Surgical kit suitable for reducing a bone fracture

Abstract

The present invention relates to a surgical assembly for the reduction of a fracture located at the level of the bone epiphyses or joints comprising: an osteosynthesis support plate (1), a set of diaphyseal fixation devices (12), a set of cannulated epiphyseal fixation devices (20), a set of fixation pins (40), at least one cannulated aiming guide (30, 30a), a cannulated tool (50) for maneuvering in rotation of said fixation devices (12, 20) and of said aiming guides (30, 30a), also serving as a measuring ancillary (to determine the length of at least some of the epiphyseal fixation devices (20) to be used), cannulated drilling equipment (for drilling holes adapted to the positioning of at least some of the fixation devices (20)), and preferably, arthroscopy equipment adapted so that the practitioner can visualize some of the operative phases. Figure for the abridged version: 16

Description

Description Title of the invention: Surgical set adapted for reduction of a bone fracture Technical field of the invention

[0001] — The present invention relates to the general field of surgical equipment, and in particular to- particularly the field of devices intended for osteosynthesis techniques.

[0002] — It relates more particularly to a surgical set (or kit) adapted for the reduction of a bone fracture, particularly a fracture located at the level of the bone epiphyses or joints. State of the art

[0003] Bone consolidation of certain fractures requires the mounting of hardware or osteosynthesis devices on the various bone fragments, to stabilize and to prevent excessive inter-fragmentary mobility.

[0004] — Surgeons then use, in most cases, osteosynthesis devices fixed by screwing onto the bone fragments, such as screws, pins or plates screwed in place to stabilize these bone fragments and consequently the fracture.

[0005] In particular, there are many types of plates associated with a set of screws fixation devices, which are offered to surgeons to reduce a fracture located at the at the level of the bony epiphyses (distal radius, proximal humerus, proximal tibia…).

[0006] The osteosynthesis support plate may then include a part of the body elongated, extended by a one-piece head section.

[0007] — The body portion of the support plate (called the diaphyseal portion of the plate) comprises a plurality of through-holes adapted for its attachment to the bone material of reception by means of fixing screws; and the head part of the support plate (called the epiphyseal portion of the plate) comprises a plurality of through-holes capable of to allow each to accommodate an elongated fixation device, in particular to ensure the desired reduction of the bone fracture.

[0008] — Very generally, after temporary anatomical reduction of the treated area to using pins, the pin(s) used are removed to allow the insertion of locking screw.

[0009] = However, the anatomical reduction achieved may change during the removal of the pins, or just after, due to lack of stability.

[0010] — Thus, in general, the current equipment and techniques available practitioners / surgeons do not allow for effective temporary stabilization or optimal fracture prior to fixation with locking screws.

[0011] — They do not always allow for high precision in reducing the fracture. And they often require a significant implementation time. Presentation of the invention In order to overcome the aforementioned drawbacks of the prior art, the present invention proposes a surgical assembly adapted for the reduction of a bone fracture, in particular a fracture located at the level of the bone epiphyses or joints, comprising: - an osteosynthesis support plate comprising a lower face and a upper face, said lower face being intended to be positioned against the receiving bone material, said support plate comprising an elongated body portion, called the diaphyseal portion of the plate, extended by a one-piece head portion, called the epiphyseal portion of the plate, said diaphyseal portion of the plate comprising a plurality of through holes, called diaphyseal holes and said epiphyseal portion of the plate comprising a plurality of through holes, called epiphyseal holes, which diaphyseal and epiphyseal holes are each adapted to allow the reception of an elongated fixation device, at least some of said epiphyseal holes comprising an internal thread, - a set of fixation devices in the receiving bone material intended to be inserted into said diaphyseal openings, called diaphyseal fixation devices, to fix said diaphyseal part of the plate to the surface of the receiving bone material, - a set of fixation devices for the bone intended to be inserted into said epiphyseal openings, called epiphyseal fixation devices, adapted in particular to allow the desired reduction of the bone fracture, - means for the rotational maneuvering of said diaphyseal fixation devices and said epiphyseal fixation devices, so as to ensure their anchoring by screwing into the receiving bone material, This surgical suite is characterized in that it also includes: - at least one tubular aiming guide, equipped with an axial channel extending along its longitudinal axis, one end of which is provided with an external thread adapted to cooperate with the tapping of one of said epiphyseal orifices, and the other end of which includes an operating recess, - a rotary maneuvering tool, designed to cooperate with the maneuvering imprint of said at least one aiming guide, for screwing its threaded end into one of said epiphyseal orifices, and its unscrewing, which rotary maneuvering tool is provided with an axial channel extending along its longitudinal axis, - a plurality of fixing pins, designed to cooperate with said at least one aiming guide, i.e. each capable of being inserted into the axial channel of said guide at least one aiming guide to ensure its longitudinal guidance and each capable of ensuring the desired temporary, at least partial, reduction of the bone fracture, - measuring means, designed to measure the depth of insertion of said fixation pins into the receiving bone material, - drilling equipment comprising a cannulated drilling tool equipped with an axial longitudinal channel, adapted to be inserted onto one of said fixation pins positioned through one of said epiphyseal orifices and to be able to drill the receiving bone material, said epiphyseal fixation organs, at least some of which are cannulated fixation organs, equipped with an axial longitudinal channel adapted for the passage of one of said fixation pins, said means for the rotational maneuver of said epiphyseal fixation organs being in the form of a cannulated maneuvering tool provided with an axial longitudinal channel adapted for the passage of one of said fixation pins, and one of whose ends is structured to cooperate with a complementary shaped head impression provided in an organ head of said epiphyseal fixation organs. Such a surgical setup allows in particular the placement of epiphyseal fixation devices while the fixation pins, placed for the anatomical reduction of the fracture, remain in place. Other non-limiting and advantageous features of the surgical assembly according to the invention, taken individually or in all technically possible combinations, are as follows: - the diaphyseal fixation elements and the epiphyseal fixation elements include the same head impression so that they can be maneuvered in rotation by the same cannulated maneuvering tool; - said at least one aiming guide includes a maneuvering imprint identical to the head imprint of said epiphyseal fixation organs so as to be able to be maneuvered in rotation by the same cannulated maneuvering tool; - the cannulated tool for rotating the aiming guides and / or epiphyseal fixation devices includes said measuring means for measuring the depth of insertion of said fixation pins into the receiving bone material; - the surgical package also includes arthroscopy equipment adapted to allow visualization in particular of the desired anatomical reduction and the placement of fixation pins and epiphyseal fixation devices in the bone material; - according to one embodiment, the epiphyseal fixation elements comprise (i) an element head provided with an external thread, which external thread is adapted to cooperate with the tapping of the epiphyseal orifices, and (ii) an element body, pro- running along the said organ head, provided with (a) a proximal part having an external thread adapted to be fixed by screwing into the receiving bone material, and (b) a distal part without a thread; - according to another embodiment, the epiphyseal fixation elements comprise (a) an element head provided with an external thread, which external thread is adapted to cooperate with the tapping of the epiphyseal orifices, and (b) an element body, extending said element head, which element body is provided with a thread along its entire length; - according to yet another embodiment, the epiphyseal fixation elements comprise (a) an element head provided with an external thread, which external thread is adapted to cooperate with the tapping of the epiphyseal orifices, and (b) an element body extending said element head, which element body is smooth, without a thread; - the surgical kit includes suitable tools for driving the fixation pins into the receiving bone material; - the surgical set includes a first type of aiming guide of a length LI, and at least a second type of aiming guide of a length L2 different from LI. Of course, the various features, variants, and embodiments of the invention can be combined in various ways, provided they are not incompatible or mutually exclusive. Detailed description of the invention Furthermore, various other features of the invention become apparent from the attached description made with reference to the drawings which illustrate non-limiting embodiments of the invention and where: [fig.1] is a perspective view of an osteosynthesis support plate that is part of the proposed surgical package; [fig.2] is a side view of one possible embodiment of a diaphyseal fixation organ forming part of the proposed surgical assembly; [fig.3] is a perspective view, from a first angle, of a possible realization of an epiphyseal fixation organ forming part of the proposed surgical assembly; [fig.4] shows the epiphyseal fixation organ of figure 3, seen in perspective from a second angle; [fig.5] is a perspective view, from a first angle, of a first form of realization of a aiming guide forming part of the proposed surgical set; [fig.6] shows the aiming guide of figure 5, seen in perspective according to a second corner ; [fig.7] is a perspective view, from a first angle, of a second form of realization of a aiming guide forming part of the proposed surgical set; [fig.8] shows the aiming guide of figure 7, seen in perspective from a second angle; [fig.9] is a side view of a fixation pin that is part of the proposed surgical set; [fig.10] is a perspective view of a possible embodiment of a cannulated maneuvering and measuring tool forming part of the proposed surgical set; [fig.11] is a perspective view of a possible embodiment of a cannulated drilling tool as part of the proposed surgical set; [fig.12] is a perspective view illustrating the operation of positioning the aiming guides on the epiphyseal part of the support plate fixed to the receiving bone material; [fig.13] is a perspective view illustrating the operation of positioning the fixation pins on the epiphyseal part of the support plate; [fig.14] is a perspective view illustrating the depth measurement operation to define the length of an epiphyseal fixation device to be used to reduce the bone fracture, followed by the operation of removing the associated aiming guide; [fig.15] is a perspective view illustrating the drilling operation for the placement of an epiphyseal fixation device; [fig.16] is a perspective view illustrating the operation of placing an epiphyseal fixation organ; [fig.17] is a perspective view showing the support plate equipped with all the epiphyseal fixation devices necessary for the reduction of the bone fracture present. surgical set As illustrated in the attached figures, the surgical assembly according to the invention, which is proposed to the practitioner / surgeon for the reduction of a fracture located at the level of the bone epiphyses (in particular a comminuted fracture), includes in particular an osteosynthesis support plate, a set of diaphyseal fixation devices, a set of epiphyseal fixation devices, a set of fixation pins, a set of aiming guides, a tool (or ancillary) for maneuvering in rotation of said fixation devices and said aiming guides, also serving as a measuring ancillary (to determine the length of at least some of the fixation devices to be used), as well as drilling equipment (for drilling holes adapted to the positioning of at least some of the fixation devices). Preferably, this surgical set also includes equipment arthroscopy (not shown) adapted so that the practitioner / surgeon can visualize the desired anatomical reduction of the joint area, and also the ongoing implantation of the fixation pins, the drilling and the placement of the fixation devices, including the epiphyseal fixation devices. The osteosynthesis support plate 1, illustrated in isolation in Figure 1, is a few millimeters thick and is delimited by an inferior face 2 intended to come into contact with the receiving bone material and by an opposing superior face 3. This support plate | includes an elongated body part 5, called the diaphyseal part of the plate, adapted to be positioned on the diaphysis of the receiving bone material, and a monobloc head part 6, called the epiphyseal part of the plate, adapted to be positioned on the bone epiphysis, at the level of the fracture to be reduced. The support plate | is provided with a plurality of orifices 7 which pass through its thickness, between its lower face 2 and its upper face 3, and which are intended for the passage of fixation devices, for its fixation on the receiving bone material and also, for some, for the desired reduction of the bone fracture. The diaphyseal part of plate 5 includes a plurality of diaphyseal orifices 7a, 7b intended for the passage of diaphyseal fixation devices for fixing the support plate 1 to the receiving bone material. Here, four of these diaphyseal openings 7a have a generally cylindrical shape. Preferably, these diaphyseal openings 7a have an internal thread 8 adapted to cooperate with a complementary thread formed on the head of the fasteners intended to be associated with them. Here again, one of these diaphyseal openings 7b has an elongated oblong shape. This oblong diaphyseal opening 7b is used to adjust the positioning of the support plate 1 on the diaphysis of the bone before the positioning of the fixation devices in the cylindrical diaphyseal openings 7a. The epiphyseal part of plate 6 comprises a plurality of epiphyseal orifices 7c arranged here on two lines substantially perpendicular to the axis of the diaphyseal part of plate 5. In the embodiment shown, the distal (end) line is composed of an alignment of four orifices 7c while the proximal line is composed of an alignment of three orifices 7c. Here, these epiphyseal orifices 7c have a generally cylindrical shape. Preferably, these epiphyseal orifices 7c have an internal thread 10 adapted to cooperate with a complementary thread provided on the head of the fastening elements intended to be associated with them. One possible embodiment of the diaphyseal fixation organ 12 is illustrated in Figure 2. This diaphyseal fixation element 12 is in the form of a fixing screw comprising - a screw head 13, at least part of whose contour is intended to come into contact with a part of the circumference of one of the diaphyseal orifices 7a, 7b, and - a screw body 14, with a longitudinal axis 14', provided with a thread 15 for its anchoring in the receiving bone material. A recessed head indentation 16 (or operating indentation 16), formed in the head of the screw 13, allows the fixing screw 12 to be rotated using a suitable tool for implantation in the receiving bone. The operating indentation 16 is located axially at the end of the fixing member 12. The perimeter of the screw head 13 includes an external thread 17 intended to cooperate with the internal tapping 8 of the diaphyseal orifices 7a to obtain a locking of the fixing screw 12 on the support plate 1. One possible embodiment of an epiphyseal fixation organ 20 is illustrated in Figures 3 and 4. This epiphyseal fixation organ 20 is in the form of an elongated cannulated organ, that is to say, equipped with an axial longitudinal channel (this axial channel being adapted for the passage of a fixation pin, as described later in the description). More specifically, this epiphyseal fixation organ 20 comprises - an organ head 21, at least part of whose contour is intended to come into contact with a part of the perimeter of one of the epiphyseal orifices 7a, 7b, and - an organ body 22, with a longitudinal axis 22°. An axial longitudinal canal 23 extends along the entire length of the epiphyseal fixation organ 20 and opens at its two ends, i.e. at the organ head 21 and at the free end of the organ body 22. A recessed head impression 24 (or maneuver impression 24), made in the head of the component 21, allows for rotation of the fixation component 20 using a suitable tool, for its implantation in the receiving bone. The maneuver impression 24 is positioned axially at the end of the fixation component 20. Advantageously, the head impression 16 of the diaphyseal fixation members 12 and the head impression 24 of the epiphyseal fixation members 20 are identical so that these two types of fixation members 12, 20 can be maneuvered in rotation by the same maneuvering tool. The periphery of the head of the organ 21 includes an external thread 25 intended to cooperate with the internal tapping 10 of the epiphyseal orifices 7c to obtain a locking of the fixing organ 20 on the support plate 1. In the illustrated embodiment, the organ body 22 is provided (a) with a part (b) a proximal portion 26, located on the side of the organ head 21, which has an external thread 27 adapted for screwing into the bone material, and (b) a distal portion 28 without a thread up to its free end. Here, the length of the threaded proximal portion 26 is between 1 / 5 and 1 / 3 of the length of the organ body 22. In one embodiment, the entire length of the body of the fastener 20 has an external thread. And according to yet another embodiment, the body of the component 22 of the fastening components 20 is smooth and therefore does not have an external thread. One possible embodiment of a aiming guide 30 for a surgical assembly according to the invention is illustrated in figures 5 and 6. This aiming guide 30 is generally in the form of a tube with a longitudinal axis of 30°, equipped with an axial orifice or channel 31. One end 32 of this aiming guide 30 is provided with an external thread 33 adapted to cooperate with the tapped hole 10 of one of the epiphyseal orifices 7c. On the other hand, the other end 34 (opposite end 32) of the aiming guide 30 includes an operating recess 35 to allow its rotation about the longitudinal axis 30' by means of a suitable operating tool. The operating recess 35 is located axially at the end of the aiming guide 30. This maneuvering impression 35 is identical to the head impression 16 of the diaphyseal fixation organs 12 and to the head impression 24 of the epiphyseal fixation organs 20 so that it can be maneuvered in rotation by the same maneuvering tool. Figures 7 and 8 illustrate an alternative embodiment of a aiming guide 30a for a surgical assembly according to the invention. This aiming guide 30a is identical to the aiming guide 30 described in relation to Figures 5 and 6, except for its length L2, which is greater than the length L1 of the aiming guide 30 described above. One possible embodiment of a fixation pin 40 for a surgical assembly according to the invention is illustrated in figure 9. This fixing pin 40 is made of metal, for example stainless steel or titanium. It is in the form of a smooth rod with a pointed end 41; its length can be between 40 and 200 mm and its constant diameter d can be between 0.8 and 2.5 mm. This diameter d of the fixing pin 40 corresponds, within play, to the diameter of the axial longitudinal channel 23 of the epiphyseal fixing member 20 and to the diameter of the axial channel 31 of the aiming guide 30, 30a. One possible embodiment of a cannulated maneuvering tool 50 for a surgical set according to the invention is illustrated in Figure 10. This operating tool 50 comprises an elongated body 51, with a longitudinal axis 50°, provided with an axial channel 52. One of its ends 53 comprises an operating head 54 and its other end 55 includes means 56 adapted for its removable attachment on a handle, The handle head 54 is arranged axially at the end 53 of the handle 50. The maneuvering head 54 is designed to be able to cooperate with the maneuvering impression 35 of the aiming guides 30, 30a, with the head impression 24 of the epiphyseal fixation members 20 and with the head impression 16 of the dia-physeal fixation members 12. On the other hand, the diameter of the axial channel 52 corresponds, within the clearance, to the diameter of the fixing pins 40. Between its two ends 53 and 56, the cannulated maneuvering tool 50 includes measuring means 57 adapted to measure the depth of penetration of the fixing pins 40 into the receiving bone material R, as explained later in the rest of the description. These measuring means 57 include an elongated light 58 allowing visual access to a part of the axial channel 52, associated with a graduation system 59. This graduation system 59 is designed, once the maneuvering tool 50 is positioned on a fixation pin 40 inserted into the bone material R, with its maneuvering head 54 engaged in the maneuvering impression of an associated aiming guide 30, 30a, to indicate to the practitioner / surgeon the depth of insertion of the fixation pin 40, by the position of the free end of this pin 40 opposite said graduation system 59, or by means of a marking line made on the length of the fixation pin 40. And the insertion length of the fixation pin 40 indicates to the practitioner / surgeon the length of the epiphyseal fixation organ 20 to be used for fixation in the bone. It is therefore understood that this cannulated maneuvering tool 50 fulfills several functions: one of rotational maneuvering of the aiming guides and fixing elements, and another of measuring the depth of penetration of the fixing pins. In alternative embodiments, several operating tools may be provided, for example if the operating footprints 16, 24 and 35 are different; or if it is desired to have a depth measuring tool separate from the rotating operating tool. One possible embodiment of a cannulated drilling tool 60 for a surgical set according to the invention is illustrated in Figure 11. This 60 cannulated drilling tool consists of a drill bit intended to cooperate with a rotating drive tool, such as a surgical motor or drill (not shown) to together constitute a drilling equipment. The cannulated drilling tool 60 comprises an elongated body 61 provided with an axial longitudinal orifice or channel 62. One of its ends 63 comprises a drill head 64 and its other end 65 includes means 66 adapted to attach to the head of the associated drill (or surgical motor) so as to ensure the rotational drive of the drill head 64. The diameter of the axial longitudinal channel 62 corresponds, within the clearance, to the diameter d of the fixing pins 40. The surgical set according to the invention further advantageously includes a tool adapted for driving the fixation pins 40 into the bone material R. This tool may consist of a drill (or surgical motor). And according to yet another particularity, this surgical set can also include arthroscopy equipment adapted so that the practitioner / surgeon can visualize live in particular the anatomical reduction of the fracture, and also the placement of the fixation pins 40 and the epiphyseal fixation organs 20 in the bone material R. This arthroscopy equipment, not shown and classic in itself, includes a miniaturized camera at the end of an optical fiber connected to a screen. To enable the implementation of a surgical procedure adapted to the fracture present, the surgical kit according to the invention proposed to the practitioner comprises: - a plurality of osteosynthesis support plates | which differ in their general shape and / or dimensions, - a plurality of diaphyseal 12 and epiphyseal 20 fixation organs of different shapes and / or sizes, - at least one 30, 30a aiming guide, and preferably several 30, 30a aiming guides (some identical to each other and others different in length), - several 40 fixing pins of identical or different lengths, - at least one tool 50 for measuring the length of the epiphyseal fixation devices 20 to be put in place, and for the rotational maneuvering of the various fixation devices 12, 20, as well as the aiming guides 30, 30a, - a set of 60 drilling tools, - a drill-type tool or surgical motor, for drilling tools 60 and for driving the fixation pins 40 into the receiving bone material R, - Arthroscopy equipment to visualize the anatomical reduction of the fracture and also the placement of, in particular, 40 fixation pins, 20 epiphyseal fixation devices and 12 diaphyseal fixation devices, - possibly a set of drill guides. Mératoi Figures 12 to 17 illustrate in different stages the operating procedure for the reduction of a bone fracture using a surgical assembly according to the invention described above. Figure 12 illustrates a bone material R (e.g., the end of a radius) comprising a diaphyseal part RI and an epiphyseal part R2 that has suffered a bone fracture which we seek to reduce. Initially, the diaphyseal part 5 of an osteosynthesis support plate 1 is fixed to the diaphyseal part R1 of the bone material R by means of diaphyseal fixing screws 12, so that the epiphyseal part of the plate 6 is located opposite the bone fracture to be reduced. In the embodiment shown, a diaphyseal fixation screw 12 is implanted into the bone material R via the oblong diaphyseal opening 7b, and another diaphyseal fixation screw 12 is implanted into the bone material R via one of the cylindrical diaphyseal openings 7a. All cylindrical diaphyseal openings 7a can be fitted with a diaphyseal fixation screw 12 to optimize the fixation of the osteosynthesis support plate 1. These diaphyseal fixing screws 12 are put in place by means of a screwdriver by cooperation of its operating head with the head impression 16 of said dia-physeal screws 12. Once the epiphyseal portion of plate 6 is correctly positioned over the bone fracture to be reduced, the practitioner positions the aiming guides 30, 30a onto this epiphyseal portion of plate 6. To do this, the external thread 33 of the distal end 32 of the aiming guides 30, 30a is screwed onto the threaded hole 10 of the selected epiphyseal openings 7c. This screwing can be performed using the cannulated maneuvering tool 50 (whose maneuvering head 54 cooperates with the maneuvering impression 35 of the aiming guides 30, 30a). As can be seen in Figure 13, the practitioner then positions the fixation pins 40 using the aiming guides 30, 30a. Each fixation pin 40 passes through the axial channel 31 of one of the aiming guides 30, 30a and is guided by it. The insertion of the fixation pins 40 is carried out using appropriate tools such as a drill (or surgical motor); and this insertion can be performed arthroscopically so that the practitioner can precisely visualize the positioning of each fixation pin 40. The insertion of the fixation pins 40 is carried out until their pointed end 41 reaches the opposite cortex of the bone. Next, as shown in Figure 14, the practitioner positions the cannulated maneuvering and measuring tool 50 on a fixation pin 40, with its associated aiming guide 30, 30a still in place, to implement its "depth measurement" function in order to measure the depth of insertion of this fixation pin, so as to know the length of the epiphyseal fixation organ 20 which will have to be used here. To do this, as mentioned above, the practitioner positions the maneuvering tool 50 on the fixation pin 40 inserted into the bone material R, with its maneuvering head 54 engaged in the maneuvering impression 35 of the aiming guide 30, 30a; and the graduation system 59 associated with the elongated light 58, opposite the positioning of the free end of the fixation pin 40 (or opposite a marking line on the length of this pin) indicates to the practitioner the depth of insertion of the pin 40, and therefore the required length of the epiphyseal fixation device 20 to be used subsequently. The practitioner then removes the aiming guide 30, 30a using the cannulated maneuvering tool 50 (this removal is performed without affecting the positioning of the associated fixation pin 40). The receiving orifice for the epiphyseal fixation device 20 can then be drilled using the drilling equipment, including the cannulated drilling tool 60, as illustrated in Figure 15. Preferably this drilling operation is carried out under arthroscopy; it is guided by the fixation pin 40 and it is carried out until the opposite cortex is reached (preferably without crossing this cortex). The end of the fixation pin 40 preferably remains pushed in and held by this cortical bone. Once the drilling has been completed, the chosen epiphyseal fixation member 20 can be implanted by driving and / or screwing into the resulting borehole, as can be seen in Figure 16. This operation is carried out by driving and screwing using the cannulated maneuvering tool 50, the epiphyseal fixation member 20 being guided by the fixation pin 40. The epiphyseal fixation member 20 is locked in position by screwing the external thread 25 of its head 21 onto the internal thread 10 of the associated epiphyseal orifice 7c. This screwing can be completed, after removal of the fixation pin 40, using a solid (non-cannulated) screwdriver. This operation to place the epiphyseal fixation organ 20 can be performed under arthroscopy. All the pins necessary for the reduction of the fracture can be put in place. Then, the aforementioned operations of taking depth measurements (figure 14), removing the aiming guide 30, 30a, drilling (figure 15) and placing the epiphyseal fixation device 20 (figure 16), are carried out for each of the fixation pins 40, to obtain the osteosynthesis support plate 1 equipped with all the epiphyseal fixation devices 20 necessary for the reduction of the bone fracture present, as illustrated in figure 17. As an alternative embodiment, a single aiming guide 30, 30a can be provided in the surgical assembly according to the invention, this single aiming guide being reused after the positioning of each fixation pin 40 and the placement of a epiphyseal fixation organ 20. Preferably, several 30, 30a aiming guides are used, the longest of which can be used to move aside certain tissues, nerves or other structures when positioning them on the osteosynthesis plate, in order to facilitate access to the bone area to be treated. In general, such a surgical approach makes it possible to facilitate and optimize the temporary stabilization of an articular fracture.

Claims

Demands

1. Surgical kit adapted for the reduction of a bone fracture, etc. particularly a fracture located at the level of the bone epiphyses, including: - an osteosynthesis support plate (1) comprising an inferior face (2) and an upper face (3), said lower face (2) being intended to be positioned against the receiving bone material (R), which support plate (1) includes an elongated body part (5), referred to as part diaphyseal plate (5), extended by a one-piece head portion (6), said epiphyseal portion of plate (6), said diaphyseal portion of plate (5) comprising a plurality of through holes (7a, 7b), called diaphyseal orifices (7a, 7b), and said epiphyseal portion of plate (6) comprising a plurality of through orifices (7c), called epi- orifices physes (7c), which diaphyseal orifices (7a, 7b) and epi- Physaria (7c) are capable of each allowing the reception of an organ of elongated fixation (12, 20), at least some of said epiphyseal orifices (7c) including an internal tapping (10), - a set of fixation devices (12) in the bone material (R) intended to be inserted into said diaphyseal orifices (7a, 7b), called organs of diaphyseal fixings (12), for fixing said diaphyseal portion of the plate (5) on the surface of the bone material (R), - a set of fixation devices (20) in the bone material (R) intended to be inserted into the said epiphyseal orifices (7c), called organs of epiphyseal fixation (20), adapted in particular to allow the desired reduction of the bone fracture, - means (50) for the rotational operation of said organs diaphyseal fixation (7a, 7b) and of said epiphyseal fixation organs (7c), so as to ensure their anchoring by screwing into the bone material (R), characterized in that it further comprises: - at least one tubular sighting guide (30, 30a), equipped with a axial canal (31) extending along its longitudinal axis (30”), of which one end (32) is provided with an external thread (33) adapted to cooperate with the tapping (10) of one of said epiphyseal orifices (7c), and the other end (34) of which comprises an imprint of maneuver (35), - a rotating maneuvering tool (50), designed to cooperate with the maneuvering footprint (35) of said at least one aiming guide (30, 30a), for screwing its threaded end (32, 33) into one of said epiphyseal orifices (7c), and its unscrewing, which tool (50) of The rotating mechanism is provided with an axial channel (52) extending along of its longitudinal axis (50°), - a plurality of fixing pins (40), designed to cooperate with said at least one aiming guide (30, 30a), that is to say each one suitable for to be inserted into the axial channel (31) of said at least one aiming guide (30, 30a) to ensure its longitudinal guidance and each capable of ensuring the desired reduction, at least temporary and partial, of the fracture bony, - measuring devices (50, 57, 58, 59), designed to measure the depth of insertion of said fixing pins (40) into the receiving bone material (R), - drilling equipment including a cannulated drilling tool (60) equipped of an axial longitudinal channel (62), adapted to be able to be inserted on one of the said fixing pins (40) positioned through one of the said epiphyseal orifices (7c) and to be able to drill the material bony (R), said epiphyseal fixation organs (20) presenting at least for some in the form of cannulated fixation organs (20), equipped with a axial longitudinal channel (22) adapted for the passage of one of said pins fixing (40), said means (50) for the rotational operation of said organs epiphyseal fixation (20) in the form of a cannulated tool maneuvering (50) provided with an axial longitudinal channel (52) adapted to passage of one of the said fixing pins (40), and one of the ex- tremites (53, 54) is structured to cooperate with a head imprint (24) of complementary form provided in an organ head (21) of the said epiphyseal fixation organs (20).

2. Surgical set according to claim 1, characterized in that said diaphyseal fixation organs (12) and said organs of epiphyseal fixation (20) include a single head impression (16, 24) so ​​that they can be rotated by the same tool maneuvering cannula (50).

3. Surgical set according to any one of claims 1 or 2, characterized in that said at least one aiming guide (30, 30a) includes a maneuvering footprint (35) identical to the footprint of head (24) of said epiphyseal fixation organs (20) so as to be able to To be maneuvered in rotation by the same cannulated maneuvering tool (50).

4. Surgical assembly according to any one of claims 1 to 3, characterized in that the cannulated tool (50) for rotational maneuvering of the aiming guides (30, 30a) and / or epiphyseal fixation devices (20) includes said measuring means (57, 58, 59) for measuring the depth of insertion of said fixing pins (40) into the bone receiving material (R).

5. Surgical set according to any one of claims 1 to 4, characterized in that it includes suitable arthroscopy equipment to allow visualization, in particular, of the anatomical reduction sought, and the installation of the fixing pins (40) and the epiphyseal fixation organs (20) in bone material (R).

6. Surgical assembly according to any one of claims 1 to 5, characterized in that said epiphyseal fixation organs (20) com- take - a head of organ (21) provided with an external thread (25), which external thread (25) is adapted to cooperate with the tapping (10) epiphyseal foramina (20), and - an organ body (22), pro- running along said organ head (21), provided (a) with a proximal part (26) comprising an external thread (27) adapted to be fixed by screwing into the bone material (R), and (b) of a distal part (28) without threads.

7. Surgical set according to any one of claims 1 to 5, characterized in that said epiphyseal fixation organs (20) com- take - a head of organ (21) provided with an external thread (25), which external thread (25) is adapted to cooperate with the tapping (10) epiphyseal foramina (7c), and - an organ body, extending said organ head, which organ body is provided with a thread on its entire length.

8. Surgical set according to any one of claims 1 to 5, characterized in that said epiphyseal fixation organs (20) com- take - a head of organ (21) provided with an external thread (25), which external thread (25) is adapted to cooperate with the tapping (10) epiphyseal foramina (7c), and - an organ body extending said organ head, which organ body is smooth, devoid of thread.

9. Surgical set according to any one of claims 1 to 8, characterized in that it includes drill-type tools or surgical motor adapted for driving in said fixation pins {40) in the bone material {R).

10. Surgical set according to any one of claims 1 to 9, characterized in that it comprises a first type of aiming guide (30) of a length (L1), and at least a second type of aiming guide (30a) of a length (L2) different from (L1).