BOA Travelling Fellowship Report – Limb Reconstruction Service

NSW, Sydney, Australia

Iundertook a six-month fellowship under the supervision of Dr Tim O’Carrigan at the Limb Reconstruction Service NSW, based at Macquarie University Hospital. After completing training, I was keen to undertake a fellowship where I would be exposed to a breadth of techniques in foot and ankle surgery, as well as complex deformity correction.

My specific aims were to develop experience in the areas of minimally invasive foot and ankle surgery, ankle arthroplasty and lower limb deformity correction. The fellowship provides extensive exposure to minimally invasive procedures, including bunion correction (eg, MICA), lesser toe deformity correction, distal metatarsal minimally invasive osteotomy (DMMO), calcaneal osteotomy as part of flatfoot or cavovarus corrections, as well as applications in diabetic foot to offload bony prominences. In addition to learning the techniques, it was particularly interesting to see the benefits of a minimally invasive approach when patients return to clinic with less pain and swelling than I have observed with some of the traditional open procedures.

There was an emphasis on ankle arthroplasty using computed tomography (CT)-based planning, and 3D-printed patient specific jigs to narrow the error margins when judging implant position and alignment. In complex cases, a weight bearing CT was used to assess and plan correction of intra/extra-articular deformities, which was carried out either at the time of the ankle arthroplasty or as a staged procedure in more severe cases.

There is a fortnightly combined complex clinic where patients with severe deformities attend for assessment and a consensus opinion on management. CT imaging is linked with modelling software to understand the deformity and to plan the correction in detail. This formed the basis for manufacturing 3D-printed patient specific jigs to maximise the accuracy and effectiveness of the deformity correction. It was particularly interesting to understand the process using the modelling software, which is led by Dr Mustafa Alttahir, and to see how this translated into very accurate and easy-to-use jigs in the operating theatre. This clinic was a great learning experience, seeing a high volume of cases in patients with deformities associated with, for example, trauma, congenital abnormalities and polio. n