A 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 provides a nail that can be introduced into the intramedullary canal of a bone, particularly the intramedullary canal of the femoral diaphysis axis, where the nail has a hole that is generally aligned in a transverse direction with respect to the longitudinal axis of the nail, and where a connecting device protrudes beyond both sides of the hole and can be introduced into the hole so as to move along a transverse axis in an outer direction and an inner direction that is oriented opposite to the outer direction. In particular, a bone screw is provided, and the connecting device can be fixed in place at an end in a bone portion, particularly at the femoral head, using a thread provided on the connecting device. The present invention relates to an apparatus for treating fractures, particularly fractures of the proximal femur, such as fractures of the femoral neck.

[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 diaphysis axis, and then a connecting device is introduced into the nail, and the connecting device is fixed in place in the femoral head at the correct location.

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

[0004] Therefore, for rapid healing, it is important to have a certain degree of mobility between the femoral head and the femoral diaphysis axis. For this 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 with respect to the nail. According to the above document, this mobility is achieved using a grab screw arranged distally on the nail, and the screw slides in a groove of the connecting device.

[0005] However, it has been proven that it is not possible to achieve optimal healing for all patients using this type of device.

[0006] This is addressed by the present invention. An object of the present invention is to specify the type of device mentioned above, which can be better adapted to the individual patient needs. Furthermore, this type of method is specified.

[0007] According to the present invention, a first object is provided which an adjustment device can be fixed in the correct position in various positions relative to the nail, particularly using threads within the adjustment device and within the nail, wherein the adjustment device has a first stop surface that restricts the outward movement of the connecting device when the connecting device and the adjustment device are positioned on the nail, and as a result, the outer end position to which the connecting device can move outward relative to the nail can be changed by changing the position of the adjustment device relative to the nail.

[0008] In the course of the present invention, it was discovered that the same mobility of the connecting device relative to the nail, or transverse play between the connecting device and the nail, is not equally beneficial for all patients, and that the ability of the connecting device to move to varying degrees relative to the nail may be advantageous depending on patient-specific parameters, particularly, for example, height, weight, bone density, fracture type, and similar factors. According to the present invention, this adaptability of mobility or play that promotes healing can be achieved in a structurally particularly simple manner by an adjustable device that can be fixed in the correct position at various positions relative to the nail, the adjustable device restricting the outward mobility of the connecting device within the shape fit via a first stopping surface.

[0009] Typically, the connecting device may be connected to the femoral head using threads provided at its ends, and for this purpose, it is usually embodied as a bone screw. However, the connecting device may be embodied in any other suitable manner to enable connection to a bony portion, such as the femoral head.

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

[0011] Typically, the transverse axis is roughly perpendicular to the longitudinal axis of the nail, usually at the angle that the axis of the femoral neck takes with respect to the axis of the femoral shaft, for example, between 110° and 140°.

[0012] Preferably, the adjustment device can be screwed into the nail, specifically preferably distal to the coupling device, and, for example, preferably at a slight angle with respect to the transverse axis. Thus, the play of the coupling device relative to the nail can be easily changed by changing the screwing depth of the adjustment device, which is typically embodied as an adjustment screw.

[0013] The first stopping surface may be formed by a single surface only. However, it may be provided that the first stopping surface is formed by a plurality of stopping surfaces that act simultaneously and, in a particularly effective manner, restrict the mobility. For example, it has been shown that when only a single first stopping surface is used, there is a risk that the adjustment device will slide along the connecting device and, consequently, its movement will be less restricted than intended. In particular, it may be provided that the first stopping surface is formed by two or three stopping parts that act simultaneously, for example, primary, secondary, and tertiary first stopping parts. Thereafter, the primary stopping part may be located, for example, at the outer end of the adjustment device, the secondary stopping part, for example, roughly in the center of the adjustment device, and the tertiary stopping part within the region of the inner end of the adjustment device.

[0014] It is beneficial if the first stopping surface is formed at least partially within the region of the outer end of the adjustment device by a shoulder or collar, particularly an adjustment screw collar. The collar may be embodied as an adjustment screw collar and may be positioned at the outer end of the adjustment screw, for example, to be in contact with and supported by the connecting device at a predetermined relative position of the connecting device and the adjustment device, and thereby to prevent further movement of the connecting device relative to the adjustment device in the outward direction.

[0015] Preferably, the first stop surface is formed at least partially by a portion of the threads of the adjustment device, so that the adjustment device can be secured in the correct position relative to the nail using the threads. In particular, the inner end of the threads may function as a stopper against the corresponding surface of the coupling device to restrict the outward movement of the coupling device.

[0016] The first stopping surface is at least partially formed by a portion of the threads of the connecting device, and it has been proven effective that the threads can be used to secure the connecting device in the correct position at the end within the bone portion. Thus, the threads of the connecting device can function as a stopping portion, for example, by having the outer end of the threads contact and support the adjusting device at a predetermined relative position between the adjusting device and the connecting device, thereby restricting further outward movement of the connecting device.

[0017] Preferably, the adjustment device is connected to the nail by a screw thread, and a thread lock, particularly a plastic piece, is provided to increase friction in the screw thread to prevent the adjustment device from loosening. Thus, unintended loosening of the adjustment device is prevented in a simple manner.

[0018] To easily prevent errors during insertion of the device due to overtightening, preferably, the adjustment device can be screwed onto the nail only to a predetermined position, which is provided to be structurally implemented using a wrench, preferably a hex wrench, starting from the predetermined position of the adjustment device, so as not to generate any contact with the corresponding mating member in the adjustment device, in particular the hex socket.

[0019] It is beneficial if the adjustment device has a second stopping surface that restricts the inward movement of the connecting device when the connecting device and the adjustment device are positioned on the nail.

[0020] In addition, the adjusting device may be provided to take an angle with respect to the connecting device, resulting in an inclination through which the mobility of the connecting device is defined. Thus, the mobility of the connecting device with respect to the nail in the transverse direction can be structurally altered through the angle between the adjusting device and the connecting device, and, while the surgery is still in progress, through the position of the adjusting device with respect to the nail or the depth of screwing it in. The angle is, for example, 0.8° to 2°.

[0021] Alternatively, it can also be provided that the inner terminal position of the connecting device relative to the nail is formed by a stop on the nail, and that the stop prevents further inward movement of the connecting device starting from a specific position. For this purpose, a collar or shoulder may be provided, for example, on the outer end of the connecting device that protrudes outward from the nail on the outer side, and the collar or shoulder is larger than the diameter of the hole in the nail, and the connecting device is guided through the nail through the hole, so that, starting from a predetermined position, the outer collar or outer shoulder is in contact with and supported by the nail, thereby forming a stop that prevents further inward movement of the connecting device.

[0022] Preferably, the position of the adjustment device relative to the nail can be changed along the adjustment direction, particularly along a straight line. This can be implemented in a simple manner, especially when the adjustment device is embodied with an external thread and the nail has a corresponding internal thread and the shaft extends along the adjustment direction.

[0023] Preferably, the first and second stop surfaces are aligned at different angles with respect to the adjustment direction, so that when the position of the adjustment 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 coupling device relative to the nail, but also the size of the play can be changed as a result of the change in the position of the adjustment 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 adjustment device. This is especially true when the second stop surface is embodied by a cylindrical envelope surface of the adjustment device, which is embodied as an adjustment screw. In this case, only the size of the play and the position of the first stop surface are changed using the position of the adjustment device or the depth of the screw threading.

[0024] Particularly preferably, the position of the adjustment device with respect to the nail can be changed along the adjustment direction, where the adjustment direction is aligned at an angle of 0.1° to 15°, particularly 0.8° to 2°, with respect to the transverse direction, where the adjustment direction and the transverse direction are preferably coplanar.

[0025] In this way, a design is achieved in a structurally simple manner in which a change in the position of the adjustment device relative to the nail has various effects on the position of the first stop surface and on the position of the second stop surface. Thus, the first stop surface may be formed, for example, the surface of the adjustment device that is generally perpendicular to the adjustment direction, in particular by the thread flank of the adjustment device embodied as an adjustment screw, while the second stop surface may be formed, for example, a cylindrical surface that rotates symmetrically in the adjustment direction, in particular a conical or cylindrical surface that extends concentrically in the adjustment direction, or the outer surface of the adjustment device embodied as an adjustment screw. Because there is a corresponding small angle between the adjustment direction and the transverse direction, a change in the position of the adjustment device in the adjustment direction therefore has a substantially equal and large effect on the position of the first stop surface, and has little to no effect on the position of the second stop surface.

[0026] For example, if the second stop surface is formed by the cylindrical surface of the adjustment device concentric in the adjustment direction, the adjustment direction is aligned at a certain angle with respect to the transverse direction, and a groove corresponding to the adjustment device is positioned within the connecting device at the corresponding angle, then the position of the second stop surface is defined only by that angle, but in contrast to the first stop surface, it does not change when the screw-in depth of the adjustment device is changed, and the first stop surface is formed by the surface or thread flank of the adjustment device, and the adjustment device may be embodied as an adjustment screw.

[0027] Typically, the adjustment device is embodied to be longer than the hole portion, and as a result, the adjustment device can be connected to the nail at a position protruding beyond both sides of the hole portion, where the first stop surface is provided to be disposed inside from the nail. Typically, the adjustment device extends through the entire nail, for example, at the opening of the nail. Thus, the opening through which the adjustment device protrudes through the nail can also coincide with the hole through which the connecting device protrudes through the nail. Accordingly, the corresponding hole portion can be embodied in the distal region having a thread for the adjustment device.

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

[0029] The connecting device has a groove that interacts with the adjustment device and extends along the connecting device. As a result, when the connecting device and the adjustment device are connected to the nail, it is beneficial if the adjustment device restricts, preferably prevents, the rotation of the connecting device around the transverse axis. During the healing of a femoral neck fracture where the femoral neck naturally undergoes strain, typically torsional loads also act on the femoral neck, and this load can lead to an undesirable rotation of the connecting device with respect to the nail, so this is particularly beneficial. Thus, this type of rotation around the transverse axis is efficiently prevented if a corresponding groove is provided that interacts with the adjustment device such that the adjustment device engages the groove and thereby prevents the rotation of the connecting device with respect to the nail.

[0030] On the one hand, to achieve a simple structure and on the other hand, to achieve particularly good contact between the adjustment device and the connection device, it is beneficial if the hole is embodied to receive the connection device in the proximal region and to receive the adjustment device in the distal region. Descriptions such as distal, proximal, lateral, and medial are understood in this case to refer to the intended placement of the device on a human bone, typically the femur. Thus, when used as intended, the adjustment device is positioned below or distally from the connection device.

[0031] It is beneficial if the connection device has a through-hole that protrudes from the outer end to the inner end and a K-wire can be inserted into the through-hole. Thus, the connection device can be introduced into the femoral neck in a particularly accurate manner in that initially only one hole with a small diameter is introduced into the femoral neck, then the K-wire is introduced into the hole with the small diameter, as a result the K-wire is introduced as a guide for a hole with a larger diameter that generally corresponds to the diameter of the connection device, the K-wire functions as a guide for the larger drill, then the larger drill is removed, and the connection device is introduced into the femoral neck using the K-wire as a guide.

[0032] A cannulated introduction device is provided that 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, and as a result, bone cement or another reinforcing material can be introduced through the cannulated introduction device to the region of the femoral head, if the bone nail is located within the femoral shaft axis and the introduction device is connected to the nail. Typically, bone cement or other reinforcing material can be introduced through a cannula that is detachably and temporarily introduced into the intubation of the introduction device, which can be embodied as a through-hole through the introduction device. Typically, the device also includes this type of cannula corresponding to the cannulated introduction device.

[0033] Naturally, as an alternative to a cannula temporarily introduced into the introduction device to introduce bone cement or other reinforcing material into a first bone bore through the introduction device, the introduction device itself may be provided as a cannula, thereby allowing the bone cement or other reinforcing material to be introduced directly into the first bone bore through a hole in the introduction device, thus eliminating the need for an additional separate cannula.

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

[0035] Therefore, the connecting device is introduced into the femoral neck in two stages, specifically, first to a position, for example, 20 to 40 mm, and especially about 30 mm, away from the terminal position in the femoral neck, and then bone cement is introduced into the terminal region of the femoral neck, typically using a cannula, through the inserted introduction device, and immediately thereafter the connecting device moves to the aforementioned terminal position in the femoral neck to displace the bone cement located within the terminal position, thereby enabling a method in which the bone cement is dispersed within the bone. This is particularly advantageous for patients with advanced osteoporosis in order to disperse the bone cement within the porous bone and thereby fix the bone. Particularly preferably, the K-wire is removed only after the connecting device has been fully introduced into the femoral neck to its terminal position, and also typically only after the bone cement has completely hardened. As a result, the progression of bone cement into the joint capsule, which is unacceptable under any circumstances, is reliably prevented. However, this can occur if the K-wire is removed too early, as there is a risk that the femoral head may be penetrated during the introduction of the K-wire into the femoral head, resulting in the formation of a sufficiently long opening to the joint capsule. In other words, the K-wire effectively closes any possible openings to the joint capsule during the introduction of bone cement, thereby preventing unintended intrusion of bone cement into the joint capsule.

[0036] Preferably, the connecting device has threads at its ends that can be used to secure the connecting device to the correct location within the femoral head. With respect to the interaction of the connecting device with the adjustment device, typically the connecting device further comprises a contact surface corresponding to the adjustment device, which may also be simultaneously embodied as a groove to prevent rotation using the adjustment device. Typically, the corresponding contact surface must be located on the side where the adjustment device is positioned relative to the connecting device, typically on the distal side. To still ensure high variability in terms of possible screw-in depths, preferably, at least two corresponding contact surfaces are provided such that they are distributed around the circumference of the connecting device. Then, for example with a thread pitch of 3.2 mm, the connecting device can be introduced into the femoral head not only with a step screw-in depth of 3.2 mm, but also with a step screw-in depth of 1.6 mm using two contact surfaces that are, for example, uniformly distributed around the circumference.

[0037] Typically, the adjustment device has a generally cylindrical or conical outer contour with threads, and the adjustment device can be screwed into the nail using the threads, typically in a position distal to the connecting device. Typically, the length of the adjustment device is greater than the length of the opening in the nail, and the adjustment device is guided through the nail through the opening, and as a result, the adjustment device typically protrudes past both sides of the nail. It may also be provided that the adjustment device is approximately as long as the connecting device, and as a result, the adjustment device can be embodied 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 about the transverse axis and rotation of the femoral head fragment about the connecting device can be effectively prevented.

[0038] According to the present invention, another objective is achieved by the type of method described above, in which an adjustment device is connected to a nail and the adjustment device restricts the mobility of the connecting device relative to the nail along the transverse axis. Typically, the apparatus according to the present invention is used for this type of method. Typically, the transverse axis is roughly perpendicular to the longitudinal axis of the nail, at an angle usually taken by the axis of the femoral neck with respect to the axis of the femoral shaft, for example, an angle of 110° to 140°.

[0039] It is beneficial if the first K-wire is first introduced along the transverse axis into the femoral neck up to the femoral head, and the first K-wire has a smaller diameter than the connecting device, and then the first bony hole for the connecting device is introduced into the femoral neck, where the first K-wire acts as a guide, and immediately after that the connecting device is introduced into the femoral neck through the nail. This ensures particularly accurate introduction of the connecting device into the femoral neck, because the hole required for the K-wire has a very small diameter, for example, 1.5 mm, and the hole can be introduced very accurately. Typically, the hole for this purpose is introduced using a K-wire, and as a result, the K-wire acts first as a drill and then as a guide for the larger bony hole and the connecting device.

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

[0041] Particularly preferably, the K-wire is removed after the connecting device has been fully introduced into the femoral neck. Thus, the K-wire is removed laterally only after the final positioning of the connecting device in the femoral neck.

[0042] In particular, with regard to fractures in the base region of the femoral neck, it may be advantageous to introduce the second K-wire to the femoral head with an offset axis to prevent rotation of the femoral head during drilling or screwing in for the connecting device.

[0043] Particularly in the case of patients with osteoporosis, it may be advantageous if the connecting device is initially introduced only to an intermediate position into the first bone cavity, then bone cement is introduced into the end region of the first bone cavity, and immediately thereafter the connecting device is fully introduced into the first bone cavity, at which point the bone cement located in the end region is dispersed within the femoral head. Thus, the final introduction of the connecting device into the end region causes the dispersion of bone cement, and the connecting device acts as a plunger that disperses the cement. Therefore, the connecting device may, for example, be temporarily fixed in the correct position up to approximately 30 mm before the final position in the first stage, after which bone cement is introduced, and immediately thereafter the connecting device moves another 30 mm to the final terminal position in the medial direction. Following the hardening of the bone cement, the K-wire is then removed. If the femoral head is penetrated during the introduction of the K-wire into the femoral head, bone cement passing from the femoral head into the joint capsule through a passage opening that may have been unintentionally created is therefore prevented during bonding due to the K-wire's position within the femoral head.

[0044] Particularly preferably, the bone cement is introduced into the end region of the first bone hole through an intubated introduction device, the introduction device being guided through a nail through an opening through which the adjustment device can be guided through the nail, and being removed from the nail after the introduction of the bone cement, and immediately thereafter the adjustment device is inserted, particularly screwed, into the opening. The opening may coincide with the hole, as described, and as a result in an elongated hole, within which the connecting device is located in the upper or proximal region and the adjustment device is located in the lower or distal region.

[0045] To introduce an adjustment device that can protrude similarly into the femoral head region, the second bony hole is typically introduced into the femoral neck, typically similarly 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 particularly 0.1° to 15° and particularly 0.8° to 2° relative to the first K-wire, and then the second bony 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 bony hole, and the adjustment device is provided to protrude past both sides of the nail. [Brief explanation of the drawing]

[0046] Additional features, advantages, and effects of the present invention are derived from the exemplary embodiments described below, as referenced in the drawings:

[0047] [Figure 1] This is a diagram of the apparatus according to the present invention in various operating states, as seen in a cross-sectional view. [Figure 2] This is a diagram of the apparatus according to the present invention in various operating states, as seen in a cross-sectional view. [Figure 3] This is a diagram of the apparatus according to the present invention in various operating states, as seen in a cross-sectional view. [Figure 4] This is a detailed diagram of a further apparatus according to the present invention. [Figure 5] This is a detailed diagram of a further apparatus according to the present invention. [Figure 6] This is a detailed diagram of a further apparatus according to the present invention. [Figure 7] This is a diagram illustrating various process steps for carrying out the method according to the present invention. [Figure 8] This is a diagram illustrating various process steps for carrying out the method according to the present invention. [Figure 9] This is a diagram illustrating various process steps for carrying out the method according to the present invention. [Figure 10]This is a diagram illustrating various process steps for carrying out the method according to the present invention. [Figure 11] This is a diagram illustrating various process steps for carrying out the method according to the present invention. [Figure 12] This is a diagram illustrating various process steps for carrying out the method according to the present invention. [Figure 13] This is a diagram illustrating various process steps for carrying out the method according to the present invention. [Figure 14] This is a diagram illustrating various process steps for carrying out the method according to the present invention. [Figure 15] This is a diagram of a further apparatus according to the present invention. [Figure 16] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 17] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 18] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 19] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 20] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 21] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 22] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 23] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 24] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 25] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 26] This is a diagram illustrating various process stages in a further method according to the present invention. [Figure 27] This is a schematic diagram showing a detailed view of the apparatus according to the present invention. [Figure 28]This is a schematic diagram showing a detailed view of the apparatus according to the present invention. [Figure 29] This is a schematic diagram showing a detailed view of the apparatus according to the present invention. [Figure 30] This is a detailed diagram of a further apparatus according to the present invention. [Figure 31] This is a detailed diagram of a further apparatus according to the present invention. [Modes for carrying out the invention]

[0048] Figures 1 to 3 show the apparatus according to the present invention in various operating states. The apparatus comprises a bone nail, partially illustrated, which may be positioned along a longitudinal axis 4 within the intramedullary canal of the femur, which begins at the superior or proximal end of the femur. In addition, the apparatus comprises a connecting device, embodied here as a bone screw 5, which is positioned within a hole 3 of the nail 1 to connect the femoral shaft axis 2 to the fractured femoral head 8. For this purpose, threads are provided on the medial end 14 of the bone screw 5, which can be screwed into the femoral head 8. The hole 3 and the bone screw 5 are aligned so that the bone screw 5 can connect to the nail 1 along a transverse axis 21 which is aligned transversely with respect to the longitudinal axis 4 of the nail 1, typically at an angle of approximately 130° with respect 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 axis 2.

[0049] The bone screw 5 is not screwed in together with the nail 1, but is connected so that it can move along the transverse axis 21, thereby achieving particularly good healing. Furthermore, in the apparatus according to the present invention, an adjustment device is provided, which is embodied in this case as an adjustment screw 20, which can be screwed together with the nail 1, specifically, through it into an opening located in the lower region of the hole 3 through which the bone screw 5 extends from the nail 1.

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

[0051] Furthermore, a second stop surface 10 is also provided on the adjustment screw 20, and this second stop surface 10 restricts the movement of the bone screw 5 in the inward direction 7. The second stop surface 10 is positioned on the circumferential surface of the adjustment screw 20 and is therefore oriented approximately perpendicular to the first stop surface 9 and approximately coaxial with the adjustment direction 11. This second stop surface 10 is derived from an angle α of approximately 1.2° between the adjustment direction 11 and the transverse direction.

[0052] Figure 1 illustrates the position of the adjustment screw 20, where it is fully screwed into the nail 1, and as a result the bone screw 5 is not movable relative to the nail 1, and the bone screw 5 is supported both by contacting the first stop surface 9 and the second stop surface 10 on the adjustment screw 20.

[0053] Figures 2 and 3 show further operating positions. Compared to Figure 1, in Figure 2 the adjustment screw 20 is slightly loosened outward from the nail 1 6, which creates mobility or play 17 of the bone screw 5 relative to the adjustment screw 20 or the nail 1 in the outward direction 6 and, conversely, inward direction 7.

[0054] Figure 3 shows a further operating position, in which the adjustment screw 20 is further loosened outward 6 from the nail 1 compared to Figure 2, and as a result the play 17 of the bone screw 5 is greater than that in the operating position shown in Figure 2.

[0055] Therefore, the mobility of the bone screw 5 relative to the bone nail is restricted by the adjustment screw 20 in the outward direction 6 using a first stop surface 9, which in this case is located at the inner end 14 of the adjustment screw 20. Movability in the inward direction 7 in the direction of the transverse axis 21 is restricted by a second stop surface 10 on the adjustment screw 20, which is formed by the generally cylindrical outer surface of the adjustment screw 20. This is brought about by the angle α in which the adjustment axis of the adjustment screw 20 is oriented with respect to the transverse axis 21, and as a result, the movement of the adjustment screw 20 along the adjustment direction 11 has various effects on the positions of the first and second contact surfaces. Therefore, with the movement of the adjustment screw 20 along the adjustment direction 11, not only is the position of the stop surface displaced, but the play 17 of the bone screw 5 relative to the nail 1 and the adjustment screw 20 is also changed. Therefore, the angles and dimensions of the bone screw and the adjustment screw can be similarly selected such that the position of the first stop surface is not altered by changes in the position of the adjustment screw, but only by changes in the screwing depth.

[0056] Figures 4 to 6 show further exemplary embodiments of the coupling device and adjustment device of the apparatus according to the present invention. Here, similarly, the coupling device is embodied as a bone screw 5 having internal threads, and the adjustment device is embodied as an adjustment screw 20. In particular in Figure 4, grooves 12 corresponding to the first and second contact surfaces of the adjustment screw 20 are also visible along the longitudinal direction on the bone screw 5, and the grooves 12 provide contact surfaces for the bone screw 5 corresponding to the first and second contact surfaces on the one hand, and prevent rotation of the bone screw 5 around the transverse axis 21 when the adjustment screw 20 is positioned within the area of ​​the contact surfaces on the other hand. For this purpose, the grooves 12 correspond to the adjustment screw 20 and are preferably approximately parallel to the adjustment direction 11 in the operating position. Consequently, the grooves 12 typically take an angle α of 1.2° with respect to the transverse direction 21, for example.

[0057] Typically, the corresponding grooves 12, having surfaces corresponding to a first stop surface 9 and a second stop surface 10, may be provided only once on the bone screw 5, typically along the axis or transverse axis 21 of the bone screw 5. However, preferably, the grooves 12 are provided to be arranged multiple times, at least twice, so that they are distributed around the circumference of the bone screw 5, as shown in Figures 5 and 6, because there are multiple possibilities in the way in which 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 so that they are distributed around the circumference at two opposite positions, a screwing depth of 1.6 mm steps is possible, because one of the grooves 12 is advantageously located in the working position, corresponding to the adjustment screw 20.

[0058] As can be seen in Figures 5 and 6, the horizontal axis 21 and the adjustment axis take an angle α with respect to each other, resulting in a tilt that causes various effects on the individual first stop surface 9 and second stop surface 10 as the adjustment device 20 moves in the adjustment direction 11.

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

[0060] As can be understood from the exemplary embodiments in Figures 4 to 6, each bone screw 5, according to these embodiments, has a collar 18 at its outer end 13 that can function as a stopper and define the inner end position of the bone screw 5 interacting with the adjustment screw 20 and / or nail 1. However, this collar 18 may be omitted, as the inner movement in particular can also be defined by the interaction of the bone screw 5 and the adjustment screw 20.

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

[0062] Therefore, Figure 7 shows the state in which the first K-wire has been introduced. Figure 8 shows the steps of the method in which the second K-wire 15 has been introduced. Figure 9 shows the steps of the method in which the first bone hole 23 for the bone screw 5 has been introduced into the femoral neck 22, the drill has been embodied so that it is hollow, and guided by the corresponding K-wire 15. For this purpose, additional positioning aids may be provided, for example, by X-ray irradiation or the like.

[0063] Figure 10 shows a situation where the first bone pit 23 has already been formed, but the second bone pit 24 has not yet been formed. As can be understood, the K wire 15 remains inside the first bone pit 23 even after the first bone pit 23 has been drilled.

[0064] Figure 11 shows the steps of the method in which the second bone hole 24 is drilled using the K wire 15 as a guide.

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

[0066] Figure 12 shows the steps of how the bone screw 5 is introduced into the first bone hole 23, specifically using the K wire 15 in the same way, with the second bone hole 24 already completed, and the K wire 15 similarly serving as a guide for the bone screw 5. For this purpose, the bone screw 5 has a central through-hole 19 extending from the inner end 14 to the outer end 13. Thus, the K wire 15 is removed only after the bone screw 5 has been fully introduced into the first bone hole 23. Next, as can be understood in Figure 13, the second K wire 15 is also removed.

[0067] Finally, an adjustment screw 20 is introduced, as can be understood in Figure 14. The mobility of the bone screw 5 relative to the nail 1 can be influenced by the position of the adjustment screw 20 along the adjustment direction 11, which can be changed using the adjustment screw 20 and the threads on the nail 1.

[0068] Figure 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 one embodiment of this type, rotation of the femoral head 8 around the bone screw 5 is effectively prevented. Thus, the adjustment screw 20 also functions as an anti-rotation mechanism for the femoral head 8 relative to the femoral shaft axis 2.

[0069] Figures 16 to 26 illustrate a further method according to the present invention for treating a femoral fracture, in which bone cement 26 is also introduced into the femoral head 8.

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

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

[0072] Therefore, the illustrated introduction device 16 has an outer contour corresponding to the adjustment screw 20 in at least the area in which the device is in contact with the nail 1, but does not have threads, although it is certainly possible to have threads. The introduction device 16 is further inserted so that after the device is positioned below the bone screw 5, bone cement 26 can be introduced into the end region of the first bone hole 23 through intubation using a cannula 25. For this purpose, the bone screw 5 is not initially introduced completely into the first bone hole 23, but only to the introduction position as can be understood in Figures 19 to 22, which is 30 mm away from the end position where the bone screw 5 is not located as far as, for example, the stage of the method illustrated in Figure 23.

[0073] While the bone screw 5 is held in the introduction position shown in Figures 19 to 22, the 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 the cannula 25 that is temporarily inserted into the introduction device 16, the introduction device 16 itself may be embodied as the cannula 25.

[0075] Figure 20 illustrates the introduction of the cannula 25 into the intubation of the introduction device 16, which is embodied as a hole, and Figure 21 illustrates the introduction of bone cement 26 into the femoral head 8 through the cannula 25. 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] Next, the bone screw 5 is fully screwed into its terminal position within the first bone hole 23, specifically before the bone cement 26 hardens, and as shown in Figure 23, the bone cement 26 located at the terminal position and not yet hardened is distributed within the femoral head 8.

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

[0078] As can be seen in Figure 25, the adjustment screw 20 is then screwed distal to or below the bone screw 5 into the nail 1, 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 introduction. This position, which marks the completion of the introduction of the device for treating the fracture, is illustrated in Figure 26. The depicted adjustment screw 20 reaches the area of ​​the femoral head 8, and as a result, the screw allows for the ability to set the play 17 of the bone screw 5, preventing rotation of the bone screw 5 around the transverse axis 21, as well as rotation of the femoral head 8 around the transverse axis 21, and consequently preventing loosening of the screw connection between the femoral head 8 and the bone screw 5.

[0079] By not removing the K-wire 15 from the first bone hole 23 until the bone cement 26 has hardened, it is effectively prevented that the liquid bone cement 26 will penetrate the joint capsule before hardening if the femoral head 8 is unintentionally pierced by the K-wire 15 during its introduction. This is because the K-wire 15 seals any unintentional openings that may have formed within the femoral head 8.

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

[0081] The apparatus according to the present invention enables particularly effective treatment of femoral fractures, because the mobility of the bone screw 5 relative to the nail 1 and, consequently, the mobility of the femoral head 8 relative to the femoral shaft axis can be easily modified even while the surgery is still in progress, allowing for particularly good adaptation of said mobility to individual patients.

[0082] Figures 27 to 29 schematically illustrate the interaction between the bone screw 5 and the adjustment screw 20 in one embodiment of the apparatus according to the present invention, similar to the situation depicted in Figures 1 to 3, but with detailed illustrations of the interaction between the first contact surface, the second contact surface, and the groove 12. Here, for particularly good visualization of the interaction, further modifications are shown in which the angle α is approximately 3°, the groove 12 extends close to the transverse axis 21, and the nail 1 has a much smaller diameter than the bone screw 5 and the adjustment screw 20. On the other hand, in actual apparatuses, the angle α is typically less than 2°, the groove 12 may not be as remarkably prominent, and the diameters of the nail 1, bone screw 5, and adjustment screw 20 may differ from those shown in Figures 27 to 29, particularly as illustrated in Figures 1 to 26.

[0083] To make it clear, the groove 12 in the bone screw 5 corresponds to the adjustment screw 20, specifically in terms of dimensions and also in terms of the angle α that the groove 12 and the adjustment screw 20 take with respect to the transverse axis 21.

[0084] In this case, where the adjustment screw 20 is formed by a body that is substantially cylindrical in the region of the groove 12 and the groove 12 is realized accordingly, the cylindrical envelope surface of the adjustment screw 20, which is rotationally symmetric with respect to the adjustment axis, specifically forms a second stop surface 10 that interacts with the corresponding surface of the groove 12, starting from the depth of screwing the adjustment screw 20 into the nail 1, and at this screwing depth, the adjustment screw 20 is in contact with the bone screw 5. Therefore, this second contact surface defines the inner end position of the bone screw 5, and starting from there, further movement of the bone screw 5 in the inward direction 7 parallel to the transverse axis 21 relative to the nail 1 is no longer possible, specifically independent of any further possible movement of the adjustment screw 20 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 adjustment screw 20 with the bone screw 5. Therefore, the inner end position of the bone screw 5 is fixed starting from the contact of the adjustment screw 20 with the bone screw 5 in this exemplary embodiment, and the inner end position does not change with the screwing depth of the adjustment screw 20, which moves along the adjustment direction 11 if there is a change in the screwing depth. Thus, the position of the second stop surface 10 is structurally fixed in this exemplary embodiment via the dimensions of the adjustment screw 20 and the bone screw 5 and the angle α between the bone screw 5 and the adjustment screw 20.

[0085] However, in contrast to the second stop surface 10, the position of the first stop surface 9 can be directly altered by a change in the screwing depth of the adjustment screw 20. The first stop surface 9 defines the outer end position of the bone screw 5, i.e., the position from which further movement of the bone screw 5 in the outward direction 6 relative to the nail 1 is no longer possible. In this case, the first stop surface 9 is formed by the surface of the adjustment screw 20, which is aligned approximately perpendicular to the adjustment axis. Of course, the first stop surface 9 can also be formed by alternatively various surfaces of the adjustment screw 20, the position of which is altered by a change in the screwing depth relative to the corresponding surface of the groove 12, particularly using the screw flank.

[0086] Figure 27 shows the position of the device similar to that shown in Figure 1, where the adjustment screw 20 is screwed in to its maximum depth, and as a result the bone screw 5 is simultaneously supported in contact with both the first stop surface 9 and the second stop surface 10, with no play 17; therefore the bone screw 5 is immovable relative to the nail 1.

[0087] Figure 28 shows a position similar to that shown in Figure 2 or 3, where the adjustment screw 20 is slightly loosened outward from the nail 1; therefore, the screw-in depth is smaller than that at the position shown in Figure 27. The position of the bone screw 5 has not changed from the position shown in Figure 27. As stated, since the position of the second stop surface 10 has not been changed in this case using the screw-in depth, the bone screw 5 is still supported in contact with the second stop surface 10 and is therefore still located at the inner terminal position where further movement of the bone screw 5 in the inward direction 7 is not possible. However, since the first stop surface 9 is no longer supported in contact with the bone screw 5 here, as a result, the bone screw 5 can move outward along the transverse axis 21 relative to the nail 1. Thus, as shown, a play 17 is resulting between the inner terminal position where the bone screw 5 is located in Figure 28 and the outer terminal position to which the bone screw 5 can move.

[0088] Figure 29 shows the apparatus from Figures 27 and 28 with the screw-in depth unchanged from that in Figure 28. However, in contrast to Figure 28, the bone screw 5 is now located at its outer end position and is supported in contact with the first stop surface 9 on the adjustment screw 20, but no longer supported in contact with the second stop surface 10. Therefore, starting from this position, only movement of the bone screw 5 relative to the nail 1 in the inward direction 7 is possible, but no further movement in the outward direction 6 is possible.

[0089] Herein, therefore, the change in the screw-in depth affects the change in the position of the first stop surface 9 by the cosine of the angle α, and therefore approximately 1:1 for small angles α, but not for the position of the second stop surface 10. Thus, the size of the play 17 is also changed approximately 1:1 with the screw-in depth.

[0090] Figures 30 and 31 show detail diagrams of further exemplary embodiments of the apparatus according to the present invention. This apparatus comprises a first contact surface 9 formed by three simultaneously acting restraints: a primary restraint 9a at the outer end 13 of the adjustment device, similarly formed here by the adjustment screw 20; a secondary restraint 9b at the inner end 14 of the adjustment screw 20, through which the adjustment screw 20 is screwed into the nail 1; and a tertiary restraint 9c at the inner end 14 of the adjustment screw 20. At the tertiary restraint 9c, the inner end 14 of the adjustment screw 20 interacts with the thread pitch of the bone screw 5. With the three restraints 9a, 9b, and 9c acting simultaneously, unintended sliding of the adjustment screw 20 along the bone screw 5 is prevented in a simple manner, and thus its mobility is reliably restricted.

[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 friction between the threads of the adjustment screw 20 and the nail 1, thereby preventing unintended loosening of the adjustment screw 20.

[0092] Here, the adjustment screw 20 is equipped with a hexagonal socket 29 at its outer end 13 and can be actuated using a hexagonal key (not shown). To prevent the adjustment screw 20 from being unintentionally screwed too far, the hexagonal wrench is embodied such that it can only be guided along the adjustment screw 20 inward 7 relative to the bone screw 5 to a predetermined position. For this purpose, a stopper may be provided, for example, on the hexagonal wrench and / or the bone screw 5. Thus, starting from a predetermined screwing depth of the adjustment screw 20, the hexagonal key loses contact with the adjustment screw 20 or slides out of the hexagonal socket 29 so that further screwing is impossible. In this way, the adjustment screw 20 is prevented from being unintentionally screwed too far with a structurally simple design.

[0093] Figure 31 is a detailed view showing the primary stop. As can be understood, the adjustment screw 20 has a collar at its outer end, which is formed by an adjustment screw collar 28. This collar is in contact with and supports the bone screw 5, starting from a predetermined relative position between the adjustment screw 20 and the bone screw 5, thereby preventing further movement of the bone screw 5 relative to the adjustment screw 20 in the outward direction 6. As a result, this primary stop acts simultaneously with the secondary stop 9b and the tertiary stop 9c, effectively preventing the adjustment screw 20 from sliding on the bone screw 5.

[0094] In addition, the method according to the present invention ensures that the bone cement 26 does not penetrate the joint capsule, thereby significantly reducing the risk of complications. According to this specification, the following items are also disclosed: [Item 1] For example, a connecting device is provided, particularly a bone screw, which can be introduced into the intramedullary canal of a bone, particularly into the intramedullary canal of the femoral shaft axis, wherein the nail has a hole that is generally aligned transversely with respect to the longitudinal axis of the nail, wherein the connecting device can be introduced into the hole so that it can move along the transverse axis within the hole, passing both sides of the hole and oriented laterally and medially in the opposite direction to the laterally direction, wherein the connecting device can be fixed in the correct position at the end of a bone portion, particularly the femoral head, particularly using threads provided on the connecting device, for fractures, particularly femoral fractures. A device for treating a fracture of the proximal femur, for example, a fracture of the femoral neck, the device provides an adjustable device that can be fixed in the correct position in various positions relative to the nail, in particular by using threads within the adjustable device and within the nail, wherein the adjustable device has a first stop surface that restricts the outward movement of the connecting device when the connecting device and the adjustable device are positioned on the nail, and as a result, by changing the position of the adjustable device relative to the nail, the outward terminal position to which the connecting device can move outward relative to the nail can be changed. [Item 2] The apparatus according to item 1, wherein the first stopping surface is formed at least partially within the region of the outer end of the adjustment device by a shoulder or collar, in particular an adjustment screw collar. [Item 3] The apparatus according to item 1 or 2, wherein the first stopping surface is at least partially formed by a portion of the threads of the adjustment device, and the adjustment device can be secured in the correct position relative to the nail using the threads. [Item 4] The apparatus according to item 1 or 2, wherein the first stopping surface is at least partially formed by a portion of the threads of the connecting device, and the connecting device can be secured in the correct position at the end within the bone portion using the threads. [Item 5] The apparatus according to item 1 or 2, wherein the adjustment device is connected to the nail by a screw thread, and a screw lock, particularly a plastic piece, that increases friction in the screw thread is provided to prevent the adjustment device from loosening. [Item 6] The device according to item 1 or 2, wherein the adjustment device can be screwed onto the nail only to a predetermined position, where this is structurally implemented using a wrench, preferably a hex wrench, starting from the predetermined position of the adjustment device, such that no further contact is made with the corresponding mating member in the adjustment device, in particular the hex socket. [Item 7] The apparatus according to item 1, wherein the adjustment device has a second stop surface that restricts the inward movement of the connecting device when the connecting device and the adjustment device are positioned on the nail. [Item 8] The apparatus according to item 1 or 7, wherein the position of the adjustment device relative to the nail can be changed along the adjustment direction, particularly along a straight line. [Item 9] The apparatus according to item 8, wherein the first stop surface and the second stop surface are aligned at different angles with respect to the adjustment direction, and as a result, when the position of the adjustment device relative to the nail is changed, the outer end position can be changed to a greater extent than the inner end position. [Item 10] The position of the adjustment device relative to the nail may be changed along the adjustment direction, where the adjustment direction is aligned at an angle of 0.1° to 15°, particularly 0.8° to 2°, with respect to the transverse direction, where the adjustment direction and the transverse direction are preferably in the same plane, as in the apparatus according to item 1 or 2. [Item 11] The adjustment device is embodied to be longer than the hole, and as a result, the adjustment device may be connected to the nail at a position where it protrudes past both sides of the hole, where the first stop surface is positioned inward from the nail, as in the apparatus according to item 1 or 2. [Item 12] The apparatus according to item 1 or 2, wherein the connecting device has a groove that interacts with the adjusting device and extends along the connecting device, and as a result, when the connecting device and the adjusting device are connected to the nail, the adjusting device restricts, preferably prevents, the rotation of the connecting device around the transverse axis. [Item 13] The apparatus according to item 1 or 2, wherein the hole is embodied to receive the connecting device in the proximal region and the adjusting device in the distal region. [Item 14] The connecting device according to item 1 or 2, wherein the connecting device has a through-hole portion protruding from an outer end to an inner end, into which a K wire can be inserted. [Item 15] The apparatus according to item 1 or 2, wherein an intubated introduction device is provided which can be connected to the nail as an alternative to the adjustment device, and in particular which can be inserted into the hole of the nail instead of the adjustment device, so that bone cement can be introduced to the region of the femoral head through the intubated introduction device when the bone nail is positioned within the femoral shaft axis and the introduction device is connected to the nail. [Item 16] A method for treating a fracture of the femoral neck, comprising: introducing a nail into the intramedullary canal of the femoral shaft axis; subsequently introducing a connecting device to the nail; and fixing the connecting device in the correct position within the femoral head, wherein an adjustment device is connected to the nail, and the adjustment device restricts the mobility of the connecting device relative to the nail along the transverse axis, wherein the apparatus described in particular in item 1 or 2 is used. [Item 17] The method according to item 16, wherein 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, thereafter a first bony hole for the connecting device is introduced into the femoral neck, where the first K-wire acts as a guide, and immediately thereafter the connecting device is introduced into the femoral neck through the nail. [Item 18] The method according to item 17, wherein the first K-wire is removed after the connecting device has been fully introduced into the femoral neck. [Item 19] The method according to item 18, wherein the connecting device is initially introduced only to an intermediate position into the first bone cavity, thereafter bone cement is introduced into the end region of the first bone cavity, and immediately thereafter the connecting device is fully introduced into the first bone cavity, at which point the bone cement located within the end region is dispersed within the femoral head. [Item 20] The method according to item 19, wherein the bone cement is introduced into the end region of the first bone hole through an intubated introduction device, the introduction device is guided through the nail through an opening through which the adjustment device can be guided through the nail, and 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. [Item 21] The method according to item 20, wherein, distal to the region where the connecting device can be connected to the nail, a second K-wire is introduced into the femoral neck at an angle of particularly 0.1° to 15° and particularly 0.8° to 2° relative to the first K-wire, thereafter a second bony 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, thereafter the adjustment device is introduced into the second bony hole, the adjustment device protruding past both sides of the nail.

Claims

1. A device for treating a fracture, comprising a nail that can be introduced into an intramedullary canal of bone, wherein the nail has a hole that is generally aligned transversely with respect to the longitudinal axis of the nail, wherein a connecting device is provided that can be introduced into the hole so as to be able to move within the hole along a transverse axis in an outward and inward direction opposite to the outward direction, wherein the connecting device can be fixed in the correct position at an end in a bone portion, and an adjustable device is provided that can be fixed in the correct position at various positions relative to the nail, wherein the adjustable device has a first restraining surface that restricts the outward movement of the connecting device when the connecting device and the adjustable device are positioned on the nail, wherein the outward end position to which the connecting device can move outward relative to the nail can be changed by changing the position of the adjustable device relative to the nail, wherein the first restraining surface is formed by a plurality of restraining surfaces acting simultaneously.

2. The apparatus according to claim 1, wherein the nail can be introduced into the intramedullary canal of the femoral shaft axis.

3. The apparatus according to claim 1, wherein the connecting device is a bone screw.

4. The apparatus according to claim 1, wherein the fracture is a fracture of the proximal femur or a fracture of the femoral neck.

5. The device according to claim 1, wherein the end portion of the bone portion is the femoral head.

6. The apparatus according to claim 1, wherein the connecting device can be fixed in the correct location using screw threads provided on the connecting device.

7. The apparatus according to claim 1, wherein the adjustment device can be fixed in the correct position at various positions relative to the nail using threads within the adjustment device and within the nail.

8. The apparatus according to claim 1, wherein the first stopping surface is formed at least partially by a shoulder or collar within the region of the outer end of the adjustment device.

9. The apparatus according to claim 8, wherein the collar is an adjustment screw collar.

10. The apparatus according to any one of claims 1, 8, or 9, wherein the first stopping surface is at least partially formed by a portion of the threads of the adjustment device, and the adjustment device can be secured in the correct position relative to the nail using the threads.

11. The apparatus according to any one of claims 1, 8, or 9, wherein the first stopping surface is at least partially formed by a portion of the threads of the connecting device, and the connecting device can be fixed in the correct position at the end within the bone portion using the threads.

12. The apparatus according to any one of claims 1, 8, or 9, wherein the adjustment device is connected to the nail by a screw thread, and a screw lock that increases friction in the screw thread is provided to prevent the adjustment device from loosening.

13. The apparatus according to claim 12, wherein the screw lock is a piece of plastic.

14. The apparatus according to any one of claims 1, 8, or 9, wherein the adjustment device can be screwed onto the nail only to a predetermined position, and the fact that the adjustment device can be screwed onto the nail only to a predetermined position is structurally implemented using a wrench that, starting from the predetermined position of the adjustment device, no longer generates any contact with the corresponding mating member of the adjustment device.

15. The apparatus according to claim 14, wherein the mating member is a hexagonal socket and the wrench is a hexagonal wrench.

16. The apparatus according to claim 1, wherein the adjustment device has a second stop surface that restricts the inward movement of the connecting device when the connecting device and the adjustment device are positioned on the nail.

17. The apparatus according to claim 1 or 16, wherein the position of the adjustment device with respect to the nail can be changed along the adjustment direction.

18. The apparatus according to claim 17, wherein the position of the adjustment device with respect to the nail can be changed along a straight line.

19. The apparatus according to claim 17, wherein the first stop surface and the second stop surface are aligned at different angles with respect to the adjustment direction, and as a result, when the position of the adjustment device relative to the nail is changed, the outer end position can be changed to a greater extent than the inner end position.

20. The apparatus according to any one of claims 1, 8, or 9, wherein the position of the adjustment device with respect to the nail can be changed along the adjustment direction, where the adjustment direction is aligned at an angle of 0.1° to 15° with respect to the transverse direction.

21. The apparatus according to claim 20, wherein the adjustment direction is aligned at an angle of 0.8° to 2° with respect to the transverse direction.

22. The apparatus according to claim 20, wherein the adjustment direction and the transverse direction are in the same plane.

23. The apparatus according to any one of claims 1, 8, or 9, wherein the adjustment device is embodied to be longer than the hole, and as a result, the adjustment device may be connected to the nail at a position where it protrudes past both sides of the hole, and the first stop surface is positioned inward from the nail.

24. The apparatus according to any one of claims 1, 8, or 9, wherein the coupling device has a groove that interacts with the adjustment device and extends along the coupling device, and as a result, when the coupling device and the adjustment device are connected to the nail, the adjustment device restricts the rotation of the coupling device around the transverse axis.

25. The apparatus according to any one of claims 1, 8, or 9, wherein the connecting device has a groove that interacts with the adjusting device and extends along the connecting device, and as a result, when the connecting device and the adjusting device are connected to the nail, the adjusting device prevents the connecting device from rotating around the transverse axis.

26. The apparatus according to any one of claims 1, 8, or 9, wherein the hole is embodied to receive the connecting device in a proximal region and the adjusting device in a distal region.

27. The apparatus according to any one of claims 1, 8, or 9, wherein the connecting device has a through-hole portion that protrudes from the outer end to the inner end, and a K-wire can be inserted into the through-hole portion.

28. Further comprising an intubated introduction device used before the adjustment device is fixed, The apparatus according to any one of claims 1, 8, or 9, wherein the intubated introduction device may be connected to the nail as an alternative to the adjustment device, and as a result, bone cement can be introduced to the region of the femoral head through the intubated introduction device when the bone nail is positioned within the femoral shaft axis and the introduction device is connected to the nail.

Images