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Notes from Italy

Monday, May 19, 2014

Orthopaedic Institute for Children extends its international reach to Rome, Italy.

Jennifer Beck, M.D.
Pediatric Orthopaedic Surgical Fellow 2013-2014

BLOG ONE - May 14, 2014

After finishing five years of othopaedic residency at Loyola University in Chicago, I was honored with the Schwartz Traveling Fellowship Scholarship at residency graduation.

The Schwartz Traveling Fellowship is offered annually to a physician completing the orthopaedic residency at Loyola, or completing a formal post-residency fellowship, after completing the Loyola Orthopaedic Residency.  The award will go to an individual of exemplary character, who arranges a two to six week trip to study specific areas of Orthopaedics considered valuable by the Board of Directors of the Orthopaedic Association. The program of study and travel should have specific value regarding the indivudal(s) practice plans, or have humanitarian value.

After residency I will complete two one-year fellowships: one here at OIC in pediatric orthopaedics, and one at Boston Children's Hospital in pediatric sports medicine. With the objectives of my education, career, and the traveling fellowship in mind, I planned a trip to Rome, Italy to spend one week learning from a pediatric orthopaedic surgeon at Bambino Gesu Hospital and one week learning from a sports medicine surgeon at Sapienza University.

Typically, residents who are granted this scholarship complete their traveling fellowship immediately after residency or after their one year fellowship. Understanding my unique post-residency double fellowship plans and Dr. Scaduto's dedication to international partnerships, I was granted time away from my pediatric orthopaedic fellowship at OIC to complete my Schwartz Traveling Fellowship.

BLOG TWO - May 15, 2014

Buon Giorno from Rome, Italy!

I am working at the Ospedale Pediatrico Bambino Gesu (Baby Jesus Pediatric Hospital). There are four sites to this public hospital and it is the only pediatric hospital in the greater Rome area. Rome has approximately six-million people in a very small geographic area. I have visited the two sites that are within Rome, Gianicolo and San Paolo. Gianicolo is a large hospital complex with every pediatric sub-specialty and takes care of most of the pediatric orthopaedic trauma in the area. The orthopaedic and traumatology section has its own ward consisting of one hallway with nine double rooms housing at most 18 patients. San Paolo in the south of Rome is the ambulatory surgery center and clinics. Two other sites are outside of Rome.

I am mainly working with Dr. Francesco Falciglia, who has been in practice for more than 20 years. Dr. Falciglia is a prominent researcher in numerous areas including SCFE treatment, pediatric ACL reconstruction, and surgical management of acute ankle sprains. He has over 20 publications in both clinical and basic science research. We have had wonderful and lively discussions regarding his research and how it has changed his practice.

The pediatric orthopaedic staff includes 20 surgeons that work four to eight hour shifts, six days per week. Sundays are off for everyone, unless you are "on emergency." It doesn't seem like they work many hours at the public hospital, but attending physicians supplement their income by working at private hospitals the rest of the time. They have one resident on service at most. Surgeons operate in teams of three in one operating room, completing cases scheduled from the day prior.

Heath care for children is entirely free and paid for by the government. They keep children in the hospital for much longer and treat pathology differently than we do because of this system.

To give one example of a major difference in treatment, I will discuss supracondylar humerus fractures. If the fracture requires surgery, they place the child in traction in the hospital for two days. They believe this helps reduce the fracture and reduce swelling at the time of surgery. Then they operate on the child in a technique similar to ours. The child then stays two to three more days in the hospital for observation. They see 150 supracondylar fractures per year and each child stays approximately five days in the hospital. This is a similar volume to ours, with very different length of hospital stay.

I have to admit that I have spent some time wandering the streets of Rome, seeing the unbelievable historical sites, and eating food that can only be described as "delizioso!" Hearing the Pope bless the crowd at Saint Peter's Square and walking around the 2,000-year old Colosseum and Roman Forum, the juxtaposition of religion, history and culture, both old and new, peaks my curiosity as I round every corner in Rome. Thankfully, I have more time here in Rome to continue learning and adventuring!

Caio!
Dr. Jennifer Beck
Orthopaedic Institute for Children/UCLA

BLOG THREE - May 21, 2014

I had a wonderful first week at Bambino Gesu learning about a variety of pediatric orthopaedic topics such as new approaches to SCFE treatment, physeal sparing ACL techniques and research, and pelvic osteotomies for bladder extrophy. The team at Bambino Gesu went out of their way to teach me about their philosophies and techniques. I cannot thank them enough for their time and efforts.

My second week in Rome is being spent at Sant Andrea Hospital, part of Sapienza University, with Dr. Ferretti and his orthopaedic department. This time feels more like traditional American orthopaedic education. They have a faculty of 15 with 25 residents to educate.

The morning starts with 7:15am conference given by one of the faculty members. We have focused our lectures this week on ACL reconstructions and their unique philosophy to include extra-articular repair or reconstruction of the anterolateral ligament of the knee along with the ACL reconstruction. I was fortunate to see a chronic ACL tear reconstruction with anterolateral ligament reconstruction as my first case on Monday. I was quickly able to connect the lecture principles with the surgery because of this. Later this week, an acute ACL reconstruction with repair of the anterolateral ligament is planned. Luckily, I will get to see both techniques in one week.

After lecture, we have team rounds where the entire department (yes, as many faculty, nurses, physical therapists, and residents as can attend) sees and discusses each of the patients. After rounds, the new patients are reviewed and the next day's operative schedule is planned. The inpatient hospital ward is different than American systems for two reasons. One: part of their emergency room is dedicated to sports injuries. If an acute ACL tear is seen in the ER, it gets admitted to the hospital for sugical planning within a few days. For example, a patient was admitted on Wednesday for surgery next Tuesday. They will stay as an inpatient the entire time to ensure surgery happens on Tuesday. Two: patients in need of hip and knee replacements or revision replacements will also get admitted from clinic or the ER for surgical planning. They also may wait as an inpatient for days depending on the amount of trauma cases during those days, or, they can be discharged without surgery if a non-operative treatment plan is determined to be better.

I have spent each day in surgery comparing Italian and American operative techniques on knee/hip/shoulder arthroplasty and fracture management, the bread and butter of orthopaedics. Some other interesting cases upcoming this week include neuro-muscular scoliosis fusion, repair of ankle ligaments in an acute ankle sprain, and repair of a quadriceps musculo-tendonous junction tear. I also will have the opportunity to talk with their PMR chairman who is active in Platelet Rich Plasma and Ultrasound techniques and research.

In between surgeries, I spend time talking with the residents about their education system. Needless to say, it has made me very thankful for my residency training at Loyola and my fellowship training at OIC.

Ciao from Rome!

Dr. Jennifer Beck
Orthopaedic Insitute for Children/UCLA