DE102014109935A1 - Positioning device for fixing an intramedullary nail in a long bone - Google Patents

Abstract

The present invention relates to a positioning device (100, 100 ', 100' ') for fixing an intramedullary nail (19) in a long bone, comprising a guide bow (1), which has an adjusting device (3) and a sleeve guide (2) Adjusting device (3) having a sighting device (5), and wherein the aiming device (5) is adapted to receive a locking device (21) or an instrument (23) for acting on the locking device (21); and wherein the sleeve guide (2) comprises a sleeve (7), wherein the sleeve (7) relative to the sleeve receptacle (2) rotatably and / or displaceably in the sleeve guide (2) is arranged, and wherein the sleeve (2) is a continuous Longitudinal opening for receiving a guide device (9) herein.

Description

The invention relates to a positioning device for fixing an intramedullary nail in a long bone according to claim 1.

Intramedullary nails are known tools for the treatment of fractures of long bones. They are inserted into the medullary canal of the fractured bone to mechanically bridge the bone fracture. Intramedullary nails can be designed as so-called interlocking nails. In the latter, locking screws serve to secure the connection between bone and locking nail against displacement.

In previously customary locking nails the locking screws are placed in discrete openings of the intramedullary nail in a predetermined position to the intramedullary nail in the bone. The exact placement of the locking screws in the intramedullary bone intramedullary nail requires a great deal of experience of the surgeon in introducing the intramedullary nail into the bone.

The object of the present invention is to provide a positioning device for fixing an intramedullary nail in a long bone.

The object of the invention is achieved with a positioning device having the features of claim 1.

In the following, the terms interlocking nail and intramedullary nail are used interchangeably.

The positioning device according to the invention comprises a guide arc with an adjusting device. The adjusting device has at least one aiming device. The aiming device is adapted to receive a locking device, such as a locking screw, or an instrument for acting on the locking device, such as a screwdriver, a drill or a spiked wire (wire for train fixation of bone debris or implants), in particular detachably.

The guide arc has a sleeve guide, which in turn has a sleeve. The sleeve is rotatably and / or slidably disposed in the sleeve guide relative to the sleeve receptacle. For this purpose, the sleeve receptacle has, for example, a continuous longitudinal opening or a tube section (both terms are used synonymously herein).

The sleeve in turn has a continuous longitudinal opening or a pipe section in which / which a guide device can be arranged or arranged.

In all the above and following embodiments, the use of the term "may be" or "may have" etc. is synonymous with "preferably" or "preferably has", etc., and is intended to explain embodiments of the invention.

Whenever numerical words are mentioned herein, those skilled in the art will understand these as indicating a numerically lower limit. If this does not result in a contradiction that is recognizable to the person skilled in the art, the person skilled in the art therefore always reads "at least one" or "at least one", for example, when specifying "a" or "one". This understanding is also encompassed by the present invention as the interpretation that a numerical word such as "a" may alternatively be meant as "exactly one" wherever technically possible for those skilled in the art. Both are encompassed by the present invention and apply to all number words used herein.

Advantageous developments of the present invention are the subject of subclaims and embodiments.

In some embodiments of the invention, the guide device is preferably arranged relative to the sleeve displaceable and / or rotatable in the sleeve.

In certain embodiments of the invention, the guide arc is slidable along the longitudinal axis of the sleeve relative to the sleeve and rotatably disposed about the longitudinal axis of the sleeve relative thereto.

In some embodiments of the invention, the guide device has a connecting portion for releasably connecting the sleeve to an intramedullary nail.

In some embodiments according to the invention, a fixing of an intramedullary nail is to be understood as meaning a connection of the intramedullary nail to locking screws. The intramedullary nail is fixed in the bone by inserting the locking screws. The positioning device according to the invention therefore serves for fixing. It also serves to fix or, in some particular embodiments, may be used for each.

The guide arc with the adjusting device, which has a target device, may be referred to as a target strap in some embodiments according to the invention. The aiming bar is preferably designed arcuate, at least in sections thereof.

In some embodiments of the invention, the locking device is a locking screw or a locking pin. However, the present invention is not limited thereto.

In some embodiments according to the invention, the receiving device provided for receiving a locking screw in the intramedullary nail is a device having at least one prefabricated through-opening for the locking screw. The receiving device may be sleeve-shaped or roller-shaped. The receiving device can be composed of several parts and / or more materials (composite). For example, a plastic ring can be used as part of the receiving device. The plastic ring can advantageously prevent accidental unscrewing of the locking screw.

In certain embodiments of the invention, the receiving device is an opening or a bore in the intramedullary nail.

In certain embodiments of the invention, the aiming device is prepared and / or configured for setting, applying, guiding, aligning, drilling in and / or screwing in the locking device.

In some embodiments according to the invention, the guiding device is to be understood as meaning a hollow or tubular or preferably elongate device provided with a passage opening in the longitudinal direction through which a tool can be guided. Correspondingly, in some embodiments of the invention, the guiding device could also be referred to as a clamping device or intramedullary nail receiving device.

In some embodiments of the invention, the guide device is a tubular, internally hollow rod, or a hollow tube. The guiding device can be provided and prepared for manual, releasable fixing or fixing or fastening of the intramedullary nail to or in the sleeve. In particular, at one axial end thereof, the guide device may comprise a handle, a knob or similar arrangement for manually rotating the guide device about its longitudinal axis, such as when screwing the guide device to the intramedullary nail. The handle or knob can be knurled, for example.

At the opposite end of the guide device, this can carry a thread, preferably an external thread, or an externally threaded portion. The external thread may be tuned to be connected to an internal thread or a female threaded portion at an axial end of the intramedullary nail.

In certain embodiments of the invention, the guide device is provided and prepared for guiding a tool therethrough for frictionally locking the receiving device and the locking device guided in the receiving device. A non-positive locking can be achieved for example by tightening a threaded pin, which acts in the intramedullary nail on the receiving device.

In some embodiments of the invention, the guide device is configured to releasably clamp the intramedullary nail against the sleeve.

In certain embodiments of the invention, the guide device is arranged coaxially with the longitudinal axis of the sleeve.

In some embodiments of the invention, the sleeve, particularly on an outer or peripheral surface thereof, has a slotted guide along which the guide arc or portion thereof can be moved along the sleeve or relative to the sleeve.

The term "slotted guide", as used herein, describes in some embodiments of the invention designated as a slot slot, web, recess or groove, in or on or along the one device, in particular the guide arc, guided or positively driven.

By means of the gate, the movement of the guide arc is predetermined or defined relative to the sleeve in some embodiments of the invention. The transfer function of the slide guide is determined and specified by the course of the slot, the web, the recess or the groove.

The slotted guide is preferably used in particular for driving or aligning the target device and the locking device received therein, in particular the locking screw, on the prefabricated through holes of the intramedullary nail for the locking screw.

The slotted guide can be a combined displacement movement (in the direction of the longitudinal axis the sleeve) and / or rotational movement (in the circumferential direction of the sleeve) generate.

Furthermore, the slide guide can specify an initial position and / or an end position of the displacement path.

The slotted guide can be designed as a helical groove.

In certain embodiments of the invention, the backdrop on the sleeve by means of eroding, machining, z. B. made by milling or drilling or by laser machining of the sleeve.

In certain embodiments according to the invention, the sleeve is produced together with the slide by means of an additive (generative) manufacturing process (eg by means of laser sintering).

In some embodiments of the invention, the gate is made by an applied method (eg, welding).

In some embodiments of the invention, the sleeve has at least one latching position, which is provided on or in the sleeve.

The latching position may be for releasably fixing or locking the guide arc in at least one predetermined position on the sleeve or relative thereto.

The latching position is preferably not integrated into the slide guide but is separate from this before, for example, at least in part, on one side of the sleeve, which is opposite to that side with the slotted guide.

The latching position can, for example in the circumferential direction of the sleeve, on an opposite, rotated by 180 degrees side of the sleeve, be arranged.

The latching position may be a depression in the lateral surface of the sleeve. It can be a through opening in the wall of the sleeve.

For example, the guide arc by means of a pin which is integrated or inserted into the guide arc, on the one side of the sleeve (viewed in the circumferential direction of the sleeve) are guided along the slotted guide. On the opposite side of the sleeve, the guide bow may have a latching arrangement which is designed to engage in the latching position, preferably to engage in it.

The latching position can be a shaping in the backdrop. It may be a through hole or an opening of the wall of the sleeve.

The latching position may be configured to allow the guide sheet to be locked to the sleeve by means of clamping, ratcheting or positive engagement.

The guide bow can be locked in one of the locking positions, for example by means of a bolt or locking pin. Thus, its orientation to the sleeve is set releasably.

In some embodiments of the invention, the guide arc has at least one latching pin or bolt for releasably engaging the guide arc on or in the at least one latching position of the sleeve. An arrangement or positioning of the latching pin in a latching position may be referred to as a latching arrangement. If the detent pin is not engaged, can be spoken of a non-latching arrangement. The latch pin may be arranged to be repeatedly moved between the two aforementioned positions, the latching arrangement and the non-latching arrangement.

In certain embodiments of the invention, the latch pin is arranged to be manually engaged or positioned in the latched position and / or manually disengaged or decoupled. For such a manual operation, a translation, a gear, a slider or the like may be provided. The manual operation can be spring-assisted. Alternatively, the latching and / or the disengagement or decoupling can be done without manual operation, for example by means of a spring-loaded ball or a similar arrangement.

In some embodiments of the invention, the latching position has a longitudinal groove aligned in the circumferential direction of the sleeve, wherein a longitudinal groove may be an elongated groove extending in any direction, recess or through opening in the lateral surface of the sleeve.

The longitudinal groove may allow for a displacement of the detent pin or bolt in the circumferential direction of the sleeve and, relative thereto, within the limits set by the geometry, after engagement of the detent pin in the detent position. The enabled displacement of the latch pin after latching may be referred to as a play of the latch pin in the latched position. The game can be specified by means of the shape of the longitudinal groove, in particular its length. For example, such a game, an alignment, shifting or positioning of the locking screw within a passage opening for the locking device (eg., a slot or a hole) in the intramedullary nail allow within predetermined (one-sided or bilateral) limits.

In certain embodiments of the invention, the longitudinal groove is designed to move the locking device or screw with a game in a defined amount or extent, for example +/- 10 ° in the circumferential direction of the sleeve, for example, based on the center of the passage opening in the intramedullary nail, or rotate / pivot.

In some embodiments according to the invention, the guide bow has a locking device, in particular a locking screw, for preferably manually locking the guide bow in a position of the guide bow predetermined relative to the sleeve by means of the locking pin in a selected latching position.

After locking the guide bow can not be moved relative to sleeve.

In certain embodiments of the invention, the sleeve has markings by means of which the current position of the guide arc relative to the sleeve can be controlled.

The locking positions or the link or the linkage arrangement on or in the sleeve can be concealed in a movement of the guide arc in the slotted guide so that a user of the positioning device according to the invention does not see the current or current position of the guide arc between the locking positions or in the backdrop. Nevertheless, it may be helpful for the user to recognize, for example, in which of several latching positions the latching pin of the guide arc is currently located. This can advantageously facilitate and simplify the further positioning of locking screws in the intramedullary nail by means of the positioning device according to the invention. Therefore, the sleeve can provide an orientation guide for the user that reflects or reflects the link and the slide guide in a visible area for the user on the surface of the sleeve. In such embodiments according to the invention, the scenery can be impressed or visualized on the sleeve in this visible region, for example by means of an engraving mirror image.

In certain embodiments of the invention, the guide means for releasably connecting the sleeve to the intramedullary nail is disposed inside the sleeve and preferably coaxially or parallel to the longitudinal axis of the sleeve.

In order to use the positioning device according to the invention for fixing the intramedullary nail, it is provided to connect the positioning device with the intramedullary nail to be fixed. The connection arrangement provided for this purpose has in particular a first and a second component.

The first component may be a web-groove connection for the rotationally secure mutual arrangement of sleeve and intramedullary nail to each other. For example, the sleeve has at one axial end at least one, but preferably two, three or more (for example axial) webs, projections, pins or shoulders, which are in a corresponding number of (for example axial) grooves, slots or depressions at one axial end of the intramedullary nail engage positively. Alternatively, the intramedullary nail may have the heels or the like and the sleeve may have the grooves or the like. Combinations of these are possible.

After the sleeve and intramedullary nail are arranged such against rotation and preferably also in a predetermined manner to each other, the sleeve and the intramedullary nail can be interconnected by means of a second component, in a re-releasable manner. This second component can be realized by means of the guide device. For this purpose, the guide device can be arranged inside the sleeve and coaxially with the longitudinal axis of the sleeve. The guide device can be inserted through the sleeve and screwed together by means of an external thread or external thread section arranged at the axial end of the guide device with an internal thread or internal thread section of the intramedullary nail. The guide device thus clamps the intramedullary nail detachably against the sleeve and holds it in this manner connected to the guide arc, preferably in a predetermined orientation to the latter.

By means of the two components described above can be advantageously achieved that the intramedullary nail, while it is screwed to the guide device or the screw is solved with this, so for example after carried out fixation of the intramedullary nail by means of the locking screw (s), does not rotate in the screwing direction or with you. Such avoidance of rotation or rotation, even small, on the order of a few degrees, may be advantageous and important for the later stability of the tubular bone.

In some embodiments of the invention, the guide device is tubular or hollow inside and thus configured to guide or pass a tool. The tool can be used, for example, to actuate or Screw (tightening and loosening) serve a locking or locking device inside the intramedullary nail. The locking or locking device can be designed as a clamping screw for fixing or clamping an adjustable receiving device for a locking screw.

For example, the tool for screwing or clamping may have an internal threaded pin in the intramedullary nail. The tool can be a hexagon socket wrench. The tool can for example be designed to apply a torque of, for example, about 5 Nm, 7 Nm or 9 Nm or a range between 5 to 9 Nm.

In certain embodiments according to the invention, the adjustment device is limited together with the target device to be aligned with the intramedullary nail or can be displaced unrestrictedly along the guide arch. The direction of displacement along the guide arc is defined as the x direction. The aiming device is designed to receive a locking device, in particular a locking screw, or an instrument for acting on the locking device. Thus, the locking device can be aligned using the positioning device according to the invention in a superimposed movement along the guide arc in the x direction and according to the position of the guide arc to intramedullary nail according to the slide guide on the sleeve and positioned to subsequently fix the locking screw in intramedullary nail.

In some embodiments of the invention, the guide arc is formed at least in sections as a circular arc or a circular arc. The adjusting device is displaceable at least in sections along a circular arc.

In certain embodiments of the invention, the aiming device has a one or more openings directed at the intramedullary nail, passing through the adjustment device or piercing through the adjustment device. The opening (s) is / are designed in particular for receiving a locking device or an instrument for acting on the locking device present in a receiving device of the intramedullary nail.

In certain embodiments according to the invention, the guide arc has stops for limiting the displacement path of the adjusting device along the circular arc. The stops can advantageously improve the handling of the positioning device according to the invention, for example, by the adjustment device can be aligned faster or easier to a desired, selected or targeted passage opening in the intramedullary nail. The attacks can continue to be provided with respect to anatomically meaningful positioning of the locking devices.

In some embodiments according to the invention, the aiming device is displaceably arranged in the longitudinal direction of the guide arc (x-direction) and perpendicular to the longitudinal direction of the guide arc (y-direction) in the circumferential direction of the sleeve. By means of this displaceability both in the x-direction and in the y-direction, an instrument in the aiming device, which can be connected to a locking device, can be moved and positioned within a circular cutout. The circular surface of this circular section can be spanned by the x-direction and the y-direction. The target device can be arranged perpendicular to this circular surface. The center of the circle lies in particular in the receiving device for the locking screw in the intramedullary nail, in particular at the intersection of the receiving device of the locking screw and the longitudinal axis of the intramedullary nail (or the longitudinal axis of the sleeve). Intramedullary nail and positioning can be coordinated accordingly. The movement of the instrument on the surface of the circle and its positioning can be compared with the movement and operation of a joystick.

In certain embodiments of the invention, the aiming device is arranged in the adjusting device and displaceable relative thereto or to the guide arc.

In some embodiments according to the invention, the adjusting device is arranged in at least a first position, referred to here as an adjusting position, for moving the aiming device relative to the adjusting device or to the guiding arc. In at least one second position, here referred to as a fixed position, the adjusting device for fixing the target device is arranged immovable relative to the adjusting device or the guide arc, which can be effected in particular by means of frictional engagement.

The fixation of the target device relative to the adjusting device or relative to the guide arc is preferably releasable again.

The first position is provided in particular for the positioning and alignment of the locking screw on the desired receiving device in the intramedullary nail. After the alignment is completed and the locking screw is then to be fixed in the receiving device or through the receiving device in the tubular bone, the aiming device is fixed relative to the adjusting device (second position). In this position, the Target device and in particular the adjustment relative to the guide bow no longer be moved or moved. Subsequently, by means of an instrument, which is connected to a locking screw, and which is arranged in the target device, the locking screw can advantageously be easily and securely fixed in the desired position in the intramedullary nail and in the long bone.

The positioning and / or the fixation of the aiming device relative to the adjusting device can take place in different ways. The different versions are based in particular on a 3-shell model or a 3-shell arrangement. The radially inner shell may be a portion of the guide arc. The radially outer shell may be the adjustment device or a portion thereof. In the middle shell between the inner and the outer shell in particular the target device is integrated. The middle shell is movable and / or positionable between the outer shell and the inner shell. The fixation of the middle shell after the positioning and alignment of the aiming device has been completed can be carried out in different ways. Exemplary examples of this fixation are described below.

A first concept for fixing the middle shell is referred to herein as a spring pin concept. One or more spring pins, which are integrated, for example, in the outer shell, press with their spring force directly or indirectly on the middle shell. By these contact forces, the middle shell is pressed on or against the inner shell and fixed by means of friction in contact with this. The contact forces can be varied based on the number and / or spring strength of the spring pins, so that on the one hand the target device remains movable, on the other hand, the frictional forces are high enough to allow for a completed positioning and alignment an exact screwing the locking screw.

A second concept is referred to here as a flap concept. The outer shell is hinged on one side. On a (opposite to the shell top) of the articulated bearing position, a device for fixing or clamping the outer shell is arranged with the inner shell. For example, by means of a thumbscrew, an eccentric, a snap hook or the like, the outer shell can be fixed and clamped on or against the middle and inner shell. When this device fixes the outer shell with the inner shell, e.g. B. by manually tightening a thumbscrew, the middle shell in which the target device is arranged, clamped and immovable. On the other hand, if this device is loosened, the middle shell can be moved and thus the target device can be positioned and aligned.

A third concept is referred to here as the spring concept. The middle shell has two shells arranged radially one above the other. The two superimposed shells are pressed radially apart by means of springs which are arranged between these two shells. Furthermore, at least one of the two shells can have surface structures, for example elevations, which can engage in further surface structures on the radially inner side of the outer, opposing shell. The surface structures on the inside of the outer shell may, for example, be holes into which the elevations engage or engage.

A fourth concept is referred to here as a thread concept. The middle shell has two separately manufactured, radially stacked shells, which are interconnected by means of a thread. By rotating one of the two shells relative to the second shell, the shells, depending on the direction of rotation, either rotated or rotated apart, d. H. their distance from each other is reduced or increased. If these two shells are rotated apart, the inner and outer shell are braced and thus fixed.

A fifth concept uses leverage to tighten the outer shell against the middle shell or loosen tension. In the ground state, the outer shell pushes in the clamped state on the middle shell, which is fixed or immobile in this ground state. When the outer shell is pushed radially outward or bent outward by means of leverage, the middle shell loosens. The aiming device can be aligned and positioned until the outer shell returns to the ground state and the middle shell is fixed. The leverage is applied in particular by manual force.

Some or all embodiments according to the invention may have one, several or all of the advantages mentioned above and / or below.

By means of the positioning device according to the invention advantageously minor misalignments during positioning and / or screwing (the so-called "setting") of locking screws can be corrected in an intramedullary bone intramedullary nail during surgery.

The location and angle of holes for the locking screws and their location can advantageously be adjusted intraoperatively by means of the positioning device according to the invention to the individual anatomical and resulting from an injury situation.

Furthermore, advantageously by means of the positioning device according to the invention, the angle of the intramedullary nail penetrating locking screws can be varied intraoperatively, for example, to reposition fracture fragments or anatomically correct to adapt.

By means of the latching arrangement of the positioning device according to the invention, the latching arrangement can advantageously be locked in a defined position along the longitudinal axis of the sleeve by positive engagement between on the one hand the bolt of the latching arrangement of the guide arc and on the other hand the sleeve. Furthermore, this form-fit can be performed by means of a slot in the circumferential direction of the sleeve to specify or allow a defined or limiting rotation between the guide arc and the sleeve. This serves the surgeon within certain limits still intraoperatively align the locking devices relative to the intramedullary nail.

By means of the markings for position control of the guide arc relative to the sleeve, the surgeon can advantageously be assisted in tracing the position of latching positions and / or slots along the longitudinal axis of the sleeve. By means of the markings, the position of latching positions and / or elongated holes or longitudinal grooves can advantageously be visualized. The orientation (direction of rotation and indication of the angle of the guide arc relative to the sleeve) of the guide arc relative to the intramedullary nail or the through holes for screwing the locking screws into the intramedullary nail can be facilitated so advantageous.

According to the invention, the positioning device can be reliably and easily releasably connected to the intramedullary nail to be fixed. Thus, the positioning device can be decoupled from the fixed intramedullary nail and removed. In this case, the first component, a web-groove connection, serve the rotationally secure mutual arrangement of sleeve and intramedullary nail. It can advantageously ensure that the intramedullary nail during screwing or during the release of the screw between the guide device and intramedullary nail, advantageously does not rotate or rotates. This helps to prevent the achieved position of the intramedullary nail in the bone when connecting the positioning device on the intramedullary nail or when releasing the positioning of the intramedullary nail by the introduction of torque.

The present invention is explained below by way of example with reference to the accompanying figures, in which identical reference numerals designate identical or similar components. In each schematically simplified figures:

1 shows a positioning device according to the invention of a first exemplary embodiment in a perspective view;

2 shows the positioning device according to the invention 1 with an intramedullary nail, a locking screw and an instrument for inserting the locking screw;

3 shows a portion of the positioning device according to the invention with a sleeve and a slotted guide in the sleeve, and a latching arrangement;

4 shows the section of the positioning device according to the invention 3 with a guide arc section;

5 shows the section of the positioning device according to the invention 3 in another view with multiple locking positions and markers for position control;

6 shows the components of the positioning device according to the invention 5 with a guide arc section;

7 shows a guide device with a sleeve connected to an intramedullary nail;

8th shows the guide device 7 , with the intramedullary nail, but without the sleeve;

9 shows the guide device 7 ;

10 shows a further embodiment of the positioning device according to the invention, wherein the target device is arranged by means of a spring-pin concept between the adjusting device and the guide arc;

11 shows a detailed view of an adjustment with a target device of the positioning of 10 ;

12 shows the detail view of the 11 without outer shell of the adjusting device;

13 shows a further embodiment of the positioning device according to the invention;

14 shows the latching arrangement of the embodiment of the 13 in detail;

15 shows a further latching arrangement with a spiral spring;

16 shows a further latching arrangement with a leaf spring and a lever;

17 shows a further latching arrangement with a locking pin for its insertion obliquely from above into the sleeve;

18 shows a further latching arrangement with a locking pin for its lateral insertion into the sleeve;

19 shows a two-part target device of the positioning device;

20 shows an adjusting device with a snap device for fixing the target device on the guide arc;

21 shows a target device with a hole arrangement for an instrument;

22 shows the positioning of the 10 in another view;

23 shows the positioning of the 22 in a sectional view;

24 shows the positioning of the 22 in a sectional view with a flap concept for fixing the adjusting device on the guide arc;

25 shows a target device, which is arranged and movable by means of a spring concept between the adjusting device and the guide arc; and

26 shows a target device, which is arranged and movable by means of a threaded concept between the adjusting device and the guide arc.

1 shows a positioning device according to the invention 100 a first exemplary embodiment in a perspective view obliquely from above. The positioning device 100 includes a guide bow 1 with a sleeve guide 2 , an adjusting device 3 and a target device 5 , a sleeve 7 and a guide device 9 ,

The guide bow 1 take the sleeve 7 in the sleeve receptacle 2 on and around a longitudinal axis 11 the sleeve 7 relative to the sleeve 7 shifted and / or around the longitudinal axis 11 in the circumferential direction 13 the sleeve 7 to be turned around. The sleeve 7 points for these sliding and rotating movements of the guide arc 1 preferably a slotted guide (or predetermined path paths) on (see 5 ). Optionally positions are specified along this slotted guide (see 5 ), where the guide bow 1 preferably by means of a latching arrangement 15 can be locked.

Is, as in the example of 1 a latching arrangement 15 provided in certain embodiments of the invention after successful engagement of the guide arc 1 by means of a locking screw 17 or another fixative manually on or on the sleeve 7 be fixed or the further twistability and / or longitudinal displacement of the guide arc 1 relative to the sleeve 7 To get picked up. After fixation is the guide arch 1 positioned in the final position to then fix an intramedullary nail by means of locking screw (see 2 ).

If such a fixation is provided, it takes place, for example, by means of frictional engagement or by means of positive locking between the locking screw 17 and the sleeve 7 ,

The optionally provided adjusting device 3 is along the guide arc 1 displaceable in x-direction. After the final position of the adjusting device 3 has been achieved by moving, the adjustment 3 by means of the aiming device 5 , which is executed in this embodiment, by way of example at the same time as a locking screw, or a differently configured fixing device, on the guide arc 1 fixed and / or clamped by friction. The target device 5 For this purpose, preferably has a shape that is easy to grasp, for example the in 1 shown triangular shape, on, to their manual detection.

The guiding device 9 has an in 1 not shown opening at her (relative to 1 ) upper end. It also has another opening at its lower end, so that it has a continuous cavity for receiving a in 1 not shown tool 55 (please refer 13 ) for blocking the in 1 also not shown intramedullary nail 19 or to accommodate other items. The longitudinal axis of the guide device 9 is preferably parallel to that of the sleeve 7 in which the guiding device 9 is included, or is with the longitudinal axis 11 the sleeve 7 identical.

In addition, positioning aids 27 for positioning locking screws on the positioning device 100 be provided.

2 shows the positioning device according to the invention 100 out 1 with an intramedullary nail 19 , a locking screw 21 and an instrument 23 for inserting the locking screw 21 , The instrument 23 is through the target device 5 and in the present example also by at least a portion of the guide arc 1 passed through.

Before inserting or screwing in the locking screw 21 in the intramedullary nail 19 can the guide bow 1 as already in 1 described along the longitudinal axis 11 moved and / or these in the circumferential direction of the sleeve 7 to be turned around. Furthermore, the adjustment 3 along the guide arc 1 be moved in the x direction. This positioning (displacement and rotation) is continued until an alignment with a targeted opening or through-hole 25 in the intramedullary nail 19 is achieved and the locking screw 21 in the intramedullary nail 19 and in one the intramedullary nail 19 surrounding tubular bones (in 2 not shown) can be fixed. The positioning device according to the invention 100 advantageously allows this positioning of the locking screw 21 (and possibly further locking screws 21 ) after insertion of the intramedullary nail 19 continue in the long bones while doing various through holes 25 by means of the aiming device 5 to control, from the perspective of the user optimal positioning of the one or more locking screws 21 was achieved.

In addition, in turn, more locking screws 21 ' through the positioning aids 27 through or through this into the intramedullary nail 19 be screwed. These positioning aids 27 offer no possibilities of positioning along the longitudinal axis of the guide arc 1 and thus a fixed, predetermined, possibly also vertical (to the longitudinal axis 11 ), or angled positioning of the locking screws 21 in the intramedullary nail. These positioning aids 27 can be used as so-called immovable target bores for more distal locking screws 21 ' be designated.

3 shows an inner portion of the positioning device according to the invention 100 with a sleeve 7 and a backdrop tour 29 in or on the sleeve 7 , as well as the latching arrangement 15 , One in the 3 shown components in the use state of the positioning device 100 covering cover, which is part of the guide arch 1 is is in for better visibility 3 not shown in 4 however, already.

A guide paragraph 31 (or pin) in 3 simplified as a single part is shown, but in the assembly in the guide arc 1 is integrated and part of the sleeve guide 2 is permitted by his intervention in the slotted guide 29 the sleeve 7 a positive connection between the guide arc 1 or the sleeve guide 2 and the sleeve 7 , The guide bow 1 is by means of the guide paragraph 31 in or along the slide tour 29 guided.

Alternatively, the guide paragraph 31 in the sleeve 7 integrated or with the sleeve 7 be connected. In this case, the slotted guide could 29 in the sleeve guide 2 (S. 4 ) be integrated.

The scenery tour 29 is in an upper part thereof (referring to the representation of 3 , ie between the upper end of the sleeve 7 and the guide paragraph 31 ) is being executed. By means of this straight gate section is the guide arc 1 during assembly of the positioning device according to the invention 100 in the sleeve 7 introduced (or vice versa).

Alternatively, the guide bow 1 also different with the sleeve 7 connected or mounted on this. For example, the outer diameter of the sleeve 7 in the upper area (above the gate guide 29 ) by twice the depth of the straight groove of the sleeve smaller than in 3 be illustrated outer diameter, so that the guide shoulder 31 over the entire circumference at the upper end of the sleeve 7 can be postponed to this.

The scenery tour 29 may be referred to in a lower part thereof as helical groove. In the lower area the slotted guide runs 29 not - or essentially not - straight, but twisted, coiled, tortuous or the like.

The guide bow 1 is therefore in its use by means of the slotted guide 29 guided along a predefined path or at least limited. The guide bow 1 can therefore only along the through the slotted guide 29 predetermined path or limited relative to the sleeve 7 moved and / or moved only in predetermined positions and / or rotated or rotated.

The leadership of the leadership paragraph 31 in the slide tour 29 can be referred to as a positive tongue and groove connection.

Along the slide tour 29 , and as part of this, are in the example of the 3 at the curved or curved places, extensions 33 intended. These can optionally be groove-like. Their longitudinal axis preferably extends substantially or exclusively in the circumferential direction 13 the sleeve 7 , These extensions 33 mark or code for so-called snap-in positions 35 on the in the circumferential direction 13 opposite side of the sleeve 7 into which a bolt or detent pin described below 39 can engage. locking positions 35 can as long holes in the circumferential direction 13 be designated. The locking positions 35 and their function become too 5 described in more detail. The structure and function of the latching arrangement 15 become too 5 described in more detail.

4 shows the section of the positioning device according to the invention 100 out 3 inserted in the upper section of the guide arch 1 , In this view is the lead paragraph 31 in the guide bow 1 integrated arranged. The sleeve 7 is in the receiving section of the guide bow 1 for the sleeve 7 , the sleeve guide 2 , added. The scenery tour 29 is covered by this, only the lowest, groove-shaped extension 33 is recognizable.

Furthermore, in 4 an internal thread 28 with a cone-shaped approach for receiving the locking screw 17 (please refer 1 ).

5 shows the section of the positioning device according to the invention 100 out 3 in another view. To recognize are several locking positions 35 and markings for position control 37 , The view in 5 is about 180 degrees in the circumferential direction 13 opposite the view 3 and 4 turned.

The latching positions 35 correspond with the groove-shaped extensions 33 the slide tour 29 (please refer 3 ) and the markers for position control 37 ("1", "2" and "4", position "3" is hidden and not visible). For example, the mark "1" corresponds to the uppermost lock position, which in 5 with the bolt 39 is engaged. This arrangement corresponds to the arrangement in FIG 3 and 4 in which the guide paragraph 31 in the topmost groove-shaped extension 33 the slide tour 29 is shown.

A locking of the latching arrangement 15 , and thus the lead sheet 1 in which the latching arrangement 15 is integrated and which by means of the locking in relation to the sleeve 7 set or in further movement or rotation relative to the sleeve 7 is limited takes place by means of positive connection between the bolt 39 and the latching position 35 at a predetermined and defined position of the sleeve 7 , Before the bolt 39 in a latching position 35 engages, the bolt can 39 achieved by means of a bias, in particular by means of a spring, on the sleeve 7 act. The bolt 39 then comes in contact (rubbing) along the sleeve 7 guided.

The latching position 35 is designed as a slot, but may also have other arbitrary shapes. In a slot shape of the latching position 35 can the guide bow 1 within the slot in the circumferential direction 13 the sleeve 7 move. This so-called game of leadership bow 1 in the sleeve 7 can be the positioning and screwing the locking screw 21 in the intramedullary nail 19 facilitate (see 2 ).

The markers for position control 37 ("1", "2" and "4") are visualization aids and thus orientation aids for the user of the positioning device 100 with respect to the direction of rotation and / or the indication of an angle of the guide arc 1 , Using these markers 37 the user can check the location of the locking positions 35 easy to understand.

The locking of the bolt 39 in one of the snap-in positions 35 takes place by means of the latching arrangement 15 , In the locked state in which the bolt 39 in the latching position 35 preferably presses a tensioning device, such as a double leaf spring 41 like those of 5 , on the bolt assembly 43 (corresponds to an extension of the bolt 39 ) and braces them in the latching position 35 , An accidental slipping out of the bolt 39 from the locking position 35 This can be advantageously prevented. A decoupling of the latching position 35 takes place by means of, in particular manual, depression of a lever 45 (or by operating another, suitable device), for example by means of a gear connection 47 the bolt arrangement 43 , and with it the bolt 39 , pulls out or decouples. Following the decoupling, the guide bow 1 , relative to the sleeve 7 , moved again according to the course of the slide guide and, for example, in a further Einrastposititon 35 be positioned.

6 shows the components of the positioning device according to the invention 100 , what a 5 can be seen, at least covered by a section of the guide arc 1 who already like to 4 discusses the latching arrangement 15 covered.

The guide bow 1 conceals all four snap-in positions in the present example 35 so that the user can not initially see in which latching position 35 the bolt 39 is engaged. For this reason, the marker is optional 37 for position control on the surface of the sleeve 7 intended. In 6 it can be seen that the bolt 39 in the highest latching position 35 is there because the mark 37 on the "1", so the top mark 37 , compare to 5 , shows.

7 shows the guide device 9 , inserted into the longitudinal opening having a sleeve 7 , and connected to the intramedullary nail 19 ,

The sleeve 7 is exemplary by means of two bars 49 (in 7 is only the front jetty 49 visible) against rotation with the intramedullary nail 19 connected, with the webs 49 positively in grooves of intramedullary nail 19 are introduced. This connection can be referred to as tongue and groove connection. For fixing the sleeve 7 with the intramedullary nail 19 For example, further, an optional thread 51 (External thread) at the lower end of the guide device 9 (please refer 9 ) in a Innengwinde of the intramedullary nail 19 , if present, screwed in. The intramedullary nail 19 is thus torsional as safe against displacement on the sleeve 7 fixed ("adapted"). The location or position of the sleeve 7 relative to the intramedullary nail 19 is thus preferably fixed both in the longitudinal direction and in the circumferential direction.

8th shows the guide device 9 out 7 with only the intramedullary nail 19 without sleeve 7 ,

9 shows the guide device 9 out 7 as a single part with the external thread 51 at the lower end of the guide device 9 ,

10 shows a further embodiment of a positioning device according to the invention 100 ' ,

The adjusting device 3 is designed as a section of a spherical surface with a circular opening. The shape of the adjusting device 3 may also have a differently shaped, only optionally curved or straight surface instead of a spherical surface.

The adjusting device 3 is on the lead sheet 1 fixed (the more detailed description of the fixation becomes the 22 and 23 illustrated).

The example circular opening in a central or central region of the adjustment 3 is to guide the target device 5 and the instrument 23 (which for insertion of the locking screw 21 serves) provided. The longitudinal axis of the instrument 23 is perpendicular to the sphere surface. The extension of the longitudinal axis of the instrument 23 runs through the center of the hole or through hole in the intramedullary nail 19 ,

The instrument 23 becomes in the aiming device 5 guided. The target device 5 is optionally cupped with annular concentrically arranged grooves, grooves or elevations around the central guide of the instrument 23 running around. The cup-shaped aiming device 5 may be referred to as the middle shell, which, viewed in the radial direction, between the outer shell, which of the adjusting device 3 corresponds, and the inner shell, which the cup-shaped surface of the guide arc 1 corresponds, is arranged.

The target device 5 , ie the middle shell, can be moved or moved between the inner and the outer shell. In this movement, optional radially spring loaded pins grip 53 or pins in the annular grooves or grooves of the aiming device 5 one. This creates a defined and exact positioning of the instrument 23 , and thus the locking screw 21 , possible. The groove distances from each other correspond to a specific and predetermined deflection of the target device 5 , which can be given in an angle or a number of degrees. In this embodiment, the deflection between two annular grooves corresponds to an angle or degree of one degree (1 °). This principle or concept with spring-loaded pins 53 , which engage in grooves, can be referred to as a spring-pin concept.

The arrangement of the radially spring-mounted pins 53 on the radially outer surface of the aiming device 5 is in 12 shown in the adjusting device 3 (outer shell) was removed for clarity.

The arrangement in 10 allows a deflection of the instrument 23 (and thus the locking screw 21 ) of a desired or predetermined number of degrees (or a degree range), for example of ten degrees (10 °) relative to the central starting position in the middle (this starting position is entered in FIG 10 . 11 and 12 shown and referred to as zero-degree position (0 °)).

By means of an optional, combined positive connection (between the pins 53 and the annular grooves of the aiming device 5 ) and a frictional engagement (between the middle and the outer shell) is a fixing of the position of the instrument 23 for screwing or setting the locking screw 21 allows.

The target device 5 may optionally rest on a circular section of a structure which underlies the aiming device 5 is arranged. In this way, it can be ensured that the target device 5 is preferably performed at a constant distance to a destination.

11 shows a detailed view 10 with the adjusting device 3 (outer shell), the target device 5 (middle shell), the guide arch 1 (inner shell), the sleeve 7 , the intramedullary nail 19 and the instrument 23 for inserting the locking screw 21 , Furthermore, non-movable instruments 23 ' (the target device 3 is relative to the guide bow 1 not movable) for screwing or screwing in additional locking screws 21 ' shown.

12 shows the view 11 without the adjustment device 3 (outer shell) to show the position of the pins 53 on the target device 5 (middle shell).

13 shows a further embodiment of the positioning device according to the invention 100 '' ,

The guide bow 1 is divided into two parts in this embodiment. A first section (in 13 the left portion) of the two-part guide arc 1 has the sleeve guide 2 is exemplified straight and runs in this embodiment substantially perpendicular to the longitudinal axis 11 the sleeve 7 , In the sleeve 7 is the guide device 9 introduced, in turn, the tool 55 , For example, a hexagon, for example, for blocking the intramedullary nail 19 , along the longitudinal axis 11 to be led. Alternatively, instead of the tool 55 also other objects by means of the guide device 9 be guided.

The first section has a second section (in 13 the right section) of the guide arc 1 connected. The second section comprises the target device 5 , The connection of both sections, for example by means of a socket 57 be executed. In the socket 57 becomes the lock pin 39 (or bolt of the latching arrangement), which is in 13 from the guide bow 1 is concealed and in 14 as another latching arrangement 15 ' is explained in more detail. The locking pin 39 is preferably by means of at least one lever 59 or a different arrangement actuated or moved. The lever 59 is in 13 shown in two different positions. The function of the lever 59 becomes 14 described in more detail.

The second section of the guide arch 1 includes the adjusting device 3 as well as the target device 5 , in the 13 in an exploded view, ie not mounted, are shown. In the assembled state, the adjusting device 3 at the top (referring to the view in 13 ) For example, with the socket 57 connected, as in 14 is shown.

The adjusting device 3 is, for example, at the lower end thereof, by means of a connecting screw 65 with the second section of the guide bow 1 connected or fixed to it.

The target device 5 is by means of a so-called rotary tensioner 67 between the adjusting device 3 and the second section of the guide arc 1 fixed.

Concerning. the function of the target device 5 will be on the description of 10 directed.

14 shows the further latching arrangement 15 ' the embodiment of the 13 ,

The latching arrangement 15 ' based on a magnetically supported fixation of the locking pin 39 in the latching positions 35 , The magnetic coupling is by a magnet or magnetic material, or as here by two magnets 61 . 63 realized at the outer end of the latch pin 39 may be arranged and which, facing each other, have different polarities. The first magnet 61 For example, with the jack 57 and / or with the guide bow 1 be connected. The second magnet 63 can with the outer end of the latch pin 39 be connected. By means of the lever 59 The two magnets can be pressed apart and thus the locking pin 39 from the locking position 35 decouple or pull out. This is the lever 59 in the direction of the arrow 60 pushed inwards, so due to the angled lever 59 the locking pin 39 and the magnet 63 be pushed to the outside.

15 shows a further latching arrangement 15 ' with a spiral spring 69 , In the locked state is the coil spring 69 compressed. For decoupling the locking pin 39 by means of a handpiece 71 pulled outward, the locking pin 39 from a latching position 35 pulled out and the coil spring 69 actively stretched. After repositioning the guide arch 1 may be the detent pin 39 by returning the handpiece 71 inward and compressing the coil spring 69 in its initial state again in one of the locking positions 35 the sleeve 7 be locked.

16 shows a further latching arrangement 15 ' with a leaf spring 73 and a lever 75 , Analogous to the description of the 15 becomes the leaf spring 73 , and / or due to the tensioning, by depressing the lever 75 curious; excited. Simultaneously with the tensioning of the leaf spring 73 becomes the lock pin 39 by means of the handle 71 from the locking position 35 pulled out and decoupled. After a new positioning of the guide bow 1 may be the detent pin 39 again in another latching position 35 in the sleeve 7 be inserted and locked.

17 shows a further latching arrangement 15 ' with a snap-in pin 39 (the detent pin 39 can be referred to as a plug-in pin), which obliquely from above into a latching position 35 in the sleeve 7 is introduced.

18 shows a further latching arrangement 15 ' with a snap-in pin 39 for its lateral insertion into a latching position 35 the sleeve 7 , The locking pin 39 can after snapping by pressing or turning the handle 71 and an optional thread 77 be fixed.

19 shows a two-part target device 5 of the embodiment 13 , Two sections of the target device 5 For example, by means of a thread 79 be bolted together. The external thread of in 15 left portion of the two-part target device 5 gets into the internal thread of in 15 right section of the target device 5 screwed.

By means of a two-part target device 5 Various advantages can be achieved, such as a combination of different materials (higher strengths of a bushing for guiding a tool for inserting the locking device or the locking screw 23 . 23 ' , see, for. B. 2 ) or an increase in the strength or flexural rigidity of the aiming device 5 ,

20 shows an adjustment 3 with a snap device 81 for fixing the adjusting device 3 on the guide bow 1 in a side view. The direction of the arrow indicates the direction of closing, closing or snapping the adjusting device 3 on or at the guide bow 1 , The snap device 81 is particularly elastically deformed or bent during snap action, so that after snapping the snap device 81 at the guide bow 1 hooks. To open, the snap device 81 be elastically bent up and unfolded.

In the opened state, for example, the target device 5 be replaced or adapted.

21 shows another target device 5 with a holes arrangement 83 for an instrument 23 (please refer 22 ). Compared to the embodiments of the target device 5 for example the 11 or 12 in which the target device 5 having only one hole, the aiming device 5 but between the guide bow 1 and the adjusting device 3 is three-dimensionally movable in several axial directions, is the target device 5 in 21 only around an axis (the central axis of the target cylindrical device 5 ) rotatable. This restriction of movement may be advantageous, for example, the angles for an instrument 23 in the respective holes to limit and thus the angle for setting locking screws 21 by means of the positioning device 100 narrow.

The target device 5 can by means of a locking screw 85 be fixed.

22 shows the positioning device 100 ' of the 10 with the guide bow 1 , the adjusting device 3 , the sleeve 7 , the intramedullary nail 19 , the target device 5 as well as the instrument 23 for inserting the locking screw 21 in another view. In the 10 shown annularly arranged grooves are for simplified representation in 22 Not shown.

The adjusting device 3 is by means of (for example) four (optional) punctiform fixations 87 with the guide bow 1 connected.

23 shows the positioning device 100 ' of the 22 in a sectional view.

24 shows the positioning device 100 ' of the 22 in a sectional view with a flap concept for fixing the adjusting device 3 on the guide bow 1 , The flap concept in this embodiment has only two (or optionally only one) punctiform fixation 87 on one side of the adjusting device 3 on. The fixation 87 can for example be designed as a joint. On the opposite side is the adjusting device 3 by means of a thumbscrew 89 (or an eccentric, a snap hook or similar) with the guide bow 1 connected. By means of this connection, the adjusting device 3 on the guide bow 1 pressed or pressed so that the aiming device 5 between the adjusting device 3 and the guide bow 1 is clamped or fixed.

By means of the flap concept, for example, it is advantageously possible to use the target device 5 exchange.

25 shows a target device 5 , which by means of a spring concept between the adjusting device 3 and the guide bow 1 is arranged and movable. The target device 5 In this embodiment comprises two sections or shells, between which a coil spring 91 is arranged. By means of the spiral spring 91 is the upper portion (relative to 25 ) pushed upwards. As a result, resting on the top rests 93 in holes 95 (or grooves) on the bottom of the adjustment 3 one. For example, ten surveys each 93 and drilling 95 be arranged on the top or bottom.

26 shows another target device 5 , which by means of a thread concept between the adjusting device 3 and the guide bow 1 is arranged and movable. By means of a thread 97 may be the top shell of the targeting device 5 against the underside of the adjusting device 3 and the underside of the lower shell of the aiming device 5 against the top of the guide arch 1 be pressed and fixed.

LIST OF REFERENCE NUMBERS

100, 100 ', 100' '

positioning

 x

x-direction; Displacement direction of the adjusting device along the guide arc

 y

y-direction; Direction perpendicular to the direction of displacement of the adjusting device along the guide arc; in the circumferential direction of the sleeve

1

guide arch

2

sleeve guide

3

adjustment

5

target device

7

shell

9

guiding device

11

Longitudinal axis of the sleeve

13

Circumferential direction of the sleeve

15, 15 '

A latching

17

locking screw

19

Mark Nagel

21, 21 '

Locking device; locking screw

 23, 23 '

Instrument for inserting the locking device or the locking screw

25

Through opening

27

positioning

28

inner thread

29

link guide

31

guide shoulder

33

grooved extension of the slotted guide in the circumferential direction of the sleeve

35

click position; Slotted holes in the sleeve

37

Marking for position control

39

detent pin; Bolt of latching arrangement

41

leaf spring

43

bolt arrangement

45

lever

47

gear train

49

Bridge of the sleeve

51

thread

53

Pen; Bounced resiliently in the radial direction

55

Tool

57

Rifle

59

lever

60

Direction of displacement of the lever; arrow

61

magnet

63

magnet

65

connecting screw

67

rotary tensioner

69

Spiral spring for snap-in pin

71

handpiece

73

leaf spring

75

lever

77

Thread on the locking pin

79

Thread of the two-part target device

81

snap device

83

Holes assembly

85

locking screw

87

punctiform fixation

89

thumbscrew

91

Spiral spring for target device

93

Elevations on top of the target device

95

Holes on the bottom of the adjustment

97

Thread for target device

Claims (17)

Positioning device ( 100 . 100 ' . 100 '' ) for positioning and / or fixing an intramedullary nail ( 19 ) in a long bone, comprising - a guide arch ( 1 ), which comprises or is connected to: - an adjusting device ( 3 ), wherein the adjusting device ( 3 ) at least one target device ( 5 ), and wherein the target device ( 5 ) is formed to a locking device ( 21 ) or an instrument ( 23 ) for acting on the locking device ( 21 ); and - a sleeve guide ( 2 ) with a sleeve ( 7 ), wherein the sleeve ( 7 ) relative to the sleeve receptacle ( 2 ) rotatable and / or displaceable in the sleeve guide ( 2 ), and wherein the sleeve ( 2 ) a continuous longitudinal opening for receiving a guide device ( 9 ) herein. Positioning device ( 100 . 100 ' . 100 '' ) according to claim 1, further in the sleeve ( 7 ) inserted guide device ( 9 ). Positioning device ( 100 . 100 ' . 100 '' ) according to claim 1 or 2, wherein the sleeve ( 7 ) and / or the guiding device ( 9 ) a connecting section for their detachable connection with an intramedullary nail ( 19 ) having. Positioning device ( 100 . 100 ' . 100 '' ) according to any one of the preceding claims, wherein the sleeve ( 7 ) a slide guide ( 29 ) for guiding a section, in particular a guide paragraph ( 31 ), the lead sheet ( 1 ) or the sleeve guide ( 2 ) along the sleeve ( 7 ), or vice versa. Positioning device ( 100 . 100 ' . 100 '' ) according to one of the preceding claims, wherein the guide arc ( 1 ) has a locking pin which can be moved between at least two positions ( 39 ), and wherein the sleeve ( 7 ) at least one latching position ( 35 ) for inserting or locking the locking pin ( 39 ) herein. Positioning device ( 100 . 100 ' . 100 '' ) according to claim 4 or 5, wherein the latching position ( 35 ) one in the circumferential direction ( 13 ) of the sleeve ( 7 ) aligned longitudinal groove ( 33 ), wherein the longitudinal groove ( 33 ) a shifting of the locking pin ( 39 ) in the circumferential direction ( 13 ) of the sleeve ( 7 ) in the locked state of the locking pin ( 39 ) in the latching position ( 35 ). Positioning device ( 100 . 100 ' . 100 '' ) according to any one of the preceding claims, wherein the sleeve ( 7 ) Markings ( 37 ) for checking the position and / or position of the guide arc ( 1 ) relative to the sleeve ( 7 ) having. Positioning device ( 100 . 100 ' . 100 '' ) according to one of the preceding claims, wherein the guiding device ( 9 ) an external thread ( 51 ) Positioning device ( 100 . 100 ' . 100 '' ) having. Positioning device ( 100 . 100 ' . 100 '' ) according to claim 8, wherein the guiding device ( 9 ) for guiding a tool ( 55 ) is hollow in its interior, with a longitudinal opening and / or tubular. Positioning device ( 100 . 100 ' ) according to one of the preceding claims, wherein the adjusting device ( 3 ) together with the in use of the positioning device ( 100 . 100 ' . 100 '' ) on the intramedullary nail ( 19 ) to be aligned ( 5 ) along (x-direction) of the guide arc ( 1 ) is arranged displaceably. Positioning device ( 100 . 100 ' . 100 '' ) according to one of the preceding claims, wherein the guide arc ( 1 ) is formed at least in sections as a circular arc, and wherein the adjusting device ( 3 ) is arranged to be displaceable at least in sections along the circular arc. Positioning device ( 100 . 100 ' . 100 '' ) according to one of the preceding claims, wherein the target device ( 5 ) one on the intramedullary nail ( 19 ), the adjusting device ( 3 ) piercing opening ( 25 ) having. Positioning device ( 100 . 100 ' . 100 '' ) according to one of the preceding claims, wherein the guide arc ( 1 ) Stops for limiting the displacement of the adjusting device ( 3 ) along the circular arc. Positioning device ( 100 . 100 ' . 100 '' ) according to one of the preceding claims, wherein the target device ( 5 ) in the longitudinal direction (x-direction) of the guide arc ( 1 ) and perpendicular (y-direction) to the longitudinal direction (x-direction) of the guide arc ( 1 ) is displaceable or movable. Positioning device ( 100 . 100 ' . 100 '' ) according to one of the preceding claims, wherein the target device ( 5 ) in the adjusting device ( 3 ) and is arranged relative to this displaceable. Positioning device ( 100 . 100 ' . 100 '' ) according to claim 15, wherein the target device ( 5 ) in at least a first position for moving the target device ( 5 ) relative to the adjusting device ( 3 ) is movably arranged and in at least a second position for releasably fixing the target device ( 5 ) relative to the adjusting device ( 3 ) is arranged immovable. Positioning device ( 100 . 100 ' . 100 '' ) according to one of the preceding claims, detachably connected to an intramedullary nail ( 19 ).

Images