DE102018002705B4 - System for the reduction of fragments of the supporting apparatus by means of a rope osteosynthesis - Google Patents

Abstract

System for repositioning fragments of the supporting apparatus, comprising a surgical wire rope (1), a tensioning instrument (2) with a tensioning mechanism (3) for generating a tensile force on the surgical wire rope (1) and a crimp sleeve (4) designed to fix the surgical wire rope to be tensioned (1) on at least one fragment (5) of the support apparatus, characterized in that the crimp sleeve (4) has a bearing area (6) with a through hole (7) from its top to its underside and a bore (7) on the top of the bearing area (6). Deformation area (8), wherein the deformation area (8) is formed from two flat crimping wings (9) that can be pressed against each other, which are arranged opposite one another at the outlet opening of the bore (7) above the support area (6), wherein a crimping wing (9) has a the bore (7) facing clamping surface (10) and the bore (7) facing away from the pressing surface (11) and wherein the Pressfläc he (11.1) of the first crimping wing (9.1) and the pressing surface (11.2) of the second crimping wing (9.2) enclose an angle α (12) with a size of 0° < α < 180°, the system having a guide means (15) for guiding the surgical wireline (1) through a through-bore (16) in a fragment (5) of the supporting apparatus, and a socket (19) on either the first end (17) of the surgical wireline (1) for creating temporary guiding contact with the tip (20) of the guide means (15) is set up or the surgical wire (1) has a rod-shaped guide element (18) at its first end (17), the receptacle (19) being used to create a temporary guide contact with the tip (20) of the Guide means (15) is set up on the head side of the rod-shaped guide element (18).

Description

The invention relates to a system for the reduction and stabilization of fragments of the supporting apparatus of humans or animals. Such systems have been known in surgery for a long time and are familiar to the specialist public under the name of rope cerclage or rope osteosynthesis.

The rope osteosynthesis became known through the publications of Prof. Labitzke at the end of the nineties of the last century. It detached the wiring from the fragments. In contrast to pure wiring with a surgical solid wire, in which the wire ends are twisted against each other in order to apply sufficient tension to the fragments to be repositioned, wire rope ends, which are more flexible in use, have a tendency to move quickly after being twisted to wriggle out again, to be uptight.

In most known rope osteosynthesis, the rope foundation and rope fixation of the wire rope is therefore carried out by means of squeezing or clamping sleeves in which the ends of the wire rope are clamped and clamped in them by deforming the sleeves.

Among other things, describes the EP 1 933 740 B1 a fastening device for such a rope cerclage system, in which one end of the surgical wire rope has a thickening which is inserted into a clamping element and is prevented from sliding out by the thickening at the end. The second end is looped around the bone. The loop is closed by pulling the second end through an opening in the clamping element and then securing the wire rope in the clamping element.

In the U.S. 4,976,712 A a T-shaped cover sleeve for K-wire ends is disclosed, which is slipped over the end of the wire protruding from the body part and clamped therewith for permanent fixation on the wire end.

From the US 2003/0023241 A1 describes a clamping sleeve with a union nut of a surgical snare device through which the strand of the snare is passed in order to be able to fix the snare in its position. The clamping sleeve is slotted on both sides over a partial area in the longitudinal direction, so that in this area two wings are formed which are movable relative to one another and which are pressed against the strand when the union nut is screwed on.

A collet, in which both ends of the surgical wire rope are clamped in the collet, is in the U.S. 5,423,820 A shown. The clamping sleeve is L-shaped and has two sleeve-like extensions, in each of which a wire rope end is clamped.

Crimp sleeves, which have to be connected to the wire rope on both sides, have proven to be difficult to use because of their unwieldiness.

Further embodiments for ferrules are in the U.S. 6,120,505 A and U.S. 5,476,465 A described.

the US 8 469 966 B2 as well as the EP 2 731 527 B1 disclose embodiments of tensioning tools with which the tensile stress required for repositioning the bones or cartilage can be generated.

The disadvantage of the known systems is that they can only be used to a limited extent for repositioning or osteosynthesis of small bone fragments such as occur in the hand or in the foot, due to the size or shape of the known compression sleeves. In addition, these can lead to an impairment of the soft tissue structures or even to their damage. Another problem arises from the fact that protruding wire rope ends can perforate the skin.

It also had to be determined that the associated clamping tools are not suitable for bone surgery on small fragments because of their size. When using them, there is a risk of breaking the fragile bones or cartilage when the wire rope is pulled, due to the inability to adjust the tension. Furthermore, a large clamping tool hinders the view into the operating field, especially when the smallest bone parts of the hand or foot are to be fixed.

The task is therefore to provide a system for the repositioning of fragments of the supporting apparatus, such as bones, cartilage, tendons, ligaments or fragments thereof, which is small and handy and which simplifies the surgical technique in such a way that the repositioning of fragments of the supporting apparatus in can be carried out in a shorter time.

To achieve the object, a system for repositioning fragments of the supporting apparatus is specified, which has a surgical wire rope, a tensioning instrument with a tensioning mechanism for generating a tensile force on the surgical wire rope, and a crimp sleeve. The crimp barrel is prepared to attach the surgical wire rope to be tensioned to at least one frag ment of the supporting apparatus, whereby the term “surgical wire rope” also includes surgical threads or highly flexible surgical solid wires.

The repositioning system is characterized in that the crimp sleeve comprises a support area with a through hole from its top to its underside and a deformation area set up on the top of the support area, the deformation area being formed from at least two crimping wings which can be pressed against each other over a large area and which are located opposite one another Outlet opening of the bore are arranged in the support area. A crimping paddle has both a clamping surface facing the bore and a pressing surface facing away from the bore. The pressing surface of the first crimping wing and the pressing surface of the second crimping wing enclose an angle α with a size of 0 ° <α <180 °. The angle α and the longitudinal axis of the bore are preferably in the same plane.

The support area describes the part of the crimp barrel that rests on the fragment surface. The underside of the support area is preferably designed to be flat. On the side of the support area facing away from the fragment surface there is the deformation area of the crimp sleeve, in which one end of the wire rope is clamped by pressing the clamping surfaces of the crimping wings against one another. For this purpose, the crimping wings are pressed against one another, for example, by means of a pair of pliers, the jaws of which are placed on the pressing surfaces of the crimping wings, the end of the wire rope being clamped between the crimping wings. A rounded design of the crimp wings has a gentle effect on the surrounding soft tissue. To improve the clamping properties, the clamping surfaces of the crimping wings can have a roughened surface.

In one embodiment, a half-shell-shaped recess is set up in the clamping surface of the crimping blade, which partially continues the wall of the hole set up in the contact area in the deformation area of the crimp sleeve and extends it over the contact area into the deformation area.

In the simplest embodiment, the hole is aligned essentially perpendicular to the underside of the support area, whereby the crimp sleeve can be placed directly on the drill hole of a fragment hole in order to be able to insert a wire rope guided through the fragment hole in the exit direction into the crimp sleeve without its curvature.

For the reduction system according to the invention, two areas of application are described below by way of example in which the reduction system according to the invention can be used.

The first division concerns the repositioning of fragments by means of a ring closure of the wire rope, in which the two rope ends are connected to one another via the crimp sleeve.

In order to keep the contact area of the crimp barrel as small as possible for use in microsurgery, the present reduction system does not require the second end of the wire rope to be jammed with the crimp barrel. In contrast to known cerclage systems, the crimp sleeve is already firmly connected to the second end of the surgical wire rope due to the manufacturing process. The second end of the wire rope is advantageously welded to the outer area of the contact area of the crimp barrel, preferably with a point laser.

The problem with the repositioning of tiny fragments, as occurs, for example, in the reconstruction of severed fingers, is that the periosteum or other connective tissue surrounding the bone fragment protrude after the preparation of the drill holes and cover the drill holes again. The surgeon is forced to feel the drill holes. A second-saving laying of the wire rope is therefore almost impossible and the operation time is sometimes significantly longer.

To remedy this problem, the system comprises a guide means for guiding the surgical wire rope through a perforation in the fragment. A guide means can be a K-wire, a guide wire or a drill.

In an advantageous version, the surgical wire rope has a rod-shaped guide element at its first end as a counterpart to the guide means. The rod-shaped guide element is preferably longer than the through-hole in the fragment and is inherently resistant to bending, as a result of which the surgical wire rope can simply be guided through the through-hole.

In order to simplify the guidance of the wire rope through the perforation with the aid of the guide means and thus to accelerate the surgical step, a receptacle for producing a temporary guide contact with the tip of the guide means can be set up at the first end of the surgical wire rope or at the head end of the rod-shaped guide element .

"Temporary guide contact" means that the tip of the guide means, for example a K-wire, a guide wire or a drill, is brought into direct contact with the end of the wire rope, but no force-fit connection is formed between the two system parts.

To simplify handling, the guide element in a further embodiment has a smaller diameter than the guide means used for guiding.

When the wire rope is passed through the perforation in the fragment, the tip of the guide means is first brought into contact with the receptacle to produce a temporary guide contact, and then the guide means is slowly withdrawn backwards out of the perforation. The first end of the wire rope follows the through-hole while maintaining contact with the tip of the guide means and assumes its position there.

In order to prevent the contact from slipping out of the receptacle due to the guide means tip slipping sideways, the receptacle can be designed to produce a temporary guide contact with the tip of the guide means in the form of a funnel-shaped or concave recess extending from the head side of the rod-shaped end piece in its longitudinal direction.

For the ring closure (loop) of the wire rope, its first end is passed through the hole in the support area of the crimp barrel, in order to then tension the wire rope using the tensioning instrument. When the tensile force required to reposition the fragments is reached, the crimping wings are pressed together with the inclusion of the wire rope.

In a second variant, the two ends of the wire rope are not connected to one another by the crimp sleeve to form a loop to reposition fragments, but an anchoring device is set up at the second end of the surgical wire rope, with which the wire rope is placed on the surface of a first fragment of the supporting apparatus with tensile strength or is anchored.

To place the anchoring device on the outside of the first fragment, a perforation is first made through the fragments to be refixed, and the wire rope with the anchoring device is pushed through the perforation until it has reached the surface of the first fragment.

After the anchoring device has been placed on the surface of the first fragment, tensile stress is applied to the wire rope by threading the crimp barrel onto the first end of the wire rope and pressing the crimp barrel against the surface of a second fragment, where it is clamped to the wire rope.

The anchoring device according to the invention is advantageously designed to be expandable or expandable, so that anchoring of the surgical wire rope on a surface of a fragment occurs in that the expanded or expanded anchoring device comes to rest at least in part on the surface of the fragment. The anchoring device prevents the surgical wire rope from sliding back and forms the tension-pressure point in order to be able to apply the tension required for refixation to the wire rope.

The anchoring device is advantageously designed to be self-expanding, so that when a pull is exerted on the surgical wire rope in the opposite direction to the direction of insertion of the wire rope, the anchoring device is spread apart or unfolded.

A deployable anchoring device in its simplest form is a rod which is connected to the wire rope via a hinge-like connection and which is placed on the wire rope during the introduction through the prepared fragment hole. After reaching the outside of the fragment to be refixed, the articulated rod of the anchoring device is folded down by tightening the surgical wire rope, creating a backstop on the outside of the fragment and the tension-compression point for applying the refixation tension.

In a particular embodiment, the expandable sheath is surrounded by a cannula-like sheath which prevents the anchoring device from prematurely unfolding or from getting caught in the fragment bore. After the anchoring device has been advanced to the target location, it is only released by withdrawing the cannula-like sheath, after which the deployment mechanism or expansion mechanism can be actuated or the anchoring device unfolds or expands independently.

After the anchoring device has been positioned, a crimp sleeve according to the invention is threaded onto the first end of the wire rope on the underside of the through-hole, the support area facing the underside surface of the fragment.

The surgical wire rope is inserted into the tensioning instrument to apply the tension required to re-fix the fragments. When the tensioning mechanism is actuated, the wire rope and the anchoring device attached to it are tightened. After the desired tensile stress has been achieved, the crimping wings of the crimp barrel are pressed against one another so that the crimping barrel forms the counter-pressure point to the anchoring device in order to keep the tension on the surgical wire rope that brings about the re-fixation over the long term.

This variant of the reduction system according to the invention, designed as a longitudinal single strand, can be used, for example, to re-fix cartilage-ligament structures, such as the triangular disc in the wrist, in particular to re-fix the ulnocarpal disc (or TFCC).

The tensioning instrument of the reduction system comprises a grip sleeve and a tensioning arm connected to the grip sleeve. The function of the tensioning arm is to press the crimp barrel, which is slidingly mounted on the surgical wire rope, with its support area against the surface of a fragment, in order to then apply tension to the wire rope by actuating the tensioning mechanism, so that the wire rope is under tension when the crimp barrel is with it jammed in the wire rope. For this purpose, a stop with a guide eye is set up at the end of the tensioning arm.

After the wire rope has been threaded through the hole in the crimp barrel, it is guided through the guide eye of the stop for tensioning. The guide eyelet is dimensioned such that the crimp sleeve cannot pass the guide eyelet, but strikes there. The tension arm has on the underside a guide device which is applied from the stop to the crankshaft and which is set up to support the wire rope in the pulling direction and to guide it to the crankshaft.

The crankshaft is rotatably mounted in the grip sleeve. In order to prevent uncontrolled return of the crankshaft, the clamping device is equipped with a locking mechanism that holds the crankshaft in a set position opposite the grip sleeve. The latching mechanism is advantageously such that the crankshaft can only be rotated in one direction of rotation and a return in the opposite direction is inhibited.

In the crankshaft mounted in the grip sleeve, a socket is set up which is oriented transversely to the crankshaft longitudinal axis and into which the surgical wire rope can be inserted with its first end through an opening in the grip sleeve. By then turning the crankshaft, the wire rope is wound up and the crimp sleeve is pressed against the underside of the through-hole in the fragment by means of the stop on the tensioning arm, whereby tension and tension are applied to the wire rope.

In order to reduce the tension and thus the position of the fragments to be repositioned, if necessary. To be able to correct, a means for releasing the locking mechanism is also set up in the tensioning instrument, whereby the crankshaft can be freed and, if necessary, the wire rope can be unwound from the crankshaft.

• 1: eine erste Ausführungsform des Repositionssystems von Fragmenten des Stützapparates,
• 2a - 2d: Seiten- und Querschnittsansichten einer Crimphülse,
• 3: Detaildarstellung des Kontaktbereiches zwischen dem stabförmigen Führungselement und der Spitze des Führungsmittels,
• 4a - 4b: Seitendarstellung des Spanninstruments,
• 5a - 5b: Querschnittsdarstellung des Spanninstruments und
• 6: Darstellung einer zweiten Variante des erfindungsgemäßen Repositionssystems aufweisend eine Verankerungsvorrichtung am zweiten Ende des Drahtseils.

The invention is explained in more detail below with the aid of two exemplary embodiments. The figures show:

• 1 : a first embodiment of the system of repositioning fragments of the supporting apparatus,
• 2a - 2d : Side and cross-sectional views of a crimp barrel,
• 3 : Detailed representation of the contact area between the rod-shaped guide element and the tip of the guide means,
• 4a - 4b : Side view of the tensioning device,
• 5a - 5b : Cross-sectional view of the tensioning device and
• 6th : Representation of a second variant of the reduction system according to the invention having an anchoring device at the second end of the wire rope.

the 1 shows a first variant of the reduction system according to the invention, which comprises a K-wire 15, which forms the guide means of the illustrated reduction system, a wire rope 1 with a rod-shaped guide element 18 at its first end 17 and a crimp sleeve 4 at its second end 22 and a tensioning instrument 2 .

The rod-shaped guide element 18 has a receptacle on its head side for producing a temporary guide contact with the tip 20 of the K-wire 15.

The crimp sleeve 4 laser-welded to the second end 22 of the wire rope 1 has a flat support area 6 and a deformation area 8 with two crimp wings 9.1 and 9.2 which can be pressed against one another.

The associated tensioning instrument 2 shows a grip sleeve 24 with a tensioning arm 25, a stop 26 with a guide eye 27 is set up at its outer end. A crankshaft (not shown) is mounted in the grip sleeve 24 and can be turned by hand with a rotary knob 33 in order to wind up the wire rope 1. In order to be able to unwind the wire rope from the crankshaft again, the tensioning instrument 2 is equipped with a lever 32 which, when actuated, releases the crankshaft into a freewheel, which allows the crankshaft to rotate in the reverse direction of rotation.

the 2a - 2d show a crimp barrel 4 according to the invention in different views.

the 2a shows a cross section of the crimp barrel 4. It is shown that a bore 7 is guided through the crimp sleeve 4, which extends from the underside of the support area 6 into the deformation area 8 and through which a surgical wire rope can be guided. In the clamping surfaces 10.1 and 10.2 of the crimping wings 9.1 and 9.2, half-shell-shaped recesses 13.1 and 13.2 are set up in the continuation of the wall 14 of the bore 7.

In the side view of the crimp barrel 4 ( 2 B) it is shown that the pressing surface 11.1 of the first crimping wing 9.1 and the pressing surface 11.2 of the second crimping wing 9.2 enclose an angle α (12) with a size of 0 ° <α <180 °. The angle α (12) and the longitudinal axis of the bore 7 lie in the same plane.

the 2c shows a further side view of the crimping sleeve 4, in which the crimping wings are designed as semicircles, whereby the surrounding soft tissue is protected from damage.

The top view ( 2d ) on the crimp sleeve 4 reproduces the crimp wings 9.1 and 9.2 forming the deformation area 8, which are set up mirror-symmetrically around the exit opening of the bore 7 on the support area 6 and whose clamping surfaces 10.1 and 10.2 have half-shell-shaped recesses 13.1 and 13.2 in the continuation of the bore 7.

the 3 shows the moment at which a K-wire stuck in a through-hole 16 in a fragment 5 of the supporting apparatus functions as a guide means 15 with respect to a surgical wire rope 1 as an aid for guiding the wire rope 1 through the through-hole 16.

At the first end 17 of the wire rope 1, a rod-shaped guide element 18 is set up, which has a funnel-shaped recess 21 at its head end. The tip 20 of the K-wire 15 engages in this recess 21 and makes a temporary guide contact with the rod-shaped guide element 18 without forming a force-fit connection with the wire rope 1 via the rod-shaped guide element.

The tensioning instrument 2 of the reduction system is in the 4 a and 4b as a side view and in the 5a and 5b shown in cross-sectional views.

The tensioning instrument 2 consists of a grip sleeve 24 with a tensioning arm 25 and a crankshaft 28 with a rotary knob 33 for manually turning the crankshaft 28 mounted in the grip sleeve 24.

The tension arm 25 has the functions of pulling the wire rope 1 by actuating the tensioning mechanism 3 and of holding the wire rope 1 and the crimp sleeve 4 in a desired position while maintaining the tension state while the crimp sleeve 4 is clamped on the wire rope 1. For this purpose, the tension arm 25 is equipped at its outer end with a stop 26 with a guide eye 27 through which the surgical wire rope 1 can be threaded.

On the underside, the tensioning arm 25 has a guide device 29 which is applied from the stop 26 to the crankshaft 28 and in which the surgical wire rope 1 is guided to the crankshaft 28.

The crankshaft 28 is rotatably mounted in the grip sleeve 24 and is equipped with a locking mechanism. A resiliently mounted latching mechanism 3 is set up between the rotary knob 33 and the grip sleeve 24, which fixes the crankshaft 28 in relation to the grip sleeve 24 in a rotational position that has been reached.

In the crankshaft 28 there is set up a holder 30 which is oriented transversely to the crankshaft longitudinal axis and into which the surgical wire rope 1 can be inserted through an opening 31 in the grip sleeve 24.

By turning the rotary knob 33, the crankshaft 28 mounted in the grip sleeve 24 is rotated, the surgical wire rope 1 introduced into the socket 30 being wound onto the crankshaft 28.

In order to decouple the latching mechanism 3, a means for releasing the latching mechanism, in the illustrated embodiment the pressure lever 32, is also set up. With the pressure lever 32, the rotary knob 33 and the crankshaft 28 connected to it can be pushed upwards, as a result of which this is decoupled from the latching mechanism and set in an uninhibited freewheeling mode, so that the wire rope 1 can be unwound again from the crankshaft 28 by rotating in the opposite direction.

the 6th shows a second embodiment of the reduction system according to the invention. This repositioning system, designed as a single-strand connection, is used in this example to refix cartilage-ligament structures in the wrist.

In this second embodiment, to reposition the fragments 5.1 (bones) and 5.2 (cartilage), the two ends 17 and 22 of the surgical wire rope 1 are not connected to one another by the crimp sleeve 4 to form a loop, but rather at the second end 22 of the surgical wire rope 1 Anchoring device 23 is set up in the form of a locking rod that is hinged to the end 22 of the wire rope 1 and configured to be foldable, with which the wire rope 1 is placed on the surface of the cartilage 5.2 in a tensile manner.

To refix the cartilage 5.2, after the preparation of the perforations 16.1 and 16.2, the second end 22 of the wire rope 1 equipped with the hinged locking rod 23 is pushed through the fragment holes to the target location until the locking rod 23 is completely pushed out on the other side of the cartilage-ligament and can fold down there.

After opening the locking bar 23 as a tension-compression point, a crimp sleeve 4 has been threaded onto the first end 17 of the wire rope 1 to form a counter-pressure point, the support area 6 of which faces the underside of the underside through hole in the bone 5.1. To apply the tensile stress, the surgical wire rope 1 is inserted into the tensioning instrument 2, the tensioning arm 25 with the stop 26 pushing the crimp sleeve 4 against the through hole 16.1 in the bone 5.1.

List of reference symbols

1

Wire rope

2

Tensioning instrument

3

Clamping mechanism

4th

Crimp barrel

5

Fragment of the supporting apparatus

6th

Edition range

7th

drilling

8th

Deformation area

9

Crimping wing

10

Clamping surface

11th

Pressing surface

12th

Angle α

13th

Half-shell-shaped recess

14th

Wall of the bore

15th

Guide means

16

Perforation in a fragment

17th

First end of the wire

18th

Rod-shaped guide element

19th

Recording for creating a temporary guide contact

20th

Tip of the guide means

21

deepening

22nd

Second end of the wire rope

23

Deployable anchoring device

24

Grip sleeve

25th

Tension arm

26th

attack

27

Guide eyelet

28

crankshaft

29

Guide device

30th

Socket in the crankshaft

31

Opening in the grip sleeve

32

Means for releasing the locking mechanism

33

Means for rotating the crankshaft

Claims (8)

System for repositioning fragments of the supporting apparatus comprising a surgical wire rope (1), a tensioning instrument (2) with a tensioning mechanism (3) for generating a tensile force on the surgical wire rope (1) and a crimp sleeve (4) prepared for fixing the surgical one to be tensioned Wire rope (1) on at least one fragment (5) of the supporting apparatus, characterized in that the crimp sleeve (4) has a support area (6) with a bore (7) extending from its top to its underside and one on the top of the support area (6) ) comprises deformation area (8), the deformation area (8) being formed from two crimping wings (9) which can be pressed against one another over a large area and which are located opposite one another at the outlet opening of the drill tion (7) are arranged above the support area (6), wherein a crimping wing (9) has a clamping surface (10) facing the bore (7) and a pressing surface (11) facing away from the bore (7), and the pressing surface (11.1) of the first crimping wing (9.1) and the pressing surface (11.2) of the second crimping wing (9.2) enclose an angle α (12) with a size of 0 ° <α <180 °, the system having a guide means (15) for guiding the surgical wire rope (1) through a through hole (16) in a fragment (5) of the supporting apparatus, and either at the first end (17) of the surgical wire rope (1) a receptacle (19) for producing a temporary guide contact with the tip (20) of the guide means (15) or the surgical wire (1) has a rod-shaped guide element (18) at its first end (17), the receptacle (19) for producing a temporary guide contact with the tip (20) of the guide means (15) ) on the head side e of the rod-shaped guide element (18) is set up. System for the reduction of fragments of the supporting apparatus according to Claim 1 , characterized in that the surgical wire (1) has a rod-shaped guide element (18) with a receptacle (19) at its first end (17), the receptacle (19) for producing a temporary guide contact with the tip (20) of the Guide means (15) in the form of a funnel-shaped or concave recess (21) running from the head side of the rod-shaped guide element (18) in the longitudinal direction thereof. System for the reduction of fragments of the supporting apparatus according to Claim 1 or 2 , characterized in that the angle α (12) and the longitudinal axis of the bore (7) lie in the same plane. System for the reduction of fragments of the supporting apparatus according to one of the Claims 1 until 3 , characterized in that following the course of the longitudinal axis of the bore (7) in the clamping surface (10) of a crimping wing (9) a half-shell-shaped recess (13) is set up, which the wall (14) of the bore leading through the contact area (6) (7) continues in the deformation area (8) of the crimp sleeve (4). System for the reduction of fragments of the supporting apparatus according to one of the Claims 1 until 4th , characterized in that the crimp sleeve (4) is welded on the outside to the second end (22) of the surgical wire rope (1). System for the reduction of fragments of the supporting apparatus according to one of the Claims 1 until 4th , characterized in that at the second end (22) of the surgical wire rope (1) a deployable anchoring device (23) for tensile anchoring of the wire rope (1) on the surface of a fragment (5) of the supporting apparatus is set up. System for the reduction of fragments of the supporting apparatus according to Claim 6 , characterized in that the anchoring device (23) is designed to be self-unfolding, so that when a pull is exerted on the surgical wire rope (1) in the opposite direction to the direction of insertion of the wire rope (1) into a through-hole (16) in a fragment (5) of the supporting apparatus a spreading or unfolding of the anchoring device (23) occurs. System for the reduction of fragments of the supporting apparatus according to one of the Claims 1 until 7th , characterized in that the tensioning instrument (2) is designed to receive the first end (17) of the surgical wire rope (1), the tensioning instrument (2) having a grip sleeve (24), a tensioning arm connected to the grip sleeve (24) ( 25), whereby a stop (26) with a guide eye (27) is set up on the end of the clamping arm (25) and the clamping arm (25) has a guide device (29) applied from the stop (26) to the crankshaft (28) for guiding the wire rope ( 1), a crankshaft (28) mounted in the grip sleeve (24) with a locking mechanism (3) that can be rotated in only one direction of rotation and with a socket (30) oriented transversely to the longitudinal axis of the crankshaft, into which the surgical wire rope (1) via the guide device (29) can be inserted with its first end (17) through an opening (31) in the grip sleeve (24), and a means (32) for releasing the locking mechanism.

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