Fixation device for transverse bone distraction

Abstract

The invention comprises a fixation device (1) for transverse bone distraction with an elongated base body (3) having a top surface (5) facing away from the bone, a bottom surface (7) facing the bone, a central section (9), a first end (11) and a second end (13), a first outer Schanz screw (15) attached to the first end (11) on the bottom surface (7) of the base body (3), and a second outer Schanz screw (17) attached to the second end (13) on the bottom surface (7) of the base body (3), at least one inner Schanz screw (19) attached to the central section (9) on the bottom surface (7) of the base body (3), and at least one displacement device (21) configured to displace the at least one inner Schanz screw (19) away from the bone relative to the outer Schanz screws (15, 17), wherein the inner and outer Schanz screws (15, 17, 19) are set up to do so,to engage with the bone at its bone-facing end, wherein the at least one inner Schanz screw (19), the outer Schanz screws (15, 17) and the sliding device (21) do not project beyond a bone-facing surface of the fixation device (1) in a functional state of the fixation device (1), so that the surface of the fixation device (1) forms a substantially flat, protrusion-free surface.

Description

[0001] The present patent application relates to a fixation device for transverse bone distraction.

[0002] Such devices are used in the field of orthopedics and limb correction, particularly, but not exclusively, for patients with diabetes. According to the US Centers for Disease Control and Prevention (CDC), approximately 7.8% of the entire US population had diabetes in 2007, which corresponds to almost 24 million people. These patients often experience the problem of insufficient blood flow, especially in the lower legs, which, combined with pre-existing diabetes, can lead to dramatic complications, including amputation, if injuries occur in this area. The treatment of these patients and the complications that frequently arise resulted in total direct and indirect costs of US$174 billion in the US in 2007, for example.

[0003] Peripheral vascular and neurological complications closely associated with foot ulcers accounted for 31% and 24% of costs, respectively, and were among the main causes of hospital length of stay. More than 60% of non-traumatic lower limb amputations occur in diabetic patients, and at least 80% of amputations are preceded by an ulcer.

[0004] In recent years, it has been observed that transverse distraction using an external fixation device significantly improves blood flow to the lower extremities, thereby generally preventing amputation. Several studies, including some in China, have confirmed this finding; for example, more than a thousand patients have already been treated there with such an external fixation device during transverse bone distraction. In this procedure, a portion of the lower leg bone (tibia) is removed, and new bone tissue is generated by transversely distracting this portion.

[0005] DE 10 2014 112 573 A1 discloses an intramedullary nail for the longitudinal distraction of a long bone, which is essentially arranged within the long bone.

[0006] CN 2460057 Y discloses a fixation device for transverse bone distraction with screws that are screwed into the bone and clamped in a holder, and a sliding device that is attached to a base body together with the holders. Traction pins are pushed through bores in the bone fragment and are bent into an L-shape at their ends to exert traction on the bone fragment. The traction pins are pushed through the sliding device and guided by it. By means of a clamping unit, which is arranged away from the bone and away from the sliding device, the traction pins are clamped so that they can be adjusted in a transverse direction relative to the bone by means of an adjusting wheel and a spindle.

[0007] Chinese patent application CN 106108992 A discloses a generic fixation device for transverse bone distraction, comprising a main body and a parallel secondary body, each with a receiving device for bone pins at its end. The main body and secondary body are connected to each other via a screw mechanism, wherein a knurled nut located in the main body can move a threaded rod, the bone-facing end of which is connected to the secondary body at its center.

[0008] These known devices, however, have several disadvantages. In particular, their design and structure, with numerous adjustment options, make them very cumbersome for the surgeon to handle and require a significant time investment. This large number of adjustment options is unnecessary in the operating room and only complicates handling the device, potentially prolonging the operation unnecessarily. Furthermore, the geometry of these devices, with their long, protruding pins and screws, poses a risk of the patient's lower leg becoming caught on a table or chair leg, or other objects. Additionally, the design is inconvenient for everyday use, especially when dressing or sleeping.

[0009] It is therefore the object of the present invention to overcome at least some of the disadvantages of the prior art and to provide a fixation device that is easy to handle, simple in design and lightweight, and facilitates daily use and use during surgery.

[0010] This problem is solved by the subject matter of claim 1. Advantageous embodiments and configurations are described in the dependent claims.

[0011] According to the invention, a fixation device for transverse bone distraction is provided with an elongated base body having a top surface facing away from the bone, a bottom surface facing the bone, a central section, a first end, and a second end, a first outer Schanz screw attached to the bottom surface of the base body at the first end, and a second outer Schanz screw attached to the bottom surface of the base body at the second end, at least one inner Schanz screw attached to the bottom surface of the base body in the central section, and at least one displacement device configured to displace the at least one inner Schanz screw away from the bone relative to the outer Schanz screws, wherein the inner and outer Schanz screws are configured to engage with the bone at their end facing the bone.wherein the at least one inner Schanz screw, the outer Schanz screws and the sliding device do not project beyond a bone-facing surface of the fixation device in a functional state, so that the bone-facing surface of the fixation device forms a substantially flat, protrusion-free surface.

[0012] The flat surface of the fixation device, free of protrusions, points, or edges, significantly improves handling and reduces the risk of injury to the patient. Furthermore, its relatively simple design facilitates operation during surgery. This structure also results in a low profile and light weight for the device, as its length and width can also be reduced. The term "essentially flat surface" here does not refer to a completely smooth, continuous surface; rather, it includes other components such as the sliding mechanism or other elements integrated into the flat surface that do not impair handling with protrusions, edges, points, screws, pins, etc. Crucially, the transitions between the components, e.g.,The transitions between the top of the base body and the sliding mechanism are designed in such a way that cables, hoses, (clothing) fabrics, and the like cannot snag or become entangled. Therefore, the components at these transitions can be appropriately rounded, beveled, or flattened. Furthermore, the flexible arrangement of the sliding mechanism allows for simple designs that save space, additional elements, and thus costs, while also simplifying assembly.

[0013] In preferred embodiments, when the sliding mechanism is actuated, a) the at least one inner locking screw can be fixed to the base body, or b) the at least one inner locking screw can be moved relative to the base body. In embodiment a), a particularly simple and streamlined design is achieved because additional elements can be omitted. This simplifies handling for the operator or medical personnel. In embodiment b), precise adjustment of the degree of displacement is possible, because the sliding mechanism is adjusted using only one element.

[0014] In an advantageous embodiment, the sliding device comprises at least one part from the group consisting of a knurled or rotary head, a knurled nut, a knurled screw, a screw, a profiled screw head, and a guide element. Other designs of the sliding device that can be easily operated by hand are also possible. The purpose of this is for an adjusting element of the sliding device to effect the relative displacement of at least one Schanz screw with respect to the base body. Adjusting elements with a knurled profile are simple in structure, readily available, and reliable in function. They can be made, for example, of a suitable metal or metal alloy, or a suitable plastic such as polypropylene (PP), polycarbonate (PC), acrylonitrile butadiene styrene (ABS), polyetheretherketone (PEEK), or another suitable solid polymer material.In addition to those mentioned above, other adjustment elements are also suitable for relative displacement.

[0015] In further embodiments, the fixation device can have at least one fastening element, each configured to prevent or allow displacement of the inner or outer Schanz screws. The fastening element allows the inner or outer Schanz screws to be fixed to or relative to the base body, so that the entire fixation device remains in the position determined by the surgeon, relative to the patient. This is essential for the healing process, because only the bone fragment attached to the Schanz screw(s), which are variably mounted on the base body, is moved away from the bone in small increments after initial placement, allowing new bone tissue to be generated according to the principles of callus distraction. It is important that both the outer and inner Schanz screws can perform the fixing function.In special embodiments, all Schanz screws can also have such a fastening device, for example to prevent self-adjustment of the sliding device or unwanted adjustment by the patient or other persons.

[0016] The fastening device preferably comprises a bore on one side of the base body and a fastening element received therein. A threaded stud or the like can then, for example, be inserted into the correspondingly threaded lateral bore in the base body and engaged with the bolt by means of an internal hexagon socket or a similar screw connection, creating a force-fit or form-fit connection such that the bolt is clamped essentially perpendicular to its direction of movement and thus prevented from moving. It should be noted that other clamping mechanisms can also achieve the releasable fixing of the bolts, for example, a lever mechanism, a clamping cone, or an eccentric mechanism.

[0017] The lateral bore for the fastening device should not be confused with the bores from the top to the underside of the base body for receiving the Schanz screws. These vertical bores do not need to be through-holes. However, through-holes offer the advantage that the base body with the continuous vertical bores can be used as a drilling template. In this way, the insertion points for the Schanz screws on the bone can be precisely marked.

[0018] In further advantageous embodiments, the inner and / or outer Schanz screws can have a metric thread at their upper end and a thread suitable for bone fixation at their lower end. Thread types other than metric threads can also be used. The threads at the upper end of the Schanz screws allow for relatively easy adjustment by means of the adjustment mechanism using the aforementioned adjusting elements such as knurled screws, etc. This also enables precise distance adjustment. The threads at the lower end of the Schanz screws are designed to easily penetrate the outer bone tissue and engage the interior of the bone. For this purpose, the Schanz screws generally have a sharp or beveled tip, which further facilitates penetration into the bone.Compared to pins without threads, Schanz screws equipped with bone threads offer significantly better adhesion and fixation to the bone.

[0019] It should be noted that the Schanz screws do not necessarily have a round cross-section in their upper region. For example, the cross-section can be polygonal. They can also be flattened on one or more sides in the longitudinal direction, thus interacting with the displacement mechanism to create a rotationally stable displacement relative to the base body. An example of a non-round cross-section in the upper region is a flattening on two opposite sides, with the (metric) thread still present on the remaining outer surfaces. When an adjusting nut attached to the base body engages with the Schanz screw, and the adjusting nut is subsequently turned, the base body moves vertically up or down along the Schanz screw, while the Schanz screw remains constantly aligned with the base body in its longitudinal direction.The screw does not rotate relative to the base body. This effect can also be achieved with other geometric structures of the screw and the associated adjusting elements of the displacement device. It is also conceivable that the screws in the upper, guided area do not have a thread, but only a guide geometry; that is, the guide and thread are separated longitudinally.

[0020] In preferred embodiments, the displacement device can include an adjusting element that is received in a recess of the base body, wherein movement of the adjusting element causes a displacement of the inner or outer Schanz screw relative to the base body. For the application of the fixation device, it is important that the distance of the extracted bone fragment to the fixed bone can be adjusted as precisely as possible, as this is the only way to optimize the treatment. Adjusting elements such as knurled screws with a scale or similar units with suitable scales are particularly well suited for this purpose. It is also important to ensure that the setting, once made, cannot be changed independently in order to prevent any resetting or backward movement against the distraction.The sliding mechanism can incorporate sufficient friction, for example in the screw or clamping elements, to prevent set distance values ​​from changing unintentionally. Alternatively, the sliding mechanism can also include an additional clamping element.

[0021] In another embodiment, the base body can have at least one recess on its side. This allows for material savings, making the entire fixing device lighter and improving handling. For example, the recesses could be designed so that the base body conforms to the contours of a hand. Similarly, the surface of the base body can be rounded or chamfered at the edges, including those facing bones, to soften any other sharp edges.

[0022] In particularly preferred embodiments, the displacement device can comprise an elongated inner body, wherein the inner body is preferably receptacled in a receiving space on the underside of the base body. The at least one inner Schanz screw can be attached to the inner body. In such a configuration with at least one inner Schanz screw on the inner body, the alternative b) described above is realized, i.e., by actuating the displacement device on the base body, to which the outer Schanz screws are attached, the inner body is moved relative to the base body. In other words, the movement of the inner body relative to the base body causes a simultaneous and uniform displacement of the inner Schanz screws attached to the inner body.When the sliding mechanism is actuated, not the entire base body together with the at least one inner Schanz screw moves as in the alternative a) described above, but only the inner body.

[0023] The adjustment mechanism can include a threaded screw connecting the base body to the inner body. This screw has a knurled head and is designed to move the inner body, along with the bone segment, away from or towards the base body relative to the bone by turning it. As described above, this allows for a uniform displacement with the most precise dimensional adjustment possible. However, other adjustment mechanisms are also possible that do not rely on a thread or rotation. For example, a smooth-topped screw is clamped in the base body so that it can slide. A locking or ratchet mechanism can be used for this purpose.

[0024] In selected embodiments, the base body can be at least partially designed as a tubular hollow body. The cross-section can be circular, elliptical, square, rectangular, or polygonal. The sliding mechanism and other elements can then be formed by corresponding fixed inserts to ensure the element's function. Such inserts can then be, for example, glued or otherwise attached to the base body.

[0025] Alternatively, the base body can also be made from a solid material such as a metal or metal alloy. Plastics suitable for medical products can also be used as solid materials, for example, thermosets or thermoplastics, as well as fiber-reinforced plastics such as GRP or CFRP.

[0026] In certain advantageous embodiments, at least the base body and / or the inner body, or even other components, can be manufactured using 3D printing. 3D printing is currently a fast and cost-effective manufacturing process. It is characterized by the fact that different materials can be used on the same workpiece, and devices such as the fixing device according to the invention can be manufactured in a single operation. 3D printing also makes it possible to create suitable, stable structures such as skeletal structures, honeycomb structures, and others that are comparatively complex and expensive to produce using conventional manufacturing methods.

[0027] In further preferred embodiments, the displacement device can be operated by means of an actuator. This allows for precise, and optionally automatic, adjustment of the displacement device. The actuator can also be manually adjustable. Electric drives for the actuator are preferred, but other types of actuators can also be used.

[0028] The present invention is described below with reference to preferred examples and embodiments, in which: Fig. 1 is a perspective view of a first embodiment of the fixing device according to the invention; Fig. 2 a cross-sectional view and side view of a section of the fixing device made of Fig. 1 represents; Fig. 3 is a perspective detail view of a second embodiment of the fixing device according to the invention; Fig. 4 shows a side view of a bolt according to a preferred embodiment of the fixing device according to the invention; Fig. 5 is a perspective view of a third embodiment of the fixing device according to the invention; Fig. 6 a schematic detail view of a displacement device according to the embodiment from Fig. 5 shows; Fig. 7 shows a side view of a sluice screw with part of a displacement device according to a further embodiment; Fig. 8 a partial side view of a screw with part a displacement device according to a further embodiment; and Fig. Figure 9 shows a schematic perspective view of a fourth embodiment of the fixing device according to the invention.

[0029] Fig. Figure 1 shows a schematic perspective view of a first embodiment of the fixing device according to the invention. The fixing device 1 comprises a base body 3, which in this embodiment is essentially cuboid in shape and has a top surface 5, a bottom surface 7, a central section 9, a first end 11, and a second end 13. A first outer locking screw 15 is attached to the first end 11 in a through bore 12, such that it projects from the bottom surface 7 of the base body 3. Similarly, a second outer locking screw 17 is arranged at the second end 13 in a through bore 12 on the bottom surface 7 of the base body 3. The two outer locking screws 15 and 17 are arranged essentially parallel to each other with axes of rotation 20 which, in the embodiment shown here, lie in the plane of symmetry 14 extending from the top surface 5 to the bottom surface 7 of the base body 3.

[0030] In the Fig. In the embodiment shown in Figure 1, the upper surface 5 of the base body 3 faces away from the bone during transverse distraction, and the lower surface 7 of the base body 3 faces the bone with the Schanz screws. The central section 9 has two inner Schanz screws 19 on its lower surface 7, which are also arranged in bores 12 with the axis of rotation 20. The bores 12 of the inner Schanz screws 19 are parallel to each other and, in the illustrated embodiment, also parallel to the bores 12 of the outer Schanz screws 15, 17. However, this parallelism is not mandatory. Both the outer and inner Schanz screws are at least partially provided with a metric (external) thread 18 in their upper region, i.e., the region that engages with the base body 3. In other words, the Schanz screws not engaging with the displacement device can also be smooth in their upper region.

[0031] In the embodiment shown here, the first outer hand screw 15 and the second outer hand screw 17 are each effectively connected to a displacement device 21, which is configured to displace the base body 3, and thus the inner hand screws 19 fixedly connected to the base body 3, in a vertical direction relative to the outer hand screws 15, 17. For this purpose, the displacement device 21 includes an adjusting wheel that is received in a recess in the base body 3. In the embodiment shown here, the recess extends from one side to the other side of the base body 3. It should be noted that this does not necessarily have to be symmetrical in this way, but can also be, for example, designed on one side only, so that the displacement device or the adjusting wheel 21 projects only on one side of the base body 3.A rotation of the adjusting wheel 21 causes an axial displacement of the base body 3, including the inner Schanz screws 19, which are attached to the bone fragment to be distracted, relative to the outer Schanz screws 15, 17, which remain stationary during the displacement. This is achieved by the adjusting wheel 21 having a threaded bore 25 in its center, which engages the external thread 16 on the upper section of the outer Schanz screws 15, 17. The outer circumference of the adjusting wheel 21 has knurling 22 or another type of roughened gripping surface, designed to be touched, for example, by the fingers of an operator, so that the adjusting wheel 21 rotates about the axis of rotation 20 of the Schanz screws 15, 17. Consequently, when the adjusting wheel is moved, neither the inner nor the outer Schanz screws rotate about their axis of rotation 20.

[0032] In order for the adjusting wheel 21 to be rotatably mounted inside the base body 3 about the axis of rotation 20, it preferably has a guide element 27 on its upper and / or lower side, as described with reference to Fig. 2 is described in more detail. The two inner Schanz screws 19 are firmly connected to the base body 3 in their upper region, i.e., for example, screwed or clamped in the bores 12 by means of threads. Once the vertical position of the inner Schanz screws 19 is determined, they are preferably fixed by a fastening device. In the embodiment shown here, the fastening device is formed by a bore 23, which is essentially perpendicular to the axes of rotation 20 and has an internal thread into which a corresponding screw or threaded stud can be inserted and, upon contact with the inner Schanz screw 19, results in its axial fixation. The fastening device 23 can, however, be loosened again during or after intended use of the fixing device 1.Regarding the fastening device 23, it is conceivable that its axial movement is prevented not by a bore with an inserted screw, but by another type of clamping. Examples of such clamping include wedges, clamping or clamping cones, clamping plugs, clamps with a bayonet fitting similar to a garden hose clamp, and the like.

[0033] Fig. Figure 2 shows a cross-sectional view and a side view of a section of the shifting device. Fig. 1. In the top view, the adjusting wheel 21 can be seen with its threaded bore 25 in the axis of rotation 20 and a knurling 22 on its outer circumference, which is designed to allow a user to turn the adjusting wheel 21 with their fingers. In the side view of the Fig. Figure 2 also shows the knurling or grip area 22 in the circumferential direction. Guide elements 27 are arranged on the upper and lower surfaces of the adjusting wheel 21, respectively, to allow the adjusting wheel 21 to rotate within the recess of the base body 3 with essentially no play. It is also possible that a proper bearing arrangement using a ball or needle bearing is provided. However, for the sake of simplicity, the embodiment shown here omits complex bearing arrangements for the adjusting wheel 21.

[0034] It should be noted that the adjusting wheel 21 can also be guided in the base body 3 without guide element(s) 27.

[0035] For the function of the fixing device according to the invention in the embodiment shown here, it is essential that the outer Schanz screws 15, 17 are firmly held in the bores 12 and that, when the sliding device 21 is moved, i.e., when the adjusting wheel is turned, the sliding device 21, together with the base body 3 and the inner Schanz screws 19 attached to it, moves vertically relative to the non-rotating outer Schanz screws 15, 17. Another way to constructively achieve the property of the rotationally fixed axial bearing of the outer Schanz screws 15, 17 in this embodiment is to flatten the outer Schanz screws in the area where they are held or guided inside the base body 3, i.e., in the bores 12. Accordingly, the bores 12 can then have an internal cross-section complementary to the cross-section of the Schanz screws.It is understood that, in addition to flattening, other geometric configurations of the outer clevis screws are possible. Likewise, other shapes and counter-shapes of the displacement device 21 and the upper ends of the outer clevis screws 15, 17 are possible. The base body 3 can thus be fixed against rotation with respect to the outer clevis screws 15, 17 in such a way that axial rotation of the clevis screws 15, 17 is not possible, but only vertical displacement in the longitudinal direction of the clevis screws, effected by rotating the displacement device 21.

[0036] Fig. Figure 3 shows a perspective detail view of a second embodiment of the fixing device according to the invention. The difference to the first embodiment from Fig. The difference lies in the fact that the outer cleat screws 15, 17 are arranged at the very outermost points at the first and second ends 11, 13, respectively. The design and fastening of the inner cleat screws 19 is essentially identical, which is why they are described in Fig. 3 are not shown. One can see in Fig. 3 the first end 11, at which the bore 12 with the external hand screw 15 inserted therein is provided at a small distance from the end face of the base body 3. The adjusting wheel 21 from the first embodiment has the same internal structure. Unlike the first embodiment, however, the adjusting wheel 21 projects beyond the end face of the base body 3. In the base body 3, the recess for receiving the adjusting wheel 21 is enlarged such that the adjusting wheel 21 with the (in Fig. The guide element 27 (as shown in Figure 2) can be inserted from the end face of the base body 3. This recess can also be used to accommodate a fastening device 23 to prevent axial rotation of the adjusting wheel 21. For example, the fastening device 23 can also be a threaded pin inserted from the end face or side, or another clamping element that clamps between the base body 3 and the surface of the adjusting wheel 21. Other configurations of the clamping device are also possible. One advantage of the second configuration shown in Figure 2 is that the clamping device can be inserted from the end face or side face. Fig. The difference in the embodiment shown in Figure 3 is that the base body can be made shorter and the contact area or circumferential surface of the adjusting wheel 21 is increased compared to the first embodiment. This improves handling somewhat. Furthermore, a measuring scale mounted on the circumferential surface of the adjusting wheel 21, for example, can be more easily read; this scale serves to set the axial displacement of the outer Schanz screws 15, 17 as precisely as possible.

[0037] Fig. Figure 4 shows a side view of an internal or external Schanz screw according to a preferred embodiment of the fixation device according to the invention. A Schanz screw used here is typically made of a medical-grade plastic or metal, or a suitably appropriate metal alloy, and has a thread 16 in the upper section, a substantially smooth middle section, and a so-called bone thread 29 in the lower section. As mentioned above, the material can also be a plastic that meets the requirements for medical compatibility and suitability for use in transverse bone distraction. It is understood that only the Schanz screws in the upper region need to have a thread if they engage in this region with a sliding device with an internal thread for axial movement. Therefore, the Schanz screws in the upper region can also be designed without a thread.The bone thread 29 has a relatively high thread pitch, which serves to drive the Schanz screw into the bone with as few turns as possible. For the purposes of precise positioning and easy insertion into the bone surface, the Schanz screw preferably has a chamfered, sharp tip at its lower end. The thread 16 in the upper part of the screw is designed as a metric thread in the embodiments presented here, for example, with an outer diameter of 4 mm. It is also possible to use a different type of thread instead of a metric thread, for example, an inch thread. The lengths of the corresponding thread sections are adapted to the type of bone to be distracted and thus to the length of bone distraction. When distracting the tibia, the distraction dimension is typically between 5 mm and 25 mm, preferably between 10 mm and 20 mm.As mentioned above, the cross-section of the bolt in the upper area does not necessarily have to be round, but can be irregular or asymmetrical due to the need for torsional strength. For example, the bolt may be flattened on two opposite sides in the longitudinal direction or have a D-profile, i.e., smooth on one side and threaded on the remaining circumference.

[0038] Fig. Figure 5 shows a schematic perspective view of a third embodiment of the fixing device according to the invention. The basic structure of the fixing device 1 in this embodiment is similar to that of the first embodiment shown in Figure 5. Fig. 1, in particular the basic body 3 has essentially the same shape. In describing the in Fig. In the third embodiment shown in section 5, particular attention is therefore drawn to the differences from the first embodiment. Fig. 1. The first outer clevis screw 15 is also attached to the first end 11 of the base body 3, and the second outer clevis screw 17 is also attached to the second end 13 of the base body 3, each from the underside 7 in bores 12, which are not visible here due to the perspective view, but can also be through-holes. In contrast to the first embodiment, the bores 12 can also be not through-holes, i.e., they do not extend through the top surface 5 of the base body 3 and form a blind hole, so that the top surface 5 forms a flat, smooth surface without recesses or projections. The first outer clevis screw 15 and the second outer clevis screw 17 are received in the bores 12 and are each fixed or held in place by a fastening device 23. Similar to the description of the fastening device 23 with reference to the first embodiment in Fig. 1 The fastening device 23 here comprises a threaded bore that extends from the end face of the base body 3 parallel to the longitudinal axis of the base body 3 into the bore 12. A threaded stud with an internal hexagon socket is inserted into this threaded bore, for example, so that it can be screwed in or out again by a suitable tool or clamped from above (see Fig. 8) The second outer hand screw 17 is also fixed in the same way by a fastening device 23 (not visible here). It is also possible that the bore belonging to the fastening device 23 is located not on the end face, but on the side surface of the base body 3.

[0039] Accordingly, in this third embodiment in Fig. 5 the inner bolts 19 are arranged so that they can be displaced in their longitudinal direction along the axes 20 relative to the base body 3 by means of the displacement device 21, by means of a central adjusting wheel 21a, which is arranged between and thus interacts with two substantially identical adjusting wheels. In this third embodiment, the displacement device 21 comprises an adjusting wheel which, as in the first embodiment, is aligned coaxially with the corresponding bolt and is arranged substantially centrally within the base body 3 with respect to the axis of symmetry 14. As with reference to Fig. As described in Figure 1, a rotation of the adjusting wheel causes a longitudinal displacement of the inner Schanz screw 19 along the axis 20, whereby the Schanz screw 19 does not rotate about the axis 20 during the displacement, but remains fixed in a rotationally stable position. The arrangement of the second inner Schanz screw 19 is identical to the first Schanz screw 19, including the adjusting wheel. The rotation of the two adjusting wheels, and thus the vertical displacement of the two inner Schanz screws 19, is effected by the rotation of the adjusting wheel 21a, which has a toothing 24 on its circumferential surface that meshes with the toothing 24 on the circumferential surface of the two adjacent adjusting wheels.The slightly larger adjusting wheel 21a is also positioned centrally within the base body 3 with respect to the plane of symmetry 14 and may also include (not visible here) guide elements 27, which allow the adjusting wheel 21a to move and rotate sufficiently within the base body 3. Both outer adjusting wheels engage with their teeth 24 in those of the adjusting wheel 21a, and due to their precisely identical geometry, cause a synchronous vertical displacement of the two inner Schanz screws 19 with respect to the base body 3. In particular, the central adjusting wheel 21a may have a scale on its upper surface or circumference from which the value of the vertical displacement of the two inner Schanz screws 19 can be read. This allows medical personnel or the patient themselves to read and adjust the value of the transverse distraction.It is understood that other simple adjustment mechanisms may also be included in the displacement device 21, which achieve the same effect, namely the synchronous vertical displacement of the inner Schanz screws 19.

[0040] In a further embodiment of the Fig. In a similar embodiment, the central adjusting wheel 21a can also be arranged in a different plane than the adjusting wheels axially aligned with the inner Schanz screws 19. For this purpose, the adjusting wheel 21a has, for example, a toothed shaft inside the base body 3, which engages with the teeth of the two adjusting wheels. In this way, a gear ratio can be achieved, making the sliding mechanism easier to operate and more precisely adjustable.

[0041] In Fig. Figure 6 is a schematic detail view of components of the displacement device 21 according to the one shown in Fig. The third embodiment is shown in Figure 5. A counterclockwise rotation of the adjusting wheel 21a causes an identical, opposite rotation of the outer spur gears, whose teeth 24 engage with the circumferential teeth 24 of the adjusting wheel 21a. A clockwise rotation of the adjusting wheel 21a analogously causes a counterclockwise rotation of the spur gears.

[0042] Fig. Figure 7 is a side view of a Schanz screw with part of a sliding device according to a further embodiment of the fixing device according to the invention. As described in the embodiments described above, the axially displaceable Schanz screws can be arranged either inside the central section 9 or at the outer ends 11, 13 of the base body. The in Fig. The 7 illustrated entrenching screw 15, 17 with displacement device 21 can, for example, each be used as an outer entrenching screw in the first embodiment, which is in Fig. 1 is shown.

[0043] In contrast to the first embodiment, the adjusting wheel of the displacement device 21 has a central shaft 32 extending from the underside of the adjusting wheel facing the bone and being received in the correspondingly larger bore 12 in the base body 3 in such a way that smooth rotation and guidance are possible. As in the previously described embodiments, the circumferential surface of the adjusting wheel 21 has knurling, so that an operator can move or rotate the displacement device 21 and thereby cause a displacement of the base body 3 relative to the Schanz screws 15, 17. The displacement device 21 is rotatably mounted on the base body 3 by a corresponding guide element such that it can rotate with respect to the axis of rotation 20, but cannot be displaced in the vertical direction, i.e., along the axis of rotation 20.The rotation of the displacement device 21 thus ensures a corresponding vertical displacement of the base body 3 with respect to the Schanz screw 15, 17.

[0044] Regarding the flat top surface of the adjusting wheel of the sliding device 21, it should be noted that it is flush with the surface or top surface 5 of the base body 3, so that the entire surface of the fixing device 1 remains free of protrusions and essentially flat. If the top surface 5 of the base body 3 is not flat, the contour of the top surface of the adjusting wheel is adapted accordingly so that the transition between the components is essentially seamless and without edges.

[0045] Fig. Figure 8 is a partial side view of a bolt inserted into a bore within the base body, according to a further embodiment of the fixing device according to the invention. This embodiment is characterized in that the bore 12, as it is formed, for example, continuously through the base body 3 in the first embodiment, has an expanded area adjacent to the top surface 5, which is designed to receive a screw or clamping element 34. This screw or clamping element 34 is intended to fix the bolt 19 within the base body 3. It has, for example, a cap shape with an external thread that can engage with the internal thread of the expanded bore 12, and also an internal surface that engages with the upper end of the bolt 19 and clamps or fixes it.This inner surface may, for example, be chamfered, and the top of the screw or clamping element 34 may include an internal hexagon socket so that the element can be inserted into and secured in the upper section of the recess 12 for clamping. It is understood that other clamping mechanisms may be used here, designed to secure the Schanz screw 19 vertically within the bore 12 of the base body 3 without any part of this fastening device projecting beyond the top surface 5 of the base body 3. Rather, it is advantageous if the top surface of the screw or clamping element 34 is flush with the top surface 5 of the base body 3.

[0046] Fig. Figure 9 shows a schematic, perspective view of a preferred fourth embodiment of the fixing device according to the invention. In contrast to the embodiments described above, the one shown in Fig. The embodiment shown in Figure 9 has a cylindrical base body 3, which accordingly has a substantially round or rounded upper surface 5 and lower surface 7. The arrangement of the outer and inner bolts is similar to that of the third embodiment, which is shown in Figure 9. Fig. Figure 5 shows that the outer Schanz screws 15, 17 are vertically fixed in their respective bores 12, here by means of the fastening device 23, which is arranged on the end face of the base body 3 and here represents a threaded bore into which a clamping screw is inserted to clamp the Schanz screw 15. As already described, the fastening device 23 can also be arranged laterally on the base body 3 and accordingly inside.

[0047] The two inner Schanz screws 19 are not attached directly to the base body 3, but to an inner body 10, which has an elongated, cuboid-like shape and is received on the underside 7 of the base body 3 in a receiving space 36 of the base body 3. The receiving space 36 is preferably designed such that the contour of the inner body 10 is received within it as precisely as possible, i.e., without much play, and can be moved vertically parallel to the direction of the outer Schanz screws 15, 17. The inner body 10 is preferably made of the same material as the base body 3. The inner Schanz screws 19 are attached to the inner body 10 in a similar manner to how the outer Schanz screws 15, 17 are attached to the base body 3; that is, in the functional state, they are no longer rotatable relative to the inner body 10 and are fixed vertically with respect to the inner body 10 by means of a fastening device 23.

[0048] A displacement device 21 ensures the interaction, i.e., the relative displacement, of the base body 3 with the inner body 10 and thus with the internal Schanz screws 19 arranged thereon. A screw 26 is mounted in a bore that is arranged essentially parallel to the other bores 12 approximately in the center of the base body 3. This screw has an external thread that engages with a threaded bore approximately in the center of the inner body 10 and, when rotated, causes a vertical displacement of the inner body 10 relative to the base body 3. The screw 26, which can be integrally formed with the displacement device 21, is rotatable within the bore relative to the base body 3. The displacement device 21 is attached to the base body 3 by a corresponding guide element such that it can rotate about the axis of rotation 20 but cannot be displaced vertically.A rotation of the adjusting wheel of the displacement device 21, for example by an operator on the knurled circumferential surface 22, causes a vertical displacement of the inner body 10 and thus of the inner Schanz screws 19. In this embodiment, the maximum bone distraction path is determined by the distance by which the inner body 10 can be moved within the receiving space 36.

[0049] It should be noted that the representation of the Fig. Figure 9 is purely schematic and serves to illustrate the interaction of the sliding device 21 with the base or inner body. As described above, the upper surface of the sliding device 21 is designed such that it is flush with the upper surface 5 of the base body 3, with this transition being free of edges and protrusions. Since the sliding device 21 is provided with an adjusting wheel in the embodiment shown here, the upper surface 5 of the base body 3 must have a corresponding recess and be flattened so that the entire surface of the fixing device 1 forms a substantially flat, protrusion-free surface. In this fourth embodiment, the adjusting wheel 21 of the sliding device can also have a scale or measuring scale on its circumferential surface, which serves to measure and adjust the displacement of the inner Schanz screws 19 relative to the base body 3.

[0050] As an alternative to mounting the sliding device 21 on the top surface 5 of the base body 3, the sliding device 21 can also be arranged inside the base body 3, as for example in the first embodiment in Fig. Figure 1 shows the displacement device for the outer Schanz screws 15, 17.

[0051] Further possible designs and embodiments of the fixing device 1 according to the invention relate to the design of the base body 3, which can, for example, be designed as a hollow body. In this case, corresponding inserts, which are firmly connected to the base body 3, perform the fastening functions for the inner and outer bolts and the sliding device(s).

[0052] The invention provides a fixation device that is easy to handle, simple in design and lightweight, thus facilitating daily use and use during surgery. Reference symbol list: 1 fixing device 3 basic shapes 5 Top 7 Underside 9 Middle section 10 inner bodies 11 first end 12 bore 13 second end 14 Axis of symmetry 15 first outer bastion screw 16 threads 17 second outer bastion screw 18 threads 19 inner hand screw 20 Rotary axis 21 Shifting device 21a Adjusting wheel 22 knurling 23 Fastening device 24 teeth 25 threaded holes 26 screw 27 Guide element 29 bone threads 31 top 32 shaft 33 internal threads 34 Screw or clamping element 36 Recording room

Claims

[1] Fixation device (1) for transverse bone distraction with an elongated base body (3) having an upper side (5) facing away from the bone, a lower side (7) facing the bone, a central section (9) and a first end (11) and a second end (13), a first outer embankment screw (15) attached to the first end (11) on the underside (7) of the base body (3), and a second outer embankment screw (17) attached to the second end (13) on the underside (7) of the base body (3), at least one inner screw (19) mounted in the central section (9) on the underside (7) of the base body (3), and at least one displacement device (21) which is designed to displace the at least one inner Schanz screw (19) relative to the outer Schanz screws (15, 17) away from the bone, wherein the inner and outer Schanz screws (15, 17, 19) are adapted to be engaged with the bone at their bone-facing end, wherein the at least one inner Schanz screw (19), the outer Schanz screw (15, 17) and the displacement device (21) do not protrude beyond a surface (5) of the fixing device (1) facing away from the bone in a functional state of the fixing device (1), so that the surface (5) of the fixing device (1) facing away from the bone forms a substantially flat, projection-free surface. [2] Fixing device (1) according to claim 1, characterized by that when the shifting device (21) is actuated a) the at least one inner screw (19) is fixed to the base body (3), or b) the at least one inner Schanz screw (19) is movable relative to the base body (3). [3] Fixing device (1) according to one of the preceding claims, characterized bythat the displacement device (21) has at least one part from the group comprising a knurled or rotating head, a profiled screw head, a knurled nut, a knurled screw, a screw (26) and a guide element (27). [4] Fixing device (1) according to one of the preceding claims, characterized by in that it has at least one fastening device (23) which is designed to prevent or enable displacement of the inner or outer bolts (15, 17, 19). [5] Fixing device (1) according to claim 4, characterized by that the fastening device (23) has a bore on one side of the base body (3) and a fastening means received therein. [6] Fixing device (1) according to one of the preceding claims, characterized bythat the inner and / or outer Schanz screws (15, 17, 19) have a metric thread (16, 18) at their upper end and a thread (29) suitable for bone fixation at their lower end. [7] Fixing device (1) according to one of the preceding claims, characterized by in that the displacement device (21) has an adjusting element which is received in a recess of the base body (3), wherein a movement of the adjusting element causes a displacement of the at least one inner Schanz screw (19) relative to the outer Schanz screws (15, 17). [8] Fixing device (1) according to one of the preceding claims, characterized by that the base body (3) has at least one recess on the side. [9] Fixing device (1) according to one of the preceding claims, characterized bythat the displacement device (21) comprises a preferably elongated inner body (10), wherein the inner body (10) can preferably be received in a receiving space on the underside (7) of the base body (3). [10] Fixing device (1) according to claim 9, characterized by that the at least one inner screw (19) is attached to the inner body (10). [11] Fixing device (1) according to claim 9 or 10, characterized by in that the displacement device (21) comprises a threaded screw (26) with a head which connects the base body (3) to the inner body (10) and is designed to move the inner body (10) relative to the base body (3) towards or away from the bone by rotating. [12] Fixing device (1) according to one of the preceding claims, characterized by that the base body (3) is at least partially designed as a tubular hollow body. [13] Fixing device (1) according to one of the preceding claims, characterized by that at least the base body (3) is manufactured by means of 3D printing. [14] Fixing device (1) according to one of the preceding claims, characterized by that the displacement device can be operated by means of an actuator, preferably electrically.

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