HSS – New York City

Our final week of this amazing fellowship has comed. Mani and I spend a great and somewhat different week at the HSS in NYC. Dr. Rozbruch and Dr. Fragomen taught us lots of interesting aspects of deformity correction. We saw artificial talar bones, transparent (carbon) plates and nail, cryo-ablation of phantom pain after resection of nerves (neuromas/amputations). We saw curretage of cystic lesions, lengthening nails, and TSF frames. Proximal tibial osteotomi with TSF frame one side, and TomoFix plate on the other for correction of bilateral varus. We discusses aspects of the subtleties of LATN and LON technique and how to treat regenerate healing issues.

We also lots af patients in the clinic, both public and private. Ankle distraction for talocrural arthritis and how the frame was applied and the mobility maintained. We saw nailing assisted correction of a proximal tibial deformity, including peroneal nerve decompresssion. We had a very nice farewell dinner, together with the recidents. We learned a lot, saw a lot, and met some of the authors and inventors of techniques and articles and text books that we use regularly in our deformity planning. We also interacted with the fellows and medical students and had a fantastic time in sophisticated NYC.
Flying home with the iPhone and the pc full of notes, pictures and personal, unforgettable memories of professional knowledge sharing, friendship and network possibilities…./Ulrik

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Leaving Charlotte…

Leaving Charlotte: An amazing and very concentrated learning experience: Our week in clean and beautiful Charlotte has come to an end. From early morning to late in the evening. We have learned tons of tips and tricks on frames, flaps, pilons and non-union. We have shadowed fantastic Dr. Hsu, who patiently taught us rotational flaps in the cadaver lab, and it was a great hands on experience. Two days after, we saw one of the flaps applied to a patients An opportunity for rehearsing, testing, reading, taking notes and see the real thing. Awesome. We saw mixing of cement and the setup for antibiotic coated nails applied to non unions. I finally found the recipe that I had been looking for. We saw distraction of a hypertrophic non-union in a frame, and supplementary plating and grafting of a femoral non-union, previously nailed. We saw an ankle fusion in a frame on a diabetic pt. with a failed malleolar fracture ORIF. We did tailor spatial frame planning. We took notes on all the little subtleties of framing, pin and wire placement, the importance of balancing the talus under the tibia when fusing and dorsiflection etc. We had lectures on the rising epidemic of drug abuse on America. We were equally well received by the residents and fellows who also taught us trips and tricks and had prepared cases for us on deformity planning in Rickets and a bone transport case. The social calendar was full, and we had great dinners and discussions on teaching and learning, politics, traveling and culture. Thanks a million to Dr. Hsu and his kind family for an unforgettable week. 

We lived in a guest house provided by the hospital at a very low cost and we could walk to the hospital, making this week very budget friendly. 

Farewell to Miami

During the rest of our fantastic week in Miami, we saw more interesting cases, such as frames on pilons and open calcaneal fractures, transport frames with wires, spacers to pave the way of the transport fragment, lengthening nails, foot frames. And we got hours of ppt lectures on a number of subjects by personal time with amazing dr. Hutson, including the Panhandler syndrome, a Masquelet technique discussion, tips and tricks for transport frames, including a technical guide to the balanced wired transport fragment system. Operated with dr. Quinnan and got an excellent introduction to the fracture reduction tools that a frame has, such as joystick half pins, arced wires to pull fragments in place in to planes. We also saw a fixator assisted nailing on a regenerate that had drifted into malalignment. We saw very elegant distal tibial articular surface reduction with fine 0.45 mm threaded steinmann wires, sometime left in place. Hereafter a staged secondary transport was planned to make up for the bone loss. We  got to do some deformity planning, discussing Baumgart’s end-point-first planning, blocking screws and entry points, including supra patellar acces, parapatellar and supra-and subcutaneous acces to the tibial canal. Lengthening and planned compensation by translation when in the femur and lots of other good stuff, including contracture correction by frames.

Clinics with both private and public patients (in two different settings) was equally valuable. Thursday morning we both did Grand Rounds Lectures, and enjoyed it very much.

On thursday night we got invited to dine at dr. Hutson’s charming “Chinese” house in Coral Gables including a visit to his fantastic woodshop and saw his  top-end home made wooden furniture. We also had an interesting night, hearing anecdotes from the the life of a resident, participating at the residents informal farewell dinner at South Beach. Also got to see a bit of the fantastic art deco architecture of Miami.

And time to discuss differences in life as an orthopedic surgeon in the US and Denmark, in terms of working hours, salary, reps, number of procedures, bureaucracy, family issues, insurance, private vs. public system, presidential elections etc. 😉 Not boring, and a lot to learn for us all.

Mani is a fantastic fellow Fellow and we had a lot of fun together 🙂 and it was very useful for me to have a “local” guide to the US health care system.

We shared an AirB’nB in Brickell apartment to cut cost, and Uber’ed to work every day.

Thanks a million to Dr. Hutson, Dr. Quinnan for this unforgettable week. /Ulrik

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