Orthopaedic Surgery

Director : Assoc. Prof. Bavornrit Chuckpaiwong, M.D.

Attending staff :

Assoc. Prof. Aasis Unnanuntana, M.D., MS.
Pojchong Chotiyarnwong, Ph.D., M.D.

Honorary advisors :

Prof. Thossart Harnroongroj, M.D., ARZT FUR ORTHOPADIE, Dr. Med
Prof. kamolporn kaewpornsawan, M.D., Ph.D.

Research staff

Miss Karbkaew Soparat, B.Sc(Nursing), M.Sc.(Applied Statistics)

Miss Narumol Sudjai, B. Sc. (Applied Statistics)

Mr. Tanatip Srisuchinthara, B.Sc., MBA

Miss Siranart Kumpravat, B.Sc., M.Sc. (IT)

Mr. Harit Pumsawai, B.Sc., M.Sc.(Information technology)

Miss Wachirapan Narktang, B.Sc.(Applied statistics), M.Sc. (Applied statistics)

Miss Natthanan Thadajariyawong, B.Ba. (International Business)

Introduction

In January of 1964, orthopaedic surgery specialty was separated from the Department of Surgery and was established as its own department. At the beginning, there were only a few faculty members, and not much research was conducted or findings published. At that time, there were only 2 Thai medical journals available, Journal of the Medical Association of Thailand and Siriraj Medical Journal. Therefore, faculty members mostly preferred to write textbooks as a tool to educate medical students and other junior physicians. From 1964 to 2012, there were 397 research publications by the Department’s faculty members, with 95% of those published from 1990 forward.  Past and present Department Chairpersons have placed research as one of the most important activities for faculty members in addition to teaching and service.  With a vision for a strong structural support for research, the Department’s current Chairperson, Professor Panupan Songcharoen, MD, established the Research unit in 2010 to house researchers and research staff from all divisions within the Department of Orthopaedic Surgery. The Research unit is located on the 4^th floor of the Lottery Building that used to be occupied by the sport medicine division.

Service
The Research unit provides systematic and timely research support to the Department of Orthopaedic Surgery’s faculty members and residents. Services include research and statistic consultation, sample size calculation, preparation of proposals for review by the Siriraj Institutional Review Board (SIRB), data collection, data analyses, and preparation of research manuscripts to submit for publication. At first, there were only a small number of research staff. However, since 1990 there has been a steady increase in research activities and research publications by faculty members, resulting in an increased number of research staff to provide the needed support. Presently, we have 7 research personnel including 1 researcher, 5 research staff, and 1 administrative support staff.

Training
We provide training on introductory research methodology and basic statistics related to research in orthopedic surgery. We also provide yearly training courses to residents and other staff who are interested in research on research-related skills such as searching for literature in PubMed, using statistic program such as SPSS, and using bibliographical software such as EndNote.

Research interest
The research unit’s main function is to support research activities. Therefore, we are interested in understanding the Institutional Review Board’s approval process by analyzing barriers within the process in order to resolve those barriers and speed up the IRB approval. We are also interested in further understanding grant proposal submission and manuscript submission processes, so that we can identify potential problems in those processes and identify appropriate solutions.

Director : Professor Saranatra Waikakul, MD
Email : saranatra.wai@mahidol.ac.th

Attending staffs :
Associate Professor Apichat Asavamongkolkul, MD
Rapin Phimolsarnti, MD
Chandhanarat Chandhanayingyong, MD

Honorary advisors : Professor Yongyudh Vajaradul, MD

Introduction
     The Bangkok Biomedical Center, under the Patronage of Her Royal Highness Princess Galyani Vadhana Krom Luang Naradhiwas Rajanagarindra, is a part of the Department of Orhopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University.  The Center is Thailand’s first and only Collaborating Center of the World Health Organization for bone and tissue bank since 2005. We use donated bones and tissues from cadavers to create biomaterials that can be used in orthopedic surgery for bone and tissue replacement in conditions such as complex fracture, bone cancer, or spine surgery. The use of these biomaterials enable patients to maintain their functional capacity, improve quality of life, and continue to be productive members of society. Presently, we are have collaborated with 28 hospitals in Bangkok and other provinces to receive donation of bones and tissues from cadavers.

Clinical service
     The Bangkok Biomaterial Center, under the Royal Patronage, has supplied bone and tissue to the surgery units in many hospitals for using in large number of patients such as orthopedic surgery, ophthalmologic surgery, general surgery, plastic surgery, dental surgery, and otolaryngologic surgery. From 1984 until present, the Center has produced more than 42,605 pieces of bones and tissues and provided services to 82 hospitals in Thailand. In addition, we organize a donation campaign to solicit donation of bones and tissues from 28 affiliated hospitals, coordinate donations from both government agencies and private institutions, and provide training in bone and tissue banking to physicians, nurses, and other bone and tissue bank personnel from Thailand and other countries.

Research interest
     We have conducted research and investigate methods to improve quality of donated bones and tissues, as well as the use of platelet concentration in orthopedic surgery. We are also developing new bone and tissue products to expand their versatility in surgical use, such as bone tablet or pre-packaged bone powder in syringe to be used for dental surgery, and dried amniotic membranefor treatment of chronic wounds.

Chief : Chanin Lamsam, MD.      Email: chanin.lam@mahidol.ac.th

Attending staff :
Ekavit Keyurapan, MD.,
Bavornrit Chuckpaiwong, MD.,
Bavornrat Vanadurongwan, MD.,
Pisit Lertwanich, MD.

Honorary advisors :
Atirek  Chivabongs, MD.
Prasit  Gonggetyai, MD.
Vichai  Vanadurongwan, MD.
Teerawat  Kulthanan, MD.
Vatanachai Rojvanit, MD.

Introduction
Sports Medicine Unit, Labor and Sports Medicine Division, was established as part of the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital in 1969 when Professor Natee Rakpolamuang was the department head and Associate Professor Vichai Vanadurongwan as the head of Labor and Sports Medicine Division. The objectives of the unit are as follows:

1. To promote health among the general public
2. To provide examination service to patients with injury or pain from exercise and sports and to provide advice on appropriate exercise for different age and physical condition
3. To prevent diseases, such as cardiovascular disease, diabetes, hypertension, etc. through appropriate exercise
4. To cure some diseases, such as paralysis
5. To conduct research on Sports medicine

To educate and train physicians, medical teams, physical education masters, the general public as well as public and private organizations on sports medicine

Clinical service:

Major tasks are

1. Treat patients with injury from sports or problems with exercise at the Government Lottery Office Building, 3^rd Floor, every day during work hours
2. Provide consultative physician at the Sports Clinic, Sports Science Center, the Sports Authority of Thailand, Indoor Stadium Hua Mark and Sports Clinic at the Department of Physical Education, Pathumwan district
3. Provide rehabilitation service for patients with problems related to sports and exercise before and provide minimally invasive surgery
4. Provide regular health check up for the general public and students.
5. Train and educate medical students, physical education students, coaches and trainers on first aid during athletes’ training. The fellowship program has also been established since 2005 and produced 13 sports medicine specialists.

Conduct study and researches and publishes such research work to promote good understanding of related diseases, which will bring greater benefits in terms of prevention, treatment, health promotion and general public’s health.

Chief : Associate Professor Areesak Chotivichit, MD

Attending staffs :
Associate Professor Witchate Pichaisak, MD
Associate Professor  Surin Thanapipatsiri, MD
Associate Professor  Cholavech Chavasiri, MD
Assistant Professor Visit Vamvanij, MD
Associate Professor  Chatupon Chotigavanichaya, MD
Monchai Ruangchainikom, MD
Sirichai Wilartratsami, MD
Assistant Professor Panya Luksanapruksa, MD
Ekkapoj Korwutthikulrangsri, MD

Honorary advisors :
Professor Emeritus Charoen Chotigavanich, MD
Clinical Professor Emeritus Amnuay Unnanuntana, MD

Introduction
The Spine Surgery Division has been a part of the Department of Orthopaedic Surgery for the past 17 years. Presently, there are 11  

Clinical service
Spine surgery has been greatly advancing, both in surgical techniques and surgical materials/devices. For example, in surgery to correct Scoliosis, Titanium pedicle screw and rod are now used for surgical implant in place of Harington rod, and they not only help to correct the spine misalignment but also provide support for spine fusion.  In 2003, we began to use micro-discectomy, which is a minimally invasive surgery technique using microscope, to operate on patients with lumbar herniated disc and pinched nerves.   Later in 2005, we introduced micro-discectomy and micro-decompression spine surgery, where a small portion of the disc material is removed to relieve neural impingement and provide more room for the nerve to heal.  These microscopic procedures result in less than 2 cm incision wound for each surgical site.

Recently in 2013, we started using computer navigation system as well as Nerve Monitoring System (NIMS) during surgery to increase surgical precision and increase safety for our patients.

Presently, we provide services to approximately 800-900 cases a year. With the continuing advancement in surgical techniques including improvement of existing techniques and development of new techniques, we are able to steadily increase the number of patients we serve. We are very proud to be the surgical team who had the greatest honor of performing spine surgery for His Majesty King Bhumibol Adulyadej during his stay at Siriraj Hospital.

Training
We have residency training program as well as fellowship training program, where we accept 2 fellows per year.  To date, 19 fellows completed the program and they are now spine surgery experts at both University-affiliated hospitals and other large hospitals in the Ministry of Public Health. In addition, we offer opportunities for short term education and training for physicians from around the world.  Our surgical training using cadavers (cadaveric workshop), organized in colllaboration with domestic and international surgical equipment suppliers, has received high interest and been attended by both physicians in Thailand and those from other countries.

Research interest
We conduct basic research such as investigating the use of stem cells to repair spinal cord injury and the use of bone marrow cells to repair spine.  We also  conduct clinical research on the use of small incision technique and navigator system for spinal surgery. In addition, we are interested in epidemiologic research to use findings to improve both direct patient care and public health service system.

Chief : Professor Kamolporn Kaewpornsawan, MD;    Email: sikkw@mahidol.ac.th

Attending staffs :

Associate Professor Chatupon Chotigavanichaya, MD

Assistant Professor Perachit Eamsobhana, MD

Honorary advisors:

Clinical Professor Emeritus Prasit Gonggetyai, MD
Associate Professor Atirek Chivabongs, MS

Introduction
Although the division of Pediatric Orthopedic Surgery was not formally established until the year 2000, we have offered services in this area for a long time since the era of Professor Fuang Satsa-nguan, MD   who was the first Thai physician who traveled to the United States after the World War II to study Orthopedic Surgery with Professor Arthur Steindler in Iowa. Later, Professor Sit Tejakampuj, MD was the first member of the Department of Orthopedic Surgery who went to Germany to study pediatric orthopedic surgery with Professor Imhouser, with a specialty in treatment of club foot in children using gradual stretching method through a series of casting. Since then, many other faculty members had gone to study abroad and trained in many areas such as treatment for malformation of extremities, hip pathology resulting in dislocation, ischemic hip disease, and leg length discrepancy. These various expertise enable the division to provide comprehensive and systematic services addressing all types of abnormalities/pathology of extremities in children.

Clinical service
The Pediatric Orthopedic Surgery division offers consultation and services for children with abnormalities/pathology of extremities, fractures/ dislocation, and scoliosis. We provide detailed evaluation by highly experienced medical staff, and develop systematic and comprehensive treatment plans, including follow-up plans that taken into consideration patients’ physical development trajectory into adulthood. We aim to further advance our services to include arthroscopic hip surgery; surgery to repair/reconstruct hip socket; and the use of motion analysis lab to help with treatment planning.

Training
We began to offer a Pediatric orthopedic Surgery fellowship training program in 2002. Since then, 5 fellows have completed the program, and most are now working at medical schools.

Chief : Associate Professor Apichat  Asavamongkolkul,MD

Attending staffs :
Professor Saranatra Waikakul,MD
Professor Apichat  Asavamongkolkul,MD
Rapin Phimolsarnti, MD
Chandhanarat Chandhannayingyong, MD

Advisors :
Professor Emeritus Chareon Chotigavanich, MD
Professor Saranatra Waikakul,MD

 

Chief : Associate Professor Kongkhet Riansuwan, MD

Advisor : Professor Banchong Mahaisavariya, MD

Attending Staffs :

Assistant Professor Likit Rugpolmuang, MD

Assistant Professor Theerawoot Tharmviboonsri, MD

Instructor DirekTantigate, MD

Introduction
Orthopaedic trauma has been recognized as one of the major services since 1964 when the Department of Orthopeadic Surgery was officially established atSirirajHospital. In the past, most cases were treated by conservative means such as casting and splinting, including traction. For the surgical cases, most of the surgical procedures were open reduction and internal fixation. Treatment trend has changed over time and minimally invasive osteosynthesishas been more popular amongsurgeons in order to achieve a better outcome, especially after Professor BanchongMahaisavariya returned from KhonKaen University and joined the team in 1981. Since then, a lot of minimally invasive procedures particularly closed nailing has been introduced and many research projects investigatingorthopaedic trauma have been carried out. Recently, the service is well recognized as a subspecialty in orthopaedic surgery and there are totally 5 staff members who are experts in different aspects of this field.

Clinical service
There is a wide spectrum of cases who have been treated in the orthopedic trauma clinic, ranging from acute to chronic and from high energy trauma such as motor vehicle crash to low energy trauma such as osteoporotic fractures. Normally, we serviced more than 5000 out-patients and at least 750 cases of in-patients per fiscal year. Most of the surgical procedures are focusing on minimally invasive osteosynthesis and treatment of complications related to musculoskeletal injuries such as delayed and nonunion, malunion and deformity, and bone loss including posttraumatic degeneration of the joints.

Training

Training in this area includes both of under and postgraduate studies. Recently there are 320 medical students, 12 Residents and 3-5 fellows including guests from both of local institutions and aboard.

Research interest

• Minimally invasive osteosynthesis in both periarticular and disphyseal fractures
• Treatment of nonunion including implant failure
• High technology in orthopaedic surgery such as computer navigation and robotic surgery
• Biomechanical study and implant development
• Anatomical study especially implant-anatomy mismatching

Chief : Aasis Unnanuntana, M.D., MS.    Email : uaasis@gmail.com

Attending staffs :

Weerasak Suthipornpalangkul, M.D.

Pojchong Chotiyarnwong, M.D.

Honorary advisors :

Professor Narong Boonyaratvej, M.D.

Professor Saranatra Waikakul, M.D.

Introduction
Metabolic bone disease is an umbrella term referring to abnormalities of bone caused by a broad spectrum of disorders such as osteoporosis (รูปกระดูก). Although the metabolic bone disease service at Siriraj hospital was just established officially in 2011, the department has done tremendous work in this field decades ago led by Prof. Emeritus Narong Boonyaratvej. With a goal to implement a comprehensive patient care, the metabolic bone disease clinic was established in 2012 (รูป clinic). This clinic is the first metabolic bone disease clinic in Thailand. The goals of metabolic bone disease clinic are to advance patient care in osteoporosis, develop an infrastructure for continued clinical research, and improve the education of residents and fellows.

Clinical service
The metabolic bone disease service has continued to focus on the treatment of patients with fragility fractures. Patients at risk of osteoporosis or fragility fracture are referred to our metabolic bone disease clinic for a thorough clinical evaluation. These patients will receive a comprehensive history and physical examination, basic laboratory investigation, and appropriate medication. All patients will be instructed to take appropriate calcium and vitamin D supplements, and if indicated, anti-osteoporosis medication will be prescribed. In addition, an osteoporosis education and fall prevention protocol will be given

Training
The teaching in metabolic bone disease area involves both under-graduated and post-graduated levels. For the under-graduate level, we introduce the basics of metabolic bone diseases to the 5^th year medical student. In this topic, we cover the principle of bone remodeling process, pathophysiology and management of osteoporosis. As for the residency training program, the curriculum will be conducted via case based discussion, topic presentation and small group discussion. Some research studies of interest will also be presented and discussed regarding their relevance and their application to the routine clinical practice.

Research interest
We are interested in developing a post-fracture care program. We are creating a care team as a fracture liaison service to take care of patients with fragility fractures. Other areas of interest include the study of appropriate vitamin D supplementation for Thai patients, the effect of anti-osteoporosis drugs on osseointegration after joint replacement or spinal fusion, the use of these agents to facilitate functional outcomes after orthopaedic surgery, and clinical trials of some novel osteoporosis agents. Our future plan is to develop a multidisciplinary care team for osteoporosis patients, which will include physicians from other subspecialties including endocrinologist, nephrologist, radiologist, physiatrist and geriatrician.

Chief : Professor Panupan Songcharoen, MD

Attending staffs :

Assistant Professor Saichol Wongtrakul, MD

Torpol Vathana, MD

Roongsak Limthongthang, MD

Introduction

Hand and Microsurgery Service of the Department of Orthopaedic surgery, Siriraj hospital, provides care for the patients with hand, wrist and elbow problems including trauma, birth abnormalities, tumors, infection, inflammation, and degenerative conditions. Using holistic approach for structural bones and joint, soft tissue whether the skin, muscle, tendons, blood vessels, and nerve is essential. The procedures of hand surgery mainly involve microsurgery techniques especially for nerves and small vessels repair and reconstruction.

Professor Emeritus Natee Rukspollmuang is the pioneer of hand surgery in our department, performing numerous pediatric hand deformity corrections and tendon transfers after finished training from England.

In the early time of the department, hand services had not yet clearly assigned. With increasingly complicated problems of hand surgery encountered, the Hand and Microsurgery service has been established and Professor Panupan Songcharoen was appointed as the first chief of services.  Professor Panupan studied hand and microsurgery from England and Switzerland, particularly with the world pioneer in brachial plexus surgery, Professor Algimentas Narakas. Professor Panupan is considered to be the first physician in Thailand who treated the brachial plexus injury patients with microsurgical nerve surgery, and recognized internationally as an expert in the field of the brachial plexus surgery.

Clinical service
We provide services through our specialty clinic for patients, especially those

Chief : Associate Professor Bavornrit Chuckpaiwong, M.D. Email: chuck003@gmail.com

Attending staffs : Theerawoot Tharmviboonsri, MD

Honorary advisors : Professor Thossart Harnroongroj, MD

Introduction The Department of Orthopaedic Surgery and Physical Therapy has provided services to patients with foot and ankle pathology and injuries since Professor Fuang Satyasnguan, MD, introduced this specialty at the Department. This was followed by the expansion of this specialty service by Clinical Professor Sidhi Techakapuch, MD, who continued to broaden the care for foot and ankle pathology and injuries in both children and adults, while imparting his knowledge and skills in this area to medical students and trainees. The Orthopaedic Foot and Ankle Division was officially established on 26 March 2008, and strives to provide excellent services and advance knowledge through research on all types of foot and ankle pathology and injuries in adults.

Clinical service The Foot and Ankle Division provides services for all types of foot and ankle pathology and injuries in adults such as fractures; joint dislocation; ligament/tendon injuries; foot and ankle injuries from sports; foot and ankle arthritis; deterioration and inflammation of ligament/tendon; and tumors and infection of the ankle and foot areas.

The foot and ankle specialty has continued to progress, and we are now able to conduct more complex surgeries using advanced knowledge and state-of-the-art technologies. Examples include the use of specific instrument for small incision resulting in less recovery time for patients, knee replacement surgery, and arthroscopic surgery for bone and ligaments/tendons at and around the ankle and foot area.

 Training  We offer the fellowship training program since 2013.  Siriraj hospital was the first hospital in Thailand that has its own independent fellowship training program in foot and ankle area. In addition, we offer short courses for orthopedic surgeons who are interested in increasing their knowledge and skills in this specialty area.

Research interest  Our research focuses on complex foot and ankle deformity, sports-related foot and ankle injuries, ankle arthritis, and foot and ankle tendinopathy.