Clinical Divisions

clinical divisions

The Department of Orthopaedics is comprised of seven clinical divisions and one division that focuses on orthopaedic research.

Orthopaedic sub-specialization allows intense focus of our Faculty in the areas of paediatrics, spine, reconstructive orthopaedics, athletic injuries, upper extremity, and trauma, providing outstanding treatment to all; whether it is a newborn baby, the elderly with degenerative skeletal diseases or a hip fractures, injured persons, the weekend warrior or the elite professional athlete.

Division Head: W.D. Regan

Keeping fit through regular exercise has become a priority for many of us. Maintaining a healthy lifestyle has increased our demand for knowledge and treatment of sports-related injuries. This demand is also evident in the highly competitive sports world, where the goal is to allow the athlete to return to the game as quickly as is safely possible. While many sports-related injuries can be treated by non-surgical procedures, more serious ones involving the bones, joints, ligaments, muscles and nerves require the expertise of an orthopaedic surgeon.

The Division of Arthroscopy and Athletic Injuries is comprised of Orthopaedic Surgeons who have a subspecialty interest in the treatment of the musculoskeletal problems of active people. While the care of “elite” athletes is part of the practice of sport medicine orthopaedic surgeons, the majority of the practice involves keeping all members of the public active so they can enjoy a high quality of life. The diagnosis and treatment of orthopaedic injuries has been revolutionized by a surgical technique known as arthroscopy. Using an arthroscope, inserted into the joint cavity through a small incision, the orthopedist can get a detailed view of the entire joint, which is displayed on a television screen in the operating room. Using this minimally invasive surgical technique, the surgeon can investigate, diagnose and immediately treat many conditions, eliminating the need for more major open surgery. Furthermore, this surgery can be performed in an ambulatory setting eliminating the need for hospital admission. Recovery is hastened by minimally invasive surgery such as arthroscopy.

Arthroscopic surgery is performed at all of the teaching centers; however the focus on arthroscopic surgery and athletic injuries, under the direction of Dr. W.D. Regan, is at the Royal Columbian Hospital and the University Hospital. Patients receive postoperative care at the Allan McGavin Sports Medicine Centre and New West Orthopaedic and Sport Medicine Center. In addition to diagnosing and treating a variety of athletic injuries, the Division’s faculty members also provide consultation to local, regional, national and international professional and amateur sports teams and organizations. Faculty also provides consultation to the UBC Student Health Service.

 

Division Head: Charles Fisher

The Vancouver Spine Surgery Program at Vancouver General Hospital is home to some of Canada’s most pre-eminent orthopaedic and neurosurgical spine surgeons. We are BC’s only specialized centre for spine and spinal cord injuries and are one of Canada’s largest referral centres for complex spinal trauma and spinal disorders.

Located in the Blusson Spinal Cord Centre on the VGH Campus, our team is committed to delivering clinical excellence in the comprehensive treatment and care of patients requiring spinal surgery. Regardless of whether a patient is suffering from chronic spine and spinal cord issues, an injury due to major trauma, complex spinal cord tumours, degenerative conditions or spinal deformity, our team of surgeons and specialists work collaboratively for the benefit of our patients. We believe that there is a significantly greater opportunity for a positive outcome by having complete and comprehensive access to assessment, treatment and rehabilitation options in an environment that encourages innovation and research advancement.

Division Head: Michael Moran

Division Head: Alastair Younger

Orthopaedic conditions of the hand and upper extremity can cause major disabilities by their effect on lack of function. In the past, mainstays of treatment were open surgery including that of shoulder instability, rotator cuff repairs and shoulder arthroplasty. Conditions about the wrist and hand have been subjected to intense scrutiny especially with respect to arthritis and post-traumatic conditions.

Treatment of the upper extremity has been aided by the rapid development of arthroscopic skills and minimal surgical access techniques over the past ten years. This has resulted in a movement from an in patient-focused activity to daycare surgery. Procedures such as arthroscopic rotator cuff repair and repair of instability through the arthroscope have been major areas of focus in shoulder meetings. The elbow has been dramatically helped both for diagnostic purposes and by minimal access surgery for capsular release and fracture management. The evolution of total elbow arthroplasty has been very valuable, particularly for those middle-aged and older rheumatoid arthritic patients where a total elbow replacement has improved function.

Treatment of the wrist and hand has been revolutionized by arthroscopic minimal access techniques, used both in diagnosis and management. Newer techniques for small joint arthroplasty and hinged implants allow minimally invasive reconstructive surgery in the wrist and hand.

Growth in basic science and the application of engineering principles have enormously added to our knowledge of shoulder, elbow, wrist and hand problems and their treatment. The Division of Distal Extremities links strongly with the Division of Orthopaedic Engineering. The Division is dedicated to promoting new techniques and exploring new frontiers.

Division Head: Donald S. Garbuz

The Division of Lower Limb Reconstruction & Oncology involves reconstruction of the hip, knee, foot and ankle, as well as treatment of benign and malignant soft tissue and bone tumours.

With the ageing population, disorders affecting joints, in particular arthritis, will become more prevalent. For this reason, there will be an increased demand for surgeons who specialize in reconstruction of arthritic joints. We are very fortunate to be providers of such services. Furthermore, we are fortunate in that our results are second to none in terms of medical treatments. The success rate of hip and knee replacements are in the neighbourhood of ninety-five percent. Despite this high success rate, these are mechanical devices that tend to fail with time, as all mechanical devices do. Hip and knee replacements tend to last 10 to 15 years, and subsequently, they require further revision work. The Division specializes in such revision work, in addition to primary work. The Division also includes the foot and ankle service.

The human foot is a complex structure made up of 26 bones, 107 ligaments and 19 muscles. In addition to treating fractures and dislocations, the orthopaedic surgeon is also concerned with a wide variety of foot and ankle problems (BC Foot & Ankle Specialists: www.bcfootandankle.com), including abnormalities of the ankle, hindfoot and midfoot; diabetic foot problems; rheumatoid arthritis; and other inflammatory arthritic conditions. A variety of surgical techniques – including joint replacement, arthroscopy, arthrodesis, osteotomy and synovectomy – are used to relieve pain, correct deformities and increase mobility of the joint.

Medical research has a tremendous impact on improving the quality of life for patients with tumours in the bone, cartilage or other tissues of the musculoskeletal system. Not too many years ago, a diagnosis of bone cancer often led to amputation of the affected limb. Today, with the expertise of orthopaedic surgeons and other medical professionals, limb reconstruction surgery – replacing the cancerous area with bone harvested from a healthy part of the body, and/or a bank bone enables the patient to lead a more normal life. In some cases, the limb is reconstructed with donated bone or a custom metal implant.

Because of their complex and unique nature, musculoskeletal tumours can be difficult to diagnose and treat. At the weekly Sarcoma Conference held at the British Columbia Cancer Agency, specialized teams of medical professionals from the Departments of Orthopaedics, General Surgery, Radiation and Medical Oncology, Pathology and Radiology meet to review complex cases. The specialists diagnose and determine the best treatment based on the stage of development of the cancer, as well as the patient’s past treatment and personal needs. When surgery is necessary, the operation is often a very lengthy, one-of-a-kind procedure involving several members of the team.

Division Head: Pierre Guy

Every year, thousands of British Columbians sustain critical injuries as a result of accidents. When multiple traumas, fractures, sprains and other bone and soft tissue injuries are suffered, the patient often requires the immediate attention of the orthopaedic trauma surgeon.

The Division of Orthopaedic Trauma is one of the larger divisions within the Department and comprises 14 members based at all of the teaching hospitals. The major focus for complex adult trauma is at Vancouver Acute and the Royal Columbian Hospital in New Westminster. The Division, which serves as the province’s quaternary referral centre for orthopaedic trauma, uses a helicopter landing facility located on the roof of the Jim Pattison Pavilion at Vancouver Acute for critically injured patients arriving from throughout British Columbia.

Intramedullary nailing is an area of specialization the Division employs in the treatment of long bone injuries. The Division also concentrates on the management of complex periarticular and pelvic fractures. Some of the more common surgical techniques in the treatment of fractures include internal fixation (aligning and immobilizing the break using plates and screws or a rod) and external fixation (inserting pins into the bone through the skin and applying a metal frame around the limb). Post-traumatic reconstructive surgery includes limb shortening and lengthening and is also an area of expertise.

Division Head: Christopher W. Reilly

Treatment of children with musculoskeletal problems is actually the root of orthopaedics as a speciality. The very first specialists in this area devoted their efforts to the management of children with deformity. Most notably, these were children who either had overwhelming infection or polio. From this beginning orthopaedics rapidly developed into a speciality devoted to the musculoskeletal system for all ages and all causes and disabilities.

Paediatric orthopaedics has remained as an integral component of the specialty, and those surgeons who devote their practice to it address all forms of musculoskeletal problems that relate to the growing child. A practising community orthopedist will have approximately 10-15% of his practice devoted to problems in children.

The difference between the problems presented by the paediatric and adult population is the superimposition of growth on the presenting problem, and one of the challenges facing those who do a paediatric practice is predicting how today’s treatment will affect the child’s future. Because of the complex nature of musculoskeletal development, the surgeon must carefully consider the impact of treatment, be it non-operative (brace) or operative.

At the University of British Columbia, the Division of Paediatric Orthopaedics is based at the British Columbia’s Children’s Hospital. Here there are six active surgeons who restrict their practice to the problems of children. Also present on the children’s site is a full-time PhD biomechanist who restricts her research to problems of the developing child. At the New Westminster campus, Dr. Shafique Pirani has a major paediatric focus, as does Dr. Norgrove Penny at the Victoria campus site. Both of these gentlemen hold cross-appointments at BC’s Children’s Hospital in a consulting capacity.

The spectrum of clinical conditions seen include: paediatric trauma, developmental and early degenerative problems that affect the spine, hip, foot and ankle as well as the upper extremity. The individual diagnostic list is exceedingly long, including but not restricted to, congenital dislocation of the hip, clubfoot, brachial plexus, palsy, cerebral palsy, spinal muscular atrophy, vascular anomalies, myelomeningocele, neurofibromatosis and orthopaedic oncology.

The Division supervises an active clinical gait analysis laboratory at the Sunny Hill Hospital Site, and here complex force and pattern analysis of abnormal walking patterns provide guidance in the choice of surgical treatment for children with cerebral palsy and other motor function disorders.

The research endeavours of the Division focus on two major areas, the first of which is on the outcome of treatment of children with paediatric problems. Formal programs address the clubfoot population, children with hip disorders, the outcomes of trauma and musculoskeletal oncology. Our second area of research is on the molecular biology of multiple hereditary exostosis.

An active multidisciplinary program addressing the molecular biology and genetic expression of multiple hereditary exostosis is coordinated through Dr. Christine Alvarez’s office on the BCCH site.

Learn more: BC Children's Hospital - Orthopaedics