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Division of Orthopaedics

Orthopaedics at the U of T has a long tradition of developing innovative treatment approaches, performing research of the highest quality, developing new education programs, and providing clinical care of the highest quality possible. We are leaders in the field, and our faculty members play leadership roles nationally, and internationally. Read more »

Division Chairs for Orthopaedics - University of Toronto Orthopaedic Chairs 1976 - Today.
From left to right - Ben Alman (2006-Today), James Waddell (1996-2006), Robert Salter (1976-1986), Allan Gross (1986-1996).

Lower Extremity/Trauma

The following fellowships in Lower Extremity/Trauma are available:



Sunnybrook Health Sciences Centre

Number of Positions:
2 per year

Duration:
1 year

Site:
Sunnybrook Health Sciences Centre, Bayview Campus

Supervisors:
Dr. Hans Kreder
Dr. David Stephen


This is a one year Fellowship Program devoted to the educational activities related to the care of the critically injured patient, the integration of the orthopaedic care of these injuries with other specialties, as well as the rehabilitation and management of the musculoskeletal consequences which may result from these injuries.

This is carried out in conjunction with the core orthopaedic surgical program, allowing for experience in adult trauma and fracture management, their sequelae and complications. Subspecialty exposure to spine, post-traumatic reconstruction, upper extremity surgery, soft tissue and micro vascular techniques will also be encouraged.

The caseload, wherein the trainee is either the primary surgeon or first assistant, includes a sufficient number of index operative procedures to gain proficiency in the management of significant axial (including pelvic and acetabular) and appendicular injuries.

The fellowship is divided into six-month rotations split between Dr. Hans Kreder and Dr. David Stephen. Dr. Kreder's Fellowship is a combined trauma and arthroplasty Fellowship. He specializes in trauma surgery including pelvic and acetabular trauma, pelvic and acetabular tumour reconstruction and total joint revision, and primary arthroplasty of the hip and knee. Dr. Stephen's practice involves pelvic and acetabular trauma surgery, Ilizarov surgery for the lower extremities and adult foot reconstruction.

Objectives:
This Fellowship will allow the trainee to acquire an advanced level of skill in the management of the orthopaedic trauma population. This advanced level will be obtained from faculty-guided experience in:

  • The surgical as well as non-surgical management of musculoskeletal injuries.
  • Treatment alternatives in basic fracture care.
  • Proficiency in the treatment of complex fractures of the pelvis and acetabulum, complex fractures and injuries of the foot and ankle, arthroscopy of the knee and ankle.
  • Proficiency in the treatment of and options for limb salvage including the use of ilizarov fixation device for bone and soft tissue deficiencies, deformities and infections.
  • Algorithmic decision making with respect to timing and sequencing of multiple injury management.
  • Postoperative and outpatient care, including the direction of rehabilitation.
  • Understanding the prophylaxis and/or treatment of the complications and sequelae of musculoskeletal injuries.
  • Injury management decision making, based on age and/or co-morbid medical problems, as seen either in the pediatric or the geriatric population.
  • Developing familiarity with and understanding the historical evolution of the methods available to treat musculoskeletal injuries.
  • The use of advanced technology and instrumentation.
  • Activities that foster the development of skills in teaching as well as laboratory and clinical research related to orthopaedic trauma.
  • Ethical, economic, and legal issues as they pertain to orthopaedic trauma care.
Furthermore, it is expected that individuals completing this Fellowship training will be able to:

  • Organize and administer an orthopaedic trauma service, and coordinate the activities of the service with other administrative units.
  • Establish policies and procedures for the management of orthopaedic trauma patients.
  • Appoint, train, and supervise specialized personnel.
  • Teach the specialized body of knowledge required for the comprehensive management of the orthopaedic trauma patients.
Educational Program Curriculum Overview:
The program provides an opportunity for fellows to learn in-depth the following aspects of orthopaedic trauma care:

  • The interdisciplinary relationship between various members of the trauma team including, but not limited to, trauma and critical care, anesthesia, neurosurgery, urology, and physical medicine and rehabilitation.
  • The clinical and radiological musculoskeletal evaluation of the injured patient.
  • The pathophysiology of the multiply injured patient in addition to the associated vascular, neurological, urological, respiratory, and metabolic disorders.
  • The surgical and non-surgical management of axial and appendicular musculoskeletal injuries.
  • Principles of management of soft tissue injuries.
  • The techniques for treating deep wound and bone infections, as well as segmental bone loss, non-unions, and mal unions.
  • Principles of post-traumatic reconstructive surgery, including joint and ligament replacement, augmentation, osteotomy and fusion techniques.
  • Principles of biomechanics, biomaterials and bioengineering and how they relate to orthopaedic traumatology.
  • Biostatistics and experimental design.
  • Ethical and legal aspects of orthopaedic trauma care.
  • The use of outcomes studies.
  • The epidemiology, prevention, and mitigation of injury.
  • ATLS certification.
On Call Responsibilities:
Fellows are responsible for providing in-house on-call coverage as part of their Program – usually one in four, sometimes five.

Orthopaedic Rounds:
Fellows are encouraged to make themselves available for the many orthopaedic educational opportunities offered through the University of Toronto Orthopaedic Program including City Wide Rounds, University Rounds, Grand Surgical Rounds, etc.

Research:
As part of the Fellowship Program, it is expected that the Fellows actively participate in research and academic activities. Research projects will be supervised by the service to which the Fellow is assigned and should be formalized during the early part of the Fellowship.

Supervisors:
The supervising staff has a real and demonstrated interest in teaching and mentoring and set an example for trainees by documented scholarly pursuits including, but not limited to:

  • Participation in continuing medical and surgical education programs.
  • Active participation in regional and national orthopaedic and trauma scientific societies.
  • Demonstration of an active interest in research of orthopaedic trauma problems, and the presentation and publication of scientific work as appropriate.
The medical needs of the multiply injured patient involve the integration of multiple specialties. The supervisory staff, by example, should help the orthopaedic trauma fellow understand and promote the clinical and collegial aspects of these inter-relationships in order to encourage and enhance optimal patient care and educational opportunities.

Teaching:
Fellows participate in the educational endeavours of SHSC, and are expected to participate in the teaching activities of student nurses, staff, and other allied health professionals.

Contact:
Attn: Mrs. Carolyn Gimera, Administrative Coordinator
Division of Orthopaedic Surgery
Sunnybrook Health Sciences Centre
2075 Bayview Ave., Rm MG 314
Toronto, Ontario M4N 3M5
Tel: 416 480-4884
Fax: 416 480-5886
Email: carolyn.gimera@sunnybrook.ca

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St. Michael's Hospital

Number of Positions:
up to 4 per year

Duration:
1 year

Site:
St. Michael’s Hospital, Toronto

Supervisors:
Dr. J.P. Waddell
Dr. E. Schemitsch
Dr. E. Bogoch


This fellowship is available to surgeons who have completed their general orthopaedic training and have a specific interest in acquiring specialty skills in lower limb reconstruction. A number of fellowship positions are available in lower limb reconstruction. Three supervisors are involved in these fellowship positions; each supervisor carries out both primary and revision total hip replacement and total knee replacement surgery. In addition, there is a subspecialty component to each supervisor’s practice involving forefoot reconstruction, upper and lower limb rheumatoid arthritis surgery and knee arthroscopy. Approximately 1,000 total joint procedures are performed each year at St. Michael’s Hospital on this service. Up to four fellows can be accommodated on this service allowing fellows a comprehensive training in terms of exposure to the operating room, new patient clinic and follow-up clinic. St. Michael’s Hospital is also a Level 1 Trauma Centre and the Orthopaedic Service at St. Michael’s Hospital is fully integrated as part of the Trauma Program. All three of the supervisors in this fellowship participate fully in fracture management and their fellows will be expected to also participate in fracture management both in terms of operative and non-operative care of fractures as well as work in the Fracture Clinic.

It is anticipated that at the conclusion of the fellowship the fellow will have a comprehensive knowledge of the pre-operative assessment, intra-operative management and post-operative assessment of both routine and complex primary total hip and total knee replacement surgery as well as an improved knowledge of both the surgical and follow-up management of revision total hip and total knee replacement. In addition, the fellow will have a comprehensive knowledge of the surgical and non-surgical management of simple and complex fractures as well as the management of fractures in the polytrauma patient. In addition, it is anticipated that each fellow will satisfactorily complete one or more clinical or basic science research projects in their area of interest and expertise. St. Michael’s Hospital offers a comprehensive database for both joint replacement surgery and fracture surgery; in addition there is a fully equipped biomechanics laboratory and a surgical navigation laboratory in which fellows can complete their research projects.
The clinical responsibilities are shared between the supervisors, the fellows and residents. The fellows are expected to attend the operating room and assist or perform primary and revision total hip and total knee replacement surgery. They are also expected to attend the operating room when appropriate for the management of simple and complex fractures. In these circumstances the fellows will frequently act as assistants and residents will be the primary surgeons – all of this occurring with appropriate staff supervision. Fellows are not responsible on a day-to-day basis for care of patients on the ward but may be asked to participate in such care when residents are not available due to educational responsibilities.

Fellows will also be asked to take call in a supervisory capacity to the residents on evenings and weekends. These call obligations would seldom be more than one in six days per week or one in four weekends per month.

This fellowship provides orthopaedic graduate trainees an excellent opportunity to increase their knowledge of joint replacement surgery, learn new techniques in terms of management of difficult or complex primary hip and knee replacement as well as revision hip and knee replacement. In addition, innovations in navigation a number of programs are currently under development within the arthroplasty group including navigation, minimal incision surgery and resurfacing hip replacement. In addition, a number of innovations in comprehensive fracture management are also being developed at this hospital as part of the Trauma Program and fellows will be able to participate fully in these areas.

Contact:
Dr. James Waddell
2 Queen Street East, 10th Floor, Suite10-02a,
Toronto, ON
M5C 3G7
Ph: 416 864-5048
Fax: 416 864-6010
Email: waddellj@smh.toronto.on.ca

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