WO2011036182A1

WO2011036182A1 - Surgical clamping fixture

Info

Publication number: WO2011036182A1
Application number: PCT/EP2010/063987
Authority: WO
Inventors: Markus Regauer
Original assignee: Ludwigs-Maximilians-Universität München
Priority date: 2009-09-23
Filing date: 2010-09-22
Publication date: 2011-03-31
Also published as: DE102009042701A1

Abstract

The present invention relates to a surgical clamping fixture (42) for temporarily fixing and aligning an osteosynthesis plate (10) on a long hollow bone (100). The surgical clamping fixture (42) comprises a fixing device (1) for temporarily fixing the clamping fixture (42) at two substantially radially opposite fixing locations (101, 102) on the long hollow bone (100) and a plate holder (2) connected to the fixing device (1) for holding and aligning the osteosynthesis plate (10) against the hollow bone (100). The plate holder (2) is at a distance from the fixing device, such that the osteosynthesis plate (10) is held at at least one holding position (103) against the hollow bone (100), at a distance (A) from the two fixing locations (102, 103) along the longitudinal axis (X) of the hollow bone (100).

Description

SURGICAL HOLDING DEVICE

The present invention relates to a surgical holding device and a method for temporary fixation of an osteosynthesis plate and its alignment with respect to a bone.

BACKGROUND OF THE INVENTION

In the osteosynthesis of bone by means of (osteosynthesis) plates, e.g. in the context of bone fractures, correction or stiffening operations on the extremities or on the spine, there is a general problem in trauma surgery and orthopedics in that a suitable plate must be adapted to the bone and its position must be checked by intraoperative x-ray fluoroscopy before The plate can then finally be fixed with screws provided on the bone. Often, after primary positioning of the plate and fluoroscopic control, corrections of the positioning of the plate are still required, which then have to be checked again by X-ray fluoroscopy.

Therefore, the applied plate can be primarily only temporarily fixed to the bone until the optimal location is found and confirmed by fluoroscopy. As soon as the optimal position of the plate is confirmed, however, this positioning of the plate should also not possible change until a final fixation by means of screws is done. Depending on the anatomical localization, this required temporary fixation of plates to the bone sometimes causes considerable problems. Usually, the following procedures are practiced.

(I) Calculated fixation of the plate by means of a screw in a so-called

Long hole.

It can be done by loosening and tightening the screw still minor corrections of the plate position in the longitudinal direction along the slot and by rotation about the screw, but no parallel displacement transverse to the slot of the plate is possible. However, if fluoroscopic control requires transverse displacement, a new hole must be drilled in the bone, ie the first hole was an unnecessary injury to the bone with all the associated risks of injury eg Tendons, nerves or blood vessels by drilling. Furthermore, only a small special part of the plates used so-called slots.

(II) Fix the plate to the bone with the fingers of the surgeon.

There is understandably the problem that the fingers of the surgeon are exposed to repeated exposure to radiation. In addition, the imaged fingers of the surgeon can also affect the quality of the fluoroscopic image. Another problem is that the fixation of a plate by the fingers of the surgeon sometimes takes considerable force and it is e.g. Fatigue or muscle tremors can lead to unintentional slipping of the plate.

(III) Temporary fixation of the plate to the bone by means of actually unsuitable pliers or clamps.

Often, this will be e.g. so-called lambotte clamps used. However, for this, the bone must be bypassed in its entire circumference with a branch of the clamp until it comes to rest on the opposite side of the adjacent plate on the bone, so that the plate is pressed by means of the detected forceps perpendicular to the bone. For this, depending on the anatomical localization, a considerable additional traumatization of the tissue may sometimes be required, with the risks of additional injuries e.g. of tendons, nerves or blood vessels.

(IV) Temporary fixation of the plate to the bone by means of special pliers or clamps.

Pliers have already been developed which, on the one hand, temporarily fix the position of bone sections to one another during repositioning and at the same time make it possible to arrange an osteosynthesis plate, see, for example, CN 2708855, US Pat. No. 1,985,108 and US Pat. No. 2,460,470. However, these forceps must also encompass the bone substantially throughout the circumference, so that the use of these forceps often results in additional trauma to the tissue around the bone.

The distal radius fracture is the most common surgical fracture of the human to be treated. The problems mentioned therefore occur regularly in the corresponding surgical treatment of fractures of the distal radius bone from the flexor side. Here, the created plate must multiply by a few Millimeter be corrected in all directions, since there is usually no direct insight into the injured articular surfaces of the wrist. For this, multiple fluoroscopic controls are often required, especially in more difficult fracture forms. Any unintentional slippage of the temporarily fixed plate costs unnecessary surgery time and increases the radiation exposure. Furthermore, there is a risk of injury to the radial artery, median nerve, and tendons on the extensor side of the wrist when using unsuitable clips.

Other anatomical locations with similar problems are e.g. the clavicle, the humeral head, the humeral shaft, the elbow, the radius and ulnar shaft, the tibial plateau and the distal fibula, but in principle actually every extremity bone and possibly also the spine in ventral instrumentation.

For these reasons, therefore, a simple and cost-effective technical solution is desirable, which can afford each clinic easily and which makes it possible to fix a plate easy, fast, safe, tissue-friendly and easy and quick correctable temporarily to a bone.

It is therefore an object of the present invention to overcome the above-mentioned disadvantages of the prior art and to provide an improved device and method for temporary fixation of an osteosynthesis plate to a bone.

The object of the present invention is solved by the independent claims and the aspects discussed below. The dependent claims describe further preferred embodiments and modifications of the invention. SUMMARY OF THE INVENTION

The present invention relates to a surgical holding device (hereinafter also referred to as plate retinator) for the temporary fixation and / or alignment of an osteosynthesis plate on a longitudinally extending tubular bone. The surgical holding device has essentially two main components; a fixing device and a plate holder. The fixing device serves for temporarily fixing the surgical holding device to at least two fixing points on the long bone opposite the radial bone with respect to the tubular bone. The fixation preferably takes place via a plurality of points which are distributed over an area in order to reduce or avoid injury or contusion of the periosteum. The plate holder is connected or connectable to the fixing device and is preferably used for holding and / or aligning the osteosynthesis plate against the long bone.

In particular, the surgical holding device is characterized in that the plate holder holds or presses the osteosynthesis plate at least one stop position against the long bone, which is spaced along the longitudinal direction of the long bone of the at least two fixing points of the fixing device. Preferably, the spacings are greater than the average diameter of the long bone, preferably 2x, 3x or even greater than the average diameter of the long bone.

This spacing has the distinct advantage that the fixation device can be mounted remotely from the plate holder on the bone, whereby the image is not disturbed by the fixation device, at least in the relevant sections (e.g., hinge area) during fluoroscopy of the bone.

In other words, the fixing device according to the invention preferably has at least one pair of fixing elements or clamping elements whose distance from one another (preferably steplessly) can be reduced in order to press or clamp a bone therebetween. The connecting line, which is formed by the two fixing elements or clamping elements, is referred to below as Y-direction or Y-axis.

The plate holder holds the plate substantially along a Z-axis against the bone, with the Z-axis being perpendicular to the Y-axis.

In addition, the plate holder or holding point at which the plate holder holds the plate against the bone is spaced substantially along an X-axis or X-axis from the fixation device, preferably variable, the X, Y and Z Axes form a Cartesian coordinate system, ie with three axes on top of each other. The plate holder preferably has a first variably adjustable pressing device, which is spaced from the fixing device along the longitudinal direction of the long bone, and holds the osteosynthesis plate by pressing against the long bone. Preferably, the plate holder on a second pressing device, which may be configured fixed or adjustable. This second pressing device is preferably also spaced along the longitudinal direction of the long bone of the fixing device and also preferably also spaced from the first pressing device.

Preferably, the first and / or second adjustable pressing device has at least one adjustable screw in order to press the osteosynthesis plate against the bone.

In addition, it is preferred that the first and / or second pressing device presses the osteosynthesis plate substantially radially against the long bone. In the context of the present invention, the bone side facing the surgeon is referred to as the "upper" side; accordingly, the opposite side becomes a "lower" side. and the pages in between are called "lateral" pages. Accordingly, it is preferred that the first and / or second pressing device presses the osteosynthesis plate substantially from top to bottom against the bone (where the position indication "above" means the area outside the surface of the long bone with "bottom" the interior of the bone Long bone is meant). In order to minimize the traumatization of the tissue surrounding the bone, it is also preferred that the fixing device is not arranged opposite to this pressing force on the bone but laterally therefrom (see schematic illustration in FIG. 3).

Preferably, the first and / or second pressing device presses the

Osteosynthesis plate substantially radially downwards against the long bones, while the at least two fixing points lie substantially laterally on the tubular bone.

The temporary fixing device preferably has a clamp, wherein the clamp can be temporarily fixed to the bone via a clamping connection.

According to another preferred embodiment, the plate holder, or at least parts thereof, is made of a material called X-rays poorly absorbed than bone, allowing a substantially undisturbed X-ray image.

According to a further preferred embodiment, a toothed wheel mechanism with preferably unidirectional running direction and simple decoupling possibility is used in the region of the fixing device, whereby the clamping elements can be attached quickly and easily by hand to the bone. The secure fixation can then take place, for example, by further tightening a screw which is integrated in the gearwheel mechanism.

According to a further preferred embodiment, movable components are infinitely variably adjustable preferably in all (required) levels.

According to a further preferred embodiment, there is limited freedom of movement in the region of the central component (FIG. 5) as well as in the region of the clamping jaws, so that the corresponding elements can adapt to the anatomy of the bone, without the handling thereby being controlled by a great freedom of movement of the elements is difficult.

Preferably, the plate retainer is made according to different clinical requirements in different size dimensions and possibly also in different special designs (e.g., spine or pelvis). With regard to the size dimensions, the categories of large fragments, small fragments and mini fragments commonly used in traumatology and possibly also micro fragments are preferred. Furthermore, further special size dimensions are preferred for the field of childhood traumatology or veterinary medicine.

According to a further preferred embodiment, the plate retinator is optionally produced as a universal version or as a special version. It means universally that the plate holder via a universal connector with a preferably conventional conventional fixation device such as a Lambotte clamp or a Verbrugge forceps, as they are usually kept in each accident surgical department, combined and applicable as a plate retainer, which For example, the user could save the purchase of the fixing device. Special means in In this connection, a special optimized fixing device (FIG. 2) is securely connected to the plate holder in a functionally optimized manner.

According to a further preferred embodiment, the plate retinator is produced either as a universal version or as a special version with regard to the compatibility with osteosynthesis plates to be used. In this case, universal, for example, means that the disc holding members (210 and 220 in Fig. 2) an application of the plate Retinators when using osteosynthesis plates of all common companies (eg Synthes ^®, Stryker ^®, Leibinger ^®, Königsee ^® etc. ) allow. Special in this context means that by a special surface finish of the plate holding elements (210 or 220 in Fig. 2) at their contact surface to the osteosynthesis plate (eg special guide stamps that fit exactly and exclusively in the Scliraubenlöcher special plates) of the plates Retainer, for example, can only be used in combination with osteosynthesis plates of a certain type.

The invention also includes individual features in the figures, even though they are shown there in connection with other features and / or are not mentioned above or below.

The invention also includes embodiments with any combination of features, which are referred to or shown above or below to various Ausführungsfomien. For example, the holding device according to the invention can also be described by the following aspects.

According to a first aspect, the invention relates to a surgical holding device for temporary fixation and alignment of an osteosynthesis plate on a longitudinally extending tubular bone. The holding device comprises a fixing device for temporary fixing of the holding device on the tubular bone. Preferably, the fixing device is adapted such that the fixing device is fixed to the bone via one, two or more fixing points. Preferably, the two fixing points with respect to the tubular bone are substantially opposite, whereby a secure fixation is achieved. However, the fixation does not have to lie exactly radially opposite, ie the angle between the two connecting lines, which are formed by (i) the first fixation center of the long bone and (ii) the second fixation center of the Tubular bone, may be in the range 160-200 °, preferably 170-190 ° and more preferably 175-185 °.

The fixing device is preferably connected to a plate holder for holding and aligning the osteosynthesis plate (10) against the long bone (100). Preferably, the plate holder can be releasably connected to the fixing device. Alternatively, the connection of the plate holder with the fixing device can also be fixed or non-releasable or permanent.

In order to ensure a secure alignment of the osteosynthesis plate on the long bone, the plate is preferably held at at least two mutually spaced holding positions against the long bones. The spacing of the two holding positions is preferably along the longitudinal direction of the long bone. In addition, it is preferred that the first and / or second holding position of the two fixing points along the longitudinal direction of the tubular bone is / are spaced apart.

BRIEF DESCRIPTION OF THE DRAWINGS

Hereinafter, preferred embodiments of the present invention will be described in detail with reference to the drawings. Show it:

Fig. 1 is a perspective view of a surgical according to the invention

Retaining device, which is temporarily fixed to a tubular bone;

FIG. 2 shows a perspective view of a further embodiment of a surgical holding device according to the invention; FIG.

Figure 3 is a schematic representation of the forces occurring on the bone when the holding device according to the invention is temporarily fixed to the bone and presses the osteosynthesis plate against the boil;

4a, b shows a view from the proximal or from the distal to illustrate a connection according to the invention of fixing device and plate holder via a central component, wherein the plate holder can be moved via a connecting screw infinitely variably in the direction of bone; and a top view in longitudinal section at the height of the plate holder to illustrate a limited freedom of movement between fixing and plate holder. DETAILED DESCRIPTION OF PREFERRED EMBODIMENT

FIG. 1 shows a first embodiment according to the invention of a surgical holding device 42 which is temporarily fixed to a tubular bone 100. The illustrated holding device 42 consists essentially of two main components, a fixing device 1 and a plate holder 2. With the fixing device 1 is a temporary, i. releasable fixation made on the tubular bone. The illustrated fixation device 1 comprises a bent tong 11, which is preferably fixed only to the lateral sides of the long bone 100, i. The fixing device 1 is fixed to the bone 100 via at least two fixing points 101 and 102, which are substantially opposite to each other in relation to the bone 100. The fixation on the lateral sides of the bone 100 has a considerable advantage over the pliers known from the prior art. Since the upper side of the bone is already accessible for treating the bone, the bone only has to be "gripped" a little further up to the lateral sides in order to fix the fixation device in order to fix the fixation device. That in order to press the plate 100 to the upper side of the bone need not be, as in the prior art, the entire bone are embraced to the bottom.

In other words, the fixing device 1 according to the invention preferably has a bent pliers element 1 1 with two fixing elements or clamping elements, the distance between them can be reduced to press or clamp a bone 100 therebetween. The connecting line formed by the two fixing elements or clamping elements, i. the connecting line of the two fixing points 101 and 102, hereinafter referred to as Y-direction or Y-axis (see for example Fig. 1).

The forceps of the fixator 1 is preferably occupied in the direction of the bone with several possibly atraumatic tips, so that the bone 10 can be securely fixed without previous detachment of the periosteum, without the periosteum to squeeze. In addition, it may be advantageous if the forceps are slightly concave in shape for better adaptation to the bone 100.

The fixing device 1 is connected to the plate holder 2, preferably variably connected, wherein the plate holder 2 has the task of keeping the osteosynthesis plate 10 in a primary positioning towards the bone. The plate holder 2 holds the osteosynthesis plate 10 substantially in the direction of a Z-axis (Z-direction) against the bone 100, the Z-axis being perpendicular to the Y-axis (see, for example, FIG. 1).

The plate holder 2 shown in Figure 1, for example, two pressing devices 21 and 22, which press the plate 10 against the tubular bone and thus fix the plate temporarily to the bone. The pressing means 21 and 22 of the disc holder 2 are both adjustable in the illustrated embodiment, i. the contact pressure can be adjusted individually with both pressing devices 21 and 22. This can be achieved according to the invention, for example, by using two suitably interconnected threaded screws, with the help of which applied to the bone 100 plate 10 is pressed in infinitely adjustable strength against the bone.

Figure 3 is a cross-sectional view through a long bone 100 having the tissue 50 surrounding the bone and the upwardly open surgical port facing the surgeon. Figure 3 shows schematically the forces acting on the bone 100 forces Fi, F'i and F ₂ , when the plate 10 is pressed by means of the holding device according to the invention from above against the bone 100. The fixing device is fixed laterally to the bone 100 at least at the fixing points 101 and 102 that are opposite the bone 100 radially, ie, the substantially opposite forces Fi, F'i act to temporarily fix the fixation device to the bone. The plate 10 is held at the break point 103 (which is spaced along the longitudinal direction (X) of the bone from the points 101 and 102, this spacing is not visible in the cross-sectional view) against the bone 100, substantially radially downwards, with the force F ₂ pressed.

In other words, the plate holder or the breakpoint 103, on which the

Plate holder holding the plate 10 against the bone 100 is spaced substantially along an X-axis or X-axis of the fixing device 1, wherein the X-, Y and Z axes form a Cartesian coordinate system, ie with three mutually perpendicular axes.

According to another embodiment, not shown, the plate holder 2 may also have only a pressing device which holds the plate at a break point 103 against the bone. Since the fixing points 101 and 102 are spaced from the holding point 103 is another "breakpoint" in the form of an Ab base point advantageous to prevent twisting or tilting of the holding device 42 according to the invention around the two fixing points 101 and 102 around. Thus, for example, the fixing device may have further means, which are supported against the bone at a support point. However, the support at the further support point 104 can also be achieved by means which are part of the holding device, as shown for example in FIG. It should be noted, however, that the support point 104 need not simultaneously serve to hold the plate against the bone, as shown in FIG. One of the pressing means 21 and 22 could also be used directly against the bone, i. without an intermediate plate, to be pressed, the plate is then pressed by the other pressing device held against the bone.

The use of a holding device 42 according to the invention is described in more detail in the following exemplary working steps.

First, a suitable and appropriately pre-bent plate 10 to the

Bone 100 created by hand. Then, the disc holder 2 according to the invention is arranged with the two pressing means 21 and 22 on the plate 10; Subsequently, the plate holder 2 is fixed by means of fixing device 1 on the bone 100 via the fixing points 101 and 102. Subsequently, the two pressing devices 21 and 22 are screwed by threaded screws with their fingers until the plate 10 is easily fixed to the bone 100. It is particularly preferred that the pressing devices 21 and 22 press the plate 10 as perpendicular to the top against the bone 100 as possible. In the illustrated embodiment, the threaded screws of the pressing means 21 and 22 are substantially perpendicular to the bone top, whereby an optimal contact pressure is achieved and a tilting or slipping of the plate is substantially prevented. Thereafter, the plate 10 is optimally positioned and pressed over the at least one threaded screw of a pressing device 21 and / or 22 arbitrarily fixed to the bone 100. With such a temporarily fixed to the bone 100 plate 10 a problem-free X-ray in several levels is possible to control the position of the plate 10. If the positioning of the plate must be corrected, the at least one threaded screw of a pressing device is released until the plate 10 can be moved accordingly. Subsequently, the threaded screw is tightened again and the new position of the plate 10 checked again by fluoroscopy.

With optimal positioning of the temporarily fixed plate 10 can now be conveniently predrilled and screwed through a corresponding recess 25 in the plate holder 2 until the plate is finally fixed by screws to the bone. Then, the holding device 42 can be easily removed again by the fixing device 1 is opened. Finally, the plate can still be filled as required with other screws.

Preferably, portions of the holding device 42 according to the invention, which could interfere with the fluoroscopic control, such as e.g. Parts of the plate holder 2 with a pressing device 21, preferably made of "radiopaque" material, such as carbon. Since according to the invention the contact point 103 is offset from the fixing points 101 and 102 and the fixing device is thus offset from the area to be illuminated, the fixing device 1 can also be made of a material that absorbs X-rays (for example, metal, stainless steel), but a cheap production and easy sterilization allows.

Furthermore, a preferred embodiment of the fixing device as a special

Pliers are designed with 90 ° angled handles (see Fig. 1), whereby an undisturbed drilling and / or screws is made possible while the plate is temporarily fixed on the holding device 42. For the same reason, it is preferable to provide one or more recesses 25 in the plate holder 2 and / or the fixing device 1 over the lying plate to ensure the necessary access to the plate 10 with a drill and screwdriver. Another advantage of the holding device according to the invention is also given by the fact that with the help of this holding device on the already existing or required surgical access without additional trauma a plate can be fixed quickly, easily and safely temporarily to the bone. Furthermore, the positioning of the plate can be quickly and easily corrected and it is a trouble-free X-ray without increased radiation exposure of the surgeon possible.

By simple and safe handling, a saving of operating time, radiation exposure and staff is expected, especially for less experienced surgeons or more difficult fracture forms.

The surgical holding device according to the invention can be manufactured in different sizes (micro fragment, mini fragment, small fragment, large fragment) and shapes depending on the anatomical localization to which it is to be applied. Furthermore, a "universal" and a "special" version can be produced. The "universal" version can be used in conjunction with conventional clamps, e.g. the lambotte clamp are applied, i. the conventional clamps take over the task of the fixing device 1. The "special" version, for example, a specially constructed fixing device 1 (see Fig. 1), in order to simplify the handling even further.

The embodiment shown in FIG. 1 is only one possible embodiment of the present invention. However, a variety of other specific embodiments of the inventive principle, as defined in particular in the claims, is possible.

FIG. 2 schematically shows a further embodiment according to the invention. According to this further preferred embodiment, the fixing device 1 can be designed according to the principle of a bone ferrule with a central component 50 (see FIGS. 2, 4 and 5). The two bone jaws or clamping elements 12, which form an important element of the fixing device 1, can preferably have a certain degree of freedom of mobility for adaptation to the bone shape. Bone-baking can be carried by hand 12 quickly and symmetrically laterally to the bone via a gear mechanism with latching in one direction (similar to Fehling ^® frames in spinal surgery). The secure fixation of the bone jaws 12 is then done by tightening a corresponding gear screw 51, which is integrated in the gear mechanism and can be solved easily and quickly by unlocking again.

For secure and variable temporary fixation of the osteosynthesis plate 10 to the bone 100, the two plate-facing plate-holding members 210 and 220 may be slightly concave in shape and preferably have a grippy plate-side surface structure. Preferably, the plate holding parts or jaws 210 and 220 are freely movable (rotatable and / or tiltable) over a certain range for individual adaptation to the respective bone shape.

The two pressing means 21, 22 of the disc holder 2 are connected via connecting rods 23 to a movable block 55 inside the central component 50 (see Figs. 4 and 5), i. the plate holder 2 is connected to the fixing device 1. By tightening a threaded screw 52, the entire block 55 can be pressed together with the plate mounts 210, 220 towards the bone (see Fig. 4b). The connecting rods 23 are movably guided within the block 55, so that the distance of the respective plate holder 210, 220 to the central component 50 is quickly and preferably infinitely variably adjustable. Preferably, both the bone jaws 12 and the plate brackets 210, 220 are height adjustable with respect to their respective connectors (e.g., via threads). Additionally or alternatively, the bone jaws 12 and / or the plate mounts 210, 220 may have a certain freedom of movement to ensure adaptation to the bone shape or to the plate shape. For the same reason, the entire connecting block 55, in which the connecting rods 23 are guided, may have a certain flexibility in three planes, so as to be e.g. also to allow a slanted to the bone plate system, as for example. may be required at the tibial plateau. It is preferred that a reasonable degree of mobility is not exceeded in order to facilitate handling.

The bone jaws 12 are preferably occupied in the direction of bone with several possibly atraumatic tips, so that the bone can be securely fixed even without previous detachment of the periosteum, without squeezing the periosteum. The bone jaws 12 may also be slightly concave in shape to better conform to the bone. Certain components such as the plate mounts and the Connecting rods are in turn made according to a further preferred embodiment of "radiotranslucent" material such as carbon, as far as this is reasonably possible for technical reasons.

The exact dimensions of the individual components can, depending on the indication and anatomical localization (wrist, fingers, tibia), be optimized again, with ultimately up to four different size dimensions (micro, mini, small and large fragments) making sense and practicable , but also special constructions for certain indications such as on the pelvis or on the spine as well as special size dimensions conceivable for use in pediatric surgery or in veterinary medicine.

This alternative version of the surgical clip 42 allows for increased variability, i. It can be used in many areas and still remains in their application very simple and straightforward, in principle, only two screws 51, 52 must be operated. Furthermore, this construction always allows an optimal working area for the subsequent drilling and screwdriving due to a minimum of space required in connection with the enormous variability.

The invention also includes the exact or exact terms, features, numerical values, or ranges, etc., as above or below, of such terms, features, numerical values, or ranges in the context of terms such as "about, about, substantially," Generally, at least, "etc." were called (ie "about 3" should also "3" or "substantially radial" should also include "radial"). means moreover "and / or".

Claims

P a te n ta nsp ar che

1 . Surgical holding device (42) for temporary fixation and alignment of an osteosynthesis plate (10) on a longitudinally extending (X) tubular bone (100) with:

a fixing device (1) for temporary fixing of the holding device (42) at two radially opposite fixing points (1 01, 102) on the tubular bone (100); and

a plate holder (2) connected to the fixing device (1) for holding and aligning the osteosynthesis plate (10) against the long bone (100),

characterized in that

the plate holder (2) holds the osteosynthesis plate (10) at two holding positions (103) against the long bone (100) spaced along the longitudinal direction (X) of the long bone (100), the first holding position being at a first distance (A) is spaced from the two fixing points (101, 102).

2. The surgical device according to claim 1, wherein the plate holder (2) has a first adjustable pressing device (21, 210) extending from the fixing device (1) along the longitudinal direction (X) of the long bone (100) over the first distance (A). is spaced, and the osteosynthesis plate (10) by means of pressing against the tubular bone (100) holds.

Device according to claim 2, wherein the plate holder (2) comprises a second adjustable pressing device (22, 220) spaced along the longitudinal direction (X) of the long bone (100) from the fixing device (1) according to a second distance (B) is.

4. The device of claim 3, wherein the first and / or second adjustable pressing means (21, 22) comprises at least one adjustable screw to press the Osteosynthesepiatte (10) against the bone (100).

5. Device according to one of claims 3 to 4, wherein the first and / or second pressing means (21, 22) the Osteosynthesepiatte (10) radially against the tubular bone (100) presses.

6. Device according to one of claims 2 to 5, wherein the first and second pressing means (21, 22) the Osteosynthesepiatte (10) pressed radially against the tubular bone (100), wherein the radial pressing direction about 90 ° about the longitudinal axis of the long bone offset from the two fixing points (101, 102).

7. Device according to one of the preceding claims, wherein the temporary fixing device (1) comprises a clamp, wherein the clamp via a clamping connection temporarily on the bone (100) is fixable.

8. Device according to one of claims 3 to 7, wherein the first distance (A) and / or second distance (B) is greater than the average diameter of the long bone (100).

9. Apparatus according to claim 8, wherein the first distance (A) and / or second distance (B) is 2x, 3x or even greater than the average diameter of the long bone (100).

10. Device according to one of the preceding claims, wherein the plate holder (2) consists at least partially of a material which

X-rays are less well absorbed than the bone tissue.

1 1. Device according to one of claims 3 to 9, wherein at least one pressing device jaws (210, 220) for directly pressing the osteosynthesis plate (10) to the bone and / or the fixing device (1) has bone jaws 12, which in X- , Y and / or Z direction are variably adjustable.

12. The apparatus of claim 1 1, wherein at least one pressing device (21, 22) at least one of the jaws (210, 220) having a limited freedom of movement, wherein the limited freedom of movement of the jaw (210, 220) of the anatomical shape of the long bone is adjusted ,

13. Device according to one of the preceding claims, wherein the connection point between the fixing device (1) and holding device (2) has a central component (50), wherein the central component has a limited to adapt to the anatomical shape of the tubular bone movement.

14. Device according to one of the preceding claims, wherein the holding device comprises a gear mechanism, wherein the gear mechanism fixes the fixing device to the tubular bone (100).

15. A method for temporary fixation and alignment of an osteosynthesis plate (10) on a longitudinally extending (X) tubular bone (100) by means of a surgical holding device, in particular with a holding device (42) according to one of claims 1 to 13, with the steps :

temporarily fixing the holding device (42) to at least two substantially radially opposite fixing points (101, 102) on the long bone (100); and Aligning the osteosynthesis plate (10) against the long bone (100) by means of a plate holder (2) connected to the fixing device (1),

characterized in that

the plate holder (2) holds the osteosynthesis plate (10) at least one holding position (103) against the long bone (100) spaced along the longitudinal direction (X) of the long bone (100) from the two fixing points (102, 103) (A) is.