The exotic art of "bone lengthening" was virtually a one-man show at the James Lawrence Kernan Hospital six years ago, when Dr. Dror Paley began using a Russian surgical technique to make dwarfs taller and straighten limbs bowed by injury or disease.
But yesterday, 700 patients later, the hospital unveiled the nation's first center dedicated solely to bringing "normal" lines to bones that have been stunted, bowed or twisted.
By next summer, the University of Maryland affiliate plans to assemble a crew of 15 people -- doctors, nurses, physical therapists, a physician's assistant, medical illustrator and research analyst -- whose sole mission will be to further the development of this narrow specialty.
The university plans to spend close to $1.5 million hiring staff, building new operating rooms and renovating offices at the West Baltimore hospital.
"This really has been my dream over the years," Dr. Paley said at a news briefing yesterday.
Dr. Paley and his colleagues practice variations of the Ilizarov procedure, a technique invented by a Siberian physician in the 1950s but not practiced in North America until Dr. Paley brought it a Toronto hospital in the mid-1980s.
In the technique, surgeons break a bone at strategic places, then fit the limb with a cage-like device that resembles a large orthodontic appliance. All the stretching is done after surgery, as the fixture 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 in a more continuous motion that mimics normal growth. Either way, a patient's limb grows by about a millimeter a day.
Gillian Mueller, 16, of Long Island was born an achondroplastic dwarf: a person with foreshortened 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. Her third operation also involved an innovation: a metal rod used as a stabilizer. Inserted through the hollow center of her thigh bone, the rod acted much like an internal splint.
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.
Dwarf operations have generated considerable media attention and controversy. Advocacy groups like the Little People of America have contended the procedure stigmatizes dwarfs and works to diminish the self-esteem that short people ought to feel.
Gillian, an 11th grader, called the criticism "retarded," saying her treatment has enabled her to accomplish tasks such as reaching objects on shelves.
Besides arguing that the procedure gives dwarfs a choice, Dr. Paley pointed out that most of his work doesn't involve dwarfs at all. Of the 700 Ilizarov patients, 25 have been dwarfs, he said, and the rest people with an assortment of other conditions.
Yesterday, he 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.
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.