WO2007093855A1

WO2007093855A1 - Orthopedic devices and method for manufacturing the same

Info

Publication number: WO2007093855A1
Application number: PCT/IB2006/050482
Authority: WO
Inventors: Silvana Vese
Original assignee: Silvana Vese
Priority date: 2006-02-14
Filing date: 2006-02-14
Publication date: 2007-08-23

Abstract

The present invention relates to a method of manufacturing orthopedic devices, such as osteosynthesis devices (1, 31; 61), orthopedic prostheses (91) and the like, which devices include an osteosynthesis support (3; 33; 63; 93) having one or more through-holes (5; 5’; 5'; 5''; 35; 65; 95) into which there are inserted corresponding bushes (9; 39; 69; 99) internally provided with an axial through-hole (11; 41; 71; 101) for the passage of a pin (17) or a screw (19; 49; 79; 109) for fastening said orthopedic support to a patient's bone. According to the present invention, said bushes are caulked into the holes of the orthopedic support, whereby the coupling between said support and said bushes is free from plays and it does not risk to become loosened or degraded in time.

Description

A METHOD FOR MANUFACTURING ORTHOPEDIC DEVICES, SUCH AS OSTEOSYNTHESIS DEVICES, ORTHOPEDIC PROSTHESES AND THE LIKE₅ AND PRODUCTS MANUFACTURED THEREBY

The present invention relates to a method of manufacturing orthopedic devices, such

^■ as osteosynthesis devices, orthopedic prostheses and the like, as well as to the products manufactured by that method.

More particularly, the invention relates to a method of manufacturing osteosynthesis devices allowing immobilising one or more fractures in a long bone, such as a femur or a tibia.

Moreover, the invention relates to a method for manufacturing articular prostheses, in particular acetabular prostheses.

Osteosynthesis devices generally comprise an osteosynthesis support applied inside the fractured bone (osteosynthesis nail) or applied outside said fractured bone (osteosynthesis plate).

Osteosynthesis nails are introduced into the fractured bone substantially along the longitudinal bone axis, and are fastened to the fractured bone by using transversal compression pins or screws. In order to properly locate the osteosynthesis nail in its seat, the nail is often guided inside said seat through a guiding cable. To this end, osteosynthesis nails may have a longitudinal hollow cannula allowing the passage of the guiding cable.

Osteosynthesis plates are instead applied outside the fractured bone and are pressed against the bone by using compression pins or screws penetrating into the bone.

Acetabular prostheses generally comprise: an external acetabular cup, referred to as cotyle, which is fastened to the patient's pelvis by means of pins or screws: an internal acetabular cup; and a substantially spherical head, which is received within said internal acetabular cup. Said head has a hole for receiving one end of a stem, the opposite end of which is made to penetrate into the patient's femur.

Turning now back to osteosynthesis devices, plates developed in the past are equipped with one or more elongate barrels that are inserted into the bone and that act as guides for the compression screws, so as to ensure a correct insertion of the compression screws into the plate. The barrels, which are an integral part of the plate, allow rigidly connecting together the plate and the compression screws, thereby eliminating any play between the two parts. In order to obtain a greater versatility, patent application WO 01/91660, in the name of the same Applicant, discloses an osteosynthesis device wherein the osteosynthesis plate and the barrels through which the compression screws pass are separate pieces that can be rigidly coupled by screwing the barrels into the holes provided in the plate. In this manner, 5 barrels of different shapes and sizes, and hence screws of different shapes and sizes can be used with a same plate, according to the needs.

However, such a solution is not always optimal, since the threaded coupling between the plate and the barrel may become loosened, whereby plays arise between the barrel and the plate, which palys ultimately result in plays between the plate and the pins or screws l o inserted through the barrel.

Loosening of the coupling between the plate and the barrel can therefore result in an incorrect positioning of the pins or the screws in the bone and in a reduction of the plate pressure onto the bone itself, with even serious consequences for the patient.

Similarly, also an incorrect positioning of an osteosynthesis nail due to plays 15 existing between said nail and the pins or the screws fastening it to the bone can have serious consequences for the patient.

It is evident that, also in case of acetabular prostheses, the loosening of the coupling between the cotyle and the screws fastening it to the pelvis, and the consequent presence of plays between the cotyle and the pelvis, can have serious consequences for the patient. 20 It is an object of the present invention to provide a method of manufacturing orthopedic devices, such as osteosynthesis devices, orthopedic prostheses and the like, which method ensures a firm and enduring coupling between the orthopedic support (osteosynthesis plate or nail, cotyle, etc.) and the members - screws or pins - fastening said support to the patient's bone.

25 It is another object of the present invention to provide an osteosynthesis device in which the coupling between the osteosynthesis support (plate or nail) and the members fastening said support to the fractured bone is free from plays and is not subjected to loosening in time.

It is a further object of the present invention to provide an orthopedic prosthesis in 30 which the coupling between the prosthesis support (cotyle) and the members fastening said support to the patient's bone is free from plays or loosening.

The above and other objects are achieved by the method of manufacturing orthopedic devices according to the invention, as claimed in the appended claims, as well as by the orthopedic devices manufactured. Thanks to the use of bushes that are inserted into suitable holes formed in the orthopedic support (for osteosynthesis or for prostheses) and caulked there, the coupling between said orthopedic support and the screws or pins penetrating into the patient's bone is extremely firm and is free from loosening risks. Advantageously, the bushes preferably have an internal frusto-conical through-hole to receive corresponding screws or pins with frusto-conical heads, so that fastening of said screws or pins to said bushes is ensured by the coupling between the respective frusto- conical surfaces.

The above and other advantages of the invention will become more apparent from the following description of some preferred embodiments of the invention, given by way of non limiting examples with reference to the accompanying drawings, in which:

- Fig. 1 is a plan view of an osteosynthesis plate manufactured by the method of the invention;

- Fig. 2 is a perspective view of the bushes manufactured by the method of the invention; - Fig. 3a shows one of the bushes of Fig. 2 inserted into the osteosynthesis plate of Fig.

1, before caulking;

- Fig. 3a shows one of the bushes of Fig. 2 locked in the osteosynthesis plate of Fig. 1, after caulking;

- Fig. 4 is a perspective view of the osteosynthesis plate of Fig. I₅ equipped with compression pins and screws;

- Figs. 5 A, 5B, SC and 6 A, 6B, 6C show variant embodiments of the osteosynthesis plate and of the corresponding bushes, respectively, manufactured by the method of the invention;

- Fig. 7 is a perspective view of an osteosynthesis nail manufactured by the method of the invention;

- Fig. 8 is a part-sectional perspective view of a detail of the osteosynthesis nail of Fig. 7;

- Fig. 9 is a part-sectional perspective view of a detail of the cannulate osteosynthesis nail manufactured by the method of the invention;

- Fig. 10 is an exploded perspective view of an acetabular prosthesis manufactured by the method of the invention;

- Fig. 11 is a cross-sectional view of an enlarged detail of the cotyle of the acetabular prosthesis of fig. 10.

Referring to Figs. 1 to 4, an osteosynthesis device 1 is shown including a plate 3 having a plurality of through-holes 5 (five in the illustrated example). Said holes 5 preferably have a lowered edge 7 on face 3a of plate 3 that, in use, faces away from the fractured bone.

Device 1 further includes a corresponding plurality of bushes 9 adapted to be received in holes 5 of plate 3. To this aim, bushes 9 have a first cylindrical portion 9a with substantially the same diameter as holes 5, and a second cylindrical portion 9b with greater diameter, abutting against lowered edge 7 of face 3 a of plate 3.

Bushes 9 further have a central through-hole 11 through which pins 17 or screws 19 fastening plate 3 to the fractured bone pass.

As better shown in Figs. 3a and 3b, portion 9a of bushes 9 passing through hole 5 of plate 3 has one ore more projecting fins 13 at its end, and the edges of holes 5 on face 3b of plate 3, which face in use is in contact with the bone, correspondingly are provided with draft bevels 15,

According to the method of the invention, after having inserted bushes 9 into holes 5 (Fig. 3a), fins 13 are caulked against face 3b of plate 13 (Fig. 3b), whereby they are rigidly and firmly coupled with said plate.

It is clear that, in this manner, the coupling between bushes 9 and plate 3 is not subjected to degradation in time and does not risk loosening.

Note that it is also possible to think of making threaded holes on plate 3 and, correspondingly, of forming a thread on the external surface of portion 9a of bushes 9, so that bushes 9 are coupled with plate 3 by both caulking and screwing

Still referring to Figs. 3a and 3b, it can be seen that hole 11 has a frusto-conical profile, widening towards the outside of the plate.

In this manner, it is possible to obtain the firm engagement between plate 3 and the pins or screws used to fasten plate 3 to the fractured bone merely by using pins 17 or screws 19 with frusto-conical heads 17a, 19a.

Thanks to the optimal coupling between the frusto-conical surfaces of the walls of holes 11 and the frusto-conical surfaces of heads 17a, 19a of pins 17 and screws 19, it is possible to firmly couple said pins 17 and/or said screws 19 with said plate 3. Indeed, pins

17 and/or screws 19, when penetrating into the bone, become locked inside bushes 9, thereby consequently eliminating any play between the two parts.

Preferably, heads 17a, 19a of pins 17 and screws 19 and, correspondingly, the walls of holes 11, have coniciry ranging from 0.5° to 30°.

Note that use of bushes 9 allows exploiting the coupling between frusto-conical surfaces to lock pins 17 and screws 19 to plate 3 even in case of very thin osteosynthesis plates. By making bush portion 9b with a sufficient axial extension, it is possible to obtain frusto-conical holes 11 with a sufficient axial extension to obtain the coupling with heads 17a, 19a of pins 17 and screws 19. This would be impossible should a direct coupling between the pins or screws with plate 3 be attempted, since the axial development of a frusto-conical hole in a very thin plate would be comparable with a cylindrical hole and therefore it would not be sufficient to ensure the coupling with the pins or screws.

Figs. 5 A, 5B₅ 5C and 6A₃ 6B, 6C show variant embodiments of the osteosynthesis device of Figs. 1 to 4.

Actually, the holes in plate 3 might also have a non-circular profile: it is possible to think of square holes 5' (Fig. 5A), hexagonal holes 5" (Fig. 5B) or rectangular holes with two rounded sides 5^m (Fig. 5C).

Correspondingly, bushes 9 will have a portion with square cross-section 9a', a portion with hexagonal cross-section 9a" or a portion with a rectangular cross-section having two rounded sides 9a'". Also in this case, bush portions 9a', 9a", 9a'" intended to penetrate into holes 5', 5",

5'" of plate 3 end with fins 13 to be caulked against the face of the same plate 3, according to the method of the invention.

The method of the invention comprises the steps of:

- providing an osteosynthesis plate 3, on which one or more through-holes 5 are made; - providing corresponding bushes 9, including at least one portion 9a that has a shape and a size corresponding with those of holes 5 and that is equipped with fins 13 at its end;

- inserting bushes 9 into holes 5 and caulking fins 13 against the surface of plate 3.

The application of device 1 to bone sections separated because of a fracture is then effected through the following steps: - plate 3 is placed against the bone;

- pins 17 or screws 19 are inserted into bushes 9 and are made to penetrate into the bone, said pins or screws becoming locked inside the bushes thanks to the frusto-conical coupling, thereby fastening plate 3 to the bone.

The above description clearly shows that it is possible to provide a kit for making up an osteosynthesis device, the kit comprising an osteosynthesis plate 3 and a plurality of bushes 9. Advantageously, said orthopedic kit for osteosynthesis may comprise bushes with internal axial holes 11 with different diameters and conicity, to receive pins and/or screws with heads 17a, 19a with corresponding diameters and conicity, which pins and/or screws are possibly included within the kit, so as to meet different needs. Turning now to Figs. 7 and 8, an osteosynthesis device 31 is shown including an osteosynthesis nail 33 having a plurality of through-holes 35.

As known, contrary to osteosynthesis plates, which are applied externally of the fractured bone, nail 33 is inserted into the fractured bone, in longitudinal direction, and is secured therein by transversal pins 47 or screws 49.

Device 31 includes a plurality of bushes 39 adapted to be received in holes 35 of nail 33. To this aim, bushes 39 have a first cylindrical portion 39a with substantially the same diameter as holes 35, and a second cylindrical portion 39b, with greater diameter, abutting against a lowered edge 37 provided around each hole 35. Bushes 39 further have an axial through-hole 41 through which pins or screws fastening plate 3 to the fractured bone pass.

Similarly to what has been described in connection with osteosynthesis plates, holes 41 preferably have a frasto-conical profile in order to provide for the coupling between nail 33 and frusto-conical heads 47a, 49a of pins 47 and/or screws 49. Also in this case, bushes 39 have, at the end of the first portion 39a, fins 43 that, once bushes 39 have been inserted into holes 35 in nail 33, are caulked against the surface of nail 33; to this end, that surface has draft bevels 45. A firm and enduring coupling between nail 33 and pins 47 or screws 49 is thus ensured.

Fig. 9 shows an osteosynthesis device 61 including a cannulate osteosynthesis nail 63.

Nail 63 has a hollow cannula 64 along its axis. The aim of said cannula 64 is to allow the passage, when nail 63 is being applied to the fractured bone, of a cable guiding the nail inside the seat formed in the bone, said cable being subsequently removed once the nail is properly located. Also in this case, nail 63 has through-holes 65 receiving bushes 69 equipped with end fins 73 that, once said bushes have been inserted into said holes, are caulked against the wall of nail 63; to this end, that wall has draft bevels 75. Said bushes 69 have axial through-holes 71 through which pins or screws locking nail 63 inside the bone pass.

Bushes 69 further have a second through-hole 77, substantially perpendicular to the first hole 71 and such that, once bush 69 has been inserted into hole 65 of nail 63, said second through-hole 77 is aligned with cannula 64, thereby allowing the passage of the guiding cable.

Referring to the above description, the method of the invention comprises the steps of: - providing an osteosynthesis nail 33, 63, on which one or more through-holes 35, 65 are made;

- providing corresponding bushes 39, 69, including at least one portion 39a₅ having a shape and a size corresponding to those of holes 35, 65 and equipped with fins 43, 73 at its end;

- inserting bushes 39, 69 into holes 35, 65 and caulking fins 43, 73 against the surface of nail 33, 63.

The application of device 31, 61 to bone sections separated because of a fracture is then effected through the following steps: - nail 33, 63 is introduced into the bone, possibly with the help of a guiding cable;

- pins or screws 49, 79 are inserted into bushes 39, 69 and are made to penetrate into the bone, said pins or screws becoming locked inside the bushes, thereby fastening nail 33, 63 to the bone.

Similarly to what has been described with reference to the osteosynthesis plates, it is possible to provide a kit for making up an osteosynthesis device, the kit comprising an osteosynthesis nail 33, 63 and a plurality of bushes 39, 69 preferably having an internal axial bore 41, 71 with different diameters and conicity, to receive pins and/or screws with heads having corresponding diameters and conicity, the pins and/or screws being possibly included within the kit itself. Turning now to Figs. 10 and 11, an acetabular prosthesis 91 manufactured by the method of the invention is shown. Said acetabular prosthesis 91 includes an external acetabular cup or cotyle 93 having holes 95 through which pins or screws for the fastening to the patient's pelvis pass.

Prosthesis 91 further includes an internal acetabular cup 109 housing a substantially spherical acetabular head 111 having a threaded hole 113. A threaded end 115a of a stem 115 is screwed in said threaded hole 113, whereas the opposite end 115b of said stem penetrates into the patient's femur.

As shown in Fig. 11, prosthesis 91 includes a plurality of bushes 99 adapted to be received in holes 95 of cotyle 93. To this aim, bushes 99 have a first cylindrical portion 99a with substantially the same diameter as holes 95, and a second cylindrical portion 99b, with greater diameter, abutting against a lowered edge 97 provided around each hole 95.

Bushes 99 further have an axial through-hole 101 through which pins or screws fastening cotyle 93 to the fractured bone pass.

Similarly to what has been described in connection with the osteosynthesis devices, holes 101 preferably have a frusto-conical profile to provide for the coupling between cotyle 93 and frusto-conical head 109a of screws 109.

Also in this case, bushes 99 have fins 103 at the end of the first portion 99a, which fins, once bushes 99 have been inserted into holes 95 in cotyle 93, are caulked against the surface of nail 93. To this end, that surface has draft bevels 105. A firm and enduring coupling between cotyle 93 and screws 109 is thereby obtained.

Referring to the above description, the method of the invention comprises the steps of:

- providing a cotyle 93 for an acetabular prosthesis 91, on which cotyle one or more through-holes 95 are made;

- providing corresponding bushes 99, including at least one portion 99a having a shape and a size corresponding to those of holes 95 and equipped with fins 103 at its end;

- inserting bushes 99 into holes 95 and caulking fins 103 against the surface of cotyle 93.

The application of prosthesis 91 is then effected through the following steps: - cotyle 93 is applied to the patient's pelvis;

- pins or screws 109 are inserted into bushes 99 and are made to penetrate into the pelvis, said pins or screws becoming locked inside the bushes, thereby fastening cotyle 93 to the pelvis;

- internal acetabular cup 109 and head 111 are located inside cotyle 93; - the first end of stem 115 is fastened to head 111 and the second end of said stem is made to penetrate into the patient's femur.

Similarly to what has been described with reference to the osteosynthesis devices, it is possible to provide an orthopedic kit for making up an acetabular prosthesis, the kit including a cotyle 93 and a plurality of bushes 99 preferably having internal axial bores 101 with different diameters and conicity to receive pins and/or screws with heads having corresponding diameters and conicity, the pins and/or screws being possibly included within the kit itself.

The above description clearly shows that the present invention attains the intended objects, since coupling the bushes by caulking to an osteosynthesis support, such as an osteosynthesis device or an orthopedic prosthesis, ensures a firm coupling of said bushes and, consequently, of the pins or screws fastening said support to the patients bone, with said osteosynthesis support, without possibility of plays or loosening.

It is moreover clear that the above description has been given only by way of non- limiting example and that several other modifications and applications are possible without departing from the scope of the invention. More particularly, even if reference has been made to an acetabular prosthesis in the description of preferred embodiments of the invention, it is also possible to think of manufacturing orthopedic prostheses of different kinds (for instance, shoulder prostheses), by using the method of the invention.

Claims

Patent claims

1. A method of manufacturing an orthopedic device, such as an osteosynthesis device (1, 31; 61), an orthopedic prosthesis (91), and the like, including at least the following steps:

5 - providing an orthopedic support (3; 33; 63; 93);

- making one or more through-holes (5; 5'; 5"; 5"'; 35; 65; 95) in said orthopedic support;

- providing corresponding bushes (9; 39; 69; 99), internally provided with an axial through-hole (11; 41; 71; 101) and including at least a first portion (9a; 9a¹; 9a"; 9a^m; 39a; 99a), having a shape and a size corresponding to those of said holes in said

10 orthopedic support and equipped at its end with one or more fins (13; 43; 73; 103);

- inserting said bushes (9; 39; 69; 99) into said holes in said orthopedic support; and

- caulking said at least one fin (13; 43; 73; 103) against the surface of said orthopedic support.

2. A method of manufacturing an orthopedic device according to claim 1, further ' 15 including the step of forming on the surface of said orthopedic support (3; 33; 63; 93), in correspondence with said through-holes (5; 5¹; 5"; 5¹"; 35; 65; 95), draft bevels (15; 45; 75; 105) for receiving said at least one fin and consequently assisting in said caulking.

3. A method of manufacturing an orthopedic device according to claim 1, wherein said axial through-hole (11; 41; 71; 101) provided in said bushes is a frusto-conical hole.

20 4. A method of manufacturing an orthopedic device according to claim 1, wherein said orthopedic device is an osteosynthesis device (1) and said orthopedic support is an osteosynthesis plate (3).

5. A method of manufacturing an orthopedic device according to claim 1, wherein said orthopedic device is an osteosynthesis device (31; 61) and said orthopedic support is

25 an osteosynthesis nail (33; 63).

6. A method of manufacturing an orthopedic device according to claim 5, wherein said osteosynthesis nail (63) has a longitudinal hollow cannula (64), and wherein said method further includes the step of forming a second transversal through-hole (77) in said bushes (69), said second through-hole (77) being aligned with said cannula (64) when said

30 bushes (69) are inserted into said osteosynthesis nail (63).

7. A method of manufacturing an orthopedic device according to claim 1, wherein said orthopedic device is an orthopedic prosthesis (91) and said orthopedic support is a coryle (93).

8. An osteosynthesis device (1, 31; 61) for fastening bone portions separated because of a fracture, the device including at least:

- an osteosynthesis support (3; 33; 63) having one or more through-holes (5; 5'; 5"; 5'"; 35; 65) for fastening said support to said bone by means of pins or screws;

- at least one bush (9; 39; 69) including at least a first portion (9a; 9a¹; 9a"; 9a^m; 39a), having a cross-section with shape and size corresponding to those of said holes in said osteosynthesis support and internally provided with an axial through-hole (11; 41; 71) for the passage of at least one pin (17) or one screw (19; 49; 79) arranged to penetrate into said bone for fastening said osteosynthesis support to said bone; characterised in that said first portion (9a; 9a¹; 9a"; 9a'"; 39a) of said at least one bush (9; 39; 69) ends with one or more fins (13; 43; 73) caulked against the surface of said osteosynthesis support.

9. An osteosynthesis device (1, 31; 61) according to claim 8, wherein said at least one hole (5; 35; 65) in said osteosynthesis support and said first portion (9a; 39a) of said at least one bush have circular cross sections.

10. An osteosynthesis device (I₅ 31; 61) according to claim 8, wherein said at least one hole (5; 35; 65) in said osteosynthesis support and said first portion (9a; 39a) of said at least one bush are threaded.

11. An osteosynthesis device (I₅ 31; 61) according to claim 8, wherein said at least one hole (5'; 5") in said osteosynthesis support and said first portion (9a¹; 9a") of said at least one bush have polygonal cross sections, for instance square or hexagonal cross- sections.

12. An osteosynthesis device (1, 31; 61) according to claim 8, wherein said at least one hole (5'") in said osteosynthesis support and said first portion (9a"⁽) of said at least one bush have rectangular cross-sections with at least two rounded sides.

13. An osteosynthesis device (1, 31; 61) according to any of claims 8 to 12, wherein said axial through-hole (11; 41; 71) in said at least one bush (9; 39; 69) is a frusto-conical hole.

14. An osteosynthesis device (I₅ 31 ; 61) according to claim 13, wherein the conicity of said axial through-hole (11; 41; 71) in said at least one bush (9; 39; 69) is in the range 0.5° to 30°.

15. An osteosynthesis device (I₅31; 61) according to any of claims 8 to 14, wherein said at least one bush (9; 39; 69) further includes a second portion (9b; 39b; 69b) with greater cross-sectional size than said at least one hole (5; 35; 65) in said osteosynthesis support, so as to abut against the surface of said support.

16. An osteosynthesis device (1) according to any of claims 8 to 15, wherein said osteosynthesis support is a plate (3) adapted to be applied against said bone and fastened thereto by means of pins or screws.

17. An osteosynthesis device (31; 61) according to any of claims 8 to 15, wherein said osteosynthesis support is an osteosynthesis nail (33; 63) adapted to be introduced into a seat formed inside said bone and fastened there by means of pins or screws.

IS. An orthopedic prosthesis (91), more particularly an acetabular prosthesis, including at least:

- an external acetabular cup or cotyle (93) having one or more through-holes (95) for fastening said cotyle to a patient's first bone by means of pins or screws;

- at least one bush (99) including at least a first portion (99a), having a cross-section with shape and a size corresponding to those of said holes in said cotyle and internally provided with an axial through-hole (101) for the passage of a pin or a screw (109) arranged to penetrate into said first bone for fastening said cotyle to said bone; characterised in that said first portion (99a) of said at least one bush (99) ends with one or more fins (103) caulked against the surface of said cotyle.

19. An orthopedic prosthesis (91) according to claim 18, wherein said axial through-hole (101) in said at least one bush (99) is a frusto-conical hole and wherein said pins or screws correspondingly have frusto-conical heads (109a).

20. An orthopedic prosthesis (91) according to claim 18 or 19, wherein said at least one bush (99) further includes a second portion (99b) with greater cross-sectional size than said at least one hole (95) in said cotyle (93), so as to abut against the surface of said cotyle.

21. An orthopedic prosthesis (91) according to any of claims 18 to 20, further including an internal acetabular cup (109) intended to be received inside said coryle (93), a substantially spherical acetabular head (111) intended to be received inside said internal acetabular cup (109), and a stem (115) a first end of which is adapted to be fastened to said acetabular head, whereas the opposite end is intended to penetrate into a patient's second bone,

22. A kit for making up an osteosynthesis device (I₉31; 61), including at least:

- an osteosynthesis support (3; 33; 63) having one or more through-holes (5; 5'; 5"; 5⁽"; 35; 65) for fastening said support to a bone by means of pins or screws;

- at least one bush (9; 39; 69) including at least a first portion (9a; 9a'; 9a"; 9a'"; 39a), having a cross-section with shape and size corresponding to those of said holes in said osteosynthesis support and internally provided with an axial through-hole (11; 41; 71) for the passage of at least one pin (17) or one screw (19; 49; 79) adapted to penetrate into said bone for fastening said osteosynthesis support to said bone; characterised in that said first portion (9a; 9a'; 9a"; 9a'"; 39a) of said at least one bush (9; 39; 69) ends with one or more fins (13; 43; 73) intended to be caulked against the surface of said osteosynthesis support.

23. A kit for making up an osteosynthesis device (1, 31; 61) according to claim 22, including bushes (9; 39; 69) having a frusto-conical axial through-hole (11; 41; 71) through which at least one pin (17) or one screw (19; 49; 79) with frusto-conical head (17a; 19a; 49a; 79a) passes.

24. A kit for making up an osteosynthesis device (1, 31; 61) according to claim 23, including bushes (9; 39; 69) with axial through-holes (11; 41; 71) having different diameters and/or conicity.

25. A kit for making up an osteosynthesis device (1, 31; 61) according to any of claims 22 to 24, further including a plurality of pins (17) and/or screws (19; 49; 79).

26. A kit for making up an osteosynthesis device (1, 31; 61) according to claim 25, including a plurality of pins (17) and/or screws (19; 49; 79) with frusto-conical heads having different diameters and/or conicity.

27. A kit for making up an osteosynthesis device (1) according to any of claims 23 to 26, wherein said osteosynthesis support is an osteosynthesis plate (3).

28. A kit for making up an osteosynthesis device (31; 61) according to any of claims 23 to 26, wherein said osteosynthesis support is an osteosynthesis nail (33; 63).

29. A kit for making up an orthopedic prosthesis (91), more particularly an acetabular prosthesis, including at least: - an external acetabular cup or cotyle (93) having one or more through-holes (95) for fastening said cotyle to a patient's first bone by means of pins or screws; - at least one bush (99) including at least a first portion (99) having a cross-section with shape and size corresponding to those of said holes in said cotyle and internally provided with an axial through-hole (101) for the passage of a pin or a screw (109) adapted to penetrate into said first bone for fastening said cotyle to said first bone; characterised in that said first portion (99a) of said at least one bush (99) ends with one or more fins (103) intended to be caulked against the surface of said cotyle.

30. A kit for making up an orthopedic prosthesis (1; 31; 61) according to claim 29, including bushes (99) having a frusto-conical axial through-hole (101) through which at least one pin or screw (109) with frusto-conical head (109a) passes.

31. A kit for making up an orthopedic prosthesis (91) according to claim 30, including bushes (99) with axial through-holes (101) having different diameters and/or conicity.

32. A kit for making up an orthopedic prosthesis (91) according to any of claims 29 to 31, forther including a plurality of pins or screws (109).

33. A kit for making up an osteosynthesis device (91) according to claim 32, including a plurality of pins or screws (109) with frusto-conical heads (109a) having different diameters and/or conicity.

34. A kit for making up an orthopedic prosthesis (91) according to any of claims 29 to 33₅ further including an internal acetabular cup (109) intended to be received inside said coτyle (93), a substantially spherical acetabular head (111) intended to be received inside said internal acetabular cup (109), and a stem (115) a first end of which is adapted to be fastened to said acetabular head, whereas the opposite end is intended to penetrate into a patient's second bone.