Meet the

faculty

Martin Gargan MA (Oxon) BM, BCh, FRCS (Tr & Orth)

Paediatric Orthopaedic Surgeon; Head, Division of Paediatric Orthopaedics; Associate Professor, Department of Surgery, University of Toronto

“While working with me, fellows will learn about the diagnosis and treatment of hip dysplasia from birth to skeletal maturity, along with management of complex paediatric trauma.”

  • From: Bristol, UK
  • Medicine: University of Oxford
  • Residency: John Radcliff Hospital, Oxford, UK
  • Fellowship
  • Paediatric Orthopaedics
  • Great Ormond Street Hospital for Children, London, UK
  • Clinical Practice
  • Trauma, specifically surgery for hip dysplasia and cerebral palsy.
  • Research
  • Trauma, hip dysplasia and cerebral palsy.

REINHARD ZELLER MD, FRCSC

Paediatric Orthopaedic Surgeon; Head, Spine Program; Associate Professor, Department of Surgery, University of Toronto

“When working with me fellows will learn how to safely and efficiently treat complex spinal deformities, to understand and analyse three dimensional aspects of scoliotic deformity. They will also acquire the technical skills to carry out successful spinal deformity correction.”

  • From: Paris, France
  • Medicine: University of Paris
  • Residency: University Hospitals of Paris
  • Fellowship
  • Paediatric Spine Surgery:
  • Saint Vincent de Paul Hospital, Paris, France
  • Paediatric Orthopaedics
  • Texas Scottish Rite Hospital for Children, Dallas, Texas
  • Clinical Practice
  • Complex spine surgery in children, Early onset and late onset scoliosis, Complex congenital scoliosis, and High grade spondylolisthesis
  • Research
  • Spine deformity correction outcomes and 3D spinal deformity analysis

SIMON KELLEY MBCHB, FRCS (TR AND ORTH)

Paediatric Orthopaedic Surgeon; Assistant Professor, Department of Surgery, University of Toronto

“Working with me, fellows will learn about all aspects of limb reconstruction including modern analysis techniques and operative reconstruction with circular, monolateral and implantable devices. They will also be exposed to a large volume of hip pathology and surgery including the full range of femoral and pelvic osteotomies including hip dislocation and articulated hip distraction.”

  • From: Bath, UK
  • Medicine: University of Birmingham, UK
  • Residency: Leeds and Bristol, UK
  • Fellowship
  • Limb Reconstruction:
  • The Royal Children’s Hospital, Melbourne, Australia
  • Trans-Canada Paediatric Orthopaedics:
  • The Hospital for Sick Children, Toronto
  • Shriners Hospital for Children, Montreal
  • BC Children’s Hospital, Vancouver
  • Clinical Practice
  • Congenital limb deficiencies, Hip surgery, Skeletal dysplasias, Post-traumatic limb deformity, and Trauma
  • Research
  • Bone regeneration, Limb reconstruction outcomes and Hip dysplasia outcomes

SEVAN HOPYAN MD, PHD, FRCSC

Paediatric Orthopaedic Surgeon; Associate Professor, Department of Molecular Genetics and Department of Surgery, University of Toronto; Senior Scientist, Program in Developmental and Cell Biology, SickKids Research Institute

“Working with me, fellows will learn a contemporary approach to benign and malignant tumours, as well as to brachial plexus birth palsy. They will practice dissection skills, perform intralesional and wide resection, and undertake reconstruction using biologic and endoprosthetic techniques specific to children.”

  • From: Toronto, Canada
  • Medicine: University of Toronto
  • Residency: University of Toronto
  • Graduate: University of Toronto
  • Fellowship
  • Paediatric Orthopaedics:
  • The Royal Children’s Hospital, Melbourne, Australia
  • Orthopaedic Oncology:
  • St. Vincent’s Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia
  • Clinical Practice
  • Orthopaedic oncology, Brachial plexus palsy sequela reconstruction and Congenital anomalies
  • Research
  • Early limb bud development, Limb salvage outcomes, and Upper extremity outcomes

ANDREW HOWARD MD, FRCSC, MSC

Paediatric Orthopaedic Surgeon; Professor, Department of Surgery, University of Toronto; Senior Scientist, SickKids Research Institute; Director, Office of International Surgery, University of Toronto

“I operate on all regions of the axial and appendicular skeleton, both acutely and for reconstruction or deformity correction. Deformities from trauma, osteogenesis imperfecta and skeletal dysplasias form a large part of my elective practice. When working with me the fellow will teach the residents how to operate on common fractures, and will learn to operate on complex fractures and deformities.”

  • From: High Prairie, Alberta, Canada
  • Medicine: Queen’s University, Kingston
  • Residency: Queen’s University, Kingston
  • Graduate: University of Ottawa
  • Fellowship
  • Paediatric Orthopaedics:
  • The Hospital for Sick Children,Toronto
  • Clinical Practice
  • Skeletal dysplasias, Childhood osteoporosis, Lower extremity deformity, Spinal deformity, and Complex trauma
  • Research
  • Injury preventiton, International surgery, and Clinical epidemiology

MARK CAMP MD, MSc (bioethics), FRCSC

Paediatric Orthopaedic Surgeon; Assistant Professor, Department of Surgery, University of Toronto

“Working with me, fellows will learn a simple and reproducible, yet comprehensive, approach to manage children with cerebral palsy, spina bifida and other neuromuscular disorders. They will develop the surgical skills necessary to successfully perform lower extremity reconstruction and spinal deformity correction in these complex patients.”

Dr. Camp completed his Bachelor of Science at the University of Western Ontario and completed medical school at Queen’s University. During residency at the University of Toronto, he completed a Master of Science degree through the Surgeon Scientist Program and Royal College Clinician Investigator Program. He was awarded the T.R Sullivan Award in 2011, the J.P. Waddell Award in 2012 and in 2013, he received both the Lawson Family Fellowship for top academic resident in the Division of Orthopaedics and the Dr. Borna Meisami Award as the most compassionate resident as selected by the faculty.

Following his residency, Dr. Camp subspecialized with a fellowship in pediatric orthopaedic surgery focusing on cerebral palsy and spine surgery under Professor Kerr Graham and Mr. Ian Torode at the Royal Children’s Hospital in Melbourne, Australia.

  • From: Gaborone, Botswana
  • Medicine: Queen’s University
  • Residency: Orthopedic Residency at the University of Toronto
  • Graduate: University of Toronto
  • Fellowship: Royal Children’s Hospital, Melbourne, Australia
  • Clinical Practice
  • Lower extremity surgical management of children with cerebral palsy Neuromuscular spine surgery Pediatric Orthopaedic Trauma
  • Teaching Interests
  • In addition to informal and formal education of orthopaedic fellows and residents, Dr Camp teaches bioethics to both undergraduate and postgraduate medical and surgical trainees at the University of Toronto.
  • Research
  • Surgical ethics and Pediatric fracture management

UNNI G. NARAYANAN MBBS, MSC, FRCSC

Paediatric Orthopaedic Surgeon; Director, Fellowship Program; Associate Professor, Department of Surgery, University of Toronto; Senior Scientist, Bloorview Research Institute

“Working with me, fellows will learn a goal based approach to decision making and surgical management of ambulatory and non-ambulatory children with chronic developmental disabilities, especially cerebral palsy. The fellow will learn how to plan for, and execute the surgical management of a broad spectrum of congenital, developmental and acquired limb deformities and limb length inequalities.”

  • From: Madras, India
  • Medicine: Madras Medical College, India
  • Residency: University of Minnesota, Minneapolis
  • Fellowship
  • Cerebral Palsy and Gait Analysis:
  • Gillette Children’s Hospital
  • University of Minnesota, St. Paul, MN, USA.
  • Paediatric Orthopaedics:
  • The Hospital for Sick Children, Toronto
  • Clinical Practice
  • Lower limb length discrepancy and complex deformity correction Clubfeet and other foot disorders
  • Research
  • Patient Priorities and Outcome Measurement, Clinical Trials and Epidemiology, Outcomes Research

LUCAS MURNAGHAN MD, MED, FRCSC

Paediatric Orthopaedic Surgeon; Sports Medicine and Arthroscopy; Assistant Professor, Department of Surgery, University of Toronto; Divisional Clinical Fellowship Coordinator, Division of Orthopaedics, University of Toronto

“Working with me, the fellow will develop surgical skills specific to the treatment of acute and chronic injuries in the growing athlete. This will include a broad experience in arthroscopy of the shoulder, elbow, hip, knee and ankle.”

  • From: Ottawa, Canada
  • Medicine: Queen’s University, Kingston
  • Residency: University of Toronto
  • Graduate: University of British Columbia
  • Fellowship
  • Arthroscopy and Athletic Injuries:
  • University of British Columbia
  • Paediatric Orthopaedics:
  • The Royal Children’s Hospital, Melbourne, Australia
  • Texas Scottish Rite Hospital for Children, Dallas, Texas
  • Clinical Practice
  • Sports medicine and arthroscopy in children and young adults, Paediatric orthopaedics and Trauma
  • Research
  • Surgical education and Children’s minimally invasive surgery outcomes

STEPHEN LEWIS MD, MSC, FRCSC

Paediatric Orthopaedic Surgeon; Associate Professor, Department of Surgery, University of Toronto

“When working with me, the fellow will experience a wide variety of spinal deformities. They will learn to become comfortable with a range of spinal instrumentation techniques and perform advanced procedures such as pedicle subtraction osteotomies, Smith-Peterson osteotomies and vertebral column resection.”

  • From: Montreal, Canada
  • Medicine: McGill University, Montreal
  • Residency: University of Toronto
  • Graduate: University of Toronto
  • Fellowship
  • Adult Spine and Trauma:
  • St. Michael’s Hospital, Toronto
  • Spinal Deformity:
  • Washington University, St. Louis
  • Clinical Practice
  • Spinal deformity in children and young adults, High grade spondylolisthesis, Complex congenital scoliosis, and Spinal osteotomies
  • Research
  • Spine deformity correction outcomes, Surgical skill acquisition, and spinal deformity analysis

modular rail system

By Dr. Simon Kelley

Children with Congenital Femoral Deficiency often require extensive femoral lengthening surgery to achieve equal leg lengths.

One of the most significant complications during lengthening is that of knee joint subluxation, which occurs because of an associated congenital absence of the cruciate ligaments. One strategy to avoid this complication is to use a modular lengthening rail system which spans the knee joint to protect it from subluxation but which also incorporates a hinge to allow flexion and extension of the knee to aid rehabilitation and prevent stiffness. The key to this procedure is to apply the rail such that the hinge of the fixator precisely aligns with the centre of rotation of the knee to allow a full range of knee motion. One additional benefit of the articulated fixator is the ability to build an extension bar attachment that can lock the knee in extension and is often used at night. This is useful in more extensive lengthening when knee flexion contractures can occur and are resistant to regular physiotherapy.

Technical Specs

I always release the iliotibial band at the level of the superior pole of the patella in a femoral lengthening procedure, unless it was previously resected as part of a SuperHip procedure. Using an image intensifier I obtain a true lateral view of the knee and identify the centre of rotation of the knee (CORK), which is at the intersection of the distal femoral growth plate and the posterior cortex of the femur. An arthrogram is frequently required to outline the posterior femoral condyles to obtain the true lateral image in children. On the AP view the CORK is perpendicular to the mechanical axis of the knee. I insert a wire perfectly in plane with the CORK. The preassembled knee hinge and rail is then passed over the wire.

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The next step is to ensure stable fixation of the rail into the femur. I typically use 6mm hydroxyapatite coated stainless steel half pins inserted using a cannulated drill technique to attach the rail to the femur. The first pin to be inserted is the most proximal pin at the level of the lesser trochanter. This ensures that all of the remaining pins to be inserted will be in line with the bone. Ensuring that all the pins from the straight rail align centrally within the shaft of the bone is a critical success factor and occasionally can be challenging due to the anterior bow of the femur. Furthermore by placing the proximal pins near the most proximal extent of the femur minimizes the extent of quadriceps tethering, which negatively impacts on rehabilitation of the knee during lengthening. I typically use 3 or 4 half pins per clamp or bone segment. An excellent feature of modern modular rail systems allows the application of pins in multiple planes which adds to the stability of the construct and thus helps prevents the typical deformity of varus and procurvatum when performing femoral lengthening, which is more common with uniplanar constructs.

Once the rail has been appropriately fixed to the bone it is removed to allow the division of the femur. I prefer a percutaneous osteotomy using a drill and osteotome. It utilizes a tiny incision and retains much of the soft tissue attachments at the osteotomy site, which is necessary for excellent bone regenerate formation during lengthening. The rail is replaced and tightened. A distraction rod is applied and tested by applying 2 to 3mm of distraction to ensure separation of the bone ends to ensure that the lengthening will proceed satisfactorily. Finally the knee hinge is attached to the proximal tibia using half pins. If satisfactory alignment of the hinge has been achieved the knee will flex readily to 90 degrees, using the drop test. Lengthening Protocol

I typically utilize a latency period of 7 days prior to distraction, which then takes place at a rate and rhythm of 1mm per day in 4 increments. This is simply achieved by the patient turning a wrench in end of the distraction bar. One full turn is equivalent to one millimeter of lengthening. Distraction rate and rhythm may be varied according to the clinical and radiographic course. Once the desired length has been achieved the consolidation period takes place and usually lasts twice as long as the distraction phase. Another rule of thumb is that it takes one month per centimeter of lengthening.

Rehabilitation

Extensive physiotherapy is required for two one-hour sessions every day to ensure the maintenance of knee and hip range of motion. Clinical visits and Radiographs occur weekly during the distraction phase and monthly during consolidation.

Rail Removal

The rail and half pins are removed under general anaesthetic after radiographic consolidation of the bone regenerate. At that time I insert a Rush Rod for intramedullary stabilization of the newly lengthened femur due to the very high incidence of post lengthening fracture that has been reported in the literature. The addition of the intramedullary rod to the procedure has dramatically reduced the incidence of post-lengthening fracture. I ask my patients to avoid contact sports for one year after lengthening, and they are then free to engage in unrestricted activity. I continue to follow all my patients who have had this procedure until skeletal maturity.

Interview with Dr. Mark Camp

“I think any fellowship serves two main purposes. The first purpose is to help secure you a job. Many fellowships accomplish this purpose. The second, and far more important purpose, is to help you perform your job well from the moment you start.”

As the newest member of the Division of Orthopaedic Surgery at SickKids how do you see your role enhancing the fellowship program and the Division as a whole?

Fellows will learn a comprehensive, yet reproducible, approach to manage children with cerebral palsy. This includes the initial counselling of parents of children with cerebral palsy and non-operative management; pre-operative, intra-operative and post-operative decision-making; and techniques to surgically manage spinal and lower extremity deformity in ambulatory and non-ambulatory children with cerebral palsy.

I also have a particular interest in paediatric trauma and am developing clinical care pathways for paediatric fractures that aim to standardize paediatric fracture care, optimizing the number of clinic visits, x-rays and cast changes and decreasing the cost to the healthcare system and parents.

You are a home-grown success story having completed your residency here in Toronto. Can you give us your perspective on working in the same city that you trained in?

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As a trainee, you are sheltered from the intricacies of the local, regional, and provincial health systems. In my first year of practice I have learned an enormous amount about the system in which I work and how best to navigate it.

I benefited tremendously from completing fellowship outside of SickKids. Not only for the life experience and surgical education but the time away ensured that previous mentors viewed me as a colleague when I started practice rather than as a trainee.

Who were the biggest influences in your surgical career, and why?

Dan Borschneck encouraged me to pursue Paediatric Orthopaedic Surgery. Simon Kelley was instrumental in outlining a path to success via a fellowship in Melbourne. Kerr Graham inspired me to pursue the subspecialty of cerebral palsy. Unni Narayanan has made my transition to practice as stress-free as possible.

What is your favourite operation and why?

I thoroughly enjoy our Single Event MultiLevel Surgeries (SEMLS) in patients with cerebral palsy. These surgeries are not only challenging technically, but the pre-operative, intra-operative and post-operative decision making is nuanced and having a second surgical team operating across the table is a pleasure.

Despite just starting your practice you are already known as an outstanding surgical educator. What do you think makes you a successful surgical teacher?

This is news to me! Firstly, it is always easier to become successful in something you love doing. Secondly, I have made a point of evaluating excellent and substandard surgical educators and adapted my own teaching accordingly. Finally, asking for feedback continues to help refine my teaching.

What are you looking for in a potential fellow for the program?

The fellows that are most successful are those fellows that “own” their patients. They want to be involved in every aspect of the patient’s care, from the pre-operative decision making to the post-operative management. They therefore learn through active participation. By the end of their fellowship they are functioning as a staff surgeon and I know that their transition to practice will be (relatively)stress free. Unfortunately, I have yet to figure out how to identify these “ideal” fellows from the application process. I am confident, however, that there is little correlation with papers published or grants received.

Do you have any advice for residents on choosing an ideal fellowship?

I think any fellowship serves two main purposes. The first purpose is to help secure you a job. Many fellowships accomplish this purpose. The second, and far more important purpose, is to help you perform your job well from the moment you start. So I would look for a fellowship that is going to give you graduated responsibility where in the last few months of your fellowship you are functioning as a staff surgeon ready for your transition to practice.

Do you have any advice for surgical residents planning for a permanent staff position given the current climate of scarcity of jobs and stiff competition?

I was extremely fortunate to get a job where I did and when I did. For any job, you have to be the right person, in the right place, at the right time. I could not influence the time. To improve my chances of being in the right place, I completed a graduate degree so that I could be eligible for both community and academic positions and I completed my USMLEs so that I could be eligible for jobs in the US. To improve my chances of being the right person, I treated every day like a job interview.

You are building a novel research program in the field of surgical bioethics. What is trending in bioethics right now and how does it affect orthopaedic surgeons?

My interest in bioethics began with financial conflicts of interest between surgeons and device manufacturers. Over the past 5 years, these relationships have become far subtler and therefore more interesting to explore.

Something on the horizon is performance enhancing medication for surgeons. These medications are already commonplace in medical school and residency and in an atmosphere where patient safety is paramount, I am watching this potential development with interest.

As a die-hard South African rugby fan, who is the best Springbok ever to wear the green and gold?

Victor Matfield.

Faculty Publications And Impact Factors 2015

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Journal

Publications

    Faculty

    • Wedge
    • Camp
    • Zeller
    • Lewis
    • Hopyan
    • Gargan
    • Kelley
    • Murnaghan
    • Narayanan
    • Wright
    • Howard

    Presentation and courses 2015

    The Fellowship

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