Limb Lengthening.us
Dror Paley, MD, FRCSC
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Dror Paley is First Surgeon in U.S. to
Perform Limb Lengthening with New
PRECICE Remote Control Device
By Nancy Kennedy

An innovative new technology developed with the help of a pioneering South Florida orthopaedic
surgeon is revolutionizing the care of those with congenital or acquired leg length discrepancies.
The technology, known as the PRECICE device, was developed in consultation with Dror Paley,
M.D., FRCSC, by Ellipse Technologies, Inc. It is a non-invasive, adjustable remote-controlled
system that uses a magnetic implant that is placed inside the bone to gently and precisely
correct long-bone abnormalities.

Paley is the first surgeon in the U.S. to use the PRECICE device and performed the first three
such procedures on December 1, 2011. Paley is an internationally recognized expert on limb-
lengthening and the most experienced leg lengthening surgeon in the world. A native of
Canada, he is the founder of the Paley Limb Lengthening Institute at St. Mary’s Medical Center
in West Palm Beach, which attracts both pediatric and adult patients from all over the globe and
offers highly specialized, advanced training to orthopaedic surgeons. Paley and his staff treat a
broad range of orthopaedic conditions including congenital limb deformities, foot deformities,
bone defects and skeletal dysplasias.

Leg length discrepancies can be the result of congenital anomalies, or may occur following
accidental trauma to the leg, a disease process such as bone cancer or osteomyelitis, a deep
infection of the bone. A major fracture that heals poorly can produce a leg length discrepancy.
As Paley explains, the conventional approach to lengthening the femur or tibia bones has been
an external fixation device. This is a complex procedure in which the bone is cut and attached
with pins to an external device through the skin; it is gradually adjusted by the surgeon and as
the bone heals, it lengthens. This process has been associated with a high rate of
complications, including infection at the pin sites.

In 2001, the FDA approved the first implantable limb lengthening device called the
intermedullary skeletal kinetic distractor, or ISKD. The ISKD lengthens the bone internally,
eliminating the need for an external appliance. The ISKD is a telescopic rod implanted in the
marrow cavity of the bone and is activated by movement. It is difficult to control the
lengthening rate and therefore the ISKD involves a host of potential complications “The most
important parameter in leg lengthening is the speed of lengthening,” Paley says. “The ISKD was
unpredictable; it essentially had a mind of its own and so the rate of growth could not be
controlled. Any movement of the patient could cause rapid growth. The standard growth is 1
milliliter per day, but the ISKD could accidentally generate as much as 5 milliliters per day, with
potentially disastrous results, such as nerve damage, muscle contractions and lack of bone

The rate of lengthening problem is eliminated by the new PRECICE device, an implantable device
that is precise, gentle and completely under the control of the physician. An electronically
controlled magnet is placed inside the bone and responds to an external magnet, called an
actuator, contained within a small device that resembles a hand-held massager. When the
actuator is brought close enough to the rod inside the bone, it “captures” the magnet, causing
it to rotate. “It takes hundreds of rotations to move a milliliter, “says Paley. “It is very, very
gentle. Compared to this, the ISKD was a runaway train.”

The PRECICE device can be used to treat adolescents and adults. Children under the age of 10,
whose bones are still growing, are not candidates for PRECICE, but Paley anticipates that a
smaller device that meets their specialized needs will be developed in the future. He views limb-
lengthening surgery as a dynamic, growing orthopedic specialty with an exciting future. “Limb
lengthening is an incredible field,” he says. “It makes such a difference in quality of life for
patients. Twenty five years ago, before limb lengthening surgery was possible, people suffered
tremendously; amputation and prosthetics were the only solution to large discrepancies.
Technology like the PRECICE is encouraging orthopaedic surgeons to develop a new mindset. At
the conferences where I speak about this, I find that they are eager to learn the new

For Paley, this work is challenging and enormously satisfying. The PRECICE represents a
breakthrough in limb-lengthening surgery and the dawn of a new era in orthopaedics. “This
minimally invasive approach significantly reduces the potential for complications during recovery
and healing,” he says.

Paley makes an annual trip to Haiti with his Paley Foundation, a non-profit that provides surgery
and other medical services to those who would not otherwise receive it. He and his crew were in
Haiti nine weeks after the earthquake and had an unforgettable experience. “There were endless
lines of injured people and we did non-stop surgeries. The level of need there is indescribable; it’
s exhausting but you know you are helping and you don’t want to leave. We teach the locals so
that they can be more self sufficient. This year, we plan to go to Nicaragua too.”

The Paley Advanced Limb Lengthening Institute is located at St. Mary’s Medical Center, a 463-
bed acute care hospital in West Palm Beach that offers a broad range of medical and surgical

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