an embodiment of the device according to the invention is schematically shown, which interaction is similar to Figures 1 to 3 , but the interaction of the first contact surface, the second contact surface and the recess 12 is shown in detail here. Here, in order to visualize the interaction particularly well, a variant is also shown, which has an angle α of about 3°, a recess 12 extending almost to the transverse axis 21, and a nail 1 with a very small diameter compared to the bone screw 5 and the adjustment screw 20, while in actual devices, the angle α is usually less than 2°, the recess 12 is also less protruding, and the diameters of the nail 1, the bone screw 5 and the adjustment screw 20 can also be the same. Figure 27 to Figure 29 The differences shown in Figures 1 to 26 shown.

[0089] It can be seen that the recess 12 in the bone screw 5 corresponds to the adjusting screw 20 , ie not only in terms of size but also in terms of the angle α that the recess 12 and the adjusting screw 20 form with the transverse axis 21 .

[0090] If in this case the adjusting screw 20 is formed by a body which is essentially cylindrical in the region of the recess 12 and the recess 12 is embodied accordingly, the cylindrical envelope surface of the adjusting screw 20 which is rotationally symmetrical to the adjustment axis forms the second stop surface 10 which interacts with the corresponding surface of the recess 12, i.e. the interaction starts from the screwing-in depth of the adjusting screw 20 in the nail 1, at which the adjusting screw 20 contacts the bone screw 5. This second contact surface thus defines the medial end position of the bone screw 5, starting from which further movement of the bone screw 5 in the medial direction 7 (parallel to the transverse axis 21) relative to the nail 1 is no longer possible, i.e. the bone screw 5 cannot be moved any more, regardless of whether further movement of the adjusting screw 20 in the adjustment direction 11 occurs. In other words, starting from the contact of the adjusting screw 20 with the bone screw 5, the position of the second stop surface 10 no longer changes. Therefore, in this exemplary embodiment, the medial end position of the bone screw 5 is fixed from the time when the adjusting screw 20 comes into contact with the bone screw 5, and this medial end position does not change with the screwing depth of the adjusting screw 20, wherein if the screwing depth changes, the adjusting screw 20 moves in the adjustment direction 11. Therefore, in this exemplary embodiment, the position of the second stop surface 10 is structurally fixed by the dimensions of the adjusting screw 20 and the bone screw 5 and the angle α between the bone screw 5 and the adjusting screw 20.

[0091] However, unlike the second stop surface 10, the position of the first stop surface 9 can be directly changed by changing the screw-in depth of the adjustment screw 20. The first stop surface 9 defines the lateral end position of the bone screw 5, i.e., starting from this lateral end position, the bone screw 5 can no longer be moved further in the lateral direction 6 relative to the nail 1. In this case, the first stop surface 9 is formed by a surface of the adjustment screw 20 that is substantially perpendicular to the adjustment axis. Of course, the first stop surface 9 can also be formed alternatively by a different surface of the adjustment screw 20, the position of which is changed by changing the screw-in depth relative to a corresponding surface of the groove 1, in particular a corresponding surface with a screw side.

[0092] Fig. 27 Shown with Figure 1 , where the screwing depth of the adjustment screw 20 is maximum, so that the bone screw 5 abuts against the first stop surface 9 and the second stop surface 10 at the same time, and there is no gap 17; therefore, the bone screw 5 cannot move relative to the nail 1.

[0093] Fig.28 Shown with Figure 2 Or a position similar to the position shown in Figure 3, in which the adjusting screw 20 has been slightly screwed out laterally from the nail 1; therefore, the screwing depth is less than Fig. 27The position of bone screw 5 is shown in Fig. 27 Since, as described above, the position of the second stop surface 10 does not change with the screw-in depth in this case, the bone screw 5 still abuts against the second stop surface 10 and is therefore still in the medial end position, in which the bone screw 5 cannot be moved further in the medial direction 7. However, the first stop surface 9 no longer abuts against the bone screw 5, so that the bone screw 5 can be moved in the lateral direction along the transverse axis 21 relative to the nail 1. Therefore, as shown in the figure, Fig.28 A gap 17 is created between the medial end position where the bone screw 5 is located and the lateral end position to which the bone screw 5 can be moved.

[0094] Fig.29 Shows Fig. 27 and Fig.28 The device in the Fig.28 However, compared with Fig.28 In contrast, the bone screw 5 is now in a lateral end position and therefore abuts against the first stop surface 9 on the adjustment screw 20, but no longer against the second stop surface 10. Therefore, starting from this position, the bone screw 5 can only be moved in the medial direction 7 relative to the nail 1, but cannot be moved further in the lateral direction 6.

[0095] Therefore, the change of the screw-in depth here acts on the position change of the first stop surface 9 with the cosine of the angle α (for a smaller angle α, the change of the screw-in depth and the position change of the first stop surface 9 are close to a 1:1 relationship), but does not act on the position change of the second stop surface 10. Therefore, the size change of the gap 17 is also almost in a 1:1 relationship with the screw-in depth.

[0096] Fig.30 and Fig.31 A detailed view of a further exemplary embodiment of a device according to the invention is shown. The device comprises a first contact surface 9 formed by three parallel-acting stops, namely a first stop 9a at the lateral end 13 of the adjustment device (here also formed by the adjustment screw 20), a second stop 9b at the medial end 14 of the thread of the adjustment screw 20, by which the adjustment screw 20 is screwed into the nail 1, and a third stop 9c at the medial end 14 of the adjustment screw 20. At the third stop 9c, the medial end 14 of the adjustment screw 20 interacts with the thread pitch of the bone screw 5. By the parallel action of the three stops 9a, 9b, 9c, an unintentional sliding of the adjustment screw 20 along the bone screw 5 can be prevented in a simple manner, so that the mobility is reliably limited.

[0097] In addition, a screw lock is provided in this exemplary embodiment, which is formed by a plastic piece 27 within the thread pitch of the nail 1. The plastic piece 27 increases the friction between the thread of the adjustment screw 20 and the nail 1, thereby preventing the adjustment screw 20 from accidentally loosening.

[0098] Here, the adjusting screw 20 comprises a hexagonal slot 29 at the lateral end 13 and can be actuated using a hexagonal wrench (not shown). In order to prevent the adjusting screw 20 from being screwed in too deeply by accident, the hexagonal wrench is designed to be guided only to a predetermined position along the adjusting screw 20 in the medial direction 7 relative to the bone screw 5. For this purpose, a stopper can be provided on the hexagonal wrench and / or the bone screw 5, for example. Thus, starting from a predetermined screwing-in depth of the adjusting screw 20, the hexagonal wrench loses contact with the adjusting screw 20 or slips out of the hexagonal slot 29 and cannot be screwed in further. In this way, the adjusting screw 20 is prevented from being screwed in too deeply by accident with a structurally simple design.

[0099] Fig.31 The first stop is shown in detail. It can be seen that the adjustment screw 20 comprises, at the lateral end, a hoop formed by an adjustment screw hoop 28, which, starting from a predetermined relative position of the adjustment screw 20 and the bone screw 5, abuts against the bone screw 5, thereby preventing the bone screw 5 from moving further in the lateral direction 6 relative to the adjustment screw 20, so that the first stop acts in parallel with the second stop 9b and in parallel with the third stop 9c, thereby effectively preventing the adjustment screw 20 from sliding on the bone screw 5.

[0100] Furthermore, the method according to the invention ensures that the bone cement 26 does not penetrate into the joint capsule, so that the risk of complications is particularly low.

Claims

1. A device for treating bone fractures, in particular a device for treating fractures of the proximal femur, for example a device for treating fractures of the femoral neck, for example, the device comprising a nail (1), which can be inserted into the intramedullary canal of a bone, in particular the intramedullary canal of a femoral shaft (2), wherein the nail (1) comprises a hole (3), which is substantially aligned transversely to a longitudinal axis (4) of the nail (1), wherein the device is provided with a coupling device, in particular a bone screw (5), which can be inserted into the hole (3) so that the coupling device protrudes beyond both sides of the hole (3) and can be moved in the hole (3) along a transverse axis (21) in a lateral direction (6) and in a medial direction (7) opposite to the lateral direction (6), and the coupling device can be fixed in place at the end of a bone part, in particular a femoral head (8), wherein the coupling device is fixed in place at the end of the bone part in particular by a thread provided on the coupling device, characterized in that The device is provided with an adjustment device capable of being fixed in place at different positions relative to the nail (1), in particular by means of threads in the adjustment device and the nail (1), wherein the adjustment device comprises a first stop surface (9) which limits the ability of the connection device to move in a lateral direction (6) when the connection device and the adjustment device are arranged on the nail (1), so that by changing the position of the adjustment device relative to the nail (1), the lateral end position to which the connection device can move in a lateral direction (6) relative to the nail (1) can be changed.

2. The device according to claim 1, characterized in that The first stop surface (9) is at least partially formed by a shoulder or a snap ring in the region of a lateral end of the adjusting device, in particular at least partially by an adjusting screw collar (28).

3. The device according to claim 1 or 2, characterized in that The first stop surface (9) is at least partially formed by a portion of a thread of the adjustment device, by means of which the adjustment device can be fixed in position relative to the nail (1).

4. The device according to any one of claims 1 to 3, characterized in that The first stop surface (9) is at least partially formed by part of a thread of the coupling device, by means of which the coupling device can be fixed in place at the end of the bone part.

5. The device according to any one of claims 1 to 4, characterized in that The adjusting device is connected to the nail by a thread, wherein a screw locking member is provided to increase the friction in the thread, thereby preventing the adjusting device from loosening, and the screw locking member is particularly a plastic member.

6. The device according to any one of claims 1 to 5, characterized in that The adjusting device can only be screwed into the nail up to a predetermined position, wherein this is structurally achieved in particular with a spanner, preferably a hexagonal spanner, which no longer has any contact with a corresponding counterpart in the adjusting device, in particular a hexagonal slot, starting from the predetermined position of the adjusting device.

7. The device according to claim 1, characterized in that The adjustment device comprises a second stop surface (10) which limits the ability of the coupling device to move in the medial direction (7) when the coupling device and the adjustment device are arranged on the nail (1).

8. The device according to claim 1 or 7, characterized in that The position of the adjustment device relative to the nail (1) can be changed along an adjustment direction (11), in particular along a straight line.

9. The device according to claim 8, characterized in that The first stop surface (9) and the second stop surface (10) are aligned with the adjustment direction (11) at different angles, so that when the position of the adjustment device relative to the nail (1) is changed, the lateral end position can change to a greater extent than the medial end position can change.

10. The device according to any one of claims 1 to 9, characterized in that The position of the adjustment device relative to the nail (1) can be changed along an adjustment direction (11), wherein the adjustment direction (11) forms an angle (α) of 0.1° to 15° with the transverse direction, in particular an angle (α) of 0.8° to 2°, wherein the adjustment direction (11) and the transverse direction are preferably located in the same plane.

11. The device according to any one of claims 1 to 10, characterized in that The adjusting device is implemented with a length greater than the length of the hole (3), so that the adjusting device can be connected to the nail (1) at a position protruding beyond both sides of the hole (3), wherein the first stop surface (9) is arranged on the inner side of the nail (1).

12. The device according to any one of claims 1 to 11, characterized in that The coupling device comprises a groove (12) interacting with the adjustment device and extending along the coupling device, so that when the coupling device and the adjustment device are connected to the nail (1), the adjustment device limits the rotation of the coupling device around the transverse axis (21), preferably prevents the rotation of the coupling device around the transverse axis (21).

13. The device according to any one of claims 1 to 12, characterized in that The hole (3) is designed to receive the coupling device in the proximal region and the adjustment device in the distal region.

14. The device according to any one of claims 1 to 13, characterized in that The coupling device comprises a through hole (19) protruding from the lateral end (13) to the medial end (14), and a Kirschner wire (15) can be inserted into the through hole (19).

15. The device according to any one of claims 1 to 14, characterized in that The device is provided with a hollow introduction device (16), which can be connected to the nail (1) instead of the adjusting device, and in particular can be inserted into the hole (3) of the nail (1) instead of the adjusting device, so that when the bone nail is arranged in the femoral shaft (2) and the introduction device (16) is connected to the nail (1), the bone cement (26) can be introduced into the area of ​​the femoral head (8) through the hollow introduction device (16).

16. A method for treating a fracture of the femoral neck, wherein a nail (1) is introduced into the intramedullary canal of the femoral shaft (2), and then a coupling device is introduced into the nail (1), the coupling device being fixed in place on the femoral head (8), characterized in that Adjustment means are connected to the nail (1), which limit the mobility of the coupling means relative to the nail (1) along a transverse axis (21), wherein in particular a device according to any one of claims 1 to 15 is used.

17. The method according to claim 16, characterized in that First, a first Kirschner wire (15) is introduced into the femoral neck (22) along the transverse axis (21) until the femoral head (8), wherein the diameter of the first Kirschner wire (15) is smaller than the diameter of the connecting device, and then a first bone hole (23) for the connecting device is introduced into the femoral neck (22), wherein the first Kirschner wire (15) is used as a guide, and then the connecting device is introduced into the femoral neck (22) through the nail (1).

18. The method according to claim 16, characterized in that Once the coupling device is fully introduced into the femoral neck (22), the K-wire (15) is removed.

19. The method according to claim 18, characterized in that Initially, the connecting device is only introduced into the first bone hole (23) to the middle position, and then the bone adhesive (26) is introduced into the end area of ​​the first bone hole (23), and then the connecting device is completely introduced into the first bone hole (23), wherein the bone adhesive (26) located in the end area is distributed in the femoral head (8).

20. The method according to claim 19, characterized in that The bone adhesive (26) is introduced into the end region of the first bone hole (23) via a hollow introduction device (16), the introduction device (16) being guided through the nail (1) through an opening, the adjustment device being able to be guided through the nail (1) through the opening, and after the introduction of the bone adhesive (26), the introduction device (16) being removed from the nail (1), and the adjustment device being subsequently inserted into the opening, in particular screwed into the opening.

21. The method according to claim 16 or 20, characterized in that At the distal end of the area where the connecting device can be connected to the nail (1), a second Kirschner wire (15) is introduced into the femoral neck (22), and the second Kirschner wire (15) is particularly at an angle (α) of 0.1° to 15° with the first Kirschner wire (15), and particularly at an angle (α) of 0.8° to 2°, and then a second bone hole (24) is introduced into the femoral neck (22), wherein the second Kirschner wire (15) serves as a guide, and then the second Kirschner wire (15) is removed, and then the adjustment device is introduced into the second bone hole (24), and the adjustment device protrudes beyond the two sides of the nail (1).

Images