Linking orthopaedics and radiology - The plain film revisited I: The lower limb Programme

Linking orthopaedics and radiology - The plain film revisited I: The lower limb Registered Charity No: 215869

17 October 2013 Venue: The British Dental Association 6 CPD credits

Welcome and thank you for coming to the ‘Linking orthopaedics and radiology - The plain film revisited I: The lower limb’ event organised by the British Institute of Radiology.

This booklet contains the abstracts and biographies for each speaker (where supplied).

This meeting has been awarded 6 RCR category I CPD credits. CPD certificates will be distributed by email within 2 weeks of the meeting after the online delegate survey has been completed.

Please complete the online delegate survey using the below link. We will use your valuable feedback to improve future conferences. https://www.surveymonkey.com/s/Linking_orthopaedics_and_radiology We hope you find the day interesting and enjoyable.

Adam Mitchell Consultant Radiologist Chelsea and Westminster Hospital Meeting Organiser

We are most grateful to

for supporting this conference

Programme 08:30

Registration and refreshments

09:00 Common errors in MSK radiology of the lower limb Dr James Teh, Consultant Radiologist, Nuffield Orthopaedic Centre 09:45

Sports injuries & plain films: A sports physician’s perspective

Dr Rick Seah, Consultant in Sport & Exercise Medicine,

English Institute of Sport & Pure Sports Medicine Clinic

10:30

Refreshments

11:00

The hips and joint replacements Dr Adoni Toms, Musculoskeletal Radiologist and Mr John Nolan, Consultant Orthopaedic and Hip Surgeon, Norfolk and Norwich NHS Trust

11:45 The knee Dr Ben Roberton, Consultant Musculoskeletal and

Interventional Radiologist and

Mr Charles Gibbons, Consultant Orthopaedic Surgeon,

Chelsea and Westminster Hospital NHS Trust 12:30

The foot and ankle

Dr Monica Khanna, Consultant Radiologist and

Mr Pete Rosenfeld, Consultant Orthopaedic Foot and Ankle Surgeon, Imperial College NHS Trust

13:15

Lunch

14:15 Avoiding mistakes in bone tumour imaging: the lower limb Dr Steve James, Consultant Musculoskeletal Radiologist, The Royal Orthopaedic Hospital 15:00 Pelvic trauma Mr Paul Culpan, Consultant Orthopaedic Surgeon,

The Royal London Hospital 15:45

Refreshments

16:15 Quiz Dr Robert Pearce, Consultant Radiologist, Chelsea and Westminster Hospital NHS Trust Dr Warren Davis, Consultant Musculoskeletal Radiologist,

Ipswich Hospital 17:00

Close of meeting

Speaker profiles (where supplied) Mr Paul Culpan Consultant Orthopaedic Surgeon, The Royal London Hospital Paul qualified in Medicine from the University of Manchester in 1996 having previously completed a BSc from the University of St Andrews. His post graduate basic surgical training was undertaken through Bart’s and the Royal London surgical rotations. Following this he entered higher surgical training in Trauma and Orthopaedics on the University College London rotation. He became a Fellow of the Royal College of Surgeons (FRCS Tr & Orth) in 2005 and completed his higher surgical training in 2007.

He spent a one year fellowship in France working at the famous orthopaedic teaching centre in Garches, Paris. During this year he gained particular expertise in minimally invasive hip replacements and revision hip surgery and acetabular trauma.

Following this he moved to Abu Dhabi where he spent two and a half years working as a consultant in the largest public hospital in the country. He developed a specialist interest in pelvic and acetabular trauma.

He returned to London in 2010 to start up a pelvic and acetabular trauma unit at Bart’s and the Royal London Hospital which has developed into one of the busiest centres in the country.

Dr Warren Davis Consultant Musculoskeletal Radiologist, Ipswich Hospital Dr Davis participated in the University College Hospital training scheme. He completed a Musculoskeletal Imaging Fellowship at the Royal London Hospital and was appointed Consultant Musculoskeletal and General Radiologist at Ipswich Hospital January 2012.

Mr Charles Gibbons Consultant Orthopaedic Surgeon, Chelsea and Westminster Hospital NHS Trust Mr Charles Gibbons was appointed to The Chelsea and Westminster Hospital in 2002. He qualified at The London Hospital in 1989 and undertook junior surgical training in Bath, Stanmore and Chelmsford. He was a Knee Fellow in Melbourne and then undertook fellowship training at The Royal Adelaide Hospital in 2000.

He has published papers on bone mineralisation around prosthetic components, arthroscopic synovectomy of the knee, and cryotherapy after knee replacement surgery.

Dr Steve James Consultant Musculoskeletal Radiologist, Royal Orthopaedic Hospital Dr Steven James is a Consultant Musculoskeletal Radiologist whose NHS base is the Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham. After undertaking his radiology training in Nottingham, he completed a fellowship in musculoskeletal radiology at the Royal National Orthopaedic Hospital in London.

He has co-authored over 60 peer reviewed scientific papers and maintains a strong research and academic interest. He lectures regularly at both a national and international level. Dr James works at a tertiary referral centre for orthopaedic oncology and has developed a specialist interest in bone tumour diagnosis and intervention.

Dr Monica Khanna Consultant Radiologist, Imperial College NHS Trust Dr Monica Khanna is a Consultant Radiologist at Imperial College Healthcare NHS Trust. She has been trained at the RNOH, Stanmore, and in Toronto and is a dedicated full time Musculoskeletal Radiologist. She has co-authored two books and contributed to the MSK literature. She has presented at a number of national and international meetings on various aspects of MSK imaging and teaches on dedicated MSK imaging courses.

Mr John Nolan Consultant Orthopaedic and Hip Surgeon, Norfolk and Norwich NHS Trust John Nolan has been putting hip replacements in and taking them out (not necessarily the same ones!) in Norwich for 20 years and has completed over 5000 procedures.

He has a particular interest in metal-on-metal hips and has published extensively on these as well as the outcomes of hip surgery.

He has been a member of the Executive Committee of The British Hip Society for 6 years and will be President of the Society in 2015.

Dr Robert Pearce Consultant Radiologist, Chelsea and Westminster Hospitals NHS Trust Dr Robert Pearce studied medicine at Magdalene College, Cambridge and Imperial College, London graduating in 2000. He spent 5 years as a specialist registrar in Radiology at University College Hospital, London and received subspecialty training in musculoskeletal radiology at University College Hospital and the Nuffield Orthopaedic Centre, Oxford. He was appointed as a Consultant Radiologist at Chelsea & Westminster Hospital in 2011.

Dr Ben Roberton Consultant Musculoskeletal and Interventional Radiologist, Chelsea and Westminster Hospital NHS Trust Dr Roberton undertook undergraduate training at the University of Edinburgh and postgraduate medical training across London, before higher training in radiology at Chelsea and Westminster Hospital. His later experience included a musculoskeletal imaging fellowship, with an emphasis on sports imaging and musculoskeletal ultrasound and a prestigious interventional radiology fellowship in Vancouver, Canada, gaining experience in advanced interventional techniques with an emphasis on oncologic and musculoskeletal intervention, before returning to Chelsea and Westminster Hospital as a consultant radiologist. He has published and presented internationally on a range of topics including foot and ankle imaging, hand imaging and intervention, bone and solid organ thermal ablation and radioembolization.

Dr Rick Seah Consultant in Sport & Exercise Medicine, English Institute of Sport & Pure Sports Medicine Clinic Rick qualified from Guy’s & St Thomas’ Hospitals Medical School, King’s College London. He obtained his master’s degree in SEM with distinction from University College London.He is listed on the GMC specialist register and is a Fellow of the UK Faculty of Sport & Exercise Medicine- FSEM(UK)-, RCPL & RCSEd. He is also an accredited member of the Academy of Medical Educators.

Rick is an accredited specialist in Sport & Exercise Medicine (SEM), having completed 4 years on the London Deanery ‘run-through’ higher specialty training rotation and an extra year as a senior registrar. His specialist registrar postings include the Royal London, Whittington, University College, Homerton, St Mary’s and Charing Cross Hospitals; Royal National Orthopaedic Hospital, Stanmore and the Defence Medical Rehabilitation Centre, Headley Court.

He was an honorary research fellow at the Olympic Medical Institute and University of Southampton in 2005, carrying out clinical research to measure levels of endogenous hGH-markers in injured athletes. He was recipient of the UKADIS Malcolm Read Scholarship Award in 2009. He was a sports doctor at both Olympic & Paralympic Games in London 2012 and continues his involvement with elite sports via the English Institute of Sport.

Dr James Teh Consultant Radiologist, Nuffield Orthopaedic Centre I am a Consultant at the Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust in Oxford. I trained at Charing Cross and Westminster Medical School, University of London and qualified in 1990.

My radiological practice covers all aspects of the locomotive system including the spine. I have a particular interest in the imaging of sports injuries, rheumatological conditions and musculoskeletal tumours.

I am an Honorary Senior Clinical Lecturer for Oxford University. I act as reviewer for the British Journal of Radiology, Skeletal Radiology, Forensic Science International, British Medical Journal, Clinical Radiology, European Radiology and Investigative Radiology. I am an editor for Imaging, the educational journal of the British Institute of Radiology. I am clinical tutor for the Royal College of Radiologists. I am educational supervisor for the Oxford Radiology trainees.

I have published over 40 peer-reviewed papers and 9 chapters on musculoskeletal radiology.

Dr Adoni Toms Musculoskeletal Radiologist, Norfolk and Norwich NHS Trust Andoni Toms has spent 11 years as a Musculoskeletal Radiologist trying to solve problems for orthopaedic surgeons in Norwich. His interest in imaging of hip prostheses started with the problems encountered with metal-on-metal hips in 2005 and has led to a number of publications on plain film imaging, MRI and metal artefact reduction in hip replacements.

Abstracts (where supplied) Common errors in MSK radiology of the lower limb Dr James Teh Many injuries to the lower limb visible on X-ray have characteristic appearances according to the region injured and mechanism of injury. This lecture will cover the common errors of interpretation of lower limb injuries. The following injuries will be covered: Hip and femur Missed hip fractures Bisphosphonate fractures SUFE Avulsion injuries Knee Avulsion injuries Ankle Maissoneuve fracture Lisfranc fracture dislocation Talus fracture Paediatric ankle injuries Peroneal retinaculum avulsion 5th metatarsal fractures

Sports injuries & plain films: A sports physician’s perspective Dr Rick Seah Sports and musculoskeletal injuries are common in both elite and amateur sports. MRI scans are often requested to look for both soft tissue and bony pathology in such scenarios, but the importance of the humble plain film or ‘X-ray’ should not be overlooked. The findings on an initial plain film may heavily influence sports medicine management, particularly when a fracture is suspected. Utilised correctly, the plain film can offer additional information not readily available with more expensive imaging modalities.

The hips and joint replacements Dr Adoni Toms and Mr John Nolan Together they have reviewed hundreds of hip x-rays and correlated the appearances with intra-operative findings at revision surgery. This talk started as an instructional lesson for registrars and has been developed to cover and explain some of the many appearances seen on the plain films of hip replacement patients.

The knee Dr Ben Roberton and Mr Charles Gibbons Plain film protocols covering standard and specialist views. Assessment of the medial and lateral compartments, the patella and patellofemoral compartment (measurements of alta and baha), morphology classification, Dejour classification and dislocation injuries. Arthroplasty and osteotomies, a surgical perspective and complications. Knee reconstructions and assessment. Fracture patterns and pitfalls.

The foot and ankle Dr Monica Khanna and Mr Pete Rosenfeld Clinical and radiological interactive assessment of foot and ankle cases will be discussed highlighting the thought processes between the clinician and the radiologist in their assessment of foot and ankle radiographs. We will discuss the benefit of certain radiographic views in improving diagnostic accuracy and influencing management. Limits of radiographs and the need for further imaging will also be touched upon.

Avoiding mistakes in bone tumour imaging: the lower limb Dr Steve James The aim of this presentation is to illustrate some common mistakes or errors that can occur in the diagnosis of lower limb bone tumours. This will focus on radiographs and the radiographic characterisation of bone lesions. The importance of knowing patient age will be discussed as well as the impact of radiographic technique in diagnosis. The implications of diagnostic error will also be addressed focusing on some specific cases to show the unfortunate outcomes that may occur when optimum image interpretation and staging is not performed.

Pelvic Trauma Mr Paul Culpan This talk will aim to outline the specific detail and a system that a Pelvic and Acetabular surgeon may use in evaluating plain radiography of the pelvis. It will outline the various radiographic lines and features from which the surgeon is able to classify the fracture pattern and explain how this can assist in his surgical planning. The importance of Judet views in interpreting an acetabular fracture; and of the pelvic inlet and outlet views in defining a pelvic ring injury will be illustrated. The talk with also lead into the role of plain imaging intra operatively and will hope to provide a surgical context for why the Pelvic and Acetabular trauma surgeon is still relying on plain radiography today.

Quiz Dr Robert Pearce and Dr Warren Davis This session is an informal quiz, consolidating some of the themes of the day. The quiz will focus on subtle and / or clinically important pathology.

Please remember to complete the online delegate survey using the below link. https://www.surveymonkey.com/s/Linking_orthopaedics_and_radiology Your certificate of attendance will be emailed to you within the next two weeks once these have been completed.

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28 february 2014 london biological optimisation in radiotherapy 13 march 2014 london GO TO WWW.BIR.ORG.UK FOR MORE INFORMATION AND TO REGISTER!

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