- Department of Orthopaedic Surgery -

Major changes have taken place in recent years. Prior to 1992 there was no Consultant Orthopaedic Surgeon on the Island and the service was limited to emergencies, minor elective surgery and out-patient consultations by a visiting Orthopaedic Surgeon.

This changed in 1992 when Mr David Pring was appointed, followed by Mr Nicolas Van der Hauwaert in 1996. This meant that most major surgery could be offered locally. At the same time various orthopaedic sub-specialities were developed such as advanced arthroscopic procedures, improved fracture care, spinal surgery, foot and hand surgery etc. The team increased to 3 with the appointment of Mr Vhadra in December 2004.

In 2006, Mr Van der Hauwaert returned with his family to Belgium. In February 2007, Mr Joslin was appointed and he then undertook further training in foot surgery before joining the team in January 2008.

The Orthopaedic Surgeons have a close working relationship with local supportive disciplines, including Dr Jocelyn Briggs, Consultant Geriatrician, specialised Physiotherapists (members of the Guernsey Physiotherapy Group), a dedicated Plaster Technician (Princess Elizabeth Hospital) and Occupational Therapists and they have developed many tertiary referral links with UK orthopaedic specialists.

Personnel:
Consultants Mr David Pring FRCS FRCS(Ed) MBBS
Mr Ranjan Vhadra MBBS, FRCS (Eng),
FRCS (Tr & Orth)
Mr Christopher Joslin MB ChB
FRCS (Tr & Orth)
Personal Assistants Mrs Louise Walster (PA to Mr Pring)
Sonia Le Messurier (PA to Mr Joslin)
Mrs Sue Laine (PA to Mr Vhadra)

Mr Pring trained as a general Orthopaedic Surgeon and has a special interest in shoulder surgery.

Mr Vhadra trained as a general Orthopaedic Surgeon and has a special interest in lower limb surgery, particularly hips and knees.

Mr Joslin trained as a general Orthopaedic Surgeon and has a special interest in foot surgery.

Acute Trauma

All fractures are seen in the Princess Elizabeth Hospital Accident & Emergency Department. The majority of cases are treated locally, but there are established links with centres of excellence in the UK - mainly Exeter and Southampton. Spinal injury patients are referred to Salisbury or the Royal National Orthopaedic. Soft tissue injuries requiring major plastic surgery are referred to Salisbury.

Fracture Clinics

5 per week

In addition to new fractures, soft tissue injuries, post-op orthopaedic and trauma follow up cases are seen. A hand clinic service is available for all hand injuries seen in A&E as a "safety net".

A fast track sports injury service is also provided.

Fracture Clinic Staff

Receptionists: 2
Plaster Technician: Mr Nigel Smith

Mr Smith is an accredited Plaster Technician who looks after plasters, braces etc. He also manufactures splints and orthoses using lightweight materials. Existing appliances and plasters can be seen by Mr Smith outside Fracture Clinic hours by contacting A&E.

Fracture Clinic Nurse

The A&E nurses staff the Fracture Clinics. This enables them to gain expertise in the diagnosis and treatment of fractures. This had led to better primary treatment of fractures in the A&E Department.

Operating Sessions

The department has 7.5 operating sessions per week.

Outpatient Clinics (Alexandra House)

Non-emergency referrals for orthopaedic assessment are allocated to all 3 Consultants except for sub-specialty referrals, requests for second opinions and referrals to a named Consultant. These are then categorised by the Consultant into Urgent, Soon or Routine appointments. There are 9 clinics per week at the MSG.

Alderney Clinics (Mignot Memorial Hospital)

Mr Pring holds an out-patient clinic in Alderney approximately once a month.

Patient Information Booklets

Information booklets regarding specific types of traumatic and acquired conditions and their treatment (conservative and operative) are available in both the MSG and Fracture Clinics.

Local interdisciplinary referrals

Geriatrics
Ozanne Ward is visited at least twice a week by a member of the Geriatric Team. Patients may be referred to the King Edward VII Hospital for rehabilitation.

Oncology
The Orthopaedic Department receive oncological referrals for the stabilisation of metastatic disease of long bones.

Rheumatology
A local service is provided by Dr Nigel Byrom, supported by visiting Physicians from Southampton (Dr Cawley and Dr Davidson)

Special Clinical Services

Investigations:

MRI Scans
MRI scans are now available in the PEH.

EMG studies
General EMG referrals are made to the Neurophysiology Department at Southampton or in cases of suspected thoracic outlet syndrome to Exeter or foot disorders to Bristol.

Ultrasound/CT scans are referred locally to the Department of Radiology at the PEH.

CT, MRI and ultrasound investigations for orthopaedic disorders should only be requested by the Consultants or after discussion with the Department of Radiology.

Fast Track Services - via GP referrals

  1. Fast track epidurals for sciatica - by letter directly to the Pain Clinic.
  2. Fast track knee referrals - acute knee injuries are seen in the Fracture Clinic (degenerative disease excepted).
  3. Hand injuries - fast track services are provided in the Fracture Clinic.

Operative Procedures

Joint Replacements
A 1st degree hip, knee and shoulder joint replacement service is provided. Implants include the Exeter cemented system, surface hip replacement (Corin), cemented hip (SL Plus), NexGen total knee and Oxford Unicompartmental, Copeland shoulder replacement and the Delta III.

Arthroscopic Surgery
A comprehensive knee arthroscopy service including meniscal repair, ACL reconstruction, chondroplasty, removal of loose bodies, patellofemoral re-alignment procedures and reduction and fixation of intra-articular fractures is provided. Arthroscopic procedures on the shoulder, ankle and elbow are also available.

Shoulder Surgery
Since 1992 Mr Pring has provided a shoulder service which now includes shoulder replacements, diagnostic and operative shoulder arthroscopies.

Complex Foot Surgery
Mr Joslin provides a foot service including ankle replacements, Os calcis osteotomy, mid and hind foot fusion, tendon transfer and lengthening and bunion surgery.

Hand Surgery
Carpal tunnel, trigger finger, fusions, scaphoid grafting, trapezectomies, Dupuytren's, etc.

Trauma Surgery
A vast stock of modern implants is available to internally stabilise long and small bones as well as a choice of external fixators.