200803808 九、發明說明： 優先權請求 本申請案基於35U.S.C.§119⑷請求在2006年四月n曰 提出申請之美國專利案第60/790,828號的優先權，其係在此 5 被併入以供參考。 L發明所屬技術領域】 發明領域 本發明通常係與一矯形裝置有關。 L· Λ. ^3 10 發明背景 一些患者受到至少一部分之踩關節需要有效地移動的 各種不同病症的困擾。此等的病症包含有嚴重關節炎、一 或更多骨頭之區域感染及/或無血管性壞死、脛骨_距骨或距 跟關節的先天變形，或是特定類型的神經病。在所有的這 15些病症中，該等骨頭彼此相對的任何運動都會在足部或腳 踝造成劇烈的疼痛，而使得患者變得無法有效行走或是對 足部施加任何壓力。因此，患者會選擇固定踩關節而開始 在沒有腳踝和足部的極度疼痛下開始步行。 踝關節的固定作用通常係藉著將一或更多堅硬的桿件 20或銷插入腳踝以及足部的後足部分來進行。其會永久地將 特定的骨頭附接於其他的骨頭上。這種永久固定骨頭的醫 療類型係為踝關節固定術。在正常的踩關節中，因為骨頭 的位置關係，-垂直地通過跟骨進入脛骨内之長直桿件通 常會穿過距骨。 5 200803808 【發明内容】 發明概要 為了踝關節固定術而開發之桿件和銷結構係受到各種 不同限制的困擾。一些在其等之腳踝内已經插入了舊的桿 5 件和銷裝置之患者，係苦於與應該要被固定的脛骨與跟骨 之間的相對運動有關的問題。其會在該經固定的關節中導 致顯著的疼痛，而在患者步行或站立時造成不安定性。其 也會在關節内部導致額外的傷害，因為螺絲或其他組件會 磨擦並研磨一或者更多的骨頭，其通常會使得具有嚴重的 10 關節或骨頭問題之患者更虛弱且相對地更疲軟。此外，後 足部的解剖排列方式方式並不適合於導入長直桿件，因為 由跟骨的足底部分至該距骨本體並進入脛骨的骨髓腔處係 為一幫曲。 因此，目前需要有一種改良型的踝關節固定總成，其 15 可以提供因為受傷或足部或腳踝疾病而需要此種治療的患 者，更佳而更穩定且可靠的腳踝與後足部固定作用。 本發明提供一種用於患者的踝關節固定術之外科植入 物和外科植入物套組，該患者在其等之腳踝中係受苦於嚴 重的骨頭缺陷，以及一種運用具有一彎曲部的踝關節固定 20 釘，而在一個體中進行建立一踝關節固定術的方法。 在一態樣中，一踝關節固定釘包含一堅硬的圓形脛骨_ 距骨-跟骨桿件，其具有一末端部分和一近端部分以及一位 在該末端部分中之彎曲。該桿件進一步包含有用於鎖固螺 絲之近端與末端螺孔。該桿件在該近端部分中可以具有一 6 200803808 彎曲。在該近端部分的彎曲以及在該末端部分的彎曲，可 以在該固定釘的兩端之間產生一抵銷作用。該彎曲部分可 以被架構以配合該後足部的一解剖排列方式。該彎曲部分 係為5與20度之間的角度。該桿件可以具有一介於10-13公 5 釐之間的直徑。該桿件可以具有一介於15至30cm之間的長 度。該固定釘包含一堅硬的圓形脛骨-距骨-跟骨桿件，其在 該末端部分中可以具有一彎曲，且該桿件進一步包含有用 於鎖固螺絲之近端與末端螺孔。 在另一態樣中，一外科植入物套組包含有一踝關節固 1〇 定釘，其包含有一在該末端部分中具有一彎曲之堅硬的圓 形脛骨-距骨-跟骨桿件，該桿件進一步包含有用於鎖固螺絲 之近端與末端螺孔，以及後端至前端鎖定螺絲，其中該固 定釘和該等螺絲係被架構成可以鎖固在一起，以形成一橫 越過該踝關節之壓迫來輔助關節固定。該外科植入物套組 15可以進一步包含一條預先構形以與該固定釘的彎曲配合之 V線，以為削鑽該用於插入該固定釘的開口之作用提供導 引。該套組也可以包含一被架構成使得該導線可以通過之 可撓性的擴孔鑽。該套組包含一在該近端部分中具有彎曲 部分之桿件。在該近端部分之彎曲與在該末端部分之彎曲 20可以在该固定釘的兩端之間產生—抵銷作用。該彎曲部分 可以被架構以配合該後足部的一解剖排列方式。該彎曲部 分的角度可以介於5至2〇度之間。該桿件的直徑可以介於1〇 至13公爱之間。該桿件的長度可以介於15至30cm之間。 在另一態樣中，在一個個體中建立踝關節固定術的方 7 200803808 法，包含有在該等跟骨、距骨和脛骨的本體中形成一開孔、 在腳跟的足底部份中將一關節固定釘由該跟骨插入至距骨 和脛骨，並且將該固定釘以後端與前端鎖定螺絲鎖固於該 跟骨中來輔助關節固定作用。該方法可以進一步包含使用 5 —導線來配合該固定釘的彎曲，以為削鑽該用於插入該固 定釘的開口之作用提供導引。該方法也可以包含使用可撓 性的擴孔鑽來通過該該導線，以鑽開脛骨腔。 本發明之一或更多具體例的細節係被描述在隨附的圖 式和下述的說明中。本發明的其他特徵、目的和優點將可 10 以由該等描述與圖式以及該等申請專利範圍中變的顯而易見。 圖式簡單說明 第1A圖係為腿部和足部的後視概要圖，其顯示後足部 的結構排列以及在該後足部裡面之該具有二個彎曲的關節 固定釘之位置。 15 第1B圖係為腿部和足部的後視概要圖，其顯示後足部 的結構排列以及在該後足部裡面之該具有一彎曲的關節固 定釘之位置。 第2A圖顯示該相消型脛骨-距骨-跟骨的關節固定釘的 後視圖。 20 第2B圖顯示該相消型脛骨-距骨-跟骨的關節固定釘的 前視圖。 弟2C圖顯不該相消型腔骨-距骨-跟骨的關郎固定釘的 側視圖。 第3圖顯示在一可密封的無菌包裝中之外科植入物套 8 200803808 組的概要圖。 【實施冷式】 車父佳實施例之詳細說明 第lAm兒明在一正常而健康的足部中 ，和排列方式，並進—步描述一與後足‘：骨 方式相配合的該具有彎㈣之躁關節㈣賴=歹1 ^含有跟骨、料和㈣。距骨.跟t =設計是長直的，而沒有可以產生-抵鎖仙之=: 足部的解剖排列方式之彎曲己口後 10 定钉_在㈣面中為圖’㈣關節固 面中4 0形的桿件，其具有可以產生— 抵銷仙之配合後足部的解構造之—㈣曲21或是二個讎 曲20。 參照第2A-C圖，該桿件具有用來接受鎖定螺絲之近端 3〇和末端螺孔40。該桿件在該近端部分中可以具有一彎 曲。該桿件在該末端部分中可以具有一彎曲。在該近端部 分的彎曲以及在該朱瑞部分的彎曲可以在該固定釘的兩端 之間產支一抵銷作用。該彎曲部分可以被架構以配合一後 足部的解剖排列方式。該彎曲部分的角度可以介於5至20度 <間。該弯曲部分的角度可以是15度。該彎曲部分的角度 可以在該固定釘的製造期間加以固定。 參照第2A-B圖，當該圓定釘的長柄50係與該固定釕的 短柄60平行時，該桿件可以具有二個彎曲。參照第2八圖， 由該長柄50延伸的軸線A1將與由該短柄60延伸的軸線A2 平行。該桿件可以異有二個每個都介於5至20度之間的彎 9 200803808 曲。該桿件可以具有二個每個都係為10度之彎曲。該桿件 可以具一介於10至13公釐之間的直徑。該桿件可以具有一 介於15至30cm之間的長度。該長柄的長度!^與短柄的長度 L2之比，可能是介於1 : 1至5 : 1之間。該等長度^和^可 以依據该患者的尺寸比例來架構。該長柄L1的長度可以介 於7·5至25cm之間，而該短柄L2的長度可以介於2.5至15cm 之間。 該桿件和螺絲的尺寸可以在長度或直徑上作變化，所 以可以有許多用於來不同尺寸的患者之不同尺寸的裝置。 10這使得外科醫生可以選擇並運用二個對特定患者最適合之 特定組件，在外科醫生已經針對該需要外科手術介入之傷 害、疾病或缺陷的特性與嚴重度進行分析之後。在一個較 佳方法中’其可以提供-長度介於15i30cm之間、直徑介 ^於9至14公麓之間的垂直桿件類型。其可以提供長度介於 15 5.5tG7em之間、直徑介於4至7公复之間的傾斜螺絲。這些 使得外科醫生可以選擇將會適用於大多數患者的桿件與螺 絲組合。如果需要有不同的尺寸或角度時，其等可以向製 造商進貨，或以訂做的方式來製造，其係較佳地使用電腦 控機械加工方法(例如雷射切割技術）以使得訂做製造的額 20 外成本最小化。 、 除了，該桿件和螺絲係較佳地應該要具有斜角但不能 是銳利的尖端。該螺絲尖端可以至少在自該向後延伸^ 大約L5cm或更遠處的區域中具有外螺紋。這些螺紋應該具 有-可以允許該具螺紋的尖端可以被牢固地固定，並在該 10 200803808 螺絲於外科手術安置期間被鎖緊時可以拉引該脛骨下端之 跨距和高度。較佳的尺寸（包括螺距、深度以及螺牙形狀) 已經為將進入骨頭之内被插入的穿線於的螺絲被建立；那 些尺寸係為製作此等外科植入物的公司所熟是知的。非常 5 細的螺紋將因為其等會使得骨頭材料破碎與崩裂而無法被 使用；相反的，其通常使用介於1.5至5公釐之間的螺紋跨 距以及超過1公釐的螺紋高度（深度）。 在一具體例中，該桿件可以藉著在該等跟骨、距骨和 脛骨的本體中形成一開孔，而自該腳跟的足底部分來插 10 入。一具有類似的抵銷作用或彎曲之導線，可以一逆行方 向來通過進入一脛骨腔内。一與固定釘的彎曲相配合之預 先構形導線80可以被用來為削鑽該用於插入該固定釘的 開口之作用提供導引。然後一擴孔鑽可以通過該預先彎曲 的導線以形成或鑽開該脛骨腔。該擴孔鑽可以是一可撓性 15 擴孔鑽。或者，任何其他適當的鑽削工具可以被用來形成 或擴大該用於插入該固定釘之開口。該固定釘可以從該跟 骨通過進入至該距骨，然後進入該脛骨，並以後端與前端 鎖定螺絲鎖固於該跟骨中。一力量可以被施加至該足部的 足底表面，而且該固定釘的近端部分係被鎖固以形成一橫 20 越過該踝關節之壓迫來輔助關節固定。 一踝關節固定總成可以在一個踝關節内，由一位外科 醫生使用可以被製造成容納於一套組中之組件來形成。大 體而言，其係被預期可以有二種套組。參照第3圖，一套組 可以包含有單一組的組件，例如一包含有一堅硬的圓形脛 11 200803808 10 15 20 骨-距骨-跟骨桿件之關節固定釘1〇，該桿件在末端部分中具 有'^曲’該桿件進一步包括有用於鎖固螺絲之近端30和 末端螺孔40，以及後端至前端鎖定螺絲7〇，其中該固定釘 …和轉螺絲係被架構成可以鎖固在—起，以形成—橫越過 關節之麼迫來輔助關節固定。該外科植入物套組可以 進步包合一與固定釘的弯曲相配合之預先構形導線8〇， =為削鑽該用於插人該蚊釘的開口之作用提供導引。該 組可以進—步包含一可挽性擴孔鑽％。此種套組可以在 ㉚科醫生已經分析特定患者之問題和需求之後，由一外科 以、h薦、有7^王6丁製之精讀尺寸的兩個組件。該套組可 密 I:—^ 工作之=型的套組（其可能比較受到一些外科醫生 乍=滅或_診所喜愛）可以包含有許多種 )及數種母個都具有所需長度之螺絲(譬如5.5至 形導線=可以包含與固定釘的彎曲相配合之預先構 料。此等套=該用於插入該固定釘的開口之作用提供 導線之可撓性擴孔=鑽二ΓΓ通過該被預先彎曲的 以針對任何特脛骨腔:其允許外科醫生可 同類別中選擇-較㈣結合。 〇喊取传之不 件包=二二卜科套組係典型地將任何與所有的可植入組 、、”寺在無菌狀態下的密封包裝裡面。可植入組件 12 200803808 可以用不銹鋼、鈦或任何其他適何用於植入之適當的材質 來製成。然而，應該要注意的是在此所揭示的任何植入組 件，都可以藉著高溫高壓滅菌法或類似的方式而輕易地消 毒滅菌。 5 本發明已經描述一些具體例。然而，應該要了解的是 在不背離本發明的精神和範圍下，可以進行各種不同的修 飾。因此，其他的具體例也落在下述之申請專利範圍裡面。 I：圖式簡單說明3 第1A圖係為腿部和足部的後視概要圖，其顯示後足部 10 的結構排列以及在該後足部裡面之該具有二個彎曲的關節 固定釘之位置。 第1B圖係為腿部和足部的後視概要圖，其顯示後足部 的結構排列以及在該後足部裡面之該具有一彎曲的關節固 定釘之位置。 15 弟2A圖顯不該相消型腔骨-距骨-跟骨的關郎固定釘的 後視圖。 弟2B圖顯不該相消型腔骨-距骨-跟骨的關卽固定釘的 前視圖。 第2C圖顯示該相消型脛骨-距骨-跟骨的關節固定釘的 20 側視圖。 第3圖顯示在一可密封的無菌包裝中之外科植入物套 組的概要圖。 13 200803808 【主要元件符號說明】 10…踝關節固定釘 80…預先構形導線 20，21···彎曲 90…可撓性擴孔鑽 30…近端螺孔 100...密封包裝 40…末端螺孔 Al，A2…軸線 50".長柄 L1...長柄長度 60···短柄 70...後端至前端鎖定螺絲 L2…短柄長度 14</ RTI> </ RTI> </ RTI> <RTIgt; </ RTI> <RTIgt; </ RTI> <RTIgt; </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> <RTIgt; for reference. FIELD OF THE INVENTION The present invention relates generally to an orthopedic device. L· Λ. ^3 10 BACKGROUND OF THE INVENTION Some patients suffer from a variety of different conditions in which at least a portion of the joints need to move effectively. Such conditions include severe arthritis, regional infections of one or more bones and/or avascular necrosis, congenital deformation of the tibia talus or the talus, or a specific type of neuropathy. In all of these 15 conditions, any movement of the bones relative to each other can cause severe pain in the foot or ankle, making the patient unable to walk effectively or exert any pressure on the foot. Therefore, the patient will choose to fix the joint and begin to walk without extreme pain in the ankles and feet. The fixation of the ankle joint is typically performed by inserting one or more rigid members 20 or pins into the ankle and the hindfoot portion of the foot. It permanently attaches specific bones to other bones. The type of medical treatment that permanently fixes the bone is an ankle arthrodesis. In a normal stepped joint, because of the positional relationship of the bone, a long straight member that passes vertically through the calcaneus into the tibia usually passes through the talus. 5 200803808 SUMMARY OF THE INVENTION Summary of the Invention Rods and pin structures developed for ankle arthrodesis are subject to various limitations. Some patients who have inserted the old rod and pin device in their ankles suffer from problems associated with the relative motion between the tibia and the calcaneus that should be fixed. It can cause significant pain in the fixed joint and cause restlessness when the patient walks or stands. It also causes extra damage inside the joint because the screw or other component can rub and grind one or more bones, which often makes patients with severe 10-joint or bone problems weaker and relatively weaker. In addition, the anatomical arrangement of the hindfoot is not suitable for the introduction of a long straight member because it is a chord from the plantar portion of the calcaneus to the talus body and into the medullary cavity of the tibia. Therefore, there is a need for an improved ankle joint fixation assembly that provides a better, more stable and reliable ankle and hindfoot fixation for patients requiring such treatment for injuries or foot or ankle diseases. . The present invention provides an ankle arthrodesis implant and a surgical implant set for a patient who suffers from severe bone defects in their ankles and a use of a tendon having a bend The joint is fixed with 20 nails, and a method of establishing an ankle arthrodesis is performed in one body. In one aspect, an ankle articular fixation nail comprises a rigid circular tibia talc-calculus member having an end portion and a proximal portion and a bend in the end portion. The lever further includes a proximal end and a distal threaded hole for locking the screw. The rod may have a 6 200803808 bend in the proximal portion. The bending of the proximal portion and the bending of the end portion can produce an offset between the ends of the fixing nail. The curved portion can be configured to conform to an anatomical arrangement of the hind foot. The curved portion is an angle between 5 and 20 degrees. The rod may have a diameter of between 10 and 13 mm. The rod may have a length of between 15 and 30 cm. The fixation stud includes a rigid circular tibia-talar-gastrospial member that can have a bend in the end portion and that further includes proximal and distal threaded holes for the locking screw. In another aspect, a surgical implant set includes an ankle joint fixation staple comprising a curved, humeral-talar-calcaneus member having a curved shape in the end portion. The lever further includes a proximal end and a rear screw hole for locking the screw, and a rear end to the front end locking screw, wherein the fixing nail and the screw are framed to be locked together to form a cross over the crucible The compression of the joints assists in the fixation of the joints. The surgical implant set 15 can further include a V-wire that is pre-configured to flex with the fixation peg to provide guidance for the purpose of cutting the opening for insertion of the fixation peg. The kit may also include a reamer that is framed to allow the wire to pass through. The kit includes a rod having a curved portion in the proximal portion. The bending at the proximal portion and the bending 20 at the end portion can create an offset effect between the ends of the fixing nail. The curved portion can be configured to conform to an anatomical arrangement of the hind foot. The angle of the curved portion may be between 5 and 2 turns. The rod can be between 1 至 and 13 gong in diameter. The length of the rod can be between 15 and 30 cm. In another aspect, the method of establishing an ankle arthrodesis in an individual 7 200803808 includes forming an opening in the body of the calcaneus, talus, and tibia, and in the foot of the heel A joint fixation nail is inserted into the talus and the tibia by the calcaneus, and the posterior end and the front end locking screw of the fixation nail are locked in the calcaneus to assist the joint fixation. The method can further include using a 5-wire to engage the bending of the staple to provide guidance for the effect of the opening for inserting the fixation staple. The method can also include using a flexible reamer to pass the wire to drill the iliac cavity. The details of one or more specific embodiments of the invention are described in the accompanying drawings and the description below. Other features, objects, and advantages of the invention will be apparent from the description and appended claims. BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1A is a rear perspective view of the leg and foot showing the structural arrangement of the hind foot and the position of the two-bend joint fixing nail in the rear foot. 15 Fig. 1B is a rear perspective view of the legs and feet showing the structural arrangement of the hind foot and the position of the curved fixation pin in the posterior foot. Figure 2A shows a rear view of the dissected tibia-talar-calcane joint fixation nail. 20 Figure 2B shows a front view of the dissected tibia-talar-calcane joint fixation nail. The 2C figure shows a side view of the deboning cavities - talus - calcaneus. Figure 3 shows a summary of the group of implants 8 200803808 in a sealable aseptic package. [Implementation of the cold type] The detailed description of the embodiment of the car father is shown in a normal and healthy foot, and the arrangement, and further describes the one with the hind foot ': bone mode with the bend (four) The ankle joint (4) Lai = 歹 1 ^ contains the calcaneus, material and (four). The talus. With t = the design is long straight, and no one can be produced - the lock is immortal =: The anatomical arrangement of the foot is bent after the mouth is fixed 10 _ in the (four) plane is the figure '(4) joint solid surface 4 A 0-shaped rod having a decoupling structure that can produce - offset the rear foot - (4) curved 21 or two twists 20. Referring to Figures 2A-C, the lever has a proximal end 3〇 and an end tapped bore 40 for receiving a locking screw. The rod may have a bend in the proximal portion. The rod may have a bend in the end portion. The bending at the proximal portion and the bending at the junip portion can produce an offset between the ends of the fixing nail. The curved portion can be configured to conform to the anatomical arrangement of a hind foot. The angle of the curved portion may be between 5 and 20 degrees. The angle of the curved portion may be 15 degrees. The angle of the curved portion can be fixed during the manufacture of the fixing nail. Referring to Figures 2A-B, when the long shank 50 of the rounded staple is parallel to the short shank 60 of the fixed jaw, the member can have two bends. Referring to Figure 28, the axis A1 extending from the long shank 50 will be parallel to the axis A2 extending from the shank 60. The rod can have two bends each of which is between 5 and 20 degrees. The rod may have two bends each of which is 10 degrees. The rod may have a diameter of between 10 and 13 mm. The rod may have a length of between 15 and 30 cm. The ratio of the length of the long handle!^ to the length L2 of the short handle may be between 1:1 and 5:1. The lengths ^ and ^ can be constructed according to the size ratio of the patient. The length of the long handle L1 may be between 7 and 5 cm, and the length of the short handle L2 may be between 2.5 and 15 cm. The size of the rods and screws can vary in length or diameter, so there can be many different sized devices for patients of different sizes. 10 This allows the surgeon to select and apply two specific components that are most suitable for a particular patient, after the surgeon has analyzed the characteristics and severity of the injury, disease, or defect requiring surgical intervention. In a preferred method, it can provide a vertical member type having a length between 15 and 30 cm and a diameter between 9 and 14 mm. It can provide tilting screws with a length between 15 5.5tG7em and a diameter between 4 and 7 gong. These allow the surgeon to choose the combination of rod and screw that will be suitable for most patients. If different sizes or angles are required, they can be purchased from the manufacturer or manufactured in a custom-made manner, preferably using computer controlled machining methods (such as laser cutting techniques) to make custom manufacturing. The external cost is minimized. In addition, the rod and screw system should preferably have a bevel but not a sharp tip. The screw tip may have an external thread at least in a region extending from the rearward portion by about L5 cm or more. These threads should have - allowing the threaded tip to be securely fastened and to pull the span and height of the lower end of the tibia when the 10 200803808 screw is locked during surgical placement. The preferred dimensions (including pitch, depth, and thread shape) have been established for the threads that are inserted into the bone to be inserted; those dimensions are well known to those skilled in the art of making such surgical implants. Very fine 5 threads will not be used because they will break and crack the bone material; instead, they typically use a thread span of between 1.5 and 5 mm and a thread height of more than 1 mm (depth) ). In one embodiment, the member can be inserted from the sole portion of the heel by forming an opening in the body of the calcaneus, talus, and tibia. A wire with a similar offset or bend can be passed through a tibia cavity in a retrograde direction. A pre-configured wire 80 that cooperates with the bending of the staples can be used to provide guidance for the purpose of cutting the opening for insertion of the staple. A reamer can then pass through the pre-bent wire to form or drill the tibia cavity. The reamer can be a flexible 15 reamer. Alternatively, any other suitable drilling tool can be used to form or enlarge the opening for insertion of the staple. The fixation pin can pass from the talus to the talus and then into the tibia, and the posterior end and the front end locking screw are locked in the calcaneus. A force can be applied to the plantar surface of the foot and the proximal portion of the staple is secured to form a transverse 20 compression across the ankle joint to assist in articular fixation. An ankle arthrodesis assembly can be formed in an ankle joint by a surgeon using components that can be fabricated to be contained in a set. In general, the system is expected to have two sets. Referring to Fig. 3, a set of components may comprise a single set of components, such as a rigid circular cymbal 11 200803808 10 15 20 bone-talc-heelal bone joint fixation pin 1 〇, the rod at the end The lever having a '^曲' in the portion further includes a proximal end 30 for locking the screw and an end screw hole 40, and a rear end to the front end locking screw 7〇, wherein the fixing nail and the rotating screw are formed by the frame Locked in to form a cross-over joint to assist in joint fixation. The surgical implant set can be advanced to include a pre-configured lead 8 配合 that cooperates with the bending of the staple to provide guidance for the purpose of cutting the opening for inserting the mosquito. The group can further include a pullable reamer %. This kit can be used by a surgeon to analyze the problems and needs of a particular patient, and to have two components that are surgically sized, have a fine reading size of 7^ kings. The set can be densely I:-^ working = type of set (which may be more like some surgeons 灭 = 或 or _ clinic favorite) can contain many kinds) and several kinds of mothers have the required length of the screw (For example, a 5.5-shaped wire = may include a pre-structure that cooperates with the bending of the fixing nail. These sleeves = the function of the opening for inserting the fixing nail provides a flexible reaming of the wire = the drill hole passes through the Pre-bent to target any special iliac cavity: it allows the surgeon to choose from the same category - more than (4). Screaming is not included in the package = 2nd Buco Suite is typically any and all implantable Into the group, "the temple is in a sealed package under sterile conditions. The implantable component 12 200803808 can be made of stainless steel, titanium or any other suitable material suitable for implantation. However, it should be noted that Any of the implant components disclosed herein can be easily sterilized by autoclaving or the like. 5 Specific examples have been described in the present invention. However, it should be understood that without departing from the invention spirit And various modifications can be made in the scope of the invention. Therefore, other specific examples are also within the scope of the following patent application. I: Brief description of the drawing 3 Figure 1A is a rear view of the leg and the foot. It shows the structural arrangement of the hindfoot 10 and the position of the two-bend joint-fixing nails in the posterior foot. Figure 1B is a rear view of the leg and the foot, showing the hind foot The structural arrangement and the position of the curved fixation nail in the posterior foot. 15 The 2A diagram shows the posterior view of the eccentric cavities - talus - calcaneus. The figure shows a front view of the deboning cavities-talar-calcaneal fixation nails. Figure 2C shows a 20 side view of the dissected tibia-talar-calcane joint fixation nails. Figure 3 shows A schematic view of a set of implants in a sealable aseptic package. 13 200803808 [Description of the main components] 10... Ankle fixation nails 80... Pre-configured wires 20, 21···Bending 90...flexible Spiral reaming 30...proximal screw hole 100...sealed package 40... End screw hole Al, A2... axis 50". long handle L1... long handle length 60···short handle 70... rear end to front locking screw L2... short handle length 14