Australian Doctors for Africa was formed in 2005 to provide some focus on the orthopaedic needs of the east coast of Africa. With the support of the college and the AOA, and in response to requests for assistance, the size and scope of the organisation has increased. ADFA has four active projects based primarily around the provision of orthopaedic services and teaching, along with the supply of medical, surgical and hospital equipment. Each location has different needs and is the subject of a different three-year development partnership. In Addis Ababa, Ethiopia the programme is mainly teaching the trainee orthopaedic surgeons, coordinating the visits of volunteers from other organisations and providing hospital equipment. A container of hospital beds, crutches, wheelchairs and splints have just arrived. An orthopaedic team led by Dr Tony Jeffries visited for two weeks in September 2009 to teach the operative management of forearm fractures, improve the sterile technique in the operating theatres and deliver and install an intramedullary nailing set. In Hargeisa Somaliand, ADFA is involved with the Faculty of Medicine of the University of Western Australia to develop a curriculum with School of Medicine and provide medical staff for clinical teaching. In Bosaso, Puntland, Northern Somalia, we, together with Rotary, are assisting with the construction of new theatre wards and furnishing with hospital beds and equipment. Here, the orthopaedic service is consulting and operating rather than teaching. In Madagascar we have been building up the talipes screening and plaster treatment service, providing container loads of medical and surgical equipment and conducting bi-annual orthopaedic operating visits. The next visit is in November 2009 with orthopaedics, gastroenterology and urology specialists from ADFA.
A new approach to the hip is described that allows better exposure for difficult revision surgery without the need for trochanteric osteotomy. A V-shaped myofascial flap consisting of the proximal part of vastus lateralis and its fascia with gluteus medius and minimus, is reflected off the greater trochanter and proximal femur giving access to the entire capsule of the hip. If the leg has been significantly lengthened by the revision procedure, abductor tension can be adjusted at closure by altering the reattachment of the flap, analogous to a V-Y-plasty.
