Directorates / Trauma & Orthopaedics

   

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BACKGROUND HISTORY
Komfo Anokye Teaching Hospital (KATH) is located in Kumasi, the capital of the Ashanti with a total  projected population of  four million, seven hundred and eighty thousand, three hundred and eighty(2010) (4,780,380).
The Trauma and Orthopaedics Directorate was carved out of the Directorate of Surgery in 2006. It is currently located at the Accident and Emergency Centre of KATH. It is a one hundred and forty-eight (148) bed capacity directorate with the major orthopaedics wards at C1A,C2A &B and B3. It is a moderately well-equipped level I trauma and orthopaedics management centre with four (4) operating rooms with four (4) C-arm, X-ray machines, two (2) new arthroscopy machines, moderately well-equipped orthopaedics library with internet facility and yet to be operational video conference centre for telemedicine.
The vision of the directorate is to provide excellent trauma and orthopaedic services comparable to international standards.

Dr. Vincent Ativor
HEAD OF DIRECTORATE

STRUCTURE AND MEMBERSHIP OF MANAGEMENT TEAM
The Trauma and Orthopaedics Directorate has a six member management team and the composition includes, the Head of Directorate, Lead Clinician, Pharmacy Manager, Nurse Manager, Business Manager and Accountant.

  1. Dr. Vincent Ativor (MB, ChB, MGCS, FGCS, FWACS, MLS Cert).

Consultant Orthopaedic and Trauma Surgeon,
Head of the Trauma and Orthopaedics Directorate and
Head of the management team.

  1. Dr. Raphael Quartey (MD, PhD).

Consultant Orthopaedic and Trauma Surgeon,
Lead Clinician of trauma and orthopaedics directorate and
Member of management team.

  1. Mr. Michael Assenso

Deputy Director of Pharmaceutical Services
Head, Accident and Emergency Pharmacy and
Member of management team.

  1. Mrs. Mabel  Adarkwa (DDNS)

Deputy Director of Nursing Services and
Member of management team.

  1. Mr. Alfred Adu Yamoah

Business Manager/Health Services Administrator.
Member of management team.

  1. Mr. Frank Oduro-kyei

Principal Accountant and
Member of management team.

There are other heads of the various units at the directorate who are responsible to the day to day running of clinical services.
The management team holds at least a meeting on monthly basis and all in-charges or heads of units meeting quarterly.

KEY FUNCTIONS AND SERVICES

The Trauma and Orthopaedics Directorates provides the following services:

  1. Out-patient specialist clinical services.
  2. Specialist surgical operative services.
  3. In-patient clinical services.
  4. Minor surgical and orthopaedics services like splinting of limbs or orthosis, application of Plaster of Paris(POP).
  5. Clubfoot management services in collaboration with the Ghana Clubfoot Project, a non-profit making organization.
  6. Undergraduate clinical medical students, post-graduate surgical residents and senior residents training:

 The directorate has accreditation for the training of fellows in orthopaedics and trauma for Ghana College of Surgeons and presently awaiting the accreditation by the West African college of surgeons.
Currently there are five (5) senior residents in training at the directorate.
Post-graduate surgical residents do six (6) months rotation through the directorate. Emergency medicine residents, family medicine residents and residents from other surgical disciplines as well as foreign trained medical students pass through the directorate for further training.
Both final year medical students and fourth year clinical junior clerks rotate through the directorate.

  1. Outreach training services:

The trauma and orthopaedics directorate in collaboration with the AO Alliance Foundation organizes training in non-operative and basic surgical principles in trauma management for surgeons, medical officers, residents, physiotherapists, nurses and operating room personnel in Ghana and beyond. The target group comprises practitioners from the district and regional hospitals, teaching hospitals and selected private hospitals across Ghana and beyond.

 

HUMAN RESOURCE SITUATION

The trauma and orthopaedics directorate has a  total staff strength of one hundred and seventy (170), which comprises of;

  1. Eight(8) consultant and senior specialists.
  2. Five (5) senior residents.
  3. Five (5) medical officers and surgical residents.
  4. Ninety-seven (97) nurses
  5. Thirteen (13) House officers/Interns.
  6. One (1) pharmacist.
  7. Fifteen (15) Health Assistants.
  8. Eight (8) Administrative Staff
  9. Seventeen (17) Hospital Orderlies.
  10. Two (2) porters

 

 

UNITS AND THEIR SERVICES
The Trauma and Orthopaedics Directorate is made up of the following units:

  1. Specialist Outpatient Clinics:

Located in consulting room nine(CR9);
Monday - Friday. New referrals and post-operative outpatients are seen here.

  1. Orthopaedic and Trauma Wards: In-patients clinical services are provided in the orthopaedics and trauma wards which includes:

*C1A (female orthopaedics ward).
*C2A and B (adult male orthopaedics wards).
*B3 partial (pediatrics orthopaedics ward).

  1. Accident and Emergency Centre:

All emergency orthopaedics cases, accident and trauma patients are brought to the Accident and Emergency Centre where they are triage to Yellow, Orange or Red wards at the Centre for re-assessment, resuscitation and further management.
There are clinical decision making units (CDU) for male adults, female adults and paediatric patients at this Centre.
There is a Special Ward located at the centre for admission for   patients who cherish privacy.

  1. Operative room (OR): 24-hour working operating room for surgical services at the accident and emergency centre. Major specialist surgical operations including locked intramedullary nailing for long bone fractures, debridement and external fixation for open fractures, open reduction and internal fixation with plate and screws, joint replacement surgeries (knee and hip joint) and arthroscopic surgeries. Other surgical procedures include dynamic hip screw fixation, tension band wire fixation, flexible titanium nailing (FTN) for paediatric long bone fractures, deformity correction and limb reconstruction surgeries.

 

  1. Plaster of Paris(POP) application unit: this is located in the accident and emergency centre. Manipulation and closed reduction of fractures and joint dislocations and application of plaster of Paris, splints, and removal of POP, K- Pins, etc. are done here.

 

  1. Clubfoot correction unit: this unit is run in collaboration with the Ghana Clubfoot Project, a non-profit making organization.

The unit is located at the physiotherapy unit.
It has trained clubfoot management technicians with occasional visit by an orthopaedic surgeon on Wednesdays to do minor surgeries like percutaneous Achilles tenotomies. Patients are managed based on Ponsetti method where serial manipulation and casting are done on weekly basis from Monday to Friday. Difficult foot deformities are referred for further management through the main OPD in CR9 by orthopaedic surgical team.

 

INTERNAL OR LOCAL COLLABORATION
Internally, the trauma and orthopaedics directorate of KATH has collaboration with other directorates in the hospital for exchange of consultancy services and referrals.
There is collaboration between the directorate and the Ghana Clubfoot Project for the training of personnel and management of clubfoot deformities in our communities.
A collaboration between the Trauma and Orthopaedics Directorate and the AO Alliance Foundation, training on the management of trauma is brought to the doorsteps of medical practitioners and surgeons across Ghana and beyond.
The Trauma and Orthopaedic Directorate also collaborates with the Urology unit of the Surgical Directorate on the management of urinary bladder ex-trophy especially during the visits of the International Volunteers in Urology, IVU, from the USA; Pelvic osteotomies and stabilization of the pelvis are done by orthopaedic surgeon from our directorate.

INTERNATIONAL COLLABORATIONS
The Trauma and Orthopaedics Directorate has a vibrant collaboration with a number of international partners to improve trauma and orthopaedic education and management, exchange programs for senior specialists, senior residents and nurses and research.
Our partners include the following:

 

  1. American Academy of Orthopaedic Surgeons (AAOS),   USA
  2. Health Volunteers Overseas (HVO),  USA.
  3. University of California, San Francisco (UCSF) Orthopaedics Department, USA.
  4. Institute of Global Orthopaedics and Traumatology (IGOT)/UCSF/OTI, USA.
  5. University of Utah Orthopaedics Department, Utah,USA.
  6. SIGN Fracture Care International, Washington State, USA.
  7. AO Foundation, Davos, Switzerland.
  8. The Apollo Hospitals, India.

TRAINING AND RESEARCH

  1. Post-Graduate Fellowship

The trauma and orthopaedics directorate secured accreditation for post-graduate fellowship training in trauma and orthopaedics for senior residents and rotational training for other fellows in the surgical discipline who need specialization in orthopaedics trauma.
Currently the Ghana College of Surgeons and Physicians as well  as the Ghana Medical and Dental Council have completed their accreditation inspection visit and are more than satisfied with the training facilities and human resource in the directorate. The West African college of surgeons is expected to conduct their accreditation inspection soon.
The directorate currently has five (5) senior residents undergoing fellowship training in Trauma and Orthopaedics surgery ; one(1) in the final of three (3) year fellowship program, one (1) in the second year and three (3) in their first year of training.

  1. Surgical residents and medical officers training.

Surgical residents rotate through the trauma and orthopaedics directorate on six (6) monthly basis.

  1. Family medicine residents, emergency medicine residents and residents for other surgical discipline

These categories of residents also rotate through the trauma and orthopaedics directorate.

  1. House Officers / Interns training

The trauma and orthopaedics directorate has accreditation by the Medical and Dental Council of Ghana for the training of house officers / interns. They do atleast two (2)months rotation. These include house officers from the foreign trained doctors group.

  1. Daily Clinical Meeting

The trauma and orthopaedics directorate engages in daily clinical meeting from Monday to Friday for the presentation and discussion on all emergency cases and other interesting cases reporting for management. The meeting starts from exactly 8am to 9am.
At these presentations and discussions, AO principles of fracture management, basic trauma life support (BTLS) and advance trauma life support (ATLS) protocols are highlighted.

  1. Residents presentation

There are twice weekly residents and senior residents presentations to the trauma and orthopaedics directorate basically on Tuesday and Thursdays. These presentations are supervised by consultants and senior specialists from the directorate and others from general surgery, neurosurgery, plastics and reconstructive surgery when necessary.

  1. Consultants’ presentation

Consultants’ presentations are done on Wednesdays based on research work, expert opinion and experience.

  1. Morbidity, mortality and surgical audit

These are held once a month, usually on Wednesday.

  1. Lectures by our collaborators e.g. HVOs

From 2010 to date, the Trauma and Orthopaedic Directorate of KATH has been welcoming HVOs who spend about three (3) to six (6) weeks with us in the directorate. Professor Peter Trafton,  the Program Director of HVOs and Ms. AmberCaldwell, the Director of Administration at IGOT, UCSF continue to play major roles in ensuring HVOs visit to our directorate. Their continual visit has enhanced the teaching of trauma and orthopaedics as well as research which has tremendously improved trauma and orthopaedics practice in Ghana as a whole.
Our consultants, senior specialists, senior residents, medical students and nurses have benefitted from the teaching and conduct of researches by HVOs and other collaborators like the AO SEC foundation (now AO Alliance foundation) and recently the Apollo Hospitals group among other.
A number of researches have been jointly conducted in the Trauma and Orthopaedics Directorate with our HVO partners. These have been published in the various journals of surgery.
There are a number of on-going researches by individuals including nurses at the directorate. Our senior residents are expected to do a research and present a dissertation as part of the requirements for final fellowship examination.

  1. Training of nurses

The trauma and orthopaedics directorate continue to build its human resource capacity by sponsoring nurses to attend internal AO foundation trauma management courses, operative room personnel (ORP) courses. KATH has been playing a vital role in sponsoring our operative room(OR) nurses for perioperative courses and degree nursing courses.
The Directorate also organizes tutorials on orthopaedic practice for all nurses in the directorate on 2-weekly basis.

  1. International observership and fellowship training

Through the collaboration with our international partners and assistance from KATH, our senior residents have had the opportunity of attending international conferences like the AO foundation basic, advance and masters .principles on trauma management, SIGN  fracture care international conferences, IGOT International Flap Courses and Research Symposia, OTA conference , AAOS fellowship courses and fellowship observership training at Department of Orthopaedics and Traumatology, UCSF, University of Utah Teaching Hospital Department of Orthopaedics and Traumatology, and the Orthopaedics Learning Centre (OLC), Rosemont, Illinois, Chicago.USA

 

DIRECTORATE CLINIC DAYS

There are five (5) Trauma and Orthopaedics Teams A,B,C,D and E all headed by a consultant or senior specialist traumatologist/orthopaedic surgeon and a hand orthopaedic team.

Team A: Headed by Dr. Peter Konadu;
Out Patient Department (OPD) Clinic day : Fridays from 9:00 am at Specialist  Consulting Room9.

Team B: Headed by Dr. Dominic Awariyah;
Out Patient Department (OPD) Clinic day: Tuesdays from 9:00am at Specialist Consulting Room 9

Team C: Headed by Dr. Raphael Kumah- Ametepey;
Out Patient Department (OPD) Clinic day: Mondays from 9:00am at Specialist Consulting Room 9.

Team D:  Headed by Dr.Vincent Ativor;
Out Patient Department (OPD) Clinic day: Wednesdays from 2:00pm at Specialist Consulting Room 9.

Team E: Headed by Dr. Raphael D. Quartey;
Out Patient Department (OPD) Clinic day: Thursdays from 2:00pm at Specialist Consulting Room 9..

All the teams have two (2) elective operative room days and do ward rounds three times in a week.
Emergency cases are dealt with as soon as they are ready for surgery.

 

CONTACT AND ADDRESS
C/O The Head,
Trauma and Orthopaedics Directorate,
Komfo Anokye Teaching Hospital,
P.O.Box 1934,
Kumasi, Ghana.
TEL: +233244512447
EMAIL: vincentativor@yahoo.com /ativorvincent@gmail.com.