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OREF-Dr Mahendra Patel-GOA
Traveling fellowship, 2006- Report
Dr. Pranav A Shah
204, Garden View, Opp. GIDC Garden, Koparli Road,
Vapi (Pin – 396191), Gujarat
Hospital (0260) (2425102, 2428102) Residence (2435387) Mobile 9824125445 email : pranavchishah@yahoo.co.in
Scholarship period April 17 2006 to June 13 2006

CONTENTS

1. Scholar Background
2. The Hospital for Special Surgery (HSS), NEW YORK.
3. The Orthopaedic Trauma Service at the HSS.
4. Clinical and Academic Experience
5. Daily Logbook
6. Strong and week points
7. Acknowledgements

Scholar Background :
Dr. Pranav A. Shah , is a practicing orthopedic surgeon in Vapi (a small industrial town in South Gujarat} since 5 years. He is also honorary orthopedic surgeon visiting government hospitals in Daman and Silvassa since 2001. Dr. Shah was 2nd rank in Gujarat University during M.B.B.S. from B.J. Medical college, Ahmedabad. He was topper in M.S. Orthopedics, also from Gujarat University. He did his D.N.B. also in 2001, from New Delhi. Dr. Pranav was selected from short-listed 9 candidates, by interview committee, under leadership of Dr. Mahendra Patel in January 2006. His special interest is in Trauma Care and complicated orthopedic trauma surgery. He also visited Johannesberg hospital trauma centre in November 2005, to study trauma system in South Africa.

The hospital for special surgery (HSS) New York :

The HSS is a premier super-speciality orthopedic hospital in Manhattan, N.Y. It is ranked 2 in U.S.NEWS survey for 2004 and 2005, among all orthopedic centers in the USA. It is a part of the New York Presbyterian healthcare system, affiliated to the Weil Medical College and Cornell University. They have fully functional subspecialities- Trauma, Arthroplasty, Sports medicine and Arthroscopy (official doctors for the New York Mets, Giants, and Yankees), Spine surgery, Pediatric Orthopedics, Hand surgery and Microsurgery and Rheumatology. There are 16 fully equipped, state-of-the-art operating rooms and 4 ambulatory surgical suites. Together they handle close to 16,000 musculoskeletal surgeries every year. Research and Continuing medical education is the hallmark here, apart from high quality healthcare. They also have an in-house journal – THE HSS JOURNAL, which is a reputed indexed journal and HSS intranet for academic inputs.

The Orthopaedic Trauma Service at the HSS :

Dr. David L. Helfet is the director of the OTS at the HSS, and he was my guide for this fellowship. Dr. Helfet is an international authority for Pelvis and Acetabular fractures and he is co-author with Dr. Tile in the TEXTBOOK OF PELVIC AND ACETABULAR FRACTURES. He is an A.O. instructor for trauma and has been course director and a well known teacher for advanced courses in pelvis and acetabular fractures. He has many papers in international journals on orthopedic trauma since last 3 decades. The OTS does not have a trauma centre, yet the trauma service is very busy with referred patients from all over USA and Canada, Europe and other countries. Most cases operated here are either pelvis and acetabulum fractures or complicated (loss of fixation, non-unions, etc) cases. The OTS is A. O. recognized teaching centre for fracture fixation techniques including the newer design locking plates for proximal and distal humerus, distal radius, proximal and distal femur, proximal and distal tibia, etc. There was an A.O. fellow from Italy for similar fellowship with me. Apart from learning in the clinics and O.R ( they were kind enough to allow us to scrub with them), there was also a psychomotor lab and a cadaveric lab for hands on training. We also got an opportunity to see advances in CAS (Computer assisted surgeries -with the navigator) and its use in complicated trauma surgeries.

Clinical and Academic Experience:

From clinics on Monday to surgeries throughout the week and reading at the research office on weekends, the learning experience at the HSS was extra-ordinary. Dr. Helfet and his team ( 3 fellows, 2 residents and 2 clinical assistants, apart from 2 international visitors and 5 office staff) are always on the move throughout the week. But the weekend was usually busier for him - being a teacher (Thailand, Switzerland and Canada in April and May) in A. O. advanced courses. Dr. Helfet has very good rapport with all his patients and he always insists on his students to learn good communication skills also. Appreciably, he never criticizes the work of the previous surgeon in complicated cases. There is emphasis on pre operative planning and most of the times the post operative X-ray will look exactly like the pre-op planned template. The use of C.T. scans, saw bone models and standard A.O. template sheets was compulsory in pre-op planning, which included the surgical approach, the fixation steps and the post-op rehabilitation. Academic meetings were conducted every Tuesday and Thursday at 7 am, wherein all interesting cases operated in the previous week were reviewed with relevant theoretical review of literature including clinical studies on the topic from the HSS. Every fortnight a symposium with hands on workshop was conducted in the psychomotor lab. I attended 2 symposiums – on fractures of pelvis and on fractures of calcaneum. Once a month, a prominent national teacher was invited for an oration on a topic of current interest (MRI in ankle injuries).

Daily Log Book :

DATE SURGERY OBSERVED

17-Apr CLINIC (opd from 830 am to 500 pm)
18-Apr Pelvis ORIF re-do, change of S I joint screw)
19-Apr Prox. Tibia ORIF with locking plate
20-Apr total knee replacement( 2 revisions)
21-Apr humerus shaft comm. # ORIF with locking plate
24-Apr CLINIC (opd from 830 am to 500 pm)
25-Apr non union prox 1/4 shaft tibia # tension band plating, 4 part prox humerus ORIF with humerus locking plate.
26-Apr 3 part prox humerus ORIF with locking plate (gardener approach)
27-Apr watched 3 shoulder arthroscopies
28-Apr watched 2 TKRs, (primary)
1-May CLINIC (opd from 830 am to 500 pm)
2-May ORIF (double plating) for comminuted # acetabulum(extended ilioinguinal approach), ROH
3-May Re-do for varus collapse prox. humerus plate. Distal 1/3 humerus plating with locking distal humerus plate.
4-May Re-do for failed TFN comminuted subtroch fracture with prox femur locking plate.
5-May pelvis ORIF for type 3 fracture (S I screws and plating symphysis)
8-May CLINIC (opd from 830 am to 500 pm)
9-May Re-do for failed LISS, lower 1/3 femur (ipsilat TKR done 2 yrs), 90/90 plating done with demineralised bone matrix
10-May 2 humerus shaft non unions (aseptic) ORIF + BG
11-May Ganz periacetabular osteotomy for DDH in 17 yr F
12-May ORIF for ant column comm acetabular # with ilioinguinal approach
13-May Symposium for calcaneal fractures and hands on workshop
15-May CLINIC (opd from 830 am to 500 pm)
16-May I/L nailing for OG2 # lower T/F, excission of HO for hip stiffness in 2 yr old ORIF # acetabulum
17-May excission of HO around knee, 2 Removal of Hardware (prox tibia and ankle)
18-May 3/52 maluniting ankle # ORIF (Fib plating,syndes stabilisation). Removal of tibia fixator
19-May hands on training for plating acetabulum on saw bone pelvis, S I Screw fixation and video demo
22-May CLINIC from 830 am, vascularised fibular graft for infected non union lower 1/3 tibia with double plating.
23-May 4 part I/A scapula, mid 1/3 clavicle # ORIF with both plating(scapula 3 minifrag plates)
24-May re-do for failed implant mid 1/3 clavicle #, ROH from prox tibia, ROH from olecrenon)
25-May watched arthroscopies of knee
26-May watched arthroscopies ( knee & shoulder)
29/5 to 13/6 Visited Metro hospital and trauma centre, Cleveland.
14 June Fly back to India

Strong and weak points :
 

This fellowship is probably the only one of its kind which allows an Indian doctor to visit USA and study the advances in orthopedic surgery, with expenses borne totally by the fellowship. This is the strongest point of this fellowship. This should certainly inspire other Indian stalwarts in the USA to get involved in such academic activities in other faculties as well. The efforts and the vision of Dr. Mahendra Patel, the strongest support of this fellowship, are really appreciable and he deserves many many thanks for this.
The fact that OREF is the official sponsor of this fellowship increases the credibility of the fellowship and is a matter of pride to the selected fellow. The Patel Travelling Fellowship is also listed in the OREF annual report and on the official OREF website. This is also a matter of honour for the Gujarat Orthopedic Association.
The weak points – THERE ARE NONE.

Acknowledgement:

The foremost thanks are due to Dr. Mahendra patel for starting a fellowship like this and for continually keeping in touch and guiding the fellow throughout his stay in the USA.
Thanks also to the selection committee - Dr. Manjul Joshipura, Dr. Pankaj Divetia, Dr. Harsh Shah, Dr. Pankaj Patel, Dr. M. M. Prabhakar and Dr. Jawahar Jethwa.
Thanks to the previous fellows who gave valuable guidance and who have set good example for future recipients.
Thanks to Dr. David Helfet, Rena, Craig, Dr. George Partal, Dr. Andrew and Dr. Yoram at the HSS, New York. Thanks to Dr. Brendan Patterson, Emigda, Shailja, Dr. Sontich and Dr. Siddhu from the Metro Hospital, Cleveland. They were all very helpful and co-operative in my study, stay and completion of the fellowship in the best possible way.

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