Fully implantable motorized intramedullary nail Fitbone® is an innovative device that restores symmetry and length of the lower extremities via stimulating growth of the patient's own bones. As compared with the implantation of an Ilizarov apparatus (external frame), which has traditionally been used in similar situations for more than a century and has not had a worthy alternative all this time, this technique is much less traumatic for the bone and surrounding soft tissues. The anatomical construction Fitbone® does not limit patient’s physical activity and makes life during the treatment process as comfortable as possible.
Here you can see the cost of the procedure for leg lengthening with the help of the Fitbone® device at the German University Hospitals. Leave your request and we will provide a free consultation with a doctor and arrange the entire treatment process.
Issuing an invitation for treatment for quick medical visa receiving
Booking an appointment at any convenient for you time
Preliminary organization of comprehensive examination and discussion of the treatment plan
Transfer from the airport to the hospital and back to the airport
Interpreting services and services of a personal medical coordinator
Assistance in arranging further surgical treatment, if necessary
Provision of medical insurance in case of treatment complications covering the sum of 200,000 euros
Preparation and translation of medical records and recommendations from the hospital
Assistance in the subsequent communication with attending physician, including advice on repeated X-ray scans through the unique medical document management system E-doc
The principle of the Fitbone® therapeutic effect
The Fitbone® system consists of several components, each of which plays special role in the process of bone lengthening:
- Fitbone® nail. During the surgical intervention the nail is placed inside the femur or tibia (the main bone of the shin). Once the procedure is complete, the surgeon does not connect separated for the nail insertion bone areas, as the missing bone tissue will be formed exactly there. The Fitbone® nail is blocked inside the bone, i.e. intramedullary, and creates a solid basis for its elongation.
- External control unit with a transmitter. The electronic control unit allows the doctor to select the individual speed of distraction of the divided bone parts from each other. Properly selected distraction speed is important for the adequate growth of bone and associated tendons, blood vessels and nerves. Once all the necessary physical parameters are determined, the control unit creates an electrical impulse corresponding to them. With the help of the transmitter, the pulse reaches the receiver.
- Receiver is placed in near the Fitbone® nail – it is implanted under the skin of the thigh or shin. When receiving an electrical impulse from the transmitter, the receiver starts the miniature Fitbone® nail electric motor and provides a bone distraction process. The important features of the Fitbone® system include the transfer of impulse through intact skin and the autonomous operation of the core inside the bone. After an appropriate training the patient can easily conduct all the necessary manipulations on his own, at home.
The Fitbone® system, developed in the Munich Center for Corrective and Reconstructive Surgery of Extremities (ZEM) by Professor Baumgart, creates new, artificial growth zones in the femur and/or tibia. Surgical bone separation, reliable fixation on a solid metal nail and constant controlled tension create favorable conditions for the natural biological process of new bone tissue formation.
Actually, conventional intramedullary nails made of steel or titanium have been used in surgery for more than 50 years. A fundamentally new feature of the Fitbone® system is equipping the nail with an internal electric motor, which provides a minimal, but constant and uniform bone tension, and works uninterruptedly from an external power source. In the scope of clinical practice, the technique is quite young (it has been used for about 20 years), but it has already demonstrated unique benefits and helped thousands of patients from all over the world.
Therapeutic possibilities of the Fitbone® intramedullary nail
Fully implantable motorized intramedullary nail Fitbone® can be successfully used in patients:
- With shortened limbs after trauma or removal of a bone part due to medical indications (for example, after bone tumor treatment)
- With poorly developed lower extremities, including congenital pathologies and dysplastic processes that occurred in the adulthood
- With deformed limbs (for example, in ICP, O-shaped and X-shaped curvature)
- With a general low height due to the impaired development of cartilage or bone tissue, hormonal disorders (for example, in achondroplasia or Russell-Silver syndrome)
- With a general low height, if there is no other pathology (familial short stature)
The results of Fitbone® nail treatment are most noticeable in patients with severe impairments, namely leg length difference exceeding 6-8 cm, pronounced deformities after injuries and previous surgical interventions. In such cases the use of the Fitbone® system can completely correct the cosmetic defect and, which is more important, restore the function of the injured limb. Advanced models of the device can lengthen the hip up to 85 mm and the shin – up to 65 mm. To achieve the best results, the device can be simultaneously implanted in both the thigh and shin. This allows to achieve even greater limb lengthening and increase the growth speed up to 2 mm per day.
The Fitbone® nail can also be used in less severe cases, for example, in a leg length difference of 2-3 cm, minor axial deviations (O-shaped and X-shaped legs) or torsion deformities (incorrect foot or thigh turn). An early restoration of the normal limb structure allows avoiding such future complications as gait and balance disorders, back pain, spinal deformities, hip diseases and even fractures. Patients often try to undergo conservative treatment – buy special shoes, use orthoses and canes. However, this solves the problem only partially. It is highly likely that a patient will still require surgical treatment in the future, but it will be delayed and performed at a more advanced stage of the disease.
The Fitbone® nail implantation is the optimal solution for the patients, which want to increase their height. At the same time, the possibility of performing surgery does not depend on the causes of short stature, whether it is a genetic syndrome, a systemic disease or individual trade. Naturally, in this case the Fitbone® nail will be implanted in both legs, while the treatment time will depend on the desired outcome. In such a situation, at the initial stage of treatment, before bone strengthening, the patient will temporarily need to use a wheelchair. With the help of an additional intermediate surgical intervention, the height can be increased for more than 10-15 cm.
The procedure of the Fitbone® intramedullary nail implantation
Preparation for the Fitbone® intramedullary nail implantation begins with a thorough examination, which includes:
- Detailed clinical examination
- Measurements of all lengths and axes of the lower limbs
- Comprehensive X-ray examination
- CT/MRI scans with the use of high resolution tomographic scanners
Then the doctor and the patient discuss the desired treatment outcome in detail. Based on all the information, the team of specialists determines the optimal zones of bone dividing and the most suitable model of the Fitbone® intramedullary nail. If necessary, there can be made an individually constructed nail, adapted to the needs of the patient.
Specialists of the Munich Center for Corrective and Reconstructive Surgery of Extremities (ZEM) apply the "reverse planning" method. This means that they proceed from the desired final result to the selection of surgical technique, distraction speed and intensity of physical rehabilitation in the postoperative period. Once the patient has received all recommendations, he has several months to prepare for treatment and choose the date of surgery. Six weeks before admission, the patient will have the second outpatient consultation, during which it will be possible to clarify all the issues directly with the surgeon once more.
Shortly before the planned surgical procedure the patient will be admitted to the specialized partner clinic of the Munich Center for Corrective and Reconstructive Surgery of Extremities (ZEM), namely, the Munich Hospital of the Brothers of Mercy. After preliminary laboratory examination and appointment with an anesthesiologist, the patient will undergo an implantation of the individually selected Fitbone® nail. The surgical procedure is performed under general anesthesia and, depending on the complexity of the intervention, can last up to 3 hours. During the surgical intervention a specific radiopaque mesh is used. This ensures an ideal alignment of the nail along the axis of the bone. After the operation the patient will be transferred back to the ward, since there is usually no need to stay in the intensive care unit.
A hospital stay is not limited to simple passive follow-up by healthcare professionals. The next day after the operation, the patient can move using crutches. The crutches or a cane are required to reduce weight load on the operated leg. Doctors recommend limiting it up to 20% of body weight. After undergoing control X-rays, the patient will continue training in proper walking with crutches, special exercises and work with the Fitbone® system external control unit. In 6-10 days after the surgery, the patient will be discharged from the hospital and continue treatment at home.
The process of bone lengthening and result consolidation
The first session of distraction (leg lengthening) takes place on the 5th day of the hospital stay, under the supervision of the attending physician. After this, the patient will conduct such sessions at home every day, according to the intensity regimen recommended by the doctor. On average, the distraction session takes about 5 minutes a day and can be done at any time.
The accuracy and reliability of the electronic control unit allows achieving a uniform limb elongation with a recommended rate of 1 mm per day. This speed provides normal growth of the bone and accompanying blood vessels and nerves, muscles and soft tissues. When implanting the Fitbone® nail into the thigh and shin simultaneously, the growth rate doubles and reaches 2 mm per day.
The location of the Fitbone® nail inside the bone, without external fixation and skin damage, makes the treatment process completely painless. Absence of external fixators eliminates the risk of infection inherent in earlier osteosynthesis techniques and the damage to the soft tissues of the thigh and shin. The patient can wear usual casual clothes, swim and take shower, walk with the help of crutches (until a new bone is strengthened enough) and even drive (if the left leg has been operated).
If it is necessary to lengthen the bone significantly (up to 5 cm or more), there may be some discomfort due to the soft tissue tension and pressure on the joints. Consistent therapeutic exercises help to cope with discomfort, as well as provide consistent with the bone growth soft tissue stretching and motor function. In certain cases, the patient can additionally undergo a course of physiotherapeutic treatment.
The process of distraction and bone callus formation is carefully monitored during weekly outpatient consultations with the treating surgeon. During each appointment the patient undergoes physical examination and X-ray control, so the doctor has an accurate picture of the bone growth dynamics. With the course of time, in absence of complications and good growth speed, consultations will become more rare.
Achievement of the desired limb length is followed by the initiation of next treatment stage – consolidation, or strengthening of the new bone. The final formation of bone tissue takes 2-3 times longer than the distraction process does. During this time, the patient continues using the Fitbone® nail, but without the daily distraction procedures. At the consolidation stage, the patient should increase the load on the operated leg. After completing this stage, the Fitbone® nail will be removed during the repeated operation. The repeated intervention is performed through a skin incision less than 5 mm in length, which allows achieving a good cosmetic effect and ensuring absence of scars.
Treatment by Professor Rainer Baumgart, author of the technique, is totally possible
Prof. Dr. Dr. med. Rainer Baumgart dedicated his scientific research and practical experience to correcting limb asymmetry and stimulating bone growth. Professor wanted to preserve all the undeniable benefits of Ilizarov technique and complement them with comfort for the patient and lower risk of complications during treatment. The research project, which began in 1988 in Munich, resulted in the development of the world's first fully implantable motorized intramedullary nail Fitbone®. After the technical improvement, the device was implemented into the clinical practice and has been successfully used for more than 20 years.
Specialists of the Munich Center for Corrective and Reconstructive Surgery of Extremities (ZEM) annually examine and treat more than 500 patients with a similar pathology. Given the high qualifications of Professor Baumgart and his colleagues, both German citizens and patients from other countries of Europe, USA and Russia, seek medical help in the Center. It should be noted that doctors and administrative staff of the healthcare institution are competent only in providing medical services for international patients. The documentary work and organizational issues of the trip are provided by the official partner of the Munich Center for Corrective and Reconstructive Surgery of Extremities (ZEM) – Booking Health, the certified operator of medical tourism, which annually helps hundreds of patients with orthopedic problems to receive quality and effective treatment abroad.
To begin preparation for your journey, examination and treatment, you should leave a request on Booking Health website. The same day you will be contacted by our patient case manager, who will clarify the details of your condition and coordinate further actions. You will be carefully guided through preparation of documents for traveling abroad and initial consultation with Professor Baumgart.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova