Train the trainer.

The «Zimmer Biomet Academy Foot & Ankle Training» was an unusual and thrilling meeting, but it would be better if we describe the life of a surgeon and a specialist first, in order to understand everything.

Who is an orthopedic surgeon?

usuelli-protesi-di-caviglia-operazione

An orthopedic surgeon is someone who has studied Medicine: 6 long years, made of joy but also uncertainty and sacrifices.

Then, he has to attend a 5-year specialty course, which should be dedicated to training.

However, the young doctor often feels exploited, used and not evaluated properly. The luckier ones, as it happened to me, have one or more experiences abroad in referral centres, in order to gain knowledge and further skills. Undoubtedly, everything is clearly more fascinating but, anyway, a precarious financial state and an uncertain future are realities one has to confront himself with.

The journey is hard and long, but it needs to be mentioned to understand who we are going to have in front of us: a man who gets up early in the morning, who is inside the operating room already at 7 o’clock, whereas lots of people would have just begun their day.

A surgeon is a person who, after finishing operating, whether if he’s tired or not, satisfied of himself or – on the contrary – a little less, regardless of his own emotions, has already people in front the door of his office who are waiting for him.

They are patients, full of expectations about coming out from that appointment – for which, perhaps, they’ve been waiting for months – with some answers.

Legitimacy: it’s the spice of my life.

You skip lunch and dedicate yourself to them till late at night. It is a beautiful, yet fast-paced life. We also need to take into account meetings, hospital assemblies, both of administrative and scientific kind. Lots of us have wives, husbands, children who beg for a little time to spend with them, one task after another. Usually, our loved ones have understood that a doctor’s life is a sort of mission for his entire family but, of course, they would like to have some of our time too.

Us, we are doctors for the other ones; for them, a dad, a mum, a wife, a husband, a son.

Here we are: doctors who put everything aside and isolate ourselves when we’re inside the operating room.

A comparison with sport life

These days, the US Open are in New York and to me, a doctor who has wanted to be a tennis player since he was a child, the analogy comes easy. Our operating room is, in some ways, very similar to a tennis player’s game. When everything is ready, we deal with one transition after another, without thinking about the “before” anymore, without complaining. A phase after another, a transition after another. We must never look back, only ahead.

In order for this to happen in a flowing way, everything must be perfect: the operating room temperature, the instruments, the equipment: everything must have its precise and consequential logic.

Doing it alone is impossible. As a matter of fact, there exist two different types of guardian angels: nurses and specialists.

Nurses

usuelli-infermieri

Nurses are constantly under pressure and often, under our judgement.

Sometimes, our need for perfection influences them too. They really endure a lot, because actually they have two jobs: they are the surgeon’s guardian angels and the patient’s guardian angels. A very gruelling task.

This is the reason why, during these years, a new figure was born: the specialist.

The specialist

A specialist is a professional figure who has had a profound evolution throughout the years.

He began as an expert of some particular interventions, sent by a company which produces prostheses or specific instruments as surgeon’s support. Historically, he has always been a former scrub nurse, with such an experience – gained over time – that he is always able to express his opinion or make a winning suggestion during an intervention. Today, a specialist can still be a former scrub nurse; however, most of the times, he is a biomedical engineer. In any case, his skills have considerably expanded throughout the years.

Today, it is the joining link between the company and the surgeon and, in a greatly-developed era of technology, that’s fundamental.

A successful specialist enjoys the surgeon’s trust, has a total knowledge on prosthesis or the instruments he represents, and has seen the greatest possible number of surgeries, performed by the greatest number of different surgeons. Nevertheless, this is not to be confused with scientific evolution, which has different channels.

In fact, during meetings or through scientific magazines, surgeons communicate to each other their own results and make the scientific evolution possible.

usuelli-specialist

The specialist’s role, instead, is more linked with the growth and the improvement of the surgeon’s “technical gesture”, due to his considerable and unique experience of performing specific interventions.

Orthopedic interventions, in fact, require always more important equipment, which is significantly hard to manage or even to “keep it tidy”.

The specialist has this great logistical task.

Sometimes, he prearranges everything for the best, even days before an operation, as well as attending the surgery; then, he tidies up and leaves again for another hospital, another surgeon, another intervention.

A life made of long-hour drives, dinners and nights spent in a hotel, always far from your loved ones. A life made of sacrifices to enable me, a surgeon, to work as best I can.

Meeting on ankle arthrosis: ankle prosthesis and arthrosis

usuelli-congresso

Today’s meeting, the «Zimmer Biomet Academy Foot & Ankle Training» has made me encounter some specialists from all Europe, 20 different countries.

The aim of the meeting was to share my team’s achievements in terms of ankle arthrosis.

The first thing, obviously, was explaining to them why the movement preservation is important: it’s up to them to send the message to their surgeons of reference after.

The movement needs to be preserved because it is life.
— Still —

Those are an osteopath’s words, not a surgeon’s.

It is truly remarkable how different experiences have common goals: the movement is the bedrock of a healthy life for physiotherapists, chiropractors, osteopaths and surgeons.

It is a great message, stronger than the limits imposed by different doctrines and disciplines.

We talked about the studies which used to motivate this principle: these are studies which analyse how the patient is able to walk with arthrodesis.

An arthrodesis is a surgical procedure which consist in a joint fusion, cancelling its movement.

Historically, it has been the only surgical solution for the patients affected by ankle arthrosis for years.

Today, there’s the “surgery which preserves movement”.

This kind of intervention can be summed up in 2 different types of surgeries:

  1. surgery preserving the joint;
  2. surgery substituting the joint.

The first one is a brand-new topic in the ankle world and it is based on the realignment principle, which is linked with the cartilage reconstruction.

In ankle arthrosis, in fact, the cartilage damage is very often connected with deformities.

Recent achievements have shown how some biological procedures of cartilage reconstruction which are linked to osteotomies [surgical techniques to correct deformities], can give great results without replacing the joint and, on the contrary, preserve the joint the patient was born with.

The latter is, of course, the ankle prosthesis topic: the joint is replaced when it cannot be fixed anymore. In these cases, the first fundamental thing to do is communicating with the patient.

Sometimes, in fact, the affected patient has developed ankle arthrosis following a significant trauma. Likewise, he often has a healthy contralateral ankle!

A prosthesis will never work as well as a healthy ankle but, it is undoubtedly better than a joint affected by arthrodesis.

Once the patient has been given notice of this aspect accurately, some technical knowledge is essential.

Anterior or lateral approach

usuelli-portesi-di-caviglia-sala

Today, in fact, it is possible to implant a prosthesis with an anterior or lateral approach (incision). Contrary to people’s belief, the lateral approach offers an excellent control of all deformity levels, and enables to minimize the size of the implant.

By looking at an x-ray, a novice too can understand how this prosthesis implanted laterally may resemble a healthy ankle, with remarkable functional results.

Of course, this surgical choice requires a great deal of attention and some specific technical skills from the surgeon’s point of view, and the specialist has to help him as best as he can.

The importance of today’s meeting.

Lastly, we have to remind that arthrodesis is absolutely not an obsolete operation, and it has some indications.

There are cases, in fact, where the joint fusion is fundamental.

For that, research and technology offer a lot of instruments to us, in order to be the less invasive as possible, by reducing the size of incisions, the surgery and recovery time.

They are specific plaques which give an extra help to the surgeon: they can be reproduced indeed, in terms of foot and ankle positioning.

They are specific tools that, if used correctly, can decrease the risk of an improper positioning, which is linked to a technical error.

Today has been a riveting challenge and if, thanks to my job, I succeeded in helping specialists from all Europe with choosing their best surgeons, I am very glad of it.