Division of Orthopaedic Trauma

 

Staff

 

Mission

‘Excellence in the management of musculoskeletal trauma’

This implies:

  • Managing patients with musculoskeletal trauma by a team of staff dedicated to the continuous advancement in trauma care
  • Facilitating research and quality control in trauma care through standardization of surgical routines and documentation
  • Providing of training and updating knowledge of trauma surgeons
  • Establishing an international identity in collaboration with other organizations and institution
  • Overview of Orthopaedic Trauma Service

 

Background

The Division of Orthopaedic Trauma was officially established during the major restructuring of our department in 2003. Trauma service plays a major and crucial role in our department, both in the field of clinical service, research and education. Our mission is to provide the best trauma service to our patients by the fusion of traditional wisdom and newest technology, and to lead our Department to be one of the best trauma centres in the world. Not only serving the south of Hong Kong island where many elderly are living, we are the level 1 trauma centre in Hong Kong as well as the tertiary referral centre of complicated trauma cases. As one could imagine, there is a constantly high admission rate of a wide variety of trauma cases ranging from simple hip fractures to complicated multiple trauma cases. Despite this immense workload, our long developed and well organized trauma operation list system helps to alleviate the situation effectively. The trauma list system not only helps to shorten the pre-operative waiting time for the trauma patients, it also provides a good opportunity for the senior surgeons to share their experience and educate the trainees in a structured manner.

Regular follow-up of our patients in the out-patient clinic comprises a major part in our daily work. Although the work load is always high in trauma division, in order to improve our service, special outpatient clinics were set-up in order to explore and evaluate the newly developed techniques and implants. Through this constant and regular assessment of patient clinical outcome, many clinical studies are performed, completed and published in international journals.

Among all the trauma cases, the hip fracture is probably the commonest but definitely not the easiest fracture to treat. Yearly, there were about 400 hip fracture cases admitted. With the improvement of medical care, the life expectancy of our population is increasing. Elderly with multiple medical problems and extreme age are frequently admitted with fractures in very osteoporotic hips. Since the early 2007, our department was the first in the region to introduce the Critical Clinical Pathway for Geriatric Hip Fractures. Through the cooperation between the trauma surgeons, anaesthetists, nurses and allied health personnel, the average pre-operative waiting time improved to less than 48 hours after admission. Also the average length of hospital stay was shortened by 5 days. This achievement was recognized and received the Hospital Authority Outstanding Team Award in 2007/8. The work will not stop here. The liaison with the Department of Medicine to investigate the increasing problem of osteoporosis is another big leap in the management of the hip fracture patients in Hong Kong.

Minimally invasive surgery is now part of the standard management in our daily service whenever applicable. The technique has been refined in the past years. The preservation of soft tissue viability, careful handling of traumatized area and the utmost attention to the biology of bone healing have led us to achieve excellent results in fracture management reaching international standards. The years’ experience in minimally invasive surgery leads us to share some of the good and bad in this technique and these were also published in international trauma journals.

With the frequent use of minimally invasive surgical technique, increased exposure to radiation during intraoperative assessment is inevitable. Therefore, the development of computer navigation aided surgery naturally follows. Our application of computer navigation in trauma service ranged from acute pelvic fracture fixation to late reconstruction of long bone malunion. We believe that the development of computer navigation assisted operation is only in its infanthood. With the light-speed improvement of computer hardware and software, we are going to explore the potential of this technique.
 

Representative Publications in Scientific Journals

  • Leung F, Chow SP: A randomised prospective trial comparing Low Contact Dynamic Compression Plate and Point Contact Fixator in forearm fractures Journal of Bone and Joint Surgery, American vol., Dec 2003; 85: 2343-2348
  • Leung F, Tu YK, Chew W, Chow SP: Comparison of External and Percutaneous Pin Fixation with Plate Fixation of Intra-articular Distal Radius Fractures: A Randomized Study Journal of Bone and Joint Surgery, American vol., Jan 2008; 90:16-22
  • Leung F, Zhu L, Ho H, Lu W, Chow SP: Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate – a biomechanical study in a cadaveric model The Journal of Hand Surgery (British), vol 28B, 3, June 2003: 263-6.
  • Leung F, Chow SP: Locking compression plate in the treatment of forearm fractures: a prospective study Journal of Orthopaedic Surgery 2006:14(3):291-4
  • Leung F, Ozkan M, Chow SP: Conservative treatment of intra-articular fractures of the distal radius – factors affecting functional outcome. Hand Surg, Dec 2000, 5, No. 2, 145-153
  • Leung F, Xiang Z: Locking Compression Plate fixation for periprosthetic femoral fracture Chinese Journal of Reparative and Reconstructive Surgery, 2, (16), March, 2002
  • Leung F, Kwok HY, Pun TS, Chow SP: The use of Ilizarov external fixation in distal tibia fractures Injury 2004 Vol 35/3, 278-283
  • Leung F: Editorial – Surgery for elderly wrist fractures: For better form or better function? Journal of Orthopaedic Surgery 2005:13(3):221-222
  • Leung F, Paata G, Fung B, Chow SP: Arthroscopic assessment of soft tissue injuries in comminuted intra-articular fractures of the distal radius The Chinese Journal of Orthopaedic Trauma, March 2006, vol. 8 (3), 203-207
  • Leung F: Editorial – What is the goal of surgical treatment of elderly distal radius fractures? The Chinese Journal of Orthopaedic Trauma, March 2006, vol. 8 (3), 201-202
  • Lau TW, Leung F, Chan CF, Chow SP: Wound complication of minimally invasive plate osteosynthesis in distal tibial fracture Int Orthop. 2007 Jun 16; Epub ahead of print
  • Lau TW, Leung F, Chan CF, Chow SP: Minimally invasive plate osteosynthesis in the treatment of proximal humeral fracture Int Orthop. 2007; 31: 657-664
  • Wong MK, Leung F, Chow SP: Treatment of distal femoral fractures in the elderly using a less-invasive plating technique Int Orthop. 2005 Apr;29(2):117-20.
  • Chow SP, Leung F: Trauma Care system in Hong Kong Injury Sep 2003;34(9):684-5
  • Haroon R, Leung F, Lu W, Fung B, Chow SP: Biomechanical Evaluation of Plate Osteosynthesis for AO type C2 Fracture of the distal radius – a cadaver study Hand Surgery , Dec 2003, vol 8, no. 2
  • Zhu L, Ho H, Lu W, Leung F, Chow SP: A cadaveric model for biomechanical study of fixation methods for AO type C2 fractures of distal radius: design and testing with dorsal plating fixation. Hand Surgery Dec 2002;7(2):279-83
  • Zhu L, Ho H, Lu W, Leung F, Chow SP: A cadaveric model for biomechanical study in fixation methods for distal radius fracture of AO type C3. The Chinese Journal of Orthopaedic Trauma, Dec 2002, vol 4, no. 4
  • Lu W, Zhu LJ, Ni G, Leung F, Chow SP: Five fixation methods for unstable intra-articular fractures of the distal radius: an in vitro biomechanical study using cadaveric model The Chinese Journal of Orthopaedic Trauma, March 2006, vol.8 (3), 208-211

 

Publication in Book Chapters

  • AO Manual of Fracture Management: Internal fixators (LISS and LCP),Stuttgart, Thieme Verlag. Proximal Humeral fractures 6.1.7; Distal tibial fractures 10.2.4
  • AO Manual of Fracture Management: Minimally invasive plate osteosynthesis (MIPO), Stuttgart, Thieme Verlag. Implants (Chapter 4); Reduction techniques (Chapter 7); Humerus, Proximal 11.2; Femur; Distal 15.2; Tibia and Fibula, Proximal 16.3

Future Development

With the increasing number of geriatric fracture patients, one would expect the multiple difficulties encountered in trauma service. Introduction of good implants and techniques to tackle these osteoporotic fractures is important but only comprise a small part of the whole management plan. Good medical support, follow-up treatment of the osteoporosis, prevention of fracture in high risk groups and tailored rehabilitation plans are all the aspects we are facing in the future.

The collaboration of computer navigation and modern techniques in fracture management will be another future trend. Through the structural gathering and evaluation of the result and then critical analysis of the data, the future of our clinical practice will be based on our published conclusions. We always believe education is very important. The continued support to various courses, workshops and seminars in other countries is one of our future objectives.

C3 distal radial fracture, locking plate fixation

Minimally invasive surgery

Pre-operative planning

Surgery

Computer navigation surgery

Biomechanical testing

Cadaveric workshop in minimally invasive surgery

AO course

Pelvic ring fixation

(Left) Periprosthetic fracture fixation
(Right) MIPO of humerus