Positioning device

Abstract

The invention relates to a positioning device (1) for a bone implant, in particular an intramedullary nail (2), for positioning and / or fixing a bone implant. The positioning device (1) has a curved handle (3) with a target guide (4) for guiding a bone drilling device (5), which target guide (4) defines a target axis (Z), and the curved handle has a connecting element (6) for detachably connecting a bone implant to the curved handle (3) and an alignment sight (7). The alignment sight has a first indicator structure (11) for indicating the path of the target axis by means of the indicator structure (11) in a second X-ray image of the alignment sight (7) along a target line of sight (S2) which lies in a first alignment plane formed by the target axis (Z) and the first indicator structure (11). In order to provide optimized operation, the alignment sight has a second indicator structure (12) for indicating an orthogonal tilt of the line of sight from the first alignment plane in a first X-ray image of the alignment sight (7) along the line of sight (S1) deviating from the target line of sight (S2). The invention also relates to a method for treating a bone fracture.

Description

Technical Field

[0001] The present invention relates to a positioning device for a bone implant (in particular an intramedullary nail), for positioning and / or fixing the bone implant, typically for treating fractures (in particular fractures of the proximal femur), wherein the positioning device has a curved handle, the curved handle has a target guide (e.g. a target hole) for guiding a bone drill device, wherein the target guide defines a target axis, and wherein the curved handle has a connecting element for detachably connecting the bone implant to the curved handle, and an alignment sight, wherein the alignment sight has a first indicator structure for indicating the path of the target axis by means of the indicator structure in a second X-ray image of the alignment sight along a target line of sight, the target line of sight being located in a first alignment plane formed by the target axis and the first indicator structure.

[0002] The present invention also relates to a method for treating a fracture, in particular a proximal femur fracture, wherein an intramedullary nail is inserted into the intramedullary canal of a bone, in particular the proximal femur, using a positioning device, wherein the intramedullary nail is connected, in particular detachably connected, to a curved handle of the positioning device, wherein the curved handle comprises a target guide for guiding a bone drill device into the bone along a target axis, wherein the curved handle has an alignment sight for aligning the target axis, wherein the alignment sight comprises a first indicator structure, which is configured to indicate the path of the target axis in a second X-ray image of the alignment sight along a target line of sight, which target line of sight is located in a first alignment plane formed by the target axis and the first indicator structure. Background Art

[0003] The device and method of the above-mentioned type for treating proximal femoral fracture or femoral neck fracture are known in the prior art.In order to treat femoral neck fracture, usually intramedullary nail is introduced into the intramedullary canal of the proximal femur of fracture, and with coupling device (normally bone screw), intramedullary nail is anchored in the bone material of femur.For this reason, intramedullary nail usually has the hole extending transverse to its longitudinal axis, and bone screw is introduced into the hole in a prominent manner through the hole, so that one end of bone screw protrudes into the femoral head.In femur, inserting bone screw usually needs bone hole passage, and it leads to femoral head through the hole of intramedullary nail.For this reason, usually guide wire is introduced into the femoral head first, so that then along guide wire guide tubular drill to form bone hole passage.

[0004] The intramedullary nail is usually introduced and positioned with a positioning device, which includes a curved handle to which the intramedullary nail is coupled, after which the surgeon inserts and aligns the intramedullary nail into the intramedullary canal of the femur by guiding the curved handle into the intramedullary canal of the femur. The curved handle usually has a target guide for guiding a guide wire along a target axis specified by the target guide. The target axis usually extends from the target guide through the hole of the intramedullary nail.

[0005] The challenge of correct positioning is usually that the intramedullary nail must be correctly positioned in the femur with a positioning device, and the guide wire must be guided to the appropriate depth of the femoral head. For this reason, an X-ray image is usually made to monitor or identify the position of the intramedullary nail and the bone drill device. In order to estimate the position of the guide wire in the femoral head area relative to the femoral head, it is known to equip the curved handle with an alignment sight, wherein the alignment sight includes an indicator visible in the X-ray image, which is generally in the shape of a U-shaped depression. When the line of sight of the X-ray image (the X-ray image is made along this line of sight) is located in the first alignment plane formed by the target axis and the indicator, the X-ray image can be used to indicate the path of the target axis. Therefore, it is necessary to align the line of sight of the X-ray image so that the line of sight, the indicator and the target axis are located in a plane so as to estimate the position or path of the target axis in the X-ray image, and correspond to the guide wire introduced along the target axis relative to the femoral head.

[0006] The corresponding adjustments for aligning the sight lines, indicators and target axis often prove to be a difficult task, especially considering that the resolution or imaging capabilities of X-rays are often not particularly clear and are associated with extended treatment times, significant radiation exposure for the patient or operating personnel. Since the path of the target axis is usually not visible in the X-ray image, it is often also necessary to approach the femoral head with a guide wire along the target axis until the guide wire is visible in the X-ray image in order to estimate the path of the target axis based on the guide wire, thereby allowing the sight lines of the target axis, indicator and X-ray image to be aligned with each other. Any resulting misalignment of the guide wire in the bone can cause damage to the bone material of the femur.

[0007] This is where the present invention comes in. The object of the present invention is to specify a device of the above-mentioned type which allows an optimized treatment when implanting a bone implant. A corresponding method is also specified. Summary of the invention

[0008] According to the present invention, if the first purpose is achieved by a device of the aforementioned type, the alignment sight includes a second indicator structure, which is configured to display an orthogonal tilt of the line of sight from the first alignment plane in the first X-ray image along a line of sight deviating from the target line of sight so as to allow the line of sight to be aligned with the target line of sight.

[0009] The invention is based on the idea of ​​designing the alignment sight such that a tilt of the line of sight of the X-ray image of the alignment sight relative to a first alignment plane defined by the target axis and the first indicator structure can be easily discerned in the X-ray image without error.

[0010] This is achievable if the display of the orthogonal tilt of the line of sight of the first X-ray image relative to the first alignment plane is separated from the first indicator structure, particularly since the first indicator structure typically needs to be compared with the path of the target axis (for example by inserting a bone drill device along the target axis) in order to detect the orthogonal tilt.

[0011] By arranging the alignment sight to include a second indicator structure, the function of which is to indicate that the sight line has an orthogonal tilt with the first alignment plane or to make this tilt obvious in the first X-ray image of the alignment sight, this misalignment can be quickly and effectively identified. The sight line can be aligned so that it is located in the first alignment plane. Therefore, the alignment sight (particularly the first indicator structure or the second indicator structure) represents the direction or actual position of the target axis in the bone, or particularly according to the reference point of the bone drill device introduced along the target axis. In particular, it is not necessary to insert the bone drill device into the bone so that it is used for adjustment to detect the target axis. This allows the adjustment or alignment of the sight line of the target axis, the first indicator structure and the first X-ray image to be performed simply and effectively, thereby reducing time requirements and / or X-ray radiation exposure. By first performing alignment and only then having to guide the bone drill device into or into the bone, potential damage can be reduced. This allows optimized treatment when implanting a bone implant.

[0012] The bone drill device can be a bone drill or a targeting wire, such as a Kirschner wire, also referred to as a Kirschner wire. Typically, the present invention provides for first guiding the targeting wire (particularly the Kirschner wire) into the bone so as to define a drilling path with the targeting wire, along which the bone drill is then guided along the targeting wire. For this purpose, the bone drill typically comprises a through-channel for passing the targeting wire through so as to guide the bone drill along the targeting wire. If the targeting wire is used as a guide, it is also referred to as a guide wire. The target guide defines a target axis along which the bone drill device can be guided with the target guide. The bone can be a bone part, particularly the proximal femur, or the fracture can be a fracture of the femur, particularly a fracture of the proximal femur.

[0013] The first X-ray image or the second X-ray image is usually produced by an X-ray device, which is preferably configured so that the imaging direction or the line of sight of the X-ray image (from which the X-ray image is produced) can be variable (in particular controlled). It is suitable that the tilt angle of the imaging direction or the line of sight is preferably variable (in particular controlled) within two degrees of freedom. This has proven to be suitable when the X-ray device is configured as a medical C-arm. The X-ray image can be one or more X-ray images.

[0014] An X-ray image (particularly the first X-ray image or the second X-ray image) of the alignment sight is usually made with a line of sight or an imaging direction, so that the target axis or the target axis segment of the target axis to be displayed by the first indicator structure and the alignment sight in the X-ray image are arranged one after another along the line of sight, so that the alignment sight represents a reference point for the path of the target axis (particularly its path in the bone). Alignment of the line of sight is also called rough alignment, in which the line of sight has an inclination angle orthogonal to the first alignment plane, or does not coincide with the target line of sight. The orthogonal inclination of the line of sight or the imaging direction of the first X-ray image to the first alignment plane indicates the inclination of the line of sight or the imaging direction orthogonal to the first alignment plane relative to the first alignment plane. This applies similarly to the orthogonal inclination of the line of sight relative to the second alignment plane described below.

[0015] Advantageously, the first indicator structure and / or the second indicator structure are formed with at least one protrusion and / or at least one depression so as to form a structure identifiable in the X-ray image, in particular a structural feature identifiable respectively. It is also possible to conveniently provide more than one protrusion or depression. For example, the protrusion or depression that can be introduced into the alignment sight base body by machining can be part of the alignment sight base body. The connecting element and the target guide that are usually provided for connecting the intramedullary nail to the bending handle are arranged at a certain distance from each other on the bending handle, preferably on different ends of the bending handle. It is suitable that the connecting element and the target guide are connected to the bending handle arm of the bending handle, wherein the connecting element is arranged on the first end and the target guide is arranged on the second end of the bending handle, which second end is usually opposite to the first end. Preferably, the alignment sight is configured as a part of the first end of the bending handle, or in particular forms the first end of the bending handle. The connecting element can be arranged, in particular detachably arranged, on the alignment sight, in particular on the alignment sight base body.

[0016] It is advantageous if the second indicator structure is formed by a plurality of structural elements arranged at least in sections sequentially, which are arranged parallel to the first alignment plane or in an arrangement direction aligned parallel to the target line of sight, so that the orthogonal inclination of the line of sight in the first X-ray image from the first alignment plane is represented by the relative position of the structural elements, or can be identified from such a position. For example, it is represented by a different relative position of the structural elements compared to the expected relative position of the structural elements in the second X-ray image of the alignment sight along the target line of sight. The structural elements are usually spaced apart from each other in a direction orthogonal to the arrangement direction. Obviously, the structural elements are represented in the X-ray image by the corresponding images representing them. The corresponding structural elements can be formed with protrusions and / or depressions, or can be formed by a part of said protrusions and / or depressions. For example, the structural elements configured as protrusions or depressions can each be arranged at least sectionally one behind the other in the arrangement direction, so that in the second X-ray image of the alignment sight a defined lateral distance or no lateral distance is formed between the structural elements or imaging features representing them, and so that the first X-ray image of the alignment sight shows different lateral distances between the structural elements or lateral distances at a first position, such as a gap, while the line of sight is tilted orthogonally from the first alignment plane. Obviously, the relative positions and / or distances of the structural elements in the corresponding X-ray images are related to the images of the structural elements, by means of which they are shown in the X-ray images.

[0017] Advantageously, the second indicator structures (in particular the structural elements) are configured such that they indicate in the first X-ray image the direction of the orthogonal tilt of the line of sight from the first alignment plane. Thus, if in the X-ray images on these or their images it can be discerned in which of the two directions orthogonal to the first alignment plane the orthogonal tilt exists. This allows for efficient detection and correction of misalignment of the line of sight.

[0018] This can be conveniently achieved by: when the second indicator structure comprises at least two first structural elements and at least one second structural element, the second structural element is spaced apart from the first structural element in an arrangement direction parallel to the first alignment plane or parallel to the target line of sight, so that when compared with a second X-ray image of the alignment sight, the first X-ray image of the alignment sight shows a direction-dependent lateral displacement of the second structural element relative to the first structural element, which lateral displacement depends on the direction of the orthogonal inclination of the line of sight from the first alignment plane. The first structural elements are usually spaced apart from each other in a direction orthogonal to the arrangement direction. A plurality of first and / or a plurality of second such structural elements can be provided to improve recognizability. For example, the first structural element and at least one second structural element can be formed with protrusions and / or depressions, wherein the first structural element and the second structural element are arranged sequentially at least in sections in the arrangement direction. For example, the structural elements can be configured and arranged such that a gap (also called a tilt indicator gap) exists between the first structural elements, such that the second structural element is arranged in the second X-ray image at the center of the gap along the target line of sight, and the second structural element is shown in the first X-ray image (when the line of sight is tilted orthogonally from the first alignment plane) as moving from the first alignment plane in the direction of the first structural element or other structural elements, which depends on the direction of the orthogonal tilt of the line of sight.

[0019] It is advantageous for good detectability in the X-ray image if the second indicator structure is formed with a plurality of gap-delimiting walls such that the gap-delimiting walls form two tilt indicator gaps spaced apart from one another in the first X-ray image of the alignment sight, wherein the direction of the orthogonal tilt can be read off by comparing the gap widths of the tilt indicator gaps. Suitably, one or the other tilt indicator gap has a greater reduction in its gap width depending on the direction of the orthogonal tilt of the line of sight from the first alignment plane. For determining the target alignment, it has proven effective when the gap-delimiting walls form two tilt indicator gaps spaced apart from one another with the same gap width when the gap-delimiting walls are in the second X-ray image of the alignment sight or when the line of sight is in the first alignment plane. The respective tilt indicator gap is typically formed by at least one of the first structural elements and at least one of the second structural elements, each of which forms one of the gap-delimiting walls.

[0020] If the first gap-delimiting wall and the second gap-delimiting wall each form a wall pair so as to form a corresponding tilt indicator gap in the first X-ray image or in the second X-ray image, a practical implementation is possible, wherein the second gap-delimiting wall of the first gap-delimiting wall is arranged downstream at least in sections in the arrangement direction or in a direction parallel to the first alignment plane, and wherein in one wall pair, the first gap-delimiting wall is arranged orthogonally to the first alignment plane in the first direction, and in the other wall pair, the first gap-delimiting wall is arranged downstream of the second gap-delimiting wall in a direction opposite to the first direction, so that in the X-ray image of the alignment sight, one or the other tilt indicator gap has a greater reduction in its gap width depending on the direction of the line of sight tilting from the orthogonality of the first alignment plane. The corresponding first gap-delimiting wall and the second gap-delimiting wall are usually arranged at a distance from each other in a direction orthogonal to the arrangement direction and may at least partially overlap each other in this direction. In the arrangement direction, the second gap-delimiting wall is preferably arranged between the first gap-delimiting walls. It has proven to be effective if the second gap-delimiting wall of the corresponding wall pair has a greater longitudinal extension in the arrangement direction than the first gap-delimiting wall. The gap defining walls are preferably configured as rails, whose respective longitudinal axes are substantially parallel to the arrangement direction. The respective first gap defining wall generally represents one of the first structural elements, and the respective second gap defining wall represents one of the second structural elements. The respective first gap defining wall and the second gap defining wall may be configured to overlap or be spaced apart from each other in a direction orthogonal to the arrangement direction. The arrangement direction generally refers to a direction parallel to the first alignment plane or parallel to the target line of sight.

[0021] A high readability is achievable when the alignment sight is configured such that the first indicator structure in the second X-ray image of the alignment sight is arranged between two tilt indicator gaps of the second indicator structure. For simple and fast reading, it is advantageous if the first indicator structure in the second X-ray image forms a cutout, wherein the cutout bottom of the cutout preferably indicates the path of the target axis. The cutout wall of the cutout can be formed by a structural element of the second indicator structure. For example, one of the gap-delimiting walls having a tilt indicator gap, respectively.

[0022] Advantageously, the alignment sight has a third indicator structure, which is configured to display in a third X-ray image of the alignment sight, in particular the first X-ray image and / or the second X-ray image of the alignment sight, an orthogonal tilt of the line of sight of the third X-ray image from a second alignment plane aligned at right angles to the first alignment plane, so as to align the line of sight of the third X-ray image with the second alignment plane. Thus, a reference point for the actual position of the segment of the target axis in the bone displayed with the first indicator structure can be defined. The third X-ray image can be the first X-ray image and / or the second X-ray image, whereby the line of sight of the first X-ray image or the second X-ray image of the alignment sight corresponds to the line of sight of the third X-ray image of the alignment sight, respectively. Thus, a misalignment or tilt of the corresponding line of sight in the first alignment plane or in a direction parallel to the first alignment plane can be detected and improved. By adjusting the line of sight of the corresponding X-ray image relative to the first alignment plane and the second alignment plane, the line of sight can be set in an optimized manner, so that the real position of the target axis or the bone drill device relative to the bone structure shown in the X-ray image can be better estimated. Suitably, the target line of sight is also located in the second alignment plane. The target line of sight is then defined by the intersection line of the first alignment plane and the second alignment plane, along which the first alignment plane and the second alignment plane intersect. It is particularly advantageous if the second alignment plane is aligned orthogonally to the target axis. If the target line of sight thus extends orthogonally to the target axis, or the line of sight can be adjusted accordingly, the longitudinal distance along the target line of sight in the X-ray image of the alignment sight corresponds to the longitudinal distance along the target axis.

[0023] The third indicator structure is preferably formed with a plurality of alignment structures arranged one after another in the arrangement direction, so that the defined alignment or superposition of the alignment structures indicates the arrangement of the line of sight of the third X-ray image within the second alignment plane. Suitably, the third indicator structure is formed by at least one or more protrusions and / or at least one or more recesses so as to form a structure that is recognizable in the X-ray image. The protrusions or recesses may be part of the alignment sight matrix, or may be introduced into the alignment sight matrix by machining. The first indicator structure, the second indicator structure and the third indicator structure may be formed by common protrusions and / or recesses. An embodiment of the third indicator structure or alignment structure may be implemented in a manner similar to the first indicator structure or the second indicator structure or their structural elements.

[0024] Advantageously, the alignment structures are arranged such that they form a predetermined target superposition profile in a third X-ray image of the alignment sight, wherein the line of sight of the third X-ray image is in the second alignment plane, wherein each alignment structure forms only a partial profile of the target superposition profile. Obviously, it is suitable that the target superposition profile is not formed by the second alignment plane when the line of sight is orthogonally inclined. For example, the target superposition profile can be arranged to represent a depression or protrusion with a defined shape, such as a parabolic shape. It is suitable that one of the alignment structures is formed by a structural feature, such as the aforementioned cut-out through which the first indicator structure is formed. Preferably, the alignment structures each form a depression or protrusion in the X-ray image.

[0025] The connecting element of the curved handle can usually be used to detachably connect a bone implant (particularly an intramedullary nail) to the curved handle (particularly in an interlocking and / or friction-locking manner). To this end, the connecting element can include a first coupling element, which can be detachably connected to a second coupling element of the intramedullary nail, and the second coupling element corresponds to the shape of the first coupling element, such as by forming an interlocking and / or friction-locking connection and cooperating with each other. The curved handle can usually be connected to the intramedullary nail in a rotationally fixed manner. It is usually arranged that when the bone implant (particularly the intramedullary nail) is connected to the connecting element, the user (usually a surgeon) guides the bone implant to the bone (particularly introduced into the bone) by guiding the curved handle, and aligns the bone implant relative to the bone.

[0026] The alignment sight is usually formed from a radiopaque material. It therefore represents identifiable structures in the X-ray image, in particular structures with greater contrast compared to bone and / or tissue. Advantageously, other parts of the positioning device, such as the curved handle section of the curved handle or the curved handle arm on which the target guide is arranged, are formed from an X-ray transparent material so that these represent structures with lower contrast compared to the alignment sight or compared to bone and / or tissue in the X-ray image.

[0027] Advantageously, a positioning system for positioning and / or fixing an intramedullary nail in a bone (particularly the proximal femur) is provided to treat a fracture (particularly a fracture of the proximal femur), wherein the positioning system has a positioning device and an intramedullary nail, the intramedullary nail can be introduced into the intramedullary canal of the bone, wherein the intramedullary nail has a hole protruding transversely relative to the longitudinal axis of the intramedullary nail to accommodate a coupling device (particularly a bone screw) to introduce the coupling device into the hole, so that the coupling device protrudes beyond the hole on at least one side (particularly both sides), wherein the coupling device can be, for example, screwed on an end face in a bone part (particularly the femoral head). In this case, the positioning device can be suitably configured as particularly described above. The bone drill device can be configured as a bone drill or a guide wire, particularly a Kirschner wire. Advantageously, the bone drill device and / or the coupling device are components of the positioning system. The intramedullary nail is usually (particularly as described above) detachably connected to the connecting element of the positioning device, so that the intramedullary nail is introduced into the intramedullary canal of the bone using the positioning device. The intramedullary nail is usually configured so that when the intramedullary nail is connected to the connecting element, the hole axis of the hole is aligned with the target axis. The target axis generally defines a path for introducing the bone screw into the intramedullary nail.

[0028] By making an X-ray image of the alignment sight (in particular based on the aforementioned second X-ray image), the orthogonal tilt of the line of sight from the alignment plane is discernible or indicated by the second indicator structure on the X-ray image. Thus, the line of sight of the X-ray image and the first alignment plane can be aligned with each other so that when the intramedullary nail is in particular detachably connected to the connecting element, a bone drill device (e.g. a target wire, in particular a Kirschner wire) can be guided along the target axis, in particular through the hole, with the target guide of the positioning device, and wherein the bone drill device has a path indicated in the X-ray image with the first indicator structure.

[0029] Preferably, the target guide comprises a guide device and a drilling device guide, wherein the drilling device guide comprises a drilling device channel for guiding a bone drilling device, wherein the drilling device guide has an interlocking (particularly detachable) connection with the guide device, so that the drilling device guide can be movably guided relative to the guide device along the target axis to guide the drilling device channel to the bone surface of the bone or to the intramedullary nail when the intramedullary nail is introduced into the bone. Therefore, the bone drilling device is protected by the drilling device guide. The diameter of the drilling device channel is usually configured according to the diameter of the bone drilling device. Depending on the bone drilling device to be used, different drilling device guides can be appropriately used, wherein the diameter of the drilling device channel is configured to be suitable for the diameter of the bone drilling device. In a state where the drilling device guide of the drilling device channel is connected to the guide device, the drilling device channel is usually arranged along the path of the longitudinal axis of the drilling device guide, or the longitudinal axis of the drilling device channel is aligned along the target axis so as to guide the drilling device along the target axis. The drilling device channel can, for example, be configured as a drilling hole. The drilling device guide generally comprises a rod-shaped section which forms the end of the drilling device guide facing the intramedullary nail when guided by the guiding device, or is in particular substantially rod-shaped. The guiding device and the drilling device guide are generally configured so that the drilling device guide, when in an expanded position protruding in the direction of the intramedullary nail, bridges the path section between the guiding device and the intramedullary nail so as to guide the bone drill device along the path section in a protected manner. Suitably, the drilling device guide can be substantially guided to the intramedullary nail, wherein the remaining distance to the intramedullary nail can vary according to the thickness of the corresponding bone. It is generally provided that the drilling device guide is pushed through the body tissue surrounding the bone until near the bone surface of the bone or near the intramedullary nail. Therefore, the bone drill device can be protected by the drilling device guide while being positioned in the drilling device channel until near the intramedullary nail or bone, so as to then further insert the bone drill device into the bone. The guiding device can be formed with a guide channel into which the drilling device guide can be introduced in an interlocking manner. The guide channel typically defines a guide channel axis that matches the target axis and along which the drilling device guide can be movably guided.

[0030] Advantageously, the target guide comprises a tissue protection sleeve, which can be moved relative to the guiding device so as to at least partially enclose the drilling device guide in the deployed position of the drilling device guide, in which the drilling device guide is guided by the guiding device towards the bone or the intramedullary nail so as to separate the drilling device guide from the body part tissue surrounding the bone. This makes it possible to reduce (especially prevent) any damage to the body part tissue when the drilling device guide moves. The tissue protection sleeve can be suitably formed with an encapsulation surface at least in sections, which encapsulates the drilling device guide at least partially (preferably to a large extent, especially completely) in the circumferential direction of the drilling device guide when the drilling device guide is introduced into the drilling device guide channel. This is particularly suitable for the end element of the tissue protection sleeve facing the intramedullary nail. Advantageously, the tissue protection sleeve is configured to encapsulate the drilling device guide in its deployed position substantially along a large part of the drilling device guide, in particular along the entire longitudinal extension of the drilling device guide, between the deployed position and the guiding device. A high degree of practicality is achievable when the tissue protection sleeve can be connected to the guide device in an interlocking (particularly detachable) manner, so that the tissue protection sleeve can be moved relative to the guide device along the target axis in order to guide the tissue protection sleeve towards the bone surface of the bone or the intramedullary nail when the intramedullary nail is introduced into the bone. Advantageously, the tissue protection sleeve is provided to include a drilling device guide channel for guiding a drilling device guide, wherein the drilling device guide can be connected to the drilling device guide channel in an interlocking (particularly detachable) manner, so that the drilling device guide can be movably guided along the target axis relative to the tissue protection sleeve. Thus, the tissue protection sleeve can be guided along the target axis between the body part tissues until near the bone; thereafter, the drilling device guide can be guided into the deployed position. Preferably, the tissue protection sleeve can be introduced into the guide channel of the guide device in an interlocking manner. The tissue protection cover can then be introduced into the guide channel of the guide device in an interlocking manner so as to be introduced near the intramedullary nail or bone; thereafter, the drilling device guide can be introduced into the drilling device guide of the tissue protection cover in an interlocking manner so as to be introduced near the intramedullary nail while being at least partially enclosed by the tissue protection cover.

[0031] Advantageously, the guide device comprises a plurality of guide channels, wherein the guide channels are each configured for a movable guide connection with a drilling device guide or a tissue protection sleeve, wherein preferably, different guide channels have different target axes or define different guide channel axes to guide the bone drilling device along these axes. Therefore, the guide device can be provided to include at least one or more additional guide channels, each additional guide channel defining another guide channel axis or another target axis, so that the drilling device guide and / or the tissue protection sleeve that are movably guided along the other guide channel axis (particularly detachably) are connected to the guide device, in particular in the aforementioned manner. Then, the drilling device (e.g., a bone drill or a guide wire, in particular a Kirschner wire) can be guided along the other guide channel axis with the drilling device guide in the aforementioned manner. The intramedullary nail can suitably include at least one or more other holes, wherein the corresponding hole axes of the other holes coincide with one of the guide channel axes respectively. It can be provided to introduce another coupling element (e.g., a bone screw) into the corresponding other hole, and the bone screw protrudes beyond the corresponding other hole at least on one or both sides, so as to fix the intramedullary nail in the bone.

[0032] Suitably, the target guide (in particular the guiding device) is detachably connected to the curved handle arm of the curved handle so as to release the target guide or the guiding device from the curved handle arm of the curved handle. A connecting device can be suitably provided, by which the target guide (in particular the guiding device) and the curved handle arm can be detachably connected to each other (in particular in an interlocking and / or friction-locking manner). This allows the target guide (in particular the guiding device) to be connected to the curved handle only after the intramedullary nail has been introduced into the bone. This simplifies the operation during the operation. Preferably, the alignment sight is detachably connected to the curved handle arm via a connecting adapter (in particular in an interlocking and / or friction-locking manner).

[0033] A further object is achieved by a method of the aforementioned type, wherein a first X-ray image of an alignment sight of a curved handle is made along the line of sight, whereby an adjustment of the line of sight to a first alignment plane is performed based on a second indicator structure of the alignment sight, the indicator structure being configured to indicate an orthogonal tilt of the line of sight from the first alignment plane in the X-ray image of the alignment sight. The method is generally provided to be performed using a positioning device as described herein or a positioning system as described. As described above, the adjustment or alignment of the line of sight of the target axis, the first indicator structure and the X-ray image can be performed simply and practically, so that time requirements and / or radiation exposure can be reduced.

[0034] The target axis is usually aligned transversely to the length axis of the intramedullary nail, preferably so that it splits the intramedullary nail or coincides with the hole axis of the hole of the intramedullary nail, particularly as described above. For treatment of the proximal femur, the target axis is usually aligned with the longitudinal axis of the intramedullary nail at an angle aligned with the longitudinal axis of the femur relative to the longitudinal axis of the femoral neck, usually at an angle of 110 ° and 140 °. If the bone is a femur, the target sight line of the X-ray usually corresponds to a lateral-medial view of the body where the femur or its portion is a femur.

[0035] Suitably, a bone drill device, in particular a K-wire, is guided into the bone along a target axis via a target guide of the curved handle, wherein the line of sight is adjusted based on the second indicator structure before and / or after the bone drill device is visible in the first X-ray image for comparison with the first indicator structure. An optimal adjustment of the line of sight can be achieved before and / or after the bone drill device is visible in the X-ray image.

[0036] The intramedullary nail is usually provided with a hole extending transversely relative to the longitudinal axis of the intramedullary nail to accommodate a coupling device (particularly a bone screw), wherein a bone drill device (particularly a Kirschner wire) is guided through the hole along the target axis via a target guide. The hole usually includes a hole axis corresponding to the target axis. The bone drill device can be a bone drill or a targeting wire, particularly a Kirschner wire. Using the coupling device, the intramedullary nail can be fixed in the bone, or the bone material of the bone can be connected to the intramedullary nail using the coupling device. For this reason, the coupling device can be introduced into the hole of the intramedullary nail so that the coupling device protrudes beyond the hole at least on one side (particularly on both sides). The coupling device is usually anchored in the bone material of the bone by at least one end of the coupling device, and is usually anchored by the front end entering the bone in the insertion direction of the coupling direction. For this reason, the end can have a thread.

[0037] Typically, a bone drill device is used to introduce a bone hole passage into the bone along the target axis, typically through the hole of the intramedullary nail; then, a coupling device is introduced into the hole along the bone hole passage. If the bone is a proximal femur, the bone hole passage typically extends along the target axis to the femoral head, wherein the coupling device is preferably introduced into the hole so that one end of the coupling device protrudes into the femoral head or is, for example, anchored in the femoral head with a thread.

[0038] Advantageously, the bone drill device configured to have a targeting wire (particularly a Kirschner wire) less than the diameter of the coupling device is first introduced into the bone along the target axis, particularly in the aforementioned manner, according to which the bone hole passage is introduced into the bone using a bone drill, wherein the targeting wire is used as a guide. The coupling device can then be introduced into the hole via the bone hole passage, usually so that the coupling device at least protrudes beyond the hole on one side or both sides. In this case, the second bone drill device or the bone drill and / or the coupling device are usually configured to be tubular, so as to guide them along the targeting wire. For this reason, the bone drill device or the coupling device can include a feed-through channel. If bone is the proximal femur, the coupling device is usually fixed in the femoral head with the end of the coupling device. Usually after the coupling device is introduced into the hole of the intramedullary nail and particularly introduced into the femoral head, the guide wire is removed.

[0039] Advantageously, other guide wire (particularly Kirschner wire) is introduced into the femoral head at the deviation axis, so as to avoid the femoral head from rotating when drilling bone hole passage (particularly the second bone hole passage) and / or when coupling device is introduced into the hole of intramedullary nail, the guide wire of expansion can preferably extend into the femoral head through the other hole of intramedullary nail along other target axis. Other guide wire can be suitably introduced into the femoral head together with guiding device, for example, via the other guiding channel of guiding device.

[0040] The first X-ray image of the alignment sight generally refers to an X-ray image of the alignment sight along a line of sight that is tilted orthogonally from the first alignment plane. The second X-ray image of the alignment sight generally refers to an X-ray image of the alignment sight along a line of sight that is located in the first alignment plane. BRIEF DESCRIPTION OF THE DRAWINGS

[0041] Other features, advantages and effects are shown in the exemplary embodiments described below. The referenced drawings show:

[0042] Figure 1 It is a positioning device for intramedullary nails;

[0043] Figure 2 and Figure 3 It is the alignment sight of the positioning device from different sight lines;

[0044] Figure 4 is an X-ray image of the proximal femur along a line of sight located in a plane having a target axis and a first indicator structure;

[0045] Figure 5 is based on Figure 4 Additional X-ray images of the embodiment of the invention wherein the K-wire is introduced into the bone along the target axis;

[0046] Figure 6 yes Figure 2 and Figure 3An inclined plan view of the alignment sight on the indicator structure of the alignment sight;

[0047] Figure 7 It is a guide device for the target guide;

[0048] Figure 8 It is the tissue protection sleeve of the target guide;

[0049] Fig. 9 It is the drilling device guide of the target guide. DETAILED DESCRIPTION

[0050] Figure 1 A schematic diagram of a positioning device 1 for an intramedullary nail 2 is shown, which is used to position and fix the intramedullary nail 2 in the intramedullary canal of a bone, in particular the proximal femur. The purpose is usually to treat a fracture, in the case of the proximal femur usually a femoral neck fracture. The positioning device comprises a curved handle 3, which has a target guide 4 for guiding a bone drill device 5 (e.g. a Kirschner wire) along a target axis Z; a connecting element 6, which is used to connect the intramedullary nail 2 to the curved handle 3 in a rotationally fixed manner; and an alignment sight 7, which is used to display the path of the target axis Z in an X-ray image, so as to align the target axis Z with the alignment sight 7 when the intramedullary nail 2 is introduced into the bone. The connecting element 6 and the target guide 4 are arranged on a curved handle arm 9 of the curved handle 3 at a distance from each other, usually at different ends of the curved handle arm 9.

[0051] The intramedullary nail 2 comprises a hole 10 extending transversely to its longitudinal axis to accommodate a coupling device (e.g. a bone screw) so that the intramedullary nail 2 is fastened by introducing the coupling device into the hole 10 so that the coupling device protrudes beyond the hole 10 in the bone. The coupling device is usually anchored on an end face in a bone part, usually in the femoral head in the case of the proximal femur. When the intramedullary nail 2 is connected to the connecting element 6, the axis of the hole 10 coincides with the target axis Z, so that the target axis Z protrudes through the hole 10, as shown in FIG. Figure 1 As shown. It is usually arranged that the bone drill device 5 configured as a Kirschner wire is first guided through the hole 10 along the target axis Z using the target guide 4, and then the bone drill is introduced into the hole 10 for the bone hole passage in the bone along the target axis Z, wherein the Kirschner wire serves as a guide for the bone drill. The coupling device can then be introduced into the hole 10 of the medullary canal via the bone hole passage.

[0052] While making an X-ray image of the alignment sight 7, an alignment of the target axis Z in the bone is performed in order to guide the K-wire or the coupling device to a suitable depth and position in the bone so that the first indicator structure 11 of the alignment sight 7 shown in the X-ray image represents a reference point for the path of the target axis Z in the bone. The X-ray image is usually performed with an X-ray device 13 having a controllable and variable line of sight S1 of the X-ray image. The first indicator structure 11 is configured to display the path of the target axis Z in the X-ray image of the alignment sight 7 along a target line of sight S2, which is located in a first alignment plane formed by the target axis Z and the first indicator structure 11. This is in Figure 2 It is shown in Figure 2 A first alignment plane is shown that crosses the target axis Z at right angles to the drawing plane. In order to allow alignment of the line of sight S1 of the X-ray image of the alignment sight 7 according to the target line of sight S2, i.e. to detect misalignment of the line of sight S1, the invention provides that the alignment sight 7 comprises a second indicator structure 12, which is formed to indicate in the X-ray image an orthogonal tilt of the line of sight S1 from the first alignment plane. This is Figure 2 and Figure 3 Shown in.

[0053] Figure 2 and Figure 3 The positioning device (particularly Figure 1 A schematic diagram of an alignment sight 7 of a positioning device) wherein Figure 2 , the alignment sight 7 is shown along the first alignment plane from a vantage point of the alignment sight 7, and Figure 3 1 shows the alignment sight 7 viewed from a vantage point of the alignment sight 7 when tilted orthogonally to the first alignment plane. The first indicator structure 11 is formed with a recess so that the image of the first indicator structure 11 forms a cut (particularly a U-shaped or V-shaped cut) in the X-ray along the target line of sight S2 so as to show the path of the target axis Z with the cut, similar to Figure 2 The path of the target axis Z is in particular marked by the base of the cutout. For a precise display, it is expedient if the recess or cutout has a conical cross section in the direction of its depth. The indicator structure is preferably formed as a projection or a depression.

[0054] The second indicator structure 12 is formed with a plurality of gap-defining walls spaced apart from one another and is in particular embodied as a track which is substantially parallel and orthogonal to the length axis of the first alignment plane or parallel to the line of sight S1, such that the gap-defining walls in the X-ray image of the alignment sight 7 along the target line of sight S2 form two tilt indicator gaps 14 spaced apart from one another, wherein the first gap-defining wall 15 and the second gap-defining wall 16 each form a wall pair to form a respective tilt indicator gap 14, wherein each second gap-defining wall 16 is at least sectionally arranged downstream of the first gap-defining wall 15 in a direction parallel to the first alignment plane, and wherein, in one wall pair, the first gap-defining wall 15 is arranged downstream of the second gap-defining wall 16 in a first direction orthogonal to the first alignment plane, and in the other wall pair, the first gap-defining wall 15 is arranged downstream of the second gap-defining wall 16 in a direction opposite to the first direction, such that in the X-ray image of the alignment sight 7, depending on the direction in which the line of sight S1 is tilted from the orthogonality of the first alignment plane, one or the other tilt indicator gap 14 has a greater reduction in its gap width. Figure 2 , Figure 3 and Figure 6 The arrangement of the gap-delimiting walls is particularly evident, wherein Figure 6 A schematic diagram of a tilted plan view of an alignment sight on a gap-delimiting wall is shown. Due to this arrangement of the gap-delimiting walls, the direction of the orthogonal tilt of the sight line S1 from the target sight line S2 can be efficiently and easily read in the X-ray image. Advantageously, the tilt indicator gap 14 has an equally large gap width in the X-ray image along the target sight line S2. By arranging the first indicator structure 11 between the tilt indicator gaps 14, a particularly sensitive display of the orthogonal tilt can be achieved. As in Figure 2 and Figure 3 Similarly, we can see that Figure 2 The tilt indicator gap 14 in the embodiment has the same large gap width, while in Figure 3 In the embodiment, one of the tilt indicator gaps 14 has a smaller gap width than the other tilt indicator gap 14 due to the orthogonal tilt, which depends on the respective direction of the orthogonal tilt of the first alignment plane.

[0055] Preferably, the alignment sight 7 has a third indicator structure 17 so as to display in the X-ray image of the alignment sight 7 an orthogonal tilt of the line of sight S1 from a second alignment plane aligned at right angles to the first alignment plane, the first alignment plane being defined by the target axis Z and the first indicator structure 11. Thus, the line of sight S1 can also be actually aligned relative to the second alignment plane. The third indicator structure 17 can preferably be formed with two alignment structures 25, which are configured as recesses and are arranged one after the other in a direction parallel to the first alignment plane, wherein a defined superposition of the recesses in the X-ray image forms a target superposition contour. As shown in Figure 2 and Figure 3 As shown in , this can be achieved by having one of the recesses of the third indicator structure 17 be realized by a recess of the first indicator structure 11 and the other recess being arranged behind the former in the direction of the target sight line S2.

[0056] Figure 4 The following is shown as part of an exemplary treatment of a proximal femur fracture. Figure 2 or Figure 3 In particular, the alignment sight 7 is based on Figure 1 A portion of a positioning device 1 according to an embodiment. The X-ray image shows the alignment of the target axis Z on the femoral head so that the K-wire is introduced into the femoral head along the target axis Z after the target axis Z is aligned. For illustrative purposes, the target axis Z is drawn as a dotted line in the X-ray image. The line of sight S1 of the X-ray image is aligned relative to the first alignment plane so that the tilt indicator gaps 14 have substantially equal gap widths; therefore, the cutouts of the first indicator structure 11 indicate the path of the target axis Z. Figure 5 Shown according to Figure 4 FIG. 1 is a further X-ray image of the alignment sight 7 of FIG. 1 , wherein a K-wire is introduced into the femoral head along the target axis Z. The longitudinal axis of the K-wire extends according to the path indicated by the cutout of the first indicator structure 11 .

[0057] Figure 6 Shows Figure 2 and Figure 3 Schematic diagram of an alignment sight 7 in an inclined plan view on the first indicator structure 11 and the second indicator structure 12 of the alignment sight 7. As described above, one of the first gap-defining walls 15 and one of the second gap-defining walls 16 respectively form one of the wall pairs so as to form one of the inclined indicator gaps 14 in the X-ray image. The first gap-defining walls 15 and the second gap-defining walls 16 of the corresponding wall pairs are spaced apart from each other in a direction orthogonal to the target line of sight S2, and may also overlap each other. The recess of the first indicator structure 11 is located between the two wall pairs. Figure 6 The centrally located circular structures shown in represent holes in the alignment sight body which are incorporated when manufacturing the alignment sight 7 in order to implement the indicator structures into the alignment sight body of the alignment sight 7 .

[0058] In order to guide the bone drill device 5 with the target guide 4, it is suitable that the target guide 4 includes a guide device 18 and a drilling device guide 19, wherein the guide device 18 is configured to guide the drilling device guide 19, and the drilling device guide 19 is configured to guide the bone drill device 5, such as Figure 1As shown. The guide device 18 is usually detachably connected to the curved handle arm 9. The drilling device guide 19 can preferably be detachably arranged on the guide device 18. The drilling device guide 19 can be stabilized by the drilling device guide 19 so as to guide the bone drill device 5 into the bone. The drilling device guide 19 is usually guided to the bone through the body part tissue surrounding the bone and between the body part tissue surrounding the bone. In order to separate the drilling device guide 19 from the body part tissue to protect the body part tissue, it is appropriate that the target guide 4 includes a tissue protection sleeve 20 that at least partially encapsulates the drilling device guide 19. Figure 7 shows a schematic diagram of the guiding device 18, Figure 8 A schematic diagram of a tissue protection sleeve 20 is shown, and Fig. 9 The target guide 4 (particularly Figure 1 Schematic diagram of a drilling device guide 19 of a target guide 4). The guide device 18 includes a guide channel 22 so that the drilling device guide 19 and the preferred tissue protection sleeve 20 can be movably introduced into the guide channel 22 along the guide channel 22 in an interlocking manner. The present invention arranges the guide channel 22 to be aligned with the curved handle 3 so that the guide channel axis of the guide channel 22 coincides with the target axis Z; therefore, the drilling device guide 19 or the tissue protection sleeve 20 can be moved along the target axis Z, such as Figure 1 As shown. The drilling device guide 19, which is usually essentially rod-shaped, includes a drilling device channel 24, through which a bone drilling device 5 (especially a Kirschner wire) can be guided. The tissue protection sheath 20 includes a drilling device guide channel 23 so that the drilling device guide 19 can be movably introduced into the drilling device guide channel 23 along the drilling device guide channel 23 in an interlocking manner. The tissue protection sheath 20 is configured to at least partially enclose the drilling device guide 19. The present invention appropriately provides that the tissue protection sheath 20 can be introduced into the guide channel 22, so that the tissue protection sheath 20 can be deployed relative to the guide channel 22 in the direction of the intramedullary nail 2, so as to guide the tissue protection sheath 20 to the intramedullary nail 2 or the bone, which is Figure 1As shown in . Then, the drilling device guide 19 can be guided along the drilling device guide channel 23 toward the intramedullary nail 2 or the bone. In this case, the present invention sets the longitudinal axis of the drilling device channel 24 to coincide with the target axis Z. The drilling device (e.g., a Kirschner wire) can then be introduced into the bone through the drilling device channel 24 of the drilling device guide 19 guided along the target axis Z. If the tissue protection sleeve 20 is not used, the drilling device guide 19 can be introduced into the guide channel 22 so that the drilling device guide 19 can be expanded relative to the guide channel 22 in the direction of the intramedullary nail 2 so as to guide the drilling device channel 24 to the intramedullary nail 2. To this end, the cross-section of the drilling device guide 19 can be configured to correspond to the shape of the cross-section of the guide channel 22.

[0059] Thus, advantageously, the positioning device 1 comprises an alignment sight 7 with a first indicator structure 11 for displaying the path of the target axis Z in an X-ray image of the alignment sight 7 along the target line of sight S2, wherein the first indicator structure 11 and the target axis Z define a first alignment plane, and wherein the alignment sight 7 comprises a second indicator structure 12 configured for indicating an orthogonal tilt of the line of sight S1 from the first alignment plane in an X-ray image of the alignment sight 7 along the line of sight S1. Thus, the line of sight S1 of the X-ray image of the alignment sight 7 can be aligned according to the first alignment plane or the target line of sight S2. When the intramedullary nail 2 is introduced into the intramedullary canal of the bone with the positioning device, the first indicator structure shown in the X-ray image of the alignment sight 7 with the line of sight S1 adapted to the target line of sight S2 represents a reference point for the path of the target axis Z in the bone. If the second indicator structure 12 is formed with two tilt indicator gaps 14, the two tilt indicator gaps 14 are preferably implemented with protrusions or recesses, wherein the direction of the orthogonal tilt from the first alignment plane can be read on the tilt indicator gap 14, a compact structure can be achieved, and the orthogonal tilt or alignment of the line of sight S1 of the X-ray image can be simply and effectively determined.

Claims

1. A positioning device (1) for a bone implant, in particular an intramedullary nail (2), for positioning and / or fixing a bone implant, typically for treating fractures, in particular fractures of the proximal femur, wherein the positioning device (1) has a curved handle (3), the curved handle (3) having a target guide (4), such as a target hole, for guiding a bone drill device (5), wherein the target guide (4) defines a target axis (Z), and wherein the curved handle (3) comprises a connecting element (6) for detachably connecting the bone implant to the curved handle (3) and an alignment sight (7), wherein the alignment sight (7) comprises a first indicator structure (11) so that the path of the target axis (Z) is displayed with the first indicator structure (11) in a second X-ray image of the alignment sight (7) along a target line of sight (S2), the target line of sight (S2) being located in a first alignment plane formed by the target axis (Z) and the first indicator structure (11), characterized in that The alignment sight (7) comprises a second indicator structure (12) configured to indicate, in a first X-ray image of the alignment sight (7) along a line of sight (S1) deviating from the target line of sight (S2), an orthogonal tilt of the line of sight (S1) from the first alignment plane to allow adjustment of the line of sight (S1) to the target line of sight (S2).

2. The positioning device (1) according to claim 1, characterized in that The first indicator structure (11) and / or the second indicator structure (12) are formed with at least one protrusion and / or at least one depression so as to form a structure that can be identified in an X-ray image.

3. The positioning device (1) according to claim 1 or 2, characterized in that: The second indicator structure (12) is configured such that the second indicator structure (12) indicates in the first X-ray image the direction in which the line of sight (S1) is tilted from the orthogonality of the first alignment plane.

4. The positioning device (1) according to any one of claims 1 to 3, characterized in that: The second indicator structure (12) is formed with a plurality of gap defining walls, so that the gap defining walls form two tilt indicator gaps (14) spaced apart from each other in a first X-ray image of the alignment sight (7), wherein the direction of orthogonal tilt can be read by comparing the gap widths of the tilt indicator gaps (14).

5. The positioning device (1) according to claim 4, characterized in that: The respective tilt indicator gap (14) is formed in the X-ray image by a first gap-delimiting wall (15) and a second gap-delimiting wall (16) which each form a wall pair, wherein the second gap-delimiting wall (16) is arranged at least in sections downstream of the first gap-delimiting wall (15) in a direction parallel to the first alignment plane, and wherein, in one of the wall pairs, the first gap-delimiting wall (15) is arranged downstream of the second gap-delimiting wall (16) in a first direction orthogonal to the first alignment plane and in the other wall pair in a second direction opposite to the first direction, so that in the X-ray image of the alignment sight (7), the gap width of one or the other tilt indicator gap (14) has a greater reduction depending on the direction in which the line of sight (S1) is tilted from the orthogonality of the first alignment plane.

6. The positioning device (1) according to claim 4 or 5, characterized in that: The alignment sight (7) is configured such that the first indicator structure (11) in the second X-ray image is arranged between the two tilt indicator gaps (14), wherein the first indicator structure (11) is preferably implemented with a cutout.

7. The positioning device (1) according to any one of claims 1 to 6, characterized in that: The alignment sight (7) comprises a third indicator structure (17), which is configured to indicate, in a third X-ray image of the alignment sight (7), in particular in the first X-ray image and / or the second X-ray image of the alignment sight (7), that the line of sight of the third X-ray image is tilted orthogonally from a second alignment plane aligned at right angles to the first alignment plane, so as to align the line of sight of the third X-ray image with the second alignment plane.

8. The positioning device (1) according to claim 7, characterized in that The third indicator structure (17) is formed with a plurality of alignment structures (25) arranged one after another in a direction parallel to the target line of sight (S2), so that a defined alignment or superposition of the alignment structures (25) indicates the arrangement of the line of sight of the third X-ray image within the second alignment plane.

9. A positioning system for positioning and / or fixing an intramedullary nail (2) in a bone, in particular in the proximal femur, to treat fractures, in particular fractures of the proximal femur, wherein the positioning system comprises a positioning device (1) and an intramedullary nail (2), wherein the intramedullary nail (2) can be introduced into the intramedullary canal of the bone, wherein the intramedullary nail (2) has a hole (10) protruding transversely relative to the longitudinal axis of the intramedullary nail (2) to accommodate a connecting device, in particular a bone screw, to introduce the connecting device into the hole (10) so that the connecting device protrudes beyond the hole (10) on at least one side, in particular on both sides, wherein the connecting device can be fixed on the end face of a bone part, in particular a femoral head, and characterized in that The positioning device (1) is configured as a positioning device (1) according to any one of claims 1 to 8.

10. The positioning system according to claim 9, characterized in that: The target guide (4) comprises a guide device (18) and a drilling device guide (19), wherein the drilling device guide (19) comprises a drilling device channel (24) for guiding a bone drill device (5), wherein the drilling device guide (19) can be connected to the guide device (18) in an interlocking manner, in particular detachably connected, so that the drilling device guide (19) can be movably guided along the target axis relative to the guide device (18) to guide the drilling device channel (24) to the bone surface of the bone or to the intramedullary nail (2) when the intramedullary nail is introduced into the bone.

11. The positioning system according to claim 10, characterized in that: The target guide (4) comprises a tissue protection sleeve (20) which is movable relative to the guide device (18) so as to at least partially enclose the drilling device guide (19) in an expanded position, wherein the drilling device guide (19) is guided in the direction of the bone or the intramedullary nail (2) so as to separate the drilling device guide (19) from the body part tissue surrounding the bone.

12. A method for treating a bone fracture, in particular a proximal femur fracture, wherein an intramedullary nail (2) is introduced into the intramedullary canal of a bone, in particular a proximal femur, using a positioning device (1), in particular a positioning device (1) according to any one of claims 1 to 8, wherein the intramedullary nail (2) is connected, in particular detachably connected, to a curved handle (3) of the positioning device (1), wherein the curved handle (3) comprises a target guide (4) for guiding a bone drill device (5) into the bone along a target axis (Z), wherein the curved handle has an alignment sight (7) for aligning the target axis (Z), wherein the alignment sight (7) comprises a first indicator structure (11), the first indicator structure (11) being configured to indicate the path of the target axis (Z) in a second X-ray image of the alignment sight (7) along a target line of sight (S2), the target line of sight (S2) being located in a first alignment plane formed by the target axis (Z) and the first indicator structure (11), characterized in that A first X-ray image of the alignment sight (7) of the bending handle (3) is made along the line of sight (S1), and according to the first X-ray image, the line of sight (S1) is adjusted to a first alignment plane based on a second indicator structure (12) of the alignment sight (7), and the second indicator structure (12) is configured to indicate an orthogonal tilt of the line of sight (S1) from the first alignment plane in the X-ray image of the alignment sight (7).

13. The method according to claim 12, characterized in that A bone drill device (5), in particular a Kirschner wire, is guided into the bone along the target axis (Z) using the target guide (4) of the curved handle (3), wherein the line of sight (S1) is adjusted based on the second indicator structure (12) for comparison with the first indicator structure (11) before and / or after the bone drill device (5) becomes visible in the first X-ray image.

14. The method according to claim 12 or 13, characterized in that The intramedullary nail (2) comprises a hole (10) which extends transversely relative to the longitudinal axis of the intramedullary nail (2) to accommodate a coupling device, in particular a bone screw, wherein the bone drilling device (5), in particular a Kirschner wire, is guided through the hole (10) along the target axis (Z) by the target guide (4).

15. The method according to claim 15, characterized in that First, a bone drill device configured as a targeting wire, in particular a Kirschner wire, is guided through a hole (10) along a target axis (Z), wherein the diameter of the bone drill device is smaller than the diameter of the connecting device; then a bone hole channel is introduced into the bone along the target axis (Z) using the bone drill, wherein the targeting wire serves as a guide; then the connecting device is introduced into the hole (10) via the bone hole channel.

Images