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POSI-Prof Kaye Wilkins travelling fellowship report - 2015

It gives me immense pleasure and satisfaction in writing this report. I first of all I thank you for giving me this opportunity to pursue this fellowship that has brought a significant difference in understanding paediatric orthopaedics.

Sir, I had opted for the entire duration of 6 weeks for this prestigious fellowship i.e from 1st of April to 16th of May 2015. During this period I visited three centres in Mumbai:

Dr Taral Nagda, Institute of Paediatric Orthopaedics.
Dr Alaric Aroojis, Kokilaben Dhirubai Ambani hospital.
Dr Ashok N Johari, Children’s Orthopaedic centre.

As all of them are centres of excellence in this field there was a lot that I gained from each of them, and so there would be many things beyond words mentioned here.


INSTITUTE OF PAEDIATRIC ORTHOPAEDIC DISORDERS (IPOD)

During my tenure at the IPOD, I got to meet Dr Taral Nagda and his team (Dr Jaideep Dhamele, Dr Chasanal Rathod, Dr Sachin, Dr Prasanna and other non medical staff). During this period I could get an idea of paediatric orthopaedics beyond clinical and academics. I was actively involved in all the activities of the institute.

During the OPD hours I could see almost the entire spectrum of paediatric orthopaedic disorders and the interactive discussion about the cases with Dr Taral has made my approach to them better in terms of clinical examination and decision-making. I could learn a few tips and tricks of paed-orth examination. I was fortunate to be able to attend the speciality clinics run by the institute: CP clinic, Outreach clinic and visit to charitable hospitals. Dr Jaideep and Dr Chasanal briefed me about the patients and the decision making process involved in each of the patients visiting the clinic. During the operating hours I got the opportunity to assist Dr Taral Nagda in some complex surgeries for example safe surgical dislocation, femoral head reduction osteotomy and relative neck lengthening. The surgical skills were impressive and I could clarify my doubts with him. Apart from that I could see some standard procedures for CP like ultrasound guided botulinum toxin injection, multilevel soft tissue releases and various procedures for correction of knee and foot deformities.

The academic part of the tenure was equally good and interactive. We discussed a few cases and reviewed the literature for each. Apart from that we had a journal club meet every Wednesday where I got an opportunity to present the review on CP foot. I got valuable inputs for the tips on reviewing literature and presentation skills. Also Dr Taral Nagda extended on to me an opportunity to present one of his case in the BOS master series on Perthes disease held at Nanavati Hospital. Also it was very fortunate that I could attend the gait course held at Jupiter Gait Lab at Jupiter Hospital, where we had a good one to one interaction with Dr Abhay Khot, who made us understand the gait cycle and the gave an insight into 3D gait analysis.

Regarding the outreach activity, I attended one of the camps organized by IPOD and could see the amount of burden of the differently abled children in society and the need to extend a helping hand to them.

To summarize my term at IPOD was a perfect blend of academics, clinical, outreach and administrative/organizational training.


KOKILBEN DHIRUBAI AMBANI HOSPITAL

During this tenure of fellowship I made visit to this hospital, where I got the opportunity to share some time with Dr Alaric Aroojis, in OPD as well as operating room. Although it was a short visit of just two days, I got to interact with him on different grounds as paedorth fellowships, research and literature review and critical analysis. He also briefed me as to how a reviewer sees an article. In short it was a short and crisp briefing of clinical, communication, operating and academicians briefing of paediatric orthopaedic skills.

There was a last moment change in my plans in going to Dr Hitesh Shah at Manipal, but Dr Ashok N Johari Sir very kindly accommodated me in spite of his busy schedule.


CHILDREN’S ORTHOPAEDIC CENTRE: DR ASHOK N JOHARI

It was fortunate that I could get to work with Sir and attend his Surgeries and out patient clinics. At the clinics I was able to see patients not only how they were at present but also the meticulously kept data and clinical findings at each visit from the very first consultation gave an excellent picture of how the child was few years back. The clinical examination protocols for most of the common paedorth disorders was of great help while evaluating the child so that we don’t miss even a minute point which might have an impact on decision making. I could see a good number of patients for rare orthopaedic cases with a well maintained track record of all the interventions done till date so that it gave me a brief idea of its prognosis and expected outcomes. That really helps in giving the parents the realistic expectations in that particular scenario.

Cerebral palsy was another group of disorder that I got to see in big number. The clinical evaluation, planning the treatment and counseling of the patients were impressive, especially when Sir explained me about the complex interplay of muscles in gait and producing a deformity.

During operative days I assisted him in almost 6-7 cases per day which was an exhaustive mental exercise for the day, but left me more charged to experience more. The meticulousness in every step of surgery and the determination for perfection to the last degree of correction was the central core of every surgery. To mention a few surgeries: shoulder muscle transfer, physeal injury of the head of radius, lengthening (ulnar, femoral, tibial), Taylor Spatial frame, Magnetic rods for the severe curvatures of the spine in young child, entire spectrum of procedures for CTEV right from tenotomy to JESS and many more.

It was a great experience assisting Sir, who is pioneer in botulinum toxin therapy for CP. I was lucky to assist him injecting almost all the common muscles by the manual method. He gave tips as to how one can increase the accuracy of this technique in case we do not have access to modern devices like ultrasound machine.

One of the recent most technologically advanced implant for spine: MAGNETIC ROD for the growing spine was done by him recently for a very severe congenital kyphosis in a young girl.

I could attend the first of its kind academic initiative by BOS in collaboration with Harward Medical School: CONNECT, that had a series of debates on various orthopedic topics. There he summarized on the management of pink pulseless hand in supracondylar fracture in pediatric population that gave lot of clearance in thinking of the house.

Seeing the enormous patient database and availability of clinical resources this centre would be ideal for many research projects in paediatric orthopaedics. But due to lack of time it was not possible in this short duration. Given an opportunity it would be a great chance to do some high level research.

Respected Dr Usha Johari, was also very kind in making my stay and food throughout the period comfortable. I am very thankful for the hospitality and kind consideration.


SUMMARY

Sir, the aims and objectives with which I had taken up this fellowship were totally fulfilled and I have gained what I was looking for. I look forward to use this knowledge and experience in my clinical set up, and I hope this would help me in delivering better and updated knowledge based services to children in my region.

I once again thank you for the wonderful opportunity that you extended to me.

Warm regards.

Dr Amit Nemade