Our week in West Palm Beach began at 6:30 am at the surgical center. By 7:50 am 2 cases had been completed and we were on our way to the Paley Institute at St Mary’s Hospital. We spent the day in the office with Dr Paley, seeing his pre-op patients for the upcoming week as well as some new and follow-up patients. During the course of the day we lost track of the number of patients we saw, with patients from all over the world coming to seek his expertise. There were patients with fibula hemimelia, tibial hemimelia, congenital femoral deficiency, Ollier’s disease and multiple epiphyseal dysplasia. We also saw patients with both internal lengthening devices and external fixation devices, including the new rail and hexapod systems designed by Dr Paley. At the end of a long clinic we had a very enjoyable meal at a Mediterranean restaurant near the hospital.
Tuesday was spent in the OR, observing the insertion of Precise nails in patients with congenital femoral deficiency, bilateral Precise nailing for stature lengthening, hemiepiphysiodesis, derotational osteotomy and femoral osteotomy and triple pelvic osteotomy via the SUPER hip approach in a patient with Multiple Epiphyseal Dysplasia. After a hard day’s work we were very graciously entertained by Dr Paley. We took a trip on Dr Paley’s boat around the inlet, followed by a very relaxed and enjoyable barbecue at Dr Paley’s house.
Wednesday morning began with a 35 mile bike ride with Dr Paley around Palm Beach with the southern Florida sun beating down. Dr Paley cycles 5 days a week and is a force to be reckoned with on 2 wheels! We went straight from cycling to the OR, where we were able to see a peroneal nerve decompression for a patient undergoing a derotational osteotomy with an IM nail, a proximal femoral osteotomy, a distal femoral extension osteotomy and internal lengthening for Ollier’s disease.
Thursday was again spent in the OR, watching percutaneous application of 8 plates, a distal tibial TSF for lengthening and deformity correction in a patient with fibula hemimelia. It was very interesting to see the percutaneous distal tibial osteotomy performed via the Gigli saw. The final case of the day was a patient with congenital femoral deficiency with a knee flexion contracture. He underwent a peroneal nerve decompression, gastrocnemius release, posterior capsular release, distal femoral shortening osteotomy, superknee ligament reconstruction procedure and supra tubercular tibial opening wedge osteotomy. We were both impressed by the meticulous attention to detail of Dr Paley throughout this long and complicated case.
Friday morning began at 7am with a multidisciplinary case conference where the patients for the next week were discussed with the surgical and anaesthetic teams. This was followed by rounds of the patients on the floor, and then a tour of the physiotherapy department where we were able to witness many patients undergoing lengthening receiving the treatment that is so imperative to the success of their surgery. We then had a teaching session with Dr Paley on the SUPER ankle and the SUPER hip, followed by discussion on the TSF and Precise with Dr Robbins. After this we were straight to the office for another clinic again full of patients with congenital deformity, achondroplasis,congenital pseudarthrosis of the tibia and even upper limb abnormalities.
This week has been a truly invaluable experience. The sheer volume of patients and the variety of cases is staggering. Dr Paley and his team have been the most gracious hosts, taking the time to teach us and make sure that our every need was been taken care of. The pace and productivity of Dr Paley and the Paley institute is truly remarkable and both Natasha and I have learnt an immeasurable amount in a short time.