Volume 02/ Issue 01 / January 2014
boa.ac.uk
Page 38
JTO Features
AOTrauma Fellowship – Chikamori Hospital, Kochi, Japan Dennis Kosuge Orthopaedic Specialist Registrar
Kochi city is located on Shikoku Island, a one hour flight from Tokyo. The local airport is named after Ryoma Sakamoto, a key figure in Japan’s modernisation in the 1830s. Kochi is renowned for its excellent food, the most well-known of which is ‘Katsuo no tataki’ – seared bonito.
Being half-Japanese, curiosity and the ability to speak the language made me choose Japan for my AOTrauma Fellowship. Chikamori Hospital in Kochi is the only recognised AO Trauma centre in Japan. The Orthopaedic Department consists of Professor Kiyoto Kinugasa (Supervising Director) and three other ‘Chiefs’ who are the equivalent of Consultants. There are six orthopaedic trainees who are Specialist Registrar equivalents, all of differing seniority. The senior surgeons are general orthopaedic surgeons whose repertoire ranged from cervical discectomy and fusion, finger fractures, acetabular and pelvic fractures to total hip and knee replacements. The day begins with the trauma conference at 08:20. Pre-operative and post-operative cases are discussed, highlighting the differing practices between Chikamori Hospital and the UK.
Dennis Kosuge
Chikamori Hospital Orthopaedic Department, plus myself
One such example was their use of dynamic MRI to assess femoral head vascularity in cases of intracapsular fractures. In the elderly patient, fixation of displaced fractures would be considered if the dynamic MRI demonstrates favourable vascularity. It is not something I have seen being used in the UK and is certainly worth considering if it will allow us to identify those that will go on to unite without avascular necrosis. The paucity of anaesthetists in Japan requires the orthopaedic trainees to be well-versed in administration of spinal anaesthetics and brachial plexus blocks. All cases that are amenable to surgery under regional block are performed without an anaesthetist. In cases requiring a GA, the anaesthetist was present during induction and extubation sometimes running several operating rooms at once. The monitoring and maintenance was performed by trained, operating room nurses.