AO Foundation Annual Report 2005 by AO Foundation

Annual Report 2005

AO Vision Our vision is excellence in the surgical management of trauma and disorders of the musculoskeletal system. AO Mission Our mission is to foster and expand our network of healthcare professionals in education, research, development, and clinical investigation to achieve more effective patient care worldwide.

Table of contents Introduction

Inter view with the President and the Chairman

Overview

AO Surgery Reference: surgeonsâ&#x20AC;&#x2122; gateway to quick online reference

Clinical Priority Programs: focused to achieve maximum clinical impact

The AO network: spanning the globe with AO exper tise

Specialties

General Trauma: a year of conceptual innovation

AOSpine in full motion

Setting the basis for CMFâ&#x20AC;&#x2122;s future development

On the path to more choice for veterinar y surgeons

ORP activities steadily on the rise

Networking

Commitment to the AO cause around the globe

AO Alumni Association: bringing the world together

Enabling and sustaining self-sufficient healthcare systems

Trustee Meeting 2005: taking stock and envisaging the future

Key activities

Creating the state of the ar t in postgraduate medical education

Finding answers to clinically relevant challenges

Developing concepts for fracture fixation in osteoporotic bone

TK-System: regionalization put into practice

Growing demand for clinical research

AORF: a triple win for researchers, AO, and the patient

Governance

Organizational development and finance

Governing bodies of the AO Foundation

Abbreviations

Addresses

“We’re putting AO in the driver’s seat.” Interview with the President of the AO Foundation and the Chairman of the Board of Directors

Dr. Kellam, at the beginning of your presidency in mid-2004, you emphasized the need for AO to regain relevance for the practicing surgeon. What has been achieved so far?

We have established the concept of Clinical Priority Programs as a reality. The Degeneration and Regeneration of the Intervertebral Disc program has been successfully executed and is under review as to its future. The Fracture Fixation in Osteoporotic Bone program has started, and the Large Bone Defect Healing program is in peer review. The heart of each program is an unresolved clinically signiﬁcant problem with an epidemiological dimension and a severe impact for the patient. These clinically driven programs will make us more relevant to both surgeons and patients. James Kellam :

What is the status of the fourth program?

The Craniomaxillofacial specialty has chosen image analysis as an aid to preoperative planning of complex craniofacial deformity correction as its program. This topic has not only broad support within the CMF community but is also relevant for other specialties. I am optimistic that it can be launched by the end of 2006. Ke l l a m :

Speciﬁcally what new partnerships were formed?

Under the Fracture Fixation in Osteoporotic Bone program, for example, AO has partnered with leading radiology experts in the USA, Germany, and the UK to complement our internal knowledge and technology. In addition, our cooperation with BrainLAB in the field of computerassisted surgery has opened up a whole new spectrum of clinical options. Rauh : In support of more effective research partnerships, we have started to replace baseline funding with project-based funding. This puts AO in the driver’s seat as we define the deliverables for each partnership more clearly, but it also forces us to monitor progress continuously. In this context, the AO Biotechnology Advisory Board—BAB—has firmly established its role. The board consists of leading scientists in biomaterials and biotechnology. It advises AO in its field of specialization and actively funds research. It now has a permanent seat on the Academic Council and the AO Research Board and is well interlinked with our structures. Ke l l a m :

Has the reorganization of the Academic Council in 2004 brought its desired effect?

We are much more responsive with a more effective decision-making process and more productive meetings. The establishment of Specialty Academic Councils in December has opened up access to the scientiﬁc part of the Foundation for more surgeons. Rauh : We set up a new professional support structure for the Academic Council. All decisions now have a clear time and money line, and follow-through is ensured. Kellam :

What organizational changes have occurred as a result of these priorities?

The level of structuring and integration of these programs is new for the Foundation and has strengthened internal cooperation. It has also paved the way for new partnerships with external experts. The interdisciplinary planning and reporting will form a new mindset as simple standardized processes are deﬁned. This requires new management skills and adequate tools. Markus Rauh :

Annual Report 2005

Introduction

Overview

Specialties

Networking

Key activities

Governance

“The regions’ enthusiasm is truly contagious.” Markus Rauh

“We act more like a team now.” James Kellam

In what other areas did AO demonstrate its ability to innovate?

The Triennial AOAA Symposium saw the successful introduction of the ﬁrst computer-assisted trauma teaching modules, developed in cooperation with BrainLAB. With improved modules, the Davos Course participants had a similarly positive experience. The introduction of the new expert nailing concept will extend intramedullary nailing indications for long bones. As a consequence, a new educational program will be forthcoming. Rauh : At a process level, AO introduced peer reviews by independent, highly regarded experts as a standard element of all new projects before release, during the projects, as well as at the end. This has made us more open and responsive to the outside world reinforcing that we’re deﬁnitely not an “old boys’ club.” Another highlight was Ke l l a m :

the Surgery Reference, which went live for a closed user group in 2005. We started with ﬁrst modules for human long bones, and additional modules as well as CMF and Spine will follow later. This online reference will set new standards in surgical education. It promotes a concise hands-on visual approach and is the result of the joint efforts of dozens of leading surgeons from around the world. The Foundation has released additional funds to make more modules available faster while meeting the rigorous AO standards. Who will beneﬁt from this new reference?

Living up to our vision of spreading excellence in the surgical management of trauma and disorders of the musculoskeletal system, we will grant access to surgeons and ORP worldwide, not only AO members. Our own members, however, will Rauh :

James Kellam

Markus Rauh

President of the AO Foundation

Chairman of the Board of Direc tors

Introduction

Overview

Specialties

Networking

Key activities

Governance

Annual Report 2005

“Our stakeholders credit us for our strong beliefs.” James Kellam

have free access. We are currently redeﬁning our membership scheme. Once this is ready, we’ll decide on the different access levels and ﬁnancial conditions applicable from 2007. What about network growth as one of AO’s strategic goals?

We have attracted a record number of course participants and the Alumni Association is growing. The regions are now more fairly represented in our key bodies such as the Expert Groups of the TK-System. We will also adjust representation of the regions and specialties in the Board of Trustees. AOLAT will be a model under our new regional system, where each region will have a centralized ofﬁce and regional manager, as well as a specialty structure. Rauh : Our new map of the world is a major breakthrough. Giving the regions more say is key if we want to leverage them as ambassadors of our cause. Their enthusiasm is truly contagious and has sparked new activities away from the center. For example, AO East Asia moved into Vietnam with an educational initiative last year. It took the Foundation a while to understand the contribution of the regions. Kellam : The way we all interact within the Foundation is strengthening our network. We act more like a team now and address issues openly. People are learning that they are part of something bigger and it’s not about everyone doing their own thing. It’s great to see how hidden agendas are gradually disappearing. Ke l l a m :

AO Foundation and Synthes, Inc. agree to new contract On March 14, 2006, shortly prior to publication of this report, the AO Foundation and Synthes, Inc. agreed to continue their successful cooperation under a new contract. Synthes, Inc. will acquire the Synthes trademarks and brands and substantially all of the intellectual property from AO at approximately CHF 1 billion. This transaction will provide a solid financial basis for AO and pendent academic and scientific

Where is the developing world on the AO radar?

organization. In a separate agree-

Rauh :

strengthen its position as an inde-

ment, AO and Synthes, Inc. agreed to continue their long-standing cooperation for the benefit of patients and surgeons worldwide. The closing of the transaction is subject to regulatory approval.

Annual Report 2005

We leveraged our experience from the disaster relief efforts in Asia after the tsunami disaster in 2004 and, jointly with Synthes, set up a crisis management group and disaster relief plan. It builds on our local structures and features an emergency stock of implants and instruments. Sadly,

Introduction

Overview

Specialties

it was put to the test almost immediately as the devastating earthquake hit Pakistan in October. Ke l l a m : We’re continuing our efforts in Africa, Asia, and Latin America through the Socio Economic Committee, with education as the primary goal. All our courses, fellowships, and mentorships are long-term and involve local officials and governments. It’s about enabling the infrastructure, and this must be appropriately financed and monitored. In early 2005, AO conducted a global reputation survey. What were the main findings?

We collected statistically relevant data that clearly shows AO has a strong reputation across all regions, specialties, and age groups. We now know that our reputation capital lies mainly in our services and that our stakeholders rate our education and research and development excellent. They also credited that we are an organization with strong values and emphasize methods and principles over products. But we were also made aware of some areas where we are vulnerable. These ﬁndings are considered in all our strategic initiatives, such as our reinforced regionalization efforts and the development of a new membership concept. Rauh :

What are your main goals for 2006?

The first goal will be further standardizing our processes. Second, we must maintain the momentum in our Clinical Priority Programs but not neglect our other stakeholders’ benefits such as a state-of-theart education. Third, the definition of a new global membership scheme will be important for the organization. R a u h : Developing a sustainable funding strategy under a new contract with Synthes is high on my agenda. And, of course, taking the Surgery Reference public is also an important milestone. Kellam :

Networking

Key activities

Governance

AO Surgery Reference: surgeons’ gateway to quick online reference in daily clinical life Surgeons worldwide can now tap into a unique pool of specialized knowledge that supports them throughout the entire surgical management process.

April 2006 saw the public introduction of what is likely to become one of the most valuable references to practicing surgeons worldwide. Building on a unique combination of text and images, AO Surgery Reference guides surgeons through the surgical management process, step-bystep, starting with diagnosis and ending with rehabilitation. Currently, six anatomical regions representing more than 3,000 web pages are online. The addition of other modules is imminent. Unmatched beneﬁts 1

AO Surger y Reference grants the surgeon quick access to detailed knowledge including the appropriate patient preparation and surgical procedures.

Surgeons are guided through the surgical management process step-by-step, or they can shor tcut to a specific piece of information via the navigation bar.

The heart of AO’s Knowledge Portal is more than an extra channel through which AO disseminates its know-how on the principles and methods of fracture treatment. AO Surgery Reference takes into account surgeons’ limited amount of time in daily clinical work. In a few minutes, they can look up and print out the appropriate patient preparation, recommended approach, and surgical procedures. The test users appreciated the highly practical approach presented.

Traumaline

The Traumaline database is another important addition to the AO Knowledge Portal. It contains most traumaand or thopedic - related studies published since 2000, and includes therapeutic, prognostic, and diagnostic research. Titles are listed by level of evidence, with the most relevant studies, such as randomized controlled trials, appearing at the top.

Introduction

Overview

Specialties

Networking

Key activities

From surgeons, for surgeons

More than ﬁfty of the world’s most renowned surgeons and younger talents with a successful publishing record are contributing to AO Surgery Reference. Combining the know-how from 20 countries ensures that the rigorous AO standards are met while keeping in mind local particularities.

The modules were tested extensively with closed AO user groups. In three phases, they were rolled out to AO Trustees, Alumni, and Faculty members. Based on their feedback, AO Knowledge Services continually enhanced the solution for maximum usability. More anatomical regions lined up

The introduction of another half-dozen anatomical regions is expected for 2006. In addition to general trauma, development of CMF modules is underway, with spine modules planned next. In line with AO’s vision and mission, the Board of Directors decided in December to extend free subscriptions to institutional and individual users from both inside and outside the AO community until the end of 2006. It will then decide on the final subscription model. As a nonprofit organization, AO sees the main payback of its investment in the application of its principles by potentially 250,000 surgeons—for the benefit of patients worldwide. www.aofoundation.org/surgery

Governance

Annual Report 2005

Focused to achieve maximum clinical impact With the launch of its Clinical Priority Programs (CPPs), AO ensures its different activities are focused on solving clinically relevant problems for the benefit of patients and surgeons.

In 2004, the Academic Council (AcC) decided to focus its scientiﬁc activities on four Clinical Priority Programs (CPPs). The programs address clinical problems that either have a severe impact for the individual patient or a signiﬁcant epidemiological dimension.

nal experts, such as the AO Biotechnology Advisory Board (BAB). The reviewed and adapted program is then approved by the AcC and the budget released by the Board of Directors (AOVA) before the program is executed. Outcomes are regularly monitored to ensure optimal results.

Seven-step process

Each CPP follows a multidimensional, interdisciplinary approach spanning the entire organization and beyond. A core team of surgeon champions and scientiﬁc partners heads up each program and is responsible for continuously controlling project outcomes. To complement internally available expertise and technologies, partnerships constitute an important element in each CPP. Likewise, close collaboration with industrial partners is sought from the start as this will guarantee an optimal technology transfer and implementation.

Each program must produce relevant results within three to five years. The starting point of a standard seven-step process is the identification of a highly relevant unsolved clinical problem. This phase involves an extensive literature review, upon which the scope of the clinical priority is defined. In a next phase, the program details are worked out by a program team including the definition of subprojects, internal and external partners, as well as project cost and milestones. The next phase is a peer review conducted by internal and exter-

Content and status of the Clinical Priority Programs (CPPs)

Fracture Fixation in Osteoporotic Bone: Execution of this program, with the suppor t of Stephan Perren, under the guidance of surgeon champion Michael Blauth and scientists Jörg Goldhahn and Norber t Suhm, star ted in 2005. It aims to develop and evaluate new concepts for the treatment of fractures in osteoporotic bone and addresses the problem of implant anchorage in poor-quality bone stock. Large Bone Defect Healing: Under surgeon champions Mark Vrahas and James Kellam, and scientists Mauro Alini and Erich Schneider, this program aims to develop an off-the-shelf, multifactor biologically active solution for implantation into 3- to 5-cm defects. The proposal went into peer review at the end of 2005.

Annual Report 2005

Introduction

Overview

Degeneration and Regeneration of the Intervertebral Disc: Under surgeon champions Max Aebi and Norbert Boos, and scientists Stephen Ferguson, Donal McNally, Thomas Stef fen, Mauro Alini, and Keita Ito, this program has focused on the causes and mechanics of disc degeneration and the development of biological treatment solutions. The research focus was defined already in 2002 and a CPP formed in 2004. Its results are currently being reevaluated. CPP 4 (under deﬁnition): The original focus of this program was broadened towards imaging and planning of surger y. A new proposal established by representatives of the CMF specialty will be submitted to the AcC in 2006. With its current focus, this program will also generate benefits beyond the CMF community.

Specialties

Networking

Key activities

Governance

Each Clinical Priority Program follows a standard seven-step process.

Problem identiďŹ cation

Clinical priority deďŹ nition

Program details

Peer review

AcC/AOVA approval

The comprehensive approach realized by the CPPs leads to increasing project complexity, calling for a more demanding set of management skills. While AO has displayed good cost and expenditure management in the past, this new approach also calls for a stronger focus on performance and project management. To meet the increased challenge, AO has taken a multitude of measures. It has put cross-divisional planning and reporting tools into place, including a new project and quality management (PQM)

Key focuses of CPPs and interactions with AO functions and specialties: The example of Fracture Fixation in Osteoporotic Bone

This CPP covers key aspects of fracture treatment in osteoporotic bone ranging from diagnosis to education. It is driven by the combined knowledge of dif ferent internal and external par tners. Currently five internal and 13 external institutions are involved.

Introduction

Overview

Execution

Reevaluation

tool. This will allow for continuous project controlling and timely corrective action in the case of deviations from the plan. It also builds the foundation for activitybased costing (ABC), which will permit to attribute costs accurately to projects rather than functions in the future. AO has also stepped up training in the management of complex projects.

General Trauma

b a

Spine

d CMF

Clinical Investigation

Research & Development

Clinical Investigation

TK-System

Education

a) Identification of answerable clinical questions, incl. literature review. b) Development of methods for pre- and intraoperative assessment of local bone qualit y. c) Research into an animal model of osteoporosis. d) Research for an improved understanding of the principles of implant anchorage. e) Collaboration with industrial par tner to ensure implementation of new knowledge in products. f ) Identification of measurable outcomes and suitable study design, followed by prospective clinical studies. g) Product and concept cer tification. h) Transfer of knowledge into clinical practice through teaching.

Specialties

Networking

Key activities

Governance

Annual Report 2005

The AO network: Spanning the globe with AO expertise With its new regional concept, AO is well-positioned to disseminate its knowledge and principles of fracture care to a growing number of surgeons and operating room personnel (ORP) around the world.

In September 2005, the Board of Directors approved a proposal for a new organization of the AO world. At the heart of the new concept is the goal of achieving more adequate representation in AO’s main bodies of community members from rapidly growing geographic regions. The new structure draws on that of several organizations, among them the World Health Organization (WHO), which will optimally support AO’s regionalization strategy. A new feature under the adapted concept is the admission of subregions, such as AO East Asia, which is part of AO Asia Paciﬁc.

North America Alumni Chapter North America

In the future, regional ofﬁces will be set up in all regions with regional managers for each. AO Latin America recently hired a regional director under the new concept. As a complement, a manager will be appointed at the Davos head ofﬁce to liaise with the regions and ensure an aligned development within the framework of the AO Foundation.

Latin America Alumni Chapters Argentina Bolivia Brazil Chile Colombia Costa Rica Ecuador Mexico Peru Paraguay Uruguay Venezuela

Annual Report 2005

Introduction

Overview

Specialties

Networking

Key activities

Governance

Europe Sections

Alumni Chapters

AO Austria

Austria

Ireland

Spain

AO Germany

Bulgaria

Israel

Slovenia

AO Spain

Czech Republic

Italy

Sweden

AO Switzerland

Estonia

Netherlands

Switzerland

AO UK

France

Nor way

Turkey

Germany

Por tugal

Hungar y

Russia

Asia Pacific Subregions AO East Asia AO Oceania

Alumni Chapters Australia China Hong Kong India Japan New Zealand South Korea Sri Lanka Taiwan Thailand

Middle East Alumni Chapters Eg ypt Iran Jordan Lebanon United Arab Emirates

Africa Alumni Chapter South Africa

Introduction

Overview

Specialties

Networking

Key activities

Governance

Annual Report 2005

General Trauma: a year of conceptual innovation In the wake of the launch of several new systems in 2004, the focus in 2005 was on redefining the related concepts and techniques, as well as introducing expert knowledge at AO Courses and major international congresses.

With the introduction of the Expert Tibial Nail System (ETNS) in 2004, the concept and techniques of intramedullary (IM) nailing are now being redeﬁned. Surgeons learned these new techniques at the AO Davos Courses in December. AO surgeons also expanded the indications and implants of the Locking Compression Plate System (LCP). Both these systems have opened up a range of new treatment options for complex fractures leading to more effective patient care. In addition, Reamer-Irrigator-Aspirator (RIA) seems to be an effective method of obtaining a bone graft. Partnering for success

AO symposia at major inter-

The partnership with BrainLAB resulted in the development of the first orthopedic trauma modules in computer-assisted surgery (CAS). The initial results presented at the Triennial AOAA Symposium in Sardinia were further refined successfully for the Davos Courses. Development of a new validated scapular classification system was begun in cooperation with the Orthopaedic Trauma Association (OTA).

High visibility at congresses

The AO symposia at major international congresses, including EFORT in Portugal, SICOT in Turkey, and DGU/DGOOC in Germany reinforced AO’s leading position in trauma education. AO was also invited to organize a symposium at the annual meeting of the British Orthopaedic Association (BOA). The regions left no doubt they are an increasingly important driver of trauma education. The August Advanced Course held in Ribeirão Preto, Brazil, was rated excellent by both faculty and participants, upping the benchmark. Following the introduction of numerous innovations, 2006 will be a year of consolidation at the conceptual level. The Trauma SAcC, a result of the recent reorganization of the Academic Council, is already progressing and will further enhance the innovation process.

national congresses, including EFORT in Lisbon, Por tugal, were well at tended emphasizing AO’s leading position in trauma education. 2

The par tnership with BrainL AB resulted in the first computerassisted surger y (C AS) course modules at the Davos Courses.

Through its presence at major trauma congresses, AO keeps in touch with the global trauma communit y.

Annual Report 2005

Internally, the trauma group cooperated closely with the AO Development Institute (ADI), AO Research, and AO Clinical Investigation and Documentation (AOCID) in deﬁning AO’s Clinical Priority Programs. The Fracture Fixation in Osteoporotic Bone program began, while the Large Bone Defect Healing program was sent to the AO Biotechnology Advisory Board (BAB) and clinician scientists for review. More specialty involvement occurred with the establishment of a Specialty Academic Council (SAcC).

Introduction

Overview

Specialties

Networking

Key activities

Governance

AOSpine in full motion AOSpine continued to strengthen its position by expanding its regionalization program, launching an innovative member scheme, and spearheading exciting forward-looking research into non-fusion technology (NFT).

AOSpine Europe delivered two landmark educational events which focused on the Intervertebral Disc and Live Tissue Complications Management. The events were uniquely endorsed by the European Association of Neurological Societies (EANS) and the Spine Society of Europe (SSE).

AOSpine moving the lecture room into the operating room with live tissue training.

Marinus de Kleuver explains how AOSpine is a global organization to course participants.

The AOSpine Research Network (AOSRN), in conjunction with the European Cells and Materials (ECM), organized a highly successful research congress in Davos on Spinal Motion Segment. The event was attended by over 100 leading spine researchers and surgeons.

The launch of InSpine magazine is yet another example of increasing benefits for AOSpine members.

AOSpine Latin and North America demonstrated camaraderie by holding the ﬁrst dual-region course in Cancun, Mexico. The course focused on the differing cultural perspectives to the indication and approaches to treating degenerative spine disease.

New AOSpine leadership

Michael Janssen (left) took over from Max Aebi as Chairperson of AOSpine International (AOSI) after Max Aebi had completed his term. Max Aebi significantly contributed to AOSpine’s recognition within the spine community. One of Michael Janssen’s first priorities is to restructure the AOSI Board to better fit the future challenges of running a global organization.

Introduction

Overview

Specialties

Networking

Key activities

Focused on clinical priorities

A main focus of AOSpine has been the degeneration and regeneration of the intervertebral disc, one of AO’s Clinical Priority Programs. Leading institutes in Zurich, Bern, Davos, Nottingham, and Montreal have joined the AOSRN in studying disc nutrition, tissue engineering, as well as disc inflammation and pain development. The first phase of the program has been concluded following a positive peer-review process. Strong surgeon involvement and member benefits

The AOSpine Technical Commission (AOSTK) was created in 2005 with four Expert Groups focusing on spine. This enables greater involvement of spine surgeons to ensure medical guidance in the development of new treatment options. AOSTK has advanced minimally invasive surgery (MIS) and focused on non-fusion technology to preserve patients’ spinal motion. AOSpine looks forward to partnering with BrainLAB to develop computerassisted surgical procedures. Clinical teams have initiated outcome studies in North America and Europe, and similar activities are planned in Latin America and Asia in 2006. In 2005, 20 AOSpine Country Chapters were founded to drive activities and member services at the local level. Recruitment has been high as local surgeons feel excited and empowered to get involved. AOSpine’s 4,500 members now beneﬁt from numerous new products such as InSpine magazine, Evidence Based Spine Surgery Journal, and the Spine Principles book, as well as new web-based services and faculty training courses.

Governance

Annual Report 2005

Setting the basis for CMF’s future development Establishing the organizational basis for further development was a priority for AO Craniomaxillofacial (AO CMF). While considerable progress has already been made, the topic will remain the focus of attention in the near future.

The AO Foundation’s reforms of the Academic Council (AcC) and the Technical Commissions (AOTKs) and Expert Groups, as well as the refocusing of its research activities through Clinical Priority Programs had a big impact on AO CMF’s agenda for 2005. Deﬁning new organizational structures and a dedicated Clinical Priority Program were the main focus. Faculty development forum as catalyst

The international CMF Faculty Development Forum in Brazil in August marked an important milestone in 2005. At the event, the AOTK (CMF) held its constituting meeting. Members from Europe, the Americas, as well as Asia are now represented in a more balanced way.

Representatives of AO CMF

Progress was also made in the deﬁnition of a framework for the Specialty Academic Council (SAcC). With the overall structure outlined, further discussions will follow on the detailed design, in particular regarding regional representation. Finalizing the structure of this key body will be a priority for 2006.

Advancing strategic projects

AO CMF also advanced other projects of strategic importance. To provide the global CMF community with a tailor-made networking platform, four regional representatives were given the mandate to submit a proposal for an AO CMF Alumni Association. It aims for a close cooperation with the AO Alumni Association while catering for the specific education, networking, and information need of CMF surgeons. The decision to relaunch the “Journal of Craniomaxillofacial Trauma” in mid-2006 is another important measure to strengthen the CMF network. The journal, to be published by Thieme Medical Publishers, will be the official organ for AO CMF and its alumni association. In Asia, the two educational groups of East Asia South and the Far East merged successfully to constitute the new CMF East Asia Board. Building regional structures will remain high on the agenda, in particular in the Middle East, Southern Africa, and Asia Pacific.

and AO Publishing discuss the relaunch of the “Journal of Craniomaxillofacial Trauma.” 2

The newly constituted CMF East Asia Board suppor ts AO CMF’s intensified regionalization ef for ts.

Educational activities developed well with another strong increase in courses and seminars planned for 2006.

Annual Report 2005

Much time was devoted to defining the strategic direction of AO CMF’s research activities. As a result, “Imaging and Planning of Surgery” was identified as a proposal for AO’s fourth Clinical Priority Program and has received broad support from the CMF faculty. While a core interest for CMF, the topic is also relevant to other specialties. The detailed project proposal will be defined in 2006.

Introduction

Overview

Specialties

Educational activities developed well in 2005, with 40% more courses and seminars planned for 2006. The CMF Principles Course in Prague in March 2005 marked a milestone as it was the ﬁrst course held in one of the new European Union member states.

Networking

Key activities

Governance

On the path to more choice for veterinary surgeons Strengthening its value proposition for members, expanding its educational offering, and advancing its development projects were the main focuses of the AO Veterinary specialty (AO Vet).

2005 was a year of increasing demand for AO Vet Courses. A perennial highlight was the Principles and Advanced Courses on Fracture Treatment in Equine and Small Animals in Ohio, USA. They were attended by an international audience of 252 veterinarians. To spur regionalization, AO Vet held its ﬁrst course in Latin America in Santiago, Chile, in March 2006. Advanced Courses on Horses and Pets will be held in San Diego, California, in September. New knowledge-sharing platform

The novel one-day member event preceding the Davos Courses created a new plat form for informal knowledge sharing.

The USA saw the revival of AO

Another highlight was the Davos Courses. To foster knowledge sharing, a novel oneday precourse event was offered for AO Vet members. In a forward-looking atmosphere, they discussed new principles and implants and explored applications of the Locking Compression Plate System (LCP) from General Trauma and UniLOCK plates from CMF in their specialty. Another focus was on minimal invasive osteosynthesis (MIO) in animals.

Vet student courses with a first course held at Texas A & M Universit y. 3

The student courses give students access to AO exper tise while still in veterinar y school.

Other events included an LCP workshop at the Surgical Summit of the American College of Veterinary Surgeons in San Diego. This was complemented with two fellowships in veterinary clinics and the revival

of student courses in the USA, with a ﬁrst course held at Texas A &M University. More courses will follow throughout the USA, with local AO Vet members as faculty. This creates a win-win situation as students beneﬁt from AO while still in veterinary school and AO Vet acquires access to talented future surgeons. Innovations well on track

Development of the new TPLO (Tibial Plateau Leveling Osteotomy) plate with LCP features was concluded and has entered clinical testing. This plate will benefit larger dogs diagnosed with cruciate ligament ruptures. The 3.5 LC-DCP broad (Low Contact Dynamic Compression Plate) was well received, opening up a host of applications for the benefit of large dogs. Further material and end-clamp design improvements are underway for the Clamp Rod Internal Fixator (CRIF). AO Vet continued to pursue its vision of high-quality implants specifically designed for animal surgery. The planned Specialty Academic Council (SAcC) for AO Vet will further strengthen AO’s veterinary community.

Interdisciplinary workshop on animal models

AO Vet took the lead in organizing a workshop on “Experimental Animal Models in Musculoskeletal Research” in Davos in Februar y 2006. It was attended by leading European veterinar y and human surgeons, researchers, legal and ethics exper ts, and animal rights organizations. They explored new paths in solving ethical issues and defined concer ted action to achieve more effective and morally acceptable animal research.

Introduction

Overview

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Governance

Annual Report 2005

ORP activities steadily on the rise With the introduction of several innovative new educational formats and the continued verve of operating room personnel (ORP) leadership, 2005 marked another year of strong quantitative and qualitative growth in ORP activities.

A record number of 91 AO ORP Courses in 34 countries testiﬁes to the ever-growing thirst of operating room personnel (ORP) for specialized training. Among the main course highlights in 2005 was an ORP Course in Goettingen, Germany, where virtual x-raying was introduced as a novel technology. It allows ORP to start with a dry run at x-raying in front of the monitor before handling the c-arm, all of which is done without actual radiation. This type of training is conducive to three-dimensional thinking, which is crucial to ensure that the surgeons get good-quality x-rays when inserting an implant. Demand for the course exceeded the number of spots available by far, and the course was very well rated by the participants. Several other ORP Courses were run in parallel with courses for surgeons. This allowed both courses to exploit the common synergies in course content and logistics. For the ﬁrst time, such parallel courses were held in Germany. In the Bochum ORP Course, particular attention was given to hands-on exercises, which was very much appreciated by the participants.

vary strongly by country and that in many cases, the standards of practice are undergoing major changes, making harmonization even more challenging. On track for exciting ORP development options

With an extended team, ORP leadership has been signiﬁcantly strengthened to devise new strategies for growing the network and creating exciting development perspectives for ORP within AO. The ORP Alumni Chapter founded in 2003 to link very active members of the ORP faculty grew to 52 specialists in 19 countries. This number is bound to grow steadily with new learning, teaching, and networking opportunities scheduled for 2006. The regional Educators’ Seminar in Thailand in April and the Educators’ Seminar in Davos in December will be ideal platforms for further faculty development. Another important event in 2006 will be the participation of ORP in the joint meeting of the German, Swiss, and Austrian AO Alumni Chapters in Germany in May, which may well lead to the recruitment of new ORP faculty members.

ORP attending Triennial AOAA Symposium

ORP Alumni members from 19 countries at tended the Triennial AOA A Symposium in Sardinia.

Vir tual x-raying was introduced as a novel technolog y at the ORP Course in Goet tingen, Germany.

Training session for the Swiss ORP facult y team in Davos.

Annual Report 2005

Another highlight was the attendance of 27 ORP Alumni members from 19 countries of the Triennial AOAA Symposium in September. While the participants appreciated taking part in the general Alumni activities, they also beneﬁted from a dedicated ORP track, where they discussed possible contributions to an ORP book. The discussions made it clear that the healthcare and legal environments in which ORP work today

Introduction

Overview

Specialties

Networking

Key activities

Governance

Commitment to the AO cause around the globe 2005 saw a growing level of activities in all of AO’s established regions and sections. The development of new and locally adapted educational formats, increasing investments in faculty development, closer cooperation with the Alumni Chapters, and a growing interest in research activities were some of the main themes. News from the regions

The first-ever AO seminar in Vietnam took place in Ho Chi Minh City in April. It marks a further step in the continuous efforts of AO East Asia (AOEA) to involve additional countries. A first AO Principles Course will follow in 2006. The first Indonesian AO Advanced Course on Fracture Management held in Bali in August was equally important and may lead to the formation of a local Alumni Chapter in the near future. The first AO Regional Combined Course with Advanced, Pelvic, Minimally Invasive Surgery, and Masters courses will be held in Thailand in April 2006. It will be preceded by an AO Tips for Trainers (TfT) Course—a premier in AOEA and an important step in the region’s faculty development efforts. The reorganization of the TK-System has resulted in a steep increase of Asian members in the Expert Groups, which recognizes the expertise and importance AOEA has within the AO network.

The first Tips for Trainers (TfT) Course in Por tuguese in São Paulo, Brazil, was a resounding success.

Guest of honor James Kellam at the Annual General Meeting of AO East Asia in Kyoto, Japan.

The Executive Strategic Retreat in Philadelphia, USA, paved the

Faculty education in AO Latin America (AOLAT) saw two important novelties. In April, the region’s first Tips for Trainers (TfT) Course was held. It brought together 25 faculty members from the trauma, spine, and CMF specialties. In August, a national TfT Course was held in Brazil, the first ever in a language other than English. Another one is planned in Chile for August 2006 to continue the region’s faculty qualification initiative.

way for impor tant educational and scientific initiatives of AO Nor th America.

Introduction

Overview

Important steps were taken in advancing the region’s organizational structure.

Specialties

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Key activities

The new AOLAT Trustee Council provides overall guidance. The reorganized AOLAT Executive Board now comprises representatives from all specialties and, together with the three Specialty Boards, is responsible for the region’s activities. Their work will be supported by the new regional director hired in early 2006 as part of AO’s global regionalization strategy. A backbone of AOLAT’s growth is the development of AO Alumni Chapters. Membership rose from 328 in 1998 to 709 in 2005. The growing educational activities in Central America increase the potential for the creation of new chapters in the coming years. An Executive Strategic Retreat held in Philadelphia in March resulted in numerous important decisions for AO North America (AONA), including a new one-year fellowship program to be launched in 2006. It aims to develop new faculty by enabling an intensive exchange with experienced faculty for up to ten talented young surgeons per year. Clinical research activities will also be stepped up, leveraging the expertise of the AO Clinical Investigation and Documentation (AOCID) resources opened in New York in 2004. To best support these and other strategic initiatives, the organizational structure of AONA was adapted, establishing new specialized committees for fellowships and postgraduate education, clinical and scientiﬁc research, as well as international educational affairs.

Governance

Annual Report 2005

Educational activities remained stable at high volume and quality levels. The trauma group held its biannual Faculty Forum in November. The three-day event united 120 faculty members to discuss and decide on future educational offerings, faculty issues, and related topics. In addition to these new activities, the ﬁrst North American Course Chairmen and Course Directors’ Seminar was held as the ﬁrst in a series of advanced courses directed at faculty education and development.

The December 2005 death of Jörg Böhler, Honorar y Member of AO Austria and Honorar y

With the ongoing changes to AO’s regional structure and the formation of new regions in the Middle East and Africa, further growth in activities can be expected.

President of the Austrian Societ y

for Traumatolog y, presented a

News from the sections

severe loss to the field.

The cooperation between AO Austria (AOA) and the Austrian Alumni Chapter was very successful in 2005. All courses were jointly organized and staffed.

A stone’s throw from the Charité, Berlin, AO Germany’s new branch of fice is housed in the same building as most German surgical associations.

Swiss surgeon Marc Lot tenbach during his reverse fellowship in Eritrea in 2005, with surgeon Teclegiorgis Semere and scrub nurse For tunat Wunesh. The prior year, the Eritreans had been received in Fribourg, Switzerland.

Fulvio Urso-Baiarda (right) re-

The main educational event in Austria was an AO Advanced Course held in Salzburg in November. On this occasion, the format of so-called master presentations was successfully piloted. These longer presentations by top faculty members provide more room for moderated discussions. This new format was very well received and will be extended into 2006.

ceives the 2005 AOUK Research Prize from Anthony Cross. 5

With the death of Rafael Orozco (foreground, at 25th anniversar y of AOE in 1996), AO Spain lost

The new Anatomical Specimen Course scheduled for September 2006 in Graz will provide a valuable complement to the existing educational offering in Austria.

one of its founding and honorar y members. 6

Anthony Cross (lef t) hands over the presidency of AOUK to John O’Dowd.

Annual Report 2005

In December, Jörg Böhler, Honorary Member of AO Austria and Honorary President of the Austrian Society for Traumatology, passed away at the age of 87. Over 500

Introduction

Overview

Specialties

speeches worldwide, 360 publications, as well as numerous textbooks have made him a legend in trauma. On the educational front, AO Germany (DAO) successfully piloted a new format for its Annual Meeting in May. The chairmen of the Expert Groups from Germany provided participants with an update on trends. In addition, two presentations focused on recent findings from AO’s research activities. This early access to new and partly unpublished information was greatly appreciated by the 140 participants. The close cooperation with the German Alumni Chapter was continued. Today, Alumni members account for about 25% of German teaching activities. To professionalize research funding, a German AO Research Fund was established. It supports scientific clinical research in an innovative approach. DAO provides not only funding but also methodological and infrastructure support, delivered by five associated research competence centers. This ensures an optimal return on funds invested and helps avoid duplication of efforts. Two projects were already successfully concluded. In March 2006, DAO opened a national branch office in Berlin, in the building that houses most other major German surgical associations. This facilitates networking and creates synergies. The office’s main tasks are to provide support to the course chairmen and manage member administration and services. AO Spain (AOE) has engaged more members as international faculty, in particular with teaching activities in Davos and Latin

Networking

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Governance

America. Teaching activities in Spain remained stable. A high need has been identified for courses for operating room personnel (ORP). A first ORP Course was run in 2005, and three more are planned for 2006 to cater for the growing demand. In September 2006, the first AO Masters Course will take place, marking a new era in AOE’s educational activities. AOE has further strengthened its cooperation with the Spanish Alumni Chapter. All four new AOE members were recruited from among the Alumni, who traditionally remain members in the Alumni Chapter. A painful loss to the section was the death of Rafael Orozco, who was a founding and honorary member of AOE and one of the key drivers of its successful development. Rafael Orozco also cofounded the Maurice E. Müller Foundation in Spain and coauthored several books on fracture care including the “Atlas of Internal Fixation.” The main educational event of AO Switzerland (AOCH) was its second Senior Swiss Resident Course on the topic of foot fractures. Based on earlier feedback, the interactive part of the course was extended and new formats piloted which foster more controversial case discussions between lecturers and participants. A new feature was the combination of the course with an anatomical specimen module.

Within the scope of AO’s Reverse Fellowship Program, two Swiss surgeons completed a reverse fellowship in Eritrea. In 2004, an Eritrean surgeon and a scrub nurse had completed a fellowship in Switzerland. Further two-way exchanges have been approved for 2006. This year’s highlight for AOUK was its Annual General Meeting at Alton Towers in November. 140 faculty members gathered at the event, which featured a number of group and faculty meetings. It also marked the handover of the presidency from Anthony Cross to John O’Dowd. Educational activities decreased slightly from 2004 due to some special courses taking place only every second or third year. The course administration has been reorganized and is now the responsibility of the AOUK Education Department, a standalone educational facility. Course activities will increase sharply in 2006 due to cyclical and new courses, such as a shoulder and a pediatric course. This year’s AOUK Research Prize was awarded to Fulvio Urso-Baiarda from Mount Vernon Hospital, Middlesex, for his paper on “The Modiﬁed Hand Injury Severity Score as a Predictor of Return to Work.”

AOCH decided that all Swiss AO Courses should remain multilingual and be run in a combination of German, French, and English. The cooperation with the Swiss Alumni Chapter was intensiﬁed. All courses and seminars were jointly organized, and open to members from both groups.

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Annual Report 2005

AO Alumni Association: bringing the world together 2005 marked another year of intense activity and growth of the AO Alumni Association (AOAA) with a special event highlight in September: The Triennial AOAA Symposium presented an excellent networking opportunity for a record number of 280 attendees from over 50 countries.

The AO Alumni Organization (AOAA) is one of the most important gateways for young surgeons, residents, and operating room personnel (ORP) to develop professionally and experience the AO spirit through personal and professional friendships. By the end of 2005, a total of 3,308 members from 92 countries had seized the opportunity to join, which represents a net increase of 99 over 2004. 1

Lively discussions were a common sight at the Triennial AOA A Symposium in Sardinia.

A record number of 280 Alumni from over 50 countries at tended the Triennial AOA A Symposium in September.

The breaks allowed for intense net working with colleagues from all over the world.

Alumni members are eager to test the pilot C AS modules

In addition to regional and international activities, members benefit from the activities of their local chapters, which organize their own educational, scientific, and social activities with financial support from the AOAA head office. With the official formation of the Jordan and New Zealand Chapters in April 2005 and March 2006, respectively, the number of local chapters has risen to 49, with a chapter in Poland soon to follow.

developed with AO’s new indus-

trial par tner BrainL AB.

Thrilling activities in Brazil

Antonio Pace, AOA A President

2005 was a particularly busy year for Brazil, where membership rose to 237 members. Many were excited to join in the bustling activity of both scientiﬁc meetings and

(lef t), with former AO President and founding member Mar tin Allgöwer.

social gatherings. Two highlights included the Brazilian Trauma Association Meeting in Bento Gonçalves in April and the Brazilian Orthopedic Society Meeting in Vitória in November, which featured an AOAA meeting with scientiﬁc sessions and a special social event. In the same month, an AO Tips for Trainers (TfT) Course was held in Portuguese in São Paulo. In Brazil, where all faculty members are also Alumni, six Basic Courses and one Advanced Course took place. Beneﬁts for members

AOAA members again beneﬁted from a host of services, including free access to selected educational material and a case discussion forum on the AO Knowledge Portal, access to AO publications and videos, which can be purchased at special rates, and an online member directory to facilitate international knowledge exchange. The AO Foundation in 2005 increased its efforts to integrate the Alumni group more closely with key AO activities. Among others, the Alumni had access to the new AO Surgery Reference on the portal before it went public. Their feedback was swiftly integrated into the

Election of new AOAA Committee members

At the Triennial Symposium, the AOAA General Assembly reelected Antonio Pace of Italy as AOAA President, Helton Defino of Brazil as Vice-President, and Peter Messmer of Switzerland as Secretar y for a period of three years. Theerachai Apivatthakakul of Thailand was elected as new treasurer and Jorge E. Alonso of the USA as special advisor to the Committee. In his function as President of AO International, Joachim Prein joined as new ex-officio member.

From left to right: Helton Defino, Joachim Prein, Antonio Pace, Jorge E. Alonso, Peter Messmer, Theerachai Apivatthakakul.

Annual Report 2005

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solution and will beneﬁt many more practicing surgeons worldwide. There was also a lot of evidence of increasing cooperation between the Alumni Chapters and the AO regions and sections. In addition, Alumni were the ﬁrst to try the new trauma modules in computerassisted surgery (CAS) developed with AO’s new industrial partner BrainLAB. Many of them had not been confronted with this promising technology until the Triennial AOAA Symposium in Sardinia, Italy, from September 18–21. The reactions were truly exciting. Sardinia: a meeting of the minds

For the ﬁrst time in its history, the Triennial AOAA Symposium was held outside Switzerland. It was attended by a record number of 280 people from over 50 countries. The Alumni beneﬁted not only in terms of learning about the state of the art in surgical management but also regarding networking. Networking was not restricted to the Alumni community and AO faculty but included members from the most important AO bodies such as the Academic Council (AcC) and the Expert Groups of the TK-System, who introduced the latest developments in concepts and systems.

Urs Jann receives honorary membership

Urs Jann (right), who initiated the AOAA in 1989 and retired as AO’s Director of Finance and Administration at the end of 2005, received honorary membership at the Triennial AOAA Symposium in Sardinia, from AOAA President Antonio Pace (middle) and Peter Messmer, the organizer of the symposium.

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The participants especially welcomed the “worst case” group sessions, where they were able to present their own most complicated cases. With their different backgrounds and level of professional experience, the participants brought in new perspectives. For many, this experience was also enlightening as they were confronted with rather different healthcare and resident training systems.

The reports from former AO Fellows on their experiences in host clinics around the world was another highlight. Their account was encouraging to others and gave a good understanding of the possibilities for improving professional knowledge through fellowship education. Leisure activities and a banquet dinner on the last evening topped off this international event, with many looking forward to upcoming regional gatherings and the next Triennial AOAA Symposium, which will take place during AO’s ﬁftieth-anniversary year in 2008. Planned future activities

In the meantime, Alumni activities are expected to remain at a peak. Among the regional and international highlights are the three-country meeting of the German, Austrian, and Swiss Alumni Chapters in Germany from May 18–20, 2006, the AOAA Asian Chapter Symposium in South Korea in October 2007, and the Latin American Symposium in Mexico in 2008. These and other Alumni activities will continue to “bring the world together,” as one longstanding AOAA member described his experience in Sardinia.

Governance

Annual Report 2005

Enabling and sustaining self-sufficient healthcare systems Through its Socio Economic Committee (SEC), the AO Foundation continued to support teaching activities for doctors and operating room personnel (ORP) in some of the world’s poorest countries.

training in Malawi.

Intensive short trainings

and operating room personnel (ORP). In Jimma, Ethiopia, and Asmara, Eritrea, these projects are well under way, and surgeons as well as ORP fellows are going there. In Ghana, the organizational and administrative preparations were ﬁnalized for the Koforidua project and the ﬁrst team worked there in February 2006. The preparations for an SEC Reverse Fellowship project with the Moi Medical School in Eldoret, Kenya, are at an advanced stage. In these projects, SEC combines its efforts with other nongovernmental organizations (NGOs). In Ethiopia, the German-based “Menschen für Menschen” association and in Ghana, the Dutch-based group “Care to Move” are the partners. This allows SEC to concentrate on teaching.

SEC Chairman Paul Demmer

Under the SEC Reverse Fellowship Program, trained surgeons reside for several weeks in the target community, where they undertake training of local surgeons

Together with the East, Central, and South African Orthopaedic Association (ECSAOA), SEC has developed a one-year fellowship for

SEC is faced with a poor infrastructure and ill-maintained equipment at most of the clinics where it is active in Africa.

Local and international facult y members receive a one-day training prior to the ORP Course in Blant yre, Malawi.

Nonoperative treatment is an important addition where preconditions for operative fracture care are nonexistent.

4/5

Practical exercises with SECsponsored equipment are an

Although frequently faced with the most adverse conditions, the Socio Economic Committee (SEC) has supported activities in Africa, South America, Oceania, and Asia for several years now. In addition to deﬁciencies at the level of infrastructure and lack of medical know-how as well as educated healthcare personnel, the situation is further exacerbated in many cases by widespread food shortage as the prime concern, civil war, and corruption. AO has strictly focused on training local practitioners and improving local facilities in close cooperation with national and regional surgical associations to ensure a long-term impact of its initiatives.

impor tant emphasis of the

gave an update at the Trustee Meeting on ongoing projec ts in the developing world.

Successful sponsorship for orthopedic/trauma training

The five-year trainee sponsorship for Linda Mbekeane, a young Malawian doctor to become a trained or thopedic surgeon, was continued successfully in 2005 with Linda passing Par t I of the annual Or thopaedic Specialist Examination of the College of Surgeons of East, Cental, and Southern Africa. James Munthali and Maundo Chowa successfully finished their surgical training in Lusaka, Zambia, and Emmanuel Makasa and Emmanuel Simwanza are in their second year of training in the Lusaka Teaching Hospital. All are sponsored by SEC under the condition that they remain in their home countries at the end of their training.

Annual Report 2005

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African surgeons. The successful candidates spend one year in recognized orthopedic/ trauma units in South Africa and complete the fellowship with a diploma examination. Two candidates passed in 2005 and four will be taken in the program in 2006. The successful Ribeirão Preto project in Brazil was continued, where on average two orthopedic surgeons from lesser developed areas of Brazil spend four weeks at the project hospital each month. Since the program’s inception in 2000, the number of trained fellows has risen to 82. They beneﬁted from attending operations, workshops with synthetic bones, case discussions, and lectures and seminars. To sustain the initiative, the senior orthopedic surgeons who acted as mentors during the fellows’ stay will keep in touch with them and discuss cases via the Internet. This program could not be extended to Rio de Janeiro as planned. However, a ﬁrst call for fellows is expected for São Paulo in 2006, and activities are underway for Mexico. Successful initiative in Malawi

In Africa, educational activities focused on Cameroon, Eritrea, Ethiopia, Ghana, Kenya, Malawi, Rwanda, Tanzania, Uganda, and Zambia. Four projects were supported in Malawi, the fourth poorest country in the world with a population of 12 million and one qualiﬁed local orthopedic surgeon, as well as three orthopedic surgeons from the UK. A one-day DispoFix workshop was attended by Orthopedic Clinical Ofﬁcers (OCOs). OCOs are not doctors but perform the majority of all fracture treatment. The OCOs were enthusiastic about the workshop and left no training opportunity wasted.

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The OCO hostel, teaching facility, and library established with the help of SEC and opened in 2004, were gutted by a fire in September and will have to be rebuilt with the support of SEC. An ORP Course in Blantyre was attended by 26 participants from Malawi, Tanzania, and Zambia. For the first time, this course was preceded by a oneday training for faculty members, five of whom were Malawian ORPs. The prospective research project on Open Reduction and Internal Fixation (ORIF) in HIV-positive patients was continued with an article published in the Journal of Bone and Joint Surgery. In 2006, AO will continue its activities in Malawi. The annual Principles of Operative Fracture Management Course, jointly organized by SEC and ECSAOA, will take place in Blantyre. Nonoperative fracture care

Since the preconditions for operative fracture care are frequently nonexistent in the hospitals in Africa’s developing countries and per-capita pharmaceutical expenditure is as low as one dollar per year, SEC has developed and introduced courses on nonoperative fracture treatment. Three two-day nonoperative fracture treatment courses were held in Kenya. Logistical collaboration with the African Medical and Research Foundation (AMREF) and ECSAOA was essential for these outreach teaching events. For 2006, courses have been organized for Ethiopia, Ghana, Tanzania, Malawi, and Uganda.

Governance

Annual Report 2005

Trustee Meeting 2005: Taking stock and envisaging the future The 21st annual meeting of the Board of Trustees of the AO Foundation was held in Amelia Island, Florida, USA, from June 21–24. It provided an excellent platform for information sharing, discussing current and future opportunities for AO, as well as networking with colleagues from other regions and specialties.

Chaired by James Kellam, President of the AO Foundation, the 2005 Trustee Meeting was attended by 128 Trustees and ex-ofﬁcio Trustees. In addition to the General Assembly, it gave the Board of Trustees as the leading governing body of the AO Foundation ample opportunity to share information with colleagues from other regions and specialties, discuss the strategic position of AO with regard to industry and the developing world, and learn about the latest developments in education, technology, and services in scientiﬁc presentations and breakout sessions. Challenging AO’s role in the developing world

The parallel breakout sessions provide ample room for intensive discussions.

The Trustees discuss the latest concepts and developments with members of the Exper t Groups of the TK-System.

James Kellam (second from right) honors the outgoing Trustees (from lef t to right): Kenneth A. Johnson, USA, Got t fried Köberle, Brazil, and Lutz-Peter Nolte, Switzerland. Not present in picture: Kerong

The meeting was kicked off with a stimulating and provocative symposium on AO’s role in the developing world, moderated by President-Elect Christian van der Werken and Paul Demmer, Chairman of the Socio Economic Committee. One of the things agreed upon by the Trustees was an extended reverse fellowship program in developing countries, which should be sustainable for ﬁve years with mandatory institutional and government support. Suthorn Bavonratanavech and Urs Jann presented AO’s response to the tsunami disaster in 2004 and introduced a new disaster relief plan for joint relief efforts with Synthes, Inc., which permits a faster response to crises.

Dai, China. 4

The Trustees at the General

Exploring new developments and concepts

Assembly.

Other plenary sessions focused on building a research network (Robin Poole), nonfusion spine surgery (Max Aebi, Norbert Boos, Michael Janssen), entrepreneurship (Stefan Vilsmeier, BrainLAB), 20 years of AO education in Thailand (Suthorn Bavonratanavech, James Kellam), the future of

Many impor tant decisions are taken by AO Trustees with the help of the Audience Response System.

Members elected in 2004 attend their first Trustee Meeting.

Annual Report 2005

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AO education (Robert Fox, Joe Green), the AO Research Fund (Adrian Sugar), and Vertical Expandable Prosthetic Titanium Rib (Robert M. Campbell, Jr.). During the “Meet the Expert Groups” session, the Trustees met with the Expert Groups of the TK-System to discuss new concepts and developments applicable to their practices and regions. They learned about the surgeon-industry interface that is most fruitful for the innovation process. For the first time, the Trustees were able to attend two of five breakout sessions instead of one. Eric Johnson, Brett Bolhofner, Christian Krettek, Richard Lange, René Marti, Jeffrey Mast, and Keith Mayo ran a course on problem fractures. Steve Schelkun and Michael Redies, Don Webb, and Andy Weymann focused on the advantages of eLearning. Mark Vrahas, Mauro Alini, Jürg Gasser, Erich Schneider, Margarethe Hofmann, and Brigitte von Rechenberg led a session on clinically relevant information on bone and bone healing for the practicing surgeon. Joe Green, Piet de Boer, John Frodel, and Lisa Hadfield-Law focused on maximizing the effect of teaching. Finally, Beate Hanson, David Helfet, and Michael Suk presented a session on how to choose an outcome measure. The General Assembly received reports from President James Kellam, Chairman of the Board of Directors Markus Rauh, and CEO Gregor Strasser. It elected five new Trustees, honored four outgoing Trustees, and appointed two new Honorary Members. Jaime Quintero was reelected to the Board of Directors. The revised charter and bylaws of the AO Foundation, which stipulate the

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formation of Specialty Academic Councils and a new code for representation in AO’s main bodies, as well as new guidelines for Trustees, were adopted. AO spirit comes to the fore

Although the program was full of meetings and scientific sessions starting at 7 a.m., there was enough room for networking with colleagues from the same and other regions. The meeting closed on a particularly harmonious note as Diego Fernandez stunned the group with a piano performance on the final night, and colleagues spontaneously joined in singing to fill the air with the legendary “AO spirit.” It brought Amelia Island’s marketing slogan, “Easy to get to and hard to leave,” to life.

The next annual meeting of the Board of Trustees is scheduled for June 15–18, 2006. It will take place in Bern, Switzerland, which is home to Maurice E. Müller, one of the founding fathers of AO and cofounder of the AO Foundation.

Newly elected Trustees Kodi Kojima, Brazil Claudio V. Lamartina, Italy Antonio Barquet , Uruguay Shantharam M. Shett y, India Bingfang Zeng , China New Senior Trustees Gottfried Köberle, Brazil Lutz-Peter Nolte, Switzerland

Our cordial thanks go to Urs Jann, who stepped down as Director of Finance and Administration at the end of 2005 after 20 years with the AO Foundation, including the organization of many successful Trustee Meetings. He will continue to support AO on special assignments.

Kenneth A . Johnson, USA Kerong Dai, China New Honorary Members Reinhold Ganz, Switzerland John Webb, UK

Disaster relief plan established

Following the tsunami disaster in Asia in late 2004, AO and Synthes, Inc. set up a joint crisis management group and disaster relief plan. The plan was put to the test after the devastating ear thquake hit the Himalayan region in Fall 2005. This experience led to a refinement of the emergency kit of instruments and implants as well as the logistical setup.

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Early appointment of well-connected local contacts will ensure quick release of the aid material to the affected region. All requests for suppor t will be rigorously scrutinized to most effectively leverage the resources invested. As a principle, crisis management suppor t will be restricted to major natural disasters for a limited amount of time.

Governance

Annual Report 2005

Creating the state of the art in postgraduate medical education AO International (AOI) embarked on a series of initiatives targeting the entire educational management process as well as strengthening AO’s cross-media educational mix for the benefit of learners and faculty.

Hands-on training remains an impor tant pillar of AO education.

Davos Course par ticipants get acquainted with the theor y and practice of the latest concepts and techniques.

AO Education introduced a course module blending computer-assisted surgery (CAS) and minimal invasive osteo synthesis (MIO), which are becoming increasingly important.

In 2005, some 50 teaching videos were issued in DVD format with a sophisticated navigation scheme.

AO Education is continually extending its reach. In April 2005, AO held its first-ever seminar in Vietnam.

The combination of 3-D animations and real clinical footage underscores the stronger clinical focus of AO teaching videos.

Despite many new channels and formats, AO Courses are and will remain the main pillar of AO education. A well-trained faculty is the key to success. AO International (AOI), therefore, enhanced its efforts in faculty support with revised course syllabi, new case material, and teaching videos for the AO Principles and Advanced Courses, which can be accessed through the AO Knowledge Portal. It also rolled out its two-day Tips for Trainers (TfT) Course to new locations. A highlight was the first TfT Course conducted in a language other than English. The participants from all over Brazil who met in São Paulo appreciated the opportunity to express themselves in their native language, which facilitated a vivid discussion and improved the learning outcome. This was made possible thanks to the recruitment of a second adult educator, who is fluent in Portuguese and Spanish. For the first time, TfT Courses were preceded by an e-based precourse assessment module, to allow course participants to gain insight into their level of knowledge and course needs. Six TfT Courses are planned for 2006 underscoring AOI’s commitment to faculty development.

Tailoring courses to learners’ needs

A precourse needs assessment pilot was also successful for other AO Courses, including an AOSpine Course in Brazil and a Pelvis Course in Germany. The online assessment helped enroll the participants in the rightlevel course and adapt the content to their needs. It is planned to incorporate a precourse needs assessment module into the AO Principles and Advanced Courses, which will be piloted at four courses in 2006. The pilot project focusing on the evaluation of the Davos Courses in 2004 has been simpliﬁed and was tested in the 2005 Davos Courses, using the Audience Response System. Revisions will result in a more concise module, which will be available for major regional courses in 2006. Additional postcourse eLearning modules were added that will allow course participants to test their knowledge and earn CME (Continuing Medical Education) credits. Hands-on formats

At the 2005 Davos Courses, an important innovation was introduced with a course combining minimal invasive osteosynthe-

Education as backbone of regional development: The example of AOLAT

Most activity occurring in the regions relates to education. The first Latin American AO Course dates back to 1971. The following years, structures were built around a few enthusiastic local faculty members. From 1994, growth was spurred by the founding of twelve national AO Alumni Chapters which exist today within Latin America. The idea for a formal AOL AT region was initiated by

Annual Report 2005

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Overview

regional Trustees in 1997 and implemented a year later. In 2005, AOLAT introduced a new organizational structure with regional specialty boards, and in early 2006 a regional manager was hired under AO’s new regional structure. With its histor y and dynamic adaptations to meet growing needs, AOLAT can ser ve as a role model for the development of other AO regions.

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sis (MIO) and computer-assisted surgery (CAS). The latter was developed in collaboration with BrainLAB. The computer-assisted surgery focused on two practical modules— sacroiliac screw fixation in the pelvis and the reduction of a femoral fracture for nailing. The creation of more teaching modules incorporating CAS is under development. Through its presence at major congresses, AO was highly visible in the surgical community around the world. Its symposia on osteoporotic fractures at the SICOT World Congress in Istanbul, on intramedullary nailing at the EFORT Congress in Lisbon and the first Joint Congress of the DGU/ DGOOC in Berlin were attended by more than 600 participants in total. AO was present with its own booth, which featured presentations of the latest innovations including the online AO Surgery Reference. This involvement led to important new contacts and resulted in numerous applications for the AO Alumni Association membership. With its manual on Internal Fixators, AO Publishing will launch the first manual focusing on the indications and techniques of the new Locking Compression Plate

System (LCP). It features more than 120 cases from surgeons around the world. A manual on Elastic Stable Intramedullary Nailing (ESIN) in children’s fractures is due for publication, while other projects were signiﬁcantly advanced. Among them is a completely revised second edition of the AO Principles in Fracture Management (PFxM) textbook, which will comprise the latest concepts, and a book on minimal invasive osteosynthesis (MIO) initiated by AO East Asia. Video production reinvented

The introduction of an improved video production workflow led to increased efficiency and flexibility. With its new mobile production units, AO can take postproduction to the surgeons, saving them valuable time. The first product under this new concept is a video on PFNA (Proximal Femoral Nail Antirotation). The collaboration with BrainLAB produced two videos on computer-assisted surgery. Another novelty is the stronger clinical focus of teaching videos. Through the use of 3-D animations in combination with real clinical footage, surgeons get better support as to the right entry point and angle of nails.

100

From 2003 to 2005, the number of courses (excluding ORP) rose by 58% , with fur ther growth expected for 2006. In parallel international faculty grew by 70 % .

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0 Principles

Advanced

Pelvic

Hand

Foot

2003

2004

2005

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Spine

2006 (plan)

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CMF

Veterinar y

ORP*

* includes all specialties and seminars

Annual Report 2005

Finding answers to clinically relevant challenges An important cornerstone of AO’s medically guided value chain, AO Research continued to shed light on clinically relevant questions through state-of-the-art basic and applied research, thereby paving the way for innovative solutions that will translate into direct patient benefit.

Preparation of stem and endothelial cell co-cultures.

A distal humerus plate is fixed in an experimental setup.

An inter ver tebral disc is carefully inser ted into a bioreac tor container.

New research into the charac teristics of various metal sur faces helps prevent tendon adhesion to implants.

The 6th International Conference on Sur face and Tissue Interaction (BIOSURF VI) in Lausanne, which was coorganized by the AO Biotechnolog y Advisor y Board and the AO Research Institute, drew an international audience of 160 specialists.

AO Research produced several important findings in 2005, which underscore AO’s leading role in the life sciences. For example, in the area of bone tissue engineering, significant progress was made in a project that investigates the possibility of simultaneously growing bone and new blood vessels into large bone defects as they occur in severe open fractures, infections, or after tumor resection. Bone normally has a considerable self-healing capacity. This is not the case with insufficient vascularization, a common problem in tissue-engineered bone grafts used to fill these critical-size defects. In-vitro tests have shown that, with appropriate stimulation, vessels form when endothelial cells are collected and cultured in a 3-D matrix. In AO’s Large Bone Defect Healing Clinical Priority Program, this project will be taken into the in-vivo phase to investigate if these cell cultures can be induced to form vessels in bone grafts inside an animal model.

Annual Report 2005

Important results were obtained in a collaborative research project into the causes of disc degeneration, a common phenomenon observed in human beings. In this project, which involves the AOSpine Research Network (AOSRN) partners, the AO Research Institute (ARI) developed a model for testing the effectiveness of proposed therapies. For the ﬁrst time, the entire intervertebral disc with endplates of a large animal was successfully cultured in vitro. The outcomes, which were presented to a high-proﬁle audience at the European Cells and Materials (ECM) Congress, claimed much attention in the international spine community.

Introduction

Overview

Specialties

Preventing soft-tissue adhesion to implants

An international research network led from within ARI, including the Swiss Federal Institute of Technology in Zurich, the University of Glasgow, the Robert Mathys Foundation, and Synthes, Inc., explored the causes of soft-tissue adhesion to titanium implants, a major cause of tendonitis, tendon ruptures, and reduced hand motion. Tests have shown that titanium surfaces, like stainless steel, must be polished to inhibit soft-tissue adhesion. With this knowledge, plates from titanium and titanium alloys, one of the most biologically advanced metals, present a new treatment option for patients in the hand as well as other areas of internal fracture fixation. Another project demonstrated the superiority of Locking Compression Plates (LCPs) over Dynamic Compression Plates (DCPs) in fixing fractures in poor-quality bone. In a study investigating distal humerus fractures, it was shown that LCPs create a construct that is significantly stronger than with DCPs. Clinicians now have evidence that allows them to extend this indication into higher degrees of osteoporosis—for the benefit of millions of patients worldwide. Combined expertise for best results

2005 was a year of reorientation for AO Research. With the introduction by the Academic Council of Clinical Priority Programs for the entire organization, AO Research is increasingly focusing its resources in the areas of bone defects and disc degeneration. The expertise available through ARI

Networking

Key activities

Governance

is complemented with internal and external partners. These include the AO Research Fund (AORF), the AO Biotechnology Advisory Board (BAB), AO’s international research networks, including the Collaborative Research Centers (CRCs), and the AOSRN. Funds will be increasingly allocated on a project basis with clearly specified outcomes, as opposed to baseline funding. This model also helps resolve financial and intellectual-property issues. The results of workshops and meetings on fracture treatment and osteoporosis, attended by internal medicine, orthopedic, and traumatology experts, were published in a supplement to Osteoporosis International Journal. This publication essentially summarizes the contribution of AO Research in osteoporotic fractures. In December 2004, a scientific meeting was organized by ARI and the TK-System on the use of antibiotics on implants. It will result in a similar publication in 2006.

Biotechnology Advisory Board promotes new research

The BAB instituted a new research initiative into the use of osteoinductive factors to improve treatment strategies for defects in the locomotor system. Its third global research call resulted in some 30 applications, of which eight were chosen for full proposal submission in a rigorous peerreview process. Three projects were ﬁnally selected for ﬁnancial support. BAB members Margarethe Hofmann and David Grainger as well as Geoff Richards from ARI coorganized the 6th International Conference on Surface and Tissue Interaction (BIOSURF VI) in Lausanne, where the AO Foundation played a prominent role.

European Space Agency awards grant to bone formation project

The AO Research Institute (ARI) was awarded EUR 144,000 from the European Space Agency (ESA) in March 2005 for its contribution to the project “Bone Formation in a Combined Circumfusion/ Loading Chamber for Ex-Vivo Bone Culture.” The project is a collaboration of Geoff Richards with Jos Vander Sloten (Leuven, Belgium), David Jones (Marburg, Germany), and Laurence Vico (St Etienne, France).

Introduction

Overview

Specialties

Networking

Key activities

By using human tissue within the novel bone culture chamber ZETOS (shown left), a development previously sponsored by the 3R Research Foundation (Reduce, Refine, Replace animal experimentation), it may be possible to reduce the need for animal models to study osteoporosis of cancellous bone. The system may also be useful for studying bone metabolism in pharmaceutical research and development.

Governance

Annual Report 2005

Developing concepts for fracture fixation in osteoporotic bone With an extended network of partners, the AO Development Institute (ADI) focuses on the development of concepts of relevance to millions of patients with fractures in osteoporotic bone.

The focus of the AO Development Institute (ADI) in 2005 was on concept development for a standardized augmentation technique to enable better implant anchorage in osteoporotic bone. What started as a strategic initiative in 2003 to develop new competencies has become an integral part of AO’s Clinical Priority Program “Fracture Fixation in Osteoporotic Bone.” Closing a material gap

1/2

While the conventional rigid implant cuts through the osteoporotic bone (1), the augmentation technique helps keep the implant firmly in place (2).

3/4

ADI’s standardized augmentation technique achieves more homogeneous distribution of bone cement around the implant (3) than preexisting techniques (4).

Implant development has largely focused on good bone stock in the past. However, mechanical failure may occur as the rigid implants cut through the osteoporotic bone. This often necessitates revision surgery, which is risky for the patient and costly to society given the high absolute number of cases. While the use of bone substitute materials to improve the interface between structurally weak bone and rigid implants is not new, this augmentation technique has not become widespread for lack of standardized materials and techniques. ADI has achieved reproducible results and a simple application through innovative techniques, which are likely to be clinically tested and reﬁned in the near future.

ADI’s competence in mechanical, hardware-based solutions was essential in complementing augmentation technique with innovative measurement tools to intraoperatively determine the cases where implant augmentation will allow for maximum patient beneﬁt. Joining forces with renowned institutions

Major success factors of AO’s Clinical Priority Programs are integrated research, clinical, and teaching networks. In the area of mechanical measurement and augmentation technique, ADI strengthened its links in particular with Innsbruck Medical University, University of Heidelberg, University of Bern, and University of California at San Francisco. To ensure implementation of its concepts in products, ADI established a close relationship with the Task Force Osteoporosis of Synthes, Inc. In addition to its focus on osteoporosis, ADI ran smaller projects with universities and the other AO institutes. Demand in 2005 was particularly high for its database of CT scans, for which use by further industrial and nonproﬁt organizations is now being investigated.

Augmentation technique: for the beneﬁt of patients

Conventional implants may cut through the osteoporotic bone of older patients. While such failure occurs in only 5% of proximal femur fractures, the high incidence rate of this type of fracture and the need for revision surger y make it a relevant problem for the patient and society as a whole. Cutout can be prevented through the use of augmentation technique—a major focus of the AO Development Institute in 2005.

Annual Report 2005

Introduction

Overview

Specialties

Networking

Key activities

Governance

TK-System: Regionalization put into practice While undergoing a major reorganization to better meet the needs of the AO specialties and regions and accelerate the innovation process, the TK-System approved numerous new devices and techniques.

In 2005, the TK-System underwent major changes in an effort to intensify regional involvement of surgeons in its Expert Groups (EGs) and provide more autonomy to the specialties of General Trauma, Spine, and CMF through a new three-pillar model.

The new External Fixation

At the expense of European surgeons, who had been overrepresented given AO’s increasing globalization, more representatives were appointed from Asia Paciﬁc, Latin America, and North America. Over a period of ten months, US participation grew by 75%, while the number of Asians tripled and that of Latin Americans even quintupled. By the end of 2005, more than 100 surgeons in General Trauma, Spine, CMF, and Veterinary contributed their medical know-how in the specialty Technical Commissions (AOTKs).

New TK-approved products

Despite this reshuffling, the TK-System approved no less than 43 new products in General Trauma, 29 in Spine, 14 in CMF, and four in Veterinary. The new family of expert intramedullary nails is now almost complete, the line of external fixators has been complemented with small and medium fixators, and the range of anatomically precontoured plates has been expanded. TomoFix, the implant family for corrective osteotomy, was further expanded, which has led to an actual revival of that technique. All major developments were accompanied by international user meetings. These meetings allow for an open exchange of first clinical experience and user-friendly communication of the latest novelties.

Working Group af ter its first meeting and Theddy Slongo from the Pediatric Exper t Group (second from right, front row). 2

The winners of the TK Recognition Award 2005 (from left to right): Christoph Sommer, Switzerland, Anselmo Reyes, Mexico, Theerachai Apivatthakakul, Thailand, and Tim Weber, USA, together with Norbert Haas, Head of the TK-System.

Introduction

Overview

At the level of Working and Expert Groups, one major change concerned the ComputerAssisted Surgery Expert Group (CSEG). Taking into account the different regional situations and needs, a special subgroup was set up for the USA. The cooperation of the CSEG with industrial partner BrainLAB was highly successful and led to the introduction of the ﬁrst combined computer-assisted surgery (CAS) teaching modules at the 2005 Davos Courses.

Specialties

Networking

Key activities

The busy year culminated in a festive act that testiﬁes to the new globalized TKSystem. At the opening ceremony of the 83rd Davos Courses in December, the TK Recognition Award 2005 was presented to four trauma surgeons from AO’s established four regions. Tim Weber, USA, was honored for his contribution to the Reamer-Irrigator-Aspirator (RIA), Christoph Sommer, Switzerland, for the Locking Compression Plate (LCP), Theerachai Apivatthakakul, Thailand, for minimal invasive osteosynthesis (MIO), and Anselmo Reyes, Mexico, for the Modular Distal Aiming Device (MoDAD).

Governance

Annual Report 2005

Growing demand for clinical research To meet the growing demand for evidence-based knowledge, AO Clinical Investigation and Documentation (AOCID) stepped up its core activities in 2005 while at the same time expanding into new areas including an FDA trial study.

Demand for evidence-based knowledge continued to rise in 2005, confirming the strategic goals of AOCID. In its core competence of clinical studies, AOCID initiated five new studies. Through its New York resources , two spine studies in North America were started under the leadership of the Scientific Committee (SciCom) with representatives from AOSpine North America and AO North America, as well as AOCID. This successful new model, which unites the local specialty and AO organizations as well as international AOCID experts, may well lead the way for other specialties and regions. This development is supported by the continued expansion of AO’s clinical research network which creates a triplewin situation for patients, clinics, and AO. While patients benefit from independent studies and state-of-the-art knowledge in their regions, the clinics get evidence-based support and AO gains access to frontline surgeons. The option of setting up additional local resources is currently being examined. All eyes on cost effectiveness 1

AOCID has been publishing extensively on study results and methods in peer-reviewed journals.

The progress of patient treatment is carefully recorded and then evaluated by the AOCID team.

Demand in 2005 was par ticu-

With increasing financial pressure on healthcare systems worldwide, cost-beneﬁt analysis—an integral part of all AOCID studies since 2004—has gained in importance. In 2005, publications for the novel AOCID project with the Chilean Health Care Organization in Latin America went into review. A new study was initiated in Chile and another one in Mexico.

surger y (EBOS). 4

AOCID booths are an important plat form for knowledge exchange and consulting.

Annual Report 2005

The prospective bone-substitute study initiated in 2004 now includes more than the expected 60 cases. It was decided to extend the study to 12 months as the impact of the “chronOS Inject” bone substitute will be easier to evaluate. Current studies and ﬁrst FDA trial

With ﬁve new studies and six studies completed in 2005, AOCID is currently supervising 22 studies. A hallmark study initiated in 2005 is a US Food and Drug Administration (FDA) trial of the bone substitute P15. It is run in collaboration with the University of Washington in Seattle, the leading epidemiological university in the USA. Randomized FDA trials are considered among the most difﬁcult studies. AO may leverage its expertise from this experience as the healthcare market is expected to request more randomized studies in the future. Growing demand for AOCID services

larly high for training sessions on evidence-based or thopedic

high tibia osteotomy (HTO) as a standardized model, this randomized controlled trail focuses on the difference of patients treated with HTO receiving COLLOSS as an interponate and those receiving it without an interponate. The main outcome is early onset of bone healing. A second HTO study investigates whether HTO performed using computer-assisted navigation has lesser variance in the difference between the observed and planned correction angles in the leg axis than do nonnavigated HTOs.

Ongoing clinical investigation in biotechnology

A large new study explores the beneﬁts of COLLOSS. This substance is believed to induce osteogenesis in bone defects. Using

Introduction

Overview

Specialties

The request by third parties for services continued to rise in 2005. In addition to clinical studies, demand was particularly high for evidence-based teaching activities (EBOS), which AOCID developed together

Networking

Key activities

Governance

with AO International (AOI) and the AO Research Institute (ARI). Extensive literature searches were run for projects within AO’s Fracture Fixation in Osteoporotic Bone Clinical Priority Program as well as within the Large Bone Defect Healing program, among others. In addition, AOCID expanded the clinical research section on the AO Knowledge Portal and developed Traumaline, a sophisticated orthopedic literature database indicating the level of evidence of each entry.

AOCID was involved in four classification projects in different specialties. A web-based international multicenter agreement study with 275 fractures and 77 surgeons for the validation of the pediatric long-bone fracture classification was completed. Further evaluation is due in a prospective study. In addition, a comprehensive software solution for the classification of injuries has been advanced with the inclusion of a foot module and the Müller AO Classification of Long Bones.

Distribution of study types 0

In 2005, AOCID reached its strategic goal of increasing the propor tion of RCT and comparative studies to over 50 % of total studies.

Handling tests Case series Comparative studies Randomized controlled trial (RCT)

2003

2005

Cost-beneﬁt analysis: Conservative vs operative fracture treatment

The importance of cost-benefit analysis is high as healthcare systems worldwide are struggling to contain cost. Where possible, the analysis includes a comparison of the benefits of operative versus nonoperative fracture treatment or other treatment options. Factors considered include the severity of the fracture type, the soft-tissue situation, and the socioeconomic situation of the patient. As a rule, AO adopts the viewpoint of the patient. Studies are restricted to simple fractures for which the outcomes of operative and conser vative treatments are identical. For example, the pioneer study in Chile from 2003 to 2005 showed that patients whose type-A tibia fracture was treated operatively were able to return to work

Introduction

Overview

Specialties

Networking

(RTW) on average 85 days prior to conservatively treated patients. The extra cost for this reduction in RTW is USD 4,000. Decision makers use these results in combination with socioeconomic data. With an average local monthly salar y of USD 100, the Chilean society, for example, is unlikely to opt for faster RT W. A trend is emerging here toward more comprehensive health technology assessments (HTA), which go beyond cost-benefit analysis to include the standpoints of all players in a societ y. With its proven track record, vast expertise, and service orientation, AOCID is well positioned to be a preferred project par tner.

Key activities

Governance

Annual Report 2005

AORF: a triple win for researchers, AO, and the patient Reorganization of the AO Research Fund (AORF) continued in 2005, leading to a new application process and guidelines, widened membership in the AORF Commission, and a new grant category focusing on AO’s Clinical Priority Programs.

As a research-based organization, AO has been encouraging excellence in research with grants for start-up and innovative projects for the past 22 years. Thanks to the reorganization of the AO Research Fund (AORF), with important changes taking effect as of January 1, 2006, it will be able to deal more effectively with the increasing number of applications as well as promote research speciﬁcally in AO’s new Clinical Priority Programs. Successful year for researchers

In 2005, a total of 40 new projects were funded, which corresponds to an approval rate of 36%. Again, the standard of all applications was high ensuring a very competitive process. The quality and originality of each application was judged by two reviewers, with a binding decision taken in a majority vote by the AORF Commission. In 2005, 59 projects in 14 countries around the world were supported with a total sum of CHF 2,682,410. Project details can be found at www.aofoundation.org/aorf.

Geographical distribution of funded studies 2005 Countr y

Number Amount in of projec ts CHF 1,0 0 0

Australia

Austria

Canada

124

Denmark

Finland

Germany

718

Greece

Hong Kong

Singapore

Sweden

Switzerland

435

Turkey

270

USA

759

Annual Report 2005

At the Trustee Meeting in June 2006, the AORF Commission will award the ﬁrst AORF Prize of CHF 10,000 to the best completed project and, in addition, will recognize one highly commended project. The winner will give a lecture on their work to the AO Trustees. With Stephen Ferguson and Mark Markel joining in 2006 in addition to Steve Krikler, the Commis sion has been expanded to include a second person from spine and one person from the veterinary team, better representing AO’s specialties on this board. All members now also contribute to the monitoring of the progress of projects.

Introduction

Overview

Specialties

The next application deadlines are August 15, 2006, and February 15, 2007. The Commission encourages applications from around the world and all specialties in an effort to extend AO’s knowledge to the global research community and promote forward-looking research that will beneﬁt patients with trauma and disorders of the musculoskeletal system. 2006: geared to AO’s clinical priorities

While still awarding Start-up Grants of up to CHF 60,000 p.a. for up to two years to young researchers and scientists, a new Focus Grant category has been created to support projects within AO’s Clinical Priority Programs. These will be for up to CHF 100,000 p.a. for a maximum period of three years. For the ﬁrst time, more experienced and proven researchers are eligible to apply. The Commission members and their network of scientists and surgeons will continue to review applications. For Focus grants within the ﬁeld of tissue engineering, they will be joined by reviewers from the AO Biotechnology Advisory Board (BAB). Projects supported by technical area Subject

Number of projects

Biomaterials/Metallurg y Biomechanical Biological C AOS, 3-D reconstruc tion Clinical

Amount in CHF 1,000

100

3.7

142

5.3

510

19.0

1.2

450

16.8

Implant development

3.0

Maxillofacial

354

13.2

196

7.3

761

28.4

Spine Tissue reac tion Transplantation Total

Networking

2.1

2,682

100

Key activities

Governance

Organizational development and finance During the financial year 2005, the AO Foundation spent a total of CHF 69.1 million supporting the various AO institutions and promoting AO. Total expenditure since 1960 has thus reached almost CHF 700 million.

Source of funds by geographic region

Distribution of headcount at year-end

Nor th America

52%

Research

Europe

29 %

Development

33% 14 %

A sia Pacific

12%

Qualit y assurance

10 % 21%

Latin America

Education

Middle East

Spine

Africa

CMF

Regionalization

AO Center

Administration

Evolution of funds spent 1995–2005 (CHF in millions) 70 60 50

In 2005, the AO Foundation spent a total of CHF 69.1 million, of which CHF 13.2 million was contributed to research, CHF 5.4 million to development, CHF 13.2 million to education, and CHF 5.1 million to quality assurance. CHF 12.3 million was assigned to the AO specialties AOSpine (CHF 11.4 million) and CMF (CHF 0.9 million). For regional as well as Foundation and Trustee activities, CHF 15.2 million was spent in total. The AO Center accounted for CHF 3.6 million. Unforeseen expenses amounted to CHF 1.1 million. In addition, an important allocation could be made to the reserve pool. From a functional point of view, 27% was spent on personnel costs, 65% on operating costs, and 8% on investments. In 2005, the AO Foundation placed particular emphasis on biotechnology, spine, knowledge services, IT projects, and community communication. The collaboration with BrainLAB in the ﬁeld of computer-assisted surgery (CAS) was intensiﬁed in the year 2005. BrainLAB is becoming an increasingly important partner of the AO Foundation in research, development, as well as education.

Funding 30 20 10 0

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Royalties from Synthes, Inc. were generated in the following regions: 52% in North America, 29% in Europe, 12% in Asia Paciﬁc, and 7% in other regions. In addition to the direct funding of the AO Foundation, external funding in the amount of CHF 1.6 million was obtained in 2005, including from the Landschaft Davos.

Unforeseen

AOSpine

Outlook

Foundation and Trustee activities

Education

AO Center

Qualit y assurance

Regionalization

Development

CMF

Research

In the future, the AO Foundation intends to further increase its regionalization and specialization efforts, as well as its endeavor to allocate more funds to AO’s deﬁned Clinical Priority Programs.

Introduction

Overview

Specialties

Networking

Key activities

Governance

Annual Report 2005

Governing bodies of the AO Foundation (as per December 31, 2005) Board of Trustees

The Board of Trustees is the “AO parliament,” consisting of 164 leading surgeons from around the world, including ex-ofﬁcio Trustees. The Trustees approve amendments to the charter and elect the members of the Academic Council (AcC). They function as ambassadors for AO in their country or region and communicate the AO philosophy. They transmit AO information to national institutions and other AO surgeons and bring feedback regarding special needs into AO. Since each Trustee serves for a limited number of years, constant rejuvenation of the Board is guaranteed.

Board of Directors (AOVA)

The Board of Directors implements the goals and proposals of the Academic Council. Its 12 members include three representatives of the licensed manufacturer of Synthes products. Markus Rauh, Chairman * James Kellam, President Christian van der Werken, President-Elec t Max Aebi *** Roland Brönnimann, Synthes, Inc. ** James Gerr y, Synthes, Inc. ** Eric Johnson Paul Manson Bruno Noesberger Tim Pohlemann Jaime Quintero Ciro Römer, Synthes, Inc. ** Gregor Strasser, CEO ** Urs Jann (Advisor y Member) ** Urs Weber (Minutes) ** *

casting vote

** non-voting members *** not present in pic ture

Annual Report 2005

Introduction

Overview

Specialties

Networking

Key activities

Governance

Academic Council (AcC)

The Academic Council lays down the AO Foundation’s medical and scientiﬁc goals. Elected by the Board of Trustees, it has 17 members and is supported by four Specialty Academic Councils (SAcCs), specialized steering boards, and other ex-ofﬁcio members. James Kellam, President Christian van der Werken, President-Elec t René Mar ti, Past-President Max Aebi, SAcC AOSpine Brian Alper t Jörg Auer, SAcC AO Vet ** Michael Ehrenfeld, SAcC CMF David Grainger, Biotechnolog y Advisor y Board * ** Norber t Haas, Head of TK-System * David Helfet, Documentation & Publishing Board * ** Jesse Jupiter, Education Board * Cléber Paccola Pietro Regazzoni, Development Board * Norber t Südkamp, Research Board * Peter Traf ton Michael Wagner Tobias Hüt tl (Executive Secretar y) * *

non-voting members

** not present in pic ture

AO Executive Management (AOEM) Gregor Strasser, CEO Heike Grahlow, Head of Communications Beate Hanson, Direc tor AOCID Urs Jann, Direc tor Finance & Administration Michael Piccirillo, Direc tor AOSpine Joachim Prein, President AOI (from July 2005) Thomas Rüedi, President AOI (until June 2005) Erich Schneider, Direc tor ARI Philip Schreiterer, Head of TK Of fice Norber t Suhm, Direc tor ADI

Introduction

Overview

Specialties

Networking

Key activities

Governance

Annual Report 2005

Abbreviations Organizational terms

Technical terms

AcC

Academic Council

ABC

Ac tivit y-based costing

ADI

AO Development Institute

CAOS

Computer-aided or thopedic surger y

Stands for the German “Arbeitsgemeinschaf t für Osteo-

CAS

Computer-assisted surger y

synthesefragen,” i.e. literally “Association for Osteosynthesis”

CME

Continuing Medical Education

AOA

AO Austria (sec tion)

CMF

Craniomaxillofacial

AOA A

AO Alumni Association

CRIF

Clamp Rod Internal Fixator

AOCH

AO Switzerland (sec tion)

Computed tomography

AOCID

AO Clinical Investigation and Documentation

DCP

Dynamic Compression Plate

AOE

AO Spain (sec tion)

EBOS

Evidence-based or thopedic surger y

AOEA

AO East Asia (region)

ESIN

Elastic Stable Intramedullar y Nailing

AOEM

AO Executive Management

ETNS

Exper t Tibial Nail System

AOI

AO International

HTA

Health technolog y assessment

AOLAT

AO Latin America (region)

HTO

High tibia osteotomy

AONA

AO Nor th America (region)

Intramedullar y

AORF

AO Research Fund

LC-DCP

Low Contac t Dynamic Compression Plate

AOSI

AOSpine International

LCP

Locking Compression Plate (System)

AOSRN

AOSpine Research Net work

MIO

Minimal invasive osteosynthesis

AOSTK

AOSpine Technical Commission

MIS

Minimally invasive surger y

AOTK

AO Technical Commission

MoDAD

Modular Distal Aiming Device

AOUK

AO United Kingdom (sec tion)

NF T

Non-fusion technolog y

AOVA

Board of Direc tors (from the German “ Ver waltungsausschuss”)

OCO

Or thopedic Clinical Of ficer

ARI

AO Research Institute

ORIF

Open Reduc tion and Internal Fixation

BAB

AO Biotechnolog y Advisor y Board

ORP

Operating room personnel

CPP

Clinical Priorit y Program

PFNA

Proximal Femoral Nail Antirotation

CRC

Collaborative Research Center

PFxM

Principles in Frac ture Management

CSEG

Computer-Assisted Surger y Exper t Group, within the

PQM

Projec t and qualit y management

TK-Sys m

RCT

Randomized controlled trial

DAO

AO Germany (sec tion)

RIA

Reamer-Irrigator-Aspirator

Exper t Group, within the TK-System

RT W

Return to work

SAcC

Specialt y Academic Council

TPLO

Tibial Plateau Leveling Osteotomy

SEC

Socio Economic Commit tee

Tf T

Tips for Trainers (facult y development course)

Annual Report 2005

Addresses AO head office

Regions and sections

AO Foundation

AO Austria (AOA)

AO Latin America (AOLAT)

AO Switzerland (AOCH)

Clavadelerstrasse 8

President

CH-7270 Davos Platz

Prof. Dr. Michael Wagner

Dr. Fiesky A . Nun˜ez Vasquez

Prof. Dr. med. Roland P. Jakob

Switzerland

Head of the Depar tment of

Regional Direc tor

Clavadelerstrasse 8

Phone +41 81 414-2801

Traumatolog y

Luis Javier Parra

CH-7270 Davos Platz

Fax

Wilhelminenspital

Calle 134 No. 13-83 Of. 809

Switzerland

E-mail

Montlear tstrasse 37

Bogotá

Phone +41 81 414-2700

foundation @aofoundation.org

A-1160 Vienna

Colombia

Fax

Web

Austria

Phone +57 1 520 09 20

E-mail

Phone +43 149 150 -4301

E-mail aolat@ cable.net.co

claudio.gubser@aofoundation.org

Fax

Web

+41 81 414-2280

w w w.aofoundation.org

Alumni

+43 149 150 -4309

w w w.aolat.org AO UK (AOUK)

E-mail michael.wagner@ wienkav.at AO Alumni Association (AOAA)

+41 81 414-2284

AO North America (AONA)

President

Clavadelerstrasse 8

AO East Asia (AOEA)

President

Mr. John K. O‘Dowd, MD, FRCS

CH-7270 Davos Platz

President

Prof. John Howard Wilber

AOUK

Switzerland

Dr. G. On Tong

P.O. Box 1658

c/o AO International

Phone +41 81 414-2690

P.O. Box 53

West Chester, PA 19380

Marlborough House

Fax

Laksi

USA

York Business Park

E-mail alumni @aofoundation.org

Donmuang

Phone +1 610 344-2000

Nether Poppleton

Web

Bangkok 102 10

Fax

York, YO26 6RW

w w w.aofoundation.org /aoi/alumni

Thailand

E-mail ellisa @aona.org

E-mail aoea @access.inet.co.th

Web

Phone +44 1904 787767

AO Germany (DAO)

AO Spain (AOE)

E-mail aouki @aol.com

President

Web

Prof. Dr. Hans-Jörg Oestern

Víctor Manuel Alvarez Fernandez MD

Langenbeck-Virchow-Haus

Dept. of Or thopaedic Surger y &

Luisenstraße 58-59

Traumatolog y

D-10117 Berlin

Hospital de Jove

Phone +49 30 -28004420

Avda. Eduardo Castro

Fax

E-33290 Gijón

+41 81 414-2283

+1 610 344-2001 w w w.aona.org

Fax

+49 30 -28004429

E-mail unfallchirurgie. Web

+44 1904 787767 w w w.aouk.org

Phone +34 985 32 0308

sekretariat@akh-celle.de

Fax

w w w.ao-deutschland.de

E-mail

+34 985 31 5710

traumatologia @ hospitaldejove.com Web

w w w.aoes.org

Annual Report 2005

AO Foundation Clavadelerstrasse 8 CH-7270 Davos Platz Switzerland Phone Fax E-mail Web

+41 81 414-2801 +41 81 414-2280 foundation@aofoundation.org www.aofoundation.org

Concept and editing: AO Foundation, Communications, Davos, Switzerland Enzaim Communications AG, Zurich, Switzerland Layout: nougat Grafik und Illustration GmbH, Basel, Switzerland Print: Budag AG, Davos, Switzerland ÂŠ 4/2006 AO Foundation