Travelling Fellowship Reports
Executive Summary: “This Fellowship was spent at the Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics in Kurgan, Russia, where in the last century, Gavriil Abramovich Ilizarov discovered and applied the principle of ‘tension-stress."
I aimed to gain experience of this method in a high volume centre, understand the scope of its application, meet surgeons from a variety of international backgrounds, gain historical perspective in an area of interest to me and ultimately use this to benefit patients in the UK.
This was a 4 week structured Fellowship that was comprised of theatre time, case discussions, lectures and workshops with Saturday mornings reserved for sawbone work. There was the opportunity to scrub in and assist with cases in theatre.
Surgeons were extremely experienced with techniques and circular frames were applied efficiently with a heavy reliance on knowledge of anatomical landmarks over intra-operative radiography. They were supported by a multi-disciplinary team, with patients often staying at the centre for their entire duration of time in circular frame, giving them access to optimised nursing care and rehabilitation.
The pathology observed was varied and included traumatic and elective conditions in both the paediatric and adult population. Examples included limb lengthening, non-union surgery, acute fracture fixation in the upper and lower limbs, the management of the diabetic foot and bone infection. Whilst the majority of the work performed at the centre uses the Ilizarov apparatus, internal fixation is available for certain cases, as is joint replacement surgery.
In summary I felt that my objectives for going were achieved and also that the visit took place at the right time as I had attained CCT and had Fellowship experience in this technique prior to the visit. I would like to thank the Ilizarov Scientific Centre for hosting me and also the BOA for the generous award of the Zimmer Travelling Fellowship.
Executive Summary: “I spent two weeks at the Institut de la Main in Paris, a private centre of excellence for hand and wrist surgery. I visited in the final months of my specialist training and I was hosted by Prof. Mathoulin and Drs. Leclercq, Gras and Arnout. Prof. Mathoulin has pioneered many arthroscopic wrist operations and Dr. Leclercq is an expert on the management of Dupuytren’s disease and upper limb spasticity."
"I was fortunate to assist with the following arthroscopic procedures: scaphoid non-union grafting and fixation, TFCC and scapholunate ligament repairs, ganglion excisions and arthroscopic interposition tendon arthroplasty for stage 2 SNAC. Most cases of carpal tunnel syndrome were decompressed endoscopically, with open decompression (‘classique’) reserved for severe or recurrent cases. The team highlighted patient satisfaction with smaller scars and reduced scar pain. The minimally invasive operations were associated with steep learning curves, perhaps explaining their scarcity in specialist practice.
Open operations included De Quervain’s and cubital tunnel decompressions, thumb collateral ligament repairs and a midcarpal fusion for hemiplegia. I am interested to explore the lateral digital rotation flap for use in my future practice. Theatre efficiency was optimised through a selection of lists being delivered across two operating theatres. All cases underwent regional blockade and supplementary general anaesthesia proved a rare exception.France is often overlooked as a fellowship destination; however, the institute’s dedication to minimally invasive surgery was an inspiration. I am grateful to the team for their hospitality (despite my terrible French!) and to the BOA for their support.”
Executive Summary: “I was honoured to be a recipient of a BOA European Travelling Fellowship Award 2018 to attend the AO Research Institute Davos, Davos, Switzerland. For 6 months over the summer of 2018, I was invited to be a research fellow at the AO Research Institute Davos (ARI). The ARI has a long standing, international reputation as a centre of excellence for orthopaedic research with techniques that have been developed there being used in every hospital around the world, virtually every day. Implant concepts established by the AO Foundation have been emulated by every implant manufacturer and through the AO courses that are delivered in countries around the world, discoveries made are disseminated in a broad, expeditious fashion."
Executive Summary: “I utilised the BOA Travelling Fellowship Award to visit the Endo-Klinik in Hamburg, Germany. I spent one week in July 2017 at this renowned centre and was able to pick up several key things that I would like to bring into my routine practice."
The set-up for the management of prosthetic joint infections (PJI) is immensely focused. The Endo-Klinik aggressively implements basic principles of management from the changing rooms through to peri- and post-operative care. The multidisciplinary team is decisive and there is a fantastic sense of collegiality and shared vision.
There is also a research drive geared towards improving clinical outcomes whilst also addressing the necessity for basic science research. Biological markers are utilised and critically evaluated with results of their practice routinely published. There is an immense drive towards establishing early diagnosis through use of biological markers.
Finally, the service itself is rapid and runs like clockwork. The staff are welldrilled and the culture is goal oriented so individuals and teams can get on with the necessary tasks to facilitate smooth running of the theatre unit. There are many features which I believe will be of value in the NHS.
The trip was supplemented by an enlightening visit to the Link Orthopaedic factory.
Overall, the experience of five tremendous days has given me a lot of material to reflect on as I continue in my training in the UK. I’d like to thank Professor T.Gehrke and Dr Akos Zahar for inviting me, and the BOA for facilitating this trip.
Executive Summary: “I would firstly like to extend my gratitude to the British Orthopaedic Society and ZimmerBiomet for providing this award. It was truly appreciated. I travelled to Switzerland for two weeks during December 2016 to visit two busy centres- CHUV, Lausanne and Schulthess Clinic, Zurich."
I was hosted by Dr John Duff MD at the former and Dr Deszo Jeszenszky MD at the latter. I met the spinal teams at both centres including Dr Victor Bartanusz, Prof. Roy Daniel at CHUV Lausanne and Dr Tamas Fekete, Dr Daniel Haschtmann, Dr Frank Kleinstück at Schulthess Clinic. I was warmly received and I am very grateful to them.My primary interest is in spinal surgery and I travelled to Switzerland while on fellowship to see and learn techniques that I have not had as much exposure to previously. Like Ireland where I have trained as an orthopaedic surgeon, there is an increasing prevalence of elderly patients with pathologic fractures from osteoporosis or from metastatic tumor, both conditions disproportionately affecting the vertebral column. I had a superb exposure to complex spinal pathology and procedures. The health system in Switzerland is highly organised with efficient access to imaging techniques and inter-speciality referral. Both hospitals are quite different- the CHUV Lausanne is a publically funded university hospital while the Schulthess Clinic is a foundation-based hospital. Both institutions have strong academic records and I partook in the morning meetings which included local research, discussion of complex cases and training of junior trainees. Unlike in Ireland, the spinal unit at both centres had a mix of both orthopaedic and neurological surgeons which conferred the benefit of different training backgrounds and perspectives on addressing spinal pathology.
Executive Summary: "I began my travelling Fellowship at the Rizzoli Orthopaedic Institute in Bologna, Italy. I was based within the Orthopaedic Oncology unit, which is run by Professor D Donati. My key aims of visiting the Rizzoli was to gain further experience in allograft reconstructions as well allograft prosthetic composites. Which are two reconstruction techinques that are commonly used in Bologna. They are a large tertiary referral unit and I was able to see multiple cases every day. The bone bank in Bologna was really impressive and highlighted the need for careful pre-op planning to provide appropriate allografts."
The second part of my travelling fellowship was visiting the Leiden University Medical Centre (LUMC) in the Netherlands. I was hosted by Prof M van der Sande who heads the Bone & Soft Tissue tumour service at the LUMC.
Leiden are a very academic centre which has an excellently set up research unit. They have experience in implant design , including a hemipelvic reconstruction whch bears their name, “LUMiC by implantcast. They have experience in massive endoprostheses and I was able to get involved in these cases in the LUMC.I am very grateful for this opportunity to visit these excellent centres. It allowed me to experience some unique techniques at high volume bone tumour units.
Executive Summary: “Exeter’s excellence in Trauma and Orthopaedic surgery is renowned. The Exeter Spinal Fellowship is named after the late Norman Capener, who was a Senior Orthopaedic Surgeon at the Princess Elizabeth Orthopaedic Hospital and Royal Devon and Exeter Orthopaedic Hospital from the 1930’s to 1960’s. He was a great leader in spinal surgery and pioneered the thinking and treatment of spondylolisthesis. He was an early proponent of anterior lumbar surgery. This Fellowship was created in his honour and is a fellowship dedicated to the advancements of the theory and practice of all aspects of spinal surgery, and is based at the Princess Elizabeth Orthopaedic Centre in Exeter."
The Fellowship is supervised by Mr. Daniel Chan, Mr. Andrew Clarke, Mr. Michael Hutton, Mr. Shahid Khan and Mr Oliver Stokes, all Consultant Orthopaedic Spinal Surgeons. The unit also includes five specialist physiotherapy practitioners which form part of the team.
The Exeter Spinal Unit covers a wide catchment area and provides routine and complex spinal reconstruction surgery services to people in Devon and Cornwall. A full range of spinal disorder, ranging from degenerative pathologies through to tumour resection and reconstruction surgery in all regions of the spine (cervical, thoracic, thoracolumbar and lumbar), are treated. The only spinal surgeries that are not performed at Exeter include intra-dural pathologies and primary spinal bone tumours.
Executive Summary: “Having undertaken an MD at University College London on management of periprosthetic joint infections (PJIs) after hip and knee replacements, I wanted to visit leading centres in the world to further enhance my knowledge of the subject and hence my choice of The HELIOS ENDO-Klinik Hamburg."
I spent 2 weeks with Professor Gehrke’s team where I observed their strict protocols whilst performing primary and revision arthroplasty surgery being vigilant to the consequences of PJIs and optimising patient care peri-operatively to prevent such infections. On the other hand, for clinically suspected cases, I observed their approach utilising evidence based medicine and novel diagnostic tools to diagnose infection. Treatment of established PJIs at the ENDO-Klinik also follows clear protocols taking into account patient’s presentation and comorbidities and involving the patient with the decision making process throughout. Of particular interest to me was learning how they utilise a single stage revision for almost all comers in treating hip and knee PJIs achieving 93% infection control at 10 years follow-up.
I have also observed the differences in the healthcare systems between the UK and Germany and the central role of theatre assistants in efficiency utilisation of theatre time. Similar to university hospitals in the UK, there are also dedicated teams working on research and I had great pleasure working on a number of research projects and publications during my visit to the ENDO-Klinik.Overall this has been a unique experience for me and again I would like to thank BOA, the sponsors, Professor Gehrke and his team for giving me the opportunity to visit The HELIOS.
Executive Summary: “I spent 2 weeks in May 2016 as a BOA travelling fellow at the Endo-Klinik in Hamburg, Germany with my primary interest being the management of soft tissue and bony defects in the acetabulum and femur."