This visit was shortened by the postponement of my flight to Tonga from a Monday morning flight to Tuesday evening. Fortunately, I was able to undertake surgery on Saturday to maximize the shortened visit.

The visit proved to be valuable with the use of the trauma table for three cases that would not have been possible otherwise. The first fracture neck of femur was performed as well as a closed femoral rodding using the trauma table. I was also able to undertake fixation of a severe Paediatric hip case using the trauma table, that was otherwise going to be referred to the Shriners Hospital in Hawaii.

There were three hypertrophic femoral non-union fractures  that required fixation after the patients had been treated unsuccessfully for months in traction. Significant cases of osteomyelitis were reviewed and two cases required surgery. An advanced case of an aggressive bone cancer in a teenage boy was referred to the Sarcoma team in Middlemore hospital for further management.

One case, a late dislocated right shoulder that was offered surgery did not front up for surgery. This does happen from time to time and is due to a perception that alternative medicine is still an option for Tongans, sadly to their detriment.  

The visit proved to be valuable for teaching the resident Doctors in the clinic setting and in theatre. I allowed surgeons to be involved with cases to gain experience and confidence in surgical procedures.

The arrival of new equipment allowed for a closed rodding of a femur, which in the past would have been done as an open procedure. The merits of this procedure are that it is accepted as best practice.

There was much discussion with the surgical team about new projects to be undertaken, particularly upgrading the theatres using Indian experience and materials at considerably lower costs. Three nurses have been chosen to attend the AO nurses fracture trauma course to be held in Auckland in June. The arthroplasty project will now be a part of the project following the upgrade of one or two theatres.

A matter that has come up with this visit is the need for arthroscopic equipment as with each visit there are one or two cases that would be helped with arthroscopic surgery. Splints are scarce and having common splints available for knee and ankle injuries would be helpful.

Dr Tevita Tu’ungafasi has been given support from PMA to attend a course in preparation for the medical English exam which to date he has been unable to pass. Once he has passed this exam he will be appointed to work as an Orthopaedic Surgical Registrar at Whanganui hospital for a year to eighteen months. His training will be vital to the success of the Orthopaedic Surgical trauma project that Rotary has been so supportive of.

The Nuku’alofa Tongan Rotary club have indicated they would like to be involved with medical projects. Correspondence has already been undertaken through the Orthopaedic Surgical trauma project and the hope is that this relationship may be enhanced with the direct involvement of this club with projects mentioned above.

OUTPATIENT CLINIC

Wednesday morning a clinic was undertaken from 8.30 to 12.30 pm with about 35 patients assessed with Dr Alamea Aholelei and Tevita Tu’unagafasi.

Operative cases were chosen from this clinic to supplement the cases that were already booked for theatre, mainly inpatient cases.

OPERATION LIST

Wed 29 March 2023 pm

‘O K F 51

ORIF of atrophic non-union left spiral femoral shaft #. (post 4/12 Traction, Morbidly obese) Surgeon Drs J van Dalen, Alamea Aholeli and Tevita Tu’ungafasi.

Thursday 30 March

S M M 43

ORIF of hypertrophic non-union right femoral shaft #. (post 4/12 traction) Surgeons Drs J van Dalen. Alamea and Tevita Tu’ungafasi.

M T F 39

Right Carpal tunnel release under Local anaesthetic. Surgeons Drs J van Dalen and Alamea Aholeli

M T F 23

ORIF of # shaft right Femur – Closed intramedullary nailing. (Acute case) Surgeons Drs J van Dalen, Alamea and Tevita Tu’ungafasi.

Friday 31 March 2023

M M M 13

Fixation of SUFE left hip joint. (Acute on chronic – significant slip) Surgeons Drs J van Dalen, Alamea Aholeli and Tevita Tu’ungafasi.

T M F 84

ORIF of right intertrochanteric # with dynamic hip screw and plate. (# two weeks old) Surgeons Drs J van Dalen, Alamea Aholeli and Tevita Tu’ungafasi.

A P M 44

ORIF of non-union # right proximal Tibia. (Post 4/12 Segmental # Rx conservatively.) Surgeons Drs J van Dalen, Alamea Aholeli and Tevita Tu’ungafasi

Saturday 1 April 2023.

S M M 43

ORIF of hypertrophic non-union # left Femur. Staged procedure. Surgeons Drs J van Dalen, Alamea Aholeli and Tevita Tu’ungafasi.

K H M 11

Debridement and Sequestrectomy right proximal humerus Surgeons Drs J van Dalen and Tevita Tu’ungafasi.

N M 13

Debridement and sequestrectomy left tibia (Osteomyelitis) Surgeon Dr J van Dalen.

John van Dalen FRACS

Visiting Orthopaedic Surgeon

1 April 2023