Mr. Paul David Dunkow - Orthopaedic Surgeon
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Meet Mr. Paul David Dunkow
 
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Mr. Paul David Dunkow

Senior House Officer Posts

Aug 1996

  • Commenced South Manchester University Teaching Hospital
    Basic Surgical Rotation.

Aug 1996 – Feb 1997

  • General Surgery South Manchester University Hospital.

Feb 1997 – Aug 1997

  • Orthopaedics South Manchester University Hospital.

Aug 1997 – Feb 1998

  • ICU/ Vascular South Manchester University Hospital.

Feb 1998 – Aug 1998

  • Cardiothoracic Surgery South Manchester University Hospital.

Aug 1998 – Feb 1999

  • Orthopaedics Stepping Hill Hospital, Stockport.

Feb 1999 – Aug 1999

  • Orthopaedics North Manchester General Hospital.

Aug 1999

  • Joined North West Trauma and Orthopaedic Higher Surgical Rotation

Aug 1999 – July 2000

  • Stepping Hill Hospital, Stockport.
    Gained experience in general orthopaedics and trauma. 4 months with Mr. MA Morris (special interest hand surgery), 4 months with Mr. RA Dalal (special interest paediatrics), 4 months with Mr. BD Todd (special interest spine). Good introduction to orthopaedic surgery both general and specialist and wide variety of trauma.

Aug 2000 - July 2001

  • Tameside General Hospital.
    6 months with Mr. BN Muddu (special interest upper limb and general orthopaedics) and Mr. MA Pena (special interest lower limb arthroplasty and general orthopaedics). 6 months Mr. TH Dunningham (special interest primary and revision lower limb arthroplasty) and Mr. RJ Creedon (special interest hand surgery and lower limb arthroplasty).

Aug 2001- July 2002

  • South Manchester University Hospitals Trust.
    6 months with Mr. DM Lang (special interest knee arthroplasty and soft tissue reconstruction). 6 months with Mr. M Holt (special interest shoulder replacement and arthroscopic shoulder surgery). Excellent exposure to knee arthroplasty and soft tissue reconstruction of the knee. Arthroscopic surgery of the knee including meniscal repair. Extensive experience of arthroscopic shoulder surgery including rotator cuff repair, subacromial decompression, arthroscopic stabilisation and joint replacement surgery.

Aug 2002 - July 2003

  • Royal Manchester Children’s Hospital, Hope Hospital
    6 months working for Professor CSB Galasko. Excellent exposure to wide variety of textbook style paediatric cases in clinic and theatre. Regular opportunities to perform paediatric procedures including open reduction of DDH and pelvic and femoral osteotomies. Wide assortment of paediatric trauma. 6 months with Mr. S Jari increasing exposure to TKR, unicompartmental knee replacement and soft tissue knee reconstruction. Regular specialist knee clinics. Good opportunity to develop arthroscopic and open surgical skills.

Aug 2003 - July 2004

  • Bolton Royal Hospital.
    6 months with Mr. J Warner and Mr. S Hodgson, followed by 6 months with Mr. G Shepard. Excellent exposure to basic and advanced upper limb procedures focusing on both elective and trauma shoulder, elbow and hand procedures. 6 months with Mr. G Shepard focusing on primary knee replacement, complex primary knee replacement and revision knee surgery.

Aug 2004 - July 2005

  • Fellowship
    6 months under the supervision of Mr. A Clayson gaining experience of pelvic trauma surgery, primary lower limb arthroplasty, pelvic osteotomy and hip replacement in the young patient. 6 months with Mr. D Lang performing primary knee arthroplasty, revision knee surgery and soft tissue procedures of the knee.

Current Position

  • Consultant Orthopaedic Surgeon Blackpool Victoria Hospital

Publications

  1. Tennis Elbow: Comparison of open and percutaneous techniques: a prospective randomised controlled trial. PD Dunkow, BN Muddu. Journal of Bone and Joint Surgery (Br) July 2004; 86-B: 701.

  2. Functional Outcome Was Better After Percutaneous Surgery Than After Open Formal Release For Tennis Elbow. Evidence Based Orthopaedics. Journal of Bone and Joint Surgery (Am) Feb 2005; 87-A: 467.

  3. Experience of Orthopaedics in a developing country: the value to orthopaedic trainees. PD Dunkow. Editorial, Hospital Doctor March 2002.

  4. Treatment of Osteoporosis: a missed opportunity in hospital fracture clinics. Osteoporosis International 13, 2002. PD Dunkow, MG Smith, DM Lang.

  5. Osteoporosis: awareness and instigation of treatment after osteoporotic fracture following fracture clinic attendance. Annals of the Royal College of Surgeons of England. 86 (5) 344-347: 2003.

  6. To have a chaperone or not. BN Muddu, PD Dunkow. Hospital doctor. November 2001.

  7. Life Above the Neck: Brain tumour presenting as carpal tunnel syndrome. P Dunkow, S El-Kodar, M Pena. Journal of Hand Surgery. Journal of Hand Surgery. Accepted.

  8. True Aneurysm of the Transplanted Renal Artery in a Kidney Transplant Recipient. Paul D. Dunkow, John S. Abraham, Robert W.G. Johnson. Nephrology, Dialysis and Transplantation. Oct 1994.

  9. Tibialis anterior tendon rupture- an association with restless legs syndrome. Graham D Smith, Paul Dunkow, Bisal Muddu. Orthopaedic Update India. June 2001.

  10. Floating index metacarpal from double dislocation, Rex C; Morris MA; Dunkow PD, Stepping Hill Hospital, Department of Orthopaedics, Stockport, UK, Indian Journal of orthopaedics. 2002 Apr; 36(2): 129-30.

  11. A simple technique for removal of screws with damaged heads. Bhutta MA, Dunkow PD, Lovell ME Ann R Coll Surg Engl 85(3):207 (2003).

  12. Wound closure with subcuticular vicryl. PD Dunkow. Orthopaedic Update India.

  13. Closed manipulation of the tibia: a simple technique. PD Dunkow, N Allaf, ME Lovell. Annals of the Royal College of Surgeons of England. Ann R Coll Surg Engl. 2004 Sep;86(5):382-3.

Abstracts

  1. Treatment of Osteoporosis: a missed opportunity in hospital fracture clinics. British Journal of Bone and Joint Surgery (abstract). MG Smith, PD Dunkow, DM Lang.

  2. Tennis Elbow: Comparison of Open and Percutaneous Techniques: a prospective randomised controlled trial. Journal of Shoulder and Elbow Surgery (abstract). PD Dunkow, BN Muddu.

  3. Tennis Elbow: Comparison of Open and Percutaneous Techniques: a prospective randomised controlled trial. European Journal of Shoulder and Elbow Surgery (abstract). PD Dunkow, BN Muddu.

  4. Penetrating Trauma of the Lumbar Vertebrae. PD Dunkow, DM Lang. Injury (abstract).

  5. British Society Children’s Orthopaedic Surgery (BSCOS), June 2003. Changing Practice in Paediatric Orthopaedics: An overview from The Royal Manchester Children’s Hospital 1970-2000. PD Dunkow, HC Mirza, CSB Galasko.


Submitted

  1. Surgery for congenital pseudarthrosis of the clavicle: a triumph of surgical technique over reason. H Mirza, PD Dunkow, LM Muir. Submitted to Paediatric Journal orthopaedics.

  2. Extent of osteoarthritis in the knee: the predictive value of radiographs. Submitted to the Annals of the Royal College of Surgeons of England.


Research

  1. A prospective randomised controlled trial to compare the success rates of tennis elbow release using either an open or percutaneous technique. Study now completed. Paper published in JBJS. Presented paper as podium presentation at British elbow and surgery Society June 2002. Presented as podium presentation at European society of Shoulder and Elbow Surgery September 2002. Presented at the BOA, Birmingham 2004.

    Recommended as example of how to conduct a “high quality prospective randomised controlled trial”, level I evidence. Nominated as benchmark for future randomised controlled trial by Evidence- Based Orthopaedics Journal of Bone and Joint Surgery (Am) February 2005. Nominated for inclusion into the Cochrane Database.

  2. OPIS Osteoporosis Patient Identification System. Founder and developer of the system which is being introduced in trusts in the North West (currently on trial in Pennine Acute Trust). This system is designed to provide a method by which primary care teams can automatically be alerted to a patient with an osteoporotic distal radial fracture and provides the means to automatically commence appropriate treatment.

    A comprehensive package including patient information leaflets, a freephone number provided by the National Osteoporosis Society and training days for trusts wishing to use the product has been put together.

    This product has been endorsed by the Pennine Acute PCT and by the secretary of the National Osteoporosis Society. OPIS has also been incorporated into the National Service Framework for Older People in Bury General Hospital.

  3. The value of radiographs in predicting the assessment of the extent of knee osteoarthritis. The ability to assess the confinement to the medial compartment of osteoarthritis of the knee and the intactness of the ACL. Prospective trial. A prospective study performed at South Manchester. 68 patients undergoing total knee replacement and arthroscopy. Study now completed. 3 papers produced in total. For submission to Journal of Knee Surgery. Paper presented as podium presentation at the BOA Birmingham September 2003.

  4. Changing Practice in Paediatric Orthopaedics: An overview from The Royal Manchester Children’s Hospital 1970-2000. Supervisor Professor Galasko. Presented at British Society of Children’s Orthopaedics (BISCOS). See audit section.

  5. Triple arthrodesis in adolescents for Charcot Marie Tooth Syndrome. A review of procedures and outcomes in Royal Manchester Children’s Hospital. Supervisor Professor Galasko. 26 patients assessed so far using force plate analysis and Maryland Foot score.

  6. Prospective study comparing the functional outcome, length of hospital stay and range of motion following 2 different total knee replacement prosthesis. Ongoing research at North Manchester General Hospital, Pennine Acute Trust.

  7. Tibial Plateau Fractures and the use of percutaneous fixation. Study to assess the efficacy compared to formal plate fixation and the long term outcome. Assesses the need joint replacement and patient function.

Presentations

  1. American Academy of Orthopaedic Surgeons New Orleans Feb 2003. Podium and poster presentation. Treatment of Osteoporosis: a missed opportunity in hospital fracture clinics. MG Smith, PD Dunkow, DM Lang.

  2. 11th Meeting of the combined Orthopaedic Associations, Sydney 2004. Tennis Elbow: Comparison of open and percutaneous techniques: a prospective randomised controlled trial. Podium Presentation. PD Dunkow, BN Muddu.

  3. Silver Jubilee of Indian Orthopaedic Association. Tennis Elbow: Comparison of open and percutaneous techniques: a prospective randomised controlled trial. PD Dunkow, BN Muddu.

  4. British Orthopaedic Association. Osteoporosis: awareness and instigation of treatment after osteoporotic fracture following fracture clinic attendance. MG Smith, PD Dunkow, DM Lang.

  5. British Orthopaedic Association. Tennis Elbow: Comparison of open and percutaneous techniques: a prospective randomised controlled trial. Birmingham 2003. PD Dunkow, BN Muddu.

  6. British Orthopaedic Association. Extent of osteoarthritis in the knee: predictive value of radiographs. Birmingham 2003. PD Dunkow, MG Smith, DM Lang.

  7. World Health Organisation. Third International Symposium on Clinical Aspects of Osteoporosis and osteoarthritis. Barcelona, Spain 6-9 November 2002. Osteoporosis: awareness and instigation of treatment after osteoporotic fracture following fracture clinic attendance. MG Smith, PD Dunkow, DM Lang.

  8. British Elbow and Surgery Society June 2002. Tennis Elbow: Comparison of open and percutaneous techniques: a prospective randomised controlled trial. Podium presentation. PD Dunkow, BN Muddu.

  9. European Society of Shoulder and Elbow Surgery September 2002. SECEC. Tennis Elbow: Comparison of open and percutaneous techniques: a prospective randomised controlled trial. Podium presentation. PD Dunkow, BN Muddu.

  10. British Trauma Society Leeds 2002. Penetrating Trauma of the Lumbar Vertebrae. Podium presentation. PD Dunkow, DM Lang.

  11. European Congress of Sports Medicine, 14th -16th May 2003 Belgium. Poster presentation. Tennis Elbow: Comparison of open and percutaneous techniques: a prospective randomised controlled trial. PD Dunkow, BN Muddu.

  12. EFFORT, Helsinki May 2003. Poster presentation. Osteoporosis: a missed opportunity. Awareness and instigation of treatment after osteoporotic fracture following fracture clinic attendance. MG Smith, PD Dunkow, DM Lang.

  13. EFFORT, Helsinki May 2003. Tennis Elbow: Comparison of open and percutaneous techniques: a prospective randomised controlled trial. Podium presentation. PD Dunkow, BN Muddu.

  14. British Society Children’s Orthopaedic Surgery (BSCOS), June 2003. Changing Practice in Paediatric Orthopaedics: An overview from The Royal Manchester Children’s Hospital 1970-2000. PD Dunkow, HC Mirza, CSB Galasko.

  15. National Osteoporosis Society, June 2003. Poster presentation. Osteoporosis: a missed opportunity. Awareness and instigation of treatment after osteoporotic fracture following fracture clinic attendance. MG Smith, PD Dunkow, DM Lang.

  16. Pelvic fractures. Initial management and treatment. Presented on Basic Orthopaedic Course for Senior House officers at Tameside Hospital. Member of Faculty for course run in March 2001 and September 2001. PD Dunkow.

Meetings and Conferences Attended

  • North West Hip Society Meeting Manchester 2001
  • British Orthopaedic Association Cardiff 2002
  • British Elbow and Shoulder Surgery (BESS) annual meeting Norwich 2002
  • European Shoulder and Elbow Surgery (SECEC) meeting Budapest 2002
  • North West Annual meeting 2001, 2002, 2003, 2004
  • North West Paediatric Meeting Liverpool 2001
  • World Health Organisation. Third International Symposium on Clinical Aspects of Osteoporosis and osteoarthritis. Barcelona, 2002
  • British Trauma Society Leeds 2002
  • American Academy of Orthopaedics Surgery, New Orleans 2003
  • National Osteoporosis Society, Bath 2003
  • British Society Children’s Orthopaedic Surgery (BSCOS), Sheffield 2003
  • British Orthopaedic Association (Birmingham, September 2003.)
  • Osteoporosis Seminar, Ayreshire 2004
  • Indian Orthopaedic Association Silver Anniversary, Bangalore 2003

Audit

  1. Audit of osteoporosis awareness in patients who have sustained osteoporotic wrist fractures and subsequent hip fractures. This audit was designed to fulfill the requirements of The National Service Framework for Older People and the new NICE guidelines for Osteoporosis. Results presented both nationally at the BOA, the National Osteoporosis Society and The American Academy of Orthopaedic Surgeons, New Orleans. See OPIS.

  2. Audit of Changing Practice in Paediatric Orthopaedics: An overview from The Royal Manchester Children’s Hospital 1970-2000. Supervisor Professor Galasko. Presented at BSCOS. Audit designed to look at how the numbers and types of procedures have changed in orthopaedics over the course of the last 30 years. The data was analysed to illustrate the change in approach to management and the way in which the number and types of procedure have changed. Results presented at the British Society of Children’s Orthopaedic Surgery 2004.

  3. Fracture neck of femur care pathway: comparing current practice at north Manchester General to established and published pathways. Aiming to assess impact on department of introducing similar pathways and improve “patient journey”.

    In addition to my personal audit projects I have supervised numerous audit projects for Senior House Officers and medical students over my training period. I have supervised the data collection and the structure of the audit and the presentation of the results at regular audit meetings.


Teaching Experience

  • Basic Surgical Skills Course

    Member of Faculty of the Royal College of Surgeons of England Basic Surgical Skills Course. Organised and ran the orthopaedic section of the Basic Surgical Skills Course at the Royal College of Surgeons of England. This course involved the organising and setting up of the various orthopaedic teaching stations and the supervision and examination of the course attendees. Member of Faculty for 2001, 2002, 2003, 2004. Invited to run course for following year.

  • Manchester FRCS Orth Short Cases Course

    Organised and run the “Manchester FRCS Orth Short Cases Course”. The only short cases course in the country designed to prepare candidates for the short cases part of the Orthopaedic Exit Exam, now for the second year running. Venue South Manchester University Teaching Hospitals. A well received course run specifically for senior orthopaedic trainees. 100% pass rate 2004.

  • North Manchester MRCS Course

    Member of Faculty for North Manchester MRCS Course. Examiner for course 2003, 2004, 2005. A well respected national course running for 15 years which is designed to prepare candidates for the final part of the MRCS.

  • MRCS E-Step course

    Organised cases for presentation on the MRCS E-Step course and acted as moderator for question and answer sessions.

  • Basic Orthopaedic Course for Senior House Officers

    Member of faculty and presenter on Basic Orthopaedic Course run for senior house officers at Tameside Hospital. Presented lecture on management of pelvic trauma.

  • Anatomy Demonstrator University of Manchester

    I found this to be a challenging and rewarding post. I developed a sound understanding of the skills required to teach students both from a practical sense as well as a more formal didactic style. I learnt the principals of motivating students and the art of encouraging the best performance from my tutorial group.

  • Medical Student Lectures and PBL Modules

    Regular lectures and presentations to medical students (both formal lectures and informal), as well as regular bedside teaching to 3rd, 4th and 5th year students

    Responsibility for medical student Problem Based Learning (PBL) tutorials. I have regularly prepared lectures for the medical students and supervised them in orthopaedic clinics.

  • Medical Student OSCE

    I have experience of examining medical students in their final year for the OSCE stations. This provided me with a valuable insight into the skills required of final year students and the standards required to produce the next generation of doctors.

Management Experience

  • Management Course

    Manchester Management Course 2005. This course is specifically designed to address the current difficulties and issues facing the modern day NHS. It addresses the issues of "plurality of providers", "payment by results", the NHS IT programme, “choose and book" and the problems associated with meeting government targets and waiting lists. This course aims to prepare Specialist Registrars for the transition to becoming a consultant.

  • European Working Time Directive (EWTD)

    Responsibility for helping to implement the European Working Time Directive (EWTD) for at North Manchester General Hospital. This involved working with the medical staffing department to develop rotas which were EWTD compliant. I was responsible for liaising with the various department and differing levels of junior doctors to in an attempt to maintain compliance and to address the problems associated with this. I gained an increased understanding of the nuances of the EWTD and how to implement workable rotas for junior doctors.

  • Rota Master and Holiday Coordinator

    Responsible for running the weekly SHO, SpR and consultant rota at North Manchester General Hospital. Management responsibility for organising annual and study leave for all grades of doctors at North Manchester General Hospital.

    Organisation of study leave and annual leave for junior doctors at various hospitals. I developed my people management skills which were required to co-ordinate the departmental annual and study leave. This lead to a greater appreciation of the pressures faced by rota masters and the need to balance a service commitment to the unit and at the same time fulfil junior doctors educational and holiday commitments.

  • Financial Management Experience

    Experience of applying and successfully acquiring a grant for setting up a multi-disciplinary project at trust level. This involved working with both the hospital IT department and the commercial sector and giving regular briefings and progress report. I was also responsible for putting together a business plan in order to identify the potential cost savings to a trust and PCT by setting up a new service.

  • Directorate Meetings

    I attended both the business and directorate meetings at Tameside General Hospital. This provided me with a valuable insight into the problems facing both the clinicians and the management. This demonstrated the importance of developing a good working relationship with the management team and being able to appreciate problems from both a clinical and non-clinical perspective. It enabled me to understand the complexities of interdepartmental budgets and allocation of monies between departments. In addition to this I developed a greater understanding of how teams must work together to deliver a solution which optimises patient care within the financial restraints of the resources allocated.

  • Tier 2 Combined Orthopaedic and Physiotherapy service

    Involved in assessing the cost-effectiveness of using a physiotherapy tier 2 services to triage orthopaedic referrals. Assessed the mechanisms required to implement the service and potential problems and pitfalls associated with the service. Looked at patient satisfaction and effect on service delivery. Also considered the impact on surgeons and waiting lists and government targets.

Operative and Clinical Experience

A Broad experience of both trauma and elective orthopaedics. I have rotated through all the major orthopaedic specialties including paediatrics, hand, spinal surgery, upper and lower limb arthroplasty. In addition I have benefited from the vast amount of trauma work at Stepping Hill, Tameside, Wythenshawe and Royal Bolton. My operative experience has allowed me to perform the majority of basic orthopaedic procedures.

At South Manchester I obtained excellent experience in knee arthroplasty and soft tissue reconstruction of the knee. The following six months I obtained good operative experience in open and arthroscopic shoulder surgery. I became confident in the operative management of patients with frozen shoulder, shoulder instability, impingement syndrome and rotator cuff tear.

At the Royal Manchester Children’s Hospital developing excellent exposure to paediatric orthopaedics. Weekly special and neuromuscular clinics specialising in patients with muscular dystrophy and cerebral palsy etc. Good operating exposure for routine and specialist procedures including DDH open reduction and pelvic and femoral osteotomies, leg length discrepancy and cavo-varus/ plantar-valgus foot deformity.

At Hope Hospital I gained an increasing amount of experience in knee arthroplasty and some soft tissue reconstruction. I improved my arthroscopic skills and undertook regular specialist knee and foot and ankle clinics.

During my period at Royal Bolton I furthered my knowledge of primary and complex primary joint replacement and gained a sound knowledge of the basics and problems associated with revision knee surgery. I also gained operative experience of the management of complex wrist fractures.

During my fellowship year I have tailored my training to provide me with a combination of exposure to lower limb arthroplasty and reconstructive surgery of both the hip and knee. I achieved a vast exposure to pelvic trauma and pelvic reconstruction at North Manchester General and am currently gaining my final experience of knee arthroplasty, arthroscopic techniques and ligament reconstruction at Wythenshawe Hospital.


Courses

  • ATLS 1998
  • AO Basic Course Jun 1999
  • Leeds Basic Knee Course Nov 2000
  • Leeds Basic Hip Course Nov 2000
  • Clinical governance course May 2001
  • Surgical Approaches Course Oswestry Oct 2001
  • Instructional course European society of Shoulder and Elbow surgery
  • Critical appraisal of research course Tameside 2002
  • Attending the AAOS New Orleans 2003 instructional lectures
  • Oswestry FRCS Orth course October 2003
  • Alder Hey Paediatric Course April 2004
  • Bristol basic Science Course January 2004
  • Oswestry clinical course January 2004
  • NHS Management Course April 2005

Traveling Fellowship to India February 2001

Visited India on a traveling fellowship. I began my tour by visiting Munipal Hospital in Bangalore to gain experience in the delivery of orthopaedic healthcare in India. This gave me a fascinating introduction to the way in which patients are cared for in both the private and state run systems in India. This provided me with a unique insight into the way in which an orthopaedic service can be set up and delivered with limited resources. There were significant differences between even the most basic levels of care provided in the state and private sector, highlighting the inequalities of health care in a developing country.

Following this I attended the Indian Orthopaedic Association Silver Jubilee conference and presented a paper on surgical options for tennis elbow. This is one of the largest orthopaedic conferences worldwide and was attended by both local and internationally renowned speakers. The hospitality was second to none!

I also visited the Christian Medical College in Velore, South India. This is south India’s foremost medical institution and provides medical care to millions of people from a catchment area larger than the entire U.K. I attended regular outpatient clinics and theatre sessions and ward rounds. The principles of theatre and clinics and rounds were remarkably similar to the U.K. However the case mix was unlike anything a trainee or consultant is likely to see here. The pathology was much more advanced and the priority patients have i.e. to simply be able to walk and work were tantamount. There was an opportunity to work with a leading brachial plexus surgeon and observe advanced reconstructive procedures.

In addition I had the opportunity to visit the largest leprosy unit in India and saw a truly remarkable clinical unit which illustrated the abilities of a group of people to be able to deal with a tremendously difficult condition with extremely limited resources.

I was able to help with the decision making process in the management of some of the complex trauma cases I was involved in. It was fascinating to see the different ways in which trauma was approached compared to the U.K. I felt I learned a great deal from these different approaches and these have helped my in my management of patients in my everyday practice.

I wrote up my experience and compiled information folder for future visiting registrars to India.

I published an editorial in hospital Doctor on the benefits to U.K. trainees of training in developing countries.

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