Kit, plate, insert, and method for treating clavicle

Abstract

To provide a kit, a plate, and / or an insert, which can be easily implanted, therefore cost-effectively used, minimize errors, and readily conform to a patient's anatomical structure.SOLUTION: A kit comprises at least one insert, and a plate (1) for treating a bone, specifically a clavicle. The plate (1) has a receptacle (6) for the insert. The insert has an outer contour and / or the receptacle (6) has an inner contour (C'). The insert outer contour and the inner contour (C') fit each other such that the insert inserted into the receptacle (6) can pivot about an axis which runs substantially parallel to a plate top side.SELECTED DRAWING: Figure 1a

Description

[Technical Field]

[0001] The present invention relates to a kit, a plate and an insert, as well as a method for treating bones, in particular clavicles, having the features set forth in the preambles of the independent claims. [Background technology]

[0002] It is known to treat bones, such as the human clavicle, with implanted plates, particularly in the case of fractures.

[0003] US Patent Application Publication No. 2007 / 0185493 discloses a clavicle plate having overhanging wings for fastening screws.

[0004] US Patent Application Publication No. 2005 / 085819 discloses a multi-piece implant for treating bone fractures.

[0005] US Patent No. 9,149,312 discloses a clavicle plate in which an additional body portion can be connected to the plate by a string.

[0006] However, known implants and methods have various drawbacks: for example, it is difficult to temporarily fixate the implanted plate, it is often difficult to connect the plate with sutures, and the connection of the plate to the bone by bone screws is not very flexible. Summary of the Invention [Problem to be solved by the invention]

[0007] The object of the present invention is therefore to avoid the known drawbacks and in particular to provide kits, plates and / or inserts that are easy to implant and therefore cheap to use, less prone to errors and at the same time more adaptable to the patient's anatomy. [Means for solving the problem]

[0008] According to the present invention, these and other problems are solved by a kit, a plate and an insert, as well as a method having the features of the independent claims.

[0009] The kit according to the present invention includes at least one insert and one plate for treating a bone, particularly a clavicle. The plate has a receptacle for the insert. The insert has an outer contour, and the receptacle has an inner contour. The inner and outer contours are adapted to each other so that the insert inserted into the receptacle can pivot about an axis that extends essentially parallel to the upper surface of the plate.

[0010] In particular, the insert can be used to form a connection with bone or other body parts. This can be achieved by various connection mechanisms, as described in more detail below. Connections with screws or threads are particularly advantageous. Because the insert can pivot in the inserted state, anchoring is generally more flexible, for example, since its orientation can also be adjusted during implantation.

[0011] The insert is preferably configured to remain pivotable within the receptacle in the final insertion position when the screw or thread is inserted.

[0012] In particular, the insert can pivot within the receptacle about exactly one axis parallel to the upper surface of the plate.

[0013] Preferably, the outer contour of the insert and / or the inner contour of the receptacle are at least partially rounded. Additionally or alternatively, the outer contour and / or the inner contour may have an at least partially rotationally symmetric shape, particularly preferably at least partially cylindrical, stepped cylindrical, conical, elliptical, hyperbolic or parabolic, in particular in a cross section perpendicular to the longitudinal axis.

[0014] A rotationally symmetrical structure of the inner and / or outer contours perpendicular to the longitudinal axis, at least partially, preferably completely, is advantageous for precisely defined mounting of the insert and simultaneously allows for precisely defined pivoting. Therefore, the upper and lower surfaces of the insert preferably do not differ in such a rotationally symmetric insert, allowing for fast and reliable insertion. Therefore, the insert cannot be placed laterally inverted in the receptacle. Alternatively, the upper and lower surfaces of the insert may differ, i.e., only one correct orientation is possible.

[0015] Additionally, the insert is preferably molded so that the insert can be fully seated within the receptacle in the plate.

[0016] The insert can therefore be placed flush with the plate in the receptacle and / or lowered onto the plate, so that the plate does not have any irregularities due to the insert.

[0017] Furthermore, this arrangement allows the plate to be positioned flush with the bone regardless of the positioning of the insert, which makes fixation, especially provisional fixation, easier.

[0018] Partially rounded shapes are intended to include, in particular, shapes having a circular cross section, for example along the longitudinal axis. Similarly, all shapes formed along an edgeless surface and not linear should be understood to be rounded.

[0019] Such a shape makes it particularly easy to pivot the insert within the receptacle. Preferably, the outer and inner contours are adapted to one another in such a way that the insert inserted in the receptacle is displaceable in the longitudinal direction of the plate, in particular such that the insert can be stably inserted in different positions along the longitudinal direction, and for this purpose the receptacle has, in particular in the longitudinal direction, a support surface which extends parallel to the lower surface of the plate and which is longer than the dimension of the insert in the longitudinal direction.

[0020] This allows for more customization of the fixation of plates and inserts to body parts such as bones.

[0021] The displaceability allows the fastener to flexibly adapt to the shape of a body part, such as a bone. Thus, the size or curvature of a bone, such as a clavicle, can be taken into account in the fixation. Furthermore, flexible attachment of the fastener can avoid stress between the fasteners.

[0022] Preferably, the insert is adapted to secure a thread and / or to receive a screw.

[0023] According to the first aspect of the invention, the insert preferably comprises at least one strut adapted to hold a thread. Particularly preferably, the insert comprises exactly one Equipped with struts.

[0024] This allows for a particularly simple method of attaching the thread to the insert, for example by knotting or looping. In particular, the struts can also be positioned within the through-openings so that the thread can be placed through the insert. In particular, this also allows for fixing the bone plate to the body part.

[0025] Preferably, the struts are sunken. By sunken struts, we mean that the struts are positioned inside the opening so that they are not flush with the surface of the insert on at least one side. Therefore, sunken struts are typically thinner than the insert. However, they may be flush with the surface of the insert on one side. Alternatively, they may be positioned inside the opening so that they are sunken when viewed from both sides of the opening, i.e., not flush with any surface of the insert.

[0026] The through-holes are preferably positioned on the insert so that when the insert is properly placed in the receptacle, there is a passage for receiving a thread or screw from the top of the plate to the bottom of the plate.

[0027] The opening of the insert in the receptacle may preferably be located at the top of the plate.

[0028] The insert can therefore be easily fixed by means of screws and / or threads.

[0029] In particular, this allows the node to be submerged within the insert, potentially leading to reduced tissue irritation.

[0030] Preferably, the kit comprises a suture for fixing a body part. Particularly preferably, the suture is adapted to fix the coracoid.

[0031] Alternatively, according to a second aspect of the invention, the insert comprises an opening for a receptacle for a screw, in particular a bone screw.

[0032] In particular, the openings can be designed with a thread, however, it is also possible to use openings without threads.

[0033] In particular, the openings can be essentially cylindrical and shaped as holes with a circular cross section. Alternatively, other cross sections of the openings are conceivable, such as square, elliptical, triangular, or rectangular. In particular, if the openings are designed as elongated holes, the cross section along an axis perpendicular to the axis of the hole may be circular, elliptical, rectangular, square, or rectangular. It is also conceivable to design the openings as interlocking holes.

[0034] This allows the insert to be attached to the bone with a screw, which further secures the plate to the bone. The pivoting nature of the insert also makes it possible, among other things, to adjust the angle of entry of the screw into the bone.

[0035] Preferably, the kit comprises at least one screw, in particular a non-locking screw. Alternatively, the screw can be locking. Particularly preferably, the screw is adapted to the opening of the insert so that it can be screwed through this opening. In particular, the diameter of the screw can be adapted to the inner diameter of the opening of the insert and / or the external thread of the screw can be adapted to the inner diameter of the opening of the insert. It can be adapted to the internal thread or locking profile of the opening.

[0036] The screw can be threaded through the female thread or locking profile in the opening of the insert, and the male thread of the screw can be screwed into the bone. The locking profile on the head of the screw then locks into the mating profile on the insert, thus firmly locking the screw into the insert and simultaneously securing it to the bone.

[0037] The screw may also include a head that is sized so that it does not fit through the opening. The head may also be shaped and sized so that it can be sunk into the opening of the insert if the opening is designed accordingly. It is also conceivable that the head of the screw may be shaped as a locking head.

[0038] Preferably, the insert has a holder, and the insert and the holder are connected to each other via a predetermined breaking point.

[0039] This allows the insert to be easily held and inserted into the receptacle at a desired position. The predetermined break point allows the insert to be removed from the holder at a desired time, for example, after insertion into the receptacle. The holder can also be designed to simultaneously function as a threader in addition to holding.

[0040] Preferably, the plate has at least one recess in its upper surface, which does not penetrate the plate, and which is adapted for the temporary reception of a tool, preferably pliers.

[0041] Preferably, the kit comprises a tool, particularly preferably a pair of pliers, the tool comprising at least one tip, the shape and size of which are adapted to enable it to come into operable contact with the recess in the plate.

[0042] The present invention further relates to an insert. The insert is particularly suitable for use in such a kit. Therefore, those skilled in the art will understand that all of the characteristics described herein can also be applied to the kit. Similarly, all of the characteristics of the insert described above can be used as part of the kit, in addition to or instead of a single insert. The insert is adapted to fit into a receptacle in a bone plate and includes at least one opening. The opening is adapted for fixation of a screw receptacle and / or thread. The insert is also connected to a holder via a predetermined break point.

[0043] The insert is particularly preferably partially rounded. It is also possible to design the insert with a rotationally symmetric cross section perpendicular to the longitudinal axis. It is also conceivable that the cross section of the insert has n-fold symmetry, where n can be any integer greater than 2, particularly preferably at least 3. For example, a rectangular cross section is also conceivable.

[0044] Preferably, the insert includes a strut disposed within the opening, and in particular sunk therein.

[0045] Preferably, at least one opening is adapted to receive a screw. The thread diameter of the screw is preferably 1 to 8 mm, more preferably 2 to 5 mm, and even more preferably 2.5 to 3.5 mm.

[0046] The present invention further relates to a plate for treating bones, in particular clavicles. The plate is particularly suitable for use in such a kit. It will also be clear to those skilled in the art that all the features of the plate described above in connection with the kit can also be used in the plate according to the invention. The plate includes at least one screw hole for receiving a bone screw. The plate has at least one overhanging tab at an end region.

[0047] The tab is particularly suitable for molding to individual anatomical structures and for fixation to bones or other body parts, thus allowing fixation from different angles or positions, making treatment more flexible.

[0048] Preferably, the plate comprises at least one, more preferably at least two, and even more preferably exactly two tabs.

[0049] Preferably, at least one tab is connected to the plate via at least one bendable bridge, in particular the tab has a receiving opening for a bone screw.

[0050] This allows the plate to be attached to the bone by bone screws. In particular, the bridge can be adapted to the bone in different positions and / or orientations, so that the screws can be inserted into the bone in different positions and / or orientations. This allows for a particularly advantageous treatment that can be specifically adapted to the patient's anatomy as needed.

[0051] If the bone structure is very poor there is a risk that the screws will tear out. The tabs mentioned above allow the screws to be placed further from other directions and therefore prevent these screws from tearing out.

[0052] It is also conceivable that the lug is connected to the plate by more than one bridge, for example, one tab can be connected to the plate via a double bridge.

[0053] The term bendable is intended to include at least sufficient ductility of the material so that it can be plastically deformed without fracture. In particular, bendability should also be understood so that plastic deformation can be achieved by hand tools or by hand alone, e.g., by appropriate material selection or dimensioning of the corresponding parts.

[0054] Preferably, the plate has a greater plate thickness in the region of the screw holes or receptacles than in the region of the bridges.

[0055] Preferably, the tabs and / or bridges are shaped so that the angle between the longitudinal axis of the bone screw receiving opening and the normal to the surface of the plate is at most 150°, particularly preferably at most 120°, and even more preferably at most 90°.

[0056] The present invention further relates to a plate for treating bones, particularly clavicles. The plate is particularly suitable for use in such a kit. It will be clear to those skilled in the art that all of the features of the plate described above in relation to the kit can also be used with the plate according to the present invention. Likewise, all of the features described above in relation to the plate can be combined with the plate described herein. The plate has at least one screw hole for receiving a bone screw. The plate further has an upper surface and a lower surface, the lower surface of the plate being shaped to at least partially contact the bone. The upper surface of the plate has at least one recess that does not penetrate the plate and is adapted to temporarily receive a tool. Typically, the tool is a surgical tool known to those skilled in the art.

[0057] The temporary reception is used to create a shape and / or press fit with the tool that temporarily prevents or inhibits displacement of the tool relative to the bone plate.

[0058] The plate can therefore be held in a particularly simple manner by the tool, which allows the surgeon to prevent the plate from moving relative to the bone, making the procedure easier and safer. In particular, the plate can be held without blocking the screw holes due to the tool being placed therein. Furthermore, by holding the plate in recesses adapted for this purpose, the plate can be held without play. In contrast, a plate held in the screw holes with a tool can move somewhat, which can make the procedure less safe and more cumbersome for the surgeon.

[0059] Preferably, at least one recess is arranged between the screw holes, particularly preferably midway between the screw holes, in relation to the longitudinal direction of the plate.

[0060] This allows, for example, for the plate to be held adjacent to the screw insertion site if desired, thereby minimizing the risk of slippage at the site of the screw holes used and making the procedure safer.

[0061] Preferably, at least one recess on the plate surface is located substantially midway between the outer boundaries of the plate in a lateral direction perpendicular to the longitudinal direction.

[0062] As a result, when the plate is held by a tool inserted into the recess, it is kept closer to its center of gravity, which reduces the risk of slippage and makes treatment safer.

[0063] However, naturally, recesses closer to the edge of the plate or closer to the plate hole are also conceivable.

[0064] Preferably, the recess has a longitudinal axis and is substantially rotationally symmetric about the longitudinal axis.

[0065] Rotational symmetry should in particular also include n-fold rotational symmetry, where n can be any integer, preferably an integer that is at least 2, particularly preferably at least 3. For example, recesses with a square or triangular cross section in the plate plane are also conceivable.

[0066] The recess can be shaped as a cylinder with any rotationally symmetrical base. For example, it is conceivable to shape the recess as a cylinder with a square or triangular base. Alternatively, the recess can be shaped as a pyramid, whereby the base area can also be basically any. Conical recesses are also conceivable.

[0067] However, the recesses do not have to be conical or cylindrically shaped: spherical or elliptical shapes are also conceivable, especially if the cross-sectional area of ​​the recess in the plate plane is circular or elliptical.

[0068] Alternatively, the recess is shaped as an elongated shape, which allows the tool to be guided within the recess along its longitudinal axis and the plate to be moved accordingly without the need to remove the tool from the recess.

[0069] The depth of the recess is preferably 0.01 to 2 mm, more preferably 0.1 to 1 mm, and even more preferably 0.2 to 0.5 mm.

[0070] Preferably, at least one recess in at least one direction parallel to the surface of the plate has a diameter of 0.1 to 3 mm, more preferably 0.5 to 1.5 mm, even more preferably 0.8 to 1.5 mm. It has a size range of ~1.2 mm.

[0071] In particular, for non-circular recesses, the shortest sidewall may have a value within the stated range. In particular, at least one recess in a direction in the plane of the panel surface may have a value within the ranges stated above.

[0072] Preferably, the plate is adapted in size and shape to a bone, in particular a human clavicle. Preferably, the plate therefore has a length of 30 to 150 mm and a width of 6 to 40 mm. The plate may be at least partially curved in a plane parallel to the plate surface. In particular, the radius of curvature may be 30 to 250 mm.

[0073] Preferably, the plate comprises a biocompatible material, particularly preferably made of a biocompatible material. In particular, the biocompatible material may be selected from the group consisting of implant steel, titanium, titanium alloys, ceramics, and plastics. Particularly suitable plastics include polyetheretherketone (PEEK), UHMW polyethylene (PE-UHMW), polypropylene (PP), and polyethylene terephthalate (PET).

[0074] The present invention further relates to a method for treating bones, in particular clavicles, preferably human clavicles, which method can in particular be carried out using the plates and / or inserts or kits described above.

[0075] First, the method includes providing a plate. Preferably, the plate comprises at least one tab and / or bridge connected to the tab, the tab and / or bridge being disposed on the plate, and thus preferably the tab and / or bridge is bent relative to the bone in a further step.

[0076] Preferably, the plate is held in place by a tool, in particular at least temporarily fixed to the bone. In particular, pliers can be used. The tool is preferably introduced into a recess that does not cross the plate, the cross-sectional area of ​​the recess, in particular the cross-sectional area in the plane of the plate, being adapted to the diameter of the tip of the tool.

[0077] Additionally, the plate is attached to the clavicle by at least one screw threaded into the clavicle through a screw hole in the plate.

[0078] Preferably, an additional screw is screwed into the clavicle through at least one tab, particularly through a screw-receiving opening in the tab. In particular, the tab can be connected to the plate by a flexible bridge. Additionally or alternatively, two or more screws can be screwed into the clavicle in this manner, each through one tab or several tabs. Particularly preferably, a total of two screws are screwed through one tab.

[0079] Preferably, the insert is inserted into a receptacle of a plate adapted for this purpose. The insert can be connected to the holder via a predetermined breaking point. Particularly preferably, the insert is inserted by means of the holder, and the method can further comprise the step of removing the holder by breaking the predetermined breaking point. The insert may further pivot about an axis substantially parallel to the upper part of the plate. In particular, a suture can be passed through the opening of the insert, and the suture is connected to a body part, preferably the coracoid. In particular, after passing through the opening of the insert, the thread may be connected to a strut provided therefor, in particular by a knot.

[0080] Another screw can be screwed into the clavicle through the opening in the insert, or the thread can be connected to the body part, preferably the coracoid, via a strut provided for this purpose in the opening in the insert and the thread can be fixed, thereby stabilizing the body part.

[0081] The invention is explained in more detail below with reference to the following figures and embodiments. [Brief explanation of the drawings]

[0082] [Figure 1a] 1A and 1B are a perspective view and a longitudinal cross-sectional view of a first embodiment of a clavicle plate; [Figure 1b] 1A and 1B are a perspective view and a longitudinal cross-sectional view of a first embodiment of a clavicle plate; [Figure 1c] 1A and 1B are a perspective view and a longitudinal cross-sectional view of a first embodiment of a clavicle plate; [Figure 2] FIG. 12 is a perspective view of a second embodiment of a clavicle plate. [Figure 3a] 2 is a perspective view of the clavicle plate of FIG. 1 with a side view and a bottom view with screws inserted. [Figure 3b] 2 is a perspective view of the clavicle plate of FIG. 1 with a side view and a bottom view with screws inserted. [Figure 4] FIG. 3 is a perspective view of the clavicle plate of FIG. 2 with a side view of the plate with screws inserted. [Figure 5a] 1A-1C are diagrams of steps of a method for securing an insert to a thread. [Figure 5b] 1A-1C are diagrams of steps of a method for securing an insert to a thread. [Figure 5c] 1A-1C are diagrams of steps of a method for securing an insert to a thread. [Figure 6a] 1A and 1B show a first embodiment of an insert for thread fixation in cross section along the longitudinal axis from different perspectives. [Figure 6b] 1A and 1B show a first embodiment of an insert for thread fixation in cross section along the longitudinal axis from different perspectives. [Figure 6c] 1A and 1B show a first embodiment of an insert for thread fixation in cross section along the longitudinal axis from different perspectives. [Figure 6d] 1A and 1B show a first embodiment of an insert for thread fixation in cross section along the longitudinal axis from different perspectives. [Figure 6e] 1A and 1B show a first embodiment of an insert for thread fixation in cross section along the longitudinal axis from different perspectives. [Figure 7] Figure 2 shows the use of a tool to hold the clavicle plate. [Figure 8a] 8 shows the clavicle plate of FIG. 7 in a top view and in a cross section perpendicular to the longitudinal direction. [Figure 8b] 8 shows the clavicle plate of FIG. 7 in a top view and in a cross section perpendicular to the longitudinal direction. [Figure 8c]8 shows the clavicle plate of FIG. 7 in a top view and in a cross section perpendicular to the longitudinal direction, and a method not according to the invention for holding the clavicle plate of FIG. 2 with a tool. [Figure 8d] 8 shows the clavicle plate of FIG. 7 in a top view and in a cross section perpendicular to the longitudinal direction, and a method not according to the invention for holding the clavicle plate of FIG. 2 with a tool. [Figure 9a] 1A and 1B show a second embodiment of an insert for receiving a screw in different views and in cross section along the longitudinal axis; [Figure 9b] 1A and 1B show a second embodiment of an insert for receiving a screw in different views and in cross section along the longitudinal axis; [Figure 9c] 1A and 1B show a second embodiment of an insert for receiving a screw in different views and in cross section along the longitudinal axis; [Figure 9d] 1A and 1B show a second embodiment of an insert for receiving a screw in different views and in cross section along the longitudinal axis; [Figure 9e] 1A and 1B show a second embodiment of an insert for receiving a screw in different views and in cross section along the longitudinal axis; [Figure 10a] 9a-9e illustrate method steps for using the clavicle plate of FIG. 2 with the insert of FIGS. 9a-9e. [Figure 10b] 9a-9e illustrate method steps for using the clavicle plate of FIG. 2 with the insert of FIGS. 9a-9e. [Figure 10c] 9a-9e illustrate method steps for using the clavicle plate of FIG. 2 with the insert of FIGS. 9a-9e. [Figure 10d] 9a-9e illustrate method steps for using the clavicle plate of FIG. 2 with the insert of FIGS. 9a-9e. [Figure 10e] 9a-9e illustrate method steps for using the clavicle plate of FIG. 2 with the insert of FIGS. 9a-9e. [Figure 11a] 1 shows various embodiments of a receptacle for an insert, each shown in a top view and in a cross-sectional view, with and without an insert, the insert being shown slightly tilted in each case. [Figure 11b] 1 shows various embodiments of a receptacle for an insert, each shown in a top view and in a cross-sectional view, with and without an insert, the insert being shown slightly tilted in each case. [Figure 12a] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12b] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12c] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12d] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12e] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12f] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12g] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12h] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12i] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12j] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12k]Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 12l] Various alternative inserts are received in threaded holes and secured to threads, each shown in side, bottom, top, and perspective views. [Figure 13] 12a, 12c and 12f show the use of a clavicle plate with an insert. [Figure 14a] 12A-12C illustrate method steps for using the insert of FIG. 12l. [Figure 14b] 12A-12C illustrate method steps for using the insert of FIG. 12l. [Figure 14c] 12A-12C illustrate method steps for using the insert of FIG. 12l. [Figure 14d] 12A-12C illustrate method steps for using the insert of FIG. 12l. [Figure 14e] 12A-12C illustrate method steps for using the insert of FIG. 12l. [Figure 14f] 12A-12C illustrate method steps for using the insert of FIG. 12l. [Figure 14g] 12A-12C illustrate method steps for using the insert of FIG. 12l. [Figure 14h] 12A-12C illustrate method steps for using the insert of FIG. 12l. [Figure 15] 1 shows a second embodiment of an insert for suture fixation. [Figure 16a] 16 illustrates method steps for using the insert of FIG. 15. [Figure 16b] 16 illustrates method steps for using the insert of FIG. 15. [Figure 16c] 16 illustrates method steps for using the insert of FIG. 15. [Figure 16d] 16 illustrates method steps for using the insert of FIG. 15. [Figure 17a] 10A and 10B show third and fourth embodiments of the suture fixation insert in side, top and perspective views. [Figure 17b] 10A and 10B show third and fourth embodiments of the suture fixation insert in side, top and perspective views. [Figure 18a] 5 shows a fifth embodiment of an insert for thread fixation in a top view, a perspective view, a side view and a cross-sectional view. [Figure 18b] 5 shows a fifth embodiment of an insert for thread fixation in a top view, a perspective view, a side view and a cross-sectional view. [Figure 18c] 5 shows a fifth embodiment of an insert for thread fixation in a top view, a perspective view, a side view and a cross-sectional view. [Figure 18d] 5 shows a fifth embodiment of an insert for thread fixation in a top view, a perspective view, a side view and a cross-sectional view. [Figure 18e] 5 shows a fifth embodiment of an insert for thread fixation in a top view, a perspective view, a side view and a cross-sectional view. [Figure 18f] 5 shows a fifth embodiment of an insert for thread fixation in a top view, a perspective view, a side view and a cross-sectional view. [Figure 18g] 5 shows a fifth embodiment of an insert for thread fixation in a top view, a perspective view, a side view and a cross-sectional view. [Figure 19a] 10A and 10B show a sixth embodiment of an insert for receiving a screw in a top view, a perspective view, a side view, and a cross-sectional view along the longitudinal axis. [Figure 19b] 10A and 10B show a sixth embodiment of an insert for receiving a screw in a top view, a perspective view, a side view, and a cross-sectional view along the longitudinal axis. [Figure 19c] 10A and 10B show a sixth embodiment of an insert for receiving a screw in a top view, a perspective view, a side view, and a cross-sectional view along the longitudinal axis. [Figure 19d] 10A and 10B show a sixth embodiment of an insert for receiving a screw in a top view, a perspective view, a side view, and a cross-sectional view along the longitudinal axis. [Figure 20a] 2 shows a perspective view of the clavicle plate of FIG. 1 secured to a bone; [Figure 20b] 2 shows a perspective view of the clavicle plate of FIG. 1 secured to a bone; DETAILED DESCRIPTION OF THE INVENTION

[0083] For purposes of clarity, identical features within the figures are not repeatedly marked with the same reference numerals.

[0084] FIG. 1a shows a perspective view of a clavicle plate 1. The plate 1 is curved in the longitudinal direction (L) to fit the shape of the human clavicle. The plate has nine round screw holes 7. Furthermore, the plate 1 has elongated holes 8 arranged substantially along the longitudinal direction (L). The elongated holes 8 are suitable for receiving conventional bone screws. Furthermore, the plate 1 has a receptacle 6 for an insert (10, 20 in the following figures). The receptacle has a partially rounded contour C'. In this case, the rounding is designed as an arc-shaped cross section in a plane P1 perpendicular to the longitudinal direction (L) (see FIG. 1b).

[0085] The plate has recesses 2', 2'' on its upper surface. In the plate shown here, several recesses 2' are arranged along the longitudinal direction, each halfway between two screw holes 7, 8. When viewed perpendicular to the longitudinal direction (L), these recesses 2' are arranged halfway between the edges of the plate. Further recesses 2'' are arranged close to the screw holes 7, but are not arranged along the longitudinal direction. It is not arranged in the middle of the direction (L) or perpendicular to the longitudinal direction.

[0086] The recesses are circular. The diameter of the recesses 2', 2'' in plane O (see FIG. 1c) is 1 mm. The thickness D of the plate 1 varies along the longitudinal direction (L): it is smaller at the ends of the plate 1 and increases along the longitudinal direction (L), reaching a maximum in the region of the receptacle 6.

[0087] The plate 1 further includes two tabs 5, each connected to the plate 1 via a bridge 4. The tabs 5 are annular and therefore suitable for receiving screws. The bridges 4 have a rectangular cross-sectional profile. Therefore, they only bend slightly parallel to the longitudinal direction (L) even under very strong forces. However, perpendicular to the longitudinal direction (L), the bridges 4 are flexible. In the illustrated embodiment, the tabs 5 are positioned so that screws inserted into them are substantially perpendicular to the longitudinal direction (L) and parallel to the plate surface. However, by bending the bridges 4, it is possible to achieve an inserted screw positioned at an angle not equal to 0° relative to the plate surface. Due to the slight flexibility in the longitudinal direction (L), the screws inserted into the tabs 5 remain stable against lateral forces even when the bridges 4 are bent. The plate is made of titanium or a titanium alloy.

[0088] FIG. 1b shows a cross-section of the plate 1 of FIG. 1a along plane P1. The receptacle 6 intersects plane P1. In cross section, the plate has a straight bottom surface U and a top surface O extending parallel to it. As already explained in relation to FIG. 1a, the plate thickness D along the longitudinal direction L is not constant. The top surface O and the bottom surface U are partially arranged at an angle to each other in the longitudinal direction L (see FIG. 1a, left of plane P1). The receptacle 6 has a partially rounded shape and includes a recess 23 whose surface is concavely curved and has a radius of curvature of approximately 3.5 mm. The recess connects the side wall of the receptacle 6 to the top surface O and is arranged at an angle of approximately 45° on both sides. Rounded edges E', E'' are also arranged on the top of the plate.

[0089] Figure 1c shows a cross-section of the plate 1 of Figure 1a along the plane P2. A recess 2' is arranged in the upper surface O midway between the edges E', E''. The recess 2' is designed as a truncated cone so as to have a trapezoidal cross section. The depth of the recess is 0.3 mm. The diameter of the base of the cone in the plane O is 1 mm as mentioned above. The diameter of the concave surface of the recess is 0.6 mm.

[0090] Figure 2 shows an alternative embodiment of a clavicle plate 1 similar to the plate 1 shown in Figure 1a. Unlike the plate 1 shown in Figure 1a, the plate shown does not have tabs (4 in Figure 1a) or bridges (5 in Figure 1a).

[0091] FIG. 3a shows a perspective view of the clavicle plate of FIG. 1a with screws 3 inserted into the screw holes 7. In the illustrated embodiment, the screw holes are of a variable-angle design, allowing the screws to be oriented over a range of angles. Such variable-angle holes are disclosed, for example, in WO 2006 / 099766. Alternatively, however, the screw holes can be designed as conventional, essentially cylindrical holes with internal threads. In this case, the orientation of the screws 3 substantially corresponds to the orientation of the longitudinal axis of the holes. Furthermore, rectangular holes 8 accommodate angularly unstable screws 3'. Their heads are displaceably mounted within the elongated holes 8, allowing the plate to be displaced along the elongated holes 8 relative to the screws 3'. A screw 3 is inserted into each tab 5. Each tab 5 is connected to the plate via a bridge 4 and is not bent as compared to the embodiment shown in FIG. 1. Therefore, in the illustrated embodiment, the screws are oriented parallel to the lower surface U of the clavicle plate 1.

[0092] Figure 3b shows a bottom view of the clavicle plate 1 of Figure 3a. The transverse screws from the tabs pass between the other screw shafts without contacting them. These transverse screws reduce the risk of screw backout in poor quality bone.

[0093] FIG. 4 shows a perspective view of the clavicle plate 1 of FIG. 2a with screws 3 inserted in the screw holes. The screw holes 7 are here designed for variable-angle screw receptacles, as shown, for example, in WO 2006 / 099766. The screws 3 can be threaded in an angular range of ±15° relative to the neutral position. Of course, one or more of the screw holes 7 may alternatively be shaped with a non-variable angle. The screws 3' in the elongated holes 8 are displaceably mounted and not angularly stable, so that they can be displaced along the longitudinal direction of the plate.

[0094] 5a-5d illustrate a method of using the insert 10 with the clavicle plate 1 shown in FIG. 2a. Of course, the same procedure can be performed with other embodiments of the clavicle plate and / or insert 10 other than those shown herein and / or with different bones. Furthermore, the plate 1 is shown without the bone for overview purposes (see FIGS. 20a-20b). However, this procedure can of course be performed after the screw 3 has been threaded into the bone.

[0095] Figure 5a shows how the thread 9 is first fed through the receptacle 6. The thread 9 may be made of UHMWPE. The thread 9 has two free ends F which are guided from the underside U of the plate through the receptacle 6.

[0096] Figure 5b shows how the thread 9 is then guided through the insert 10. The insert 10 is adapted to be fastened to the thread 9 and, for this purpose, has a submerged strut (not visible) and a rounded outer contour C''. The insert 10 is connected to the holder 12 via a predetermined breaking point 13 (see Figures 6a-6c). The holder has two markings 16 that, on the one hand, indicate to the user which side of the insert 10 should face the same direction as the top of the plate O during insertion, and, on the other hand, carry a serial number. The latter can be retained during treatment, thus allowing for easier documentation of the treatment. This reduces the error rate and therefore increases the safety of the treatment. The thread 9 passes through the insert 10 at one end F on both sides of the strut (see, for example, Figures 6a-6b).

[0097] FIG. 5c shows how the insert 10 is guided into the receptacle 6 of the clavicle plate by means of the retainer 12. The retainer 12 can be removed from the insert 10 by bending it to break a predetermined breaking point 13. The retainer 12 can be stored after removal and allows the inserted insert to be later identified via markings 16, including a serial number. In this case, the inner contour C' of the receptacle 6 is partially molded, while the outer contour C'' of the insert 10 is molded completely cylindrical in cross section, allowing the insert 10 to pivot within the receptacle 6 around the axis of the insert 10 and / or the receptacle 6.

[0098] Figure 5d shows how the thread 9 is finally attached to the insert 10 by means of a knot 15. It is also conceivable to use several knots. If the suture 9 is attached to the coracoid, for example via a further knot or via a loop, this is connected via the insert 10 of the clavicle plate 1 so that the distance between the coracoid and the clavicle remains constant and physiologically accurate.

[0099] Figure 6a shows a bottom view of an insert 10 that can be used in the process according to figures 5a to 5d. The insert 10 is adapted to be fixed with threads and therefore has struts 14 that are sunk and have two openings 11 through which the threads 9 can be passed. , which can then be connected to the strut 14 by a knot or loop. The insert 10 is connected to the holder 12 via a predetermined breaking point 13. The insert 10 is made of a titanium alloy and is integrally connected to the holder 12.

[0100] Figure 6b shows the insert of Figure 6a in a perspective view. The holder 12 has two markings. On the one hand, the marking "TOP" indicates that when inserted into the receptacle 6 of the clavicle plate 1, this side should face in the same direction as the top side of the plate 1. On the other hand, a second marking 16, for example in the form of a serial number or bar code, is provided, which serves to identify the insert 10 before, during and after use.

[0101] Figure 6c shows the insert 10 of Figures 6a and 6b in side view. Figure 6d shows the insert 10 of Figures 6a to 6c in the same side view as Figure 6c. When the predetermined breaking point 13 is broken, the insert 10 and the holder are no longer connected to each other.

[0102] Figure 6e shows the insert of Figure 6c in cross section along the longitudinal axis of the insert 10 and holder 12. The struts 14 are sunken to form two openings 11 through which the thread 9 can be passed.

[0103] FIG. 7 shows a schematic diagram of the holding of the clavicle plate 1 by a tool 17. The tool 17 in this case is a surgical pliers with handles 30′, 30″ that can be grasped with two fingers. The pliers 17 further include a locking ratchet 31 and at least one tip 32. The tip 32 can be inserted into the recess 2′ and is thus prevented from moving relative to the plate 1 by a secure fit. Furthermore, the locking louvers 31 allow the opening of the pliers to be locked in this position, thereby temporarily fixing the plate and eliminating the need for the user, e.g., a physician, to hold the pliers for further treatment. This frees up the hands to, for example, drive the bone screws 3 into the bone through the screw holes 7 with a screwdriver 18.

[0104] Figure 8a shows a top view of the tip 32 of the tool 17 inserted into the recess 2' as shown in Figure 7. Because the pliers are positioned in the recess 2' between the plate holes, bone screws can be threaded into these plate holes without any problems.

[0105] FIG. 8b shows a cross-sectional view of the tool 17 and plate 1 along plane P3 of FIG. 8a. The tool includes two tips 32 that are substantially identical in design. Thus, the tool 17 can be inserted into the recess 2' with both tips 32. Alternatively, it is possible to implement one side of the tool with different ends. For example, a shallow gripper can be used to grasp tissue while reducing damage to the tissue.

[0106] 8c shows a non-inventive method for holding plate 1 with a tool, in which the tip 32 of the tool is inserted into screw hole 7 to temporarily fixate plate 1. This does limit movement of plate 1 relative to tool 17. However, some movement is still possible because screw hole 7 has a size and shape that does not fit tool 17. Furthermore, screws 3 cannot be inserted into used screw holes 7, at least temporarily.

[0107] 8d shows another method for holding the plate 1 on the tool, not according to the invention. Here, the tip 32 is placed on top of the plate 0. The plate 1 and the tool 17 are connected only by a frictional connection. Therefore, the plate 1 can easily slip. Furthermore, the tip 32 and the plate can be damaged, for example scratched.

[0108] FIG. 9a shows a second embodiment of an insert 20 in a top view. The insert is adapted to receive a screw. For this purpose, it has an opening 21 through which the screw can be inserted. The insert 20 is connected to a holder 12 via a predetermined breaking point 13 having two markings 16. The holder 12 essentially corresponds to the holder of FIG. 6a.

[0109] Figure 9b shows the insert 20 of Figure 9b in a perspective view. The opening 21 for the screw receptacle is here designed without a thread. However, it is naturally conceivable that the opening could have an internal thread or another profile for an angularly stable screw receptacle, in particular a receptacle according to WO 2006 / 099766. The opening has an essentially cylindrical shape and is also designed as a blind hole 24.

[0110] Figure 9c shows the insert of Figures 9a and 9b in side view. The blind hole 24 is molded so that the insert 20 has a recess in side view.

[0111] FIG. 9d shows the insert 20 of FIGS. 9a-9c with the predetermined breaking point 13 broken, thus separating the holder 12 from the insert 20. FIG.

[0112] FIG. 9e shows the insert of FIGS. 9a-9d in a cross-sectional view along the longitudinal axis of the holder 12 and insert 20. FIG.

[0113] 10a-10e schematically illustrate a method for using the insert 20 of FIGS. 9a-9e with the screw 3' having the clavicle plate 1 shown in FIG. 2a. Of course, the same procedure can be performed with other embodiments of the clavicle plate 1 and / or insert 20 other than those shown herein, and / or with other bones other than those shown herein. Furthermore, the plate 1 is shown without bone for overview purposes (see FIGS. 20a-20b). This procedure is typically performed after the screw 3 has been threaded into the bone.

[0114] Figure 10a shows the plate 1 with screws 3 threaded into the screw holes 7, 8. The insert 20 is essentially the same as in Figures 9a to 9e.

[0115] Figure 10b shows how the insert 20 is inserted into the receptacle 6 provided for this purpose. The marking 16 indicates how the insert must be oriented, i.e., the "TOP" marking 16 faces in the same direction as the top surface O of the plate 1. However, it is possible to rotate the insert 20 within the receptacle 6. In this case, the opening 21 can be oriented so that the screw 3 inserted therein can be screwed into the bone at the desired angle. By bending the holder 12, the predetermined breaking point 13 can be broken, and the insert 20 is thus separated from the holder 12.

[0116] FIG. 10 c shows how the screw 3 ′ is inserted into the opening 21 of the insert 20 .

[0117] FIG. 10d shows the screw 3' fully inserted into the opening 21 of the insert 20. Figure 10e shows a cross section of the insert 20, screw 3' and plate 1 of Figure 10d in plane P4. The insert 20 is pivoted in the receptacle 6 so that the screw 3' is oriented at an angle to the plate 1. The opening 21 of the insert 20 is designed so that the screw 3' has clearance within the opening 21 and can also pivot relative to the opening 21 and the insert 20 if necessary. This is especially true for screws larger than the shaft of the screw 3'. This can also be achieved by an opening having a large diameter.

[0118] FIG. 11a shows various receptacles L1, L2, L3, L4, L5, L6, L7, and L8. These are not shown on the clavicle plate 1 for better illustration and overview. However, any of the illustrated receptacles L1, L2, L3, L4, L5, L6, L7, and L8 can be combined with any of the clavicle plates 1 described herein, particularly those of FIGS. 1a and 2a, and are suitable for receiving inserts 10 and 20. Receptacles L1, L2, L3, L4, L5, L6, L7, and L8 are shown below in plan view. Directly above, cross sections of each receptacle L1, L2, L3, L4, L5, L6, L7, and L8 are shown in plane P5. All receptacles L1, L2, L3, L4, L5, L6, L7, and L8 are rounded at two ends B'. On the other hand, the intermediate portion B'' has a straight portion in plan view, in particular having two mirror-symmetric side walls.

[0119] All receptacles L1, L2, L3, L4, L5, L6, L7, L8 have in common that the inner wall I is at least partially tapered from the top to the bottom, and the end B' is rounded, while the middle part B'' is straight in plan view with mirror-symmetrical sides.

[0120] The receptacle L1 has a trapezoidal cross section in the central region B''. The inner walls I of the central region B' are shaped as straight surfaces that are angled relative to one another so as to taper from the top surface O to the bottom surface U. The inner walls I of the central region B'' are shaped as straight surfaces that are angled relative to one another so as to taper from the top surface O to the bottom surface U. Thus, the receptacle L1 has a prism-like shape in the central region B''.

[0121] Receptacle L2 does not have a tapered shape in the region adjacent bottom surface U. Instead, the inner walls I of central region B'' are partially shaped parallel to one another (in the region adjacent bottom surface U). Directly above this, in the region adjacent top surface O, the receptacle has essentially the same shape as receptacle L1.

[0122] The receptacle L3 has a partly spherical and partly cylindrical inner surface I. The radius of curvature of the spherical inner surface I corresponds to the radius of curvature of the outer contour C'' of the insert 1 (see Figure 11b).

[0123] The receptacle L4 has a cross section corresponding to two rectangles. The rectangle on the top surface O is wider. The two regions of different width are separated by a boundary plane parallel to the top surface O. The two rectangles are located on the same plane.

[0124] Receptacle L5 is similar to receptacle L4, but the two regions of different widths are separated by an interface that is not parallel to top surface O.

[0125] Receptacle L6 is similar to receptacle L3, except that the radius of curvature of the spherical inner surface I is different from the radius of curvature of the outer contour C'' of the insert.

[0126] Receptacle L7 is similar to receptacles L4 and L5, with two regions of different widths separated by an oval cross section.

[0127] The cross-sectional shapes shown here are merely exemplary and other shapes are possible, particularly hyperbolic, parabolic and / or multi-step designs.

[0128] FIG. 11b shows the receptor of FIG. 11a with an insert 20 for receiving a screw. 9a, 9b, and 9c show receptacles L1, L2, L3, L4, L5, L6, L7, and L8. The illustrated exemplary insert 20 corresponds to the insert 20 of FIG. 9a, but any of the inserts 10, 20 described herein is suitable for use with any of the receptacles 6, L1, L2, L3, L4, L5, L6, L7, and L8 shown. The outer contour C'' of the insert 20 is rounded. A cross section perpendicular to the longitudinal axis of the insert 20 is a segment of a circle because the insert 20 includes a substantially linear milled portion 37. Thus, the rounded outer contour C' of the insert 20 is matched to all of the illustrated inner contours C'' so that the insert 20 can pivot in a plane perpendicular to the longitudinal axes of the insert 20 and the receptacles L1, L2, L3, L4, L5, L6, L7, and L8. Furthermore, the insert is slidable along the longitudinal axis of the receptacle 6 and cannot slide through the receptacle.

[0129] Alternatively, inserts 10, 20 having a different shape, for example an angular shape, can be inserted into the receptacles L3, L6, L7 shown in Figures 11a and 11b. Thanks to the partly rounded inner contour C' of the receptacles L3, L6, L7, pivotability is guaranteed.

[0130] Figures 12a to 12l show various inserts 10 for thread fixation that are suitable for receptacles in screw holes 7 according to WO 2006 / 099766. The use of the inserts shown in Figures 12a to 12l therefore does not require a specially adapted receptacle 6.

[0131] The inserts 10 shown in Figures 12a to 12l are adapted to be screwed into conventional screw holes in a plate. For this purpose, they have a locking area according to WO 2006 / 099766 and a receptacle for a tool. Preferably, the receptacle is designed as a Torx® drive. The inserts 10 are adapted to hold a thread and preferably have at least one hole and / or head with an undercut for this purpose. Preferably, the interlocking area is shaped so that, when screwed in, there is at least one area with a distance to the inner shape of the screw hole through which the thread can be guided. Preferably, the head has at least one recess through which the thread can be guided. In particular, such inserts allow the thread to be fixed by a knot, which is then sunk into the screw hole.

[0132] FIG. 12a shows an embodiment of an insert 10 having a coupling region 19 for receiving a variable-angle screw hole 7, as shown in WO 2006 / 099766. The insert 10 can therefore be inserted into the screw hole at different angles. It comprises a head 22 and an adjacent neck 25, which comprises a centering collar to which a thread can be attached and which is connected to the coupling region 19 via a cylindrical section. In this embodiment, the thread is guided over the plate edge. The insert shown here has a centering collar 39 on its underside. This allows the insert to align itself in the hole according to the hole axis, reducing the risk of the tip becoming dislodged when the thread is pulled.

[0133] Figure 12b shows an insert 10 similar to that shown in Figure 12a. In this case, the neck area is spherical. In this version, the thread is guided over the plate edge. In contrast to the design shown in Figure 12a, the insert shown here does not have a centering collar.

[0134] Figure 12c shows another embodiment of the insert 10 for thread fixation. It comprises a head 22 and a curved neck 25 directly adjacent to the connecting portion 19. Thus, the insert shown 10 lacks a cylindrical portion (see Figures 12a and 12b), allowing the thread held in the neck 25 to be sunk into the screw hole 7 as needed. The head 22 includes six recesses 26 through which the thread can be threaded, particularly when the insert is sunk. In this embodiment, the thread can be guided over the edge of the plate.

[0135] Figure 12d shows an insert 10 similar to that shown in Figure 12c. The head 22 has four recesses and a slot 27. The insert is drilled, i.e., sutures can be threaded through the bone. The slot 27 allows the suture to pass by the side of the screw driver blade as the insert is screwed into the plate hole, and then the suture can be secured to the neck of the insert.

[0136] 12e shows an insert 10 similar to that shown in FIG. 12, further comprising two holes 28. The two holes are symmetrical with respect to plane P6 and extend parallel to plane P6 in the connecting region 19. In the neck 25, the holes 28 are perpendicular to the holes in the connecting portion 19, making the insert 10 suitable for receiving a thread through one hole 28, which can then be wound around the neck 25 and exit through the other hole 28. Similarly, this arrangement allows for the insertion of a screwdriver blade.

[0137] Figure 12f shows an insert 10 used for a non-locking, variable angle placement in a threaded hole 7 (as shown in WO 2006 / 099766). Thread fixation can be achieved by passing the thread laterally through the insert 10 between two interlocking portions 29. By fixing the insert 10 to a plate (not shown) by the interlocking portions 19, the thread is held laterally and can be held above the insert by, for example, a knot.

[0138] Figure 12g shows an insert 10 similar to that shown in Figure 12f, which further includes a collar 30 for better gripping the insert during manufacture on the machine.

[0139] Figure 12h shows an insert 10 similar to that shown in Figure 12g, which further has a recess 31 in the collar 20, which allows the thread to be inserted into the thread hole 7 after screwing in and thus guided into the part 29 between the connecting regions without causing damage.

[0140] Figure 12i shows an insert 10 similar to that shown in Figure 12f, which further includes a recess 38 milled into the connection area 19 for better gripping during machining.

[0141] FIG. 12j shows a further embodiment of an insert 10 that can be inserted into a conventional screw hole 7 for thread fixation. It is connected to a holder 12 via a predetermined break point 13. It is formed by laser cutting as a notch from a metal sheet and further comprises markings 16 that serve to orient the insert 10 in the screw hole 7.

[0142] Figure 12k shows an insert 10 designed essentially similarly to the insert 10 shown in Figure 12i, which further comprises a holder 12 that can be bent away from the insert 10 for separation.

[0143] Figure 12l shows an insert 10 similar to that shown in Figure 12j. The holder 12, 12' comprises two parts, each connected to the insert 10 via a predetermined break point 13, 13'. The two-piece holder 12, 12' is formed from a sheet by laser cutting.

[0144] The insert of Fig. 12l has two holders. Together, the holders preferably form a guide for a thread that can be held on the insert. Both holders are connected to the insert via a predetermined breaking point so that they can be broken independently of each other. Preferably, the insert has a recess that can receive the thread. Particularly preferably, the thread in the recess cannot be removed without force.

[0145] FIG. 13 illustrates schematically the use of the insert 10 of FIG. 12 for suture fixation in a conventional screw hole 7 of a clavicle plate.

[0146] The clavicle plate 1 has a plurality of screw holes 7 as well as an elongated hole 8 . The insert 10 in Figure 12f is inserted at position X. Alternatively, the inserts in Figures 12g to 12l can be used as well. This secures two threads 9, 9', each inserted as a thread loop into the plate hole from one side. After threading into the insert, they are protected from loss, and the threads 9 are guided over the plate edge and can be knotted, for example. The thread 9' is secured in the plate hole in the same way but in the opposite direction, so they are not guided over the plate edge. Alternatively, the threads 9, 9' can be guided through the bone, protected from loss by the insert in the plate hole, and tied onto the insert.

[0147] In position Y, the insert 10 of FIG. 12a is inserted. The thread 9'' is provided with a loop fixed in the neck region 25 of the insert 10. For a better overview, the insert 10 is shown in a fully unthreaded state. By threading it further, the thread 9'' can be pressed against the top of the plate O. The thread 9 is guided over the top of the plate O and one edge of the plate 1.

[0148] The insert 10 in Figure 12c is threaded in at position Z. For a better overview, the insert is shown without threads.

[0149] Figures 14a-14h show schematically how the insert 10 of Figure 12l can be used. 14a shows two sutures 9 being fed along a first portion of the one-piece holder 12, 12', which includes two notches, into the side of the insert 10, each through an insertion slot. Each insertion slot is formed between the two pieces of the holder 12, 12'. At this point, the sutures 9 are already held in the bone and may have passed through the clavicle and clavicle plate (not shown).

[0150] FIG. 14 b shows how the thread 9 is guided close to the insert 10 . Figure 14c shows how the insert 10 is positioned relative to the clavicle plate 1 so that it is positioned over the desired screw hole 7. The threads 9 are tightened so that they snap onto the insert 10. The insert 10 is positioned so that the markings 16 face upward (from the bottom of the plate to the top of the plate O).

[0151] FIG. 14d shows how the blade 18 of the screw driver is inserted into the insert.

[0152] FIG. 14e shows the first piece 12 of the holder being broken at a predetermined breaking point 13 and removed.

[0153] Figure 14f shows how the second piece 12' of the holder is also broken off at another predetermined breaking point 13' and removed. The insert 10 is held in this position with the help of the blade 18. It is possible.

[0154] FIG. 14g shows how the blade 18 is used to thread the insert 10 into the desired threaded hole.

[0155] Figure 14h shows the plate 1 onto which the inserts 10 are screwed, so that the threads 9 are guided laterally past the inserts. They can be held above the inserts, for example, by knots (not shown).

[0156] 15 shows another embodiment of an insert 10 for thread fixation in a conventional threaded hole, which includes a holder 12 connected to the insert 10 via a predetermined break point 13. This is shaped to press fit into the threaded hole along the longitudinal axis of the holder.

[0157] 16a-16d show schematically how the insert 10 of FIG. 15 can be used. FIG. 16a shows how, in a first step, two threads 9 are threaded through the screw holes 7.

[0158] FIG. 16b shows how the insert 10 is guided towards the threaded hole 7 between the two threads.

[0159] 16c shows the press-fitting of the insert 10 into the threaded hole 7, whereby it is firmly and rotatably fixed in said threaded hole 7. During the press-fitting, the insert 10 is compressed and is then frictionally held in the plate hole 7. The steps shown here are particularly suitable for removing the retainer 12 by breaking the predetermined breaking point 13.

[0160] Figure 16d shows the plate 1 with the insert 10 inserted after removal of the holder. The two threads 9 can be tied together by a knot on the insert 10 and can thus be wrapped around the insert 10 so that the threads 9 are held on the insert 10. At the same time, the tension on the threads prevents the insert from slipping out of the plate hole.

[0161] FIG. 17a shows a further embodiment of an insert 10 for thread fixation in side view, top view, and perspective view. The illustrated insert is adapted for use in a specially designed receptacle (e.g., example 6 in FIG. 1a). The insert 10 includes a retainer 12 connected to the insert 10 by a predetermined break point. The insert is substantially flat in design and has a partially rounded shape. The insert 10 has two holes 11 through which the thread can be passed. At the predetermined break point 13, the insert has a recess 35 in the direction of the holes 11. As a result, the surface irregularities resulting from the break at the predetermined break point 13 are recessed and do not come into contact with the receptacle for the insert 10.

[0162] Figure 17b shows another variant of the insert 10, designed without a holder. However, it is conceivable to equip this insert with a holder, for example connected via a predetermined break point. The illustrated insert 10 is similar to the one shown in Figure 17a. In addition to the missing holder, this insert also has a lateral recess 34 compared to the one shown in Figure 17a, in which recess the insert can be gripped by a tool (tweezers or other holding tool).

[0163] FIG. 18a shows a further embodiment of an insert 10 for thread fixation in a bottom view. The insert 10 is similar to the insert 10 of FIGS. 6a to 6e. However, it includes spherical portions 36′, 36″ at the ends. The spherical portions 36″ are detachable via a predetermined breaking point 13. The struts 14 are connected to the support by a pair of flattened threads 11. The struts 14 form two openings 11 through which a thread (not shown) can be passed. The struts 14 are flush with the surface of the insert 10 on their underside. The insert also has no flattening on its top surface.

[0164] Figure 18b shows the insert 10 of Figure 18a in a perspective view. Figure 18c shows the insert of Figure 18a in side view.

[0165] Figure 18d shows the insert of Figure 18a in cross section in a plane parallel to the longitudinal axis of the insert 10 and the holder 12. The struts 14 are sunken and form two openings 11 through which the thread 9 can be passed.

[0166] Figure 18e shows a detailed view of the insert 10 of Figure 18a. Figure 18f shows a cross-section of the insert 10 of Figure 18a in plane P7 (see Figure 18e) with one of the openings 11 for the passage of a thread. The opening 11 is substantially cylindrical. The insert 10 has a substantially circular cross-section. However, it is also conceivable to form one side of the insert 10 in a straight line so that the cross-section has the shape of a segment of a circle (as is the case for example with the inserts of Figures 6a to 6e).

[0167] Figure 18g shows a cross section of the insert 10 of Figure 18e in a plane P8 passing through the struts 14. The struts 14 are formed flush with the outside of the insert 10 and are sunk.

[0168] Figure 19a shows another variant of an insert 20 for fixing a screw, which is here designed without a thread and has an opening 21 adapted to accommodate the receptacle of the screw. It is connected to the holder 12 via a predetermined break point 13.

[0169] Figure 19b shows the insert 20 of Figure 19a in a perspective view. The insert 20 is similar to that of Figures 9a-9e. However, like the insert 10 of Figures 18a-18g, it has a substantially circular cross-section in a plane perpendicular to the longitudinal axis of the holder 12 and the insert 20. Similarly, the insert does not have a flattening on its upper surface. The opening 21 is shaped to have a recess 24 on its upper surface so that the opening 21 is shaped as a countersink for a screw.

[0170] Figure 19c shows the insert 20 of Figure 19a in side view. FIG. 19d shows the insert 20 of FIG. 19a in cross section in a plane perpendicular to the longitudinal axes of the holder 12 and the insert 20. FIG.

[0171] FIG. 20a shows the clavicle plate 1 of FIG. 1a screwed into a human clavicle B. The plate 1 is fixed with nine screws 3 in the screw holes 7. Two screws 3 are fixed in the bone via each tab 5, and another screw 3' is fixed via the oblong hole 8. The treatment shown here was performed without the use of inserts 10, 20. However, it is conceivable to insert the inserts 10 into receptacles 6 adapted for this purpose and fix sutures thereto, or to screw further screws 3 into the bone B via the inserts 20.

[0172] FIG. 20b shows the clavicle plate 1 of FIG. 20a, with bone B shown transparent for clarity.

Claims

1. A kit comprising at least one insert (10, 20) and a plate (1) for treating a bone, in particular a clavicle (B), the plate (1) having a receptacle (6) for said insert (10, 20), - said insert (10, 20) has an outer contour (C''); - said receptacle (6) has an inner contour (C'); - said outer contour (C'') and said inner contour (C') are adapted to one another in such a way that said insert (10, 20) inserted in said receptacle (6) can pivot about an axis substantially parallel to the plate upper surface (O).

2. 2. The kit according to claim 1, wherein the outer contour (C'') of the insert (10, 20) and / or the inner contour (C') of the receptacle (6) has an at least partially rounded, in particular an at least partially rotationally symmetrical shape, preferably at least partially, in a cross section perpendicular to the longitudinal axis, a cylindrical, stepped cylindrical, conical, elliptical, hyperbolic or parabolic shape.

3. 10. A kit according to any one of the preceding claims, wherein the outer contour (C'') and the inner contour (C') are adapted to one another so that the insert (10, 20) inserted in the receptacle (6) is displaceable in the longitudinal direction (L) of the plate.

4. 10. A kit according to any one of the preceding claims, wherein the insert (10) comprises at least one strut (14), preferably exactly one strut (14), for holding the thread (9).

5. The kit of claim 4, wherein the at least one strut (14) is submerged.

6. 4. A kit according to any one of claims 1 to 3, wherein the insert (20) has an opening (21) for receiving a screw (3).

7. 10. A kit according to any one of the preceding claims, wherein the insert (10, 20) comprises a holder (12) and is connected thereto via at least one predetermined breaking point (13).

8. 10. A kit according to any one of the preceding claims, wherein the plate has at least one recess (2) on its upper surface, which does not penetrate the plate (1) and is adapted to temporarily receive a tool (17), preferably pliers.

9. 9. The kit of claim 8, further comprising a tool (17), preferably pliers, said tool (17) having at least one tip (32) sized to operably engage said recess (2) in said plate.

10. An insert (10, 20) to be received in a bone plate, said insert (20) comprising at least one opening (11, 21), said opening (11, 21) adapted to receive a screw (3) or to fix a thread, said insert being connected to at least one holder (12) via a predetermined breaking point (13).

11. A plate (1) for the treatment of, in particular, the clavicle (B), in particular for a kit according to any one of claims 1 to 12, comprising at least one screw hole (7) for receiving a bone screw (3). ) and having at least one protruding tab (5) at one end.

12. 12. The plate (1) according to claim 11, wherein the at least one tab (5) is connected to the plate (1) via at least one bendable bridge (4), the tab (5) having a receiving opening for a bone screw (3).

13. 13. The plate (1) according to claim 12, wherein the plate has a greater plate thickness in the region of the at least one screw hole (7) than in the region of the bridge (4).

14. 14. The plate (1) according to any one of claims 12 to 13, wherein the tabs (5) are shaped such that the angle between the longitudinal axis of the receiving opening for the bone screw (3) and the normal to the surface of the plate is at most 150°, preferably at most 120°, particularly preferably at most 90°.

15. A plate (1) for treating a bone (B), in particular for treating a clavicle (B), in particular for a kit according to any one of claims 1 to 9, preferably a plate (1) according to any one of claims 11 to 14, having at least one screw hole (7) for receiving a bone screw (3), further comprising an upper surface (O) and a bottom surface (U), the bottom surface (U) of the plate (1) being adapted in shape to contact the bone (B), and the plate (1) having at least one recess (2) on its upper surface (O) adapted to temporarily receive a tool (17) without penetrating the plate (1).

16. 16. The plate (1) according to claim 15, wherein the at least one recess (2) is located between the screw holes (7), preferably midway between the screw holes (7), with respect to the longitudinal direction (L) of the plate (1).

17. 17. A plate (1) according to claim 15 or 16, wherein the at least one recess (2) is arranged on the plate surface in a transverse direction perpendicular to the longitudinal direction (L) substantially centrally relative to the outer boundary of the plate (1).

18. 18. Plate (1) according to any one of claims 15 to 17, wherein the recess (2) has a longitudinal axis and is substantially rotationally symmetrical about said longitudinal axis.

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