Device for treating fractures

Abstract

The present invention relates to a device (1) for treating fractures, in particular fractures of the proximal femur, such as, for example, femoral neck fractures, comprising a plate (3) for attachment to the femur, one or more intraosseous screws (10) by means of which said plate (3) can be fixed to the femoral shaft (4) through an intraosseous screw opening (14), a coupling device, in particular a bone screw (5), arranged proximally with respect to said at least one intraosseous screw (10) by means of which said plate (3) can be coupled to the femoral head (7) through the femoral shaft (4) and femoral neck (2) at a coupling device opening (6), said coupling device being coupled to said plate (3) with clearance (21), such that said coupling device can be moved in the lateral direction (8) relative to said plate (3). In order to achieve a particularly precise and simultaneous adjustability of the clearance (21), according to the invention an adjustment device is provided which is coupled to the plate (3) and which can be positioned in different positions relative to the plate (3), by means of which the clearance (21) can be adjusted.

Description

[Technical field]

[0001] The present invention relates to a device for treating fractures, in particular fractures of the proximal femur, such as, for example, femoral neck fractures, comprising a plate for attachment to the femur, one or more intraosseous screws by means of which the plate can be fixed to the femoral shaft through an intraosseous screw opening, a coupling device, in particular a bone screw, arranged proximally relative to said at least one intraosseous screw by means of which the plate can be coupled to the femoral head through the femoral shaft and femoral neck at a coupling device opening, said coupling device being coupled to the plate with clearance, such that said coupling device can be moved in the lateral direction relative to the plate. [Background technology]

[0002] Devices of the type described in the introduction are known from the prior art for treating fractures of the femoral neck by connecting one side of a bone plate to the femoral shaft using an intraosseous screw and then connecting the femoral head to the plate via a connecting device, usually designed as a bone screw. In this connection, a mobile connection between the connecting device and the plate is advantageous to promote the healing process. It has therefore been found that small movements and compressions in the contact area between the fractured parts, i.e. usually in the region of the femoral neck, are advantageous to aid the healing process, but at the same time it is also important to prevent the bone parts from sliding too far against each other.

[0003] However, devices known from the prior art, in particular those utilizing "barrel" and / or "telescopic" screws, for example as known from WO2007 / 109302 A2, have proven to be cumbersome. Summary of the Invention

[0004] This is where the invention comes in. The aim of the invention is to propose a device of the kind described in the introduction, which is not only simple to operate but also particularly advantageous for the healing process.

[0005] This object is solved according to the invention by a device of the kind described in the introduction, in which an adjustment device is provided which is connected to the plate and which can be placed in various positions relative to the plate in order to adjust the clearance.

[0006] Due to the inventive design of the device, it has been found that as a result it is no longer necessary to use telescopic screws or the like, but in the context of the present invention, a robust structure and at the same time a simple way for adjusting the clearance can be obtained instead simply by means of a corresponding adjustment device, which at the same time may be designed in a wide manner in order to influence the amount of clearance within which the coupling device is movable relative to the plate.

[0007] It is advantageous if the adjustment device is substantially rigidly connected to the plate in the lateral and medial directions. This can be achieved, for example, by means of an adjustment device consisting of an adjustment screw which can be screwed into the plate, by means of which the mobility of the connection device relative to the plate can be adjusted. The clearance of the connection device relative to the plate can be adjusted by the screw-in depth of the adjustment screw.

[0008] It is particularly advantageously provided that the coupling device has a first stop surface which cooperates with a corresponding surface on the adjustment device and / or the plate such that the mobility of the coupling device relative to the plate in the inward direction is limited by the first stop surface, and the coupling device may consequently be moved inwardly relative to the plate until the device bears against the first stop surface, such that the inward end position of the coupling device relative to the plate is defined by the first stop surface.

[0009] In principle, the first stop surface may be designed in any way such that it bears against the adjustment device and / or the plate in the inward direction at a predefined position of the coupling device, thereby preventing any further movement in the inward direction. To this end, the stop surface may be aligned either perpendicularly to the longitudinal axis of the coupling device, along which said coupling device is movable relative to the plate, or at an angle to the longitudinal axis, in order to achieve a particularly low surface pressure.

[0010] For example, it may be provided that the coupling device has a lateral collar that forms a limit stop in cooperation with the plate, and that the coupling device can be advanced in the medial direction within the plate up to the limit stop. The coupling device may then simply be used as a traction bolt to pull the femoral head against the plate. The coupling device then has, for example, a collar or shoulder at one lateral end that is designed to be larger than the coupling device opening, so that the coupling device can only be advanced in the plate in the medial direction up to the collar.

[0011] It is advantageous if the coupling device has a second stop surface against which the adjusting device bears when the coupling device is in a lateral end position. In this way, by simply changing the position of the adjusting device relative to the plate, a change is brought about in the distance between the stops and therefore the clearance can be altered.

[0012] The second stop surface may be formed by only a single surface, which provides contact between the coupling device and the adjusting device in the lateral end position. However, it may be provided that the second stop surface is formed by several surfaces acting in parallel and limiting the mobility in a particularly effective manner. It has therefore been found that, in particular when only a single second stop surface is used, which bears against the inwardly threaded end of the adjusting device, there is a risk that the adjusting device may slide along the coupling device and / or may screw itself via the thread into the second stop surface on the coupling device, resulting in less restriction of the mobility than intended. In particular, it may be provided that the second stop surface is formed by two or three limit stops or contact surfaces acting in parallel, for example by a primary, a secondary and a tertiary second limit stop. In such a case, the primary second limit stop may for example bear against the lateral end of the adjusting device, the second limit stop may for example bear in the middle of the adjusting device and the tertiary second limit stop may bear against the adjusting device in the region of the inwardly end of the adjusting device.

[0013] It is advantageous if at least a part of the second stop surface is formed by a lateral second stop surface, which in the lateral end position at least partially bears against a shoulder or collar of the adjusting device in the region of the lateral end of the adjusting device, in particular an adjusting screw collar. The collar, preferably designed as an adjusting screw collar, may be arranged at the lateral end of the adjusting screw and may have a larger diameter than the other adjusting device, so that in the lateral end position the coupling device bears against the adjusting device, in fact against the lateral end of the adjusting device. In this case the second stop surface on the coupling device may be arranged in a recess in the lateral periphery of the terminal end in order to obtain a corresponding form lock with the collar on the adjusting device.

[0014] It is preferably provided that at least a part of the second stop surface is formed by an inward second stop surface on the coupling device, at least a part of which bears against the thread of the adjusting device in a lateral end position, in particular the inward end of the thread on the adjusting device can thus act as a limit stop for the corresponding surface of the coupling device in order to limit the mobility of the coupling device in the lateral direction.

[0015] It has been found to be advantageous if the adjustment device is connected to the plate by a screw thread, a screw lock, in particular a plastic part, is provided, which increases the friction in the screw thread and prevents the adjustment device from being removed. In this simple way, unintentional removal of the adjustment device from the plate is prevented.

[0016] In order to provide a simple way to prevent mistakes due to screwing too deeply when embedding the device, it is preferably provided that the adjustment device can only be screwed into the plate up to a predefined position, which is particularly realized by design using a wrench, preferably an Allen wrench, so that beyond the predefined position of the adjustment device, contact with a corresponding counterpart, in particular an internal hexagon in the adjustment device, is no longer produced.

[0017] It is advantageous if the coupling device is movable between limit stops between an inward end position and a lateral end position, the inward end position being defined by a first stop surface on the coupling device in cooperation with the adjustment device, and the lateral end position being defined by a second stop surface in cooperation with the adjustment device. The adjustment device thus simply defines a limit stop that limits the mobility of the coupling device. As a result, both the end position and the clearance position can be adjusted in a simple manner.

[0018] It has been found to be advantageous for the first and second stop surfaces to be arranged at stop surface angles relative to each other, in particular at different angles relative to the adjustment direction along which the adjustment device is movable relative to the plate, in particular at stop surface angles of 10° to 160°, preferably 60° to 120°, relative to each other, so that the movement of the adjustment device along the adjustment direction has different effects on the lateral end position and the inward end position. Thus, not only the position of the limit stops but also the clearance, i.e. the mobility of the coupling device between the limit stops, can be changed by changing the position of the adjustment device. In particular, if the stop surfaces are approximately parallel to the adjustment direction, the position of the adjustment device along the adjustment direction does not change the limit stops formed by the corresponding stop surfaces and / or the corresponding end positions.

[0019] Therefore, for example, if the end position in the inward direction is defined by a first stop surface, associated with the adjustment device, that is approximately parallel to the adjustment direction, a change in the position of the adjustment device along the adjustment direction does not change the end position in the inward direction.

[0020] It is advantageous if the second stop surface is approximately perpendicular to the adjustment direction and the first stop surface is approximately parallel to the adjustment direction, in particular the adjustment direction being aligned at an angle of 0.5° to 15°, preferably 0.8° to 2°, to the longitudinal axis of the coupling device, so that movement of the adjustment device along the adjustment direction causes a displacement of the second limit stop but not of the first limit stop, which provides a simple way to change the clearance.

[0021] It is particularly preferably provided that the adjustment device is embodied as an adjusting screw and the coupling device is embodied as a bone screw, the longitudinal axis of the adjusting screw being aligned at an angle (α) of 0.5° to 15°, in particular 0.8° to 2°, with respect to the longitudinal axis of the bone screw. In this way, in particular, the clearance can be modified simply by the interaction between these two screws. At the same time, a robust and easily manageable design is produced. The adjusting screw and the bone screw are usually arranged adjacent to each other and preferably project through a common opening in the plate. This allows the stop surface between the adjusting screw and the bone screw, which limits the clearance of the bone screw relative to the plate, to be realized in a structurally simple and compact manner.

[0022] It has been found to be advantageous for the adjustment device to be embodied as an adjustment screw which is arranged on a thread in the plate and can be variably positioned by the thread. The thread is preferably self-locking. The adjustment device is therefore movable laterally and inwardly only by rotation, and not by pressure in the respective laterally or inward direction. In this way, the clearance can be adjusted particularly precisely.

[0023] The adjustment device is therefore preferably variably positionable relative to the plate along the adjustment direction, in particular along the thread axis.

[0024] It is particularly advantageous if the adjustment direction is aligned at an angle of 0.5° to 10°, in particular 0.8° to 2°, to the longitudinal axis of the coupling device, the adjustment direction and the longitudinal axis of the coupling device preferably being in the same plane. This allows a particularly accurate adjustment of the clearance. A first stop surface, which is particularly simple in design, can then be realized, on which the coupling device rests in its end position in the inward direction on an adjustment device aligned at a corresponding angle to the longitudinal direction of the coupling device, and on which the coupling device rests on the adjustment device, so that here, thanks to the small angle, a particularly low surface pressure is achieved. This ensures a particularly good stability.

[0025] It is preferably provided that the connecting device has a shoulder, in particular adjacent to the chamfered area, which forms a second stop surface against which the adjusting device rests at the lateral end position of the connecting device, in particular approximately at the front surface of the adjusting device, in this way the clearance is clearly defined by both stop surfaces.

[0026] It is particularly advantageous if the two stop surfaces are arranged at different angles to the adjustment direction of the adjusting screw along which the adjusting screw can be moved relative to the plate. In this way, the movement of the adjusting screw along the adjustment direction has different effects on the inward and lateral end positions of the connecting device, which allows a simple adjustment of the clearance.

[0027] The adjusting device is preferably embodied as an adjusting screw and therefore usually has an approximately cylindrical envelope surface. With a corresponding chamfered surface on the coupling element, this then creates a line contact between the adjusting device and the coupling device in the region of the chamfered surface, which can act as a first stop surface aligned at an angle, i.e. not perpendicular, to the direction of movement of the coupling device along the longitudinal axis of the coupling device. This ensures a good force transmission at the first stop surface. If the second stop surface is located at the shoulder or at the transition from the chamfered region to, for example, a cylindrical section adjacent thereto, the second stop surface may be aligned approximately perpendicular to the longitudinal axis of the coupling device, as a result of which the movement of the adjusting device along the adjustment direction has a different strength effect on the position of the inward end position usually created by the first stop surface in cooperation with the adjusting device and on the lateral end position usually created by the second stop surface in cooperation with the adjusting device. In this way, the clearance can be easily changed by changing the position of the adjusting device along the adjustment direction, even though both stop surfaces are aligned with the adjusting device.

[0028] The cylindrical section of the coupling device is typically adjacent to the conical section in the inward direction so that a shoulder is created between the conical section and the cylindrical section, which can be used as a second stop surface to limit the mobility of the coupling device in a direction lateral to the plate.

[0029] It is advantageous if the connecting device has a chamfered area and the adjusting device has an outer contour which is cylindrical in at least some areas, the chamfered area forming a first stop surface on the connecting device which cooperates with the approximately cylindrical outer contour of the adjusting device to limit the mobility of the connecting device relative to the plate in the inward direction. The cylindrical outer contour of the adjusting device is obtained, for example, when the adjusting device is formed by an adjusting screw. This ensures a particularly effective force transmission between the connecting device and the adjusting device and enables the limit stop to be easily and robustly adjusted to define the clearance.

[0030] It is particularly preferably provided that the chamfered area is aligned with the longitudinal axis of the coupling device at a chamfer angle, which angle corresponds to the angle at which the adjustment device is aligned with the longitudinal axis of the coupling device, and that the adjustment device is arranged such that it touches the chamfered area. The adjustment device can then be screwed into the plate along the adjustment direction without colliding with the coupling device, so that the position of the lateral end position can be easily changed. The end position in the inward direction is then usually obtained from the dimensions of the adjustment device and the coupling device and can be independent of the position of the adjustment device along the adjustment direction.

[0031] It is advantageous if a traction bolt is provided that is arranged approximately parallel to the longitudinal axis of the coupling device, in particular proximal to the coupling device, and by means of the traction bolt the plate can be coupled to the femoral head through the femoral shaft and femoral neck at the traction bolt opening, preventing rotation of the femoral head relative to the coupling device.

[0032] It is usually provided that the longitudinal axis of the coupling device is aligned with the longitudinal axis of the first screw at a femoral neck angle of 10° to 60°, in particular 35° to 45°. The corresponding angle is obtained by positioning and aligning the coupling device opening and the first opening in the plate, and is optimal for treating femoral neck fractures, since the angle between the femoral neck and the femoral shaft is usually in the region of about 130°.

[0033] It is preferably provided that the coupling device is of hollow construction, so that bone cement can be introduced through the coupling device in the region of the femoral head when the device is placed on the femur.

[0034] It is also preferred if the traction bolt is of hollow construction, so that bone cement can be introduced into the area of ​​the femoral head also through the bolt, if necessary.

[0035] Further features, advantages and benefits of the present invention can be appreciated with reference to the following description of exemplary embodiments. In the drawings, to which reference will be made, the figures show: [Brief description of the drawings]

[0036] [Figure 1] 1 shows various views of a device according to the invention; [Diagram 2] 1 shows various views of a device according to the invention; [Figure 2a] Detail from FIG. [Diagram 3] 1 shows details of the device in various operating states; [Figure 4] 1 shows details of the device in various operating states; [Diagram 5] 1 shows a representation illustrating the operating principle of the device. [Figure 6] 1 shows a representation illustrating the operating principle of the device. [Figure 7] 4 shows further details of an apparatus according to the invention; [Figure 8] 4 shows further details of an apparatus according to the invention; DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0037] Figure 1 shows a cross-sectional representation of a device 1 according to the invention on a femur, including the femoral shaft 4, the femoral neck 2, and the femoral head 7. In Figure 2, this device 1 is represented in a 3D view without the femur.

[0038] In each case it can be seen that a plate 3 is provided which can be attached to the outside of the femur opposite the femoral neck 2 and which can be connected to the femoral shaft 4 by means of an intraosseous screw 10 which protrudes through an intraosseous screw opening 14 in the lower region of the plate 3.

[0039] The coupling device, here in the form of a bone screw 5, and the traction bolt 19 are arranged above and proximal to the intraosseous screw 10, are embodied as axial screws and have threads 15 only in their end regions. This allows the femoral head 7, into which it is screwed, to be pulled against the femoral neck 2 and the femoral shaft 4, so that stabilization of the fracture is achieved. For this purpose, the plate 3 is provided with a coupling device opening 6, through which the bone screw 5 projects, and a traction bolt opening 20, in which the traction bolt 19 passes through the plate 3. At its lateral end, the bone screw has a collar 22, which bears against the coupling device opening 6, so that a limit stop is formed up to which the bone screw can be introduced inwards in the plate.

[0040] The bone screw 5 is connected to the plate 3 with clearance 21 in the medial direction 11 and in the lateral direction 8. The clearance 21 is made possible by the mobility of the coupling device relative to the plate 3 between a first and a second limit stop, each located on an adjustment device formed here by an adjusting screw 9. The adjusting screw 9 has a thread 15 which corresponds to a thread 15 in the plate 3, so that the adjusting screw 9 can be screwed either in the approximately medial direction 11 into the plate 3 along the adjustment direction 16, or out of the plate 3 in the opposite direction, approximately lateral direction 8, influencing the clearance 21 of the bone screw 5 relative to the plate 3 and therewith also the mobility of the femoral head 7 relative to the femoral neck 2.

[0041] The first limit stop is formed by a first stop surface 12 at a chamfered area 17 on the bone screw 5, which is circumferentially supported on the adjusting screw 9 at the inner end position of the bone screw 5. The adjustment direction 16 is therefore not parallel to the longitudinal axis of the bone screw 5, but is arranged at an angle α of about 1.2 degrees thereto. The chamfered area 17 of the bone screw 5 is approximately parallel to the adjustment direction 16, which means that the perpendicular to the chamfered area 17 is approximately perpendicular to the adjustment direction 16, so that the inner end position is independent of the screw-in depth of the adjusting screw 9. Furthermore, the bone screw 5 at the inner end position is supported on the plate 3 via a collar 22 at its lateral end, so that this collar 22 also forms a limit stop and defines the inner end position.

[0042] The second limit stop is formed by a second stop surface 13 in the region of a shoulder of the bone screw 5, which is generated in the area between the chamfered area 17 and the cylindrical section 18 of the bone screw 5. When the bone screw 5 is in its lateral end position, said shoulder bears against the front face of the adjusting screw 9. The lateral end position therefore varies along the adjustment direction 16 with the screw-in depth of the adjusting screw 9. In this way, a change in the position of the adjusting screw 9 relative to the plate 3 leads to a change in the lateral end position of the bone screw 5 and, consequently, to a change in the clearance 21.

[0043] A traction bolt 19 is provided proximally to the bone screw 5 and is also screwed from the plate 3 into the femoral head. This additional traction bolt 19 both stabilizes the femoral head 7 at the femoral neck 2 and prevents rotation of the femoral head 7 around the bone screw 5 and / or coupling device.

[0044] As shown, the bone screw 5 and traction bolt 19 are aligned approximately parallel and at a femoral neck angle γ of about 20 degrees to 40 degrees relative to the intraosseous screw 10 .

[0045] Figure 2a shows an enlarged detail of Figure 1. Here, the circumferential collar 22 is particularly clearly evident, against which the bone screw 5 bears when in its inward end position against the plate, resulting in a limit stop being formed up to which the bone screw 5 can be advanced in the plate 3. As can be seen, the connector opening 6 is smaller than the collar 22, but is sufficiently large to ensure that the bone screw 5 can be advanced through the connector opening 6 in the plate 3 up to the collar 22.

[0046] Figures 3 and 4 show in detail the bone screw 5 and the adjusting screw 9 of the device 1 depicted in Figures 1 and 2. Figure 3 shows the bone screw 5 and the adjusting screw 9 in an end position in the medial direction, i.e. when the distance between the femoral head 7 and the femoral neck 2 is at a maximum. As can be seen, further movement of the bone screw 5 in the medial direction is then not possible, since the bone screw 5 rests on a chamfered area 17 forming a first stop surface 12 on the circumferential area of ​​the adjusting screw 9. However, the bone screw 5 and the femoral head 7 into which the end of the bone screw 5 is usually screwed can be moved in the opposite direction, i.e. laterally 8, out of this position.

[0047] As can be clearly seen here, the first stop surface 12 and the second stop surface 13 are arranged at a stop surface angle δ of about 110 degrees relative to one another. In this context, the first stop surface 12 is oriented approximately parallel to the adjustment direction 16, and the second stop surface 13 is therefore oriented at an angle α of about 110 degrees relative to the adjustment direction 16. As a result, a change in the position of the adjusting screw 9 along the adjustment direction 16 only results in a change to the lateral end position, and not to the inward end position, which is also determined by the collar 22.

[0048] 4 shows the bone screw 5, the adjusting screw 9 in its lateral end position, i.e. when the femoral head 7 cannot be moved closer to the femoral neck 2 and therefore no further movement of the bone screw 5 in the lateral direction is possible. As can be seen, the bone screw 5 in this lateral end position rests against a second stop surface 13 formed by a shoulder on the bone screw 5 approximately at the front face of the adjusting screw 9 threads.

[0049] The chamfer angle β, at which the chamfer area 17 is aligned with respect to the longitudinal axis of the bone screw 5, corresponds approximately to the angle α between the adjustment direction 16 and the longitudinal axis of the bone screw, so that the chamfer area 17 is approximately parallel to the adjustment direction 16. As a result, a change in the screw-in depth of the adjusting screw 9 has no effect on the position of the medial end position. Instead, this position is determined only by the dimensions and the angle α of the bone screw 5 and the adjusting screw 9. However, the position of the lateral end position is determined by the position of the front face of the adjusting screw 9 and therefore changes with the screw-in depth of the adjusting screw 9. As a result, the clearance 21 with which the bone screw 5 is movable with respect to the plate 3 can be easily adjusted by changing the screw-in depth of the adjusting screw 9 via the lateral end position. This adjustability is particularly important for the rapid healing of the corresponding fracture.

[0050] As can be seen in Figures 1, 3 and 4, the bone screw 5 is of hollow design so that bone cement can be introduced therethrough into the region of the femoral head 7, for example, to fix the bone screw 5 therein.

[0051] In this context, Figures 5 and 6 show the effect of the screw-in depth of the adjusting screw 9 on the clearance 21, where for the sake of clarity the dimensions and angles α are not shown to scale. As can be seen, the first stop surface 12 and the inward end position do not change along the adjustment direction 16 with the screw-in depth of the adjusting screw 9 due to the chamfered area 17 of the bone screw 5 being approximately parallel to the adjustment direction 16, but the screw-in depth has a direct effect on the second stop surface 13 which defines the lateral end position. Thus, Figure 5 shows a situation in which the adjusting screw 9 is substantially screwed into the plate 3 (not shown) so that no clearance 21 remains. In this situation, the bone screw 5 rests against both the first stop surface 12 and the second stop surface 13. In the situation shown in Figure 6, the adjusting screw 9 is laterally positioned further outwards or is not screwed into the plate 3 as deeply as shown in Figure 5.

[0052] The adjustment device embodied as an adjusting screw 9 is aligned at an angle α of approximately 1.2 degrees relative to the longitudinal axis of the bone screw 5. The cone angle of the conical region is correspondingly designed, so that a line contact is created between the adjusting screw 9 and the conical region of the bone screw 5, thereby ensuring a particularly good stabilization and transmission of forces. Here too it can be seen that the first stop surface 12 is aligned at a stop surface angle δ relative to the second stop surface 13, which in this case is equal to approximately 90 degrees, as a result of which the effect of a change in the position of the adjusting screw 9 relative to the medial and lateral end positions is different.

[0053] Although in the embodiment a corner or edge is shown at the connection between the first stop surface 12 and the second stop surface 13, it is clear that the first stop surface 12 and the second stop surface 13 may be joined, for example by a radius, and still have a corresponding stop surface angle δ relative to each other. Thus, the bone screw 5 may be easily produced using, for example, either a ball nose cutter or a shank type milling cutter.

[0054] Figures 7 and 8 show details of a further exemplary embodiment of the device 1 according to the invention. This device 1 has two contact surfaces acting in parallel, namely a primary second stop surface 13 on the coupling device, which bears against the inwardly threaded end of the adjusting device in its lateral end position, and a secondary second stop surface 13 formed by a second stop surface 13a on the lateral end of the adjusting device, the latter being shown in the detail of Figure 8 to be formed by a frontal taper and / or a peripheral recess in the coupling device, in this case in conjunction with the bone screw 5, the adjusting screw collar 23, i.e. a region of the adjusting screw 9 having a larger diameter than the rest of the adjusting screw 9. The effect of the two second stop surfaces 13, 13a acting in parallel provides a simple way to prevent unintentional sliding of the adjusting screw 9 along the coupling device, which also ensures that the mobility is limited.

[0055] The device 1 according to the invention allows a particularly simple treatment of femoral fractures, the easily adjustable clearance 21 ensuring particularly effective healing.

Claims

1. 1. A device for treating fractures, in particular fractures of the proximal femur, such as for example femoral neck fractures, comprising a plate for attachment to the femur, one or more intraosseous screws by means of which the plate can be fixed to the femoral shaft through intraosseous screw openings, a coupling device, in particular a bone screw, arranged proximally to the one or more intraosseous screws by which the plate can be coupled to the femoral head through the femoral shaft and femoral neck at a coupling device opening, the coupling device being coupled to the plate with a clearance so that the coupling device can be moved laterally relative to the plate, the device being provided with an adjustment device coupled to the plate which can be positioned in different positions relative to the plate, the clearance being adjustable by means of the adjustment device.

2. The apparatus of claim 1 , wherein the adjustment device is substantially rigidly coupled to the plate in the lateral and medial directions.

3. 3. The apparatus of claim 1 or 2, wherein the connecting device has a first stop surface that cooperates with a corresponding surface on the adjustment device and / or the plate such that the mobility of the connecting device in an inward direction relative to the plate is limited by the first stop surface.

4. 3. The apparatus of claim 1 or 2, wherein the coupling device has a lateral collar which cooperates with the plate to form a limit stop, the coupling device being advanceable inwardly within the plate up to the limit stop.

5. 3. Apparatus according to claim 1 or 2, wherein the coupling device has a second stop surface which bears against the adjustment device when the coupling device is in a lateral end position.

6. 6. The device according to claim 5, wherein at least a part of the second stop surface is formed by a lateral second stop surface which, in the lateral end position, at least partially bears against a shoulder or collar of the adjustment device in the region of the lateral end of the adjustment device, in particular an adjusting screw collar.

7. 6. The device according to claim 5, wherein at least a portion of the second stop surface is formed by an inwardly directed second stop surface on the connecting device, which at least partially bears against the threads of the adjusting device at the lateral end position.

8. 3. The device according to claim 1 or 2, characterized in that the adjusting device is connected to the plate by a screw thread, and a screw lock, in particular a plastic part, is provided which increases friction on the screw thread to prevent the adjusting device from being removed.

9. 3. The device according to claim 1 or 2, characterized in that the adjusting device can only be screwed into the plate up to a predefined position, which is achieved in particular by design using a wrench, preferably an Allen wrench, so that beyond the predefined position of the adjusting device it no longer creates contact with a corresponding counterpart, in particular an internal hexagon in the adjusting device.

10. 3. The device according to claim 1 or 2, characterized in that the coupling device is movable between limit stops between an inward end position and a lateral end position, the inward end position being defined by a first stop surface on the coupling device in cooperation with the adjustment device, and the lateral end position being defined by a second stop surface in cooperation with the adjustment device.

11. 11. The device according to claim 10, wherein the first and second stop surfaces are arranged at a stop surface angle (δ) relative to each other, in particular at different angles relative to the adjustment direction along which the adjustment device is movable relative to the plate, in particular at a stop surface angle (δ) of 10 degrees to 160 degrees, preferably 60 degrees to 120 degrees relative to each other, such that movement of the adjustment device along the adjustment direction has different effects on the lateral end position and the medial end position.

12. 12. The device according to claim 11, wherein the second stop surface is approximately perpendicular to the adjustment direction and the first stop surface is approximately parallel to the adjustment direction, in particular the adjustment direction is aligned at an angle (α) of 0.5 degrees to 15 degrees, preferably 0.8 degrees to 2 degrees, with respect to the longitudinal axis of the connecting device.

13. 3. The device according to claim 1 or 2, wherein the adjustment device is embodied as an adjusting screw and the coupling device is embodied as a bone screw, the longitudinal axis of the adjusting screw being aligned at an angle (α) of 0.5 degrees to 15 degrees, in particular 0.8 degrees to 2 degrees, relative to the longitudinal axis of the bone screw.

14. 3. The apparatus of claim 1 or 2, wherein the adjustment device is embodied as an adjustment screw disposed on a thread in the plate and variably positionable by the thread.

15. 3. The device according to claim 1 or 2, wherein the adjustment device is variably positionable relative to the plate along an adjustment direction, in particular along a thread axis.

16. 16. The device according to claim 15, wherein the adjustment direction is aligned at an angle (α) of 0.5 degrees to 10 degrees, in particular 0.8 degrees to 2 degrees, relative to the longitudinal axis of the connecting device, and wherein the adjustment direction and the longitudinal axis of the connecting device are in one plane.

17. 3. The device according to claim 1 or 2, wherein the connecting device has a shoulder, in particular adjacent to a chamfered area, which forms a second stop surface against which the adjusting device bears at a lateral end position of the connecting device, in particular approximately at the front face of the adjusting device.

18. 3. The apparatus of claim 1 or 2, wherein the coupling device has a chamfered area and at least a region of the adjustment device has a generally cylindrical outer contour, the chamfered area on the coupling device cooperating with the outer contour of the adjustment device to form a first stop surface that limits movement of the coupling device relative to the plate in an inward direction.

19. 20. The device of claim 18, wherein the chamfered area is aligned with a longitudinal axis of the connecting device at a chamfer angle (β) that corresponds to an angle (α) at ​​which the adjustment device is aligned with the longitudinal axis of the connecting device, and the adjustment device is positioned such that it touches the chamfered area.

20. 3. The device according to claim 1 or 2, further comprising a traction bolt arranged approximately parallel to the longitudinal axis of the connecting device, in particular proximal to the connecting device, by means of which the plate can be coupled to the femoral head through the femoral shaft and femoral neck at a traction bolt opening, preventing rotation of the femoral head relative to the connecting device.

21. 3. The device according to claim 1 or 2, wherein the longitudinal axis of the connecting device is aligned with a femoral neck angle (γ) of 10 degrees to 60 degrees, in particular 35 degrees to 45 degrees, relative to the longitudinal axis of the one or more intraosseous screws.

22. 3. The device according to claim 1 or 2, wherein the connecting device is of hollow design, so that when the device is placed on the femur, bone cement can be introduced through the connecting device into the area of ​​the femoral head.

Images