02 December 2025
The Lilongwe Institute of Orthopaedics and Neurosurgery (LION) is a new purpose-built trauma facility and the main trauma receiving unit in Malawi, that opened its doors in April 2023. It is now in phase 3 of its development – with an ITU and a Women’s and Children’s ward being built to hopefully ease the pressure on the (often at 250% capacity) current one 60-bed ward. Back in May 2024, when the new LION Research and Training Centre was under construction, Kate Owers, the BSSH LION Project’s Educational Lead, promised the local team that we would run their inaugural course. Following a year of partnership, planning and organisation – a bespoke practical Hand Fracture Fixation Course was delivered by a combined team of experienced BSSH, BAHT, AOUK&I, Malawian Orthopaedic Association and Plastic Surgery multi-disciplinary educators, to all the Orthopaedic and Plastic Surgery Trainees in the country.
Our aim was to support and enrich the weekly BSSH Global Hand Surgery Curriculum at LION, developed by the project’s Education Committee and being given as short interactive case-based lectures by our rotating volunteers. This focussed 2 day practical course included workshops, small-group discussions and bespoke lectures and gave the time and space for all the trainees to ask lots of questions about hand fracture management, make the most of the practical dry-bone workshops and so leave feeling more confident in this specialist area. In particular, we tried to emphasise the importance of the basics of safe initial management in the District Hospitals with splinting, elevation and adequate wound debridement - as well as the often vital role of non-operative management. With the overall aim always being to restore hand function to the patient, whichever treatment modality is chosen. Restoring hand function, especially in this population where the majority are subsistence farmers, often means saving livelihoods and thereby lives.
Course Faculty – from left to right - Jonathan Jones, Kate Owers, Noha Nyamulani, Nicholas Lubega, Will Mason, Bright Mwafulira, Chrishan Mariathas, Tilinde Chokothu, Martin Wood, Precious Kachitsa with Prisca Ibrahim and Sara Dixon on the front row. Course Programmes and lanyards ready for the Participants arrival by coach from Ufulu Gardens Hotel.
AO Manual of Hand Fracture Management - signed by the MDT Partnership – and presented by the Course Chairs to Sven Young (CEO) and Boston Munthali (Medical Director) for the LION R&TC Library
The UK team, comprising Kate Owers (Co-Chair, AOUK&I and BLLT), Will Mason (Co-Chair and AOUK&I), Chrishan Mariathas (AOUK&I and GPC Lead), Jonathan Jones (BLLT) and Martin Wodd (BLLT) arrived 3 days in advance to set up the venue and found themselves literally peeling the plastic off the front of the screens and setting out the chairs and tables as the decorators left. The venue was specifically designed as the LION’s on site research and training facility with the aim of hosting courses, conferences and being a research hub. Its design is so much more suited to such events than most hotel venues – with a large reception area, library, 2 lecture theatres, a skills lab, 2 tutor rooms on the ground floor and a conference space for 200-250 upstairs alongside the LION Club and bar for socialising and dining plus numerous research offices. The layout was perfect for the AO-style Course we were running.
We were privileged to be joined by Noha Nyamulani, Consultant Orthopaedic Surgeon from Blantyre and Co-Chair of the course, Tilinde Chokotho Head of Plastic Surgery in Blantyre, Precious Kachitsa, one of our previous BSSH LION Hand Fellows and now an Orthopaedic Consultant at LION, Bright Mwafulirwa another BSSH LION Hand Fellow and senior Plastic Surgery trainee and were also supported by Nicholas Lubega, Head of AOA for Malawi. In addition we had invaluable administrative help from Prisca Ibhrahim (AOA) and also our wonderful BSSH secretariat Charlotte Smith and Emily Lakin.
Faculty and course participants outside the new LION Research and Training Centre
Course Co-Chair Noha Nyamulani teaching 2 residents during the IM wiring practical
Course Co-Chair Kate Owers supporting future BSSH LION Hand Fellow Ali Mohamed with the wire frame practical.
We are also extremely grateful to our main sponsors, Acumed UK, who, as well as supplying 10 bespoke hand fracture fixation sets and precisely crafted synthetic bone models with specific fracture patterns, also sent out 2 of their top team players, Nic Smillie and Tom Morris. They arrived the next day and got straight to it, setting up the 10 paired work-stations in the skills lab.
In addition to amazing equipment and personnel, we also had brilliant pre-course material courtesy of AOUK&I who so generously shared their incredible resource. They also supported this LMIC course financially, alongside BSSH, so that we were able to deliver it free of charge. Something that was very important to the Course Chairs and had been their hope from the outset.
All participants had diligently worked through their logbooks beforehand and received feedback from their faculty mentors. As a result of collaboration and discussion between all faculty members, we also created a well thought-out and relevant programme that kept the participants interested and engaged throughout.
The course began with Sven Young, CEO of LION welcoming the participants and faculty of this inaugural course to the newly opened Research and Training Centre. On behalf of the faculty, Kate Owers thanked him and the entire LION team for supporting the course and presented him with a copy of the AO Manual of Hand Fracture Management – signed by the entire faculty – and which is now the first book on the shelves of their new library!
The 2 days of lectures, small group discussions comprising 4-5 participants of similar experience supported by 2 faculty and the practical sessions all ran incredibly smoothly thanks to the thorough preparation by the team and the state-of-the art IT facilities. The first day was primarily assessment and basics of internal fixation methods and the second day included some more complex procedures and soft tissue cover techniques. A copy of the programme can be found here.
Jonathan Jones delivering the first lecture on Assessment of the Injured Hand
Will Mason running a discussion group
Bright Mwafulira, previous BSSH Hand Fellow, delivering the soft tissue cover practical session, with help from Chrishan Mariathas
The Course Dinner at Ufulu Gardens on the middle evening was also hugely successful and a lot of fun– with drinks and a buffet by the beautifully lit pool and a then a ‘hand trauma’ related word game and plasticine modelling competition that got all the tables competing with each other! We can’t thank Acumed enough for also sponsoring the dinner and in fact all the refreshments throughout the course.
It was important to gain feedback for this inaugural course and so this was collected from the participants after each session eg between coffee and lunch – such that the various parts remained fresh in their minds. Overall the feedback was extremely positive, from both the participants and the faculty. In fact, so much so that we have been invited to return next year with a Wrist Fracture Course.
This unique and happy partnership between the local AOA trainers, BSSH, BAHT, AOUK&I and Acumed – all working together for the same cause - was able to deliver a wonderful educational package in an area of great need and support the BSSH LION project’s mission to Help Heal the Hands of Malawi.
BSSH AOA Hand Fracture Fixation Course 16-17th October 2025 at LION, Malawi – Participants and local Faculty with their certificates and BSSH hats supported by the UK Faculty
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