César Galo Garcia Fontecha

Head of the Orthopaedic Surgery and Traumatology Group

“Learning about what others are doing allows us to improve and develop new ideas in order to advance in the world of research.”

In 2022, the research team led by Dr. César Galo Garcia Fontecha joined the Sant Joan de Déu Research Institute as the “Orthopaedic Surgery and Traumatology” Group. We take a look at his scientific career up to the time he joined SJD Barcelona Children’s Hospital and the objectives of his new group.

Who is Dr. César Galo García Fontecha and what is his background in medical research?

I've been a specialist in traumatology and orthopaedic surgery at the Hospital Vall d'Hebron, where I did my residency, since 1995. After my residency I stayed on as a physician at Vall d'Hebron Hospital. Starting in 2000, I began to focus exclusively on paediatric orthopaedics. Within this group there was already an interest in conducting research projects to improve patient care. Together, we began to build what would become the group's lines of research and our objectives. Years later, we were recognised as an emerging group by the Agència Catalana de Recerca (Catalan Research Agency) and we began to work on new projects such as experimental surgery and the development of new surgical techniques, etc., always with a patient-centric focus. As our interest in new lines of research grew, so did our group. Until 2018.

In 2018 you joined SJD Barcelona Children's Hospital as Head of the Orthopaedic Surgery and Traumatology Department.

That's right. I joined SJD Barcelona Children's Hospital in 2018. When I arrived, the department's research activity was very limited and since I had some experience in this I decided that one of the first objectives would be to create a research group made up of orthopaedic surgeons. It just so happened that some young professionals who also shared this interest in research joined the service at that time.

How does having a research group benefit a service like yours?

Mainly because in clinical practice there are still many challenges and problems to be solved. And the way to solve them is to use the scientific method: define a hypothesis, conduct a series of experiments or observations and draw conclusions. This newly acquired knowledge is then transferred to patients. This is what we call translational research, which has a direct impact on our patients and/or the procedures we develop to care for them. It was so clear to us that we wanted to focus on research that we added two new professional roles to the service: a bioengineer and an optometrist.

What do these professionals contribute to the group?

They perform two functions within the group. On the one hand, they are responsible for research coordination, project design and assessment, start-up, etc., all essential tasks for increasing the number and quality of the projects. On the other hand, they work as researchers directly in charge of the projects. Because of our bioengineer's background in mechanics, he is a good fit for research related to deformities; and our optometrist is active in scoliosis research as part of her doctoral thesis, given the close relationship between scoliosis and vision problems.

Can you tell us a bit about what research is like in a department such as this one?

When we talk about research in orthopaedics and traumatology, there is the traditional part that takes place in the research laboratory: cells, pipettes, DNA, etc. But there is another part of the research that is closely related to the orthopaedic problems we encounter in our clinical practice and the treatments we apply. The easiest way to talk about research in orthopaedics and traumatology is to give examples.

What examples can you give us?

One of the things we do in our daily clinical practice is treat deformities or malformations. One of the techniques we use is what we call "guided growth". In other words, we take advantage of the growth by placing small implants in the growth areas to realign the deformed limb. These implants work by changing the mechanical loads of growth that can have undesirable effects or alter the future mechanics of a joint. So we conduct in-depth studies of the effects.

For example, in one of the studies we conduct resonance tests, creating two-dimensional and three-dimensional images of the growth areas through medical imaging and then applying computational meshing on the joint areas that allows us to see what the growth will look like. All of this is aimed at understanding what is happening in these patients and improving the therapeutic strategy. Another project in this field involves the computational simulation of how the limb grows in order to determine where we should place the implant or design new ones to improve the correction of the deformity.

We also conduct studies on the best therapeutic strategy for treating back deformities using different types of corsets. We monitor our patients and analyse their progress in order to determine which corset is best for them.

As you can see, all these research projects are directly related to the clinical problems we need to address.

Another example would be one of our fracture projects, where we assess which type of surgery is best for each fracture, whether a plate with screws would be best or some other type of fixator. We also upload data on fractures to an international registry in which other centres also participate. This allows us to share our data and obtain much more information, which benefits our research projects.

These are just some of the projects we are currently working on, but there are more than 20 different ones going on at this time.

What are the lines of research of all these projects?

Our group is currently working on four main lines of research led by different professionals. Dr. Laura Pérez leads a line focused on the study of congenital pathologies of the upper limbs, such as congenital malformations or lesions in the brachial plexus. A second line focusing on spinal deformities, mainly scoliosis, is directed by Dr. Alejandro Peiró. Dr. Laura Corominas directs research projects on new orthopaedic surgery techniques. And finally, in addition to coordinating the group's activities, I also lead the skeletal dysplasia line, where we study treatments with growth plates.

In your scientific research work you often collaborate with other centres. How do you organise this within the group?

It's very important to count on the collaboration of experts for the best outcomes, since they provide us with their knowledge and support in areas where we may not be experts. For example, we recently collaborated with the Catalan Institute of Nanoscience and Nanotechnology (ICN) on the development of a membrane to heal cartilage lesions. We are also working with the Barcelona Center for New Medical Technologies (BCN MedTech) at Universitat Pompeu Fabra on applying a mesh to joints to analyse the pressure loads when there are growth changes in order to determine whether overload disorders could occur in the future.

Finally, what is your opinion of the research team joining the Sant Joan de Déu Research Institute (IRSJD)?

I believe that joining IRSJD will give the group more visibility, which will allow us to enter into new internal and external collaborations. This in turn will broaden the team's vision and enable us to learn about what other teams and/or centres are doing, and it will give us ideas that we can incorporate into future projects. I think it's very important for researchers or anyone who is interested in research to open their minds and learn from others, and that includes learning about the problems or difficulties they have faced and how they solved them. In the end, if we keep to ourselves we'll only resolve the problems we encounter directly, without going a step further.

We hope that in the future this will allow us to build new collaboration networks and that projects will emerge that enable us to improve patient care and quality of life.

Doctor César Galo Garcia Fontecha

In our clinical practice there are still many challenges and problems to be solved. And the way to solve them is to use the scientific method: define a hypothesis, conduct a series of experiments or observations and draw conclusions.

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