Interview – Nicole Williams

Paediatric orthopaedic surgeon, South Australia


Nicole Williams specialises in paediatric orthopaedics at a range of hospitals in South Australia and serves as Chair of the Regional Training Committee for South Australia and Northern Territory. She was kind enough to answer a few questions about her work with children, the orthopaedic community in Australia, and her efforts with the people at Healthy Hips Australia to raise awareness and understanding of developmental dysplasia of the hip.

Nicole Ortho SA

Nicole Williams
SA & NT Regional Training
Committee Chair

On working with children


You’ve specialised in paediatric orthopaedics since the start of your orthopaedic career. Was that your intention when you first began studying medicine, or was it something you were drawn to while undertaking your education?

I ‘discovered’ orthopaedics as a fourth-year med student at the John Hunter Hospital. I scrubbed in for surgery for a fractured neck of femur and the registrar let me put in a couple of screws. The next day, the lady was up walking with a frame. I was immediately drawn to this specialty. I could use my medical knowledge to diagnose and develop a plan, then use technical skills to carry out that plan. There was also the instant feedback of an x-ray and a mobile patient to confirm that the plan had worked.

"I was immediately drawn to this specialty. I could use my medical knowledge to diagnose and develop a plan, then use technical skills to carry out that plan..." 

I first considered paediatric orthopaedics as a first-year trainee at the Women’s and Children’s Hospital in Adelaide. I’ve always enjoyed working with children. I used to do lots of babysitting, I coached Little Athletics and I’ve even worked as a fairy at children’s birthday parties. I like all the challenges of paediatric orthopaedics, including the variability of the surgery, learning about complex conditions, tricking young children into letting me examine them, supporting anxious parents and the collaboration with colleagues and other health practitioners that occurs when faced with a difficult clinical problem. 


Specialising in an age bracket seems like a different sort of specialisation than, say, focusing on a particular joint or region of the body. Does working with children feel very different to your experiences working with adults?

Physiologically there are many benefits of working with children. They generally heal well and their bones remodel. Paediatric orthopaedic surgeons sometimes joke when treating fractures in young children that “if the two ends of the bone are in the same limb, it will heal”. One of the many hats I wear is that of Trauma Director at the Women’s and Children’s Hospital. Children will often make a miraculous recovery after major trauma but they can also lull you into a false sense of security. Their greater physiological reserve can mean a grossly unwell child has few tell-tale signs. They can suddenly get very sick very quickly. A major difference working with children compared with adults as an orthopaedic surgeon is that paediatric orthopaedic surgeons spend much less time operating and much more time consulting. Also, although there is some overlap with the types of surgeries performed in adults, the techniques are often modified in children due to their size, their ongoing growth or the presence of severe deformity. 


All healthcare must carry with it a certain emotional weight, but working with very young people would seem to strengthen that element. Do you find yourself investing emotionally in your work with children?

Most of the time my job is extremely happy and rewarding. Even when a child or young person has a severe injury or disability, they usually recover well from surgery and the parents are invariably grateful. Sometimes, despite everyone’s best efforts, the outcomes aren't good and these children certainly stay in my mind. One such child was a beautiful little boy, around the same age as my daughter, who we admitted to investigate the cause of an unusual limp. The diagnosis was a progressive, untreatable neurological condition and he passed away not long after the diagnosis was made. I often think about that boy and his family, as well as other children that I've met that modern medicine and surgery couldn't fix. I hope that people cleverer than me develop screening tests, treatments and cures for the multitude of conditions that continue to affect children.  

"The diagnosis was a progressive, untreatable neurological condition and he passed away not long after the diagnosis was made. I often think about that boy and his family..."