Dr. Dror Paley
Dr. Paley serves on the Scientific and Medical Advisory Board of the MHE Research Foundation and was the first  President of ASAMI North
America, Limb Lengthening and Reconstruction Society (LLRS)
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Wings of HOPE as we REACH
for the CURE to
Multiple Hereditary Exostoses Syndrome
Multiple Osteochondroma Syndrome
Born in Tel Aviv, Israel in 1956, he moved to Canada as a child. Dr. Paley completed his undergraduate studies and medical school,
at the University of Toronto graduating in 1979. After a surgical internship at Johns Hopkins Hospital in Baltimore, he completed his
Orthopedic Residency and FRCSC at the University of Toronto in 1985. He did a fellowship in hand and trauma surgery at
Sunnybrook Hospital in Toronto, another fellowship in pediatric orthopedics at the Hospital for Sick Children in Toronto and a seven
month travelling fellowship to Russia and Italy to study with Ilizarov, Debastiani, Monticelli and Spinelli, and Cattaneo and Catagni.
In 1987 he introduced the Ilizarov method to Canada and the United States. Dr. Paley started his practice at the University of
Maryland in 1987 and became a full professor by the age of 39. He left the University in 2001 to Head the newly constructed Rubin
Institute of Advanced Orthopedics at Sinai Hospital in Baltimore. In 2009, he moved to West Palm Beach, Florida where he currently
is the director of the Paley Advanced Limb Lengthening Institute, on the campus of St. Mary’s Medical Center. He holds an academic
position as adjunct Professor at the University of Toronto and is on the faculty of the Hospital for Sick Children since 2010. Dr.
Paley also has an appointment as Professor, University of Vermont School of Medicine since 2011. At the Paley Institute he
supervises a fellowship program for US and International Orthopedic surgeons.

Dr. Paley is best known for his landmark research in the field of limb lengthening and deformity correction. His 800 page textbook
Principles of Deformity Correction is considered the Bible of deformity correction surgery. It was first published in 2001 and has
been republished in 2005 by Springer. Dr. Paley has also published 4 other books. He is also the author of 47 book chapters, 129
peer reviewed journal articles, and 54 video productions. He has presented over 1000 lectures at International Orthopaedic Society
conferences and over 900 lectures at North American Society conferences. He has served on The MHE Research Foundation
Scientific and Medical Advisory Board since its inception and presented lectures on all aspects of MHE treatment for both children
and adults.   He has also served as as speaker and Orthopaedic Chair during the MHE Research conferences. He is the world leader
in developing new comprehensive surgical procedures to treat the complex bone deformities that occur in MHE patients. His
landmark contributions on the treatment of the hip and forearm in MHE have significantly changed the function of many children
and adults with this condition. He speaks, writes, reads and lectures in six different languages. Dr. Paley is married to Jennifer and
has four children.

Dr. Paley was the founder and first president of the Limb Lengthening and Reconstruction Society of North America in 1989, and
one of the founders of ASAMI International. He was recently elected the President of the International Limb Lengthening and
Reconstruction Society whose next meeting he will organize in Miami in 2015. He is the recipient of numerous local, regional,
national and international awards both from orthopedic and non-orthopedic groups. He was awarded a Gubernatorial Citation by
the State of Maryland for his humanitarian work and was voted Health Professional of the Year by the Palm Beach Chamber of
Commerce.  He has been made an honorary member of 8 National Societies around the world. Most recently he was honored as a
Physician Hero by the Palm Beach Medical Society.  He set up the Paley Foundation which has been recognized for its clinical and
educational mission work around the world.
FUNTASIA RESEARCH BANQUET
Was held  Sept 22, 2013
The 2013 MHE Research Foundation
"The Humanitarian Scientific Achievement Award"
Was presented to
Dror Paley, MD, FRCSC
Director Paley Advanced Limb Lengthening Institute
Click Here
Multiple Osteochondromas treatment of the Lower Limb Deformities, also see Orthopaedic section of the website and
connection corner guide book

Paley, Dror

Paley Advanced Limb Lengthening Institute, 901 45th Street Kimmel Building West Palm Beach, FL 33407.

email:
dpaley@lengthening.us

There are a variety of problems related to the exostoses of Hereditary Multiple Osteochondromas.  The majority of these problems
relate to bothersome bony protrusions with their affect on surrounding joints, muscles, tendons, nerves, blood vessels and skin.
Osteochondromas can also affect growth plates and lead to limb deformities and length discrepancies.  The focus of this talk will be
on the limb deformities and discrepancies secondary to the multiple osteochondromas.

Treatment of the Lower Limb Deformities

Femero-acetabular impingement
The best way to treat this problem is ‘safe’ surgical dislocation of the hip according to the technique of Ganz from Switzerland. This
safeguards the circulation of the femoral head avoiding avascular necrosis of the femoral head. The osteochondromas can be
resected under direct vision and the femoral head templated with a spherical template to acertain if the femoral head is spherical.
The range of motion of the hip greatly improves after this surgery. It can be combined with a varus osteotomy using a blade plate
for fixation.

Valgus Knee Deformity (Knock knee deformity)
This deformity is usually in the upper tibia.  There is usually a large osteochondroma involving the upper end of the fibula. The
fibular osteochondroma often tethers or envelops the peroneal nerve.  This is a very important nerve that is responsible for
controlling the muscles that pull the foot up and out.  Injury to this nerve results in a drop foot (inability to pull the foot up).  
Correction of the valgus deformity of the upper tibia requires an osteotomy (bone cut) of the upper tibia.  All osteotomies of the
upper tibia to correct valgus stretch the peroneal nerve even in patients without HME.  In patients with HME and a fibular exostosis
the nerve is very tethered and stretched even before surgery.  The nerve can actually be inside the bone if the osteochondroma
envelops it.  Therefore to correct the deformity safely the nerve must first be found above the fibula and decompressed around the
neck of the fibula.  The osteochondroma of the fibula should be resected  If the upper fibular growth plate is considered to be
damaged beyond recovery then a segment of the fibula should be removed so that the two ends of the fibula do not join together
again to prevent re-tethering of the tibia.  Only after all of this is performed can an osteotomy of the tibia be carried out safely to
correct the valgus deformity.  The valgus deformity can either be corrected all at once or gradually.  Correcting it all at once is
usually performed by taking out a wedge shaped piece of bone and then closing the wedge to straighten the tibia.  This can be fixed
in place with a metal plate or with an external fixator. Gradual correction is carried out by minimal incision technique to cut the
bone.  The correction is achieved by use of an external fixator.  This is a device that fixes to the bone by means of screws or wires
that attach to an external bar or set of rings.  Adjustment of the external fixator slowly corrects the deformity.  This opens a wedge
instead of closes a wedge of bone. This has the advantage of adding length to the leg which if the leg is short already is
advantageous.  This type of external fixator is also used for limb lengthening.  Therefore if there is a LLD the angular correction can
be performed simultaneous with lengthening. Gradual correction is safer than acute (all at once) correction for correction of the
valgus deformity.  

Another way to address the valgus knee deformity without addressing limb length discrepancy is hemi-epiphyseal stapling of the
growth plate.  This is perhaps the most minor procedure possible and involves insertion of one or two metal staples on the medial
side (inside) of the growth plate of the upper tibia. The metal staple straddles the growth zone on the medial side preventing
growth of the medial growth plate while permitting growth on the lateral side.  This allows the tibia to slowly autocorrect its
alignment.  It is a very slow process and may require several years.  Once the tibia is aligned the staple can be removed permitting
resumption of growth from the medial side. There is a small risk of damaging the medial growth plate which could lead to a varus
bowing deformity of the tibia. Stapling can also be used in the distal tibia to correct the ankle deformity.  

Valgus deformity of the ankle
Patients complain of walking on the outer border of the foot.  Viewed from behind this posture of the foot is very apparent.  This
deformity is often well tolerated. The lower end of the tibia tilts outwards towards the fibula.  The lower end of the fibula is the
lateral malleolus.  It is important for stability of the ankle.  Since the fibula grows less than the tibia the lateral malleolus is often
underdeveloped leading to lateral shift of the talus (ankle bone).  This can eventually lead to arthritis of the ankle.  Lateral tilt of the
ankle joint is compensated by the subtalar joint (joint under the ankle) by inversion of the foot (turning of the foot in).  Since this is
a longstanding process the subtalar joint becomes fixed in this position of compensation for the ankle joint.  Therefore if one tries
to fix the ankle joint tilt completely the foot will end up tilted inwards and the patient will be standing on the outer border of the
foot.  Therefore one either has to accept the valgus ankle or correct it together with the subtalar joint fixed deformity.  This is best
done with a circular external fixator (Ilizarov device).  This correction involves gradual correction of a minimally invasive osteotomy of
the lower tibia and fibula together with distraction (pulling apart) of the subtalar joint contracture.

Flexion deformity of the knee
This deformity is usually related to tethering or locking of the soft tissues around the knee by distal femoral or proximal tibial
osteochondromas.  The treatment involves resection of the offending exostosis and lengthening of the hamstring tendons if needed.

Flexion deformity of the hip/subluxation of the hip/valgus upper femur
This is treated by resecting the offending osteochondroma of the femoral neck.  This hip capsule has to be opened to access these.  
At the same time to reduce the hip subluxation (hip coming out of joint) a varus osteotomy of the upper femur should be done
(bending the femur inwards towards the joint).  The bone can be fixed either by an internal metal plate or an external fixator.  












































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This web page was updated last on 3/6/14, 12:0O pm Eastern time
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Dr. Dror Paley's presentation during the 2012 MHE Research
Conference
Disclaimer, some of the sides contain operative pictures, also due to
technical issues some of the x-rays located in this presentation are
dark unfortunately were unable to fix this
History of Implantable Limb Lengthening and new advance of the PRECICE limb lengthening, Dr. Dror Paley
(limb lengthening without the use of an External Fixator) posted 3/6/14