World Orthopaedic Concern
Newsletter No 102 - July 2008
Websites:- www.worldortho.com
www.worldorthopaedicconcern.org
This Newsletter
is circulated through the internet, and is also sent to all WOC Regional
Secretaries in the hope that they will be able to download and distribute it to
those unconnected through the “net.”
This newsletter contains but a few items of news and
interest except the first, the program for our meeting, which follows. This Triennial Meeting, within the programme
for SICOT, is to be held at the
Renaissance Hotel in Hong Kong, in August 2008. This is our major platform for
the discussion of Orthopaedics within the context of the work of WOC. It is
hoped that as many members of both WOC and SICOT will appreciate the importance
of our meeting and be able to attend.
Every community – I reject the word country because
everywhere in the world has both poverty and opulence,
tragedy and waste – has its own current standard of practice and all are
capable of improvement. The story of WOC, and all similar bodies, is one of
progress and success; but for each little triumph there are a dozen others in
the same or similar need.
In the Agenda you
will notice that there are subjects relating to the practice of surgery under
straightened circumstances, but also to the application of advanced technology
capable of performance in an efficient and economical fashion. Nowhere is there
acceptance of what is “cheap”, in the tawdry sense of the word, because nothing
less than the highest standards are acceptable. But WOC’s emphasis is always
upon that which is both best and appropriate, and the avoidance of all that is
of marginal value to either the patient or the community.
There is also, in his Agenda, an emphasis upon those well
known and frequently seen conditions which present with the complication of
“delay”. You will note the frequent reference to the word “neglected,” implying
no failure of care but rather the appalling distances that the badly injured
and seriously ill, have to travel for hospital attention. Presented are
experiences of remarkable achievement in less than ideal circumstances.
August 26th 2008, 0905 – 0940hrs
Dr. Surijanto Muskita
A new operation for CDH
Dr. Sakthi Prasad Das.
Treatment of Neglected CTEV by Ponseti method
Dr. Lalit Maini Management Of Fractures Of Femoral Shaft In Pediatric Age Group Under Femoral Nerve Block
with Immediate Hip Spica.
Dr. Ger Olyhoek. A new operation in the treatment of neglected dislocated hips in
children in developing countries
Dr. Ram Prabhoo. Management of Intra-articular
Fractures in the Upper and Lower limbs by JESS - A Minimally Invasive technique
0940- 1000 hrs
Dr. Rajeev Naik. Percutaneous pinning of displaced supracondylar
fractures of the humerus in children- a retrospective study of 42 patients.
Dr. A N Mukherjee Clinical Experience of Intramedulllary
Splintage for Supracondylar Fractures of the Femur
Dr. Srinivas G N. Proximal femoral nail for treatment of Intertrochanteric and
Subtrochanteric Fractures - Our Experience
1000 – 1020 hrs
Dr.
Alok C Agrawal: Limb Salvage
for Malignant Bone Tumors - Our experience
Dr. Uwale Eyesan:
Challenges
in the Diagnosis and Management of Musculoskeletal Tumours in an African
Country
Dr. Hydar Kunnummal: Patellar Secondaries - A case report
1020 – 1035 hrs
Dr.
Janardhana Aithala P: Learning curve
in spine surgery: A Beginner's experience
Dr. Anil Kumar
Jain: MRI Evaluation of TB Spine lesion.
10.35 am -
10.45 am Coffee break
10.45
First JN Wilson
Memorial Oration - Prof T K Shanmugasundaram, Past President-WOC International
11.25
President's
Address - Dr S Rajasekaran, President-WOC International
1200 noon
Dr. Zile Singh
Kundu Large Gap Non-Unions of Tiba. Results of
one stage tibialization of Fibula
Dr. Raphael Ayorinde.
Concurrent
bilateral femoral neck fractures following
pelvic irradiation
Dr. John Mukhopadhaya
Results
of surgical reconstruction for fractures
of the Distal Humerus presenting late.
Dr. Muhammad Tariq
Sohail. Chronic osteomyelitis in Bone substitution
1205 - 1245 Annual
General Body Meeting (ALL are urged to Attend)
CORRESPONDENCE
The editor has
received a regular announcement of the updating and upgrading of that
invaluable teaching aid, Ron Huckstep’s 2008 WOC
Guidelines – CD Rom. I take this item with me on any teaching trip,
partly to guide me on matters which he and his co-author Dr. Eugene Sherry, know so well, and partly to leave behind after
my visit. As described below the teaching of medicine in the developing world
is under huge strain, partly on account of the demands of the sick - with education goes
an understanding of what can be done for conditions previously thought of as
incurable acts of God! - and partly because every country in the world has an
uncontrollable expansion of those weapons of mass destruction, motor cars.
The appetite for information, among the
students, is voracious. This CD Rom is hugely appreciated. “The authors are
prepared to give permission to any doctor, medical student, nurse, paramedical
personnel or others involved in trauma, to download and copy any of the
teaching aids without restriction.” The 2008 website has been designed so that
it can be easily downloaded…even on elderly equipment. The following addresses
are open:- WWW.worldortho.com “e” – rlh333@optusnet.com.au or by facsimile to 6102 9967 2971.
REGIONAL REPORTS
ETHIOPIA. This
correspondent has recently returned from a month at the Black Lion Hospital,
Addis Ababa. His visit coincided with a hugely ambitious expansion of the
Curricula of the University in order to develop all the scientific programs,
one of which is Medicine. This poses a number of obvious problems for a country
without vast natural resources. The planned expansion of places at Medical
School, for which the Black Lion is one of the principle teaching
establishments, will add enormously to the burden of the rather small team of
staff orthopaedic surgeons. Surgical teaching has been closely linked with a
procession of senior surgeons from the UK and more recently also from the US.
The list includes the names of Reggie Merryweather, Ginger
Wilson, Bill McQuillan and Geoffrey Walker, all of whom spent long periods
there. Shorter visits were made by Rang, Fearn, Eckersley, Fullilove, Tennant,
and Wood.
Inevitably, times change.
The trauma load is now massive. The daily toll of serious fractures is now in
double figures, and the call to moonlighting private practice spreads into
mid-day. There is a huge call for the teaching skills of those who are
experienced in a trauma load. If the University’s planned expansion is to be
realised there will be a gaping shortage of postgraduate (hands-on) Teaching
Staff.
As is often the case WOC is in position to provide at least
some of that requirement at the Black Lion, if skilled and experienced men are
‘to hand’. There is spacious accommodation (a flat belonging to WOC); but the
need is for periods of more than a month. My own experience is that it takes at
least two weeks before one can make a meaningful contribution to the teaching
program, both in theory and practice. It is the difference between being a
welcome visitor and being a part of the staff. The junior doctors are
desperately short of supervision. The hospital itself, structurally and
spatially fine, requires involved visitors.
In this, WOC has the opportunity to act as a bridge between
two sides of an ever widening, metaphorical river, across which there must be
continuous communication and cross fertilisation, if the best available service
to a community is to be provided. One side of the bridge is a sophisticated and
technically equipped medical service; the other is poverty, lack of training,
shortage of doctors,
of instruments and scanning facilities, and ignorance. There has to be a link
or Medicine will fail. The demands of a modern city will stretch that bridge to
the point of collapse. (Expressions of
interest can be channelled through my “E” address, (Laurence.mike@googlemail.com).
PHILLIPINES
We are delighted to receive a wonderful Newsletter from the
Palawan trust, on whose behalf Louis
Deliss has just returned from a visit to the recent recipient of the Eyre
Brooke Medal, Socrates and his wife Cecile. “Soc” maintains his principle of
“Appropriateness” – the title of his monograph on Orthopaedics on the
Archipelago.
There are several different types of Newsletter; that from
the Palawan Trust is aimed to a large extent towards potential charitable
donors. There are idyllic pictures of the country and of the islands, and of
working clinics, from Louis’s energetic and delightful diary. His narrative
gives life to the individual problems and how ingenuity can solve them in the context of the community.
What emerges from these anecdotes is a picture of surgical success in terms of
patient satisfaction, and an insight into an attractive people. The British
Palawan Trust (BPT) is approachable at WWW.britishpalawantrust.org.uk
MALAWI
John Cashman, who used to be
the paediatric orthopod, at Bristol is now well established in Blantyre. In May
of this year he had generous support from the Furlong Foundation, to mount and organise a course on the use of
Ilizarov external fixation equipment. This was keenly supported from the
surgeons of East Africa. The emphasis was upon the contribution that principle
can make towards the chronic problems so often seen in the developing world.
Care and maintenance of the reusable parts was an important feature because so
many pieces of complicated equipment can so easy fall into disuse for lack of
basic understanding of simple mechanics. This course, hopefully planned to be
repeated, was a perfect example of how the best interests of “industry” can
contribute to orthopaedic training and education without crude commercial
patronage. With the best will in the world, this philanthropy can be mobilised
to everyone’s benefit and refute some accusations that commercial involvement
in education places a bias upon science.
On the subject of Communication,
(ever a matter of concern in this office,) we have received the following
message from the president of WOC(uk), addressed to
all members and followers of WOC.
“Dear Colleague,
“The e-mail data base of WOC members will soon be
ready.
We need to help country officers to motivate
surgeon-colleagues to visit and teach; to find useful equipment; and
to obtain the funding that they ideally need to further develop their country projects.
WOC UK has about 300 members but only a few are presently active. We would like
to communicate more with our members individually
by email to try to motivate more of them to take an
active part in the WOC projects.
“If you would like to be included [and we need to
include something from all the projects we support] please send us two items of
information:
1] a one or two paragraph description of your
country project and what you need, particularly regarding colleagues to
visit and teach. This would be for the first e-mail informing
members about what countries we are involved in and the needs
of individual projects. [please send this
first]
2] a longer history and present status of your country
project. This is so that we can have this on our website for
interested colleagues to refer to before perhaps phoning you to enquire
more.
“Many colleagues are now subspecialised and may be
wary about what they might have to treat. A description of what skills are
needed might encourage them to enquire further. Also many colleagues may
find the traditional one month visit difficult to arrange with a full time
contract to fulfill. If you would consider that 2 or 3 weeks could be useful -
even if this might mean that the first visit was only partly productive
- please say so, as once interested..........”
(from Chris Lavy and Dalton Boot. <dalton.boot@which.net
International catastrophes will always capture the headlines
of the media. The most recent was probably that in Myanmar. One of our members (Ricky
Villar) was part of a humanitarian endeavour sitting off the south-west
coast of Myanmar on a well laden ship only to be turned away. But the
experience of so many of our members, even from those allowed in for
humanitarian purposes, tells us that Orthopaedics has a limited amount to offer
in the acute stage of a natural
disaster. Then is the time for the saving of life, for building of shelters and
for feeding. Medecins Sans Frontieres
has circulated an excellent publicity-style newsletter, written by their UK
Chair, Dr. Christa Hook, in which their philosophy is persuasively stated,
together with excellent photography and convincing arguments. This noble
organisation is surely the modern “French Foreign Legion.” < www.msf.org.uk
The place for orthopaedic reconstruction is measured and
above all instructional. The old story;- the gift of a fish would feed a family for a
week; the gift of fishing tackle, will feed them for life. The period of 2-3
weeks, referred to above is the minimum; a second or
third fortnight, can be truly productive.
The editor would very much like to meet his readers at the
meeting of SICOT in August. This newsletter badly needs its readers to
contribute their experiences, and to ease the circulation of this Newsletter. A
further appeal will be made through our adoptive parent body (SICOT) and also
to the “surgical trade” who have such a wide interest in the Orthopaedic World
as a whole. Pending the facility for surface mail postage, please “forward” this
newsletter as widely as possible.
M. Laurence (ed) <Laurence.mike@googlemail.com