Targeting adjustment

1. A targeting system for guiding a drill into at least one bore in a distal end portion of an intramedullary nail, comprising:

a distal targeting arm with a first end being configured to be coupled to a proximal end of the intramedullary nail, the intramedullary nail having a nail longitudinal axis extending from the proximal end of the intramedullary nail to the distal end of the intramedullary nail, the intramedullary nail capable of being bent relative to the nail longitudinal axis during insertion into an intramedullary canal of a patient;

an adjusting device coupled to a second end of the distal targeting arm, wherein the adjusting device comprises an adjusting element coupled to the targeting arm and a nail follower operatively coupled to the adjusting element, the nail follower including first and second targeting holes each being configured to receive a sleeve assembly configured to receive the drill;

wherein the adjusting element includes first and second screws which engage first and second threaded bores in the nail follower, wherein the nail follower has a follower longitudinal axis extending between the first and second targeting holes and the adjusting element has an element longitudinal axis extending parallel to the first and second screws, the follower longitudinal axis and the element longitudinal axis being perpendicular to one another in a neutral position, the first and second screws configured to be rotated in first or second directions within the threaded bores such that the follower longitudinal axis is pivoted relative to the element longitudinal axis such that positions of the first and second targeting holes are adjustable to positions other than the neutral position, so as to align targeting axes extending through the first and second targeting holes with locking axes extending through the locking holes at the distal end of the intramedullary nail when the nail longitudinal axis is bent; and

wherein the adjusting element first screw includes a first thread with a first pitch and the second screw includes a second thread with a second pitch, wherein the first pitch differs from the second pitch and wherein the first and second screws are coupled by a gear system with a gear ratio of 1:1.

2. The targeting device of claim 1 , wherein the adjusting element first screw rotates in an opposite direction relative to the second screw, when the adjusting element is operated.

3. The targeting device of claim 1 , wherein the first threaded bore in the nail follower is arranged adjacent the first targeting hole in the nail follower and the second threaded bore in the nail follower is arranged adjacent the second targeting hole, with threaded bore axes extending through the first and second threaded bores being oriented transverse to the targeting axes of the first and second targeting holes.

4. The targeting device of claim 3 , wherein the nail follower comprises first and second independent members, the first member including the first threaded bore and targeting hole and the second member including the second threaded bore and targeting hole, wherein the first member and the second member are movable relative to each other by rotation of the first and second screw so as to adjust the position of the targeting holes.

5. The targeting device of claim 1 , wherein rotation of the first and second screws in the first and second threaded bores of the nail follower respectively causes the position of a first targeting hole to be displaced by a first length and the position of the second targeting hole to be displaced by a second length, when the adjusting element is operated, wherein the first length is 8 to 12 percent larger than the second length.

6. The targeting device of claim 1 , wherein the adjusting device further comprises a housing containing the nail follower and the adjustment element, the housing including a plurality of radio-opaque markers with a distribution allowing determination of a 3D-orientation of the housing based on a 2D x-ray image.

7. A targeting system for guiding a drill into at least one bore in a distal end portion of an intramedullary nail, comprising:

a distal targeting arm with a first end being configured to be coupled to a proximal end of the intramedullary nail, the intramedullary nail having a nail longitudinal axis extending from the proximal end of the intramedullary nail to the distal end of the intramedullary nail, the intramedullary nail capable of being bent relative to the nail longitudinal axis during insertion into an intramedullary canal of a patient;

an adjusting device, the adjusting device being coupled to the distal targeting arm, wherein the adjusting device comprises an adjusting element operatively coupled to a nail follower including first and second targeting holes each being configured to receive a sleeve assembly for receiving the drill;

wherein the adjusting element includes first and second screws which engage first and second threaded bores in the nail follower, wherein the nail follower has a follower longitudinal axis extending between the first and second targeting holes and the adjusting element has an element longitudinal axis extending parallel to the first and second screws, the follower longitudinal axis and the element longitudinal axis being perpendicular to one another in a neutral position, the first and second screws configured to be rotated in first or second directions within the threaded bores such that positions of the first and second targeting holes are adjustable to positions other than the neutral position, so as to align targeting axes extending through the first and second targeting holes with locking axes extending through the locking holes at the distal end of the intramedullary nail when the nail longitudinal axis is bent; and

wherein the adjusting element first screw and second screw have equal pitches, wherein the first and second screws are coupled by a gear system with a gear ratio different from 1:1.

8. The targeting device of claim 7 , wherein the adjusting element first screw rotates in an opposite direction relative to the second screw, when the adjusting element is operated.

9. The targeting device of claim 7 , wherein the first threaded bore in the nail follower is arranged adjacent the first targeting hole in the nail follower and the second threaded bore in the nail follower is arranged adjacent the second targeting hole, with threaded bore axes extending through the first and second threaded bores being oriented transverse to the targeting axes of the first and second targeting holes.

10. The targeting device of claim 7 , wherein the nail follower comprises first and second independent members, the first member including the first threaded bore and targeting hole and the second member including the second threaded bore and targeting hole, wherein the first member and the second member are movable relative to each other by rotation of the first and second screw so as to adjust the position of the targeting holes.

11. The targeting device of claim 7 , wherein rotation of the first and second screws in the first and second threaded bores of the nail follower respectively causes the position of a first targeting hole to be displaced by a first length and the position of the second targeting hole to be displaced by a second length, when the adjusting element is operated, wherein the first length is 8 to 12 percent larger than the second length.

12. The targeting device of claim 7 , wherein the adjusting device further comprises a housing containing the nail follower and the adjustment element, the housing including a plurality of radio-opaque markers with a distribution allowing determination of a 3D-orientation of the housing based on a 2D x-ray image.

13. A targeting system for guiding a drill into at least one bore in a distal end portion of an intramedullary nail, comprising:

a distal targeting arm with a first end being configured to be coupled to a proximal end of the intramedullary nail, the intramedullary nail having a nail longitudinal axis extending from the proximal end of the intramedullary nail to the distal end of the intramedullary nail, the intramedullary nail capable of being bent relative to the nail longitudinal axis during insertion into an intramedullary canal of a patient;

an adjusting device, the adjusting device being coupled to the distal targeting arm, wherein the adjusting device comprises an adjusting element operatively coupled to a nail follower including first and second targeting holes each being configured to receive a sleeve assembly for receiving the drill;

wherein the adjusting element includes first and second screws extending along respective first and second longitudinal axes which engage first and second threaded bores in the nail follower, wherein the nail follower has a follower longitudinal axis extending between the first and second targeting holes and the adjusting element has an element longitudinal axis extending parallel to the first and second longitudinal axes, the follower longitudinal axis and the element longitudinal axis being perpendicular to one another in a neutral position, the first and second screws configured to be rotated in first or second directions within the threaded bores such that positions of the first and second targeting holes are adjustable to positions other than the neutral position with respect to the follower axis so as to align targeting axes extending through the first and second targeting holes with locking axes extending through the locking holes at the distal end of the intramedullary nail when the nail longitudinal axis is bent; and

wherein the adjusting element first screw and second screw are coupled by a gear system whereby rotation of the first screw causes the gear system to rotate the second screw to guide the targeting holes with respect to the follower axis.

14. The targeting device of claim 13 , wherein the adjusting element first screw rotates in an opposite direction relative to the second screw, when the adjusting element is operated.

15. The targeting device of claim 13 wherein the first and second screws have a different pitch and the gear system has a gear ratio of 1:1.

16. The targeting device as set forth in claim 13 wherein the first longitudinal axis and the second longitudinal axis are parallel to one another.