JPH0455068B2 - - Google Patents

Description

[Detailed Description of the Invention] [Industrial Application Field] The present invention provides a bone fixation plate for screw fixation of an acetabular fragment to the ilium based on pelvic osteotomy by rocking the acetabular top;
Alternatively, the present invention relates to a bone fixation device including a bone fixation plate and a wire fastening device for fixing an acetabular fragment to the pubic bone.

[Conventional technology]

There are various double and triple osteotomy techniques for lumbar acetabular rocking, especially in hip dysplasia in the human range. A triple osteotomy, in which the acetabulum is separated almost spherically, is considered the most promising. This is because it allows the acetabulum to tilt laterally and ventrally. This requires separation in the ilium, ischium and pubis. First, an ischiotomy is performed, in which the ischial foramen is cut relative to the obturator foramen, and the ischium is maintained dorsally, but by a ligament that passes into the eminence, the dorsal column, and the sacrum. It should be noted in this case that the bony strip formed due to the fact that the obturator foramen is actually made and the ischium is sharply stretched to become the obturator membrane can also rotate the lumbar acetabulum. As such, it must be severed.

A pubic bone cut is then made just adjacent to the hip joint. The osteotomy is made into the obturator foramen in a slightly oblique direction parallel to the acetabulum, thereby maintaining bone contact after acetabular crown rocking and allowing rapid and sufficient bone formation.

As a third step, an iliac osteotomy is performed. Beforehand, during rotation and rocking of the acetabulum, a Steinmann nail is later inserted into the acetabulum as an aid, parallel to the planned oblique, centrally descending bone incision. The osteotomy of the ilium is performed first in the same plane using an oscillating saw and then using a chisel.

The acetabulum is then rotated and swung over the lumbar head. This rotation and rocking is done to such an extent that the lumbar head must be expanded in order to reach below the acetabular crown. For this purpose, the acetabular top is stretched over the lumbar head at the Steinmann nail and also pulled forward when necessary.
In addition, the central pubic branch is pressed upward in the rotational direction. The acetabulum is then leveled with manual pressure to ensure good contact with the pubic bone.

Adequate horizontal crowning of the head must be achieved by the sclerotic area or crescent of the acetabular crown. This is because it is a suitable surface for absorbing and transmitting compressive forces caused by loading the bone. The subsequent fixation of the acetabulum is carried out via Kirschuna wires which are passed into the acetabular fragment by the pelvic wings in four different directions, the posterior ends of these Kirschuna wires being pinched in the pelvic comb and Can be bent.
This type of fixation is difficult, often provides little stability and often does not lead to the desired outcome: the acetabulum is wobbly, adequate bone formation is very slow, and the patient is unable to move the pelvis for many weeks. I have to endure it while wearing a cast.

The main reason for this is the unstable fixation by the Kirshiyuna wire, but this fixation is especially necessary for the following reasons. That is, the iliac osteotomy is performed as a flat cut, so that a wedge-shaped gap opens between the iliac alar and the acetabular fragment during ventral and lateral acetabular rocking. This wedge-shaped gap created must necessarily be filled by a bone wedge sawn from the pelvic comb and implanted into this gap, so that the triple system thus created is fixed and, even with sufficient bone formation, Because it has to be obtained.

[Problem to be solved by the invention]

An object of the present invention is to stably fix the acetabulum to the iliac alar region and pubic bone by a triple osteotomy, so that it is no longer necessary to use a Kirschuna wire and to remove or insert a bone wedge from the iliac alar region. The aim is to provide a bone fixation device that does not require

[Means to solve the problem]

In order to solve this problem, according to the present invention, a bone fixation device includes a bone fixation plate for screw fixation of an acetabular fragment to the ilium based on pelvic osteotomy by rocking the acetabular top; The plate has a proximal portion contacting the iliac alar and a distal portion contacting the acetabular fragment, the proximal and distal portions having a generally wedge-shaped transition zone integral with these portions. 10° to 50° through
are twisted around each other with a twist angle of , and the maximum width of this transition zone is at the ventral edge of the plate.

Furthermore, according to the invention, the bone fixation device additionally includes a wire fastening device for fixing the acetabular fragment to the pubic bone, the wire fastening being screwed into the acetabular fragment and the pubic bone, respectively, at a small distance. and,
It has a wire wrapped around these screws that fastens both screws and thus the acetabular fragment to the pubic bone.

〔Effect of the invention〕

Thus, according to the present invention, the acetabulum can be stably connected to the iliac alar region by the bone fixation plate,
Moreover, the approximately wedge-shaped transition zone between the two parts of the bone anchoring plate that are twisted at an angle of 10° to 50° with respect to each other prevents the movement of the acetabular fragment, especially in the ventral and lateral movements. This allows for the inclination of the acetabular fragment, which allows the incisional edge of the acetabular fragment protruding from the iliac ala to be directed against the pressure load of the lower leg.

Furthermore, the acetabular fragment and the pubic bone can be stably joined by a wire fastening device in consideration of their shape.

When using the anatomical bone plate according to the invention, stable fixation and early load-bearing capacity of the hip joint and extremities are obtained, especially due to compressive osteosynthesis between the acetabular fragment and the iliac ala. , thus first and foremost a stable fixation of the load bearing. The result is rapid post-operative mobilization of the patient.

Stable fixation of the plate in the iliac alar area ensures that the optimal pressure absorption range in the iliac alar area is
as to its location, and thus starting from the anterior superior common iliac vertebrae and from the anterior inferior common iliac vertebrae by approximately one finger width, anterior to the iliac alar, slightly distal to the gluteal tubercle, and Advantageously, it is carried out in such a way that it is captured approximately up to the anterior gluteal ligament, in particular in the ventral part between the skull and the retaining part of the sacropelvic column.

The iliac cut required for acetabular crown rocking is not made as a flat cut, as is conventional, but after rocking the acetabular fragment ventrally and laterally, the acetabular fragment, ilium and between the ischium, especially with the osteotomy surface following the approximately cylindrical skin, which is very important for the biomechanical load transfer from the femur via the acetabulum to the ilium and for sufficient bone formation after surgery. Significant advantages are obtained if a cohesive union between the acetabular fragment, iliac ala and ischium is achieved.

In order to preserve congruence conditions, the main ischial incision is combined with the use of an anatomically fitting bone plate (fixation plate) according to the invention to achieve a cohesive union of the acetabular fragment and the iliac ala. This cutting process, which is approximated to the scar, results in a direct, motion- and load-bearing stable compressive bone synthesis between the ilium and the acetabular fragment without bone wedge insertion, and thus also in the hip joint and bone Creates direct reload bearing capacity. Coupled with sufficient unhindered bone formation, rapid post-operative mobilization is possible without immobilization, usually for several weeks, with a pelvic cast.

Furthermore, the cutting process, which is performed at a distance of at least 10 mm from the acetabular rim, and preferably more, allows the acetabular fragment to fit into the ischium without centrally narrowing the pelvic space. Bone contact is also guaranteed.

The pubic osteotomy, like the ischial osteotomy, is advantageously carried out as a flat cut, with the cut surface standing almost perpendicular to the obturator comb. This cutting process finally also ensures coplanar bone contact between the acetabular fragment and the pubic bone after movement of the acetabular crown.

The configuration of the anatomical bone fixation plate according to the invention for the telescopic connection of the iliac alar and the acetabular fragment allows for different plate cross-sections and adaptations to the pelvic surface for the left or right side of the pelvis. Needless to say, it is necessary. Because these plates are adapted in shape and size to fit into the proximal and distal placement areas that occur after movement of the acetabular apex, these plates require little internal surgical reshaping. I don't. The angle between the proximal plate part and the distal plate part is also adapted to the indication and surgical requirements, so that
Adaptation to the magnitude and type of acetabular crown movement is possible.

Here, the acetabular fragment, after its movement, in particular after its ventral rocking and lateral tilting, may for biomechanical reasons also have a total of 4 to 10
There may be cases where it has to be moved inward to the center of the body by a distance of mm. As a result, the acetabular fragment in its final position no longer projects laterally beyond the iliac lateral surface with its incisal edges no longer or partially projecting;
Rather than supporting the cut edge of the acetabular apex fragment in the transition area of the fixation plate, it is appropriate to support the wedge area of the fixation plate proximally on the cut surface of the ilium in its dorsal region. be.

〔Example〕

The invention will be explained below with reference to the drawings with reference to various embodiments of plates according to the invention.

In each figure the left pelvis section and the corresponding left fixation plate are shown.

FIG. 1 is a ventral side view of the left acetabular apex fixation after a triple osteotomy with ventral and lateral acetabular apex movement. Due to the movement of the acetabular top, a part of the osteotomy surface 12 (shaded area) protrudes ventrally across the outer surface of the ilium (OSIL in the drawing) in the acetabular fragment PF. The acetabulum is marked P in the acetabular fragment PF. The obturator and ischial foramina are designated FO and FI, respectively.

It can be seen that the iliac osteotomy is treated as an approximately cylindrical cut, ie the osteotomy surfaces on the acetabular fragment and the ilium are approximately cylindrical circumferential. We strive to perform spherical osteotomy according to the surgical conditions as much as possible. This is because it produces the best congruence after acetabular crown movement. By fixation plates 1, 2, 3 attached to the ventral region of the iliac wing, the acetabular fragment PF and the ilium are fixedly connected to each other in the osteotomy plane, and by the transition zone 3 of the fixation plate:
The protruding cut edge of the acetabular fragment is supported proximally and thus against the pressure loads of the lower leg.

In the area of the sciatic foramen FI, a fixed connection between the ilium and the acetabular fragment is found, which is carried out by means of a wire fastening device (cerclage) 10 via two screws.

The osteotomy surface of the ischium (OSIS in the drawing) is visible as the shaded area.

The fixed connection between the pubic bone OSPU and the acetabular fragment PF is
This is accomplished by a wire fastening device 10 consisting of screws inserted into the pubic bone and the acetabular fragment, respectively, and wires wrapped around these screws in a figure-eight pattern.

As can be seen in Figure 1, the proximal part 1 of the fixation plate
is screwed to the ventral part of the iliac ala, and the distal part 2 of the fixation plate is screwed to the acetabular fragment. A transition area 3 between the two parts 1 and 2 of the fixing plate
is located, and this transition zone proximally extends a portion of the portion of the osteotomy surface 12 of the acetabular fragment that forms a wedge that opens ventrally and projects ventrally beyond the iliac surface. I support it. The wedge area 3 forms a lateral extension of the ilium. The maximum width of the wedge area is at the ventral edge of the plate.

FIG. 2 corresponds to FIG. 1, but in this case the acetabular fragment has been moved sufficiently medially in accordance with the indication that the osteotomy surface 12 of the acetabular fragment is no longer in the intestine. It does not project ventrally beyond the external surface of the bone, but in the ventral region of the ilium it is approximately flush with this external surface, but in the dorsal direction it recedes more and more centrally below the osteotomy surface 13 of the ilium. From Figure 2, the fixed plate is
As in the case of FIG. 1, taking into account the three-dimensional (three-dimensional) situation, the wedge-shaped transition zone 3 is integrally formed with support on each surface in the plate area, in this case the wedge-shaped transition zone 3 is formed in the dorsal direction. It is widened to engage the osteotomy surface 13 on the ilium and form, as it were, on the ilium in order to support the lateral enlargement of the osteotomy surface 12 of the acetabular fragment in the proximal direction. The pubic bone is appropriately resected to allow for medial movement and, in some cases, for lateral tilting.

In order to clarify the above-mentioned differences, fixation plates corresponding to the states of FIGS. 1 and 2 are shown side by side in intermediate proximal views for comparison in FIGS. 3 and 4, and In this case 4 is the ventral edge and 5
is the dorsal margin. The plate according to FIG. 3 is used for the situation according to FIG. 1, and the plate according to FIG. 4 is used for the situation according to FIG.

Figures 4 and 4a show a cross-section and side view of a fixation plate, particularly for humans, in which the acetabular fragment PF is rotated, swung and tilted outwards relative to the ilium OSIL. . This angle of inclination is 5 or
It is 60°. Distal part 2 is 5 to proximal part 1
or tilted at 60°.

Figures 4b and 4c show a cross-section and side view of a fixation plate, particularly for humans, in which the acetabular fragment PF is rotated, swung, tilted outward and moved inward relative to the ilium OSIL. Ru. The inward movement part M is up to 13 mm depending on the patient's size, preferably 5 mm.
Preferably, the diameter is between 13 mm and 13 mm. The angle of inclination of the iliac OSIL and the acetabular fragment PF is set at 5 to 60°, and the inclination of the distal part 2 relative to the proximal part 1 is accordingly 5 to 60°.

The length of the ventral end of the transition zone 3 therefore corresponds to the required inward movement section M. Transition area 3 is
Starting from the ventral end, a proximal part 1 and a distal part 2
It expands dorsally depending on the angle formed between the two. The transition zone 3 is thus formed by the inward movement part MA due to the desired inward movement and the wedge-shaped part due to the angle between the parts 1 and 2. The maximum width of this fixed plate is at the dorsal edge.

FIG. 5 schematically shows an embodiment of the fastening plate in accordance with FIGS. 3 and 4, in which the two support possibilities mentioned above are combined. The use of a plate of this type is suitable if, in the final position of the acetabular fragment to be fixed, the lateral incisal edges intersect each other at the ilium and the acetabular fragment within the area of the fixation plate. The plate thus has a proximal transitional wedge region 3a in the dorsal direction and a distal transitional wedge region 3b in the ventral direction, in which case it bears supporting contact with the osteotomy surface 13 on the ilium. a proximal transition wedge section 3a for contacting the osteotomy surface 12 of the acetabular fragment and a distal transition wedge section 3b for supportingly contacting the osteotomy surface 12 of the acetabular fragment.
is provided. Wedge areas 3a, 3b in the plate
The size and position of are related to the desired final position of the acetabular fragment.

The plates shown in Figures 6 to 9 are three-dimensionally curved; Figure 6 shows the central part of the plate, that is, the mounting surface, Figure 7 is a ventral view, and Figure 8 is a far side view. FIG. 9 is a sectional view taken along the - line in FIG. 6.

The plate has a long proximal part 1 with six screw seats.
and a short distal part 2 with two screw seats, between which a wedge-shaped transition zone 3 is inserted, the maximum width of which extends beyond the ventral edge of the plate. It is in 4. Starting from the dorsal edge 5 of the plate, the parts 1, 2 therefore form an angle to each other (see especially FIG. 8), in which case the dorsal edge 5 essentially forms a uniformly curved edge. The ventral edge 4 is provided with a double fold with an obtuse angle. This can especially be seen from FIG. The transition edges 6 and 8 between the distal part 2 or the proximal part 1 and the transition zone 3 have the shape of arcuate sections.

In FIG. 9 the asymmetrical recesses 7, 7' of the screw seats can be seen, which for the screw seats in the distal part 2 are directed in direction 7 and for the screw seats in the proximal part 1 in the other direction 7'. They are equally inclined to each other. These screws are not inserted into the seats axially, but are offset slightly distally in the distal part 2 and slightly proximally in the proximal part. During screwing, the plate, if not rigid, is stretched by the wedge action of the sinking head of the screw in the wedge surface of the recess between the distal part 2 and the proximal part 1. Instead, the two parts to be joined by the plate, i.e. the ilium to which the proximal part 1 is screwed and the acetabular fragment to which the distal part 2 is screwed, are rigidly clamped, i.e. their end faces are pressed together. It will be done.

FIG. 10 shows a plate with just such a distal region 2 and a transition zone 3' widened ventrally relative to the proximal region 1. FIG. Complete support of the protruding incisal edge of the acetabular fragment is thereby achieved. Optionally, short screws can also be inserted distally into the acetabular fragment in the enlarged transition zone 3'. Appropriate screw seats are shown in dashed lines.

FIG. 11 shows a plate similar to the plate according to FIG. 10, but in which the transition zone 3' and the distal region are also extended in the dorsal direction with respect to the proximal region 1.

FIG. 12 shows a plate that engages the iliac osteotomy in the region up to the sciatic foramen and is screwed into the ventral and dorsal ends, thereby providing additional fixation in the region of the sciatic foramen.

FIG. 13 shows a plate similar to the plate according to FIG. 12, but in this plate the transition zone 3' and the distal part 2 extend in the proximal area, as can also be seen from FIGS. 10 and 11. It is expanded ventrally relative to 1. The central area of the proximal part 1 has been excised, so that the proximal area essentially consists of two lobes, the ventral lobes 1 being the anchor of the fixation between the skull and the retaining part of the sacropelvic column. The dorsal ear piece 1' is used for fixation in the area of the sciatic foramen. The proximal region of the plate can also be constructed continuously, as in the case of the embodiment according to FIG. 12, as indicated by the shading. Similarly, in the embodiment according to FIG. 12, the intermediate region of the proximal part can be appropriately excised.

The three-dimensional curvature of the plate for the mating contact with the iliac ala and acetabular fragment is clearly visible in the drawing. From FIG. 9 it can be seen that the proximal part 1 is configured convexly towards the iliac ala in the proximal-distal direction, and from FIG. It can be seen that it is concavely shaped towards the acetabular fragment in direction 28. Furthermore, Figure 7, Figure 8, Figure 1
0 and 11 that the proximal part 1 is additionally concavely curved in the ventral-dorsal direction towards the iliac ala. It can be seen from FIGS. 9 and 10 to 13 that the distal part 2 is additionally convexly curved in the proximal-distal direction towards the acetabular fragment.

The embodiments according to FIGS. 10, 11 and 13 may be modified so that a ventrally extending transition zone 3' brings the entire laterally projecting osteotomy surface into the acetabular fragment. It can be modified to support only the lateral edges rather than proximally.
For this purpose, the extended region 3' is narrowed relative to the course obtained by the wedge angle, so that the maximum width of the wedge-shaped transition zone is not at the ventral edge 4 of the plate. In this embodiment, screws cannot be inserted in the dorsal direction.

The fastening plate according to the invention can be constructed from all materials known for these purposes, in particular stainless steel alloys.

As already mentioned, the iliac osteotomy must be prepared in such a way as to maintain as high a congruence of the cut surfaces as possible after movement of the acetabular crown. In this case, a spherical bone is considered to be the geometrically ideal type, and this spherical osteotomy is of course difficult to realize surgically. It has now been found that a successful approach consists in relating a flat polygonal cut to an approximate oscillation angle that can be determined by X-ray diagnosis. For this purpose, close incisions of the same length as possible are made along the arc, each at the same angle to one another, in which case at least two flat partial incisions must be made in the ilium.

Such bone cutting process can be seen from FIG. The manner of illustration is the same as in FIGS. 1 and 2. The acetabular fragment has been shifted slightly towards the center in the dorsal region, so that the cut surface of the acetabular fragment is positioned ventrally in the region of the fixation plate (not shown) with respect to the lateral incisal edge of the ilium. It can be seen that it is retracted toward the center in the anterior direction and dorsal direction. This corresponds to using a plate fitted with a flat cutting process with respect to the edge profile according to FIG. Flat osteotomies in the ilium and ischium are visible. 16th
The shape and dimensions of the osteotomy treatment shown in the figure are as shown in the central figure.
This can be seen from FIGS. 14 and 15.

FIG. 14 is a schematic representation of the left hip joint in the plane of the ilium, as easily obtained by X-ray examination. For this purpose, the following conditions must be observed. That is, the X-ray source is centered articulatingly. The radial direction is perpendicular to the plane of the iliac alar. Make sure it is almost in line with your pubic bone. The X-ray source is moved as far as possible from the plane of the iliac ala or from the plane of the membrane parallel to this plane.

This photograph is used to determine osteotomy in the ilium. By radiography of the joint in various three-dimensional views, the approximate swing angle of the acetabular fragment,
In particular, the main angles for the ventral swing can be predetermined. This angle is in the range of about 25 to about 45°, often in the range of 28 to 38°, where cases of severe hip dysplasia often require a range of about 38° of oscillation. These photographs likewise determine the location of the center of the acetabulum.

One approach for determining the osteotomy in the ilium can be seen in FIG. Due to the configuration, the greater sciatic notch is extended proximally. This notch forms a cutting straight line. Furthermore, a tangent T ₁ is applied from the acetabular center PZ to the projection of the iliac curvature and subsequently to the greater sciatic notch, and a tangent T ₂ is applied from this projection to the projection of the ventroproximal acetabular rim. Cutting point I of the extension of the greater sciatic notch
together with the tangent T ₁ and the cutting point II with the tangent T ₂ form the first corner point of the desired polygonal process in close proximity, the cutting point I corresponding to a small swing angle and the cutting point II It was found that this corresponds to a large swing angle. FIG. 6 shows a swing with a large swing angle. Starting from the cutting point II, the straight line is therefore pulled away from the extension of the greater sciatic notch with a swing angle α to the point where the straight line cuts an arc with radius PZII . The resulting osteotomy length l is returned to the greater sciatic notch (l ₀ ) and applied further onto the arc (l ₁ ). A polygonal osteotomy process occurs in the ilium, resulting in a minimum distance l ₀ to the dorsal final point E of the ischial cut. The final point of the ischial osteotomy in the obturator foramen can be freely chosen within a certain range.

In FIG. 15, the acetabular fragment is seen to be swung due to the arrangement according to FIG. 14. Congruence results from the same angle and the same length l=l ₁ . The bone wedge in the area of the ischial foramen due to the cut shape is resected in the extension of l, and the distance to the dorsal end point E ₁ is chosen larger than l ₀ depending on the ischial cut, so that even in this area The osteotomy surfaces are in contact with each other.

It goes without saying that in the polygonal osteotomies according to FIGS. 14 to 16 the design of the fixing plate must be suitably adapted to the straight osteotomy course, especially with respect to the edges of the wedge-shaped transition zone.

If the acetabular center PZ is not chosen as the pivot point, shortening or lengthening of the bone can also be performed depending on the indication.

In order to carry out the osteotomy in practice, it is advantageous to provide a gauge or mold set in relation to the size and shape of the pelvis, which indicates the osteotomy polygon for the desired swing angle; During surgery, electrical knife incision marks in the ilium and ischium can be easily made by applying appropriate molds. In the same way,
A prefabricated fixation plate set can be provided.

Figures 17, 18 and 19 show a plate for use in a triple pelvic osteotomy with axial horizontal acetabular rocking in dogs, with the osteotomy course in the ilium and ischium The axis 14, which is guided perpendicularly to the dog's body axis, ie in the plane of the wedge region 3 and along which the acetabular fragment is swung laterally, extends parallel to the dog's lumbar spinal column. It can be seen that the maximum width of the transition zone 3 is in this case at the dorsal edge 5 of the plate. In this way, the pivot axis 14 can be brought closer to the acetabular center, which results in the most functionally advantageous joint geometry after the acetabular pivot. The rocking angle, ie the angle at which parts 1 and 2 oppose each other, is preferably in the range of about 20 to 70°, preferably in the range of 30 to 60°, especially about 45° in the case of dogs.

Note that 20 is a hole for a wire fastening device.

[Brief explanation of the drawing]

Figures 1 and 2 show acetabular fragment fixation in humans; Figure 3 is a schematic diagram of the plate configuration for use according to Figure 1; Figure 4 is a plate configuration for use according to Figure 2. Schematic diagram of Fig. 4a, Fig. 4b, Fig. 4
Figures c and 4d show an advantageous plate shape; Figure 5 shows an approximately wedge-shaped transition area for contacting the osteotomy of the acetabular fragment in a dorsal direction and on the osteotomy of the ilium; Figures 6 to 9 show the shape of the plate when followed by an approximately wedge-shaped transition area for contact;
Detailed views of the type of plate shape shown in the figure, Figures 10 to 13 are detailed views of variations thereof, and Figure 14 is a hip bone with a structure for detecting the course of polygonal osteotomy in the ilium. Diagram showing the X-ray projection of the mortar area, No. 15
The figure shows the X-ray projection shown in Fig. 14 after osteotomy and acetabular fragment rocking, Fig. 16 shows the state shown in Fig. 15, and Figs. 17 to 19 show the state shown in Fig. 15. Figure 3 shows a board provided for use on dogs. 1... Proximal part, 2... Distal part, 3... Transition area, 4... Ventral edge.

Claims (1)

[Scope of Claims] 1. A bone fixing device includes a bone fixing plate for screw fixing an acetabular fragment to the ilium based on pelvic osteotomy by rocking the top of the acetabulum; It has a proximal part 1 contacting the alar and a distal part 2 contacting the acetabular fragment, the proximal part and the distal part 1,2
However, there is a nearly wedge-shaped transition area 3 that is integrated with these parts.
bone anchoring device, characterized in that the bone fixation device is twisted with respect to each other through a torsion angle of 10 to 50 degrees, and that the maximum width of this transition zone 3 lies at the ventral edge 4 of the plate. 2. Device according to claim 1, characterized in that the approximately wedge-shaped transition zone 3 is configured to contact the osteotomy surface of the acetabular fragment or the ilium. 3. Claim characterized in that the dorsal side of the substantially wedge-shaped transition zone 3b, which contacts the osteotomy surface of the acetabular fragment, is followed by a substantially wedge-shaped transition zone 3a, which contacts the osteotomy surface of the ilium. The device according to item 1 or 2 of the scope. 4. Claims 1 to 4, characterized in that both parts 1, 2 of the bone anchoring plate, on the side closer to the acetabular fragment, have edges 8, 6 adapted to the osteotomy. Apparatus according to one of clause 3. 5. Device according to one of the claims 1 to 3, characterized in that the transition zone 3 forms an obtuse angle with the two parts 1, 2 of the bone anchoring plate, respectively. 6 The bone fixation plate is bent three-dimensionally, and the proximal portion 1
is formed substantially convexly towards the iliac ala, and the distal part 2 and the transition zone 3 are formed substantially concavely towards the acetabular fragment. The device according to item 1. 7 The proximal portion 1 has a greater extension than the distal portion 2 in the proximal-distal direction, and the transition zone 3 and the distal portion 2 have a greater extension than the proximal portion 1 in the ventral-dorsal direction. Device according to claim 1, characterized in that it has. 8. Device according to claim 1, characterized in that the bone anchoring plate has a greater extension in the proximal-distal direction than in the ventral-dorsal direction. 9. Device according to claim 1, characterized in that the bone fixation plate has a greater extension in the ventral-dorsal direction than in the proximal-distal direction. 10 the bone fixation plate is extended in a proximal-distal direction;
The non-circular screw seat is provided with an asymmetrical recess, which allows the screw to be offset slightly distally in the distal part 2 and slightly proximally in the proximal part 1, so that Device according to claim 1, characterized in that dynamic compressive forces are obtained between the acetabular fragment. 11. The device according to claim 1 (FIGS. 17 to 19), characterized in that both parts 1, 2 of the bone fixation plate are each provided with a hole 20 for a wire fastening device. . 12. Device according to claim 1 (FIG. 18), characterized in that the ventral edges of both parts 1, 2 of the bone fixation plate are straight. 13. Device according to claim 1, characterized in that both parts 1, 2 of the bone fixation plate are stepped. 14. The device according to claim 1 (FIG. 4a, Figure 4b). 15 A patent characterized in that the transition zone 3 includes a substantially wedge-shaped portion and a medial translational portion MA, the width of this medial translational portion being approximately 13 mm and extending from the ventral edge to the dorsal edge. Apparatus according to claim 1. 16 The bone fixation device includes a bone fixation plate for screw fixation of the acetabular fragment to the ilium based on pelvic osteotomy by rocking the acetabular top, and a wire fastening device for fixing the acetabular fragment to the pubic bone. , the bone fixation plate has a proximal part 1 and a distal part 2 which are twisted together at a torsion angle of 10 to 50 and contact the iliac alar and the acetabular fragment, respectively, through a generally wedge-shaped transition zone 3. The wire fastener 10 has two screws screwed into the acetabular fragment and the pubic bone at small intervals, and a wire that is passed around these screws and fastens both screws and thus the acetabular fragment and the pubic bone. A bone fixation device for fixing an acetabular fragment by triple pelvic osteotomy, characterized in that it has: