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Report on the Bali trip, Lower Limb Trauma Symposium January 2012

The year 2012 started off on a high note with an invitation from Professor Bill Cummings for Dr George and me to attend a Traumatology symposium in Denpasar, Bali, Indonesia from the 23rd to the 24th January 2012. Preparations were somewhat disastrous resulting in only me having to catch a flight which did not include flying through Australia because of Visa difficulties.

Just like one has to do pre-planning before surgery, we did not do so in our flight arrangements: that was a lesson learnt the hard way.

The flight involved me flying through Port Moresby to Singapore to Denpasar, Bali. I spent a night in Singapore before flying off to Bali the next day and had to catch a cab to the Hotel Sanur Paradise. This Hotel was not only beautiful but only a 30 minute ride from the hospital.

garden pool
Sanur Paradise Hotel, Denpasar, Bali

After settling in we had a beautiful dinner with the team (Professor Bill Cumming, Professor Joe Gabriela, Dr Ben Jeffcott and 3 registrars from Australia, Andrew, James and Tom) the next day everything kicked off at the conference room in the Sanglar Hospital with numerous presentations and intense discussions with teaching from knee dislocations to fractures of the proximal tibial to Lisfrancs in the foot.

external fixation
Case of open fracture initially treated with
external fixation with the final outcome beside

There were also stations with models in knee arthroscopy and even two surgical cases done in the operating theatre. One was a open complicated open fracture with chronic osteomyelitis resulting in debridement, Ilizarov Fixation and a rotational flap from the plastic surgeons. The second was just another demonstration of knee arthroscopy in a patient with findings of a bucket handle tear.

in the workshop during surgery
Showing of the arthroscopy set in the workshop and also during surgery

Despite all the difficulties in getting to Denpasar I have to admit that this short stay in Bali was enriching for me in that I not only learnt from very experienced orthopaedic surgeons but also interacted with trainees who also had similar working environment and experiences as in the Solomon Islands. I look forward to more of such training and would like to thank my sponsors from S.S.C.S.i.P in FSM, Fiji and the Solomon Islands Government. Special thanks go to Professor Bill Cummings for his invitation to the Symposium and also for Dr Des Soares for organizing my stay. I would like to thank Professor Joe Gabriela and Dr Ben Jeffcott and the team for their teaching during the symposium. Lastly but not the least I would also like to thank Mr. William Soaki and Mr. Didi from the Solomon Islands Consular in Papua New Guinea and Indonesian Visa office for organizing my visa. To my team in the Orthopaedic thank you all for covering me during my absence from work. Tagio tumas.

  1. What did I learn?
    1. Ilizarov Technique
      The indication of this technique in an open fracture with shortening and later fixation using this technique
    2. Knee Arthroscopy
      I continued to have hands in the knee model in rotation and angulation with the arthroscopy equipment
    3. Knee Reconstruction
      In knee dislocation I learnt the importance of the posterior lateral stabilizers during fixation.
    4. Pelvic Injury
      The importance of reducing sacroiliac joint dislocation in trauma before doing any other fixation in the pelvis.
    5. Importance of soft tissue care in trauma management
      Review of soft tissue injury and infection before fracture fixation. Review of classification of open fractures
    6. Lizfrancs injury
      Importance of fixation of this type of fracture in our setting.
    7. Proper preparation in travelling
      Visa and ticketing
  2. What will I change in my daily work?
    1. Knee arthroscopy
      Should start doing knee arthroscopy in theatre and
    2. Pre-planning to do in all surgical cases
    3. Early closed reduction in all joint dislocations. The sooner the better the outcome.
    4. More knowledge in the modalities of fixation of open fractures example, the Ilizarov versus traditional external fixation.
  3. What do I want to learn next?
    1. ATLS
    2. Advanced AO Trauma Course
    3. Shoulder
      1. Rotator cuff surgery
      2. Arthroscopy

© January 2012, Dr Alex Bradley Munamua