Angelica

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Angelica (we call her Jay) fell out of a window in our country house on the outskirts of Milan, Italy from a height of nine meters on the 3rd of March, 2007. She had just turned three. Jay survived, but had multiple fractures at her pelvis and the neck of the femur. “It’s only bones,” we thought. “She will heal.”

She was treated locally. Her pelvis healed but the neck of the femur did not. She wore a full spica cast for six months, but her leg would not heal. She had a screw plate fitted in September and we thought this would do it.

The screw plate broke 13 months later in October of 2008.

Unfortunately she had developed a nonunion of the femoral neck and had lost 70% of it.

After a failed attempt to fit a new screw plate the situation precipitated. Angelica risked not walking for a very long time (15 years they would say, before being able to perform a hip replacement). Our doctor suggested we seek advice for her very severe nonunion of the femoral neck. In the meantime, all internal fixation was removed and she was put in a spica cast and did two hours of hyperbaric therapy every day for another five months.

It was now January 2009 and we started to look for the doctors with the most experience in this field. We soon discovered that her situation counted for less than 1% of fractures in children. Children normally don’t survive these high-impact traumas or they are left paralyzed. Jay was lucky, but nobody knew exactly what to do to treat her.

We saw 14 doctors we had carefully crosschecked, based in Switzerland, Italy, France, the UK, and the US.

We came across Dr. Paley, who was referred to us by our doctor and others with the caveat, “if you want to hear something completely different from mainstream….Dr. Paley uses external fixators…very long and invasive treatments.…somebody you go to when you are at your last chance.”

Maybe for us that moment had come. Dr. Paley was the 13th doctor we saw. We had accumulated enough experience and questions to know when we found ourselves in front of the right person. Dr. Paley offered us the reassurance and answers we were looking for—he was someone who would be creative in finding solutions for our daughter. Also, he was the only one who didn’t need to brainstorm with anyone else before getting back to us. He was straightforward: “I can fix her.”

We short-listed him with another doctor from the famous Mayo Clinic. After much thought, we decided to go with creativity and geniality rather than protocol and brand.

Angelica underwent surgery on the 14th of April 2009. Her situation was worse than what we had previously discussed with Dr. Paley. The neck of her femur was mostly gone. Dr. Paley tried out a few options: he had the choice of traditional approaches or trying something truly challenging: rebuilding her femoral neck and the anatomy of her right hip.

He came out of the operating room and said: “everybody else would have stuck the head to the shaft. I also tried that first but I didn’t like it.” Thank God he didn’t like it! That option would have made her limp for the rest of her life.

Anyway, this was the easy bit. Angelica’s femoral head was partially dead and diagnosed with avascular necrosis after all the surgeries she had undergone (a total of five in 2009 alone). If the head collapsed, the chances of her walking would have slimmed significantly.

It took another surgery in August, more bmp (bone morphogenic protein) and more Zometa before she was fixed.

I will never forget Dr. Paley’s SMS in September following our x-rays: “it’s either feast or famine.” Angelica’s nonunion had healed. Actually she had grown too much bone after three years of nothing! And the head was still looking good, it was regenerating itself!

Angelica is now walking and Dr. Paley says she can do anything she wants—even ski!

We can never thank Dr. Paley enough for what he has done.

Some statistics: Angelica fell from a height of nine meters (30 feet) and survived. She broke a lot of bones and developed a very rare condition called nonunion of the femoral neck. After three years she healed thanks to Dr. Dror Paley. She spent 11 months in a full spica cast (first six months then five months) and seven months with an external fixator. She underwent a total of seven surgeries, including three with Dr. Paley. His surgeries were indeed invasive and the external fixator was initially a shock but in the end with her fixator she was able to move around, swim, take showers, and be independent. One couldn’t imagine having a life even remotely similar in a cast. If you ask Angelica, Dr. Paley is her hero. She would recommend him to you for any pathology you might have!

Angelica is thrilled to now walk and begin—at 6 years old—to have a normal life. From all the surgeries she has developed a limb-length discrepancy of the leg and will have to undergo more surgery when she is older, but as she says, “it’s OK as long as I am asleep and have Dr. Big Blue Eyes looking out for me."

Alessia and Alessandro
Milan, Italy