WO2024162942A1

WO2024162942A1 - Universal pediatric telescopic rod (upeter) (intramedullary telescopic system)

Info

Publication number: WO2024162942A1
Application number: PCT/UA2023/000002
Authority: WO
Inventors: Sergii KHMYZOV; Andrii KOVALOV
Original assignee: Khmyzov Sergii; Kovalov Andrii
Priority date: 2023-02-02
Filing date: 2023-02-02
Publication date: 2024-08-08

Abstract

An intramedullary telescopic system is described, which contains: a hollow tube; a rod telescopically connected with the tube such that a first end of the rod is disposed in the tube with a possibility of axial movement therein; a screw-shaped head mounted at a second end of the rod and having an external thread and a through hole for a locking element; and either an externally threaded end element mounted in the tube and having a through hole for a locking element, provided perpendicular to an axis of the end element, or a head for a proximal part of a thigh, mounted on the tube and having a hole made at an angle across an axis of the head for the proximal part of the thigh and having an internal thread for a femoral neck telescopic locking element. A part of the tube wall is concave forming a protrusion having V-shaped cross-section such that the concave part of the tube wall forms two flat walls at an angle to each other, and an elongated groove is made on an outer surface of the rod, which corresponds in cross-sectional shape and size to the inner surface of the concave part of the tube wall. Also described are a kit of corresponding elements for assembling the intramedullary telescopic rotationally stable fixator system, and a tube and a rod, which are used in the intramedullary telescopic system.

Description

UNIVERSAL PEDIATRIC TELESCOPIC ROD (UPcTeR)

(INTRAMEDULLARY TELESCOPIC SYSTEM)

FIELD OF THE INVENTION

The present invention relates to orthopedic surgical devices, in particular to intramedullary telescopic fixators for surgical placement in a medullary canal of patient's long bones, for example in the tibia, femur, ulna or humerus. More specifically, the present invention relates to an improved system of intramedullary telescopic rotationally stable fixators, which allows the use of an implant for surgical treatment in children with diseases associated with violation of the strength of bone tissue (“bad bone quality”).

BACKGROUND FOR THE INVENTION

Diseases associated with bad bone quality and integrity are characterized by frequent fractures and/or deformations of the long tubular bones, which leads to loss of function, up to complete non-ambulating or even movement function loss and severe disability. Treatment of the deformities of long bones in such cases is usually carried out surgically, by performing corrective osteotomies with subsequent fixation of bone fragments in correct position with the intramedullary fixators of various types.

Intramedullary rods have been used for internal fracture fixation for a long time and became a “gold standard” bone fractures treatment. As a rule, the intramedullary rod has the form of a long rod/tube with a specially shaped cross-section and transverse holes at selected places along its length. The rod is placed in the intramedullary canal and fixed with transverse bone screws inserted through the transverse holes of the rod.

Patent document US6524313B 1 discloses a structure of an intramedullary rod system that consists of a hollow cylinder and a metal rod disposed therein with a possibility of axial movement. On one (distal) end of the cylinder and on one (proximal) end of the rod, there is provided a thread and a locking hole [Fassier F. Fassier-Duval Telescopic IM system TM. Surgical technique / F. Fassier. D. Paley, Pega Medical Inc., 2006. P. 20]. The operation for their installation is less traumatic, as it is performed during one surgical intervention. The metal structure lengthens as the bone grows.

At the same time, the mentioned system has the following disadvantages:

1. The system does not provide rotational stability, and therefore the torsional displacement of the bone fragments is possible, which could require additional surgical interventions or additional fixation (external fixator, plate etc.).

2. During the process of the bone growth and rod extension from the tube, the thinnest part of the telescopic rod - the inner rod - turns to the maximally loading area.

There is known patent document US 10433886B2, which describes telescopic pediatric rod (telescopic intramedullary nail), which has a retractable telescopic structure with an elimination hole and consists of a tube with a D-shaped cross-sectional profile (an outer part) and a rod with a D-shaped cross-sectional profile (an inner part) with a corkscrew tip. The presence of a D-shaped profile provides a rotational stability of the tube relative to the rod and allows the rod to increase in length as the bone grows.

The mentioned system has the following disadvantages:

1. The unfavorable property of D-shaped cross-sectional profile is wedging (jamming) if rotational forces increase.

3. The presence of a corkscrew tip a priori could not provide rotational stability at the level of the epiphysis in the area of contact with the locking element (wire).

There is also known patent document WO202124221 1 Al describing a telescopic intramedullary fixation device. The device contains a telescopic rod which consists of an outer tube and an inner rod disposed inside the tube with a possibility of axial movement therein.

A movable head is mounted on a fixed end of the inner rod, the movable head having an external thread and a through hole for a locking element. A free end of the outer tube is provided with a hole along the tube, and an external thread, and on the threaded part, perpendicular to the axis, in the tube there is a through hole for the locking element. At the other end of the outer tube, on its inner part, there is a rectangular protrusion located along the axis of the tube. There is also an elongated groove on the outer surface of the rod, which corresponds in shape and size to the mentioned protrusion on the inner surface of the tube. Patent document WO2021242211 Al also describes a telescopic intramedullary fixation device embodiment for a femoral bone, which has a cylinder-shaped head at one end of the outer tube, the outer diameter of which exceeds the diameter of the tube. Transversal to the axis at an angle of 120- 130 degrees in the mentioned head there is a hole inside which there is a thread for a femoral neck telescopic fixing element.

However, this system has the following disadvantages:

1. A rectangular protrusion on the inner surface of the tube, which provides rotational stability of the system, has a fixed position and does not allow intraoperative correction of the length of the tube depending on anatomical parameters of a patient. It is necessary either to produce each intramedullary fixation device individually, or to have a huge assortment of products (typical sizes of fixation devices) both in length and in diameter.

2. The angle of the hole in the head for fixing the femoral neck telescopic fixation element is an unchangeable parameter and cannot be changed intraoperatively. It is necessary to use another item of the external tube, which requires a significant expansion of the range of available products necessary for the operation (diameter, length, value of the angle of fixation of a proximal part of a thigh).

The main technical tasks for the creation of this invention are to eliminate the disadvantages of the existing state of the art, namely to provide a new version of a system of intramedullary telescopic rotationally stable fixators with the following properties:

1 . Minimized number of items in the kit.

2. Possibility to adjust the length of the implant in the operation room and not to lose rotational stability of the system.

3. Possibility of choosing an angle of fixation of a femoral neck when assembling the implant for the femoral bone.

4. Possibility of choosing and setting a certain angle between locking elements at the opposite ends of the implant. 5. Possibility of choosing and setting a certain angle between a locking element and a femoral neck telescopic fixator of the femoral implant.

BRIEF DESCRIPTION OF THE INVENTION

To solve the specified technical tasks, in one aspect, the invention provides a kit of elements of an intramedullary telescopic system, which contains: a hollow tube with a mounting end and a free end; a rod configured to be telescopically connected with the tube in such a way that the rod is disposed with its first end in the tube from the side of the free end of the tube with a possibility of axial movement therein; a screw-shaped head configured to be mounted on a second end of the rod, the screw-shaped head having an external thread and a through hole for a locking element; and one of the following elements: an end element with an external thread at one of its ends, configured to be mounted in the tube from the side of the mounting end of the tube, such that the threaded part of the end element is outside the tube, wherein the threaded part has a through hole for a locking element, the through hole provided perpendicular to an axis of the end element; a head for a proximal part of a thigh, configured to be mounted on the tube at the mounting end of the tube, wherein the head for the proximal part of the thigh has a cylindrical shape, wherein the head for the proximal part of the thigh has a hole provided at an angle across an axis of the head for the proximal part of the thigh, inside which a thread is made for a femoral neck telescopic locking element; wherein a part of a wall of the tube is made concave forming a protrusion having V-shaped cross-section such that the concave part of the wall of the tube forms two flat walls at an angle to each other, and an elongated groove is made on an outer surface of the rod, which corresponds in cross-sectional shape and size to the inner surface of the concave part of the tube wall.

In another aspect, the invention provides an intramedullary telescoping system, for assembling of which the elements from the kit are used, and which includes: a hollow tube with a mounting end and a free end; a rod telescopically connected to the tube in such a way that a first end of the rod is disposed in the tube from the side of the free end of the tube with a possibility of axial movement therein; a crew-shaped head mounted on the second end of the rod, the screw-shaped head having an external thread and a through hole for a locking element; and one of the following elements: an end element with an external thread on one of its ends, mounted in the tube from the side of the mounting end of the tube such that the threaded part of the end element is outside the tube, wherein the threaded part has a through a hole for locking element, the through hole provided perpendicular to an axis of the end element; a head for a proximal part of a thigh, mounted on the tube at the mounting end of the tube, wherein the head for the proximal part of the thigh has a cylindrical shape, wherein the head for the proximal part of the thigh has a hole provided at an angle across an axis of the head for the proximal part of the thigh, inside which a thread is made for a femoral neck telescopic locking element; wherein a part of a wall of the tube is made concave forming a protrusion having V-shaped cross-section such that the concave part of the tube wall forms two flat walls at an angle to each other, and an elongated groove is made on an outer surface of the rod, which corresponds in cross-sectional shape and size to the inner surface of the concave part of the tube wall.

In another aspect, the invention provides a tube for the mentioned intramedullary telescopic system, which has a mounting end and a free end, is hollow, and is configured to be telescopically connected with a rod of the intramedullary telescopic system in such a way that the rod is disposed with its first end in the tube from the side of the free end of the tube with a possibility of axial movement therein, wherein the tube is configured to: mount in the tube, from the side of the mounting end of the tube, an end element with an external thread on one of its ends such that the threaded part of the end element is outside the tube, wherein the threaded part is made with a through hole for a locking element, the through hole provided perpendicular to an axis of the end element; or mount on the tube, at the mounting end of the tube, a head for a proximal part of a thigh, wherein the head for the proximal part of the thigh has a cylindrical shape, wherein the head for the proximal part of the thigh has a hole provided at an angle across an axis of the head for the proximal part of the thigh, inside which a thread is made for a femoral neck telescopic locking element; wherein a part of a wall of the tube is concave forming a protrusion having V-shaped cross-section such that the concave part of the tube wall forms two flat walls at an angle to each other, wherein an inner surface of the concave part of the tube wall is made corresponding in cross-sectional shape and size to an elongated groove made on an outer surface of the rod. In another aspect, the invention provides a rod for an intramedullary telescopic system, which is configured to be telescopically connected with a hollow tube of the intramedullary telescopic system in such a way that the rod is disposed with its first end in the tube with a possibility of axial movement therein, and is configured to mount on at its second end a screw -shaped head having an external thread and a through hole for a locking element, and wherein an outer surface of the rod is made with an elongated groove that corresponds in cross-sectional shape and size to an inner surface of a part of a wall of the tube, which is concave forming V-shaped cross-section such that the concave part of the tube wall forms two flat walls at an angle to each other.

Tn one preferred embodiment of the invention, the plane in which the protrusion having V-shaped cross-section is made either coincides with an axis of the locking element after its installation on the mounting end of the tube, or creates an angle with the axis of the locking element after its installation on the mounting end of the tube.

In another embodiment of the invention, the concave part of the tube wall is provided along the axis of the tube at the free end of the tube, and the elongated groove is provided along the axis of the rod, such that when the rod is inserted into the tube, the concave part of the tube wall coincides with the elongated groove of the rod, wherein the concave part of the tube wall has a length less than a length of the tube and less than a length of the elongated groove.

In another preferred embodiment of the invention, the mounting end of the tube is made with a conical surface such that a diameter of the tube is narrowed at the mounting end.

In another preferred embodiment of the invention, the end of the rod has a groove for the locking element such that inserting the locking element simultaneously into the hole of the screw-shaped head and into the groove at the end of the rod leads to mutual locking of the rod and the screw-shaped head.

In another preferred embodiment of the invention, the end element is a sleeve, and the end part of the sleeve with the external thread and is a self-tapping screw, wherein preferably the end element is made with a protrusion, and the tube has a corresponding groove for preliminary orientation of the end element relative to the tube, wherein preferably one or more undercuts are made on the end element to secure the end element relative to the tube by crimping the mounting end of the tube. In another preferred embodiment of the invention, the cylinder-shaped head for the proximal part of the thigh has an outer diameter greater than the diameter of the tube, wherein preferably the tube has a groove at the mounting end, and the head for the proximal part of the thigh has a locking pin of an appropriate size for preliminary orientation of the head for the proximal part of the thigh relative to the tube, wherein preferably the head for the proximal part of the thigh has retaining pins and the tube has corresponding holes to ensure securing of the head for the proximal part of the thigh relative to the tube, wherein preferably the hole in the head for the proximal part of the thigh is made across the axis at an angle of 1 10-140 degrees, wherein the kit preferably contains two or more heads for the proximal part of the thigh, with the holes made at different angles, to provide a possibility of selecting a head for the proximal part of the thigh according to a value of said angle, depending on anatomical features of a patient.

In another preferred embodiment of the invention, the screw-shaped head has an outer diameter greater than the outer diameter of the tube and a diameter of the thread roots, which is preferably equal to the outer diameter of the tube, wherein the screw-shaped head is configured to screw into a bone and preferably is a self-tapping screw.

In another preferred embodiment of the invention, the thread inside the hole of the head for the proximal part of the thigh is made along a part or the entire length of the hole and is a cylindrical or conical thread.

In another preferred embodiment of the invention, the kit further contains the femoral neck telescopic locking element, which includes an external fixed part which diameter corresponds to the diameter of the hole of the head for the proximal part of the thigh, and which is made with a locking thread, and an internal movable part, which is made with a thread on its outer end, which diameter is greater than the diameter of the movable part, wherein the internal movable part is a self-tapping screw.

In another preferred embodiment of the invention, all the elements of the kit are made of metal, wherein preferably the concave part of the tube wall is made by plastic deformation of metal of the lube, and the elongated groove of the rod is made by machining metal of the rod.

In another preferred embodiment of the invention, the tube and the rod have lengths that are necessary for attachment to bone structures without disturbing a bone growth plate. Thus, the claimed invention offers a universal kit of elements of an intramedullary telescopic system that can be used in pediatrics. Either an end element or a head for a proximal part of a thigh can be installed on the mounting end of the tube using a special tool. The type of the element, which is installed on the mounting end of the tube, depends on a zone of application of the implant: a femur or other tubular bones. The tube is cut at the free end of the tube, which is intended for receiving the inner rod therein, so as to obtain an estimated length of the implant. After installing a corresponding element (an end element, or a head for a proximal part of a thigh, with a proper angle of the hole) on the mounting end of the tube, cutting, and processing of sharp edges from the free end of the tube, which can be done intraoperatively, a V-shaped protrusion is made on the tube, using a special tool on the inner surface of the tube at a certain distance from pre-cut edge at the free end, which is also performed intraoperatively due to plastic deformation of the metal. When the rod is inserted into the tube and the V-shaped protrusion on the tube and the V-shaped elongated groove on the outer surface of the inner rod coincide, a rotational stability of the rod relative to the tube is provided with a possibility of increasing a total length of the implant.

BRIEF DESCRIPTION OF DRAWINGS

The proposed invention is explained using the drawings which show different embodiments of the features of the present invention, are illustrative and are not limiting.

Fig. 1 schematically shows a tube and an end element for assembling an outer part of an intramedullary telescopic system for tubular bones.

Fig. 2 schematically shows the outer part of the intramedullary assembly telescopic system for tubular bones before the moment of final fixation;

Fig. 3 schematically shows the outer part of the intramedullary assembly telescopic system for tubular bones after final fixation.

Fig. 4 schematically shows the outer part of the intramedullary telescopic system for tubular bones, in which a V-shaped protrusion is made at the free end of the tube.

Fig. 5 schematically shows a tube and a head for a proximal part of a thigh for assembling an outer part of an intramedullary telescopic system for a femoral bone. Fig. 6 schematically shows the assembly and final mutual fixation of pieces of the outer part of the intramedullary telescopic system for a femoral bone.

Fig. 7 schematically shows the outer part of the intramedullary telescopic system for femoral bone, in which a V-shaped protrusion is made at the free end of the tube.

Fig. 8 schematically shows an inner part of the intramedullary telescoping system for a femoral bone, which includes a rod, on an outer surface of which an elongated V-shaped groove is made and a movable screw-shaped head with an external thread is installed.

Fig. 9 schematically shows the assembly of the outer and inner parts of the intramedullary telescoping system for femoral bone, installation of a femoral neck telescopic fixator, installation of a locking element.

Fig. 10 schematically shows the assembly of the outer and inner parts of the intramedullary telescopic system for tubular bones, installation of locking elements.

DETAILED DESCRIPTION

The following embodiments are illustrative and not limiting. It should be understood that various modifications and/or changes to the embodiments described herein may be done without departing from the disclosure, and any such modifications and/or changes fall within the scope of the disclosed invention.

With reference to Fig. 1, a universal pediatric telescopic rod is proposed, which comprises an outer tube 2 having a mounting end and a free end.

According to an embodiment of the invention, namely, when assembl ing an implant for tubular bones, a special tool can be used to install on the mounting end of the outer tube 2, which is made with a conical surface and a hole with an axis transverse to the axis of the tube 2, an end element 1 one end of which is a self-tapping screw provided with an external thread, wherein the threaded part has a through hole 8 for a locking element, which is perpendicular to the axis of the tube 2. For preliminary orientation of the end element 1 relative to the tube 2, a protrusion 3 is made on the end element 1 , and the tube 2 has a corresponding groove 4. To ensure a reliable and strong fixation of the end clement 1 relative to the tube 2, one or more undercuts 5 are made on the end element 1 . The end element 1 can be a sleeve. As shown in Fig. 2, the end element 1 is inserted into the mounting end of the tube 2, the protrusion 3 is combined with the groove 4, after which the mounting end of the tube 2 is crimped, as shown in Fig. 3. The material 6 of the tube in the fixation zone 7 is pressed into the undercut 5 and ensures a reliable mutual fixation.

After that, the tube 2 is cut from the side of the free end to a required length, the sharp edges are processed after cutting, and by the method ofcrimping from the outside in the area 9 closer to the cut free end of the tube 2, a V-shaped protrusion 10 is formed on the inner surface of the tube, as shown in Fig. 4. The plane in which the V-shaped protrusion 10 is made on the inner surface of the tube 2 can either coincide with the axis of the hole 8 for the locking element, or, at a surgeon's decision, can create a certain angle in relation to the mentioned axis.

As it is shown in Figs. 5 and 9, according to another embodiment of the present invention, namely, when assembling an implant for a femoral bone (femur), a special tool can be used to install on the mounting end of the outer tube 2, which is made with the conical surface and the hole with the axis transverse to the axis of the tube 2, a head 1 1 for a proximal part of a thigh, which is for a proximal section of an outer part 20 of a femoral neck telescopic fixator, the head 1 1 being provided with an internal threaded hole at an angle A for installing the femoral neck telescopic fixator. Position 19 in Fig. 9 shows an inner part of the femoral neck telescopic fixator, which is configured to screw into the neck of the femur.

For preliminary orientation relative to the tube 2 of the head 1 1 for the proximal part of the thigh, which is for the outer part 20 of the telescopic fixator, the tube is provided with a notch 4 at the mounting end, and the head 1 1 has a locking pin 13 of an appropriate size. To ensure a reliable and strong fixation relative to the tube 2 of the head 1 1 for the proximal part of the thigh, which is for the outer part 20 of the telescopic fixator, the head 1 1 is provided with retaining pins 12, and the tube has corresponding holes 14.

The head 1 1 for the proximal part of thcthigh, which is for the outer part 20 of the telescopic fixator, is selected according to a value of the angle A for insertion of the femoral neck telescopic fixator depending on anatomical features of a patient.

The head 1 1 for the proximal part of the thigh, which is for the outer part 20 of the telescopic fixator, is put on top of the mounting end of the tube 2, as shown in Fig. 6, the locking pin 13 is combined with the notch 4, after which the retaining pins 12 are pressed into the corresponding holes 14 of the tube 2, which ensures reliable mutual fixation.

After that, the tube 2 is cut from the side of the free end to a desired length, the sharp edges are processed after cutting, and a V-shaped protrusion 10 is formed on the inner surface of the tube 2 in the area 9 closer to the cut free end of the tube 2 by crimping from the outside, as shown in Fig. 7. The plane in which the V-shaped protrusion 10 is made on the inner surface of the tube 2 can either coincide with the plane of the hole for installing the femoral neck telescopic locking element, or, at the surgeon’s decision, it can create a certain angle (antetorsion angle) in relation to the mentioned axis.

The shape and size of the protrusion 10 on the inner surface of the tube 2 in cross-section corresponds to a V-shaped elongated groove 17 on an outer surface of an inner rod 23 shown in Fig. 8.

The inner rod 23 has the mentioned V-shaped groove 17 almost along its entire length, as shown in Fig. 8. On an end of the inner rod 23, a movable screw-shaped head 15 with an external thread is installed, which has an external diameter greater than an external diameter of the tube 2, and a diameter of the thread roots, which is preferably equal to the external diameter of the tube 2. The screw-shaped head 15 is a self-tapping screw.

As it is seen in Figs. 9 and 10, when the rod 23 is inserted into the tube 2 and the V-shaped protrusion 10 of the tube 2 coincides with the V-shaped elongated groove 17 on the outer surface of the rod 23, a rotational stability of the rod 23 relative to the tube 2 is provided while maintaining a possibility of extending a total length of the implant.

T he screw-shaped head 15 is configured to screw into a bone while the rod 23 can move in axial direction inside the tube 2.

The screw-shaped head 15 has, perpendicular to its axis, a through hole 16 for a locking element 21 , and the rod 23 has a corresponding groove 18 for the locking clement 21 on its end. After screwing the screw-shaped head 15 into a bone to a required depth, locking is performed using the locking element 21. Inserting a locking element 21 simultaneously into the hole 16 of the movable screw-shaped head 15 and into the groove 18 on the end of the rod 23 in the locking area 22, as shown in Figs. 9 and 10, leads to mutual locking of the rod 23 and the screw-shaped head 15.

In an embodiment, as shown in Fig. 10, a locking element 21 is inserted first of all into the hole 8 of the end element 1. When a locking element 21 is also inserted into the screw-shaped head 15, into the hole 16, it completely blocks the screw-shaped head 15 from rotation and movement.

The telescopic connection between the elements of the telescopic rod is intended to enable an axial movement of the ends of the elements of the telescopic rod system relative to each other to allow a normal growth of the bone. A locking element is a means for securing each end of the telescopic rod assembly to any end of a damaged long bone when the telescopic rod is implanted in the long bone.

Many modifications to the embodiments described herein, as well as other embodiments, can be apparent to one skilled in the art who can take advantage of the ideas presented in the foregoing description and related drawings. It is understandable that any such modifications and additional embodiments are covered by the scope of this disclosure which should not be limited to any of the disclosed particular embodiments.

Claims

1. A kit of elements of an intramedullary telescopic system, which contains:

- a hollow tube with a mounting end and a free end;

- a rod configured to be telescopically connected with the tube in such a way that the rod is disposed with its first end in the tube from the side of the free end of the tube with a possibility of axial movement therein;

- a screw-shaped head configured to be mounted on a second end of the rod, the screw-shaped head having an external thread and a through hole for a locking element; and

- one of the following elements:

- an end element with an external thread on one of its ends, configured to be mounted in the tube from the side of the mounting end of the tube such that the threaded part of the end element is outside the tube, wherein the threaded part has a through hole for a locking element, the through hole provided perpendicular to an axis of the end element,

- a head for a proximal part of a thigh, configured to be mounted on the tube at the mounting end of the tube, wherein the head for the proximal part of the thigh has a cylindrical shape, wherein the head for the proximal part of the thigh has a hole provided at an angle across an axis of the head for the proximal part of the thigh, inside which a thread is made for a femoral neck telescopic locking element; characterized in that a part of a wall of the tube is made concave forming a protrusion having V-shaped cross-section such that the concave part of the tube wall forms two flat walls at an angle to each other, and an elongated groove is made on an outer surface of the rod, which corresponds in cross-sectional shape and size to the inner surface of the concave part of the tube wall.

2. The kit according to claim 1 , characterized in that the plane in which the protrusion having V-shaped cross-section is made either coincides with an axis of the locking element after its installation on the mounting end of the tube, or creates an angle with the axis of the locking element after its installation on the mounting end of the tube.

3. The kit according to claim 1 or claim 2, characterized in that the concave part of the tube wall is provided along the axis of the tube at the free end of the tube, and the elongated groove is provided along the axis of the rod, such that when the rod is inserted into the tube, the concave part of the tube wall coincides with the elongated groove of the rod, wherein the concave part of the tube wall has a length less than a length of the tube and less than a length of the elongated groove.

4. The kit according to any one of the preceding claims, characterized in that the mounting end of the tube is made with a conical surface, such that a diameter of the tube is narrowed at the mounting end.

5. The kit according to any one of the preceding claims, characterized in that the end of the rod has a groove for the locking element such that inserting the locking element simultaneously into the hole of the screw-shaped head and into the groove at the end of the rod leads to mutual locking of the rod and the screw-shaped head.

6. The kit according to any one of the preceding claims, characterized in that the end element is a sleeve, and the end part of the sleeve with the external thread is a self-tapping screw, wherein preferably the end element is made with a protrusion, and the tube has a corresponding groove for preliminary orientation of the end element relative to the tube, wherein preferably one or more undercuts are made on the end element to secure the end element relative to the tube by crimping the mounting end of the tube.

7. The kit according to any one of claims 1-5, characterized in that the cylinder-shaped head for the proximal part of the thigh has an outer diameter greater than the diameter of the tube, wherein preferably the tube has a groove at the mounting end, and the head for the proximal part of the thigh has a locking pin of an appropriate size for preliminary orientation of the head for the proximal part of the thigh relative to the tube, wherein preferably the head for the proximal part of the thigh has retaining pins and the tube has corresponding holes to ensure securing of the head for the proximal part of the thigh relative to the tube, wherein preferably the hole in the head for the proximal part of the thigh is made across the axis at an angle of 1 10- 140 degrees, wherein the kit preferably contains two or more heads for the proximal part of the thigh, with the holes made at different angles, to provide a possibility of selecting a head for the proximal part of the thigh according to a value of said angle, depending on anatomical features of a patient.

8. The kit according to any one of the preceding claims, characterized in that the screw-shaped head has an outer diameter greater than the outer diameter of the tube and a diameter of the thread roots, which is preferably equal to the outer diameter of the tube, wherein the screw-shaped head is configured to screw into a bone and preferably is a self-tapping screw.

9. The kit according to any one of the preceding claims, characterized in that the thread inside the hole of the head for the proximal part of the thigh is made along a part or the entire length of the hole and is a cylindrical or conical thread.

10. The kit according to any one of the preceding claims, characterized in that it further contains the femoral neck telescopic locking element, which includes an external fixed part which diameter corresponds to the diameter of the hole of the head for the proximal part of the thigh, and which is made with a locking thread, and an internal movable part, which is made with a thread on its outer end, which diameter is greater than the diameter of the movable part, wherein the internal movable part is a self-tapping screw.

1 1. The kit according to any one of the preceding claims, characterized in that all the elements of the kit are made of metal, wherein preferably the concave part of the tube wall is made by plastic deformation of metal of the tube, and the elongated groove of the rod is made by machining metal of the rod.

12. The kit according to any one of the preceding claims, characterized in that the tube and the rod have lengths that are necessary for attachment to bone structures without disturbing a bone growth plate.

13. An intramedullary telescopic system, which contains:

- a hollow tube with a mounting end and a free end;

- a rod telescopically connected to the tube in such a way that a first end of the rod is disposed in the tube from the side of the free end of the tube with a possibility of axial movement therein;

- a screw-shaped head mounted on a second end of the rod, the screw-shaped head having an external thread and a through hole for a locking element; and

- one of the following elements:

- an end element with an external thread on one of its ends, mounted in the tube from the side of the mounting end of the tube such that the threaded part of the end element is outside the tube, wherein the threaded part has a through hole for a locking element, the through hole provided perpendicular to an axis of the end element.

- a head for a proximal part of a thigh, mounted on the tube at the mounting end of the tube, wherein the head for the proximal part of the thigh has a cylindrical shape, wherein the head for the proximal part of the thigh has a hole provided at an angle across an axis of the head for the proximal part of the thigh, inside which a thread is made for a femoral neck telescopic locking element; characterized in that a part of a wall of the tube is made concave forming a protrusion having V-shaped cross-section such that the concave part of the tube wall forms two flat walls at an angle to each other, and an elongated groove is made on an outer surface of the rod, which corresponds in cross-sectional shape and size to the inner surface of the concave part of the tube wall.

14. A tube of an intramedullary telescopic system, which has a mounting end and a free end, is hollow and is configured to be telescopically connected with a rod of the intramedullary telescopic system in such a way that the rod is disposed with its first end in the tube from the side of the free end of the tube with a possibility of axial movement therein, wherein the tube is configured to:

- mount in the tube, from the side of the mounting end of the tube, an end element with an external thread on one of its ends, such that the threaded part of the end clement is outside the tube, wherein the threaded part is made with a through hole for a locking element, the through hole provided perpendicular to an axis of the end element; or

- mount on the tube, at the mounting end of the tube, a head for a proximal part of a thigh, wherein the head for the proximal part of the thigh has a cylindrical shape, wherein the head for the proximal part of the thigh has a hole provided at an angle across an axis of the head for the proximal part of the thigh, inside which a thread is made for a femoral neck telescopic locking element; characterized in that a part of a wall of the tube is concave forming a protrusion having V-shaped cross-section such that the concave part of the tube wall forms two flat walls al an angle to each other, wherein an inner surface of the concave part of the tube wall is made corresponding in cross-sectional shape and size to an elongated groove made on an outer surface of the rod.

15. A rod of an intramedullary telescopic system, which is configured to be telescopically connected with a hollow tube of the intramedullary' telescopic system in such a way that the rod is disposed with its first end in the tube with a possibility of axial movement therein, and is configured to mount on its second end a screw-shaped head having an external thread and a through hole for a locking element, and characterized in that an outer surface of the rod is made with an elongated groove that corresponds in cross-sectional shape and size to an inner surface of a part of a wall of the tube, which is concave forming a protrusion having V-shaped cross-section such that the concave part of the tube wall forms two flat walls at an angle to each other.