WO2010076836A1

WO2010076836A1 - Surgical system and method for injecting a substance in a bone, particularly in the femoral bone

Info

Publication number: WO2010076836A1
Application number: PCT/IT2008/000826
Authority: WO
Inventors: Tonino Mascitti; Danilo Gervasoni; Davide Pizzamiglio; Matteo Pizzamiglio
Original assignee: Overmed S.R.L.
Priority date: 2008-12-31
Filing date: 2008-12-31
Publication date: 2010-07-08

Abstract

The surgical system (10) comprises: a first surgical tubular member (12) intended to be inserted into a bone (102) and having: a first axial through-cavity (16) having an opened proximal end (20), and adapted to be passed through by a guide wire (110), so as to allow the guided insertion of the first surgical tubular member (12) into the bone (102); and a plurality of first lateral through-holes (18) adapted to allow the discharge in a transversal direction of a substance to be inserted into the bone (102). The system further comprises: a second surgical tubular member (14) intended to be inserted into the first axial cavity (16) so as to couple with the first surgical tubular member (12), and having: a second axial cavity (32) suitable to be passed through by the above-mentioned substance, and which ends in a closed proximal end (34) intended to prevent that the substance is discharged beyond the opened proximal end (20) of the first surgical tubular member (12); and a plurality of second lateral through-holes (36) intended to be facing of first lateral holes (18) and suitable to allow the discharge of said substance therethrough and through said first lateral holes (18).

Description

Surgical system and method for injecting a substance in a bone, particularly in the femoral bone

Technical field of the invention

The present invention relates to a system for injecting a substance in a bone, particularly in the femoral bone. More specifically, the present invention relates to a surgical system according to the preamble of the annexed claim 1.

Furthermore, the present invention relates to a method for injecting a substance in a bone, particularly in the femoral bone. More specifically, the present invention relates to a method according to the preamble of the annexed claim 29.

Known prior art

A number of surgical systems and methods for injecting a substance in a bone, in particular in the femoral bone, are known.

From the United States patent US 2,537,070, the concept of using a surgical system which comprises a tubular member intended to be inserted in the femoral neck for fixing of the fragments of a femoral fracture is known. Such tubular member has a plurality of openings arranged on the lateral surface thereof, suitable for allowing the discharge according to a transversal direction of a substance intended to be injected in the bone. The employed substance is a reinforcing agent, which promotes the consolidation of the fracture. The tubular member passes through the fracture zone or line (or a bone weakening zone), and is then interposed between a distal region (in other words, "downstream the fracture"), and a proximal region (in other words "upstream the fracture"), therefore it results to be desirable that the reinforcing substance is distributed according to transversal directions in an axially intermediate region of the tubular member. In fact, it is precisely in the zone which is interposed between the distal region and the proximal region of the bone that the reinforcing substance is necessary.

In the international application WO 2005/053545, a surgical system for the injection of a substance in a bone is disclosed, in which a guide wire is used to allow the guided insertion of the tubular member which is typically included in the medullary region of the bone and passes through a fracture or bone weakening line (for example, in the case of osteoporosis). Therefore, the tubular member interconnects a first and a second portions of the bone which are divided by the fracture line, hi this manner, the tubular member allows obtaining the consolidation of the fracture ends, preventing flexional and rotational movements of the bone fragments. The use of the guide wire in this surgical technique is advantageous, since it allows an insertion of the tubular member in a simple and accurate manner. The fact that the tubular member has a through-recess is then a useful requirement in order it can be passed through and guided by the guide wire. Finally, the tubular member allows the injection of a substance which - as in the first case - is dispensed through holes located on the surface thereof.

However, a surgical system and a method according to such documents have some drawbacks.

One of the above-mentioned drawbacks is given by the fact that in such systems a significant distribution of the substance to be injected in the bone occurs according to an axial direction of the tubular member, while it is preferable to laterally concentrate the distribution relative to the tubular member, according to a transversal direction. In fact, the distribution in the lateral region of the substance to be injected in the bone concurs in a particularly efficient manner to the consolidation of the bone regions divided by the fracture or weakening zone.

Object of the invention

One of the objects of the present invention is to use a system and a method which allow obviating this and other drawbacks of the prior art. In particular, the system and the method according to the present invention intend to consent the use of a hollow tubular member, optionally suitable for a guided insertion in the bone through a guide wire, and to prevent the discharge of a substance to be injected through the axial proximal end of the through-recess.

Summary of the invention

The above-mentioned and other objects are achieved owing to a system the relevant characteristics of which are set forth in the annexed claim I₅ a method the main aspects of which are reported in the annexed claim 29.

According to another aspect, the present invention also relates to a surgical tubular member according to claim 21 and a method according to claim 38.

Brief description of the drawings

Further characteristics and the advantages of the present invention will be more clearly understood from the following detailed description, given by way of non-limiting example only, with reference to the annexed drawings, in which:

Fig. 1 is a sectional view of an exemplary embodiment of a system according to the present invention;

Fig. 2 is a side view of a first surgical tubular member according to the system shown in Fig. 1 ; Fig. 3 is a sectional view according to the line III-III of Fig. 2;

Fig. 3 a is an enlarged view of the section according to the line HIa-IIIa of Fig. 3;

Fig. 4 is a side view of a second surgical tubular member in accordance with the system represented in Fig. 1 ;

Fig. 5 is a sectional view according to the line V-V of Fig. 4;

Fig. 6 is a sectional view according to the line VI-VI of Fig. 4;

Figs. 7 to 12 are representations of an exemplary sequence of operative steps in accordance with the method according to the present invention; and

Fig. 13 is an enlarged view of a detail of the second surgical tubular member in accordance with the system shown in the preceding Figures;

Fig. 14 is a view of an operative step according to a further aspect of the present invention.

Detailed description

With reference in particular to Fig. 1, an exemplary embodiment of the system according to the present invention is indicated with 10.

The system 10 comprises a first surgical tubular member 12 and a second surgical tubular member 14, both having a longitudinal axis A-A.

The term "axial" is meant as referring to a parallel direction to the longitudinal axis A-A of the first surgical tubular member and the second surgical tubular member.

The term "transversal" or "radial" is meant as referring to a perpendicular direction to the longitudinal axis A-A of the first surgical tubular member and the second surgical tubular member. The term "proximal" is meant as referring to a region of the first surgical tubular member and the second surgical tubular member operatively located in a position nearer to the bone on which the system is intended to be used.

The term "distal" is meant as referring to a region of the surgical tubular member and the second surgical tubular member operatively located in a position farther from the bone on which the system is intended to be used.

The first surgical tubular member 12 is preferably made in a medical grade titanium alloy. The second surgical tubular member 14 is preferably made in steel for instrumental or surgical use. Advantageously, the first surgical tubular member 12 and the second surgical tubular member 14 are so designed as to be of a disposable type, that is, to be used during only one surgical procedure.

With reference in particular to the Figs. 2 and 3, the first surgical tubular member 12 will be now described.

In the illustrated embodiment, the first surgical tubular member 12 has a first axial through-cavity 16, a plurality of first lateral through-holes 18 and an opened proximal end 20.

Preferably, the first axial recess 16 has a first main portion 22 having a cylindrical shape of substantially circular cross-section with axis A-A. The first axial cavity 16 optionally has also a second enlarged hollow portion 24 located in the distal position and having a transversal section hexagonal and coaxial with the first main portion 22, but with a higher width compared to the latter. Between the first hollow portion 22 and the second enlarged portion 24, a fillet portion 26 is advantageously interposed, having an essentially rrusto-conical shape which is rastremated in a proximal direction. Conveniently, the second enlarged portion 24 ends transversally outwardly in a further transversal notch 28.

Suitably, the first surgical tubular member 12 has a distal end 29 with a section which is essentially circular and radially widened.

Advantageously, the first lateral through-holes 18 are of an essentially circular shape. Further advantageously, such first lateral holes 18 have axes arranged according to transversal or radial directions.

With reference in particular to Fig. 3, the first lateral holes 18 are optionally arranged on the outer surface of the first tubular member 12 according to a plurality of axial rows 18a, 18b, and 18c (in the exemplary embodiment illustrated, the axial rows are three). Conveniently, the holes belonging to the same row of the axial rows 18a, 18b, and 18c are mutually axially equispaced of one pitch p. Preferably the axial rows 18a, 18b, and 18c are also mutually angularly equispaced (in the illustrated embodiment, the axial rows are mutually spaced apart of 120°).

In a further preferred manner, the three axial rows 18a, 18b, and 18c are mutually axially offset. More specifically, the three axial rows 18a, 18b, and 18c are mutually axially offset of 1/3 of a pitch, that is p/3.

In the illustrated embodiment, the first surgical tubular member 12 has a proximal portion 30 which is externally threaded and located in the proximity of the opened proximal end 20. Advantageously, the thread obtained on the first proximal portion 30 is of the self-tapping type. Preferably, the first lateral holes 18 are located in a middle region of the first tubular member 12 with an essentially smooth surface. More specifically, such middle region can range from a first height located 4mm after the distal end, to a second height located 7mm before the threaded proximal portion 30. With reference in particular to the Figs. 4, 5, and 6, the second surgical tubular member 14 will be now described.

In the illustrated embodiment, the second surgical tubular member 14 includes a narrowed segment 31 which has a second axial cavity 32 closed by a thimble-shaped proximal end 34. Furthermore, the second surgical tubular member 14 has a plurality of second lateral holes 36, the perimetrical arrangement of which is identical to the one obtained in the first surgical tubular member 12. Therefore - for the sake of conciseness - the features of the lateral holes 36 will be not described in detail herein below. In this manner, in the assembled condition shown in Fig. 1, the first lateral holes 18 and the second lateral holes 36 are mutually aligned.

Preferably, the axial cavity 32 has a first distal part 38 with extended diameter, suitable to allow the insertion of a syringe for injecting a substance into the second surgical tubular member 14. Advantageously, the second surgical tubular member 14 further comprises a grasping portion or grip 40 located in the vicinity of the proximal end of such tubular member 14. Preferably, the grip 40 is radially widened relative to the remaining part of the second surgical tubular member 14. Optionally, the outer surface of the grip 40 has axially oriented grooves 42 (see Fig. 4), in order to create a grasping or "grip" region.

Furthermore, in the illustrated embodiment, the second surgical tubular member 14 has a radial or transversal projection 44 intended to be received by the transversal notch 28 of the first surgical tubular member 12. Preferably, the transversal projection 44 is located in a region interposed between the narrowed segment 31 and the grip 40. Furthermore, the projection 41 radially extends outwardly of the second surgical tubular member 14 and extends from a part 46 transversally widened relative to the narrowed segment 31, but narrower compared to the grip 40. Advantageously, the part 46 has the shape of a hexagonal prism coaxial with the longitudinal axis A-A. The above-mentioned projection 44 is radially overhanging from a side face of such hexagonal prism.

The transversal notch 28 and the transversal projection 44 serve as a coupling device between the first surgical tubular member 12 and the second surgical tubular member 14. For a user who desires to mutually couple the first surgical tubular member 12 and the second surgical tubular member 14, it is necessary to first insert the rod-like portion 31 into the first cavity 16 according to an axial direction. Subsequently, when the part 46 abuts against the fillet portion 26, the second surgical tubular member 14 is oriented by the user, by rotating it around the longitudinal axis A-A, until the projection 44 and the part 46 match with the notch 28 and the hollow portion 24. In this manner, by further pushing in the axial direction the second surgical tubular member 14 towards the first surgical tubular member 12 causes the alignment of the second holes 36 with the first holes 18. Therefore, the coupling device formed by the notch 28 and the projection 44 acts as an alignment device for the first and the second holes 18, 36. Alternatively, such coupling device can be advantageously replaced by a bayonet coupling device (not shown).

An exemplary execution of the method for injecting a substance in a bone according to the present invention will be now described.

The exemplary execution of such method has been illustrated for a femur. However, this example is not to be intended as limitative but, as it shall be apparent to those skilled in the art, the above-mentioned method can be equally carried out on other bones, such as, for example, the tibial bone, the peroneal bone, the humeral bone, the heel bone, etc.

With reference to Fig. 7, a first step of the method according to the present invention is illustrated. A guide device 100 of a per se known type is applied on the femur 102 of a previously anesthetized patient, for whom the presence of a fracture 104 (or also of a weakening due to osteoporosis) has been detected at the femur neck 106. The fracture 104 substantially divides the femur 102 in two parts: a proximal head region 107 and a distal trochanteric region 108.

The guide device 100 is suitably anchored on the femur 102 bone surface at the distal region 108.

By means of the guide device 100 the guide wires 110 are inserted through the distal region 108 until they reach with their 12 tip the cortical region 112 of the femur 102. Initially, each of the guide wires 110 is preferably partially inserted, then a radioscopic check is performed, which is followed by the complete insertion of the wire in the cortical region 112. Washers (not shown) can be optionally applied around the guide wires 110.

With reference to Fig. 8, a second step of the method according to the present invention is illustrated. The guide device 100 has been removed from the femur 102 and a gauge 114 is used, which is suitable to detect the length 1 of the portion of each guide wire 110 contained within the femur 102. Based on the detected length 1, the length of the tubular members 12 and 14 to be used is determined. Furthermore, radiographic detections are performed, which allow selecting the more suitable thread pitch to be adopted for the selection of the tubular members 12 and 14 to be used, as a function of the position of the fracture line 104.

Preferably, for a proper application, for selecting the first surgical tubular member 12 it is assumed that the threaded proximal portion 30 thereof can be completely contained in the proximal region 107 relative to the fracture line 104. As already mentioned before, for selecting the tubular members 12 and 14, pre-surgical radiological images and optional radioscopy checks performed during the procedure are preferably used.

With reference to Fig. 9, a third step of the method according to the present invention is illustrated. A hollow or cannulated cutter 116 of a medical drill (not shown) is employed, which performs a piercing operation in a manner guided by the guide wire 110. The drilled hole is suitable for allowing the insertion of the first surgical tubular member 12. In case the bone tissue is not very firm, it is possible to avoid the piercing in the proximal region 107, with the aim of improving the fixing of the threaded proximal portion 30 (which is self-tapping) on such proximal region 107. In this step, of the procedure, it is possible to optionally use a cortical flaring tool (not shown) in order to create a hemispherical flaring in the cortical bone in order to fit the screw heads.

With reference to Fig. 10, a fourth step of the method according to the present invention is illustrated. A hollow screwdriver 118 is used, by means of which the selected first tubular surgical members 12 are screwed until the complete adhesion of the distal end or head 29 thereof to cortical zone of the distal region 18. Subsequently, the screwing of the first tubular surgical members 12 is continued until the fracture 114 is reduced, hi other words, each of the first tubular surgical members 12 is screwed until the threaded proximal portion 30 thereof passes beyond the fractured or weakened zone 104 of the bone 102. When the screwing is continued beyond such zone 104, the distance between the proximal region 107 and the distal region 108 is reduced in a progressive manner. In fact, the proximal region 107 is made closer, by the further screwing action, to the proximal region 108. After that, it is preferable to perform further radioscopy checks. Finally, it is possible to withdraw the guide wires 110 from the femur 102 according to a per se known mode. With reference to Fig. 11, a fifth step of the method according to the present invention is illustrated, in which all the first tubular surgical members 12 have been correctly inserted in the femur 102 and all the guide wires 110 have been removed.

With reference to Fig. 12, a sixth step of the method according to the present invention is illustrated. A second surgical tubular member 14 is used, which is complementary to the plurality of the first tubular surgical members 12 inserted in the femur 102. Such second surgical tubular member 14 has the arrangement of the second holes 36 identical to the one of the first holes 18. Furthermore, a syringe 120 is arranged, which contains the substance to be injected through the tubular members 12, 14. Such substance can comprise a material intended to reinforce the zone of the femur 102 neck 106 and/or a medicament (for example, a re-growth or "augmentation" factor, platelet gel, chemotherapeutical drugs or stem cells). The syringe 120 is applied in the distal part 38 of the second surgical tubular member 14, by way of example via a "luer-lock" coupling of a per se known type. Then, the second surgical tubular member 14 is inserted in the first surgical tubular member 12 advantageously according to the previously described mode, that is, by coupling the notch 28 and the projection 44 one to the other. As already noted before, in this manner not only a coupling between the first surgical tubular member 12 and the second surgical tubular member 14 occurs, but also the alignment between the first holes 18 and the second holes 36 as well.

The substance is then started to be injected through the second surgical tubular member 14 which can outwardly transversally or radially be discharged owing to the alignment of the second lateral holes 26 with the first lateral holes 18 of the first surgical tubular member 12. Then, the second surgical tubular member 14 is decoupled from the first surgical tubular member 12 and is in sequence coupled with each of the remaining first tubular surgical members 12 for the injection of the substance sucked in the syringe 120.

The exemplary execution of the method according to the present invention illustrated in the Figs. 7 to 12 has the benefit of allowing an efficient distribution in the bone 102 of the substance to be injected, particularly owing to the use of the second surgical tubular member 14, and of ensuring at the same time the osteosynthesis in such bone 102, particularly due to the use of the first surgical tubular member 12.

According to another aspect of the present invention, the second surgical tubular member 14 can be used also without the first surgical tubular member 12 with the aim of injecting a substance in a bone (whether or not broken), particularly in the femoral bone 102. hi fact, as illustrated in Fig. 14, the surgical tubular member 14 can be inserted into the bone 102, after that such bone 102 has been previously pierced, without the aid of the guide wire. Subsequently, the axial recess 32 is passed through by the substance to be injected, and the closed proximal end 34 prevents that such substance is axially discharged from the tubular member 14. In this manner, only the plurality of lateral through-holes 36 allows the discharge of the substance to be injected through them into the bone 102. Subsequently, the second surgical tubular member 14 is removed from the bone 102.

It shall be appreciated that, the principle of the invention being understood, the embodiments and the implementation details will be able to be widely varied in relation to what has been described and illustrated by way of non- limiting example only, without for this departing from the scope of the invention as defined in the annexed claims.

Claims

1. A surgical system (10) for injecting a substance into a bone, particularly the femoral bone (102), comprising a first surgical tubular member (12) intended to be inserted in the bone (102) and having: a first axial through-cavity (16) having an opened proximal end (20), and suitable to be passed through by a guide wire (110), so as to allow the guided insertion of said first surgical tubular member (12) in said bone (102); and a plurality of first lateral through-holes (18) suitable to allow the discharge in a transversal direction of a substance to be inserted into the bone (102); said system being characterized in that it further comprises a second surgical tubular member (14) intended to be inserted in said first axial cavity (16) so as to couple with the first surgical tubular member (12), and having: a second axial cavity (32) suitable to be passed through by said substance, and which ends in a closed proximal end (34) intended to prevent that said substance is discharged beyond the opened proximal end (20) of the first surgical tubular member (12); and a plurality of second lateral through-holes (36) intended to be facing said first lateral holes (18) and suitable to allow the discharge of said substance therethrough and through said first lateral holes (18).

2. The system according to claim 1, wherein the first surgical tubular member (12) includes an outwardly radially threaded proximal portion (30).

3. The system according to claim 2, wherein said proximal portion (30) of the first surgical tubular member (12) is of the self-tapping type.

4. The system according to any one of the preceding claims, wherein the first lateral holes (18) and the second lateral holes (36) are oriented according to axes having respective transversal directions.

5. The system according to any one of the preceding claims, _s wherein the first lateral holes (18) and/or the second lateral holes (36) are arranged according to at least one first longitudinal row (18a, 18b, 18c), which axially extends on the first surgical tubular member (12), and/or respectively at least one second longitudinal row (36a, 36b, 36c), which axially extends on the second surgical tubular member (14).

6. The system according to claim 5, wherein the first lateral holes (18) and/or the second lateral holes (36) are arranged according to a plurality of first longitudinal rows^" (18a, 18b, 18c) on the first surgical tubular member (12) and/or respectively a second plurality of second longitudinal rows (36a, 36b, 36c) on the second surgical tubular member (14).

7. The system according to claim 6, wherein the first longitudinal rows (18a, 18b, 18c) are mutually axially offset and/or the second longitudinal rows (36a, 36b, 36c) are mutually axially offset.

8. The system according to claim 6 or 7, wherein the first longitudinal rows (18a, 18b, 18c) are mutually angularly equispaced and/or the second longitudinal rows (36a, 36b, 36c) are mutually angularly equispaced.

9. The system according to claim 8, wherein the first longitudinal rows (18a, 18b, 18c) are mutually angularly spaced apart of 120° and/or the second longitudinal rows (36a, 36b, 36c) are mutually angularly spaced apart of 120°.

10. The system according to claim 9, wherein the first longitudinal rows (18a, 18b, 18c) are mutually axially offset of one third of a pitch (p/3) and/or the second longitudinal rows (36a, 36b, 36c) are mutually axially offset of one third of a pitch (p/3).

11. The system according to any one of the preceding claims, comprising coupling means (28, 44) distributed between the first surgical tubular member (12) and the second surgical tubular member (14).

12. The system according to claim 11, wherein said coupling means (28, 44) allow a coupling of a releasable type between the first surgical tubular member (12) and the second surgical tubular member (14).

13. The system according to claim 11 or 12, wherein the coupling means (28, 44) concur to angularly orientate the first surgical tubular member (12) and the second surgical tubular member (14) so that the first lateral holes (18) and the second lateral holes (36) are mutually facing.

14. The system according to claim 13, wherein the coupling means are of the bayonet type.

15. The system according to claim 14, wherein the coupling device comprises a transversal notch (28) of the first surgical tubular member (12) and a transversal projection (44) of the second surgical tubular member (14) suitable to be received by said transversal notch (28).

16. The system according to any one of the preceding claims, wherein the second surgical tubular member (14) has a gripping region (40) located in the proximity of the distal end thereof.

17. The system according to claim 16, wherein the gripping region comprises a transversally widened gripping portion (40) of the second surgical tubular member (14).

18. The system according to claim 16 or 17, wherein the outer surface of the gripping region (40) has a plurality of axial grooves (42).

19. The system according to any one of the preceding claims, wherein the first through-cavity (16) has a hollow portion (24) which is transversally widened and located at the distal end relative to the remaining part of said first through-cavity (16).

20. The system according to any one of the preceding claims, wherein the first surgical tubular member (12) has a distal portion (29) which is transversally widened relative to the remaining part of the first surgical tubular member (12).

21. Surgical tubular member (14) intended to be used in a system (10) according to any one of the preceding claims, or intended to be inserted directly in the bone (102); said member (14) having: an axial cavity (32) adapted to be passed through by a substance to be injected into the bone (102), and which ends in a closed proximal end (34) intended to prevent that said substance is discharged in an axial direction from said surgical tubular member (14); and a plurality of lateral through-holes (36) adapted to allow the discharge of said substance therethrough in the bone (102).

22. The surgical tubular member (14) according to claim 21, wherein the lateral through-holes (36) are oriented according to axes having respective transversal directions.

23. The surgical tubular member (14) according to claim 22, wherein the lateral through-holes (36) are oriented according to axes having respective transversal directions.

24. The surgical tubular member according to claim 22 or 23, wherein the lateral through-holes (36) are arranged according to at least one longitudinal row (36a, 36b, 36c).

25. The tubular member according to claim 24, wherein the lateral through-holes (36) are arranged according to a plurality of longitudinal rows (36a, 36b, 36c).

26. The tubular member according to claim 25, wherein the longitudinal rows (36a, 36b, 36c) are mutually axially offset.

27. The tubular member according to claim 25 or 26, wherein the longitudinal rows (36a, 36b, 36c) are mutually angularly equispaced.

28. The tubular member according to any one of the claims 21 to 27, having a gripping region (40) located in the proximity of the distal end thereof.

29. Method for injecting a substance into a bone, particularly the femoral bone (102), comprising the following operative steps: inserting an at least one guide wire (100) through the bone (102); drilling at least one hole into said bone (102) by means of a hollow tool (116) guided by said at least one guide wire (110); arrange at least one first surgical tubular member (12) having a first axial through-cavity (16), a plurality of first lateral through-holes (18), and a first opened proximal end (20); inserting said at least one first surgical tubular member (12) into said at least one hole in a guided manner by said at least one guide wire

(110); removing said at least one guide wire (110) through the axial cavity (16) of said first surgical tubular member (12); said method being characterized in that it further comprises the following operative steps: arranging a second surgical tubular member (14) having a second axial cavity (32), which ends in a closed proximal end (34), and having a plurality of second lateral through-holes (36); insert said second surgical tubular member (14) into said at least one first surgical tubular member (12) through the first axial cavity (16), facing the second lateral holes (36) to the first lateral holes (18) and obstructing the first proximal end (20) with the second proximal end (34); injecting a substance through said second axial cavity (16), so as to allow a transversal discharge of said substance through the second lateral holes (36) and the first lateral holes (18), and to hinder an axial discharge of said substance due to the occlusion of the first proximal end (20).

30. The method according to claim 29, wherein said at least one first surgical tubular member (12) is screwed into the bone (102) due to an externally threaded proximal portion (30) thereof.

31. The method according to claim 30, wherein when said at least one first surgical tubular member (12) is screwed into the bone (102), said proximal portion (30) cut into and threads the inner walls of said bone (102).

32. The method according to claim 30 or 31, wherein when the threaded proximal portion (30) passes beyond a fractured or weakened zone (104) of the bone (102), said at least one first surgical tubular member (12) is further screwed in the bone (102) so as to progressively reduce the distance between the regions (107, 108) of the bone (102) separated by said fractured or weakened zone (104).

33. The method according to any one of the preceding claims, wherein when the second surgical tubular member (14) is inserted into the first surgical tubular member (12), they are mutually coupled.

34. The method according to claim 33, wherein when the first surgical tubular member (12) and the second surgical tubular member (14) are coupled, the first lateral holes (18) and the second lateral holes (36) are mutually facing.

35. The method according to claim 33 or 34, wherein when the second surgical tubular member (14) is inserted into the first axial cavity (16), it is rotated in the first surgical tubular member (12) until a transversal projection (44) of the second surgical tubular member (14) is coupled to a transversal notch (28) of the first surgical tubular member (12).

36. The method according to claim 33 or 34, wherein the first surgical tubular member (12) and the second surgical tubular member (14) are mutually coupled via a bayonet coupling.

37. The method according to any one of the preceding claims, wherein a plurality of holes in said bone (102) is drilled, and an associated plurality of first surgical tubular members (12) is arranged, which are inserted in the respective associated holes; said second surgical tubular member (14) being inserted and coupled from time to time in each of said first tubular surgical members (12) to inject said substance in each of said first tubular surgical members (12).

38. A method for injecting a substance in a bone, particularly in the femoral bone (102), comprising the following operative steps: drilling at least one hole in said bone (102); arranging at least one surgical tubular member (14) having an axial cavity (32), a plurality of lateral through-holes (36), and a closed proximal end (34); inserting said at least one first surgical tubular member (12) into said at least one hole; injecting a substance through said axial cavity (16), so as to allow a discharge of said substance through the lateral through-holes (36), hindering an axial discharge of said substance due to the closed proximal end (20).

39. The method according to claim 38, wherein the surgical tubular member (14) is removed from the bone (102) after the discharge of said substance from the lateral through-holes (36).