JP2020092790A - Bone fixation system - Google Patents

Abstract

To provide a bone fixation system capable of facilitating and ensuring mounting work of a mounting fixture in implant.SOLUTION: A bone fixation system 1 comprises: an implant 2 disposed in the body for bone fixation; a surgical instrument 3 including a connection part 31 formed to be connected to the implant 2; and a mounting fixture 22 detachably mounted on the implant 2. The surgical instrument 3 is formed in a connected state to the implant 2 so as to incorporate the mounting fixture 22 in a manner of being mounted on the implant 2 or a manner of being positioned and held to be mounted, between the connection part 31 and the implant 2. The surgical instrument 3 is made removable from the implant 2 while retaining the mounting fixture 22 in the manner.SELECTED DRAWING: Figure 1

Description

The present invention relates to bone fixation systems.

BACKGROUND ART As a bone fixing system for fixing a bone, one including an implant such as an intramedullary nail or a bone plate to be placed inside the body has been conventionally known. In this case, an introducing tool for introducing the implant into the body and positioning it at a predetermined position may be used, and when a fixture is attached to the transverse hole or screw hole of the implant arranged in the body. In some cases, an aiming device such as a target device may be used to accurately apply the fixture (see, for example, Patent Documents 1 and 2 below).

After the implant is introduced into the body and placed at a predetermined position, it may be necessary to attach the component to the implant according to the surgical technique. For example, a plug member called an end cap or an adjusting tool called a set screw for fixing the fixing tool is inserted into the proximal end portion of the intramedullary nail, or an adjusting mechanism provided in the implant is operated. The operation tool for this may be mounted in a required manner. Further, when using a surgical instrument such as the above-mentioned aiming instrument or introduction instrument, using a predetermined connection structure, the connecting portion of these surgical instruments and the implant are brought into a connected state, and then the surgical instrument is used. The implant is introduced into the body and positioned. In the case of a sighting instrument, a fixture is then attached to the implant using the guidance feature of the sighting instrument.

JP, 2011-78499, A JP, 2010-110552, A

However, it is difficult for an operator such as an orthopedic surgeon to access the implant positioned at a predetermined position in the body from outside the body because the body cannot be directly visually recognized. In particular, due to the minimally invasive surgical technique in recent years for reducing the burden on the patient during surgery, it is becoming more and more difficult to access implants placed in the body. On the other hand, a female screw formed on the inner surface of the shaft hole at the base end of the intramedullary nail, a plug member such as an end cap, an adjusting tool such as a set screw, an operating tool for operating the adjusting mechanism, a screw hole in a bone plate. Various kinds of wearing tools such as a guide tool such as a drill guide for making a hole corresponding to the above may be used. However, in the above situation, it is extremely difficult to attach the above-mentioned various attachments to the implant placed in the body. This is because in the work of mounting the mounting tool on the implant, it is necessary to eliminate the inclination of the mounting tool with respect to the mounted portion on the implant side with respect to the axis of the mounting tool and perform the operation in a state where the axis is accurately aligned. Also, if you forcibly attach it with the axis tilted even a little, there is a risk of destroying the wearing tool or the mounted part, or poor mounting, and if you finish the surgery without noticing this destruction or poor mounting, There is a problem that the original function of the implant cannot be exhibited. Further, there is a problem that the operation time becomes long due to time-consuming installation.

Therefore, an object of the present invention is to provide a bone fixing system that can facilitate and ensure the mounting work of the mounting tool in the implant in order to solve the above problems.

The bone fixation system of the present invention includes an implant to be placed in the body for bone fixation, a surgical instrument including a connecting portion configured to be connectable to the implant, and a mounting tool detachably attached to the implant. It is equipped with. Here, the surgical instrument is configured such that, in a state of being connected to the implant, the attaching tool in a state of being attached to the implant or in a state of being positionably held so as to be attachable can be incorporated between the connecting portion and the implant. It Further, the surgical instrument is configured to be detachable from the implant while maintaining the wearing tool in the aspect.

In the present invention, the connecting portion has a connection structure that is detachably connected to the wearing tool, and the surgical instrument is in a state of being connected to the implant or in a connectable state with respect to the implant. It is preferable that the mounting tool in the positionally held state is connected to the connecting portion and is detachable from the implant by releasing the connection of the mounting tool to the connecting portion. In this case, the surgical instrument is configured such that, in the state of being connected to the implant, the connecting portion is connected to the mounting tool and the mounting tool is mounted on the implant body. It is further desirable that the implant can be detached from the implant by disconnecting the connection part from the attachment while being attached to the implant.

In the present invention, the connecting portion may include a connecting end portion that is detachably connected to the wearing tool and an engaging end portion that is engageable with the implant in a direction orthogonal to a connecting direction. desirable. In this case, the connecting portion can be connected to the implant through the attaching tool that is connected to the connecting end and is attached to the implant or is positionably held by the implant, and is attached to the connecting end. It is configured to be removable from the implant by disconnecting the device. Also, the connection end portion includes a connection structure corresponding to the connection target structure of the wearing tool. The connection structure may be, for example, a female screw, a male screw, a convex thread, a concave groove or the like of the structure to be connected, such as a male screw, a female screw, a concave groove, or a convex groove. At this time, it is desirable that the ridges and grooves are detachably connected by elastic portions or actuating mechanisms that can be locked to each other by the concavo-convex structure. Further, the engagement end comprises an engagement structure corresponding to the engaged structure of the implant. The engagement structure can be formed by a concavo-convex structure that can be fitted to the concavo-convex structure of the engaged structure.

In the present invention, it is preferable that the connecting portion has a first connecting member having the connecting end portion and a second connecting member having the engaging end portion. Here, the mounting tool connected to the connection end portion is mounted on the implant or is positionably held so as to be mounted so that the second coupling member is sandwiched between the implant and the first coupling member. Desirably, the implant is connected to the surgical instrument in a manner. In addition, the surgical instrument is mutually attached to the implant by connecting the first connecting member to the implant in a state in which the first connecting member is attached to the implant or is positionably held in an attachable manner. It is desirable that the first connecting member and the implant, which are connected via a tool, sandwich the second connecting member. Furthermore, it is preferable that the first connecting member and the second connecting member are configured to be rotatable with respect to each other and movable in the axial direction with respect to each other within at least a predetermined range in the axial direction. In these cases, it is desirable to provide a coaxial structure in which the first connecting member is an inner shaft body and the second connecting member is an outer cylinder body.

Here, it is preferable that the mounting structure of the mounting device is configured to be mountable to the structure to be mounted of the implant by screwing around an axis. Further, it is preferable that the connection structure of the connection end portion is configured to be attachable to the structure to be connected of the attachment tool by screwing around an axis. Further, it is preferable that the engagement structure of the engagement end portion is configured to be engageable with the engaged structure of the implant in a rotation direction around the axis.

In the present invention, the first coupling member includes a holding end portion that holds the wearing tool as a part of the connection end portion, and is held by the holding end portion as another part of the connection end portion. It is preferable to provide a positioning end portion for positioning the wearing tool. At this time, the wearing tool includes a held structure held by the holding end as a part of the mounted structure, and is positioned by the positioning end as another part of the mounted structure. It is preferable to provide a positioned structure. Here, the holding end portion can be configured by a male screw, a female screw, a ridge, a groove, or the like. At this time, it is preferable that the ridges and the grooves are configured to be held by elastic portions or movable portions that can be locked to each other by the uneven structure. Further, it is preferable that the positioning end portion is configured to abut a structure to be positioned of the wearing tool and regulate a connection posture and a connecting position of the wearing tool. In particular, it is more desirable that the angular posture of the wearing tool around the axis, the posture with respect to the axial direction, and the position in the axial direction and the direction orthogonal thereto are restricted.

In the present invention, it is preferable to have an inner rod provided with the holding end and an outer sleeve provided with the positioning end. Here, by contacting the positioning end with the wearing tool held by the holding end, the wearing tool and the inner rod hold the outer sleeve in such a manner that the outer sleeve is sandwiched between the wearing tool and the inner sleeve. It is desirable to connect to one connecting member. Further, it is preferable that the inner rod and the outer sleeve are configured to be rotatable with respect to each other and movable in the axial direction with respect to each other within at least a predetermined range in the axial direction. Here, it is preferable that the holding structure is configured to be capable of being held with respect to the held structure by screwing around an axis. For example, the holding end has a male screw, and the held structure is a female screw. In this case, it is desirable that the first connecting member and the second connecting member are configured to be rotatable about the axis and movable in the axial direction. In addition, at the respective base end portions of the inner rod and the outer sleeve, rotary engaging portions (first rotary engaging portion, second rotary engaging portion) that are independently engageable with a rotary operation tool or the like are provided. It is desirable to have each joint).

The present invention may further include a fixture configured to be held by the implant. In this case, it is desirable that the wearing tool be an adjusting tool capable of adjusting the holding state of the fixing tool or include the adjusting tool. In some cases, an adjusting mechanism for adjusting the holding state of the fixture by the implant may be further provided. In this case, it is desirable that the mounting tool be an operation tool configured to operate the adjustment mechanism or include the operation tool.

In the present invention, it is preferable that the implant is an intramedullary nail having a shaft hole that opens at a connected end connected to the connecting portion of the surgical instrument. In this case, it is preferable that a mounting structure corresponding to the mounting structure of the mounting tool be provided inside the shaft hole. This mounted structure can be configured by a mounting structure of the mounting tool, for example, a male screw, a female screw, a female screw corresponding to a ridge, a groove, etc., a male screw, a groove, a ridge, and the like. Further, it is desirable to provide an engaged structure capable of engaging with the engaging structure of the engaging end portion at the opening edge of the shaft hole. The engaged structure can be configured by an engaging structure of the engaging end portion, for example, a convex protrusion, a concave notch corresponding to a concave notch, a convex protrusion, or the like. In particular, it is preferable that the mounting tool is mounted by being screwed into a screw provided on the inner surface of the axial hole of the implant. In this case, the mounting structure of the mounting device is formed by a male screw, and the mounted structure is formed by a female screw. Furthermore, it is preferable to further include an extension mounting tool (extension end cap) configured to be connectable to the mounting tool for extending the proximal end portion of the implant.

According to the present invention, the surgical instrument is connected to the implant in a state where the mounting tool is incorporated between the connecting portion and the implant, the implant is introduced into the body, and thereafter, the surgical operation is performed with the mounting tool connected to the implant. By removing the instrument, it is possible to eliminate the work of mounting the mounting tool on the implant placed inside the body, and thus to provide a bone fixation system that can facilitate and ensure the mounting work of various mounting tools on the implant. You can

It is a partial cross-sectional perspective view which shows the whole structure of embodiment of a bone fixing system with the application state with respect to bone. It is sectional drawing which shows the structure of the connection part of the surgical instrument of the same embodiment with an expanded disassembled sectional view. It is a figure which shows the structure of the surgical instrument of the same embodiment in the state which decomposed|disassembled some components. An external view of the implant (a) showing the structure of the implant (intramedullary nail) of the same embodiment as seen from a certain orientation, and a partial external view of the implant showing the appearance as seen from a different orientation (b). ) And an exploded view (c) showing the adjustment mechanism configured inside the implant. It is explanatory drawing (a) and (b) which respectively show the state before and behind the operation mode by the mounting tool (end cap) of the adjustment mechanism inside an implant (intramedullary nail). Explanatory drawing (a) which shows the released state and locked state with respect to a fixing tool (bone screw), respectively by typically showing the relationship between the position of a mounting tool inside an implant (intramedullary nail), and the operation mode of an adjustment mechanism. ) And (b). It is a partial sectional view (a), a top view (b), and a partial sectional side view (c) which show the tool used when removing a surgical instrument from an implant, and its application method. A state diagram before mounting (a) showing a mounting example of an extension end cap for extending a proximal end portion of an implant, a state diagram after mounting (b), and an enlarged exploded view of a mounting tool and an extension end cap. It is (c). An enlarged cross-sectional view (a) showing a connecting portion between a surgical instrument and an implant according to another embodiment, an exploded perspective view (b) showing a structure of a fitting, and an exploded view showing a corresponding structure of a fitting body and an extension end cap. It is a perspective view (c).

Next, embodiments of the present invention will be described in detail with reference to the accompanying drawings. First, the configuration of the embodiment according to the present invention will be described with reference to FIGS. 1 to 4.

As shown in FIG. 1, the bone fixing system 1 of the present embodiment includes an implant 2 introduced at a position in the body for holding a bone (femur) B, and an implant 2 inserted when the implant 2 is introduced into the body. The surgical instrument 3 is used as an instrument and also as an aiming instrument for introducing a fixture (bone screw) (not shown) into the implant 2 arranged in the body. The implant 2 includes an implant main body (intramedullary nail) 21, a mounting tool (end cap or operation member) 22 mounted in a shaft hole 21a opening at the proximal end of the implant main body 21, and a shaft hole 21a. The adjusting mechanism 23 is arranged and adjusts the holding state of the fixture inserted through the transverse hole 21d provided in the implant body 21.

The surgical instrument 3 is connected to the implant 2, a connecting portion 31, an arm portion 32 that is rotatably connected to the connecting portion 31 about its axis, and is connected and fixed to the arm portion 32. And a sighting portion 33 for guiding the punching tool and the fixing tool so that the fixing tool is inserted into the transverse hole 21d provided in the. The aiming portion 33 is configured such that a guide sleeve (not shown) or the like can be mounted in a posture along the guide axis 33x.

Further, the connecting portion 31 of the surgical instrument 3 is provided on the distal end side connecting end 31a connected to the implant 2 and on the opposite side of the connecting end 31a, and is inserted through the inside of the arm end portion 32a at the distal end of the arm portion 32. And a base end 31b protruding toward the base end. The base end 31b has a flange-like enlarged shape so that it can be hit with a hammer or the like when the implant 2 is introduced. An operation handle 34 is attached immediately below the base end 31b to change the extension angle of the arm portion 32 and the aiming portion 33 with respect to the implant 2 or to operate the arm portion 32 and the aiming portion 33 relative to the axis of the implant 2. Used to confirm heading. The insertion portion of the connecting portion 31 with respect to the arm end portion 32a is attached to the arm end portion 32a so as to be engageable with the arm end portion 32a in the rotational direction about the axis and movable in the axial direction. A lock ring 35a configured to be engageable and disengageable, and an operation sleeve 35b for switching between a locked state in which the lock ring 35a is engaged with the arm end 32a and a released state with respect to the arm end 32a. An angle setting mechanism 35 is provided. It should be noted that the angle setting mechanism 35 has a biasing means (coil spring) 35c built therein as shown in FIG. 2, so that even if the operating sleeve 35b releases the locking ring 35a, The stop ring 35a is pressed against the side that engages with the arm end 32a.

The example shown in FIG. 1 is introduced into the medulla of the femur as the bone B, and mainly implants a retrograde intramedullary nail for treating a fracture around the condyle Ba at the distal end of the femur. Is shown. In this case, before the surgery, the implant 2 is connected to the surgical instrument 3 in advance outside the body, the cortical bone is regenerated by reaming the condyle Ba, and the surgical instrument 3 is grasped. The implant 2 is inserted into the medulla of the femur through the opening.

As shown in FIGS. 2 and 3, the connecting portion 31 has a first connecting member 311 (which is also an inner cylindrical body in the illustrated example) formed of an inner shaft arranged on the inner circumference, and a first connecting member 311 arranged on the outer circumference. And a second connecting member 312 configured by an outer cylindrical body that accommodates the first connecting member 311. The first connecting member 311 includes an inner rod 313 arranged on the inner circumference and an outer sleeve 314 arranged on the outer circumference. The connection end 31a of the connection part 31 is provided with a connection end 311a provided at the tip of the first connection member 311. The connection end portion 311 a has a connection structure for connecting to the wearing tool 22. The connection end portion 311a is provided at the tip of the inner rod 313 and can hold the wearing tool 22 and the positioning end portion 314a that is provided at the tip of the outer sleeve 314 and can position the wearing tool 22. Composed of and. In the illustrated example, the holding end portion 313a includes a male screw that can be screwed (screw coupling, the same applies hereinafter) to a female screw 22b formed on the inner surface of a shaft hole 22a that is a held structure provided in the mounting tool 22. The positioning end portion 314a has a positioning structure including a stepped end surface corresponding to the structure to be positioned which includes the inner surface and the base end portion of the wearing tool 22. Further, this positioning structure has a rotary engaging shape such as a hexagonal column shape that is engageable in the rotational direction around the axis, corresponding to the positioned structure having a rotary engaging shape such as a hexagonal hole.

The inner rod 313 is rotatable about the axis with respect to the outer sleeve 314 while being inserted into the shaft hole of the outer sleeve 314 as shown in the drawing, and is axially movable at least within a predetermined axial range. It is configured to be movable. As a result, the holding end 313a of the inner rod 313 is inserted into the shaft hole 22a of the mounting tool 22, and the male screw of the holding end 313a is screwed into the female screw 22b of the inner surface of the shaft hole 22a. The inner surface 22e on the base end side can be held and fixed while being pressed against the positioning end portion 314a of the outer sleeve 314. At this time, the mounting tool 22 is in a position along the axis of the first connecting member 311 and is firmly positioned in the direction of the axis, and is also fixed in the rotational direction around the axis. It is said that.

At the base end of the inner rod 313, a tool engaging portion (first rotary engaging portion) 313b such as a hexagonal hole to which a rotary operation tool such as a wrench can be applied is provided. Further, on the outer peripheral surface of the base end of the inner rod 313, there is provided an operation surface 313c composed of a knurled surface or a rough surface which allows the inner rod 313 to be rotationally operated by fingers or the like. At the base end of the outer sleeve 314, a tool engaging portion (second rotary engaging portion) 314b such as a hexagonal hole to which a rotary operation tool such as a wrench can be applied is provided. Further, on the outer peripheral surface of the base end of the outer sleeve 314, an operation surface 314c including a knurled surface or a rough surface that allows the outer sleeve 314 to be rotationally operated by fingers or the like is provided. Note that 313d is a holding screw, 314d is a holding sleeve, and a female screw on the inner surface of the holding sleeve 314d fixed to the outer sleeve 314 and a holding screw (male screw) on the outer surface of the inner rod 313 can be screwed together. As a result, the inner rod 313 is screwed into the outer sleeve 314, and the inner rod 313 is set to a position within a predetermined axial range beyond the screwing range, so that the inner rod 313 is axially moved relative to the outer sleeve 314. It is configured to be movable in the axial direction and rotatable about the axis within a range (a range in which the holding screw 313d can freely move), but is configured not to fall off. Further, the protruding portion 313e of the inner rod 313 engages with the receiving portion (the holding sleeve 314d in the illustrated example) of the outer sleeve 314, so that the inner rod 313 and the mounting tool 22 held by the holding end portion 313a thereof. By integrating these three members in such a manner that the outer sleeve 314 is sandwiched therebetween, the wearing tool 22 is connected to the first connecting member 311.

The second connecting member 312 includes an engaging end portion 312a at a tip end corresponding to the connecting end 31a. The engaging end portion 312a has a concave notch or a convex protrusion at a corresponding position by forming a convex protrusion or a concave notch as an engaging structure at the tip opening edge of the outer cylindrical body. Engages with an engaged structure 21b provided at the opening edge of the proximal end of the implant 2 provided with. As a result, the second connecting member 312 is brought into a state in which the rotation of the second connecting member 312 about the axis is restricted with respect to the implant 2. The second connecting member 312 includes a base end portion that passes through the inside of the angle setting mechanism 35 at an intermediate position in the axial direction, passes through the inside of the arm end portion 32a, and then projects toward the base end side. A male screw 312c is provided at the base end of the second connecting member 312. An end nut 36 is screwed onto the male screw 312b to fix the attachment base 34a of the operation handle 34 to the arm end 32a while fixing the second connecting member 312 to the arm 32. Fixed in the direction.

As shown in FIG. 2, the mounting tool 22 has a base end side (upper side in the drawing) that is open and a front end side (lower side in the drawing) that is provided with an annular wall edge around the shaft hole 22a. Has an L-shaped cylindrical shape. A male screw 22c is formed on the outer circumference of the mounting tool 22. The male screw 22c is configured to be screwed with the female screw 21c formed on the inner surface of the shaft hole 21a of the implant body 21. The mounting tool 22 drives the adjustment mechanism 23 by pressing the adjustment mechanism 23 housed in the shaft hole 21a of the implant body 21 by the tip surface 22d provided around the shaft hole 22a, and as a result, As will be described later, the operating tool is capable of holding and fixing the fixture 24 inserted into the transverse hole 21d of the implant body 21 and releasing the fixture. On the base end side of the mounting tool 22, there is provided a base end side inner surface 22e having a rotational engagement surface such as a hexagonal hole that engages in the rotational direction.

The first connecting member 311 is rotatable about the axis with respect to the second connecting member 312 in a state of being inserted into the shaft hole of the second connecting member 312, and at least a predetermined axial direction. It is movable in the axial direction within the range. Further, in the connected state shown in FIG. 2, the attachment tool 22 is attached to the implant body 21 by screwing the male screw 22c into the female thread 21c, so that the first connecting member 311 is attached to the implant body 22 via the attachment tool 22. 21 is connected. In this state, the head portion 311b of the first connecting member 311 (corresponding to the base portion of the outer sleeve 314) is axially engaged with the receiving portion 312b of the second connecting member 312, whereby The movement of the second connecting member 312 from the implant body 21 in the axial direction is restricted. Particularly, as shown in FIGS. 1 and 2, the mounting tool 22 is deeply mounted (screwed) in the shaft hole 21 a of the implant body 21, so that the second coupling member 312 and the first coupling member 311 and the implant body. The second connecting member 312 is fixed in the axial direction with the engaging structure 312a engaged with the engaged structure 21b.

As shown in FIG. 4, a plurality of transverse holes 21d are formed in the proximal end portion of the implant body 21 of the implant 2 so as to communicate with the axial hole 21a. The adjusting mechanism 23 is housed inside the shaft hole 21a so as to correspond to the plurality of transverse holes 21d. The adjusting mechanism 23 includes a plurality of piece members such as the first piece member 231, the second piece member 232, the third piece member 233, and the fourth piece member 234, and these plurality of piece members 231 to 234 in the shaft hole 21a. A holding ring 235 for holding and a biasing means (coil spring) 236 for biasing the plurality of piece members 231 to 234 toward the opening side of the shaft hole 21a are provided. The retaining ring 235 engages the concave groove 231c on the outer surface of the first piece member 231 and the concave groove 21e on the inner surface of the shaft hole 21a to position the first piece member 231 in the shaft hole 21a corresponding to the concave groove 21e. Hold on. The biasing means 236 is arranged around the leg portion 234 of the fourth piece member 234 and pushes up the fourth piece member 234 to the opening side of the shaft hole 21a.

In the adjusting mechanism 23, each of the piece members 231 to 234 has openings 231a to 234a at positions corresponding to the transverse holes 21d of the implant body 21. Each of these openings 231a to 234a is formed so that a fixture (bone screw) inserted into the transverse hole 21d can be inserted therein. Each of the openings 231a to 234a has an opening shape that is slightly long in the axial direction of the implant body 21. The first piece member 231, the second piece member 232, and the third piece member 233 each include a pair of engaging leg portions 231b, 232b, 233b, and these engaging leg portions 231b to 233b are adjacent to each other and are adjacent pieces. The members 232, 233, 234 are connected to each other in a state of being engaged with the engaged recesses 232d, 233d, 234d.

FIG. 5 is a cross-sectional view showing a state of the adjusting mechanism 23 accommodated in the proximal end portion of the implant body 21. Here, FIG. 5A is a diagram showing a released state which is an initial state in which the wearing tool (end cap) 22 is not mounted, and FIG. 5B is wearing the mounting tool (end cap) 22. It is a figure which shows a locked state when the mounting tool 22 is screwed in to a predetermined depth. As described above, it is understood that the openings 231a to 234a provided in each of the piece members 231 to 234 are moved in the axial direction by pushing the adjustment mechanism 23 in the axial direction by the mounting tool 22.

FIG. 6 is an explanatory view schematically showing the released state (a) and the locked state (b). Note that, for convenience of illustration, in FIG. 6, unlike the above-described FIG. 5, the plurality of transverse holes 21d are schematically illustrated as all penetrating in a direction orthogonal to the paper surface. As shown in FIG. 6A, in the released state, the openings 231a to 234a (shown by solid lines) of the respective piece members 231 to 234 are the opening positions of the corresponding transverse holes 21d (shown by dotted lines). Since they are aligned, even if the fixing tool 24 (shown by a broken line) is inserted into the transverse hole 21d, the fixing tool can pass through the openings 231a to 234a with a sufficient margin. It becomes possible to freely insert and remove.

On the other hand, as shown in FIG. 6B, in the locked state, since the piece members 231 to 234 are pushed into the inner side of the shaft hole 21a by the mounting tool 22, the openings 231a to 234a also move to the inner side. Then, the transverse hole 21d is slightly displaced from the opening range in the axial direction. For this reason, the fixture 24 is sandwiched in the axial direction by the opening edges of the openings 231a to 234a and the opening edge of the transverse hole 21d that are offset from each other, and is in a tightened state. Therefore, since the fixture 24 is held by the implant body 21, it is possible to firmly support the bone together with the implant body 21.

The bone fixing system 1 of this embodiment configured as described above is used as follows. First, the implant 2 and the surgical instrument 3 are connected in advance. At this time, the mounting tool 22 is connected to the connection end portion 311a of the first connection member 311 provided on the connection end 31a of the connection portion 31 of the surgical instrument 3. This is because the male screw of the holding end portion 313a of the inner rod 313 is screwed into the female screw 22b of the shaft hole 22a of the mounting tool 22, and the proximal end inner surface 22e of the mounting tool 22 is engaged with the positioning end portion 314a of the outer rod 314. Fix it in the mated state. As a result, the posture and position of the wearing tool 22, that is, the angular posture around the axis, the posture with respect to the axial direction, and the axial direction and the position in the radial direction orthogonal to the axial direction are accurately set with respect to the connecting portion 31. The connecting end 31a of the connecting portion 31 including the first connecting member 311 and the second connecting member 312 includes the connecting end 311a and the engaging end 312a.

Then, the connecting end 31a of the connecting portion 31 of the surgical instrument 3 is brought into contact with the opening edge of the shaft hole 21a of the implant body 21, and the engaging end portion 312a of the second connecting member 312 is engaged with the engaged structure 21b of the implant body 21. In the state of being engaged (fitted) with the surgical instrument 3, the mounting tool 22 connected and fixed to the surgical instrument 3 as described above is inserted into the shaft hole 21a of the implant body 21, and the first connecting member 311 is rotated (specifically The outer sleeve 314 is rotated by using the tool engaging portion 314b), so that the male screw 22c of the mounting tool 22 is screwed into the female screw 21c provided on the inner surface of the shaft hole 21a of the implant body 21. As a result, the first connecting member 311 is screwed into the shaft hole 21a through the mounting tool 22, and the first connecting member 311 functions as a connecting bolt by tightening it tightly, and the head portion 311b thereof is The second connecting member 312 is fixed while being engaged with the receiving portion 312b and being pressed against the implant body 21. As a result, the implant body 21 is connected to the surgical instrument 3 via the mounting tool 22. That is, the first connecting member 311 is connected to the implant body 21 via the mounting tool 22, and the second connecting member 312 is sandwiched between the first connecting member 311 and the implant body 21, Since the implant main body 21 is fixed in the axial direction while being fixed in the axial direction, the axial direction and the axially connected state between the connecting portion 31 and the implant main body 21 are realized.

In the connected state of the implant 2 and the surgical instrument 3, the attachment structure 22 is attached to the depth of the release state shown in FIG. 6A due to the connection structure of the connection portion 31. Is preferred. This is because the adjusting mechanism 23 must be in the released state in order to allow the fixture 24 to be inserted into the transverse hole 21d of the implant body 21 after the implant 2 is introduced into the body using the surgical instrument 3. It will not happen. However, the above is not the case when the wearing tool 22 is configured to be operable in the connected state and the release state and the locked state can be switched.

Further, in a state where the implant 2 and the surgical instrument 3 are connected, it is not always necessary that the mounting tool 22 is connected to the connecting portion 31 and mounted to the implant body 21 as in the illustrated example. For example, in this state, the mounting tool 22 is not connected to the connecting portion 31 but is mounted to the implant body 21, in the first case, the mounting tool 22 is not mounted to the implant body 21 but is mounted to the connecting portion 31. In the second case, the mounting tool 22 is not connected to the connecting portion 31 and is not mounted to the implant body 21. In these cases, the mounting tool 22 may be incorporated between the connecting portion 31 and the implant body 21. However, in the second case and the third case, the mounting tool 22 needs to be in a state of being positioned and held so that it can be mounted on the implant 21.

Next, in the above connected state, the surgical instrument 3 is used as an insertion instrument to introduce the implant 2 into the body. At this time, if it is necessary to previously perforate the bone B, the perforation is completed before the introduction work. In the case of this embodiment, the implant 2 is inserted as an intramedullary nail from the perforation site of the condyle Ba toward the inside of the femur. In the example shown in FIG. 1, the retrograde intramedullary nail is introduced from the distal end of the femur, but it may be a normal intramedullary nail introduced from the proximal end of the femur. When the implant 2 is introduced into an appropriate position in the body, the surgical instrument 3 is used as a sighting instrument and a guide sleeve (not shown) and a drilling instrument such as a drill or a reamer guided by the guide sleeve are used to implant the implant body 21. A position corresponding to the transverse hole 21d is drilled, and then a fixing tool 24 such as a bone screw guided by the guide sleeve is introduced into the drilling site. At this time, the fixture 24 is inserted into the transverse hole 21d and the openings 231a to 234a of the piece members 231 to 234 of the adjustment mechanism 23. When the fixture 24 is a bone screw, a wrench (not shown) is passed through the guide sleeve to screw the fixture 24 into the bone.

When the application of the fixture 24 to the implant 2 is completed as described above, the surgical instrument 3 is finally removed from the implant body 21. In the present embodiment, after removing the surgical instrument 3, the mounting tool 22 is further screwed in to move the adjustment mechanism 23 to the locked state shown in FIG. 6B. However, if the structure is such that the wearing tool 22 can be operated through the inside of the connecting portion 31 (when the wearing tool 22 is configured to be operable as described above and the release state and the locked state can be switched), the surgical instrument 3 can be used. It is also possible to screw the mounting tool 22 into the locked state before removing it.

In the present embodiment, the rotating operation tool 4 shown in FIG. 7 is used for removing the surgical instrument 3. The rotary operation tool 4 includes an engagement end 41a that engages with the tool engagement portion 314b (second rotation engagement portion), a tubular portion 41b that protrudes from the engagement end 41a in the axial direction, and A support tool 41 including a support handle 41c extending from the cylindrical portion 41b to the outer periphery, an engagement end 42a that engages with the tool engagement portion 313b (first rotary engagement portion), and this engagement end. The operation tool 42 includes a shaft-shaped portion 42b extending from 42a through the inside of the tubular portion 41b of the first support 41, and an operation handle 42c provided at a base end of the shaft-shaped portion 42b.

In this detaching work, first, as shown in FIG. 7, the support tool 41 is inserted from the base end 31b of the connecting portion 31, and the engaging end 41a at the tip is inserted into the first sleeve of the outer sleeve 314 of the first connecting member 311. The tool engaging portion 134b, which is the second rotational engaging portion, is engaged. Next, the engagement end 42a at the tip of the operation tool 42 is engaged with the tool engagement portion 313b, which is the first rotation engagement portion of the inner rod 313, through the tubular portion 41b of the support tool 41. Then, while holding the support handle 41c to prevent the outer sleeve 314 from rotating by the support tool 41, the inner rod 313 is rotated by the operation tool 42 using the operation handle 42c, whereby the holding end portion 313a of the inner rod 313 is rotated. The male screw is removed from the female screw 22b of the mounting tool 22. As a result, the first connecting member 311 (inner rod 313) can be separated from the wearing tool 22, so that both the first connecting member 311 and the second connecting member 312 can be removed from the implant body 21. become. Here, the connecting portion 31 is mounted on the implant body 21 by an operation performed on a portion of the surgical instrument 3 that is disposed outside the body or an operation that is performed by an instrument inserted from the portion as described above. Since it is configured to be able to release the connection with the connection end portion 311a, the surgical instrument 3 can be easily removed without any trouble during the operation.

In the present embodiment, after removing the surgical instrument 3 as described above, the mounting tool 22 already mounted on the implant body 21 (in the released state shown in FIG. 6A) is further screwed deeply with a tool not shown. As a result, the locked state shown in FIG. As a result, the adjusting mechanism 23 holds and fixes the fixture 24 inserted in each transverse hole 21d, and thus the bone fracture portion can be held firmly.

In the present embodiment configured as described above, after the implant 2 and the surgical instrument 3 are connected in advance with the wearing tool 22 incorporated, and the implant 2 is introduced into the body, By removing the surgical instrument 3 from the implant 2 while maintaining the mounted state, it is possible to eliminate the work of mounting the mounting tool 22 separately after the implant 2 is introduced into the body. Therefore, it is possible to suppress poor mounting of the mounting tool 22 on the implant 2 and complication of mounting work, and it is possible to facilitate and ensure surgery. Particularly, as in the case of a retrograde intramedullary nail as shown in the drawing, the gaps G and G'(see FIGS. 5A and 5B) between the opening edge of the shaft hole 21a and the nearest transverse hole 21d are extremely large. When the size is small, it is extremely difficult to screw the mounting tool 22 into the female screw 21c, and the mounting tool 22 is tilted and screwed to break the screw thread, or the mounting tool 22 cannot perform its function due to improper mounting. Therefore, it is possible to reliably prevent a situation in which the time required for the time-consuming surgery for screwing the wearing tool 22 becomes long.

In particular, in the present embodiment, when the implant 2 and the surgical instrument 3 are connected to each other, the first connecting member 311 is connected to the mounting tool 22 mounted on the implant body 21, so that the mounting tools 22 are mutually attached. The first connecting member 311 and the implant body 21 that are connected to each other are configured to sandwich the second connecting member 312. Therefore, it is not necessary to provide an independent connection structure for connecting the implant 2 and the surgical instrument 3 without interposing the wearing tool 22, and only providing a connecting structure between the first connecting member 311 and the wearing tool 22. Then, since the connecting structure can be configured by utilizing the existing mounting structure of the mounting tool 22 and the implant body 21, there is an advantage that the connecting portion 31 can be easily configured.

8A to 8C show a state in which the implant 2 of the above-described embodiment is applied to the distal end of the femur, and the length of the proximal end portion is increased by mounting the implant 2 on the proximal end portion of the implant body 21. The extension end cap 26 for extending and the mounting state thereof are shown. As shown in FIG. 8A, fixing tools 24 such as bone screws 24A and 24C and a bone bolt nut assembly 24B with a washer are inserted into the plurality of transverse holes 21d of the implant body 21, and the adjusting mechanism 23 described above is inserted. It is held and fixed by. The adjusting mechanism 23 is in a locked state in which the fixing tool 24 is fixed by the screwing depth of the mounting tool 22 screwed into the shaft hole of the implant body 21.

As shown in FIG. 8A, when the proximal end portion of the implant body 21 is arranged on the inner side of the bone than the end position of the distal end of the femur, the implant 2 is closed due to the closing of the end portion. The extension end cap 26 is attached for the reason that it cannot be removed, or for preventing the proximal end portion of the implant main body 21 from inadvertently moving within the bone. In this case, as shown in FIG. 8B, by connecting the extension end cap 26 to the mounting tool 22 which is also an end cap that does not extend the base end portion of the implant body 21, the base end of the implant body 21 is connected. The department can be extended. As shown in FIG. 8C, the extension end cap 26 includes a main body 26a having substantially the same outer diameter as that of the base end portion for extending the base end portion of the implant main body 21, and the main body 26a. A protrusion 26b protruding toward the tip side, a protrusion 26c protruding further toward the tip of the protrusion 26b, and a tool engaging portion 26e formed on the base end side of the main body 26a are provided. Here, a male screw 26d that can be screwed into the female screw 22b of the mounting tool 22 is formed on the outer periphery of the protrusion 26c. Further, the protruding portion 26b has a corresponding size capable of being fitted to the base end side inner surface 22e which is the tool engaging portion of the mounting tool 22, and functions as a pilot guide for the screw coupling work of the male screw 26d and the female screw 22b. .. By forming a male screw on the outer circumference of the protruding portion 26b and a female screw on the inner surface 22e on the base end side, it is possible to perform screw connection in a wider range in the axial direction. At this time, the female screw can be constituted by a plurality of thread grooves in a mode that is divided in the circumferential direction by being separately formed on each flat surface of the hexagonal hole of the base end side inner surface 22e.

In the present embodiment, after the surgical instrument 3 is removed from the implant 2 in which the mounting tool 22 is mounted as described above, the extension end cap 26 is attached to the mounting tool 22. In this case, since the wearing tool 22 and the extension end cap 26 can be devised to correspond to each other in advance, such as the above-mentioned pilot guide, to improve the wearing ability, the wearing tool 22 is not loaded in advance. By doing so, the extension end cap 26 can be attached relatively easily. However, the mounting tool 22 and the extension end cap 26 may be previously connected or integrated to form a mounting combination, and the mounting combination may be incorporated between the implant 2 and the surgical instrument 3 described above. It may be configured to be possible. At this time, since the illustrated extension end cap 26 has an outer diameter substantially similar to that of the proximal end portion of the implant body 21 of the above-described embodiment, the engaging end portion 312a of the second connecting member 312 is not attached to the proximal end portion of the implant body 21. By enlarging the diameter together with the ends, the extension end caps 26 can be engaged with each other while being housed. Even in this case, the mounting assembly including the mounting tool 22 may not be officially mounted on the implant body 21 in some cases. For example, in the case of the positioning and holding mode in which the clamping action with respect to the second connecting member 312 by the first connecting member 311 and the implant body 21 can be realized, the mounting combined body is positioned and held so that it can be mounted on the implant body 21. It may be a modified mode.

FIG. 9( a) is an enlarged partial cross-sectional view showing a connection state between the connection portion 31 of the surgical instrument similar to the above and the connection end of the implant 2 ′ according to another embodiment. In this embodiment, the mounting tool 22' is installed between the connecting portion 31 of the surgical instrument and the implant body 21' of the implant 2', which is almost the same as the previous embodiment, and the mounting tool. 22' is mounted on the implant body 21', and further, the mounting tool 22' is connected to the first connecting member 311 (the inner rod 313 and the outer sleeve 314) similar to the previous embodiment. The engaging end portion engaged with the engaged structure 21b' of the implant body 21' around the axis by the first connecting member 311 and the implant body 21' connected via the mounting tool 22'. They are common in that the connection part 31 and the implant 2′ are connected in a state where the second connection member 312 including 312a is sandwiched. Here, the base end side inner surface 22Ae that also serves as a tool engaging portion of the attachment body 22A is axially fitted to the connecting end 311a (positioning end 314a) of the first connecting member 311 (outer sleeve 314), At the same time, the point of being engaged and fixed around the axis is the same as in the previous embodiment.

However, in this embodiment, the mounting tool 22' has a mounting tool body 22A that is mounted by being screwed with the female screw 21c' of the implant body 21', and an operating tool 22B that is mounted on the mounting tool body 22A. Therefore, it is different from the previous embodiment. Here, in the attachment body 22A, an outer peripheral surface 22Aa guided by contacting the inner surface of the shaft hole 21a' of the implant body 21', and a shaft hole formed inside the portion where the outer peripheral surface 22Aa is formed. Of the internal thread 22Ab, an internal thread 22Ac provided on the internal surface on the tip side of the internal thread 22Ab, and an external thread 22Ad provided on the outer periphery of the portion where the internal thread 22Ac is formed. Here, the male screw 22Ad is configured to be screwed with the female screw 21c' of the implant 2'. Further, the female screw 22Ab is configured to be screwed with a male screw provided on the connecting end 311a (holding end 313a) of the first connecting member 311 (inner rod 313). Further, the female screw 22Ac is configured to be screwed with the male screw 22Bc provided on the outer circumference of the operation tool 22B.

The operation tool 22B includes a shaft hole 22Ba, a female screw 22Bb, a male screw 22Bc, a front end surface 22Bd, and a base end side inner surface 22Be, which have substantially the same structure as the mounting tool 22 of the previous embodiment. However, unlike the previous embodiment, the operation tool 22B does not need to be directly connectable to the connecting portion 31. The operation tool 22B may be configured to be attachable to the wearing tool body 22A. In this manner, the mounting tool 22' is mounted on the implant body 21' while the implant body 21' of the implant 2'is connected to the connecting portion 31 of the surgical instrument, and the operating tool 22B is the mounting tool. It is attached to 22'. Then, the connecting part 31 of the surgical instrument can be detached from the implant body 21' and the mounting tool 22' while the mounting tool 22' is mounted on the implant body 21'. Therefore, although the specific structure is different, the basic function and effect of this embodiment are the same as those of the previous embodiment.

In this embodiment, after removing the surgical instrument, the operating tool 22B is rotated by inserting a tool (not shown) into the tool engaging portion of the proximal end inner surface 22Be of the operating tool 22B through the shaft hole of the mounting tool main body 22A. It can be operated. As a result, the adjusting tool 22B can be moved in the axial direction inside the implant body 21'. The operating tool 22B abuts on an adjusting mechanism such as a first piece member 231' held by a locking ring 235' engaged with a circumferential groove inside the shaft hole 21a' of the implant body 21', and its position is adjusted. Control. Thus, the holding state of the fixture (not shown) by the adjustment mechanism can be adjusted. At this time, when the operating tool 22B enters a locked state of pressing the adjustment mechanism, the operating tool 22B is pushed back toward the mounting tool main body 22A, so that an axial force is applied to the screwed portion of the mounting tool main body 22A and the operating tool 22B. At the same time as it works, the axial force also acts on the screwed portion between the mounting tool main body 22A and the implant main body 21', so that both screwed portions can be prevented from loosening.

In this embodiment, even if the operating tool 22B is not attached to the mounting tool main body 22A and the mounting tool main body 22A is used as it is as a mere end cap, it may be assembled between the connecting portion 31 of the surgical instrument in the connected state and the implant main body 21'. Good. Further, similarly to the above, the operation tool 22B is not attached to the mounting tool main body 22A, but instead, the extension end cap 26' shown in FIG. 9(c) is inserted through the shaft hole of the mounting tool main body 22A, and the male screw 26c is inserted. It is also possible to attach by screwing the ′ with the female screw 22Ab. At this time, the extension end cap 26 ′ further includes a base projection 26 b ′ that can be housed in a manner that allows rotation inside the proximal end inner surface 22 Ae of the attachment body 22 A, and further projects from the base projection 26 b ′. It is preferable to provide a tip projection 26d'. Here, the base protrusion 26b' is configured to be rotatable inside the base end side inner surface 22Ae, and the shaft center is guided by the base end side inner surface 11Ae to facilitate screwing of the male screw 26c' and the female screw 22Ab. It is desirable to have a shape that allows it. Further, it is desirable that the tip projection 26d' be configured to be able to control the adjustment mechanism, such as being able to push the first piece member 231' through the shaft hole of the attachment body 22A.

It should be noted that the bone fixing system of the present invention is not limited to the above-mentioned illustrated examples, and it goes without saying that various modifications can be made without departing from the gist of the present invention. For example, in the above-described embodiment, the connection mode of the connection end portion 311a and the mounting tool 22 is screwed, and the mounting mode of the mounting tool 22 and the implant body 21 is also screwed. However, any of these modes is not limited to screwing, and a snap fitting structure using an elastic part, a fitting actuating mechanism using an actuating part such as a diameter-expanding collet by various driving methods, or the like can be used. ..

Further, in the above-described embodiment, the mounting tool 22 has a structure that cannot be operated from the outside when the implant 2 and the surgical instrument 3 are connected, and the procedure for operating the mounting tool 22 after the surgical instrument 3 is removed. Has become. However, even in the connected state, the mounting tool 22 can be operated by, for example, operating the tool through the inside of the connecting portion 31 (the shaft hole of the inner rod 313 in the illustrated example) via a tool or an operating shaft. It may be configured to.

Further, in the above-described embodiment, the connecting portion 31 is configured to be connectable to the implant body 21 while being connected to the mounting tool 22, but the connecting portion 31 and the implant body 21 have the mounting tool 22 incorporated therebetween. It suffices if it can be connected in the state. Therefore, when the implant 2 and the surgical instrument 3 are connected to each other, the mounting tool 22 may be mounted on the implant 2 or may be positionably held so as to be mounted in a state where the mounting tool 22 is not connected to the connecting portion 31. May be. Further, even though it cannot be said that the mounting tool 22 is mounted in the implant 2 in the original system, it is sufficient that the mounting tool 22 is positioned and held in a mountable state. For example, in the connected state, the mounting tool 22 cannot be mounted on the implant body 21, but the mounting tool 22 is fitted in the inner surface region where the female screw 21c is not formed in the edge portion near the opening of the shaft hole 21a, and the mounting member 22 is mounted along the axis line. In a mode in which it is positioned and held in a normal posture or in a mode in which it is positioned and held in a normal posture along the axis by being held in the snap fitting portion provided on the edge portion. The surgical instrument 3 may be detachable while leaving the above-mentioned aspect of the implant 22. This is because, in the case of the above-described positioning and holding, even after the surgical instrument 3 is removed, the mounting tool 22 can be easily mounted as it is in a proper posture by using a tool or the like.

Further, when the connecting portion 31 and the implant main body 21 are connected, the above-described positioning and holding state is maintained, but the mounting tool 22 is mounted on the implant main body 21 by an operation performed in the connected state. You may. In this case, since the above operation can also be performed in advance, the surgical instrument 3 can be removed from the implant body 21 during the operation while the mounting tool 22 is mounted on the implant body 21.

Further, as in each of the above-described embodiments, the mounting tool 22, the operation tool 22B of the mounting tool 22', or the extension end cap 26' is held in the holding state of the fixing tool 24 or the like via the adjusting mechanism 23 or the like. Instead of being used as an operating tool for controlling, it may be configured as an adjusting tool (set screw or the like) for directly controlling the holding state of the fixing tool 24 or the like.

DESCRIPTION OF SYMBOLS 1... Bone fixing system, 2... Implant, 21... Implant main body (intramedullary nail main body), 21a... Shaft hole, 21b... Engagement structure, 21c... Female screw, 21d... Cross hole, 21e... Groove, 22... Mounting Tool (end cap or operation member), 22a... Shaft hole, 22b... Female screw, 22c... Male screw, 22d... Tip surface, 22e... Base end side inner surface, 23... Adjustment mechanism, 231... First piece member, 232... Second Piece member, 233... Third piece member, 234... Fourth piece member, 235... Locking ring, 236... Biasing means (coil spring), 24... Fixing tool (bone screw), 26... End cap for extension (extension) Wearing tool), 3... Surgical instrument, 31... Connection part, 31a... Connection end, 31b... Base end, 311... First connection member (inner shaft body), 311a... Connection end part, 311b... Head part, 312 ... second connecting member (outer cylinder) 312a... engaging end portion, 312b... receiving portion, 313... inner rod, 313a... holding end portion, 313b... tool engaging portion (first rotational engaging portion) 313c... Operating surface, 313d... Holding screw, 313e... Overhanging portion, 314... Outer sleeve, 314a... Positioning end portion, 314b... Tool engaging portion (second rotary engaging portion), 314c... Operating surface, 314d ... holding sleeve, 32... arm part, 32a... arm end part, 33... aiming part, 34... operating handle, 35... angle setting mechanism, 35a... locking ring, 35b... operating sleeve, 35c... biasing means, 36... End nut, 4... Rotating operation tool, 41... Supporting tool, 42... Operating tool

Claims (14)

A bone fixation system comprising an implant to be placed in a body for bone fixation, a surgical instrument including a connecting portion configured to be connectable to the implant, and a mounting tool detachably attached to the implant. There
The surgical instrument is configured such that, in a state of being connected to the implant, the mounting tool mounted on the implant or mounted on the implant can be incorporated between the connecting portion and the implant, Configured to be removable from the implant while maintaining the attachment in the aspect.
Bone fixation system. The connecting portion has a connection structure detachably connected to the wearing tool,
In the surgical instrument, in a state of being connected to the implant, the mounting tool mounted on the implant or mounted and positionally held is connected to the connecting portion, and the surgical tool is connected to the connecting portion. Removably configured from the implant by disconnecting
The bone fixation system according to claim 1. In the surgical instrument, in a state of being connected to the implant, the connecting part is connected to the mounting tool, the mounting tool is mounted on the implant, and the connecting part is still mounted on the implant. And detachable from the implant by disconnecting the attachment from
The bone fixation system according to claim 2. The connecting portion has a connecting end that is detachably connected to the wearing tool in a connecting direction, and an engaging end that is engageable with the implant in a direction orthogonal to the connecting direction. ,
The bone fixation system according to any one of claims 1 to 3. The connecting portion has a first connecting member having the connecting end portion and a second connecting member having the engaging end portion,
In a mode in which the mounting member connected to the connection end is mounted on the implant or is positionably held so as to be mounted, so that the second coupling member is sandwiched by the implant and the first coupling member. The implant is coupled to the surgical instrument,
The bone fixation system according to claim 4. In a state where the surgical instrument is connected to the implant, the first connecting member is attached to the implant, or is connected to the attaching tool in a position that is positionably held so that the first attaching member is attachable to the implant, thereby mutually attaching the attaching tool. The first connecting member and the implant that are connected to each other sandwich the second connecting member,
The bone fixation system according to claim 5. The first connecting member and the second connecting member are configured to be rotatable with respect to each other and movable with respect to each other in the axial direction within at least a predetermined range in the axial direction,
The mounting structure of the mounting device is configured to be mountable to the mounted structure of the implant by screw connection centering on an axis,
The engaging structure of the engaging end is configured to be engageable with the engaged structure of the implant in a rotational direction about the axis.
The bone fixing system according to claim 5 or 6. The first connecting member includes a holding end that holds the wearing tool as a part of the connecting end, and the wearing tool that is held by the holding end as another part of the connecting end. With a positioning end for positioning
The bone fixation system according to claim 7. The first connecting member includes an inner rod having the holding end portion and an outer sleeve having the positioning end portion,
By contacting the positioning end with the mounting tool held by the holding end, the mounting tool and the inner rod hold the outer sleeve, and the mounting tool is connected to the first connection. Connected to a member,
The bone fixation system according to claim 8. The inner rod and the outer sleeve are configured to be rotatable with respect to each other and movable in the axial direction with respect to each other within at least a predetermined range in the axial direction.
The holding structure of the holding end is configured to be held by a screw connection about an axis with respect to the held structure of the wearing tool.
The bone fixation system according to claim 9. Further comprising a fixture configured to be held by the implant,
The wearing tool is an adjusting tool that can adjust the holding state of the fixing tool, or includes the adjusting tool.
The bone fixation system according to any one of claims 1 to 10. Further comprising a fixture configured to be held by the implant, and an adjusting mechanism for adjusting a holding state of the fixture by the implant,
The mounting tool is an operation tool configured to operate the adjustment mechanism, or includes the operation tool.
The bone fixation system according to any one of claims 1 to 10. The implant is an intramedullary nail having an axial hole opened at a proximal end portion connected to the connection portion of the surgical instrument,
The bone fixation system according to any one of claims 1 to 12. Further comprising an extension fitting configured to be connectable to the fitting for extending the proximal end of the implant.
The bone fixation system according to any one of claims 1 to 13.

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