Blog: Serendipitous Learning Curve of Trimalleolar Ankle Fractures During the COVID-19 Pandemic

By: Pregash Ellapparadja FRCS (Trauma & Orthopaedics), Consultant Knee Surgeon, Tameside and Glossop Integrated Care Foundation NHS Trust

Learning is a lifelong process – never has this been more evident to me than during the COVID-19 pandemic. I’m a Consultant Knee Surgeon and during my training (registrar and fellowship), I had never seen or performed a posterior approach for Posterior Malleolar (PM) Fixation of Trimalleolar Fractures. During my Locum consultancy at Blackburn, I had performed just one PM fixation using posterior approach under the supervision of my Foot and Ankle colleague. In addition, I had performed one more case independently at Blackburn Hospital (See one, Do one) before moving to a substantive role at Tameside and Glossop Integrated Care Foundation NHS Trust (TG ICFT) where I have been regularly performing these surgeries as part of the trauma service provision.

There are two Foot and Ankle surgeons at TG ICFT and during the COVID-19 pandemic, one of them was required to shield. I volunteered to take the responsibility of providing this service to support with addressing our Trauma backlog.

Though initially I volunteered to do this primarily to help the service and clear the backlog, I soon took a keen interest in performing Posterior Malleolar Fixation of Trimalleolar Fractures surgeries and started regularly providing this service even after my shielding colleague had returned and was able to resume their normal services.

Between March 2020 and Feb 2021, I carried out 25 surgeries with at least 6 months follow up. To date, I have performed 29 surgeries. In addition, I have taken three of my consultant colleagues through this approach leading to at least one of them performing these surgeries regularly. I have personally fixed only nine cases while the remaining 17 cases have been performed by our registrars directly under my supervision.

Learning is a lifelong process and should not stop when one becomes a consultant. We should always be ready to come out of our comfort zone and embrace new surgical skills. Even amidst this COVID crisis, I found a silver lining through learning this new surgical skill.

Staff from NOA member organisations can find out more about my journey by attending the National Orthopaedic Alliance (NOA) Annual Members’ Conference on the 20 October 2021. Further details can be found on the NOA website here.

Pregash Ellapparadja

Pregash Ellapparadja FRCS (Trauma & Orthopaedics) is Consultant Knee Surgeon with a special interest in joint preservation surgeries including osteotomy and soft tissue knee surgery at Tameside and Glossop Integrated Care Foundation NHS Trust