Medical Alumni Association ~ School & Hospital

Bulletin of the University of Maryland School of Medicine 1987-1988 Item Type Newsletter/Magazine Publication Date 1987 Keywords University of Maryland School of Medicine--Publications; University of Maryland, Baltimore. School of Medicine Download date 11/10/2021 09:24:08 Item License https://creativecommons.org/licenses/by-nc-nd/4.0/ Link to Item http://hdl.handle.net/10713/2967 VOL. 72 University of Maryland at Baltimore/Spring 1988 No.4 Medical Alumni Association ~ School & Hospital new technique for lengthening He is fluent in both Russian and Italian, as well tube of bone identical to the bone above and be- shortened limbs and correcting as German and French. low it. One year later it is impossible to tell other severe deformities in chil- For limb lengthening, the bone is cut through which part of the bone was regenerated. dren and adults is being used at a half-inch incision in a special way that pre- The apparatus is left in place after the limb is the University of Maryland Med- serves the blood vessels inside the bone and in lengthened to allow the new bone to mature and ical System. This technique is the surrounding soft tissues. harden. It takes about a month to lengthen and apaQl~of restoring short an.d defoIl12ed e~x~- .,.......O~.n~e;..;,;w~e;.;;;;ekafter the bone is cut, patients start mature one centimeter of bone. A lengthening of tremities to approximately normal. turning the threaded nuts on the apparatus to ten centimeters (fouiillChes) would take ten This announcement was made at a press con- lengthen the limb 1/4 millimeter four times a day, months. To decrease the treatment time, Dr. ference held by John E. Kenzora, M.D., Head, a total of one millimeter per day. Dr. Paley uses Paley cuts the bone at two separate levels, de-' ~ Division of Orthopedic Surgery, UMMS and Pro- the phrase "a human erector set" to describe creasing the time by half. A ten centimeter fessor at the School of Medicine, and Dror this revolutionary technique. This slowly sepa- lengthening would only take five months. Paley, M.D. of the Division of Orthopedic Sur- rates the bone ends since the apparatus is con- With other procedures, patients frequently gery, UMMS, and Assistant Professor at the nected to the bone above and below the level of would not be able to bear weight on the limb for School of Medicine. the cut. The living bone tissue forms new bone much of the treatment. Contrary to other meth- "This is one of the most exciting new to try to heal the surgically created break in it. ods of treatment, Dr. Paley says "with the 11- orthopedic techniques," says Dr. Paley. "Pa- As the space between the bone ends increases, izarov Technique weightbearing is not only tients are up and able to bear weight on affected the new bone formation fills in the gap at the possible but is an important part of the treatment limbs the day after surgery. They participate in same rate. "Bone regeneration" creates a new (continued on page 2) physiotherapy, exercise and even gymnastic rou- tines shortly after the treatment. Children return to school and many adults return to work as the treatment is progressing." The Ilizarov technique, named after the Rus- sian who developed it, allows the orthopedic surgeon to achieve greater increases in length than were previously achievable, frequently in half the treatment time, and without bone grafting. Pre- viously used techniques were associated with much higher complication rates. The Ilizarov technique also allows the treatment of orthopedic conditions that previously were not treatable ex- cept by amputation, including severe congenital deformities, bone defects, and non-unions of bone. UMMS is one of about half a dozen hospitals in North America currently using these techniques. Dr. Paley was the first North American orthopedic surgeon to work and study under Professor Gavril Abramovich Ilizarov, who developed the technique in Western Siberia, Rus- sia. Dr. Ilizarov's Institute is a 1,OOO-bedhospital for bone lengthening as well as for the treatment of bone defects, bone infusions and non-unions. Dr. Paley also spent six months working with llizarov external fixator applied to leg Dr. Paley and patient David C lugh, showing I lizarov the Italian surgeons who introduced this tech- apparatus in place nique to Western Europe only seven years ago. The Bulletin Page 2 50-YearGraduates-Class of 1938 (Limb Lengthening from page 1) for the treatment of adults and children with limb length discrepancies, deformities, and difficult and stimulates more rapid healing of the bone bone healing problems. This team consists of a and soft tissues." group of nurses, physiotherapists, occupational Older techniques also required a longer hospi- therapists, technicians and surgeons, all of whom tal stay, frequently as much as weeks or months playa vital role in the team effort to comprehen- as opposed to the seven to ten days with the Ili- sively treat patients with severe skeletal zarov method. Furthermore, this only takes one problems. surgery as opposed to at least three with older A CME Course on the Ilizarov technique is techniques. The Ilizarov technique can be used scheduled for May 16-18 at the Sheraton, to lengthen the femur, tibia, foot, forearm or Tysons Corner, Va. Full information is under the upper arm, or even to lengthen amputation CME listing. stumps that are too short, including lengthening of short foot stumps. It also can be used to fill in large bone gaps and to stabilize fractures, espe- Dror Paley, M.D. is in the Division of cially those that are difficult to heal. Orthopedic Surgery, UMMS and Assistant Pro- Bone also can be widened to improve the fessor of Orthopedic Surgery in the School of Medi- shape of the calf in patients with one very thin cine. A Canadian, he received his M.D. from the calf. The same principles of slow, gradual length- University of Toronto in 1979, served his surgical ening can be used to correct severe deformities internship at Johns Hopkins and his orthopedic without the risk of injury to the arteries, veins residency at the University of Toronto, followed by and nerves of the limb. Since no big incisions or a one-year Fellowship in Hand and Trauma Sur- dissections are necessary these risks are further gery at Sunnybrook Trauma Center, Toronto. Fol- reduced. lowing this, he spent six months in Russia and Dr. Paley currently has treated more than 50 Italy, studying the llizarov technique and other patients with the Ilizarov technique, more than methods of limb lengthening, and served for a year anyone else in North America. Twelve of these on the staff of the Hospital for Sick Children, cases were treated at the University of Maryland left Shows bone cut in two places Toronto. He came to the University of Maryland Hospital. He is heading up a new unit at UMMS right Lengthening has begun-note new bone formation in November 1987. The Bulletin Presidents f\essa Page 3 Who Knows Where the Future Lies? Now that I've been Presi- Several weeks before the end of the school To use the colloquialism, you could have dent of the Medical Alumni year while having supper (it was called that in "knocked me over with a feather" when I re- Association for approx- those days), with my family, my mother asked ceived a letter, four days later, advising me that I imately nine months, I'm what would I do if I were able to complete the was accepted and to send a check for the $10.00 beginning to understand my required courses for graduation at the term end. registration fee. job a little better. Although I really had no definitive plans, but I did think Now a dilemma was created and it was real! there is a need for a fig- about the possibility of post-graduate work in What to do? Neither excitement nor accomplish- urehead in this position, mathematics as I was reasonably capable in that ment aroused me, for deep down, there was no surely a President can do academic field, and as there was also an oppor- pre-existing enthusiasm nor, as I stated above, some good in coordinating tunity at Hopkins at that time to obtain a Ph.D. special desire to study medicine. On the other ideas, keeping the politics in in two more years, if one had the necessary pre- hand, there was a feeling of guilt when the perspective, communicating requisite undergraduate courses. I mentioned thought of not accepting crossed my mind. How with fellow alumni and, in particular, establishing this to her and also advised her that "Pa" (my fa- would I dare deny this pleasure to my mother? A combination of factors probably impelled me to good public relations with all. ther) was anxious for me to go to work and be- These perceptions of my job as President and gin making a living. Ma (my mother) did not enroll, not the least of which was the fact that I did not want to go to work. What a misconcep- the following reflections upon my professional particularly feel that either of these alternatives career are not particularly "sensational" journal- were suitable and she questioned if I had any in- tion! Did any of you ever hear of Dr. Uhlenhuth? ism. I'm told, however, it's traditional for the in- terest in becoming a "doctor" (physician). This Well, here I am, President of one of the most cumbent President to write at least one article completely took me by surprise for it had not outstanding medical alumni associations.

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