08 December 2017

Every step needs proper consideration.

Breaking down the barriers between surgical disciplines

By bringing together trauma and recon surgeons for a specially designed course, each group will share knowledge that will give the other a fuller appreciation of the factors they consider in the approach to surgery.

The curriculum developers at AOTrauma and AORecon are addressing periprosthetic fracture management of the hip and knee.

"This is a major, common problem we're seeing in these disciplines," said Karl Stoffel, from the Kantonspital Baselland and Chair of the AO Foundation's Periprosthetic Fracture Task Force (PFTF) along with Luigi Zagra.

"But the problem is we [trauma and recon surgeons] don't know enough about each other. The pathways to surgery have to be the same, or at least understood on each side. And right now, there is a lot to learn on both sides," Stoffel added.

The issue

Unlike the surgery being studied, the issue itself isn't too tricky to grasp: Patients with existing hip and knee replacements can suffer fractures that require special attention due to the presence of the implants.

But too often, that operation is carried out by surgeons who are insufficiently versed in either trauma or arthroplasty, resulting in poor appraisals of the state of the existing implant and, as a consequence, suboptimal decision-making on further intervention.

Roz Mohammadi is a 37-year-old joint replacement surgeon from Amsterdam. He carries out two to three revisions a week but wants to bolster his knowledge of trauma surgery to improve patient care.

"You can find other courses out there, industry-driven or not, but they are not as complete as the Davos Courses. Here the focus is on the knowledge, on the specialty. Not the equipment."

For Maksim Lugovskoi a 59-year-old trauma-turned-recon surgeon from Tallinn, Estonia, the value was in grilling the gurus in person: "Here we can talk to the experts step by step."

A Baltic masterclass

Lugovskoi will take the skills he learns in Davos, along with new drills and clamps, and hold a masterclass for 18 trauma surgeons at the North Estonian Regional Hospital next year on cross-discipline fracture management.

"There are only 25 active trauma surgeons in Estonia, so I will be able to help a big proportion of our surgeon community," he said.

Armen Dzhagaryan, a trauma surgeon from St. Petersburg, Russia, noted that: "I'm seeing more and more cases where a mix of these skills is required, and I have to stay up to date with the demands of the patients."

He added: "These practical courses allow me to really perfect my skills not only as a trauma surgeon, but also in recon."

Optimizing patient outcomes

This new course, aimed at surgeons with five or more years of experience, premieres at the AO Foundation Davos Courses 2017, and will be rolled out globally in the coming years.

It aims to maximize patient outcomes following periprosthetic fracture by improving the practicing surgeon's ability to recognize, classify, plan, and perform internal fixation and revision total joint arthroplasty procedures around hip and knee prostheses.

Karl Stoffel, meanwhile, sees no reason why this combined approach should not be adopted in other areas.

"Could I see a day where we have a course that takes into account, for example, trauma and tumor surgery? Why not? Tumor surgeons frequently need to be able to manipulate bones, use prostheses and so on."

"Let me make it clear: We're not trying to turn trauma surgeons into arthroplasty surgeons. But perhaps this can be the beginning of a more collaborative approach to surgery."





More Images

A model provides a training for internal fixation techniques.
Faculty member Michael Huo (US) explains an exercise.
A course participant practices another surgical step.
Participants highly appreciate the hands-on exercises.
No step is taken without a precise instruction from the faculty.
Faculty member Endre Varga (HU) explains the details.
Course faculty (from left to right): S Oussedik (GB), AORecon chairperson L Zagra (IT), M Huo, M Raschke (DE), M Reilly (US) B Masri (CA), E Varga (HU), AOTrauma chairperson K Stoffel (CH).
AOTrauma/AORecon Course participants with faculty members.

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