Visit of John van Dalen Orthopaedic Surgeon

Vaiola Hospital, Nuku’Alofa, Tongatapu.

Monday 29 August to Saturday 3 September.

This visit was the first Orthopaedic Surgical visit by me since Dec 2019. It was originally planned for me to visit in March 2020, but this was cancelled because of Covid 19. Once the quarantine restrictions were removed in Tonga in July 2022, plans were made for this visit.

During the intervening period I have been able to continue liaison with the Tongan Surgical team through regular zoom meetings discussing cases. In addition, I have been able to set in place a strategic plan with support from Rotary club of Whanganui North and New Zealand Aid. This plan has culminated in the award of a Rotary International global grant to further supplement funding raised through various Rotary clubs and New Zealand Aid.

I am particularly indebted for the support of this project from Tony Hodge, Whanganui North Rotary club, Michelle Nicholson-Burr from New Zealand Aid and Dr Manju Basappa, Bangalore, India, who was instrumental in securing equipment from India.

Briefly the plan over next three years commencing 2022 is to:

1.    Provide surgical equipment to enhance the outcomes of Orthopaedic Surgical procedures particularly long bone fractures using the trauma table donated by Whanganui hospital, New Zealand.

2.    Arrange three visits per year by Mr J van Dalen, Orthopaedic Surgeon to educate and support the local surgical team specifically in trauma Orthopaedic Surgery.

3.    Arrange for Dr Tevita Tu’ungafasi to work in New Zealand over a two-year period to upskill him specifically in trauma Orthopaedic surgery. Tevita was able to attend the Basic AO fracture management course held in Auckland in July 2022.

The highlight of this trip was to meet up with my Tongan surgical colleagues, Drs Bill Tangi (Head Surgeon), Alamea Aholelei and Tevita Tu’ungafasi. I was able to work closely with Drs Alamea Aholelei and Tevita Tu’ungafasi in the Outpatient department and Operating theatre sharing my knowledge and experience with them over the period I was in Tonga.

The other highlight was to receive the equipment from India without any hold ups and then sort out some of it for use in specific cases during this visit.

The following is an outline of the schedule that was arranged, and the cases undertaken in the operating theatre.

The plan is to visit in December for another week, with the hope of using the trauma table that I was able to test out as functioning adequately.

Outpatients

Monday 29 August 2022

1.    Outpatient department – Vaiola hospital.

Reviewed 25 patients with Drs Alamea Aholelei and Tevita Tu’ungafasi from 2.30pm to 6 pm.

Attached as an appendix are the specific cases seen at that clinic and during the course of the week in the Theatre suite.

Operations

Tuesday 30 August 2022

1.    IF F 11/11/2003; Three-year history of slow growing soft tissue mass outer left elbow joint. CAT scan revealed calcified soft tissue mass.

Rx Excisional biopsy of soft tissue mass left elbow joint.

Surgeon Dr Tevitia Tu’ungafasi

2.    SFM 6/3/2007; Exostosis right medial proximal tibia flare.

Rx Excision of exostosis. Assistant Surgeon Dr Tevita Tu’ungafasi. 

3.    TM M 8/1/2011 Mid shaft fracture left Tibia.

Rx MUA and application of an above knee cast. Further wedging of cast. Assistant Surgeon Dr Tevita Tu’ungafasi

4.    MV M 28 8 1995 Bilateral ruptured ligamentum patella.

Rx Repair using Semitendinosus augment with fibre wire on left side. Right to be done in December. Assistant Sugeon Dr Alamea Aholelie

5.    MF M 27/01/01 Displaced angulated fracture of Right 4^th Metacarpal

Rx Application of Zimmer traction splint.

Wednesday 31 August

1.    MF M 27/01/01, Displaced angulated fracture of Right 4^th Metacarpal.

Rx Percutaneous fixation of right 4^th Metacarpal #. Assistant Surgeons Dr Alamea Lolelei and Dr Tevita Tu’ungafasi.

2.    UH M 30 /1/94, proximal #s Radius and Ulnar right forearm

Rx ORIF of the #s. Assistant Surgeons Dr Alamea Lolelei and Dr Teivta Tu’ungafasi.

3.    TM M 16/06/94, Displaced lateral tibial plateau fracture left knee joint. Old.

Rx ORIF with bone grafting left tibial plateau fracture. Assistant Surgeon Dr Alamea Alolelei.

Thursday 1 September

1.    TL F 25/11/1983 Displaced bicondylar fracture right proximal Tibia

Rx ORIF of bicondylar fracture. Assistant Surgeon Dr Alamea Alolelei

2.    UP 8/05/1977 M Fracture right radial head, partial resected and causing impingement.

Rx: Resection of remaining Radial head right elbow. Assistant Surgeon Dr Alamea Alolelei.

3.     UH M 30/01/1994. Fracture left radius and ulnar.

Rx ORIF of fracture left Radius and Ulnar. Assistant Surgeon Dr Alamea Alolelei.

Friday 2 September

1.    PM M 25/06/58 Displaced comminute # of left Patella

Rx ORIF of Patella left knee. Assistant Surgeon Dr Alamea Alolelei.

2.    SN M 14/07/2004 Chronic Ostemyelitis left proximal Tibia

Rx Surgical debridement. Assistant Surgeon Dr Alamea Alolelei.

3.    VV 30 M Open comminuted # proximal phalanx right proximal phalanx.

Rx Washout/ Debridement and application of Zimmer traction splint. Assistant Surgeon Dr Alamea Aholelei.

Saturday morning 3 September

1.    Assessed trauma table, with theatre nursing staff and Dr Aholelei and Tu’ungafasi.

2.    Set up three External fixator sets – 2 x Tibial and 1x Wrist/forearm.

J van Dalen FRACS

Orthopaedic Surgeon

September 2022