Bilateral lengthening of both thigh bones (left) and both shin lower legs (right)
Positions of bone cutting in bilateral limb lengthening (left: thigh bones - right: lower legs)
Positions of the BETZBONE®-medullary nails in bilateral limb lengthening (left: thigh bones - right: lower legs)
X-ray of a patient with bilateral lengthening of both thigh bones
Guideline 1: Bilateral lengthening of one segment
(Chapter in film starting at 2:38) - Bilateral lengthening means the lengthening either of both thigh bones or both shin bones at the same time. It is the more comfortable treatment procedure with the shortest treatment time, because it meets the particular needs of the soft tissue, which needs to be stretched and, thereby, adapted to the elongated bone. With the increasing length of the bone, the soft tissue, like muscles, ligaments and nerves, which are partly fixed at the bone, are more and more stretched. The increasing stretch leads to pain and the patient can ease this pain by bending his or her legs, a characteristic relief action. The higher the lengthening distance in each leg, the higher the discomfort.
A suitable treatment consists of special stretching exercises, physiotherapy, machine workouts (like those at a gym), and hydrotherapy by exercising in a warm pool, all of which allow the soft tissue to be slowly stretched and thus adapted to the elongated bone.
With bilateral lengthening - of either both thighs or both lower legs at the same time - this is achieved in the quickest and easiest way. The stretching of the soft tissue is limited to one segment in each leg (thigh or lower leg) and thus kept to a comfortable level. Furthermore, the lengthening and stretching is divided symmetrically along both sides - left and right - of the body and thus the orientation of the biomechanical axis of the body is undisturbed as much as possible. Under these conditions, the stretching of the soft tissue can be achieved in a comparably less uncomfortable and shorter treatment time.
In 1999, Dr. Betz performed the first ever simultaneous four-fold lengthening, meaning the lengthening of both thigh- and both shin-bones at the same time. But when comparing the level of discomfort and the complete treatment time (until the achievement of a normal gait pattern) of simultaneous four-fold lengthening and consecutive bilateral two-fold lengthening, the bilateral two-fold lengthening proved to be the superior method, giving better results in a shorter time.
The simultaneous lengthening of thigh- and shin bone in one leg only, also titled "Rapid Lengthening," has also been shown to be inferior. The intention of Rapid Lengthening, billed as an innovative idea, is to overcome the insufficient lengthening capacity of the nails used. Because of its discomfort, we don't recommend this method to our patients either.
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Stretching of the soft tissue in bilateral lengthening of both thigh bones (left) and both shin lower legs (right): The stretching is limited to one segment in each leg (thigh or lower leg) and thus kept to a comfortable level. Lengthening and stretching is divided symmetrically along both sides - left and right - and thus the orientation of the biomechanical axis of the body is undisturbed as much as possible. The distances in centimeter are just examples.