Nationwide changes in the organisation of specialist medical training present a challenge to surgical trainees in terms of exposure to an adequate case load, the acquisition of practical experience and therefore also of judgement and decision-making. When accompanied by accredited trainers exposure to practice in the developing world offers trainees the opportunity to enhance their clinical exposure as well as skills in communication, teaching, management and leadership. This paper analyses the training value for orthopaedic trainees of a novel orthopaedic project undertaken in
From 1994 to 2004, the authors treated 17 patients (nine males and eight females) with Blount disease admitted to the Disabled Children’s Home in Naro Moru (Kenya). Age at intervention ranged from 2 to 16 years (mean 8). In sevencases, the deformity was unilateral and mean age was 8.9 years; in the remaining 10 the deformity was bilateral and mean age was 8.5 years. Tibial proximal metaphyseal corticotomy was performed in 13 cases, and it was associated with calf bone osteotomy in patients aged over 5 years. In eight cases, metaphyseal osteotomy was associated with bone graft from homolateral calf bone and synthesis with Kirschner wire or “staples”, in nine it was performed without bone graft, and in one with axial external fixation. Complications included the following: infection with common peroneal nerve paresis treated with antibiotic therapy and transposition of tibialis posterior to tibialis anterior (one case); relapse of deformity treated with a new osteotomy (one case); incomplete correction (two cases); and pseudoarthrosis with loss of correction treated with a new osteotomy, removal of the pseudoarthrosis area and axial external fixation (one case). Nine patients for a total of 15 tibias were followed up at 1–10 years (mean 5.2). Results were good in 10 cases, with aligned limb and stable knee, fair in three cases, with X-ray evidence of varus deformity <
15° and/or knee instability in orthostasis, and poor in two cases with deformity >
15°, knee instability, length discrepancy >
3 cm. Age at operation and consequent severity of joint deformity influenced the results. Good results were obtained mainly in patients with Blount disease degree 1–3, whereas poor results were obtained in most patients with epiphyseal deformity >
degree 4.
The COVID-19 pandemic presents an unprecedented burden on global healthcare systems, and existing infrastructures must adapt and evolve to meet the challenge. With health systems reliant on the health of their workforce, the importance of protection against disease transmission in healthcare workers (HCWs) is clear. This study collated responses from several countries, provided by clinicians familiar with practice in each location, to identify areas of best practice and policy so as to build consensus of those measures that might reduce the risk of transmission of COVID-19 to HCWs at work. A cross-sectional descriptive survey was designed with ten open and closed questions and sent to a representative sample. The sample was selected on a convenience basis of 27 senior surgeons, members of an international surgical society, who were all frontline workers in the COVID-19 pandemic. This study was reported according to the Standards for Reporting Qualitative Research (SRQR) checklist.Aims
Methods
Chris Lavy is an orthopaedic surgeon in Oxford (UK) who lived and worked in Malawi for ten years. There he helped build an orthopaedic hospital and research unit. He was also one of the founders of COSECSA, the regional college of surgeons for East and Central Africa in 1999.