Orthopedic device with pivoting rotational axis

Abstract

The invention relates to an orthopedic device (1) with a proximal part (10) for placing on an upper arm or a thigh and a distal part (20) for placing on the lower arm or the lower leg, said parts being pivotally connected together via at least one lateral joint device (30. The orthopedic device has at least one securing device (11, 21), by means of which the orthopedic device (1) can be secured to the limb, wherein the lateral joint device (30) and / or the medial joint device (40) has a rotary joint with a receiving section (31) and a received section (33), and the received section (33) is received in the receiving section (31) in a rotatable manner relative thereto. The receiving section (31) of the lateral joint device (30) and / or the medial joint device (40) is designed to allow a movement of the section (33) rotatably received by the receiving section in the distal-proximal direction and / or in the ventral-dorsal direction.

Description

[0001] OT Medizintechnik GmbH Description Orthopedic device with pivoting axis of rotation The present invention relates to a medical or orthopedic device according to claim 1, a set according to claim 21 or 42, a joint device according to claim 22 and a method according to claim 43 or according to the respective preambles or generic terms of these claims. An orthopedic device is an externally worn aid, for example an orthosis. It is used, for example, in the case of degeneration, after injuries or to prevent injuries / incorrect loading of joints, e.g. in the case of ligament tears or wear and tear of joints. These orthopedic devices are also used after surgical interventions such as joint replacement or operations on the joint structure or other operations on bony or muscular structures or operations on the ligaments.Orthopedic devices are designed to relieve, stabilize, or realign joints, muscles, or bones. They can be made from a wide variety of materials, such as fabrics, plastics, metals, silicones, or combinations thereof. Orthopedic devices can be used on upper and lower extremities. They can, for example, reduce misalignments, restrict or prevent joint movements, or redistribute or reduce loads. One object of the present invention is to provide a further orthopedic device and a set. The object of the invention is achieved by an orthopedic device having the features of claim 1, a set having the features of claim 21 or 42, a joint device having the features of claim 22, and a method having the features of claim 43.According to the invention, an orthopedic device is proposed for application to the two anatomies adjacent to an anatomical joint, e.g., the thigh and lower leg. The device has a proximal part for application to the proximal of the two anatomies adjacent to an anatomical joint, e.g., an upper arm or a thigh, and a distal part for application to the distal anatomy, e.g., the forearm or the lower leg. The proximal and distal parts are pivotally or rotatably connected to one another via at least one lateral joint device and optionally also a medial joint device. Furthermore, the orthopedic device has at least one fastening device with which the orthopedic device can be secured to the limb.The lateral joint device and / or the medial joint device has / have a rotary joint with or consisting of one - or exactly one - receiving section and one - or OT Medizintechnik GmbH exactly one - received section, wherein the received section is rotatably received in the receiving section relative to the latter. The receiving section of the lateral joint device and / or the medial joint device is designed to allow a translational movement of the section rotatably received therein in at least one direction, and / or a movement of the section rotatably received therein in a first, in particular distal-proximal, direction and / or in a second, in particular ventral-dorsal, direction.Alternatively or additionally, the receiving section of the lateral joint device and / or the medial joint device can be designed to allow tilting, pivoting, wobbling or inclining of the section rotatably received therein or its longitudinal axis. According to the invention, a rotational movement is thus preferably possible from a structural perspective, wherein the movements structurally enabled by the joint device are not limited to pure rotational movements, but rather the joint device preferably allows at least one further form and / or direction of movement, in particular continuously. The lateral and / or medial joint device is preferably designed to allow movement, tilting, pivoting, wobbling or inclining of the section rotatably received therein or its longitudinal axis or the rotation axis during use of the medical device, e.g. due to, caused by, or following flexion or extension by the patient.OT Medizintechnik GmbH According to the invention, a set is further proposed which comprises an orthopedic device according to the invention and / or a joint device according to the invention, on the one hand, and at least two inserts and / or at least two gears, on the other hand, wherein the inserts differ from one another and / or the gears differ from one another. Furthermore, the invention proposes a joint device for a medical device, in particular for a medical device according to the invention, which has or forms a rotary joint, or a joint with at least one rotary joint function, a receiving section, and a received section. The received section is received in the receiving section so as to be rotatable relative to the latter.Furthermore, the receiving section is designed and / or arranged to allow movement of the section rotatably received therein, or a section thereof, in a distal-proximal direction and / or in a ventral-dorsal direction, and / or to allow inclination, pivoting, or tilting of the rotatably received section relative to the receiving section or a rotational axis of the joint device, or vice versa, in particular in a stepless manner. Preferably, the joint device is designed to allow movement, tilting, pivoting, wobbling, or inclination of the section rotatably received therein, or its longitudinal axis or the rotational axis, during use of the joint device, e.g., due to or following flexion or extension by the patient.OT Medizintechnik GmbH The method according to the invention relates to the preparation of a medical device according to the invention and comprises providing a medical device according to the invention, performing all steps required before putting on the medical device, such as making adjustments to be tailored to the patient, or ensuring that these steps have been completed until the medical device is ready for putting on such that there is play between the components involved in the formation of the joint device such that their relative movement to one another, both rotating and moving, tilting, pivoting or tipping, is maintained. Embodiments according to the invention can have some, some or all of the following features in any combination, unless this is recognizably technically impossible for a person skilled in the art.In all of the following statements, the use of the expressions “can be” or “can have” etc. is to be understood as synonymous with “is preferably” or “preferably has” etc. and is intended to explain embodiments according to the invention. Whenever numerical words are mentioned herein, those skilled in the art will understand this as indicating a numerical lower limit. Unless this leads to a contradiction recognizable to those skilled in the art, those skilled in the art will therefore always read “at least one” or “at least one” when stating “a” or “an”. This understanding is also encompassed by the present invention, as is the interpretation that a numerical word such as “a” can alternatively be meant as “exactly OT Medizintechnik GmbH a”, wherever this is recognizably technically possible for those skilled in the art. Both are encompassed by the present invention and apply to all numerical words used herein. Whenever spatial specifications are mentioned herein, such as, for example,Whenever reference is made to “above”, “below”, “left” or “right”, the person skilled in the art will understand this to mean the arrangement in the figures attached here and / or in the state of use. “Below” is closer to the center of the earth or the lower edge of the figure than “above”. The terms “medial”, “lateral”, “dorsal”, “ventral”, “proximal” or “distal”, when used in relation to the patient, are based, as is usual in medicine, on the assumption of a patient standing upright with their arms hanging down with their palms facing forwards (ventrally). Whenever reference is made to directional information, such as, for example, “left”, “right”, “right”, “medial”, “lateral”, “dorsal”, “ventral”, “proximal” or “distal”, when used in relation to the patient, the assumption is made, as is usual in medicine, that the patient is standing upright with their arms hanging down with their palms facing forwards (ventrally). For example, when reference is made to “medial”, “lateral”, “dorsal”, “ventral”, “proximal” or “distal” with regard to the orthopaedic device, the person skilled in the art understands this to mean the direction in relation to the intended or planned use of the orthopaedic device, i.e. in the way in which the doctor would refer to the orthopaedic device when it is applied to the patient as intended.The first direction can be a direction along a longitudinal extension or direction of the proximal or distal part. The second direction can be a direction along a transverse extension or direction of the proximal or distal part. OT Medizintechnik GmbH The first direction can be a direction along a longitudinal extension or direction of an upper part or lower part described below. The second direction can be a direction along a transverse extension or direction of the upper part or lower part. Although the device according to the invention is primarily referred to herein as an orthopedic device, the invention is not limited thereto. Rather, it can be directed to a medical device. The replacement of “orthopaedic device” as used herein with “medical device” or “medical device” is therefore also encompassed by the disclosure of the invention.Advantageous further developments of the present invention are each the subject of dependent claims and embodiments. Whenever an embodiment is mentioned herein, this represents an exemplary embodiment according to the invention, which is not to be understood as limiting. If it is disclosed herein that the subject matter according to the invention has one or more features in a specific embodiment, it is also disclosed herein that the subject matter according to the invention expressly does not have precisely this or these features in other, likewise inventive embodiments, e.g. in the sense of a disclaimer. For each embodiment mentioned herein, it therefore applies that the opposite embodiment, formulated by OT Medizintechnik GmbH, for example, as a negation, is also disclosed.When reference is made herein to a joint device, in particular one according to the invention, what is disclosed in this regard can also apply to the lateral joint device and / or medial joint device disclosed herein, and vice versa. Although the invention is discussed below primarily with reference to the thigh and lower leg or upper arm and forearm, the invention is not limited thereto. It can generally be intended for application to the two anatomies adjacent to an anatomical joint. In some embodiments of the orthopedic device according to the invention, the permitted movement is or includes pivoting by means of the lateral joint device and / or the medial joint device about a plurality of joint axes or about a joint axis or rotation axis that changes, in particular moves, wanders, tilts, or pivots, relative to the proximal part and / or the distal part during pivoting.A rotation axis, as used herein, can be a physical axis, similar to the pin or pivot of a hinge joint. A rotation axis, as used herein, can alternatively refer to a non-physical curve or straight line by means of which the center of rotation of a rotation can be determined. A joint axis, as used herein, is an imaginary axis in some embodiments. It is not a physical axis in these OT Medizintechnik GmbH embodiments; in other embodiments, this is different. A joint axis, as used herein, is a rotation axis in some embodiments. Both terms can therefore be interchangeable. In some embodiments, the allowing is achieved by the receiving portion serving as a guide or longitudinal guide for the received portion.The receiving portion can be configured as a through-opening in either the upper part or the lower part; this can be slit-shaped, oval, circular, or in another shape. In some embodiments, the receiving portion is configured to limit the permitted movement of the received portion in the distal-proximal direction and / or in the ventral-dorsal direction within the receiving portion. In some embodiments of the orthopedic device, the lateral joint device and / or the medial joint device comprise / comprise an upper part and a lower part, wherein the upper part is connected to the proximal part and the lower part is connected to the distal part, or vice versa. In some embodiments, the upper part comprises a through-opening as the receiving portion, and the lower part comprises a projection or pin as the received portion.The reverse configuration, in which the OT Medizintechnik GmbH lower part has the through-opening, is also encompassed by the present invention. In some embodiments, the pin has an external thread, wherein the orthopedic device has an element that has an internal thread for screwing with the external thread. To ensure that inclination, pivoting, or tipping of the orthopedic device according to the invention or the joint device according to the invention remains permitted even in the ready-to-use assembled state, or during use, so that the inclination, pivoting, or tipping, etc., occurs according to the movement performed by the patient, such as flexion or extension, a corresponding device, e.g. a spacer or a distance maintainer, can be provided, or alternatively a precaution or a mechanism with the structure and / or function of the device described below.This corresponding device can ensure the necessary play between the components involved in the design of the joint device, such as the upper and lower parts mentioned below, in such a way that their relative movement to one another, both rotating and moving in the further direction, which leads to tilting, pivoting or tipping, remains possible. Such a device can include or consist of a shell, a spacer, a projection of the screw, a sleeve which limits the screwing of a first component into a second component with regard to the screwing path, e.g. a sleeve pushed over the shaft of a screw, a screw with a partial thread, dimensioned such that the possibility of screwing it in is limited, a shoulder, a cotter pin, a spring or mechanical spring which ensure the required distance OT Medizintechnik GmbH and / or the play and the like.In some embodiments, the upper part of the lateral or medial joint device optionally has a concave curvature on its side facing the lower part or is optionally otherwise non-planar in the region of the joint device. In these embodiments, the lower part advantageously has a convex curvature on its side facing the upper part or is optionally otherwise non-planar in the region of the joint device. The through-opening or the edge of the upper part forming it is, in certain embodiments, curved in a longitudinal section (or when viewed from the side) and / or in a cross-section (or when viewed from the front), preferably concavely curved on its upper side. In some embodiments, the orthopedic device according to the invention has an insert with a through-opening.The insert is designed to be received, preferably detachably, on or in the upper part of the lateral or medial joint device as a receiving section, in particular in the through-opening of the upper part. Alternatively, the insert is provided, preferably detachably, on or in the upper side of the lower part. When inserted in this way, it serves to receive the received section, at least in sections, in its through-opening. OT Medizintechnik GmbH In some embodiments, the through-opening of the upper part of the lateral or medial joint device has a first depth. The insert has a first thickness in a first section and a second thickness in a further section, wherein the first thickness is less than the first depth. In some embodiments, the second thickness corresponds to the first depth.In some embodiments, the orthopedic device according to the invention does not have an actuator that would be attached to the upper part and the lower part at fastening points and could influence pivoting of the upper part relative to the lower part. In some embodiments, the orthopedic device further comprises an angle limiter. In some embodiments, the angle limiter, upper part and / or lower part can, by way of example, have connecting devices that are suitable and intended to connect these three components to one another, in particular detachably, e.g., positively and / or non-positively, as through-openings that can serve, for example, to receive a screw, a snap connection, an internal thread, e.g., on the underside of the angle limiter, which is optionally provided for screwing to an external thread on the upper side of the lower part.In some embodiments, the angle limiter is arranged to limit the positioning of the fastening section of the upper part relative to the fastening section of the lower part. The positioning is usually the result of a rotation or a combined movement with a rotation, and the task of the angle limiter can be to limit the rotation to a specific angular range. In some embodiments, the angle limiter has one, two, or more pins, projections, or pins. They can limit flexion and extension of the joint provided with the orthopedic device, for example, by striking a stop when rotation occurs between the upper and lower parts. They can be designed to be adjustable. The angle of the permitted movement(s) can thus be adjustable.In some embodiments, the lower part and / or upper part each have a curvature on the surfaces facing each other, or where they are in contact with each other or rest on each other during use, or on sections of such surfaces. The curvature can be a concave curvature for one of the two components, e.g., for the upper part, and a convex curvature for the lower part, or vice versa. The curvature can be such that, in some embodiments, the upper part or lower part having this curvature has a longitudinal curvature in the curved surfaces. In some embodiments, the curved surface has a spherical or spherical segment-shaped section, alternatively a curvature, convexity, or concavity in at least two mutually perpendicular directions. The curvature can result in a spherical dome shape.OT Medizintechnik GmbH In some embodiments, it is provided that the angle limiter has or is a combination of components or sections which has a projection or an edge against which another section of the angle limiter, e.g. one or more of the optional pins, abuts. In some embodiments, the lower part has a projection as the section to be received or received, e.g. a circular projection, a pin or the like. In some embodiments, the pin can have an internal thread. Alternatively, it has other connecting devices which serve to connect to the angle limiter, for example projections of a snap and / or locking connection. In some embodiments, the angle limiter is integrated into the upper part of the joint device.In some embodiments, the lower part has an optional toothed ring on its upper side or the upper part has an optional toothed ring on its lower side, which can be part of an optional tooth engagement mechanism. The toothed ring or the tooth engagement mechanism can be arranged around the circumference of the aforementioned projection or pin, or around parts of the circumference thereof, e.g. only by 300° or less. Accordingly, an optional toothed rail (generally also called a tooth section) can be provided on the upper side of the lower part or on the lower side of the upper part, which can also be part of the tooth engagement mechanism. OT Medizintechnik GmbH When the lateral joint device and / or medial joint device is in use, the teeth of the toothed ring in such embodiments engage with the teeth of the toothed rail.This can thus bring about a translational (forced) guidance of the lower part relative to the upper part upon rotation of the lower part relative to the upper part, or vice versa, i.e. a rotation which follows a translation. In some embodiments, the lower part optionally has a projection or pin as the section to be received or received, such as the aforementioned, for example circular projection or pin. In some embodiments, the pin or projection can have an internal thread. In some embodiments, the lateral joint device or the medial joint device have an insert. The insert can be made of the same material or a different material than the section of the lateral joint device or the medial joint device that receives it, or can have such a different material.In some embodiments, the insert is connected, preferably detachably, to a section of the upper part or the lower part that receives it. In some embodiments, the section of the upper part or the lower part that receives it optionally has a receptacle, recess, opening or the like. This can be suitable and / or provided to receive the insert in a form-fitting and force-fitting manner and / or in a rotationally fixed manner. OT Medizintechnik GmbH In some embodiments, the insert itself has a recess that has or forms a stop, e.g. in the form of an edge, e.g. as a boundary of the recess of the insert, which is received, for example, in a continuous receptacle. In other embodiments, the recess is a depression, a cutout, or the like. In some embodiments, the insert is designed as an inlay. It can be provided in various geometries.The set according to the invention can have or include inserts in or with different geometries. The insert, which does not necessarily have to be designed in order to be inserted, but can also be placed on top, etc., is optionally designed with a, for example, central, through-opening. Such a through-opening makes it possible, for example, to design edges on opposite sides of the insert as stops for, for example, pins. The plurality of edges or the like designed at the through-opening or otherwise opposite one another makes it possible to limit the width of the movement path, for example of the pins, on both sides or individually during rotation. The insert can have a continuous frame structure, but does not have to. In some embodiments, it is the through-opening that serves as a guide for the received section.In some embodiments, the optional toothed rail is preferably provided in a recess or depression on the underside of the upper part. The depression can have a smaller depth or material thickness than those sections of the upper part adjacent to or bordering the recess. In other embodiments, the optional toothed rail is provided in a recess or depression on the top side of the lower part. In some embodiments, the optional toothed rail is part of the tooth engagement mechanism. In some embodiments, the recess or depression can have a circular shape, an elliptical shape, a polygonal shape, a rectangular shape, a combination of shapes, namely partly rectangular, partly partially circular or semi-circular, for example as a combination of a rectangle and each end face being curved thereto.This is not to be understood as limiting; any suitable shape of recess or depression is encompassed by the present invention. In some embodiments, the optional dental splint may form part of the boundary of the recess. In some embodiments, the insert may be provided with a further dental splint on its outer edge, by means of which it can engage with the teeth of the dental splint of the recess when inserted into the upper part when in use in the recess of the lateral hinge device and / or medial hinge device. The dental splints in these embodiments can ensure a positive fit of the insert in the upper part.Alternatively, instead of the additional toothed splint, the outer edge of the insert can have a recess, a recess, or another geometric configuration that allows the insert to be inserted into the recess without the existing toothed splint of the upper part getting in the way. In some embodiments, the insert has an additional toothed splint on the inside of its through-opening, which engages with the teeth of a gear when the lateral joint device and / or medial joint device is in use. In some embodiments, the insert serves to adapt the geometry (or one or more aspects thereof) of the upper part, insofar as this plays a role in the joint connection between the upper and lower parts.These aspects can include the length of the effectively available through-opening, its width, the length of the recess, its width and / or the shape and / or length of the further toothed rail measured against that of the toothed rail of the upper part, etc. In some embodiments, it can be possible to provide inserts with different geometries, which can each be inserted into the upper part in order to accommodate and engage with gears with different diameters. Such different inserts can be part of the set according to the invention. In some embodiments, the gear has a through-opening. OT Medizintechnik GmbH In some embodiments, the gear has teeth facing this through-opening that point radially inwards. Alternatively or additionally, it has teeth on its outer circumference that point radially outwards.In some embodiments, the gear can engage with the teeth of the gear ring of the lower part by means of the radially inward-facing teeth and / or with the radially outward-facing teeth engage with the gear rail of the insert or, if the insert were omitted, with the gear rail of the upper part. In certain embodiments, engagement or rotationally stable mounting or reception of the gear on the lower part is also possible through other designs which do not require a gear ring on the lower part. A rectangular geometry, a triangular geometry, an oval geometry, etc. can be used as an alternative to a gear connection. In some embodiments, the set according to the invention can, alternatively or in addition to the insert or to the multiple inserts, have a plurality of gears, preferably with different diameters.In some embodiments, the gear ring or gearwheel has at least two teeth which are at different distances from a directly adjacent tooth. In this way, when the gear ring or gearwheel rolls through a predetermined angular range (e.g. due to a rotation of 5°), a translation of varying magnitudes can occur along the correspondingly designed dental splint. This includes the dental splint being one piece or being formed by several OT Medizintechnik GmbH partial dental splints. It is also included that the gear ring or gearwheel is not provided with teeth around its entire circumference and / or that not all of its teeth have the same distance from a center of rotation or turning of the gear ring or gearwheel, but different distances.In some embodiments, the upper part and the lower part are connected to one another in such a way, for example by fixing the angle limiter by means of a screw in such a way that the upper part and lower part are held together, that the tooth engagement mechanism brings about a translational (positive) guidance of the lower part relative to the upper part upon rotation of the lower part relative to the upper part, or vice versa, i.e. a rotation which follows a translation. A suitable receiving section for the screw can be provided for this purpose. In some embodiments, the lower part has, for example, a circular projection or pin as an optional receiving section for the screw. In some embodiments, the receiving section has an internal thread. Alternatively, it has other connecting devices which serve to connect to the angle limiter, for example projections of a snap and / or locking connection.In some embodiments, the screw is cannulated, in particular to guide a K-wire through it and / or to mark the center of rotation of the joint. OT Medizintechnik GmbH In some embodiments, the receiving section has an optional first marking, for example a projection, to which an optional second marking, for example on the gear, can be aligned. This can prove advantageous during assembly. Any other type of marking as an orientation aid is also encompassed by the present invention. Everything stated herein regarding the design of the upper part can, in certain embodiments, also apply to a design of the lower part, and vice versa. In some embodiments, X-ray markers are positioned or integrated on and / or in the medical device.In some embodiments, it is provided to carry out active movement support of the joint by means of the medical device, for example by coupling it to a motor. This coupling can be carried out, for example, by means of a gear wheel, cable pull or the like. Such a coupling can advantageously be used for patients with neurological disorders, or for physiotherapeutic purposes, for example after injuries or operations. In some embodiments, the upper part and / or the lower part and / or the joint device are made of steel, stainless steel, fiber-reinforced plastic, high-performance plastic or combinations thereof or comprise such a material or such a combination of materials. OT Medizintechnik GmbH Targeted valgus or varus is thus advantageously possible using the medical device according to the invention.In some embodiments, the medical device is integrated into a fabric, for example a knit, for sole guidance / stabilization purposes. Such integration can be advantageous in sports or for preventative purposes. In some embodiments, the upper and lower parts are held together only by a joint connection, e.g., by means of the receiving section and the received section or a screw, pin connection, material spring, or the like holding the upper and lower parts together. More than one such screw, pin connection, material spring, and / or the like is not provided in these embodiments. In some embodiments, the upper and lower parts are rotatably connected to one another only by means of the one receiving section and the one received section, or the medical device has only one receiving section and one received section, not several.In some embodiments, the upper part and lower part lie at least partially above one another or on top of one another. They can both have a corresponding curvature, e.g. the upper part is concave and the lower part is convex. In some embodiments, the upper part and lower part touch each other in the curved regions during rotation. OT Medizintechnik GmbH In some embodiments, the upper part and lower part lie at least partially above one another or on top of one another. In certain embodiments, no further, third or yet further component is arranged between the upper part and lower part, in particular none that has a curvature as described herein or a dome shape. In some embodiments, the medical device has only one upper part as disclosed herein and / or only one lower part as disclosed herein.In certain embodiments, the medical device has only an upper part, which is connected to the lower part as disclosed herein to achieve the joint function. In some embodiments, neither the upper part nor the lower part has a plurality of teeth on the front side, end side and / or on its outer circumference, with which it would engage with another element of the medical device to achieve the joint function. In some embodiments, the upper part and / or the lower part have only one through-opening through which a joining element, such as a screw, is passed, which would achieve the joint function. In certain embodiments, the upper part has one or only one through-opening through which a joining element, such as a screw, is passed, which is required to achieve the joint function.In some embodiments, the lower part does not have such a through-opening and / or OT Medizintechnik GmbH does not have a through-opening through which a joining element, such as a screw, is or will be passed. In some embodiments, the lower part has a thread for screwing in a screw extending through the through-opening of the upper part. Such a screw can be screwed in. In certain embodiments, the medical device does not have an element that is separate from the upper part and the lower part or is separate from them, which is required to achieve the joint function and is intended for screwing with a screw, in particular no clamping shoe, no nut or the like.In certain embodiments, the medical device does not have a bearing arrangement that is separate from the upper part and the lower part, or that is separable or manufactured separately, in particular none that is required to achieve the joint function, in particular no clamping shoe, no nut. In certain embodiments, the joint device or the medical device does not have a bearing arrangement that is positively and / or non-positively inserted into the upper part or into the lower part or that can be connected thereto in order to form the rotary joint between the upper part and the lower part. In some embodiments, the joint device or the medical device does not have a bearing arrangement that has a curvature as disclosed herein, e.g., convex, concave, or dome-shaped, for example on exactly one side (e.g., top side or bottom side) or exactly two sides thereof.OT Medizintechnik GmbH In some embodiments, the upper part is only connected to the proximal part, but not to the distal part, or only part of the proximal part, but not the distal part, and / or the lower part is only connected to the distal part, but not to the proximal part, or only part of the distal part, but not the proximal part. In other embodiments, this is exactly the opposite. In some embodiments, the upper part has at least one fastening device for its fastening to the proximal part or to the distal part. The fastening device can be part of a snap connection, openings for the passage of pins or screws or the like. The same can be the case for the lower part for its fastening to the distal part or to the proximal part. In some embodiments, the upper part and / or the lower part are manufactured in one piece, e.g. stamped from sheet metal.In some embodiments, the upper part and lower part each form a joint surface of the joint device. In some embodiments of the joint device according to the invention, the permitted movement is or includes pivoting about a plurality of joint axes or about a joint axis or rotation axis that changes, in particular moves, wanders, tilts or pivots, relative to the proximal part and / or the distal part during pivoting. OT Medizintechnik GmbH In some embodiments of the joint device, this permission is brought about and supported by the receiving section serving as a longitudinal guide for the received section. In some embodiments, the receiving section and / or another section of the joint device are configured to limit the permitted movement of the received section in the distal-proximal direction and / or in the ventral-dorsal direction within the receiving section.In some embodiments, the lateral joint device comprises an upper part and a lower part, wherein the upper part is connected to the proximal part of the medical device and the lower part is connected to the distal part of the medical device, in particular detachably and / or relatively movable, displaceable, tiltable or pivotable and / or rotatable, or vice versa. In some embodiments of the joint device, the upper part or the lower part comprises a through-opening as the receiving section and the lower part comprises a projection or pin as the received section. In some embodiments, the projection or pin has an external thread, and the medical device comprises an element having an internal thread for screwing into this external thread.In some embodiments, the upper part of the joint device has a concave curvature on its side facing the lower part and the lower part has a convex curvature on its side facing the upper part. OT Medizintechnik GmbH In some embodiments, the joint device according to the invention has an insert with a through-opening. The insert is designed to be detachably received in the upper part or in the lower part (as a receiving section for receiving the received section). In some embodiments of the joint device, the upper part or the lower part has a recess or a through-opening for receiving the insert. In some embodiments of the joint device, the upper part and / or the lower part has a recess or a depression on both its upper side and its lower side.In some embodiments of the joint device, the upper part and / or the lower part have at least or exactly two, three or four different thicknesses. In some embodiments, the recess or through-opening for receiving the insert has a plurality of teeth, e.g. in the form of a dental rail. In some embodiments, the insert of the joint device has a plurality of teeth, e.g. in the form of a dental rail, on its outer circumference and / or on its inner circumference, which delimits the optional through-opening. In some embodiments, the joint device has a toothed rim for engaging with one or more of the plurality of teeth or dental rails. OT Medizintechnik GmbH In some embodiments, the joint device has a gear for engaging with one or more of the plurality of teeth or dental rails and / or with the toothed rim.It has already been mentioned above that the gear, like the ring gear disclosed herein, does not have to carry teeth over its entire circumference, but in some embodiments only in selected angular ranges of the circumference. A gear as disclosed herein can have a through-opening. The through-opening can have a geometry suitable for a positive fit, e.g., carry teeth, be triangular or polygonal, oval, etc. Such a geometry can be provided even without the need for a through-opening, e.g., in connection with a recess in the gear, a projection on the gear that engages a recess or opening in the lower or upper part, etc. A gear as disclosed herein can carry teeth both on its outer diameter (radially outward-facing) and in the region of a through-opening (radially inward-facing).In some embodiments, the joint device according to the invention has a detachably and / or adjustably provided angle limiter which limits a rotational movement between the upper part and the lower part, preferably in one or more than one direction of rotation. In some embodiments, the angle limiter of the joint device has at least one insertion opening for receiving a pin received or receivable therein, wherein the insertion opening is preferably a through-opening. In some embodiments of the joint device, the through-opening of the upper part or the lower part has a first depth. The insert has a first thickness in a first section and a second thickness in a further section, wherein the first thickness is less than the first depth. In some embodiments, the second thickness corresponds to the first depth.In some embodiments, the medical device is a knee orthosis or is designed to be worn on the knee. In some embodiments, the medical device is an elbow orthosis or is designed to be worn on the elbow. In some embodiments, the medical device is not a hip orthosis or is not designed to be worn on the hip. In some embodiments, the joint device has a connecting means, which can be, for example, mushroom-shaped, bowl-shaped, cup-shaped, half-shell-shaped and / or convex on its underside, e.g., in a side view. The connecting element can rest with its underside on the edge of the through-opening of the upper part, wherein the through-opening can be circular, oval, rectangular, polygonal, square, etc. A screw connection, a plug-in connection, a snap connection, etc.can connect the connecting means to the lower part (alternatively: to the upper part). A head of the connecting means, which has a diameter which is larger than the diameter of the through-opening of the upper part, can lie on one side of the upper part. The connecting means can have a stem which is connected to the lower part and extends through the through-opening. The stem can be longer than the through-opening is deep or the upper part is thick. The width or diameter of the stem can be thinner than the diameter of the through-opening. The upper part and / or lower part can be shaped flat. In some embodiments, the joint device has no more than three, four, five or six components or consists of no more than these. Some or all embodiments of the invention can have one, several or all of the advantages mentioned above and / or below.OT Medizintechnik GmbH One advantage of the present invention can be that the joint unit or joint units of the orthopedic device, in contrast to a simple hinge joint, does not reduce or limit the flexion / extension movement during flexion / extension to just a rotation about exactly one axis of rotation that is fixed or spatially unchanged in relation to space or a coordinate system as a single axis of movement for the flexion / extension movement. Rather, during the flexion / extension movement, the at least one axis of rotation can oscillate, wobble or pivot around a point or area and / or the at least one axis of rotation can move, whereby the axis of rotation, or a section thereof, can move in space or in the coordinate system during flexion / extension, in particular in the first, in particular distal-proximal, direction mentioned here and / or in the second, in particular ventral-dorsal, direction.A further advantage of the present invention may be that the orthopedic device allows the flexion of a joint to which it is applied to be performed with a pivoting axis of rotation, as this allows for flexion / extension that approximates the physiological or anatomical movement. This was not previously possible with conventional orthopedic devices. A further advantage of the present invention may be the ability to immobilize joints in defined positions. This can contribute to faster healing, especially immediately after surgery.OT Medizintechnik GmbH A further advantage of the present invention may be that a patient requires only one orthopedic device for the entire period of joint care, i.e., from immediately after surgery until the joint regains its full load-bearing capacity, since this device can be fixed in various positions and / or its range of motion can be adjusted to the respective load situation. This can help save time for adjustments and, above all, costs. The present invention can also advantageously represent a possible device for support during sports. This can help prevent injuries.By means of the present invention, tissue or skin damage, for example due to pressure points or chafing from the orthopedic device, circulatory disorders, unfavorable loading of bones and joints, irritations and / or associated infections, which often occur with conventional orthopedic devices, can be advantageously reduced and / or even prevented. The present invention is described below purely by way of example with reference to the attached figures. In them, identical reference numerals designate identical or similar components. In the figures, reference can be made to the descriptions and reference numerals of the other figures to avoid repetition. The following applies: Fig. 1 shows the orthopedic device according to the invention in a first embodiment in perspective; OT Medizintechnik GmbH Fig.2A shows the upper part of a lateral joint device or medial joint device of an orthopedic device; Fig. 2B shows the lower part of a lateral joint device or medial joint device of an orthopedic device; Fig. 2C shows a further, optional element of the orthopedic device; Fig. 3A shows an insert for insertion into the upper part of the lateral joint device or the medial joint device; Fig. 3B shows the upper part of a lateral joint device or a medial joint device with an inserted insert; Figs. 4A and 4B show a lateral joint device or a medial joint device of the orthopedic device according to the invention in an exemplary embodiment, each in a side view; Fig. 5A shows the lateral joint device or the medial joint device of Fig. 4A in a top view; OT Medizintechnik GmbH Fig.5B shows the lateral hinge device or the medial hinge device of Fig. 5A in a further angular position; Fig. 6A shows the lateral hinge device or the medial hinge device in a further embodiment in a top view; Fig. 6B shows the lateral hinge device or the medial hinge device of Fig. 6A in a side view; Fig. 6C shows the lateral hinge device or the medial hinge device of Fig. 6A in a different angular position than in Fig. 6A in a top view; Fig. 6D shows the lateral hinge device or the medial hinge device of Fig. 6C in a side view; Fig. 6E shows the lateral hinge device or the medial hinge device of Fig. 6A in an exploded view; Fig. 6F shows the upper part of the lateral hinge device or the medial hinge device of Fig. 6E looking at the underside; Fig.7A shows the lateral joint device or the medial joint device in a further OT Medizintechnik GmbH embodiment in a perspective obliquely from above; Fig. 7B illustrates pivoting of the axis of rotation of the lateral joint device or the medial joint device; Fig. 7C shows the lower part of the lateral joint device or the medial joint device of Fig. 7A in a perspective obliquely from above; Fig. 8 shows the lateral joint device or the medial joint device in a further embodiment with an insert in plan view; Fig. 9A shows the upper part of a lateral joint device or the medial joint device with a view of its underside in a further embodiment; Fig. 9B shows the lower part of a lateral joint device or the medial joint device in the further embodiment of Fig. 9A with a view of the upper side; Fig.10A shows a tooth engagement mechanism between the upper and lower parts of a lateral joint device or a medial joint device, in an embodiment without a toothed wheel; OT Medizintechnik GmbH Fig. 10B shows the tooth engagement mechanism between the upper and lower parts of a lateral joint device or a medial joint device in a further embodiment with a small diameter toothed wheel; Fig. 10C shows the tooth engagement mechanism of the upper part of a lateral joint device or a medial joint device in a further embodiment with a large diameter toothed wheel without an insert; Fig. 11A shows the placement of an angle limiter on a joint device with a tooth engagement mechanism; Fig. 11B shows the orientation of the angle limiter during assembly of the joint device in detail; Fig.11C shows the assembly of the joint device with placement of the angle limiter and a connecting device; Fig. 12A shows a joint device according to the invention in a further embodiment; Fig. 12B shows the joint device of Fig. 12A in an exploded view; OT Medizintechnik GmbH Fig. 12C shows the joint device of Fig. 12A from the side; Fig. 12D shows the joint device of Fig. 12C in the wobble position; and Fig. 13 shows the joint device in a further embodiment. Fig. 1 shows the orthopedic device 1 according to the invention in a first embodiment, its left edge is “lateral” and its right edge is “medial”. “Ventral” points out of the plane of the drawing, “dorsal” into the plane of the drawing, “distal” points downwards in Fig. 1, and proximally upwards.The orthopedic device 1 has a proximal part 10 for attachment to an upper arm or thigh and a distal part 20 for attachment to the forearm or lower leg. The proximal part 10 and the distal part 20 are pivotally connected to one another via a lateral joint device 30 and a medial joint device 40. In some embodiments, only the lateral or only the medial joint device 30, 40 is provided. The medial joint device 40, which is discussed in less detail here, can be configured like the lateral joint device 30, which is discussed primarily here, optionally in every embodiment of the lateral joint device disclosed herein. In the example of Fig. 1, the orthopedic device 1 has, by way of example, one fastening device 11 on its proximal part 10 and two fastening devices 21 on its distal part 20 (OT Medizintechnik GmbH).The orthopedic device 1 can be secured to the limb by means of the fastening devices 11, 21. The lateral joint device 30 and / or the medial joint device 40 of the orthopedic device 1 according to the invention comprise an upper part 50 and a lower part 60, wherein the upper part 50 is connected to the proximal part 10 and the lower part 60 is connected to the distal part 20 of the orthopedic device 1, or vice versa. The upper part 50 and lower part 60 are shown in Fig. 2A to Fig. 2C and are described in more detail therein. The longitudinal extent of the proximal and distal parts extends in Fig. 1 in a top-bottom direction of the figure. The transverse extent extends in Fig. 1 in a direction out of the plane of the drawing or into it. Fig. 2A shows an upper part 50 of a lateral joint device 30, as it could also be part of the medial joint device 40, and vice versa.The upper part 50 optionally has a concave curvature on its side facing the lower part 60. The lateral joint device 30 and / or the medial joint device 40 are designed to permit movement of a section 33 (see Fig. 2B) received therein during use of the orthopedic device 1 in the distal-proximal direction and / or ventral-dorsal direction. A permitted movement is or includes the OT Medizintechnik GmbH displacement of the received section 33 within a receiving section 31 and thus a displacement, e.g., radial, and / or tilting of the joint axis or rotation axis D during pivoting. By means of the thus designed lateral joint device 30 (and / or the medial joint device 40), the joint axis or rotation axis D can thus result, which changes during pivoting with respect to the proximal part 10 and / or the distal part 20. The upper part 50 has in the example of Fig.2A, the aforementioned receiving section 31 has a through-opening 51. The receiving section 31 is configured, by virtue of the through-opening 51 being elongated in this example, to permit, but also to limit, the permitted movement of the received section 33 (see Fig. 2B) in the distal-proximal direction and / or in the ventral-dorsal direction. In other words: the movement is permitted by the receiving section 31, here formed by way of example by the through-opening 51, serving as a guide or longitudinal guide for the received section 33. In the embodiment shown, the receiving section 31 would limit the movement of the section 33 received therein less in the distal-proximal direction than in the ventral-dorsal direction. This will be explained further with reference to Figs. 3A, 3B, 4A, and 4B. Fig. 2B shows the lower part 60 of a lateral joint device 30 or medial joint device 40.The lower part 60 has a convex curvature on its side facing the upper part 50, which can nestle into the concave curvature of the upper part 50. This configuration of the lateral joint device 30 and / or the medial joint device 40 can advantageously ensure a good fit of the orthopedic device 1 on the joint during use. The lower part 60 has a projection or pin 61 as the section 33 to be received or received. In the example of Fig. 2B, the pin 61 has an external thread G. The inclination, pivoting, or tilting of the rotatably received section 33 relative to the receiving section 31, or the rotational axis D of the joint device 30, 40, or vice versa, which is preferably permitted during use of the medical device 1, can optionally be achieved solely by or due to flexion or extension, i.e., by a movement performed by the patient.The medical device 1 allows this through appropriate design, e.g. as disclosed herein. Fig. 2C shows a further element 70 of the orthopedic device 1, which can be optionally provided. For example, the element 70 can have an internal thread on its underside (not visible in Fig. 2C), which can be intended and / or suitable for screwing to the external thread G (see Fig. 2B) of the lower part 60. OT Medizintechnik GmbH In the example of Fig. 2C, the element 70 is exemplarily designed with an initially round shape with recessed grips 71. The recessed grips 71 can increase the grip of the element 70 and thus significantly facilitate the described screwing of the element 70 to the external thread G of the lower part 60. The element 70 can have a sleeve with an internal thread on its underside, which is screwed onto the external thread G of the pin 61 from Fig. 2B.The sleeve and pin 61 can together form a device for ensuring or maintaining a clearance between the upper part 50 and the lower part 60, in that the sleeve is dimensioned sufficiently long such that, when it abuts the surface of the lower part 60, further approach of the upper part 50 and the lower part 60 is no longer possible. If the pin 61 is sufficiently long, the desired clearance is ensured. Further approach of the element 70 and the lower part 60 is limited. As Figs. 2A to 2C show by way of example, the joint device can consist of no more than three elements, namely the upper part and the lower part and a screw or, as here, an element 70 with an external or, as here, internal thread.This can be made possible by the lower part or the upper part already being included in the screw connection, bracing, or arrangement of the upper part and lower part, for example because one of these two parts already has a thread, as is possible in every embodiment. Otherwise, a nut or the like is additionally provided according to the invention. OT Medizintechnik GmbH joint devices which, as optionally disclosed here, consist of no more than three, four, five, or six separately present or manufactured components, in particular for producing the joint function of the joint device, can be manufactured in a clearly cost-effective, simple, and time-saving manner. Furthermore, warehousing can be simplified. Fig.3A shows an insert 80 with a receptacle, here a through-opening 83 as a receiving section 31, for insertion into a recess or through-opening 51 of the upper part 50 of a lateral joint device 30 and / or medial joint device 40. The insert 80 is designed to be releasably received, in particular without tools, in the through-opening 51 of the upper part 50 (see Fig. 3B) and to form or encompass the receiving section 31 of the upper part 50 (see also Fig. 2A), and thus serves to receive the received section 33. The insert 80 has a first thickness D1 in a first section and a second thickness D2 in a further section. Unlike in the example of Fig. 2A, it is therefore not the through-opening 51 which directly serves as a guide for the received section 33, but the through-opening 83 of the insert 80, which in turn is received in the through-opening 51.The insert 80 can be detachably received and thus replaceable. It may thus be advantageous to have a generally suitable upper part 50 injection-molded by OT Medizintechnik GmbH and then to make an adjustment using a selected insert 80. Likewise, e.g., over the course of an extended period of wear of the orthopedic device 1, the latter can be repeatedly adjusted by replacing only the insert 80. Fig. 3B shows the upper part 50 of a lateral joint device 30 or medial joint device 40 with an inserted insert 81. The through-opening 51 of the upper part 50 has a first depth T1. In the example of Fig. 3B, the first thickness D1 of the insert 81 (see analogously the insert 80 of Fig. 3A) is less than the first depth T1 of the upper part 50, and the second thickness D2 of the insert 81 corresponds to the first depth T1 of the through-opening 51 of the upper part.A set according to the invention can comprise an orthopedic device 1 according to the invention, as well as at least two inserts 80, 81 which differ from one another. By means of the inserts, the limits of the freedom of movement of the sections 33 accommodated in them can be set differently, both in the distal-proximal direction and in the ventral-dorsal direction. In this case, an enlargement of the lateral support surfaces results in greater stability (the guide surface does not disappear). OT Medizintechnik GmbH Figs. 4A and 4B show a lateral joint device 40 or a medial joint device 50 of the orthopedic device 1 according to the invention in an exemplary embodiment in a side view. The upper part 50, the lower part 60, and the element 70 can be clearly seen in Figs. 4A and 4B. The lower part 60 lies nestled in the concave section of the upper part 50 and can be fixed, preferably releasably, by means of the element 70.By means of the elongated configuration of the receiving section 31 of the upper part 50 (see, for example, Fig. 2A), the lower part 60 can be displaced downwards (in the distal-proximal direction) when the upper part 50 is pivoted relative to the lower part 60, which corresponds to a pivoting of the joint axis or axis of rotation D up to an angle α, i.e., between their positions D(A) and D(A'). It can be seen that the upper part 50 and the lower part 60 are each optionally curved once to the left and once to the right in the plane of the drawing, i.e., in their longitudinal extent, when viewed from the side, they are each curved in two opposite directions. Fig. 5A shows the lateral joint device 30 or the medial joint device 40 of Fig. 4A in plan view. In Fig.5A, fastening devices 55 of the upper part 50 and fastening devices 65 of the lower part 60 can be seen, here designed as through-openings, for example, which can serve to connect the upper part 50 to the proximal part 10 and the lower part 60 to the distal part 20 of the OT Medizintechnik GmbH orthopedic device 1 (see Fig. 1). The longitudinal extent of the upper part 50 extends in Fig. 5A, like the longitudinal extent of the lower part 60, in an up-down direction of the figure, as is also the case in Fig. 1. The transverse extent of the upper part 50 extends in Fig. 5A, like the transverse extent of the lower part 60, in a left-right direction of the figure. Fig. 5B shows the lateral joint device 30 or the medial joint device 40 of Fig. 5A in a further angular position, ie the lower part 60 has been rotated relative to the upper part 50 by an angle β.The angle β here corresponds to a maximum possible flexion of the orthopedic device 1 by means of the lateral joint device 30 or the medial joint device 40. The embodiment of Figs. 5A and 5B allows unlimited extension or flexion. This is different in the embodiment of Fig. 6A and subsequent figures. Fig. 6A shows the lateral joint device 30 or the medial joint device 40 in a further embodiment in plan view. In Fig. 6A, fastening devices 55 of the upper part 50 and fastening devices 65 of the lower part 60 can be seen, here designed as through openings, which can serve to connect the upper part 50 to the proximal part 10 and the lower part 60 to the distal OT Medizintechnik GmbH part 20 of the orthopedic device 1 (see Fig. 1). Reference is made to the explanations for the preceding figures to avoid repetition.The embodiment of Fig. 6A further comprises an optional angle limiter 95; it can optionally assume the function of element 70. Its design in Fig. 6A is purely optional. Angle limiter 95, upper part 50, and lower part 60 can thus comprise, by way of example, connecting devices which are suitable and intended to connect these three components to one another, in particular detachably, e.g., positively and / or non-positively. In the example of Fig. 6A, these are aligned through-openings which can serve, for example, to accommodate a screw. Alternatively, a snap connection between the angle limiter 95 and the lower part 60 can be encompassed by the present invention, which, for example, extends through the through-opening 51 of the upper part 50 to connect the three elements.Further alternatively, the angle limiter 95 can have an internal thread on its underside, which can be provided and / or suitable for screwing with an external thread on the top side of the lower part 60 (analogous to Fig. 2B). In the example of Fig. 6A, the angle limiter 95 is pushed onto the proximal (left in Fig. 6A) end of the OT Medizintechnik GmbH through-opening 51 of the upper part 50. This arrangement of the angle limiter 95 results in a positioning of the fastening section 55 of the upper part 50 relative to the fastening section 65 of the lower part 60, which is described in more detail in Fig. 6B. Optionally, flexion (bending) and extension (stretching) of the joint supplied with the orthopedic device 1 can be adjusted and thus limited on the angle limiter by means of at least one or, as here, two or more pins, projections, or pins 97.The pins 97 protrude beyond the underside of the angle limiter 95 and there strike a stop on one side, such as a projection or edge 99, e.g. of the upper part 50, in particular on the top side of the upper part 50. This striking action prevents further flexion or extension of the joint, depending on the setting. In the example in Fig. 6A, the angle limiter 95 fixes the joint in an extended position (0° flexion, 0° extension) by means of the positioning of the two pins 97. Using such a configuration, for example, a limitation of flexion between 0° and 120° and / or a limitation of extension between 0° and 90° can be achieved. Furthermore, using this configuration, for example, a post-operative fixation at a specific angle, e.g. in a 90° position, can be possible.To limit the extension and / or flexion to an angle or an angle range, the pins 97 in the embodiment shown here are provided on the angle limiter 95 or so that they can be moved, swapped, or otherwise moved relative to it. A pin-opening pairing as shown in the figures is only one option for the design of the angle limiter 95. The angle limiter 95 can have markings that make it easier for the practitioner to set a desired angle range or limit angles. For this purpose, degree information relating to flexion or extension can be displayed, for example, printed. Fig. 6B shows the lateral joint device 30 or the medial joint device 40 of Fig. 6A in side view. It can be seen from Fig. 6B that due to the position of the angle limiter 95 at the proximal end (in Fig.6B left, wherein proximal and distal are disclosed herein as interchangeable), in the extended position of the lateral joint device 30 and / or the medial joint device 40, the sections with the respective fastening devices 55, 65 (see Fig. 6A), which here are optionally plate-shaped or flat, are at an angle to one another that deviates from 180° by the angle γ. The possibility of adjusting this angle can, for example, help to take into account the natural "carrying angle" of an elbow joint provided with the orthopedic device 1, i.e., the natural radial deviation of the forearm from the upper arm. What is stated here regarding the "carrying angle" of the elbow joint can, in alternative embodiments and for the provision of a knee joint, also apply to its Q-angle.The normal carrying angle of the elbow (with arms outstretched and palms facing forward) is between 5° and 15° and is greater in women than in men. The normal Q- OT Medizintechnik GmbH angle with the leg outstretched is 14° for men and 17° for women. Fig. 6C shows the lateral joint device 30 or the medial joint device 40 of Fig. 6A in a different angular position than in Fig. 6A in plan view. Reference is made here to the description for Fig. 5B to avoid repetition. The pins 97 are not shown for reasons of clarity. In the example of Fig. 6C, the angle limiter 95 is pushed to the distal (right in Fig. 6C) end of the through-opening 51 of the upper part 50. This arrangement of the angle limiter 95 relative to the upper part 50 is described in more detail in Fig. 6D. Fig. 6D shows the lateral hinge device 30 or the medial hinge device 40 of Fig. 6C in side view.The distal position (right in Fig. 6A, but alternatively left) of the angle limiter 95 causes the angular position between the fastening sections 55 of the upper part 50 and the fastening sections 65 of the lower part 60 to be 180° (see Fig. 6D). Comparing Figs. 6B and 6D, it can be seen that the longitudinal displacement of the lower part 60 relative to the upper part 50, or vice versa, due to the curvature of the upper part 50 and / or the lower part 60 (the curvature is evident from the side view, see, for example, Figs. 6B and 6D), can change the height of the free end, e.g., of the lower part 60, above a horizontal when the free end of the upper part 50 rests on the horizontal. OT Medizintechnik GmbH In some embodiments, the angle limiter 95 can, in particular continuously, assume any position between the right and left edge of the through opening 51 of the upper part 50.This means that when fitting an elbow joint with the orthopedic device 1, the carrying angle of the joint can be adjusted as required for each patient between 0° (or below or less than 0°, i.e., a negative angle) and γ. Fig. 6E shows the lateral joint device 30 or the medial joint device 40 of Fig. 6A in an exploded view. Reference is made to the descriptions of the preceding figures. Fig. 6E clearly shows the projection or edge 99 against which the pins 97 strike, thus stopping their rotation and limiting the flexion or extension of the treated joint. The lower part 60 has a circular projection or pin 61 as the section 33 to be received or received. In some embodiments, the pin 61 can have an internal thread.Alternatively, it has other connecting devices that serve to connect to the angle limiter 95, for example projections of a snap and / or locking connection. In the example of Fig. 6E, an optional toothed ring 91 that encompasses all or only part of 360° and can be part of an optional tooth engagement mechanism 90 is also arranged on the lower part 50 around the circumference of the OT Medizintechnik GmbH pin 61 or parts of the circumference thereof. This tooth engagement mechanism 90 is described in more detail in Fig. 6F. Fig. 6F shows the upper part 50 of the lateral joint device 30 or the medial joint device 40 of Fig. 6E viewed from the underside. On the underside of the upper part 50, an optional toothed rail 93 can be seen, which can also be part of the tooth engagement mechanism 90.When the lateral joint device 30 and / or medial joint device 40 is in use, the teeth of the toothed ring 91 of the lower part 50 (see Fig. 6E) engage with the teeth of the toothed rail 93 and thus bring about a translational (forced) guidance of the lower part 60 relative to the upper part 50 upon rotation of the lower part 60 relative to the upper part 50, or vice versa, i.e. a rotation which follows a translation. The optional toothed rail 93 is preferably provided in a recess or depression on the underside of the upper part 50. The depression can have a smaller depth or material thickness than those sections of the upper part 50 adjacent to the recess or delimiting it. The recess can, as shown by way of example in Fig. 6F, have a circular shape, an elliptical shape, a polygonal shape, a rectangular shape, a combination of shapes such as, for example, a hexagon or a triangle. B. as shown in Fig. 6F, namely partly rectangular, partly partially circular or semi-circular, as in Fig.6F as a combination of a rectangle and, in each case, an arcuate end face. OT Medizintechnik GmbH The optional dental splint 93 can be part of the boundary of the recess. As can be seen in the combined view of Figs. 6E and 6F, the upper part 50, or alternatively the lower part 60, optionally has a recess or depression on both its upper side and its lower side. The upper part 50 and / or the lower part 60 can, as can be seen from the combined view of Figs. 6E and 6F, have three or exactly three (alternatively, exactly or at least two, four or more) different thicknesses. The different thicknesses allow different components such as insert 80, pins 97, etc. to be functionally integrated. Fig. 7A shows the lateral joint device 30 or the medial joint device 40 in a further embodiment in a perspective obliquely from above.Since it is usually sufficient to adjust the flexion and extension options on one side (medially or laterally), the other side of the orthopedic device 1 can have a joint device, as can be seen in Fig. 7A. The adjustment options in the embodiment of Fig. 7A are more flexible, among other things because a tooth engagement mechanism such as the tooth engagement mechanism 90 in Fig. 6F is not provided in this embodiment, or because an angle limiter 95 is not provided. OT Medizintechnik GmbH The patient-specific carrying angle can adjust itself. For illustration, two positions D(A), D(A') of the axis of rotation D of the joint device 30, 40 are inserted into the through-opening of the element 70' in order to clarify the inclination of the element when moving along the through-opening 51 of the upper part 50.The through-opening 51 of the upper part 50 can also serve in these embodiments to accommodate connecting devices, in particular a screw. In some embodiments, the carrying angle and the rotation axes depend on the radius of the curvature of the upper part 50 and / or the lower part 60, e.g., where they come to rest on one another, because the pivot point is dependent on these radii and shifts when the curvature is greater or smaller. The carrying angle also depends on the length of the through-opening 51, or rather, on the distance along which the through-opening 51 allows the upper part 50 and the lower part 60 to be moved or displaced relative to one another. Fig. 7B shows a cone K and serves to illustrate the process of the possible pivoting of the rotation axis D of the lateral joint device 30 or the medial joint device 40, as mentioned here.Due to the design of the upper part 50 and the lower part 60 as disclosed herein, and in particular due to their interaction, pivoting of the rotational axis D of the joint device 30, 40 may be possible, but nevertheless limited in its extent. This can enable or support a natural movement of the joint to be treated. OT Medizintechnik GmbH The base area of ​​the cone K describes the possible orientations of the rotational axis D of the joint device 30, 40 in some embodiments, which this rotational axis D can assume when pivoting is enabled and not further restricted. Its tip is defined by the pivot point PP, which is defined by the design of the joint device and its components, e.g., by the radii of the curvatures of the upper part 50 and the lower part 60. In the present example, the intersection point of the positions D(A) and D(A'') is therefore also located (see Fig.7A) of the rotational axis D of the joint device 30, 40 also at this point. Assuming that the through-opening 51 shown in Fig. 7A is provided, the interaction of the upper part 50 and the lower part 60 means that pivoting in the example in Fig. 7B is limited to a pivot surface PF. The rotational axis D must pass through this in all its positions D(A), D(A'), D(A''); the limitation of the through-opening 51 does not allow pivoting of the rotational axis D out of this area. During flexion / extension, represented by block arrows F / E, the positions D(A), D(A'), D(A'') of the rotational axis D of the joint device, represented in Fig. 7B as a dashed-dotted line, can thus oscillate around the pivot point PP, but only within the pivot surface PF.If the through-opening of the upper part 50 is larger than the diameter of a connecting device that extends through this through-opening, this oscillation occurs around the pivot point PP within the cone. OT Medizintechnik GmbH In this case, rotation around the axis of rotation D is possible, as indicated by arrows. The axis of rotation D is therefore not spatially fixed, but can move at least with a section thereof from a position which it has assumed, for example, at the beginning of flexion. Fig. 7C shows the lower part 60 of the lateral joint device 30 or the medial joint device 40 of Fig. 7A in a perspective obliquely from above. Analogous to Fig. 6E, the lower part 60 optionally has a projection or pin as the section 33 to be received or received, such as the circular projection or pin or projection 61 of Fig. 6E. The pin or projection 61 can have an internal thread in some embodiments.Alternatively, it has other connecting devices which serve to connect to the element 70' (see Fig. 7A), for example projections of a snap and / or locking connection, or is operatively connected to such. Fig. 8 shows the lateral joint device 30 or the medial joint device 40 in a further embodiment with an insert 80 in plan view. The insert 80 is connected, preferably detachably, to the upper part 50 or the lower part 60. It serves to limit a relative movement between the upper part 50 and the lower part 60, e.g. the rotation between them. For this purpose, it can serve as a stop for a further element, which is described below in an exemplary embodiment thereof. OT Medizintechnik GmbH In the example in Fig. 8, it is the upper part 50 which has the insert 80.For this purpose, the upper part 50 optionally has a receptacle 87, depression, opening or the like, which is suitable and / or provided for receiving the insert 80 in a form-fitting and force-fitting manner. The insert 80 in turn has a recess 89 which has or forms a stop 85, e.g. in the form of an edge similar to the edge 99, e.g. as a boundary of the recess 89 of the insert 80, which here is only exemplarily received in a continuous receptacle 87; in other embodiments it is a depression, cutout, etc. The insert 80 can thus be designed, for example, as an inlay. It can be provided in different geometries and, in different geometries, can also be part of the set according to the invention. The receptacle 87 can thus receive different inserts 80, which can, for example, B. by the shape and / or location / position of their recess 89, their stops 85 and / or a through opening 83.It is obvious that, for example, differently designed stops 85 can allow different degrees of freedom with regard to flexion and / or extension while the design of the orthopedic device 1 remains otherwise unchanged. The selection of a stop 85 suitable for the specific patient is thus possible by selecting a suitable insert 80 from the set. OT Medizintechnik GmbH The insert 80, which does not necessarily have to be designed to be inserted but can, for example, also be placed on top, etc., is optionally designed to be detachably received, in particular without tools, in the receptacle 87 and to form or encompass the receiving section 31 of the upper part 50; it thus serves to receive the received section 33. The through-opening 83 serves to receive the received section 33, which has to take over the function of the pins 97 from the previous figures.This means that by means of the design of the insert 80 and in particular its stop 85, the flexion and / or extension of the joint provided with the orthopedic device 1 can be limited by limiting the movement of the received section 33 within the through-opening 83 of the insert 80. In the example in Fig. 8, it is thus the through-opening 83 that directly serves as a guide for the received section 33, or its boundary to an interior thereof, of the insert 80, which in turn is received in the receptacle 87. Since the insert 80 and the upper part 50 or the lower part 60 can be detachably connected to one another, it may advantageously be possible to have a generally suitable upper part 50 injection-molded or otherwise manufactured, and then to adapt the orthopedic device 1 using a specifically selected insert 80. Likewise, e.g.During the course of treatment or during the wearing of the orthopedic device 1, OT Medizintechnik GmbH, the latter can be repeatedly adjusted by simply replacing the insert 80. By means of the insert 80, the limits of the freedom of movement of the sections 33 accommodated in it can optionally be set differently, both in the distal-proximal direction and in the ventral-dorsal direction, as shown in Fig. 8. Thus, by means of the insert 80, for example, a limitation of flexion between 0° and 120° and / or a limitation of extension between 0° and 90° can be achieved. By means of the insert 80, a fixation can also be defined postoperatively for the treated joint, for example a 90° position. Fig. 9A shows, viewed from below, the upper part 50 of a lateral joint device 30 or the medial joint device 40 in a further embodiment.Reference is made to the descriptions of the preceding figures. On the underside of the upper part 50, comparable to the embodiment of Fig. 6F, an optional toothed rail 93 can be seen, which can be part of the tooth engagement mechanism 90. An insert 80 can be provided with a further toothed rail 93A on its outer edge and, when the insert 80 is in use in the recess of the lateral joint device 30 and / or medial joint device 40 OT Medizintechnik GmbH, can engage with the teeth of the toothed rail 93 of the recess when it is inserted into the upper part 50. This insertion and its direction are indicated by a black block arrow in Fig. 9A. The toothed rails 93, 93A can ensure a positive fit of the insert 80 in the upper part 50.Instead of the additional toothed rail 93A on the outer edge of the insert 80, the insert 80 can alternatively have a recess or a recess to the additional toothed rail 93A, which allows the insert 80 to be inserted into the recess without the already existing toothed rail 93 of the upper part 50 getting in the way. The insert 80 in the example of Fig. 9A has a further toothed rail 93B on the inside of its through-opening 83, which, when the lateral joint device 30 and / or medial joint device 40 is in use, engages with the teeth of a gear 92 (see Fig. 9B) that encompasses all or only part of 360°. It can be seen that the insert 80 serves to adapt the geometry (or one or more aspects thereof) of the upper part 50, insofar as this plays a role for the articulated connection between the upper part 50 and the lower part 60.These aspects may include the length of the effectively available through-opening 51, its width, the length of the recess, its width and / or the shape and / or length of the further toothed rail 93B measured against that of the toothed rail 93 of the upper part 50, etc. OT Medizintechnik GmbH In some embodiments, it may be possible to provide inserts 80 with different geometries, which can each be inserted into the upper part 50 in order to produce gear wheels 92 with different diameters D. Tto receive and engage with them (see Fig. 9B). Such different inserts can be part of the set according to the invention. As indicated in Fig. 9A, in some embodiments the toothed rail 93 or 93B can only extend over part of the length of the insert 80 or the through-opening 51. In this way, there can be regions in which a positive guidance is canceled, and other regions in which a positive guidance caused by the engagement with the toothed rail 93, 93B occurs again. If, for example, the toothed ring of the lower part 60 moves into one of the edge regions of the recess of the through-opening 51, i.e. right at the top or right at the bottom in Fig. 9A, a rotation about the axis of rotation D can take place without this having to be accompanied by a longitudinal displacement or pivoting.Areas in which there is no engagement of the gears allow, in some embodiments, a displacement or pivoting caused by the anatomical joint. Fig. 9B shows the lower part 60 of a lateral joint device 30 or the medial joint device 40 in the embodiment of Fig. 9A with a view of the upper side of the lower part 60. OT Medizintechnik GmbH Reference is made to the descriptions of the preceding figures. The upper part 50 of Fig. 9A and the lower part 60 of Fig. 9B can both be part of a common medical device 1 or jointly be part of a common joint device or form this. In the example of Fig. 9B, there is a single gear 92, which can optionally be regarded as part of the lower part 60. The gear 92 has a through-opening 92A.It has teeth facing radially inward toward this through-opening 92A and has teeth on its outer circumference that point radially outward. By means of the inward-facing teeth, the gear 92 can engage with the teeth of the gear ring 91 of the lower part 50 and, with the outward-facing teeth, can engage with the gear rail 93B of the insert 80 or, if the insert 80 were to be omitted, which is also encompassed by the present invention, with the gear rail 93 of the upper part 50. It should be noted that an engagement or a rotationally stable mounting or reception of the gear 92 on the lower part 60 is also possible using other designs that do not require a gear ring 91 on the lower part 60. A rectangular geometry, a triangular geometry, an oval geometry or other key-lock geometry, etc., can be used as an alternative to a gear connection as in the example in Fig.9B, which is also encompassed by the present invention. In certain embodiments, the set according to the invention can comprise a plurality of inserts 80, 81 and / or a plurality of gears 92 with different diameters D. Tor tip circle diameters (determined from head surface to head surface through the center point). If the upper part 50 and the lower part 60 are connected to one another, for example by the angle limiter being screwed - or alternatively fixed in some other way - into a receiving section 31A for the screw by means of a connecting device, for example a screw (see Fig. 11C), in such a way that the upper part 50 and lower part 60 are joined and held together, the tooth engagement mechanism 90 effects a translational (positive) guidance of the lower part 60 relative to the upper part 50 if a rotation of the lower part 60 relative to the upper part 50 is to take place, or vice versa, i.e. a rotation which follows a translation, or vice versa. The lower part 60 optionally has a receiving section 31A for the screw, a circular projection or pin. The receiving section 31A can have an internal thread in some embodiments.Alternatively, it has other connecting devices that serve to connect to the angle limiter 95, for example projections of a snap and / or locking connection. In the example of Fig. 9B, the receiving section 31A optionally has a projection as a first marking 35, to which an optional second marking 37 of the gear 92 can be aligned. This can prove advantageous during assembly. The position and design of the first and second markings 35, 37 are purely exemplary and not to be understood as limiting. Any other type of OT Medizintechnik GmbH marking as an orientation aid is also encompassed by the present invention. It should be remembered that the design of the upper part 50, as shown and discussed in the figures, can also be a design of the lower part 60, and vice versa.Thus, in some embodiments, the lower part 60 can have the recess on its upper side, unlike what is shown here by means of the figures. Fig. 10A shows the tooth engagement mechanism 90 between the upper part 50 and the lower part 60 of an inventive joint device, for example the lateral or medial joint device mentioned here, in an embodiment without a gear 92. Reference is made to the description of the preceding figures. In the example of Fig. 10A, the insert 80 optionally has a toothed rail 93A on its outer circumference, which engages positively and non-positively with the toothed rail 93 of the upper part 60 according to the principle shown in Fig. 9A. With a further toothed rail 93B, which faces its through-opening, the insert 80 engages positively with the teeth of the toothed ring 91, which in the present example is exemplarily integrated into the lower part 60.Thus, the tooth engagement mechanism 90 establishes a guided connection between the upper part 50 and the lower part 60. Fig. 10B shows the tooth engagement mechanism 90 between the upper part 50 and the lower part 60 of an inventive joint device, for example, the OT Medizintechnik GmbH lateral or medial joint device mentioned herein, in a further embodiment with a gear 92 with a small diameter DT. Reference is made to the description of the preceding figures. In the example of Fig. 10B, as well as in the example of Fig. 10A, the insert 80 has a toothed rail 93A on its outer edge, which engages the toothed rail 93 of the upper part 60 in a form-fitting and force-fitting manner.With a further toothed rail 93B at its through-opening, the insert 80 engages in a form-fitting manner with the radially outwardly arranged teeth of the gear 92, which in the present example has a small diameter DT and, in turn, engages with its radially inwardly arranged teeth in a form-fitting and force-fitting manner with the teeth of the gear ring 91, which is integrated into the lower part 60 analogously to the example in Fig. 10A. Thus, the tooth engagement mechanism 90 establishes a guided connection between the upper part 50 and the lower part 60. The option of using gears or gear rings which, like the toothed rail itself optionally, are not continuously covered with teeth and / or which have steps, has been mentioned above. Fig.10C shows the tooth engagement mechanism 90 of the upper part 50 and the lower part 60 of an inventive joint device, for example the lateral or medial joint device mentioned herein, in a further embodiment with a gear 92 with a large diameter DT without an insert 80. OT Medizintechnik GmbH Reference is made to the description of the preceding figures. In the example in Fig. 10C, no insert 80 is used. The radially outwardly arranged teeth of the gear 92, which in the present example has a larger diameter DT compared to the example in Fig. 10B, engage directly and positively with the toothed rail 93 of the lower part 60, while the radially inwardly arranged teeth engage with the teeth of the toothed ring 91, which is integrated into the lower part 60 analogously to the aforementioned examples in Figs. 10A and 10B.The toothed engagement mechanism 90 thus establishes a guided connection between the upper part 50 and the lower part 60. Fig. 11A shows the attachment of an angle limiter 95 onto a joint device 30, 40, represented by a block arrow. The gear ring 91 and the gear wheel 92 of the toothed engagement mechanism 90 can be seen through the through-opening of the upper part 50 (before the angle limiter 95 is attached). Reference is made to the description of the preceding figures, in particular to the explanations regarding the angle limiter 95. The initial position for assembly corresponds to full extension (0°), i.e. the longitudinal axes of the upper part 50 and the lower part 60 run in the same direction (at least parallel). OT Medizintechnik GmbH Fig. 11B shows the orientation of the angle limiter 95 during assembly of the joint device 30, 40 in detail. The through holes for pins 97 can be seen.Preferably, the angle limiter is aligned during assembly such that both the 0° position of extension and the 0° position of flexion are aligned with the stop 99 (see also Fig. 6E) of the upper part 50. These positions are highlighted by white circles. It can also be seen from Fig. 11B that the central through-opening of the angle limiter 95 is aligned with the through-opening of the upper part 50 so that the connecting device V can be received in the receiving section 31A of the lower part 60 (see Fig. 9B). This is described in more detail in Fig. 11C. Fig. 11C shows the assembly of the joint device with positioning of the angle limiter 95 and by means of a connecting device V, here a screw. Reference is made to the description of the preceding figures, in particular to the description of Fig. 9B. The angle limiter 95 is shown in the example in Fig.11C by means of a connecting device V, for example a screw, in a receiving section 31A provided for the connecting device (see Fig. 9B) in such a way that the upper part 50 and the lower part 60 of the joint device are joined and held together. Through this joining, the tooth engagement mechanism 90 effects a translational OT Medizintechnik GmbH (forced) guidance of the lower part 60 relative to the upper part 50 if a rotation of the lower part 60 relative to the upper part 50 is to occur, or vice versa, i.e. a rotation which follows a translation, or vice versa. The receiving section 31A of the lower part 60 (see Fig. 9B), designed for example as a circular projection or pin, in the example of Fig. 11C preferably has an internal thread suitable or provided for the screw.Alternatively, the joint device according to the invention has other connecting devices that serve to connect to the angle limiter 95, for example projections of a snap and / or locking connection or the like. Fig. 12A shows a joint device 30, 40 according to the invention in a further embodiment, viewed from the lateral side. Reference is made to the descriptions of the preceding figures. In this embodiment, an optional angle limiter 95 is optionally integrated into the upper part 50 of the joint device 30, 40. The pins 97, which serve to limit the extension or flexion of the joint to be treated, can be seen. By means of a connecting device V, here a screw, an element is arranged centrally on the connection between the lower part 60 and the upper part 50, which element has or comprises the shape of a half-shell 100 (see Fig. 12B) or is otherwise curved in a cup-like manner.The element 100 can be inserted with a lower, curved end into an opening or through-hole in the upper part 50, which is circular in this example. The function of this half-shell 100 is explained in more detail with reference to Figures 12C and 12D. The connecting device V can clamp the upper part 50, the half-shell 100, and the lower part 60 together. A spacer, such as the cylindrical shoulder that closes off the half-shell 100 at the bottom, can provide the necessary play between the upper part 50 and the lower part 60. Fig. 12B shows the joint device of Fig. 12A in an exploded view. Reference is made to the description of Fig. 12A. Fig. 12C shows the joint device of Fig. 12A from the side. The function of the half-shell 100 will be explained with reference to this and Fig. 12D.Due to its design, the half-shell 100 is movably arranged in the through-opening of the upper part 50, similar to a ball and socket joint. This enables the joint device to "wobble" – here by approximately 5° – and can thus support natural movement of the joint to be treated. Fig. 12D shows the joint device of Fig. 12C in the wobble position. It can be clearly seen that the distance S2 has decreased significantly compared to the distance S1 in Fig. 12C (S2 < S1). The half-shell 100 and with it the lower part 60 are in a significantly inclined position compared to the position in Fig. 12C, also referred to herein as the wobble position. OT Medizintechnik GmbH Such a wobble joint, e.g. as shown in Figs. 12A to 12D, can be provided on one side of the medical device, for example medially, and a joint device according to the invention on the other, for example laterally. Fig.Figure 13 shows the joint device according to the invention in a further embodiment. A connecting element V can be seen, which appears mushroom-shaped in a side view of the joint device purely by way of example. The connecting element V has a convex shape on its underside, with which it rests on the edge of the through-opening 51, which can be circular, oval, rectangular, polygonal, square, etc. A screw connection, a plug connection, a snap connection, etc.can connect the connecting means V to the lower part 60 (alternatively: to the upper part 50) in such a way that a head VK of the connecting means V, which has a diameter which is greater than the diameter of the through-opening 51, comes to rest on one side of the upper part 50, a stem VS of the connecting means V, which is connected to the lower part 60, extends through the through-opening 51, so that, since the stem VS is longer than the through-opening 51 is deep, the lower part 60 and upper part 50 can move relative to one another, i.e. there is play for this, but at the same time they cannot separate from one another. Since the width or the diameter of the stem VS is thinner than the diameter of the through-opening 51, the movement possible in OT Medizintechnik GmbH Fig. 13 in comparison of the three positions a), b) and c) of the joint device with one another can take place.It can be seen that the rotation axis D not only allows rotation (not shown), but can also pivot due to the convex or curved underside of the head VK of the connecting means V. This design is advantageous in that it is very compact, thus eliminating the need for a dome-shaped design of the upper part 50 and / or lower part 60. Both the upper part 50 and / or lower part 60 can be flat. The through-opening 51 functionally corresponds to the receiving section 31 from previous figures, and the stem VK corresponds to the received section 33 of those figures.

[0002] OT Medizintechnik GmbH List of reference symbols 1 orthopedic device 10 proximal part 11 fastening device 20 distal part 21 fastening device 30 lateral joint device 31 receiving section 31A receiving section 33 received section 35 first marking; projection 37 second marking 40 medial joint device 50 upper part 51 through-opening of the upper part 55 fastening devices of the upper part 60 lower part 61 pin, projection 65 fastening devices of the lower part 70 element with an internal thread 70' element 71 recessed grips 80 insert 81 insert 83 through-opening of the insert 85 stop; Edge 87 Receptacle for the insert 89 Recess 90 Tooth engagement mechanism 91 Toothed ring 92 Toothed wheel 92A Through hole of the toothed wheel OT Medizintechnik GmbH 93 Toothed rail 93A Toothed rail 93B Toothed rail 95 Angle limiter 97 Pins 99 Projection;Edge 100 Half shell D Rotation axis of the joint device D(A) Position of the rotation axis D(A') Position of the rotation axis D(A'') Position of the rotation axisD1 First thickness of the insert D2 Second thickness of the insert D; T Diameter of the gear F / E Flexion / Extension G External thread K Cone T1 First depth of the upper part PF Pivoting surface PP Pivot point S1, S2 Distance between lower and upper part V Fastener; screw V1 Stem of the fastener α Angle β Angle ^ (Carrying) angle

Claims

OT Medizintechnik GmbH Claims 1. Medical, in particular orthopaedic, device (1) with - a proximal part (10) for application to an upper arm or a thigh and a distal part (20) for application to the forearm orthe lower leg, which are pivotably or rotatably connected to each other via at least one lateral joint device (30) and / or one medial joint device (40); - at least one fastening device (11, 21) with which the medical device (1) can be fixed to the limb, wherein the lateral joint device (30) and / or the medial joint device (40) has or forms a pivot joint, or joint with at least one pivot joint function, with a receiving section (31) and a received section (33), and wherein the received section (33) is received in the receiving section (31) and rotatably relative to it, wherein the receiving section (31) of the lateral joint device (30) and / or the medial joint device (40) is designed and / or arranged to allow movement of the section (33) rotatably received in it, or of a section thereof, in a distal-proximal direction and / or in a ventral-dorsal direction. OT Medizintechnik GmbH to allow in the direction, and / or to allow tilting, pivoting, or tipping of the rotatably mounted section (33) relative to the mounting section (31), or an axis of rotation (D) of the joint assembly (30, 40), or vice versa, during the use of the medical device (1) by or due to flexion or extension, or thereby.

2. Medical device (1) according to claim 1, comprising - a device for ensuring or maintaining play between components involved in the design of the joint assembly (30, 40) such that their relative movement to each other allows both rotation and movement, tilting, pivoting, or tipping in the operating state of the medical device (1) and / or in a state in which the medical device (1) is maximally tensioned or pre-tensioned in the direction of the axis of rotation (D);or - a device for preventing the required clearance between components involved in the formation of the joint assembly (30, 40) from being reduced or eliminated in preparation for use of the medical device (1), such that their relative movement to each other allows rotation, movement, tilting, pivoting or tipping. OT Medizintechnik GmbH shell, a spacer, a screw projection, a sleeve which limits the screwing of a first component into a second component with respect to the screwing path, e.g., a sleeve pushed over the shank of a screw and / or a screw with a partial thread, dimensioned such that the possibility of screwing it in is limited, and the like, comprise or consist of the following.

3. Medical device (1) according to claim 1 or 2, wherein the allowing is effected and / or supported by the receiving section (31) serving as a longitudinal guide for the received section (33).

4. Medical device (1) according to any one of the preceding claims, wherein the receiving section (31) and / or another section of the joint assembly (30, 40) is configured to limit the allowed movement of the received section (33) in the distal-proximal direction and / or in the ventral-dorsal direction within the receiving section (31). 5.Medical device (1) according to claim 4, wherein the lateral joint device (30) and / or the medial joint device (40) comprises an upper part (50) and a lower part (60), wherein the upper part (50) is connected to the proximal part (10) and the lower part (60) is connected to the distal part (20), in particular detachably and / or movable relative to each other, displaceable, tiltable or pivotable and / or rotatable, or vice versa. OT Medizintechnik GmbH 6. Medical device (1) according to claim 5, wherein the upper part (50) or the lower part (60) comprises a through-opening (51) as a receiving section (31) and the lower part (60) comprises a projection or pin (61) as a received section.

7. Medical device (1) according to claim 6, wherein the projection or pin (61) has an external thread (G), and wherein the medical device (1) comprises an element (70) which has an internal thread for screwing onto the external thread (G).

8. Medical device (1) according to any one of the two preceding claims, wherein the upper part (50) has a concave curvature on its side facing the lower part (60), and wherein the lower part (60) has a convex curvature on its side facing the upper part (50). 9.Medical device (1) according to any one of the preceding claims, comprising an insert (80, 81) with a through-opening (83) configured for its detachable reception in the upper part (50) or in the lower part (60), as a receiving section (31) for receiving the received section (33).

10. Medical device (1) according to claim 9, wherein the upper part (50) or the lower part (60) has a recess or a through-opening for receiving the insert (80, 81).

11. Medical device (1) according to any one of the preceding claims, wherein the upper part (50). OT Medizintechnik GmbH and / or the lower part (60) has a recess or depression on both its upper and lower surfaces.

12. Medical device (1) according to any one of the preceding claims, wherein the upper part (50) and / or the lower part (60) has at least or exactly two, three, or four different thicknesses.

13. Medical device (1) according to claim 10, wherein the recess or through-opening for receiving the insert (80, 81) has a plurality of teeth, e.g., in the form of a toothed splint (93).

14. Medical device (1) according to any one of claims 9 to 10, wherein the insert (80, 81) has a plurality of teeth, e.g., in the form of a toothed splint (93A, 93B), on its outer circumference and / or on its inner circumference, which defines the optional through-opening (83). 15.Medical device (1) according to any one of claims 13 to 14, comprising a toothed ring (91) for engaging with one or more of the plurality of teeth or toothed rails (93, 93A, 93B).

16. Medical device (1) according to any one of claims 13 to 15, comprising a gear (92) for engaging with one or more of the plurality of teeth or toothed rails (93, 93A, 93B) and / or with the toothed ring (91).

17. Medical device (1) according to any one of the preceding claims, further comprising a… OT Medizintechnik GmbH, a detachably and / or adjustable angle limiter (95) which limits a rotational movement between the upper part (50) and the lower part (60), preferably in one or more directions of rotation.

18. Medical device (1) according to claim 17, wherein the angle limiter (95) has at least one insertion opening for receiving a pin (97) received or receptable therein, wherein the insertion opening is preferably a through-opening.

19. Medical device (1) according to any one of claims 9 to 18, wherein the through-opening (51) of the upper part (50) or the lower part (60) has a first depth, and wherein the insert (80, 81) has a first thickness in a first section and a second thickness in a further section, wherein the first thickness is less than the first depth.

20. Medical device (1) according to the preceding claim, wherein the second thickness corresponds to the first depth. 21.Set comprising a medical device (1) according to any one of claims 1 to 20, and at least two inserts (80, 81) which are different from each other and / or at least two gears (92) which are different from each other.

22. Joint assembly (30, 40) for a medical device (1), in particular according to any one of claims 1 to 20, wherein the joint assembly (30, 40) is a pivot joint, or a joint with at least one pivot joint function, with a receiving section (31) and. OT Medizintechnik GmbH has or forms a received section (33), wherein the received section (33) is received in the receiving section (31) and rotatably relative to it, the receiving section (31) is designed and / or arranged to allow movement of the rotatably received section (33) therein, or a section thereof, in a distal-proximal direction and / or in a ventral-dorsal direction, and / or to allow tilting, pivoting, or tipping of the rotatably received section (33) relative to the receiving section (31), or an axis of rotation D of the joint assembly (30, 40), or vice versa, during use of the medical device (1) by or due to flexion or extension, or thereby. 23.Joint assembly (30, 40) according to claim 22, wherein the permitted movement is or comprises pivoting about several joint axes or about a joint axis or axis of rotation (D) that changes during pivoting with respect to the proximal part (10) and / or the distal part (20), in particular moving, wandering, tilting, or pivoting.

24. Joint assembly (30, 40) according to any one of claims 22 to 23, wherein the permitting is effected and / or supported by the receiving section (31) serving as a longitudinal guide for the received section (33). OT Medizintechnik GmbH 25. Joint device (30, 40) according to one of claims 22 to 24, wherein the receiving section (31) and / or another section of the joint device (30, 40) is configured to limit the permissible movement of the received section (33) in the distal-proximal direction and / or in the ventral-dorsal direction within the receiving section (31).

26. Joint device (30, 40) according to one of claims 22 to 25, wherein the lateral joint device (30, 40) comprises an upper part (50) and a lower part (60), wherein the upper part (50) is connected to the proximal part (10) and the lower part (60) is connected to the distal part (20), in particular detachably and / or movable, displaceable, tiltable, pivotable, and / or rotatable relative to each other, or vice versa. 27.

28. Joint device (30, 40) according to claim 26, wherein the upper part (50) or the lower part (60) comprises a through-opening (51) as a receiving section (31) and the lower part (60) comprises a projection or pin (61) as a received section.

29. Joint device (30, 40) according to claim 27, wherein the projection or pin (61) has an external thread (G), and wherein the medical device (1) comprises an element (70) which has an internal thread for screwing onto the external thread (G).

21. Joint device (30, 40) according to one of the two preceding claims, wherein the upper part (50) has a concave curvature on its side facing the lower part (60), and wherein the lower part (60) is attached. OT Medizintechnik GmbH, its side facing the upper part (50) has a convex curvature.

30. Joint assembly (30, 40) according to one of claims 22 to 29, comprising an insert (80, 81) with a through-opening (83), configured for its detachable reception in the upper part (50) or in the lower part (60), as a receiving section (31) for receiving the received section (33).

31. Joint assembly (30, 40) according to one of claims 22 to 30, wherein the upper part (50) or the lower part (60) has a recess or a through-opening for receiving the insert (80, 81).

32. Joint device (30, 40) according to any one of claims 22 to 31, wherein the upper part (50) and / or the lower part (60) has a recess or depression on both its upper and lower sides. 33.

34. Joint assembly (30, 40) according to any one of claims 22 to 32, wherein the upper part (50) and / or the lower part (60) has at least or exactly two, three, or four different thicknesses.

35. Joint assembly (30, 40) according to any one of claims 22 to 33, wherein the recess or through-opening for receiving the insert (80, 81) has a plurality of teeth, e.g., in the form of a toothed rail (93).

36. Joint assembly (30, 40) according to any one of claims 22 to 34, wherein the insert (80, 81) is attached at its outer OT Medizintechnik GmbH, the circumference and / or its inner circumference, which limits the optional through-opening (83), has a plurality of teeth, e.g., in the form of a toothed rail (93A, 93B).

36. Joint device (30, 40) according to one of claims 22 to 35, comprising a toothed ring (91) for engaging with one or more of the plurality of teeth or toothed rails (93, 93A, 93B).

37. Joint device (30, 40) according to one of claims 22 to 36, comprising a gear (92) for engaging with one or more of the plurality of teeth or toothed rails (93, 93A, 93B) and / or with the toothed ring (91).

38. Joint device (30, 40) according to one of claims 22 to 37, further comprising an angle limiter (95) which is releasably and / or adjustable and which limits a rotational movement between the upper part (50) and the lower part (60), preferably in one or more directions of rotation. 39.

40. Joint device (30, 40) according to claim 38, wherein the angle limiter (95) has at least one insertion opening for receiving a pin (97) received or receptable therein, wherein the insertion opening is preferably a through-opening.

40. Joint device (30, 40) according to claim 40, wherein the through-opening (51) of the upper part (50) or the lower part (60) has a first depth, and wherein the insert (80, 81) has a first thickness in a first section and a second thickness in a further section. OT Medizintechnik GmbH, wherein the first thickness is less than the first depth.

41. Joint assembly (30, 40) according to claim 40, wherein the second thickness corresponds to the first depth.

42. Set comprising a joint assembly (1) according to any one of claims 22 to 41, and at least two inserts (80, 81) which are different from each other and / or at least two gears (92) which are different from each other.

43. Method for preparing a medical device (1) according to any one of claims 1 to 20 for its use, comprising the steps of: - providing a medical device (1) according to any one of claims 1 to 20; - performing all steps required before applying the medical device (1), such as:Making adjustments tailored to the patient, or ensuring that these steps have been carried out, until the medical device (1) is ready for application such that there is clearance between the components involved in the formation of the joint device (30, 40) such that their relative movement to each other is maintained, including rotation, movement, tilting, pivoting, or tipping.

44. Method according to claim 43, further comprising applying the medical device (1) thus prepared to the patient.

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