AADO Asian Fellowship Programme 2011
Final Report from Dr. Sushil Rangdal
31 Oct – 25 Nov 2011

It is a report from Dr. Sushil Rangdali , one of the successful applicants of AADO Asian Fellowship Programme in Queen Elizabeth Hospital at Hong Kong, who had a visit there on 31 Oct- 25 Nov, 2011.

I came to know about this fellowship programme through Dr Sarvdeep Dhatt, one of the previous successful candidates of this fellowship, working at my institute. Later I became desperate for this learning activity when I observed the changes in him while managing trauma patients, after completing this fellowship. Then I firmly decided to send application for this fellowship. I am very much thankful to AADO council for replying positively to my application and granting me this fellowship.

During correspondence, starting from my application for this programme up to I received my training visa and even guide map presentation to reach the QEH before arriving to Hongkong, my every e-mail was answered humbly and honestly by Ms Terry Leung and Ms Rachel Lam. I am very much thankfull to them for their all efforts to make our stay during this training programme very comfortable.

Definitely I would like to mention about our first day when we met our Fellowship Supervisor Dr Shen W Y, an able man with humble nature, a skilled surgeon and a great teacher. At his first gesture only he made us feel very homely and comfortable, relieving all anxieties of new place. He made us familiar with ward, OT complex and even arranged small small things like lockers in changing room, security access cards etc, reflecting his micro management and meticulous planning. Then we were made aware with working schedule of the week. I was very much glad to know that there are four OT days containing two OT tables, (means lots of learning of skills) and one OPD day, on Wednesday.

The OT day use to start with morning meeting (sharp 8 am) in ward, where the newly admitted patient’s X-rays and investigations use to be discussed and patients made short listed for the day’s OT list. During these sessions I learned from Dr Shen and his trauma team regarding minutely examining the x-rays, ordering CT scan whenever there is even smallest of doubts and at least having overlooks on X- rays other than musculoskeletal system to have idea of the other comorbities while planning for surgery. The importance of pre injury mobility status in decision making for any fracture treatment is very well emphasized here and Dr Shen has made this habit of noting this history well adhered among his house officers. Suggestions for managing the patient use to freely pour in from every members of team and were thoroughly discussed for pros and cons, and best option used to be offered to patient. I was surprised to see the average age of the patients here is above 75 and managing fractures in this age group is a real challenge. Beside this these patients performed exceptionally well in their hands, as I observed the previously operated cases in follow up at OPD. More over they never developed any problems of recumbence after surgery during their stay in hospital, due to early mobilization and that was possible basically due to appropriate fixation technique. After this meet Dr Shen use to teach us topics on principles of managing different fractures by his very illustrative power point presentations, showing lots of cases of similar fracture pattern. He taught the things about importance of appropriate selection of implant for minimal damage to soft tissue around fracture. During his talks I appreciated that nailing technique in dynamic mode is very well fits in the biological way of managing fractures. The Gamma nails done here proved exceptionally good in making the patients stand on very next day which is very much essential considering the
geriatric comorbities in this age group.

In the operation theatre we observed the vigor, discipline and promptness in working pattern of nursing staff and OT technicians and there was amazing coordination among all individuals in the theatre. And that is the key of less operative time beside having a skilled surgeon.

In OT we observed different fractures of femur, tibia, ankle, humerus, but its mainly dominated by geriatric fractures like fracture of intertrochanteric region and neck of femur. It was amazing to see fixation of intertrochanteric fracture in 10 to 12 minits with Gamma nail, by almost every member of team, may it be senior surgeons like Dr Shen, Dr K B Lee or younger ones like Dr Edmund, Dr Garry. The key of this short operative time I suppose is meticulous planning, in the form of measuring the length in advance before starting surgey, proper reduction of fracture before painting-drapping and offcourse vast experience of these surgeons in managing these fractures which made them skilled in every step of nailing from entry point to distal locking. This experience they shared with us at each step while performing the procedure, which is a true learning experience.

It was wonderfull learning of fixation of fracture supracondylar with intercondylar femur with DFN from Dr K B Lee, beside other many usefull surgical tips he shared with us for other trauma surgries. Dr Shen demonstrated us many minute details regarding lag screw placement in gamma nails and distal locking techniques beside other skills of fracture fixation. There was equally good demonstrations of surgeries by Dr Edmund and Dr Gary.

On the OPD days, in morning there use to be detailed discussions on all operated cases in last week and usefull comments use to come up for discussion. It was good review of post op cases and their progress, beside comments on intra-op and post op X rays. In OPD, Dr Shen shown us many of previously operated cases and all their previous records including X-rays from first presentation to the current follow up, demonstrating complete picture of progress of the patient with particular fracture pattern and how is the implant is working with that fracture. It was practical learning of therotical principles in fracture management.

I am very glad to be part of this team during this fellowship and it was learning experience for life time. Each morning discussion and presentation by Dr Shen taught us many of the principles in fracture management. There are no words to express my gratitude towards his efforts to make us better trauma surgeon. Many many thanks to Dr Shen.

Once again I would like to thank AADO for providing this opportunity. I feel this association is committed to non biased training and academic advancement of their members and working honestly on it. This programme is really essential for every orthopaedic surgeon who wants to pursue excellence in his trauma surgery.

I congratulate to Dr Shen and his capable team for their excellent work and wish them newer heights in coming time.

Dr. Sushil Rangdal