Limb Lengthening Forum
Limb Lengthening Surgery => Limb Lengthening Doctors => Topic started by: Muse on November 10, 2013, 07:14:43 AM
-
General Information about Dr Betz of The Betz Institute, based in Germany. Contact them for specific information and latest updates.
Note: please refer to our disclaimer about The Doctors Directory http://www.limblengtheningforum.com/index.php?topic=55.0
Process:
Our patients can gain up to 4-5 inches (10-12 cm) in one operation on upper legs (femurs) or lower legs (tibias). Patients may also gain a total of 8-9 inches (20-22 cm) in 2 operations.
1st operation on femur for 4-5 inches (10-12 cm)
2nd operation on tibias for 4 inches (10 cm). The amount of gain in tibias may vary from patient to patient. In many cases it is advised by Prof. Dr. Betz to lengthen up to 6-8 cm in tibias.
Patients gain an average of 7-10 cm in one bone region at the Betz institute.
The rate of lengthening is 1 millimetre per day. Every 10 days is 1 cm Patients can gain up to 10 cm (4 inches) in 3 months.
Cost
The following prices are the standard cost for typical limb lengthening procedures:
Betzbone - 48,500 euros (bilateral femur), 51,500 euros (bilateral tibia)
Surgical Techniques
Internal Methods
-Betzbone (Current)
Previous Methods
-Albizzia
-Fitbone
-ISKD
External Methods
-Sheffield Ring fixator
-LRS Monolateral distractor
Contact Info
Updated Current Address
: Betzinstitute
Brunnenstraße 20
66538 Neunkirchen
Phone: 49 (0) 6871.92 18 70
Fax : +49 (0) 6871.92 19 07
Email: info@betzinstitute.com
Website: http://www.betzinstitute.com
Previous Address:
Betz institute
Heeresstr. 49
66822 Lebach
Germany
-
Anyone considering Dr. Betz should know that Apotheosis/Syop (same person) from old forum is in business with Dr. Betz and they are all about the money in trying to promote the Betzbone at the major risk to patients.
Dr. Betz has an incredibly high complication rate with his nail the Betzbone. It constantly bends and breaks and it cost $25,000 to replace the Betzbone with a titanium nail.
There are major complications from Dr. Betz patients that never get reported and lead to unnecessary patient suffering. Dr. Betz allows anyone to lengthen well beyond their natural limit because he doesn't want to lose money and patients by restricting their lengthening.
Patients constantly require anesthesia clicking where Dr. Betz will lengthen more than 4-5mm in the matter of a few minutes. You should NEVER lengthen more than 1mm throughout the course of a day.
Dr. Betz will over ream someones bone canal to install the larger diameter 13mm Betzbone even though this is incredibly dangerous. You should NEVER over ream the bone canal to install a larger nail.
Read the following threads for more information on how corrupt Dr. Betz is to go into business with Apotheosis/Sysop and how many complications the Betzbone patients experience.
http://www.limblengtheningforum.com/index.php?topic=24.0
http://www.limblengtheningforum.com/index.php?topic=4.0
-
We did a podcast episode with a person who did go to Dr. Betz back in 2011. It is available on the post "Natural Height Growth Podcast, Episode 12 – Andrew Tells His Story On Getting Limb Lengthening Surgery (http://www.naturalheightgrowth.com/2014/02/10/natural-height-growth-podcast-episode-12-andrew-tells-story-getting-limb-lengthening-surgery/)"
Apparently he did get a slight complication, but we would not however say all the blame is on the doctor. Some people have bones that heal at a different rate.
-
Andrewshizzles is probably my favorite CLL diary.
Looking forward to hearing this podcast.
We did a podcast episode with a person who did go to Dr. Betz back in 2011. It is available on the post "Natural Height Growth Podcast, Episode 12 – Andrew Tells His Story On Getting Limb Lengthening Surgery (http://www.naturalheightgrowth.com/2014/02/10/natural-height-growth-podcast-episode-12-andrew-tells-story-getting-limb-lengthening-surgery/)"
Apparently he did get a slight complication, but we would not however say all the blame is on the doctor. Some people have bones that heal at a different rate.
-
Thanks for this podcast. Andrew seems to be very, very happy with his life now.
And I like the part when he said, once he's done with the LL, he's not even thinking about his height now.
-
We did a podcast episode with a person who did go to Dr. Betz back in 2011. It is available on the post "Natural Height Growth Podcast, Episode 12 – Andrew Tells His Story On Getting Limb Lengthening Surgery (http://www.naturalheightgrowth.com/2014/02/10/natural-height-growth-podcast-episode-12-andrew-tells-story-getting-limb-lengthening-surgery/)"
Apparently he did get a slight complication, but we would not however say all the blame is on the doctor. Some people have bones that heal at a different rate.
Andrew's nail broke. How can you not blame the doctor? If the bone didn't heal fast enough then probably the osteotomy wasn't done well. There is so much misinformation going around.
-
Andrew said it's partly his and partly Dr Betz fault.
I don't know if it's 50-50.
-
Anyone considering Dr. Betz should know that Apotheosis/Syop (same person) from old forum is in business with Dr. Betz and they are all about the money in trying to promote the Betzbone at the major risk to patients.
Dr. Betz has an incredibly high complication rate with his nail the Betzbone. It constantly bends and breaks and it cost $25,000 to replace the Betzbone with a titanium nail.
There are major complications from Dr. Betz patients that never get reported and lead to unnecessary patient suffering. Dr. Betz allows anyone to lengthen well beyond their natural limit because he doesn't want to lose money and patients by restricting their lengthening.
Patients constantly require anesthesia clicking where Dr. Betz will lengthen more than 4-5mm in the matter of a few minutes. You should NEVER lengthen more than 1mm throughout the course of a day.
Dr. Betz will over ream someones bone canal to install the larger diameter 13mm Betzbone even though this is incredibly dangerous. You should NEVER over ream the bone canal to install a larger nail.
Read the following threads for more information on how corrupt Dr. Betz is to go into business with Apotheosis/Sysop and how many complications the Betzbone patients experience.
http://www.limblengtheningforum.com/index.php?topic=24.0
http://www.limblengtheningforum.com/index.php?topic=4.0
[/quot
Hello,
many people are talking about a lot of things they don't know exactly and they claim things concerning my person I decided to give a statement to different points of interest. I have read a lot of incorrect information and statements in this forum and I can’t let these claims unanswered because this is a serious kind of defamation. Everybody can have his own view on the different doctors and methods. Now I just want to give a statement to some discussed points and try a bit clarification. It's up to everybody to believe it or not.
I don’t have any business relation to Sysop/Apotheosis. He was and is my patient as hundreds other patients too. He did his lengthening procedure very well – also as many before and after him. I never did any surgery for him for free. I have no influence on what he wrote and is writing in old forum . It is correct that he asked me to sell Betzbone® in India but I always refused to do this because the doctors there have no experience with it. And I don’t want to make fast money at the expense of patients in India. In old forum he announced that Betzbone® will be sold in India without our agreement. Above the nail has a CE-certification for EU – not for India. Look at the doctor’s websites in India. You will not find a Betzbone®. Ask for Guichet – his nail has been sold to India. Above I often disagree with the recommendations Sysop/Apotheosis gave and is giving in the forum. He lives his own life in old forum and also during limb lengthening. I don’t have any other contact with him except as a patient of me.
-
Is this the real Dr Betz?
If you are, then thank you for participating in this forum to clear up things.
One of the main issues of your patient is the nail bending. Can you tell us more about this (update: okay, I just read your answer on the other thread)?
How many of your patients had their nails bent/broken? How many ended up getting titanium nails?
So, you confirm Sysop and Apotheosis are one and the same?
Thanks.
-
General Information about Dr Betz of The Betz Institute, based in Germany. Contact them for specific information and latest updates.
Note: please refer to our disclaimer about The Doctors Directory http://www.limblengtheningforum.com/index.php?topic=55.0
Process:
Our patients can gain up to 4-5 inches (10-12 cm) in one operation on upper legs (femurs) or lower legs (tibias). Patients may also gain a total of 8-9 inches (20-22 cm) in 2 operations.
1st operation on femur for 4-5 inches (10-12 cm)
2nd operation on tibias for 4 inches (10 cm). The amount of gain in tibias may vary from patient to patient. In many cases it is advised by Prof. Dr. Betz to lengthen up to 6-8 cm in tibias.
Patients gain an average of 7-10 cm in one bone region at the Betz institute.
The rate of lengthening is 1 millimetre per day. Every 10 days is 1 cm Patients can gain up to 10 cm (4 inches) in 3 months.
Cost
The following prices are the standard cost for typical limb lengthening procedures:
Betzbone - 48,500 euros (bilateral femur), 51,500 euros (bilateral tibia)
Surgical Techniques
Internal Methods
-Albizzia
-Fitbone
-ISKD
External Methods
-Sheffield Ring fixator
-LRS Monolateral distractor
Contact Info
Phone: +49 (0) 175 7815 512
Email: info@betzinstitute.com
Website: http://www.betzinstitute.com/contact.htm
Address: Betz institute
Heeresstr. 49
66822 Lebach
Germany
Hi,
I just want to update some information about me:
Address: Betzinstitute
Brunnenstraße 20
66538 Neunkirchen
phone: +49 (0) 151 17427960
Internal methods:
BetzboneIs this the real Dr Betz?
If you are, then thank you for participating in this forum to clear up things.
One of the main issues of your patient is the nail bending. Can you tell us more about this? How many of your patients had their nails bent/broken? How many ended up getting titanium nails?
Thanks.
Yes, I am the real Betz. No problem to give a statement to bending nails and also broken nails. Just give me one moment of time. I will like to do it.
-
If user Augustin is real dr. Betz than this forum is making one big change in CLL. I am glad doctors are aware of patients knowlegde and for sure they'll do their best not to make any more mistakes in future LL surgeries.
Dr. Betz , dr. Franz...
Congratulations LL forum.
-
If this is the real Dr. Betz then lets hear his medical opinion on the information posted today by Stadiometer. An experienced doctor like Dr. Betz after nearly 30 years in Orthopedics and limb lengthening should easily be able to respond in very detailed medical terminology while avoiding all non specific language. Then we'll know if this is the real Dr. Betz.
http://www.limblengtheningforum.com/index.php?topic=380.msg6072#msg6072
(http://i1296.photobucket.com/albums/ag19/Stadiometer/Paley1_zps82f5184b.png)
Above Information from Dr. Paley
(http://i1296.photobucket.com/albums/ag19/Stadiometer/eea96250-0311-4a53-92bf-e20fe6283876_zpscab9cbe2.jpg)
Above X-Ray from Apotheosis: Screw not angled by Dr. Betz
(http://i1296.photobucket.com/albums/ag19/Stadiometer/Paley2_zpsa151f12b.png)
Above information from Dr. Paley
(http://i1296.photobucket.com/albums/ag19/Stadiometer/DrBetzOsteotomy_zpsb1b656a3.png)
Above image directly from Dr. Betz website
-
This is an email from info@betzinstitute.com. Just to confirm that Dr Betz is really posting as 'Augustin'
(http://i60.tinypic.com/rbmcmp.jpg)
-
(http://i1296.photobucket.com/albums/ag19/Stadiometer/aed88e29-db80-41e1-a163-7f50f2b3efbf_zps8df71282.png)
Above Image: Dr. Paley ankle screw is on an angle
(http://i1296.photobucket.com/albums/ag19/Stadiometer/f446773f-37d9-4a32-8083-2843dbd6106d_zpscbef5d00.jpg)
Above Image: Dr. Rozbrusch ankle screw is on an angle
(http://i1296.photobucket.com/albums/ag19/Stadiometer/DrDonghoonLee_zpsdc1bddbb.png)
Above Image: Dr. Donghoon Lee ankle screw is on an angle
(http://i1296.photobucket.com/albums/ag19/Stadiometer/eea96250-0311-4a53-92bf-e20fe6283876_zpscab9cbe2.jpg)
Above Image: Dr. Betz ankle screw is not on an angle for Apotheosis
-
My apologies for the double post. This information did not attach properly to the above post.
(http://i1296.photobucket.com/albums/ag19/Stadiometer/DrPaleyAnkle_zps528a86a8.png)
Above Image: Information from Dr. Paley
-
Dr. Betz:
Please allow me to ask you a question that concerns me about internal lengthening. . .
What is the rate of compartment syndrome if you had any at all?
From your point of view what is the best way to minimize this complications from happening?
Also, could internal lengthening have a higher risk for compartment syndrome rather than external?
thank you
-
Dr. betz,
Thank you for coming to this forum, I am close to making a decision and all these comments really makes me guess if you are a option.
How strong is the betzbone? Why is dr guichet only using 13mm NAILS? I have never heard of any dr. guichet patients breaking their nails, why is that? If i request a 13mm nail will you acknowledge my decision. What is your opinion on ITB release? Why do you let patients weightbear so early?
-
According to Dr Betz, he will be away for sometime this week.
I'm sure he noted already these questions and it's entirely up to him when he will reply (or if he will reply at all).
It's common sense that if he doesn't reply, then these issues will keep hanging.
Despite the nail issues, all (?) of his patients seem to recommend him (If Mime is indeed his patient, then he's the first one I know who doesn't recommend him).
For the record, he is not even on my top 5 doctors to do my LL (I prefer precice).
-
I don’t have any business relation to Sysop/Apotheosis. I never did any surgery for him for free. I have no influence on what he wrote and is writing in old forum . It is correct that he asked me to sell Betzbone® in India but I always refused to do this because the doctors there have no experience with it. . In old forum he announced that Betzbone® will be sold in India without our agreement.
Above I often disagree with the recommendations Sysop/Apotheosis gave and is giving in the forum. He lives his own life in old forum and also during limb lengthening. I don’t have any other contact with him except as a patient of me.
Seems like Dr Betz is trying to distance himself from being associated with Sysop/Apotheosis. I guess this is the end of any business relationship.
And yes Sysop/Apotheosis is nothing more than a medical quack. It's funny how he feel the need to let everyone read his recommended doctors, while claiming not to favor any doctors over others.
-
I think its funny that Dr. Betz created a profile and posted on this forum back on February 27-28 and refused to answer questions about the way he places the screw near the ankle, why the Betzbone nail constantly breaks or the screws constantly break etc...
Then he posted that he would be away for a week and would be happy to answer these concerns when he gets back. Well, now it's been two weeks and still no word. I'm sure there will be plenty of people making excuses instead of asking for answers.
-
Keep calm, he's a doctor that has a lot of patients to care for, especially when he was away for a week... ::)
-
Interesting to say the least about the angle of the screws
-
Hi LLto180,
can you please post some pictures, etc. showing your experience with Dr. Betz?
Loads of random people who have no proof post negative things about Betz. >:( We would love to hear the truth from real patients like you with proof. That will show the truth to everyone. :)
-
Hello everybody,
I'm back again and I know that you waited a long time for my reply. But first of all I have to care for my patients. Above it took me a lot of time to answer and annotate all questions and thoughts.
I'm sorry to reply in this moment in German but I know also a lot of Germans are in the forum.
I will send the translation as soon as possible - I plan to do it before Easter days.
Here my reply in German concerning screw fixation in the tibia:
Fixation zwischen Wadenbein und Schienbein bei Unterschenkelverlängerung:
Von der Natur sind Wadenbein und Schienbein über eine kräftige Struktur, die sogenannte Membrana interossia, verbunden. Diese Membran spannt sich vom proximalen Fibulaende bis in den distalen Bereich und wird dort in Sprunggelenksnähe verstärkt durch die vordere und hintere Syndesmose.
Jede verlängernde Maßnahme am Unterschenkel, die mittels Fixateur extern durchgeführt wird, verbindet im proximalen und im distalen Bereich, d.h. oberhalb und unterhalb der Osteotomie an Tibia und Fibula, das Wadenbein mit dem Schienbein. So bleibt unter kontinuierlicher Distraktion, sprich Verlängerung, die korrekte Zuordnung zwischen Wadenbein und Schienbein erhalten. Dies ist von eminenter Bedeutung:
Würde keine Verbindung von Wadenbein und Schienbein anlässlich einer Verlängerung im Ilisarov-Prinzip durchgeführt und dabei mit den Verbindungsdrähten des Ringfixateurs nur die Tibia erfasst, so käme es unter kontinuierlicher Verlängerung der Tibia zu einer unkontrollierten Verlängerung der Fibula, d.h., die Membran kann die Kräfte, die bei einer Verlängerung auftreten nicht komplett an das Wadenbein übertragen, sodass das Wadenbein geringer verlängert wird als das Schienbein.
Welche Konsequenz hat eine solche unterschiedliche Verschiebung zwischen Waden- und Schienbein:
Im knienahen Bereich des Unterschenkels koold forum es durch die ungleichmäßige Verschiebung zu einer enormen Zunahme der Spannung das Ligamentum collaterale am Knie. Dies bedeutet eine enorme Spannungszunahme auf die lateralen Anteile des Kniegelenkes, eine rasch eintretende Reduktion der Kniegelenksfunktion und Schmerzen. Die Kongruenz der Gelenkmechanik wird gestört.
Im distalen Bereich sind die Auswirkungen weitaus gravierender:
Hier führt die ungleichmäßige Verlängerung von Tibia und Fibula bei fehlender korrekter Fixation zu einer massiven Störung der Gelenkgabelfunktion, das distale Wadenbein, speziell der Außenknöchel verschiebt sich im Verhältnis zur Tibia nach kranial und führt dadurch zu einer massiven Inkongruenz im Sprunggelenksbereich. Dies wiederum führt infolge der Inkongruenz zu einer raschen massiven Arthrose, d. h. extremem Gelenkverschleiß und Schmerzen und im Extremfall bis hin zur Gelenkversteifung, spontan oder durch Operation bzw. zum erforderlichen Gelenkersatz.
Bei Verwendung jeglicher Verlängerungsmarknägel ist das Wadenbein zunächst nicht – nach korrekter Einbringung des Distraktionsmarknagels – in die Fixation und Verlängerung einbezogen, wie dies jedoch beim Fixateur extern der Fall ist (zumindest bei Ringfixateur-Systemen). D.h. es bedarf einer zusätzlichen absolut zuverlässigen Verbindung zwischen Wadenbein und Schienbein im jeweils proximalen und distalen Bereich, um einer unterschiedlichen Verlängerung beider Knochen vorzubeugen.
Dieses Ziel wird bei Einsatz des Verlängerungsmarknagels in der Regel durch Verwendung von separat eingebrachten Querschrauben zwischen Wadenbein und Schienbein erreicht, in der Regel eine Schraube kniegelenksnah und eine Schraube sprunggelenksnah, dort wo auch die Verankerung bei der Versorgung spezieller Sprungelenksfrakturen stattfindet. Wir nennen diese Schraube im unteren Bereich Syndesmosenschraube, bekannt aus der Versorgung der Sprunggelenksfrakturen. Jedoch gibt es hier eine erheblichen Unterschied: bei Verwendung dieser sprunggelenksnahen Schraube, die ca. drei Querfinger oberhalb des Sprunggelenksspaltes angelegt wird, verhindert diese Schraube eine axiale Verschiebung, aber auch eine Aufweitung der Gelenkgabel. Dies ist bei Sprunggelenksfrakturen eines speziellen Typs erforderlich, da die Syndesmose, d.h. die Bandverbindung zwischen Wadenbein und Schienbein, die das korrekte Gabelspiel garantiert, zerstört ist. Hier muss die Schraube sowohl die axiale Verschiebung als auch die Seitverschiebung verhindern.
Bei der Verlängerung ist nur die Verhinderung der axialen Verschiebung gefragt, es sollte sogar durch die Verbindungsschraube gewährleistet werden, dass das normale Gelenkspiel unbedingt erhalten bleibt. Dies erreiche ich in idealer Form durch eine gewindelose, glattschaftige Verbindungsschraube, die exakt parallel zum oberen Sprunggelenk eingebracht wird, entweder von dorsolateral nach ventromedial oder umgekehrt. Ich bevorzuge die Einbringung von ventromedial, da im Bereich des Schienbeins mehr Platz existiert zur Unterbringung des kopfnahen Gewindes, was eine Dislokation der Schraube verhindern muss. Das Wadenbein wird dabei nur belastet durch den Durchmesser der glattschaftigen Schraube und nicht durch das unter dem Kopf gelegene Gewinde.
Mit dieser Schraubenanordnung sowohl proximal als auch distal wird gewährleistet, dass das Wadenbein in idealer Weise um den gleichen Betrag verlängert wird wie das Schienbein und gleichzeitig keinerlei Inkongruenz im Kniegelenks- und insbesondere im Sprunggelenksbereich resultieren kann. Durch die Verwendung spezieller Schrauben wird auch das Gabelspiel so gering wie möglich beeinträchtigt und nur die eine Komponente, nämlich die gefährliche axiale Verschiebung, verhindert.
Nach diesen Ausführungen wird es ihnen leichter fallen zu verstehen, warum eine schräge Einbringung dieser Schraube, egal von welcher Seite sowohl die Anatomie, die Physiologie und die Gelenkmechanik gravierend stört.
Zunächst macht eine Schraube die im Schaftbereich ein Gewinde trägt eine starre Verbindung zwischen Wadenbein und Schienbein, was wir nicht benötigen und was darüber hinaus die Gelenkmechanik derart stört, dass es schlimmstenfalls zu einer knöchernen Verbindung zwischen Wadenbein und Schienbein kommen kann als Antwort des Körpers. Diese knöcherne Brücke wird Synostose genannt und führt zur Verstarrung des Gelenkes mit gravierenden Folgen durch Gelenkzerstörung, Arthrose und Schmerz. Allenfalls hat eine solche Schraube einen Sinn bei hochgelegenen Sprunggelenksfrakuren, weil dadurch die korrekte Einstellung des Wadenbeins bei zerrissenen Bandstrukturen gewährleistet werden soll. Jedoch werden diese Schrauben aufgrund ihrer negativen Folgen sehr früh entfernt, in der Regel nach 6 bis 8 Wochen, um das Gelenkspiel möglichst rasch wiederherzustellen. Selbst in solchen Fällen macht eine schräge Einbringung in der Regel keinen Sinn.
Des weiteren ist eine schräge Einbringung nie in idealer Weise geeignet, eine axiale Verschiebung zu verhindern: selbst unter der Vorstellung einer günstigeren Kraftübertragung während der Distraktion – was definitiv nicht stiold forum – kann es über Seitwärtsverschiebungen zu unkontrollierbaren Druckzunahmen auf das Gelenk kommen, ganz abgesehen vom aufgehobenen Gelenkspiel.
Umso gravierender werden die negativen Folgen im Hinblick auf die notwendige Verweildauer dieser Verbindungsschrauben: im Falle komplizierter Sprunggelenks-frakturen mit Zerreißung der Syndesmose und Anteilen der Membrana interossia werden diese Schrauben nach 6 und 8 Wochen entfernt und der Patient dazu angehalten, nur Teilbelastung auszuüben. In ihrem Fall, bei Unterschenkelverlängerung müssen diese Verbindungsschrauben mindestens noch 2 bis 3 Monate über das Verlängerungsende hinaus belassen werden. Werden sie frühzeitig entfernt, so koold forum es zu einer sekundären Verschiebung mit den oben beschriebenen gravierenden Folgen. Es bedarf vor Schraubenentfernung eines weitgehenden Abbaus der Gewebespannung. Hilfreich ist hierbei, wenn es zu einer knöchernen Überbrückung auch am Wadenbein gekommen ist, da dann die negativen Auswirkungen nach einer Schraubenentfernung nicht mehr zu erwarten sind.
Wenn wir zudem davon ausgehen, dass der Patient in der gesamten Phase der Verlängerung, unmittelbar am OP-Tag beginnend, vollbelastet und sich möglichst viel bewegt um die Osteoregeneration zu stimulieren, dann werden die Folgen einer falsch eingebrachten „Syndesmosenschraube“ um so eklatanter.
Soweit zur korrekten Technik der Verbindung zwischen Wadenbein und Schienbein.
-
If this is the real Dr. Betz then lets hear his medical opinion on the information posted today by Stadiometer. An experienced doctor like Dr. Betz after nearly 30 years in Orthopedics and limb lengthening should easily be able to respond in very detailed medical terminology while avoiding all non specific language. Then we'll know if this is the real Dr. Betz.
http://www.limblengtheningforum.com/index.php?topic=380.msg6072#msg6072
(http://i1296.photobucket.com/albums/ag19/Stadiometer/Paley1_zps82f5184b.png)
Above Information from Dr. Paley
(http://i1296.photobucket.com/albums/ag19/Stadiometer/eea96250-0311-4a53-92bf-e20fe6283876_zpscab9cbe2.jpg)
Above X-Ray from Apotheosis: Screw not angled by Dr. Betz
(http://i1296.photobucket.com/albums/ag19/Stadiometer/Paley2_zpsa151f12b.png)
Above information from Dr. Paley
(http://i1296.photobucket.com/albums/ag19/Stadiometer/DrBetzOsteotomy_zpsb1b656a3.png)
Above image directly from Dr. Betz website
Hello everybody,
I'm back again and I know that you waited a long time for my reply. But first of all I have to care for my patients. Above it took me a lot of time to answer and annotate all questions and thoughts.
I'm sorry to reply in this moment in German but I know also a lot of Germans are in the forum.
I will send the translation as soon as possible - I plan to do it before Easter days.
Here my reply in German concerning osteotomy:
Zur Technik der Osteotomie an Femur und Tibia:
Seit den Anfängen des Ilisarov-Verfahrens wird die Osteotomie von außen durchgeführt. Hierzu sind verschiedene Techniken beschrieben, die sich teilweise Bohrern, teilweise speziellen Meißeln oder der Kombination aus beidem bedienen. Ebenso sind oszillierende Sägen im Einsatz, die - um es vorweg zu nehmen – meines Erachtens für Verlängerungsosteotomien keine Anwendung finden sollten, da die hochfrequente Bewegung zu Hitzeschäden an den Schnittflächen neigt, was wiederum die Heilung stört, ggf. Infekte begünstigt; darüber hinaus bedarf der Einsatz einer oszillierenden Säge des weitaus größeren chirurgischen Zugangs.
Um die knöcherne Heilung, die Osteoregeneration, besser zu verstehen, bedarf es Kenntnissen zur Ernährung des Knochens: in dem Bereich, in dem wir die Verlängerungsosteotomie durchführen müssen, wird der Knochen sowohl vom Endost, d. h. vom intramedullären Gefäßsystem als auch vom Periost, d.h. dem um den Knochen herum befindlichen Gefäßsystem ernährt.
Große Bedeutung wurde daher seit Beginn des Ilisarov-Verfahrens dem Erhalt des intramedullären Gefäßsystems zugesprochen, da bei der Durchtrennung von außen regelmäßig das periostale Ernährungssystem mehr oder weniger kompromittiert wird. Es hat sich jedoch gezeigt, dass durch die von Ilisarov selbst propagierte Corticotomie, d.h. der reinen Durchtrennung der zirkulären Hartsubstanz des Knochens nicht nur das periostale Gefäßsystem in Mitleidenschaft gezogen wird, sondern auch das endostale, auch bei noch so minutiöser Corticotomie-Technik. Arbeiten von Brutscher und Brunner am Forschungsinstitut der AO (Arbeitsgemeinschaft für Osteosynthese) in Davos haben darüber hinaus nachgewiesen, dass selbst bei Zerstörung beider Gefäßsysteme, sowohl des inneren als auch des äußeren, die knöcherne Heilung erfolgt, jedoch mit erheblicher zeitlicher Verzögerung. Daher muss es unser Bestreben sein, möglichst ein Gefäßsystem zu erhalten.
Wenn also die Indikation zur Anwendung eines Fixateur externe gegeben ist, so macht es Sinn, den Knochen über eine kleine Inzision von außen mit den oben beschriebenen Techniken schonend zu durchtrennen.
Besteht die Indikation zur Anwendung eines Verlängerungsnagels – hierzu gibt es Gott sei Dank im Indikationsbereich der kosmetischen Verlängerung kaum noch Diskussion (seit über zwei Jahrzehnten habe ich mittlerweile erfolgreich versucht, den Sinn der intramedullären Verfahren zu predigen) liegt es ebenfalls nahe, eine Osteotomietechnik zu wählen, die so gering als irgend möglich eine Schädigung der Knochenernährung hervorruft.
Die Anwendung der Marknagelverfahren zur Stabilisierung von Schaftfrakturen an Oberschenkel, Unterschenkel und Oberarm haben uns seit über 6 Jahrzehnten immer wieder gezeigt, wie wichtig es ist, die Frakturreposition und die Stabilisierung indirekt, d.h. ohne Berührung der Frakturregion – durchzuführen. Je weniger wir bei der Versorgung die Frakturregion freigelegt haben, um so besser war unser Heilungsergebnis bezüglich Zeit und Knochenneubildung.
Exakt gleich verhält es sich bei den Verlängerungsosteotomien, die letztlich künstlich herbeigeführte Frakturen darstellen. Je schonender wir die Osteotomie durchführen, umso besser wird unser Heilungsergebnis sein, d.h. wir werden in kürzerer Zeit eine weitaus bessere Knochenneubildung erzielen können. Dies hat gravierenden Einfluss auf die gesamte Nachbehandlungsphase.
Lassen Sie mich daher noch mal zurückkommen auf die beiden Ernährungssysteme, sowohl von außen als auch von innen: bei Einbringung jeglicher Marknägel zerstören wir vorübergehend das intramedulläre Gefäßsystem. In der Folge erholt sich dieses Gefäßsystem wieder, braucht jedoch wertvolle Zeit. Daher muss es in unserem Bestreben sein, soweit irgend möglich das äußere, das sogenannte periostale Gefäßsystem zu erhalten. Hieraus resultiert, dass wir möglichst das periostale System nicht von außen berühren. Was ist also naheliegender, als die Osteotomie über den Kanal durchzuführen, der später für die Einbringung des Marknagels genutzt wird. Hierzu verwenden wir verschiedene Ausführungen der Innensäge. Diese Säge wird vor Einbringung des Marknagels in die Markhöhle eingebracht und durchtrennt sukzessive exakt die Anteile des Cortex (der zirkulären Knochenhartsubstanz) und zwar nur soweit, als es erforderlich ist, durch leichten Druck von außen gegen die Gliedmaße die Fraktur zu komplettieren. D.h. wir berühren in der Regel nicht das Periost. Dies gelingt uns in nahezu 100% der Fälle in schonendster Weise mit einer speziellen von Hand betriebenen Säge die uns jegliche Hitzeentwicklung und damit Störung der Knochenheilung verhindert. Auch haben wir in unserem Repertoire druckluftbetriebene und elektrisch betriebenen Innensägen, jedoch machen wir davon nur selten Gebrauch, da sie wie jede andere oszillierende Säge zur Hitzeentwicklung und damit zur Verbrennung im Bereich der Osteotomieflächen führen können. Lediglich im Bereich der vorderen Schienbeinkante machen wir gelegentlich von diesen oszillierenden Sägen Gebrauch: im Gegensatz zum Oberschenkel, wo die Markhöhle zentral angeordnet ist und die Corticalis annähernd ähnliche dcken zirkulär aufweist, liegt die Markhöhle im dreiecksförmigen Unterschenkelknochen exzentrisch auf der Dorsalseite. Dadurch ergibt sich auf der Ventralseite im Bereich der vorderen Schienbeinkante ein erheblich größerer Corticalisdurchmesser, der aufgrund der größeren Eindringtiefe gelegentlich vorteilhaft mit einer meiner speziellen oszillierenden Sägen komplettiert wird.
Ich weiß, dass die Innensägen nicht beliebt sind, weil sie vom Operateur besonderes Geschick und technisches Einfühlungsvermögen verlangen. Ich hoffe jedoch, dass meine Ausführungen zur Anatomie und Physiologie der Knochenernährung Ihnen zweifelsfrei den Sinn der Durchtrennung des Knochens von Innen in Verbindung mit einem Verlängerungsnagelverfahren zeigen konnten.
-
I'm back again and I know that you waited a long time for my reply. But first of all I have to care for my patients. Above it took me a lot of time to answer and annotate all questions and thoughts.
I'm sorry to reply in this moment in German but I know also a lot of Germans are in the forum.
I will send the translation as soon as possible - I plan to do it before Easter days.
Here some important general information about my person and limb lengthening.
Dear Limb Lengthening Community,
mein Name ist den meisten von Ihnen bestens bekannt, ich bin Prof. Dr. med. Augustin Michael Betz.
Seit Beginn des Internetzeitalters habe ich nie Zeit in den verschiedenen Foren verbracht. Immer wieder haben mir Patienten von Informationen aus den Foren berichtet, teilweise sehr hilfreiche Informationen für den Patienten und häufig auch unrichtige, falsch verstandene und teilweise sogar für den Patienten gefährliche Informationen. Nachdem ich jetzt von mehreren Patienten auf die Existenz des „Limb Lengthening Forum“ als neue Plattform im Bereich der Verlängerung und auf dortige diffamierende Äußerungen angesprochen wurde, habe ich mir seit ein paar Wochen die Mühe gemacht, in diesem Forum und auch vergleichend im „Make me taller“ Forum zu lesen. Ich war daraufhin wirklich erschüttert über die Informationen, die zu meiner Person verbreitet wurden. So viel Diffamierung, hervorgerufen durch hasserfüllte, absolut nicht berechtigte Kommentare eines einzelnen Patienten unter dem Synonym „Mime“ hätte ich mir nie träumen lassen. Es ist wirklich erstaunlich, wie eine einzelne Person unter einem Pseudonym – ich weiß mittlerweile, um wen es sich handelt und wie wenig Grund dazu besteht – teilweise erfolgreich andere Forenteilnehmer mitreißt und in dieselben Hasstiraden einsteigen lässt.
Daher lassen sie mich, bevor ich auf ihre Fragen bezüglich Osteotomietechnik und Fixationstechnik zwischen Fibula und Tibia eingehe, m. E. wichtige Informationen vorausschicken.
Seit den 70er Jahren befasse ich mich - zunächst an der Universität des Saarlandes und dann an der Universität München - mit dem Illisarov-Verfahren. Aufgrund meiner Expertise im traumatologischen Bereich habe ich stets versucht – nach der Euphorie der Fixateur-externe-Verfahren, die auch heute noch ganz klar ihre Berechtigung haben können - soweit irgend möglich auf interne Verfahren umzusteigen. So habe ich mich – nach ausgedehnten wissenschaftlichen und klinischen Erfahrungen im Bereich der Verriegelungsnagelung – sehr früh mit dem intramedullären Verlängerungsverfahren befasst und dabei zunächst ein System inauguriert, welches auf elektromechanischem Weg mithilfe eines Marknagels sowohl die Verlängerung als auch die Segmentverschiebung ohne jegliche Verbindung nach außen bewerkstelligte. Dieses System wurde von mir entwickelt und zur Serienreife perfektioniert. Im umfangreichen klinischen Einsatz war es – trotz zahlreicher systembedingter Probleme aufgrund der Miniaturisierung – externen Systemen in der Regel um Welten überlegen. Zu diesem Zeitpunkt, als ich damit begann, mich mit internen Verlängerungsverfahren zu befassen, waren die Fixateur-externe-Verfahren auf ihrem größten Verbreitungsstand, sodass nur wenige Chirurgen weltweit sich für interne Systeme und deren Vorteile interessierten. Dies hat mich nicht daran gehindert, kontinuierlich an diesen Systemen weiterzuarbeiten und sie zu perfektionieren. Ich möchte jetzt nicht auf Details der gesamten Historie eingehen, dies würde den Rahmen sprengen, Sie müssen jedoch wissen, dass ich als Entwickler verschiedenster intramedullärer Systeme, Patentinhaber und klinischer Anwender wie kein anderer weltweit mit einem Background von mehr als 30 Jahren verfüge. Gerade vor diesem Hintergrund sind die unwahren Internetbeiträge im Forum geradezu absurd.
Seit über zwei Jahrzehnten führte ich zunächst mit meinem Fitbonesystem, später über kurze Zeit mit dem Original Albizzia System und daran anschließend in weiteren ca. 1000 Fällen jegliche Formen der Verlängerung und Segmentverschiebung bei kosmetischen und medizinischen Indikationen mit umfangreich modifizierten Albizzia-Nägeln durch. Letztlich habe ich dann alle Modifikationen und weitere Neuerungen in ein neues System einfließen lassen, welches ich dann Betzbone® nannte. Dieses System, welches neben dem Nagel weitere Komponenten wie Innensäge, Verriegelungsschrauben, spezielle Zielgeräte zur Achsenkorrektur etc. enthält, ist seit Jahren in seiner Zuverlässigkeit, in seiner Stabilität, in seiner Kontrollierbarkeit und in seiner Verlängerungskapazität jedem anderen System weltweit überlegen und wird darüber hinaus stetig weiterentwickelt. Die Handhabung des Systems ist nach Einweisung absolut fehlerfrei und ohne aufwändige Zusatzapparate durchführbar, prinzipiell ohne radiologische und sonografische Kontrollen im Verlängerungsverlauf, ohne Strahlenbelastung durch regelmäßige Röntgenaufnahmen, ohne Ultraschallkontrollen, ohne häufige klinische Wiedervorstellungen bei sofortiger Vollbelastung und der Möglichkeit der frühen Rückkehr in den Beruf, sofern es sich nicht um harte körperliche Arbeit handelt. Dies beweisen unzählige Fälle zufriedener Patienten. Die wenigsten von ihnen sind jedoch in den Internetforen engagiert, ziehen ihre gesamte Verlängerung erfolgreich und ohne großes Aufheben durch und kehren komplett wiederhergestellt in ihr Arbeitsleben zurück. Selbstverständlich ist der gesamte Ablauf der Verlängerung kein „Zuckerlecken“, die Beschwerden sind sehr unterschiedlich, es gibt Patienten, die keinerlei Schmerzmittel benötigen, andere benötigen Schmerzmittel bis hin zu Opiaten, was jedoch für den gesamten Ablauf kein größeres Problem bedeutet, auch ist am Verlängerungsende der allmähliche Stopp dieser Opiate in der Regel kein Problem.
Selbstverständlich hatten wir im Laufe der Jahrzehnte auch Fehlschläge, diese bestanden zunächst in der Unkontrollierbarkeit der Systeme, die Systeme liefen zu schnell oder zu langsam, selten in einem erwünschten Tempo, die Systeme waren nicht ausreichend tragfähig, so dass Vollbelastung nur mit zusätzlichen Hilfsmittels wie Orthesen (entlastenden Gehapparaten) möglich waren. Ansonsten ist bei bilateraler Verlängerung - was absolut sinnvoll ist - ausschließlich der Rollstuhl angesagt, was zu einer extremen Funktionseinbuße und am Verlängerungsende quasi zu einem erneuten Erlernen der Fortbewegung führt.
So muss als höchste Anforderung an ein Verlängerungssystem, welches im kosmetischen Bereich Anwendung finden soll, die Stabilität hervorgehoben werden. An Stabilität mangelt es allen Systemen, außer dem meinen! Ein System welches nicht Vollbelastung erlaubt, führt dazu, dass zuverlässig nur eine einzige Seite versorgt werden kann; hierbei ist davor zu warnen, Ober- und Unterschenkel in einer einzigen Sitzung zu verlängern, da hierbei eine Verdoppelung der täglichen Verlängerungsstrecke zustande koold forum und hierbei eine extreme Belastung der Weichteilstrukturen resultiert, die zu schwersten Kontrakturen und langen Funktionsdefiziten mit langer Rekonvaleszenz führen. Die in Ermangelung von Stabilität gepriesene einseitige Verlängerung an Ober- und Unterschenkel ist daher äußerst gefährlich und - wenn es sich um Verlängerungsstrecken jenseits von 8 – 10 cm (zusammen am Ober- und Unterschenkel) handelt – absolut davon abzuraten! Selbstverständlich verstehe ich, dass Kollegen ein solches Verfahren, in Ermangelung von Verlängerungssystemen, die Vollbelastung erlauben, anbieten.
Ein weiterer Punkt ist die Verlängerungskapazität: hier mangelt es wiederum bei fast allen Systemen außer beim Betzbone®. Selbstverständlich ist die knöcherne Heilung mit Zunahme der Verlängerungsstrecke erschwert, es stiold forum jedoch nicht – und dies beweisen meine Fälle über die letzten 20 Jahre – dass wie zunächst behauptet wurde keine Verlängerung über 5 – 6 cm hinaus durchgeführt werden darf wegen irreparabler Schäden; mittlerweile propagiert man – nachdem die Systeme mehr Kapazität erlauben - auch eine wenig riskante und vertretbare Verlängerung bis 8 cm, sobald die Systeme wiederum mehr können, wird auch dann in größeren Verlängerungsstrecken kein Problem mehr gesehen werden. Tatsache ist jedoch, dass ich seit mehr als 20 Jahren Verlängerungsstrecken von 10 cm und mehr in einer Region realisiere - ohne nachweisbare Schäden! Ich bin sicher, dass auch diese extremen Verlängerungsstrecken in Zukunft sofort propagiert werden, sobald ein anderes System als der Betzbone® in der Lage ist diese Strecken zu realisieren. Dann wird auf einmal eine solche große Verlängerungsstrecke nicht mehr als unkalkulierbares Risiko bezeichnet. Bis heute zeigen auch die aktuellsten in den Foren veröffentlichen Statistiken Verlängerungsstrecken im Mittel zwischen 3 und 5 cm, was lächerlich ist im Hinblick auf die produzierten Behandlungskosten, und dem geringen Zugewinn an Körpergröße. Diese größeren Verlängerungsstrecken haben ein höheres Heilungsrisiko – wobei bei einer primären Verlängerung aus kosmetischen Gründen in meinen Fällen kein einziger Fall vorlag, der je eine Spongiosaplastik brauchte, allenfalls eine „Anfrischung“ der Verlängerungsregion und Stabilisierung mit einem soliden Marknagel.
Selbstverständlich weisen kurze Verlängerungsstrecken eine kürzere Heilungszeit und ein geringeres Heilungsrisiko auf. Jedoch findet sich in meiner großen Zahl primärer langstreckiger Verlängerungen aus kosmetischen Gründen kein einziger Fall, der je eine Spongiosaplastik benötigte; bei schwachem Regenerat hat stets die Anfrischung der Verlängerungsregion und die erneute Stabilisierung mit einem soliden Marknagel die knöcherne Heilung herbeigeführt.
Ein weiterer wichtiger Punkt im Ablauf einer erfolgreichen Verlängerung ist die Kontrollierbarkeit der Systeme. Bis heute sind alle auf dem Markt befindlichen Systeme unzureichend in ihrer Kontrollierbarkeit, zumindest aufwändig durch häufige klinische und radiologische sowie sonografische Kontrollen, der frühere Albizzia-Nagel und der Betzbone® ausgenommen.
Mit dem Betzbone® weiß der Patient zu jedem Zeitpunkt an jeder Stelle in der Welt ohne technische Hilfsmittel, wie viel Verlängerung er durchgeführt hat. Er dokumentiert hierzu lediglich auf einem Blatt Papier mit einem Stift seine durchgeführten Verlängerungsschritte und weiß aufgrund der Gewindesteigung exakt seinen Verlängerungsstand. Kein anderes System weltweit ist in der Lage, auch nicht mit noch so aufwendiger aparativer Technik – auch nur annähernd diese Präzision zu erzielen.
Der Verlängerungs-Komfort ist durch kein anderes System zu überbieten. Hiermit meine ich die freie Fortbewegung des Patienten, auf langen Distanzen von mehreren Kilometern natürlich unter Zuhilfenahme von Unterarmstockstützen, nicht nur zur Schonung der Implantate sondern auch zur Perfektionierung des Gangbildes.
Unter Behandlungskomfort verstehe ich auch die Gestaltung der täglichen Verlängerungsschritte: führt die zunehmende Gewebespannung zu erheblichen Schmerzen und Funktionsbehinderungen, so erlaubt die Stabilität und sichere Mechanik des Systems eine Reduzierung bzw. einen kurzfristigen Stopp der Verlängerungsschritte ohne Risiko einer vorzeitigen knöchernen Überbrückung. Dies wird erreicht durch die stabile Mechanik, die selbst nach größeren Verlängerungspausen zum Zwecke des Wohlbefindens in der Lage ist, erneut ohne Nachteile die Verlängerung fortzusetzen. Besonders hilfreich ist hierbei auch die Durchführung kleinerer Verlängerungsschritte als 1 mm am Oberschenkel oder z. B. 0,7 mm am Unterschenkel. Hierbei ergibt sich rein rechnerisch zwar eine zeitliche Verlängerung der Wachstumsphase; jedoch zeigen zahlreiche Verläufe, die mit kleineren täglichen Verlängerungsschritten gearbeitet haben, nicht nur die bessere Osteoregeneration in kürzerer Zeit sondern auch die weitaus bessere Rekonvaleszenz mit Vermeidung bzw. Reduzierung von Funktionsdefiziten und Kontrakturen. D.h. in kürzerer Zeit wird letztendlich eine Normalisierung des Lebens erreicht.
Auch hierin können andere Systeme nicht mit dem Betzbone® konkurrieren, da die schwachen Antriebsmechanismen sehr rasch zum Stillstand der Verlängerung führen.
Gravierend koold forum hinzu, dass sämtliche anderen Verlängerungssysteme einer Überbohrung von 2 bis 2, 5 mm bedürfen, um eine weitgehend zuverlässige Funktion zu gewährleisten, da die geringste Verklemmung bereits aufgrund der schwachen Kraft zum Systemstillstand führt. In vielen Fällen kleiner Knochendurchmesser ist daher die Verlängerung mit intramedullären Systemen, die der Überbohrung von 2 bis 2,5 mm bedürfen, um die Funktion zu gewährleisten, nicht möglich oder sehr riskant.
Aufgrund der großen Kraft, die der Betzbone® in der Lage ist auf den Knochen zu übertragen und in Verbindung mit der soliden anatomie- und physiologiegerechten Verbindung zwischen Fibula und Tibia kann auf die sonst übliche Fibulasegmententfernung verzichtet werden. Diese Segmententfernung wird propagiert, um eine frühzeitige Heilung der Fibula und damit ein Stillstand der Verlängerung zu vermeiden. Es ist richtig, dass die endgültige knöcherne Heilung der Fibula nicht erforderlich ist, jedoch freue ich mich über jeden Fall, der am Ende der Verlängerung auch die Konsolidierung der Fibula in korrekter Position herbei geführt hat.
Ein weiterer wichtiger Punkt, der von großer Bedeutung sein kann, ist die Korrosion. Jegliche, auf dem Weltmarkt befindlichen Implantate können Korrosion entwickeln. Das Innenleben dieser Implantate enthält Materialien, die nicht korrosionsbeständig sind und aufgrund der elektromechanischen Eigenschaften auch nicht anders ausgewählt werden können. So lässt sich nur mit einer Dichtung das Eindringen der aggressiven Körperflüssigkeit in das Innere des Systems vermeiden. Insbesondere bei Zunahme der Verlängerung und damit ausgefahrenem Teleskop wird die Dichtung mehr belastet und lässt nicht selten Körperflüssigkeit in das Innere des Systems eindringen, was dort zu extremer Korrosion führt. Diese rostige Flüssigkeit dringt dann wiederum in die Markhöhle über die insuffiziente Abdichtung und führt dort zu Krankheitszeichen wie bei einer schwersten Infektion mit Rötung, Schmerzen, Schwellung. Nur die sofortige Nagelentfernung mit intensiver Spülung der Markhöhle führt hier zur Beruhigung.
Ein weiteres Phänomen ist in diesem Zusammenhang in Verbindung mit der angestrebten hermetischen Abriegelung der im Nagelinneren gelegenen Komponenten erwähnenswert: in mehreren Fällen habe ich erlebt, dass Patienten während des Aufenthaltes in größeren Höhen jenseits von ca. 2000 Metern, insbesondere während der Rückflüge über extreme, nicht therapierbare Schmerzen geklagt haben. Sobald wieder meeresniveauähnliche Höhen erreicht werden ist der Schmerz aufgehoben. Wir sind diesem Phänomen nachgegangen und können hierfür ausschließlich einen Gasaustritt aus dem Inneren des Systems über die Dichtung in die Markhöhle verantwortlich machen. Diese Schmerzen sind derart gravierend, dass sie in der Regel mit keinerlei Schmerzmittel zu behandeln sind.
Beide Punkte, sowohl Korrosion als auch der extreme Schmerz in großen Höhen, sind im Falle des Betzbone® ausgeschlossen: es gibt keinerlei Abdichtung zwischen den inneren und äußeren Nagelkomponenten, die Körperflüssigkeit zirkuliert beliebig und füllt unmittelbar nach Implantation das Nagelinnere auf. Ich erinnere mich z. B. an einen Patienten aus Colorado, der nach Oberschenkelverlängerung vor Jahren nicht in die Berge auf größere Höhe zurückkehren konnte aufgrund unerträglicher Schmerzen. Er musste seine gesamte Verlängerung in Denver durchführen und dort seiner Arbeit nachgehen. Bei der Jahre später durchgeführten Unterschenkelverlängerung mit dem Betzbone® hatte der Patient verständlicherweise die gleiche Angst. Es traten nicht nur bei ihm sondern auch bei anderen Patienten keinerlei derartige Schmerzsymptome durch Druckveränderungen auf.
Aufgrund der nicht möglichen Korrosion – da es gelungen ist sämtliche Einzelteile des Nagels aus absolut antikorrosiven Materialien herzustellen – ist der Betzbone® der einzige Nagel, der nicht zwingend entfernt werden muss. Trotzdem plädiere ich für die Entfernung, da es sich meist um jüngere Patienten handelt und der Knochen nach Entfernung des aussteifenden Nagels seine Rigidität verliert und wieder in seine alte Elastizität zurück findet nach dem entsprechenden Remodelling des Knochens.
Bezüglich Bedienbarkeit ist das System ebenfalls von keinem anderen System weltweit übertroffen. Es sind keine schweren und voluminösen Apparaturen erforderlich um die Verlängerung durchzuführen. Die gern ins Feld geführten Schwierigkeiten beim sogenannten „Clicken“ lösen sich in Wohlgefallen auf, wenn der Patient durch seinen Operateur oder erfahrene Mitarbeiter des Teams, in meinem Fall z.B. Daniela in die Funktion des Systems während des stationären Aufenthaltes eingewiesen wird und seine Ängste, selbst Hand anzulegen abgebaut sind. Dann ist der Patient an jeder Stelle weltweit in der Lage, seine Verlängerung unter einfachster Kontrolle, ohne erforderliche Apparate durchzuführen. Dieser Zustand ist in Verbindung mit der erwähnten Stabilität der Systeme von unbeschreiblichem Wert. Auch wenn in Einzelfällen die Vermittlung der Clickbewegung schwierig war, so gibt es keinen Patienten, der sein Ziel nicht erreicht hätte.
Insbesondere sind viele unserer Patienten in der Lage ihrem Beruf nachzugehen, wenn es sich wie gesagt nicht um schwere körperliche Arbeiten handelt; hierbei wird vom Patienten immer wieder die Ablenkung während der Arbeit als positiv beschrieben; unangenehm bleiben für viele Patienten die Nächte und die Wochenenden, wo ihnen die entsprechende Ablenkung fehlt.
-
Danke, Augustin.
-
Danke, Augustin.
Please be polite to him by saying Dr. or professor....or the very least Mr.!!!!
:). ;D
-
Hi guys, it's me Nader
For those who do not know me I am working together with Prof. Betz and I am now translating everything he posted into English. I am really sorry that I could not do it sooner but I had a lot of work at the university. I'm planning to post the translation at the end of this week.
Cheers
Nader
-
Hi guys, it's me Nader
For those who do not know me I am working together with Prof. Betz and I am now translating everything he posted into English. I am really sorry that I could not do it sooner but I had a lot of work at the university. I'm planning to post the translation at the end of this week.
Cheers
Nader
Look forward to it. :)
-
Andrew's nail broke. How can you not blame the doctor? If the bone didn't heal fast enough then probably the osteotomy wasn't done well. There is so much misinformation going around.
I'm a Betz patient, I had surgery back in Feb and now coming to the end of my lengthening. Now that I've lived LL, I can say that your statement is somewhat unfair. If a nail breaks, of course you can't blame the doctor. It depends entirely on how it broke. I have an 11mm nail in my left femur (13 in my right). I could easily break both my nails if I decided to go parachute jumping or hip-hop dancing, or if I ignore my doctor's advice and start walking without crutches, or act carelessly and use my crutches in snowy or icy conditions. You simply cannot categorically say its the doctors fault.
-
Hi guys, it's me Nader
For those who do not know me I am working together with Prof. Betz and I am now translating everything he posted into English. I am really sorry that I could not do it sooner but I had a lot of work at the university. I'm planning to post the translation at the end of this week.
Cheers
Nader
Hey Nader! Great to see you here. I will be in Neunkirchen tomorrow - I'm the UK guy with 2 different nails in his legs ;-)
-
Does Dr Betz encourage patients to do too much weight bearing or have the bent nail issues that were reported been from nails that are just built weak?
-
Does Dr Betz encourage patients to do too much weight bearing or have the bent nail issues that were reported been from nails that are just built weak?
I've personally seen some patients behave in irresponsible ways. Also, like me, when you go home to lengthen it's easy to forget that you're a patient. It's easy to let yourself act normally as you go to work, look after your kids, see friends, have drinks. All these activities carry risk. For instance, when I travel to the office in London, I have to stop myself from using the underground (metro) because it's easy to get pushed around by lots of people, slip, fall down the stairs etc etc.
I think you have to ask about the conditions within which the nail bent. One of my LL friends - a patient who had surgery a day after me is huge. Starting height around 178 and very muscular (he trained a lot). To be honest, we were worried for him given all these bent nail stories. You know what? He's consolidating now, he's been careful and when I saw his xrays last week, did I see bent nails? Of course not. Prof. Betz advises you to use your crutches, you can stand vertically to weight bear and this is safe, you can even take very short walks inside your house.
You tend to find that Betz' patients defend him a lot. There is a good reason for this. Prof Betz, is a great surgeon and also a fantastic human being. We have exchanged SMSs at 4am when I was worried about preconsolidation, in fact 2 weeks ago he was on vacation in Rome and he stopped his vacation early to see me. He even saw me on a Saturday because he knows I work and that this would be easier for me. How many surgeons get out of bed (let alone cancel a vacation) to see their patients on a Saturday? When I was staying at the hospital and then at Elke's house, I was surprised that he visited us every day. EVERY day, even Saturday and Sunday. Successful LL is a partnership between the patient, the surgeon and the patient's physiotherapist. They are there to help you, keep you safe, ensure your success but ultimately a lot of it is down to the patient because the patient is carrying those legs 24 hours a day. A good surgeon will give you the confidence that they are always there in the background should you need anything. You know what, I called Prof Betz' assistant today telling her I was worried about clicking in these last days and also about my final checks (lengths etc), guess what? No waiting around - I am seeing Prof Betz tomorrow. He really, truly cares and for this reason I'm glad I decided to do my LL with him.
-
That would explain the nail bends. I'd be weary about lengthening at home because of that. I guess it's impossible to stay in Germany the whole time though if you have obligations to take care of.
-
That would explain the nail bends. I'd be weary about lengthening at home because of that. I guess it's impossible to stay in Germany the whole time though if you have obligations to take care of.
There are benefits to going home too! Normality, your family, your friends, familiar TV and food all help to make you feel better about the procedure you're undergoing and take your mind off the LL. The big problem with remaining in Germany or Milan or China or India or wherever, is that you get caught in an LL bubble. It can also get very lonely. I think being at home is one of the factors that has made my LL so 'easy' compared to what you read in some patient diaries. I've been very careful throughout, so knock on wood my nails will remain just fine :-)
-
Moin, Dr. Betz,
Vielen Dank fuer Entsendung hier.
gettingtaller, do you have a diary? I want to know more about your experiences and how you're recovering at home.
Thanks
-
Moin, Dr. Betz,
Vielen Dank fuer Entsendung hier.
gettingtaller, do you have a diary? I want to know more about your experiences and how you're recovering at home.
Thanks
Like most Betz patients I have no diary I'm afraid, I'm just too busy unfortunately.
Please feel free to ask me anything you like here. Happy to answer any questions.
I saw prof betz this morning for a checkup as I plan to stop clicking soon (yippee!).
-
I'm back again and I know that you waited a long time for my reply. But first of all I have to care for my patients. Above it took me a lot of time to answer and annotate all questions and thoughts.
I'm sorry to reply in this moment in German but I know also a lot of Germans are in the forum.
I will send the translation as soon as possible - I plan to do it before Easter days.
Here some important general information about my person and limb lengthening.
Dear Limb Lengthening Community,
mein Name ist den meisten von Ihnen bestens bekannt, ich bin Prof. Dr. med. Augustin Michael Betz.
Seit Beginn des Internetzeitalters habe ich nie Zeit in den verschiedenen Foren verbracht. Immer wieder haben mir Patienten von Informationen aus den Foren berichtet, teilweise sehr hilfreiche Informationen für den Patienten und häufig auch unrichtige, falsch verstandene und teilweise sogar für den Patienten gefährliche Informationen. Nachdem ich jetzt von mehreren Patienten auf die Existenz des „Limb Lengthening Forum“ als neue Plattform im Bereich der Verlängerung und auf dortige diffamierende Äußerungen angesprochen wurde, habe ich mir seit ein paar Wochen die Mühe gemacht, in diesem Forum und auch vergleichend im „Make me taller“ Forum zu lesen. Ich war daraufhin wirklich erschüttert über die Informationen, die zu meiner Person verbreitet wurden. So viel Diffamierung, hervorgerufen durch hasserfüllte, absolut nicht berechtigte Kommentare eines einzelnen Patienten unter dem Synonym „Mime“ hätte ich mir nie träumen lassen. Es ist wirklich erstaunlich, wie eine einzelne Person unter einem Pseudonym – ich weiß mittlerweile, um wen es sich handelt und wie wenig Grund dazu besteht – teilweise erfolgreich andere Forenteilnehmer mitreißt und in dieselben Hasstiraden einsteigen lässt.
Daher lassen sie mich, bevor ich auf ihre Fragen bezüglich Osteotomietechnik und Fixationstechnik zwischen Fibula und Tibia eingehe, m. E. wichtige Informationen vorausschicken.
Seit den 70er Jahren befasse ich mich - zunächst an der Universität des Saarlandes und dann an der Universität München - mit dem Illisarov-Verfahren. Aufgrund meiner Expertise im traumatologischen Bereich habe ich stets versucht – nach der Euphorie der Fixateur-externe-Verfahren, die auch heute noch ganz klar ihre Berechtigung haben können - soweit irgend möglich auf interne Verfahren umzusteigen. So habe ich mich – nach ausgedehnten wissenschaftlichen und klinischen Erfahrungen im Bereich der Verriegelungsnagelung – sehr früh mit dem intramedullären Verlängerungsverfahren befasst und dabei zunächst ein System inauguriert, welches auf elektromechanischem Weg mithilfe eines Marknagels sowohl die Verlängerung als auch die Segmentverschiebung ohne jegliche Verbindung nach außen bewerkstelligte. Dieses System wurde von mir entwickelt und zur Serienreife perfektioniert. Im umfangreichen klinischen Einsatz war es – trotz zahlreicher systembedingter Probleme aufgrund der Miniaturisierung – externen Systemen in der Regel um Welten überlegen. Zu diesem Zeitpunkt, als ich damit begann, mich mit internen Verlängerungsverfahren zu befassen, waren die Fixateur-externe-Verfahren auf ihrem größten Verbreitungsstand, sodass nur wenige Chirurgen weltweit sich für interne Systeme und deren Vorteile interessierten. Dies hat mich nicht daran gehindert, kontinuierlich an diesen Systemen weiterzuarbeiten und sie zu perfektionieren. Ich möchte jetzt nicht auf Details der gesamten Historie eingehen, dies würde den Rahmen sprengen, Sie müssen jedoch wissen, dass ich als Entwickler verschiedenster intramedullärer Systeme, Patentinhaber und klinischer Anwender wie kein anderer weltweit mit einem Background von mehr als 30 Jahren verfüge. Gerade vor diesem Hintergrund sind die unwahren Internetbeiträge im Forum geradezu absurd.
Seit über zwei Jahrzehnten führte ich zunächst mit meinem Fitbonesystem, später über kurze Zeit mit dem Original Albizzia System und daran anschließend in weiteren ca. 1000 Fällen jegliche Formen der Verlängerung und Segmentverschiebung bei kosmetischen und medizinischen Indikationen mit umfangreich modifizierten Albizzia-Nägeln durch. Letztlich habe ich dann alle Modifikationen und weitere Neuerungen in ein neues System einfließen lassen, welches ich dann Betzbone® nannte. Dieses System, welches neben dem Nagel weitere Komponenten wie Innensäge, Verriegelungsschrauben, spezielle Zielgeräte zur Achsenkorrektur etc. enthält, ist seit Jahren in seiner Zuverlässigkeit, in seiner Stabilität, in seiner Kontrollierbarkeit und in seiner Verlängerungskapazität jedem anderen System weltweit überlegen und wird darüber hinaus stetig weiterentwickelt. Die Handhabung des Systems ist nach Einweisung absolut fehlerfrei und ohne aufwändige Zusatzapparate durchführbar, prinzipiell ohne radiologische und sonografische Kontrollen im Verlängerungsverlauf, ohne Strahlenbelastung durch regelmäßige Röntgenaufnahmen, ohne Ultraschallkontrollen, ohne häufige klinische Wiedervorstellungen bei sofortiger Vollbelastung und der Möglichkeit der frühen Rückkehr in den Beruf, sofern es sich nicht um harte körperliche Arbeit handelt. Dies beweisen unzählige Fälle zufriedener Patienten. Die wenigsten von ihnen sind jedoch in den Internetforen engagiert, ziehen ihre gesamte Verlängerung erfolgreich und ohne großes Aufheben durch und kehren komplett wiederhergestellt in ihr Arbeitsleben zurück. Selbstverständlich ist der gesamte Ablauf der Verlängerung kein „Zuckerlecken“, die Beschwerden sind sehr unterschiedlich, es gibt Patienten, die keinerlei Schmerzmittel benötigen, andere benötigen Schmerzmittel bis hin zu Opiaten, was jedoch für den gesamten Ablauf kein größeres Problem bedeutet, auch ist am Verlängerungsende der allmähliche Stopp dieser Opiate in der Regel kein Problem.
Selbstverständlich hatten wir im Laufe der Jahrzehnte auch Fehlschläge, diese bestanden zunächst in der Unkontrollierbarkeit der Systeme, die Systeme liefen zu schnell oder zu langsam, selten in einem erwünschten Tempo, die Systeme waren nicht ausreichend tragfähig, so dass Vollbelastung nur mit zusätzlichen Hilfsmittels wie Orthesen (entlastenden Gehapparaten) möglich waren. Ansonsten ist bei bilateraler Verlängerung - was absolut sinnvoll ist - ausschließlich der Rollstuhl angesagt, was zu einer extremen Funktionseinbuße und am Verlängerungsende quasi zu einem erneuten Erlernen der Fortbewegung führt.
So muss als höchste Anforderung an ein Verlängerungssystem, welches im kosmetischen Bereich Anwendung finden soll, die Stabilität hervorgehoben werden. An Stabilität mangelt es allen Systemen, außer dem meinen! Ein System welches nicht Vollbelastung erlaubt, führt dazu, dass zuverlässig nur eine einzige Seite versorgt werden kann; hierbei ist davor zu warnen, Ober- und Unterschenkel in einer einzigen Sitzung zu verlängern, da hierbei eine Verdoppelung der täglichen Verlängerungsstrecke zustande koold forum und hierbei eine extreme Belastung der Weichteilstrukturen resultiert, die zu schwersten Kontrakturen und langen Funktionsdefiziten mit langer Rekonvaleszenz führen. Die in Ermangelung von Stabilität gepriesene einseitige Verlängerung an Ober- und Unterschenkel ist daher äußerst gefährlich und - wenn es sich um Verlängerungsstrecken jenseits von 8 – 10 cm (zusammen am Ober- und Unterschenkel) handelt – absolut davon abzuraten! Selbstverständlich verstehe ich, dass Kollegen ein solches Verfahren, in Ermangelung von Verlängerungssystemen, die Vollbelastung erlauben, anbieten.
Ein weiterer Punkt ist die Verlängerungskapazität: hier mangelt es wiederum bei fast allen Systemen außer beim Betzbone®. Selbstverständlich ist die knöcherne Heilung mit Zunahme der Verlängerungsstrecke erschwert, es stiold forum jedoch nicht – und dies beweisen meine Fälle über die letzten 20 Jahre – dass wie zunächst behauptet wurde keine Verlängerung über 5 – 6 cm hinaus durchgeführt werden darf wegen irreparabler Schäden; mittlerweile propagiert man – nachdem die Systeme mehr Kapazität erlauben - auch eine wenig riskante und vertretbare Verlängerung bis 8 cm, sobald die Systeme wiederum mehr können, wird auch dann in größeren Verlängerungsstrecken kein Problem mehr gesehen werden. Tatsache ist jedoch, dass ich seit mehr als 20 Jahren Verlängerungsstrecken von 10 cm und mehr in einer Region realisiere - ohne nachweisbare Schäden! Ich bin sicher, dass auch diese extremen Verlängerungsstrecken in Zukunft sofort propagiert werden, sobald ein anderes System als der Betzbone® in der Lage ist diese Strecken zu realisieren. Dann wird auf einmal eine solche große Verlängerungsstrecke nicht mehr als unkalkulierbares Risiko bezeichnet. Bis heute zeigen auch die aktuellsten in den Foren veröffentlichen Statistiken Verlängerungsstrecken im Mittel zwischen 3 und 5 cm, was lächerlich ist im Hinblick auf die produzierten Behandlungskosten, und dem geringen Zugewinn an Körpergröße. Diese größeren Verlängerungsstrecken haben ein höheres Heilungsrisiko – wobei bei einer primären Verlängerung aus kosmetischen Gründen in meinen Fällen kein einziger Fall vorlag, der je eine Spongiosaplastik brauchte, allenfalls eine „Anfrischung“ der Verlängerungsregion und Stabilisierung mit einem soliden Marknagel.
Selbstverständlich weisen kurze Verlängerungsstrecken eine kürzere Heilungszeit und ein geringeres Heilungsrisiko auf. Jedoch findet sich in meiner großen Zahl primärer langstreckiger Verlängerungen aus kosmetischen Gründen kein einziger Fall, der je eine Spongiosaplastik benötigte; bei schwachem Regenerat hat stets die Anfrischung der Verlängerungsregion und die erneute Stabilisierung mit einem soliden Marknagel die knöcherne Heilung herbeigeführt.
Ein weiterer wichtiger Punkt im Ablauf einer erfolgreichen Verlängerung ist die Kontrollierbarkeit der Systeme. Bis heute sind alle auf dem Markt befindlichen Systeme unzureichend in ihrer Kontrollierbarkeit, zumindest aufwändig durch häufige klinische und radiologische sowie sonografische Kontrollen, der frühere Albizzia-Nagel und der Betzbone® ausgenommen.
Mit dem Betzbone® weiß der Patient zu jedem Zeitpunkt an jeder Stelle in der Welt ohne technische Hilfsmittel, wie viel Verlängerung er durchgeführt hat. Er dokumentiert hierzu lediglich auf einem Blatt Papier mit einem Stift seine durchgeführten Verlängerungsschritte und weiß aufgrund der Gewindesteigung exakt seinen Verlängerungsstand. Kein anderes System weltweit ist in der Lage, auch nicht mit noch so aufwendiger aparativer Technik – auch nur annähernd diese Präzision zu erzielen.
Der Verlängerungs-Komfort ist durch kein anderes System zu überbieten. Hiermit meine ich die freie Fortbewegung des Patienten, auf langen Distanzen von mehreren Kilometern natürlich unter Zuhilfenahme von Unterarmstockstützen, nicht nur zur Schonung der Implantate sondern auch zur Perfektionierung des Gangbildes.
Unter Behandlungskomfort verstehe ich auch die Gestaltung der täglichen Verlängerungsschritte: führt die zunehmende Gewebespannung zu erheblichen Schmerzen und Funktionsbehinderungen, so erlaubt die Stabilität und sichere Mechanik des Systems eine Reduzierung bzw. einen kurzfristigen Stopp der Verlängerungsschritte ohne Risiko einer vorzeitigen knöchernen Überbrückung. Dies wird erreicht durch die stabile Mechanik, die selbst nach größeren Verlängerungspausen zum Zwecke des Wohlbefindens in der Lage ist, erneut ohne Nachteile die Verlängerung fortzusetzen. Besonders hilfreich ist hierbei auch die Durchführung kleinerer Verlängerungsschritte als 1 mm am Oberschenkel oder z. B. 0,7 mm am Unterschenkel. Hierbei ergibt sich rein rechnerisch zwar eine zeitliche Verlängerung der Wachstumsphase; jedoch zeigen zahlreiche Verläufe, die mit kleineren täglichen Verlängerungsschritten gearbeitet haben, nicht nur die bessere Osteoregeneration in kürzerer Zeit sondern auch die weitaus bessere Rekonvaleszenz mit Vermeidung bzw. Reduzierung von Funktionsdefiziten und Kontrakturen. D.h. in kürzerer Zeit wird letztendlich eine Normalisierung des Lebens erreicht.
Auch hierin können andere Systeme nicht mit dem Betzbone® konkurrieren, da die schwachen Antriebsmechanismen sehr rasch zum Stillstand der Verlängerung führen.
Gravierend koold forum hinzu, dass sämtliche anderen Verlängerungssysteme einer Überbohrung von 2 bis 2, 5 mm bedürfen, um eine weitgehend zuverlässige Funktion zu gewährleisten, da die geringste Verklemmung bereits aufgrund der schwachen Kraft zum Systemstillstand führt. In vielen Fällen kleiner Knochendurchmesser ist daher die Verlängerung mit intramedullären Systemen, die der Überbohrung von 2 bis 2,5 mm bedürfen, um die Funktion zu gewährleisten, nicht möglich oder sehr riskant.
Aufgrund der großen Kraft, die der Betzbone® in der Lage ist auf den Knochen zu übertragen und in Verbindung mit der soliden anatomie- und physiologiegerechten Verbindung zwischen Fibula und Tibia kann auf die sonst übliche Fibulasegmententfernung verzichtet werden. Diese Segmententfernung wird propagiert, um eine frühzeitige Heilung der Fibula und damit ein Stillstand der Verlängerung zu vermeiden. Es ist richtig, dass die endgültige knöcherne Heilung der Fibula nicht erforderlich ist, jedoch freue ich mich über jeden Fall, der am Ende der Verlängerung auch die Konsolidierung der Fibula in korrekter Position herbei geführt hat.
Ein weiterer wichtiger Punkt, der von großer Bedeutung sein kann, ist die Korrosion. Jegliche, auf dem Weltmarkt befindlichen Implantate können Korrosion entwickeln. Das Innenleben dieser Implantate enthält Materialien, die nicht korrosionsbeständig sind und aufgrund der elektromechanischen Eigenschaften auch nicht anders ausgewählt werden können. So lässt sich nur mit einer Dichtung das Eindringen der aggressiven Körperflüssigkeit in das Innere des Systems vermeiden. Insbesondere bei Zunahme der Verlängerung und damit ausgefahrenem Teleskop wird die Dichtung mehr belastet und lässt nicht selten Körperflüssigkeit in das Innere des Systems eindringen, was dort zu extremer Korrosion führt. Diese rostige Flüssigkeit dringt dann wiederum in die Markhöhle über die insuffiziente Abdichtung und führt dort zu Krankheitszeichen wie bei einer schwersten Infektion mit Rötung, Schmerzen, Schwellung. Nur die sofortige Nagelentfernung mit intensiver Spülung der Markhöhle führt hier zur Beruhigung.
Ein weiteres Phänomen ist in diesem Zusammenhang in Verbindung mit der angestrebten hermetischen Abriegelung der im Nagelinneren gelegenen Komponenten erwähnenswert: in mehreren Fällen habe ich erlebt, dass Patienten während des Aufenthaltes in größeren Höhen jenseits von ca. 2000 Metern, insbesondere während der Rückflüge über extreme, nicht therapierbare Schmerzen geklagt haben. Sobald wieder meeresniveauähnliche Höhen erreicht werden ist der Schmerz aufgehoben. Wir sind diesem Phänomen nachgegangen und können hierfür ausschließlich einen Gasaustritt aus dem Inneren des Systems über die Dichtung in die Markhöhle verantwortlich machen. Diese Schmerzen sind derart gravierend, dass sie in der Regel mit keinerlei Schmerzmittel zu behandeln sind.
Beide Punkte, sowohl Korrosion als auch der extreme Schmerz in großen Höhen, sind im Falle des Betzbone® ausgeschlossen: es gibt keinerlei Abdichtung zwischen den inneren und äußeren Nagelkomponenten, die Körperflüssigkeit zirkuliert beliebig und füllt unmittelbar nach Implantation das Nagelinnere auf. Ich erinnere mich z. B. an einen Patienten aus Colorado, der nach Oberschenkelverlängerung vor Jahren nicht in die Berge auf größere Höhe zurückkehren konnte aufgrund unerträglicher Schmerzen. Er musste seine gesamte Verlängerung in Denver durchführen und dort seiner Arbeit nachgehen. Bei der Jahre später durchgeführten Unterschenkelverlängerung mit dem Betzbone® hatte der Patient verständlicherweise die gleiche Angst. Es traten nicht nur bei ihm sondern auch bei anderen Patienten keinerlei derartige Schmerzsymptome durch Druckveränderungen auf.
Aufgrund der nicht möglichen Korrosion – da es gelungen ist sämtliche Einzelteile des Nagels aus absolut antikorrosiven Materialien herzustellen – ist der Betzbone® der einzige Nagel, der nicht zwingend entfernt werden muss. Trotzdem plädiere ich für die Entfernung, da es sich meist um jüngere Patienten handelt und der Knochen nach Entfernung des aussteifenden Nagels seine Rigidität verliert und wieder in seine alte Elastizität zurück findet nach dem entsprechenden Remodelling des Knochens.
Bezüglich Bedienbarkeit ist das System ebenfalls von keinem anderen System weltweit übertroffen. Es sind keine schweren und voluminösen Apparaturen erforderlich um die Verlängerung durchzuführen. Die gern ins Feld geführten Schwierigkeiten beim sogenannten „Clicken“ lösen sich in Wohlgefallen auf, wenn der Patient durch seinen Operateur oder erfahrene Mitarbeiter des Teams, in meinem Fall z.B. Daniela in die Funktion des Systems während des stationären Aufenthaltes eingewiesen wird und seine Ängste, selbst Hand anzulegen abgebaut sind. Dann ist der Patient an jeder Stelle weltweit in der Lage, seine Verlängerung unter einfachster Kontrolle, ohne erforderliche Apparate durchzuführen. Dieser Zustand ist in Verbindung mit der erwähnten Stabilität der Systeme von unbeschreiblichem Wert. Auch wenn in Einzelfällen die Vermittlung der Clickbewegung schwierig war, so gibt es keinen Patienten, der sein Ziel nicht erreicht hätte.
Insbesondere sind viele unserer Patienten in der Lage ihrem Beruf nachzugehen, wenn es sich wie gesagt nicht um schwere körperliche Arbeiten handelt; hierbei wird vom Patienten immer wieder die Ablenkung während der Arbeit als positiv beschrieben; unangenehm bleiben für viele Patienten die Nächte und die Wochenenden, wo ihnen die entsprechende Ablenkung fehlt.
Hi everybody it's me Nader again:
finally I am happy to tell you the translation is finished and after checking with Prof. Betz here you go:
I might have done some spelling mistakes I hope you don't get mad ! And if there are any questions please fell free to contact me. (either here or write me a message)
take care
cheers
Nader
Now the translation ;D:
Dear limb lengthening community,
As a lot of you may know I am Prof. Dr. med. Augustin Michael Betz.
Since the beginning of the digital age, I have never spend time on the different forums. Patients often reported to me about the information they got on the various forums. Sometimes these were very helpful and good advices, but often the information or advices were mislead and wrong and sometimes even dangerous for the patients. So now after some patients told me about the existens of the „limb lengthening forum“ and I have been confronted with some defamatory statements which were made there, I’ve spend a few weeks time on reading in this and similar forums (e.g. make me taller“). After that I was really shoked about the information made regarding my person. I would never have dreamed of that much defamation, caused by hateful, absolutly not qualified comments from one patient using the nickname „Mime“. It’s really surprising to see how a single person using a nickname- I know now who that person is and how little his reasons are...- can motivate others on the forum to do torrents of hatred.
Thus, please allow me to provide you with some information before I continue with answering your questions regarding the osteotomy and fixation technique between tibia and fibula.
Since the 70s I am concerned – at first at the „Universität des Saarlandes“ and then at the University of Munich- with the Illisarov method. Because of my expertise in the field of trauma surgery, I have always tried to switch to an internal nailing system. Despite the fact that the euphoria for the external system can still be legitim.
After gaining several research and clinical knowledge, I’ve soon got involved with the intramedullary nailing system and I developed a lengthening device based on an electromechanical method. This nail was able to handle the lengthening without any conection to the outside. I improved this system till we could start the serial production.
This lengthening system was used a lot eventhough there were some problems due to the miniaturization of the different parts, it still had the edge on the external lengthening system.
When I started using the internal nailing system, the external lengthening system was by far the more known and more used system, thus only a few surgeons in the world were interested in a internal device and its advantages.
This of course hidered me to continue working on improving it.
I don’t want to give you a history lesson on the internal lengthening system, this would just be too much.
But still since I am a developer of different lengthening systems, an owner of several patents, a surgon who used these devices and perhaps the by far most experienced person, (regarding my 30 years of knowledge) I may be allowed to say that a lot of the information on the forum are just absurd!
I am now working for over 2 decades, first with my own fitbone-system, then for a short time with the original Albizzia nail and following that in more than 1000 cases with an modified Albizzia nail which was used for every kind of lengthening(cosmetically or medically indicated). Ultimately I concluded all modifications and new ideas into developing a new device which I named Betzbone.
This system which includes additionally to the nail a lot of different components e.g. the intramedullary saw, fixation screws, different spezialized targeting devices for the perfect arrangment of the axis..., is right now the most accurate and solid device on the market. It has the biggest range of lengthening , and is very easy to controll and handle, despite this I am still trying to improve everything of course.
The handling of my intramedullary nail is very easy and for lengthening no additional resources, e.g. X-Ray, magnet, sonographie ... are needed. Another advantage of my system is that patients don’t have to come to my office very often, thus they can start working sooner. My lengthening device is a full weight bearing system, also a very big advantage over the other lengthing systems.
I do not want to prag but this is just the feadback I get from a lot of successfully treated patients. But sadly these patients are rarely on these forums.
Of course the lengthening process is not a „piece of cake“, the complaints differ from patient to patient. There are some who do not need any pain medication at all, other on the other side need pain medications and in some rare cases even opiates are proscribed. But this is not a big deal, since at the end of the lengtheing process the patients reduce their medication slowly thus no addiction problems occur.
I had during my career of course also some failures, for example the lengthening system was uncontrollable, the nail was either lengthening too fast or too slow, but seldomly in the desired speed; or the the systems weren’t enough weight bearing. Thus for a full weight bearing an aid(e.g. orthosis) was needed. Otherwise a bilateral lengthening can only be done in the wheelchair. And this leads to an extrem functioning loss of the legs. Extremly said: at the end of the lengthening phase the patients would have had to learn again how to walk.
Hence the highest standard for a lengthening system used also for cosmetic purposes is the stability. My lengthening system is the only one on the market which can provide this standard!
With a system which does not allow full weight bearing you can only lengthen one leg at a time safely. It should be known that in these cases it is not recommended to lenghten then both upper and lower leg of side at the same time, because this would cause too much stress on the soft tissue which leads to long function loss with a long convalescence. Thus a one-sided lenghtening of both upper and lower leg due to lack of stability of the device is extremly dangerous-especially if you lenghten both together for more than 8 cm- and therefore I advice against this method. But still I get that some collegues offer this to their patients, since they do not have a full weight bearing system.
Another very important issue is the capacity of the nail, and again all system except the Betzbone have only a small capacity. Of course the more you lengthen the more the healing of the bone is impeded but it’s not true that lenghtening for more than 6 cm will cause irreparable damage.
They huge amount of cases in the last 20 years have shwon that you can even lengthen more 10 cm without any problems. I mean I am certain that as soon as a system will be able to handle the extrem lengthening properly it will be preached and so far the Betzbone is leading on this field.
And if more devices with a bigger capacity get on the market the less douts the limblengthening society will have regarding „extrem“ lengthening.
Till now even the latest data on the forums show that on average 3-5 cm were lenghtend by patients and to be honest in my opinion this is rediculously little if you consider the costs and the time. Of couse lengthening more means more risks for the healing process- eventhough I have to say that for a cosmetic lengthening I have never experienced case, where a sponiogsaplasty was needed, at most a refrechment of lengthening region or a stabilisation with a solid intramedullary nail were applied.
Of course lenghtening just a few centimeters mean a faster recovery time and a much smaller risk. But still I have had so far a huge amount of cosmetic cases where the patients lenghtend 8 or more centimeters and I have never needed to do a spongiosaplasty. In a few cases the only thing I did when the regeneration wasn’t fast enough was the refreshing of the lengthening region and a stabilization with a solid nail.
Another very important issue in course of successful lengthening is the controllability of the system. Till today, all systems on the market except the Albizzia and Betzbone show inadequate controllability, or they require at least support systems (eg. X-Ray, clinical examinations or sonography).
Patients using the Betzbone always know whereever they are how much they have lenghtend, the only thing they require is a pencil and a sheet of paper. By counting the clicks they can easily calculate their lenghtend distance. The Betzbone is the only system on the market which is that precise and it does not need any ornate systems. The other systems can not offer the patients an approximate accuracy.
The lengthening comfort is hard to beat by any other system. By this I mean the free movement of the patient, of course the patients should use crutches for longer distances. The crutches have two functions: first protect the implants and second better the walking.
When talking about the lengthening comfort I also mean the design of the daily lengthenig steps. If the huge tissue tension leads to significant pain and fuctional disabilities, the mechnaic of the Betzbone and its stability is that good that the patients are then allowed to reduce their daily number of clicks or even to stop clicking for one or two days without fearing a preconsilidation. The nailmechanic is designed in a way that stopping for a certain time does not effect its function. Beneficial is also doing small daily lengthenig steps ( 1mm on the femur and 0,7 mm on tibia per day). Of course doing just small lengthening steps increases the lengthening phase but we experienced that by acting so the healing and osteoregeneration is the best and also the functional disablilities are then limited. Which in the end means that the recovery phase is shorter and thus a normalization of the patient’s life starts earlier.
Again here no other system on the market can compete with the Betzbone, since their drive mechanism tend to stop rapidly.
Also a very serious issue is that most other systems need an overreaming of the bone for 2 -2,5 mm to guarantee an proper function, since their mechanic can not handle any deadlocks. In a lot of cases where the patients have a small bone diameter a overreaming for 2-2,5 mm is not possible or very dangerous.
When lengthening the lower leg often a part of the fibula is removed to be sure that the fibula does preconsolidate. You just need to do this if the lengthening system used is not powerfull enough to tranfer the distraction force also on the fibula. The Betzbone is powerfull enough to tranfer the force on the fibula and in combination with the modified screws we use, we don’t have to remove a part of the fibula. The only thing we need to do is to cut the bone and then it will passivly lengthen for the same amout the patient lengthend the tibia. And this of course means the perfect alignement of the bones doesn’t get affected.
It’s true that the fibula does no need to reconnect by still I am every time happy to see that the fibula is consolidated again.
Another issue which can be very important is the so called corrosion. Every implant on the market can produce corrosion.
The inner parts of the implants contain material which can produce corrosion and the thing is that we sometimes cannot waive these materials because of their electrochemical properties. The only possibilty to prevent the corrosion is to seal the internal parts of nail against the agrressive body fluids. Of course the more you lengthen and the more the telescopic mechanism is extended and the harder it is to prevent body fluids from entering the nail. Thus corrosion usullay starts at least when the lengthening process has started. Then this rusty corrosion fluid can exit the nail and enter the marrow cavity and cause diseases like an infection with redding, pain and swelling. The only therapy is to remove the nail and to douche the marrow hole intensly.
I would like to mention another phenomenon concerning the hermetic seal of the internal parts of the nail. I’ve had several cases where the patients experienced a lot of pain when beeing in a alltitude higher than 2000 meter above sea level (eg when having a long distance flight) but a soon as they reached the sea level again the pain was gone. We’ve tried to figure out an explanation for this phenomenon and the only reason this could have is that at high alltitudes there is a gas leakage out of sealed internal nail parts. The pain the patients had was very severe since it could not be treated with any medication.
Both the corrosion and the pain at high alltitudes aren’t an inssue with the Betzbone. The Betzbone does not have any sealing of the internal nail components, the body fluid can circulate through the implant freely. Infact shortly after the insertion the nail is filled with the body fluid.
I remember one patient of mine from Colorado, who did several years ago an upper leg lengthening. He could not return to the mountains and had to finish his lengthening in Denver (due to the high alltitude problem). So when he did some years later the lower leg lengthening with the Betzbone he was again afraid of the high alltitude pain. But after I convinced him to give it a try he went up the mountains and did not have any problems with the alltitude anymore. This of course wasn’t an isolated case since the other patients aswell didn’t have problems anymore.
So some may ask why doesn’t the Betzbone produce any corrosion. Well we succeded in inventing a nail where all parts are made of corrosion free material. Thus the Betzbone is the only lengthening nail on the market which does not have to be removed necessarily.
Nevertheless I recommend the removal, since most patients are young adults and after the removal of the nail the bone isn’t that stiff anymore and it regains its elasticity. Because the remodelling is an crucial for the complete bone recovery.
Also regarding the handling no system on the market can compete with the Betzbone. With the Betzbone no big and heavy instruments are need to lengthen.
The complains regarding the clicking usually resolve in pleasure when the patients are instructed during their hospital stay in how to click easily by myself or someone of my team members Daniela or Nader who can even click the patients a few times to take away their fear.
After that the patients are able to click and lengthen their self whereever they want. And this in combination with the stability of the system is something of indiscribable value. Of course we also had patients to had troubles to lear how to click but still all of them reached their goals.
And what is also worth to mention that a lot of our patients are able to work durig their lengthening phase (of course I am not talking about hard physical work). For the patients working is pleasant distraction, but still the nights and the weekends (when they usually do not work) are described as uncomfortable.
-
Hello everybody,
I'm back again and I know that you waited a long time for my reply. But first of all I have to care for my patients. Above it took me a lot of time to answer and annotate all questions and thoughts.
I'm sorry to reply in this moment in German but I know also a lot of Germans are in the forum.
I will send the translation as soon as possible - I plan to do it before Easter days.
Here my reply in German concerning screw fixation in the tibia:
Fixation zwischen Wadenbein und Schienbein bei Unterschenkelverlängerung:
Von der Natur sind Wadenbein und Schienbein über eine kräftige Struktur, die sogenannte Membrana interossia, verbunden. Diese Membran spannt sich vom proximalen Fibulaende bis in den distalen Bereich und wird dort in Sprunggelenksnähe verstärkt durch die vordere und hintere Syndesmose.
Jede verlängernde Maßnahme am Unterschenkel, die mittels Fixateur extern durchgeführt wird, verbindet im proximalen und im distalen Bereich, d.h. oberhalb und unterhalb der Osteotomie an Tibia und Fibula, das Wadenbein mit dem Schienbein. So bleibt unter kontinuierlicher Distraktion, sprich Verlängerung, die korrekte Zuordnung zwischen Wadenbein und Schienbein erhalten. Dies ist von eminenter Bedeutung:
Würde keine Verbindung von Wadenbein und Schienbein anlässlich einer Verlängerung im Ilisarov-Prinzip durchgeführt und dabei mit den Verbindungsdrähten des Ringfixateurs nur die Tibia erfasst, so käme es unter kontinuierlicher Verlängerung der Tibia zu einer unkontrollierten Verlängerung der Fibula, d.h., die Membran kann die Kräfte, die bei einer Verlängerung auftreten nicht komplett an das Wadenbein übertragen, sodass das Wadenbein geringer verlängert wird als das Schienbein.
Welche Konsequenz hat eine solche unterschiedliche Verschiebung zwischen Waden- und Schienbein:
Im knienahen Bereich des Unterschenkels koold forum es durch die ungleichmäßige Verschiebung zu einer enormen Zunahme der Spannung das Ligamentum collaterale am Knie. Dies bedeutet eine enorme Spannungszunahme auf die lateralen Anteile des Kniegelenkes, eine rasch eintretende Reduktion der Kniegelenksfunktion und Schmerzen. Die Kongruenz der Gelenkmechanik wird gestört.
Im distalen Bereich sind die Auswirkungen weitaus gravierender:
Hier führt die ungleichmäßige Verlängerung von Tibia und Fibula bei fehlender korrekter Fixation zu einer massiven Störung der Gelenkgabelfunktion, das distale Wadenbein, speziell der Außenknöchel verschiebt sich im Verhältnis zur Tibia nach kranial und führt dadurch zu einer massiven Inkongruenz im Sprunggelenksbereich. Dies wiederum führt infolge der Inkongruenz zu einer raschen massiven Arthrose, d. h. extremem Gelenkverschleiß und Schmerzen und im Extremfall bis hin zur Gelenkversteifung, spontan oder durch Operation bzw. zum erforderlichen Gelenkersatz.
Bei Verwendung jeglicher Verlängerungsmarknägel ist das Wadenbein zunächst nicht – nach korrekter Einbringung des Distraktionsmarknagels – in die Fixation und Verlängerung einbezogen, wie dies jedoch beim Fixateur extern der Fall ist (zumindest bei Ringfixateur-Systemen). D.h. es bedarf einer zusätzlichen absolut zuverlässigen Verbindung zwischen Wadenbein und Schienbein im jeweils proximalen und distalen Bereich, um einer unterschiedlichen Verlängerung beider Knochen vorzubeugen.
Dieses Ziel wird bei Einsatz des Verlängerungsmarknagels in der Regel durch Verwendung von separat eingebrachten Querschrauben zwischen Wadenbein und Schienbein erreicht, in der Regel eine Schraube kniegelenksnah und eine Schraube sprunggelenksnah, dort wo auch die Verankerung bei der Versorgung spezieller Sprungelenksfrakturen stattfindet. Wir nennen diese Schraube im unteren Bereich Syndesmosenschraube, bekannt aus der Versorgung der Sprunggelenksfrakturen. Jedoch gibt es hier eine erheblichen Unterschied: bei Verwendung dieser sprunggelenksnahen Schraube, die ca. drei Querfinger oberhalb des Sprunggelenksspaltes angelegt wird, verhindert diese Schraube eine axiale Verschiebung, aber auch eine Aufweitung der Gelenkgabel. Dies ist bei Sprunggelenksfrakturen eines speziellen Typs erforderlich, da die Syndesmose, d.h. die Bandverbindung zwischen Wadenbein und Schienbein, die das korrekte Gabelspiel garantiert, zerstört ist. Hier muss die Schraube sowohl die axiale Verschiebung als auch die Seitverschiebung verhindern.
Bei der Verlängerung ist nur die Verhinderung der axialen Verschiebung gefragt, es sollte sogar durch die Verbindungsschraube gewährleistet werden, dass das normale Gelenkspiel unbedingt erhalten bleibt. Dies erreiche ich in idealer Form durch eine gewindelose, glattschaftige Verbindungsschraube, die exakt parallel zum oberen Sprunggelenk eingebracht wird, entweder von dorsolateral nach ventromedial oder umgekehrt. Ich bevorzuge die Einbringung von ventromedial, da im Bereich des Schienbeins mehr Platz existiert zur Unterbringung des kopfnahen Gewindes, was eine Dislokation der Schraube verhindern muss. Das Wadenbein wird dabei nur belastet durch den Durchmesser der glattschaftigen Schraube und nicht durch das unter dem Kopf gelegene Gewinde.
Mit dieser Schraubenanordnung sowohl proximal als auch distal wird gewährleistet, dass das Wadenbein in idealer Weise um den gleichen Betrag verlängert wird wie das Schienbein und gleichzeitig keinerlei Inkongruenz im Kniegelenks- und insbesondere im Sprunggelenksbereich resultieren kann. Durch die Verwendung spezieller Schrauben wird auch das Gabelspiel so gering wie möglich beeinträchtigt und nur die eine Komponente, nämlich die gefährliche axiale Verschiebung, verhindert.
Nach diesen Ausführungen wird es ihnen leichter fallen zu verstehen, warum eine schräge Einbringung dieser Schraube, egal von welcher Seite sowohl die Anatomie, die Physiologie und die Gelenkmechanik gravierend stört.
Zunächst macht eine Schraube die im Schaftbereich ein Gewinde trägt eine starre Verbindung zwischen Wadenbein und Schienbein, was wir nicht benötigen und was darüber hinaus die Gelenkmechanik derart stört, dass es schlimmstenfalls zu einer knöchernen Verbindung zwischen Wadenbein und Schienbein kommen kann als Antwort des Körpers. Diese knöcherne Brücke wird Synostose genannt und führt zur Verstarrung des Gelenkes mit gravierenden Folgen durch Gelenkzerstörung, Arthrose und Schmerz. Allenfalls hat eine solche Schraube einen Sinn bei hochgelegenen Sprunggelenksfrakuren, weil dadurch die korrekte Einstellung des Wadenbeins bei zerrissenen Bandstrukturen gewährleistet werden soll. Jedoch werden diese Schrauben aufgrund ihrer negativen Folgen sehr früh entfernt, in der Regel nach 6 bis 8 Wochen, um das Gelenkspiel möglichst rasch wiederherzustellen. Selbst in solchen Fällen macht eine schräge Einbringung in der Regel keinen Sinn.
Des weiteren ist eine schräge Einbringung nie in idealer Weise geeignet, eine axiale Verschiebung zu verhindern: selbst unter der Vorstellung einer günstigeren Kraftübertragung während der Distraktion – was definitiv nicht stiold forum – kann es über Seitwärtsverschiebungen zu unkontrollierbaren Druckzunahmen auf das Gelenk kommen, ganz abgesehen vom aufgehobenen Gelenkspiel.
Umso gravierender werden die negativen Folgen im Hinblick auf die notwendige Verweildauer dieser Verbindungsschrauben: im Falle komplizierter Sprunggelenks-frakturen mit Zerreißung der Syndesmose und Anteilen der Membrana interossia werden diese Schrauben nach 6 und 8 Wochen entfernt und der Patient dazu angehalten, nur Teilbelastung auszuüben. In ihrem Fall, bei Unterschenkelverlängerung müssen diese Verbindungsschrauben mindestens noch 2 bis 3 Monate über das Verlängerungsende hinaus belassen werden. Werden sie frühzeitig entfernt, so koold forum es zu einer sekundären Verschiebung mit den oben beschriebenen gravierenden Folgen. Es bedarf vor Schraubenentfernung eines weitgehenden Abbaus der Gewebespannung. Hilfreich ist hierbei, wenn es zu einer knöchernen Überbrückung auch am Wadenbein gekommen ist, da dann die negativen Auswirkungen nach einer Schraubenentfernung nicht mehr zu erwarten sind.
Wenn wir zudem davon ausgehen, dass der Patient in der gesamten Phase der Verlängerung, unmittelbar am OP-Tag beginnend, vollbelastet und sich möglichst viel bewegt um die Osteoregeneration zu stimulieren, dann werden die Folgen einer falsch eingebrachten „Syndesmosenschraube“ um so eklatanter.
Soweit zur korrekten Technik der Verbindung zwischen Wadenbein und Schienbein.
Hi guys here is the translation of that text. Please feel free to contact me (either here or via a message) if you have any questions!
Cheers
Nader Maai
Now let me say something about the fixation between tibia and fibula in the lower leg lengthening
By nature both bones are connected by a very strong structure, the so called interosseous membrane. This membrane spans from the proximal fibula head to its distal end where close to the ankle joint it is additionally supported by a anterior and posterior syndesmosis.
In every lower leg lengthing surgery may it be with an external or internal device the fibula is fixated to the tibia above and below the cutting area. Thus it is ensured that the arrangement of the joints and hence their function is not affected by the lengthening. Otherwise since the tibia is the actively lengthend bone the fibula would not be lengthend and thus severe problems could occur. Due to the less lengthend fibula in the knee area the tension on the collateral ligaments increases enormesly which means a very high tension on the lateral part of the knee and thus reduction of function in this joint and a lot of pain of course occur. The congruence of the joint mechanics gets destroyed.
In the distal area the effects are far more severe. Here an unevenly lengthend tibia and fibula due to a non or wrong fixation causes severe troubles in the ankle joint function. The lateral malleolus (distal part of the fibula) shifts in comparism to the tibia cranially and thus causes a severe incongruity in the ankle joint. This again causes a rapid arthrosis (wear of the joint) and a lot of pain and in some extreme cases to an ankylosis, either spontanously or due to surgery and then a articifical joint may be needed.
When using an internal nailing system the fixation of the fibula to the tibia is a very important step. It’s the same when using an external ring fixator except here you have automatically more connections between the bones. This means it requires additionally very relibale connection between tibia and fibula at each areas the proximal and the distal one, to prevent an unevenly lengthening of both bones.
To optain such a connection when using an intramedullary nail normally separately inserted cross bolts are used. As a rule one screw is inserted close to the knee joint and the other one close to the ankle joint. We call this screw close to the ankle joint the syndesmosisscrew. (by the way this screw is commonly used in ankle joint surgery)
However, there is a significant difference, when using this screw close to the ankle joint, which is inserted about three fingers above the jointline, this screw hinders an axial displacement. One requires such a screw for a special type of ankle joint fractures, since the syndesmosis (the band connecting tibia and fibula and thus guarantees the correct fork alignement is destroyed).
When lenthening you just have to prevent the axial displacement, and the normal joint „room“ should be obtained.
I can realize this idea ideally by using a non-threaded, smooth connecting bolt, that is placed exactly parallel to the ankle joint line, either from dorsolateral to ventromedial or visversa.
I personally prefer the insertion from ventromedial to dorsolateral since in this area of the tibia there is more place to accomomodate the thread near the head of the screw. (This small thread is just for preventing a dislocation of the screw)
By doing so, the fibula is just affected by the diameter of the smooth part of the bolt and not by its thread.
This arrangement of the screws in both the proximal and distal area guarantees ideally the same lengthening for the fibula as for the tibia. And what is also very important it does not interfere with the alignment of neither the knee nor the ankle joint.
After knowing that you should understand why inserting a screw in an oblique angle interferes drastically with both the anatomical and physiological function of the joints.
A screw with a thread (not only in the head region) contributes to a stiff conection between fibula and tibia. This is not something we want, and even more it does affect the joint mechanics in such a way, that a bony link between both bones can occur, which is just disturbing. This bony link is named synostosis and leads to a joint immobility, destruction of the joint, arthrosis and a lot of pain. You only use such a screw for ankle joint fractures where the bands are destroyed (as mentioned before) and even then you remove that screw 6 -8 weeks after the surgery because of its negative impacts. And again even here using an oblique angle usually does not make any sense. Furthermore an oblique insertion is never ideal to prevent an axial displacement. Even if there was a more favorable power transmission during the distraction- which is definately wrong- due to sideway shifting uncontrollable pressure increases may occur, not to mention the repealed joint space.
The longer the dwell of the syndesmosis screw the worse the impacts are: in case of a complex ankle joint fracture including a breakage of the anatomical syndesmosis and partially rupturing of the interossous membrane, the screw is removed after 6-8 weeks and the patients aren’t allowed to do full weight bearing. In your case of a lower leg lengthening the screws must stay at least for 2-3 months after the lengthening phase has ended. If you remove them to early, a secondary dislocation causing the above mentioned problems occur. Before removing the screws, the soft tissue tension must be again normal (as before the surgery). A consilidation of the fibula is in such cases also very welcome, since then normally removing the screws doesn’t have a big impact anymore.
If we assume that the patient does throughout the whole lengtheing phase (starting the day of the surgery) full weight bearing and moves a lot to stimulate his osteoregeneration, the effects of a wrongly inserted screw get more blatant.
That’s it now about the corret technique for the connection of the lower leg bones.
-
Hello everybody,
I'm back again and I know that you waited a long time for my reply. But first of all I have to care for my patients. Above it took me a lot of time to answer and annotate all questions and thoughts.
I'm sorry to reply in this moment in German but I know also a lot of Germans are in the forum.
I will send the translation as soon as possible - I plan to do it before Easter days.
Here my reply in German concerning osteotomy:
Zur Technik der Osteotomie an Femur und Tibia:
Seit den Anfängen des Ilisarov-Verfahrens wird die Osteotomie von außen durchgeführt. Hierzu sind verschiedene Techniken beschrieben, die sich teilweise Bohrern, teilweise speziellen Meißeln oder der Kombination aus beidem bedienen. Ebenso sind oszillierende Sägen im Einsatz, die - um es vorweg zu nehmen – meines Erachtens für Verlängerungsosteotomien keine Anwendung finden sollten, da die hochfrequente Bewegung zu Hitzeschäden an den Schnittflächen neigt, was wiederum die Heilung stört, ggf. Infekte begünstigt; darüber hinaus bedarf der Einsatz einer oszillierenden Säge des weitaus größeren chirurgischen Zugangs.
Um die knöcherne Heilung, die Osteoregeneration, besser zu verstehen, bedarf es Kenntnissen zur Ernährung des Knochens: in dem Bereich, in dem wir die Verlängerungsosteotomie durchführen müssen, wird der Knochen sowohl vom Endost, d. h. vom intramedullären Gefäßsystem als auch vom Periost, d.h. dem um den Knochen herum befindlichen Gefäßsystem ernährt.
Große Bedeutung wurde daher seit Beginn des Ilisarov-Verfahrens dem Erhalt des intramedullären Gefäßsystems zugesprochen, da bei der Durchtrennung von außen regelmäßig das periostale Ernährungssystem mehr oder weniger kompromittiert wird. Es hat sich jedoch gezeigt, dass durch die von Ilisarov selbst propagierte Corticotomie, d.h. der reinen Durchtrennung der zirkulären Hartsubstanz des Knochens nicht nur das periostale Gefäßsystem in Mitleidenschaft gezogen wird, sondern auch das endostale, auch bei noch so minutiöser Corticotomie-Technik. Arbeiten von Brutscher und Brunner am Forschungsinstitut der AO (Arbeitsgemeinschaft für Osteosynthese) in Davos haben darüber hinaus nachgewiesen, dass selbst bei Zerstörung beider Gefäßsysteme, sowohl des inneren als auch des äußeren, die knöcherne Heilung erfolgt, jedoch mit erheblicher zeitlicher Verzögerung. Daher muss es unser Bestreben sein, möglichst ein Gefäßsystem zu erhalten.
Wenn also die Indikation zur Anwendung eines Fixateur externe gegeben ist, so macht es Sinn, den Knochen über eine kleine Inzision von außen mit den oben beschriebenen Techniken schonend zu durchtrennen.
Besteht die Indikation zur Anwendung eines Verlängerungsnagels – hierzu gibt es Gott sei Dank im Indikationsbereich der kosmetischen Verlängerung kaum noch Diskussion (seit über zwei Jahrzehnten habe ich mittlerweile erfolgreich versucht, den Sinn der intramedullären Verfahren zu predigen) liegt es ebenfalls nahe, eine Osteotomietechnik zu wählen, die so gering als irgend möglich eine Schädigung der Knochenernährung hervorruft.
Die Anwendung der Marknagelverfahren zur Stabilisierung von Schaftfrakturen an Oberschenkel, Unterschenkel und Oberarm haben uns seit über 6 Jahrzehnten immer wieder gezeigt, wie wichtig es ist, die Frakturreposition und die Stabilisierung indirekt, d.h. ohne Berührung der Frakturregion – durchzuführen. Je weniger wir bei der Versorgung die Frakturregion freigelegt haben, um so besser war unser Heilungsergebnis bezüglich Zeit und Knochenneubildung.
Exakt gleich verhält es sich bei den Verlängerungsosteotomien, die letztlich künstlich herbeigeführte Frakturen darstellen. Je schonender wir die Osteotomie durchführen, umso besser wird unser Heilungsergebnis sein, d.h. wir werden in kürzerer Zeit eine weitaus bessere Knochenneubildung erzielen können. Dies hat gravierenden Einfluss auf die gesamte Nachbehandlungsphase.
Lassen Sie mich daher noch mal zurückkommen auf die beiden Ernährungssysteme, sowohl von außen als auch von innen: bei Einbringung jeglicher Marknägel zerstören wir vorübergehend das intramedulläre Gefäßsystem. In der Folge erholt sich dieses Gefäßsystem wieder, braucht jedoch wertvolle Zeit. Daher muss es in unserem Bestreben sein, soweit irgend möglich das äußere, das sogenannte periostale Gefäßsystem zu erhalten. Hieraus resultiert, dass wir möglichst das periostale System nicht von außen berühren. Was ist also naheliegender, als die Osteotomie über den Kanal durchzuführen, der später für die Einbringung des Marknagels genutzt wird. Hierzu verwenden wir verschiedene Ausführungen der Innensäge. Diese Säge wird vor Einbringung des Marknagels in die Markhöhle eingebracht und durchtrennt sukzessive exakt die Anteile des Cortex (der zirkulären Knochenhartsubstanz) und zwar nur soweit, als es erforderlich ist, durch leichten Druck von außen gegen die Gliedmaße die Fraktur zu komplettieren. D.h. wir berühren in der Regel nicht das Periost. Dies gelingt uns in nahezu 100% der Fälle in schonendster Weise mit einer speziellen von Hand betriebenen Säge die uns jegliche Hitzeentwicklung und damit Störung der Knochenheilung verhindert. Auch haben wir in unserem Repertoire druckluftbetriebene und elektrisch betriebenen Innensägen, jedoch machen wir davon nur selten Gebrauch, da sie wie jede andere oszillierende Säge zur Hitzeentwicklung und damit zur Verbrennung im Bereich der Osteotomieflächen führen können. Lediglich im Bereich der vorderen Schienbeinkante machen wir gelegentlich von diesen oszillierenden Sägen Gebrauch: im Gegensatz zum Oberschenkel, wo die Markhöhle zentral angeordnet ist und die Corticalis annähernd ähnliche dcken zirkulär aufweist, liegt die Markhöhle im dreiecksförmigen Unterschenkelknochen exzentrisch auf der Dorsalseite. Dadurch ergibt sich auf der Ventralseite im Bereich der vorderen Schienbeinkante ein erheblich größerer Corticalisdurchmesser, der aufgrund der größeren Eindringtiefe gelegentlich vorteilhaft mit einer meiner speziellen oszillierenden Sägen komplettiert wird.
Ich weiß, dass die Innensägen nicht beliebt sind, weil sie vom Operateur besonderes Geschick und technisches Einfühlungsvermögen verlangen. Ich hoffe jedoch, dass meine Ausführungen zur Anatomie und Physiologie der Knochenernährung Ihnen zweifelsfrei den Sinn der Durchtrennung des Knochens von Innen in Verbindung mit einem Verlängerungsnagelverfahren zeigen konnten.
Now the last part of the translation: please feel free to contact me if you have any questions.
Cheers
Nader Maai
Now somethingabout the osteotomy of the femur and tibia.
Since the beginning of the Ilisaraov method the bone was cut from outside. Therefore different technique are discribed, may it be by using drills or special chisels or a combination of both. Oscillating saws are also in use – (in my opinion they shouldn’t be used for a lengthening osteotomy since the oscillating movement produces a lot of heat which impairs the healing or in some cases it may increase the risk of an infection, and furthermore the use of an oscillating saw requires a much bigger surgical approach)
In order to understand the bone healing, the so called osteoregneration, basic knowledge about the bone’s supply are required: The area in which we have to do the lengthening- osteotomy the bone is supplied from both, the endosteum ( the intramedullary vascular system) and the periosteum (the vascular system surrounding the bone)
Since the beginning of the Ilisarov procedure a great importance was awarded to the intramedullary vascular system. Because due to the cutting from outside regularly the periosteal supply of the bone was more or less comprimised.
However it has been shown that by even using the technique Ilisarov himselp propagated (the corticotomy where only the compact bone is circularly cut) not only the the periosteal but also the endoosteal supply gets impaired. But still the researchers Brutscher and Brunner (working at institute of Davos and concerned with osteosynthesis) have proven that even when the bone’s both supply systems are damaged, a regeneration can occur, it just requires then more time. Thus our goal must be to obtain both vascular systems.
So if there is an indication for using an external fixateur, it makes sense to cut the bone gently from outside with one of the above mentioned techniques.
Is there now an indication for the use of an intramedullary nail one still should try his best to maintain both vascular supply systems and thus choose an ideal cutting technique. Thank god there is no more discussion about the use of an intramedullary nail for a cosmetic lengthing (For two decades I’ve been now successfully preching about the advantage and significance of an intramedullary system).
6 decades of fracture repair with an intramedullary nail in lower or upper leg and in the upper arm have shown that the best way to reposition a fractured bone and to stabilize it, is the indirect approach, which means without touching the fractured area. The less we work on the fractured area the better the healing and the osteoregeneration process is.
The same implies for the lengthening osteotomy, since the cutting can actually be seen the same as a fracture. The more careful we cut the bone, the better the healing process will be and the faster the boneregeneration starts and this of course has a huge effect on the post-treatment care.
That’s why I want to mention again both the internal and external supply systems of the bone: When introducing any intramedullary nail into the marrow hole we destroy the intramedullary vascular system. Of course the vascular system will recover after a certain time, but this is valueable time. Knowing this our highest priority must be to maintanin the external supply system as sufficient as possible. Thus we do not touch the periosteal supply system from outside. So obviously the only reasonable way to cut the bone is from inside using the same pathway one needs anyway to insert the intramedullary nail. Therefore we use different types of intramedullary saws. These saws are inserted into the intramedullary hole (which needs to be opend anyway to insert the nail) and cut the bone from inside. This saw cuts the compact bone from inside to a point where just small pressure from outside is enough to break the bone. This means the periosteum doesn’t get touched. In almost 100% of our cases we are successful with this gentle method of cutting the bone and since we are using a manual intramedullary saw we also prevent heat production which as stated above also impairs the bone regeneration. Of course we also have electrical or air pressurized saws but we use them only rarely since they also produce a lot of heat which causes burns in the osteotomy region and thus slows down the healings process. We only use the oscillating saw sometimes in lower leg surgeries for cutting the tibia. In contrary to the femur, where the marrow hole is in the center of the bone, in the tibia the marrow whole is located more dorsaly. The tibia is also triangularly shaped which makes is harder to cut the ventral part of the bone. Using an oscillating saw is then very beneficial.
I know that the intermedullary saw is not popular, since the surgon using it requires a lot of skill and technical ability.
But still I hope that my explanation showed you how reasonable the use of an internal saw is regarding the anatomy and physiology of the bone. Especially if you use an intreamedullary nail.
-
Thank you Dr Betz for your time to explain us several important issues on LL operation and definitely the physiological principia makes sense. THis can help people realize why internal LL is safer and faster than external LL.
Iam wondering wether the corrosion problem on "the other nail" is referring to old albizzia, or also new Gnail would have also this disadvantage of not being corrosion-free.
Can anyone of the veteran members or ex LL patients remember a case of a problem due to corrosion on internal nail. Ive never read this complication mentioned before..
Best regards
-
Many thanks for the excellent info and translating work!
It would be nice if this info is posted more prominently
-
Thank you Dr Betz for your time to explain us several important issues on LL operation and definitely the physiological principia makes sense. THis can help people realize why internal LL is safer and faster than external LL.
Iam wondering wether the corrosion problem on "the other nail" is referring to old albizzia, or also new Gnail would have also this disadvantage of not being corrosion-free.
Can anyone of the veteran members or ex LL patients remember a case of a problem due to corrosion on internal nail. Ive never read this complication mentioned before..
Best regards
Dear Caribe
As stated above corrosion is an very big issue. All lengthening nails on the market which need a sealing can produce corrosion. Just to remind you what corrosion actually is: when the aggressiv body fluids get in contact with the internal parts of the nail they react with the internal parts and corrosion results which can produce an non bacertiel infection etc. Normally a type of surgical steal is used that is both easy to manufacture and as far as possible stable. The nail developer can not just take another material since different features are needed. The problem is this type of steal can produce corrosion. Of course there are other types which are corrosion free but these are very hard to manufacture and to modify and also very expensive. So far the Betzbone is the only nail which does not need any sealing because better material is used. Thus it does not produce corrosion.
Some may say the sealing used is very good but as soon as the telescopic mechanism starts automatically the sealing gets weakened and leaky.
I hope this answered your question
Nice regards
Nader Maai
-
If you have further question I will be glad to help!
-
This is great info....so how can one really choose between Dr. Betz or Dr. Guichet???
It seems that many patients from Dr Guichet are able to walk without crutches barely 6-8 weeks after lenghthening 7cm and this without breaking screws or bending nails.
I would like to book with Dr. Betz, but screw breakage or longtime on crutches seems to be a dilemma. Could you please explain it to me so I can know more about Dr. Betz?
Many thanks
-
This is great info....so how can one really choose between Dr. Betz or Dr. Guichet???
It seems that many patients from Dr Guichet are able to walk without crutches barely 6-8 weeks after lenghthening 7cm and this without breaking screws or bending nails.
I would like to book with Dr. Betz, but screw breakage or longtime on crutches seems to be a dilemma. Could you please explain it to me so I can know more about Dr. Betz?
Many thanks
This is not about the surgeon but more about the patient. If you have fast bone consolidation then you'll be waking without crutches in 6 weeks no matter which surgeon you use. Guichet has a reputation for recommending intense pre and post operative exercise and physio. I think this creates a 'perception' that you wil recover faster. From personal experience I don't think this is true. Every body is different, but most bodies just require some basic regular exercises during and after lengthening to get you off crutches faster eg IT band stretches, hip flexor stretches and crutch walking, biking to stimulate bins growth. Also, I think guichet's focus on making his patients spend a fortune at the isokinetic before and after the op is totally unnecessary. I did almost no preop preparation and nor did many of my ll friends and we're all recovering well - we just stay in top of our regular stretching and physio.
-
Dear Dr. Betz,
Thank you for joining this forum. With regard to your postings i do have a few questions which seem to be very important when doing LL with an internal method.
It is true that I had broken screws and also some broken nails. But why this happened? Did you ever ask what the patient did that he had a bent or broken nail? In most cases it was because of too much activity and too early maximum weight bearing in connection with a related osteoregeneration. In such a case every material becomes tired.
My lengthening device is a full weight bearing system, also a very big advantage over the other lengthing systems.
Hence the highest standard for a lengthening system used also for cosmetic purposes is the stability. My lengthening system is the only one on the market which can provide this standard!
a) Could you please explain the difference between full weight bearing and maximum weight bearing?
b) Are there any limitations in the weight bearing capacity of your system with regard to body weight?
c) Is the weight bearing capacity different between 11 and 13 mm nails? If yes, how much?
d) How much activity would be considered too much?
e) Except for too much activity and maximum weight bearing, what other reasons could there be for nails or screws breaking?
Looking forward to your reply.
Best regards
-
Dear hanshi
I am really sorry I could not reply earlier since I was very busy at the university. I hope this clarifies everything.
a) The difference between full weight bearing and maximum weight bearing is as follows. When we say that someone is allowed to do full weight bearing this means that they are allowed to walk carefully without crutches. They shall not carry anything heavy or stand on one leg for a long time. They shall also not jump or take 2,3 stairs at once. Or jumping down a wall or any other risky actions. You have to understand that when standing on one leg due to the leverage the forces do not just double but they get 7 times bigger. Thus we say that one should walk carefully. But still we recommend the crutches during the whole lengthening phase since the crutches help to better the walking performance. And of course crutches signal your environment to be careful.
Maximum weight bearing on the other hand means basically that the patients can behave as if they did not have any surgery. Thus the patients are allowed to do extreme sport activities (football, paragliding, alpine skiing etc.)
b) Of course the lighter a patient is the easier the nail can handle the weight. The Betzbone is the most stable lengthening device on the market and as stated somewhere above due to the ingredients of our nail it is very hard to break. But in order to lengthen without any problems one should try not to be too obese. Another issue is that the surgery is easier and saver if the patient is not to heavy.
c) Of course the bigger the diameter of the nail the more stable it is! This is due to basic physics. We always try to use the biggest possible nail, without destructing the marrow whole. Thus we have to watch for the anatomical realations. For about 70% of all nailing producers we use an 11mm diameter nail and so far we can happilly say that we do not experience such a big difference between the 11mm and 13mm diameter nail.
d) Well this is hard to answer. I mean if you are exercising 8 hours a day and your body is handling everything fine then this is ok. It is really an individual issue. But please keep in mind that when exercising this much the human body also needs time to recover!
e) Well as in every manufactured product there is a risk that the material is not perfectly processed but we check every part of nail separately and do a functional test during surgery. Another reason why screws may bend and eventually break is to fast uncontrolled movements. This is very rare. The biggest issue is actually when patients don’t have a proper bone healing and thus the nail experiences too much stress for a too long time and this might result in bending or even breaking.
I hope I could help.
Nice regards
Nader
-
Dear Mr.Nader,
Thank you for trying to answer my questions. Please tell me, are those answers your own or did you get them from Dr. Betz? I was looking for his answers. Anyway,
Dear hanshi
I am really sorry I could not reply earlier since I was very busy at the university. I hope this clarifies everything.
I'm afraid not much has been clarified yet.
a) The difference between full weight bearing and maximum weight bearing is as follows. When we say that someone is allowed to do full weight bearing this means that they are allowed to walk carefully without crutches. They shall not carry anything heavy or stand on one leg for a long time. They shall also not jump or take 2,3 stairs at once. Or jumping down a wall or any other risky actions. You have to understand that when standing on one leg due to the leverage the forces do not just double but they get 7 times bigger. Thus we say that one should walk carefully. But still we recommend the crutches during the whole lengthening phase since the crutches help to better the walking performance. And of course crutches signal your environment to be careful.
Maximum weight bearing on the other hand means basically that the patients can behave as if they did not have any surgery. Thus the patients are allowed to do extreme sport activities (football, paragliding, alpine skiing etc.)
I don't know why you are using such crazy examples. Do you really want to suggest that the people who had broken screws and nails where jumping from walls or doing extreme sport? Also walking always implies standing on 1 leg. As far as i know that is exactly what is meant by full weight bearing. It means 1 leg carries the full body weight. Since Dr. Betz cites maximum weight bearing as main culprit for the breaking failures, he must have a specific definition in mind and actually also ought to tell the patients about it.
b) Of course the lighter a patient is the easier the nail can handle the weight. The Betzbone is the most stable lengthening device on the market and as stated somewhere above due to the ingredients of our nail it is very hard to break. But in order to lengthen without any problems one should try not to be too obese. Another issue is that the surgery is easier and saver if the patient is not to heavy.
My question was very specific and could have been answered with yes or no. Dr. Paley e.g. writes on his website that the weight bearing capacity for the Precise2 with 12.5mm is 34kg per leg. Since you and Dr.Betz assert that your nail is much superior, you have to have some data to back-up your claim. Therefore please give us a figure.
c) Of course the bigger the diameter of the nail the more stable it is! This is due to basic physics. We always try to use the biggest possible nail, without destructing the marrow whole. Thus we have to watch for the anatomical realations. For about 70% of all nailing producers we use an 11mm diameter nail and so far we can happilly say that we do not experience such a big difference between the 11mm and 13mm diameter nail.
Here again my question was very specific. If there is a difference in the weight bearing capacity between the nails, how much is it? You are supposed to have data about this. If you don't, this would mean you are just making live experiments with your patients. I don't understand what you mean with nailing producers please explain.
d) Well this is hard to answer. I mean if you are exercising 8 hours a day and your body is handling everything fine then this is ok. It is really an individual issue. But please keep in mind that when exercising this much the human body also needs time to recover!
Dr. Betz wrote clearly that too much activity was one of the main reasons for breaking nails and screws. Therefore your answer cannot be right unless he was wrong.
e) Well as in every manufactured product there is a risk that the material is not perfectly processed but we check every part of nail separately and do a functional test during surgery. Another reason why screws may bend and eventually break is to fast uncontrolled movements. This is very rare. The biggest issue is actually when patients don’t have a proper bone healing and thus the nail experiences too much stress for a too long time and this might result in bending or even breaking.
Since Dr. Betz is also the manufacturer of the nail he is responsible for the quality control from start to finish. Your functioning test is just a part of it and there is no excuse for bad quality. Those fast and uncontrolled movements are not included in maximum weight bearing? If not, they must be something very specific. Please explain.
Your last sentence again contradicts the statement from Dr. Betz since he said the main reason for breaking was maximum weight bearing and too much activity. Now you mention improper bone healing. How long does the nail last before it breaks i.e. how long is "too long time " as you say.
Please keep in mind, you both say that your nail is far superior to all the others while at the same time there seem to be many cases of breaking screws and nails. I am looking for a logical unambiguous explanation for this but so far i must say it is still outstanding.
Maybe you can ask the doctor for better answers?
Best regards
Hanshi
-
these are good questions
-
these are good questions
Yes, the questions are good and should be easy to answer unless the doctor has something to hide.
There are other questions he has not answered either:
Dr. Betz:
Please allow me to ask you a question that concerns me about internal lengthening. . .
What is the rate of compartment syndrome if you had any at all?
From your point of view what is the best way to minimize this complications from happening?
Also, could internal lengthening have a higher risk for compartment syndrome rather than external?
thank you
Dr. betz,
Thank you for coming to this forum, I am close to making a decision and all these comments really makes me guess if you are a option.
How strong is the betzbone? Why is dr guichet only using 13mm NAILS? I have never heard of any dr. guichet patients breaking their nails, why is that? If i request a 13mm nail will you acknowledge my decision. What is your opinion on ITB release? Why do you let patients weightbear so early?
Therefore:
Dr. Betz, if you have nothing to hide, please answer my 5 questions :
a) Could you please explain the difference between full weight bearing and maximum weight bearing?
b) Are there any limitations in the weight bearing capacity of your system with regard to body weight?
c) Is the weight bearing capacity different between 11 and 13 mm nails? If yes, how much?
d) How much activity would be considered too much?
e) Except for too much activity and maximum weight bearing, what other reasons could there be for nails or screws breaking?
as well as those other questions.
Thank you in advance.
-
Hanshi, your style of conversation suggests you have trust issues. Nader is simply interpreting the facts for you. Furthermore, you're nit picking at his response. This is unprofessional, immature and uh instructive. If you are considering Dr Betz then make an appointment and see him (like I did) and you can get all the clarification you need. The numbers you seek are available, I'm just guessing Nader has chosen a style of answering that isn't suited to what you want to hear - this doesn't make somebody a liar.
How many docs have you met? This is what you should be doing, you cannot make any decisions at all from Internet forum conversations,
Yes, the questions are good and should be easy to answer unless the doctor has something to hide.
There are other questions he has not answered either:
Therefore:
Dr. Betz, if you have nothing to hide, please answer my 5 questions :
as well as those other questions.
Thank you in advance.
-
Hello Moderators,
could you please move gettingtaller's post to the following thread:
http://www.limblengtheningforum.com/index.php?topic=736.msg12149#msg12149
there i might answer.
Gettingtaller is trying to interrupt the discussion here by starting an argument, which is clearly trolling behaviour .
Thank you in advance.
-
My apologies if you think I'm trolling but I beg to differ.
Your questions are reasonable but your style of conversation is not constructive and occasionally comes across rude. All in my humble opinion of course.
-
Dear hanshi,
I am really sorry for not being able to answer your questions the way you prefer it. You seem to have problems with my answering stile that's why I would suggest that you make an appointment with our office thus you Prof. Betz and I can sit together and clarify everything.
Nice regards
Nader Maai
-
Dear hanshi,
I am really sorry for not being able to answer your questions the way you prefer it. You seem to have problems with my answering stile that's why I would suggest that you make an appointment with our office thus you Prof. Betz and I can sit together and clarify everything.
Nice regards
Nader Maai
I have no problem with your "answering style". You simply didn't answer my questions but just tried to deflect them. But that's your problem, not mine.
Nobody forced Dr. Betz or you to come to this forum. But since he has come here, he hardly answered any critical questions. From your reaction here it is now more than obvious, that Dr.Betz is unwilling to answer these questions in this open forum where they would be on record. During an appointment Dr. Betz could tell me or other patients anything, it wouldn't matter since it would not be on record and therefore worthless. And why on earth do i need to have a personal consultation in order to get answers to general questions which have nothing to do with myself?
His statement is clear: his nail is fully weightbearing and if the nail breaks it is the patient's fault. However neither he nor you provide any data about the weightbearing capacity of his nail. This has nothing to do with "answering style".
Therefore i conclude: The Dr. Betz' business model relies on blaming the patients for any complications. The Betzbone nail is fully weightbearing as long as it doesn't break and as soon as it breaks the patient is to blame. In order to make this business model work data about the weightbearing capacity of the nail must not be disclosed in written form.
That's also the reason why you say there is no big difference between the 11 and 13mm nails. It doesn't matter because when it breaks it's the patient's fault no matter which nail.
If this was only about breaking nails it would just be a normal scam. However, since patients can get serious injuries in case a nail breaks, this is something much much worse!
Dr. Betz could prove me wrong by answering my questions here in this open forum.
I have found an interesting piece of information on the old forum:
In the Dr. Betz diary from "Geheimes" he writes on January 19th 2009, after he had an additional surgery due to a complication(nail malfunction):
"Its now 1 week ago since I was operated. Thank god things are going better now. The first days was hard - specially mentally as you saw. There just was so many feelings involved.
I heard from other sources that some people reading my diary had gotten the impression that I was dead? or about to die?
I must say there is some people on this forum ether less intelligent or they just like to blow things way out of proportion. They read what they want to read. Even Dr.Betz and his staff told me that some people reading my diary was scared and had asked him if I was dead?? TAKE A CHILL PILL really who ever that was.
Things you read here in this diary isnt meant for you to go yapp about to every person you see or to start bothering Dr.Betz about. The man has to much to do as it is, and cant run about putting out fires everywhere just because some people do not understand the purpose of this diary.
To clearify to the less intelligent people.....this diary isnt meant to be a "fact", but rather a peek into the everyday life of a LL'er and all the issues that can happen. I do not like to have my Doctor tell me that I should stop posting my feelings on a diary because some people blows things out of proportion."
So here is the clear prove that Dr.Betz and his team have been aware of their patient's diaries all along(this was over 5 years ago) and even directly told patients not to write something.
This gives a possible explanation why diaries end abruptly or patients try to hide their complications (e.g. Andrewshizzles).
It is very likely some more trolls will come out to attack me. But i don't mind. The facts need to be pointed out in the interest of the community.
-
Therefore i conclude: The Dr. Betz' business model relies on blaming the patients for any complications. The Betzbone nail is fully weightbearing as long as it doesn't break and as soon as it breaks the patient is to blame. In order to make this business model work data about the weightbearing capacity of the nail must not be disclosed in written form.
That's also the reason why you say there is no big difference between the 11 and 13mm nails. It doesn't matter because when it breaks it's the patient's fault no matter which nail.
Couldnt agree more with this statement, poor form from Dr Betz hence why I have permanently crossed him out of my list simply for the fact that his nails bend/break and you get charged another 20,000 Eur or so more for replacements, its not just a scam its a robbery. Just goes to show how much more of a businessman he is than a caring Dr, and a seedy one at it. Sysop affiliation and numerous reports of broken nails = untrustworthy.
Greedy
Im glad there are people on here asking questions regarding the matter, I guess Im not the only one who thought about it.
-
I have read all the Dr.Betz diaries on old forum and would like to share my findings:
There are currently 38 topics under the "Dr.Betz diaries" folder. 5 of them can't be used for this analysis: David-internal femurs, S-internal tiabias, Measurements, Nctham1, and Iwill. David cancelled his surgery, Nctham is not doing cosmetic LL and the other 3 don't contain enough information.
This leaves 33 cases, which is not a small sample and quite representative since these cases cover a long time span(over 8 years).
within this sample there are 12 patients with confirrmed complications that required additional surgery:
1. Romegas (titanium replacement in 1 leg, reason unknown)
2. Tallix (titanium replacement in 1 leg due to delayed bone healing)
3. TibAndFemur (Nail bending)
4. Stillyoung (Nail bending/breaking)
5. Geheimes (Nail malfunction, bone rebroken and nail taken out and repaired)
6. Tall (Nail bending)
7. Badboy (Nail malfunction, nail exchanged, broken screw)
8. MasterHY ( wound opened and got infected, infected tissue removed surgically)
9. T.dot (nail malfunction twice. Twice nail replacement)
10. OldieButGoldie (2 broken screws)
11. Andrewshizzles (broken nail)
12. Apotheosis tibia (broken nail and delayed/non-union)
Further there are 5 diaries which end abruptly and have a high probability that the patient got a complication:
a. Timone (complains in his last post about bad bone consolidation)
b. Torontonian (vanishes very early during his lengthening)
c. Aymahano (has a lot of problems and vanishes)
d. NoSleep (vanishes just after finished clicking, was the 1st patient to use the new 11mm Betzbone)
e. DcLongFemurs (vanishes after finishing clicking, also has the 11mm Betzbone)
Are the others without complication? For my calculation i will assume so, but of course we cannot be 100% sure since we know that Other patients have tried to hide their complications. What's worth mentioning is that Lucky did have a nail malfunction. However she chose to stop lengthening at that point and therefore didn't undergo additional surgery. But she didn't reach her goal.
Also important is the vanishing of MasterHY. He had already a complication, but from his diary it is obvious that he has had a lot more problems. In my opinion he could very well have a dangerous bone infection.
Anyhow, due to the analysis we come to the following result:
Complication rate for Dr. Betz patients in our sample is between 36% and 52%. 36% is the best case scenario, 52% is the scenario where the 5 abruptly ending diaries all have had complications.
The real figure probably lies between both numbers in case some of those 5 didn't have complications.
I would recommend to read those diaries with open eyes. I have found some interesting information which seems to characterize Dr. Betz quite well. I will write about this at a later time.
-
hanshi
good work hanshi, clearly good questions. but 1 piece of advice.
when someone is going to lie (such as bets) and you know they are going to lie. you should limit yourself to like the 2 most important questions, and then wait till they answer those to ask more.
1)
BETS I DEMAND TO KNOW the weight capacity of BOTH THE 11MM AND 13 MM NAILS. I demand the specs.
I bet they cant answer, (and physics dictates that the strength of 11mm and 13mm is not the same)
2)
my second question bets: you know what. don't even worry about a second question. the above question is A CLEAR CUT NUMBERS RESPONCE! ITS NOT OPEN TO INTERPRETATION, I DONT WANT AN ESSAY. !! I WANT A NUMBER FOR EACH NAIL.
if you cant answer a simple question then your trying to deceive people bets.
-
also hashi in response to this you wrote:
Complication rate for Dr. Betz patients in our sample is between 36% and 52%. 36% is the best case scenario, 52% is the scenario where the 5 abruptly ending diaries all have had complications.
The real figure probably lies between both numbers in case some of those 5 didn't have complications.
that's not actually correct, that assumes that all the diaries were not either:, fake, altered by sysop, person banned then diary end written by administrator, or any of the many things old forum has been caught doing to alter diaries.
think about how many "good diaries" we got from sarin. how many were lies. for all we know other diaries from bets could have had bad complications and those complications which were negative reviews could have been left out.
all we know is that around 50% of people had complications with his nail, providing every single diary is legit. I speculate that this nail is very unreliable in UPWARDS of 50% of cases. expect to spend extra money on additional surgeries when the nail FAILS.
-
Interesting reading. I'm a Betz patient in recovery. Some of you will question my identity but if you want to, you can confirm with blackbear and lucki (both of whom have diaries) that I am who I say I am as I have met them both on multiple occasions.
I think it's worth saying that I've met more Betz patients in-person than the number of diaries that you refer to. I met them in the UK (where I live) and I also met them at various stages of recovery during my own consultation, surgery and recovery. I stay in regular contact with a lot of them as we find each other to be a great sources of information and support for when we have questions. I can say that whilst one or two are struggling with recovery, none have serious issues. When I say "struggle", I just mean that their bodies are slower to recover than some of the others - that's just life.
It is true that every patient is different. Some patients tolerate the challenges and recover fast, others really really struggle. From my personal perspective, I had surgery in Feb, stayed on crutches until June and have been walking without them up until now. My x-rays look great, my consolidation is on-track and (touch wood), I don't have any nail or screw issues. I have followed Dr Betz and Nader's advice very closely and I'm pleased to say that my recovery is good. I do of course have some issues - my legs feel very tight, I still have some numbness on my thighs but on the whole I can walk in a way that is getting very close to normal (my muscles are still weak, as well as tight). Unlike other patients, I am lucky enough to also have a LL surgeon here in the UK that tracks and monitors me. I did this because I wanted a second surgeon taking care of me just in case (what if Dr Betz gets hit by a bus - God forbid). I can say that my UK surgeon has confirmed that there are absolutely no issues so far with my recovery or condition.
I think when people write diaries, one should understand that they're writing at times when they may be experiencing pain. They may be experiencing emotional issues related to their surgery and condition, and these might impact what they write and how they write. Diaries are not a scientific representation of how these patients traversed their LL journeys - no matter how much you try to apply statistics to them. Most patients DO NOT write diaries - they quietly do the surgery and just get on with their lives. No dramas, no issues. When people write about bad bone consolidation, it's not the Doctor's fault. When an open wound gets infected it's just a bit of bad luck, could happen to anyone - in MasterHY's case, it was dealt with quickly anyway. When they disappear there is not catastrophic issue, they usually have lives outside of forums etc.
Honestly, there is so much misinformation here. It bothers me that people are getting such a negative view of Dr Betz when my experience (and my patient friends' experiences) have been mostly positive.
Some personal facts:
1. I asked if I needed titaniums (people here argue that Betz tries to sell you these as an expensive extra). He could have said "YES", but he actually said "NO". He told me that my consolidation was good and there was no need for me to pay the extra money. If he said yes, then I would have paid for them - Dr Betz knows what I do for a living and he knows my financial position - it would not be hard for me to pay for the titaniums.
2. I had the same complication twice. My bone healing was very fast on my left leg and my nail became very hard to click. On both occasions I traveled to Germany, I got booked into hospital, anesthetized and clicked. In both instances, it cost Dr Betz money to rent out the anesthetic doctor, nurses, recovery room and of course his time. He could easily have asked me for money and I would have paid but he did not. In both instances he absorbed the cost without needing to. What can I say? Is this the behavior of a scammer? Make your own decision, but my view is that these are the actions of a good man.
3. On the second occasion (above), Dr Betz was on vacation. He cut his trip short to see me as I had a meeting on Monday and could only see him on Saturday. He did this for my convenience and I am very grateful.
4. While in Germany, Dr Betz was available every day, including Saturday and Sunday. He could choose not to be, but he actually cares about his patients and their progress and takes a very real interest in them. One of the reasons he's hard to reach for consultation is because he's so busy with his patients.
5. His attention to detail is crazy. If you look at another famous patients diary, you will see an x-ray where the screw sticks out a whole cm into the flesh. This was not a betz patient. Betz insists on measuring every screw for each patient and manufactures it to size before using it - did you know that? Minimises irritation and risk. I dont' want to mention names, but another famous surgeon created some issues for another patient with the way he was placing screws.
Guys. If you want to speak to a current patient, feel free to meet me in a major UK city (London, Birmingham or Manchester). I'm happy to share my experiences, advice and concerns. Just send me a personal message. If you want to keep slating Dr Betz then go ahead, for everyone else, please just go and see a few surgeons - Betz, Guichet, whoever. It's not fair to expect Doctors to spend hours on forums - you don't do this before heart or brain surgery, you meet them not chat on forums so please treat your LL in the same serious way.
-
we don't give a crap about 10 billion people who had LL if they did not write a diary.
out of all the diaries we have the nail failed 50% of the time, these people did not start writing a diary before the nail collapsed or because the nail collapsed: they started writing the diary before the nail collapsed so the statistics are accurate. out of X number of diaries 50% had a nail that was not strong enough.
no one is saying you cant successfully do LL with bets, we are saying his nail is .
don't try and change this into an emotional argument based on feelings.
when a nail fails in 50% of the diaries, I don't give a crap if the gy is a nice man or cares about his patients, its still a crap nail.
and the bull about bets not spending hours upon hours on a forum............ cut the bull , this is about bets not answering a simple question which involves 2 numbers for the 11mm and 13mm nail and their weight bearing capability. it takes 2 seconds but he refused to answer this question to every patient. that makes him a deceiver because he does not want to answer it. it has nothing to do with "spending thousands of hours on a forum". don't try to manipulate what is really going on here.
the doctor is not the problem. the device is. and I bet the doctor knows his device has a high fail rate so he refuses to answer the question.
-
edit
the second line should have read as:
out of all the diaries we have the nail failed 50% of the time, these people did not start writing a diary after the nail collapsed or because the nail
-
we don't give a crap about 10 billion people who had LL if they did not write a diary.
out of all the diaries we have the nail failed 50% of the time, these people did not start writing a diary before the nail collapsed or because the nail collapsed: they started writing the diary before the nail collapsed so the statistics are accurate. out of X number of diaries 50% had a nail that was not strong enough.
no one is saying you cant successfully do LL with bets, we are saying his nail is s**t.
don't try and change this into an emotional argument based on feelings.
when a nail fails in 50% of the diaries, I don't give a crap if the gy is a nice man or cares about his patients, its still a crap nail.
and the bull s**t about bets not spending hours upon hours on a forum............ cut the bull s**t, this is about bets not answering a simple question which involves 2 numbers for the 11mm and 13mm nail and their weight bearing capability. it takes 2 seconds but he refused to answer this question to every patient. that makes him a deceiver because he does not want to answer it. it has nothing to do with "spending thousands of hours on a forum". don't try to manipulate what is really going on here.
the doctor is not the problem. the device is. and I bet the doctor knows his device has a high fail rate so he refuses to answer the question.
It is very naive not to "give a crap" (as you say) about people that didn't write diaries. If you base your life decisions on evidence that is known to be unrepresentative of the broader population (in your example, 10 billion) then that's your choice lol. If one of my employees took that approach to business I would fire them.
There is an emotional angle to my comments, of course. Surgery is not an entirely scientific process. The human body is unpredictable - some people die form H1N1 and others don't. A big part of LL is all about emotions and your state of my mind and thus a doctor who understands this and keep you sane through the process is actually contributing to improved chances of a good recovery. If anything, I would say your reaction is much more emotional than the comments I made ;-)
Your view that "the nail is " is you opinion - this is fine, get a nail from Guichet or elsewhere. All I can say is that today I walked from one meeting to another in central London, without crutches, without full consolidation and I feel great. I've been doing this for a few weeks, as have my co-patients who are recovering with me. All good. If my nails are to others, well that's cool, because they do the job for me and my co-patients.
Regarding the numbers (11 vs 13mm) - I can't speak for Betz. Maybe he is being too cautious in discussing the specifics. All I can say is that in my business we don't discuss facts in public forums when the recipients of that information appear hostile or could use that information against you - rightly or wrongly. Actually, as I think about it, there is no area of medicine or surgery where a responsible surgeon would publicly commit to anything given that every individual is so truly and utterly different.
-
well let me first state that your education in statistical analysis is quite lacking. hopefully in time you can see the error in your ability to comprehend why we do not need a sample size of 10 billion studies to determine a hypothesis that the bets nail is not reliable.
you are obviously bias. you love bets because your particular nail did not break. that is fine I am glad you had a good outcome unlike many others. so you are quite welcome to defend him in this unrational manner.
H1N1 was a scam from the beginning. (yes I am qualified to say that) but that is another story.
Regarding the numbers (11 vs 13mm) it is quite clear that because of your emotional attachment for bets due to having successfully changed your life for the better, that you will rationalize anything in order to make him appear as a good man. when in fact the reason people are disgruntled is because when he was asked nicely many time over by many people he refused to answer truthfully.
being dishonest and withholding information tends to make people disgruntled. especially when you are told a nail is weight bearing when it is NOT in 50% of patients.
-
Geez, if Betz is going to take one's hard earned money, he is obligated to answer all pertinent questions on both of his 'Betz Nails' during the consultation, and even be prepared to back up his answers.
-
Interesting reading. I'm a Betz patient in recovery. Some of you will question my identity but if you want to, you can confirm with blackbear and lucki (both of whom have diaries) that I am who I say I am as I have met them both on multiple occasions.
I think it's worth saying that I've met more Betz patients in-person than the number of diaries that you refer to. I met them in the UK (where I live) and I also met them at various stages of recovery during my own consultation, surgery and recovery. I stay in regular contact with a lot of them as we find each other to be a great sources of information and support for when we have questions. I can say that whilst one or two are struggling with recovery, none have serious issues. When I say "struggle", I just mean that their bodies are slower to recover than some of the others - that's just life.
It is true that every patient is different. Some patients tolerate the challenges and recover fast, others really really struggle. From my personal perspective, I had surgery in Feb, stayed on crutches until June and have been walking without them up until now. My x-rays look great, my consolidation is on-track and (touch wood), I don't have any nail or screw issues. I have followed Dr Betz and Nader's advice very closely and I'm pleased to say that my recovery is good. I do of course have some issues - my legs feel very tight, I still have some numbness on my thighs but on the whole I can walk in a way that is getting very close to normal (my muscles are still weak, as well as tight). Unlike other patients, I am lucky enough to also have a LL surgeon here in the UK that tracks and monitors me. I did this because I wanted a second surgeon taking care of me just in case (what if Dr Betz gets hit by a bus - God forbid). I can say that my UK surgeon has confirmed that there are absolutely no issues so far with my recovery or condition.
I think when people write diaries, one should understand that they're writing at times when they may be experiencing pain. They may be experiencing emotional issues related to their surgery and condition, and these might impact what they write and how they write. Diaries are not a scientific representation of how these patients traversed their LL journeys - no matter how much you try to apply statistics to them. Most patients DO NOT write diaries - they quietly do the surgery and just get on with their lives. No dramas, no issues. When people write about bad bone consolidation, it's not the Doctor's fault. When an open wound gets infected it's just a bit of bad luck, could happen to anyone - in MasterHY's case, it was dealt with quickly anyway. When they disappear there is not catastrophic issue, they usually have lives outside of forums etc.
Honestly, there is so much misinformation here. It bothers me that people are getting such a negative view of Dr Betz when my experience (and my patient friends' experiences) have been mostly positive.
Some personal facts:
1. I asked if I needed titaniums (people here argue that Betz tries to sell you these as an expensive extra). He could have said "YES", but he actually said "NO". He told me that my consolidation was good and there was no need for me to pay the extra money. If he said yes, then I would have paid for them - Dr Betz knows what I do for a living and he knows my financial position - it would not be hard for me to pay for the titaniums.
2. I had the same complication twice. My bone healing was very fast on my left leg and my nail became very hard to click. On both occasions I traveled to Germany, I got booked into hospital, anesthetized and clicked. In both instances, it cost Dr Betz money to rent out the anesthetic doctor, nurses, recovery room and of course his time. He could easily have asked me for money and I would have paid but he did not. In both instances he absorbed the cost without needing to. What can I say? Is this the behavior of a scammer? Make your own decision, but my view is that these are the actions of a good man.
3. On the second occasion (above), Dr Betz was on vacation. He cut his trip short to see me as I had a meeting on Monday and could only see him on Saturday. He did this for my convenience and I am very grateful.
4. While in Germany, Dr Betz was available every day, including Saturday and Sunday. He could choose not to be, but he actually cares about his patients and their progress and takes a very real interest in them. One of the reasons he's hard to reach for consultation is because he's so busy with his patients.
5. His attention to detail is crazy. If you look at another famous patients diary, you will see an x-ray where the screw sticks out a whole cm into the flesh. This was not a betz patient. Betz insists on measuring every screw for each patient and manufactures it to size before using it - did you know that? Minimises irritation and risk. I dont' want to mention names, but another famous surgeon created some issues for another patient with the way he was placing screws.
Guys. If you want to speak to a current patient, feel free to meet me in a major UK city (London, Birmingham or Manchester). I'm happy to share my experiences, advice and concerns. Just send me a personal message. If you want to keep slating Dr Betz then go ahead, for everyone else, please just go and see a few surgeons - Betz, Guichet, whoever. It's not fair to expect Doctors to spend hours on forums - you don't do this before heart or brain surgery, you meet them not chat on forums so please treat your LL in the same serious way.
Was the famous patient Leechlet and his doctor, Guichet?
-
If it's true that the nail failure rate is as high as 50%, and he is not disclosing this information than he is gambling with peoples time and money. He would be obligated to add a weight limit stipulation for both the 11mm & 13mm nails &b disclose the specs for the nails. If not then he would be an unethical, uncaring, and greedy doctor if he ignores the problem by looking the other way.
On the flip side maybe all the patients who had nail failure were too damn careless all of the time.
-
On the flip side maybe all the patients who had nail failure were too damn careless all of the time.
I honestly believe there is some truth to this point. I was just personal messaging with a member here and he asked me about consolidation. One of the big no-nos of recovery is drinking alchohol. Booze kills your body's ability to create new bone, but despite the doctor's advice i saw some (mostly younger patients) still knocking back beers like it didn't matter - and then they complain about consolidation problems. Incidentally, I'm 40 so a little older than most LL patients. Add to that, patients that decide to go sky diving (oh yes), clubbing and do water sports (I mention no names!).
I'm not sure if I mentioned this, but I think I'm the first patient to have both the 11mm and the 13mm nails. Betz doesn't like reaming your marrow hole if the 13 doesn't fit (introduces lots of new risks) and so he prefers to insert the 11 in that case. My 11 has been fine so far. My 13mm leg (right) has been the weaker one throughout and so my left leg has been supporting my right leg ever since I got off crutches; bizarrely therefore my 11mm nail has been supporting my 13m nail :-)
To GROWtalORdieTRYING1: the 10billion patient sample was in reference to your flippant remark about basing all of your conclusions on a tiny number of diaries. There is no need to be offensive every time your fingers touch the keyboard ;-)For what it's worth, I'm a former research scientist so stats were my life (I've since got a real life by leaving research and running a global business - much more fun!). This also means that I see the weakness in stats - like when you base important life decisions on the murmurings of a small number of people who decided to post their diaries online lol.
-
I'm not sure if I mentioned this, but I think I'm the first patient to have both the 11mm and the 13mm nails. Betz doesn't like reaming your marrow hole if the 13 doesn't fit (introduces lots of new risks) and so he prefers to insert the 11 in that case. My 11 has been fine so far. My 13mm leg (right) has been the weaker one throughout and so my left leg has been supporting my right leg ever since I got off crutches; bizarrely therefore my 11mm nail has been supporting my 13m nail :-)
That's very interesting. All that reaming for the 13mm nail must have really affected the structural integrity of that leg thereby making it the weaker leg.
-
That's very interesting. All that reaming for the 13mm nail must have really affected the structural integrity of that leg thereby making it the weaker leg.
That makes sense, except that he didn't ream my right femur - there was already enough space for the 13. He could have reamed my left femur to fit a 13 but decided not to ream and fitted an 11 instead.
-
Geez, if Betz is going to take one's hard earned money, he is obligated to answer all pertinent questions on both of his 'Betz Nails' during the consultation, and even be prepared to back up his answers.
Actually he does. When you go for a consultation he will spend *A LOT* of time with you. He will also accept questions by email or SMS after the face to face meeting and will reply to those quickly. This form of "private" communication he is comfortable with and he will answer your questions about the nails and everything else in written form. it's not like he's trying to lure you into a face to face conversation that he can deny in future - it really isn't like that. I don't know for sure, but I'm guessing that like with other surgeons or professions it's not particularly smart offering "generic" answers on a public forum when there are people that have an objective to destroy your character. In that instance, my advice is always to stay silent.
-
it's not like he's trying to lure you into a face to face conversation that he can deny in future
lol, that's exactly what Dr. Betz does. He tells his patients “ i guarantee that the nail is safe”. But after it breaks and the patient is injured he won't mention his “guarantee” anymore. I strongly advise against trusting Dr. Betz. Anyway he wrote here already exactly what he is telling all his patients during the consultation. So there's no need to pay 400 Euro and go to Germany to get exactly the same sales pitch.
Internal lengthening methods have been hyped a lot, but they are more risky than externals.
-
To GROWtalORdieTRYING1: the 10billion patient sample was in reference to your flippant remark about basing all of your conclusions on a tiny number of diaries. There is no need to be offensive every time your fingers touch the keyboard ;-)For what it's worth, I'm a former research scientist so stats were my life (I've since got a real life by leaving research and running a global business - much more fun!). This also means that I see the weakness in stats - like when you base important life decisions on the murmurings of a small number of people who decided to post their diaries online lol.
statistics can be skewed to mean anything. we both know this.
however we cant go making statements on the statistics based on theoretical data that never existed.
until you present diaries we can only go with the data we have currently.
and the data than then be cross analyzed with the statistics from guich which does not have a 50% nail break rate.
or we can cross analyse the statistics from any other internal nail doctor to get a comparison.
the point being that no matter what excuses you make for bets, or no matter how many statements about how you think it was the patient in every case for their nail breaking the fact remains that this same nail break rate is not present in guich diaries.
so either magically guich only accepts patients that are not going to "destroy the nail themselves" or guich is using a better nail.
-
out of curiosity what kinds of things (side effects) can happen when you ream the bone.
-
That makes sense, except that he didn't ream my right femur - there was already enough space for the 13. He could have reamed my left femur to fit a 13 but decided not to ream and fitted an 11 instead.
Okay, you had two different sized bone canals and this enabled you to use different sized Betz Nails , both 11 & 13, and so no reaming was actually done here. I must have skimmed your post very quickly and didn't catch that.
-
out of curiosity what kinds of things (side effects) can happen when you ream the bone.
I'm no doc so if anybody else can add anything here then please feel free...
What I can remember, betz told me that the highest risk is fracture from a severely weakened femur. The walls of your femur are thinned down to make space and can crack or splinter if you're unlucky enough. I know Leechlet was really concernd about this as he got reamed for 13s but of course there was no fracture issue in the end. I think betz also said that the small particulates of bones could come loose and cause an aneurism. Aneurisms can be fatal but the chances are low.
-
I am from germany. I wanted to go with betz. But now it seems that it would be no good choice. But What doctor do you recommend?
-
bets is still a doctor who will get you through leg lengthening. he is not a butcher, just make sure you have enough money to pay for a replacement nail if you go through with him.
if you are a millionaire and money means nothing to you then bets is a fine choice.
-
Actually money is no problem. My concern is that i look wired afterwards. I wanted to Do 5cm femur. I also wanted to be able to do the whole thing in 6 months. But there are voices saying it takes years to walk again without others to notice.
-
bets is still a doctor who will get you through leg lengthening. he is not a butcher, just make sure you have enough money to pay for a replacement nail if you go through with him.
if you are a millionaire and money means nothing to you then bets is a fine choice.
That's not true. Dr. Betz has many patients with permanent problems long time after. Why do you make such statements without knowing Dr. Betz?
-
I was making a relative comparison to a butcher.
a butcher would be someone like sarin.
remember the word I inserted to make a comparison. ...................1 more time.......... butcher.
my statement was bets is not a butcher.
however if you want to have a brand new discussion on the statistics of patients with long term serious complications.
then I am all for it. :) the nail strength is already statistically validated. so if you want to shift gears and discuss bets as a doctor then present your stats. :)
if you can present a compelling argument then I am more than happy to call bets a butcher. :)
-
There are 2 main categories of patients who get serious injuries with Dr. Betz:
The first are the femur patients with broken nails. Depending on the circumstances these patients get serious injuries like fractures, nerve damage and muscle injuries. Just use common sense and imagine what can happen in case a nail breaks in a leg which is under mechanical tension from being lengthened. Further the patients can fall down and get additional injuries and fractures. Another risk is the transport of the patient with the broken nail which has sharp edges and easily cuts muscles and nervs.
The second category are all of Dr. Betz's tibia patients. They really are getting butchered. Hardly any of them remains without problems. Compartment syndrome, permanent nerve damage, non-union and bone infection are very common. There is only 1 diary but look what happened to Apotheosis: non-union plus broken nail plus bent fibula screws which will lead to arthritis in the future. In addition he got a bone infection during his arm lengthening. And now, nearly 3 years after his tibia surgery he is still not fully consolidated.
You might call Dr. Betz as you like, but the matter is very serious.
-
Thank you for your information Mime.
-
im not saying your wrong.
far from it.
however that does not constitute proof.
we need total number of diaries and then total number of recorded complications in those diaries to work out a statistic for incidence.
this is only theoretical complications. if we are going to make claims we need to crunch the numbers properly and not use anecdotal evidence.
I am curious. how many diaries do we have with bets on LL Forum? and old forum ?
-
I always thought Betz is the Best doctor to go with. There are so many positive diaries on old forum . I Do Not understand where you get this Bad opinion about betz. I had consultation with him. He Showed some patients. All were well
-
Yes because a doctor whos trying to get your money will show you patients with complications.... Of course he'll show you the good stories, every doctor out there will do the same
What he hasnt shown you are the bent and broken nails that SO MANY of his patients end up getting which then needs to be replaced with titanium nails which cost another $20-30,000, I havent checked the replacement price in quite sometime but thats how much they were before I think.
Originally I was also on the Betz bandwaggon and had him locked in for my first femur surgery until I read more of his patients diaries on old forum and realised they all had something in common, bent or broken nails.. Im sure Dr Betz knows about this problem but wont fix it, why? Because its another $20-30,000 in his pocket, thats why
If you've had a consultation with Betz and feel he is the one, then go for it, nobody is stopping you, your money your decision. Im sure Betz is a good doctor and isnt a butcher like Dr Sarin, but he seems to lack ethics and morals. Seems more like a businessman(and a shady one at it) than a caring doctor. Me personally Im looking elsewhere atm. Add to that his affiliation and dealings with Sysop/Apo/Anderson or what ever pseudonym he's going with these days and you get the point
-
There are also some without any problems like hanna or goldie
-
oldie but Goldie = 65kg very light.
hanna = don't know weight: but she is a girl who was 158cm. so probably not very heavy.
but either way there are only 50% of people with nail breaks so there will no doubt be people who weigh less and are complication free.
-
Okay once again, ones question on the reliability of the Betz Nail can be answered by asking Betz himself. Now how difficult can this be?
Your questions could be something like what I have below:
1) Exacty what is the total number of Betz Nail patients have you had in your entire career?
2) Okay, now what is the precise total who had a nail brake on them at some point? And it doesn't matter
right now how the nail broke or who is at fault, I just want the information on the precise number of
patients who had a nail that broke at some point while still in their leg.
Once you have the answers on the total number of broken nails during Betz career you can then go on to ask him further & more specific questions of course.
For Christ sake, nows not the time to be shy here. Your hard earned money and the health of your legs is on the line.
-
Okay once again, ones question on the reliability of the HYDROLIC Nail can be answered by asking DR SARIN himself. Now how difficult can this be?
Your questions could be something like what I have below:
1) Exacty what is the total number of HYDROLIC Nail patients have you had in your entire career?
2) Okay, now what is the precise total who had a nail brake on them at some point? And it doesn't matter
right now how the nail broke or who is at fault, I just want the information on the precise number of
patients who had a nail that broke at some point while still in their leg.
SARINS ANSWER IS 100% OF PATIENTS ALL RECOVERED 100% TO HEALTHY. FEW HAD COMPLICATIONS THAT WERE FIXED AND ALL PEOPLES ARE HAPPY NOW FOREVER......................
WHEN OUR STATS DONT MATCH DR SARINS STATMENT WE CALL BULL ON WHAT THE DOCTOR TELLS US.
doctors lie.
-
I'm sure doctors do lie all the time and you should take what they say with a grain of salt. But I'm sure records are on file somewhere whenever there is a scheduled surgery to remove a broken nail. That likely doesn't apply to India however. Of course there will be patients with broken nails who flee and never return to Germany, something to keep in mind.
One strange thing that doesnt make sense is we never hear a peep from the people who's nails have broke on them. For Christ sake we have people selling their homes and everything they own to have this surgery. Help your fellow man here.
-
Okay once again, ones question on the reliability of the HYDROLIC Nail can be answered by asking DR SARIN himself. Now how difficult can this be?
Your questions could be something like what I have below:
1) Exacty what is the total number of HYDROLIC Nail patients have you had in your entire career?
2) Okay, now what is the precise total who had a nail brake on them at some point? And it doesn't matter
right now how the nail broke or who is at fault, I just want the information on the precise number of
patients who had a nail that broke at some point while still in their leg.
SARINS ANSWER IS 100% OF PATIENTS ALL RECOVERED 100% TO HEALTHY. FEW HAD COMPLICATIONS THAT WERE FIXED AND ALL PEOPLES ARE HAPPY NOW FOREVER......................
WHEN OUR STATS DONT MATCH DR SARINS STATMENT WE CALL BULL s**t ON WHAT THE DOCTOR TELLS US.
doctors lie.
I'm sure doctors do lie all the time and you should take what they say with a grain of salt. But I'm sure records are on file somewhere whenever there is a scheduled surgery to remove a broken nail. That likely doesn't apply to India however. Of course there will be patients with broken nails who flee and never return to Germany, something to keep in mind.
One strange thing that doesn't make sense is we never hear a peep from the people who's nails have broke on them. For Christ sake we have people selling their homes and everything they own to have this surgery. Help your fellow man here.
-
And What doctor do you suggest?
-
I have read all diaries on old forum of betz. IT seems all are doing well. I Still dont get why here you warn for going with betz.
-
hey coppkillr.
I don't know who that question is aimed at.
but if its for me, I don't really care who a person chooses. so I don't recommend anyone. im just making a statistical analysis for a nail. im not even making an assessment on the doctor, just his nail.
so again, I don't really recommend or care who someone chooses.
-
Ok. But also i cant See the problems of the betznail. I cannot find ppl complaining.
-
well I see many people complaining. not sure why you cant.
-
The discussion should focus more on the information that is available. We can easily estimate the number of CLL patients of doctor Betz:
Under the "doctors that i do recommend for leg lengthening" section are answers from Dr.Betz on several questions:
Here are the responses from Dr. Betz, updating his information with 2012 pricing and details.
1. How many patients have been treated by you for Cosmetic Leg Lengthening?
Over 450 cosmetic limb lengthening procedures with internal devices.
In 2012 the number was 450. How many are there now, 2 years later?
15. Is there any other information that you would like to have included?
Prof. Dr. Betz is the most experienced limb lengthening surgeon in the world with internal devices and is a pioneer that has invented the most technological advanced telescopic nail. Cosmetic limb lengthening is a routine procedure for Prof. Dr. Betz in which he performs approx. 5-7 procedures per month.
Since there are 5-7 new patients per month the current number of cosmetic patients is around 600. We can also see how big this business for Dr. Betz is. 600 patients means roughly 30 million Euro turnover which is around 40 million US$. Since he is the manufacturer of the nail himself his profit margin is very high. Anyway, let's continue our investigation.
Since we know the total number of patients we can easily make an error calculation on our statistic above http://www.limblengtheningforum.com/index.php?topic=132.msg16324#msg16324
with the hypergeometric distribution.
The result is:
The complication rate for all of doctor Betz patients is
higher than 30% with a probability of 99.7%
higher than 40% with a probability of 89%
This clearly settles the dispute about whether or not the sample is big enough. Our gettingtaller troll has lost the battle.
What does Dr. Betz say about his complication rate?
8. In what percentage of cases do your patients experience complications?
a. Major complications - 0% (Fatty embolism, paralysis, nerve damage, deformity, loss of function)
b. Broken screw - 1-2 % (Results from a fall or excess pressure). This can be changed in an outpatient procedure.
c. Bent nail - 1-2 % (Results from an accident and can be removed and replaced with a titanium nail).
d. Infection - 0%
e. Non union - 1-2 % (only in medical indications in lower leg)
This is probably also what he is telling prospective patients during his consultation. Please notice that there is no mentioning of 'maximum weight bearing'.So we have proof that Dr.Betz is a liar.
I have found some more interesting facts which i will write about later. Stay tuned.
-
The discussion should focus more on the information that is available. We can easily estimate the number of CLL patients of doctor Betz:
Under the "doctors that i do recommend for leg lengthening" section are answers from Dr.Betz on several questions:In 2012 the number was 450. How many are there now, 2 years later?Since there are 5-7 new patients per month the current number of cosmetic patients is around 600. We can also see how big this business for Dr. Betz is. 600 patients means roughly 30 million Euro turnover which is around 40 million US$. Since he is the manufacturer of the nail himself his profit margin is very high. Anyway, let's continue our investigation.
Since we know the total number of patients we can easily make an error calculation on our statistic above http://www.limblengtheningforum.com/index.php?topic=132.msg16324#msg16324
with the hypergeometric distribution.
The result is:
The complication rate for all of doctor Betz patients is
higher than 30% with a probability of 99.7%
higher than 40% with a probability of 89%
This clearly settles the dispute about whether or not the sample is big enough. Our gettingtaller troll has lost the battle.
What does Dr. Betz say about his complication rate?This is probably also what he is telling prospective patients during his consultation. Please notice that there is no mentioning of 'maximum weight bearing'.So we have proof that Dr.Betz is a liar.
I have found some more interesting facts which i will write about later. Stay tuned.
Ok what else did you find?
-
Unlike the vast majority of the comments on this thread, my point of view is based on my actual experience lengthening 10.5cm with Dr.Betz. I had my nails removed during the second week of October, on the same day as OldieButGoldie (http://www.limblengtheningforum.com/index.php?topic=286.0) who has a diary here.
Generally, I think forums such as this one are great, but they also tend to be afflicted by a phenomenon known as 'arm chair' experts. If you have ever attended a bull fight, there is always row upon row of buLL Forumight critics, all of them giving their 'professional' opinion on bull fighting. Ultimately, the only folks who really know what its like to fight a bull, are those who get into the arena and fight the bull. Everyone is free to voice their opinion, but be wary of taking buLL Forumighting lessons from a spectator.
Before I voice my opinion about Dr. Betz, let me clarify a couple of things from first hand experience. Many of the points below have been previously elucidated by gettingtaller in this same thread, so to some extent I'm just rehashing the experience of someone else who has also spoken from first person experience.
- The vast majority of LL patients will not keep a diary. Many of them don't even know of LL forums or speak/write English. In the time that I spent in Germany for the initial surgery, I knew more than a dozen patients and only two of them started diaries (Torontian & DCLongFemurs). Both of them stopped posting to their diaries even though they did go on to complete LL successfully. When I went back to get my nails removed, I met 9 patients at the hospital, (2 for nail removal the rest for nail insertions), and only one (OldButGoldie) had a diary.
- Many of the LL patients I met, myself included, did not want to disclose the LL procedure to friends or even familiy. I wager that many of the visitors to this forum who are thinking of getting LL also have the same sentiment i.e. get the procedure done quietly, recover and get back to life. Of the 80+ patients each year who get the surgery done with Dr.Betz, most do just that i.e. put on your game face, wrestle the bull that is LL, recover, go on with your life and enjoy your new height. Many people are attracted to Internal LL because of the possibility of doing the process discreetly i.e. no external fixators & you can walk without crutches faster than the alternatives, so it should come as no supprise that many of them don't want to advertise the fact they are doing LL, even in an anonymous forums such as this.
- The diaries and shared experiences of those who have gone through LL is a great resource for those others who are considering the procedure. However, most of the folks who have done LL will tell you that it's a frustrating experience trying to convey realistic expectations to prospective LL'ers. Between the folks who think they know it all based on what they have read and those who want to hear their assumptions validated, however unrealistic they might be, many LL'ers opt to steer clear of posting in the forums. Believe me, when you are in the 2nd or 3rd month of lengthening, the last thing you want to spend your time doing is banter with an 'arm chair' LL expert. And once you are done with LL, most people want to forget about the experience and move on with their lives.
- The stats posted above about the complication rate for Dr.Betz are just plain moronic to the verge of being criminal. There are 38 diaries spanning the period beginning 2007. During that period, approximately 600 patients have done LL with Dr.Betz. How daft would someone have to be, to conclude that for the ~600 patients, you'll take 12 dairies that mention complications, and resolve that the complication rate for Dr.Betz is between 36% and 52%. With that kind of proficiency in math, one ought to consider asking for a refund from whoever taught them math. 12 out of 600 is 2% and even that cannot be considered a valid figure because the vast majority of LL patients don't patronize LL forums or care to maintain a diary. During the time that I stayed in Germany for the initial procedure and then subsequently for the removal, I met at least 20 patients personally. Out of these, there was one guy who fell in the bathroom and bent his nail such that it had to be replaced with a titanium fixator. Then there was another who was well on his way with LL but decided to go back to his construction job and not use crutches. He broke the screws on one leg which resulted in a fracture and he had to get titaniums and stop lengthening since you can't continue LL with a fractured bone. So that is 1% of the patients who I knew personally, but even I would be foolish to take that as a representative sample and use it to postulate what the complication rate for Dr.Betz is.
- Since 2007 there have been Betz patients who have used LON, ISKD, Fitbone, Albizia, Precice, BetzBone, etc. all of which have different performance profiles. Some like the Fitbone had a notoriously high failure rate due to the electrical mechanism failing, and hence methods like Fitbone are no longer used, even though Fitbone spared patients the tribulation of clicking. The point is, if your going to analyze complication rates, you have to consider the method used.
- It's never wise to tempt fate, least of all, when you have two broken bones in your legs being held together by screws. The 13mm BetzBone will comfortably hold the weight of a 240lb guy. But the same does not apply to the screws that attach the nail to your bones, and that is where most structural failures occur. This means that if mother nature gave you bones that are on the brittle side, then use the damn crutches until you have achieved consolidation, even if you have a nail that can bear your whole weight. This also means that as the weeks and months drag on and you are eager to stop using the crutches, you have to be judicious about when to walk without crutches. Most of the instances of broken screws & bent nails have occurred after the lengthening period and prior to consolidation. So regardless of which doctor you use, if you over exert the nails & screws, there's a good chance you'll end up back in the OR to get titaniums.
I did my LL surgery with Betz in August of 2012, and went from 173.5cm to 184cm on the 13mm BetzBone. Based on my starting height, LL for me was obviously for cosmetic reasons and with a gain of 10.5cms, I did more than most patients do on a single section. The passage of time since when I finished lengthening in December 2012 has somewhat obscured how difficult the lengthening was, particularly towards the end of the process. But what is apparent even to this day is that the process was 20% Betz, 30% Physiotherapist and 50% me. Let me explain.
- Surgery is trivial. They roll you into the OR. You fall asleep. You wake up 3-4 hours later. The nails are in. Betz plays a big role here.
- You spend the first week in the hospital, getting used to walking around on crutches with two broken legs. Betz comes in to check on you every day, but its mostly the nurses, therapist and other LL patients that interact with you.
- On the second week, you start clicking. Betz will help with this but many patients start clicking on their own or with one of Betz's assistants. Some patients have a hard time with the initial clicking which necessicates more involvement from Betz.
- After the second week, you leave the hospital and go to a residence of your choosing. From this point onwards, Betz will continue to visit as well as his assistants, but most of the therapy is from the physio therapist.
- Once confortable with clicking, many patients leave Germany and go back home. I left after one month and continued to lengthen for 2 more months at home. During this period, you take xrays every month and send them to Betz to make sure that the nail and screws are still fine. But mainly you continue with your physio 4-5 times a week.
- After lengthening, the consolidation period begins and the length of this depends on how much lengthening you did as well as how quickly your bone consolidates. You continue to take xrays every month and send them to Betz and you also keep up with physio. As your legs get stronger and you get more bone consolidation, you are able to stop using the crutches gradually. Unfortunately, some patients get too confident with their stronger legs and assume that they can get back to doing all sorts of activities, and the resulting over-exertion causes the screws or nail to bend.
What I'm trying to illustrate above is that in the typical 3 month LL duration, the doctor will play a pivotal role in the first 2 weeks, then it'll be up to you to be disciplined and follow instructions for the remaining 10 weeks. Most patients do so successfully but it requires discipline & dedication. In this particular respect, Guichet is different in that he insists that most of his patients stay in Milan for the entire lenthening period. This approach has its merits since most patients have difficulties staying focused and doing what they need to do for the entire LL period.
Before I decided to go with Betz, I interviewed with both Guichet & Betz and found both of them to be very capable. However, I was not keen on doing LL in such a big city as Milan, so I opted for the quiet German country side. I'm from the US, so both places would have been foreign and with foreign languages, neither of which I knew. Prior to the surgery, I actually did the Isometric training that Guichet requires although Betz said he didn't think it was necessary in my case.
As a doctor, I think Dr.Betz is as good as they come, and the vast majority of this patients, even those who have had complications will probably share the same sentiment. Aside from his command of the surgical procedure, I don't know many doctors who will physically carry you to the toilet when you are unable to walk (tibia patients can't walk at all during the first 5 days after surgery), call hotels, physical therapist and massage therapist and personally make reservations for you, drive half an hour out of his way so that he can visit you at your hotel, or sit with you until all your questions are answered. The one downside I will mention is that he runs such a busy schedule so if you do go for an interview, you'll probably be waiting for an hour or so, but once you get in, he'll stay with you until you run out of questions.
Having said that, my advice is that if you are considering Dr.Betz, then at the very least vist both Betz and Guichet and then make your choice. In both cases, insist that you be allowed to visit some of their current patients, particularly the ones who are already clicking. I say this because the patients who are 1-2 weeks after surgery are in too good shape to convey the real nature of LL. Best to see patients who've been clicking for a while. You don't know LL until you've been clicking for a while. If you can, visit Peter Woll in Wadern and ask to observe one of the therapy sessions. Ultimately, it would be fool hardy to choose a doctor based on what you read on these forums. If you're gonna expend that much money, pain, sweat and tears doing LL, you owe it to yourself to observe first hand what its all about.
I'm 6.05ft tall now and for the rest of my life I'll be thankful to Dr.Betz for making that possible, althought like I said above, 50% was me struggling to keep going. If I woke up and found myself at 173cm, I'd go back to Betz. I am also sure that other doctors such as Guichet, Paley, etc are also capable, but I can only speak from my personal experience.
-
I stopped reading when you said you lengthened 10.5cm.... ???
Definitely went to Betz...
Yikes
-
Unlike the vast majority of the comments on this thread, my point of view is based on my actual experience lengthening 10.5cm with Dr.Betz. I had my nails removed during the second week of October, on the same day as OldieButGoldie (http://www.limblengtheningforum.com/index.php?topic=286.0) who has a diary here.
Generally, I think forums such as this one are great, but they also tend to be afflicted by a phenomenon known as 'arm chair' experts. If you have ever attended a bull fight, there is always row upon row of buLL Forumight critics, all of them giving their 'professional' opinion on bull fighting. Ultimately, the only folks who really know what its like to fight a bull, are those who get into the arena and fight the bull. Everyone is free to voice their opinion, but be wary of taking buLL Forumighting lessons from a spectator.
That's the problem with this forum. It's full of people who didn't have LL but think they know everything better than someone who actually did LL or even worse, they think they know better than LL-doctors. So just ignore this people, most of them have other, more serious problems than height...
-
Thanks AtlasSearching....that was well written
-
So it took them more than 1 month before they dared to attack me again. And with such lame lies!
In the time that I spent in Germany for the initial surgery, I knew more than a dozen patients and only two of them started diaries (Torontian & DCLongFemurs). Both of them stopped posting to their diaries even though they did go on to complete LL successfully.
Torontonian had his surgery in 2010 and DCLongFemurs had his in 2012. It must have been difficult to meet them at the same time when they started their diaries.
It's really fascinating how any sockpuppet can claim to be a patient and make massive advertising for doctors. This is like on Amazon where some authors write positive reviews of their books.
Anyhow, i don't want to waste my time with trolls and continue with my findings about Dr.Betz.
There are some interesting examples of Dr. Betz's behaviour which show dishonesty, negligence and sloppyness towards his patients.
Here one of them: Geheimes had a nail which stopped clicking in his left leg.
1. What happened to my left leg:
My left leg stopped making clicking sound and also the clicking feeling stopped 1.december 2008. I was told that this was "normal", and that I should keep on clicking both my legs as usual. I was also told to take a x-ray of my legs about mid december and send this to Dr.Betz via e-mail so that he could confirm if there was something wrong or not.
I did so, and got a answer 19th of december from Dr.Betz telling me everything was fine, and that I did not need to worry.
About 31st of December, when I was in the shower, I noticed that my right leg was much longer then the left leg. I had been watching my legs since 1.december, but it was not so easy to tell. Even my physiotherapist could not determin by looking if this was the case. But 31st, was 1 month = 2cm since I had last clicked my left leg. This was now obvius.
I did travel to Dr.Betz 6th of December, and meet with him. We took x-ray and he tried to click me. His judgement was clear: PRE-BONE CONSOLIDATION!!
My left leg had extreme fast bone-consolidation compared to right leg. And now it was to late...1 month of consolidation...he could not just click it with force.
Then :
About my left leg...remember I said Dr.Betz would first try to do Anesthetic Clicking? Well he actually made it! He managed to brake the Bone consolidation even after so long time, but he had to Operate me because the Nail was broken on the inside. Since I had kept on clicking (trying to click), I had actually destroyed the nail from the inside. If I had come back to germany right away, then the nail would not have had to be taken out.
Dr.Betz took the nail out and fixed the nail, then put it back in.
Dr. Betz blamed the premature consolidation on the fact that Geheimes clicked only 10times per day after he reached 2cm(he got this advice from "Tall" on old forum ). His Pre-consolidation happened at 7.5cm.
I guess I could have made a deal about the fact that non discovered my fast bone consolidation, but I kinda took the hint and the hint was "you did not listen to us, but took some advice from a forum". Actually, it was no hint, he said it straight to my face Smiley This means that from his point of view, this is my fault and not his. If I had done 15 clicks this would not have happened. But if I had done 15 clicks and it still would have happened, then I would have made a big deal about it. Because believe it or not, if I had done 15 clicks, and I still would have had bone consolidation, I still would have had to pay for the hospital and all even though I was not to blame.
So despite the fact that Dr.Betz did not react when he was told about the clicking problem he blamed everything on the patient due to him not clicking fast enough. Fact is that the nail was defect, but this also was blamed on the patient. However, it is more plausible to assume that the defect nail caused the premature consolidation than vice-versa.
But here comes the proof that Dr.Betz was intentionally lying to the patient:
In MasterHY's diary we find the following:
31 days post op:
I dropped the clicking rate from 15 per day to 10. Had a long talk with Dr. Betz, and he advised that in the beginning it is necessary to do 15 clicks to prepare the soft tissue for stretching, but that afterwards it is very much recommended to click at a lower rate, maybe 10-12. He mentioned that the overall recovery will be much better as well as minimizing loss of function, with 10 clicks than with 15, since the soft tissue has more time to adapt. I have witnessed some people with severe loss of function and walking ability, they are just plowing through to finish clicking, but paying little attention to physical exercise, stretching, and good form.
Dr. Betz gave an example and said that normally in children, it takes approximately 2 years to grow somewhere between 8-10 centimeters, and we are speeding up that process tremendously by distracting the nail. Thus logically the body will adapt and handle 10 clicks much better than 15 clicks.
My pain from clicking has gone down tremendously by clicking at a lower rate. I know lots of times people are very anxious to get through the clicking phase, but at what cost to the body? So it makes more sense to be a little more patient and have better recovery and less pain.
So here clearly Dr.Betz gives the advice to MasterHY to do only 10 clicks per day, which before he said was the reason for nail damage and premature consolidation.
Maybe one cannot choose a doctor only on basis of a forum. However one can clearly decide which doctor not to choose. Why go to a doctor who lies to his patients?
As an add-on here a quote from OldieButGoldie who is a genuine patient and a good guy:
I am not posting this to promote Dr. Betz since I know of the many patients of his who are having complications.
I can give more examples.
-
Hanshi, it is because of pretenders such as yourself that most actual LL'er don't bother to post to this forums. Trying to argue with a pretender has the same efficacy as arguing with a door stop.
Since in your own words you believe in OldieButGoldie, you can PM him and ask him about the patient who had his nails removed before he did. I went in at 8am and OldieButGoldie was next after me. The day before surgery, OldieButGoldie and I had discussed driving together to Warden to visit Peter Woll since we had both done physio with him.
As for the diaries, Torontonian had his nails put in in 2010 and two years later in 2012 came back to have them removed. DCLongFemurs had his nails put in in 2012. Point is, they both stopped posting to the forums but went on to complete their LL successfully. I still keep in touch with DcLongFemurs and he'd probably be tickled silly to know that I'm on the forums bantering with the same brand of arm chair expert that had plagued his diary.
Do not flatter yourself by thinking that my response was an attempt on attack you. Having never done the procedure, your opinions are vacuous. I'd give credence to anyone who has actually gone through the crucible, whether it turned out well for them or not. Like I mentioned in my earlier post, I personally know 2 patients who broke their nails while I was in Germany, so its not like I'm looking back through rose colored glasses. I did however, take particular exception at your earlier pathetic attempt at math. If that's you bringing your mental faculties to bear, lets just say that that dog doesn't hunt.
Given that your opinions are devoid of any actual experience, how about you do the next best thing and ask the people whose words you are distorting to speak for themselves? Lets hear more from the actual LL'ers for a change. Given that there's 3-7 patients going through Betz every week, surely you can find some actual patients to buttress your otherwise vacuous claims?
The topic at hand is not some subjective exercise to channel made up speculations. You either have the chops or you don't. You either have done LL or you haven't. Its pathologically presumptuous to give testament on an experience you have never gone through or pretend to speak on the behalf of those who have. Picking off passages from other peoples diaries does not give you standing. As the saying goes, the devil will cite scripture if it suits his purpose. More likely, you're a hack working in collusion with one of the competing doctors to skim off some of the patients that would otherwise go to Betz. Yeah, you have been called out.
Like I said before, I speak from my own experience and don't begrudge those others who speak from their own experiences whether good or bad. But I'm loathe to entertain the fabrications of a pretender.
-
Hanshi, it is because of pretenders such as yourself that most actual LL'er don't bother to post to this forums. Trying to argue with a pretender has the same efficacy as arguing with a door stop.
Since in your own words you believe in OldieButGoldie, you can PM him and ask him about the patient who had his nails removed before he did. I went in at 8am and OldieButGoldie was next after me. The day before surgery, OldieButGoldie and I had discussed driving together to Warden to visit Peter Woll since we had both done physio with him.
As for the diaries, Torontonian had his nails put in in 2010 and two years later in 2012 came back to have them removed. DCLongFemurs had his nails put in in 2012. Point is, they both stopped posting to the forums but went on to complete their LL successfully. I still keep in touch with DcLongFemurs and he'd probably be tickled silly to know that I'm on the forums bantering with the same brand of arm chair expert that had plagued his diary.
Do not flatter yourself by thinking that my response was an attempt on attack you. Having never done the procedure, your opinions are vacuous. I'd give credence to anyone who has actually gone through the crucible, whether it turned out well for them or not. Like I mentioned in my earlier post, I personally know 2 patients who broke their nails while I was in Germany, so its not like I'm looking back through rose colored glasses. I did however, take particular exception at your earlier pathetic attempt at math. If that's you bringing your mental faculties to bear, lets just say that that dog doesn't hunt.
Given that your opinions are devoid of any actual experience, how about you do the next best thing and ask the people whose words you are distorting to speak for themselves? Lets hear more from the actual LL'ers for a change. Given that there's 3-7 patients going through Betz every week, surely you can find some actual patients to buttress your otherwise vacuous claims?
The topic at hand is not some subjective exercise to channel made up speculations. You either have the chops or you don't. You either have done LL or you haven't. Its pathologically presumptuous to give testament on an experience you have never gone through or pretend to speak on the behalf of those who have. Picking off passages from other peoples diaries does not give you standing. As the saying goes, the devil will cite scripture if it suits his purpose. More likely, you're a hack working in collusion with one of the competing doctors to skim off some of the patients that would otherwise go to Betz. Yeah, you have been called out.
Like I said before, I speak from my own experience and don't begrudge those others who speak from their own experiences whether good or bad. But I'm loathe to entertain the fabrications of a pretender.
How are your proportions,walking and sitting after all that lengthening?
-
How are your proportions,walking and sitting after all that lengthening?
Greek-Semidget, I'll take a pic of my legs and post under the Height & Proportions section so a not to hijack the topic of this thread.
-
Greek-Semidget, I'll take a pic of my legs and post under the Height & Proportions section so a not to hijack the topic of this thread.
I have posted a reply to your questions under Example proportions after LL (http://www.limblengtheningforum.com/index.php?topic=1120.0)
-
Interesting aside: Wang Bei/Ronne, the international patient liason in Beijing for Dr. Xia, claimed that Dr. Betz had shut down operations because he kept making mistakes. Naturally, lies to slander the competition.
-
The biggest liar is still Dr.Betz himself. Patients with complications get to know his real face. He is a genuinely evil person and i can only warn people. Dr.Betz exposes his patients to more risk than most other doctors. He seems very friendly during consultation( for which he takes 400 Euro but doesn't even examine you. All you get is an x-ray, a photoshop mock-up and a sales pitch) but this is only his advertizing masquerade. Once you run into trouble you will find out he was lying to you.
His complication rates are indeed as high as shown by hanshi. I got similar figures (30-40%for femur patients and much higher for tibia) from different independant sources, all people who work with his patients.
How about his skills? Difficult to judge for a patient but there are 2 indicators which show that his skills are below average:
1. his high complication rate.
2. all other doctors do things completely differently(preparation, bone cutting, screw fixation, weight bearing, lenghtening amount, medication,etc) Therefore either Betz is correct or Guichet and Paley are correct. In view of Dr.Betz's high complication rates it is rather easy to give an answer to that.
With Dr. Betz it is well possible to get a worst case outcome, i.e. being crippled for life and not even reaching your lengthening goal after paying all that money. By the way, he is an old man and no longer at the height of his abilities. For his age he is doing too many surgeries(regular surgeries plus emergency surgeries for his complication cases). The fact that he overestimates his capabilities increases the risk for his patients. His team too is very weak. Interestingly, Nader who wrote here is assisting him during his surgeries. However Nader is only a medical student.
As for the treatment of Dr.Betz, after his patients leave the hospital there is practically no treatment. The patients are more or less on their own and there is hardly any follow-up by Dr.Betz. The patient could be dead and Dr. Betz wouldn't notice. Also there is no planning for emergency cases. There have been several times when patients had their nail broken that they couldn't reach Dr. Betz by phone. His assistants don't know what to do in that case either. Dr. Betz hardly ever takes precautions to ensure his patients safety. He will always tell the patient not to worry. I'm telling you, with Leg Lengthening you should be worried! And if a doctor tells you otherwise you can be sure it's unsafe with him.
-
Interesting aside: Wang Bei/Ronne, the international patient liason in Beijing for Dr. Xia, claimed that Dr. Betz had shut down operations because he kept making mistakes. Naturally, lies to slander the competition.
Yeah, there's a couple of characters on here whose primary goal is to slander the competition in the hopes of driving patients away from the competition. In the case of Dr.Betz, its the classic scenario of the underdogs nipping at the heels of the top dog to try and get a piece of the action. They would be much better served by trying to up their game and provide some legit competition rather than mud slinging. Unfortunately though, its seems that for these detractors, its much easier to try to drag someone else into the mud rather than clean up their act.
-
His complication rates are indeed as high as shown by hanshi. I got similar figures (30-40%for femur patients and much higher for tibia) from different independant sources, all people who work with his patients.
Pray do tell, who are these so called "different independant sources" you are referring to? For all we know, you could be taking counsel from little green men. The figures posted above by Hanshi are basically a heaping helping of BS and even he did not bother to back them up after his pathetic attempt at math was exposed. So how about you put on your arithmetic hat and show us how you arrived at "30-40% for femur patients and much higher for tibia". In this endeavor, do not be afraid to brandish your most advanced command of statistics for fear that we will not comprehend it. You might be on to something here, but more likely it'll be a realization that you are not as good at math as you thought you were.
With Dr. Betz it is well possible to get a worst case outcome, i.e. being crippled for life and not even reaching your lengthening goal after paying all that money.
Well damn, you just paraphrased the concept of a Gaussian distribution in a novel albeit crass manner. Read on it a bit. With any doctor, its possible to get a worst case outcome or a best case outcome. That's not news. If you're claiming to know the actual percentage occurrence of either, do regale us with the factual data, not annecdotes that might as well be coming from little green men.
By the way, he is an old man and no longer at the height of his abilities. For his age he is doing too many surgeries(regular surgeries plus emergency surgeries for his complication cases). The fact that he overestimates his capabilities increases the risk for his patients. His team too is very weak. Interestingly, Nader who wrote here is assisting him during his surgeries. However Nader is only a medical student.
Say, do you know his actual age or this is another piece of information from the little green men? Secondly, what, in your "professional" opinion, is the ideal number of surgeries he should be doing at his age? How did you come to posses such intimate knowledge about his abilities so much so that you find yourself in a position to declare that he is no longer at the height of his abilities? Generally speaking, a rational person will go with the more experienced practioner as opposed to the upstart, particularly if that upstarts way of gaining clientele is by trying to slander the experienced practitioner.
Now personally, I leaned on Dr.Betz the day after my first surgery and we walked the length of the hospital hall together with no crutches. Didn't notice him struggling to support my 175lb frame. Neither did I notice him having any issues when he lifted up my roommate from the bed to a wheelchair.
As for the treatment of Dr.Betz, after his patients leave the hospital there is practically no treatment. The patients are more or less on their own and there is hardly any follow-up by Dr.Betz. The patient could be dead and Dr. Betz wouldn't notice. Also there is no planning for emergency cases. There have been several times when patients had their nail broken that they couldn't reach Dr. Betz by phone. His assistants don't know what to do in that case either. Dr. Betz hardly ever takes precautions to ensure his patients safety. He will always tell the patient not to worry. I'm telling you, with Leg Lengthening you should be worried! And if a doctor tells you otherwise you can be sure it's unsafe with him.
Again, do enlighten us, what treatment are you referring to after leaving hospital? I left hospital after 2 weeks and continued to lengthen for another 2.5 months, and so did the more than dozen other patients who I knew during my lengthening, most of whom left Germany after the first month. Every day you take your meds, do physio, do clicking, repeat. What is this mysterious ailment that would need treatment for 3+ months or are you referring to the statistically unavoidable cases that end up with a broken nail or some other complication? There were 2 of such cases during my lengthening period so they do occur, but like hell are you going to imply that all patients need to be under treatment for 3+ months because 1-2% get broken nails or some other complications.
I also call BS on your declaration that "with Leg Lengthening you should be worried". That's utter nonsense and fear mongering. With Leg Lengthening you should be careful and observant. Myself and the vast majority of my peers did just that and are none the worse for wear after completing LL. Within that mix there will invariably be some who get a complication due to no fault of their own as well as the knuckleheads who test the limits and end up with broken nails and all sorts of other complications. You reap what you sow.
Finally, if you're going to make assertions, back it up with actually experience and facts as opposed to quoting bogus sources. You either put up the facts to back your assertions or shut up. You are entitled to your own opinions not your own facts, so expect to be called out if you try to potray your opinions as facts. I've clocked in excess of two years going through LL first hand, and I don't have the inclination to countenance charlatans who think they know a whole bunch about LL because, well, they googled it.
Ultimately, you are not fooling anyone. The only mystery that remain is which of the underdog doctors you are working with to try to scalp clients from Betz.
-
Well now we know who Atlas is working for :D
-
Well now we know who Atlas is working for :D
All my posts include a footer that clearly indicates that I did LL with Betz in 2012, so it's not liked you've chanced upon some late breaking news. Secondly, I did my LL in 2012, well before this forum even came into existence, so its not like I decided to do LL 2 years ago in order to "work" for Betz on a forum that did not as yet exist. Unfortunately for me, I don't get visited by little green men to relay that sort of time travel information to me. Until I did my removal surgery in October 2014, I didn't know about the existence of this forum but I knew about the old forum. So, Cannibal, your point is?
-
All my posts include a footer that clearly indicates that I did LL with Betz in 2012, so it's not liked you've chanced upon some late breaking news. Secondly, I did my LL in 2012, well before this forum even came into existence, so its not like I decided to do LL 2 years ago in order to "work" for Betz on a forum that did not as yet exist. Unfortunately for me, I don't get visited by little green men to relay that sort of time travel information to me. Until I did my removal surgery in October 2014, I didn't know about the existence of this forum but I knew about the old forum. So, Cannibal, your point is? Or did you just feel the need to run your mouth?
Any criticism directed toward Dr. Betz seems to hit a little too close to home as far as you're concerned is all I'm saying.
Mime is a former Betz patient as well. What makes your thoughts on Betz anymore legit than his?
-
Any criticism directed toward Dr. Betz seems to hit a little too close to home as far as you're concerned is all I'm saying.
Mime is a former Betz patient as well. What makes your thoughts on Betz anymore legit than his?
I don't have any issues at all with anyone voicing criticism of Dr.Betz or any other doctor. Hell, I've indicated in some of my posts that I personally know of patients who broke their nails, so I'm not sugar coating his track record. I do have issues with anyone who makes some assertions and doesn't back them up with data or facts. I'm not going to give a pass to anyone who says "30-40%" but can't show how they arrived at that figure. Neither am I going to give a pass to someone whose sources are mythical "different independant sources".
If someone steps up with an assertion that is backed up by verifiable facts/data, then I'll say Amen to that. That kind of information will stand on its own two feet by the nature of its own veracity, not someones subjective opinion. Where I come from, you don't pee on someone and tell them that its raining. That's basically what some guys on here are doing when they throw around some random figures and expect to get a free pass.
If I come across as being exacting, its because I have first hand experience with LL. I don't begrudge Mime or anyone else saying that they had a bad experience with Dr.Betz, nor should anyone else come to a conclusion based on my experience, but if anyone if going to start throwing around figures, they'd better be ready to show how they came around to them.
Of the more than 600 patients that have gone through Betz, my relevance is at most 0.167% and so is that of Mime. So if Mime is going to make a claim concerning 30-40% of patients, he'd better show us who these 180 to 240 patients are and how he came to know of their experiences. But if he is speaking of his own personal experience which amounts to 0.167% as does mine, then I say, by all means proceed sir.
-
Fact is no one here including yourself Atlas is actually giving any facts, just pure subjective opinions. Why? Because until Dr Betz actually shows any of us actual numbers and records of patients, its all he said, she said. You say 600 patients, based on what? Word of mouth from Dr Betz? He could say 10,000 patients and you'd still believe him. No doctor will ever release these sort of information to patients, you're naive if you think otherwise
He probably did 600, no one here knows, only he knows. And I do agree that not all of his so called 600 patients write diaries but the ones who did, do provide some insight on their experiences. 30-40% is not a definitive answer and I highly doubt anyone on here including Atlas will have a definitive answer. So take it with a grain of salt and make your decisions carefully.
Me personally I dont care since I wont be going to Dr Betz, not because of his alleged complication rates but simply because he is/was affiliated with Sysop/Apo/Andersen or w/e else pseudonyms he's going with these days. Just that alone is enough for me to think that Dr Betz is more of a businessman than a caring doctor. And no I dont have pure facts or numbers to back that statement up. Anyone affiliated with Sysop is just as bad. And because I prefer Precice and not having to click
-
Hanshi's math is correct. Nobody can prove it wrong. This Atlas guy has no arguments against it but is just trolling.
Dr. Betz is 63 years old.
-
The whole issue is subjective. Let's be honest here, some have even had complications with the almighty revered Dr. Guichet!!!
ANY method and ANY doctor may carry the risk of complications at one point or another- Why? Because if you haven't noticed, we live in an imperfect world as imperfect people.
At the end of the day, each one makes their own decision based on what they believe is good for them. Take the good with the bad and thread a personal path on this. No need to to try slander, bicker, argue over things that are defined by angles of varied experiences.
-
He probably did 600, no one here knows, only he knows. And I do agree that not all of his so called 600 patients write diaries but the ones who did, do provide some insight on their experiences. 30-40% is not a definitive answer and I highly doubt anyone on here including Atlas will have a definitive answer. So take it with a grain of salt and make your decisions carefully.
I most definitely don't provide any definitive answers. I can talk definitively only in regard to my own experience doing LL. I will, however, liberally call out anyone who tries to make generalizations that purport to speak on the behalf of other people. Having done LL, the one constant that I found is that everyone's experience is different. In the postings that I have made about my LL experience such as this one (http://www.limblengtheningforum.com/index.php?topic=1120.0), I clearly indicate that my experience should not be taken as a recommendation on how much to lengthen, which LL method to use, etc. I'm simply stating how things went for me. Anyone considering LL should invariably take what they read on the internet with a grain of salt. Forums provide some insight, but it's still best to consult with a couple of doctors, talk to their patients one on one & see the facilities for yourself.
Hanshi's math is correct. Nobody can prove it wrong. This Atlas guy has no arguments against it but is just trolling.
What Hanshi did is juju not math. In that regard, it is as correct as juju could possibly be correct. We are in agreement though, that nobody can prove juju wrong. For someone who has never done LL, Hanshi seems to know a whole lot about it so evidently, the juju is very strong with him.
As for me trolling, it takes one to know one, umm, Mime. You seem to be carrying a gigantic chip on your shoulder, the aftermath, I am guessing, of your LL not turning out well. As I've said before, everyone is free to voice their opinions and preferences, but it's puerile to throw a tantrum because someone did not have the same experience as you did.
-
The whole issue is subjective. Let's be honest here, some have even had complications with the almighty revered Dr. Guichet!!!
ANY method and ANY doctor may carry the risk of complications at one point or another- Why? Because if you haven't noticed, we live in an imperfect world as imperfect people.
At the end of the day, each one makes their own decision based on what they believe is good for them. Take the good with the bad and thread a personal path on this. No need to to try slander, bicker, argue over things that are defined by angles of varied experiences.
You are missing the point. The point is that it is less safe to go with Betz and that he cannot be trusted.
-
What Hanshi did is juju not math. In that regard, it is as correct as juju could possibly be correct. We are in agreement though, that nobody can prove juju wrong. For someone who has never done LL, Hanshi seems to know a whole lot about it so evidently, the juju is very strong with him.
As can be seen again this Atlas guy doesn't have any arguments. It's just hot air.
He is claiming to be a patient, but hasn't given any proof that he is. Dr.Betz is making millions with cosmetic LL therefore it is easy for him to hire someone to write on this forum.
Interestingly neither Betz nor his assistant write here anymore although they could easily answer directly. The reason is simple:
They cannot answer the critical questions asked before and they cannot claim their complication rate is lower. Instead they resort in sending trolls here.
Dr. Betz is not trustworthy and has a lot of criminal energy. People who want to go with him should think twice. There is hardly any patient protection under German law and you will be fully at the mercy of Dr. Betz. Complications can happen with any doctor, but the worst thing is when you get a complication and find out that you cannot trust your doctor. That's exactly what happens with Dr. Betz patients. So be warned.
-
Cannibal is one miserable dude who lives just to attack top LL doctors to feel better about his lack of chances.
-
Let's be honest here, some have even had complications with the almighty revered Dr. Guichet!!!
Of course! They won’t be honest because that’s there job here.
-
Cannibal is one miserable dude who lives just to attack top LL doctors to feel better about his lack of chances.
It isn't just a coincidence that the only doctors you come here to support are the two most advertised on old forum .
-
As can be seen again this Atlas guy doesn't have any arguments. It's just hot air.
He is claiming to be a patient, but hasn't given any proof that he is. Dr.Betz is making millions with cosmetic LL therefore it is easy for him to hire someone to write on this forum.
Mime, it seems that you think I'm here to banter with you but that's not my intention at all. That would be a futile endeavor. Anosognosia is a bane and I'm not about to try curing it. I will say though, that there are some folks on here who have ailments, the least of which is being short.
It does tickle me however, that the dude who failed miserably at LL wants me to give him proof that I was a Betz patient. Since you seem to know a whole lot about the Betz operation, inquire with the patients who were in Neunkirchen in October and they'll tell you about me. Even better, OldieButGoldie has a diary on here and he too was getting his nails removed the same day as I did. But dude, first get a handle on your paranoia otherwise all else is mute.
-
Mime, it seems that you think I'm here to banter with you but that's not my intention at all. That would be a futile endeavor. Anosognosia is a bane and I'm not about to try curing it. I will say though, that there are some folks on here who have ailments, the least of which is being short.
It does tickle me however, that the dude who failed miserably at LL wants me to give him proof that I was a Betz patient. Since you seem to know a whole lot about the Betz operation, inquire with the patients who were in Neunkirchen in October and they'll tell you about me. Even better, OldieButGoldie has a diary on here and he too was getting his nails removed the same day as I did. But dude, first get a handle on your paranoia otherwise all else is mute.
So again this guy is not able to give proof that he is a real patient. Neither can he give any arguments. Instead he is only trying to insult. Also he is hogging this thread. His agenda is obvious.
His trolling won't help to whitewash Dr. Betz's reputation though.
-
So again this guy is not able to give proof that he is a real patient. Neither can he give any arguments. Instead he is only trying to insult. Also he is hogging this thread. His agenda is obvious.
His trolling won't help to whitewash Dr. Betz's reputation though.
Seriously Mime, you are mental. We get it, you are the angry short dude enraged with the world for failing to get taller. You'll have to live with your failure. Also, you have the complex, but you aren't Napoleon, so quit puffing up yourself as if you have any merit to judge who is or is not a Betz patient. The most you seem capable of is rehashing the same tired diatribe you have been spewing all along. If you can't be logically, at least try to be original so that your posts are so insufferable. I've got a nagging feeling though, that I'm flogging a dead horse.
-
Here's an interesting statement from Dr.Guichet about the Betzbone:
"THE BETZBONE® NAIL
The BetzBone is a modified copy of the Version 1 of the Albizzia Nail, with a system of bone fixation fragile and at risk of fractures, which often makes necessary its replacement with a static intramedullary nail. This induces a larger number of surgery for each patient. It did not spread to other surgeons yet.
Please note on the x-rays the hypotrophic healing 11 months after the surgery."
The x-ray is on his website under the link:
http://www.leg-limb-stature-lengthening-taller-height-increase-cosmetic.eu/us/technology%20comparison%20with%20other%20internal%20lengthening%20nails.php
-
God damn why do u think its from guichut?
It seems to be simply advertisement, right?
-
Hi, here's the latest update from MasterHY. I put it here just in case it'll be deleted. We all feel with you Master and wish you all the best.
"Hey guys I'm back. I decided its about time to give an update. This is going to be too long to write in one reply, and I simply don't have so much spare time these days.
Let me just first off start by saying that what I write here is my opinion, and in no way reflects the experience of others. Please keep that in mind when making judgements about doctors and this process. Each experience in LL is unique and I can only share mine through my own experience.
I'll start of by saying that I have not recovered. My own understanding of why I have not recovered has to do with the nails that were used, along with an infection that I got when my hip wound opened up just weeks after the surgery on my left leg. I can sit here and bash Doctor Betz, but I won't do that. I will however just document my own experience about how my case was handled and people can decide for themselves what is best or good information for them.
I am in the process of a two stage surgery with an Orthopedic surgeon from the US. The total extra this has cost me is as follows:
July 2014 - flew to Germany in what was terrible condition, exchanged both nails for titaniums. Stayed total of 3 weeks, total Cost including lodging, PT, and surgery was 45K. Prior to that, I was paying nearly 3k per month with a specialist in LL who had helped AndrewShizzles. The sessions did me no good, because overall the bone was not healing. So in addition to the 45K , I had paid almost 12K just in maintenance costs as I like to think of it. Total Cost 12K + 45K = 57K.
By December of 2014, it was clear that my left leg would not heal, and my right just started healing only after the nail exchange. I then asked professor Betz to help me, and he advised I should wait longer. Most surprising was that his attitude towards me had changed. All along he was blaming me for the situation, and later he started to give very vague answers, and even told he doesn't have time to sit and answer my emails. I was asking specific questions and he was giving me short general answers. This was the most shocking aspect , to have your own doctor blame you for something clearly not in your control and to tell you "I don't know why this happened." I was like, wtf? How can a surgeon not know these things? I will explain more later.
By this time I was out of my mind, because I had no solutions and only guess work to go with. I decided that I would not wait longer and immediately contacted several LL doctors here in the US to see what my options are. Lo and behold, to my surprise, most doctors were quoting me 150K for a 2 stage procedure. Again I will get into all of that later, but for now I'll just tell that, my new cost will be approximately 150K.
So here is a summary people: 1. Paid nearly 80-90K for original surgery and costs
2. Paid 57K for PT and nail replacement due to Betz recommendation in July of 2014 when bones were not healing.
3. Paying nearly 150K for correcting what I am left with now, which is a bone deformity.
Grand total: 287K USD
If you guys think that this will not happen to you, I suggest you guys think long and hard. I am not a naysayer, but this experience was something I did not even fathom. I paid for the best doctor thinking I will have the most professional and best team as this is not something to take lightly, and it failed. Will I heal? I am optimist and I will get through this, but I just want others to know, that there is nothing compared to having your health. Sometimes be careful what you wish for.
I will fill on all the gaps in the days ahead. Take care ya'll. "
-
150 k usd for correcting bone deformity? ???
-
From What I remember he did something like 9 cm. It is one of the risks you take for longer lengthening.
-
This sounds pretty awful, I wonder if this is a general risk or if it was caused by having a neglient surgeon?
-
He did 9.9 cm that's almost 10cm in 140days since his first surgery, that's in 4.6 month time limit.
-
This can't be good for Betz reputation. The least he could have done is assume some financial responsibility for this problem even if it was mostly the patient's fault. From what I heard, Betz paid for AndrewShizzles's titanium replacement when his nail broke. I really feel bad for MasterHY's situation.
-
He did 10cm. This is just stupid, sorry.
Second he should have seen on xrays that his bones do not heal. Something is wrong in the Story.
-
3. Paying nearly 150K for correcting what I am left with now, which is a bone deformity
yes he did stupid things, he trusted a doctor who told him he can do 10cm. not very smart.
but forget about that.
the real question is what bone deformities. we cant pass judgment until that comes to light.
-
No betz says always 8cm.
10cm is just stupid. Sure He will never recover.
I Do not understand why the guy not simply looked on his xrays. He must have noticed that there is no healing.
Also He clicked on a frequency totaly unsafe. 1,4mm per day is just crazy.
-
Dr Augustin Betz:
- Our patients can gain up to 4-5 inches (10-12 cm) in one operation on upper legs (femurs) or lower legs (tibias). Patients may also gain a total of 8-9 inches (20-22 cm) in 2 operations. 1st operation on femur for 4-5 inches (10-12 cm). 2nd operation on tibias for 4 inches (10 cm). The amount of gain in tibias may vary from patient to patient. In many cases it is advised by Prof. Dr. Betz to lengthen up to 6-8 cm in tibias. Patients gain an average of 7-10 cm in one bone region at the Betz institute. The rate of lengthening is 1 millimetre per day
http://www.limblengtheningforum.com/index.php?topic=1882.msg29944#msg29944
rubbish. never trust doctors. they lie all the time. they promise you the world. they tell you everything will be fine.
-
No betz says always 8cm.
10cm is just stupid. Sure He will never recover.
I Do not understand why the guy not simply looked on his xrays. He must have noticed that there is no healing.
Also He clicked on a frequency totaly unsafe. 1,4mm per day is just crazy.
i think the best safe rate of clicking is 0.55mm for 3 days , 0.66mm for 2 or 3 days , 0.75mm for 1 or 2 days with good focus on diet and physical activity like Walking. No matter what any doctor of the world says , i will make sure to lengthen safely and patiently without bothering about the time duration , after all LL is about sacrificing your TIME + MONEY ,
-
Dr Augustin Betz:
- Our patients can gain up to 4-5 inches (10-12 cm) in one operation on upper legs (femurs) or lower legs (tibias). Patients may also gain a total of 8-9 inches (20-22 cm) in 2 operations. 1st operation on femur for 4-5 inches (10-12 cm). 2nd operation on tibias for 4 inches (10 cm). The amount of gain in tibias may vary from patient to patient. In many cases it is advised by Prof. Dr. Betz to lengthen up to 6-8 cm in tibias. Patients gain an average of 7-10 cm in one bone region at the Betz institute. The rate of lengthening is 1 millimetre per day
http://www.limblengtheningforum.com/index.php?topic=1882.msg29944#msg29944
rubbish. never trust doctors. they lie all the time. they promise you the world. they tell you everything will be fine.
FP you're so opinionated and rude, but so right! Doctors promise you the world, they tell everything will be fine, but they're false. They don't care about you, but their own business. Everything is pure crap.
-
quote from tallerbetter:
your information is so amazing, factual and really does show what bets tells his patients. thank you for your contribution FP.
response:
why thank you dear fellow comrade in leg lengthening, It makes me happy to see that the factual information I spread is helping others in need. :)
but on a serious note. I feel sad for all the people who go into this and have their lives ruined because they blindly trusted someone. people sometimes forget that a doctor is just a person. and people lie and manipulate all the time. blind faith is never good. faith is good, just not blind faith.
-
Hi FP. Thanks. I think your posts are very valuable, but the quote that you include is not mine. Those aren't my words. where did you find that quote?
-
it was me being funny lol :) :) :) :) :) lol
-
so after defaming monegal hes here to defame betz and franz good job
-
so after defaming monegal hes here to defame betz and franz good job
He's not defaming. He has just given his opinion about those people. He has manipulated my words, though.
-
some doctor exert their reputation to give the illusion to their patients they can, safely, lenghten more than they should.
Besides, some like apotheosis and tall have not made it easier,
-
Yeah, they even make up stories of fake patients who have lengthened much, even 20 cm, and that they're alright. This is insane! They've no ethics.
-
so after defaming monegal hes here to defame betz and franz good job
everyone don't pay attention to itsmylife. he is training to become a doctor so he is subjectively biased. he does not care who is right or wrong he is defending doctors in general.
to do this he is branding 3 doctors names together vs a forum member.
the point of this statement from itsmylife is to attack character and demonize in order to strengthen the doctors position(doctors in general not a particular doctor), the actual argument presented is that of doctor authority vs a "demonized" person with no supposed character.
of course this is all rubbish. its just its my life attempt to give credibility back to doctors in general. because he is becoming a doctor
----------------------------------
he is not impartial and so in my opinion he hold little weight In his opinion on this matter.
--------------------------------
now if he was actually being sincere he would have addressed actual content regarding bets instead of this underhanded tactic.
----------------------------------
so lets address doctor bets since itsmylife brought up that we could somehow try to badmouth his works with slander.
no one needs to say anything that isn't supported.
from MASTERHY
Hey guys I'm back. I decided its about time to give an update. This is going to be too long to write in one reply, and I simply don't have so much spare time these days.
Let me just first off start by saying that what I write here is my opinion, and in no way reflects the experience of others. Please keep that in mind when making judgements about doctors and this process. Each experience in LL is unique and I can only share mine through my own experience.
I'll start of by saying that I have not recovered. My own understanding of why I have not recovered has to do with the nails that were used, along with an infection that I got when my hip wound opened up just weeks after the surgery on my left leg. I can sit here and bash Doctor Betz, but I won't do that. I will however just document my own experience about how my case was handled and people can decide for themselves what is best or good information for them.
I am in the process of a two stage surgery with an Orthopedic surgeon from the US. The total extra this has cost me is as follows:
July 2014 - flew to Germany in what was terrible condition, exchanged both nails for titaniums. Stayed total of 3 weeks, total Cost including lodging, PT, and surgery was 45K. Prior to that, I was paying nearly 3k per month with a specialist in LL who had helped AndrewShizzles. The sessions did me no good, because overall the bone was not healing. So in addition to the 45K , I had paid almost 12K just in maintenance costs as I like to think of it. Total Cost 12K + 45K = 57K.
By December of 2014, it was clear that my left leg would not heal, and my right just started healing only after the nail exchange. I then asked professor Betz to help me, and he advised I should wait longer. Most surprising was that his attitude towards me had changed. All along he was blaming me for the situation, and later he started to give very vague answers, and even told he doesn't have time to sit and answer my emails. I was asking specific questions and he was giving me short general answers. This was the most shocking aspect , to have your own doctor blame you for something clearly not in your control and to tell you "I don't know why this happened." I was like, wtf? How can a surgeon not know these things? I will explain more later.
By this time I was out of my mind, because I had no solutions and only guess work to go with. I decided that I would not wait longer and immediately contacted several LL doctors here in the US to see what my options are. Lo and behold, to my surprise, most doctors were quoting me 150K for a 2 stage procedure. Again I will get into all of that later, but for now I'll just tell that, my new cost will be approximately 150K.
So here is a summary people: 1. Paid nearly 80-90K for original surgery and costs
2. Paid 57K for PT and nail replacement due to Betz recommendation in July of 2014 when bones were not healing.
3. Paying nearly 150K for correcting what I am left with now, which is a bone deformity.
Grand total: 287K USD
If you guys think that this will not happen to you, I suggest you guys think long and hard. I am not a naysayer, but this experience was something I did not even fathom. I paid for the best doctor thinking I will have the most professional and best team as this is not something to take lightly, and it failed. Will I heal? I am optimist and I will get through this, but I just want others to know, that there is nothing compared to having your health. Sometimes be careful what you wish for.
I will fill on all the gaps in the days ahead. Take care ya'll.
I rest my case. the fruit of the man is from his own patients, no one here needs to say bad things about him nor intends to, his own patients have told us he is terrible.
in future its my life don't make statements to demonize people, instead bring up content to support an argument for debate.
take care my friend.
-
fp lol owned itsmylife
-
Im not saying they are good doctors but they have a name here on the forum. They have a reputation to protect. You've no name. I see no point stoking the fire if ex-patients have already complained so-and-so.
You seem to be anti-doctors and anti-establishment.
-
Im not saying they are good doctors but they have a name here on the forum. They have a reputation to protect. You've no name. I see no point stoking the fire if ex-patients have already complained so-and-so.
You seem to be anti-doctors and anti-establishment.
It's not FP who discredits them. They discredit themselves through the negative outcomes of their patients, and their arrogant and rude words and behaviour in the forum.
-
What are your problems with betz. The most diaries and especially the most successful diaries are from betz patients. Im in contact with several patients. They are all fine.
Masterhy is a Bad Story but He pushed too far. He had infection and still lengthened to 10cm. Betz should have stpped him but He was not staying in germany.
-
What are your problems with betz. The most diaries and especially the most successful diaries are from betz patients. Im in contact with several patients. They are all fine.
Masterhy is a Bad Story but He pushed too far. He had infection and still lengthened to 10cm. Betz should have stpped him but He was not staying in germany.
Stop lying about MasterHY. Betz told him there was no infection. Then he told him to click until his goal despite his problems and later after there was no callus he wrote him“I don't understand your worries at all”.
-
This is Not right. I talked about masterhy. He went home, clicked on his own, ignored everything, and then everything was damaged He wanted helps.
-
This is Not right. I talked about masterhy. He went home, clicked on his own, ignored everything, and then everything was damaged He wanted helps.
You are a liar just like the doctor you are trying to promote. You have no shame or human decency.
You are just speculating that people are too lazy to read Masterhy's diary which unfortunately is often the case.
One needs to be extremely gullible to become a Betz patient these days.....
-
You are the only guy blaming betz. If He is as Bad as you sag, why are there none Bad diaries. Also you can ask ex patients who are in contact with other llrs. They are all satisfied. You probably do not have the money and have to go to india.
-
You are the only guy blaming betz. If He is as Bad as you sag, why are there none Bad diaries. Also you can ask ex patients who are in contact with other llrs. They are all satisfied. You probably do not have the money and have to go to india.
Coppkillr,
I suggest you stop writing about my case, since you have no clue whatsoever about me and what happened. Why do you feel the need to promote something that you have no experience with? I am not going to respond to any of your comments, as this is the only thing I want to write here so that other members can understand that you have no clue about my situation. I am respectfully asking you to not write about me anymore or talk about my case as if you have first hand knowledge. Mime if you read this, please send me a private message. thanks.
MasterHY
-
Thats true. But do you think there are no problems with other doctors??
It is Bad What happend to you. And I also blame betz for not stopping patients at 6cm.
But we all know it gets very risky above 7cm.so in my eyes patients doing this should not blame the doctor. Thats just my mindset.
And I am in contact with several betz patients. There are no others with problems.
I Feel with you. I hope you will recover.
-
I flew to germany to see this doctor and also dr guichet! is a small countryside clinic.. don't feel safe! But he seems a good doctor and i spoke to some patients of his! Though I think dr. guichet is better!
-
It is actually a 4 floor clinic.
Why do you think guichet is better?
What did the patients tell you.?