Surgical Treatment of Chronic Elbow Dislocation Allowing for Early Range of Motion: Operative Technique and Clinical Results

Surgical Treatment of Chronic Elbow Dislocation Allowing for Early Range of Motion: Operative Technique and Clinical Results

This is the largest case series of surgically treated patients with chronic elbow dislocation. Using our surgical technique, 97% of patients had good or excellent outcome with a low complication rate. Open reduction of chronic elbow dislocation can be accomplished while permitting early motion with minimal recurrent dislocation risk.

We have developed a straightforward surgical technique that allows for early elbow range of motion (ROM) with a little risk of recurrent instability. We present the operative technique and results of this surgical technique from 2 tertiary centers in Ethiopia. Our hypothesis is that our surgical technique and postoperative rehabilitation protocol allows for good patient outcome regardless of injury duration.

Duane R. Anderson, MD,* Justin M. Haller, MD,Lucas A. Anderson, MD,Samuel Hailu, MD,Abebe Chala, PT,* and Shawn W. ODriscoll, MD, PhD§


Teamwork at SCH

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As our capabilities at Soddo Christian Hospital expand, we are working together as a team to make diagnoses, and provide cutting edge treatment for patients.  The other day, we had a woman present to the Emergency Room with upper abdominal pain and fever.  The ER docs did a great job with the bedside ultrasound finding what appeared to be either a fluid collection or a mass in her liver (top left picture).  Then, a CT scan by the Radiology Department confirmed that it was indeed an abscess in the liver (lower pane).  Finally, our expert radiologist teamed up with our surgeons (that's our chief resident Dr. Segni in the top right picture) to do an ultrasound-guided percutaneous drain.  This is a minimally invasive way to get the infection out instead of a big operation.

We are so proud of all of our services working together to get the best outcomes for patients!  Praise God for new technologies and teamwork!

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Neurosurgery at SCH?!?

What do you think happens when you combine the following:

  1. A country with the highest number of pedestrians struck by vehicles relative to cars on the road
  2. A brand new CT scanner among a population of 5 million people who previously had none

If you answered, “a lot of new diagnoses of head trauma”, you’d be right.  Our CT scanner is practically smoking with all the head CTs for trauma that are being done.  Most of the time, we find non-operative bleeds.  But the last two weeks has been extraordinary.  In September alone, we have taken seven patients to the OR with epidural and subdural hematomas that required emergency surgery.

head bleedsAbove are just four of the actual scans done here in the past two weeks.  And there are more!  We’ve had great outcomes so far, and our surgery residents and staff are doing more emergent neurosurgery than they ever could have imagined.

We praise God that He provided through our donors.  Through your generosity, we got a CT scanner.  And it is being used for His glory as lives are being saved.  May the name of Christ go forth in southern Ethiopia as we use this gift.  That is our prayer.

Empowering the Next Generation

Imagine a missionary doctor sitting under a tree in Africa, seeing patients as they line up from far and near.  She sees 100 patients a day or more.  In a year, perhaps 3000.  In ten years, 30,000.  Not a bad contribution to the problem of suffering in her country.  But imagine how burned-out, how completely exhausted she is after this work.  And when she finally gives up, the work is finished.  Many thousands of patients were treated, and many lives saved even.  But the work is not enduring.  It is not sustainable.

Now, imagine that same doctor pouring her life into doctors-in-training in that country.  Year after year, spending intentional time teaching 10-15 resident physicians.  In ten years’ time, perhaps 20 or 30 are trained.  Each of those go on to treat thousands of patients in their careers.  Some of them are retained as teaching physicians, and they in turn pour into others.  This is multiplication.  This is empowerment.  The impact of that one person is perhaps 50-fold when compared to the lone worker at the beginning of our story.

This is what we do at Soddo Christian Hospital through PAACS.SCH_Surgery130

The Pan-African Academy of Christian Surgeons was founded in 1996 with one residency program in the jungles of Gabon.  Since then, it has grown to twelve programs in ten countries.  We are one of those programs.  Why is it so important to train African surgeons?

Right now, 56 million people in sub-Sahara Africa are in need of surgery.  In most of the continent, there is one surgeon for every 250,000 population.  In Ethiopia, there are only a 300 surgeons for a country with almost 90 million inhabitants.  (If WHO guidelines were met, we would have 4,150!)  PAACS has the goal to train 100 surgeons by 2020.  Thirty-six have been trained thus far, and God-willing, the goal will be met by 2019.

Because the program is fully accredited, our graduates are eligible to be members of the College of Surgeons of East, Central, and Southern Africa.  And in turn, are fully licensed by the country of Ethiopia as surgeons.  And the faculty actively disciple the residents during their training - teaching them not just excellent surgical practice, but equipping them with the spiritual tools to use medicine to bring people to Christ.

We praise God for this kind of empowerment and training.  Of Africans.  For Africa.


Battling the Brain Drain

What is the “brain drain” anyway?  In developing countries all over the world, the “brain drain” refers to the tendency of qualified and skilled workers to leave the country in search of greener pastures.  To America, to Europe.  The salary of a physician in the USA may be 100 times that of his counterpart in the developing world.  Is it any wonder that so many leave?

And yet, the consequences are felt by the countries they leave behind.  The people in those countries long for skilled engineers to design their infrastructure.  For skilled physicians and surgeons to treat their medical problems.  For talented musicians and artist to elevate their culture.


Physicians in Ethiopia

In health care, the effects are especially acute.  People’s lives are at stake.  The minister of health for Ethiopia has even famously said that there are more Ethiopian physicians in Chicago than in Ethiopia itself!    So the country is taking on the challenge head on.  Thirteen new medical schools were opened in the past two years.   But this just means more junior level doctors who will also be looking for the exits.


We can train them in a specialty.  You see, the vast majority of Ethiopian medical school graduates (general practitioners, or GPs, they are called) are looking to advance their education by further training.  Just like in the US and other places, they want to do a postgraduate residency.  Whether it’s Obstetrics/Gynecology, Internal Medicine, Radiology, Pediatrics, or whatever.  They are not content to be only graduated GPs.  They want that further training.

And so, Soddo Christian Hospital is actively battling the brain drain as well.  We have a five year General Surgery residency that is fully accredited by Ethiopia’s Higher Education Authority and COSCESA – the College of Surgeons of Central, East, and South Africa.  We are actively discipling them with the Word of God.  As they study Jesus’ heart for the “least of these”, they are motivated to use their skills to alleviate the crisis in their own nation.  Not leave for another country.  Yes, that's right.  Our graduates stay in Ethiopia!  And so, we see Dr. Frehun in Addis, and Dr. Haile in Asela and Dr. Tedi here in Soddo training more surgeons.   By God’s grace, all of our graduates have stayed home!

We’ll tell you more about PAACS and how this organization is helping not just Ethiopia, but all of Africa, in the next post…

SCH Graduate Makes History

Recently, the very first graduate from the PAACS program in Ethiopia did something unique in his own country. He led a team that separated conjoined (“Siamese”) twins. To our knowledge, nothing like that had ever been attempted in Ethiopia. Dr. Frehun Ayele, who trained as a pediatric surgeon at the BethanyKids at Kijabe Hospital PAACS program after graduating from the general surgery program in Ethiopia, led a team of surgeons from Myungsung Christian Medical Center to perform the incredibly delicate and complicated operation. The baby sisters were born at a health center in the countryside and were abandoned by their mother. They were given to a Catholic mission group here who then brought them to MCM. One of the twins had a severe, fatal heart defect and it soon became clear that she could not survive. This made transfer abroad impossible because of time considerations, so Frehun made the difficult decision to take them to the operating room to separate them. It was clear that one of the twins would die, sacrificing her life for her sister's. Dr. Frehun concluded that if he did not intervene urgently, both babies would die. The surviving twin, Mariam, is doing well. Please pray for her as she recovers. We praise God for Frehun's faithfulness in serving Him as he serves the sick children of Ethiopia.

Frehun Ayele watching the preparation of the two children prior to their separation
Conjoined twins at Myungsung Christian Medical Center were lovingly cared for

Welcome Home!

The PAACS apartment building from the outside
The PAACS apartment building from the outside
move in day
Move-in day!

There's no place like home!  And now, after many years of prayer and preparation, the new Soddo PAACS apartment building is complete, and our residents have moved in to their new homes.

The finished building has 7 apartments (1 three-bedroom, 3 two-bedrooms and 3 one-bedroom apartments). These new apartments will allow the surgical residents to have a reliable source of power and water. And, since they are on the hospital's campus, it will significantly improve their home security, including that of their families. From an educational standpoint, this will also allow us to improve the residents' experience with night call. This will allow senior residents to take back-up call in the night and gain experience in teaching junior residents under faculty supervision in the night hours.

We want to extend our deep appreciation to everyone who gave so graciously to make this happen. We have been encouraged by everyone's support and gifts, even in the end as we raised money to furnish each apartment. A big thank you goes to Africa Mission Healthcare Foundation for their donation that funded over a third of the project costs!

The residents are enjoying living in the same building and often eat together, sing praise music together and enjoy holidays together since they are away from their extended families.  Dr. Surafel said, "Living on-campus together gives us lots of time for fellowship and we eat many meals together.  It is also easier to see patients more quickly."

Many of the missionary kids and PAACS residents' kids enjoying the same playground!
Many of the missionary kids and PAACS residents' kids enjoying the same
Interior of one of the apartments
Interior of one of the apartments

White Coat Ceremony

What is a white coat ceremony, you ask?  Well, according to Wikipedia, it is the ritual that marks the transition of a student of medicine from the pre-clinical years to the clinical years.  The white coat has been worn for over 100 years by medical professionals, and is clearly associated with the trade.  Everyone likes ceremonies, and for doctors, this is an important ritual that bestows the rights as wells as responsibilities on new doctors.

Though typically done with medical students, we have developed our own version of the white coat ceremony for our PAACS residents.  Performed as they begin their five year training, we assemble in the chapel here at Soddo Christian Hospital and deliver a charge to the new young surgeons.  This past week, we welcomed Dr. Gezahegn and Dr. Ebeneezer into the ninth class of surgical residents here.  Here is how it happened:

Residents awaiting the start of the program
Residents awaiting the start of the program
Dr. Gray washing Ebenezer's feet
Dr. Gray washing Ebenezer's feet

The time was opened with a song and prayer led by Pastor Daniel, SCH’s head chaplain.  Then Dr. Gray read John 13 reminding all of the servant leadership by Jesus and do likewise.  “For I have given you an example – you should do just as I have done for you.” John 13:15.  Dr. Mark Karnes shared his prayer for the residents from Colossians chapter 1.  He charged them with 3 important things to remember throughout their training.  First, God is in control; rest and trust in this.  Second, treat all patients with care and compassion as if they were family.  Third, know your limits and don’t be afraid to ask for help.

Next, Dr. Seigni Bekele, SCH’s chief resident encouraged the interns with some scripture and words of wisdom.  He read from Hebrews 12:1-2, mentioning the men of faith that are listed in the chapter before this.  He emphasized that there are many people of faith who pray continually for PAACS and for the residents here.  He challenged the interns to remember they are a part of something great and many people have gone before them in sacrifice and prayer to get the program to where it is today.  And for that we are thankful and give glory to God.  “Keeping our eyes fixed on Jesus, the pioneer and perfecter of our faith.” Hebrews 12:2

Dr. Karnes washing Gezahegn's feet
Dr. Karnes washing Gezahegn's feet

Dr. Gray spoke last pointing out that in order to be the greatest we need to be the least.  And that the desire in us to be the greatest is not wrong, but it is what we are aiming for that makes the difference.  If we stay focused on eternity and we strive to do well for the eternal, then the world may consider us crazy, but we will know we are aiming for something great.


Finally, following Jesus' example from John 13, Dr. Karnes and Dr. Gray washed the feet of Dr. Gezahegn and Dr. Ebenezer.  Not something you'd find in most white coat ceremonies, but servant leadership being the focal point of our training, a practice that we feel is essential to this rite of passage.  As staff physicians, we want to model servant leadership to even our newest trainees, as we begin to mentor them.  A blessing was prayed over them as we concluded the ceremony.



Front row, Left to Right: Dr. Ben Martin (Emory resident), Dr. Gezahegn (1st year), Dr. Ebenezer (1st year), Dr. Bob Greene (ortho visitor , Netsanet (administrative assistant .  Back row, Left to Right: Dr. Paul Gray (PAACS Ethiopia Director), Dr Moges (3rd year), Dr. Surafel (2nd year), Dr. Seigni (4th year), Dr. Mark Karnes (OB/GYN)
Front row, Left to Right: Dr. Ben Martin (Emory resident), Dr. Gezahegn (1st year), Dr. Ebenezer (1st year), Dr. Bob Greene (ortho visitor , Netsanet (administrative assistant . Back row, Left to Right: Dr. Paul Gray (PAACS Ethiopia Director), Dr Moges (3rd year), Dr. Surafel (2nd year), Dr. Seigni (4th year), Dr. Mark Karnes (OB/GYN)

Another Surgeon For Ethiopia

This is a guest post from Dr. Jon Pollock, originally featured on his personal blog.  Dr. Pollock is a staff surgeon at Myungsung Christian Medical Center in Addis Ababa, our sister hospital.  Our surgery residents, including Dr. Daniel Gidabo, train at both facilities: here in Soddo and at MCM in Addis.  (In fact, Dr. Pollock himself previously served as one of our staff surgeons here!)  The following is his account of Dr. Daniel's graduation:

Dr. Daniel surrounded by our staff surgeons and current PAACS residents

Last Saturday, we celebrated the graduation of the sixth PAACS resident in Ethiopia.   Dr. Daniel Gidabo finished his five years of training in general surgery at the end of August.   Daniel has taken a position as a surgeon in his hometown, a city of more than 100,000 people that has not had a full time surgeon in a very long time.   There Daniel will have the opportunity to treat hundreds and thousands of people who otherwise would have died without surgery.   We are very proud of Daniel and his accomplishments.  He has a well deserved reputation as a bold and effective evangelist and has led literally hundreds of people to Christ during our time with us.

Dr. Pollock speaking at the graduation ceremony

During my remarks at his graduation ceremony, I spoke to Daniel from Psalm 34, one of my favorite Psalms.  It begins with triumphant words of praise.

I will extol the Lord at all times;

His praise will always be on my lips.

My soul will boast in the Lord;

let the afflicted hear and rejoice.

Glorify the Lord with me;

let us exalt his name together.

These words were particularly appropriate for this day.   We praise God for what he has done for us.   When Daniel started his training five years ago, he had no guarantees that his work would amount to anything.   The PAACS program in Ethiopia was not accredited at that time.   There was little hope that this little upstart program would ever amount to anything.   Fast forward five years and we are accredited by both the Ethiopian Ministry of Education and the Ministry of Health and the College of Surgeons of East, Central and Southern Africa.  We have expanded from one hospital to two and have tripled the number of residents in the program.  This is only because of what God has done to bless the work he has called us to do.  Praise God for what he had done. I sought the Lord, and he answered me;

He delivered me from all my fears.

I assured Daniel that there will be times that he will be afraid.  Fear is an integral part of being a surgeon, particularly in the first year starting out on your own in practice.  I urged him to seek after the Lord, and He would deliver him from all his fears.  Delivery from fears comes with another promise if we look to him.

Those who look to him are radiant;

their faces are never covered with shame.

I encouraged Daniel to look to Him and be radiant.

This poor man called, and the Lord heard him;

He saved him out of all his troubles.

I reminded Daniel that his hometown has been without a surgeon for years and that people were crying for help.

Taste and see that the Lord is good;

blessed is the man who takes refuge in him. 

As PAACS surgeons, this is as essential to our lives as anything we do in the operating room.   We have the unbelievable privilege to invite people to “taste and seek” that the Lord is good.   I encouraged Daniel to continue to be bold in his witness.

The righteous cry out, and the Lord delivers them;

He delivers them from all their troubles. 

The Lord is close to the brokenhearted

and saves those who are crushed in spirit.

Finally, I told Daniel that as surgeons in Ethiopia, if we let ourselves, our hearts will be broken and our spirits crushed.   There are so many challenges, so much pain and disease, so much death that if we are not careful, we can become hardened and uncaring.  But as painful as it can be, we must allow our hearts to remain soft and able to be broken, because the pain, disease and death that we face everyday, breaks the heart of God.