MXPA00008787A - Spiral-blade insertion instrument - Google Patents

Abstract

The invention relates to a device for introducing a spiral blade into an intramedullary nail, comprising a target-finding stay (1), a bored hole (5) situated at one end (2) of the target-finding stay (1) and extending from the inner side (3) to the outer side (4), a guiding sleeve (8) having a central axis (18) and attached coaxially in relation to the bored hole (5), and a pin (9) which is able to slide in the guiding sleeve (8). The spiral blade (12) is removable attached to the front end (10) of the pin (9). Means (50;51) are arranged on the peripheral surface (17) of the pin (9) and the bored hole (70) of the guiding sleeve (8) which interlock with each other in such a way that the pin (9) can be moved in the bored hole (70) of the guiding sleeve (8) only in a screw-like manner in the direction of the central axis (18). If required an axially movable tissue-protective sleeve (30) can also be attached coaxially in relation to the pin (9).

Description

INSTRUMENT OF INSERT BLADE IN SPIRAL The invention relates to a device for introducing a spiral blade into a bone nail according to the general concept of claim 1. In the case of femur fractures, rapid mobilization is often necessary. In such cases or also when the knee joint is already open, a bone nail may be implanted in the thigh distally, that is, from the knee. In this case, such bone pins are often implanted with a spiral blade, which is medially and laterally translated for the fixation of the bone nail. For this purpose, in the bone nail there is a hole with a longitudinal cut, for example, in the form of a groove or in a shape similar to a keyhole. _ J a ^ opening for the spiral blade on the bone nail is a little larger than the spiral blade. That is why the spiral blade can only be inserted into the bone nail at certain angles of rotation. So that only the cross section of the spiral blade breaks the bone, the spiral blade at the moment of being inserted must rotate about its longitudinal axis. But in order to reach the longitudinal opening in the bone nail when the spiral knife is inserted, it must be in a certain position when the blade is spirally inserted into the bone nail. Up to now, during the insertion of the spiral blade, the bone was pierced to the nail, so that by rotating the correct position of the spiral blade could be found in place, or the instrument indicated the direction in this case. This is possible since in this case the blade is already on the nail. However, with this the support for the spiral blade in the bone is lost. The invention wishes to solve this problem. The object of the invention is to enable the spiral blade to be positioned so that the spiral knife adopts a turning angle during assembly when it is inserted into the bone nail, which coincides with the orientation of the longitudinal opening in the bone nail. The invention solves the problem posed with a device for introducing a spiral blade into a bone nail having the features of claim 1. By means of the device according to the invention, it is achieved that for the assembly the angle of rotation is obtained correct position and position of the correct spiral blade regardless of the width of the condyle and thereby independently of the entry point of the spiral blade into the bone. Furthermore, with the aid of the device it should be possible for the mandrel of the device that introduces the spiral blade to be brought against the bone only until this mandrel reaches the bone when the spiral blade is inserted. This exact positioning of the spiral blade in the bone can be performed half the device according to the invention in the following ways: visually, without auxiliary elements, which nevertheless requires a large opening around the bone; - with X-rays; - with the help of cameras, which can be taken away from the bone and a screen; - the separation between the device and the bone is measured and, based on the value, a fixing ring is fixed as a stop on the mandrel that introduces the spiral blade; the mandrel that introduces the spiral blade of the device is close to the bone prior to the assembly of the spiral blade and simultaneously a fixing ring is fixed as a stop on the mandrel that introduces the spiral blade; a protective sleeve of the calibrated tissue around the mandrel that introduces the spiral blade can be moved axially in the device. The value read on the protective cap of the calibrated bed is adjusted on the mandrel that introduces the knife with the help of a stop. The mandrel with the stop thus adjusted, with the spiral knife inserted, is stopped in the guide tube by which it is carried to the mandrel, so that the spiral knife is positioned correctly in axial direction; the mandrel that introduces the spiral blade of the device is given a larger diameter than the spiral blade and supports next to the bone, the blade being spirally inserted; and the protective sleeve of the tissue around the mandrel that introduces the blade can be moved axially in the device and has a length such that the recess at the rear end of the mandrel is next to this protective sleeve of the fabric, when the spiral blade is inserted. at. bone. The sleeve can move in the axial direction in the device and can have a length such that it can rest with its anterior end on the bone. In a preferred embodiment of the device according to the invention, it contains a stirrup which can be fastened by a screw to the bone nail. In the added piece attached to the abutment there is a hole that is flush with the longitudinal opening in the bone nail. In coaxial form with this orifice, a guide bushing in which a mandrel is slidably inserted is placed in the added part. The spiral blade is releasably held in the forward end of the mandrel. The mandrel is provided on its peripheral surface with two grooves separated from each other by 180 ° on the periphery, wherein the passage of the spiral-shaped grooves corresponds to the passage of the spiral blade. In the guide sleeve, two bolts are placed transverse to the central axis of the guide sleeve, so that they are inserted into the grooves in the form of a spiral. When the mandrel is moved in the axial direction by means of a force acting in this direction, the mandrel is forced to perform a rotary movement by the sliding bolts in the spiral grooves. Since the weights of the spiral grooves in the mandrel correspond to the passage of the spiral blade, it can be inserted into the bone nail without jamming and without great losses due to friction. By the position of the cams, the correct position of the spiral blade will be given in each position of the movement made. Due to the design of the bracket and the guide tube, the separation between the bone nail and the end of the spiral blade at the beginning of the movement made is always the same and with it the proper angle of rotation for the assembly of the blade in spiral independently of the width of the condyle and thereby independently of the entry point of the spiral blade in the bone. A sliding element in the direction of the central axis of the mandrel, which can be fixed on the mandrel, is placed on the mandrel at the end remote from the spiral blade. This element serves as a final stop in the axial direction for the mandrel when the spiral knife is inserted into the bone nail. The assembly of the spiral blade is carried out with the help of a guide wire, which is placed in the bone with the help of a bushing for boring before introducing the spiral blade. Another preferred embodiment of the device according to the invention differs from the embodiment described above because an additional part is placed on the stirrup as a guide sleeve. In this guide bushing a protective sleeve of the fabric is positioned in the direction of the bone nail in a coaxial and telescopic manner which is secured by a sliding grip in a longitudinal groove in the sleeve against rotation about the longitudinal axis. Markings on the protective sleeve of the fabric allow a longitudinal adjustment of the protective sleeve of the fabric, which can be adjusted so that the protective sleeve of the fabric when inserting the spiral blade rests squarely on the bone. The assembly of the spiral blade is also carried out in this embodiment with the help of a guide wire which is inserted through a hub for drilling which is placed coaxially in a protective cam sleeve located in the guide sleeve . The protective cam sleeve is inserted into the guide sleeve, so that when drilling the cams are not damaged. The length of the spiral blade is then read on the guide wire and the bushing is again removed for drilling. Through the protective cam sleeve and the protective sleeve of the fabric, the lateral cortex is pierced with a hole that is guided axially by the guide wire, so deeply until the hole makes contact with the stop provided for it in the cam protective sleeve. . The lava protective cap is then removed, the position is read on the marking on the protective sleeve of the fabric and the sliding element is placed as a stop according to this position on the mandrel that introduces the spiral knife. The mandrel is then inserted with the spiral blade placed so that the element fixed on the mandrel as a stop rests on the guide sleeve and the spiral blade thus remains fully inserted. Another embodiment of the device according to the invention differs from the embodiment described above in that the guide bushing inside the protective sleeve of the fabric and facing the stirrup is placed axially fixed. The guide sleeve is housed in the hole of the protective sleeve of the fabric concentrically with respect to the central axis and fixed in the axial direction by bolts, which are fastened in the guide sleeve and in the stirrup. The protective sleeve of the fabric can be fixed with respect to the bracket by means of a fastening screw extending in the bracket. Another embodiment of the device according to the invention is characterized in that the mandrel on its wrapping surface is provided with a trapezoidal thread of an inlet or manifold not of automatic retention or of a similar shape instead of one or more slots in spiral shape and because in the guide casing a corresponding internal thread is placed. A further embodiment of the device according to the invention, unlike the embodiments described above, is characterized in that the element that during the insertion of the spiral knife serves as an axial stop and can be fixed on the mandrel in an axially selectable position. It is locked by a retaining screw which can be screwed radially into the element and tightened on the mandrel. In another embodiment of the device according to the invention, the sliding element on the mandrel, which serves as a stop, is blocked by a coupling which is inserted into the annular grooves placed on the mandrel. In a further embodiment of the device according to the invention, one or more spherical pressure pieces are placed on the stop, which can slide on the mandrel. These spherical pressure pieces engage in annular grooves provided for this in the mandrel and are used for blocking the element used as a stop. In another embodiment of the device according to the invention, the element used as a stop is designed in the form of a nut and is screwed to the mandrel, which is provided with a corresponding external thread. Another embodiment of the device according to the invention is characterized in that the element used as a stop can be blocked by a radially sliding pin. This pin engages in holes that are axially placed on the mandrel and thereby the stopper can slide on the mandrel. Another additional embodiment of the device according to the invention is characterized in that the element used as a stop through a radially extending groove is designed as an open ring and is provided with a screw that moves trans erally to this end. slot, so that the element is blocked on the mandrel by a pressing. Other Further embodiment of the device according to the invention differs from the previous embodiments in that the mandrel that introduces the spiral blade has a larger diameter than the spiral blade itself. With the inserted spiral blade the mandrel will then rest on the bone. The advantages achieved by the invention lie mainly in that, thanks to the device according to the invention, the positioning of the spiral knife is allowed., so that the spiral knife upon entering the bone nail adopts a rotation angle that coincides with the orientation of the longitudinal opening in the bone nail. By means of the device according to the invention, the correct angle of rotation and the correct position of the spiral blade, irrespective of the width of the condyle and thus independently of the entry point of the spiral blade into the bone, will be available for assembly. At the same time, the bolts penetrating the grooves extending over the spiral-shaped mandrel make the mandrel and thus the spiral blade placed at its end in a movement in the axial direction also perform a rotation movement. Since the passage of the spiral grooves corresponds to the passage of the spiral blade, the spiral blade during assembly will rotate in the bone nail so that the position of its transverse surface during the entire assembly process coincides with the longitudinal opening in the bone nail. The spiral blade can thus be mounted much more easily. The invention and the embodiments of the invention will be explained in more detail below on the basis of partially schematic illustrations of various exemplary embodiments.

Fig. 1 shows a plan view of the bone with the bone nail and of an embodiment of the device according to the invention with a cut through the guide sleeve; Fig. 2 shows a plan view of the bone with the bone nail and of a further embodiment of the device according to the invention; Fig. 3 shows a plan view of the bone with the bone nail and of a further embodiment of the device according to the invention with a partial cut through the guide sleeve; Fig. 4 shows a plan view of the bone with the bone nail and of a further embodiment of the device according to the invention; and Fig. 5 shows a plan view of the bone and a further embodiment of the device according to the invention with a cut through the guide sleeve and the tissue protective sleeve. FIG. 1 shows an embodiment of the device according to the invention "comprising a bracket 1 with a through hole 5 from the inner side 3 to the outer side 4 of the bracket 1 placed at one end 2 of the bracket 1 , a guide bushing 8 with the hole 70 with a central axis 18 perpendicular to the bone nail 28 fastened to the hole 5 in coaxial form, and a mandrel 9 sliding in the guide bushing 8. The step 1 is connected by a screw 33 with the bone nail 28. The sliding mandrel 9 in the guide sleeve 8 exactly matches the opening in the form of a lock hole 29 in the bone nail 28 in which a spiral blade 12 is placed. placed on the anterior end 10 of the mandrel 9 so that it can be released, so that the possible positions for insertion in the bone nail are determined. The stirrup 1 is an open angular part with an inner surface 3, an outer surface 4, a front end 6 and a rear end 2. At its front end 6 the stirrup 1 is joined with the bone nail 28 aligned with the axis of the bone. bone nail 28 through the abutment tube 27 and the connecting screw 33. This determines the separation between the spiral blade 12 and the bone nail 28 at the beginning of the movement performed by the mandrel 9. The position of the spiral blade 12 is determined by bolts 15; 16 and a spiral guide 13; 14 on the mandrel 9. The dimensions of the design are thus chosen, so that the separation between the spiral blade 12 and the bone nail 28 and the angle of rotation of the spiral blade 12 given by the guide bush 8 and the mandrel 9 sliding thereon coincides so that the cross section of the spiral blade 12 on contacting the bone nail 28 enters the longitudinal opening 29 in the shape of a lock hole (round, shaped of endidura, rectangular). the mandrel is provided on its peripheral surface 17 with two spiral-shaped grooves 13; 14. Two or more bolts 15; 16 are located transversely to the central axis 18 in the guide sleeve 8. The bolts 15; 16 are positioned offset from each other and inserted into the hole 70 of the guide sleeve 8 so that each bolt 15; 16 engages in one of the spiral grooves 13; 14. A rotational movement is applied to the mandrel 9 which has a movement in the axial direction. The steps of the two spiral-shaped grooves 13; 14 correspond to the passage of the spiral blade 12, so that a 360 ° rotation of the mandrel 9 the spiral blade 12 will also execute a rotation about its axis of 360 °. The bolts 15 and 16 are located in their position so that the spiral blade 12 which is mounted on the mandrel 9 is guided by the bolts 15 and 16 so that the spiral blade 12 enters the opening 29 in the nail for bone 28. On the mandrel 9 a sliding element 20 is located in the axial direction, which can be fixed by means of a retaining screw 21 which can be screwed radially through the element 20 in any axial position on the mandrel 9. With the help of this sliding element 20 which can be fixed, the mobility of the mandrel 9 can be limited in the direction axial, so that the path (A) traveled by the spiral blade 12 corresponds to the possible movement of the mandrel 9, which is determined by the separation (A) between the fixed ring 20 and the rear end 25 of the bushing 8. By inserting the spiral blade 12 into the bone 22, the mandrel 9 can be moved against the bone only until the spiral blade 12 is inserted into the bone 22 and into the bone nail 28 and the anterior end 10 of the mandrel. 9 rests on the outer surface of the bone 22. The assembly of the spiral blade 12 is carried out with the help of a guide wire, which is placed on the bone before the insertion of the blade into the bone. 12 with the help of a bushing for boring and extends during the introduction of the blade in spiral 12 through a hole 53 made especially in the mandrel 1 9. The embodiment of the device according to the invention shown in Fig. 2 it differs from the embodiment shown in Fig. 1 in that a protective sleeve of the fabric 30 is used for the protection of the fabric upon insertion of the spiral blade 12. This tissue protective sleeve 30 is placed in the guide bush 8 slidably coaxial with the central axis 18 and secured against rotation about the central axis by a handle 35, guided in a slit 36 extending along the central axis 18 in the guide sleeve 8 With the help of this handle 35, the protective sleeve of the fabric 30 of the guide tube 8 can be easily removed, the height can be regulated continuously and the protective sleeve of the tissue gone 30 is insured, so that you can not fall off the stirrup. In its outer casing surface 32, the tissue protective casing 30 is provided with a marking 45, which allows longitudinal positioning in the direction of the central axis 18. The mandrel 9 is staggered in its diameter .. The part 40 of the mandrel 9 oriented against the bone nail 28 has its diameter dimensioned so that it is slidably supported in the protective sleeve of the tissue 30. A part 41 of the mandrel 9 remote from the bone nail 28 has a larger diameter that fits the hole 70 in the guide sleeve 8. On this part 41 of the mandrel 19 the spiral grooves 13 are placed.; 14. In the embodiment of the device according to the invention shown in Fig. 2 The bolts 15; 16 further away from the bone nail 28 are in the guide sleeve. In this way, a telescopic arrangement of the guide sleeve 8 and of the protective sleeve of the tissue 30 is possible. In this way, only the protective sleeve of the tissue 30 can slide in the guide sleeve 8. The guide sleeve 8 has a fixed distance from the nail for the nail. bone 28. The axial attachment of the sliding element 20 to ensure the maximum insertion depth of the spiral blade 12 is possible with a retaining screw 21 in the sliding element 20 as shown in Fig. 1. Unlike the variant shown in FIG. 1, in the variant shown in FIG. 2, concentric grooves 42 are located in the mandrel 9 which can represent an aid for the longitudinal adjustment of the mandrel path 9. The embodiment of the device according to FIG. the invention described in Fig. 3 differs from the variant described in Fig. 2 only in that the protective sleeve of the fabric also serves as a stop for the mandrel 9 when the spiral knife 12 is inserted. For this purpose, the tissue protective sleeve 30 is placed on the bone prior to the assembly of the spiral knife 12 and locked in the axial direction by means of a retaining screw. 43. The mandrel 9 has a smaller diameter in its front part, which extends in the tissue protective sleeve 30 than in its rear part 41 which extends in the guide sleeve 8. When the rear part 41 of the mandrel 9 with its larger diameter it reaches the protective sleeve of the fabric 30, the mandrel 9 will rest on the tissue protective sleeve 30 and the bone can no longer be displaced in the axial direction. The rear part of the mandrel 9 having the larger diameter is provided on its peripheral surface 17 with two grooves 13; 14 in spiral form. Two or more bolts 15; 16 are located transverse to the central axis 18 in the guide bushing 8. the pins 15; 16 are arranged with one another and protrude in the hole ~ 70, so that each bolt 15; 16 engages in one of the slots 13; 14 in spiral form. Instead of the slots 13; 14 in spiral shape in mandrel 9 and bolts 15; 16 in the guide bushing 8, a trapezoidal thread of an inlet or manifold may also be placed in the mandrel 9 and in the guide bushing 8. With this, the helical movement could also be generated. The embodiment of the device according to the invention described in FIG. 4 differs from the embodiment described in FIG. 1 only in that the diameter of the mandrel 9 is greater than that of the spiral knife 12. this way, with the spiral blade 12 inserted, the mandrel 9 apcya on the surface of the bone and thereby saves a stop in the axial direction. Analogously to the embodiment shown in FIG. 1, the mandrel 9 is provided on its peripheral surface 17 with two grooves 13; 14 in spiral form. Two or more bolts 15; 16 are located transversely to the central axis 18 in the guide sleeve 8. The bolts 15; 16 are arranged between themselves and project into the hole 70 of the guide sleeve 8, so that each bolt 15; 16 engages in one of slots 13; 14 in spiral form. Instead of the slots 13; 14 in the form of a spiral in the mandrel 9 and the bolts 15; 16 in the guide bushing 8, a trapezoidal thread of an inlet or manifold may also be placed in the mandrel 9 and in the guide bushing 8. With this, the helical movement could also be generated. The embodiment of the device according to the invention shown in FIG. 5 differs from the embodiment described in FIG. 3 only in that the guide bushing 8 inside the protective sleeve of the fabric 30 is 'fixed in shape'. axial with respect to the bracket 1. The tissue protective sleeve 30 is placed in the hole 5 of the bracket 1 in a sliding manner and can be moved in the direction of the central axis 18 in both directions. If the protective sleeve of the fabric 30 is brought axially to the correct position, it can be fixed 19 on the bracket 1 by means of a fastening screw 60 which moves on the bracket 1. The protective sleeve of the fabric 30 has a length, so that At the end of the socket, tissue retractor 30 remote from the bone 22 is supported by a fixed cope 66 placed on the mandrel 9, when the spiral blade 12 as shown in Fig. 2 is in the bone nail 28. The The guide bushing 8 is located in the hole 61 of the tissue protective sleeve 30 in a conical shape with the central axis 18 and fixed in the axial direction by bolts 65 which are attached to the guide bushing 8 and the bracket 1. For that the protective sleeve of the fabric 30 can move in the direction of the central axis 18 it is provided with longitudinal holes 64 which serve as recesses for the bolts 65 which hold the guide sleeve 8. This will enable move both the protective sleeve of the fabric 30 and the mandrel 9 in the direction of the central axis 18, without the guide sleeve 8 moving axial direction. This will also fix the position of the bolts 15; 16 with respect to the bracket 1. That is to say, that also the position of the spiral blade 12 is determined by the bolts 15; 16 and the slots 13; 14 in spiral form in coda axial position of the mandrel. This embodiment of the device according to the invention can also be used in place of the spiral grooves 13, 14 in the mandrel 9 and the bolts 15, 16 in the guide bush 8, in the mandrel 9 and in the guide bushing 8 a trapezoidal thread of an inlet or multiple.

Claims (32)

1. CLAIMS 1. Device for inserting a spiral blade through a bone nail comprising 108 elements: A) a stirrup with one outer side, one inner side and two ends, with a through hole placed at one end of the stirrup, between the inner side and the outer side; B) a guide bushing having a central axis held in the bracket, whose cylindrical through hole extends coaxially with the hole; and C) - a cylindrical mandrel sliding in the hole of the guide bushing; a spiral blade can be placed at the front end of the mandrel so that it can be released, characterized in that the mandrel on its peripheral surface and the hole of the guide sleeve are provided with elements that fit together, so that the mandrel in the hole of the Guide bush in the direction of the central axis can only move helically. Device according to Claim 1, characterized in that the elements which are interconnected to each other are positioned with respect to the angle of rotation around the central axis, so that the mandrel, when displaced along the central axis by the Guide bush and it is with the axis that cuts the central axis forming an angle with the central axis of the stirrup tube placed on the second end of the stirrup, adopts an angle of rotation suitable for blocking. 3. Device according to claim 1 or 2, characterized in that it further comprises a connecting screw with the bone nail, with the help of which the stirrup can be positioned and attached to the bone nail. Device according to one of claims 1 to 3, characterized in that the mandrel is provided on its peripheral surface with at least one spiral-shaped groove and at least one bolt transverse to the central axis is placed on the guide sleeve , so that it locks into one of the spiral grooves. 5. Device according to one of claims 1 to 3, characterized in that the mandrel is provided on its peripheral surface with an external thread that is not self-retentive and an internal thread is placed in the hole of the guide bushing. correspondent. 6 Device according to one of claims 1 to 3, characterized in that the mandrel is provided on its peripheral surface with two spiral-shaped grooves offset from each other by 180 ° on the periphery of the mandrel. 7. Device according to one of the rei indications 1 to 4 or 6, characterized in that two or more bolts are placed in the guide bushing transversely with respect to the central axis at any height with the corresponding correct angle displaced from each other, so that coda one of the bolts fits into one of the spiral shaped slots. 8. Device according to one of claims 1 to 7, characterized in that the guide bushing can be clamped on the outer side or on the inner side of the step. 9. Device according to one of claims 1 to 8, characterized in that additionally there is a protective sleeve of the fabric coaxial with the central axis. 10. Device according to claim 6n 9, characterized in that the protective sleeve of the fabric can slide axially along the central axis. 11. Device according to one of claims 9 or 10, characterized in that the protective sleeve of the fabric is secured against rotation about the central axis by means of a handle movable in the guide sleeve in a coaxial groove and can be moved axially with the help of this handle. 12. Device according to one of claims 9 to 11, characterized in that the protective sleeve of the fabric is provided with a marking applied on the peripheral surface for a selectable axial positioning. 13. Device according to one of claims 1 to 12, characterized in that the mandrel at its rear end is provided with a head which serves as a stop and protruding from the diameter of the mandrel. 14. Device according to one of claims 1 to 13, characterized in that a sliding element is located on the mandrel in the direction of the central axis, which can be fixed in any position. 15. Device according to claim 14, characterized in that the sliding element can be fixed by means of a retaining screw screwed radially in the mandrel 1. 16. Device according to claim 14, characterized in that the sliding element is grooved radially and perpendicularly with respect to the central axis and is tightened by a screw that moves perpendicularly with respect to the groove and can therefore be fixed to the mandrel. 17. Device according to claim 14, characterized in that the sliding element can be fixed axially by at least one spherical pressure piece that engages in corresponding grooves. 18. Device according to re i indi cation 6n 14, characterized in that the sliding element is formed as a nut and is screwed to the mandrel through a corresponding thread. 19. Device according to claim 6n 14, characterized in that the sliding element can be fixed by means of a bolt that fits into corresponding holes in the mandrel and slides radially through the element 1 i zant e. 20. Device according to claim 14, characterized in that the element comprises a radially sliding ring, which engages in a groove located in the mandrel for a fixation on the mandrel. 21. Device according to one of the rei indications 1 to 20, characterized in that the guide bushing together with a protective sleeve of the fabric, which extends beyond the guide bushing in the direction of the spiral blade, is dimensioned so that with the blade When the spiral is inserted, the recess of the mandrel is supported on the rear end of the sleeve 10 tissue protector. 22. Device according to one of the rei indications 1 to 13, characterized in that the guide bushing is dimensioned in its length of 15 so that with the spiral knife inserted, the mandrel head is supported on the rear end of the guide sleeve. 23. Device according to one of the 20 claims 1 to 20, characterized in that the diameter of the mandrel is greater than the diameter of the spiral knife so that the mandrel with the inserted spiral blade rests on the bone. 24. Device according to one of claims 1 to 23, characterized in that, additionally, at the front end of the bracket, it is positioned so that a drilling device can be released with the help of which a hole can be drilled in the bone. 25. Device according to one of claims 1 to 10, 13 to 20 and 22 to 24, characterized in that the guide bushing is placed inside the protective sleeve of the fabric, and in front of the bracket in an axially fixed manner. 26. Device according to claim 25, characterized in that the protective sleeve of the fabric can be fixed with respect to the bracket by means of a fastening screw (60) that moves in the bracket. 27. Device according to claim 25 or 26, characterized in that the guide bushing in the hole of the protective sleeve of the fabric is supported concentrically with respect to the central axis and fixed in axial direction by means of bolts, which are fastened in the bushing guide and in the stirrup. 28. Device according to one of claims 1 to 27, characterized in that it also comprises a spiral blade. 29. Device according to the rei indication 28, characterized in that the passage of the spiral grooves in the mandrel corresponds to the passage of the spiral blade. 30. Device according to one of the rei indications 1 to 29, characterized in that it also comprises a bone nail, this bone nail being joined by a screw (33) with the bracket. 31. Device according to claim 30, characterized in that the pins in the guide bush are positioned with respect to the angle of rotation around the central axis, so that the spiral knife can be inserted with the mandrel provided with spiral-shaped slots a movement along the central axis in the transverse opening provided for it in the bone nail. 32. Device according to claims 5 and 30, characterized in that the internal thread in the guide bush is positioned with respect to the angle of rotation around the central axis, so that the spiral knife can be inserted with the mandrel provided with external thread by a movement along the central axis in the transverse opening provided for it in the bone nail.