MediGence: Enabling Better Health Decisions

Manuela, aged 64, who is from Germany, has had an ongoing progressive shortening of one leg relative to the other, which was beginning to have a major effect on her moving, standing and independent living. This case was complicated.

Living with prolonged diabetes is affecting her ability to heal.
Before structural issues may lead to concern for infection.
Requires precise correction of limb length.
Declined use of external fixators due to perceived risks and limitations on lifestyle.

Like many international patients, she has sought out many paths before seeking help. In Germany, Turkey and India, she has consulted many doctors with the end result being:

Too complex.
The only option was to use the external fixator.
No guarantee of success with the advanced internal system for limb lengthening.

In India, high volumes of orthopedic services were available, but only a few of the orthopedic surgeons were willing to review and evaluate her case without being able to provide her with the internal lengthening options she was looking for.

The issue for Manuela is not just the medical side of her problem, but also availability, alignment and feasibility.

MediGence has changed its approach to treating patients, moving from coordinating treatment services to providing clinical direction. Dr. Vishwas Kaushik, who took over the case of Manuela, made it clear that he would not be treating this case as an ordinary assignment. The focus of his work was on how to structure the clinical navigation process in such a way that:

The entire treatment pathway is re-evaluated.
Identification of surgeons who can handle complex, high-risk reconstruction.
Real-time verification of the availability of advanced implant systems.
Complete alignment of treatment with the patient's non-negotiable requirements.
Maintaining financial feasibility and quality of care.

The first hospital plan established as part of this process was a complete failure because it offered no guarantee that the needed implants would be available to the patient; this created a point of no return in the case, when most pathways would typically collapse.

Instead of continuing to pursue the first plan despite the failure of that plan to guarantee an implant for Manuela, Dr. Kaushik decided to withdraw from the current plan and create a new plan from the ground up.

To accomplish this, Dr. Kaushik took the following actions:

Escalate directly with multiple surgical teams
Utilise parallel consults to confirm clinical opinions
Coordinate backend with implant vendors
Restructure treatment packages to fit Manuela's budget.

Finding the Right Surgeon

The incident aligned Dr. Ashish Chaudhry with Aakash Health Super Speciality Hospital. The success of this outcome was facilitated by accurate matching of:

Surgeon's capabilities
Implant availability
Hospital infrastructure
Patient expectations

The surgeon and advisory team determined that an internally magnetic limb lengthening system was the best way to treat the patient, but they were unsuccessful despite multiple consultations with doctors across multiple countries. This was a pivotal point in treatment.

Treatment Strategy and Execution

A comprehensive reconstruction protocol was established utilising the following plan:

Limb lengthening utilising the internal magnetic nail system (Precice)
Monitoring/reducing the chances of osteomyelitis
Evaluating stability of previous fusions (TTC considerations)
Making intraoperative decisions related to plate removal/stabilising the bone

The execution was focused on performing precise, controlled bone distraction, minimising the risk of infection, restoring proper biomechanical alignment, and providing long-term structural stability. The area-specific protocols were established based on this patient's medical history to help limit the risk of postoperative complications.

Recovery and Rehabilitation

Her recovery progressed steadily and was structured. With ongoing assistance provided from both clinical staff and rehabilitation staff:

She was able to increase her mobility progressively
Her limbs regained symmetry
Her dependence on assisted mobilisation decreased
She was able to manage her everyday activities.

Long-term Relief for Manuela

The case of Manuela demonstrates how complex cases require more than just treatment; they also require precision, coordination and planning that puts the patient at the centre of the process.

Patients with complex, multi-faceted and high-risk situations can overcome even the most complex high-risk challenges if they are provided with appropriate clinical direction and adequate clinical expertise. This case has shown how aligned decision-making can not only restore the patient's mobility but also restore his or her independence, self-confidence, and overall quality of life.