Page 97 - Hospital Authority Convention 2018

Masterclasses

M4.1 Advances in Trauma Management 14:30 Room 221

Joy and Sorrow in Traumatology Training
Kam CW
Department of Accident and Emergency, Tuen Mun Hospital, Hong Kong
“Training Staff, Helping Patients and Saving Lives” is the prime theme in traumatology education to maximise the outcomes HOSPITAL AUTHORITY CONVENTION 2018
of the casualties and to eliminate preventable mortality.
In an advanced ageing city with predominant healthcare focus on cancer, degenerative diseases and airway infective
diseases, traumatology would be a neglected “No Man’s Land of Non-specialty”.
On one hand, the volume burden is not high enough to justify full-scale teams. On the other hand, the presentation time is
too irregular to attract clinicians to dedicate their whole career life, not to mention the lack of private practice option. Most
manpower is dedicated to services with very scarce resources ear-marked for training.
The three conventional learning domains comprise of cognitive, pyschomotor and affective. It has to be extended to
knowledge, skills, attitude and action to translate to bedside clinical assessment and intervention to identify injuries to treat
obstructed airway, hypoventilation, and to stop bleeding and rescue the brain and limb functions according to a life-saving
priority sequence.

The traditional textbook reading, systemic lectures and tutorial provide the knowledge foundation. The hands-on animal
tissues practice helps build up the procedural skills. The simulation workshop is an important (but expensive) learning tool for
the teamwork including, but not limited to, organization, communication, problem recognition/solving, briefing and debriefing
with built-in continuous quality improvement.
The more recent web-based computer-assisted goal-directed learning modules would be better tailored to individual Monday, 7 May 2018
learning/training preference, ability, revision and retention.
Besides traumatology training, sustainability element must be constructed to maintain the expertise and interest of clinicians
to avoid premature burn-out as well as to set up Succession Training Plan for each rotation of three to five years at the Post-
specialist Level to help ensure the international standards can be maintained.

Traumatology training is filled with frequent challenges with occasional joy.

M4.2 Advances in Trauma Management 14:30 Room 221

Updates on Definitive Management of Pelvic Fractures
Chui KH
Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong

Open reduction and internal fixation (ORIF) is the gold standard surgical treatment for pelvi-acetabular fracture. It usually
requires extensive surgical dissection and long operating time, and is commonly associated with considerable amount of
blood loss. Navigation-assisted minimally invasive percutaneous screw fixation (MIS) for pelvi-acetabular fractures was
recently advocated. Since 2015, we have developed 3D-navigation MIS for pelvi-acetabular fractures. It requires a radiolucent
table, an intra-operative 3D-machine and a navigation system. It allows accurate screws insertion to pelvises with complex
anatomy, resulting in much less intra-operative blood loss, shorter operative time and lower radiation exposure to the
operating staff. Following implementation of this fixation technique, the management logistic of pelvi-acetabular fractures in
our Centre was tailored and incorporated to our three-in-1 exsanguinating pelvic fracture protocol. With appropriate fracture
reduction and pre-operating planning and assessment, we observed a significant shift in our practice from traditional ORIF to
MIS guided by 3D-navigation on pelvi-acetabular fracture. Our cumulative experience on this technique revealed high fracture
union rates and low complication rates. We believe that 3D-navigation MIS is a safe and effective alternative for most pelvi-
acetabular fractures.

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