Surgical instrument for reducing fractures

Abstract

Surgical instrument (100) for reducing fractures, comprising: a support piece (1) with a guide structure (10) defining a longitudinal axis (A1), at least one hook (2A, 2B) detachably fastened to the support piece (1), a spindle (3) movably guided in the guide structure (10) of the support piece (1) along the longitudinal axis (A1), said spindle having an external thread (30) and a working end (31); a spindle counterpart (4) movably mounted on the support piece (1) with an engagement structure (40) which is designed to engage in the external thread (30) of the spindle (3), wherein the spindle (3) has an at least partially continuous opening (37) along the longitudinal axis (A1).

Description

[0001] The present invention relates to a surgical instrument for reducing fractures, e.g. for aligning or generally for moving individual bone parts or fragments.

[0002] In the case of bone fractures, it may be necessary to realign or reposition the individual fragments during a surgical procedure. This typically involves instruments with a hook and a mandrel. The hook and mandrel can be moved relative to each other to reposition the bone fragments.

[0003] The not yet published DE 10 2022 211 215.6 describes a surgical instrument for reducing fractures. The surgical instrument comprises a support piece with a guide structure defining a longitudinal axis, a hook detachably attached to the support piece, and a spindle movably guided along the longitudinal axis in the guide structure of the support piece. Said spindle has an external thread and a spindle counterpart movably mounted on the support piece with an engagement structure designed to engage the external thread of the spindle. The engagement structure engages the external thread of the spindle via an elastic prestressing element, which prestresses the spindle counterpart into an engaged position.This ensures that the spindle can be displaced along the longitudinal axis by rotating about a spindle axis parallel to the longitudinal axis, wherein the spindle counterpart can be moved into a release position in which the engagement between the external thread and the engagement structure is released to such an extent that the spindle can be displaced along the longitudinal axis by applying an axial force directed along the spindle axis.

[0004] CN 2 117 861 U describes a surgical tool for inserting bone screws. The tool has a fixation instrument for fixing the bone fragments to be screwed in. The fixation instrument comprises an inner tube, which is provided with an external thread at a rear end and has an elongated recess in a central region, and an outer tube, which is slidably guided on the inner tube and has an elongated recess. An arcuate fixation hook is attached to a front end of the inner tube. A rod is slidably guided inside the inner tube, the front end of which is designed to bear against a bone fragment and which is provided with transverse grooves in a central region. A pivotable lever is provided on the outer tube and is pretensioned by a spring into an engaged position in which one end of the lever engages with the transverse grooves of the rod.An axial position of the outer tube relative to the inner tube can be determined by means of a flange nut that is screwed onto the thread at the rear end of the inner tube.

[0005] Another surgical instrument for holding a connecting plate to a broken bone is described in EP 0 686 375 A1. A rod with an external thread and a hook provided at the end supports a tubular piece, which has a second hooked portion for counter-holding. A wing nut is screwed onto the external thread of the rod, by means of which a force can be applied to the tubular piece in the axial direction, creating a clamping force between the hooked portions.

[0006] The displacement or tensioning of a clamping element guided on a hook via a clamping nut which engages with an external thread provided on the hook is also described in DE 299 16 202 U1.

[0007] EP 2 844 166 A1 describes a positioning instrument comprising a box, a first rod which passes through a passage of the box and is axially displaceable relative to the box, and a second rod which is displaceably guided on the first rod. The first rod has transverse grooves on its outer circumference and can be locked to the box by means of a preloaded lever which engages in the transverse grooves. Furthermore, the first rod has an axial bore through which the second rod projects. The second rod is provided with an external thread and is axially displaceable by means of a nut which is fixedly positioned relative to the first rod.

[0008] US 2 427 128 A discloses a surgical instrument for reducing fractures, wherein an elastic prestressing element prestresses a spindle or a toothed arc segment in the direction of an actuating handle.

[0009] A fixation wire can be used to assist in the reduction of fractures, allowing fixation of bone parts or facilitating the alignment of individual bone fragments along the central axis of the bone.

[0010] WO 89 06948 A1 describes a positioning instrument for reducing a bone gap. It consists of two rod segments that are partially inserted into one another and can be moved translationally and / or rotationally along their longitudinal axis. The outer rod segment is equipped with a continuous channel to allow the passage of the inner rod segment. The inner rod segment combines a guide wire with a measuring scale, which can be used to monitor how far the inner rod segment has been inserted into the medullary canal of a bone. Two locking screws enable releasable fixation of the two rod segments to one another.

[0011] It is an object of the present invention to provide further embodiments of an improved instrument for reducing fractures, in particular an instrument which is practical to handle and enables a precisely metered application of force.

[0012] This object is achieved by the features of patent claim 1. Advantageous embodiments emerge from the dependent claims, the description and the figures.

[0013] According to the invention, a surgical instrument for reducing fractures comprises a support piece with a guide structure defining a longitudinal axis, at least one hook detachably attached to the support piece, and a spindle movably guided along the longitudinal axis in the guide structure of the support piece. The spindle has an external thread into which a spindle counterpart movably mounted on the support with an engagement structure can be engaged. Furthermore, the spindle has an at least partially through opening. A preferred method for creating such an opening in a body is a coaxial or axially parallel bore, but other methods such as reaming are conceivable. In particular, the cross-section of the opening is not limited to a circular shape.In the case of a completely through-opening, a fixation wire can be inserted into the instrument to provide another option for fixating bone fragments or to facilitate the repositioning of bone fragments. The use of a fixation wire is particularly advantageous because the fixation wire can be used as a control element regarding the positioning and orientation of bone fragments relative to one another. Together with the actuation of the spindle, this enables particularly precise repositioning. In addition, an at least partially through-opening facilitates cleaning of the spindle by using the at least partially through-opening as a suction and / or irrigation channel.According to an advantageous embodiment, it can be provided that the spindle counterpart is mounted on the carrier piece in such a way that the engagement structure is movable between the engagement position and the release position in a direction transverse to the longitudinal axis.

[0014] According to an advantageous embodiment, the engagement structure can be formed at a first end of the spindle counterpart, and a second end protrudes from the support piece in a transverse direction extending perpendicular to the longitudinal axis. Thus, the spindle counterpart can be easily actuated from the edge or side of the support piece to disengage the engagement structure from the external thread of the spindle. This further simplifies the operation of the instrument.

[0015] According to an advantageous embodiment, the spindle can be linearly displaced by rotating about its longitudinal axis, for example, to precisely apply a desired force to the fracture. To achieve the linear displacement, the engagement structure engages the external thread of the spindle.

[0016] According to an advantageous embodiment, the spindle counterpart can be mounted on the support piece in a linear guide extending transversely to the longitudinal axis, allowing linear displacement. This design also allows for easy handling for moving the spindle counterpart from the engagement position to the release position.

[0017] According to an advantageous embodiment, it can be provided that the spindle counterpart is mounted on the carrier piece so as to be rotatable about an axis of rotation extending perpendicular to the longitudinal axis. For example, the spindle counterpart can be designed as a type of rocker arm, which facilitates simple operation. Further optionally, it can be provided that the axis of rotation is formed between a first end and a second end of the spindle counterpart. If the spindle counterpart protrudes laterally beyond the carrier piece with the second end, the engagement structure can be released from the external thread of the spindle, for example by moving the second end of the spindle counterpart in the direction of the carrier piece. This further facilitates intuitive and simple operation of the instrument.

[0018] According to an advantageous embodiment, the engagement structure can be provided with a plurality of engagement elements, in particular in the form of teeth or pins, which can be brought into engagement with the external thread. This offers the advantage that the axial force can be better supported on the engagement structure.

[0019] According to an advantageous embodiment, it can be provided that the engagement elements have at least one sliding surface which, with respect to the longitudinal axis, faces a first end of the carrier piece and is inclined such that the external thread of the spindle slides along the sliding surface when an axial force is applied along the spindle axis from the first end towards a second end of the carrier piece, so that the engagement structure is moved from its engagement position to its release position. Thus, the engagement structure can be disengaged in one direction, namely in the direction from the rear, first end to the front, second end of the carrier piece, by an axial force on the spindle. This means that the spindle can thus be pushed through in one direction without actively actuating the spindle counterpart, which further facilitates handling.

[0020] According to an advantageous embodiment, the at least partially through-opening of the spindle can be arranged coaxially with the longitudinal axis. Due to the coaxial arrangement of the partially through-opening of the spindle, the position of a fixation wire clamped in the partially through-opening of the spindle does not shift when the spindle rotates about the spindle's longitudinal axis.

[0021] According to an advantageous embodiment, it can be provided that the spindle guided in the guide structure can be moved with a working end beyond the second end of the carrier piece, so that the fracture can be reduced by the working end of the spindle and an end region of the at least one hook facing away from the carrier. The actuating end of the spindle, located opposite the working end, projects beyond the first end of the carrier piece. The spindle thus extends over the entire length of the carrier piece. For example, the actuating end can be provided with a handle to facilitate rotating and sliding the spindle. Such a design allows the surgical instrument to be easily designed with a large working range.

[0022] Preferably, the spindle is mounted on the support piece so that it can be displaced along the longitudinal axis in the guide structure. Together with the at least one hook, which is releasably attached to the support piece, a distance between a working end of the spindle and at least one end region of the at least one hook, located remote from the support piece, can be varied by linearly displacing the spindle along the longitudinal axis, e.g., reduced, in order to reposition or reduce a fracture using the working end of the spindle and the at least one end region of the hook.

[0023] According to an advantageous embodiment, the guide structure of the spindle can be guided within the support piece. This is achieved by a recess in the support piece, which extends continuously between a first end and a second end of the support piece. A preferred method for creating the recess for the guide structure is a coaxial or axially parallel bore in the support piece, but other methods are conceivable. In particular, the cross-sectional area of ​​the recess is not limited to a circular shape. Implementing it as a recess in the support piece ensures secure guidance of the spindle.

[0024] According to an advantageous embodiment, the support piece can have a flat or substantially flat first surface and a flat or substantially flat second surface oriented opposite to the first surface, with the longitudinal axis running parallel to the first and second surfaces. The support piece can, in particular, be designed as a substantially plate-shaped part, with the guide structure extending along the surfaces. In particular, the recess, which optionally forms the guide structure, can run in the material between the first and second surfaces.

[0025] According to an advantageous embodiment, the support piece can be designed as a handle. Accordingly, the support piece fulfills both the function of a handle by which the instrument can be held, as well as the function of guiding the spindle and holding the at least one hook. This further facilitates handling of the instrument and achieves a more compact design.

[0026] According to an advantageous embodiment, the spindle can have a first spindle part, on which the external thread is formed, and a second spindle part, which is guided on the first spindle part for linear movement and preloaded by a spring against movement in the direction of the first spindle part. The first and second spindle parts are thus resiliently mounted relative to one another. This allows a force applied to the fracture by the spindle to be cushioned to a certain extent, e.g., if the working end of the spindle accidentally comes into contact with the fracture during rapid adjustment.

[0027] According to an advantageous embodiment, the working end of the spindle can be moved into the guide structure of the support piece. This creates the largest possible working area between the at least one hook and the spindle. Furthermore, the working area can be flexibly adapted, for example, by using a shorter or longer spindle and / or different hook shapes and lengths.

[0028] According to an advantageous embodiment, it can be provided that the working end of the spindle has a locking piece, wherein an attachment can be locked to the locking piece, wherein the guide structure at the second end of the carrier piece preferably has a receptacle through which the working end of the spindle can be moved in the direction of the first end of the carrier part, so that the attachment locked to the locking piece can be released, in particular pulled off, from the spindle in the receptacle. The receptacle can be formed, for example, by an end region of the guide structure. For example, if the guide structure is in the form of a bore or generally by a recess, the recess can have a widening at its axial end. The attachment locked to the locking piece of the spindle can be inserted into this receptacle by moving the spindle into the guide structure and can be stripped off the spindle therein.An advantage of this design is that the attachment can be removed without tools, which reduces the risk of injury.

[0029] According to an advantageous embodiment, it can be provided that the locking piece of the spindle, for example for realizing a locking mechanism at the working end of the spindle, has in particular the shape of a ball, a ball tapering towards the working end of the spindle or a cone.

[0030] According to an advantageous embodiment, the attachment, which is locked to the locking piece, can be shaped, in particular, like a plate or a rocker. The surface of the attachment can have spike- or tooth-shaped structures on the side facing away from the spindle to improve engagement with tissue, such as bone fragments.

[0031] According to an advantageous embodiment, it can be provided that, in the case of an attachment in the form of a rocker, the rocker is mounted at least partially rotatably about a longitudinal or transverse axis in order to achieve more flexible adaptation to a round or flat bone fragment. For this purpose, the rocker can be provided with stop points at which it is locked against further rotation relative to the respective longitudinal or transverse axis. This ensures that the rocker does not shift when pressure is applied to the fracture gap of the bone, but rather forms a support for the clamped bone.

[0032] According to an advantageous embodiment, the locking piece and / or the working end of the spindle can have, in addition to the at least partially continuous opening along the spindle's longitudinal axis, further openings, for example holes or pores in the spindle surface. These further openings are connected via channels with at least partially continuous openings along the spindle's longitudinal axis and can be used to implement or improve a targeted rinsing or suction function of the instrument.

[0033] According to an advantageous embodiment, the at least partially continuous opening along the spindle's longitudinal axis can be provided with a connection for a fluid line at the distal end of the spindle. Common types of connections used in medical technology, such as a Luer, Luer-Lock, bayonet, or Christmas tree connection, can preferably be used for the connection to improve the fluid flow behavior. However, other connection types are conceivable.

[0034] According to an advantageous embodiment, different arrangements for the openings on the locking piece of the working end of the spindle are conceivable, for example, a diffuse, concentric, radial, or crossing arrangement. The openings connected to the at least partially continuous opening can also extend over the outer surface of the spindle and / or on an attachment that is locked to the locking piece.

[0035] According to an advantageous embodiment, the at least one end region of the at least one hook can have an associated locking piece, with which an associated attachment can be locked. By using various locking pieces and / or attachments of the at least one hook, further repositioning and fixation modes can be realized.

[0036] According to an advantageous embodiment, the attachment, which is locked to the locking piece, can be provided, in particular, in the shape of a plate, a rocker, a groove, a nose, or a bracket. The surface of the attachment can have thorn- or tooth-shaped structures on the side facing away from the at least one hook to facilitate engagement with tissue, such as bone fragments.

[0037] According to an advantageous embodiment, it can be provided that the at least one end region of the at least one hook is blunted in order to avoid injury to surrounding tissue.

[0038] According to an advantageous embodiment, the at least one hook can have exactly two end regions. Depending on the shape of the bone fragments to be repositioned, this can be advantageous for making the fragments easier to reposition. For example, the at least one hook is implemented as a double hook or in the form of a hook with two ball tips as associated locking pieces.

[0039] The instrument preferably has an elastic prestressing element which prestresses the spindle counterpart into an engaged position in which the engagement structure is in engagement with the external thread of the spindle. This ensures that the spindle can be adjusted along the longitudinal axis by rotating about a spindle axis parallel to the longitudinal axis, e.g. coaxial, wherein the spindle counterpart is movable into a release position in which the engagement between the external thread and the engagement structure is released to such an extent that the spindle can be displaced along the longitudinal axis by applying an axial force directed along the spindle axis, in particular without rotating the spindle about the spindle axis. The prestressing element is coupled to the spindle counterpart in such a way that it applies a prestressing force to the spindle counterpart and thereby prestresses it into an engaged position. The prestressing element can, e.g.on the support piece and on the spindle counterpart. The spindle counterpart can be moved into a release position against the preload force of the preload element. If rapid adjustment of the spindle along the longitudinal axis is desired, the spindle counterpart can be moved into the release position, allowing linear displacement of the spindle without rotation around the spindle's longitudinal axis. One advantage of this design is that the spindle can be adjusted quickly to cover a longer distance, as well as precisely over shorter distances. This facilitates quick and easy handling of the instrument.

[0040] The carrier piece preferably has at least one holder with at least one receiving gap. At least one linearly movable locking bolt is located in the at least one receiving gap, wherein the at least one hook has at least one connecting piece positioned in the at least one receiving gap. The at least one connecting piece has at least one locking opening into which the at least one locking bolt projects in order to fix the at least one hook to the carrier piece. By fixing the connecting piece in the receiving gap by means of the locking bolt, an easily detachable yet reliable connection is realized.

[0041] According to an advantageous embodiment, it can be provided that the at least one locking bolt can be moved out of the at least one locking opening of the at least one connecting piece of the hook without the use of tools by applying a tensile force, so that the at least one hook can be removed from the support piece. This further facilitates handling of the instrument.

[0042] According to an advantageous embodiment, it can be provided that the at least one holder has at least one first block. The at least one first block has a passage in which the at least one locking bolt is guided. The at least one first block is spaced from at least one second block by at least one receiving gap. The at least one locking bolt has at least one head located outside the at least one receiving gap for applying the tensile force. The at least one bolt can therefore be moved out of the at least one receiving gap by means of the at least one head without the need for a tool.

[0043] According to an advantageous embodiment, it can be provided that the at least one locking bolt is secured in a form-fitting manner on the at least one first block in the locking position and in a retracted position in which the at least one locking bolt is retracted from the at least one receiving gap, i.e. does not protrude into the at least one locking opening, against falling out of the passage. For example, the at least one bolt can be provided with a groove in which a first and a second recess are formed at a distance from one another, wherein a securing element, e.g. in the form of a ball, is held on the at least one first block, which protrudes into the groove and is preloaded into the groove by a spring.When the at least one locking bolt is positioned in the locked position, the securing element engages in the first recess. When the at least one locking bolt is positioned in the retracted position, the securing element engages in the second recess. The securing element prevents the instrument from falling out, further facilitating handling of the instrument, particularly its reprocessing, e.g., disinfection of the device.

[0044] According to an advantageous embodiment, the at least one holder and the connecting piece can be designed such that the connecting piece can be fixed to the holder in multiple rotational positions with respect to a central axis of the at least one locking bolt. For example, the at least one holder and the connecting piece can each have contact surfaces that abut one another and thereby ensure a positive fixation with respect to rotation about the central axis. Optionally, the at least one holder can be provided with different contact surfaces that enable fixation in different rotational positions.

[0045] Preferably, the at least one holder is formed by exactly one holder that surrounds the spindle on at least three sides. In this case, the surgical instrument has a first hook and a second hook. The configuration of a spindle-enclosing holder creates space for mutually stabilizing hook receptacles on the holder. The use of two hooks increases flexibility during the operation.

[0046] Alternatively, the at least one holder can be formed by exactly two holders, each having a hook receptacle. In this case, the surgical instrument also has a first hook and a second hook. The use of two hooks increases flexibility during the operation.

[0047] According to an advantageous embodiment, the hook receptacle of the second hook can be the same size as or larger than the hook receptacle of the first hook. This allows the second hook to be subsequently inserted during the ongoing surgical procedure without having to remove the instrument from the surgical area.

[0048] According to an advantageous embodiment, the surgical instrument can have an actuating piece at the actuating end of the spindle, which can be used to apply a torque to the spindle. The actuating piece can have a torque limiter that couples the actuating piece to the spindle and is designed to allow relative rotation between the spindle and the actuating piece when the torque applied to the actuating piece exceeds a predetermined threshold. This allows the force applied by the spindle to the fracture to be limited in a simple and effective manner. This further facilitates the dosage of the force applied by the instrument.

[0049] According to an advantageous embodiment, the actuating piece of the spindle, a head of the at least one locking bolt, and / or lateral projections of the support piece can have at least one axially parallel or coaxial, at least partially continuous opening relative to the longitudinal axis of the spindle. This at least one at least partially continuous opening can be provided to accommodate one or more additional fixation wires that can be introduced into the surgical area.

[0050] With regard to directions and axes, in particular directions and axes relating to the course of physical structures, the course of an axis, a direction or a structure “along” another axis, direction or structure is understood to mean that these, in particular the tangents resulting at a respective point of the structures, each run at an angle of less than or equal to 45 degrees, preferably less than or equal to 30 degrees and particularly preferably parallel to one another.

[0051] Embodiments of the invention are described in detail with reference to the figures. They show: Fig. 1 is a perspective view of a surgical instrument according to an embodiment of the present invention; Fig. 2 a sectional view of the Fig. 1 instrument shown; Fig. 3 a detailed view of the Fig. 2 area marked by the letter Z; Fig. 4 is a sectional view of a surgical instrument according to another embodiment of the present invention; Fig. 5 is a partial plan view of a surgical instrument according to another embodiment of the present invention; Fig. 6 is a sectional view of a surgical instrument according to a further embodiment of the present invention in the region of a second end of a carrier piece of the instrument; Fig. 7 the instrument Fig. 1, wherein a hook of the instrument is shown in a rotated position; Fig. 8 is a side view of a surgical instrument according to another embodiment of the present invention; Fig. 9 is a side view of a surgical instrument according to another embodiment of the present invention; Fig. 10 is a partial plan view of a surgical instrument according to another embodiment of the present invention; Fig. 11 is a partial plan view of a surgical instrument according to another embodiment of the present invention; Fig. 12A is a sectional view of a surgical instrument according to an embodiment of the present invention in the region of a second end of a support piece of the instrument; Fig. 12B is a sectional view of a surgical instrument according to a further embodiment of the present invention in the region of a second end of a support piece of the instrument; Fig. 13 is a side view of a surgical instrument according to another embodiment of the present invention; Fig. 14 is a partial view of a surgical instrument according to another embodiment of the invention; Fig. 15 is a partial view of a surgical instrument according to another embodiment of the invention; Fig. 16 is a perspective view of a surgical instrument according to another embodiment of the invention; Fig. 17 is a side view of a surgical instrument according to another embodiment of the invention; Fig. 18 a partial view of the carrier piece and the guide structure of the Fig. 17 shown instrument in a sectional view; Fig. 19 is a partial sectional view of the support piece and the guide structure of a surgical instrument according to a further embodiment of the invention; Fig. 20 is a partial view of a surgical instrument according to another embodiment of the invention; Fig. 21 a partial view of the Fig. 20 shown surgical instrument from the side; Fig. 22 is a sectional view of a surgical instrument in the region of the second end of a support piece according to a further embodiment of the present invention; Fig. 23A is a sectional view in the area of ​​the second end of the support piece of the Fig. 22 shown surgical instrument according to a first embodiment; Fig. 23B is a sectional view in the area of ​​the second end of the support piece of the Fig. 22 shown surgical instrument according to a second embodiment; Fig. 24 is a partial perspective view of a surgical instrument according to another embodiment of the present invention; Fig. 25 is a perspective view of a surgical instrument according to another embodiment of the present invention; Fig. 26 a plan view of the Fig. 25 surgical instrument shown; Fig. 27 is a side view of a surgical instrument according to another embodiment of the present invention; Fig. 28 is a partial perspective view of a surgical instrument according to another embodiment of the present invention; Fig. 29A-B Detailed views of possible designs of the end region of the hooks of a surgical instrument; Fig. 30A-D Detailed views of further possible designs of the end area of ​​the hooks of the surgical instruments; Fig. 31A-D Detailed views of further possible designs of the end area of ​​the hooks of the surgical instruments; Fig. 32A-C Sectional views of the rotating mechanism of a possible design of the end area of ​​the hooks of the surgical instruments Fig. 33 is a sectional view of the spindle of a surgical instrument according to an embodiment of the present invention; Fig. 34A a detailed view of the Fig. 33 area marked by the letter E in a first possible embodiment; Fig. 34B is a sectional view of the Fig. 34A described area; Fig. 35A a detailed view of the Fig. 33 area marked by the letter E in a second possible embodiment; Fig. 35B is a sectional view of the Fig. 35A described area; Fig. 36 AC Detailed views of possible designs of the connections to the at least partially through opening of the spindle of a surgical instrument; Fig. 37 a partial view of the carrier piece of a surgical instrument according to another embodiment of the present invention. Fig. 38 A sectional view of the hook of a surgical instrument according to another embodiment of the present invention.

[0052] In the figures, the same reference symbols denote identical or functionally identical components, unless otherwise stated.

[0053] Fig. 1 shows an example of a surgical instrument 100 for reducing fractures. As in Fig. 1, the instrument 100 comprises a carrier piece 1, a hook 2A, a spindle 3 and a spindle counterpart 4. Furthermore, the instrument 100 comprises, as shown in the Fig. 2 and Fig. 3, an elastic prestressing element 5.

[0054] The carrier piece 1 can, as shown in the Fig. 1 and Fig. 2, for example, be formed as a plate-shaped part with a substantially T-shaped periphery. In general, the carrier piece 1 may extend between a first end 11 and a second end 12 in a longitudinal direction. Optionally, the carrier piece 1 has a flat or substantially flat first surface 1a and a flat or substantially flat second surface 1b oriented opposite to the first surface 1a, as in Fig. 1 as an example. The first and second surfaces 1a, 1b are connected by a peripheral surface 1c, which defines the outer periphery of the carrier piece 1. Optionally, the carrier piece 1 can have a plurality of longitudinally adjacent openings 13, which extend between the first and second surfaces 1a, 1b. The carrier piece 1 can in particular be designed as a handle. For example, the carrier piece 1 can have recesses 1d in the peripheral surface 1c, as in Fig. 1, or generally have a structure. Alternatively or additionally, the outer circumference of the carrier piece 1, as shown in Fig. 1 purely by way of example, have lateral projections 19 to facilitate gripping of the carrier piece 1 by hand. The spindle 3 of the surgical instrument 100 shown has an at least partially through opening 37, which extends from an actuating end 32 of the spindle 3 to the working end 31 of the spindle 3. The nature of the at least partially through opening 37 of the spindle 3 is described in the description of the Fig. 33 is explained in more detail.

[0055] The support piece 1 generally comprises a guide structure 10 which defines a longitudinal axis A1. The longitudinal axis A1 extends, as shown in Fig. 1 between the first and second ends 11, 12 of the support piece 1. In particular, the longitudinal axis A1 may extend parallel to the first and second surfaces 1a, 1b of the support piece 1. As shown in the Fig. 1 and Fig. 2, the guide structure 10 can be formed, for example, by a bore or generally a recess 10A in the carrier piece 1. For example, the recess 10A or generally the guide structure 10 can extend continuously from the first to the second end 11, 12 of the carrier piece 1, as shown in Fig. 1 is shown as an example. As in Fig. 12A and Fig. 12B schematically shown and explained in detail later, the recess 10A, which in the example shown is realized as a bore, can be widened at the second end 12 of the carrier piece 1 in order to form a receptacle 12A.

[0056] The carrier piece 1 can be made, in particular, of a metal material, for example, stainless steel, titanium, or the like. It would also be conceivable for the carrier piece 1 to be made of a plastic material.

[0057] The hook 2A is used to apply a force or to move the fracture, in particular a bone fragment. As in Fig. 1 purely by way of example, the hook 2A can extend between a first end 21A and an end region 22A. Fig. 1 purely by way of example, has a first, at least partially linear section 2.1A, which extends from the first end 21A. Adjoining the linear section 2.1A is a curved section 2.2A, which has an end region 22A of the hook 2A. The invention is not limited to this hook shape. Fig. 8 to 11 show further hooks 2A as examples, which will be explained in more detail below.

[0058] The hook 2A is detachably attached to the support piece 1. In particular, the hook 2A can, as in Fig. 1, can be attached at its first end 21A to the support piece 1, in particular in the region of the second end 12 of the support piece 1.

[0059] As in Fig. 1, the carrier piece 1 can, for example, have a holder 14A to which the hook 2A is releasably fixed by means of a locking bolt 17.1. Fig. Fig. 6 shows schematically a sectional view in the region of the second end 12 of the carrier piece 1 through the holder 14A and the hook 2A. In general, the holder 14A has a receiving gap 14.1A, which, for example, as in Fig. 6 can be defined by a first block 15.1 and a second block 16.1. The first and second blocks 15.1, 16.1 can, for example, protrude from the first surface 1a of the carrier 1 and be spaced apart along the longitudinal axis A1. The first block 15.1 has a passage 15.1A. The second block 16.1 optionally has an opening 16.1A positioned coaxially with the passage 15.1A. The locking bolt 17.1 is mounted for linear movement in the passage 15.1A.

[0060] As in Fig. 6, the hook 2A can be provided at its first end 21A with a connecting piece 24A, which can be inserted into the gap 14.1A and has a locking opening 27.1. The connecting piece 24A can, for example, have a shape corresponding to the gap 14.1A. The locking bolt 17.1 is movable between a locking position, which is Fig. 6, and a retracted position. In the locking position, the locking bolt 17.1 projects through the locking opening 27.1 of the connecting piece 24A of the hook 2A and optionally also into the opening 16.1A of the second block 16.1, as shown in Fig. 6. By pushing the locking bolt 17.1 through the locking opening 27.1, the hook 2A is fixed to the carrier piece 1. In the retracted position, the locking bolt 17.1 is retracted from the receiving gap 14.1A and thus also from the locking opening 27.1, so that the hook 2A can be removed from the carrier piece 1.

[0061] As in Fig. As shown schematically in Figure 6, the locking bolt 17.1 can have a head 17.1A, which forms an end of the locking bolt 17.1 that protrudes outside the receiving gap 14.1A from the block 15.1. A user can grasp the locking bolt 17.1 at this head 17.1A and apply a pulling force to move it into the retracted position. The locking bolt 17.1 can generally be moved out of the locking opening 27.1 of the connecting piece 24A of the hook 2A without the need for tools by applying a pulling force.

[0062] Furthermore, it can be provided that the locking bolt 17.1 is secured in the locking position and in the retracted position in a form-fitting manner on the first block 15.1 against falling out of the passage 15.1A. For example, as shown in Fig. 6 purely by way of example, a securing element 18.1 is provided in the first block 15.1, which is guided perpendicular to a longitudinal axis M17.1 of the bolt 17.1 and is prestressed by means of a spring (not shown) such that it projects into a groove 18.1A extending along the longitudinal axis M17.1 of the locking bolt 17.1 and rests against the bottom of the groove 18.1A. The securing element 18.1 can be, for example, a ball, a pin or the like. A first and a second notch 18.1B, 18.1C are formed at axial ends of the groove 18.1A. When the locking bolt 17.1 is positioned in the locking position, as in Fig. As shown in Figure 6, the securing element 18.1 engages the first notch 18.1B. When the locking bolt 17.1 is positioned in the retracted position, the securing element 18.1 engages the second notch 18.1C.

[0063] Furthermore, the holder 14A and the connecting piece 24A can optionally be designed such that the connecting piece 24A can be fixed to the holder 14A in several rotational positions with respect to a central axis of the locking bolt 17.1. Fig. 1, for example, it is shown that the hook 2A is fixed to the holder 14A in such a way that the curved section 2.2A lies in a plane extending perpendicular to the first surface 1a of the carrier piece 1. In Fig. 7, however, it is shown that the hook 2A is fixed to the holder 14A in such a way that the curved section 2.2A lies in a plane extending parallel to the first surface 1a of the support piece 1. A vertical axis A24 of the connecting piece 24A extends in Fig. 7 therefore parallel and in Fig. 1 is therefore perpendicular to the first surface 1 a of the support piece 1.

[0064] The fixing in the different rotational positions can be achieved, for example, by a form fit due to contact surfaces 14k, 24k, as shown in Fig. 6 is shown schematically. In the Fig. 6 and Fig. 1, a flat contact surface 24k of the connecting piece 24A rests against a flat first contact surface 14k of the holder 14A, which is oriented away from the first surface 1a of the carrier piece 1 and runs parallel to it. In the rotational position shown in Fig. 7, the flat contact surface 24k of the connecting piece 24A lies on a flat second contact surface 14l of the holder 14A ( Fig. 1), which runs perpendicular to the first surface 1a of the support piece 1. Other fixing options in different rotational positions are also conceivable, e.g., via corresponding polygonal shapes of the locking bolt 17.1 and the locking opening 27.1 of the connecting piece 24A.

[0065] The spindle 3 extends along a spindle axis A3 between a working end 31 and an actuating end 32. As in Fig. 1, the spindle 3 has an external thread 30, e.g., a metric thread, a round thread, a buttress thread, a flat thread, a trapezoidal thread, a tapered thread, a Whitworth thread, a pipe thread, or the like. As shown in the Fig. 1 and Fig. 2, the external thread 30 can optionally be formed only in a part of the length of the spindle 3. At the working end 31, the spindle 3 can optionally have a locking piece 34 in the form of a ball head with a tip, as shown in the Fig. 1 and Fig. 2 is shown purely as an example. The working end 31 serves, together with the end region 22A of the hook 2A, to apply a force to the fracture in order to reduce it. An actuating piece 36, e.g. in the form of a handle as shown in the Fig. 1 and Fig. 2 shown schematically.

[0066] As particularly in Fig. 2, the spindle 3 is movably guided in the guide structure 10 of the carrier piece 1 along the longitudinal axis A1. In particular, the spindle 3 extends through the recess 10A. The spindle axis A3 is parallel, in particular coaxial, to the longitudinal axis A1. As shown in the Fig. 1 and Fig. 2, it can be provided that the spindle 3 has a length between its working end 31 and its actuating end 32 which is greater than a length of the carrier piece 1 along the longitudinal axis A1 between the first and the second end 11, 12. In general, the spindle 3 with the working end 31 is movable beyond the second end 12 of the carrier piece 1, so that the fracture can be repositioned or temporarily fixed by the working end 31 of the spindle 3 and the end region 22A of the hook 2A. At the same time, the actuating end 32 of the spindle 3 projects beyond the first end 11 of the carrier piece 1, as shown in the Fig. 1 and Fig. 2. Furthermore, it can also be optionally provided that the working end 31 of the spindle 3 can be moved into the guide structure 10 of the support piece 1. The spindle 3 can thus be retracted to such an extent that it no longer protrudes beyond the second end 12 of the support piece 1. For example, the spindle 3 can be pulled out of the guide structure 10 or the recess 10A at the first end 11 of the support piece 1.

[0067] The spindle counterpart 4 and the elastic preload element 5 are in the Fig. 2 and Fig. 3. The spindle counterpart 4 has an engagement structure 40 which is designed to engage the external thread 30 of the spindle 3. As can be seen in particular in Fig. 3 is shown by way of example, the engagement structure 40 may have a plurality of engagement elements 40A, e.g. in the form of teeth as in Fig. 3 are shown purely by way of example, which are adapted in their shape and arrangement to the pitch and flank shape of the threads of the external thread, so that they can be engaged with the external thread 30. As an alternative to teeth, other engagement elements 40A, e.g., in the form of pins or the like, could also be provided.

[0068] As in the Fig. 2 and Fig. 3, the spindle counterpart 4 can generally be an elongated component that extends between a first end 41, on which the engagement structure 40 is formed, and a second end 42. The spindle counterpart 4 is movably mounted on the carrier piece 1. For example, the carrier piece 1 can have a recess 45, e.g. as an opening in the circumferential surface 1c, in which the spindle counterpart 4 is movably mounted. The spindle counterpart 4 can, for example, be rotatably mounted on the carrier piece 1 about a rotation axis A4 extending perpendicular to the longitudinal axis A1. This is shown by way of example in the Fig. 2 and Fig. 3, wherein the carrier piece 1 is rotatably mounted between its first and second ends 41, 42 about the rotational axis A4, which extends perpendicular to the first surface 1a of the carrier piece 1. Alternatively, it can also be provided that the spindle counterpart 4 is mounted on the carrier piece 1 in a linear guide (not shown) extending transversely to the longitudinal axis A1, e.g., along a transverse axis C1, such that it is linearly displaceable. The second end 42 can, for example, protrude laterally beyond the carrier piece 1 or the peripheral surface 1c with respect to the transverse axis C1, which extends generally transversely to the longitudinal axis A1, as shown in Fig. 3 is shown as an example for the rotatably mounted spindle counterpart 4.

[0069] The spindle counterpart 4 is generally between an engagement position which is Fig. 3, and a release position. In the engaged position, the engagement structure 40 is in engagement with the external thread 30 of the spindle 3. In the example of Fig. 3, the engagement elements 40A thus engage in the external thread 30 of the spindle 3. As a result, the spindle 3 can be displaced along the longitudinal axis A1 by rotating about its spindle axis A3, e.g., in order to apply force to a fracture via the working end 31 using the hook 2A as a counterbearing. In the release position (not shown), the engagement between the external thread 30 and the engagement structure 40 is released at least to such an extent that the spindle 3 can be displaced along the longitudinal axis A1 by applying an axial force directed along the spindle axis A3, in particular without rotating the spindle 3 about the spindle axis.

[0070] The elastic prestressing element 5 can be designed as a spring, e.g. as a leg spring, as in Fig. 3, or as a leaf spring, torsion spring, spiral spring or the like. The preloading element 5 preloads the spindle counterpart 4 into the engaged position. For example, as shown in Fig. 3, the preloading element 5 is supported on the support piece 1 and on the spindle counterpart 4 and applies a preload force to the spindle counterpart 4. In the example of Fig. 3, the preloading element 5 applies a force directed away from the longitudinal axis A1 between the rotational axis A4 and the second end 42 to the spindle counterpart 4, which causes the engagement structure 40 provided at the first end 41 to be held in engagement with the external thread 30 of the spindle 3.

[0071] To move the spindle counterpart 4 from the engaged position into the release position, a force directed opposite to the pretensioning force of the pretensioning element 5 can be applied, for example, to the second end 42 of the spindle counterpart 4, e.g. by a user moving the second end 42 of the spindle counterpart 4 in the direction of the carrier piece 1 with respect to the transverse axis C1. In general, it can be provided that the spindle counterpart 4 is mounted on the carrier piece 1 in such a way that the engagement structure 40 is movable between the engaged position and the release position in a direction transverse to the longitudinal axis A1. Furthermore, it is conceivable that the force necessary to move the spindle counterpart 4 from the engaged position into the release position is applied via the spindle 3.For example, the engagement elements 40A can have at least one sliding surface which, with respect to the longitudinal axis A1, faces the first end 11 of the carrier piece 1 and is inclined such that the external thread 30 of the spindle 3 slides along the sliding surface when an axial force is applied along the spindle axis A3 from the first end 11 in the direction of the second end 12 of the carrier piece 1, and thereby displaces the engagement structure 40 outwards transversely to the longitudinal axis A1, so that the engagement structure 40 is moved from its engagement position into its release position.

[0072] Regardless of how the spindle counterpart 4 is moved from the engagement position to the release position, a linear movement of the spindle 3 along the longitudinal axis A1 can occur in the release position without having to rotate the spindle 3. This facilitates the rapid overcoming of larger distances.

[0073] Optionally, a securing element 44 can be provided, which secures the spindle counterpart 4 in the engaged position against movement into the release position. As shown in Fig. 4, the securing element 44 can be designed, for example, as a screw which locks the spindle counterpart 4 against the carrier piece 1. If the spindle counterpart 4, as in Fig. 4, is rotatably mounted on the carrier piece 1, the securing element 44 can, for example, be guided through the spindle counterpart 4 in the region of the second end 42 and be supported on the carrier piece 1.

[0074] While in the Fig. 1 to 4 instruments 100 are shown with only one spindle counterpart 4, the invention is not limited to this. Fig. 5 shows an example of an instrument 100 having a first and a second spindle counterpart 4A, 4B, which are arranged on opposite sides of the carrier piece 1 with respect to the longitudinal axis A1. The mode of operation is identical to the mode of operation with only one spindle counterpart 4, wherein in Fig. 5 an engagement structure 40 of the first and second spindle counterpart 4A, 4B engages in the external thread 30 of the spindle 3.

[0075] As already explained, the support piece 1 can be combined with various hooks 2A. These can, for example, be releasably fixed to the holder 14A in the manner described. Fig. 1, Fig. 16 and Fig. 17 shows a hook 2A, the end region 22A of which is positioned coaxially to the spindle axis A3 or longitudinal axis A1. Fig. Figure 8 shows, by way of example, a hook 2A whose end region 22A is positioned at a distance d22 from the spindle axis A3 or longitudinal axis A1. The end region 22A is located on the side of the first surface 1a of the support piece 1. Fig. 9 shows a hook 2A in which the curved section 2.2A has a significantly larger radius than in the Fig. 1, Fig. 7 and Fig. 8 and whose second end 22 is positioned at a distance d22 from the spindle axis A3 or longitudinal axis A1 on the side of the second surface 1b of the carrier piece 1.

[0076] In the Fig. 1 and 7 to 9, the hooks 2A each extend in one plane, e.g. in a plane containing the longitudinal axis A1. In Fig. 10 shows, by way of example, a hook 2A having a first linear section 2.1C extending from the first end 21A of the hook 2 in the plane containing the longitudinal axis A1, and a second linear section 2.1D extending at an angle from one end of the first linear section 2.1C. Fig. 11 shows, by way of example, a hook 2A, which also has a first and a second linear section 2.1C, 2.1D, wherein the first linear section 2.1C extends from the first end 21A of the hook 2A in the plane containing the longitudinal axis A1. The second linear section 2.1D is connected to the first linear section 2.1C by a connecting section 2.1E, which extends from the end of the first linear section 2.1C at an angle to it, and extends parallel to the plane containing the longitudinal axis A1.

[0077] As already explained above, it can optionally be provided that the working end 31 of the spindle 3 can be moved into the guide structure 10 of the carrier piece 1. The guide structure 10 can optionally have a receptacle 12A at the second end 12 of the carrier piece 1. As in Fig. 12A and Fig. 12B schematically and purely by way of example, the receptacle 12A can be formed, for example, by an end region of the recess 10A, which optionally has a larger diameter than the remaining recess 10A. This receptacle 12A can be used, for example, to strip off an attachment 35 from the working end 31 of the spindle 3. The working end 31 of the spindle 3 can optionally have a locking piece 34, e.g. in the form of a ball, which in the present example is Fig. 12B is additionally provided with a point. In principle, other locking pieces 34, e.g., lugs, brackets, grooves, rockers, etc. are also conceivable. An attachment 35, e.g., in the form of a plate as in Fig. 12, can have a locking structure 35A complementary to the locking piece 34, e.g. in the form of a recess or a spring element, which can be locked to the locking piece 34. When the working end 31 of the spindle 3 can be moved in the direction of the first end 11 of the carrier part 1, the attachment 35 comes into contact with the second end 12 of the carrier part 1, while the part locked to the locking piece 34 is moved into the receptacle 12A and is released, in particular pulled off, from the spindle 3.

[0078] Fig. 12B shows, by way of example, that the partially continuous opening 37 of the spindle 3 does not have to extend completely along the longitudinal axis A1 of the spindle 3 to the working end 31 of the spindle 3, but can end at an end point 64. In this case, the at least partially continuous opening 37 opens into at least one point (not shown) on the lateral surface 75 of the spindle 3.

[0079] Although only one-piece spindles 3 have been explained so far, the invention is not limited thereto. Optionally, the spindle 3 can have a first spindle part 3A, on which the external thread 30 is formed, and a second spindle part 3B, which is guided for linear movement on the first spindle part 3A. This is illustrated schematically and by way of example in Fig. 13. The second spindle part 3B has the working end 31. For example, it can be provided that the at least partially through opening 37 of the spindle 3 extends completely over one of the spindle parts 3A, 3B, preferably over the first spindle part 3A. As in Fig. 13, the other of the spindle parts 3A, 3B has a guide shaft 33B, in the case of Fig. 13 the second spindle part 3B. Furthermore, it can be provided that the at least partially through opening 37 is connected to the outer circumference of the respective spindle part 3A, 3B by an elongated hole 33C, and a locking pin 33D is guided in the elongated hole 33C, which is connected to the guide shaft 33B of the other spindle part 3A, 3B. By means of a spring 33, the spindle parts 3A, 3B can be preloaded away from one another, i.e. against a movement of the spindle parts 3A, 3B towards one another. When the working end 31 comes into contact with a bone part, the applied force is thus limited by the spring 33 until the spring travel and / or the guide path defined by the at least partially through opening 37 and guide shaft 33B has ended.

[0080] The Fig. 14 and Fig. 15 each show an instrument 100 constructed as explained above and additionally comprising a clamp 6 for attaching a connecting rod (not shown) via which the instrument 100 can be connected to another instrument 100. The clamp 6 can, for example, be attached to the first block 15.1 of the holder 14A, as in Fig. 14 as an example. Alternatively, the clamp 6 can also be provided in the region of the second end 12 of the carrier 1 on its second surface 1b, as shown in Fig. 15 is shown as an example. Alternatively, it is also conceivable that the clamp 6 is attached to a hook 2A, e.g., to its connecting piece 24A.

[0081] Fig. 16 shows an example of another surgical instrument 100 which differs from the one shown in Fig. 1 and Fig. 2 only by the connection of the optional actuating piece 36 to the spindle 3.

[0082] As in Fig. 16, the instrument 100 can optionally additionally comprise a torque limiter 7. The torque limiter 7 is connected to the actuating end 32 of the spindle 3. The torque limiter 7 can in particular be detachably connected to the actuating end 32 of the spindle 3, for example via a coupling 38, e.g. in the form of an AO coupling, ¼'', Dental, Hudson, ZIH, WA coupling or the like, as in Fig. 16 is shown as an example. Alternatively, the torque limiter 7 can also be permanently connected to the actuating end 32 of the spindle 3. The actuating piece 36 is permanently or detachably connected to the torque limiter 7. The torque limiter 7 thus couples the actuating piece 36 to the spindle 3.

[0083] The torque limiter 7 can, for example, have an input element (not shown) connected to the actuating piece 36, and an output element (not shown) connected to the spindle 3. The output and input elements can, for example, be in frictional contact and preloaded against one another so that they slide against one another when a predetermined threshold is reached when a torque is applied to the output and input elements. Thus, the input and output elements, and consequently spindle 3 and actuating piece 36, can rotate against one another when a predetermined torque is exceeded. Of course, a different structural design of the torque limiter 7 is also conceivable. In general, the torque limiter 7 is designed to permit relative rotation between the spindle 3 and the actuating piece 36 when the torque applied to the actuating piece 36 exceeds a predetermined threshold.

[0084] The Fig. 17 to 19 show examples of further surgical instruments 100 which differ from the one shown in the Fig. 1 and Fig. 2 only by an optional stop 39 provided on the spindle 3. As shown in Fig. 17, the stop 39 can be provided on the outer circumference of the spindle 3. The stop 39 can, for example, be designed as a component separate from the spindle 3, which is detachably connected to the spindle 3. For example, the stop 39 can have two ring segments, which can be screwed together in order to be clamped to the spindle 3. Alternatively, the stop 39 can also be formed integrally with the spindle 3. The spindle 3 can, for example, have a radial collar, which forms a projection in the outer circumference of the spindle 3, as shown in the Fig. 18 and Fig. 19 is shown schematically and purely as an example.

[0085] As in the Fig. 17 to 19, stop 39 can be arranged in an area facing away from the working end 31. The first end 11 or the circumferential surface 1c of the support piece 1 can serve as a counter bearing against which the stop 39 strikes when the spindle 3 moves in the direction of the second end 12 of the support piece 1, for example, as shown in the Fig. 17 and Fig. 18 is shown by way of example. Alternatively, it is also conceivable that the guide structure 10 itself functions as a counter bearing. For example, the recess 10A can be widened in the region of the first end 11 of the carrier piece 1, so that between the first and the second end 11, 12 of the carrier piece 1, a shoulder 10B is formed in the recess 10A, against which the stop 39 of the spindle 3 strikes when the spindle 3 moves in the direction of the second end 12 of the carrier piece 1, as shown in Fig. 19 is shown schematically.

[0086] Fig. 20 and Fig. 21 show, by way of example, an alternative embodiment for a hook 2A of the surgical instrument 100. The curved section 2.2A of the hook 2A is radially curved and has a separation gap S22, which divides the hook into a double hook shape with a first end region 22A and a second end region 22B. The space thus gained in the separation gap S22 can be used to attach a guide body 22F at the transition between the linear section 2.1A and the curved section 2.2A of the hook 2A. The guide body 22F has a receptacle 022F through which a cerclage wire (not shown in the figures) can be pushed.

[0087] Fig. 22 shows schematically a sectional view in the region of the second end 12 of the carrier piece 1. In contrast to the embodiment according to Fig. 6 shows a surgical instrument 100 which, in addition to a holder 14A for a first hook 2A, has a second holder 14B for a second hook 2B. For the construction of the holder 14A, reference is made to the explanations for Fig. 6.

[0088] The holder 14B has a receiving gap 14.2A, which is as in Fig. 22 are defined by a first block 15.2 and a second block 16.2. The first and second blocks 15.2, 16.2 protrude from the first surface 1b of the carrier 1 and are spaced apart from one another in the horizontal direction, i.e., with respect to the longitudinal axis A1 of the spindle 3. The first block 15.2 has a passage 15.2A. The second block 16.2 optionally has an opening 16.2A positioned coaxially with the passage 15.2A. The locking bolt 17.2 is mounted for linear movement in the passage 15.2A.

[0089] As in Fig. 22, the hook 2B can be provided at its first end 21B with a connecting piece 24B, which can be inserted into the gap 14.2A and has a locking opening 27.2. The connecting piece 24B can have a shape corresponding to the gap 14.2A. The locking bolt 17.2 is movable between a locking position, which is Fig. 22, and a retracted position. In the locking position, the locking bolt 17.2 projects through the locking opening 27.2 of the connecting piece 24B of the hook 2B and optionally also into the opening 16.2A of the second block 16.2. By pushing the locking bolt 17.2 through the locking opening 27.2, the hook 2B is fixed to the carrier piece 1. In the retracted position, the locking bolt 17.2 is retracted from the receiving gap 14.2A and thus also from the locking opening 27.2, so that the hook 2B can be removed from the carrier piece 1.

[0090] As in Fig. As shown schematically in Figure 22, the locking bolt 17.2 can have a head 17.2A, which forms an end of the locking bolt 17.2 that protrudes outside the receiving gap 14.2A from the block 15.2. A user can grasp the locking bolt 17.2 at this head 17.2A and apply a pulling force to move it into the retracted position. The locking bolt 17.2 can be moved out of the locking opening 27.2 of the connecting piece 24B of the hook 2B without the need for tools by applying a pulling force.

[0091] Furthermore, it can be provided that the locking bolt 17.2 is secured in the locking position and in the retracted position in a form-fitting manner on the first block 15.2 against falling out of the passage 15.2A. For example, as in Fig. 22, a securing element 18.2 is provided in the first block 15.2, which is guided perpendicular to a longitudinal axis M17.2 of the bolt 17.2 and is pretensioned by a spring (not shown), so that the securing element 18.2 projects into a groove 18.2A extending along the longitudinal axis M17.2 of the locking bolt 17.2 and rests against the bottom of the groove 18.2A. The securing element 18.2 can be a ball, a pin, or the like. A first and a second notch 18.2B, 18.2C are formed at axial ends of the groove 18.2A. When the locking bolt 17.2 is positioned in the locking position, as in Fig. 22, the securing element 18.2 engages the first notch 18.2B. When the locking bolt 17.2 is positioned in the retracted position, the securing element 18.2 engages the second notch 18.2C. In Fig. 22 shows that the receiving gap 14.2B for the hook 2B is approximately the same size as the receiving gap 14.2A for the hook 2A.

[0092] Furthermore, the holder 14B and the connecting piece 24B can optionally be designed such that the connecting piece 24B can be fixed to the holder 14B in several rotational positions with respect to a longitudinal axis M17.2 of the locking bolt 17.2. The fixing in the different rotational positions can be effected, for example, via a positive connection due to mutually abutting contact surfaces 14k, 24k. Fig. In the rotational position shown in Fig. 22, a flat contact surface 24k of the connecting piece 24B rests against a flat first contact surface 14k of the holder 14B, which is oriented away from the flat second surface 1b of the carrier piece 1 and runs parallel to it.

[0093] Fig. 23A schematically shows a cross section at the second end 12 of the carrier piece 1 of the surgical instrument 100 according to the Fig. 22 shown version along the vertical axis H24.

[0094] Fig. Figure 23B describes an alternative embodiment in which only a single holder 14A is used, which encompasses the support piece 1 and the spindle 3 guided inside the support piece from three sides. The hooks 2A, 2B can be fixed to this single holder 14A via their associated connecting pieces 24A, 24B.

[0095] Fig. Figure 24 shows a perspective view of a surgical instrument 100 according to a further embodiment of the present invention. The hook 2A is designed as a double hook with two end portions 22A, 22B, whereas the second hook 2B has only a single hook with a single end portion 22C. Due to the vertical position of the connecting pieces 24A and 24B, the hook 2B is clamped into the instrument 100 such that it Fig. 20 closes the separation gap S22 between the end regions 22A and 22B of the hook 2A.

[0096] The hook 2B can be configured to engage with the hook 2A, but configurations are also conceivable in which the hooks 2A, 2B do not touch each other or only touch each other via a point contact. Fig. 25 and Fig. 26 describe a further embodiment of the surgical instrument 100 with two hooks 2A, 2B, which are arranged eccentrically with respect to the longitudinal axis A1 of the spindle 3. In this embodiment, the hook 2A also has a first and a second linear section 2.1C, 2.1D, wherein the first linear section 2.1C extends from the first end 21A of the hook 2A to a connecting section 2.1E. The connecting section 2.1E adjoins the end of the first linear section 2.1C and extends from its first end at an angle to 2.1C until it merges into the second linear section 2.1D at its second end. Due to the selected orientation of the connecting piece 24A, the first linear section 2.1C of the hook 2A extends in the plane containing the longitudinal axis A1 above the spindle 3, and the second linear section 2.1D extends in a plane parallel to the plane containing the longitudinal axis A3, which contains the longitudinal axis A5.

[0097] The second hook 2B has a first and a second linear section 2.1F, 2.1G. The first linear section 2.1F of the hook 2B is in the Fig. 26, since, like the first linear section 2.1C of the hook 2A, it extends in the plane containing the longitudinal axis A3. However, in contrast to the first linear section 2.1C, the first linear section 2.1F runs below the spindle 3. The first linear section 2.1F extends from the first end 21B of the hook 2B to a connecting section 2.1H. The said connecting section 2.1H adjoins the end of the first linear section 2.1F and extends from its first end at an angle to 2.1F until it merges into the second linear section 2.1G at its second end. The second linear section 2.1G runs in a plane parallel to the plane containing the longitudinal axis A3, which plane contains the longitudinal axis A6.

[0098] It is possible that the parallel plane containing the longitudinal axis A5 and the parallel plane containing the longitudinal axis A6 are identical. In this case, both hooks 2A and 2B describe an identical path above and below the spindle, respectively, and can touch each other at the end regions 22A, 22B in a point contact. Fig. 25 and Fig. In the case shown in Figure 26, the planes are not identical, the second linear sections 2.1D and 2.1G run on opposite sides with respect to the spindle 3.

[0099] The use of a 2A hook is not mandatory for the use of a 100 surgical instrument. Fig. 27 shows a surgical instrument with a first holder 14A and a second holder 14B. Only on the second holder 14B is a hook 2B connected to the connecting piece 24B. The hook 2B is designed as a singular hook, which thus has only a single end region 22C. In contrast, the hook 2B in Fig. 28 is designed as a double hook, which has two end regions 22C, 22D.

[0100] Fig. 29A to 32C show possible general designs of tips of a hook 2.

[0101] Fig. 29A and Fig. 29B show that a curved section 2.2 of the hook 2 can taper to a point or a blunt point towards its end region 22.

[0102] Fig. 30A to 30C show possible designs of the locking piece 54 at the end region 22 of the hook 2. Accordingly, the locking piece 54 can be provided with a ball tip, as a hemisphere with thorn- or tooth-shaped attachments, or with a crown shape. In addition, Fig. 30D a plate-shaped attachment 55, which has a Fig. 12 described locking mechanism with a locking piece 54 designed as a ball point.

[0103] For hooks 2 with a double hook shape, a rocker mounted at least partially rotatable about a horizontal axis A7H or a vertical axis A7V can be used as attachment 55, as shown in Fig. 31A and Fig. 31B. The Fig. The rocker shown in Figure 31A is characterized by a single working end 22, which is located between the outer flat surfaces 23 of the rocker.

[0104] The at least partial rotatability of rockers as attachment 55 for the locking piece 54 of a hook 2 and / or as attachment 35 for the locking piece 34 of the spindle 3 is determined by the Fig. 31A described rocker: Fig. 32A shows the Fig. 31A, which is mounted for rotation about a horizontal axis A7H and is in a normal position, i.e., the center axis M55 of the rocker is aligned coaxially or axially parallel to the spindle's longitudinal axis A1 (not shown). From the normal position, the rocker can be rotated both clockwise and counterclockwise about the horizontal axis A7H. Fig. 32B shows that the rocker, when rotating about the horizontal axis A7H, abuts against a first stop surface 71 of the locking piece 34, 54, so that a counterclockwise rotation from the normal position is possible by a maximum angle of rotation α.

[0105] Fig. 32C shows that the rocker abuts a second stop surface 72 when rotating about the horizontal axis A7H, so that a counterclockwise rotation from the normal position is possible by a maximum angle of rotation β.

[0106] Fig. 31B to 31D show possible designs of the hook 2 as a double hook, which has exactly two general end regions 22X1, 22X2. A design without a locking piece 54 is, for example, a Y-shaped double hook. A possible design with a locking piece 54 is the one shown in Fig. 31C shown double hooks with two ball tips, but all of the hooks shown in Fig. The locking pieces shown in 30A to 30D can be used.

[0107] All of the Fig. The general embodiments of a hook 2 shown in Figures 29A to 31D can be applied to both the hook 2A and the hook 2B of a surgical instrument 100.

[0108] Fig. Figure 33 shows a sectional view of the spindle 3 of a surgical instrument. The spindle 3 has an at least partially through opening 37, which extends coaxially to the longitudinal axis A1 of the spindle 3 from its actuating end 32 to its working end 31. As shown in Fig. 34A and Fig. As can be seen in Figure 34B, the working end 31 or the outer surface 75 of the spindle 3 has openings 38 through which liquids can be supplied or sucked away. The openings 38 at the working end 31 of the spindle 3 are connected via contact channels 38A to the at least partially continuous opening 37. If the spindle 3 has a locking piece 34 at its working end 31, the openings 38 can also extend onto the surface of the locking piece 34, as shown in Fig. 35A and Fig. 35B.

[0109] Fig. 36A shows a sectional view of the actuating end 32 of the spindle 3 when using a Christmas tree connector 81 for connecting a fluid line (not shown) to the at least partially through opening 37. The Christmas tree connector 81 protrudes beyond the actuating end 32 of the spindle 3 and tapers to its connecting end 81.1. The side surfaces 81.2 of the Christmas tree connector 81 form a wave- or jagged structure.

[0110] Fig. 36B shows a sectional view of the actuating end 32 of the spindle 3 when using a Luer connection 82 for connecting a fluid line (not shown) to the at least partially through-opening 37. The Luer connection 82 is located inside the actuating end 32 of the spindle 3 and is realized by changing the properties of the at least partially through-opening 37: In a head section 32.1 of the actuating end 32, a first section 37.1 of the at least partially through-opening 37 extends, which tapers conically and merges into a second section 37.2 of the at least partially through-opening 37 in a constriction 82.1 in the transition section 32.2 of the actuating end 32. The second section 37.2 of the at least partially through-opening 37 has a smaller diameter than the smallest diameter of the first section 37.1.

[0111] Fig. 36C shows a sectional view of the actuating end 32 of the spindle 3 when using a Luer lock 83 for connecting a fluid line (not shown) to the at least partially continuous opening 37: The Luer lock 83 protrudes beyond the actuating end 32 of the spindle 3 and extends to a connecting flange 83.1. The outer contour lines 83.2 of the Luer lock 83 run parallel to one another. The at least partially continuous opening 37 tapers conically in a first section 37.1 within the Luer lock 83 and merges seamlessly at the actuating end 37 into a second section 37.2, which is circular and has the smallest diameter of the first section 37.1.

[0112] Fig. 37 shows a section of the support piece 1 of a surgical instrument 100, which has openings 49 parallel to the longitudinal axis A3 of the spindle 3. These parallel openings 49 can be located on the heads of the locking bolts 17.1A and 17.1B, which are inserted into the holders 14A, 14B. Likewise, the lateral projections 19 of the support piece 1 and / or the actuating piece 36 at the actuating end 32 of the spindle can have parallel openings 49.

[0113] Fig. 38 shows a cross-section of the at least one hook 2A, 2B of a surgical instrument 100, wherein the at least one connecting piece 24A, 24B has bores 65 and an opening 67. The opening 67 serves to receive a connecting rod (not shown) to connect the instrument 100 to another instrument 100. The bores 65 serve to receive a clamp 6 with a threaded part 66, which is screwed into the bores 65 to lock a received connecting rod against axial displacement. Fig. 38 shows only a single clamp 6, which is in a locked position. However, it is conceivable that additional clamps 6 could be screwed into free holes 65 to create a frictional connection.

[0114] Although the present invention has been explained above using exemplary embodiments, it is not limited thereto but can be modified in a variety of ways. In particular, combinations of the above embodiments are also conceivable. QUOTES CONTAINED IN THE DESCRIPTION

[0000] This list of documents submitted by the applicant was generated automatically and is included solely for the convenience of the reader. This list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions. Cited patent literature

[0000] DE 10 2022 211 215.6

[0003] CN 2 117 861 U

[0004] EP 0 686 375 A1

[0005] DE 299 16 202 U1

[0006] EP 2 844 166 A1

[0007] US 2 427 128 A

[0008] WO 89 06948 A1

[0010]

Claims

[1] Surgical instrument (100) for reducing fractures, comprising: a carrier piece (1) with a guide structure (10) defining a longitudinal axis (A1), at least one hook (2A, 2B) detachably attached to the carrier piece (1), a spindle (3) with an external thread (30) and a working end (31) movably guided in the guide structure (10) of the carrier piece (1) along the longitudinal axis (A1); a spindle counterpart (4) movably mounted on the carrier piece (1) with an engagement structure (40) designed to engage the external thread (30) of the spindle (3), wherein the spindle (3) has an opening (37) at least partially extending along the longitudinal axis (A1). [2] Surgical instrument (100) according to claim 1, characterized by , that the at least partially through opening (37) of the spindle (3) is arranged coaxially to the longitudinal axis (A1). [3] Surgical instrument (100) according to claim 1 or 2, characterized by, that the guide structure (10) extends continuously between a first end (11) and a second end (12) of the support piece (1), wherein the spindle (3) with the working end (31) is movable beyond the second end (12) of the support piece (1), so that the fracture can be repositioned and / or temporarily fixed by the working end (31) of the spindle (3) and an end region (22A, 22B, 22C, 22D) of the at least one hook (2A,2B) located away from the support (1), and wherein an actuating end (32) of the spindle (3) located opposite to the working end (31) projects beyond the first end (11) of the support piece (1). [4] Surgical instrument (100) according to claim 3, characterized by , that the working end (31) of the spindle (3) can be moved into the guide structure (10) of the carrier piece (1). [5] Surgical instrument (100) according to any one of the preceding claims, characterized by, that the working end (31) of the spindle (3) has a locking piece (34), wherein an attachment (35) can be locked to the locking piece (34). [6] Surgical instrument (100) according to claim 5, characterized by , that the locking piece (34) and / or the working end (31) of the spindle (3) has further openings (38) in its surface which are connected to the at least partially through opening (37) of the spindle (3). [7] Surgical instrument (100) according to any one of claims 3 to 6, characterized by , that the end area (22A, 22B, 22C, 22D) of the at least one hook (2A, 2B) has an associated detent (54) with which an associated attachment (55) can be locked. [8] Surgical instrument (100) according to any one of claims 3 to 7, characterized by , that the at least one hook (2A, 2B) has exactly two end regions (22A,22B,22C,22D). [9] Surgical instrument (100) according to one of the preceding claims, comprising an elastic preloading element (5) which preloads the spindle counterpart (4) into an engagement position in which the engagement structure (40) engages with the external thread (30) of the spindle (3), so that the spindle (3) can be adjusted by a rotation about a spindle axis (A3) parallel to the longitudinal axis (A1) along the longitudinal axis (A1). [10] Surgical instrument (100) according to one of the preceding claims, wherein the carrier (1) has at least one holder (14A, 14B) with at least one receiving slot (14.1A, 14.1B) and at least one linearly movable locking bolt (17.1, 17.2), wherein the at least one hook (2A, 2B) has at least one connecting piece (24A, 24B) positioned in the at least one receiving slot (14.1A, 14.1B), wherein the at least one connecting piece (24A, 24B) has at least one locking opening (27.1, 27.2) into which the at least one locking bolt (17.1, 17.2) projects to fix the at least one hook (2A, 2B) to the carrier (1). [11] Surgical instrument (100) according to claim 10, characterized by that the instrument has exactly one holder (14A) which encloses the spindle (3) on at least three sides, wherein the surgical instrument (100) has a first hook (2A) and / or a second hook (2B). [12] Surgical instrument (100) according to claim 10, characterized by , that the instrument has a first holder (14A) and a second holder (14B), wherein the surgical instrument (100) has a first hook (2A) and / or a second hook (2B). [13] Surgical instrument (100) according to one of claims 10 to 12, wherein an actuating element (36) at the actuating end (32) of the spindle (3), a head (17.1A, 17.2A) of the at least one locking bolt (17.1, 17.2), and / or lateral projections (19) of the carrier piece (1) have at least one opening (49) parallel to the longitudinal axis (A1) of the spindle (3).

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