In Episode 48 we speak with Professor Nando Ferreira (Tygerberg Hospital, Cape Town, South Africa) who is an internationally renowned expert in the world of limb reconstruction and musculoskeletal infections. He is an experienced clinical professor with a strong educational and academic background.

In this episode we speak about:

01:30: BACKGROUND

1. His background, career choice and what's was his the draw towards limb reconstruction? His training in South Africa and in Russia. Building the limb reconstruction unit and winning allies.

13:55: ACADEMIA

2. Academia including obtaining a PhD through publication, research protocols in South Africa and research that he is the most proud of.

21:50: CLINICAL CONSIDERATIONS

3. Clinical considerations including limb reconstruction and the surgical management of musculoskeletal infections

46:10: CONTEMPORARY CAREER

4. Contemporary career, having an international outlook and the limb reconstruction / framing course

56:00: TEACHING AND TRAINING

5. Tips and tricks for early career surgeons

Professor Kevin Shea is an orthopaedic surgeon and academic at Stanford University Medical Center (California, USA) and the Lucile Packard Children's Hospital. He is well known as a founding member of PRiSM, ROCK and SCORE. He is in the presidential line at POSNA.

In this engaging episode, Prof Shea and I cover a lot of ground including:

Prof Shea's orthopaedic journey and life lessons: 01:20

• Work ethic and the value of hard consistent work
• Coaching and Mentoring
• Medical school (UCLA and time in the Soviet Union)
• Fellowships including Rady Children's Hospital (San Diego, USA), Bern (Switzerland) with Dr Ganz (Switzerland), Dr Fernandez (Trauma) and Dr Staubli (Sports), Lecco (Italy) for Ilizarov training, South America for the AOSSM Traveling Sports Medicine Fellowship
• Private Practice in Boise and being invited to become Professor of Orthopaedics at Stanford University
• The concept of "Deep Work"
• Planning early / mid / late career
• Value = Quality / Cost, what is the role of orthopaedic surgeons in this equation?
• The need to balance work and personal life

Paediatric Sports Injuries (42.00)

• How as the world of paediatric sports injuries changed during his career?
• Is there an increasing incidence and have the nature of the injuries changed?
• Have our interventions evolved?
• What is the role of injury prevision programs?
• What is the next big advance in the field?

Paediatric Knees (53:00)

• How did he go about setting up a cadaveric lab?
• Did he find anything surprising in the dissections?
• How has his deep understanding of anatomy influenced his clinical and operative techniques?

Research groups - PRiSM, ROCK and SCORE (64:15)

• Why establish these groups? What is the importance of an interdisciplinary approach to advancing research?
• What impact have these groups had so far?

Orthopaedic Education - What are his top tips for medical students, residents and newly qualified surgeons? (69.30)

• The importance of good cultures and teams

Final thoughts and advice (72.00)

Dr Evelyn Kuong is an Associate Professor at the Li Ka Shing Faculty of Medicine (University of Hong Kong) and an Orthopaedic Consultant at the Duchess of Kent Children's Hospital.

This episode covers skeletal dysplasias and is of particular interest for those approaching postgraduate examinations and the general orthopaedist who may encounter the occasional patient with a rare condition. We discuss a system of decision making, the role of the MDT and how to approach rare dysplasias. We delve into achondroplasia, pseudoachondroplasia, MED and SED. We then discuss the treatment of short stature in general terms.

We finish by discussing Dr Kuong's orthopaedic journey and her perspective on diversity in orthopaedics.

We speak with Dr Marí Thiart who is an orthopaedic surgeon in Tygerberg, Cape Town, South Africa. She is also the president of the International Orthopaedic Diversity Alliance. In this episode we discuss the set up of South African paediatric orthopaedic services, trauma, infection and training.

01:08: Set-up of Paeds Ortho Services in South Africa

04:40: Set-up of South African Trauma Services

06:30: Blunt vs Penetrating Trauma

10:50: Common Trauma in Cape Town and Top Tips

16:00: How to manage gunshot injuries in children

18:15: Musculoskeletal Infection in Children including acute haematogenous osteomyelitis (PhD subject of Dr Thiart)

21:50: Offending organisms

23:40: Surgical management of osteomyelitis is rare right? - "100% of kids need surgery"

28:00: Critical bone defects in infection

33:00: Quick Fire Round - High yield orthopaedic topics for the FRCS / Postgraduate exams

43:40: IODA and how to get involved

We speak with Mr Emeka Oragui (Chelsea & Westminster Hospital, London) about femoral acetabular impingement, sportsman hernia and treating young patients with hip replacement surgery through an anterior approach.

In this episode we cover:

01:40: What is femoral acetabular impingement (FAI)?

06:00: Is hip arthroscopy witchcraft? 

08:20: Is subtle hip dysplasia under diagnosed? How does this link to FAI? 

10:27: Pearls of wisdom – How do you approach a young person with vague pain in the hip with an MRI scan showing a labral tear? 

20:10: Sportsman Hernia – an interface area. The anatomy and what is the genesis? What is the Doha agreement?

27:00: Should orthopods stray north of the inguinal ligament?

34:25: What can an orthopaedic surgeon do to treat sportsman hernias?

42:50: Anterior approach hip replacement

Mr Andy Williams (Fortius, London, UK) spends an hour speaking with us about his life lessons, philosophy on knee surgery and how to optimise your performance. This is an episode not to be missed!

Timestamps:

01:40: From humble beginnings and overcoming imposter syndrome

04:29: Should orthopods be builders? How do we become more precise?

06:38: How did your fellowship and having experience abroad influence your practice? Should trainees aim for some time away and why?

11:18: How has your philosophy on knee surgery changed over time? How does treating elite athletes influence your management of non-athletes?

15:38: Are athletes anatomy different? Can you extrapolate your research and results in athletes to non-athletes?

18:06: Is ACL surgery easy? What are the 7 steps to the perfect ACL Reconstruction? What ACL Graft options do you consider and when?

24:14: How much data do you need to change your practice?

28:35: MCL injuries... should be be treating them surgically?

32:40: What is your non-operative MCL Rehab protocol and why?

35.20: What are the lessons that you've learned from professional sports?

40:46: The importance of having the right team, how to set-up a team and how do you choose your colleagues? How do you choose your physios?

46:45: The importance of being a perfectionist

47:50: Rehab prescriptions and what do muscles do? The importance of doing the basics really well.

50:30: The importance of psychology in sports

52:00: Any advice for trainees for how to optimise our training, adopt a winning mentality and become top surgeons?

Mr Nev Davies (Reading, UK) is a consultant knee surgeon who has championed injury prevention through SKIPP Charity's Power Up To Play national campaign. In this episode we discuss the role of injury prevention and what we can do to reduce the incidence of young adult knee injuries.

Link to the charity here: https://poweruptoplay.org

We feature Professor Sandeep Patwardhan (Sancheti Hospital, Pune, India) who is the Vice-President of the Paediatric Orthopaedic Society of India. He has a wealth of experience in managing children with trauma and orthopaedic conditions. In this episode we cover:

Public vs Private Healthcare in India: 01:06

MSK Infections in Children: 07:30

DDH: 18:35

SCFE: 20:35

Perthes: 30:55

Clubfoot: 35:55

Tumours: 41:25

Training the next generation: 42:55

Professor Heather Vallier (Case Western Reserve University, Cleveland, Ohio) is the 36th President of the Orthopaedic Trauma Association (OTA) and the first ever female President. She is well known in the world of orthopaedic trauma and has been instrumental in several leading publications within this field. In this podcast we discuss the importance of recognising psychological trauma and how this is both cost effective and improves patient outcomes. We discuss the evolution of trauma care including early appropriate care, predictive modelling and clinical grading systems. We also discuss several METRC studies which have shaped trauma practice in recent years. 

Professor McNally (Oxford, UK) has been an influential force in the world of fracture related infections. This episode highlights some of the key points we should all be aware of when managing orthopaedic patients with bone infection. 

Ms Deepa Bose (Birmingham, UK) discusses the indications for using tibial nails and circular frames. We also discuss the management of infected tibial nails.