WO2019185077A1 - System for repositioning fragments of the musculoskeletal apparatus by cable osteosynthesis - Google Patents

Abstract

The invention relates to a system for repositioning fragments of the musculoskeletal apparatus, having a surgical cable (1), a tensioning instrument (2) with a tensioning mechanism (3) for generating a tensile force on the surgical cable (1), and a crimp barrel (4) designed for fixing the surgical cable (1) to be tensioned on at least one fragment (5) of the musculoskeletal apparatus. The crimp barrel (4) comprises a contact region (6) with a bore (7) leading from the upper side to the lower side thereof and a deformation region (8) provided on the upper side of the contact region (6). The deformation region (8) is formed from two crimp wings (9) which can be pressed flat against each other and are arranged opposing each other on the bore (7) above the contact region (6). One crimp wing (9) has a clamping face (10) facing the bore (7) and a pressing face (11) facing away from the bore (7), the pressing face (11.1) of the first crimp wing (9.1) and the pressing face (11.2) of the second crimp wing (9.2) forming an angle α (12) of 0° < x < 180°.

Description

 System for repositioning of fragments of the supporting apparatus by means of a rope osteosynthesis

The invention relates to a system for reduction and stabilization of fragments of the human musculo-skeletal system or in animals. Such systems have long been known in surgery and familiar to the trade public under the name Seilcerclage or Seilosteotomie.

The Seilosteosynthese became known through the publications of Prof. Labitzke end of the nineties of the last century. She replaced the wiring of the fragments. Unlike pure wiring with a surgical

Solid wire, which entangles the ends of the wires to provide sufficient tension on the fragments to be reduced, must be clamped to wire ends that are more flexible to use but tend to quickly recover after twisting.

Seilfundamentierung and rope fixation of the wire rope is carried out in most known Seilosteosynthesen therefore by means of crimping or clamping sleeves, in which the ends of the wire rope clamped and jammed by deformation of the sleeves therein.

 Among other things, EP 1 933 740 B1 describes a fastening device for such a rope cerclage system, in which one end of the surgical wire rope has a thickening, which is inserted into a clamping element and prevented by the end-side thickening of slipping out. The second end is looped around the bone. The loop is closed by pulling the second end through an opening in the clamping element and then fixing the wire rope in the clamping element.

A clamping sleeve, in which both ends of the surgical wire rope in the

Clamping ferrule is shown in US 5,423,820. The clamping sleeve is L-shaped and has two sleeve-like extensions, in each of which a wire rope end is jammed.

Squeeze sleeves, which must be connected to both sides of the wire, but proved to be less user-friendly because of their unwieldiness. Further embodiments of crimp sleeves are described in US 6 120 505 and US 5,474,665.

 US Pat. No. 8,469,966 B2 and EP 2 731 527 B1 disclose embodiments of clamping tools with which the tensile stress required for the reduction of the bones or cartilage can be generated.

 A disadvantage of the known systems is that they can only be used to a limited extent for repositioning or osteosynthesis of small bone fragments, as they occur in the hand or in the foot, due to the size or shape of the known crimp sleeves. In addition, these can lead to impairment of the soft tissue structures or even to their damage. Another

Problem arises in that protruding wire ends can perforate the skin.

 It also had to be determined that the associated clamping tools are not suitable for the bone surgery of small fragments because of their size. When used, there is a risk of breaking the fragile bones or cartilage when tightening the wire because of the lack of controllability of the tensile stress. Furthermore, a large clamping tool obstructs the insight into the

Operating field, especially if the smallest parts of the bone should be fixed by hand or in the foot.

 The task is, therefore, a system for the repositioning of fragments of the

To provide supportive apparatus such as bones, cartilage, tendons, ligaments or fractions thereof, which is small and handy, and which simplifies the surgical technique so that the reduction of fragments of the supporting apparatus can be carried out in a shorter time.

 To achieve the object, there is provided a system for repositioning fragments of the supporting apparatus comprising a surgical wire rope, a tensioning instrument with a tensioning mechanism for generating a tensile force on the surgical wire rope and a crimping sleeve. The crimp barrel is adapted to clamp the surgical wire rope to at least a fragment of the

The term "surgical wire rope" also includes surgical threads or highly flexible surgical solid wires.

The reduction system is characterized in that the crimp barrel has a support area with one of its upper side to its underside continuous Bore and a set up on the upper side of the support region deformation region comprises, wherein the deformation region of two flat against each other crimped crimping blades is formed, which are arranged opposite to the outlet opening of the bore in the support area. A Crimpflügel has both a bore facing the clamping surface and a bore facing away from the pressing surface. The pressing surface of the first Crimpflügels and the pressing surface of the second Crimpflügels include an angle a with a size of 0 ° <a <180 °, in particular an angle a with a size of 90 ° <a <180 °. Preferably, the angle a and the longitudinal axis of the bore lie in the same plane.

In a preferred embodiment, the oppositely disposed clamping surfaces or first clamping surface segments of the Crimpflügel include an angle ß with a size of 0 ° <ß <180 °.

The support area describes the part of the crimp barrel that is on the

Fragment surface rests. The underside of the support area is preferably configured plan. On the side facing away from the fragment surface of the

Supporting region is the deformation region of the crimp barrel, in which a wire rope end is clamped by pressing together the clamping surfaces of the Crimpflügel. For this purpose, for example, by means of a pair of pliers whose jaws are attached to the pressing surfaces of Crimpflügel, the Crimpflügel

crimped against each other, wherein the wire end is clamped between the Crimflügeln. A rounded design of the Crimpflügel has a gentle effect on the surrounding soft tissue. The top can also be designed to reduce the material support on the fragment surface to the edge sloping. To improve the clamping properties, the clamping surfaces of the Crimpflügel may have a roughened surface.

In one embodiment, in the clamping surface of the Crimpflügels a

Semi-shell-shaped recess set, which continues in parts of the wall of the arranged in the contact area bore in the deformation region of the crimp barrel and extended over the support area into the deformation area inside.

In a further embodiment of a crimp sleeve whose Crimpflügel are formed angled. An angled Crimpflügel consists of a first

Crimpflügelsegment with a first clamping surface segment and a second Crimpflügelsegment with a second clamping surface segment. The first and the second clamping surface segment of an angular crimping blade form an angle of 90 ° <g <180 °. Advantageously, in the embodiment of two angled Crimpflügel the clamping surface segments of the second

Crimp wing segments aligned parallel to each other. The pressing surface on the first crimping blade segment of the first crimping blade and the pressing surface on the first crimping blade segment of the second crimping blade (9.2) enclose the angle a with a size of 0 ° <a <180 °.

In a further embodiment, a bead-shaped elevation can be applied to a clamping surface, which is advantageously aligned transversely to the bore longitudinal axis. In the formation of the angled Crimflügeln runs the bead-shaped elevation along or in the bend between the first and the second Crimpflügelsegment.

In the simplest embodiment, the bore is aligned substantially perpendicular to the underside of the support area, whereby the crimping sleeve can be placed directly on the wellbore of a fragment bore, in order to be able to introduce a wire rope guided through the fragment bore without its curvature into the crimping sleeve in the exit direction.

For the reposition system according to the invention, two areas of application are described below by way of example, in which the inventive

Reduction system can be used.

The first division concerns the reduction of fragments by a ring closure of the wire rope, in which the two cable ends via the crimp sleeve together

get connected.

In order to keep the contact area of the crimp barrel as small as possible for use in microsurgery, the present reduction system dispenses with a

Jamming of the second wire end with the crimping sleeve. In contrast to known cerclage systems, the crimp barrel is firmly connected to the second end of the surgical wire rope as a result of the production.

Advantageously, the second cable end is connected to the outside of the

Bearing region of the crimp sleeve welded, preferably with a point laser.

The problem with the repositioning of micro fragments, as occurs for example in the reconstruction of severed fingers, is that the Bone fragment surrounding periosteum or other connective tissue after preparation of the drill holes and cover the drilled holes again. The surgeon is forced to feel the drill holes. A second-saving laying of the wire rope is therefore almost impossible and the operation time is sometimes prolonged significantly.

To remedy this problem, the system comprises a guide means for guiding the surgical wire rope through a perforation in the fragment. The

In particular, the guide element is a separate instrument that is not permanently connected to the wire rope, such as a K-wire, a guide wire or even a surgical drill.

The surgical wire rope has in an advantageous version at its first end via a rod-shaped guide element as a counterpart to the guide means. The rod-shaped guide element is preferably chosen longer than the

Piercing in the fragment and in itself resistant to bending, causing the surgical

Wire rope can be easily passed through the through hole.

In order to simplify the guidance of the wire rope through the through hole with the aid of the guide means and thus to accelerate the operation step, at the first end of the surgical wire rope or at the head end of the rod-shaped guide element, a receptacle for generating a

temporary guiding contact with the tip of the guiding means.

"Temporary guide contact" means that the tip of the guide means, for example, the tip of a K-wire, the end of a guide wire or the tip of a drill is brought into direct contact with the end of the wire rope, but no frictional connection between the two system parts is trained.

For ease of handling, the guide element in a further embodiment has a smaller diameter than the guide means used for guiding.

When passing the wire through the through hole in the fragment, the tip of the guide means is first with the receptacle for generating a

Temporary management contact brought into contact, then the

Continuously move the guide slowly backwards out of the perforation. there follows the first end of the wire while maintaining the contact with the tip of the guide means in the through hole and there takes its position.

To a slipping of the contact by sliding sideways

To prevent guide tip of the recording, the recording for generating a temporary guide contact with the tip of the

Guide means in the form of a running from the head side of the rod-shaped end piece in the longitudinal direction extending funnel-shaped or concave depression.

For the ring closure (loop) of the wire rope whose first end is passed through the hole in the support area of the crimp barrel, then to tension the wire rope using the tensioning instrument. Upon reaching the tensile force required to reposition the fragments, the crimps are crimped together, including the wire rope.

In a second embodiment, not the two ends of the wire rope are connected by the crimp sleeve to a loop for the reduction of fragments, but at the second end of the surgical wire rope is a

Anchoring device set up, with which the wire rope tensile on the

Surface of a first fragment of the supporting apparatus is placed or anchored.

To place the anchoring device on the outside of the first fragment, a through hole is first laid through the fragments to be refixed, the wire rope with the anchoring device advances as far as through the

Pushed through bore until it has reached the surface of the first fragment.

After placement of the anchoring device on the surface of the first fragment, tension is applied to the wire rope by threading the crimp barrel onto the first end of the wire rope and pressing the crimp barrel against the surface of a second fragment where it is jammed with the wire rope.

The anchoring device according to the invention is advantageously designed to be deployable or expandable, so that an anchoring of the surgical wire rope on a surface of a fragment occurs in that the unfolded or spread anchoring device at least in part on the surface of the Fragments comes to rest. The anchoring device prevents the surgical wire rope from sliding back and forms the tension-pressure point in order to be able to apply the tension required for refixation to the wire rope.

Advantageously, the anchoring device is designed selbstentfaltend, so that upon exercise of a train on the surgical wire in the opposite direction to the direction of insertion of the wire rope spreading or deployment of the

Anchoring device occurs.

A deployable anchoring device, in the simplest embodiment, is a rod connected via a hinged connection to the wire rope which is applied to the wire rope during insertion through the prepared fragment bore. After reaching the outside of the fragment to be refixed by tightening the surgical wire rope of the hinged rod of the anchoring device

folded down, whereby on the outside of the fragment a backstop and the train-pressure point for applying the Refixationsspannung is formed.

In a particular embodiment, the deployable is surrounded by a cannula-like sheath which prevents the anchoring device from premature deployment or snagging in the fragment bore. after the

Anchoring device has been advanced to the destination, this is only released by the retraction of the cannula-like shell, after which the

Unfolding mechanism or Aufspreizmechanismus can be actuated or unfolds the anchoring device independently or spreads.

After the positioning of the anchoring device, a crimping sleeve according to the invention is threaded onto the first end of the wire rope on the underside of the throughbore, with the support region facing the underside surface of the fragment.

To apply the tension required for the refixation of the fragments, the surgical cable is inserted into the tensioning instrument. Under operation of the tensioning mechanism, the wire rope and the attached thereto

Anchoring device tightened. After reaching the desired

Tensile stress, the Crimpflügel the crimping sleeve are pressed against each other, so that the crimping sleeve forms the counter-pressure point to the anchoring device to keep the refixing voltage on the surgical wire rope in the long term. This variant of the reduction system according to the invention designed as a longitudinal single strand can be used, for example, for refixing cartilaginous ligament structures, such as the discus triangularis in the wrist, in particular for refixing the ulnocarpal disc (or also TFCC).

The tensioning instrument of the reduction system comprises a grip cuff and a tensioning arm connected to the grip cuff. The tensioning arm has the function of pressing on the surgical wire slidingly mounted crimp barrel with the support portion against the surface of a fragment, and then bring under the operation of the tensioning mechanism train on the wire so that the wire rope is under tension when the crimp barrel with the wire rope is jammed. On the tensioning arm a stop with guide eyelet is set up for this purpose.

After the wire rope has been threaded through the hole of the crimping sleeve, it is guided through the guide eye of the stopper for clamping. The guide eye is dimensioned such that the crimping sleeve can not pass the guide eye, but strikes there. The clamping arm has a bottom side of the stop for

Crankshaft applied guide device which is adapted to store the wire in the pulling direction and to guide it to the crankshaft.

The crankshaft is rotatably mounted in the grip sleeve. To one

To prevent uncontrolled return of the crankshaft, the tensioning instrument is equipped with a detent mechanism, which faces the crankshaft

Hold the grip in a set position. Advantageously, the locking mechanism of the shape that the crankshaft can be rotated only in one direction of rotation and a return is inhibited in the opposite direction.

In the stored in the grip sleeve crankshaft is a transversely to

Crankshaft longitudinal axis aligned socket set, in which the surgical wire rope is inserted through an opening in the handle sleeve with its first end. By then turning the crankshaft is the

Wrapped wire rope and pressed the crimp barrel by means of the stop on the tensioning arm against the underside of the through hole in the fragment, whereby tension and tension is applied to the wire rope.

To reduce the tension and thus the position of the to be reduced

Fragments if necessary to be able to correct is in the tensioning instrument additionally a means set for releasing the latching mechanism, whereby the crankshaft is set in the freewheel and, if necessary, the cable can be unwound from the crankshaft again.

The invention will be explained in more detail with reference to two embodiments. The figures show:

Fig. 1: a first embodiment of the reduction system of

 Fragments of the supporting apparatus,

2a-2d: side and cross-sectional views of a first embodiment of a crimp sleeve,

3a-3d: side and cross-sectional views of a second embodiment of a crimp barrel,

Fig. 4: Detailed representation of the contact area between the

 rod-shaped guide element and the top of the

 Guide means,

5a-5b: side view of the tensioning instrument,

6a - 6b: cross-sectional view of the tensioning instrument and

Fig. 7: Representation of a second variant of the invention

 Reduction system comprising an anchoring device at the second end of the wire rope.

1 shows a first variant of the reduction system according to the invention, a K-wire 15, which forms the guide means of Repositionssystems shown, a wire rope 1 with a rod-shaped guide member 18 at the first end 17 and a crimp sleeve 4 at the second end 22 and a

Clamping instrument 2 includes.

The rod-shaped guide member 18 has on its head side a receptacle for generating a temporary guide contact with the tip 20 of the K-wire 15th

The crimping sleeve 4 laser-welded to the second end 22 of the wire rope 1 has a flat support region 6 and a deformation region 8 with two

Pressable crimp blades 9.1 and 9.2. The associated tensioning instrument 2 shows a grip sleeve 24 with a

Clamping arm 25, at the outer end of a stop 26 is set with a guide eye 27. In the grip sleeve 24, a crankshaft (not shown) is mounted, which can be manually rotated with a knob 33 to wind the wire rope 1. In order to unwind the wire from the crankshaft again, the tensioning instrument 2 is equipped with a lever 32 which, when actuated, releases the crankshaft into a freewheel which controls the rotation of the crankshaft

Crankshaft allowed in the rearward direction of rotation.

FIGS. 2a-2d show a crimp barrel 4 in accordance with the invention

different views.

FIG. 2a shows a cross section of the crimping sleeve 4 again. It is shown that through the crimping sleeve 4, a bore 7 is guided, which extends from the bottom of the support portion 6 into the deformation region 8 and through which a surgical wire rope is feasible. In the clamping surfaces 10.1 and 10.2 of

Crimpflügel 9.1 and 9.2 are in the continuation of the wall 14 of the bore 7 half-shell-shaped recesses 13.1 and 13.2 set up.

In the side view of the crimping sleeve 4 (FIG. 2b), it is shown that the pressing surface 1.1 of the first crimping blade 9.1 and the pressing surface 11.2 of the second crimping blade 9.2 enclose an angle a (12) with a size of 0 ° <a <180 °. The angle a (12) and the longitudinal axis of the bore 7 lie in the same plane.

In addition, the clamping surface of the first Crimpflügels and the clamping surface of the second Crimpflügels are preferably aligned such that they include an angle ß with a size of 0 ° <ß <180 °.

FIG. 2c shows a further side view of the crimping sleeve 4, in which the

Crimped wings are formed as semicircles, causing the surrounding

Soft tissue is protected from damage.

The plan view (FIG. 2d) of the crimping sleeve 4 reproduces the crimping pegs 9.1 and 9.2 forming the deformation region 8, which are mirror-symmetrical about the crimping pegs 9.1 and 9.2

Outlet opening of the bore 7 are arranged on the support area 6 and the clamping surfaces 10.1 and 10.2 have half-shell-shaped recesses 13.1 and 13.2 in the continuation of the bore 7. FIGS. 3a to 3d show a second embodiment of the crimping sleeve 4, in which the crimping blades 9.1 and 9.2 are of angled design. In the basic structure, an angled Crimpflügel 9 of a first Crimpflügelsegment 34 and a second Crimpflügelsegment 35 are arranged to each other. The clamping surface of an angled Crimpflügels 9 is divided into a first clamping surface segment 38 and a second clamping surface segment 39, which are at an angle g, which is smaller than 180 °, aligned with each other. The second clamping surface segments 39.1 and 39.2 of the second Crimpflügelsegmente 34.1 and 34.2 of the two Crimpflügel 9.1 and 9.2 are aligned parallel to each other. The pressing surface 1 1 .1 on the first

Crimpflügelsegment 28.1 of the first Crimpflügels 9.1 and the pressing surface 1 1.2 on the first Crimpflügelsegment 28.2 of the second Crimpflügels 9.2 include the angle a with a size of 0 ° <a <180 °.

In the bend 36 between the first clamping surface segment 38 and a second clamping surface segment 39, a bead-shaped elevation 37 is applied, which are both set at the same height on the respective clamping surface and aligned transversely to the bore longitudinal axis of the bore 7. The bead-shaped elevations 36.1 and 36.2 extend longitudinally in the respective bend 37.1 and 37.2 between the first 34.1, 34.2 and the second

Crimpflügelsegment 35.1, 35.2 of each Crimpflügels 9.1, 9.2.

FIG. 4 shows the instant in which a K-wire inserted in a throughbore 16 in a fragment 5 of the support apparatus acts as a guide means 15 with respect to a surgical wire rope 1 as an aid for guiding the wire rope 1 through the throughbore 16.

At the first end 17 of the wire rope 1, a rod-shaped guide member 18 is arranged, which has a funnel-shaped recess 21 at the head end. In this recess 21, the tip 20 of the K-wire 15 engages and enters a temporary guide contact with the rod-shaped guide member 18, without forming a frictional connection with the wire rope 1 via the rod-shaped guide member.

The tensioning instrument 2 of the reduction system is shown in FIGS. 5a and 5b as a side view and in FIGS. 6a and 6b in cross-sectional views. The tensioning instrument 2 consists of a grip sleeve 24 with a tensioning arm 25 and a crankshaft 28 with a rotary knob 33 for manually rotating the crankshaft 28 mounted in the grip sleeve 24.

The tensioning arm 25 has the functions under the operation of the tensioning mechanism 3 to train on the wire rope 1 and to keep the wire rope 1 and the crimping sleeve 4 in a desired position while maintaining the state of tension while the crimping sleeve 4 is jammed on the wire rope 1. The clamping arm 25 is for this purpose at its outer end a stop 26 equipped with a guide eye 27 through which the surgical wire rope 1 is threaded.

The tensioning arm 25 has, on the underside, a guide device 29, which is applied by the stop 26 to the crankshaft 28, in which the surgical wire rope 1 is guided to the crankshaft 28.

The crankshaft 28 is rotatably mounted in the handle sleeve 24 and equipped with a locking mechanism. Between the knob 33 and the

Grip sleeve 24 is a spring-mounted latching mechanism 3 is arranged, which reached the crankshaft 28 relative to the handle sleeve 24 in one

Fixed rotational position.

In the crankshaft 28 is aligned transversely to the crankshaft longitudinal axis

Socket 30 is established, in which the surgical wire rope 1 through an opening 31 in the handle sleeve 24 can be inserted.

By turning the rotary knob 33, the crankshaft 28 mounted in the grip sleeve 24 is rotated, wherein the surgical wire rope 1 inserted into the socket 30 is wound onto the crankshaft 28.

In order to decouple the latching mechanism 3, a means for releasing the latching mechanism, in the illustrated embodiment, the pressure lever 32 is additionally set up. With the pressure lever 32, the knob 33 and the so

connected crankshaft 28 are pushed upwards, causing them from the

Locking mechanism decoupled and is placed in an unrestrained freewheel, so that the wire rope 1 by a rotation in the opposite direction again from the

Crankshaft 28 can be handled.

FIG. 7 shows a second embodiment of the invention

Repositionssystems. This trained as a single strand connection Reduction system is used in this example to refix cartilaginous ligament structures in the wrist.

In this second embodiment, for the reduction of the fragments 5.1 (bone) and 5.2 (cartilage) the two ends 17 and 22 of the surgical

Wire rope 1 is not interconnected by the crimping sleeve 4 to a loop, but at the second end 22 of the surgical wire rope 1 is a

Anchoring device 23 in the form of a hinged at the end 22 of the wire rope 1 and hinged designed locking bar, with which the wire rope 1 tensile strength on the surface of the cartilage is placed 5.2.

For the purpose of refixing the cartilage 5.2, after the preparation of the drill holes 16.1 and 16.2, the second end 22 of the wire rope 1 fitted with the foldable locking rod 23 is pushed through the set fragment bores to the destination until the locking rod 23 is completely on the otherworldly cartilage band side

pushed out and can fold down there.

After unfolding the locking bar 23 as a train-pressure point is a crimping sleeve 4 has been threaded onto the first end 17 of the wire rope 1 to form counter-pressure point, the support area 6 faces with the underside of the lower side bore in the bone 5.1. To apply the tension, the surgical wire rope 1 is inserted into the tensioning instrument 2, wherein the

Clamping arm 25 with the stop 26, the crimping sleeve 4 pushes against the perforation 16.1 in the bone 5.1.

Claims

claims: 1. System for repositioning of fragments of the supporting apparatus comprising  a surgical wire rope (1),  a tensioning instrument (2) with a tensioning mechanism (3) for generating a tensile force on the surgical wire rope (1) and  a crimping sleeve (4) prepared for fixing the surgical wire rope (1) to be braced to at least one fragment (5) of the  Supporting apparatus characterized in that the crimping sleeve (4) comprises a support region (6) with a continuous from the top to the bottom bore (7) and on the top of the support area (6) deformation area (8), wherein the deformation region (8 ) from two surfaces against each other  compressible Crimflügeln (9) is formed, which are arranged opposite to the outlet opening of the bore (7) above the support area (6),  wherein a crimping pad (9) has a clamping surface (10) facing the bore (7) and a pressing surface (11) facing away from the bore (7) and wherein the pressing surface (11.1) of the first crimping blade (9.1) and the pressing surface (11.2) of the second Crimpflügels (9.2) include an angle a (12) with a size of 0 ° <x <180 °. 2. System for repositioning of fragments of the supporting apparatus according to claim 1, characterized in that the angle a (12) and the longitudinal axis of the bore (7) lie in the same plane. 3. system for repositioning of fragments of the support apparatus according to claim 1 or 2, characterized in that the course of the longitudinal axis of the bore (7) following in the clamping surface (10) of a Crimpflügels (9) a half-shell-shaped recess (13) is arranged, the the wall (14) of the through the contact area (6) leading bore (7) in the deformation region (8) of the crimp sleeve (4) continues. A system for repositioning fragments of the brace apparatus according to any one of claims 1 to 3, characterized in that the system comprises guide means (15) for guiding the surgical wire rope (1) through a throughbore (16) in a fragment (5) of the brace apparatus includes. 5. System for repositioning of fragments of the supporting apparatus according to one of claims 1 to 4, characterized in that the surgical wire rope (1) at its first end (17) has a rod-shaped guide element (18). A system for repositioning fragments of the brace apparatus according to any one of claims 4 or 5, characterized in that at the first end (17) of the surgical wire rope (1) or at the Head side of the rod-shaped guide element (18) has a receptacle (19) for generating a temporary guide contact with the tip (20) of the guide means (15) is arranged. A system for repositioning fragments of the support apparatus according to claim 6, characterized in that the receptacle (19) for generating a temporary guiding contact with the tip (20) of the guide means (15) in the form of a from the head side of the rod-shaped guide member (18). in the longitudinal direction  extending funnel-shaped or concave depression (21) is formed. 8. A system for repositioning of fragments of the support apparatus according to one of claims 1 to 7, characterized in that the crimp sleeve (4) on the outside with the second end (22) of the surgical wire rope (1) is welded. 9. system for repositioning of fragments of the supporting apparatus according to one of claims 1 to 7, characterized in that at the second end (22) of the surgical wire rope (1) a deployable  Anchoring device (23) is arranged for the tensile anchoring of the wire rope (1) on the surface of a fragment (5) of the support apparatus. 10. A system for repositioning of fragments of the supporting apparatus according to claim 9, characterized in that the anchoring device (23) is selbstentfaltend formed, so that upon exercise of a train on the surgical wire rope (1) in the opposite direction to the insertion direction of the wire rope (1) in a Through hole (16) in one Fragment (5) of the support apparatus, a spreading or unfolding of the anchoring device (23) occurs. 11. A system for repositioning of fragments of the support apparatus according to one of claims 1 to 10, characterized in that the tensioning instrument (2) for receiving the first end (17) of the  surgical wire rope (1) is prepared, wherein the tensioning instrument (2)  a grip sleeve (24),  a clamping arm (25) connected to the gripping sleeve (24), wherein a stop (26) with guide eye (27) is arranged on the clamping arm (25) and the clamping arm (25) engages one of the stop (26) and the crankshaft (28). arranged guide device (29) for guiding the wire rope (1), in the handle sleeve (24) mounted crankshaft (28) with a rotatable in one direction locking mechanism (3) and with a transversely to the crankshaft longitudinal axis aligned socket (30), in which the surgical wire rope (1) can be inserted via the guide device (29) through an opening (31) in the grip sleeve (24) with its first end (17),  and means (32) for releasing the latching mechanism.