WO2018172974A1

WO2018172974A1 - Reconstruction intramedullary rod for treatment of fractures within femur neck and greater trochanter

Info

Publication number: WO2018172974A1
Application number: PCT/IB2018/051937
Authority: WO
Inventors: Józef Borowski
Original assignee: Medgal Sp. Z O.O.
Priority date: 2017-03-22
Filing date: 2018-03-22
Publication date: 2018-09-27
Also published as: PL232289B1; EP3600097A1; PL420955A1

Abstract

A reconstructive femoral nail for treatment of fractures within the femoral neck and greater trochanter, comprising a femoral intramedullary nail (1) for stabilizing fractures of the proximal part of the femur, comprising a proximal part, a neck bone screw hole in the proximal part, at least one anti-rotation pin hole arranged above the neck bone screw hole and a long axis of the femoral intramedullary nail (1); a neck bone screw (2) for stabilizing the femoral head, passing through the neck bone screw hole at an angle relative to the long axis of the proximal part of the femoral intramedullary nail (1), wherein the neck bone screw (2) is lockable against rotation and shifting relative to the femoral intramedullary nail (1); at least one anti-rotation pin (3) for blocking rotation of the femoral neck and femoral head relative to the femoral shaft, passing through the anti-rotation pin hole, essentially parallel to the neck bone screw (2). The reconstructive femoral nail characterizes in that the femoral intramedullary nail (1) comprises further at least one reconstructive screw hole arranged above at least one anti-rotation pin hole, and at least one reconstructive screw (4) for reconstructing the femoral greater trochanter, passing through the reconstruction screw hole, essentially perpendicularly to the long axis of the proximal part of the femoral intramedullary nail (1).

Description

RECONSTRUCTION INTRAMEDULLARY ROD FOR TREATMENT OF FRACTURES WITHIN FEMUR NECK AND GREATER TROCHANTER

FIELD OF THE INVENTION

[0001] The object of the invention is a reconstructive femoral nail for treatment of comminuted fractures of the proximal part of the femur, particularly fractures within the greater trochanter and femoral neck.

BACKGROUND OF THE INVENTION

[0002] A femoral intramedullary nail is known from the patent description No. PL 6463 I B, particularly for treatment of femoral neck fractures, in the form of a cannulated rod with reconstructive openings situated at an angle in the range of 120°÷ 135 to the nail axis and at an angle of 5°÷ 25 relative to other locking holes. The proximal part of the femoral intramedullary nail has threaded holes for bone screws, additionally enabling osteosynthesis of greater trochanter bone fragments.

[0003] An intramedullary stabilizer for treatment of fractures of the proximal part of the femur is known from the patent description No. PL 190375 B, consisting of an intramedullary nail having an arched profile and in the shape of an elongated cone having a round cross-section and with two holes drilled in the nail at an obtuse angle in the vertical plane only, having different diameters and threaded in their upper interior part for entry of an externally threaded guide sleeve, with a bone screw mounted slidably in the sleeve with an element enabling its screwing into the bone in the part to be osteosynthesized as well as a rod placed in the nail guide hole, stabilizing the axial position of the intramedullary nail, wherein the rod has a cylindrical thru-hole in the distal part for the fixing screw and a longitudinal recess for the screw for an axial compensation of the intramedullary nail position. [0004] An intramedullary nail is known from the Polish patent application No. PL 380676 A, containing at least one anti-rotation pin situated outside of the area of the compensating screw axis of symmetry and axially blocking a bone screw, wherein this anti-rotation pin is equipped with a thread. The bone screw is placed without non- rotatably- slidably within the sleeve and is fixed therein by means of a set screw, forming the preassembled unit.

[0005] A Gamma-type intramedullary nail is also known, wherein a neck bone screw is situated at an angle to the nail axis in the upper segment. Depending on needs, the bone screw angle of inclination amounts to 120°, 125°, 130° or 135°. The bone screw has four channels on its cylindrical segment, which interoperate with the compensating screw screwable from the top in the threaded hole leading to the fixed bone screw. The compensating screw enters one of the channels and secures the neck bone screw against shifting and rotation.

[0006] In a different realization, the Gamma-type intramedullary nail is additionally equipped in the proximal segment with an anti-rotation pin situated above the neck bone screw and parallel to it. The anti-rotation pin, more precisely, the anti-rotation screw, forms a threaded joint with the intramedullary nail. [0007] The DHS angular bone plate is also known, wherein a bone screw is situated in an upper segment, at an angle of 125°, 130° or 135° to the plate body depending on needs. The bone screw is situated in the plate in non-rotationally-slidably and is secured against sliding out of the plate by means of a compression screw.

[0008] However, the aforementioned known reconstructive femoral nails do not allow for reconstructing the anatomy of the greater trochanter in the proximal segment, which is the point of attachment for important muscle groups, adversely effecting the treatment process and further rehabilitation.

SUMMARY OF THE INVENTION

[0009] An aim of the invention is to provide a reconstructive femoral nail that allows treatment of fractures of the proximal epiphysis of the femur, particularly fractures within the femoral neck and greater trochanter.

[0010] These and other aims of the present invention, which will arise from the following description, are achieved by a reconstructive femoral nail, the primary features thereof have been specified in independent claim 1. [0011] Preferred embodiments of the invention are specified in dependent claims 2 to 19.

[0012] The advantage of the reconstructive femoral nail according to the invention for treatment of fractures within the femoral neck and greater trochanter is capability of treating comminuted fractures of the proximal part of the femur. [0013] Yet another advantage is the capability of reconstructing the anatomy of the proximal femoral epiphysis, particularly the anatomy of the greater trochanter, which is the point of attachment for important muscle groups, beneficially effecting the process of treatment and further rehabilitation.

[0014] Faster rehabilitation during the post-operative period thanks to reconstruction of the anatomy of the proximal part of the femur is another advantage. [0015] Yet another advantage is the capability of securing the femoral head against rotation during insertion of the neck bone screw by means of the anti-rotation pin.

BRIEF DESCRIPTION OF THE DRAWING FIGURES

[0016] The subject of the invention is illustrated by the realization example in the drawing, wherein: Fig. 1 shows a side view with partial longitudinal cross-sections of one embodiment of an reconstructive femoral nail according to the invention,

Fig. 2 shows a front-back view of the embodiment of the reconstructive femoral nail from fig. 1,

Fig. 3 shows a top view of the embodiment of the reconstructive femoral nail from fig. 1

Fig. 4 shows a front-back view of another embodiment of the reconstructive femoral nail according to the invention,

Fig. 5 shows a side view with partial longitudinal cross-sections of yet another embodiment of the reconstructive femoral nail according to the invention,

Fig. 6 shows a side view of the embodiment of the reconstructive femoral nail design according to the invention from fig. 5,

Fig. 7 shows a top view of embodiment of the reconstructive femoral nail design from fig. 5,

Fig. 8 shows a bottom view of the embodiment of the reconstructive femoral nail from fig. 5,

Fig. 9 shows a side view of further embodiment of the reconstructive femoral nail according to the invention,

Fig. 10 shows a front-back view of a preferred embodiment of the reconstructive femoral nail from fig. 6 with a reinforcing element,

Fig. 11 shows a side view with partial longitudinal cross-sections of the preferred embodiment of the reconstructive femoral nail according to the invention from fig. 10, Fig. 12 shows a front-back view of the preferred embodiment of the reconstructive femoral nail from fig. 9 with a reinforcing element.

DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION

[0017] Referring to figures, a reconstructive femoral nail according to the invention, intended for treatment of fractures within the femoral neck and greater trochanter comprises a femoral intramedullary nail 1 for arranging in the medullary cavity of the femur. The femoral intramedullary nail 1 comprises a bone neck screw hole in the proximal part. The axis of the neck bone screw hole is arranged at an angle a in the range from 120° to 135°, relative to the long axis the proximal part of the femoral intramedullary nail 1, as seen in the front-back view as in fig. 2, 4, 6, 9, 10 and 12.

[0018] A neck bone screw 2 is arranged in the bone screw hole for proper orientation and stabilization the neck and head of the femur relative to the femoral shaft, wherein an angle a at which the neck bone screw 2 is arranged relative to the long axis of the proximal part of the femoral intramedullary nail 1 is defined by the neck bone screw hole, as specified above, as seen in the front-back view as shown in fig. 2, 4, 6, 9, 10 and 12. A known neck bone screw is used. Therefore, the matter of the neck bone screw will not be discussed further here. The neck bone screw 2 is locked in its position against shifting and rotation by means of a compensating screw 7. The compensating screw 7 is arranged in a threaded hole in the long axis of the proximal part of the femoral intramedullary nail 1 from the top of the proximal part of the femoral intramedullary nail 1, as shown in fig. 1 and 5. The femoral intramedullary nail 1 comprises a blind screw 5, as shown in fig. 1, 3, 5 and 7, securing the femoral intramedullary nail 1 against osseous tissue overgrowth.

[0019] At least one threaded hole for the anti-rotation pin is arranged in the proximal part of the femoral intramedullary nail 1, above the neck bone screw hole in the direction of the top end of the nail 1. The axis of the anti-rotation pin hole is essentially parallel to the axis of the neck bone screw hole. In one preferred embodiment, this at least one the anti-rotation pin hole is arranged laterally relative to the long axis of the proximal part of the femoral intramedullary nail 1, as shown in the figures. In one preferred embodiment, the femoral intramedullary nail 1 comprises one anti-rotation pin hole, arranged laterally on the left or on the right side relative to the long axis of the proximal part of the femoral intramedullary nail 1. In another preferred embodiment, the femoral intramedullary nail 1 comprises two anti-rotation pin holes, wherein one of them is arranged laterally on the left side and the other is arranged laterally on the right side of the long axis of the proximal part of the femoral intramedullary nail 1, on the side opposite to the first the anti-rotation pin hole, as shown in fig. 1 and 5.

[0020] An anti-rotation pin 3 is placed in the anti-rotation pin hole for blocking rotation of the femoral head relative to femoral shaft, wherein an angle at which the anti-rotation pin 3 is arranged relative to the long axis of the proximal part of the femoral intramedullary nail 1 and the neck bone screw 2 is determined by the anti-rotation pin hole, as specified above. The anti-rotation pin 3 is screwed into the anti-rotation pin hole and is essentially parallel to the neck bone screw 2, and at an angle a in the range from 120° to 135°, as seen in the front-back view shown in fig. 2, 4, 6, 9, 10 and 12. Depending on needs, one anti- rotation pin 3 can be used. This single anti-rotation pin 3 may be arranged on the left side, as shown in fig. 3 and 7, or on the right side relative to the long axis of the proximal part of the femoral intramedullary nail 1, as needed. Two anti-rotation pins 3 can also be used, in both anti-rotation pins holes, accordingly. A known anti-rotation pin is used. Therefore, the matter of the anti-rotation pin will not be discussed further here. [0021] The femoral intramedullary nail 1 comprises at least one hole for the bone screw at its distal end. The axis of the bone screw hole is essentially perpendicular to the long axis of the distal part of the femoral intramedullary nail 1. In one preferred embodiment, the axis of the bone screw hole runs essentially in the same direction as the axis of the neck bone screw hole, as seen in the top view. In another embodiment, the axis of this hole runs at an angle relative to the axis of the neck bone screw hole. In such a preferred embodiment, the axis of the bone screw hole runs to the left at an angle p or to the right at an angle ε relative to the axis of the neck bone screw hole, as seen in the top view. Angle p and ε is independently in the range from 0° to 30°. In yet another preferred embodiment, the femoral intramedullary nail 1 comprises in the distal part two bone screw holes, the axes of which run independently, as described above. In the most preferred embodiment, the femoral intramedullary nail 1 comprises two bone screw holes, wherein the axis of the first reconstructive screw hole runs to the left at an angle p, and the axis of the second reconstructive screw hole runs to the right at an angle ε, wherein angles p and ε are independently in the range from 0° to 30°. The bone screw hole(s) is/are arranged on the long axis of the distal part of the femoral intramedullary nail 1.

[0022] A bone screw 6 is placed in the bone screw hole for distal locking the femoral intramedullary nail 1 in the femoral shaft, wherein the angle at which the bone screw 6 is arranged relative to the long axis of the distal part of the femoral intramedullary nail 1 is determined by bone screw the hole, as indicated above. Depending on needs, one or more bone screws 6 may be used. In one preferred embodiment, a single bone screw 6 is used, wherein this single screw 6 is screwed into the bone screw hole and has the orientation of the given bone screw hole, as described above. The bone screw 6 is screwed into the reconstructive screw hole and is essentially at a right angle to the long axis of the distal part of the femoral intramedullary nail 1 and runs essentially in the same direction as the neck bone screw 2, as seen in the front-back view shown in fig. 2. Alternatively, the bone screw 6 is screwed into the bone screw hole and is essentially at a right angle to the long axis of the distal part of the femoral intramedullary nail 1 and runs to the left at an angle p relative to neck bone screw 2, or alternatively, to the right at an angle ε, wherein angles p and ε are independently in the range from 0° to 30° (not shown in figures). In another preferred embodiment, two bone screws 6 are used. In this case, the bone screws 6 are screwed into the reconstructive screw holes and are essentially at a right angle to the long axis of the distal part of the femoral intramedullary nail 1 and run, accordingly, to the left at an angle p and to the right at an angle ε relative to neck bone screw 2, as seen in the view from the top as shown in fig. 8, wherein angles p and ε are independently in the range from 0° to 30°. Depending on needs, a different combination of two bone screws 6 can also be used, the distribution and orientation of which is determined by the distribution and orientation of the bone screw holes. The use of at least two bone screws 6 in any of the angular configurations, as described above, allows multi-planar locking the femoral intramedullary nail 1 in the femoral shaft, resulting in even more certain convalescence during treatment of fractures of the proximal part of the femur. A known bone screw is used. Therefore, the matter of the bone screw will not be discussed further here.

[0023] At least one threaded hole for the reconstructive screw is arranged in the proximal part of the femoral intramedullary nail 1 , above the neck bone screw and the anti- rotation pin hole(s), in the direction of the top end of the nail 1. The axis of the reconstructive screw hole is essentially perpendicular to the long axis of the proximal part of the femoral intramedullary nail 1, as shown in fig. 1 to 2, 4 to 6, 9 to 10 and 12.

[0024] In one preferred embodiment, the femoral intramedullary nail 1 comprises one reconstructive screw hole. In a preferred embodiment, the axis of the reconstructive screw hole essentially runs in the same direction as the axis of the neck bone screw hole, as seen in the view from the top. In another preferred embodiment, the axis of this hole runs at an angle relative to the axis of the neck bone screw hole. In this embodiment, the axis of the reconstructive screw hole runs to the left at an angle β or to the right at an angle δ relative to the axis of the neck bone screw hole. Angle β and δ is independently in the range from 10° to 85°. In another preferred embodiment, the femoral intramedullary nail 1 comprises two reconstructive screw holes, the axes of which run independently, as described above. In more preferred embodiment, the femoral intramedullary nail 1 comprises two reconstructive screw holes, wherein the axis of the first reconstructive screw hole runs to the left at an angle β, and the axis of the second reconstructive screw hole runs to the right at an angle δ, wherein angles β and δ are independently in the range from 10° to 85°. In the most preferred embodiment, the femoral intramedullary nail 1 comprises four reconstructive screws holes. Preferably, the four reconstructive screw holes are arranged in groups of two each, wherein one group of holes is arranged above another group of the reconstructive screw holes, as shown in fig. 5, 6, 9 to 12. Preferably, the reconstructive screw holes in each group run independently at an angle of β and δ, accordingly, as described above. The use in the proximal part of the femoral intramedullary nail 1 of four reconstructive screw holes enables adaptation of the configuration of reconstructive screws 4 to the type of comminuted fracture of the femoral proximal part. The use of multiple reconstructive screw holes allows better fixture of reconstructive screws in fragments. The reconstructive screw hole(s) is/are arranged laterally relative to the long axis of the proximal part of the femoral intramedullary nail 1, as shown in fig. 1 to 3. Alternatively or additionally, the reconstructive screw hole(s) is/are arranged essentially on the long axis of the proximal part of the femoral intramedullary nail 1, as shown in fig. 4 and 6 to 12. In one preferred embodiment, the screw holes intersect within the femoral intramedullary nail 1, as shown in fig. 6 to 12. In another preferred embodiment, the screw holes do not intersect within the femoral intramedullary nail 1, i.e. , they are distributed next to one another in the proximal part of the femoral intramedullary nail 1 above the anti-rotation pin hole(s). [0025] A reconstructive screw 4 is arranged in the reconstructive screw hole for stabilizing the femoral greater trochanter, wherein the angle at which the reconstructive screw 4 is oriented relative to the long axis of the proximal part of the femoral intramedullary nail 1 and the neck bone screw 2 is determined by the reconstructive screw hole, as indicated above. Depending on needs, one or more reconstructive screws 4 may be used. In one preferred embodiment, a single reconstructive screw 4 is used, wherein this single screw is screwed into the reconstructive screw hole and has the orientation of the given reconstructive screw hole, as described above. The reconstructive screw 4 is screwed into the reconstructive screw hole and is essentially at a right angle to the long axis of the proximal part and runs essentially in the same direction as the neck bone screw 2, as shown in fig. 4. Alternatively, the reconstructive screw 4 is screwed into the reconstructive screw hole and is essentially at a right angle to the long axis of the proximal part and runs to the left at an angle β relative to the neck bone screw 2, as shown in fig. 9, or alternatively, to the right at an angle δ (not shown in figures), wherein angles β, δ are independently in the range from 10° to 85°. In another preferred embodiment, two reconstructive screws 4 are used. In this case, the reconstructive screws 4 are screwed into the reconstructive screw holes and are essentially at a right angle to the long axis of the proximal part and run, accordingly, to the left at an angle β and to the right at an angle δ relative to the neck bone screw 2, as shown in fig. 3 and 7, wherein angles β, δ are independently in the range from 10° to 85°. In the case of the femoral intramedullary nail 1 with four reconstructive screw holes, one or two reconstructive screws 4 in the desired angular configuration are used as needed. As mentioned above, the use of a reconstructive screw(s) in the femoral intramedullary nail 1 with multiple holes in various configurations enables better reconstruction in comminuted fractures of the proximal part of the femur. This is particularly important in the case where the fracture line is close to the reconstructive screw and the reconstructive screw is in a low position. In such a case, the appropriate reconstructive screw hole can be selected and reconstructive screw 4 can be used in a manner eliminating the risk that a bone fragment breaks off during fixing the reconstructive screw 4. Depending on needs, a different combination of two reconstructive screws 4 can also be used, the distribution and orientation of which are determined by the distribution and orientation of the reconstructive screw holes.

[0026] As mentioned above, a reconstructive screw 4 is used for stabilizing the femoral greater trochanter. In one preferred embodiment, a reconstructive screw 4 is threaded throughout its entire length, as shown in fig. 5 to 9. In another preferred embodiment, a reconstructive screw 4 is partially threaded in order to enable strong and precise compression of fragments of the greater trochanter, as shown in fig. 1 to 4. In yet another preferred embodiment, the recurrent screw 4 is grounded at its tip, and it is not threaded near the screw head. In the case of such a reconstructive screw 4, it is possible to lead the thread to only one of the fragments. In the case where the femoral intramedullary nail 1 comprises two or more reconstructive screws 4, then, depending on needs, reconstructive screws 4 of the identical or different threading can be used, as described above.

[0027] In a preferred embodiment, the femoral intramedullary nail 1 comprises a reinforcing element 8 for reinforcing the joint between the femoral intramedullary nail 1 and the reconstructive screw(s) 4. The reinforcing element 8 is arranged inside the femoral intramedullary nail 1, at the least around the reconstructive screw hole(s). In a preferred embodiment, the reinforcing element 8 is arranged inside the femoral intramedullary nail 1 in the hole on the long axis of the proximal part of this nail 1. In an even more the preferred embodiment, the reinforcing element 8 is arranged in the hole inside the femoral intramedullary nail 1 over the length, essentially, from the compensating screw 7 to the blind screw 5, as shown in fig. 11. The reinforcing element comprises at least one reconstructive screw hole, wherein the number of the reconstructive screw holes in the reinforcing element 8 corresponds to the number of the reconstructive screw holes in the femoral intramedullary nail 1. The position and orientation of the reconstructive screw hole(s) in the reinforcing element 8 correspond to the position and orientation of the reconstructive screw hole(s) in the femoral intramedullary nail 1, as described above. In a preferred embodiment, the reconstructive screw hole(s) in the reinforcing element have a smaller diameter than the reconstructive screw hole(s) in the femoral intramedullary nail 1, enabling intraoperational threading the reinforcing element 8 and more stable fixation of bone fragments to the nail. In a preferred embodiment, the reinforcing element 8 is a sleeve. The use of a sleeve allows for free access to the compensating screw 7 for regulation during implantation of the femoral intramedullary nail 1 in the femur. Alternatively, the reinforcing element 8 is a cylinder. The reinforcing element 8 is installed in the femoral intramedullary nail 1 by means of any suitable method. Preferably, the reinforcing element 8 is manufactured separately from the femoral intramedullary nail 1, then the reinforcing element 8 is placed in the femoral intramedullary nail 1. Preferably, reinforcing element 8 is placed in the femoral intramedullary nail 1 with so-called negative allowance. However other methods of fixing the reinforcing element 8 in the femoral intramedullary nail 1 are possible, including for example, but not limited to, gluing. The reinforcing element is manufactured from any biocompatible medical material that ensures strengthening of the joints between the femoral intramedullary nail 1 and the reconstructive screw(s) 4. Preferably, the reinforcing element 8 is made from plastic, including for example, but not limited to, ultra-high molecular weight polyethylene (UHMWPE), polyether ether ketone (PEEK). Preferably, the reinforcing element 8 is made from polyether ether ketone. [0028] The reconstructive femoral nail according to the invention significantly improves the conditions for treatment of fractures within the femoral neck and greater trochanter, particularly comminuted fractures of the proximal epiphysis of the femur, and also accelerates rehabilitation during the post-operative period. [0029] The features, as specified in the above described embodiments of the invention, particularly in the preferred embodiments of the invention, may be freely combined or replaced in any combination, and all potential new connections or combinations are considered to be fully disclosed in the description of the present invention. [0030] The invention has been described above using the preferred embodiments that serve solely as examples. Based on the above disclosure, a specialist will identify that modifications, variants or equivalents consistent with the inventive spirit and intent of the present invention are possible without exceeding the scope of the appended patent claims.

List of references 1 femoral intramedullary nail,

2 neck bone screw,

3 anti-rotation pin,

4 reconstructive screw,

5 blind screw,

6 bone screw,

7 compensating screw,

8 reinforcing element.

Claims

PATENT CLAIMS

1. Reconstructive femoral nail for treatment of fractures within the femoral neck and greater trochanter, comprising a femoral intramedullary nail (1) for stabilizing fractures of the proximal part of the femur, comprising a proximal part, a neck bone screw hole in the proximal part, at least one anti- rotation pin hole arranged above the neck bone screw hole, and a long axis of the femoral intramedullary nail (1); a neck bone screw (2) for stabilizing the femoral head, passing through the neck bone screw hole at an angle relative to the long axis of the proximal part of the femoral intramedullary nail (1), wherein the neck bone screw (2) is lockable against rotation and shifting relative to the femoral intramedullary nail (1); at least one anti-rotation pin (3) for blocking rotation of the femoral neck and femoral head relative to the femoral shaft, passing through the anti-rotation pin hole essentially parallel to the neck bone screw (2); characterized in that the femoral intramedullary nail (1) comprises further at least one reconstructive screw hole arranged above at least one anti-rotation pin hole, and at least one reconstructive screw (4) for reconstructing the greater trochanter of the femur, passing through the reconstructive screw hole essentially perpendicularly to the long axis of the proximal part of the femoral intramedullary nail (1).

2. Reconstructive femoral nail according to claim 1 , characterized in that the neck bone screw (2) is arranged at an angle (a) in the range from 120° to 135°, relative to the long axis of the proximal part of the femoral intramedullary nail (1).

3. Reconstructive femoral nail according to claim 1 , characterized in that the neck bone screw (2) is locked by means of a compensating screw (7).

4. Reconstructive femoral nail according to claim 3, characterized in that the compensating screw (7) is arranged in the long axis of the femoral intramedullary nail (1) for blocking the neck bone screw (2).

5. Reconstructive femoral nail according to claim 1, characterized in that at least one anti-rotation pin hole is arranged laterally relative to the long axis of the proximal part of the femoral intramedullary nail (1).

6. Reconstructive femoral nail according to claim 1, characterized in that the femoral intramedullary nail (1) comprises a first anti-rotation pin hole arranged laterally relative to the long axis of the proximal part of the femoral intramedullary nail (1).

7. Reconstructive femoral nail according to claim 6, characterized in that the femoral intramedullary nail (1) comprises a second anti-rotation pin hole arranged laterally relative to the long axis of the proximal part of the femoral intramedullary nail (1) on the side opposite to the first hole for anti-rotation pin (3).

8. Reconstructive femoral nail according to claim 1, characterized in that the femoral intramedullary nail (1) comprises at least one bone screw hole in its distal part, wherein a bone screw (6) for immobilizing the femoral intramedullary nail (1) in the medullary cavity of the femur, that is placed, passes through the bone screw hole essentially at a right angle to the long axis of the distal part of the femoral intramedullary nail (1).

9. Reconstructive femoral nail according to claim 8, characterized in that the bone screw (6) passes through the bone screw hole essentially perpendicularly to neck bone screw (2).

10. Reconstructive femoral nail according to claim 8, characterized in that the bone screw (6) passes through the bone screw hole at an angle (ε, p) in the range from 0° to 30° relative to the neck bone screw (2).

11. Reconstructive femoral nail according to claim 1, characterized in that the femoral intramedullary nail (1) comprises one reconstructive screw hole arranged essentially centrally relative to the long axis of the proximal part of the femoral intramedullary nail (1).

12. Reconstructive femoral nail according to claim 1, characterized in that at least one reconstructive screw hole is arranged laterally relative to the long axis of the proximal part of the femoral intramedullary nail (1), wherein a reconstructive screw (4), that is placed, passes through the reconstructive screw hole at an angle (β, δ) in the range from 10° to 85° relative to neck bone screw (2).

13. Reconstructive femoral nail according to claim 1, characterized in that the femoral intramedullary nail (1) comprises a first reconstructive screw hole arranged laterally relative to the long axis of the proximal part of the femoral intramedullary nail (1), wherein the reconstructive screw (4), that is placed, passes through the reconstructive screw hole at an angle (β, δ) in the range from 10° to 85° relative to neck bone screw (2).

14. Reconstructive femoral nail according to claim 13, characterized in that the femoral intramedullary nail (1) comprises a second reconstructive screw hole arranged laterally relative to the long axis of the proximal part of the femoral intramedullary nail (1), on the side opposite to the first reconstructive screw hole, wherein the reconstructive screw (4), that is placed, passes through the reconstructive screw hole at an angle (β, δ) in the range from 10° to 85° relative to neck bone screw (2).

15. Reconstructive femoral nail according to claim 1, characterized in that the reconstructive screw (4) is partially threaded for precise compressing fragments of the greater trochanter.

16. Reconstructive femoral nail according to claim 1, characterized in that it comprises further a reinforcing element 8 for reinforcing the joint between the femoral intramedullary nail 1 and the reconstructive screw(s) 4, provided inside the femoral intramedullary nail 1, at the least around the reconstructive screw hole(s) of the nail 1.

17. Reconstructive femoral nail according to claim 16, characterized in that the reinforcing element 8 is arranged in a hole in the long axis of the proximal part of the femoral intramedullary nail 1.

18. Reconstructive femoral nail according to claim 17, characterized in that the reinforcing element 8 is a sleeve.

19. Reconstructive femoral nail according to claim 16, characterized in that the reinforcing element 8 is made of plastic, preferably polyether ether ketone.