AT525310A1 - positioning device - Google Patents

Abstract

The invention relates to a positioning device (1) for a bone implant for positioning and/or fixing the bone implant, the positioning device (1) having a handle (3) with a target guide (4) defining a target axis (Z) for guiding a bone drill (5) wherein the handle bar (3) has a connection element (6) for detachable connection to the bone implant and an alignment visor (7) with a first indicator structure (11) in order in a second X-ray image of the alignment visor (7) along a desired line of sight (S2) , which lies in a first alignment plane formed by the sighting axis (Z) and the first indicator structure (11), to display a course of the sighting axis (Z), the alignment visor (7) having a second indicator structure (12) in order in a first X-ray image of the alignment sight (7) along a line of sight (S1) deviating from the target line of sight (S2), an orthogonal tilting of the line of sight (S1) from the first alignment plane. Provision is made for the second indicator structure to be formed with gap delimiting walls forming coupling display columns spaced apart in the first x-ray image, with a direction of the orthogonal tilting being readable by comparing the gap widths of the tilting display columns. The invention further relates to a method for treating a bone fracture.

Description

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positioning device

The invention relates to a positioning device for a bone implant, in particular an intramedullary nail, for positioning and/or fixing the bone implant, usually for treating a bone fracture, in particular a fracture of a proximal femur, the positioning device having a handle with a target guide, such as a target hole, for guiding of a bone drilling device, wherein the target guide defines a target axis, and wherein the handle has a connecting element in order to detachably connect the bone implant to the handle, and an alignment visor, wherein the alignment visor has a first indicator structure, in a second x-ray image of the alignment visor along a Target line of sight, which lies in a first alignment plane formed by the sighting axis and the first indicator structure, has a course of the sighting axis with the first indicator structure

to display.

The invention also relates to a method for treating a bone fracture, in particular a proximal femur fracture, with a positioning device being used to insert an intramedullary nail into an intramedullary canal of a bone, in particular a proximal femur, with the intramedullary nail being connected, in particular detachably, to a handle of the positioning device is, wherein the handle has a target guide for guiding a bone drill into the bone along a target axis, wherein the handle for aligning the target axis has an alignment visor, wherein the alignment visor has a first indicator structure which is formed, in a second X-ray image of the alignment visor along a Target line of sight, which lies in a first alignment plane formed by the sighting axis and the first indicator structure, a course of the

display target axis.

Devices and methods of the type mentioned at the outset for treating a fracture of a proximal femur or a femoral neck fracture are known from the prior art. It is usually provided that, to treat a femoral neck fracture, an intramedullary nail is inserted into the intramedullary canal of the fractured proximal femur and secured with a coupling device, usually a bone screw, in the

Bone material of the femur is anchored. To this end, the intramedullary nail often has a cross

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to its longitudinal axis running bore, through which the bone screw is inserted superior to the bore, so that one end of the bone screw protrudes into the femoral head. Insertion of the bone screw usually requires a bone drilling channel in the femur, which leads through the hole in the intramedullary nail to the femoral head. For this purpose, a guide wire is usually first inserted into the femoral head in order to then insert a cannulated drill along the

Guide wire to lead to form the bone drilling channel.

The intramedullary nail is usually introduced and positioned using a positioning device which has a handle to which the intramedullary nail is coupled, after which a surgeon inserts and aligns the intramedullary nail into the intramedullary canal of the femur by guiding the handle. The handle usually has a target guide for guiding the guide wire along a target axis, which is specified by the target guide. The target axis usually runs

starting from the target guide through the hole in the intramedullary nail.

A challenge with proper positioning is usually the need to properly position the intramedullary nail with the positioning device in the femur and to guide the guide wire to an appropriate depth of the femoral head. For this purpose, x-rays are usually taken in order to monitor or identify a position of the intramedullary nail and bone drilling device. In order to estimate a position of the guide wire in the area of the femoral head in relation to the femoral head, it is known to equip the handle with an alignment visor, with the alignment visor having an indicator which can be seen in the X-ray image, often in the form of a U-shaped indentation . With the indicator, a course of the sighting axis can be displayed in the x-ray exposure when a line of sight of the x-ray exposure, along which the x-ray exposure is taken, lies in a first alignment plane formed by the sighting axis and the indicator. It is therefore necessary to align the line of sight of the X-ray image in such a way that the line of sight, the indicator and the axis of sight lie in one plane in order to determine a position or course of the line of sight in the X-ray image and, accordingly, the guide wire to be inserted along the axis of sight relative to the femoral head

to estimate.

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A corresponding adjustment for the alignment of the line of sight, indicator and sighting axis regularly proves to be a difficult task, especially in view of the usually not particularly pronounced resolution or representation of the X-ray image and is associated with an extended treatment time, a pronounced radiation exposure of the patient or the operators connected. Since the course of the target axis is not usually visible in the X-ray image, it is often also necessary to approach the guide wire along the target axis to the femoral head so that it is visible in the X-ray image in order to use the guide wire to estimate the course of the target axis so that the axis of sight, the indicator and the line of sight of the radiograph can be aligned with each other. This leads to incorrect positioning of the guide wire in the bone

can lead to damage to a bone material of the femur.

This is where the invention comes in. The object of the invention is to specify a device of the type mentioned at the outset, which enables optimized treatment when implanting a bone implant. A corresponding procedure is to follow

be specified.

The first object is achieved according to the invention by a device of the type mentioned at the outset if the alignment visor has a second indicator structure which is designed to indicate an orthogonal tilting of the line of sight from the first alignment plane in a first X-ray image of the alignment visor along a line of sight deviating from the desired line of sight , to adjust the

Allow line of sight to the target line of sight.

The basis of the invention is the idea of designing the alignment visor in such a way that a tilting of a line of sight of an X-ray image of the alignment visor in relation to the first indicator structure defined by the sighting axis and the first

Alignment level can be recognized easily and with little error in the X-ray image.

This can be achieved if an indication of an orthogonal tilting of the line of sight of the first X-ray exposure in relation to the first alignment plane is decoupled from the first indicator structure, especially since the first indicator structure usually has a

Matching with a course of the target axis is required — for example, by inserting the

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Bone drill along the sighting axis — to detect orthogonal tilt

to be able to

By providing that the alignment visor has a second indicator structure, the function of which is to indicate in the first x-ray image of the alignment visor that there is an orthogonal tilting of the line of sight from the first alignment plane or to make such a misalignment recognizable and practicable. The line of sight can be aligned in such a way that it lies in the first alignment plane. The alignment visor, in particular the first indicator structure or second indicator structure, thus represents a reference point in an x-ray image of the alignment visor for a direction or real position of the sighting axis, or in particular corresponding to the bone drilling device inserted along the sighting axis. In particular, it is not necessary to introduce the bone drilling device into the bone in order to use this for recognizing the target axis for adjustment. This makes it possible to carry out the adjustment or alignment of the sighting axis, the first indicator structure and the line of sight of the first x-ray exposure in a simple and practical manner, so that the time required and/or the exposure to x-rays can be reduced. The potential for damage can be reduced by the fact that the alignment can take place first and only then the bone drilling device has to be guided into or in the bone. This way is one

optimized treatment in the implantation of the bone implant can be achieved.

The bone drilling device can, for example, be a bone drill or a target wire, such as a K-wire, also referred to as a Kirschner wire. As a rule, provision is made for a target wire, in particular a K-wire, to be guided into the bone first in order to use the target wire to define a drilling path along which a bone drill is then guided along the target wire. For this purpose, the bone drill usually has a feed-through channel for guiding the target wire through, in order to guide the bone drill along the target wire. If the target wire is used as a guide, it is also referred to as a guide wire. The target guide defines the target axis along which the bone drilling device can be guided with the target guide. The bone can be a bone part, in particular a proximal femur, or the bone fracture can be a fracture

of the femur, in particular the proximal femur.

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The first or second x-ray exposure is generally taken with an x-ray apparatus which is preferably designed in such a way that a recording direction or line of sight of the x-ray exposure from which the x-ray exposure is taken can be varied, in particular in a controlled manner. It is expedient if a tilt angle of the recording direction or line of sight can be varied, preferably in two degrees of freedom, in particular in a controlled manner. It has proven useful if the X-ray apparatus is designed as a medical C-arm. The X-ray can be one or more

be x-rays.

The X-ray images, in particular the first or second X-ray image, of the alignment visor are usually taken with a line of sight or recording direction such that the line of sight or a line of sight segment of the line of sight, which is to be displayed with the first indicator structure, and the alignment visor in the X-ray image along the line of sight are arranged one behind the other in order to represent a reference point for the course of the sighting axis, in particular its course in the bone, with the alignment sight. An alignment of the line of sight, wherein the line of sight has a tilt angle with respect to the first alignment plane orthogonal to it or does not match the desired line of sight, is also referred to as coarse alignment. The orthogonal tilting of the line of sight or the recording direction of the first X-ray exposure from the first alignment plane denotes a tilting of the line of sight or recording direction in relation to the first alignment plane in a direction orthogonal to the first alignment plane. This applies analogously to an orthogonal tilting of the line of sight in relation to the second one described below

alignment plane.

It is advantageous if the first indicator structure and/or the second indicator structure is formed with at least one elevation and/or at least one depression in order to form a structure that can be identified in an X-ray image, in particular structural features that can be identified in each case. Several elevations or depressions can also be expediently provided. The elevations or depressions can be part of an alignment visor base body, which are introduced into the alignment visor base body, for example by machining. Usually it is provided that the connecting element for connecting the intramedullary nail to the handle and the

Target guidance spaced from each other, preferably at different ends of the

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Handle bar, are arranged on the handle bar. It is expedient if the connecting element and the target guide are connected to a handle arm of the handle, the connecting element being arranged at a first end and the target guide being arranged at a second end of the handle, generally opposite the first end. It is practicable for the alignment visor to be designed as part of the first end of the handle or, in particular, to form the first end of the handle. The connecting element can on the alignment visor, in particular the

Alignment visor body, in particular detachable, is arranged.

It is favorable if the second indicator structure is formed with a plurality of structural elements arranged one behind the other at least in sections in an arrangement direction aligned parallel to the first alignment plane or parallel to the desired line of sight, so that the orthogonal tilting of the line of sight from the first alignment plane in the first X-ray exposure is caused by a relative position of the structural elements is shown or is recognizable by such. For example, due to a different relative position of the structural elements compared to an intended relative position of the structural elements in the second x-ray image of the alignment visor along the target line of sight. In this case, the structural elements are usually spaced apart from one another in a direction orthogonal to the arrangement direction. It goes without saying that the structural elements are shown in the x-ray image by respective images representing them. The respective structural element can be designed with an elevation and/or depression or be formed by a part of one. For example, structural elements designed as elevations or depressions can be arranged one behind the other at least in sections in the arrangement direction, so that in the second X-ray image of the alignment visor there is a defined lateral distance or no lateral distance between the structural elements or imaging features representing them, and in the first X-ray image of the alignment visor under orthogonal Tilting of the line of sight from the first alignment plane, there is a different lateral distance or a lateral distance in the first place, for example a gap, between the structural elements. It goes without saying that a relative position and/or a distance between the structural elements in the respective x-ray exposure is reflected in the images of the

Related structural elements, through which these are represented in the X-ray.

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It is advantageous if the second indicator structure, in particular the structural elements, are designed in such a way that they indicate a direction of orthogonal tilting of the line of sight from the first alignment plane in the first x-ray image. So if it can be seen in the X-ray image of these or their images, in which of the two directions orthogonal to the first alignment plane the orthogonal tilting is present. As a result, line-of-sight misalignment can be efficiently detected

and be corrected.

This can expediently be implemented by the second indicator structure having at least two first structural elements and at least one second structural element, which second structural element is spaced apart from the first structural elements in an arrangement direction parallel to the first alignment plane or parallel to the target line of sight, so that the first X-ray image of the alignment visor shows a direction-dependent lateral displacement of the second structural element relative to the first structural elements as a function of the direction of the orthogonal tilting of the line of sight from the first alignment plane in comparison to the second x-ray image of the alignment sight. The first structure elements are usually spaced apart from one another in a direction orthogonal to the arrangement direction. A plurality of first and/or a plurality of second such structural elements can be provided for better recognition. The first structural elements and the at least one second structural element can be formed, for example, with elevations and/or depressions, the first structural elements and the second structural element being arranged downstream of one another at least in sections in the arrangement direction. For example, the structural elements can be designed and arranged in such a way that there is a gap between the first structural elements, also referred to as a tilting display gap, so that the second structural element is arranged in a middle of the gap in the second X-ray image along the desired line of sight and in the first X-ray image at orthogonal tilting of the line of sight from the first alignment plane, the second structural element depending on the direction of the orthogonal tilting of the line of sight from the first alignment plane in the direction of one or

other first structural element is shown shifted.

For good visibility in the X-ray, it is favorable if the second

Indicator structure is formed with multiple gap boundary walls, so that

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Gap boundary walls in the first x-ray image of the alignment visor form two spaced-apart tilting display gaps, a direction of the orthogonal tilting being readable by a comparison of the gap widths of the tilting display gaps. It is expedient if, depending on the direction of the orthogonal tilting of the line of sight from the first alignment plane, one or the other tilting display gap has a greater decrease in its gap width. To determine the target orientation, it has proven useful if the gap boundary walls form two spaced-apart tilting display columns with the same gap width in the second X-ray image of the alignment visor or when the line of sight lies in the first alignment plane. The respective tilting display gap is usually formed with at least one of the first structural elements and at least one of the second structural elements, which

each form one of the gap boundary walls.

A practicable implementation can be achieved if, to form the respective tilting display gap in the first or second X-ray exposure, a first gap delimiting wall and a second gap delimiting wall form a pair of walls, with the second gap delimiting wall of the first gap delimiting wall in the arrangement direction or a direction parallel to the first alignment plane at least is arranged downstream in sections, and wherein in one of the wall pairs in a first direction orthogonal to the first alignment plane and in the other wall pair in a direction opposite to the first direction the first gap boundary wall is arranged downstream of the second gap boundary wall, so that depending on the direction of the orthogonal tilting of the line of sight from the first Alignment plane in the x-ray of the alignment sight one or the other tilting display slit shows a larger decrease in its slit width. The respective first gap delimiting wall and second gap delimiting wall are usually arranged at a distance from one another in a direction orthogonal to the arrangement direction and can at least partially overlap one another in this direction. In the arrangement direction, the second gap delimiting walls are preferably arranged between the first gap delimiting walls. It has proven useful if the second gap-delimiting wall of a respective pair of walls has a greater longitudinal extension in the direction of arrangement than the first gap-delimiting wall.

The gap boundary walls are preferably in the form of rails, each with one

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Longitudinal axis formed substantially parallel to the arrangement direction. The respective first gap delimiting wall usually represents one of the first structural elements and the respective second gap delimiting wall represents one of the second structural elements. The respective first and second gap delimiting wall can be designed to overlap or be spaced apart from one another in a direction orthogonal to the arrangement direction. Arrangement direction usually means a direction parallel to the first

Alignment plane or parallel to the design line of sight.

A high level of readability can be achieved if the alignment visor is designed in such a way that the first indicator structure is arranged between the two tilting display columns of the second indicator structures in the second x-ray image of the alignment visor. For easy and quick reading, it is favorable if the first indicator structure forms an incision in the second X-ray exposure, with the incision floor of the incision preferably indicating the course of the sighting axis. The incision walls of the incision can be formed with structural elements of the second indicator structure. For example, with one of each

Gap boundary walls of tilting display column.

It is advantageous if the alignment visor has a third indicator structure which is formed, in a third X-ray image of the alignment visor, in particular the first and/or second X-ray image of the alignment visor, an orthogonal tilting of the line of sight of the third X-ray image from a second alignment plane, which is perpendicular aligned with the first alignment plane to align the line of sight of the third radiograph with the second alignment plane. As a result, a reference point for a real position of a segment of the target axis indicated with the first indicator structure can be defined in the bone. The third radiograph may be the first and/or second radiograph, correspondingly then the line of sight of the first or second radiograph of the alignment visor corresponds to the line of sight of the third radiograph of the alignment visor. In this way, a misalignment or tilting of the respective line of sight in a direction within or parallel to the first alignment plane can be detected and improved. By appropriate adjustment of the line of sight of a respective X-ray with respect to

the first and second alignment level can be adjusted to optimize the line of sight,

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so that a real position of the target axis or of the bone drilling device in relation to a bone structure shown in the X-ray image can be better estimated. It is expedient if the target line of sight also lies in the second alignment plane. The desired line of sight is then defined by a line of intersection of the first alignment plane and the second alignment plane at which these intersect. It is particularly favorable when the second alignment plane is aligned orthogonally to the sighting axis. If, as a result, the target line of sight runs orthogonally to the sighting axis or the line of sight can be adjusted accordingly, longitudinal distances in an X-ray image of the

Alignment sights along the line of sight to longitudinal distances along the sighting axis.

The third indicator structure is preferably formed with a plurality of alignment structures arranged one behind the other in the arrangement direction, so that in the third x-ray exposure a defined alignment or superimposition of the alignment structures indicates an arrangement of the line of sight of the third x-ray exposure within the second alignment plane. It is expedient if the third indicator structure is formed by at least one or more elevations and/or at least one or more depressions in order to form a structure that can be identified in the X-ray image. The elevations or depressions can be part of the main body of the alignment visor or can be introduced into it by machining. The first, second and third indicator structure can be formed by common elevations and/or depressions. The third indicator structure or the alignment structures can be formed in a manner analogous to the first or second indicator structure

or their structural elements can be implemented.

It is favorable if the alignment structures are designed in such a way that they form a predetermined target overlay contour in the third x-ray image of the alignment visor when the line of sight of the third x-ray image lies in the second alignment plane, with each of the alignment structures forming only a partial contour of the target overlay contour. It goes without saying that it is expedient if the desired overlay contour is not formed in the case of an orthogonal tilting of the line of sight from the second alignment plane. For example, it can be provided that the target superimposition contour represents a depression or elevation with a defined shape, for example a parabolic shape. It is useful if one of the

Alignment structures by a structural feature, for example the aforementioned

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Incision, with which the first indicator structure is formed, is implemented. It is practical if the alignment structures each have a recess or elevation in the

make x-ray.

The bone implant, in particular the intramedullary nail, can usually be releasably connected to the handle via the connecting element of the handle, in particular in a form-fitting and/or non-positive manner. For this purpose, the connection element can have a first coupling element which can be releasably connected to a second coupling element of the intramedullary nail that corresponds in shape to the first coupling element, for example by being inserted into one another to produce a positive and/or non-positive connection. The handle bar can usually be connected to the intramedullary nail in a torsionally rigid manner. It is usually provided that a user, usually a surgeon, with the bone implant connected to the connecting element, in particular a marrow nail, guides the bone implant by guiding the handle bar to or into the bone, in particular inserts it, and relative to it

aligns.

The alignment visor is typically formed from a radiopaque material. As a result, this represents a recognizable structure in an X-ray image, in particular a higher-contrast structure compared to bone and/or tissue. It can be advantageous to use other parts of the positioning device, such as a handle segment or the handle arm of the handle, on which the target guide is arranged to form from a radiolucent material, so that this in the X-ray image compared to the alignment visor or compared to

Bone and / or tissue represents low-contrast structure.

It is advantageous if a positioning system is provided for positioning and/or fixing an intramedullary nail in a bone, in particular a proximal femur, for treating a fracture, in particular a fracture of a proximal femur, the positioning system comprising a positioning device and an intramedullary nail, which can be introduced into an intramedullary canal of the bone, wherein the medullary nail has a bore running transversely to a longitudinal axis of the medullary nail for receiving a coupling device, in particular a bone screw, to which

Introduce the coupling device into the hole in such a way that the coupling device

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Bore at least on one side, in particular both sides, surpasses, wherein the coupling device is end in a bone part, in particular a femoral head, fixable, for example with a thread. The positioning device can expediently be designed as described above, in particular. The bone drilling device can be designed as a bone drill or guide wire, in particular a K-wire. It is advantageous if the bone drill and/or the coupling device is part of the positioning system. The medullary nail can usually be releasably connected to the connecting element of the positioning device, in particular as stated above, in order to introduce the medullary nail with the positioning device into the intramedullary canal of the bone. The medullary nail is generally designed in such a way that when the medullary nail is connected to the connection element, the drilling axis of the bore corresponds to the target axis. The target axis usually defines the path along which the bone screw is to be

to be inserted into the intramedullary nail.

By taking an X-ray of the alignment visor, in particular according to the aforementioned second X-ray, an orthogonal tilting of the line of sight from the first alignment plane can be seen in the X-ray based on the second indicator structure or is indicated by this. The line of sight of the X-ray image and the first alignment plane can be aligned with one another, so that when the intramedullary nail is connected, in particular detachably, to the connection element, a bone drilling device, such as a target wire, in particular K-wire, with the target guidance of the positioning device, in particular through the bore, along the target axis is feasible and in the X-ray one with the

having the history displayed in the first indicator structure.

It is practical if the target guide has a guide device and a drill guide, with the drill guide having a drill channel for guiding the bone drill, with the drill guide being able to be connected to the guide device in a form-fitting, in particular detachable, manner, so that the drill guide can be displaced relative to the guide device along the target axis is to guide the drill channel to a bone surface of the bone or to the medullary nail when the medullary nail is inserted into the bone. To this

way, the bone drill is protected by the drill guide. a diameter

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of the drill channel is usually designed according to a diameter of the bone drill. Depending on the bone drilling device to be used, different drilling device guides can be used with a diameter of the drilling device channel that is matched to a diameter of the bone drilling device. When the drill guide is connected to the guide device, the drill channel is usually arranged to run along a longitudinal axis of the drill guide or a longitudinal axis of the drill channel is aligned to run along the target axis in order to guide the drill along the target axis. The drill channel can be designed as a borehole, for example. The drilling device guide generally has a rod-shaped segment which, when guided with the guide device, forms an end of the drilling device guide that faces the intramedullary nail, or is in particular essentially rod-shaped. The guide device and drill guide are usually designed such that the drill guide in an extended position pushed in the direction of the intramedullary nail bridges a section between the guide device and the intramedullary nail in order to guide the bone drill protected along this section. It is expedient if the drill guide can be guided essentially up to the medullary nail, with a remaining distance from the medullary nail being able to vary depending on the thickness of the respective bone. It is usually provided that the drilling device guide is pushed between the body tissue surrounding the bones up to the vicinity of the bone surface of the bone or to the vicinity of the intramedullary nail. The bone drilling device can be guided protected by the drilling device guide in the drilling device channel up to the vicinity of the intramedullary nail or bone, in order to then introduce the bone drilling device further into the bone. The guide device can be formed with a guide channel into which the drill guide can be inserted in a form-fitting manner. The guide channel generally defines a guide channel axis that coincides with the target axis

which guided the drill guide is displaceable.

It is favorable if the target guide has a protective tissue jacket that can be moved relative to the guide device, in order to at least partially encase the drill guide in an extended position of the drill guide, in which the drill guide is guided by the guide device in the direction of the bone or intramedullary nail.

to guide the drill from a body part tissue surrounding the bone

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separate. As a result, damage to the body part tissue when the drill guide is moved can be reduced, in particular prevented. The protective tissue jacket can expediently be designed at least in segments with an enveloping surface which, when the drill guide is inserted into the drill guide channel, at least partially, preferably largely, in particular completely, encloses the drill guide in the circumferential direction of the drill guide. This applies in particular to an end piece of the tissue protective jacket that faces the intramedullary nail. The tissue protective jacket is advantageously designed to encase the drill guide in its extended position essentially along a large part, in particular an entire length of the drill guide between the extended position and the guide device. A high level of practicability can be achieved if the protective tissue jacket can be connected to the guide device in a form-fitting, in particular detachable, manner, so that the protective tissue jacket can be displaced relative to the guide device along the target axis, in order to move the protective tissue jacket to a bone surface of the bone or to the insert intramedullary nail. Advantageously, it is provided that the protective tissue casing comprises a drill guide channel for guiding the drill guide, wherein the drill guide can be positively, in particular releasably, connected to the drill guide channel, so that the drill guide can be displaced relative to the protective tissue casing along the target axis. As a result, the protective tissue sheath can be guided along the target axis between part of the body tissue up to the vicinity of the bone and then the drill guide can be guided into the extended position. It is practicable if the tissue protective jacket can be inserted into the guide channel of the guide device in a form-fitting manner. The protective tissue jacket can then be inserted into the guide channel of the guide device in a form-fitting manner in order to guide the protective tissue jacket close to the intramedullary nail or bone, and then the drill guide can be inserted in a form-fitting manner into the drill guide of the protective tissue jacket so that the drill guide is at least partially encased by the protective tissue jacket in the vicinity of the intramedullary nail

or bone to lead. It is advantageous if the guide device has a plurality of guide channels, wherein

the guide channels each for a slidably guided connection with a

Drill guide or a tissue protective coat are formed, wherein

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preferably different guide channels define different target axes or guide channel axes in order to guide a bone drilling device along them. Correspondingly, it can be provided that the guide device has at least one or more further guide channels, each of which defines a further guide channel axis or further target axis, in order to be displaceable around a drill guide and/or a protective tissue jacket along the further guide channel axis, in particular in the aforementioned manner, with the Guide device, in particular releasably to connect. A drilling device, such as a bone drill or a guide wire, in particular a K-wire, can then be guided in the aforementioned manner with the drilling device guide along the further guide channel axis. The intramedullary nail can expediently have at least one or more further bores, with a respective bore axis of the further bores corresponding in each case to one of the guide channel axes. It can be provided that a further coupling element, such as a bone screw, is inserted into the respective further bore, which protrudes beyond the respective further bore at least on one side or on both sides

to fix the medullary nail in the bone.

It is expedient if the target guide, in particular the guide device, is detachably connected to the handle arm of the handle, in order to detach the target guide or guide device from the handle arm of the handle. A connecting device can expediently be provided with which the target guide, in particular the guide device, and the handle bar arm can be releasably connected to one another, in particular in a positive and/or non-positive manner. This makes it possible for the target guide, in particular the guide device, to be connected to the handle bar only after the intramedullary nail has been inserted into the bone. This facilitates handling during treatment. It is practical if the alignment visor can be releasably connected to a connection connection, in particular in a form-fitting and/or force-fitting manner

connected to the handlebar arm.

The further object is achieved by a method of the type mentioned at the outset if a first X-ray image of the alignment visor of the handlebar is taken along a line of sight, after which the line of sight is adjusted to the first alignment plane using a second indicator structure of the alignment visor,

which is formed, in an X-ray photograph of the alignment sight, an orthogonal one

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Show line-of-sight tilt from the first alignment plane. It is usually provided that a positioning device or a positioning system described in this document is used to carry out the method. As explained, an adjustment or alignment of the sighting axis, the first indicator structure and the line of sight of the x-ray exposure can be carried out easily and practicably, so that a time requirement and/or radiation exposure is involved

is reducible.

The target axis is usually aligned transversely to a longitudinal axis of the medullary nail, preferably in such a way that it separates the medullary nail or coincides with a drilling axis of a hole in the medullary nail, as explained in particular above. To treat a proximal femur, the target axis is generally aligned at an angle, at which a longitudinal axis of the femur is to a longitudinal axis of the femoral neck, to the longitudinal axis of the intramedullary nail, usually at an angle of 110° and 140°. If the bone is a femur, the target line of sight of the X-ray image usually corresponds to a lateral-medial view of the femur or its part

femur is.

It is expedient if a bone drilling device, in particular a K-wire, is guided into the bone along the targeting axis via the target guide of the handle, with the line of sight being adjusted using the second indicator structure before and/or after the bone drilling device is used in the first X-ray image for a comparison with the first indicator structure is visible. An optimized line of sight adjustment is achievable before and/or after the bone drill in the radiograph

is visible.

It is usually provided that the intramedullary nail has a bore running transversely to a longitudinal axis of the intramedullary nail for receiving a coupling device, in particular a bone screw, with the bone drilling device, in particular the K-wire, being guided through the bore along the target axis via the target guide. The bore usually has a bore axis that coincides with the target axis. The bone drilling device can be a bone drill or a target wire, in particular a K-wire. With the coupling device of the intramedullary nail in

Fixed bone or a bone material of the bone via the coupling device

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be coupled to the intramedullary nail. For this purpose, the coupling device can be inserted into the bore of the intramedullary nail in such a way that the coupling device protrudes beyond the bore at least on one side, in particular on both sides. The coupling device is usually connected to at least one end of the coupling device, usually the end preceding the coupling direction in the insertion direction into the bone, in

Bone material of the bone anchored. For this purpose, the end can have a thread.

As a rule, a bone drilling channel is introduced into the bone with the bone drilling device along the target axis, usually through the hole in the intramedullary nail, and then the coupling device is introduced into the hole along the bone drilling channel. If the bone is a proximal femur, the bone drilling channel usually extends along the target axis into the femoral head, with the coupling device preferably being introduced into the bore in such a way that one end of the coupling device protrudes into the femoral head or into it, for example with

a thread, is anchored.

It is favorable if first a bone drill designed as a target wire, in particular a K-wire, which has a smaller diameter than the coupling device, is introduced into the bone along the target axis, in particular in the aforementioned manner, after which a bone drill channel is drilled along the Target axis is introduced into the bone, with the aiming wire serving as a guide. The coupling device can then be introduced into the bore via the bone drilling channel, usually in such a way that the coupling device protrudes beyond the bore at least on one side or on both sides. The second bone drilling device or the bone drill and/or the coupling device are usually cannulated in order to guide them along the target wire. For this purpose, the bone drilling device or the coupling device can have a feed-through channel. If the bone is a proximal femur, the coupling device is usually fixed in the femur head with one end of the coupling device. The guide wire is usually removed after the coupling device has been inserted into the bore of the intramedullary nail and

is introduced in particular in the femoral head.

It can be beneficial to use an additional guide wire, in particular a K-wire

off-axis into the femoral head in order to rotate the femoral head

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drilling the bone drill channel, in particular the second bone drill channel, and/or inserting the coupling device into the bore of the intramedullary nail. The further guide wire can extend along a further target axis, preferably through a further bore of the intramedullary nail, into the femur head. The further guide wire can expediently be introduced into the femur head with the guide device, for example via a further guide channel of the guide device

become.

Alignment sight first x-ray commonly refers to an alignment sight x-ray taken along a line of sight with the line of sight orthogonally tilted from the first alignment plane. Second Alignment Shield X-ray commonly refers to an X-ray of the

alignment sight along a line of sight lying in the first alignment plane.

Further features, advantages and effects result from the exemplary embodiments presented below. In the drawings to which reference is made

is taken, show:

1 shows a positioning device for an intramedullary nail;

Figures 2 and 3 show an alignment sight of a positioning device from different lines of sight;

4 shows an X-ray image of a proximal femur along a line of sight which lies in a plane with a sighting axis and the first indicator structure;

FIG. 5 shows another X-ray exposure according to FIG. 4 with a K-wire inserted into the bone along the target axis; FIG.

6 shows the alignment sight of FIGS. 2 and 3 in an oblique plan view of indicator structures of the alignment sight;

7 shows a guidance device of a route guidance;

8 shows a protective tissue covering of a target guide;

9 shows a drill guide of a target guide. Fig. 1 shows a schematic representation of a positioning device 1 for a

Medullary nail 2 for positioning and fixing the medullary nail 2 in an intramedullary

Canal of a bone, especially a proximal femur. purpose is common

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a treatment of a fracture of the bone, in the case of a proximal femur often a femoral neck fracture. The positioning device comprises a handle 3 with a target guide 4 for guiding a bone drilling device 5, for example a K-wire, along a target axis Z, a connecting element 6 to connect the intramedullary nail 2 to the handle 3 in a torsionally detachable manner, and an alignment visor 7 to for aligning the sighting axis Z when the intramedullary nail 2 is inserted into the bone, using the alignment visor 7 to display a course of the sighting axis Z in an X-ray image. The connection element 6 and the target guide 4 are spaced apart from one another on a handle arm 9 of the handle 3, usually on

different ends of the handle bar arm 9 arranged.

The medullary nail 2 has a bore 10 running transversely to its longitudinal axis for receiving a coupling device, such as a bone screw, in order to fasten the medullary nail 2 in the bone by inserting the coupling device into the bore 10 so that the coupling device protrudes beyond the bore 10. The coupling device is usually anchored at the end in a bone part, in the case of a proximal femur usually in the femoral head. When the intramedullary nail 2 is connected to the connecting element 6, an axis of the bore 10 and the target axis Z match, so that the target axis Z passes through the bore 10, shown in Fig. 1. It is usually provided that a bone drilling device designed as a K-wire is inserted first 5 is guided through the bore 10 via the target guide 4 along the target axis Z, and then a bone drill for drilling 10 a bone drill channel is introduced into the bone along the target axis Z, with the K-wire serving as a guide for the bone drill. The coupling device can then be inserted into the bore 10 via the bone drill channel

of the medullary canal.

Alignment of the target axis Z in the bone in order to guide the K-wire or the coupling device to a suitable depth and position in the bone is carried out by taking x-rays of the alignment visor 7, so that a first indicator structure 11 of the alignment visor 7 is a reference point in the x-rays for a course of the target axis Z in the bone. The X-ray exposures are generally performed using an X-ray apparatus 13 with a controllably variable line of sight S1 of the X-ray exposure. The first

Indicator structure 11 is designed to be visible in an X-ray of the

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Alignment visor 7 to display the course of the sighting axis Z along a target line of sight S2 lying in a first alignment plane formed with the sighting axis Z and the first indicator structure 11 . This is illustrated in FIG. 2, where in FIG. 2 the first alignment plane runs through the sighting axis Z at right angles to the plane of the drawing. In order to enable the line of sight S1 of an X-ray image of the alignment visor 7 to be aligned in accordance with the target line of sight S2, i.e. to detect a misalignment of the line of sight S1, it is provided that the alignment visor 7 has a second indicator structure 12, which forms an orthogonal tilt in the X-ray image of the line of sight S1 from the first alignment plane.

This is illustrated in FIGS. 2 and 3 .

Fig. 2 and Fig. 3 show schematic representations of an alignment visor 7 of a positioning device, in particular that of Fig. 1, wherein in Fig. 2 the alignment visor 7 is shown from a view of the alignment visor 7 along the first alignment plane, and in Fig. 3 from a view of alignment sight 7 under orthogonal tilt from the first alignment plane. The first indicator structure 11 is formed with a depression, so that the first indicator structure 11 forms an incision, in particular a U-shaped or V-shaped incision along the target line of sight S2 in an X-ray image, in order to use this to indicate the course of the sighting axis Z, analogously to Fig. 2 The course of the sighting axis Z is marked in particular by a bottom of the incision. For accurate display, it is expedient if the depression or incision has a tapering cross section along its depth direction. The indicator structures are preferred as incorporated into an alignment sight body

introduced elevations or depressions formed.

The second indicator structure 12 is formed with a plurality of gap boundary walls, which are aligned substantially parallel to the first alignment plane or parallel to the line of sight S1 and are orthogonal to their longitudinal axes, spaced apart from one another, in particular as rails, so that the gap boundary walls are two from each other in an X-ray image of the alignment visor 7 along the nominal line of sight S2 form spaced tilting display column 14, to form the respective tilting display column 14 in each case a first gap boundary wall 15 and a second gap boundary wall 16 form a pair of walls, each of which the second

Gap boundary wall 16 of the first gap boundary wall 15 in one direction

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parallel to the first alignment plane, and with one of the wall pairs in a first direction orthogonal to the first alignment plane and the other wall pair in a direction opposite to the first direction, the first gap delimiting wall 15 is arranged after the second gap delimiting wall 16, so that depending on the direction of the orthogonal tilting of the line of sight S1 from the first alignment plane in the X-ray image of the alignment sight 7, one or the other tilting display gap 14 has a greater decrease in its gap width. An arrangement of the gap boundary walls can be seen in particular from FIGS. 2, 3 and 6, with FIG. 6 showing a schematic representation of the alignment visor in an oblique top view of the gap boundary walls. As a result of this arrangement of the gap boundary walls, a direction of the orthogonal tilting of the line of sight S1 from the desired line of sight S2 is practicable and easy to read in the x-ray image. It is favorable if the tilting display gaps 14 have gap widths of the same size along the nominal line of sight S2 in an X-ray exposure. By arranging the first indicator structure 11 between the tilting display columns 14, a particularly sensitive display of the orthogonal tilting can be achieved. As analog in

2 and FIG. 3, the tilting display columns 14 in FIG. 2 have the same gap widths, while in FIG orthogonal tilt from the first

alignment plane.

It can be practicable if the alignment sight 7 has a third indicator structure 17 in order to detect an orthogonal tilting of the line of sight S1 from a second alignment plane in an X-ray image of the alignment sight 7, which is aligned at right angles to the first alignment plane defined with the sighting axis Z and the first indicator structure 11. to display. As a result, the line of sight S1 can also be practically aligned in relation to the second alignment plane. The third indicator structure 17 can preferably be formed with two alignment structures 25 configured as indentations arranged one behind the other in a direction parallel to the first alignment plane, with a defined superimposition of the indentations in the X-ray image forming a target superimposition contour. This can like

from Fig. 2 and Fig. 3 can be implemented by one of the wells of the third

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Indicator structure 17 is implemented by deepening the first indicator structure 11 and

another recess is located behind the intended line of sight S2 in a direction thereof.

FIG. 4 shows an X-ray image of an alignment visor 7 according to FIG. 2 or FIG. 3 as part of an exemplary treatment of a fracture of a proximal femur. In particular, the alignment visor 7 is part of a positioning device 1 according to an embodiment according to FIG. The target axis Z is shown as a dashed line in the X-ray image for the sake of illustration. The line of sight S1 of the X-ray image is aligned relative to the first alignment plane in such a way that the tilting display gaps 14 have essentially the same gap widths, so that the incision in the first indicator structure 11 thus indicates the course of the sighting axis Z. FIG. 5 shows another X-ray image of the alignment sight 7 according to FIG. 4, a K-wire being inserted into the femoral head along the sighting axis Z. FIG. The longitudinal axis of the K-wire runs in accordance with that with the incision of the first

Indicator structure 11 displayed course.

Fig. 6 shows a schematic representation of the alignment visor 7 of Fig. 2 and Fig. 3 in an oblique top view of the first indicator structure 11 and second indicator structure 12 of the alignment visor 7. One of the first gap boundary walls 15 and one of the second gap boundary walls 16 form, as as set forth above, one of the pairs of walls to form each of the slit display gaps 14 in the radiograph. The first gap-limiting wall 15 and second gap-limiting wall 16 of the respective pair of walls are spaced apart from one another in a direction orthogonal to the desired line of sight S2 and can also overlap one another. The depression of the first indicator structure 11 is located between the two pairs of walls. The visible in Fig. 6 centrally located circular structures represent bore holes in the alignment visor body, which in the course of manufacturing the alignment visor 7 for converting the indicator structures into a

Alignment visor body of the alignment visor 7 were introduced.

To guide the bone drill 5 with the target guide 4, it is useful if

the target guide 4 has a guide device 18 and a drill guide 19,

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wherein the guide device 18 is designed to guide the drill guide 19 and the drill guide 19 is designed to guide the bone drill 5, shown in FIG. The drill guide 19 can preferably be arranged detachably on the guide device 18 . With the drill guide 19, the drill guide 19 can be stabilized in order to guide the bone drill 5 to the bone. The drill guide 19 is usually guided between a part of the body tissue surrounding the bone to the bone. In order to separate the drill guide 19 and body part tissue from one another to protect the body part tissue, it is expedient if the target guide 4 has a protective tissue jacket 20 which at least partially encases the drill guide 19 . Fig. 7 shows a schematic representation of a guide device 18, Fig. 8 a schematic representation of a tissue protective jacket 20 and Fig. 9 a schematic representation of a drill guide 19 of a target guide 4, in particular that of Fig. 1. The guide device 18 has a guide channel 22, to insert the drill guide 19 and preferably the protective tissue jacket 20 in a form-fitting manner along the guide channel 22 into the guide channel 22 . It is provided that the guide channel 22 is aligned on the handlebar 3 in such a way that a guide channel axis of the guide channel 22 coincides with the sighting axis Z, so that the drill guide 19 or the protective tissue jacket 20 can be displaced along the sighting axis Z, as can be seen in Fig. 1. The drill guide 19, which is generally essentially rod-shaped, has a drill channel 24 through which a bone drill 5, in particular a K-wire, can be guided. The protective tissue jacket 20 has a drill guide channel 23 in order to insert the drill guide 19 into the drill guide channel 23 so that it can be displaced in a form-fitting manner along the drill guide channel 23 . The protective tissue jacket 20 is designed to at least partially encase the drill guide 19 . It is expediently provided that the tissue protective jacket 20 can be inserted into the guide channel 22, so that the tissue protective jacket 20, guided with the guide channel 22, can be extended relative to the guide channel 22 in the direction of the medullary nail 2 in order to guide the tissue protective jacket 20 to the medullary nail 2 or bone, this is shown in Figure 1. The drill guide 19 can then be guided along the drill guide channel 23 to the intramedullary nail 2 or bone. It is envisaged that one

Longitudinal axis of the drill channel 24 coincides with the sighting axis Z. Afterward

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For example, a drill, such as a K-wire, guided through the drill channel 24 of the drill guide 19 along the sighting axis Z can be inserted into the bone. If no protective tissue jacket 20 is used, the drill guide 19 can be inserted into the guide channel 22, so that the drill guide 19 with the

Guide channel 22 can be extended out relative to the guide channel 22 in the direction of the medullary nail 2 in order to guide the drill channel 24 to the medullary nail 2 . For this purpose, a cross section of the drill guide 19 can have a shape corresponding to a cross section of the

Guide channel 22 may be formed.

It is therefore advantageous if the positioning device 1 has an alignment visor 7 with a first indicator structure 11 for displaying a course of the sighting axis Z in an X-ray image of the alignment visor 7 along a target line of sight S2, with the first indicator structure 11 and the sighting axis Z defining a first alignment plane , and wherein the alignment visor 7 has a second indicator structure 12 which is designed to indicate an orthogonal tilting of the line of sight S1 from the first alignment plane in an X-ray image of the alignment visor 7 along a line of sight S1. As a result, the line of sight S1 of the X-ray image of the alignment visor 7 can be aligned in accordance with the first alignment plane or target line of sight S2. When the intramedullary nail 2 is inserted with the positioning device into the intramedullary canal of a bone, the first indicator structure represents a reference point for a course of the sighting axis Z in the bone in an X-ray image of the alignment visor 7 with a line of sight S1 adapted to the target line of sight S2. If the second indicator structure 12 is formed with two tilting display columns 14, which are preferably formed with elevations or depressions introduced into an alignment visor body, with a direction of the orthogonal tilting of the first alignment plane being readable on the tilting display columns 14, a compact structure and a simple and practicable determination of a orthogonal tilting or alignment of the line of sight S1 performed an X-ray

become.

Claims (15)

15 20 25 30 25 claims 1. Positioning device (1) for a bone implant, in particular an intramedullary nail (2), for positioning and/or fixing the bone implant, usually for treating a bone fracture, in particular a fracture of a proximal femur, the positioning device (1) having a handle (3) with a target guide (4), such as a target hole, for guiding a bone drilling device (5), the target guide (4) defining a target axis (Z), and the handle bar (3) having a connecting element (6) that can be detached around the bone implant to be connected to the handle (3), and having an alignment visor (7), wherein the alignment visor (7) has a first indicator structure (11) in order to be able to be detected in a second X-ray image of the alignment visor (7) along a target line of sight (S2) which is shown in a first alignment plane formed by the sighting axis (Z) and the first indicator structure (11), to display a course of the sighting axis (Z) with the first indicator structure (11). , characterized in that the alignment visor (7) has a second Indicator structure (12) which is designed to indicate an orthogonal tilting of the line of sight (S1) from the first alignment plane in a first X-ray image of the alignment visor (7) along a line of sight (S1) deviating from the target line of sight (S2) in order to make an adjustment the line of sight (S1) to the Allow target line of sight (S2). 2. Positioning device (1) according to claim 1, characterized in that the first indicator structure (11) and / or the second indicator structure (12) is formed with at least one elevation and / or at least one depression to a in a X-ray identifiable structure to form. 3. Positioning device (1) according to claim 1 or 2, characterized in that the second indicator structure (12) is formed such that this in the first X-ray image a direction of orthogonal tilting of the line of sight (S1) from the first level of alignment. 4. Positioning device (1) according to any one of claims 1 to 3, characterized characterized in that the second indicator structure (12) with several Gap boundary walls is formed so that the gap boundary walls in the first 15 20 25 30 26 X-ray image of the alignment visor (7) form two spaced apart tilt display gaps (14) with a direction of orthogonal tilt through a comparison of the gap widths of the tilting display column (14) can be read. 5. Positioning device (1) according to Claim 4, characterized in that a first gap-delimiting wall (15) and a second gap-delimiting wall (16) form a pair of walls to form the respective tilting display gap (14) in the X-ray image, with the second gap-delimiting wall (16) at least in sections downstream of the first gap-limiting wall (15) in a direction parallel to the first alignment plane, and wherein in one of the wall pairs in a first direction orthogonal to the first alignment plane and in the other wall pair in a direction opposite to the first direction the first gap-limiting wall (15) of the second wall boundary wall (16) is arranged downstream, so that depending on the direction of the orthogonal tilting of the line of sight (S1) from the first alignment plane in the X-ray image of the alignment visor (7) one or the other tilting display gap (14) has a greater decrease in its gap width. 6. Positioning device (1) according to claim 4 or 5, characterized in that the alignment visor (7) is designed such that in the second radiograph the first indicator structure (11) is arranged between the two tilting display columns (14). is, wherein preferably the first indicator structure (11) is implemented with an incision. 7. Positioning device (1) according to one of claims 1 to 6, characterized in that the alignment visor (7) has a third indicator structure (17) which is formed in a third X-ray image of the alignment visor (7), in particular the first and/or or the second radiograph of the alignment sight (7) to indicate an orthogonal tilt of the line of sight of the third radiograph from a second alignment plane oriented perpendicular to the first plane of orientation to correspond to the line of sight of the third radiograph align with the second alignment plane. 8. Positioning device (1) according to claim 7, characterized in that the third indicator structure (17) with several in a direction parallel to the target line of sight (S2) successively arranged alignment structures (25) formed so that in the third 15 20 25 30 27 X-ray image a defined alignment or superimposition of the alignment structures (25) an arrangement of the line of sight of the third X-ray image within the second level of alignment. 9. Positioning system for positioning and/or fixing an intramedullary nail (2) in a bone, in particular a proximal femur, for treating a fracture, in particular a fracture of a proximal femur, the positioning system having a positioning device (1) and an intramedullary nail (2) which can be introduced into an intramedullary canal of the bone, the intramedullary nail (2) having a bore (10) running transversely to a longitudinal axis of the intramedullary nail (2) for receiving a coupling device, in particular a bone screw, in order to insert the coupling device in such a way to introduce the bore (10), that the coupling device projects beyond the bore (10) at least on one side, in particular on both sides, the coupling device being fixable at the end in a bone part, in particular a femur head, characterized in that the positioning device (1) according to a of claims 1 to 8 is formed. 10. Positioning system according to Claim 9, characterized in that the target guide (4) has a guide device (18) and a drill guide (19), the drill guide (19) having a drill channel (24) for guiding the bone drill (5), wherein the drill guide (19) can be positively, in particular releasably, connected to the guide device (18), so that the drill guide (19) can be displaced relative to the guide device (18) along the target axis, in order to open the drill device channel (24) when the intramedullary nail is inserted into the bone lead to a bone surface of the bone or to the intramedullary nail (2). 11. Positioning system according to claim 10, characterized in that the target guide (4) has a protective tissue jacket (20) that can be moved relative to the guide device (18) in order to position the drill guide (19) in an extended position in which the drill guide (19) points in the direction of the bone or medullary nail (2) is guided, at least partially to encase the drill guide (19) of the bone to separate surrounding body part tissue. 15 20 25 30 28 12. A method for treating a bone fracture, in particular a proximal femur fracture, with a positioning device (1), in particular a positioning device (1) according to any one of claims 1 to 8, an intramedullary nail (2) in an intramedullary canal of a bone, in particular a proximal femur, the intramedullary nail (2) being connected, in particular detachably, to a handle (3) of the positioning device (1), the handle (3) having a target guide (4) for guiding a bone drill (5) into the bone along a sighting axis (Z), wherein the handle bar has an alignment visor (7) for aligning the sighting axis (Z), the alignment visor (7) having a first indicator structure (11) which is designed, in a second X-ray image of the alignment visor ( 7) along a target line of sight (S2) which is formed in a first alignment plane li formed by the sighting axis (Z) and the first indicator structure (11). designed to display a course of the sighting axis (Z), characterized in that a first X-ray of the alignment sight (7) of the handlebar (3) is carried out along a line of sight (S1), after which an adjustment of the line of sight (S$1) to the first alignment plane using a second indicator structure (12) of Alignment visor (7) takes place, which is formed, in an X-ray image of the alignment visor (7), an orthogonal tilting of the line of sight (S1) from the first to show the alignment plane. 13. The method according to claim 12, characterized in that a bone drilling device (5), in particular a K-wire, is guided into the bone along the target axis (Z) via the target guide (4) of the handle bar (3), the adaptation of the Line of sight (S1) using the second indicator structure (12) takes place before and/or after the bone drill (5) in the first X-ray image for a comparison with the first indicator structure (11) is visible. 14. The method according to claim 12 or 13, characterized in that the intramedullary nail (2) extends transversely to a longitudinal axis of the intramedullary nail (2). Bore (10) for accommodating a coupling device, in particular a bone screw, the bone drill (5), in particular the K-wire, being guided through the bore (10) via the target guide (4) along the target axis (Z). becomes. 15. The method according to claim 15, characterized in that first a bone drilling device designed as a target wire, in particular a K-wire, which has a smaller diameter than the coupling device, is guided through the bore (10) along the target axis (Z), after which a bone drill channel is introduced into the bone along the target axis (Z) with a bone drill, the target wire serving as a guide, after which the coupling device via the bone drill channel in the bore (10) is introduced.