AO Masterclass in post traumatic deformity – Tübingen 2017

Ronald van Heerwaarden and Steffen Schröter were the course convenors of the AO Masterclass in post traumatic deformity (April 2017) in Tübingen near Stuttgart in Southern Germany.

There was an excellent international faculty in addition to the German national faculty - all real experts in osteotomy and particularly post-traumatic deformity.

The UK experts were David Elson and Matt Dawson, myself and Chris Wilson. The German experts included Ronald, Steffen, Joerg Harrer and Atesch Ateschrang. Vladimir Goldman was the expert from Jerusalem. All really leading world experts in osteotomy and particularly in the really more difficult cases of post-traumatic deformity.

Matt Dawson

Ronald van Heerwaarden

What was new?

The interesting thing about this course was the fact that it was pitched at a very senior level to consultants, most of whom had many years of trauma experience, and it was predominantly 'case-based' discussions. So that meant we could take delegates through the whole gamut of different injuries to the joint surface - both medially and laterally - and outside the joint, with extra-articular deformity causing problems to joints above and below.

The faculty had a huge experience and there were many cases of extreme deformity, particularly from Israel and Germany where Vladimir and particularly Steffen and Joerg are considered to be National experts and there units to be referral centres.

It's amazing just how far we have got in terms of the extremes of deformity that we can treat - some of the cases were so extreme. There was one case in particular of a 7-year old boy who was a patient of Joerg's from Angola - he had had a road traffic accident and his distal tibia (shin) healed at 90 degrees to the angle it should have been in - so his foot was completely pointing in the wrong direction! Joerg was able to re-fracture this and osteotomise, removing 4 cm of bone and straighten his leg using a frame. He managed to gradually lengthen his leg back to the normal length with a normal result, which was just superb.

Precise lengthening nail

We've come a long way with lengthening, and the new Precice lengthening nail is a fantastic device that allows limb lengthening very safely. The faculty were using the nail regularly and none of them reported any failures but had only excellent results with this innovative piece of equipment from NuVasive. It's a nail that is motorised and is controlled by the patient at a rate that is appropriate, and using magnets and an external control device the nail can progressively be lengthened up to 7 centimetres.

My key takeaway

The key message for post-traumatic deformity is that osteotomy now has the leading position in re-aligning and - where appropriate - lengthening deformed limbs. The opportunity for biological as opposed to non-biological options is ever expanding. I have many cases of my own of extreme post-traumatic deformity where we've carried out operations to realign and restore the joint to its normal shape. And the most interesting thing about these cases is - if you get it right - your patients end up with a totally normal outcome.

It was a great meeting. As always I learned a lot and am glad that I was able to make some good contributions. Ronald and Steffen should be commended for this superb course.

Steffen put on a superb two day course, which included live demonstrations of the approaches for osteotomy surgery.

It was a fairly closed course sent out to trauma experts through the AO Foundation so we only had 30-40 delegates, which made it small enough such that we could break into small tutorial groups. We then used case-based discussions to take the delegates through interesting cases discussing the different types of osteotomy using plates, nails and other techniques for fixation.

They have to be one of the leading cadaveric facilities in Europe at the University of Tübingen. Approaches are everything for osteotomy and this teaching session I think was extremely valuable for delegates. It's all about appropriate exposure and safety - and making it easy.

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