April 7, 8, and 9—Durban
We were met at the airport in Johannesburg by Dr. James Craig, who took us on a brief tour of the city. After coffee at the Johannesburg Country Club, we had lunch at Dr. Craig's house and headed back to the airport for a later flight to Durban. We were met at the Durban airport, taken to the Holiday Inn Garden Court, and hosted throughout our stay in Durban by Dr. Robert Fraser, Dr. K. S. Naidoo, Dr. Ismail Goga, and Dr. Teddy Govender. That night, we attended an orientation session that was hosted by our local faculty. During this meeting, Michael Wirth was elected photographer and James Wright was appointed scribe. We then went to bed.
The tour began on Tuesday, April 8. In the morning, we viewed the marine wildlife of the adjacent Indian Ocean at the Natal Shark Board Research Centre. In addition to the regular presentation for the public, we had a private tour and discussion with some of the researchers at the Centre. After lunch at the University Club of the University of Natal, we began the afternoon at the Medical School, University of Natal, with clinical case presentations by Dr. Naidoo and Dr. Shidi Senoge. Dr. Govender presented a paper on the treatment of tuberculosis of the spine, and Dr. Naidoo discussed the treatment of unreduced anterior dislocations of the shoulder. The ABC Fellows' presentations included a discussion by Peter Weiss on bone-retinacular-bone reconstruction for scapholunate instability, a discussion by Michael Wirth on the San Antonio rehabilitation program for the shoulder, and a discussion by Graham King on post-traumatic elbow contractures. In the evening, we were hosted at the residence of Robert and Rosemarie Fraser for the first of many wonderful South African braai (barbecues). We had an exciting drive back to our hotel to end our first day in South Africa.
On Wednesday, April 9, the morning started with radiographic and ward rounds at the King Edward Hospital. After lunch at the Durban Country Club, we returned to the Medical School at the University of Natal for case presentations by Dr. Goga. The first ABC Fellows' presentation, regarding avascular necrosis of the hip, was by Jay Lieberman. Bill Maloney discussed polyethylene wear particles associated with total hip arthroplasty, James Wright discussed the measurement of physical function of children, and Ken Koval discussed the treatment of distal femoral fractures. That night, we were treated to curry at the medical school with the registrars and faculty.
April 10 through 16—Cape Town
On Thursday, April 10, we departed at 6:30 A.M. for Cape Town. We were met at the airport by Professor Johan Walters and Dr. Pradeep Makan. We proceeded directly to Grote Schur Hospital, where Dr. Chris Maraspini and Dr. Gordon Siboto presented trauma cases. Dr. Martin Singer then presented a number of cases from the Hand Unit.
In the afternoon, we visited the Princess Alice Hospital and had a buffet lunch. We then attended a clinical conference at which Dr. Jim Crozier and Dr. Makan presented the cases of a number of patients who had a spinal disorder. At the Princess Alice Hospital, we were met by our local hosts, who kindly allowed us to stay with them in Cape Town. For most of the remainder of our visit to South Africa, we were hosted at the homes of the South African faculty. That night, we dined at the home of Johan and Shirley Walters.
On Friday, April 11, we had an early morning run with one of the local registrars, Michael Dickson. We attempted to run up the side of Table Mountain but were not entirely successful, partly because of the concern that one of the Fellows might require cardiopulmonary resuscitation. We returned to the Princess Alice Hospital, where Dr. Garth Grobler presented the cases of several patients who had had an arthroplasty. We then went to lunch with the registrars at the Constantia Uitsig, a local winery and fine restaurant. In the afternoon, presentations were made by the ABC Fellows. Graham King discussed hinged external fixation of the elbow, Jay Lieberman presented a report on osteonecrosis of the hip, Peter Weiss reported his experience with a new method of metacarpophalangeal joint arthroplasty, and James Wright discussed the measurement of physical function of children. In the evening, we were hosted by Dr. Tony Mullins in his private box and watched a rugby game in which Western Province soundly thumped their opponents.
Saturday, April 12, was a blindingly bright day. We began with pediatric rounds at the Red Cross Hospital, where we were guided by Teddy Hoffman. We then went on ward rounds at the Maitland Cottage Hospital. For the remainder of that day, Teddy Hoffman was kind enough to guide us around Cape Point, where we bought local curios at the side of the highway, viewed penguins, went to the Cape Point lookout to view the Point of Good Hope, and had lunch at the Two Oceans Restaurant. That evening, we were hosted at the home of a local registrar, Willem van der Merwe, where we feasted on crayfish that had been caught and barbecued by the registrars.
On Sunday, April 13, we were picked up by Dr. Jimmy Wade and Peter Daneel, who took us to Stellenbosch University. The afternoon was spent touring several local vineyards, including a stop at Franschoek. We then returned for dinner with our local hosts.
On Monday, April 14, we started with rounds at Tygerberg Hospital, which were hosted by Professor Gert Vlok. After reviewing the fracture care that had been delivered the night before, we listened to several case presentations and Professor Vlok discussed the treatment of spinal tuberculosis. We had lunch at the medical school and then attended a scientific session at which presentations were made by the ABC Fellows. Bill Maloney discussed bone-cement interfaces and the effect of particulate debris, Michael Wirth talked about revision total shoulder arthroplasty, and Ken Koval discussed rehabilitation after intertrochanteric fractures of the femur. That evening, we had a casual braai with the registrars and faculty at the house of Professor Vlok, who prepared the steaks in his trademark style.
On April 15, we went on radiographic rounds at Tygerberg Hospital and then proceeded to Conradie Hospital, where we met the indefatigable Dr. Dennis Newton. We had an interesting tour of the hospital that included ward rounds and a review of the care of patients with spinal injuries. The afternoon was spent either playing golf or working out at the local gym. That night, we attended a meeting of the Western Cape Orthopaedic Association at the Panorama University, where two ABC Fellows presented papers. Bill Maloney discussed osteolysis around total hip prostheses, and Jay Lieberman presented a report on the development of regional gene therapy for the induction of bone. The next morning, April 16, was spent shopping and sight-seeing at the Cape Town waterfront, the Aquarium, and the Imax theater.
April 16 and 17—Bloemfontein
That afternoon, we flew to Bloemfontein, where we were met by Professor Robert Snowdowne, Dr. John Shiply, Dr. Johan Kruger, and Dr. Kobus Smit. We spent the evening at a local steak house getting to know our local hosts and listening to folklore about previous ABC tours.
On Thursday, April 17, we traveled to the National Hospital at the University of Free State for a day of academic meetings. Dr. Shiply provided an orientation to Bloemfontein, Dr. Jacob Swart discussed the etiology of clubfoot, Dr. Allan van Zyl discussed revision total knee arthroplasty and total knee replacement after high tibial osteotomy, and Dr. K. Kapnoudhis discussed severe malalignment of lower limbs in children. The ABC Fellows made a number of presentations: Ken Koval talked about proximal femoral fractures, Peter Weiss talked about bone-retinacular-bone replacement for the treatment of scapholunate instability, Jay Lieberman discussed prophylaxis against deep-vein thrombosis after joint arthroplasty, Michael Wirth discussed revision total shoulder arthroplasty, Graham King talked about fractures of the capitellum and trochlea, Bill Maloney discussed osteolysis at the site of total hip replacement, and James Wright talked about explanations for area variation in the utilization of operative procedures. That night, we had a braai at Professor Snowdowne's house, where Michael Wirth was kindly presented with a large set of gemsbok antlers.
April 18, 19, and 20—Welgevonden Game Farm
On Friday, April 18, we flew to Johannesburg, where we were met at the airport by Carolyn du Plessis and Dr. Thys de Beer. We enjoyed a superb weekend at the private game farm of Daan and Carolyn du Plessis, who overwhelmed us with their wonderful hospitality. This game farm is one of fifty in an area of 29,000 hectares and is a true sanctuary of nature. During the two days spent traveling through the farm, we saw white rhinoceros (Fig. 1), impala, baboon, porcupine, jackal, a black mamba, zebra, warthog, klip springer, rhebok, water buck, sable, red hartebeest, blesbok, blue wildebeest, kudu, owl, eland, Cape hare, giraffe, and one very large angry elephant.
On April 20, en route back to the farm, we became firmly mired in the mud. After several hours of attempted extrication, James Wright and Michael Wirth jogged off in search of help (jogging through an open game farm allowed us to keep the pace fairly brisk). However, we were rescued by the liberated crew in the truck, and, after washing off the mud, we traveled back to Johannesburg.
April 20 through 23—Johannesburg
We were met by Professor Einhardt Erkin, Dr. James Craig, and our local hosts at the Johannesburg Country Club, where we all had dinner.
On Monday, April 21, we had a tour and went on ward rounds at the Baragwanath Hospital, followed by a lunch in the hospital. The Baragwanath Hospital is on the edge of Soweto and is one of the largest hospitals in the world, with extensive experience in the treatment of trauma. The afternoon was spent at the Bone Research Laboratory at the University of Witwatersrand Medical School, where we were guided by Dr. Nicholaas Duneas. Dr. Barry Sweet and Dr. Mike Byrd provided an overview of the bone and research unit. In the afternoon, the ABC Fellows presented several talks at the scientific session: Ken Koval spoke about orthopaedic challenges in an aging population, James Wright discussed femoral fractures in children, Jay Lieberman discussed deep-vein thrombosis and total hip arthroplasty, and Graham King reported on post-traumatic stiffness of the elbow. That night, we had dinner at the Emoyeni, a local historic site adjacent to the medical school.
On Tuesday, April 22, we went on ward rounds at Johannesburg Hospital and then were given a tour of the Hope Home by Professor Erkin. The Hope Home is a wonderfully bright facility that cares for children who are chronically disabled. It has a beautiful view of Johannesburg that includes the elephant cage at the Johannesburg Zoo. The afternoon was spent touring the Museum of Africa. After the tour, late in the afternoon, we began an academic session of ABC Fellows' talks. Bill Maloney discussed pelvic osteolysis at the site of total hip arthroplasty, Peter Weiss discussed arthrodesis of the wrist, and Michael Wirth discussed sternoclavicular injuries. That night, we were treated to a tour of the Johannesburg Zoo. This experience was particularly enjoyable because many of the indigenous animals become more active at night. This tour was followed by a braai with local faculty at Emoyeni.
April 23 through 26—Pretoria
On Wednesday, April 23, we were picked up by Dr. Bennie Lindeque and Dr. Theo le Roux and were taken to the University of Pretoria, where we were met by Professor Klaas Maritz. The morning was spent discussing several case presentations. After lunch at the medical school, the ABC Fellows made several presentations: Jay Lieberman discussed prophylaxis against deep-vein thrombosis in total hip replacement, Bill Maloney discussed surveillance for deep-vein thrombosis after total hip arthroplasty, Peter Weiss discussed reconstruction of the scapholunate ligament, and Ken Koval discussed the treatment of intertrochanteric fractures of the femur. In addition, Dr. Thys de Beer presented the cases of several patients who had a condition involving the shoulder; this presentation included a demonstration of the use of ultrasonography for evaluation of the shoulder. Dr. Thian Stoffberg discussed the treatment of os acromiale. Dr. de Beer talked about arthroscopic reconstruction of the anterior aspect of the shoulder capsule. Dr. le Roux discussed reconstruction after the resection of a tumor. That night, we attended a local reception at a medical school, which was attended by faculty and a very enthusiastic group of registrars.
On April 24, we visited Kalafong Hospital. We were hosted by Dr. Davie Koekemoer, who presented numerous clinical cases. In the afternoon, we were transported to Medical University of South Africa (MEDUNSA) Medical School, where we were hosted by Professor Robert Golele, Dr. Palty Lekalakala, and Dr. Mac Lukhele. After lunch at the Caladrius restaurant, we returned to the school for the ABC Fellows' presentations. James Wright discussed the effect of case definition on the incidence rates of sarcoma, Graham King talked about elbow fractures in the elderly, Jay Lieberman talked about avascular necrosis of the hip, and Ken Koval talked about distal femoral fractures. That night, we were graciously hosted with a braai at the house of Professor Golele.
On April 25, we returned to MEDUNSA Medical School, where Dr. Ulrich Mennen, from the hand and microsurgery department, presented a number of papers on a wide range of topics, including the clamp-on plate, the use of early corrective operations for the treatment of arthrogryposis of the wrist and elbow, the evaluation of function of the flail upper limb, the indications for the use of semi-occlusive dressing for the treatment of hand wounds, and the results of some preliminary research on end-to-side nerve transfers. Peter Weiss gave an ABC Fellows' presentation about metacarpophalangeal arthroplasty. This session was followed first by a tumor conference, hosted by Professor Golele, and later by a spine and trauma conference. In the afternoon, we moved to the Whistletree Guest House, where we had a wonderful dinner and enjoyed our final night out with the registrars. On Saturday, April 26, we had one last day of shopping for African curios. In the evening, we took an overnight flight to London.
April 27, 28, and 29—London
On Sunday morning, April 27, we were met by Mr. David Jones, the honorary secretary of The British Orthopaedic Association, and Eileen Arnold, the secretary for the ABC trip, who superbly organized our entire stay in Great Britain. We checked into the Kensington Park Hotel, and the remainder of the day was spent exercising, visiting the British Museum, and finally sleeping.
On April 28, we were picked up by Mr. Andrew Jackson and Mr. Roger Vickers and were transported to St. George's Hospital. The morning began with a trauma program. During the coffee break, we had the opportunity to view Benjamin Brodie's surgical instruments and peruse some of his books detailing his early treatment of open fractures. In the afternoon, we attended a session at which Mr. Martin Bircher discussed anterior pelvic diastasis and pseudodiastasis in motorcycle riders, Mr. Paul Calvert discussed habitual subluxation of the shoulder in adolescents, Mr. Simon Bridle discussed impaction bone-grafting and revision hip procedures, and Mr. Adrian Fairbank discussed the radiographic prediction of failure of total knee arthroplasty performed without cement. Michael Wirth made an ABC Fellows' presentation on total shoulder arthroplasty. In addition, two interesting cases were presented by Mr. Jackson.
In the afternoon, we had lunch and enjoyed an excellent burgundy at the offices of The Journal of Bone and Joint Surgery. We then were taken on a tour by the editor, Mr. Philip Fulford, who explained the editorial review process and discussed some of the recent changes in the management of the British Journal. That night (Fig. 2), we were hosted at the Royal College of Surgeons by Sir Rodney Sweetnam, Professor Tom Ducksworth, Mr. Fulford, Mr. Vickers, Mr. Jones, and Professor George Bentley. We learned about the history of the college and had the opportunity to view much of the artwork, including portraits of James Hunter.
On Tuesday, April 29, we visited Stanmore Royal National Orthopaedic Hospital at the College of London, where we were hosted by Professor Bentley. The morning was filled with academic sessions, during which Mr. Thomas Carlstedt discussed implantation of spinal nerves, Mr. Brian Bradnock discussed ultrasonic extraction of cement, Mr. David Lee talked about the effect of mechanical compression on articular cartilage, Mr. H. Noordeen discussed recent views on spinal injuries, Mr. Michael Braden reported on new polymers for clinical application, Mr. Nicholas Goddard spoke about attitudes in the United Kingdom regarding the management of young osteoarthrotic patients, and Mr. Ian Bayley described a system for the classification of shoulder instability. The morning ended with a case conference on pediatric orthopaedics, hosted by Mr. Tony Catterall and Ms. Debra Eastwood. After lunch, Mr. Steve Cannon and Mr. Tim Briggs presented a clinical conference on tumors. The ABC Fellows' presentation was by Ken Koval, who discussed rehabilitation after intertrochanteric fractures of the femur. Professor Bentley presented a paper on cartilage resurfacing in synovial joints, and Mr. Mike Sullivan talked about the British low-back-pain study. The afternoon included tours of the laboratories and biomechanical facilities. In the evening, we had dinner at Ye Olde Cheshire Cheese.
April 30 through May 4—Oxford
On Wednesday, April 30, we traveled by coach to Oxford and were met by Professor John Kenwright at the Randolph Hotel. After lunch at the Old Parsonage Hotel, Monica Cunliffe provided a wonderful historic tour of Oxford. That evening, dinner was hosted by Vivien and John Kenwright and was attended by all of the previous ABC Fellows from the Oxford area.
On Thursday, May 1, we awoke at 5:00 A.M. in order to attend the May Morning Celebration on Magdalen Bridge. This is a traditional celebration during which Magdalen Choristers sing madrigals in the tower to welcome the advent of spring. Oxford students also jumped from Magdalen Bridge into several feet of muddy water, only to be hauled off to either the hospital or the police station. Later that morning, we traveled to the Nuffield Orthopaedic Centre to hear scientific presentations. Mr. Mike Benson talked about the long-term results of the treatment of dysplasia of the hip and presented the case of a child who had a difficult problem involving the ankle. Mr. John Williams and Mr. Andy Carr presented a paper on the normal patterns of motion of the shoulder and elbow and then presented the cases of two patients who had a problem involving the shoulder. Mr. Paul Cooke presented the case of a patient who had rheumatoid arthritis of the ankle. Mr. Jeremy Fairbank and Mr. James Wilson-MacDonald presented the case of a patient who had a problem involving the spine and then discussed the Medical Research Council spinal stabilization trial comparing arthrodesis and rehabilitation. Dr. Tony Berendt discussed delayed presentation of spinal infection. Mr. David Murray reported on the ten-year survival of the Oxford unicompartmental knee replacement; this was followed by a case presentation and a spirited discussion. Mr. Peter McLardy-Smith discussed periprosthetic intertrochanteric fractures of the femur and presented the case of a patient who had such a fracture. Mr. Max Gibbons and Mr. John Spivey presented the case of a five-year-old patient who had osteosarcoma. James Wright gave the ABC Fellows' presentation, entitled "Asking Patients What They Want: A New Method of Assessing Orthopaedic Procedures." On Thursday night, we attended a black-tie dinner at the Wadham College and enjoyed a late night of celebrating the English election, among other things.
On the morning of Friday, May 2, at the Nuffield Orthopaedic Centre, Mr. Hamish Simpson presented a paper on the research and clinical applications of distraction osteogenesis, Mr. Peter Kyberd presented a paper on the myths about prosthetic hands, Dr. Gill Urban discussed disc degeneration of the spine, Dr. Amy Zavatsky presented a paper on the kinematics and mechanics of the knee joint, Mr. David Murray presented a paper on the problem of patients who are lost to follow-up, and Dr. Nick Athanasou discussed aseptic loosening. The ABC Fellows' paper was presented by Jay Lieberman, who discussed the role of gene therapy in the healing of bone defects. After lunch, we traveled to the John Radcliffe Hospital, where Mr. Bob Handley and Mr. Phillip Wild presented trauma cases.
Saturday, Sunday, and Monday were free. Several of the Fellows rode the Dutch barge on the River Severn and enjoyed a trip to the home of Shakespeare in Stratford-on-Avon.
May 5 and 6—Birmingham
On Monday, May 5, the group reunited and took a train to the Pine Lodge Hotel in Birmingham. We were met by our local host, Mr. Simon Carter, who escorted us to dinner at Warwick Castle. It was an appropriately stormy night to have a feast in a medieval castle, and we were entertained with singing and jokes by a local acting troupe.
On the morning of May 6, at the Royal Orthopaedic Hospital, Mr. Carter, Mr. Rob Grimer, and Mr. Roger Tillman presented the cases of a number of patients who had been managed because of a tumor. Research presentations followed: Mr. Chris Bradish reported on the use of limb-lengthening for the treatment of fibular hemimelia, Mr. Tillman reported on the use of the growing endoprosthesis for the treatment of cancer in children, Mr. Andrew Thomas discussed the structure and function of the National Health Service, Mr. John O'Hara talked about the treatment of dysplasia of the hip in young adults, Dr. Paul Pynsent talked about the cost of total hip replacement, Mr. Derek McMinn discussed the metal-on-metal surface replacement arthroplasty, Mr. Duncan Learmouth talked about recent developments in the treatment of problems involving the knee and shoulder, Mr. Alistair Stirling presented the Birmingham experience with vertebral malignant tumors from 1992 to 1996, and Mr. Mike Waldram discussed outpatient electromyography and described a clinical grading system for the evaluation of Dupuytren contracture. The ABC Fellows' presentations included a report by James Wright on the measurement of physical function of children, a discussion by Bill Maloney on the treatment of pelvic osteolysis, and a talk by Graham King on the release of post-traumatic elbow contracture. The afternoon session adjourned after several case presentations by Mr. Patty Mulligan. That night, we had a casual dinner at a local Balti curry house.
May 7 and 8—Oswestry
On Wednesday, May 7, we traveled by bus to the Wynnstay Hotel in Oswestry, where we were met by Professor James Richardson. We had a late-afternoon academic program at the Robert Jones and Agnes Hunt Institute of Orthopaedics. Mr. Cormac Kelly discussed glenohumeral arthroplasty, Mr. R. Morgan-Jones discussed the use of suction-irrigation systems in the treatment of chronic osteomyelitis, Dr. Jan Herman Kuiper discussed the science of impaction grafting as we know it, Mr. David Griffins discussed the use of an absorbable tendon or ligament substitution for percutaneous repair of ruptured Achilles tendons, Mr. Martin Northmore-Ball discussed the factors that affect stability after revision total hip replacement, Mr. Chris McGeoch discussed the use of semiconstrained hinges for the revision of failed Stanmore prostheses, Mr. Andrew Roberts reported the results of a longitudinal study of Perthes disease, Mr. Gwyn Evans talked about factors influencing the prevalence of avascular necrosis during the treatment of dysplasia of the hip, Mr. D. Rees talked about current trends in the treatment of defects of cartilage cells, and Professor James Richardson discussed biomechanics as the basic science for orthopaedics. Peter Weiss gave the ABC Fellows' presentation on metacarpophalangeal arthroplasty. That night, we had dinner with the local faculty at the Walls, a converted schoolhouse.
On May 8, we had an interesting tour of the operating rooms, the gait laboratory, and the cartilage research laboratories. Later that day, we traveled by bus to Sheffield.
May 8 and 9—Sheffield
On Thursday, May 8, we were met and hosted by Mr. Mike Bell, Mr. Stephen Norris, Professor Tom Duckworth, and Professor Michael Saleh. We stayed at the Swallow St. George's Hotel, where many of the members of the ABC club were staying. That night, we had dinner at Stephen Norris's house.
On Friday, May 9, we traveled to the Sheffield Children's Hospital for ward rounds, which were hosted by Mr. Bell. We then heard a number of case presentations, and Mr. Jason Bernard presented a paper on the effects of clodrinate on limb-lengthening. Next, we traveled to the Northern General Hospital. After an introduction by Professor Duckworth, Mr. Gavin Holt presented a paper on a new method for assessing surgeons' suturing ability, Mr. Bell discussed the treatment of osteogenesis imperfecta with use of the Sheffield rod system, Professor Saleh discussed the biomechanical and clinical indications for the Sheffield hybrid fixator, Mr. Tom Smith talked about Charcot-Marie-Tooth disease, Mr. David Stanley talked about the prevalence and etiological aspects of primary osteoarthrosis of the elbow, Mr. Ian Stockley discussed the use of impaction grafting during revision procedures performed because of infection at the site of a total joint arthroplasty, Mr. Jonathan Redden talked about arthroscopic arthrodesis of the ankle, and Mr. Graham Russell talked about recent advances in bone biology and the treatment of osteoporosis. The ABC Fellows' papers were presented by Michael Wirth, who discussed biological fixation of polyethylene glenoid prostheses inserted without cement, and Graham King, who discussed fractures of the capitellum and trochlea. Later that night, we attended a black-tie dinner with the ABC club at Hassop Hall, where we learned more about the history of the ABC tour from Professor George Bentley. Jay Lieberman gave a toast about the top ten ways you know that the ABC tour has gone on too long.
The ABC club meeting was held on Saturday, May 10. Mr. John Dickson presented a paper on materia non medica, Mr. Simon Donnell compared the lateral radiograph with arthroscopy of the patellofemoral joint, Mr. David Barrett talked about the loss of proprioception in the osteoarthrotic knee, Mr. Martyn Porter talked about Charnley arthroplasty in patients who are less than forty years old, Mr. Sean Hughes discussed revascularization of intervertebral discs, and Mr. Derick St. Clair Strange (one of the original 1948 ABC tour members) discussed fringe orthopaedics. The ABC Fellows' presentations were made by James Wright, who talked about measuring satisfaction as an outcome of orthopaedic procedures, and Ken Koval, who talked about the treatment of intertrochanteric fractures of the femur.
May 10 through 13—Glasgow
On Saturday, May 10, we made the long trip by train to Glasgow. We were met at the station by Mr. Ian Kelly and Professor David Hamblen and then were taken to the Stakis Grosvenor Hotel. The remainder of the day was free, and the evening was spent on the streets of Glasgow.
On Sunday, May 11, we had a free day, which was spent visiting Glasgow and Edinburgh and playing golf at the Western Gales course. That night, we enjoyed a casual dinner at the home of Helen and Ian Kelly, after which Ian played the bagpipes.
On Monday, May 12, we traveled to the Western Infirmary for an academic session, during which Mr. Kelly discussed the role of replacement of the humeral head in the treatment of rheumatoid arthritis, Mr. James Crossain discussed prevention of adhesions after experimental tendon injury, Mr. Lech Rymaszewski discussed post-traumatic elbow stiffness, Mr. David Allan discussed the outcome of hip arthroplasty, Mr. Andrew Kinninmonth talked about the use of the Ilizarov technique for the treatment of chronic bone infection, Mr. Tim Hemms discussed repair of avulsed cervical nerve roots and also the role of magnetic resonance imaging in the treatment of traction injuries of the adult brachial plexus, Mr. George Bennet talked about the use of limb-lengthening in the treatment of Turner syndrome, Mr. Charles Court-Brown discussed the treatment of tibial fractures with reaming and nailing of the tibia, Mr. Malcolm Macnicol discussed long-term pelvic remodeling after Chiari medial displacement osteotomy, and Professor Hamblen talked about problems in the treatment of osteosarcoma. The ABC Fellows' presentation was made by Ken Koval, who discussed the treatment of intertrochanteric fractures of the femur. The afternoon ended with a case presentation. In the evening, we had dinner at the historic Royal College of Surgeons in Glasgow, where we were hosted by Professor Hamblen.
On Tuesday, May 13, we traveled to Strathclyde University, where Dr. Joseph Barbanel and Dr. S. E. Solomonidis reported on the research of the biomechanics unit, including that regarding gait analysis and prosthetic design.
May 13, 14, and 15—Wrightington
On Tuesday afternoon, we traveled by train to Wrightington, where we were met by Mr. Paul Siney and our host, Professor Michael Wroblewski. We had dinner and a reception with local faculty and registrars and were then taken to the Wrightington Hotel and Country Club.
On Wednesday, May 14, we had concurrent sessions on the upper extremity and on arthroplasty (reflecting the relative strengths of our group). Part of the time was spent in the operating room, and the rest of the time was spent listening to scientific presentations. Mr. Jim Loudon discussed fracture of the cement mantle and long-term survival of the stem, Mr. Kevin Hardinge presented a report on John Charnley and his contributions to orthopaedic surgery, Mr. Aslam Mohammed talked about antiseptic inhibition of bone-cell proliferation, Mr. Anthony Browne discussed anterior reconstruction of the shoulder in professional rugby players, and Professor Wroblewski discussed low-friction arthroplasty in young patients. The ABC Fellows' presentations were made by Bill Maloney, who talked about the implant-bone interface, and Jay Lieberman, who talked about measuring the outcome of total hip arthroplasty. In the afternoon, Mr. John Stanley introduced the upper extremity unit, Mr. Ian Trail reported on the Wrightington experience with the Souter elbow arthroplasty, and Mr. D. Nattall discussed radiographic analysis, the long-term survival of Souter total elbow prostheses, and the factors involved in total elbow replacement. Presentations by the ABC Fellows included a discussion by Peter Weiss on metacarpophalangeal arthroplasty and a report by Graham King on post-traumatic contractures of the elbow. That night, we had dinner at the High Moor Restaurant with faculty and registrars. The next morning, we visited the Charnley Museum.
May 15, 16, and 17—Leeds
On the afternoon of Thursday, May 15, we traveled to the Marriott Hotel in Leeds, where we were met by our host, Professor Robert Dickson. After drinks at a local pub, we had dinner at a superb Indian restaurant. The next morning, we began the academic program at St. James' University Hospital in Leeds. After an introduction by Professor Dickson, Professor Duncan Dowson talked about joint lubrication and motion and about design issues related to joint replacement, Mr. David Limb talked about neurological injury and the biomechanics of thoracolumbar burst fractures, Mr. Michael Smith presented current concepts in imaging, Mr. Malcolm Smith discussed stimulation of inflammatory markers after blunt trauma and HLAdr antigen expression and intrapulmonary shunt after trauma, and Mr. Peter deBoer discussed how much movement is desirable at the site of a fracture. The ABC Fellows' presentation was by Michael Wirth, who talked about rehabilitation of the shoulder. In the afternoon, after lunch, Mr. Simon Kay reported on his experience with microsurgery in children, Mr. Malcolm Smith and Mr. Simon Knight discussed the orthoplastic treatment of open fractures, Mr. David MacDonald and Mr. Martin Stone talked about impaction grafting and revision hip procedures, and Professor Dickson and Mr. Peter Millner presented the Leeds philosophy regarding the treatment of idiopathic scoliosis. That night, we had dinner at the Alwoodley Country Golf Club, where we were hosted by Professor Dickson.
On Saturday, May 17, we went on a day trip to York and had the opportunity to tour the town. We had lunch at the Purey Cust Nuffield Hospital and had an extended tour of the stained glass windows in York Minster. The tour was given by Peter Gibson, a remarkable man who has devoted his entire adult life to the restoration and maintenance of the stained glass windows.
May 18, 19, and 20—Cambridge
The next morning, we headed off to the Garden House Hotel in Cambridge, where we were met by our hosts, Mr. Bernard Meggitt and Mr. Chris Constant. That night, we were generously hosted at the home of Bren and Bernard Meggitt. On Monday, May 19, we traveled to Addenbrooke's Hospital, where scientific papers were presented. Mr. Constant talked about the assessment of shoulder function, Professor Laurie Hall talked about magnetic resonance imaging of joints, Mr. Fabian Norman-Taylor discussed bone xenografts from transgenic pigs, Mr. Meggitt talked about x-ray isotope co-registration (superimposition of radiographs and bone scans) of the foot, and Mr. Richard Willar talked about arthroscopy of the hip. This was followed by case presentations and a debate, led by Mr. Murray Matheson, in which we discussed the relative benefits of different training programs and the recent changes to the British orthopaedic training program. The ABC Fellows' presentation was made by Jay Lieberman, who talked about regional gene therapy. After lunch, we had an afternoon session during which Mr. Meggitt discussed art and the critical diagnosis of rheumatoid arthritis. The ABC Fellows' presentation was made by Graham King, who discussed the biomechanical compression of a scaphoid screw. That night, we had a tour of the ancient book library at Jesus College, which includes the first bible ever printed in North America. This was followed by a black-tie dinner at Jesus College, which included a twenty-minute history of the college by Mr. Meggitt.
The next morning, we toured Kings College by punting along the River Cam behind the colleges and then had lunch at the Aviators Pub. In the afternoon, we departed for Norwich.
May 20 and 21—Norwich
In Norwich, we were met by our local hosts, Mr. Simon Donnell and Mr. Hugh Phillips. We stayed at the homes of local faculty. That evening, we had a wonderful curry dinner at the house of Trish and Hugh Phillips. The next morning, we attended the operating and outpatient departments at Norwich Hospital. This was followed by lunch at the Adam and Eve Pub, a historic tour of Norwich, and a kind gift of Norfolk hats to all of the Fellows by Mr. Donnell. The afternoon ended with a round of English clay pigeon shooting. Many of the Fellows had never held a gun before, let alone shot one, but we were all resolved to buy shotguns as soon as we returned home. That evening, we had dinner with the local faculty at the Wilder Beast Arms.
May 22—London
The next morning, we departed from Norwich to return to London. The roads around the Kensington Park Hotel were closed because of a gas explosion, so, after circling the hotel for two hours, we gleefully dragged our luggage the last four blocks to get to the hotel. The final evening was spent wandering the streets of London, viewing local sights, including the Parliament buildings and Westminster Abbey. The next morning, we departed for the return flight home via Chicago.
Summary
The fellowship was forty-nine days long, and we visited seven centers in South Africa and twelve centers in Great Britain. In South Africa, we presented thirty-nine papers and heard eleven presentations; in Great Britain, we presented twenty papers and heard eighty-two presentations.
The entire group almost certainly gained weight (estimated at two-thirds from alcohol and one-third from food), but no records were kept. We had a bimodal distribution of the average time spent by Fellows exercising, with one Fellow exercising twice a day and one Fellow exercising twice. Although we did not come close to breaking any athletic records, we sustained numerous so-called athletic injuries, including a partial gastrocnemius tear, Achilles tendinitis, a fifth lumbar herniated disc (including a dropfoot—now resolved), rotator cuff tendinitis, groin rash, and a torn volar plate injury to the thumb. Our only record set (and in a new category) was 648 e-mails sent and received, most (courtesy of IBM Global Internet) through a single laptop computer.
As a group, we were honored to be chosen and were delighted to have the opportunity to visit and meet our new friends in South Africa and Great Britain. We extend our deepest thanks to The American Orthopaedic Association, The Canadian Orthopaedic Association, The British Orthopaedic Association, The South African Orthopaedic Association, and all of our local hosts for this once-in-a-lifetime opportunity.