NHS Practice

Contact Details : NHS Address

Orthopaedic Department,                
Level 11,
Plymouth Hospitals NHS Trust,
Derriford Hospital,
Plymouth,
Devon.
PL6 8DH.
Telephone 01752 439176
Secretary – Mrs Liz Binding
Website www.pposw.co.uk


James was appointed as a Consultant Trauma and Orthopaedic Surgeon at Derriford Hospital in January 2006. James has a busy practice including Paediatric Orthopaedic Surgery, Foot and Ankle Surgery in Adults and Trauma.

Paediatric Orthopaedics

James has regular children’s clinics based at Derriford Hospital but also outreach clinics in the community. James works with Mr Ben Holroyd and Mr Robert Jeffery who are consultant orthopaedic colleagues. James will see and assess any child with an orthopaedic problem.
James has monthly clinics at Newton Abbott and in Cornwall. The Cornwall clinics are based at Bodmin Hospital and at the Child Development Centre at Treliske Hospital . James also has visiting clinics at Woodlands Special School and Dame Hannah Rogers School and the Child Development Centre at Scott Hospital in Plymouth. 

Developmental Dysplasia of the Hip (DDH)

Derriford hospital has a multidisciplinary approach to DDH. James has a monthly clinic to assess children. James works closely with Dr Rima Vaitkute who is a Consultant Neonatologist and Mr Ben Holroyd. Clinics run on a Wednesday afternoon. In Children under 6 months of age ultrasound scans are performed. In older children X-rays are performed.

Cerebral Palsy

In children who have cerebral palsy, there is an injury to the brain. This brain injury does not progress. There are several types of cerebral palsy but a common feature is that the muscles are excitable. This excitability is termed spasticity.  The spasticity in the muscles causes the muscles to be weak and short.
Initial treatment is aimed at building up the muscle strength and to stretch out the tight muscles. To get the maximum benefit from these exercises they must be performed on a regular basis. It is good to think of these muscles as the muscles of an athlete. The muscles need to be developed by using them and then this muscle need to be maintained by continued use.  A physiotherapist will educate the child and parent of how to perform these exercises and will continue to monitor progress.
The spasticity in the muscles may result in altered growth of the limbs. Muscles may become short. Bones may not grow and develop in a normal way. An orthopaedic surgeon can assess these changes and may be able to offer treatment. This may range from injections of botulinum toxin into muscles to reduce the excitability. Special splints may also help maintain mobility. Sometimes surgery to realign bones and joints may be required.
Some children with cerebral palsy encounter difficulty with walking. Analysis of this walking may help guide further treatment and this assessment is called gait analysis. Gait analysis is performed at Plymouth Allied Health Centre on the campus of St Mark and St John. The analysis is performed by Professor Jon Marsden and usually takes about an hour to perform. The gait analysis requires walking up and down whilst wearing special markers on the body.  Once the analysis has been performed then Professor Marsden and James Metcalfe meet and discuss the results; a treatment regime is then suggested.  Physiotherapists are also invited. Parents and children are then invited back to clinic to share the results.

Club Feet

The treatment of club feet has been revolutionised by the use of the Ponseti method. This method was introduced to Plymouth by Mr Jeffery in 2003. The Ponseti manipulations are performed by physiotherapists . Sometimes the child need a small operation to improve the range of motion of the ankle . This is called a tenotomy and can be performed under general anaesthetic. If there is a relapse of the deformity later, then a more complex procedure may be needed and this may include correction of the deformity with an ilizarov frame.

Limb Deformity Correction

The lower limb in a child may not grow in the correct way leading to a deformity. This may result in an abnormal way of walking or symptoms of pain. This can be assessed using special X-rays and the level of the deformity can be found and a correction can be achieved. This correction may be achieved by altering the growth of the bone. By stopping part of a bone growth plate from growing the remaining growth plate can correct the deformity. This is achieved by the use of screws and plates. If there are no growth plates then the deformity can be corrected by cutting the bone and using a special frame on the outside of the bone to correct the shape of the bone. James has a large experience of such frames as the Ilizarov frame and the Taylor Spatial Frame. 

Trauma

James has an extensive experience of dealing with adult and paediatric trauma. James is on the on-call rota at Derriford hospital will assess and treat major upper and lower limb trauma. James has specialist skills in dealing with lower limb trauma and limb reconstruction with external fixators such as the Ilizarov frame and taylor spatial frame. James also has experience in treating complex foot and ankle trauma such as Lisfrac injuries, complex mid foot injuries and oscalcis fractures.
James also treats the complications of trauma for instance non-union and malunion. Again the treatment of these usually involves limb reconstruction with Ilizarov frames.
James has experience in treating children’s trauma and can assess and treat both upper and lower limb trauma. Broken bones in children will usually be treated in a cast but sometimes operations are necessary. James is able to treat such injuries and can treat long bone fractures with intra-medullary nails.