In June, John Herzenberg, M.D., and Philip McClure, M.D., volunteered for a week at St. Timothy’s Government Hospital in Liberia, West Africa. The two surgeons, along with Dr. Herzenberg’s wife, Merrill Chaus, R.N., a PACU nurse at Sinai’s Surgery Center of Baltimore, worked with local missionary physician, James Appel, M.D., and his wife, Sarah Appel, R.N., to operate on 11 patients with a variety of complex orthopedic issues. The hospital’s facilities are austere, with unstable power, and where C-arms are unavailable in the Operating Room (OR). The Sinai team brought its own battery-powered C-arm the SMART-C ®on a humanitarian loan from the equipment’s manufacturer, Turner Imaging Systems of Orem, Utah.

Dr. Herzenberg, director of Pediatric Orthopedics at Sinai Hospital and director of the International Center for Limb Lengthening at the Rubin Institute for Advanced Orthopedics, and Dr. McClure, director of the Pediatric Limb Lengthening Fellowship Program, used the SMART-C ® to enable visualization of bone and implant constructs during the surgical procedures. They evaluated the use of this ultra-portable mini C-arm as an alternative to the standard-sized C-arm systems. In the United States, the SMART-C ® is being adopted by professional sports teams, in clinics, medical education environments (labs), and in the OR.  In Liberia, large C-arms have proven heavy, expensive, sensitive to voltage fluctuations and heat, and often break down, rendering them useless in developing areas with inconsistencies in power and supplies, and outside the service area for manufacturers.

“Liberia was the most resource-challenged country that I’ve ever been to,” says Dr. Herzenberg, who has participated in dozens of international medical missions to Haiti and other countries over the past 24 years. For one young patient, the team performed guided growth, which was never before been attempted in Liberia. They implanted a small plate to influence the growth over a year or two, enabling the legs to straighten without the need for cutting bone.

“In order to do this, you absolutely need a C-arm because you have to place one screw above the growth plate and one screw below the growth plate. You can’t do that without an X-ray in the operating room,” Dr. Herzenberg explains.

Other cases involved using the SMART-C® to X-ray the hips of two adolescent girls suffering from slipped hip joints. Other cases involved procedures to cut leg bones and correct severe bowlegs and apply external fixators. Another involved repair of a complex nonunion of the tibia in a 4-year-old child, and inserting an internal rod and an external fixator, to induce healing. “Without having a C-arm, this would have been impossible to do,” Dr. Herzenberg notes.

Currently, Dr. Appel has plans with construction starting on an orthopedic specialty hospital in Monrovia, Liberia to continue his humanitarian work to help the poor and underserved.  This facility, one of the first of its kind in the area, is expected to treat hundreds of patients a year from the local region and surrounding areas. Many of the surgeries performed are for debilitating trauma or cruel orthopedic diseases where patients previously had no means of care.

Turner Imaging Systems is committed to promoting health equity with advanced fluoroscopy solutions. If you or a colleague need a reliable mini C-arm in a remote setting, contact our team today to learn about SMART-C ® offers for doctors contributing to health equity.

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