Orthopedic cable bone delivery device and bone delivery system comprising same

Abstract

The invention relates to a medical cable (9) comprising: a flexible body (93) having an outer cable diameter, the body (93) having a first end (90) and a second end (91); and at least one lead wire (98) extending from the first end (90) and / or the second end (91) of the body (93), the lead wire having a wire diameter and being more flexible than the body (93), the wire diameter being less than half the cable diameter, the lead wire defining a closed loop (92).

Description

[0001] Cross - reference to related applications

[0002] This application claims the priority of PCT Patent Application No. PCT / EP2022 / 087716, filed on December 23, 2022. Technical field

[0003] The present invention generally relates to orthopedic bone transport systems and associated medical cables.

[0004] The present invention thus has useful applications in the field of orthopedics, particularly in the treatment of bone defects. Background art

[0005] External fixation systems are used in a variety of surgical procedures, including fracture reduction, limb lengthening, and correction of deformities, as well as the treatment of non - unions, malunions, and bone defects. For the treatment of bone defects, a rigid frame including upper (proximal) and lower (distal) outer circular support members is placed externally around the affected limb and attached to the associated upper (proximal) and lower (distal) bone segments using wires and / or pins. The proximal outer support member and the distal outer support member of the rigid frame are interconnected by a threaded rod or telescopic rod, which stabilizes the spatial positioning of the distal bone segment relative to the proximal bone segment. Then one of those bone segments (e.g., the proximal one) is divided (e.g., via osteotomy) into two bone segments, thereby creating a third (intermediate) bone segment, also known as the transport bone segment, which is gradually transported through the bone defect area, thereby creating newly formed bone tissue in the transport path.

[0006] The stabilization of the transport bone segment via cables has been used for bone transport, which significantly reduces soft - tissue - related complications compared to alternative techniques. However, traditional surgical methods using transmission cables (such as Weber cable - bone transport or balanced cable - bone transport) have the disadvantage of being extremely complex. Specifically, the practitioner must spend a significant amount of time correctly inserting the medical cable to be fixed to the interposed bone segment. Moreover, the rollers and tie rods occupy space on the outer support member, restricting the positions for other connections and wire / pin fixation elements. Finally, the cable ends located between the proximal outer support member and the distal outer support member are unprotected and may be damaged from the outside, thus not providing sufficient stability for the fixation of the transport bone segment.

[0007] Therefore, the technical problem on which the present invention is based is to design a cable - based bone transport system that solves at least some of the disadvantages of the prior art, and in particular a medical cable that can be advantageously employed in such a cable - based bone transport system. Summary of the invention

[0008] The idea of the solution that forms the basis of the present invention is to modify traditional surgical techniques and design a medical cable with a looped end that can be easily routed through a bone segment during a surgical procedure. As described in the detailed description, the looped end can be engaged by a hook tool and then pulled within holes drilled in the bone and in the medullary cavity, thus greatly simplifying the surgeon's task.

[0009] In view of the above, the technical problem is solved by a medical cable that includes: a flexible body having an outer cable diameter, the body having a first end and a second end; and at least one lead wire that extends from the first end and / or the second end of the body, the lead wire having a wire diameter and being more flexible than the body, the wire diameter being less than half of the cable diameter, and the lead wire defining a closed loop.

[0010] Preferably, two lead wires that define a closed loop are provided at both the first end and the second end.

[0011] Preferably, the first end of the cable is visually distinguishable from the second end of the cable. This can be achieved by different markings or color differences in the lead wires attached to the first end and the second end, respectively.

[0012] The wire diameter of the lead wire is preferably less than one-third of the cable diameter, and even more preferably less than one-fifth of the cable diameter.

[0013] Preferably, the body of the medical cable is formed of multiple strands, each strand having a plurality of filaments.

[0014] Preferably, the strands and the lead wires are made of different materials; in particular, the strands can be metal wires, while the lead wires can be polymer wires, such as nylon wires.

[0015] Preferably, the lead wire that forms the closed loop extends from the body by at least 40 mm, ideally at least 90 mm. Preferably, the lead wire is at most 200 mm, ideally at most 150 mm.

[0016] The length of the body is preferably included between 500 mm and 1200 mm.

[0017] The medical wire according to the present invention preferably includes a size index at the first end and / or the second end.

[0018] The technical problem is also solved by an orthopedic bone delivery system, which includes: an external fixation frame adapted to be firmly attached to at least one fixed bone segment; at least one cable pulling device (preferably two), which is adapted to be fixed on the external fixation frame; at least one medical cable adapted to be fixed to the delivery bone segment and wound around the cable pulling device, and the medical cable has a closed loop at its opposite ends.

[0019] The cable pulling device may further include a balance screw or pin adapted to be anchored to at least one fixed bone segment to redirect the medical cable within the medullary cavity of the bone segment.

[0020] The technical problem is also solved by a drill guide for guiding a surgeon to implant the orthopedic bone delivery system, which includes: a cannula extending along a first axis, the cannula having a first end configured to be received in the medullary cavity of the bone; a first arm extending perpendicular to the cannula along a second axis; a second arm attached to the first arm at a first joint; the second arm includes a first guide hole spaced from the first joint along a direction parallel to the first axis; a third arm attached to the second arm at a second joint, the second joint being spaced from the first guide hole along a direction parallel to a third axis, and the third axis is orthogonal to both the first axis and the second axis; the third arm includes a second guide hole spaced from the second joint along a direction parallel to the second axis.

[0021] Preferably, the first guide hole is parallel to the second axis and the second guide hole is parallel to the third axis.

[0022] Preferably, the cannula includes a movable support that can move along the first axis to adjust the amount of the length of the cannula that can be inserted into the medullary cavity.

[0023] Preferably, the first joint and the second joint are rotatable so that the first arm, the second arm, and the third arm can be set to a planar configuration for packaging, storage, and / or transportation of the drill guide.

[0024] It should be understood that the above general description and the following drawings and detailed description are essentially exemplary and illustrative, and are intended to provide an understanding of the present disclosure without limiting the scope of the present disclosure. In this regard, from the following, additional aspects, features, and advantages of the present disclosure will be clear to those skilled in the art. One or more features of any implementation or aspect can be combined with one or more features of other implementations or aspects.

[0025] The features and advantages of the present invention will be disclosed with reference to the accompanying drawings that relate to exemplary and non-limiting implementations. BRIEF DESCRIPTION OF THE DRAWINGS

[0026] The drawings illustrate implementations of the systems, devices, and methods disclosed herein and, together with the description, are used to explain the principles of the disclosure.

[0027] Figure 1 A perspective view showing a first embodiment of an orthopedic bone delivery system according to the present invention;

[0028] Figure 2 A perspective view showing a second embodiment of an orthopedic bone delivery system according to the present invention;

[0029] Figure 3 A side view showing a medical cable according to the present invention;

[0030] Figure 4A Shows Figure 1 the middle section of a medical cable;

[0031] Figure 4B Shows Figure 1 the end section of a medical cable;

[0032] Figure 5A A side view showing the end of a medical cable according to an alternative embodiment of the present invention;

[0033] Figure 5B A cross-section taken along plane A-A of the medical cable of FIG. 5;

[0034] Figures 6 - 20 Shows the various stages of preparing a delivery bone segment according to a method of implanting a medical cable according to the present invention in an orthopedic bone delivery system;

[0035] Figure 21 A perspective view showing a first embodiment of a cable balance screw as part of an orthopedic bone delivery system according to the present invention;

[0036] Figure 22 A perspective view showing a second embodiment of a cable balance screw as part of an orthopedic bone delivery system according to the present invention;

[0037] Figure 23 A perspective view showing a third embodiment of a cable balance screw as part of an orthopedic bone delivery system according to the present invention;

[0038] Figure 24 A perspective view showing a drill guide according to the present invention;

[0039] Figure 25 Shows Figure 24Another perspective view of the drill guide;

[0040] Figure 26 showing the Figure 24 drill guide in a folded configuration;

[0041] Figure 27 showing Figure 24 an exploded view of the drill guide.

[0042] These figures will be better understood with reference to the following detailed description. Detailed Description

[0043] In the following detailed description, reference is made to the accompanying drawings, which form a part hereof, and in which specific embodiments are shown by way of illustration. In the drawings, like numerals describe substantially similar components throughout several views. Other embodiments may be disclosed and structural changes may be made without departing from the scope of the present disclosure. Accordingly, the following detailed description should not be taken in a limiting sense.

[0044] By way of example, the present disclosure relates to a segmental bone delivery system 1 that employs an innovative technique based on pulling a medical cable 9 by a cable pulling device 8 that has a spool around which the medical cable 9 is wound. However, the medical cable according to the present invention can also be used with different segmental bone delivery systems (e.g., a standard balanced cable bone delivery system).

[0045] The bone delivery system 1 is designed to apply a translational force to the delivery bone segment 10 by reducing the length of the flexible medical cable 9 attached to the delivery bone segment 10. To this end, it employs a concept similar to that used for tuning stringed musical instruments. One end of the medical cable 9 is fixed to the spool of the cable pulling device 8 via a worm gear mechanism, and the medical cable 9 is wound around the spool of the cable pulling device 8.

[0046] In the case of a musical string, the other end of the string is fixed and not allowed to translate. When the tuning mechanism is rotated, the tension in the string changes, which also changes its resonant frequency. The worm gear mechanism ensures that the tension will be maintained when the mechanism is no longer rotated. The worm can rotate the worm gear to tighten the cable, but the worm gear cannot rotate the worm to release the tension in the cable.

[0047] In the bone delivery system 1, shortening the cable 9 to tension the cable 9 causes the bone delivery segment 10 to move. The distance that the bone delivery segment 10 can travel varies depending on how much the cable 9 can be wound around the spool of the cable pulling device 8.

[0048] The bone segment transportation is carried out in steps, where the transportation distance for each step is preferably from 0.25 mm to 0.50 mm, and it is carried out 2 to 4 times a day, but can be flexible depending on bone formation. Additionally, it can be completed by steps of 0.20 mm carried out four or five times a day. In most cases, a total transportation distance of 1.0 mm is required per day.

[0049] Figure 1 and Figure 2 FIG. 6 shows an example of a bone transportation system 1, 1' according to an embodiment of the present invention. The bone transportation systems 1, 1' are provided with a cable pulling device 8 for bone transportation and are attached to a bone segment.

[0050] The bone transportation systems 1, 1' according to the present invention are intended to be applied to the long bones of a patient. In Figure 1 the embodiment, the long bone is the tibia; in Figure 2 the embodiment, the long bone is the femur.

[0051] The bone transportation systems 1, 1' include an external frame 47, which is characterized by a proximal ring 37 and at least one distal ring 38 - two in Figure 2 the embodiment. The proximal ring 37 and the distal ring 38 are respectively anchored to the proximal fixed bone segment 39 and the distal fixed bone segment 40 by means of tension lines and / or fixing pins 41. The proximal ring 37 is connected to the distal ring 38 by means of a longitudinal rod 42. Preferably, the longitudinal rod 42 is extensible.

[0052] The transported bone segment 10 is axially included between the proximal fixed bone segment 39 and the distal fixed bone segment 40.

[0053] The bone transportation systems 1, 1' include two cable pulling devices 8, which are attached at diametrically opposite positions on one of the distal rings 38 by bolts. In Figure 1 the embodiment, the cable pulling devices 8 are placed outside and inside with respect to the distal fixed bone segment 40. In Figure 2 the embodiment, the cable pulling devices 8 are placed in front of and behind the distal fixed bone segment 40. In other embodiments, the cable pulling devices can be placed at different positions and do not need to be diametrically opposite: for example, one device can be placed in the front and the other device can be placed in the middle. A medical cable 9 is pulled between the two cable pulling devices 1, and the medical cable 9 follows the path described below.

[0054] The bone transportation system 1 further includes a device 43 for redirecting the medical cable 9 at the distal fixed bone segment 40. Preferably, the device 43 for redirecting the medical cable 9 takes the form of a pivot pin or a screw, which is implanted in the distal fixed bone segment 40 along the anteroposterior direction.

[0055] The PCT priority application No. PCT / EP2022 / 087716 describes in detail exemplary embodiments of a cable pulling device 1 for use with bone delivery systems 1, 1' according to Figure 1 and Figure 2 , which PCT priority application is incorporated herein by reference.

[0056] Figure 3 An example of a medical cable 9 according to the present invention is shown. The medical cable 9 has a body 93 having a first end 90 and a second end 91 opposite the first end 90. The body 93 preferably has an outer cable diameter D between 1.6 mm and 2.2 mm and a total length between 500 mm and 1200 mm.

[0057] At both the first end 90 and the second end 91, the medical cable 9 has a closed loop 92. The closed loop 92 is defined by a lead 98 attached to the first end 90 and the second end 91 of the body 93. The lead 98 has a wire diameter d that is much smaller than the cable diameter D, preferably less than one-fifth of the cable diameter D. When extending from the respective end of the body 93 to the tip of the closed loop 92, the lead 98 has a length between 90 mm and 150 mm.

[0058] As best seen in Figure 4A , the body 93 of the medical cable 9 is formed by a plurality of strands 94, each strand being made up of a plurality of filaments 95. The filaments 95 are preferably metal wires, such as made of stainless steel or titanium. In the exemplary embodiment depicted herein, the body 93 has seven strands 94: one central strand arranged according to a honeycomb layout and six transverse strands. A gap 97 is defined at the intersection of the central strand and two adjacent transverse strands. Each single strand 94 has seven filaments 95, and the seven filaments 95 are also arranged with six transverse filaments around a central wire.

[0059] As best seen in Figure 4B , opposite ends of each lead 98 are inserted into two of the voids 97, preferably two diametrically opposed voids 97. The lead 98 passes through the gap to secure it to the body 93. In some examples, the lead 98 can be further secured to the body 93 using an adhesive (such as glue or tape). In some examples, a curable resin can be applied at the location where the lead 98 passes through the body 93, and UV light or a heat source can be used to cure the resin and attach the lead 98 to the body 93. In some examples, a sleeve can be slid over the lead 98 and onto the body 93. Then, the sleeve can be crimped in place to secure the lead 98 to the body 93. In Figure 5A , Figure 5BIn the examples seen in, the joining piece 980 (e.g., a stainless - steel joining piece) can be welded at one end of the body 93 or one of its strands 94. The joining piece 980 is characterized by an eyelet 981 through which the lead 98 passes. Various combinations of these techniques can be used to ensure that the lead 98 remains fixed to the body 93.

[0060] Given the above layout, the lead 98 has a wire diameter d that is less than or equal to the wire diameter of the gap 97, which in turn is comparable to the diameter of the single - strand wire 95. The lead 98 can be made of a material different from that of the strand 98 (e.g., a non - metallic material with a higher degree of flexibility, such as a polymer, e.g., nylon). Preferably, the opposing leads 98 have different colors, or are provided with visual or tactile markings to easily distinguish the first end 90 from the second end 91 of the medical cable 9. The body 93 of the medical cable 9 can also have different colors or markings at its first end 90 and second end 91.

[0061] The medical cable 9 enters the transfer bone segment 10 at its resected end and is attached to the transfer bone segment by means of the outer ring 44, passes through at least one first tangential hole 11 made in the transfer bone segment 10 into its medullary cavity and into the bone defect area following the bone axis, enters the fixed distal bone segment 40 from the medullary cavity, and after being orthogonally re - oriented around the pivot pin or screw 43, exits the distal bone segment 40.

[0062] The medical cable 9 is symmetrically stabilized on the transfer bone segment 10 by axially withdrawing both ends into the medullary cavity.

[0063] In the distal fixed bone segment 40, the two ends of the medical cable 9 rotate around the pivot pin 43 and exit the cortex on two different sides through the second and tangential holes 12.

[0064] The bone transfer system employing the medical cable 9 according to the present invention can be implanted according to the following reference Figures 6 - 21 described advantageous surgical methods. This method is described herein with reference to the femur having a proximal fixed bone segment 39 and a distal fixed bone segment 40, but it can equally be applied to other long bones.

[0065] In Figure 6 the steps of the surgical method depicted in, the proximal bone is cut in a manner known per se to release the transfer bone segment 10.

[0066] In Figure 7 and Figure 8In the steps of the surgical method depicted, the first tangential hole 11 is drilled through the transfer bone segment 10 by means of a drilling tip 100. In some examples, the first hole may extend in the medial-lateral direction, but any suitable orientation may be used. It has been observed that this step may be performed before the step of cutting the proximal bone, such that at this stage, the transfer bone segment 10 may still be fixed to the proximal bone segment 39.

[0067] The diameter of the first tangential hole 11 is preferably at least twice the diameter D of the cable. As best seen in Figure 8 the first tangential hole 11 is made at a short distance from the distal edge of the transfer bone segment 10. Such a distance may be, for example, approximately 10 mm. The first tangential hole 11 traverses the medullary cavity 14, preferably in its middle.

[0068] In Figure 9 and Figure 10 In the steps of the surgical method depicted, the first end 90 of the medical cable 9 is inserted into the first tangential hole 11. As shown in the figure, a pulling instrument 157 may be used to facilitate the routing of the medical cable 9 in the first tangential hole 11. The pulling instrument 157 includes a hook 158, a handle 159, and a shaft 160 extending between the hook 158 and the handle 159. The hook 158 and the shaft 160 pass through the two cortices of the transfer bone segment 10 in the first tangential hole 11. Then, the hook 158 engages the loop 92 defined by the lead 98 at the first end 90 of the medical cable 9. Finally, the hook 158 retracts within the first tangential hole 11, pulling the loop 92 of the cable across the two cortices of the transfer bone segment 10 such that it spans the medullary cavity 14 in diameter.

[0069] In Figures 11 - 13 In the steps of the surgical method depicted, the first end 90 of the medical cable 9 is routed through the distal opening of the medullary cavity 14. First, as Figure 11 shown, the pulling instrument 157 is axially inserted through the distal opening of the medullary cavity 14. Then, the hook 158 engages the loop 92 spanning the medullary cavity. Thereafter, as Figure 12 and Figure 13 shown, the pulling instrument 157 is pulled distally to traction the loop 92 and the first end 90 of the medical cable 9 through the distal opening of the medullary cavity 14. Thereby, it becomes easier for the thicker body 93 of the medical cable 9 to bend.

[0070] In Figures 14 - 17In the steps of the surgical method depicted, the second end 91 of the medical cable 9 is also routed through the distal opening of the medullary cavity 14 via the first tangential hole 11. The routing of the second end 91 can be carried out in the same manner as the routing of the first end 90, first by tangentially pulling the loop 92 through the first tangential hole 11 and second by pulling it distally through the medullary cavity 14. At the end of these operations, the medical cable 9 forms an outer loop 44 around the transfer bone segment 10, while both opposite ends 90, 91 extend outside the distal opening of the medullary cavity 14 along the anatomical axis.

[0071] In Figure 18 In the steps of the surgical method shown, a second tangential hole 12 and a third tangential hole 13 are drilled in the fixed distal fixation bone segment 40. Preferably, the second and third tangential holes 12, 13 are drilled along two orthogonal directions, which are the radial directions of the bone segment. The second tangential hole 12 can be aligned with the first tangential hole 11. The second tangential hole 12 can extend along the mid-lateral direction, while the third tangential hole 13 can extend in the anteroposterior direction. The second tangential hole 12 can be located slightly more distally on the distal fixation bone segment 40 relative to the third tangential hole 13, for example, about 3.5 mm more distally. It is observed that the steps of drilling the second tangential hole 12 and the third tangential hole 13 can be performed before or after the cable is routed through the first tangential hole 11 and the medullary cavity 14. Both the second tangential hole 12 and the third tangential hole 13 are preferably bicortical holes.

[0072] In Figures 19 - 20 In the steps of the surgical method depicted, the first end 90 and the second end 91 of the medical cable 9 are routed through the proximal opening of the medullary cavity 14 of the fixation bone segment 40 and finally withdrawn through the second hole 12. The pulling instrument 157 can be used again to engage the loop 92 and pull the ends 90, 91 through the holes. It can be observed that the first end 90 and the second end 91 should pass through the opposite second tangential holes 12 respectively. The fact that the two opposite ends 90, 91 are visually distinguishable helps the surgeon to distinguish between the two opposite loops 92 when engaging the two opposite loops 92 with the hook 158.

[0073] In a final step not shown in the figure, the first end 90 and the second end 91 of the cable can be fixed to the external fixator structure. At least one (preferably two) ends of the medical cable 9 can be wound around the spool of the cable pulling device 8 fixed to the external fixator structure.

[0074] After the medical cable 9 is withdrawn from the second tangential hole 12a, the balance screw 43 can be fixed to the distal fixed bone section 40 across the medullary cavity through the third tangential hole 13. The balance screw 43 can be used as a support pin to convert the horizontal force on the cable 9 into a vertical force to pull the transfer bone section 10 during transfer. In this regard, the first end 90 of the cable 9 can pass through the distal side of the balance screw 43 and leave the distal bone section 40 through one of the second tangential holes 12, while the second end 91 of the cable 9 can pass through the distal side of the balance screw 43 and leave the distal bone section 40 through the other second tangential hole 12.

[0075] Examples of the balance screws 43, 43', 43'' are shown in Figures 21 - 23 FIG. 5. The balance screws 43, 43', 43'' include a shaft 171 having a first threaded region 171a, a second threaded region 171b, and an intermediate region 171c positioned between the first and second threaded regions. The intermediate region 171c can be smooth to reduce the friction between the cable 9 and the shaft 171. In the Figure 21 example of FIG. 6, the intermediate region 171c includes a guiding groove 171d for guiding the medical cable 9. Figure 23 FIG. 9 illustrates an example of the balance screw 43'' having threads in the intermediate region 171c, the intermediate region 171c having a smaller diameter and being blunter compared to the threads in the first and second threaded regions 171a, 171b. The helical groove between the threads in the intermediate region 171c can be used as a cable guide to hold the first end 90 of the medical cable 9 in the first helical groove and hold the second end 91 of the medical cable 9 in the second helical groove. The balance screws 43, 43', 43'' can be characterized by having a head with a hexagonal recess for a fixing tool.

[0076] Figures 24 - 27 FIG. 13 shows a drill guide that can be used to drill one or more of the first tangential hole 11, the second tangential hole 12, and the third tangential hole 13. The drill guide 172 includes a sleeve 177 integrally attached to a vertical first arm 178. The sleeve 177 is configured to be axially inserted into the medullary cavity 14 of the bone, wherein the first arm 178 deviates tangentially from the bone. Thus, the sleeve 177 is configured to extend along a first axis x following the proximal-distal direction, and the first arm 178 is configured to extend along a second axis y. A third axis z orthogonal to the first and second axes is also defined. The first arm 178 includes a handle extending away from the sleeve 177.

[0077] The drill bit guide 172 further includes a third arm 180 attached to the second arm and a second arm 179 connecting the first arm 178 to the third arm 180. The second arm is L-shaped and has: a first portion that is attached to the first arm 178 and extends parallel to the first axis x; and a second portion that is attached to the third arm 180, is perpendicular to the first portion and is thus oriented parallel to the third axis z. A first guide hole 182 that is parallel to the second axis y and thus points to the first guide hole 177 of the cannula is provided at the junction between the first portion and the second portion. The third arm 180 extends perpendicular to the second portion of the second arm 179 (substantially parallel to the first arm 178, i.e., along the second axis y). The guide hole supports a second guide hole 183 that points along the third axis z at its free end.

[0078] A movable support 184 is provided that can slide along the length of the cannula 177. The movable support 184 can be set to adjust the length of the cannula 177 entering the medullary cavity 14. The movable support 184 is mounted to a guide rod 185 that slides within a slot in the first arm 178 and can be locked therein by manipulating an external key 186.

[0079] The distance between the third arm 180 and the first guide hole 182 can be adjusted along the axis of the second portion of the second arm 179. For this purpose, the third arm 180 is slidably mounted on a rod 187 that is integral with the second portion of the second arm 179 and can be locked in a plurality of positions along the rod due to a locking mechanism 188 engaged in a plurality of grooves in the rod 187.

[0080] In use, the first guide hole 182 can be used to drill the third tangential hole 13, while the second guide hole 183 can be used to drill the second tangential hole 12. Also, the cannula 177 can be used during surgery to guide the medical cable 9 while a redirect pin or balance screw passes through the first guide hole 182.

[0081] As best shown in Figure 26 The first arm 178, the second arm 179, and the third arm 180 can be coupled to a rotary joint such that the drill bit guide can be reconfigured into a planar configuration for packaging.

[0082] Although specific examples have been illustrated and described above, those of ordinary skill in the art will recognize that arrangements that achieve the same results can replace the specific embodiments shown. This disclosure is intended to cover adaptations or variations of one or more embodiments of this disclosure. It should be understood that the above description has been made in an illustrative rather than a restrictive sense. The scope of one or more examples of this disclosure should be determined with reference to the appended claims and the full scope of the equivalents given by those claims.

Claims

1. A medical cable (9), comprising: A flexible body (93), the flexible body (93) having an outer cable diameter (D), the body (93) having a first end (90) and a second end (91); And At least one lead wire (98), the at least one lead wire (98) extending from the first end (90) and / or the second end (91) of the body (93), the lead wire having a wire diameter (d) and being more flexible than the body (93), the wire diameter (d) being less than half of the cable diameter (D), the lead wire defining a closed loop (92).

2. The medical cable (9) according to claim 1, wherein, Two lead wires (98) defining a closed loop (92) are provided at both the first end (90) and the second end (91).

3. The medical cable (9) according to claim 2, wherein, The first end (90) of the cable is visually distinguishable from the second end (91) of the cable.

4. The medical cable (9) according to claim 3, wherein, The first end (90) and the second end (91) are distinguishable due to different markings or color differences in the body (93) and / or in the lead wires (98) respectively attached to the body (93).

5. The medical cable (9) according to any one of the preceding claims, wherein, The wire diameter (d) is less than one-third of the cable diameter (D), preferably less than one-fifth of the cable diameter (D).

6. The medical cable (9) according to any one of the preceding claims, wherein, The body (93) is formed of a plurality of strands (94), each strand having a plurality of filaments (95).

7. The medical cable (9) according to claim 6, wherein, The filaments (95) and the lead wires (98) are made of different materials.

8. The medical cable (9) according to any one of the preceding claims, wherein, The lead wire (98) forming the closed loop (92) extends from the body by at least 70 mm, preferably at least 90 mm.

9. The medical cable (9) according to any one of the preceding claims, the medical cable further comprising at least one size index (99) at the first end (90) and / or at the second end (91).

10. An orthopedic bone delivery system (1, 1'), comprising: An external fixation frame (37, 38, 42), the external fixation frame (37, 38, 42) being adapted to be firmly attached to at least one fixed bone segment (39; 40); At least one cable pulling device (8), the at least one cable pulling device (8) being adapted to be fixed to the external fixation frame (37, 38, 42); At least one medical cable (9), the at least one medical cable (9) being adapted to be fixed to a delivery bone segment (10) and to be wound around the cable pulling device (8), the medical cable (9) having closed loops (92) at opposite ends of the medical cable (9).

11. The orthopedic bone delivery system (1, 1') according to claim 10, further comprising a balance screw or pin (43) adapted to be anchored to at least one fixed bone segment (39; 40) to redirect the medical cable (9) within the medullary cavity of the bone segment (39; 40).

12. A drill guide (172), comprising: A cannula (177) extending along a first axis (x), the cannula (177) having a first end configured to be received in the medullary cavity (14) of a bone; A first arm (178) extending perpendicular to the cannula (177) along a second axis (y); A second arm (179) attached to the first arm (178) at a first joint; the second arm (179) includes a first guide hole (182) spaced from the first joint along a direction parallel to the first axis (x); A third arm (180) attached to the second arm (179) at a second joint, the second joint being spaced from the first guide hole (182) along a direction parallel to a third axis (z), the third axis (z) being orthogonal to both the first axis (x) and the second axis (y); the third arm (180) includes a second guide hole (183) spaced from the second joint along a direction parallel to the second axis (y).

13. The drill bit guide (172) according to claim 12, wherein, The first guide hole (182) is parallel to the second axis (y), and the second guide hole (183) is parallel to the third axis (z).

14. The drill bit guide (172) according to claim 12 or 13, wherein, The cannula (177) includes a movable support (184) movable along the first axis (x) to adjust the amount of the length of the cannula (177) that can be inserted into the medullary cavity (14).

15. The drill guide (172) according to any one of claims 12 to 14, wherein, The first joint and the second joint are rotatable such that the first arm (178), the second arm (179), and the third arm (180) can be set to a planar configuration for storage and transportation.

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