FR2587196A1 - Apparatus for in situ location of the transverse holes of a hollow pin implanted in the medullary canal, for holding fragments of a fractured bone - Google Patents

Abstract

This apparatus allows the axes of the transverse holes t1 and t2 of the pin to be located using a drill guide 6 without it being necessary to perceive the holes or to use X-rays. For this purpose, the drill guide 6 can be adjusted on a mounting 3 with two degrees of freedom, the adjustment being performed as a function of positional data relating to the axis of the hole t1, t2 picked up by means of sensors 14 which can be inserted into the pin B. These sensor means are mechanical and/or use a radiation which is non-traumatising such as light, possibly pulsed.

Description

APPARATUS FOR IN SITU LOCATING HOLES OF A SPINDLE
HOLLOW IMPLANTED IN THE MEDULAR CHANNEL, FOR CONTAINMENT
FRAGMENTS OF A FRACTURE BONE
The present invention relates to an apparatus intended to be used during the fixation of a pin in a fractured bone.

 Osteosyntese procedures are currently carried out using rigid reinforcing elements which are associated with fractured bone in order to strengthen it and restore the patient's ability to recover as quickly as possible. movement. These reinforcing elements are constituted for example by plates, fixed on the external face of the bone on either side of the fracture, or by hollow pins which are intended to be inserted into the medullary canal of the bone. . These latter elements are used more and more often, because they are the least traumatic for the patient and allow a stiffening of the fractured bone, the pin resisting not only to compressive or tensile forces, but also to torsion. It is this latter property of the pins which can only be obtained if it is blocked not only longitudinally, but also in rotation about its axis, in particular in certain types of so-called "low" or "high" fractures (diaphyso-epiphyseal fractures). .

Consequently, if the spindle must resist torsion, it is necessary to place transverse screws which pass diametrically through the bone as well as one or more pairs of aligned holes provided in particular near the distal end of the spindle. This practice is especially applied in the case where the fractured bone is the femur or the tibia.

 The pins are known per se. They generally have an approximate clover-shaped section, one end being slightly flared and provided with an internal thread, the other end being slightly tapered to facilitate insertion into the medullary canal. In addition, depending on the application, the spindle can be slightly curved along its longitudinal axis and it has a longitudinally slit over its entire length which gives it a certain flexibility in bending, this yes cermet, during insertion , a perfect adaptation to the shape of the spinal canal. Of course, the surgeon has a choice from several lengths and several diameters which are a function of the bone treated and the size of the patient's limb.

 According to the technique which is currently used, the surgeon first of all places the pin in a known procedure and then works to locate the transverse holes located at the distal end of the pin. For this purpose, he has at his disposal an X-ray locating device by means of which he can point on the skin of the limb the place where the axis of the holes crosses this skin then after having made an incision, he drills a hole using a drill through the holes in the spindle.

Finally, the screw can be installed.

 This process therefore requires X-ray work to which both the patient and the treating staff are exposed. The localization operation taking about two hours, we must count on an exposure of about 400 to 1000 REM per intervention. This large dose, to which the treating staff is exposed each time an operation is performed, has hitherto hesitated surgeons to use this method, they prefer either to use plates or pins without transverse reinforcement screws.

 The prolonged duration of the use of the device during an intervention naturally blocks it for interventions that are performed at the same time in a hospital operating room other than the one in which the considered intervention takes place. This requires very tight programming of interventions, which is undesirable, especially if there are emergencies.

 The object of the invention is therefore to provide an apparatus for locating in situ the transverse holes of a hollow pin implanted in the medullary canal for the containment of fragments of a fractured bone which is designed so as to avoid any use of X-rays. during tracking.

According to the invention, the apparatus for locating in situ the transverse holes of a hollow pin implanted in the medullary canal of a bone for the containment of fragments of the latter after a fracture, said pin being provided at its proximal end. fixing means for said device, while the hole or holes to be located are provided at least at its distal end, is characterized in that it comprises
- a support intended to be attached to said pin to
using said fixing means;
- a drilling guide defining an axis to be
placed in coincidence with the axis of the hole to be marked to allow
be the transverse drilling of the bone exactly in alignment
with this hole;
- a frame integral with said support and carrying said
drilling guide so as to give it at least two
degrees of freedom with respect to said spindle, one of which is
a rotation around it in a plane containing the axis
of the hole and the other of which is a translation of the axis of the
guide parallel to itself,
- measuring means to successively provide a pre
better information concerning the direction of the axis of the hole,
then a second information concerning the distance separating
this direction of the research axis,
- And adjustment means for bringing the axis of said guide
drilling coincident with the axis of the hole in function
said information.

 Thanks to these characteristics, the location can be carried out in just a few minutes without the use of X-rays, which constitutes an appreciable time saving, especially in polytrauma patients. In fact, the measuring means can be mechanical and / or of the electromagnetic radiation type, the wavelength of which is situated in a range which makes this radiation non-traumatic both for the service personnel and for the patient.

The invention will be better understood on reading the description which follows of several embodiments of the invention, description which is made with reference to the accompanying drawings in which:
- Figures 1 and 1A show a schematic representation of the position of the device according to the invention during an intervention to restrain a fractured femur;
- Figures 2 and 2A show views similar to those of Figures 1 and 1A, showing the case of the containment of a tibia fracture;
- Figure 3 shows a diagram for the analysis of the principle which is the basis of the present invention;
- Figure 4 is a schematic perspective representation, on a larger scale compared to Figures 1 and 2, of a first embodiment of the invention;
- Figure 5 is a partial exploded perspective view of the proximal part of the apparatus according to the invention;
- Figures 5A and 5B show in sectional views a detail of the apparatus shown in Figures 4 and 5;
- Figures 6 and 7 are perspective views showing, for the case of the containment of a tibia fracture, the location of the device according to the invention, the two views being taken respectively at different angles;
- Figure 8 is a schematic perspective view of the first feeler means used in the apparatus according to the invention;
- Figure 9 shows the second feeler means of this device;
- Figure 10 is a perspective representation of a variant of the apparatus;
- Figures 11 and 12 show another embodiment of the invention, respectively before and after the adjustment;
- Figures 13A to 13D show four variants of the first feeler means, respectively in a and b;
- Figures 14A to 14C show four variants of the second feeler means;
- Figures 15A to 15C relate to other variants of these second feeler means.

 FIGS. 1 and 1A represent the case of an osteosynthesis intervention on the femur, FIG. 1 showing the position of the device according to the invention, generally designated by reference 1, when locating a transverse hole pr3ti9u rs oe brooch which one supposes already to be put in ice in the ^ medullary of the femur.

 FIG. 1A shows an example of a spindle, also known, which can be used for an osteosynthesis intervention to which the apparatus according to the invention applies. We see that this pin B is formed by a rod which is made of a metal inert to human moods and tissues. This rod is hollow and has a section approximately in the shape of a clover giving it a certain flexibility so that the rod can adapt perfectly to the shape of the medullary canal when it is placed in the bone. It will therefore be noted from now on that not only does the rod not have a rectilinear shape, but that, moreover, during its positioning in the bone, it will admit a certain deformation which is not known a priori.

 Pin B has a proximal end a with an al mouth which is internally threaded. When inserted, this proximal end first receives an anvil which is screwed into the threaded hole and on which the practitioner can strike to facilitate insertion.

 At its opposite end a2, the pin B has two transverse holes tl and t2 which are intended to receive locking screws (not shown in the figures) which are generally delivered with the pin B.

 Of course the pins are supplied in different length and diameter dimensions as is well known to specialists.

 Figures 2 and 2A show the case of an osteosynthesis intervention on the tibia, Figure 2A showing the shape of a pin B 'used in this case. We see that this pin has a curved proximal end with a mouthpiece as in the case of the pin intended for the femur. In addition, on the outside of the elbow, this pin B 'has a through hole which is not visible in the drawing. For the rest, pins B and B 'are identical in shape.

 It should also be noted that when inserting the pins into the bones to be contained. they undergo a torsional deformation, the spindle "screwing" in some way into the medullary canal by its external shape, which notably increases the rigidity of the assembly constituted by the spindle and the bone.

 In other words, the holes t1 and t2 which it is a question of locating do not retain, with respect to the mouthpiece, neither the axial position, nor the position in the radial plane with respect to the mouthpiece, which Obviously complicates the locating operation, it being understood that after insertion the holes are no longer visible and that it is desired to avoid any use of X-rays to locate them.

 We will now refer to FIG. 3 which represents the operating principle of the apparatus according to the invention, the representation applying equally to the interventions of FIGS. 1 and 2 and of course to the other interventions which can be carried out by osteosynthesis.

 This figure schematically represents the bone bone surrounded by the CH flesh and provided with a medullary canal C.

 However, before describing in detail Figure 3, we will already refer to Figure 4 to know the different main organs of the device according to the invention which, as we can see, is used here for the containment of the fracture a femur bone. We recognize a pin B with its proximal end a and its distal end, the two transverse holes tl and t2 as well as the mouthpiece al provided with its internal thread. It is on this mouth that is screwed a support 2 which constitutes the organ of the device remaining fixed during the location. This support which, in the embodiment shown, has the shape of a sector of a circle, defines a plane XOZ (here vertical) in which is located a point O considered as the origin of the coordinate system XYZ and which is a reference system in the description which follows.

The origin O of this coordinate system is located on the axis OY constituting at this point the tangent to the axis of pin B which, as indicated above, is not a straight line, but a line more or less curved, depending on the shape of the pin at the origin and also according to the deformations that this pin undergoes when it is inserted into the bone.

 The device also includes an adjustment bracket 3 which is articulated on the support 2 around the axis OY.

 The bracket 3 comprises a first branch 3a extending perpendicular to the axis OY and a second branch 3b aui extends parallel to this axis along the pin B when the device is in place for the measurement.

 On the branch 3b is mounted movable along its longitudinal axis a slide 4 provided with two transverse passages 5 intended to receive a drilling guide 6. The latter is dimensioned to be able to receive a drill bit 7 for drilling adaptable to a surgical drill (not shown). The slide 4 can move in a longitudinal slide 8 of the branch 3b while being able to be locked in this slide by a clamping mechanism (not shown) which can be actuated using a lever 9.

 The bracket 3 which is therefore articulated around the axis OY on the support 2 can be blocked relative to the latter by means of a screw 10 which acts on the circular edge 11 of the support 2 (see also FIGS. 5A and 5B which we will come back to later). In addition, the branch 3b is made in the form of a toggle and is therefore divided itself into a first part 12a close to the arm 3a as well as a part 12b in which is provided the slide 8, the articulation of the toggle (UU axis) can be locked with a screw 13.

 The apparatus also includes first feeler means 14 essentially formed by a rod 15 which can be inserted into the bore of spindle B and which carries at its front end a feeler 16 (FIG. 8) and at its opposite end an actuator 17, these members being described below with reference to FIG. 8. It suffices for the moment to note that these first feeler means 14 are provided with an index 18 which is intended to cooperate with a reference 19 provided on the bracket 3 and more precisely on the branch 3a thereof on the face which is not visible in FIG. 4. However, this mark 19 can be seen for example in FIGS. 5, 7 and 11, the index 18 being in turn the best visible in Figure 5.

 Finally, it is necessary at this stage of the description to refer to FIG. 9 which represents an example of second feeler means 20 also intended to be inserted into the spindle B and acting in cooperation with the drilling guide 6.

Referring again to FIG. 3, this is traced in the plane XOZ and on this plane has been projected a section BA of the pin B passing through one of the transverse holes TA of the latter assuming that the pin is perfectly straight and has not undergone any deformation during insertion into the bone. The figure also shows the projection of the same section indicated by
BB, but this time in its position as it is, namely when the spindle was deviated by the medullary canal and taking into account its original non-rectilinear shape. In order to increase the clarity of this figure, the deviation of the spindle has been greatly exaggerated. It should also be noted that, strictly speaking, this example only refers to a femur pin because the tibia pin (Figure 2A) is very curved near its mouth; the support of the device then being arranged slightly differently (see Figure 7). We will come back to this point later. However, the principle of the measurement resulting from FIG. 3 is applicable as well to the case of the femur as that of the tibia.

 It is obvious that the center of the section BA coincides with the center O of the coordinate system XYZ, the center of the section BB indicated by O 'being deviated by a deviation e and the spindle itself having undergone a torsion making in so that the diametral plane passing through the axis of the hole TA undergoes an angle rotation to position itself as indicated for the hole TB in FIG. 3. This also represents the drilling guide 6 as well as the sketch of the section of the branch 3b of the bracket 3 in different positions which will now be explained.

 The purpose of the locating operation consists definitively in placing the axis SS of the drilling guide (which is initially effectively coincident with the axis OX as shown) on the axis defined by the hole TB of the spindle, that is to say in coincidence with the RR axis. If this operation can be carried out with precision, the surgeon will be sure to pierce the bone in such a way that the drill passes in the spindle through the hole TB and this without it being necessary that he actually sees this hole. It will therefore not be necessary to carry out a bloody opening of the CH flesh at the place where the hole TB is located or to carry out any X-ray research.

 The marking is carried out according to the invention in two steps which consist respectively and first of all in placing the drilling guide 6 so that its axis SS is located in a plane parallel to the axis RR and containing the axis OY, then shifting the drilling guide 6 in translation, so that the axes RR and SS coincide. It is understood, by examining FIG. 4, that the first step is carried out by rotating the bracket 3 around the axis OY (first degree of freedom of the drilling guide), the second step consisting in breaking the toggle joint 12a, 12b at the location of the axis UU (second degree of freedom), the slight defect introduced by the fact that this last step is a rotation being negligible1 taking into account the various dimensions of the organs in play (length of the spindle in particular).

 The angular offset a is measured using the first feeler means 14 which define a plane in which the axis of the rod 15 and the index 18 are located (see FIGS. 4 and 5). The probe 16 is capable of making this plane coincide with the real axis R-R of the hole TB when it is inserted in the spindle B up to the height of the hole. If this axis is deviated, the index 18 will not be located in the plane XOY of FIG. 4, but will be inclined by the angle a sought with respect to the reference 19 traced on the branch 3a of the bracket 3. To do coincide the index 18 with this mark 19, it is then necessary to unscrew the screw 10 and rotate the bracket 3 by the angle a around the axis OY, which places the branch 3b in the position indicated in dotted and referenced 3b 'in Figure 3.

 The first sensor means 14 have then done their work and the practitioner can remove them from pin B.

 It must replace them with the second feeler means 20, a preferred embodiment of which is shown in FIG. 9. In the case shown, these means comprise a flash lamp 21 fixed to the end of a catheter 22 which can be inserted into pin B and which can be supplied with energy by a supply device 23 known per se connected to the lamp 21 by conductors 24. The flash lamp 21 is preferably associated with a reticle 25 which can be inserted into the sliding block 4 (FIG. 4) in place of the drilling guide 6. To obtain the offset of the distance d from the axis OX '(FIG. 3) to the axis RR, it is then sufficient to operate the flash lamp 21 after having inserted it into the spindle up to the height of the hole TB, to unscrew the screw 13 blocking the toggle joint 12a, 2b and to ensure that the center of the reticle 25 is placed in the center of the hole TB whose outline clearly through the flesh of the member concerned thanks to the flashes produced by the lamp 21. Once the coincidence has been obtained, it suffices to re-tighten the screw 13, to remove the reticle 25 and to reinsert the drilling guide 6 in the block 4, the axis SS of this guide then exactly coinciding with the axis RR from hole TB.

 It should be noted that the process which has just been described is exactly the same whether it is the contention of an invoice of the femur or the tibia, with the close reservation indicated above with regard to the support 2 .

 It will also be noted that the locating operations are extremely simple and rapid, the surgeon being able to perform them in just 5 minutes, whereas so far with an x-ray machine, it takes approximately two hours to obtain the same result, although the accuracy of the measurement is not as satisfactory as that obtained using the apparatus of the invention.

 We will now describe in more detail the construction of this device with reference to FIGS. 4 to 7.

 The support 2 (Figure 5) comprises a fixing plate 26 on which is provided a projection 26a which has a shape complementary to the mouth of the pin B, this shape is not of revolution so that this plate can only be locked by simple screwing in one radial position with respect to spindle B. The plate 26 is secured to a support plate 26b, for example using a dovetail attachment 27 , the circular edge of this support plate having two lateral flanges 28a and 28b delimiting a groove whose bottom is hollowed out in a rounded shape (see FIG. 5B at 29).

 The plate 26 is pierced with a hole which is intended to receive the intermediate surface 30 of a screw 31, one of the ends 32 of which consists of a threaded end fitting suitable for the thread of the spindle B and the opposite end part of which 33 serves as a rotation bearing for the branch 3a of the bracket 3 by being inserted into an opening 34 of this branch. The screw 31 is pierced with an axial hole 35 in order to allow passage to the feeler means 15 and 20. Finally, the end face of the part 33 of the screw 31 is hollowed out with a hexagonal cavity 36.

 The locking screw 10 (FIG. SA) which crosses the branch 3b through a threaded hole 37 carries at its end a centering finger 38 which is intended to come to bear against the bottom 29 of the groove delimited by the flanges 28a and 28b in order to apply the square 3 against the plate 26.

 The first fear means 14 have been shown in detail in FIG. 8 in which we see the rod 15, the feeler 16 and the index 18 already mentioned above. At its distal end, the rod 15 carries two jaws 39a and 39b articulated around an axis 40 and urged outwards thanks to a rope 41. The latter passes through the rod 15 and is attached to an actuating plate 42 sliding on the rod 15 against the action of a compression spring 43. This spring is supported on a counter-plate 44 mounted transversely at the end of the rod 15 and fixed relative thereto.

 A support plate 45 is slidably mounted on the rod 15, while being provided with springs 47 which cooperate with transverse grooves 48 provided on this rod to define different lengths, each position corresponding to a spindle length capable of being used by the surgeon. Consequently, at the start, this plate 45 is adjusted in such a way that the feeler means 14 are adapted to the length of the spindle B used. The streaks 48 are therefore advantageously associated with a length graduation. The support plate 45 carries the index 18 here constituted by a rectilinear rod extending radially. It is this rod which must therefore be placed in coincidence with the reference 19 of the branch 3a.

 It should be noted that the radial position of the index 18 corresponds to the plane defined by the jaws 39a and 39b apart, so that when these are blocked in a hole in the spindle, the index 18 is located in a plane in which is also the axis of the hole concerned.

 Figures 6 and 7 show the case of a location during an intervention on the tibia. As the tibia pins have an inclined tip (see Figure 2A), the support of the device used in this case is slightly different from that just described. In fact, this support indicated by the reference 2 ′ comprises a lateral tab 49 in which the fixing screw 31 is inserted (FIG. 5) this support comprising a through hole to allow the insertion of the feeler means 14, roughly in the alignment of spindle B ', this support defining, as in the case described above, the reference plane YOZ with respect to which the other tracking parameters are defined. For the rest, both in terms of its construction and in terms of its operation, the apparatus of FIGS. 6 and 7 is identical to that shown in FIG. 4.

 We will now describe another embodiment of the part 12b of the toggle joint which constitutes the branch 3b of the bracket 3 (FIG. 10). In this case, this part 12b comprises a rule 50 with an L-shaped section, the two wings of which are provided with grooves 51 and 52 in which a slide 53 is guided, shaped so as to be able to receive the drilling guide 6. Of course , the rule 50 can be blocked with respect to the other part 12a of the toggle joint thanks to the nut 13. Furthermore, it is possible to provide a graduated strip 54 mounted removably on the edge of one of the wings of rule 50 and intended to provide the practitioner with an indication of the length of the spindle used.

 In Figures 11 and 12, there is shown respectively before and after its adjustment, an apparatus produced according to another embodiment of the invention. More specifically, the part 12b of the toggle joint constituting the branch 3b of the bracket 3 here comprises an adjustment block 55 which passes before a rule which is flush with the upper face of the latter. In this way, a mark 56 traced on this block can cooperate with a graduation 57 provided directly on the ruler.

 FIGS. 13A to 130 show several possibilities for producing the first sensor means.

 In FIG. 13A, the rod 15 carries at its free end two elastic tabs 58 which are provided at their free end with balls 59 capable of partially penetrating into the openings which define the transverse fixing holes in each pin.

The tabs 58 and the balls 59 can be retracted by traction to roughly enter into the extension of the contour of the rod 15 during the insertion of the feeler means into the spindle.

 The schematic view of FIG. 13B shows that the first feeler means can also comprise a member 60 in the form of a bellows which can be inflated or deflated by blown air or discharged from a pipe 61 placed in the rod 15.

 FIG. 13C shows that it is represented, as a reminder, the feeler means 20 already shown in FIG. 9. It is therefore here a flash lamp 21 capable of emitting light radiation 66 in the pin B towards the outside, this light radiation being apparent through the flesh of the limb being treated, the light effect being improved by the lightning provided by the lamp.

 FIG. 14B shows a variant in which a non-traumatic source of radiation 67 is provided outside the member under treatment, this source radiating through the hole concerned in pin B on a sensor 68 of this type. radiation, which can possibly be pulsed. In this case, the axis of the hole can be found for example by detecting a maximum amplitude of the radiation emitted. The radiation itself can be constituted by a high frequency radio wave with a wavelength chosen in such a way that it is not traumatic for the patient or for the treating staff.

 In FIG. 14C, it is a radiation transceiver 69 which sends its radiation onto a reflector 70 placed opposite. This returns part of the radiation through the pin hole so that it can be detected there.

 Finally, FIG. 14D shows that in the case of a reflector 70 the radiation can be pulsed or otherwise characterized by a modulation in order to improve the detection thereof and, consequently, the accuracy of locating the pin hole .

 FIG. 15A shows yet another variant in which there is provided a light source 71 which can be a laser for example, emitting a light ray on a mirror 72 mounted in the support 3 of the apparatus and returning the light ray to another reflector device 73 located at the end of a rod (not shown). This latter device returns the radiation in both directions through the hole in the spindle, which allows it to be identified, for example by a reticle, as has been described in connection with FIG. 9.

 Of course, the laser 71 can be replaced by a light source with flashes 74 shown in FIG. 15B. Finally, it is also possible to use a conventional endoscope 75 with the shape shown in FIG. 15C.

Claims (12)

 1. Apparatus for locating in situ the transverse holes of a hollow pin (B) implanted in the medullary canal (C) of a bone (OS) for the containment of fragments thereof after a fracture, said pin (B ) being provided at its proximal end with fixing means for said device, while the hole or holes to be located are provided at least at its distal end, this device being characterized in that it comprises  - a support (2) intended to be attached to said pin (B)  using said fixing means;  - a drilling guide (6) defining an axis (S-S) to be  placed in coincidence with the axis (R-R) of the hole (TB) to be located  to allow the transverse drilling of the bone exactly in  alignment with this hole (TB);  - a frame (3) integral with said support (2) and carrying said  drilling guide so as to give it at least two  degrees of freedom with respect to said spindle (B), one of which  is a rotation around it in a plane containing  the axis (R-R) of the hole (TB) and the other of which is a translation  the axis (S-S) of the guide (6) parallel to itself;  - measuring means (14, 20) for successively supplying  a first information concerning the direction (O-X ') of  the axis (R-R) of the hole (TB), then a second piece of information  concerning the distance (d) separating this direction from the axis  sought (R-R);  - And adjustment means for bringing the axis (S-S) of said guide  drilling (6) coincident with the axis (R-R) of the hole (TB)  based on said information.  2. Apparatus according to claim 1 characterized in that said frame (3) further comprises means (4, 8, 12a, 12b, UU) to decompose the translational movement of the axis (SS) of said drilling guide (6) into a linear translation in a direction perpendicular to said plane containing the axis (RR) of the hole (TB) of the spindle (B) and a translation by rotation of this same axis (SS) around an axis (UU) which is parallel to this plane.  3. Apparatus according to any one of the claims nns and 2 characterized in that said measuring means (lO, 20) c-mcrendent first feeler means (14) placed at the end of a rod (15) intended to be inserted in the spindle (B) to orient the latter as a function of the attitude of the axis (RR) of said hole (TB), this rod comprising at its other end an index (18) providing said first information.  4. Apparatus according to claim 3 characterized in that said measuring means (14, 20) further comprising second feeler means (20) comprising a device (21) emitting non-traumatic electromagnetic radiation and capable of emitting a beam from the hole to be identified and in that said measuring means comprise a reticle device (25) intended to be placed on the drilling guide and to be centered on the beam of radiation perceptible in this guide through said hole, the bone and the flesh which surrounds it, by displacement of the drilling guide (6), these second feeler means thus providing said second information.  5. Apparatus according to claim 4 characterized in that the radiation emitting device (21) is arranged to emit pulsed radiation.  6. Apparatus according to any one of claims 4 and S characterized in that said radiation, possibly coherent, at the wavelength of visible light.  7. Apparatus according to claim 6, characterized in that said emitting device is a lamp (21) mounted at the end of a catheter insertable in the pin (B).  8. Apparatus according to claims (5 and 7) taken together characterized in that said lamp (21) is a flash lamp.  9. Apparatus according to claim 4 characterized in that said transmitter device is part of a transmitter-receiver assembly (69) placed on one side on the axis of the hole (TB) to identify and further comprising a reflector device ( 70) place the other side of the hole on this same axis (RR).  10. Apparatus according to any one of claims 1 to 9 characterized in that said frame (3) has the shape of a square urea one of the branches (3a) of which is articulated on said support (2) in s' extending approximately perpendicularly to said pin (B) when the apparatus is in place, in that the other branch (3b) extends approximately longitudinally relative to this pin along the bone to contain by being made as a toggle (12a, 12b), the element of this toggle remote from the first branch of the bracket (3) slidingly carrying said drilling guide (6).  11. Apparatus according to any one of claims 3 to 19 characterized in that said first feeler means (14) comprise two pal page elements (39a, 39b) mounted articulated on the end of the rod (15) intended to be inserted in the spindle, these elements being able to lock in the spindle openings (B) defining said transverse hole (TB) whereby said rod acquires a fixed angular position representing the direction of the axis of the hole, reflected on the spatial position of said index (18).  12. Apparatus according to claims 10 and 11 taken together characterized in that said index (18) cooperates with a mark (19) traced on the first branch (3a) of the bracket of said frame.