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Chapter in film

CONTACT - starting at 1:30

CONSULTATION - starting at 2:13

OPERATION - starting at 4:26

CLINICAL STAY - starting at 6:26

LENGTHENING - starting at 7:35

CONSOLIDATION - starting at 9:06

REMOVAL - starting at 10:22



A typical limb-lengthening procedure at the BETZ INSTITUTE® can be divided into seven characteristic steps. The complete treatment time from the operation until the removal of the nails takes about 1.5 to 3 years. Immediately after the operation, on the same day, the patients are mobilized in full weight-bearing conditions. After that first day, the patient is still allowed to bear their own full weight. But it has been shown that longer distances (2 - 3 km/1.25 - 1.86 miles per day) can be completed with a much more precise gait pattern if the patients make use of crutches. Usually, our patients are able to normally walk without any help from crutches after a period of 6 months to 1 year after the operation, though that is, of course, dependent on the lengthening distance and the osteogeneration.


Yvonne Betz in contact with a patient


(Chapter in film starting at 1:30) - Because more than 90% of our patients come from overseas, the first contact usually takes place via email or phone. Yvonne Betz and her team answer questions and sort out organizational points. After almost 20 years of experience in primarily cosmetic limb-lengthening, we are deeply familiar with the concerns and wishes of our international patients.


Dr. Augustin Betz


(Chapter in film starting at 2:13) - The first consultation is made to get to know the BETZ INSTITUTE®. In a meeting lasting several hours, an extensive medical check-up (clinical examination, x-rays, etc.) and advisory session, including the simulation and discussion of the patient's treatment wishes, is carried out. Every single detail from the operation on, including the follow-up treatment, risks and possible complications, are discussed and then given to every patient in the form of an information file. Afterwards, the patient has the opportunity to meet with patients who have already had the lengthening surgery and are in different phases of the lengthening process (clinical stay, rehab, etc.). At the end, every as of yet unanswered question is answered with patience. Thus, every patient has the best possible information to make a decision about their treatment. Of course, the patients are encouraged not to hesitate to contact the Betz Institute via phone or e-mail with any further questions or fears.

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Surgery team at the BETZ INSTITUTE®

3. Operation

(Chapter in film starting at 4:26) - It is necessary that our patients arrive at the BETZ INSTITUTE® at least 2 days before the operation. There are different reasons for that: first, the patients with long-distance flights have the opportunity to acclimatize, so the risk of thrombosis is therefore reduced. After the clarification of unanswered questions, the judicially necessary written briefingand consent agreement for the operation is filled out. Due to German law, the written consent agreement has to be signed at least 48 hours before the operation. Then surgery preparations, like laboratory tests and the briefing about anesthesia, takes place. The operation is performed either with general anesthetics or regional anesthetics. For the lengthening of both thighs, the whole operation process takes between 2.5-4 hours, depending on the level of difficulty. The operation process time for both shin bones is about 1.5 hours.
After appropriate preparation in the operation theatre, the opening and dissection of the medullary cavity are performed to implant the telescopic nail. Through the same approach, the bone is cut from the inside with the help of a specially developed internal saw, taking care that no heat occurs while sawing. In this way, the nutritive outer bone skin (periosteum) and the surrounding soft tissue are preserved and no extra scars are generated from the bone cutting.
Afterwards, the nail is inserted into the medullary cavity and affixed to the bone. Through this method, the patient is usually left with just 3 scars of only 3-5 mm/0.12-0.2 inch and one scar of about 15 mm/0.6 inch. On the lower leg, 9 to 11 scars of 3-5 mm/0.12-0.2 inch are necessary for the fixation screws and one scar of about 15 mm/0.6 inch is necessary for the insertion of the nail.
This minimally invasive and preservation-based approach, which is frequently updated to adhere to the latest developments in modern medicine, has been made to minimize blood loss and avoid pain. Through its sophisticated operation technique, the BETZ INSTITUTE® is setting itself apart from any other lengthening center.

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A potential patient in consultation speaking with a patient in the lengthening phase


(Chapter in film starting at 6:26) - Post-operation, the patients usually stay in the Institute for 10-14 days. From a medical point of view, the patients may be released earlier if they so choose. But it's been shown that patients are much more stable and familiar with the treatment procedure of lengthening and training if they remain in the Institute for the the recommended period of time. Due to the flat rate per case, which is used in Germany, a shorter or longer clinical stay up to a maximum of 21 days makes no price difference.
Intense physiotherapy is, of course, part of the clinical stay and starts from the first day after the operation on. Dietetic and cultura-orientated food is, of course, available.

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Patient managing the lengthening clicking mechanism without any assistance


verlaengerung clicks.jpg

Patient documenting the number of clicks and therefore the lengthening distance per day


verlaengerung rehab

Thanks to self-managing of the lengthening via clicking, patients are absolutely free to choose the location where the lengthening will take place. Many patients choose a rehab center in their home countries.


(Chapter in film starting at 7:35) - The lengthening phase starts 7 days after the operation. The industry standard is to lengthen the thigh bones by 1 mm/0.04 inch per day. Smaller daily lengthening distances below 1 mm/0.04 inch, like those performed at the BETZ INSTITUTE®, may lead to a longer overall lengthening period, but also allow for bones to heal more quickly and altogether more healthily on a segment-by-segment basis. Furthermore, due to the reduced irritation of the soft tissue at these lower lengthening distances, the overall wellness of the patient is less disturbed. This is why we recommend the reduction of the daily lengthening distance down to 0.7-0.9 mm/0.027-0.035 inch, depending on the lengthened region. This less taxing process is only possible with the BETZBONE® because this nail - in contrast to every other internal system - never fails to overcome one of the potential problems brought about by shorter lengthening distances - the premature bridging of hard bone tissue into the soft, calcifying tissue of the lengthening gap (preconsolidation). With the reduction of the daily lengthening distance from 1 mm/0.04 inch per day to 0.7-0.9 mm/0.027-0.035 inch, a lengthening of 9 cm/3.5 inch takes about 3 to 4 months, with good mobility and the uncompromised ability to work.
The control of the daily lengthening steps is unbelievably easy: the patient documents his daily progress (number of the clicks) in a table. Thereby, the patient has a detailed overview of the lengthening distance gained throughout every step of the process. There is no other method - including x-ray, CT scan or sonography - which provides such a precise lengthening control. Furthermore, the BETZBONE® daily control can be done by the patient him- or herself anywhere in the world, and, in addition, with only the minimal radiation exposure of occasional x-ray scans. As an added level of caution, the patient has a single x-ray scan done at intervals of 4-6 weeks.
Therefore, if the patient wants to perform the lengthening in his or her home country, this is only possible with the BETZBONE® Nail. As a result of this opportunity, the patient can continue to do his or her everyday job concurrently with the lengthening, provided it isn't a job which requires intensive effort.
If the patient doesn't want the lengthening to take place in a private setting, it is, of course, possible to do the lengthening and the follow-up treatment in the BETZ INSTITUTE®. But there is no medical reason for that.

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Physiotherapy in Rehab Center Saarschleife


(Chapter in film starting at 9:06) - The consolidation starts when the desired lengthening distance is reached. The healing of the bone is surveyed in x-ray scans. From the operation on, minerals and vitamins are provided for the support of the bone's healing process. Overall, the consolidation phase is very different from patient to patient. Generally, it can be said that for every lengthened centimeter (0.4 inch) the bone needs 6 to 12 weeks (depending on the region) to heal. But this doesn't mean that the patients are immobilized. On the contrary, it is recommended that the patients train their legs through controlled physical stress, using crutches (for a time). To stimulate the bone healing process, a distance of several kilometers should be covered every day. Moving with a precise gait pattern on crutches in a familiar and safe surrounding (at home, at work, etc.) is very beneficial. Our BETZBONE® patients are mobilized from the first day on, starting directly on the operation day.

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Removal of the lengthening nail from the right thigh bone


(Chapter in film starting at 10:22) - The date of the removal should be chosen at a time when risky sporting activities can be avoided for 2-3 months (football, paragliding, downhill-running, etc.). The bone loses a part of its stability for a short period of time when the nail is removed. The subsequent so-called "remodeling" leads to the bone having a perfect elasticity and stability, just as it did before the lengthening. At the BETZ INSTITUTE®, the nail removal is performed about 1-2 years after the lengthening. Patients are usually released from the hospital the day after the operation.

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