Adrian Talia

Orthopaedic Surgeon

General

Area of specialty: Foot & Ankle, Trauma

Please call or chat face-face, especially when on call. Text messages or WhatsApp is fine, but only for non-urgent things or if I miss your call.

Email ahead of time for elective list booking requests – however if you look at the scanned booking form or patient outpatient notes, you will often find equipment required for the case.

I will participate in the on call roster at Footscray and Sunshine.

I have fortnightly half day trauma lists at Footscray (see below), do your best to save F&A trauma cases for these lists.

Roster

  • Week 1
    • Weds PM Theatre – Footscray (Trauma)
    • Fri AM OPC
  • Week 2
    • Weds All day Theatre – Williamstown
    • Fri AM OPC
  • Week 3
    • Weds PM Theatre – Footscray (Trauma)
    • Fri AM OPC
  • Week 4
    • Thurs All day Theatre – Williamstown
    • Fri AM OPC

Common Operations and Equipment Preferences

These are a guide only and be sure to always double check/email prior to the lists as per usual protocol. F&A surgery has so many different procedures it’s hard to be complete with guides like this – not like the hip & knee surgeons!

Positioning and preferences

For all ankle cases – thigh torniquet and popliteal sciatic + saphenous block. Set up supine, with wedge under buttock and a sterile obligatory F&A bump. After prep, drape and setting up diathermy etc. Exsanguinate with Esmarch bandage then inflate torniquet.

Special case 1: ankle arthroscopy is set up with a distractor (Smith & Nephew – Guhl distractor).

Special case 2: cases requiring access to posterior ankle (such as achilles surgery) require the patient set up lateral with affected side down.

For all foot cases – calf torniquet and ankle block (from anaesthetist, or us, I don’t mind). Set limb up on bone foam ramp plus sterile F&A bump. After prep, drape and setting up diathermy etc. Exsanguinate with Esmarch bandage then inflate torniquet.

BIPOLAR DIATHERMY FOR ALL F&A CASES – SET TO 15

Closure (all cases): 2/0 vicryl and 3/0 prolene unless otherwise specified.
Dressing (all cases): Primapore unless otherwise requested.

Music: very important, I always operate with music. Feel free to bring a speaker and your own playlist, otherwise I will bring mine! 🧠🦾

ELECTIVE

Forefoot

Midfoot

Hindfoot

Ankle

Grafts:

  • Augment (PDGF) – Stryker (Wright)
  • Allovance
  • Structural bony allografts and Tendon allografts from Aus Biotech

Diabetic Foot Cases 

  • Case by case basis
  • Major reconstructions will probably require large amounts of metal..
  • Most Diabetic foot cases will also require local antibiotic delivery, my preference is Cerament
    • distributed by AKVA surgical in Australia

TRAUMA

For trauma cases, I will always do my best to use implants that are consigned to western, I will only request loan gear if I think the on shelf kit is vastly inferior.

Do not book loan equipment without checking first, we should generally try our best to use what’s on shelf.

Upper Limb

  • Clavicle fractures – Styker clavicle locking plates
  • For acute AC joint injuries – Synthes clavicle hook plate
  • For chronic AC joint injuries – refer to UL surgeon
  • Proximal humeral fractures – refer to UL surgeon
  • Humeral shaft fractures
    • Proximal shaft – Synthes PHILOS plate
    • Mid shaft – Synthes large fragment locking plate (posterolateral approach)
      • If appropriate then Smith and Nephew anterior MIPO humerus plate
    • Distal shaft – Synthes 3.5mm extra articular distal humeral locking plate
  • Humeral nail – Synthes Multi-loc humeral nail
  • Elbow fractures
    • Distal humeral supracondylar/intercondylar fractures: If internal fixation required – Stryker distal humeral periarticular locking plates with 4mm ASNIS screws
    • If total elbow replacement required – refer to UL surgeon
  • Radial head fractures:
    • Internal fixation – Medartis 2.2/3.0 CCS cannulated screws or Medartis radial neck plates
    • Replacement – Older patients – Whatever is onshelf (nothing fancy – doesn’t really matter). Younger patients I prefer to use a pyrocarbon radial head replacement (Tornier/Wright or LMT)
  • Olecranon fractures: Over 80 year old you really need to think hard about whether they need to be fixed (see Duckworth’s paper). Most can be fixed with tension band wire construct. If comminuted then olecranon plate fixation (whatever is on shelf)
  • Distal radius fractures – Synthes VA distal radius volar plate.
  • Scaphoid Fractures – Medartis 2.2/3.0 CCS or Medartis scaphoid specific volar locking plate

 

Lower limb

Hip fractures

  • DHS
    • Stable pertroch fractures 3 hole (Evans classification)
    • Subcapital fractures 2 hole with antirotation screw (large fragment partial thread cancellous)
  • Short Nail (Gamma) – unstable pertroch fractures (or really sick patient that needs fast operation.
  • Long Nail (prefer T2 alpha Recon) – subtrochanteric fractures or subtrochanteric extension
    • For subtrochanteric fractures that are really displaced or flexed I prefer to do these in the lateral position with beanbag and have a very low threshold to open these to reduce them.
  • For arthroplasty cases
    • Stryker Exeter Stem
    • Trident cup if needs THR
    • Metal on Poly
  • Femoral Shaft – T2 alpha recon nail (antegrade depending on level of fracture)
  • Periprosthetic proximal femur – Zimmer NCB or Synthes VA-LCP proximal femur
  • Distal femur
    • Extra-articular – have low threshold for retrograde nail or nail/plate construct
    • Intra-articular – ORIF with (low threshold for dual plating)

Tibial Fractures

Ankle Fractures

  • Simple – synthes small fragment
  • Complex – Stryker Variax
  • Syndesmosis – Arthrex Tightrope in most cases
  • Posterior malleolus – ASNIS screws or if plating then assess on case-by-case basis

Talus, Lisfranc, Calcaneal, tarsal and metatarsal fractures

  • I regard these as subspecialty cases and therefore would be happy to order in kit for this. See elective section above.

 

Company Reps and Contact Details:

Medartis:

Arthrex:

Exactech: Mark Jones (AP surgical – distributor) – 0499 206 847 / mark@apsurgical.com.au

Paragon28: Distributed via Pulse Orthopaedics

Stryker (Wright):

Australian Biotechnologies (grafts): graftorders@ausbiotech.com.au

AKVA Surgical (Cerament/OrthoFix): Maryam Afsal maryam@akvasurgical.com