Device for treating fractures

Abstract

The present invention relates to an apparatus for treating fractures, in particular fractures of the femoral neck, comprising a nail (1) which can be introduced into the intramedullary canal of a bone, in particular into the intramedullary canal of a femoral shaft (2), said nail (1) having a bore (3) aligned generally transversely to a longitudinal axis (4) of said nail (1), wherein a connecting device, in particular a bone screw (5), is provided which can be introduced into said bore (3) so as to protrude past either side of said bore (3) and move within said bore (3) along a transverse axis (21) in a lateral direction (6) and in a medial direction (7) oriented opposite to said lateral direction (6), said connecting device being fixed in place at the end of a bone part, in particular the femoral head (8), in particular by means of a screw thread provided on said connecting device. In order to achieve mobility of the femoral head (8) relative to the femoral shaft, according to the invention, an adjustment device is provided which can be fixed in place at various positions relative to the nail (1), in particular by means of a screw thread in the adjustment device and in the nail (1), where the adjustment device has a first stop surface (9) which limits the mobility of the coupling device in the lateral direction (6) when the coupling device and the adjustment device are placed on the nail (1), so that by changing the position of the adjustment device relative to the nail (1), the lateral end position up to which the coupling device can be moved in the lateral direction (6) relative to the nail (1) can be changed.Furthermore, the invention relates to a method for treating a fracture of the femoral neck, in which the nail (1) is introduced into the intramedullary canal of the femoral shaft (2), after which a coupling device is introduced into the nail (1) and the coupling device is fixed in the right place in the femoral head (8).

Description

[Technical field]

[0001] The present invention relates to an apparatus for treating fractures, in particular fractures of the proximal femur, for example fractures of the femoral neck, comprising a nail which can be introduced into the intramedullary canal of a bone, in particular into the intramedullary canal of the femoral shaft, said nail having a hole aligned generally transversely to the longitudinal axis of said nail, wherein a connecting device, in particular a bone screw, is provided which protrudes past either side of said hole and can be introduced into said hole so as to be movable within said hole along a transverse axis in a lateral direction and in a medial direction oriented opposite to said lateral direction, said connecting device being fixed in place at the end of a bone part, in particular at the femoral head, in particular by means of a screw thread provided on said connecting device.

[0002] The present invention further relates to a method for treating a fracture of the femoral neck in which a nail is introduced into the intramedullary canal of the femoral shaft, after which a connecting device is introduced into the nail and secured in place within the femoral head.

[0003] From the prior art, devices and methods of the type mentioned at the outset are known, in particular for treating fractures of the femoral neck.

[0004] Therefore, a certain degree of mobility between the femoral head and the femoral shaft is important for rapid healing, for which reason, for example, a device is known from document US 8,172,841 B2, which allows a certain degree of mobility of the connecting device relative to the nail, according to which this mobility is achieved by means of a grub screw arranged distally on the nail, which slides in a groove in the connecting device.

[0005] However, it has been proven that this type of device does not provide optimal healing for all patients.

[0006] This is addressed by the present invention. The object of the present invention is to specify an apparatus of the type mentioned at the outset which can be better adapted to the needs of the individual patient. Furthermore, a method of this type is specified.

[0007] According to the invention, the first object is achieved with an apparatus of the type mentioned at the beginning, in which an adjusting device is provided which can be fixed in place in various positions relative to the nail, in particular by means of a screw thread in the adjusting device and in the nail, the adjusting device having a first stop surface which limits the mobility of the connecting device in the outward direction when the connecting device and adjusting device are placed on the nail, so that by changing the position of the adjusting device relative to the nail, the outer end position up to which the connecting device can be moved in the outward direction relative to the nail can be changed.

[0008] In the course of the invention, it was discovered that the same mobility of the connecting device relative to the nail, or the transverse play between the connecting device and the nail, is not equally beneficial for all patients, and that it may be advantageous for the connecting device to be movable to a different extent relative to the nail, depending on patient-specific parameters, in particular, for example, height, weight, bone density, type of fracture, and the like. According to the invention, this adaptability of mobility or play, which promotes healing, can be realized in a structurally particularly simple manner by means of an adjustment device which can be fixed in place in different positions relative to the nail, which limits the mobility of the connecting device in the outward direction within the form-fit via a first stop surface.

[0009] Typically, the coupling device can be connected to the femoral head by means of a screw thread provided at its end and for this purpose is usually embodied as a bone screw, however, the coupling device may be embodied in any other suitable manner to allow it to be connected to a bone part such as, for example, the femoral head.

[0010] In addition, it will be appreciated that the device of the present invention may also be used to treat fractures other than those of the femoral neck, particularly fractures in the region of the proximal femur.

[0011] Typically, the transverse axis is generally transverse to the longitudinal axis of the nail, usually at an angle that the axis of the femoral neck makes with respect to the axis of the femoral shaft, for example, 110° to 140°.

[0012] Preferably, the adjustment device can be screwed into the nail, specifically preferably distal from the connecting device, and preferably at a slight angle to the transverse axis, for example, so that by changing the screw-in depth of the adjustment device, which is typically embodied as an adjustment screw, the play of the connecting device relative to the nail can be easily changed.

[0013] The first stop surface may be formed by only a single surface. However, it may be provided that the first stop surface is formed by a plurality of stop surfaces which act simultaneously and thus limit the mobility in a particularly effective manner. For example, if only a single first stop surface is used, it has been proven that there is a risk that the regulating device slides along the coupling device and thus the movement is limited less than intended. In particular, it may be provided that the first stop surface is formed by two or three stops acting simultaneously, for example a primary, a secondary and a tertiary first stop. Thereby, the primary stop may be arranged, for example, at the outer end of the regulating device, the secondary stop, for example, approximately in the center on the regulating device and the tertiary stop in the region of the inner end of the regulating device.

[0014] It is advantageous if the first stop surface is formed at least partly in the region of the outer end of the adjusting device by a shoulder or collar, in particular an adjusting screw collar, which may be embodied as an adjusting screw collar and may for example be positioned at the outer end of the adjusting screw in order to bear against the connecting device in a predefined relative position of the connecting device and the adjusting device and thus to prevent further movement of the connecting device relative to the adjusting device in the outer direction.

[0015] Preferably, the first stop surface is at least partially formed by a portion of the thread of the adjusting device, provided that the adjusting device can be fixed in place relative to the nail by means of the thread, in particular an inner end of the thread can act as a stop against a corresponding surface of the connecting device to limit movement of the connecting device in an outward direction.

[0016] The first stop surface is at least partially formed by a portion of the thread of the connecting device, by means of which the connecting device can be effectively fixed in place at its end in the bone part. The thread of the connecting device can thus act as a stop, for example, in that the outer end of the thread bears against the adjusting device at a predefined relative position of the adjusting device and the connecting device, thus limiting further movement of the connecting device in the outer direction.

[0017] Preferably, the adjusting device is connected to the nail by a screw thread, and it is provided that a thread lock, in particular a plastic piece, which increases the friction in the screw thread, is provided to prevent loosening of the adjusting device. Thus, unintended loosening of the adjusting device is prevented in a simple manner.

[0018] In order to easily prevent errors during insertion of the device due to over-threading, it is preferably provided that the adjusting device can only be screwed onto the nail up to a predefined position, whereby this is in particular structurally implemented by means of a wrench, preferably a hexagonal wrench, which starting from a predefined position of the adjusting device no longer produces any contact with a corresponding mating part in the adjusting device, in particular a hexagonal socket.

[0019] It may be beneficial if the adjusting device has a second stop surface that limits the mobility of the connecting device in a medial direction when the connecting device and adjusting device are positioned on the nail.

[0020] In addition, it may be provided that the adjustment device is at an angle relative to the connecting device, resulting in a tilt through which the mobility of the connecting device is defined. Thus, the mobility of the connecting device relative to the nail in the transverse direction can be structurally changed through the angle between the adjustment device and the connecting device, and through the position or screw-in depth of the adjustment device relative to the nail while the operation is still in progress. The angle is, for example, 0.8° to 2°.

[0021] Alternatively, it can of course be provided that the medial end position of the connecting device relative to the nail is formed by a stop on the nail, which prevents further movement of the connecting device in the medial direction starting from a certain position. For this purpose, a collar or shoulder can for example be provided at the outer end of the connecting device protruding outwardly from the nail on the lateral side, said collar or shoulder being larger than the diameter of the hole in the nail through which the connecting device is guided through the nail, so that starting from a predefined position, the outer collar or shoulder bears against the nail and thus forms a stop preventing further movement of the connecting device in the medial direction.

[0022] Preferably, it is provided that the position of the adjustment device relative to the nail can be varied along an adjustment direction, in particular along a straight line, which can be implemented in a simple manner, in particular when the adjustment device is embodied with an external thread and the nail with a corresponding internal thread, an axis extending along the adjustment direction.

[0023] Preferably, the first and second stop surfaces are aligned at different angles relative to the adjustment direction, so that when the position of the adjusting device relative to the nail is changed, the outer end position can be changed to a greater extent than the inner end position. Thus, not only the position of the play of the connecting device relative to the nail, but also the size of the play can be changed as a result with a change in the position of the adjusting device relative to the nail. It may also be provided that the position of the second stop surface does not change with the position of the adjusting device. This is particularly true if the second stop surface is embodied by a cylindrical envelope surface of an adjusting device embodied as an adjusting screw. In this case, only the size of the play and the position of the first stop surface are changed with the position of the adjusting device or with the screw-in depth of the adjusting screw.

[0024] Particularly preferably, it is provided that the position of the adjustment device relative to the nail can be changed along an adjustment direction, wherein the adjustment direction is aligned at an angle of 0.1° to 15°, in particular 0.8° to 2°, to the transverse direction, wherein the adjustment direction and the transverse direction are preferably in the same plane.

[0025] In this way, a design in which a change in the position of the adjusting device relative to the nail has a different effect on the position of the first stop surface on the one hand and on the second stop surface on the other hand is realized in a particularly simple manner structurally. Thus, the first stop surface can be formed, for example, by a surface of the adjusting device that is approximately perpendicular to the adjustment direction, in particular by a thread flank of the adjusting device embodied as an adjusting screw, while the second stop surface can be formed, for example, by a cylindrical surface that extends rotationally symmetrically in the adjustment direction, in particular by a conical or cylindrical surface that extends concentrically in the adjustment direction, or by an outer surface of the adjusting device embodied as an adjusting screw. With a corresponding small angle between the adjustment direction and the transverse direction, it therefore occurs that a change in the position of the adjusting device in the adjustment direction has approximately equally large effects on the position of the first stop surface and has almost no effect or no effect at all on the position of the second stop surface.

[0026] For example, if the second stop surface is formed by a cylindrical surface of an adjusting device concentric with the adjustment direction, which is aligned at an angle to the transverse direction and a groove corresponding to the adjusting device is arranged in the connecting device at a corresponding angle, the position of the second stop surface is only defined by said angle but, in contrast to the first stop surface, does not change when the screw-in depth of the adjusting device is changed, which first stop surface is formed by a face or thread flank of the adjusting device, which adjusting device can be embodied as an adjusting screw.

[0027] Typically, the adjusting device is embodied to be longer than the hole, so that it can be connected to the nail at a position that protrudes past both sides of the hole, provided that the first stop surface is located inwardly from the nail. Typically, the adjusting device extends through the entire nail, for example at an opening in the nail. Thus, the opening through which the adjusting device protrudes through the nail may also coincide with the hole through which the connecting device protrudes through the nail. Thus, a corresponding hole may be embodied in the distal region that has a thread for the adjusting device.

[0028] The coupling device and the adjustment device are typically embodied to be generally elongated and preferably generally cylindrical, especially since the corresponding hole in the femoral head usually also has a cylindrical cross section.

[0029] It is advantageous if the connecting device has a groove that interacts with the adjusting device and extends along the connecting device, so that when the connecting device and the adjusting device are connected to the nail, the adjusting device limits, preferably prevents, rotation of the connecting device about the transverse axis. This is particularly advantageous since during healing of a fracture of the femoral neck, where the femoral neck is naturally strained, typically also torsional loads act on the femoral neck, which loads can lead to undesired rotation of the connecting device relative to the nail. This type of rotation about the transverse axis is therefore effectively prevented if a corresponding groove is provided that interacts with the adjusting device such that the adjusting device engages in the groove and thus prevents rotation of the connecting device relative to the nail.

[0030] In order to achieve a simple construction on the one hand and a particularly good contact between the adjustment device and the connecting device on the other hand, it is advantageous if the holes are embodied to receive the connecting device in the proximal region and to receive the adjustment device in the distal region. It will be understood that the descriptions distal, proximal, lateral and medial respectively refer in this case to the intended positioning of the device on a bone of the human body, typically the femur. Thus, when used as intended, the adjustment device is positioned below or distal to the connecting device.

[0031] It is advantageous if the connecting device has through holes projecting from the lateral end to the medial end, into which a K-wire can be inserted. Thus, the connecting device can be introduced into the femoral neck in a particularly precise manner in that initially only one hole with a small diameter is introduced into the femoral neck, and then a K-wire is introduced into said hole with a small diameter, so that the K-wire is introduced as a guide for a hole with a larger diameter that corresponds approximately to the diameter of the connecting device, and the K-wire serves as a guide for said larger drill, after which the larger drill is removed and the connecting device is further introduced into the femoral neck using the K-wire as a guide.

[0032] It is particularly advantageous if a cannulated introduction device is provided which can be connected to the nail as an alternative to the adjustment device and in particular can be inserted into the hole of the nail instead of the adjustment device, so that bone cement or another reinforcing material can be introduced through the cannulated introduction device up to the region of the femoral head when the bone nail is placed in the femoral shaft and the introduction device is connected to the nail. Typically, the bone cement or other reinforcing material can be introduced through a cannula which is removably and temporarily introduced into the cannulation of the introduction device, which can be embodied as a through hole through the introduction device. Typically, the apparatus also includes a cannula of this type which corresponds to the cannulated introduction device.

[0033] Naturally, as an alternative to a cannula being temporarily introduced into the introduction device in order to introduce bone cement or other reinforcing material into the first bone hole portion through the introduction device, it may be provided that the introduction device itself is embodied as a cannula, so that the bone cement or other reinforcing material is introduced directly into the first bone hole portion through a hole in the introduction device, and an additional separate cannula is omitted.

[0034] It will be appreciated that any other suitable reinforcing material may be used as an alternative to bone cement, and therefore, for the purposes of this application, the term bone cement also includes other suitable materials.

[0035] Thus, the connecting device is introduced into the femoral neck in two stages, specifically, firstly, only to a position away from the end position in the femoral neck, for example, by 20 mm to 40 mm, in particular by approximately 30 mm, after which bone cement is introduced into the end region of the femoral neck via a cannulated introducing device, typically using a cannula, and immediately thereafter the connecting device moves to said end position in the femoral neck to push aside the bone cement located in the end position, thereby allowing a method in which the bone cement is dispersed into the bone. This is very advantageous, especially for patients with advanced osteoporosis, for dispersing the bone cement in the porous bone and thus fixing the bone. Particularly preferably, the K-wire is removed only after the connecting device has been completely introduced into the femoral neck to the end position, and also typically only after the bone cement has completely hardened. As a result, it is reliably prevented that the bone cement advances into the joint capsule, which cannot be allowed to occur under any circumstances. However, this may occur if the K-wire is removed earlier, especially since there is a risk that the femoral head will be pierced during the introduction of the K-wire into the femoral head, resulting in the formation of a full length opening to the joint capsule. In other words, the K-wire thus effectively closes a possible passage opening into the joint capsule during the introduction of the bone cement, thereby preventing unintended entry of the bone cement into the joint capsule.

[0036] Preferably, the coupling device comprises at its end a thread with which it can be fixed in the right place in the femoral head. With regard to the interaction of the coupling device with the adjustment device, typically the coupling device further comprises a contact surface corresponding to the adjustment device, which may be simultaneously embodied as a groove to prevent rotation with the adjustment device. Typically, the corresponding contact surface must be arranged on the side, typically distal, on which the adjustment device is arranged relative to the coupling device. In order to still ensure high variability in terms of possible screw-in depths, it is preferably provided that at least two corresponding contact surfaces are provided such that they are distributed over the circumference of the coupling device. Then, with a thread pitch of, for example, 3.2 mm, the coupling device can be introduced into the femoral head with a screw-in depth of 1.6 mm steps, not only with a step screw-in depth of 3.2 mm, but with two contact surfaces arranged such that they are, for example, uniformly distributed over the circumference.

[0037] Typically, the adjustment device has a generally cylindrical or conical outer contour with a screw thread, by means of which it can be screwed into the nail, typically at a position arranged distally with respect to the connecting device. Typically, the length of the adjustment device is greater than the length of the opening in the nail, through which the adjustment device is guided through the nail, so that it typically protrudes past both sides of the nail. It may also be provided that the adjustment device is embodied so that it is approximately as long as the connecting device, so that it can protrude from the lateral side of the nail into the area of ​​the femoral head. As a result, the connecting device can be fixed, and rotation of the connecting device around the transverse axis and rotation of the femoral head fragments around the connecting device can be effectively prevented.

[0038] According to the invention, the other object is achieved by a method of the type mentioned at the beginning, in which an adjustment device is connected to the nail, which limits the mobility of the connecting device relative to the nail along a transverse axis. Typically, a device according to the invention is used for this type of method. Typically, the transverse axis is generally transverse to the longitudinal axis of the nail, usually at an angle that the axis of the femoral neck makes with the axis of the femoral shaft, for example at an angle of 110° to 140°.

[0039] It is advantageous if a first K-wire is first introduced into the femoral neck along the transverse axis up to the femoral head, the first K-wire having a smaller diameter than the connecting device, after which a first bone hole for the connecting device is introduced into the femoral neck, where the first K-wire acts as a guide, and immediately afterwards the connecting device is introduced into the femoral neck through the nail. This ensures a particularly accurate introduction of the connecting device into the femoral neck, in particular because the hole required for the K-wire has a very small diameter, for example 1.5 mm, and can be introduced very accurately. Usually, the hole for this purpose is introduced with a K-wire, so that the K-wire first serves as a drill and then as a guide for the larger bone hole and the connecting device.

[0040] Typically, the K-wire also serves as a guide for the introduction of a coupling device into the femoral neck or into the femoral head.

[0041] Particularly preferably, it is provided that the K-wires are removed after the connection device has been fully introduced into the femoral neck, so that the K-wires are removed in the lateral direction only after final positioning of the connection device at the femoral neck.

[0042] Especially for fractures in the region of the base of the femoral neck, it may be advantageous to introduce a second K-wire off-axis into the femoral head to prevent rotation of the femoral head when drilling or threading the connecting device.

[0043] It may be advantageous, especially for osteoporotic patients, if the connecting device is initially only introduced into the first bone hole to an intermediate position, after which bone cement is introduced into the end region of the first bone hole, and immediately thereafter the connecting device is fully introduced into the first bone hole, where the bone cement located in the end region is dispersed into the femoral head. Thus, the final introduction of the connecting device into the end region causes the dispersion of bone cement, the connecting device acting as a plunger to disperse the cement. Thus, the connecting device may, for example, be temporarily fixed in place in a first stage, up to approximately 30 mm before the final position, after which bone cement is introduced, and immediately thereafter the connecting device is moved another 30 mm in the medial direction to the final end position. Following hardening of the bone cement, the K-wire is then removed. If the femoral head is pierced during introduction of the K-wire into the femoral head, bone cement is thus prevented from passing from the femoral head into the joint capsule through a passage opening that may have been created inadvertently during adhesion due to the K-wire being located within the femoral head.

[0044] Particularly preferably, it is provided that the bone cement is introduced into the end region of the first bone hole through a cannulated introduction device, which is guided through the nail through an opening through which the adjustment device can be guided through the nail, and which is removed from the nail after the introduction of the bone cement, and immediately thereafter the adjustment device is inserted, in particular screwed, into the opening. The opening, as mentioned, can correspond to a hole, so that in the hole, which is embodied elongated, the connecting device is arranged in the upper or proximal region and the adjustment device in the lower or distal region.

[0045] To introduce an adjustment device that can also protrude into the femoral head region, a second bone hole is typically introduced into the femoral neck, typically also from the lateral side of the femur. For this purpose, preferably, a second K-wire is introduced into the femoral neck, distal to the region where the connecting device can be connected to the nail, at an angle of, in particular, 0.1° to 15°, in particular 0.8° to 2°, relative to the first K-wire, and then a second bone hole is introduced into the femoral neck, where the second K-wire acts as a guide, and immediately thereafter the second K-wire is removed, and then the adjustment device is introduced into the second bone hole, the adjustment device protruding past both sides of the nail. [Brief description of the drawings]

[0046] Further features, advantages and benefits of the present invention emerge from the exemplary embodiments described below, in which reference is made to the drawings in which:

[0047] [Figure 1] 1 shows, in cross-section, a device according to the invention in various operating states; [Diagram 2] 1 shows, in cross-section, a device according to the invention in various operating states; [Diagram 3] 1 shows, in cross-section, a device according to the invention in various operating states; [Figure 4] FIG. 2 is a detailed view of a further device according to the invention; [Diagram 5] FIG. 2 is a detailed view of a further device according to the invention; [Figure 6] FIG. 2 is a detailed view of a further device according to the invention; [Figure 7] FIG. 2 is a diagram of various process steps for carrying out the method according to the invention. [Figure 8] FIG. 2 is a diagram of various process steps for carrying out the method according to the invention. [Figure 9] FIG. 2 is a diagram of various process steps for carrying out the method according to the invention. [Figure 10]FIG. 2 is a diagram of various process steps for carrying out the method according to the invention. [Figure 11] FIG. 2 is a diagram of various process steps for carrying out the method according to the invention. [Figure 12] FIG. 2 is a diagram of various process steps for carrying out the method according to the invention. [Figure 13] FIG. 2 is a diagram of various process steps for carrying out the method according to the invention. [Figure 14] FIG. 2 is a diagram of various process steps for carrying out the method according to the invention. [Figure 15] FIG. 2 is a diagram of a further device according to the invention. [Figure 16] 3A-3C are diagrams of various process steps in a further method according to the invention; [Figure 17] 3A-3C are diagrams of various process steps in a further method according to the invention; [Figure 18] 3A-3C are diagrams of various process steps in a further method according to the invention; [Figure 19] 3A-3C are diagrams of various process steps in a further method according to the invention; [Figure 20] 3A-3C are diagrams of various process steps in a further method according to the invention; [Figure 21] 3A-3C are diagrams of various process steps in a further method according to the invention; [Figure 22] 3A-3C are diagrams of various process steps in a further method according to the invention; [Diagram 23] 3A-3C are diagrams of various process steps in a further method according to the invention; [Figure 24] 3A-3C are diagrams of various process steps in a further method according to the invention; [Diagram 25] 3A-3C are diagrams of various process steps in a further method according to the invention; [Figure 26] 3A-3C are diagrams of various process steps in a further method according to the invention; [Figure 27] FIG. 2 is a detailed view of the device according to the invention in a schematic view. [Figure 28]FIG. 2 is a detailed view of the device according to the invention in a schematic view. [Figure 29] FIG. 2 is a detailed view of the device according to the invention in a schematic view. [Diagram 30] FIG. 2 is a detailed view of a further device according to the invention; [Diagram 31] FIG. 2 is a detailed view of a further device according to the invention; DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0048] 1 to 3 show the device according to the invention in various operating states. The device comprises a bone nail, only partially shown, which can be placed along a longitudinal axis 4 in the intramedullary canal of the femur, which can start at the upper or proximal end of the femur. In addition, the device comprises a connecting device, here embodied as a bone screw 5, which is placed in a hole 3 of the nail 1 in order to connect the femoral shaft 2 to the broken femoral head 8. For this purpose, a screw thread is provided at the inner end 14 of the bone screw 5, which can be screwed into the femoral head 8. Thereby, the hole 3 and the bone screw 5 are aligned such that the bone screw 5 can be connected to the nail 1 along a transverse axis 21, which is aligned transversely to the longitudinal axis 4 of the nail 1, typically at an angle of approximately 130° to the longitudinal axis 4 of the nail 1, so that the transverse axis 21 extends generally along the femoral neck and the nail 1 extends generally along the femoral shaft 2.

[0049] The bone screw 5 is not screwed in with the nail 1 but is connected in such a way that it can move along a transverse axis 21, which allows a particularly good healing to be achieved. Furthermore, in the device according to the invention, an adjustment device is provided, which in this case is embodied as an adjustment screw 20, which can be screwed in with the nail 1, in particular into an opening which in this case is arranged in the lower region of the bore 3 through which the bone screw 5 extends through the nail 1.

[0050] Here, the adjusting screw 20 limits the mobility of the bone screw 5 relative to the nail 1 depending on the screwing depth. For this purpose, a first stop surface 9 is provided on one side, which limits the mobility of the bone screw 5 in the outer direction 6. The first stop surface 9 on the adjusting screw 20 thus forms the outer end position of the bone screw 5 and is oriented approximately perpendicular to the axis or adjustment direction 11 of the adjusting screw 20. The first stop surface 9 on the adjusting screw 20 can be formed, for example, by a thread flank.

[0051] Additionally, a second stop surface 10 is also provided on the adjusting screw 20, which limits mobility of the bone screw 5 in the medial direction 7. The second stop surface 10 is disposed on a circumferential surface of the adjusting screw 20 and is thus oriented generally perpendicular to the first stop surface 9 and generally coaxial with the adjustment direction 11. This second stop surface 10 results from an angle α of approximately 1.2° between the adjustment direction 11 and the transverse direction.

[0052] FIG. 1 illustrates a position of the adjusting screw 20 where the adjusting screw 20 is fully threaded into the nail 1 so that the bone screw 5 is not movable relative to the nail 1 and the bone screw 5 rests both against a first stop surface 9 and also against a second stop surface 10 on the adjusting screw 20.

[0053] 2 and 3 show a further operating position, in which in FIG. 2 compared to FIG. 1 the adjusting screw 20 has been slightly unscrewed in the lateral direction 6 from the nail 1, whereby a mobility or play 17 of the bone screw 5 relative to the adjusting screw 20 or relative to the nail 1 occurs in the lateral direction 6 and conversely in the medial direction 7.

[0054] FIG. 3 shows a further operating position, in which the adjusting screw 20 is unscrewed further in the outer direction 6 from the nail 1 compared to FIG. 2, so that the play 17 of the bone screw 5 is greater than in the operating position shown in FIG.

[0055] The mobility of the bone screw 5 relative to the bone nail is therefore limited by the adjusting screw 20 in the outer direction 6 by means of a first stop surface 9, which in this case is arranged at the inner end 14 of the adjusting screw 20. The mobility in the inner direction 7 in the direction of the transverse axis 21 is limited by a second stop surface 10 on the adjusting screw 20, which is formed by the substantially cylindrical outer surface of the adjusting screw 20. This is brought about by the angle α at which the adjustment axis of the adjusting screw 20 is oriented relative to the transverse axis 21, so that a movement of the adjusting screw 20 along the adjustment direction 11 has a different effect on the position of the first and second contact surfaces. Thus, with the movement of the adjusting screw 20 along the adjustment direction 11, not only are the positions of the stop surfaces displaced, but also the play 17 of the bone screw 5 relative to the nail 1 and relative to the adjusting screw 20 is changed. Thus, the angles and dimensions of the bone screw and the adjustment screw may be similarly selected such that the position of the second stop surface or the medial termination position of the bone screw relative to the nail is not changed by a change in the position of the adjustment screw, but only a change in the screw depth affects the position of the first stop surface.

[0056] 4 to 6 show further exemplary embodiments of the coupling device and the adjustment device of the apparatus according to the invention, where likewise the coupling device is embodied as a bone screw 5 with an internal thread, respectively the adjustment device as an adjusting screw 20. In particular in FIG. 4, a groove 12 corresponding to a first and a second contact surface of the adjusting screw 20 is also visible along the longitudinal direction on the bone screw 5, said groove 12 providing, on the one hand, a contact surface of the bone screw 5 corresponding to the first and the second contact surface, and on the other hand preventing a rotation of the bone screw 5 about a transverse axis 21 when the adjusting screw 20 is arranged in the area of ​​said contact surfaces. For this purpose, the groove 12 corresponds to the adjusting screw 20 and is preferably generally parallel to the adjustment direction 11 in the working position. As a result, the groove 12 typically takes an angle α of, for example, 1.2° with respect to the transverse direction 21.

[0057] The corresponding groove 12, which typically has surfaces corresponding to the first stop surface 9 and the second stop surface 10, may be provided only once on the bone screw 5, typically approximately along the axis or transverse axis 21 of the bone screw 5. However, it is preferably provided that said groove 12 is arranged several times, at least twice, such that it is distributed over the circumference of the bone screw 5, as illustrated in Figures 5 and 6, in particular since then there are several possibilities as to how the bone screw 5 can be screwed into the nail 1. Thus, for example with a thread pitch of 3.2 mm, if the corresponding grooves 12 are arranged such that they are distributed over the circumference in two mutually opposite positions, a screw-in depth of 1.6 mm steps is possible, in particular since one of the grooves 12 is arranged in the working position, advantageously in a position corresponding to the adjusting screw 20.

[0058] As can be seen in Figures 5 and 6, the horizontal axis 21 and the adjustment axis are at an angle α with respect to each other, which results in a tilt that has a different effect on the respective first and second stop surfaces 9, 10 upon movement of the adjustment device 20 in the adjustment direction 11.

[0059] As can be seen in Figures 5 and 6, the adjustment screw 20 can also be embodied as a long screw protruding into the area of ​​the femoral head 8 to effectively prevent rotation of the femoral head 8 around the bone screw 5 when subjected to strain.

[0060] As can be seen in the exemplary embodiments of Figures 4 to 6, the bone screws 5 each comprise, according to these embodiments, a collar 18 at the outer end 13 which may act as a stop and define the inner end position of the bone screw 5 interacting with the adjusting screw 20 and / or the nail 1. However, this collar 18 may also be omitted, since in particular the inner movement may also be defined by the interaction of the bone screw 5 and the adjusting screw 20.

[0061] Figures 7 to 14 show various stages of the method according to the invention for treating femoral fractures. As can be seen in Figures 7 and 8, a K-wire hole is first introduced into the femoral neck 22 using a drill with a small diameter, and then a K-wire 15 is positioned in said hole. For this purpose, the K-wire itself is typically embodied as a drill, so that the K-wire hole can be introduced using the K-wire, after which the K-wire 15 remains in the bone. The K-wire 15 is then used to guide a drill with a larger diameter, so that a first bone hole 23 for a connecting device, in this case also embodied as a bone screw 5, and a second bone hole 24 for an adjustment device, in this case also embodied as an adjustment screw 20, can be accurately introduced.

[0062] Thus, Fig. 7 shows a situation in which a first K-wire has been introduced. Fig. 8 shows a method stage in which a second K-wire 15 has been introduced. Fig. 9 shows a method stage in which a first bone hole 23 for a bone screw 5 has been introduced into the femoral neck 22, the drill being embodied as being hollow and guided by a corresponding K-wire 15. For this purpose, additional positioning assistance may be provided, for example by means of X-ray irradiation or the like.

[0063] 10 shows a situation where the first bone hole 23 has already been formed, but the second bone hole 24 has not yet been formed. As can be seen, the K-wire 15 remains in the first bone hole 23 even after the drilling of the first bone hole 23.

[0064] FIG. 11 shows a step in the method where a second bone hole 24 is drilled, again using the K-wire 15 as a guide.

[0065] As an alternative to using the K-wire 15 as a guide, the second bone hole 24 may be introduced without the K-wire 15, ie, without a guide, using a solid drill.

[0066] 12 shows a stage of the method in which the bone screw 5 is introduced into the first bone hole 23, also with the aid of the K-wire 15, in particular in that the second bone hole 24 has already been completed, and the K-wire 15 serves as a guide for the bone screw 5. For this purpose, the bone screw 5 comprises a central through hole 19 extending from the inner end 14 to the outer end 13. The K-wire 15 is therefore only removed after the bone screw 5 has been completely introduced into the first bone hole 23. Then, as can be seen in FIG. 13, the second K-wire 15 is also removed.

[0067] Finally, the adjustment screw 20 is introduced, as can be seen in Fig. 14. The position of the adjustment screw 20 along the adjustment direction 11, which can be varied by means of the adjustment screw 20 and the threads on the nail 1, can be used to affect the mobility of the bone screw 5 relative to the nail 1.

[0068] 15 shows an alternative embodiment in which a long adjustment screw 20 is provided that protrudes into the area of ​​the femoral head 8. In an embodiment of this type, rotation of the femoral head 8 around the bone screw 5 is effectively prevented. The adjustment screw 20 therefore also serves as an anti-rotation mechanism for the femoral head 8 relative to the femoral shaft 2.

[0069] 16 to 26 show a further method according to the invention for treating femoral fractures, in which bone cement 26 is also introduced into the femoral head 8. FIG.

[0070] As depicted in Figures 16 and 17, a first bone hole 23 is also introduced into the femoral neck 22 for this purpose, in which case a K-wire 15 is also previously introduced, which subsequently serves as a guide for a larger drill.

[0071] The method illustrated here relates to the treatment of femoral fractures in osteoporotic patients, for which reason bone cement 26 is introduced before the final introduction of the bone screw 5 and the adjusting screw 20 into the end region of the femoral head 8. For this purpose, an introduction device 16 is provided, which is illustrated in Figures 18 to 23. The introduction device 16 is introduced into the femoral neck 22 through an opening in the nail 1 and into a second bone hole 24, through which the adjusting screw 20 is alternatively and also subsequently introduced through the nail 1. In this case, this opening is also part of the hole 3 through which the bone screw 5 is guided through the nail 1.

[0072] The illustrated introduction device 16 therefore at least in the region where it contacts the nail 1 has an outer contour corresponding to the adjustment screw 20, but is not threaded, although it can of course also be threaded. The introduction device 16 is further cannulated so that after it has been positioned under the bone screw 5, bone cement 26 can be introduced into the end region of the first bone hole 23 through cannulation using the cannula 25. For this purpose, the bone screw 5 is not initially introduced completely into the first bone hole 23, but only up to an introduction position, as can be seen in figures 19 to 22, which is e.g. 30 mm away from the end position where the bone screw 5 is not located until the method step illustrated in figure 23.

[0073] While the bone screw 5 is held in this introduction position illustrated in Figures 19 to 22, bone cement 26 is introduced into the end region of the first bone hole 23 or into the region of the femoral head 8 using a cannula 25 inserted into the introduction device 16.

[0074] As an alternative to a cannula 25 being temporarily inserted into the introduction device 16 , the introduction device 16 itself may be embodied as the cannula 25 .

[0075] The introduction of a cannula 25 into the cannulation of the introduction device 16, embodied as a hole, is illustrated in Figure 20, and the introduction of bone cement 26 through the cannula 25 into the femoral head 8 is illustrated in Figure 21. Figure 22 shows the cannula 25 being removed from the introduction device 16, while the introduction device 16 remains in the second bone hole 24.

[0076] The bone screw 5 is then fully screwed into the first bone hole portion 23 to its terminal position, specifically before the bone cement 26 hardens, and the unhardened bone cement 26 located in the terminal position is dispersed into the femoral head 8, as shown in FIG. 23.

[0077] Next, as can be seen in FIG. 24, the introduction device 16 is removed from the second bone hole 24 and from the hole 3 of the nail 1 .

[0078] As can be seen in Fig. 25, the adjusting screw 20 is then screwed into the nail 1 distally from or below the bone screw 5, and finally, after the bone cement 26 has hardened, the K-wire 15 is removed from the bone screw 5, which guides the bone screw 5 during the introduction. This position, which represents the completion of the introduction of the device for treating a fracture, is illustrated in Fig. 26. The depicted adjusting screw 20 reaches into the area of ​​the femoral head 8, so that it allows the ability to set the play 17 of the bone screw 5 and prevents not only the rotation of the bone screw 5 around the transverse axis 21, but also the rotation of the femoral head 8 around the transverse axis 21 and thus the loosening of the threaded connection between the femoral head 8 and the bone screw 5.

[0079] By not removing the K-wire 15 from the first bone hole portion 23 until after the bone cement 26 has hardened, the liquid bone cement 26 is effectively prevented from entering the joint capsule before it has hardened if the K-wire 15 unintentionally pierces the femoral head 8 during its introduction, particularly since the K-wire 15 seals any opening that may have been unintentionally created in the femoral head 8.

[0080] A collar 18 may be provided at the outer end 13 of the bone screw 5 in this embodiment to define an inner termination position by a form fit or stop with the nail 1 and / or adjustment screw 20 .

[0081] The device according to the invention allows for an effective treatment of femoral fractures in particular, since the mobility of the bone screw 5 relative to the nail 1 and thus of the femoral head 8 relative to the femoral shaft can be easily altered even while the operation is still in progress, in order to allow a particularly good adaptation of said mobility to the individual patient.

[0082] Figures 27 to 29 show diagrammatically the interaction of the bone screw 5 and the adjusting screw 20 in one embodiment of the device according to the invention, similar to the situation depicted in Figures 1 to 3, but with a detailed illustration of the interaction of the first contact surface, the second contact surface and the groove 12. Here, in order to visualize the interaction particularly well, a variant is further shown, with an angle α of approximately 3°, the groove 12 extending closely to the transverse axis 21 and the nail 1 having a very small diameter compared to the bone screw 5 and the adjusting screw 20, whereas in a real device, as depicted in particular in Figures 1 to 26, the angle α is typically smaller than 2°, the groove 12 may be significantly less pronounced and the diameters of the nail 1, the bone screw 5 and the adjusting screw 20 may differ from those depicted in Figures 27 to 29.

[0083] As can be seen, the groove 12 in the bone screw 5 corresponds to the adjusting screw 20 , specifically both in terms of dimensions and also in terms of the angle α that the groove 12 and the adjusting screw 20 make with respect to the transverse axis 21 .

[0084] If, as in this case, the adjusting screw 20 is formed by a body that is substantially cylindrical in the region of the groove 12 and the groove 12 is correspondingly embodied therein, the cylindrical envelope surface of the adjusting screw 20, which is rotationally symmetrical with respect to the adjustment axis, forms a second stop surface 10 which interacts with the corresponding surface of the groove 12, in particular already starting from the screw-in depth of the adjusting screw 20 in the nail 1, at which the adjusting screw 20 comes into contact with the bone screw 5. This second contact surface therefore defines the inner end position of the bone screw 5, starting from which a further movement of the bone screw 5 in the inner direction 7 parallel to the transverse axis 21 relative to the nail 1 is no longer possible, independently of a possible further movement of the adjusting screw 20 in particular along the adjustment direction 11. In other words, the position of the second stop surface 10 no longer changes starting from the contact of the adjusting screw 20 with the bone screw 5. Thus, the medial end position of the bone screw 5 is fixed starting from the contact of the adjusting screw 20 with the bone screw 5 in this exemplary embodiment, and the medial end position does not change with the screw-in depth of the adjusting screw 20, which moves along the adjustment direction 11 when there is a change in the screw-in depth. Thus, the position of the second stop surface 10 is structurally fixed in this exemplary embodiment via the dimensions of the adjusting screw 20 and the bone screw 5 and the angle α between the bone screw 5 and the adjusting screw 20.

[0085] In contrast to the second stop surface 10, however, the position of the first stop surface 9 can be directly changed by a change in the screw-in depth of the adjusting screw 20. The first stop surface 9 defines the outer end position of the bone screw 5, i.e. the position starting from which further movement of the bone screw 5 in the outer direction 6 relative to the nail 1 is no longer possible. In this case, this first stop surface 9 is formed by a face of the adjusting screw 20 which is aligned approximately perpendicular to the adjustment axis. Naturally, the first stop surface 9 can alternatively also be formed by various surfaces of the adjusting screw 20, the position of which is changed by a change in the screw-in depth relative to the corresponding surface of the groove 12, in particular by means of the thread flank.

[0086] FIG. 27 shows a position of an apparatus similar to that illustrated in FIG. 1, in which the screw-in depth of the adjusting screw 20 is at a maximum, so that the bone screw 5 is simultaneously supported against both the first stop surface 9 and also against the second stop surface 10, there is no play 17; therefore, the bone screw 5 cannot move relative to the nail 1.

[0087] FIG. 28 shows a position similar to that shown in FIG. 2 or 3, in which the adjusting screw 20 has been slightly unscrewed outward from the nail 1; therefore the screw-in depth is less than in the position shown in FIG. 27. The position of the bone screw 5 has not changed from the position shown in FIG. 27. As mentioned, the position of the second stop surface 10 has not been changed in this case with the screw-in depth, so that the bone screw 5 still bears against the second stop surface 10 and is therefore still located in the inner end position, in which no further movement of the bone screw 5 in the inner direction 7 is possible. However, the first stop surface 9 now no longer bears against the bone screw 5, as a result of which the bone screw 5 can move in the outer direction along the transverse axis 21 relative to the nail 1. Thus, as shown, a play 17 results between the inner end position in which the bone screw 5 is located in FIG. 28 and the outer end position to which the bone screw 5 can be moved.

[0088] Figure 29 shows the device from Figures 27 and 28 with the screw-in depth unchanged from Figure 28. However, in contrast to Figure 28, the bone screw 5 is now located in the outer end position and thus bears against the first stop surface 9 on the adjusting screw 20 but no longer against the second stop surface 10. Starting from this position, therefore, only movement of the bone screw 5 relative to the nail 1 in the medial direction 7 is possible, but no further movement in the lateral direction 6 is possible.

[0089] Here, therefore, the change in the screw-in depth affects the change in the position of the first stop surface 9 with the cosine of the angle α, and therefore approximately 1:1 for small angles α, but has no effect on the position of the second stop surface 10. The size of the play 17 therefore also changes approximately 1:1 with the screw-in depth.

[0090] 30 and 31 show detailed views of a further exemplary embodiment of the device according to the invention, which comprises a first contact surface 9 formed by three simultaneously acting stops, in particular a primary stop 9a at the outer end 13 of the adjusting device, which is here also formed by the adjusting screw 20, a secondary stop 9b at the inner end 14 of the thread of the adjusting screw 20, by means of which the adjusting screw 20 is screwed into the nail 1, and a tertiary stop 9c at the inner end 14 of the adjusting screw 20. At the tertiary stop 9c, the inner end 14 of the adjusting screw 20 interacts with the thread pitch of the bone screw 5. With the three stops 9a, 9b, 9c acting simultaneously, unintended sliding of the adjusting screw 20 along the bone screw 5 is prevented in a simple manner and thus the mobility is reliably limited.

[0091] Furthermore, in this exemplary embodiment, a screw lock is provided, which is formed by a plastic piece 27 within the thread pitch of the nail 1. This plastic piece 27 increases the friction between the thread of the adjusting screw 20 and the nail 1, so that unintentional loosening of the adjusting screw 20 is prevented.

[0092] Here, the adjusting screw 20 is provided with a hexagonal socket 29 at the outer end 13 and can be actuated using a hexagonal key, not shown. In order to prevent the adjusting screw 20 from being screwed in too far unintentionally, the hexagonal wrench is embodied in such a way that it can only be guided along the adjusting screw 20 in the medial direction 7 relative to the bone screw 5 up to a predefined position. For this purpose, a stop can be provided, for example, on the hexagonal wrench and / or on the bone screw 5. Starting from a predefined screwing depth of the adjusting screw 20, the hexagonal key thus loses contact with the adjusting screw 20 or slides out of the hexagonal socket 29, such that further screwing in is not possible. In this way, the adjusting screw 20 is prevented from being screwed in too far unintentionally with a structurally simple design.

[0093] 31 shows the primary stop in a detailed view. As can be seen, the adjusting screw 20 is provided at its outer end with a collar formed by an adjusting screw collar 28, which bears against the bone screw 5 starting from a predefined relative position of the adjusting screw 20 and the bone screw 5, thus preventing further movement of the bone screw 5 relative to the adjusting screw 20 in the outer direction 6, so that this primary stop acts simultaneously with the secondary stop 9b and simultaneously with the tertiary stop 9c, as a result of which sliding of the adjusting screw 20 on the bone screw 5 is effectively prevented.

[0094] In addition, the method according to the invention ensures that the bone cement 26 does not penetrate into the joint capsule, which makes the risk of complications particularly low.

Claims

1. For example, a method for treating a fracture, particularly a large fracture, is provided, comprising a nail which can be introduced into the intramedullary canal of a bone, particularly into the intramedullary canal of a femoral shaft, said nail having a hole aligned generally transversely to the longitudinal axis of said nail, said connecting device being introduced into said hole so as to protrude past either side of said hole and move within said hole along a transverse axis in a lateral direction and in a medial direction oriented opposite to said lateral direction, said connecting device being fixed in place at an end of a bone part, particularly at the femoral head, particularly by means of a screw thread provided on said connecting device.

1. An apparatus for treating fractures of the proximal femur, e.g., fractures of the femoral neck, comprising an adjustment device which can be fixed in place at various positions relative to the nail, in particular by means of threads in the adjustment device and in the nail, and wherein the adjustment device has a first stop surface which limits the mobility of the connecting device in a lateral direction when the connecting device and adjustment device are placed on the nail, such that by changing the position of the adjustment device relative to the nail, the lateral end position up to which the connecting device can be moved in a lateral direction relative to the nail can be changed.

2. 2. The apparatus according to claim 1, wherein the first stop surface is formed at least partly in the region of an outer end of the adjusting device by a shoulder or a collar, in particular an adjusting screw collar.

3. 3. The apparatus of claim 1 or 2, wherein the first stop surface is defined, at least in part, by a portion of a thread of the adjusting device, the thread being used to lock the adjusting device in place relative to the nail.

4. 3. The apparatus of claim 1, wherein the first stop surface is defined, at least in part, by a portion of a thread of the connecting device, the thread being used to secure the connecting device in place at an end within a bone portion.

5. 3. The apparatus according to claim 1 or 2, wherein the adjusting device is connected to the nail by a screw thread, and a screw lock, in particular a plastic piece, which increases the friction in the screw thread, is provided to prevent loosening of the adjusting device.

6. 3. The device according to claim 1 or 2, wherein the adjusting device can be screwed onto the nail only up to a predefined position, which is in particular structurally implemented by means of a wrench, preferably a hexagonal wrench, which starting from a predefined position of the adjusting device no longer creates any contact with a corresponding mating part in the adjusting device, in particular a hexagonal socket.

7. The apparatus of claim 1 , wherein the adjusting device has a second stop surface that limits mobility of the connecting device in a medial direction when the connecting device and adjusting device are disposed on the nail.

8. 8. The apparatus according to claim 1 or 7, wherein the position of the adjustment device relative to the nail can be varied along an adjustment direction, in particular along a straight line.

9. 9. The apparatus of claim 8, wherein the first and second stop surfaces are aligned at different angles relative to the adjustment direction such that when the position of the adjustment device relative to the nail is changed, the lateral end position can be changed to a greater extent than the medial end position.

10. 3. The apparatus according to claim 1 or 2, wherein the position of the adjustment device relative to the nail can be varied along an adjustment direction, wherein the adjustment direction is aligned at an angle of 0.1° to 15°, in particular 0.8° to 2°, to the transverse direction, wherein the adjustment direction and the transverse direction are preferably in the same plane.

11. 3. The apparatus of claim 1 or 2, wherein the adjustment device is embodied to be longer than the hole such that the adjustment device can be connected to the nail at a position protruding past both sides of the hole, and wherein the first stop surface is located inwardly from the nail.

12. 3. The apparatus of claim 1 or 2, wherein the connecting device has a groove that interacts with the adjusting device and extends along the connecting device, such that when the connecting device and the adjusting device are connected to the nail, the adjusting device limits, preferably prevents, rotation of the connecting device about the transverse axis.

13. The apparatus according to claim 1 or 2, wherein the holes are embodied to receive the connecting device in a proximal region and to receive the adjusting device in a distal region.

14. 3. The apparatus of claim 1 or 2, wherein the connecting device has a through hole protruding from an outer end to an inner end, through which a K-wire can be inserted.

15. 3. The apparatus according to claim 1 or 2, wherein a cannulated introduction device is provided which can be connected to the nail as an alternative to the adjustment device, in particular which can be inserted into the hole in the nail instead of the adjustment device, so that bone cement can be introduced through the cannulated introduction device to the region of the femoral head when the bone nail is placed in the femoral shaft and the introduction device is connected to the nail.

16. 1. A method for treating a fracture of the femoral neck, in which a nail is introduced into the intramedullary canal of the femoral shaft, after which a connecting device is introduced into the nail and fixed in place in the femoral head, wherein an adjustment device is connected to the nail, which limits the mobility of the connecting device relative to the nail along the transverse axis, in particular where an apparatus as described in claim 1 or 2 is used.

17. 17. The method of claim 16, wherein a first K-wire is first introduced into the femoral neck along the transverse axis to the femoral head, the first K-wire having a smaller diameter than the connecting device, after which a first bone hole for the connecting device is introduced into the femoral neck, where the first K-wire acts as a guide, immediately after which the connecting device is introduced through the nail into the femoral neck.

18. 20. The method of claim 17, wherein the first K-wire is removed after the connecting device is fully introduced into the femoral neck.

19. 20. The method of claim 18, wherein the connecting device is initially only introduced into the first bone hole to an intermediate position, after which bone cement is introduced into an end region of the first bone hole, and immediately thereafter the connecting device is fully introduced into the first bone hole, where the bone cement located in the end region is dispersed into the femoral head.

20. 20. The method according to claim 19, wherein the bone cement is introduced into the end region of the first bone hole through a cannulated introduction device, which is guided through the nail through an opening through which the adjustment device can be guided through the nail, and which is removed from the nail after the introduction of the bone cement, and immediately thereafter the adjustment device is inserted, in particular screwed, into the opening.

21. 21. The method according to claim 20, wherein a second K-wire is introduced into the femoral neck distal to a region where the connecting device can be connected to the nail, in particular at an angle of 0.1° to 15°, in particular 0.8° to 2°, relative to the first K-wire, after which a second bone hole is introduced into the femoral neck, where the second K-wire acts as a guide, immediately after which the second K-wire is removed, and then the adjustment device is introduced into the second bone hole, where the adjustment device protrudes past both sides of the nail.

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