Lower Extremity & Trauma

Sunnybrook Health Sciences Centre

Number of Positions

2 per year

Duration

1 year

Site

Sunnybrook Health Sciences Centre, Bayview Campus

Supervisors
  • Dr. Hans Kreder
  • Dr. David Stephen

This is a one year Fellowship Program devoted to the educational activities related to the care of the critically injured patient, the integration of the orthopaedic care of these injuries with other specialties, as well as the rehabilitation and management of the musculoskeletal consequences which may result from these injuries.

This is carried out in conjunction with the core orthopaedic surgical program, allowing for experience in adult trauma and fracture management, their sequelae and complications. Subspecialty exposure to spine, post-traumatic reconstruction, upper extremity surgery, soft tissue and micro vascular techniques will also be encouraged.

The caseload, wherein the trainee is either the primary surgeon or first assistant, includes a sufficient number of index operative procedures to gain proficiency in the management of significant axial (including pelvic and acetabular) and appendicular injuries.

The fellowship is divided into six-month rotations split between Dr. Hans Kreder and Dr. David Stephen. Dr. Kreder’s Fellowship is a combined trauma and arthroplasty Fellowship. He specializes in trauma surgery including pelvic and acetabular trauma, pelvic and acetabular tumour reconstruction and total joint revision, and primary arthroplasty of the hip and knee. Dr. Stephen’s practice involves pelvic and acetabular trauma surgery, Ilizarov surgery for the lower extremities and adult foot reconstruction.

Objectives

This Fellowship will allow the trainee to acquire an advanced level of skill in the management of the orthopaedic trauma population. This advanced level will be obtained from faculty-guided experience in:

  • The surgical as well as non-surgical management of musculoskeletal injuries.
  • Treatment alternatives in basic fracture care.
  • Proficiency in the treatment of complex fractures of the pelvis and acetabulum, complex fractures and injuries of the foot and ankle, arthroscopy of the knee and ankle.
  • Proficiency in the treatment of and options for limb salvage including the use of ilizarov fixation device for bone and soft tissue deficiencies, deformities and infections.
  • Algorithmic decision making with respect to timing and sequencing of multiple injury management.
  • Postoperative and outpatient care, including the direction of rehabilitation.
  • Understanding the prophylaxis and/or treatment of the complications and sequelae of musculoskeletal injuries.
  • Injury management decision making, based on age and/or co-morbid medical problems, as seen either in the pediatric or the geriatric population.
  • Developing familiarity with and understanding the historical evolution of the methods available to treat musculoskeletal injuries.
  • The use of advanced technology and instrumentation.
  • Activities that foster the development of skills in teaching as well as laboratory and clinical research related to orthopaedic trauma.
  • Ethical, economic, and legal issues as they pertain to orthopaedic trauma care.

Furthermore, it is expected that individuals completing this Fellowship training will be able to:

  • Organize and administer an orthopaedic trauma service, and coordinate the activities of the service with other administrative units.
  • Establish policies and procedures for the management of orthopaedic trauma patients.
  • Appoint, train, and supervise specialized personnel.
  • Teach the specialized body of knowledge required for the comprehensive management of the orthopaedic trauma patients.
Educational Program Curriculum Overview

The program provides an opportunity for fellows to learn in-depth the following aspects of orthopaedic trauma care:

  • The interdisciplinary relationship between various members of the trauma team including, but not limited to, trauma and critical care, anesthesia, neurosurgery, urology, and physical medicine and rehabilitation.
  • The clinical and radiological musculoskeletal evaluation of the injured patient.
  • The pathophysiology of the multiply injured patient in addition to the associated vascular, neurological, urological, respiratory, and metabolic disorders.
  • The surgical and non-surgical management of axial and appendicular musculoskeletal injuries.
  • Principles of management of soft tissue injuries.
  • The techniques for treating deep wound and bone infections, as well as segmental bone loss, non-unions, and mal unions.
  • Principles of post-traumatic reconstructive surgery, including joint and ligament replacement, augmentation, osteotomy and fusion techniques.
  • Principles of biomechanics, biomaterials and bioengineering and how they relate to orthopaedic traumatology.
  • Biostatistics and experimental design.
  • Ethical and legal aspects of orthopaedic trauma care.
  • The use of outcomes studies.
  • The epidemiology, prevention, and mitigation of injury.
  • ATLS certification.
On-Call Responsibilities

Fellows are responsible for providing in-house on-call coverage as part of their Program – usually one in four, sometimes five.

Orthopaedic Rounds

Fellows are encouraged to make themselves available for the many orthopaedic educational opportunities offered through the University of Toronto Orthopaedic Program including City Wide Rounds, University Rounds, Grand Surgical Rounds, etc.

Research

As part of the Fellowship Program, it is expected that the Fellows actively participate in research and academic activities. Research projects will be supervised by the service to which the Fellow is assigned and should be formalized during the early part of the Fellowship.

Supervisors

The supervising staff has a real and demonstrated interest in teaching and mentoring and set an example for trainees by documented scholarly pursuits including, but not limited to:

  • Participation in continuing medical and surgical education programs.
  • Active participation in regional and national orthopaedic and trauma scientific societies.
  • Demonstration of an active interest in research of orthopaedic trauma problems, and the presentation and publication of scientific work as appropriate.

The medical needs of the multiply injured patient involve the integration of multiple specialties. The supervisory staff, by example, should help the orthopaedic trauma fellow understand and promote the clinical and collegial aspects of these inter-relationships in order to encourage and enhance optimal patient care and educational opportunities.

Teaching

Fellows participate in the educational endeavours of SHSC, and are expected to participate in the teaching activities of student nurses, staff, and other allied health professionals.

Contact

Attn: Mrs. Carolyn Gimera, Administrative Coordinator
Division of Orthopaedic Surgery
Sunnybrook Health Sciences Centre
2075 Bayview Ave., Rm MG 314
Toronto, Ontario M4N 3M5

Tel: (416) 480-4884
Fax: (416) 480-5886

Email: carolyn.gimera@sunnybrook.ca