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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Day 2

Today started with a lively consensus conference and review of cases from the previous week, followed by clinic. Patients at various stages of treatment were very welcoming to our presence, as has everyone in the Department. The afternoon was spent ‘playing’ with the TL-Hex hardware and software in preparation for one of tomorrow’s cases.

The day was rounded off with some local cuisine – accompanied by some light reading!image

Week 1 Orlando

Natasha and I arrived to a wet and windy greeting as tropical storm Colin approached central Florida. The first stop on our fellowship is the Nemours Children’s Hospital in Orlando, a brand new purpose built facility. It is located in the centre of Lake Nona Medical City, a new high tech development just 10 minutes from Orlando airport.

Our host is Dr Christopher Iobst, who has prepared a fantastic program of academic and social activities for the week. Monday morning was spent in clinic with Dr Iobst, where we were exposed to a wide range of clinical problems seen in limb deformity, varying from miserable malalignment to brachydactyly. It was great to see how an experienced limb reconstruction surgeon runs his clinics and we gained many tips and tricks along the way.

Monday afternoon was spent running through a sawbones lab using the Smith and Nephew Modular Rail System for spanning the kneeing during femoral lengthening cases. We were able to spend time gaining hands on experience of the intricacies of the system. Following this we went through the pre-operative planning and software programming for the TSF for a case of cubitus varus schedule for later in the week.

In the evening we were very graciously hosted at Luma Restaurant in Winter Park, where Dr Chad Price presented the Orlando hip procedure for congenital femoral deficiency and Dr Steven Frick provided us with some very enlightening career advice.

Miami is off to a great start

Ulrich and I were welcomed warmly at Jackson Memorial. Our first day in Miami was nothing but spectacular. Dr. Hutson and Dr. Quinnan have a very  unique practice, with a mix of acute trauma as well as late complications related to trauma, infection and even pediatric deformities that persisted into adulthood. No shortage of cases that benefit from the use of frames!

Dr. Quinnan started us off with a day of cases, including a distal tibial nonunion treated with a TSF, a severe knee flexion contracture treated with a TSF and posterior releases, and a polytrauma case with a Pilon treated in an Ilizarov. The method of using an ilizarov frame from the very beginning for pilon fractures is an interesting take that has many clear benefits. He of course addresses the articular surface with buried wires, screws and low profile plates. He explained that cases with bone loss or angular deformity are addressed with a transport 6 weeks after injury. A very novel approach indeed that eliminates the need for bulky plates which has a potential advantage in reducing infections and wound complications.

What was impossible to miss today was Dr. Quinnan’s attention to detail. We were guided through the planning, execution and followup plans for these cases, with a plethora of tips from using iced saline for a saw blade, cork on wires to prevent getting stuck with a sharp point, and washing your pins through the cannula to make sure the dog doesn’t have anything to lick! Oh and Ulrik my co-fellow modeled the chic Miami style lead gowns for us.