AO Foundation Annual Report 2006 by AO Foundation

AO Foundation

Annual Report 2006 Making strategy happen

Our vision is excellence in the surgical management of trauma and disorders of the musculoskeletal system. 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.

Annual Report 2006

Table of contents

Strategy

Interview with the President and the Chairman AO on the move

3 6

Specialties

General Trauma: dedicated to research and innovation AOSpine: ready for take-off AO CMF: closing the gaps on the world map AO Vet: a committed advocate for animal patients ORP: building up momentum

9 10 11 12 13

Network

Trustees Meeting: where surgery meets art The AO world: growing closer together Regions and sections: a global buzz of activity AOAA: a growing international family SEC: a partner, not a donor

15 16 18 21 22

Key activities

Working together for the AO Mission Education: from missionary to global service provider Research: building fruitful collaborations AOSRN: refreshing the network Research funding: an investment in future patient beneďŹ t Development: adding the missing piece of information TK-System: pacesetter for innovative treatment concepts Clinical Investigation: reaching new dimensions

25 26 28 30 31 32 33 34

Governance

Finance: towards greater independence Governing bodies of the AO Foundation

37 38

Abbreviations Addresses

40 41

AO has become a focused, strategy driven organization.

Annual Report 2006

Strategy

Christian van der Werken

Markus Rauh

“We’re securing our future as an independent, nonproﬁt organization.” Interview with Christian van der Werken, President of the AO Foundation, and Markus Rauh, Chairman of the Board of Directors

Prof. van der Werken, you have just completed your ﬁrst six months as President of the AO Foundation. What was the most important topic on your agenda during that time?

That’s an easy one. It’s deﬁnitely the continuation of the four Clinical Priority Programs—or CPPs, as we call them—although I’ve also been involved in many other projects. The CPPs have clearly helped us focus our efforts and improve cooperation throughout the organization. Markus Rauh And that has also given us the courage to say no to certain other projects. So with the same amount of resources and people, we can accomplish a lot more in less time.

Christian van der Werken

What progress has been made in the CPPs?

We have made huge advances with the “Fracture Fixation in Osteoporotic Bone” program. The research has produced ﬁrst results, which will be presented at the Trustees Meeting in June in Beijing. I’m really looking forward to that, because I know the ﬁndings are very promising.

painful process. There was a lot of discussion back and forth. But in December 2006, the Academic Council finally approved the new proposal. So we’re now ready to move into execution. Rauh We learned a lot during this whole process. In the past, we were probably not critical enough of our own performance. We had to learn how to structure a project proposal and get it through a rigorous approval process. And we did. Van der Werken That’s absolutely right. We’ve also realized that you will never find definitive solutions to such complex problems. So we’ve shifted away from imposing rigid deadlines on these programs. Instead, we’re focusing on clear milestones and concrete outcomes.

Van der Werken

What about the CPP “Large Bone Defect Healing”?

This program was the ﬁrst to undergo the new, very strict peer review. I have to say it was a long, sometimes even Van der Werken

What is the status of the other two programs?

“Degeneration and Regeneration of the Intervertebral Disc” has produced some very interesting interim results, and AOSpine is currently renewing its network to continue this successful research. As for “Imaging and Planning of Surgery,” I have to admit we are still in the process of development. But we’re making good progress and I’m quite conﬁdent that this program will pass the peer review in 2007. Van der Werken

Apart from the CPPs, what are other highlights in AO‘s research activities?

The move into biotechnology is a huge trend! The Biotechnology Advisory Board has had a strong impact here; they’ve really become part of the AO family. This has helped to better integrate biotechnology into our research efforts, and build up competence in this ﬁeld. I think about 70 percent of all research currently under way is in some way related to biotech. Van der Werken

“The Clinical Priority Programs have helped us focus our efforts and improve cooperation.” Christian van der Werken

And what is happening in education?

We are putting a lot of effort into developing our AO faculty. Plus, we are working on a pre- and postcourse needs assessment system that will allow us to better understand the learning needs of participants, and the success of our training. All of this aims at keeping our teaching activities top-notch. Rauh Another important project is our plan to open comprehensive teaching centers for very advanced learning needs in Europe and North America. These centers will be coﬁnanced by the AO Foundation and a large personal donation from Hansjörg Wyss. We’re currently evaluating several concepts for these ﬂagship training centers. Van der Werken

Dr. Rauh, last year you mentioned a sustainable funding strategy as one of your priorities. What has been achieved so far?

A lot. In March 2006, we signed the socalled Asset Purchase Agreement regarding the transfer of patents and trademarks to Synthes. This contract has since been put into practice, which means there is a new financial flow that is no longer royalty-based. This is a crucial step toward securing our financial independence. In addition, we have come to an agreement with Synthes on the terms of the new cooperation agreement. Unfortunately, it could not be executed so far, because it’s still under review by the German Federal Cartel Office. The good news is that this delay, however, does not impact our operations or financing in any way. Rauh

Another key topic is preoperative planning. Of course, this has been done as long as surgery has existed. But now computer systems are replacing pencil and paper, and this dramatically affects what we are able to accomplish. The training tool we’re developing is making good progress. And we are also evaluating a system based on 3-D images for clinical use. Rauh

Last year, you launched the online Surgery Reference. How has this tool developed?

We have allocated additional resources to this project so that we can keep it moving at full speed. By the end of 2005, the database already covered about 30 percent of the human body. Today, it’s about 60 or 70 percent—a major achievement! And we have established clear responsibilities for editorship, to ensure tight quality control. Van der Werken

How is this new tool perceived by the users?

Extremely well. It won several prizes in the 2006 WebAwards competition, which is like an Oscar for online tools. As exciting as that is, what’s more important is that we’re currently getting more than 4,000 page views a day. We can see that surgeons all over the world are starting to use it—that we have created something very useful. Van der Werken

Regionalization was another important topic in 2006.

Very much so. Historically, we started out with our sections here in Europe. Then AO North America was born as the first region, and by now they have a highly efficient organization. Latin America and Asia Pacific are relatively young regions, which are catching up at an impressive pace. Van der Werken In 2006, we established a regional office in Latin America. We hired a full-time regional manager and are seeing a lot of activity there. And now we’re starting a comparable organization in Asia Pacific. Rauh

Annual Report 2006

Strategy

Will it be modeled after Latin America?

Not necessarily. We’ve learned that there’s no such thing as “one size fits all.” Each organization has to accommodate the specific needs of its particular region in terms of culture, language, and scientific background. The common thread is that there will be a highly professional AO organization in all regions. Rauh

So what is the status in Asia Paciﬁc?

The biggest news there is that we have set up a legal entity and an ofﬁce in Hong Kong. We also appointed a regional manager, who has been running the organization since January 1, 2007. I’m convinced he will substantially contribute to moving AO forward in this dynamic region. Van der Werken

What inﬂuence will this regionalization have on your headquarters in Davos?

We’re putting our best efforts into making the central organization more aligned and more professional. We have implemented a project and quality management tool that incorporates project-based reporting. It has been in use since January 2007. We have also taken steps to improve our communication, and established a professional HR department operating from Davos. Rauh

“There is no ‘one size fits all.’ Each organization has to accommodate the specific needs of its region.” Markus Rauh

I understand you are also working on a new membership scheme?

That’s right. We decided on the general concept in December 2006, and this year we’re moving toward implementation. One challenge is to ﬁnd a suitable IT tool to manage member administration globally. The basic idea is that we want to be able to follow up on all members from their ﬁrst contact with AO throughout their entire AO “career.” Van der Werken And that’s a dynamic process: You may start as a course participant, become Rauh

a fellow, and later a faculty member, and maybe end up as a board or commission member. At all stages, we want our members to get the right information at the right time, from the right source. And they should always get more than they “pay for”! What else will keep you busy in 2007?

I’m currently putting a lot of my time into preparations for the 50 th anniversary of the AO Foundation in 2008, a project which is both exciting and fun. But even more important is the introduction of our new foundation design. In the past, one of our main weaknesses has been that every AO organization looked completely different—it was pure chaos! What we need is one common look that unmistakably presents AO as one organization. Van der Werken

What is the current status of this project?

We had long, and sometimes rather emotional, discussions on the topic within the organization. But we ﬁnally agreed on a new brand hierarchy and design. The change is not revolutionary—the logo is still yellow and blue. But the important thing is for everybody to agree to it and start using it. The Annual Report 2006 will be the ﬁrst major publication in the new look. And the rest will follow step by step until the end of the year. Van der Werken

And what is on your agenda for 2007, Dr. Rauh?

My main concern is to ensure the independence of our organization. This means not only ﬁnding a viable solution for our future cooperation with Synthes, but also broadening our scope and establishing partnerships with other parties. That’s also important for our educational activities, to ensure that we maintain our CME) accreditation. Rauh

And in the long-term view?

As you see, we’ve made a lot of profound changes recently by establishing new structures such as the regions, the Specialty Academic Councils, and the CPPs. So, quite simply, my long-term objective is to make this new organization work and perform for the beneﬁt of the patient. That, after all, is our raison d’être. Rauh

AO on the move AO has undergone profound changes during the past three years. Not surprisingly, this has necessitated long, but ultimately fruitful discussions within the organization. In 2006, major headway was made in four strategic initiatives. Empowering the AO Regions Historically, AO acted like a centrally led missionary organization, spreading the AO principles around the world from Davos. North America was the ﬁrst region established outside Europe, and now constitutes the largest unit within AO. More recently, Latin America and Asia Paciﬁc also developed active AO communities. The growing expertise in, and maturity of, these regions has called for a new approach.

Focusing on clear clinical priorities In 2004, AO decided to focus its scientiﬁc activities on four Clinical Priority Programs (CPPs). All four made good progress in 2006: p

The “Fracture Fixation in Osteoporotic Bone” program is the most advanced. It has already produced promising interim results, which will be presented at the Trustees Meeting in June 2007.

Under the regionalization program started in 2004, AO is adapting its structures and empowering the AO Regions. Within the framework provided by the AO Foundation, they will be responsible for representing AO in the respective parts of the world and coordinating between the individual countries. Regional representation in important bodies such as the Board of Trustees or the Technical Commissions is also continually adjusted to better reﬂect AO’s global footprint.

“Large Bone Defect Healing” was the ﬁrst CPP to pass a new, very strict peer review process. Profound, time-consuming discussions were necessary to arrive at a commonly agreed redeﬁnition. In December 2006, the Academic Council approved the revised proposal, and this CPP is now ready for execution.

Research on the “Degeneration and Regeneration of the Intervertebral Disc” was started in 2002, producing valuable ﬁndings, and later transformed into a CPP. It was decided to renew the network of partners in 2006 after the existing contracts had expired. The new research network is currently being established.

Progress on the fourth CPP was deliberately slowed down to proﬁt from the experience gained with the new peer review process. In 2006, the program was deﬁned under the title “Imaging and Planning of Surgery.” Details are currently being elaborated before it will go into peer review in 2007.

Support offices with Regional Managers are being set up in all regions. North America has been operating a well-developed and efficient organization for many years. The organization in Latin America became operational in 2006. A milestone in the regionalization strategy was the integration of all Asian countries under one roof. The Region AO Trauma Asia Pacific was formally established in 2006, and the regional headquarters in Hong Kong will take up operations in 2007. The European regional office will remain in Davos. With all regions holding more responsibility, coordination and exchange between them has become a priority. A first Regional Manager Meeting took place in December 2006, and bilateral exchange is underway between AO Latin America and AO North America.

Originally limited to a ﬁve-year duration, the Clinical Priority Programs today focus on achieving clear milestones and continually producing visible results. Their introduction has generally led to stronger alignment and improved coordination within AO.

Annual Report 2006

Strategy

Aligning the core organization Greater responsibility of the regions calls for a lean and efﬁcient center. Efforts to align the AO central organization to this new role were continued in 2006 and expanded to new areas. A major step forward was the transformation of the former AO International (AOI) into AO Education (AOE). While traditionally also responsible for managing AO’s international network, AOE now focuses on providing support for top-quality medical education. In this new role, AOE acts as a service provider for local educational activities, and bears responsibility for ensuring quality and innovation in AO Courses.

1 AO is focusing its research

efforts on clearly deﬁned clinical priorities, such as osteoporosis. Fat staining allows the investigation of irrigated trabecular bone structure, which is the crucial element for standardized cement augmentation of osteoporotic bone. 2 The AO building in Davos

houses the worldwide headquarters and research center of the AO Foundation.

Clearer roles have also been assigned to the different locations of AO. While Davos will remain the organization’s headquarters and research center, the ofﬁce in Dübendorf is being expanded to accommodate more service-related functions such as publishing and media services. Regional ofﬁces will provide local support to AO surgeons within their own time zone and culture. Moreover, the central functions are increasingly professionalized. A project and quality management (PQM) system has been introduced, and became fully operational with the 2007 budget. To support the selection and development of the more than 200 AO employees, a professional human resources department has been established. New contracts with Synthes, Inc. have also made professional asset management necessary to ensure the long-term funding of AO activities. 7

Strengthening the positioning of AO In the past, it was often challenging to show that AO is a medically guided, nonproﬁt organization, and to avoid confusion with commercial partners. The new contracts with Synthes, Inc. enable AO to better present its status to the surgical community and beyond. An important stepping stone in this context is the renewed foundation design. Since 2004, AO representatives from various specialties and regions have been involved in this process. Not surprisingly, opinions on the desired outcome varied and discussions were long, controversial, and sometimes emotional. However, in 2006 consensus was achieved and the renewed foundation design approved. While giving AO a fresher, more modern look, the revised design clearly evolves from the old one. Thus it visibly connects AO’s rich past and successful future. However, this new look will only have an impact if applied consistently by all AO organizations around the globe—something which has proven difﬁcult in the past. To ensure consistent application of the new foundation design and to support local users, a web-based branding tool was procured and is currently being put into operation. In 2007, the new design will be gradually introduced to all AO publications and events. This rollout will complete with the Davos Courses in December, in time for AO’s 50 th anniversary in 2008.

The AO specialties are reorganized with one common goal: constantly improving patient care.

Annual Report 2006

Specialties

General Trauma: dedicated to research and innovation Guided by its new Specialty Academic Council, General Trauma continually seeks to promote innovative concepts for improved fracture treatment. It beneﬁts from the valuable expertise provided by an extensive network of external partners.

1 The preliminary results of a

clinical study indicate the superior performance of the PFNA over its predecessor. 2 The newly established SAcC

General Trauma (from left to right): David Helfet, Nikolaus Renner (Chairman), Mark Vrahas, Piet de Boer, Antonio Pace, Peter Messmer, José Batista Volpon, Tobias Hüttl. Not in the picture: Chris Moran, David Stephen.

Under the leadership of its new Chairman, Nikolaus Renner, the recently established Specialty Academic Council General Trauma (SAcC General Trauma) took up its scientiﬁc and academic work in 2006. Among others, the SAcC General Trauma reviewed two new modules for the AO Surgery Reference, a comprehensive online reference guiding surgeons through the surgical management process. In close collaboration with the AO Knowledge Portal team, it thereby helped ensure the persistent high quality of content.

been introduced a year earlier. With its unique spiral blade perfectly fitted to the bone, the PFNA achieves even greater rotational stability than the conventional proximal femoral nail (PFN). To investigate its benefits, AO Clinical Investigation and Documentation (AOCID) ran a comparative observational study including eleven international clinics and more than 300 patients. While the final results are not yet available, preliminary results indicate the superior performance of the PFNA over its predecessor.

Innovation in fracture treatment The SAcC General Trauma is also responsible for reviewing the Clinical Priority Programs (CPPs) related to this specialty. In 2006, the “Fracture Fixation in Osteoporotic Bone” program advanced well, producing highly promising intermediary results. These will be presented to the Trustees in June 2007. “Large Bone Defect Healing” was the ﬁrst program to undergo a new, very strict review. This time-consuming process led to some delay before the redeﬁned proposal was approved by the Academic Council in December 2006. Execution of this program is high on the agenda for 2007.

Building on external cooperation In all these endeavors, General Trauma is supported by its external partners. In the context of the CPP “Large Bone Defect Healing”, this network was further strengthened in 2006. While the scientiﬁc lead remains ﬁrmly with AO, the Collaborative Research Centers add valuable expertise to the program.

Clinical studies are used to evaluate the beneﬁts of new products. For instance, in 2006 a study was conducted on the proximal femoral nail antirotation (PFNA), which had 9

Good progress was also achieved with the classiﬁcation project run jointly with the Orthopaedic Trauma Association (OTA). The classiﬁcation of foot fractures developed by AO in 2006 is currently being validated. Collaboration with BrainLAB continued for the development of orthopedic trauma modules in computer-assisted surgery (CAS), but clinical breakthrough of this technology in trauma has yet to come.

AOSpine: ready for take-off AOSpine is on its way to becoming the ﬁrst truly international, academic spine society in the world. 2006 was a hallmark year with three major achievements: establishment of a central organization, expansion of the global spine network, and preparation of a new membership scheme to be launched in mid-2007. A milestone in 2006 was the creation of a legal entity for AOSpine International within the framework of the AO Foundation. Much more than a symbolic act or recognition of past achievements, this creates the prerequisite for building a global spine community under a single roof.

A global network under one roof Its new status enables AOSpine to establish other legal entities around the world. With 30 new country chapters founded in 2006, AOSpine now runs a network with a presence in 50 countries. Rather than being associated merely by name, they will all become part of a transparent legal structure. AOSpine has also established the infrastructure needed to manage its network at a regional level. Four Regional Boards are responsible for driving and coordinating activities within their respective geographic areas.

In addition, as a legal entity AOSpine can offer worldwide membership in a truly international academic spine organization. The number of members has grown rapidly in recent years, reaching a record high of almost 7,000 in 2006. Currently free of charge, membership will become subscription-based with the launch of the new AOSpine membership scheme in mid-2007. This is expected to lead to a healthy, strategically desirable downsizing to about 3,000 committed members.

Creating strong leadership In 2006, major steps were also accomplished in creating a strong, central spine organization. Among them was the restructuring of the AOSpine International Board (AOSI), which was expanded to provide the necessary resources for its strategic responsibilities. Two important new positions were created: Kenneth Cheung took over as Research Executive, with a responsibility to coordinate basic and applied research; Michael Grevitt is managing the reputation of AOSpine as the new Marketing Executive. Record figures in education In addition to strengthening its structure, AOSpine is pushing ahead with seminal research on the degeneration and regeneration of the intervertebral disc (see page 30). The educational offering was also stepped up in 2006. The Davos Courses included five dedicated spine courses, which attracted close to 300 participants, almost doubling the previous year’s attendance. This huge interest and the positive feedback received—also reflected in other events around the world— illustrate the high relevance of these courses to spine care professionals.

Membership pays off Subscribing members proﬁt from a large range of beneﬁts and value-added services, including: p discounts on selected AOSpine Courses

and products;

AOSpine membership development

p webcasts of lectures, practicals, and live

surgeries during AOSpine Courses;

7,000

p full-text online access to selected spine

6,000

journals (OVID);

5,000

North America Middle East Latin America Europe Asia Paciﬁc Africa

p access to Evidence-Based Spine Surgery

(EBSS), a review of key literature;

4,000

p free subscription to InSpine, AOSpine’s

3,000

international magazine;

2,000

p access to AOSpine member lounges at

major spine congresses;

1,000 0

p and, of course, being part of the world’s 2004

2005

2006

2007

largest spine community.

Annual Report 2006

Specialties

AO CMF: closing the gaps on the world map 2006 was a year of reorganization for AO Craniomaxillofacial (AO CMF). With new structures and guidelines, AO CMF is ready to further strengthen its global network and push ahead with a Clinical Priority Program focusing on imaging and planning of facial reconstruction. The new CMF Specialty Board was put into operation in 2006. In addition to providing academic and scientific guidance, it fulfills a range of governance tasks for the specialty. In parallel, a CMF Research and Development Committee was established with a mandate to coordinate between all AO CMF entities involved in research and development. These clearly defined structures, as codified in the recently approved CMF Specialty Guidelines, have led to improved communication and collaboration within this specialty, as well as with other parts of AO.

Filling the “blank spots” AO CMF also took a major step forward in strengthening its regional structures. The CMF East Asia Board, founded in 2005 and renamed CMF Asia Board when China joined in 2006, started a number of initiatives in the region. A major highlight was the opening of a CMF fellowship center at the University of Hong Kong.

Page 10 1 Building the global AOSpine

community: Luiz Vialle at the AOSpine Latin America Strategic Meeting in Recife, Brazil, in September 2006. 2 Teaching effective spine

strategies: one of ﬁve dedicated spine courses in Davos, in December 2006. Page 11 3 Participants during a

CMF workshop at the Davos Courses 2006. 4 The newly launched specialty

website will help strengthen the CMF community.

In 2007, AO CMF will continue its efforts to close the remaining geographic gaps. In March 2007, a meeting took place in Dubai laying the cornerstone for a CMF Middle East Board. AO CMF will also move into India with a 2.5day CMF Principles Course, preceding the International Conference on Oral and Maxillofacial Surgery (ICOMS) in Bangalore. Strengthening the CMF community 2006 saw the foundation of the CMF Membership Association, which is to become a new backbone of the global CMF community. Although associated with the AO Alumni Association, its members will beneﬁt from additional CMF features, such as a free subscription to the “Journal of Craniomaxillofacial Trauma.” With a new editorial board and new guidelines established in 2006, this magazine will be launched in 2007. 11

Another community-building platform is the CMF website, which went online in late 2006. It includes a privileged area where CMF faculty can access dedicated content such as faculty support packages. Two Faculty Development Forums held in Europe and the USA provided additional opportunity for further improvements in CMF education. CPP defined with focus on CMF AO CMF also worked on the details of the Clinical Priority Program (CPP) initiated in 2005. The pace was deliberately slowed in order to profit from the experience gained in the review process of the “Large Bone Defect Healing” program. The new CPP “Imaging and Planning of Surgery” has now been defined and will move into peer review in 2007. While ultimately benefiting all AO specialties, it will initially focus on the anatomical reconstruction of hard and soft tissues in the facial area.

AO Vet: a committed advocate for animal patients In 2006, the AO Veterinary Specialty (AO Vet) continued to strive for better care of animal patients with a growing number of specialized products and courses. Veterinary expertise is also increasingly sought after by AO researchers working with animal models. In 2006, AO Vet underwent a number of organizational changes. Don Hulse took over as Chairman from Rico Vannini, who had led the specialty group for two years. New guidelines for the specialty were developed, and approved in December 2006. Based on these, the Specialty Academic Council AO Vet (SAcC AO Vet) will take up operations in 2007. Deﬁning clear roles and responsibilities has also helped AO Vet establish a stronger standing within the AO family.

1 A total of 15 dedicated vet

courses were held in 2006. Here, an arthroscopic observation during an equine course in Davos. 2 Preoperative planning at

a canine course in Davos, in December 2006. 3 Faculty members of the

ﬁrst AO Vet Course in Latin America.

Setting standards for animal models Building on its improved visibility, AO Vet is adopting an advisory role for other AO units. Researchers show an increasing interest in veterinarians’ expertise regarding methodological and ethical questions involved in animal models. A workshop on “Experimental Animal Models in Musculoskeletal Research” in early 2006 has kick-started this development. The consensus resulting from this workshop was summarized in a paper titled “Reﬁning animal models in fracture research: seeking consensus for optimization of both welfare and scientiﬁc validity for appropriate biomedical use”. This paper is currently in peer 12

review and will be published in 2007. The vision of AO Vet is to define stringent standards for effective and morally acceptable animal models. While opinions on the ethical dimension often differ between researchers and veterinarians, both sides are eager to continue this important dialogue. For this purpose, a joint congress is planned for 2007. Expanded teaching and product offering In 2006, AO Vet expanded its teaching activities with 15 courses held throughout the year. Two workshops on the use of locking compression plates (LCP) in animals were especially popular. AO Vet also continued the successful format of student courses in Europe and the USA. These courses allow university students to benefit from AO knowhow while giving AO Vet access to talented future surgeons. An important step in the geographic expansion was the Small Animal Course in Santiago de Chile—the first course held in Latin America. It was fully booked three months in advance. Due to the overwhelming interest, further courses have been scheduled for 2007 in Colombia and 2008 in Argentina. Progress was also achieved in AO Vet’s endeavor to create high-quality implants specifically for animal patients. Three differently sized tibial plateau leveling osteotomy (TPLO) plates were introduced, designed for the management of cruciate ligament ruptures in dogs. The limited contact dynamic compression plate (LC-DCP) family has grown with the approval of an LC-DCP 3.5 for dogs and an LC-DCP 5.5 for horses. The trend, however goes undoubtedly towards the locking plates.

Annual Report 2006

Specialties

ORP: building up momentum With an extended team, AO has stepped up its service offering for operating room personnel (ORP). Faculty training was high on the agenda in 2006, with two Educators’ Seminars held in Switzerland and Thailand. Thanks to increased resources, the ORP team in Davos was able to provide stronger support and guidance to ORP around the world. A range of new educational materials was produced, and speciﬁc content was added to the AO Knowledge Portal, making this a valuable tool for community building. Davos-based ORP team members also increased their international presence by participating in 30 events throughout the year.

1 Lively discussions characte-

rized the Educators’ Seminar in Chiang Mai, Thailand. 2 The “three-color system”

helps get the course participants even more involved. 3 The Educators’ Seminar in

Davos attracted 21 participants from 18 countries.

Highly interactive faculty training While surgeons will always remain important contributors, ORP courses increasingly rely on a dedicated ORP faculty. Consequently, faculty development was high on the agenda in 2006. For the ﬁrst time, ORP from Belgium, France, and Malawi participated in the courses. A number of qualitative changes were introduced with the aim to enhance the level of interactivity. An important novelty in this respect is the use of a “three-color system”— a simple but highly effective audience response system (ARS) using green, yellow, and red cards. One of the main highlights in 2006 was the Educators’ Seminar in Davos in December. During the six-day course, the 21 participants from 18 countries gained ample knowhow allowing them to develop and manage their own ORP courses. Using a highly inter13

active format, the program covered both technical and didactical topics as well as an introduction to the AO Foundation. The course received enthusiastic feedback. Participants especially appreciated the opportunity to work with ORP colleagues from around the world and learn from their diverse experience. Earlier in the year, a similar course in Chiang Mai, Thailand, attracted more than 20 participants from ﬁve Asian countries. The seminar stood out for its lively interaction. The positive reactions from the participants give reason to believe that this event will help foster a strong ORP Alumni network in Asia. Unlike the AO Alumni Chapters for surgeons, ORP Alumni are recruited exclusively from faculty. Vivid exchange with surgeons In spring 2006, twelve ORP Alumni participated in the D-A-CH Meeting, which was organized jointly by the AO Alumni Chapters of Germany, Austria, and Switzerland. In addition to a dedicated ORP program, they also attended parts of the regular program for AO surgeons. The meeting thus provided an excellent platform not only for exchange among ORP from different countries but also for interaction with surgeons. This close cooperation will continue as ORP Alumni join the German Alumni Meeting in 2007. It illustrates the mutual respect that exists between AO surgeons and ORP, and the great potential for learning from each other.

AO is expanding its global network of surgeons, operating room personnel, and researchers.

Network

Annual Report 2006

Trustees Meeting: where surgery meets art In June 2006, 144 Trustees and ex-ofﬁcio Trustees gathered in Bern, Switzerland, for their 22 nd annual meeting. The busy program took the participants from the latest scientiﬁc developments, including stem cell research, to major highlights of art and architecture.

Zentrum Paul Klee Paul Klee (1879–1940) ranks as one of the leading artists of the 20 th century. Home to some 40% of his oeuvre of 10,000 paintings, watercolors, and drawings, the Zentrum Paul Klee in Bern, Switzerland, houses the largest collection of a single artist in the world. Inaugurated in 2005 and accommodated in a stunning building by Italian star architect Renzo Piano, it aims to become the leading center of competence for Paul Klee’s work and life. AO founding member Maurice E. Müller was the driving force behind this ambitious project, and a main donor.

1 A visit to the Zentrum

Paul Klee marked the cultural highlight of the 2006 Trustees Meeting. 2/3 Standing ovations were

given for the inspiring speech by AO founding member Maurice E. Müller.

As the leading decision-making body of the AO Foundation, the Board of Trustees meets annually to share information and vote on strategic issues and top-level appointments. The 22 nd Trustees Meeting took place in Bern, Switzerland, from June 15 to 18, 2006. A special honor was the presence of AO founding members Martin Allgöwer and Maurice E. Müller, whose inspiring dinner speech was enthusiastically received by the audience. Part of the event was held at the Zentrum Paul Klee, a renowned cultural center that is strongly supported by Maurice E. Müller (see box). Strategy and science The meeting was chaired by James Kellam, President of the AO Foundation, who handed over his presidency to Christian van der Werken at the end of the event. In his inaugural speech, Christian van der Werken highlighted the achievements of his predecessor, who had critically evaluated AO’s situation and initiated several decisive strategic programs. The new President committed himself to reinforcing this strategic thrust with an emphasis on deﬁning AO’s future role, expanding the organization’s network, and further enhancing its reputation. A highlight of the scientiﬁc part of the program was the Stem Cell Symposium. Leading 15

internal and external experts provided an update on the possibilities and limitations of stem cell research, including a discussion of ethical issues. Overall, the symposium underlined the huge potential of this young ﬁeld of research while also showing that a breakthrough may still be 20 years away. Networking and motivation Networking with colleagues from all regions and specialties was also an important aspect of the Trustees Meeting. The ongoing Soccer World Cup provided additional opportunities for community building. The social program also included a presentation on “the winds of change” by Swiss scientist and adventurer Bertrand Piccard, who was the ﬁrst man to circle the world in a balloon. His thought-provoking speech on the famous “Orbiter 3” journey left the audience inspired to strive for their own personal goals—and the mission of AO.

North America Alumni /Country Chapter North America

The AO world: growing closer together With its six regions, 63 Alumni and country chapters, and development projects in 15 countries, AO has established a truly global network. Currently, a new organizational structure is being implemented. It aims to more tightly align all units in their common goal of achieving better patient care around the world. In the nearly 50 years since its foundation, AO has grown from an initially Swiss and later European organization to a global network spanning ﬁve continents. This development has called for an adjustment of AO’s organizational structure. 2005 saw the approval of a new organization by the Board of Directors while in 2006, major steps were accomplished in implementing this new structure. An important aim of this reorganization is to achieve adequate regional representation in AO’s main bodies, including the Board of Trustees and the Technical Commissions. In 2004, most members of the TK-System were from Europe and the USA. By the end of 2006, members from Latin America and Asia Paciﬁc represented almost one-fourth of the TK-System.

Another major thrust is empowering the AO Regions, and giving them full responsibility for representing AO in the respective parts of the world. To steer and facilitate regional activities, support offices with Regional Managers are currently being set up. In 2006, the Latin America office became operational, and an office was formally established in Asia Pacific.

Latin America Alumni/Country Chapters Argentina Bolivia Brazil Chile Colombia Costa Rica Ecuador Guatemala Honduras Mexico Peru Paraguay Puerto Rico Uruguay Venezuela

Annual Report 2006

Network

Europe Sections

Alumni /Country Chapters

AO Austria AO Germany AO Spain AO Switzerland AO UK

Austria Belgium Bulgaria Czech Republic Estonia France Germany Hungary Ireland

Israel Italy Latvia Lithuania Netherlands Norway Poland Portugal Romania

Russia Spain Slovakia Slovenia Sweden Switzerland Turkey UK

Asia PaciďŹ c Alumni/Country Chapters Australia China Hong Kong India Japan Malaysia New Zealand Singapore South Korea Sri Lanka Taiwan Thailand

Middle East Alumni/Country Chapters Egypt Iran Jordan Kuwait Lebanon Libya Saudi Arabia United Arab Emirates

SEC activities Through its Socio Economic Committee (SEC), AO together with local partners runs a number of development projects in the following countries:

Africa Alumni /Country Chapter South Africa

Latin America

Africa

Asia PaciďŹ c

Brazil

Ghana Eritrea Ethiopia Kenya Malawi Uganda Zambia Zimbabwe

Indonesia (Bali) Philippines Solomon Islands Fiji India Papua New Guinea

AONA is also a leading example of how to manage CME accreditation.

Regions and sections: a global buzz of activity A broad range of high-level educational events and networking activities in 2006 illustrate the continuous drive of the AO Sections and Regions around the world. In the wake of the ongoing regionalization initiative, the latter are gaining new possibilities to sustain their dynamic growth. In accordance with AO‘s regionalization strategy, the AO Regions are gaining more power and responsibilities. New infrastructure and enhanced resources enable them to support the AO Mission more actively, not only in terms of education but also research. Record numbers in North America AO North America (AONA) constitutes the largest region. In 2006, AONA proved its innovative drive with the launch of a new fellowship program. Eight high-ranking institutions were selected to receive funding for one long-term fellowship a year each. To support integration into the AO community, the fellows and their mentors will be invited to an AO Fellows Conference which will be held annually starting 2007. Teaching activities reached a peak in 2006 with over 4,000 participants in 50 courses. However, AONA’s main concern is to ensure and continually enhance the quality of teaching. Both AOSpine and AO CMF held a Faculty Development Forum to further develop and improve their educational offering. With its CME Advisory Board and newly established Conﬂict Resolution Subcommittee, 18

A newly launched educational offer is the AO Geriatric Fracture Course held in fall 2006. In addition to its focus on the treatment of osteoporotic bone, this three-day course provided a holistic view of the care of elderly patients. Due to its success, this concept will not only be continued in the USA but also exported to Europe. AONA also started an ongoing exchange with AOLAT aiming to explore joint interests and synergies. A first top-level meeting in late 2006 set a promising start to this crosscontinental cooperation. Latin America with new management In 2006, AO Latin America (AOLAT) made major progress in establishing a strong and active AO Region. The new regional structure was put into operation with the approval of the relevant guidelines and the appointment of Luis Javier Parra as Regional Manager. He assumed various managerial responsibilities allowing the AOLAT boards to focus on the strategic development of the region. Course activities in the region remained stable at a high level. A first AO Principles Course in El Salvador and a workshop in the Dominican Republic marked further steps in the strategy of expanding AO’s presence in Central America and moving into the Caribbean. Another important event was the first ever AOLAT Veterinary Course held in Chile, to be followed by a course in Colombia in 2007. A cross-specialty Tips for Trainers Course underscored the region’s dedication to faculty development. The short-term fellowship program in Ribeirão Preto, Brazil, which has been successfully run for several years with the support of the Socio Economic Committee, is being extended across the region. A second hub was opened in São Paulo, Brazil, with Guadalajara, Mexico, to follow in 2007.

Annual Report 2006

Network

Asia Pacific under one roof In 2006, Asia Pacific implemented a new regional organization. In November, the Trustees of AO China decided to join AO East Asia, bringing the most populous country into the region. After Australia and New Zealand followed in December 2006, the organization was renamed AO Trauma Asia Pacific (AOTAP). With India accepting the invitation to join in early 2007, Asia Pacific is now integrated under one roof. To support the development of this young and dynamic region, a regional office is being set up in Hong Kong under newly appointed Regional Manager Urs Mattes.

1 With 50 courses offered in

2006, AONA reached out to some 4,000 surgeons. Here, preparations for a live telecast surgery in the Mammoth Lakes Hospital. 2 Practical exercises at the

Marco Island Hand & Wrist Course in June 2006. 3 Global exchange: Luis Javier

Parra, Regional Manager AOLAT, with Urs Mattes, newly appointed Regional Manager AOTAP. 4 Live surgery at the ﬁrst

Regional Combined Course in Chiang Mai, Thailand.

Educational activities were expanded in 2006, both in terms of content and geography. April 2006 saw the ﬁrst ever AO Course in Vietnam, as well as the ﬁrst Regional Combined Course in Thailand. The latter included four parallel courses, attracting some 300 surgeons and operating room personnel (ORP). A Tips for Trainers Course preceded the program, thus allowing faculty to apply their learning without delay. The work of Asian surgeons found special recognition in 2006 with Theerachai Apivatthakakul from Thailand receiving the Hardi Weber Award for his contributions to the new AO teaching package on minimally invasive osteosynthesis.

News from the European sections: specialties established in Austria AO Austria (AOA) continued its close cooperation with the national Alumni Chapter in 2006, recruiting most of its faculty among Alumni. Representation of the specialties was also strengthened with the foundation of spine and CMF groups in Austria. The two Anatomical Specimen Courses held for the first time as official AO Courses constituted a highlight in educational activities. Both events—one held in German and one in English—were fully booked, attracting a total of 180 participants. Besides a Principles Course for Trauma, the full-week program included special courses such as pelvis, foot, and pediatrics. At the Annual Meeting 2006, Röbi Frigg, CTO of Synthes, Inc., received honorary membership in recognition of his special contribution to the work of AO Austria. Germany increases research support Membership in AO Germany (DAO) showed a solid upward trend in 2006, which is expected to continue in 2007. The newly established national branch office in Berlin commenced its work, and the German Research Fund took up operations. Three biomechanics projects have been supported so far; a forth one has recently been accepted. Among the 49 courses held in 2006, the pelvic course in Homburg and the foot course in Dresden stood out with their combination of high-level talks and practical exercises. Another highlight was the D-A-CH Meeting in

5 During the 2006 general

meeting of AO Germany, ten new members were admitted, bringing total membership to over 250.

Ulm organized jointly by the Alumni Chapters of Germany, Austria, and Switzerland. Attracting some 80 surgeons and 12 ORP, the event received enthusiastic feedback from the participants. First Masters Course in Spain AO Spain (AOES) in 2006 strongly increased its teaching activities, reaching out to 747 participants in 13 courses. A highlight was the ﬁrst AO Masters Course held in Spain. 40 experienced surgeons gathered in Toledo in September to gain expert know-how on osteosynthesis. Participants appreciated the interactive course format, including the use of an audience response system and controversial debates. AOES also stepped up its offers for ORP with two fully booked courses. 2007 will see the ﬁrst Tips for Trainers Course on the Iberian Peninsula, held in Spanish. The close cooperation with the Spanish Alumni Chapter was successfully continued during 2006. Alumni once again represented the majority of faculty, with three new members recruited from the Alumni Chapter.

1 The ﬁrst AO Masters Course

in Spain attracted 40 experienced surgeons. 2 The Swiss Residents Course

is a backbone of the AOCH community.

Community-building in Switzerland The most important educational event of AO Switzerland (AOCH) was the traditional Swiss Residents Course in Davos in December 2006. This multilingual event builds the backbone of AOCH community development, bringing together residents and experienced surgeons for a week of intense interaction. It also provides an excellent platform for younger surgeons to start their career as AO faculty. Due to the strong demand, this course will be run annually as of 2007. 20

During the annual meeting of AOCH in Bern, a symposium on pediatric fractures took place. The “hints and tricks” session was particularly well received as a platform for sharing experience and ideas. A special honor was the presence of AO founders Maurice E. Müller and Martin Allgöwer, as well as longstanding AOCH executive member Hansbeat Burch. UK pushes for innovation In 2006, AOUK again proved to be innovative in education. For instance, the Current Concept Course was introduced, speciﬁcally targeting surgeons and ORP in their midcareer. The small learning groups and balanced content mix were highly appreciated. The Spine Forum, now in its third year, attracted some 20 senior residents and fellows. AOUK also launched a Faculty Fellowship Program providing senior UK surgeons the opportunity to participate in a three- to ﬁveday, peer-to-peer visiting fellowship. A highlight of the AOUK Annual General Meeting was the thought-provoking speech on latest trends in the healthcare sector held by special guest Max Aebi, who also awarded the AOUK Research Prize to Amit Bidwai from the King George Hospital in Ilford.

Annual Report 2006

Network

AOAA: a growing international family More and more surgeons and operating room personnel are joining the AO Alumni Association (AOAA) to foster both professional and personal relationships. In 2006, the three-country meeting in Ulm, Germany, was a perfect occasion to experience the “AO spirit.” For surgeons and operating room personnel (ORP), the AO Alumni Association (AOAA) is an ideal platform for personal development and professional exchange. To many, it has also become a way of building and maintaining friendships with peers around the world.

Healthy growth and expansion By the end of 2006, the AOAA comprised 3,705 members from 94 countries. This represents an increase of 10% over the previous year—a healthy and pleasant growth. Rather than merely adding numbers, the AOAA aims for quality growth, seeking committed members who are able and keen to actively contribute to the various Alumni activities.

trated how much they appreciated the combination of professional and personal interaction. A busy year ahead The year 2007 will feature a busy agenda for AO Alumni, especially in Asia. June 2007 will see three parallel specialty symposia in Shanghai, China, following the Trustees Meeting in Beijing. In October, the 2 nd Asian Alumni Chapter Symposium will take place on Jeju Island, South Korea. Of course, Alumni in other parts of the world will also continue their networking with a range of activities and events.

Alumni beneﬁts

Over the past year, the AOAA has also expanded its geographic reach. Three new Alumni Chapters were established in Libya, New Zealand, and Poland. The latter grew out of an informal group initiated several years ago by AO Honorary Trustee Joseph Schatzker. With a total of 51 Alumni Chapters, the AOAA today runs a globe-spanning network. Alumni meeting—three in one Within this network, the German-speaking region has traditionally been very strong. A highlight on the 2006 agenda was the D-A-CH Meeting, which is organized every three years by the Alumni Chapters of Germany, Austria, and Switzerland.

1 Strong friendships: Alumni

from around the world at the Alumni Meeting in Davos. 2/3 With the world’s highest

church tower, Ulm provided a suitable backdrop to the highly successful D-A-CH Meeting.

The 2006 event, which took place in Ulm, Germany, attracted over 80 surgeons and 12 operating room personnel, who joined for a dedicated ORP program. The surgeons’ program focused on two issues: treatment of early infection after osteosynthesis, and fracture care in children. Of course, there was also ample time for social activities, including a chance to climb the world’s highest church tower. Feedback from the participants illus21

AO Alumni proﬁt from a wide range of beneﬁts, including: p newsletters with regular information about

AO and AOAA activities; p access to closed-user-group pages on the

AO Knowledge Portal; p a personal AO Alumni e-mail address; p regular receipt of AO publications including

the AO Injury Supplement, the Orthopedic Trauma Directions, AO Dialogue, and the AO Annual Report; p special discounts on other AO publications and teaching videos; p access to AOAA Symposia; p access to AOAA meetings held during major international conventions. Membership is open to AO Faculty, AO Fellows, AO Advanced Course participants, as well as surgeons involved in the worldwide AO activities.

SEC: a partner, not a donor In 2006, the Socio Economic Committee (SEC) continued to provide a range of training opportunities for surgeons and operating room personnel in developing countries. Key to sustainable improvement is gaining local commitment and ensuring that know-how stays in the target countries. Through its Socio Economic Committee (SEC), AO supports professional trauma care in the developing world. Rather than merely donating money or material, it aims to actively contribute to the establishment of self-sufficient and sustainable healthcare systems. In this endeavor, SEC follows a long-term, pragmatic approach. All care providers in the respective countries—from nurses to professors—are treated as equal partners of AO. Based on their needs, a reciprocal partnership is developed and usually defined in a contract. Thus AO does not act as a benevolent donor but as a reliable partner who provides help in return for the contributions made by local parties. Effectively stopping the brain drain Fellowships have proven an efficient way to build up surgical competence in lesser developed regions. However, the key to AO’s commitment is to ensure that the know-how gained will remain in the target country. A great success in this respect has been the one-year fellowship offered jointly with the East, Central, and Southern African Orthopaedic Association (ECSAOA). Every year, this program provides four African surgeons the possibility to undergo advanced training 22

in South Africa completed with a diploma. As stipulated in their contract, all candidates so far returned to their home base after concluding the program to continue operating and teaching there for a minimum of two years. Ideally, surgeons do not have to leave their country to receive training. A good example is the short fellowship run in Brazil, which is now being extended to other countries of Latin America and beyond (see box page 23). Joining forces with nongovernmental organizations SEC also supports training of orthopedic surgeons. So far, two sponsorships have been granted at the Lusaka University Medical School, Zambia, and one at the Cure Hospital and Medical School, Malawi. The latter is run by Cure International, a nongovernmental organization (NGO) dedicated to healing children with crippling orthopedic conditions. It operates its own, well-equipped hospitals in eight developing countries. Due to this good experience and the complementary aims of both organizations, the cooperation with Cure International was expanded in 2006. It now includes two new sponsorships in Kenya and Uganda, where candidates receive full-ﬂedged surgical training at the respective Cure hospitals, including a number of AO Courses. Their education will be funded by AO subject to two conditions: ﬁrstly, that the participant remain in his or her home country for at least four years; and secondly, that he or she become an AO faculty member, thereby acting as a multiplier within the region.

Annual Report 2006

Network

Fighting for local buy-in Still in evolution is the SEC Reverse Fellowship Program, currently run in Malawi, Eritrea, Ethiopia, and Ghana. Under this program, an experienced surgeon is placed in a target community for several weeks, training local surgeons and operating room personnel (ORP). The success of his or her work, of course, depends heavily on the buyin of local partners. At the beginning of 2006, the SEC analyzed the outcome of these programs. While the local organizers in Malawi have truly taken ownership of the program, driving it forward with enthusiasm and pride, this kind of dedication still needs to develop in other target countries. Based on these ﬁndings, a new contract was drafted which aims to foster local commitment.

1/2 The Beit Trust Cure

International Childrens’ Hospital in Zambia offers professional care for children with orthopedic conditions. 3/4 Nonoperative treatment

is a main focus of SEC courses in Africa, like here in Ghana. 5/6 One of the poorest

countries in the world, Malawi, beneﬁts from targeted SEC activities.

Education focused on nonoperative care SEC also supports African surgeons who wish to enroll in the AO Principles Course run twice a year in South Africa. However, most developing countries lack the facilities necessary for operative fracture treatment— a notion which was again confirmed by the feedback on the first AO Principles Course organized in Cameroon in 2006. Therefore, SEC has intensified its teaching activities focusing on nonoperative treatment. The course specifically developed for this purpose was held successfully in four African countries in 2006, reaching a total of over 150 participants. Nonmedically qualified care providers are encouraged to attend, since they are the ones that actually treat 23

fractures. Special material is created to support such nonoperative courses. A DVD on plaster techniques was published in 2006, and another one on closed reduction techniques is planned for 2007. While courses in Africa have traditionally relied heavily on foreign teachers, AO aims to build up local faculty. In 2006, a Tips for Trainers Course was organized in South Africa—a premiere on this continent. Another important milestone was the ORP Course in Zambia in March 2007, the ﬁrst to completely rely on local faculty.

Training concept, made in Brazil In Brazil, a large number of surgeons operate in rural areas too remote to allow regular medical training. To help them stay up to date, SEC runs a short fellowship at the Universidade de São Paulo in Ribeirão Preto. Fellows participate in a four-week intensive refresher course, and stay in close contact with their mentors afterwards. An AO Principles Course is organized every other year speciﬁcally for former fellows. The program proved a great success, turning out a total of 91 enthusiastic fellows since its launch in 2000. To expand this highly effective concept, a second hub was opened last year in São Paulo, Brazil. In 2007, the concept will be extended to Mexico, and a similar program for India is currently in the making.

AO has established clear priorities for all its key activities.

Annual Report 2006

Key activities

Working together for the AO Mission A number of institutes and organizational units represent the core of AO’s key activities in education, research, development, and clinical investigation. In constant and close collaboration, they strive to spread surgical excellence and achieve improved patient care. The following pages provide an overview of major activities and developments in 2006. AO Education (AOE) AOE disseminates the AO principles and philosophy of fracture management to the worldwide surgical community. Besides organizing and supporting a broad range of high-level courses for surgeons and operating room personnel, AOE publishes scientific literature and provides state-of-the-art didactical materials. AO Research Institute (ARI) ARI is a leading center of scientific inquiry on trauma and diseases of the musculoskeletal system. Its 70 staff members conduct highquality research in this field, investigate the performance of surgical procedures, devices and substances, and render contract research services within AO and for external parties. Biotechnology Advisory Board (BAB) BAB is an independent group of research experts with an important mandate to support AO research. It monitors scientific developments in biotechnology, pinpointing those areas most relevant to AO’s current clinical priorities, and conducts its own international research funding program. AOSpine Research Network (AOSRN) In 2002, AOSpine established an open network of institutions around the world to exploit synergies and pursue common scientific goals in research related to the intervertebral disc. The AOSRN raises its profile through organizing scientific conferences and initiating high-impact publications. AO Research Fund (AORF) The AORF supports scientific research on trauma and disorders of the musculoskeletal system and related fields. Grants are awarded to basic science projects relevant to AO and to studies on general trauma, spine, craniomaxillofacial, and veterinary surgery.

AO Development Institute (ADI) ADI occupies a valuable niche between laboratory research and product development. Relying on the input of surgeons and in close cooperation with the other AO institutes, it develops innovative concepts that combine hardware, biological materials, and new technologies. TK-System The TK-System is responsible for the clinical testing and approval of new operation techniques, implants, and instruments, as well as creating related educational material. It comprises some 120 of the world’s leading surgeons, organized in three Technical Commissions and a number of Expert Groups. AO Clinical Investigation and Documentation (AOCID) AOCID conducts sophisticated patient studies, guided by the principles of evidencebased medicine, to gather additional safety and efﬁcacy data for approved products. Its unparalleled experience in the ﬁeld of orthopedic medicine is appreciated by AO as well as external customers.

Education: from missionary to global service provider Under a new name and with a reinforced leadership, AO International (AOI) has been transformed into a global educational service and competence center. Today’s AO Education (AOE) continues to provide ﬁrst-class medical training, building on common processes and the highest quality standards.

Traditionally, AO International (AOI) had performed a dual task: Besides bearing responsibility for AO’s educational activities, it played the role of AO ambassador to the world. With the latter function increasingly concentrating in the hands of the President of the AO Foundation, AOI became free to focus on its core competence: providing advanced medical education to surgeons and operating room personnel (ORP).

1/2 Nearly 20,000 surgeons

worldwide attended an AO Course in 2006. Here, the 2006 Davos Courses. 3 The new pre- and post-

course needs assessment helps faculty tailor courses to participants’ needs. 4 Fresh from the press:

the second edition of the “AO Principles of Fracture Management” book. 5 Andy Weymann, Reto Babst,

and Theerachai Apivatthakakul (from left to right), winners of the Hardi Weber Prize 2006.

for local education, which entails much more than providing infrastructure and course material. AOE is the main innovator and driving force behind AO’s educational activities, in terms of both content and tools.

Education going local In addition, the varying demands and growing maturity of the regions called for a different approach to education. Rather than being centrally planned and staffed, the courses are increasingly organized and taught by local specialists. This approach allows tailoring of the courses towards speciﬁc local needs and provides new possibilities to regional faculty members, who assumed their new role with great enthusiasm.

Focus on participants’ needs and knowledge Moreover, AOE provides standardized processes, such as the new pre- and postcourse needs assessment. The core of this process is an online questionnaire consisting of two parts. The “perceived needs” of a participant are captured through a self-assessment of the relevant competencies. A subsequent test of the related know-how shows the “actual needs” of the participant. Before an AO Course, the aggregated results allow faculty to understand the motivation and learning needs of the group and to plan the course content accordingly. Afterwards, they help to analyze the success of the course.

To handle the growing range of responsibilities, the management of AO Education (AOE) was expanded to include Director Piet de Boer and Vice-Director Joachim Prein. Under their leadership, AOE has been reorganized and more closely integrated into the AO organization. In addition to offering central training, such as the ﬂagship Davos Courses, it now focuses on its role as service provider

In 2006, the new tool was successfully piloted in ﬁve courses around the world, including the Davos Courses in December. Following four more tests in the ﬁrst half of 2007, the tool will be presented to the AO Trustees at the Beijing meeting in June. Pending their approval, it will be made available to the regions and is expected to become a standard process for all AO Courses

Annual Report 2006

Thomas Rüedi retires In 2006, Thomas Rüedi, founding member of the AO Foundation and long-standing President of AO International, went into retirement. His personal commitment signiﬁcantly contributed to developing AO into a world-class provider of medical education.

Key activities

once the planned online course registration tool is in place. Certified quality AOE also assures the consisting high quality of AO Courses around the world. Knowing that every surgeon trained will operate on approximately 1,000 patients a year is a strong motivator to strive for excellence. While major courses have always carried Continuing Medical Education (CME) accreditation as a quality seal, in 2006 accreditation became mandatory for most AO Courses. The absence of any undue influence by industry is an important prerequisite for CME accreditation. While the question of what undue influence entails will always be subject to interpretation, there is a current trend towards a stricter definition. AOE has responded to these tightened requirements with revised guidelines, and industry is no longer represented on AOE boards. Action is also taken at a regional level. For instance, in addition to its existing CME Advisory Board, AO North America has established a Conflict Resolution Subcommittee to manage potential conflicts of interest faster and more professionally. A busy year in education and publishing In spite of all organizational changes, AOE in 2006 continued its educational activities at a high pace. A total of 322 AO Courses and 78 ORP Courses were held globally, attracting close to 20,000 surgeons and more than 5,300 ORP participants. The Tips for Trainers Course has become a well-established quality development tool, attended 27

by more than 750 faculty members to date. The AO Fellowship program is a further way to foster individual development and attract young talents to the organization. In 2006, close to 300 surgeons participated in fellowships of three to six months, including 43 fellows from AOSpine. AO also showed a high level of activity in publishing with three new books released in 2006. These include new manuals on the use of internal ﬁxators, minimally invasive plate osteosynthesis (MIPO), as well as elastic stable intramedullary nailing (ESIN) in children. A milestone in 2007 is the publication of the second expanded edition of the AO Principles of Fracture Management, which has long become the standard reference book in operative fracture care.

New teaching package on MIO Minimally invasive osteosynthesis (MIO) has been a clinical hot topic for years. Following an initiative by Asian surgeons, AOE in collaboration with AO Trauma Asia Paciﬁc and the AO Knowledge Portal team compiled an educational package around this topic. It contains presentations, didactical posters, a video, an e-learning platform, as well as three books including the recently published “AO manual of fracture management: minimally invasive plate osteosynthesis”. In recognition of their contribution to this teaching package, Theerachai Apivatthakakul, Reto Babst, and Andy Weymann received the Hardi Weber Prize 2006. Named after the late AO member and Honorary Trustee Bernhard Georg Weber, this prize is awarded annually for extraordinary merits in education.

Research: building fruitful collaborations For the AO Research Institute (ARI), 2006 was a year of investment in its research network, expanding cooperation both within the AO and with external partners. Towards this end, ARI pushed ahead with a range of clinically relevant research projects, including the use of a small animal model for osteoporosis with specially adapted ﬁxation elements.

1/2 130 specialists attended

the ECM VII Conference in Davos. 3 Miniature instruments and

implants are indispensable for small animal models of osteoporosis. 4 BAB members and partici-

pants at the Biotechnology Symposium: James Kellam, Christian van der Werken, David Grainger, Margarethe Hofmann, Anthony Robin Poole, Adrian Sugar, Norbert Haas, Paul Manson (from left to right).

An important step ahead was achieved in the Clinical Priority Program (CPP) “Fracture Fixation in Osteoporotic Bone.” The AO Research Institute (ARI) together with the AO Development Institute (ADI) developed specially adapted implants and techniques to use rats and mice to investigate fracture treatment and bone healing in osteoporotic bone. So far, animal models had been difﬁcult to apply for this widespread clinical problem, and attempts to develop large animal models of osteoporosis had proven unsatisfactory. The shift towards small animals became possible through close cooperation with ADI to downsize hardware and adapt surgical techniques.

ling,” which was approved by the Academic Council in December 2006. With the admission of Saarland University Homburg, Germany, as a new Collaborative Research Center, valuable expertise was added to the network.

The beneﬁts of small animal models are manifold: Besides being more time and cost efﬁcient, they also provide advantages in methodology and are often considered ethically more acceptable. Since most institutes are able to work with small animals, this also increases the number of potential research partners.

Research into soft-tissue adhesion in titanium plates initiated in 2005 has moved into a translational phase. This includes testing the actual implants for various uses, developing recommendations for their manufacturing, and scrutinizing potential risks such as reduced infection resistance.

Promising research results Good progress was also achieved with other research projects and collaborations. Among others, ARI intensiﬁed its external collaboration under the CPP “Large Bone Defect Hea28

Under the CPP “Degeneration and Regeneration of the Intervertebral Disc,” the bioreactor developed in 2005 was put into application. To investigate degeneration and nutrition issues, in vitro tests were conducted using entire intervertebral discs of large animals. Although still in the initial phase, these tests proved the high potential of the method.

Providing and sharing know-how 2006 saw an increased demand for contract research, mainly in the ﬁelds of animal models and biotechnology. The growing “customer list” illustrates the excellent reputation ARI enjoys in the global research com-

Annual Report 2006

Compiled know-how In order to facilitate information dissemination, ARI produced a DVD titled “AO Publications 2004–2005.” Comprising a total of 257 articles published by AO researchers or with support from AO, it provides an overview of the latest research in trauma and disorders of the musculoskeletal system. The DVD can be ordered free of charge through the AO Knowledge Portal (www.aofoundation.org).

Key activities

munity. This growing demand and the enhanced possibilities offered by the planned cooperation agreement with Synthes, Inc. indicate that contract research will play an increasingly important role in the future.

awarded annually for signiﬁcant contributions to the ﬁeld of orthopedic and trauma surgery. Stefan Milz, Group Leader Tissue Morphology, received the 2006 Don Joy Award for his paper on tissue engineering.

ARI also continued to organize and participate in a number of important research events. One highlight in 2006 was the seventh European Cells and Materials Conference (ECM VII) in Davos. Gathering some 130 clinicians, biologists, chemists, engineers, and material scientists for an update on the latest developments in cartilage and joint repair, this event continued the success of the previous year. Participants appreciated the multidisciplinary approach and the interactive format of the conference, where the majority of time was devoted to group discussions.

Biotechnology in the limelight Biotechnology has become an integral part of AO, thanks in part to the Biotechnology Advisory Board (BAB). Through its representation on the Academic Council and Research Board, this body is now well-integrated into the organization and has left its footprint on several research projects.

Recognized researchers ARI’s activities in 2006 were complemented with a number of research publications such as the latest “Injury—Supplement to the International Journal of the Care of the Injured”, which includes key articles and a summary of the 2005 workshop on the use of antibiotics in implants. A continually high level of peer-reviewed publications testiﬁes to the quality and relevance of ARI’s publications. Special recognition was again bestowed on individual researchers from ARI. In recognition of his merits in trauma research and the directorship of the ARI, Erich Schneider received the Dieffenbach Award from the German Trauma Society (DGU). This prize is 29

In particular, BAB contributed to the design of the CPP “Large Bone Defect Healing.” While originally involved only as a reviewing body, in 2006 it adopted a more active role and helped deﬁne the program as an advisory board. The resulting proposal is a good example of how biotechnology can add signiﬁcant value to trauma research. Another highlight was the Biotechnology Symposium in Lausanne, Switzerland, organized by BAB with support from the AO Research Board and the AO Research Fund. Attracting over 100 participants, this event provided an effective platform for building a network of researchers involved in biotechnology. A follow-up event, planned for 2007, will address not only researchers but also clinicians, industry representatives, and legal advisors.

AOSRN: refreshing the network Established in 2002, the AOSpine Research Network (AOSRN) has produced valuable ﬁndings that help understand why back pain occurs—and how it can be treated. To continue its research efforts with fresh vigor, AOSpine is now renewing its network. The AOSpine Research Commission (AOSRC) manages the global basic and clinical research efforts within AOSpine. This includes overseeing the AOSpine Research Network (AOSRN), an afﬁliation of research institutes that conduct collaborative research towards a common goal—understanding the pathogenesis of disc degeneration and its potential treatment. Disc degeneration is considered the predominant source of chronic lower back pain, one of the most frequent medical problems in the developed world.

Valuable research findings This collaborative research effort was started in 2002 and later formalized under the Clinical Priority Program “Degeneration and Regeneration of the Intervertebral Disc.” The network included five leading institutes from the Universities of Zurich, Bern, Hong Kong, Nottingham, and Montreal, as well as the AO Research Institute (ARI). In this first phase, research focused on disc nutrition and its consequences for tissue repair, as well as disc inflammation and pain development. It has produced some highly relevant findings: p

Three-dimensional radiographic methods have enabled identiﬁcation of degenerative processes and investigation of possible biological factors for treatment.

A mathematical model has allowed signiﬁcant predictions of the effects of therapies. It demonstrates that cells in the inner annulus are vulnerable to nutritional deﬁcit of glucose, and to relatively small changes in disc permeability and endplate function.

Morphologic and molecular investigation of discal inﬂammatory mechanisms as sources of disc degeneration showed the relevance of identifying signalling cascades

1 The intervertebral disc

bioreactor developed at the AO Research Institute contributed important ﬁndings to the research of AOSRN.

linking degeneration to pain induction and identifying new, specific pharmaceutical targets to fight back pain. Research with a fresh vigor At the end of 2005, the three-year funding contracts for the AOSRN expired. Rather than simply reconfirming the existing partnerships, AOSpine decided to renew its network and broaden its research scope to include new areas. However, funding for the existing projects continued throughout 2006 to ensure the continuity of this research. In August 2006, an open call to support the AOSRN resulted in 38 high-quality preapplications from the USA, Europe, and Asia Pacific. 18 applicants were invited to submit full proposals for peer review. The members of the new AOSRN—probably seven to eight research centers from around the globe—are currently under selection. Their funding will begin in June 2007, continuing AOSpine’s efforts to understand and fight the severe clinical problem of disc degeneration.

An alternative to fusion While patients with degenerative disc disease (DDD) have traditionally received spinal fusion, disc prostheses today represent a real alternative. In December 2006, the AOSpine Technical Commission approved its ﬁrst Total Disc Replacement Technologies for the cervical and lumbar spine (ProDisc-C and ProDisc-L, respectively). This was preceded by a sevenyear, randomized clinical trial by the US Food and Drug Administration (FDA) which included nearly 300 patients. The study showed signiﬁcant advantages over fusion technology, notably a much higher motion preservation.

Annual Report 2006

Key activities

Research funding: an investment in future patient benefit With a more efficient organization and an expanded Commission, the AO Research Fund (AORF) supports research of relevance to AO’s mission. The year 2006 was marked by a highly selective approval process and the presentation of the first AORF Prize Award.

The structural changes implemented over the past years became fully operational in 2006 and helped the AO Research Fund (AORF) to efficiently fulfill its mission—to promote research that will benefit patients with disorders of the musculoskeletal system in the fields of basic science, general trauma, spine, as well as craniomaxillofacial and veterinary surgery. With 16 reviewing members covering a broad range of competencies, the AORF Commission is well equipped to oversee this endeavor.

Applications welcome The AORF welcomes grant applications by researchers from all specialties and all parts of the world. The next application deadlines are August 15, 2007, and February 15, 2008. For details, please see www.aofoundation.org/aorf

1 Distinguished research:

Adrian Sugar awards the ﬁrst AORF Prize Award to Karen Burg. 2 Members of the AORF

Commission at work (from left to right: Steve Krikler, Erich Schneider and Wouter Dhert).

Focused and selective funding In 2006, the number of grant applications rose to 120, illustrating the continually high need for research funding as well as testifying to AO’s growing reputation in the research community. However, only 17 new projects were accepted bringing the approval rate down from 36 % to 15 %. This highly selective approval process was the result of a stronger focus on AO’s clinical priorities, as well as a tighter budget and higher individual grants. AORF in 2006 supported 47 projects from 12 countries with a total sum of CHF 2.36 million. Among them, biological research in areas like tissue reaction and bone healing has evolved into the largest field. With four projects from China supported in 2006, Asia Pacific is now starting to make its way on the map. For 2007, AORF expects its budget to again provide more scope for project funding. Throughout the past year, AORF continued its close collaboration with other parts of AO. The AO Biotechnology Advisory Board (BAB) played a particularly important role, helping to review applications in the field of biotechnology for the new CHF 300,000, three-year Focus Grants. BAB also encourages research into biotechnology through its own funds. Since 2003, it has supported eight 31

projects in areas relevant to AO, such as gene delivery, stem cells, and growth factors. In 2006, two of these projects were successfully concluded while two more produced highly promising interim results. Honoring excellent research At the 2006 Trustees Meeting, the ﬁrst AO Research Fund Prize Award was presented to Karen Burg. The award recognizes the best AORF-funded project concluded within the respective year. Karen Burg’s work on “Tissue-Engineered Bone Replacement Systems” was selected unanimously for its scientiﬁc excellence and high relevance to AO. Shortly after completing her project, Karen Burg was appointed Professor of Bioengineering at Clemson University, South Carolina, USA.

Projects support by area

Subject

Number of projects

Amount in CHF 1,000

in %

10 14 1 25

509 745 56 1,310

21.5 31.5 2.4 55.4

1 2

26 78

2.2 0.0 1.1 3.3

Biological: – Tissue reaction – Bone healing – Transplantation Total Biological Biomechanical: – Biomechanical ﬁxation – Biomechanical joints – Biomechanical general Total Biomechanical Biomaterials/Metallurgy Implant development Clinical

2.4 0.0

515

21.8

Organs, Species: – Maxillofacial – Spine Total Organs, Species

1 6 7

33 320 353

1.4 13.5 14.9

CAOS, 3-D reconstruction

2.1

2,363

100

Total

Development: adding the missing piece of information Pursuing its focus on fractures in osteoporotic bone, the AO Development Institute (ADI) has developed a device for intraoperative measurement of bone quality. In a few years, DensiProbe™ Hip could help surgeons decide on the most suitable treatment option.

Within the framework of the respective Clinical Priority Program (CPP), the AO Development Institute (ADI) has concentrated its efforts on innovative concepts for fracture treatment in osteoporotic bone. Since osteoporosis is a key clinical issue, the publications and many presentations given by ADI team members in 2006 met with great interest in the trauma surgeons’ community.

Evaluating risk factors In 2005, ADI elaborated a standardized augmentation technique applying bone cement to improve implant purchase in soft osteoporotic bone. Before moving into the clinical stage, this technique underwent additional tests in 2006 to validate potential risks stemming from the heat generated by the curing bone cement. Once approved, augmentation technique will help prevent cutout in proximal femur fractures, reducing the need for life-threatening and costly revision surgery.

However, the vast majority of patients suffering from hip fracture can be treated securely without augmentation. To understand which patients are likely to benefit from augmentation, surgeons look at four risk factors: fracture type, quality of fracture reduction, position of the implant, and bone quality. While the first three can be assessed through intraoperative fluoroscopy, the latter has so far remained guesswork. Sophisticated measurement tools such as osteodensitometry and quantitative computer tomography (QCT) are usually not available preoperatively or intraoperatively. 1 DensiProbe™ Hip enables

the surgeon to perform intraoperative measurement of local bone quality. 2 The DensiProbe™ Hip

device has been adapted for use with Dynamic Hip Screw (DHS).

From guesswork to measurement ADI has developed an easy-to-use device for the intraoperative mechanical measuring of bone quality—the DensiProbe™ Hip. This probe is inserted at the very spot where the implant is going to be inserted, and measures the resistance of trabecular bone against 32

breakaway torque while turned by the surgeon. In laboratory experiments, this method has shown high correlation to QCT, the golden standard of bone densitometry. Endurance tests performed on bones with a standardized fracture and implant position confirmed the ability of DensiProbe™ Hip to forecast implant cutout. Towards a new clinical standard DensiProbe™ Hip has received CE certification and is ready for evaluation. The first clinical applications took place at the University Hospital of Basel, Switzerland. In 2007, a multicenter clinical study will follow to evaluate the method. Long-standing partners as well as several university hospitals have shown interest in participating, adding potential members to AO’s global network. AO surgeons will get a first grip on the new device during the Geriatric Fracture Course in Davos in December 2007, which is organized jointly by the CPP’s core team and AO Education. In three to five years‘ time, DensiProbe™ Hip should be available as a clinical standard, benefiting patients and the entire healthcare system.

Annual Report 2006

Key activities

TK-System: pacesetter for innovative treatment concepts In 2006, a total of 76 new products were approved as safe and effective. In addition to its role as a certiﬁcation body, the TK-System, with its network and regionalized structure, is increasingly acting as collector and disseminator of ideas of new treatment concepts within AO. With the new regional structures fully implemented, the network of the TK-System now includes some 120 renowned surgeons from all parts of the world. Regional representatives in the Expert Groups are assuming an increasingly active role and fostering involvement in regional events. The Combined Regional Courses organized jointly with AO Trauma Asia Paciﬁc in April 2006 are but one example of this close collaboration.

Gatekeeper and pacesetter An intensified dialogue with the regions helps the TK-System strengthen its role as collector and disseminator of ideas for new treatment concepts. To fulfill its mission, the TK-System is in close contact with the other parts of AO. For instance, it cooperates with the AO Research Institute on several research projects, initiates studies run by AO Clinical Investigation and Documentation, and provides medical guidance within the scope of projects led by the AO Development Institute. In its certification function, the TK-System has continued to complement important treatment concepts and devices. With the approval of the Lateral Femoral Nail System, the expert nail family is now complete and includes a range of new and improved implants. Due to its innovative shape and new

entry point, the Lateral Femoral Nail reduces the risk of damage to soft tissues. The family of external ﬁxation systems has also grown by a number of new products, including the Distraction Osteogenesis Ring System. This innovative system allows controlled bone distraction. In total, 76 new products were approved in 2006—41 in general trauma, 22 in spine, nine in CMF, and four in veterinary. Recognizing special merits 2006 saw the rare presentation of an AO Innovation Award, which is presented by the AO Foundation’s Board of Directors (AOVA) only upon special proposal of the TK-System. The prize was bestowed on Sigvard T. Hansen jr., head of the Hanson Foot and Ankle Institute at Harborview Medical Center, Seattle, USA. It recognizes his lifetime achievement and exceptional contribution to the development of new concepts, technologies, and treatment options in trauma, reconstructive, and orthopedic foot surgery. This prize has only been awarded three times in the past decade. The 2006 TK Recognition Award was presented to Alex Staubli, head of the orthopedic department of the Cantonal Hospital of Lucerne, Switzerland, for his numerous contributions to conceptual enhancement in the ﬁeld of osteotomies around the knee joint.

TK-System: Membership Development Total: 43

Total: 74

Total: 101

Total: 120

50 40 30 1 Sigvard T. Hansen jr. (right)

receives the AO Innovation Award from Norbert Haas (left) and James Kellam.

Europe USA Latin America Asia

20 10 0

1997

2004

2005

2006

Clinical Investigation: reaching new dimensions With the completion of its largest ever comparative studies and the preparation of a second FDA trial, AO Clinical Investigation and Documentation (AOCID) has firmly established itself as a leading clinical research organization. The strong increase in services provided by AOCID reflects the growing interest of AO surgeons in clinical research. With the completion of 13 studies, 2006 was a year of harvest for AO Clinical Investigation and Documentation (AOCID). Preliminary analysis indicates that these studies produced valuable new and sometimes surprising evidence for the practicing surgeon. Most of the findings, however, will not become available until 2007, as it takes six months on average after completion of a study to analyze and publish its results. Bigger is better New dimensions were reached in terms of study size. More than 600 patients were included in a comparative study concerning different methods for treating fractures of the proximal humerus: internal locking system (PHILOS), locking plate (LPHP), and nailing (PHN). This study investigated outcomes of conservative versus operative treatment of this complex fracture. 1/2 The extended US office

housed in the Overlook Center, Princeton, New Jersey, makes AOCID know-how available in the Americas. 3 In 2006, AOCID has once

again proven its ability to handle the most complex study designs.

The global comparative study of the use of locking compression plates (LCP) in treating distal radial fractures also included over 600 patients. The three main arms of the study compared the use of plates of varying sizes (2.4 mm and 3.5 mm) and conservative treatment. An additional side arm focused speciﬁcally on China. Since fractures of the distal radius are the most frequent fracture of 34

all, this study is of particularly high relevance for the practicing surgeon. Despite their demanding character, both studies achieved a follow-up rate of over 80 %. The follow-up rate indicates the percentage of patients initially included in the study for which a complete outcome record was obtained. An 80 % rate is required to achieve scientifically sound findings which are representative of the entire sample group. With these two projects, AOCID has once again proven its ability to conduct complex multicenter studies with several side arms in an multicultural context. Mastering stringent FDA requirements While AOCID has run randomized trials for several years, an important milestone was achieved in 2006 with the successful start of the first Investigational Device Exemption (IDE) trial designed to meet the stringent requirements of the US Food and Drug Administration (FDA). Conducted on behalf of an external client, this trial investigates a synthetic bone filler used in cervical spine fusion. It started in the first quarter of 2006, and the database is expected to be completed within two years.

Annual Report 2006

Positive evaluation by Swissmedic The Swiss Agency for Therapeutic Products (Swissmedic) ensures the quality, safety, and efﬁcacy of medicines and medical devices to be placed on the Swiss market. Similar to the FDA in the USA, it also randomly examines organizations active in this ﬁeld. In November 2006, AOCID underwent such random inspection by Swissmedic. After comprehensive material had been provided about its studies and procedures, a full-day onsite investigation of a selected study and the corresponding organizational background took place. AOCID was able to demonstrate the high quality level of its documentation, organization, and performance, resulting in a very positive report by Swissmedic.

Key activities

Hopes that this first FDA trial will help establish AOCID as a clinical research organization in this demanding market have materialized more quickly than expected. Already, a second external client has chosen AOCID to run an FDA trial on its behalf. The setup is currently being prepared, and the trial is scheduled to be filed in spring 2007. Increasingly complex study designs In line with the strategic decisions taken in 2003, the general trend away from handling tests and case series towards the more demanding study designs of comparative studies and randomized controlled trials has continued. To make AOCID know-how in this field more readily available in the Americas, the US office in Princeton, New Jersey, was expanded in 2006 and staffed with a manager intensively trained at Swiss headquarters. From among eight new studies initiated in 2006, two are directly related to the “Fracture Fixation in Osteoporotic Bone” Clinical Priority Program (CPP). They investigate complications related to osteoporosis in proximal humeral and distal radial fractures. Both fracture types are particularly common among elderly patients. AOCID was already strongly involved in the definition of this CPP, for example by providing extensive literature searches. Placing high priority on these new studies, it has continued its strong support of this program.

Another new project is a proximal femoral nail antirotation (PFNA) randomized controlled trial conducted in Spain. For the first time, this study compares the effectiveness of implants of two competing producers, in this case nails used for proximal femur fractures from Stryker and Synthes, Inc. Strong demand for services Providing research-related services, such as methodological support, literature searches, and the newly launched support in medical writing, is an important and growing part of AOCID’s work. The vast majority of these services are provided free of charge to surgeons from the AO community. However, external parties are also turning to AOCID, which illustrates the potential of these marketable services. Teaching activities were also expanded in 2006 in Latin America and Asia Pacific, and a special certification is planned to ensure the future high level of AOCID clinical studies.

AOCID: Services rendered to external parties (numbers of external requests) 200

150

100

Methodological services Literature services Publication services Teaching services Other services

2002

2003

2004

2005

2006

Stringent rules of governance are vital for AO as an independent, medically guided organization.

Annual Report 2006

Governance

Finance: towards greater independence The increased activities of all AO institutions led to a 6% growth in funds spent, totaling CHF 73.2 million in 2006. Going forward, a new funding structure will help secure the ﬁnancial independence of AO.

Main growth drivers (increase in operating expenses 2005–2006, in CHF million)

Allocation of AO Foundation funding 1999–2006 (in CHF million) 80 70

2.5 2

1.5

Unforseen Management and Trustees activities AO center Regionalization Quality assurance CMF Spine Education Development Research

0.5 20

AOSpine AO CID Mgt. and Trustees activities ARI Education

Orgin of income 2004–2006 (in CHF million) 100 80 60 40 20 0

2004

2005

2006

Dissolution of reserves Third/other party Return on invested capital Income from cooperation agreement Income from royalties

10 0

1999

2000

2001

2002

2003

During the ﬁnancial year 2006, the AO Foundation allocated CHF 73.2 million to the various AO institutions, which represents an increase of 6 % over 2005. About 60% of the 80 total sum was allocated to research and development (CHF 14.2 million), education and 70 publishing (CHF 14.0 million), and AOSpine 60 (CHF 14.1 million). The rest was spent almost evenly on the AO management and Trustees 50 activities (CHF 6.2 million), quality assurance 40 (CHF 6.6 million), regional activities (CHF 6.3 million), and the central infrastructure 30 (CHF 7 million). CHF 1 million was spent on 20 CMF activities.

10 Increased activities and spending 0 growth in spending is due to increased The activities across the entire AO organization. The main growth driver was AOSpine (+CHF 2.8 million), which expanded strongly in terms of both activities and geography. The growth of AOCID (+CHF 1.5 million) is mainly due to an increase in third-party studies. As a consequence of this heightened activity level, the total headcount in Switzerland increased from 199 (2005) to 230 (2006).

2004

2005

2006

New funding structure The conclusion of the Asset Purchase Agreement with Synthes, Inc. in August 2006 marked a decisive step towards greater ﬁnancial independence. Due to the sale of a large number of patents and trademarks to Synthes, Inc., total assets of the AO Foundation increased from CHF 120.5 million to CHF 1.1 billion. This new capital base will secure the future funding of activities in pursuit of the AO Mission. Under the new contract, revenues shifted from sales-related royalties to compensations for cooperation services. The resulting decrease in royalties received from Synthes, Inc. (– 15 % in 2006) will be compensated through an increase in interest income, which slowly started to show in 2006 (+ 6 %) and will take full effect as of 2007. Revenues generated through services provided to third parties saw a sharp increase (+ 41 %), in line with the organization’s strategy.

Governing bodies of the AO Foundation (as per December 31, 2006)

Board of Trustees (1) The Board of Trustees is the “AO parliament,” consisting of 168 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 (2) The Board of Directors implements the goals and proposals of the Academic Council. Its 15 members include three (nonvoting) representatives of Synthes, Inc. Back row, from left to right: – Andreas Lindner, CFO* – James Kellam, Past-President (permanent guest) – Ciro Römer, Synthes, Inc.* – Urs Weber (minutes)* – Eric Johnson – Roland Brönnimann, Synthes, Inc.* Middle row, from left to right: – Suthorn Bavonratanavech – Bruno Noesberger – Tim Pohlemann – James Gerry, Synthes, Inc.* – Gregor Strasser, CEO* Front row, from left to right: – Jaime Quintero – Christian van der Werken, President – Markus Rauh, Chairman** – Paul Manson, President-Elect – Michael Janssen

* nonvoting member ** casting vote

Annual Report 2006

Governance

Academic Council—AcC (3) 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. Back row, from left to right: – Jörg Auer – Norbert Südkamp (CP AO Research Board)* – Paul Manson (President-Elect) – Norbert Haas (President AOTK)* – James Kellam (Past-President) – Tobias Hüttl (General Manager)* Middle row, from left to right: – Michael Ehrenfeld (CP SAcC AO CMF) – Peter Trafton – Michael Wagner – Cléber Paccola – David Helfet (CP AO Documentation & Publishing Board)* Front row, from left to right: – Christian van der Werken, President – Jesse Jupiter (CP AO Education Board)* – Pietro Regazzoni (CP AO Development Board)* – David Grainger (Representative BAB)* – Nikolaus Renner (CP SAcC General Trauma) * nonvoting member

Not in the picture: – Max Aebi (CP AOSpine)

AO Executive Management—AOEM (4) The AO Executive Management implements the decisions taken by the AOVA, and supervises the activities of the operational functions of the AO Foundation. It consists of the CEO and ten line managers who are responsible for operational management within their respective areas. Back row, from left to right: – Tobias Hüttl, General Manager AcC – Piet de Boer, Director AOE – Joachim Prein, Vice-Director AOE – Philip Schreiterer, Head of TK Ofﬁce – Michael Piccirillo, Director AOSpine – Norbert Suhm, Director ADI Front row, from left to right: – Erich Schneider, Director ARI – Gregor Strasser, CEO – Beate Hanson, Director AOCID – Irène Zuberbühler, Head of HR – Andreas Lindner, CFO

Annual Report 2006

Abbreviations

Organizational terms

Technical terms

AcC

Academic Council

ARS

Audience response system

ADI

AO Development Institute

CAS

Computer-assisted surgery

Stands for the German “Arbeitsgemeinschaft für Osteosynthese-

CME

Continuing Medical Education

fragen,” ie literally “Association for Osteosynthesis”

CMF

Craniomaxillofacial

AOA

AO Austria (section)

DDD

Degenerative disc disease

AOAA

AO Alumni Association

ESIN

Elastic stable intramedullary nailing

AOCH

AO Switzerland (section)

FDA

Food and Drug Administration (USA)

AOCID

AO Clinical Investigation and Documentation

IDE

Investigation Device Exemption

AOE

AO Education (formerly AOI)

LCP

Locking compression plate

AOEM

AO Executive Management

LC-DCP

Limited contact dynamic compression plate

AOES

AO Spain (section)

LPHP

Locking proximal humerus plate

AOI

AO International (now AOE)

MIO

Minimally invasive osteosynthesis

AOLAT

AO Latin America (region)

MIPO

Minimally invasive plate osteosynthesis

AONA

AO North America (region)

ORP

Operating room personnel

AORF

AO Research Fund

PHILOS

Proximal humerus internal locking system

AOSI

AOSpine International

PHN

Proximal humerus nail

AOSRN

AOSpine Research Network

PFN

Proximal femoral nail

AOTAP

AO Trauma Asia Paciﬁc (region)

PFNA

Proximal femoral nail antirotation

AOUK

AO United Kingdom (section)

PQM

Project and quality management

AOVA

Board of Directors (from the German “Verwaltungsausschuss”)

QCT

Quantitative computer tomography

ARI

AO Research Institute

TPLO

Tibial plateau leveling osteotomy

BAB

AO Biotechnology Advisory Board

CPP

Clinical Priority Program

CRC

Collaborative Research Center

DAO

AO Germany (section)

SAcC

Specialty Academic Council

SEC

Socio Economic Committee

Annual Report 2006

Addresses

AO head ofﬁce

Regions and sections

AO Foundation

AO Austria (AOA)

AO Latin America (AOLAT)

AO Switzerland (AOCH)

Clavadelerstrasse 8 CH -7270 Davos Platz Switzerland Phone +41 81 414-2801 Fax +41 81 414-2280 foundation@aofoundation.org www.aofoundation.org

President Prof. Dr. Michael Wagner Head of the Department of Traumatology Wilhelminenspital Montleartstrasse 37 A -1160 Vienna Austria Phone +43 149 150-4301 Fax +43 149 150-4309 michael.wagner@wienkav.at

President Dr. Fiesky A. Nun˜ ez Vasquez Regional Manager Luis Javier Parra Calle 134 No.7B-83 Of. 809 Bogotá Colombia Phone + 57 1 627 24 11 aolat@cable.net.co www.aolat.org

President Prof. Dr. med. Roland P. Jakob Clavadelerstrasse 8 CH -7270 Davos Platz Switzerland Phone +41 81 414-2700 Fax +41 81 414-2284 claudio.gubser@aofoundation.org

Alumni AO Alumni Association (AOAA) Clavadelerstrasse 8 CH -7270 Davos Platz Switzerland Phone +41 81 414-2690 Fax +41 81 414-2283 alumni@aofoundation.org www.aofoundation.org/aoi/alumni

AO North America (AONA) AO Asia Paciﬁc (AOAP) President Dr. G. On Tong Regional Manager Urs Mattes CEO Business Center Limited 22/F, 3 Lockhart Road Wanchai Hong Kong Fax +852-2290 9182 aoap@aofoundation.org AO Germany (DAO) President Prof. Dr. Hans-Jörg Oestern Langenbeck-Virchow-Haus Luisenstrasse 58–59 D -10117 Berlin Germany Phone +49 30-28004420 Fax +49 30-28004429 unfallchirurgie.sekretariat@ akh-celle.de www.ao-deutschland.de

President Prof. John Howard Wilber P.O. Box 1658 West Chester, PA 19380 USA Phone +1 610 344-2000 Fax +1 610 344-2001 ellisa@aona.org www.aona.org AO Spain (AOES) President Víctor Manuel Alvarez Fernandez MD Dept. of Orthopaedic Surgery & Traumatology Hospital de Jove Avda. Eduardo Castro E-33290 Gijón Spain Phone +34 985 32 0308 Fax +34 985 31 5710 traumatologia@hospitaldejove.com www.aoes.org

Concept and editing: AO Foundation, Communications, Davos, Switzerland Enzaim Communications AG, Zurich, Switzerland Layout: Festland, St. Gallen, Switzerland Print: Printlink, Zurich, Switzerland © 4 /2007 AO Foundation

AO UK (AOUK) President Mr. John K. O’Dowd, MD, FRCS AOUK c/o AO Education Marlborough House York Business Park Nether Poppleton York, YO26 6RW GB Phone +44 1904 787767 Fax +44 1904 787767 aouki@aol.com www.aouk.org

AO Foundation Clavadelerstrasse 8 CH -7270 Davos Platz Switzerland Phone +41 81 414-2801 Fax +41 81 414-2280 foundation@aofoundation.org www.aofoundation.org