The General Orthopaedic division is the youngest division in the department. It was established on January 1st of 2005 during the departmental infra-structure reform when three teams were restructured into seven sub-specialty divisions. The main aim of creating this division was to train orthopaedic surgeons to manage general orthopaedic problems and master common orthopaedic surgical procedures. These invaluable skills can later be carried out into private practice.
The division is responsible for the front-line management of all orthopaedic emergency admissions, interdepartmental consultations in Hong Kong West Cluster and triaging complicated orthopaedic problems to other divisions. Some of the general orthopaedic problems include geriatric hip fracture, bone and joint degeneration, infections and tumours. These are the patient groups that have the highest demand on public health services in our cluster. With an ageing population, we expect an increasing demand in general orthopaedic care.
The division plays an important coordinating role in the department. Through coordination, we aim at efficient utilization of the manpower and resources. The division therefore works intimately with other divisions in various meetings, operative sessions, and specialist out-patient clinics.
Our division includes five to six trainers and equal number of trainees. Some of the trainees in the division are rotation trainees from various departments. To ensure adequate supervision and quality patient care, we adopt the principle of “specialist-led service” in all clinical duties. Moreover, structured training activities are organized for our juniors. These include a series of seminars emphasizing on common orthopaedic problems and practical pitfalls. In our “general round”, division members take turn to organize journal reviews and clinical case conferences. During the weekly “peri-operative meeting”, all operated and scheduled cases are discussed. Members can share their experiences during the meeting and at the same time proper pre-operative preparations are ensured. Our division also collaborates closely with the radiology and pathology departments in organizing the “musculoskeletal round”. Patients with diagnostic challenges or interesting radiological or pathological findings are discussed.
Queen Mary Hospital has been endorsed as one of the three quaternary referral centres for musculoskeletal tumours in Hong Kong since 2000. We provide care for oncology patients referred from other HA hospitals and private doctors of Hong Kong. A multidisciplinary team approach is essential in the management of musculoskeletal tumours. We have established a multidisciplinary team including clinical oncologists, paediatric oncologists, orthopaedic surgeons, radiologists and pathologists.
All referrals are screened by our oncology specialists and consultations are arranged within minimal waiting time. All tumours are staged and worked up according to specifically designed protocols. The overall treatment plan is designed after assessment by the multidisciplinary team and thorough discussion with patients and their relatives.
Surgeries ranging from simple excision to wide resection of tumours with complex reconstruction are performed. With the advancement in technology and surgical skills, we are capable of performing limb-sparing resection with similar oncological outcome as the amputation. Large bone defects are usually reconstructed with tumour prosthesis. In selected cases, various bone and soft tissue allografts are used.
Most of the primary bone malignant tumours are found in adolescents close to the growth plates. One of the surgical challenges is the anticipated leg length discrepancy resulting from tumour resection. We have successfully implanted the “growing prostheses” to paediatric tumour patients. Through minimally invasive or non invasive procedures, the prosthesis can be lengthened to equalize the leg length of the patient during growth.
The advancing technology of computer navigation has been applied to assist multiple orthopaedic operations. We are routinely using the technology in minimal-invasive total knee arthroplasty and high tibial osteotomy. The surgeon can accurately determine the bone cuts, limb alignment and prosthesis position using the navigation system. Navigation technology has also been successfully used in femoral osteotomy.
Computer navigation in orthopaedic oncology surgery has also become a routinely applied technology to provide precise pre-operative planning and accurate bone cut intra-operatively. Without it, some surgeries cannot be accurately performed.Massive acetabular metastasis can also be reconstructed by fixing the acetabular component on a framework of threaded pins. The pins are inserted accurately through navigation into the remaining intact pelvis.
A significant number of our patients suffer from musculoskeletal infection. These range from life-threatening necrotizing fasciitis to complicated chronic osteomyelitis. The management of orthopaedic infection especially the acute ones require high index of suspicion and experience. With the accumulation of extensive experience, our division is developing in the direction of “subspecialization” in musculoskeletal infection.
Osteoporosis-related fractures are becoming a growing problem. This is particularly essential in our cluster, which is the eldest part of Hong Kong. General Orthopaedic Division actively collaborates with the Trauma Division and the Department of Medicine in organizing a holistic fragility fracture management program. We aim to achieve secondary fracture prevention in our osteoporotic patients through proper investigations, education, drug treatment and regular monitoring.