PIOA graduate Dr Areta Samuelu was delighted to welcome PIOA lecturers Dr. Tim Gregg from Wellington, NZ and Dr Jason Donovan from Waikato, NZ on a surgical visit. Tim and Jason are experienced paediatric orthoapedic surgeons. The purpose of the visit was to help and train Areta in the management of congenital pseudoarthosis of the tibia, a rare but debilitating condition affecting the lower limb. You can read about the visit in detail below.

Some pictures from the visit.

Pre-op xray showing pseudoarthosis(false joint) at mid tibia
Post op XR after correction

Congenital Pseudoarthrosis of the Tibial- Extremely rare- 1:140,000-190,000- Anterolateral Bowing and Congenital Pseudoarthrosis of the Tibia are congenitalconditions, most commonly associated with Neurofibromatosis Type 1, that present with abowing deformity of the tibial.- Diagnosis is confirmed with radiographs of the tibia.- Treatment is nonoperative with bracing for patients who are weightbearing withoutpseudoarthrosis or fracture. Surgical correction is indicated in the presence ofpseudoarthrosis or fracture.- Risk Factors- Up to 55% associated with Neurofibromatosis Type 115% associated with Fibrous Dysplasia

In planning for both these cases, it took a year for it to fruition. Both cases turned up to our clinic in 2021 and then the whole of 2022- 2023 took time for us to plan around covid and especially counselling for the parents in both these cases as both cases will need follow up till these kids reach skeletal maturity as both cases are very rare and only a few people can do this operation.With the use of our network in both NZ and Australia, we reach out for help, and we develop a discussion and options for both patients, In March 2023, they visited Samoa as course convenors for the PIOA Paediatric Module. This great opportunity was considered also to discuss and ask for their advice on the complex paediatric cases we had on island.Dr.Tim Gregg and Dr.Jason Donovan are both renowned consultant orthopedic surgeons working in Wellington and Waikato NZ respectively. They specialize in Pediatric orthopedics and are facilitators / Mentors for the PIOA (Pacific Island Orthopedic Association) program in the Pacific and are integral part of the training program for NZ trained orthopedic surgeons.Following this meeting, both surgeons then made their own arrangements by volunteering freely and own funding through the PIOA collaboration to aid and management of our complex cases.As part of our planning phase, we had the privilege of having one of the reps from NZ to assist us with the equipment’s from Paragon Medical.

Pre op xrays of child 2
Front view
Side view
Post op xrays
Resting after surgery

Both Tim and Jason Volunteered their precious time and expertise in coming to Samoa to perform surgeries for both these rare cases for free. Both Surgeons paid for their airfares and accommodation to travel for that week in Samoa.With all the cost involved for both these cases each case cost about 50,000-70,000NZD for each patient if they were to be transfer to NZ for this treatment and even more for other special services involved.This not only benefited our government but also building capacity for our local staff in knowledge and to operate on these rare cases. This was the biggest success of the visit for both families and also our health department especially moving forward to the future of developing specialized services on island.

The team

First and foremost, we would like to thank team from New Zealand for the sacrifice they made while on holiday to operate on these surgeries. It goes without saying that their willingness and commitment to help us cater to the people of our country is remarkable and incomparable. They also managed to provide their own equipment that were used on their cases which was a huge help for us during our busy schedules in the theatre. The surgeries that were carried out are usually done overseas but having them performed on island made a huge impact on the lives of our patients and the services that we provide locally.To our local staff, thank you for showing up and being able to show enthusiasm to learn and grow in this profession. It is a milestone to witness and observe high skilled surgeons in action and I hope that we have each learnt a lot from this rewarding experience.Thank you also to Dr Faamuamua Arasi and Dr Cecelia B Vaai for working side by side with us in the past few weeks. Malo lava le tautua.And lastly, we’d like to acknowledge the Ministry of Health and Director General for the support and making sure that this visit took place so that we’re able to further our knowledge in a field that’s forever evolving every day in terms of surgical techniques and case management.