Stretching Bones Through Surgery

The nation's first center dedicated solely to stretching bones that have been stunted, bowed or twisted is being assembled at a University of Maryland-affiliated hospital. The James Lawrence Kernan Hospital on Monday unveiled plans to assemble a staff of 15 people — doctors, nurses, physical therapists, a physician's assistant, medical illustrator and a research analyst — for the center. The university plans to spend close to $1.5 million hiring staff, building new operating rooms and renovating offices for the Maryland Center for Limb Lengthening and Reconstruction. They will be expanding an ongoing practice that uses something called the Hizarov procedure. This is a bone-lengthening technique invented by a Siberian physician in the 1950s, but not practiced in North America until Dr. Dror Paley brought it to a Toronto hospital in the mid-1980s. Dr. Paley is an associate professor of orthopedic surgery at the University of Maryland Medical Center and will be co-director of the new center. "This really has been my dream over the years," Dr. Paley said at a news conference Monday. Dr. Paley and associates have used the Ilizarov procedure on roughly 700 patients with a variety of conditions from dwarfism to those who have one limb shorter than another due to injury or infection. In the technique, surgeons break bones at strategic places, and then fit the limb with a cage-like device that holds it together. Stretching is done as the device gradually moves apart and stimulates the growth of new bone, muscle and nerve cells.

The patient either extends the scaffolding four times a day by twisting a wrench, or lets computerized motors do the work. Either way, a patient's limb grows by about a millimeter a day. On Monday, Dr. Paley introduced a woman whose legs were bowed because of rickets, a football player who was left with one leg shorter than another because of an ankle fracture and a female body-builder whose left leg became twisted in the aftermath of a gunshot wound. Gillian Mueller, 16, of Long Island was born an achondroplastic dwarf: a person with shortened legs and arms, but a head and torso of average size. In three separate procedures ending last year, she stretched out to a height of 5 feet, 1/4 inch. She was the first person in North America to have the three major bones of her legs and arms her thigh, shin and upper arm lengthened by the Ilizarov procedure. She not only "grew" to a nearly average height, but also emerged from the process with a body that is almost normally proportioned. The procedure does cause moderate to severe pain but Miss Mueller and others said the pain abates a few days or weeks after surgery. Shirley Johnson, a 20-year-old manicurist from Baltimore, was so deformed with rickets that her knees were 20 inches apart when she stood. In 1989, Dr. Paley performed two operations six months apart breaking each leg in five places. Each leg took three months of straightening and three months of rest to harden the new bone. Ms. Johnson wore an Ilizarov cage that was hinged at the fractures so that it straightened rather than stretched the bones. In effect, it pushed the knees inward so they now touch when she stands. "Research will be an important focus at the new center," said Dr. John Herzenberg, another co-director. "We are working on ways to further improve the procedure and use the most sophisticated technology available."

    THE FREDERICK POST
    February 13th, 1992

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