the drawings illustrate one of several different methods for fixation o fracture at the neck of a femur by means of a device according to the present invention . as previously indicated , fig1 depicts upper portions of a femur with a femur neck fracture 1 , and an outer bone fragment 2 and an inner bone fragment 3 on their respective sides of the fracture . a securing date 4 which forms part of the d vice according to the present invention for fixation means in the form of bone screws or bone nails , in the version depicted two substantially parallel bone screws 5 , 6 ( see fig9 - 11 ) for fixing the bone fragments 4 , 3 , is disposed on the outside of the outer bone fragment 2 . the respective bone screws 5 , 6 are preferably integral . the securing plate 4 is so arranged that it allows movement of the outer bone fragment 2 relative to it , i . e . it is not connected to the outer bone fragment nor arranged in some other way whereby it would have moved with the latter upon compression of the bone fragments 2 , 3 . in the femur , a guide wire 7 with a diameter of preferably about 2 . 4 mm has been drilled through the outer bone fragment 2 and into the inner bone fragment 3 under radioscopy and with guidance by a guide sleeve 8 with an inside diameter of preferably about 2 . 5 mm . the guide wire 7 is intended to guide a drill for drilling a hole for the bone screw 5 in the bore fragments 2 , 3 . according to the invention , the guide sleeve 8 for the guide wire 7 is applied in the securing plate 4 , by preferably being screwed firmly in a threaded hole 9 running through the plate , and having for the purpose an externally threaded forward end portion 10 ( see fig2 depicting the guide sleeve 8 when it has been unscrewed from the plate 4 ). this externally threaded forward end portion 10 does of course have an outside diameter corresponding to the diameter of the threaded hole 9 in the securing plate 4 , i . e . preferably about 9 - 10 mm . after the removal of the guide sleeve 8 for the guide wire 7 , a second wide sleeve 11 , with an inside diameter of preferably about 6 . 5 mm and an externally threaded forward portion with the same outside diameter as the first guide sleeve , is applied in , i . e . screwed into , the threaded hole 9 in the securing plate 4 ( fig3 ). this guide sleeve 11 is intended to guide a drill 13 , which has running through it a duct 12 for the wire guide 7 ( see fig5 - 10 ), for drilling the hole for the bone screw 5 in the bone fragments 2 , 3 . when the second guide sleeve 11 has been attached to the securing plate 4 , a gauge rod 14 is inserted at the rear of this guide sleeve and through the sleeve towards the bone 2 , 3 . the gauge rod 14 can be used in a conventional manner to indicate how far the drilling should go or how long the bone screw 5 should be for optimum function . in fig4 the gauge rod 14 has been removed . the hole for the bone screw 5 can now be drilled . accordingly , as illustrated in fig5 , the drill 13 provided with the duct 12 is introduced through the guide sleeve 11 towards the bone fragment 2 and the drilling of the hole for the bone screw 5 is commenced , using a suitable drive device 15 . the drill 13 has an outside diameter of preferably about 6 . 5 mm and fits exactly in the guide sleeve 11 . the drill 13 is guided by the guide sleeve 11 to a correct position against the bone fragment 2 and thereafter by the guide wire 7 through the bone fragment 2 and past the fracture 1 into the bone fragment 3 . monitoring that the hole for the bone screw 5 is of a correct length is carried out with advantage at the rear of the guide sleeve 1 where the drill 13 or the drive device 15 bears suitable markings 16 . this entails the drill 13 being halted about 2 cm from the tip of the guide wire 7 , i . e . about 2 cm before reaching the point to which the bon screw 5 is intended to be screwed in . after any necessary adjustment of the securing plate 4 sideways , a further second guide sleeve 11 is now applied as per fig6 in a second threaded hole 9 running through the plate . alternatively , a guide sleeve 8 for a guide wire 7 may be applied first and the same procedure as before , with the same parts as above , may be carried out . with advantage , although not depicted in the drawings , guide sleeves of desired kinds 8 , 11 may already from the outset be applied in the respective threaded holes 9 in the securing plate 4 to give the surgeon a better grasp for correct control of the guide wire 7 and the respective drills 13 , 17 . the guide sleeve 11 in the version depicted is intended to guide a drill 17 without a duct for the guide wire but with a conical tip ( see fig7 ). this solid drill 17 is driven in to a desired position for the bone screw 6 by means of the drive device 15 . the correct length is read with advantage at the rear of the guide sleeve 11 , where the drill 17 or the drive device 15 bears suitable markings 16 ( fig7 ). the drill 17 and the guide sleeve 11 for it are removed ( fig8 ), leaving a hole 18 for the one screw 6 in the bone fragments 2 , 3 , which hole is shorter than the distance to which the bone screw is intended to be screwed in . the bone screw 6 can now , by means of a first fixing portion in the form of a threaded forward end portion 19 , be screwed in through the free threaded hole 9 in the securing plate 4 ( see fig9 ) and into the hole 18 in the bone fragments 2 , 3 in order to fix these bone fragments . alternatively , the threaded forward end portion 19 of the bone screw 6 may be somewhat smaller and only be in contact with , i . e . ride on , the threads in the threaded hole 9 in the plate 4 . for example , the thread on the threaded forward end portion 19 of the bone screw 6 may be about 8 mm , while the thread in the threaded hole 9 in the securing plate 4 may , as previously indicated , be about 9 - 10 mm . the bone screw 6 is screwed in by using a suitable tool in the version depicted a suitable type of screwdriver 20 alternatively it is of course possible to conceive of using for his purpose the same drive device 15 as for the drills 13 , 17 . the bone screw 6 is screwed in until the second fixing portion in the form of a threaded rear end portion 21 thereof engages in the threaded hole 9 in the securing plate 4 and locks the bone screw to the plate , while at the same time the threaded forward portion 19 of the bone screw is screwed through the outer bone fragment 2 and into the inner bone fragment 3 for engagement therein and locking of the latter bone fragment to the bone screw and the plate , and hence also of the outer bone fragment 2 between the plate and the inner bone fragment . the middle portion 22 of the bone screw 6 , which is preferably unthreaded , has with advantage an outside diameter corresponding to that of the drill 17 , i . e . about 6 . 5 m . in fig1 the bone screw 6 is fully screwed in . in fig1 the drill 13 , the guide sleeve 11 for the drill , and the guide wire 7 have been removed . the bone screw 5 , preferably similar in form to the bone screw 6 , is screwed into the threaded hole 9 in the plate 4 freed by the removal of said items and into the hole 23 created by the drill 13 ( fig1 ) in the bone fragments 2 , 3 for fixation of the bone fragments . the result is a stable connection between the securing plate 4 and the bone screws 5 , 6 which prevents the bone screws from changing their angular position relative to the plate and relative to one another in such a way that the bone screws would have crossed one another . there is also optimum fixation of the bone fragments 2 . 3 by the bone screws 5 , 6 . however , the bone screws 5 , 6 are also configured , as a result of their smooth middle portion 22 , to allow the bone fragments 2 , 3 to be compressed so that the outer bone fragment 2 slides inwards away from the securing plate 4 towards the inner one fragment 3 into which the bone screws are firmly screwed . on such occasions , the securing plate 4 will , through being locked to the bone s move away from its abutment against the outer bone fragment 2 ( this is represented schematically in fig1 by the intermediate space 24 between the securing plate and the outer hone fragment ), but without affecting the strength of the connection and without any impairment of function . fig1 and 14 depict alternative versions of the securing plate 4 . the securing plate 4 has in these versions three threaded holes 9 for bone screws . in all the versions depicted , the threaded holes 9 for the bone screws run substantially parallel with one another so that the bone screws 5 , 6 will likewise run substantially parallel with one another . parallel running of the fixation means facilitates in particular the sliding movement of the outer bone fragment 2 along the fixation means ( along the middle portion 22 thereof ) for compression of the bone fragments . the securing plate 4 according to the present invention may be used not only for femur neck ( collum femoris ) fractures but also for , for example , upper arm ( humerus ) fractures . since during operations for fixation of bone fragments at bone fractures it is important that the fixation means assume exactly predetermined positions relative to the hone fragments and to one another , it is of advantage that the device according to the invention also allows the application of guide sleeves for guidance of drills for drilling holes for the bone screws in the bone fragments , and / or guide sleeves for guidance of guide wires for said drills , in the same holes in the securing plate as are intended for the fixation means . this means that surgical staff need no longer keep count of an unnecessarily large number of different items for performing an operation , operating time becomes shorter and risks and complications for patients are reduced . it will be obvious to one skilled in the art that the device according to the present invention can be modified and altered within the scope of the claims set out below without departing from the idea and objects of the invention . thus , as indicated above , the securing plate 4 may be used for guide sleeves 8 for guide wires and thereafter for guide sleeves 11 for drills or , for example , immediately for guide sleeves 11 for drills . the securing plate 4 may of course also be used only for guide sleeves 8 for guide wires , followed by drill guidance solely by guide wire , without special guide sleeves for drills . the securing plate 4 may also be used for bone screws of different kinds from the bone screws 5 , 6 described above or for other types of fixation means , e . g . bone nails . a bone nail may have a sleeve and , disposed therein , a pin arranged for movement in the sleeve so that at least a forward portion of the pin can be driven outwards through at least one side aperture in the sleeve , in which case this forward portion constitutes a first fixing portion in the form of at least one hook which engages in the inner bone fragment , and the respective bone nail has in addition a second fixing portion of the type described above . as the density in the inner bone fragment is greatest at its centre , it is of advantage if the respective bone nail is applied in such a way that the forward portion of the pin is caused , during the driving , to engage in the central portions of the bone fragment . the respective bone nail may also be so configured as to achieve engagement in the central portions of the inner bone fragment . for example , where there is a threaded second fixing portion , the threads therein may e so disposed and / or configured that said result is achieved . having the forward portion of the pin in the respective bone nail pointing towards the centre of the inner bone fragment not only means that the bone nails have a better grip in the inner bone fragment but also counteracts the risk of rotation or other movement of the bone nails . said first and second fixing portions of the fixation means may also be other than threaded portions . the size and choice of material of the constituent items of an operating set may vary as necessary and desired .
the present invention relates to a device for fixation of bone fragments at bone fractures . the device comprises at least two fixation means and a securing plate . with the object of preventing or counteracting re - dislocation , the respective fixation means each have a first fixing portion for fixing the fixation gleans in an inner bone fragment , a second fixing portion for locking the fixation means to the securing plate which is disposed on the outside of an outer bone fragment and allows movement of the outer bone fragment relative to it , so that the fixation means are prevented from changing their angular position relative to the securing plate and relative to one another , and a middle portion which is situated between the fixing portions and runs through the outer bone fragment , along which middle portion the outer bone fragment can slide inwards towards the inner bone fragment in which the fixation means is fixed .