ORTHOPAEDICS AND TRAUMA

BACKGROUND

The Orthopaedics Unit and the General Surgery Unit were the two foundational Units in the Department of Surgery of the University College, Ibadan in 1948, which was active at the old Adeoyo Hospital before the present site of the University College Hospital, Ibadan was commissioned in 1957.

The pioneer Orthopaedic surgeons of the Unit at this time were Mr. Richards, a British surgeon and Mr. M.A.O. Jaja, a Nigerian surgeon. These two were joined by Mr. E,A, Lawson, Mr. G.A. Oyemade, Mr., W.W. Ebong and Mr. O.A. Olusanya between 1960 and 1980.  These eminent surgeons were astute specialists and prolific writers who contributed to several reputable local and international journals which helped to put UCH, Ibadan as one of the top hospitals in the commonwealth at the time.

The difficult years of military dictatorship in Nigeria in the 80s and 90s, led to an exodus of Nigerian health professionals including the entire consultant staff of the Unit. This brought about a challenging and tough period for the Unit, though succour was provided by the some alumni of the Hospital by the names of Dr. Obileye and Dr. Adetunji, both of whom created time from their respective private practice to provide orthopaedic cover for the University College Hospital, Ibadan.

The rebirth of the Unit however, began with the arrival of Mr. Temitope Alonge FRCS (Now Professor of Orthopaedics and immediate past Chief Medical Director of the Hospital) in 1995 following his attainment of the Fellowship of both the Royal College of Surgeons, Edinburg in 1991 and the West African College of Surgeons in 1994 respectively. He was later joined by Mr. Segun Ogunlade FRCS (now Professor of Orthopaedic Surgery) in 1996 and Mr. Bade Omololu FRCS (now Professor of Orthopaedic Surgery) in 1997. These ‘three revolutionaries’, championed the reawakening of the then sleeping orthopaedic giant in Ibadan and through their doggedness, dedication, hardwork and foresight, they were able to initiate a sustainable and reputable orthopaedic services and training in Ibadan. The first product of the training of the Unit is Professor Babatunde Solagberu, who is among the other seventeen orthopaedic surgeons that underwent their full training in Ibadan. Some other individuals (besides the aforementioned 17), from various centers in the country and abroad also passed through the training at different times.

The Unit was formally transformed into a department of the University College Hospital, Ibadan by the Board of Management in 2002. At inception, it had three (3) consultant staff and two (2) senior registrars. There was also a Plastering Unit in the Department. The pioneer head of the department was Professor Temitope Alonge. The addition of Dr. Tayo Ayorinde, Dr. Leke Ifesanya and Dr. Imoniche Adeoye-Sunday and later, Dr. Olurunisola to the Department, made it possible for the Department to be divided into three Units for subspecialization. It also galvanized the now reputable UCH, Ibadan training plaster technician training course. Since then, the recruitment of Dr. Joshua Ogundele, Dr. Michael Okunola, Dr. Abraham Anejukwo Dr. Bayo Obamuyide and Dr. Ajibola Oladiran, has further facilitated sub-specialization in keeping with best global practices.       Following the resignation of four of the consultants in the Department in recent times, there were additions of six new consultants in the persons of Dr Olugboyega  Oyewole, Dr Richard Omoyeni, Dr Mosimabale Balogun, Dr Tolulope Ogunrewo, Dr Chuka Iken and Dr Vincet Arowosaye lately.

The Department also has an Alumni of the University of Ibadan as well as a Senior Consultant Arthroplasty and Arthroscopy surgeon in the United Kingdom – Mr. Charles Ayekoloye FRCS, serving as a visiting consultant to the Department. At present, the department has twelve (12) consultants, ten (13) senior registrars, ten (13) registrars , twenty-seven (29) plaster technicians and Three(3) administrative staffs. The headship of the Department through the years is shown in the table below:

HEADSHIP OF THE ORTHOPAEDICS & TRAUMA DEPARTMENT FROM INCEPTION

S/N     Name Period of Headship

1. Professor Temitope Alonge 2002-2006
2. Professor Ajibade Omololu 2006-2010
3. Professor Olusegun Ogunlade 2010-2013
4. Dr. Adeleke Ifesanya              2013-2014
5. Dr. Imoniche Adeoye-Sunday   2014-2017
6. Dr. Michael Okunola                2018 till date

ACHIEVEMENTS

Orthopaedics in Ibadan is at the forefront in limb reconstruction surgeries in Nigeria, using the conventional llizarov and linear rail devices as well as the computer assisted Taylor Spatial Frames for both congenital and post traumatic limb deformity correction.

The performance of the Department and the successes recorded in the total knee and hip arthroplasty program with over 200 cases in 36months including revision surgeries for failed primary surgeries in India, has gained the Department a reputation as a Center with a high rate of successful outcome, thus increasing the referral of patients to the department from within and outside the country.

The Plaster Technician Training School of the department with basic and advanced course modules has become a center whereby other schools send their students to for supernumerary attachments.

The department has consistently retained the accreditation of its training program by the West African College of Surgeons and the National Postgraduate Medical College, leading to the production of high quality Orthopaedic specialists.

The firm footing of the sub-specialization drive of the department has given support for an orthopaedic spine surgeon of the Department to undergo further fellowship training. This (i.e. the sub-specialization drive) has also enabled the exposure of more recently qualified Orthopaedic surgeons to advanced arthoscopic training as well as the pursuit of the procurement of equipments to support the delivery of these services.

The proficiencies of the consultant staff of the department have been recognized some of which have been manifested via the provision of leadership by these consultants in various capacities in training and administration in the University College Hospital, Ibadan. It is noteworthy that the immediate past Chief Medical Director i.e. Prof. Temitope Alonge who was formerly a Deputy Chairman, MAC is a Professor of Orthopaedic Surgery. Prof. Omololu was also the Coordinator of the Ibadan Basic Trauma Course while Prof. S.O. Ogunlade has in the past served as the Hospital Theatre Manager, and as a Deputy Chairman, MAC. Dr. I.I. Adeoye-Sunday who is the immediate past head of the Department, is the Chairman of the Hospital Mentorship Program.

The Department is involved in the care of over 60% of the patients that present in the Emergency Department and is equally involved in the care of about 20% of the remaining patients that are attended to in other Units. The department runs two (2) specialized clinics weekly and as well runs an operative session every day of the week performing between 450-550 major surgeries annually.

The department through the efforts of the ‘three revolutionaries’, popularized the AO concept of fracture fixation and it is worthy of note that Prof. Temitope Alonge became an alumnus of the AO in 1992 following his advance AO course in Davos, Switzerland. Other consultants subsequently attained the status after their participation in AO Fellowship.

Temitope Alonge also popularised the Belfast technique in the treatment of chronic osteomyelitis and he formulated the ceftriaxone-polymethyl methacrylate beads as an integral part of the Belfast operation.

RESOURCES AND ACTIVITIES

MANPOWER

1. Unit I: Arthroscopy and Sports Medicine/ Adult Reconstruction(Hip & Knee)/ Bone Infection /Trauma

–           Professor T O Alonge

–           Dr A B.Oladiran

–           Dr O.A. Oyewole

–           Dr C.T. Iken

1. Unit II: Paediatrics/Limb Lengthening and Deformity Correction/Arthroplasty/ Spine/ Trauma

–           Dr M O Okunola

–           Dr  R.A. Omoyeni

–          Dr M.J. Balogun

–          Dr T.O. Ogunrewo

1. Unit III: Arthroplasty/ Paediatric Orthopaedics/ Oncology/ Trauma

–           Professor S O Ogunlade

–           Dr I I Adeoye-Sunday

–           Dr A A Anejukwo

–          Dr V Arowosaye

The following privileges are shared by the units:

1)        Beds Space: The Department has access to forty two (42) beds primarily and a number of secondary beds in other wards.

2)        Operating Sessions

1. Two Elective Orthopaedic operating sessions per week in the main Theartre
2. Four Trauma operating sessions per week including Saturday morning in Accident and Emergency Department.
3. One outpatient operating session per week for minor procedures
4. Emergency operating sessions are round the clock

3)        Clinics: Two outpatient clinics per week

1. Fracture Clinic -Monday 8:00am
2. Orthopaedic Clinic-Friday 8:00am

4)        Emergency calls throughout the month.

5)        Residents’ and Consultants’ Ward Round

A consultant teaching round holds at least once a week in each unit and an additional business round once every week. A daily Senior Resident round also incorporates teaching with patient care. Each unit receives emergencies in a one-in-three days basis.

LEARNING CONFERENCES AND LECTURES

These are activities run by the resident staff under the supervision of consultants.  They are designed for teaching both undergraduate students and residents. The traditional strong emphasis on academics as regards research, updates and other formal conferences in this department has continued unabated.

1. Fracture Forum

This takes place every Monday morning and it involves in-depth discussion of allnew fracture cases seen the previous week and treatment planning.

2. Journal Club

This holds every Wednesday. At these fora, standard orthopaedic

articles are critiqued and College research projects and proposals are

also presented for defence.

3. Departmental Seminar

The weekly departmental seminar holds every Thursdays and covers the various aspects of orthopaedics from basic science, paediatrics, trauma, oncology, sport medicine, lower limb reconstruction and social issues relating to orthopaedic practice.Each week, a resident prepares a topic allocated to him/her a few weeks earlier and presents it after which he/she responds to comments and questions from consultants and residents. Emphasis is also placed on learning how to present at scientific meetings.

4. Joint Meetings with Surgery Department
5. Surgery Grand Rounds: During these meetings, which take place every Tuesday, the various divisions on a rotational basis make an in-depth presentation. These meetings cover aetiopathology, clinical profiles, management and outcome, with literature review of a surgical disease process. Recent advances are discussed.Research works of members are also presented. Proceedings of Grand Rounds are published in the Ibadan Surgeon.

1. Morbidity and Mortality Meetings

A regular surgical audit comprising consultants, residents and house officers holds every Wednesday of the week to assess and learn from the diagnostic and management procedures involved in patient care, complications and their management, and appropriateness of laboratory studies, operative procedures and drug therapy. Mortalities of the previous week are summarised and discussed division by division.  A particular division (chosen by rotation) rounds up the day by presenting a major morbidity or mortality case for discussion.

1. Surgical Pathology Meetings

These take place every fortnight on Thursdays at 3.00 pm, to review the histology of biopsy or operation specimens and reconcile with clinical and operative findings. The histology slides are previously selected by representatives of the two departments. These sessions are usually supplemented, where relevant, by attendance at post mortem examinations and organ demonstrations and discussions.

1. Surgery-Radiology Conference

This holds on alternate Wednesdays at 3.00 pm. Radiographs of patients currently on the ward are selected and listed for discussion. There are special sessions held for basic teaching and illustrations on special techniques e.g. ultrasound, computerized tomography, angiography, etc.

1. Surgery Journal Club

This meeting holds every Monday at 4.00 pm. It is moderated by a consultant, usually with other consultants present. It enables the residents to critically review journal articles and also learn of recent advances.