AO Foundation Annual Report 2010 by AO Foundation

Annual Report 2010 Transforming Surgeryâ&#x2C6;&#x2019;Changing Lives

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

Exploratory Research Feature Story Fulfilling unmet research needs Collaboration drives research results Securing the AO‘s future beyond tomorrow Expanding the platform Education Feature Story AO Surgery Reference goes mobile Harnessing technology to teach Lifelong learning

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Strategy

Our mission is to foster and expand our network of health care professionals in education, research, development, and clinical investigation to achieve more effective patient care worldwide.

A talk with the President and the Chairman of the AO Foundation Continued growth of clinical relevance and guidance

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AO Specialties AOTrauma—delivers the best patient care in musculoskeletal trauma AOSEC—2010 was a watershed year AOSpine—the global leader in cutting-edge education and research AOCMF—a global driving force in innovative education and research AOVET—education leads the way

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AO Service Units Research and Development—the future of trauma research Exploratory Research—where science meets clinics Clinical Investigation—a leader in evidence-based clinical trials TK System—a year of planned change Education—major new education initiatives

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Governance Governance—enhancing the clinical guidance of the AO Foundation Finance—financial reporting aligned with new organizational structure Governing bodies of the AO Foundation Addresses

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Annual Report 2010

Exploratory Research Feature Story

Fulfilling unmet research needs LBDH CRP expands understanding of large bone defects Developing solutions for critical size bone defects is just one part of the bone repair and regeneration work under way as part of AO Exploratory Research’s Large Bone Defect Healing Collaborative Research Program (LBDH CRP). Prof Steven Buchman, AO Craniomaxillofacial representative to the AO Exploratory Research Board (AOERB) and “godfather” to the LBDH CRP, said the program is transforming the way research is done.

tissue engineering to better understand the successful, predictable and durable regeneration of human tissue and to exploit those discoveries in innovative ways to expand our capabilities to heal the sick and reconstruct the disfigured,” he explained.

“The LBDH CRP has high relevance for both craniomaxillofacial and orthopedic trauma surgeons because both Specialties encounter

“From the research and clinical perspectives, I am excited about what can come out of this program,” he said.

As a researcher and full-time clinician in a teaching hospital, Buchman sees the LBDH CRP from two perspectives.

“AO Exploratory Research fulfills an unmet need for translational research, which is not only basic science, but coming up with solutions that surgeons can use.”

Prof Steven Buchman, AOCMF representative to the AOERB

large bone defects that will not heal on their own or are not amenable to bone grafting,” said Buchman, Director of the Craniofacial Anomalies Program at the University of Michigan Medical Center. “But there is more to this CRP than just doing the research; sharing ideas and resources can help move the research to the next level.” Buchman said applied tissue engineering is one area where the LBDH CRP, now in its fourth year of funding, contributes to better understanding of large bone defects. “Our challenge is to refine the techniques of

“The outcomes that lead to improved patient care come from the researchers’ labs.” The collaborative approach of the LBDH CRP positions the AO Research Institute Davos (ARI) to do what it does best and leverage the competencies of some of the world’s foremost research institutes to answer clinicians’ questions and—ultimately—improve patient care. “AO Exploratory Research fulfills an unmet need for translational research, which is not only basic science, but coming up with solutions that surgeons can use,” Buchman said.

Steve Buchmann, courtesy of the University of Michigan Health System

Annual Report 2010

Exploratory Research Feature Story

Collaboration drives Central role of Exploratory Research explained

research results Research Network

Patients

The AO Research Institute has a Primus inter Pares, “first among equals,” role as coordinator of the network of researchers involved in a working on a CRP. Each network is composed of

Improved patient care is at the heart of the AO mission. The AOER provides an expert, collaborative framework for working toward innovative solutions to patient care problems. Patients are the ultimate beneficiaries of the AO research outcomes and the contributions of the research network, which is working toward cutting edge solutions to clinical problems.

Collaborative Research Programs

Surgeons As the health care experts closest to patients, the AO’s global network of surgeons specialized in the treatment of trauma and disorders of the musculoskeletal system fuel the exploratory research process by putting forward the clinical challenges they face. Surgeons guide exploratory research funding and have key stewardship roles in all Collaborative Research Programs.

Exploratory Research As a link between the patient’s bedside and the researcher’s laboratory bench, AO Exploratory Research (AOER) funds high potential research projects which are the most likely to lead to next-generation musculoskeletal therapies to improve patient care. By fostering a

both ARI scientists and researchers from institutes around the world collaborating across disciplines to exchange insights, foster innovation and meet clinical challenges.

global network of science professionals focused on truly novel approaches and theories in bone repair and regeneration and in cartilage and disc repair and regeneration, AOER harnesses internal and external research expertise to benefit the AO mission.

AOER Collaborative Research Programs (CRPs) address problems relevant to two AOER focus fields: bone repair and regeneration (mechanisms, bone induction/repair, bone substitute, implant design) and cartilage-disc repair/regeneration (mechanisms, inflammation, replacement, implant design). Three such CRPs under way today are Large Bone Defect Healing, Annulus Fibrosus Rupture, and Acute Cartilage Injury.

Specialties Outcomes of AOER CRPs are expected to be relevant to at least two of the four AO Specialties. At the conclusion of a CRP, a Specialty may choose to fund and further develop protocols, approaches and techniques advanced by the program. Within the appropriate Specialty, this would take the form of a Clinical Priority Program (CPP) aimed at developing clinically viable and usable solutions to specified clinical problems, within a defined time frame.

Annual Report 2010

Exploratory Research Feature Story

Securing the AO’s future Teamwork solves research problems Prof Michael Schütz knows first hand the value of AO research. As a junior resident, he worked part-time for the AO Foundation setting up clinical studies. Today, as Chair of the AO Exploratory Research Board (AOERB), Schütz is convinced that AO Exploratory Research (AOER) is key to securing the future of the AO. “Exploratory research is an investment in the development of next-generation knowledge. For the AO to secure its future, we must be on the cutting-edge of everything we deliver,” he said. AOER is distinguished by its ability to success-

Musculoskeletal Regeneration, is part of the Long Bone Defect Healing CRP (LBDH CRP). “My work is focused on critical size bone defects and tissue engineering approaches mimicking original bone to treat them. These are based on the combination of biomaterials with stem and progenitor cells that stimulate the formation of new bone and promote neovascularization, crucial for the transport of oxygene and nutrients,” Verrier said, adding that collaborations offer exchanges of ideas, technologies and valuable feedback.

“The multidisciplinary landscape of research today demands that groups team up Sandra Steiner, Head of AO Exploratory Research for impact.” fully span the interests of AO Specialties and pair the expertise of the AO Research Institute Davos (ARI) with complimentary research institutes worldwide. Having surgeons in key decision-making and advisory roles ensures clinical relevance, and ARI has a “first among equals” position in all AOER collaborations. “The multidisciplinary landscape of research today demands that groups team up for impact. The Collaborative Research Program (CRP) strategy of funding research consortia instead of stand-alone projects is novel in the AO Foundation,” says Sandra Steiner, Head of AOER. ARI’s Sophie Verrier, Principal Investigator,

Matthias Laschke, Sophie Verrier and David Eglin discuss the LBDH CRP in the ARI lab in Davos

Matthias W Laschke, Deputy Director of the Institute for Clinical and Experimental Surgery, University of Saarland, Homburg, Germany, is part of the network of research institutes that collaborate with ARI on the LBDH CRP. “This program appeals to me because I have a medical background but am not as familiar with materials science as our colleagues at ARI,” he said. “ARI and our institute bring out the best in one another.” This kind of teamwork has the power to secure the AO’s position in the scientific community and expand the research to solve problems that impede patient care, according to Schütz.

LBDH CRP meeting in Boston with the research network consortia representatives

Annual Report 2010

Exploratory Research Feature Story

Expanding the platform Two new collaborative programs launched An AO Collaborative Research Program (CRP) focused on treating Annulus Fibrosus Rupture (AFR) could bring relief to patients suffering from AFR-related disc degeneration and low back pain, according to Prof Keita Ito, who teaches biomedical engineering at Eindhoven University in the Netherlands and is an AOSpine International Board member.

the disc with bone fusion or implant. “Each of these treatments has its own problems. It is obvious that researchers need to tackle this issue.”

The new AFR and Acute Cartilage Injury (ACI) CRPs, both within the focus field of Cartilage and Disc Repair and Regeneration, join Large Bone Defect Healing (LBDH CRP) to total three programs aimed at resolving clinical problems faced by AO surgeons.

“Right now, work is under way on biological solutions, including novel biomaterials. With the right team, we have a very good chance of finding the right solution,” he said. “I believe the AFR CRP could produce good outcomes and potential solutions in the next five years.”

Now, Ito said, is the right time for the AFR CRP, which is relevant to both AOSpine and AOVET.

“Now is the right time for the AFR CRP, which is relevant to both AOSpine and Prof Keita Ito, AOSpine International Board Member AOVET.” Rupture of the annulus fibrosus—the strong wrapping that constitutes the outer portion of the intervertebral disc—typically leads to disc generation and low back pain. “When a disc herniates, the jelly-like nucleus pulposus at the center of the disc comes out through the tear. If it pushes up against the nerve root, it can cause a lot of pain. The nucleus pulposus isn’t meant to be exposed to the rest of the body and has an inflammatory effect,” said Ito, “godfather” to the new AFR CRP. He said past treatments have included pain medication, snipping away exposed nucleus pulposus, or in drastic cases replacing

Keita Ito setting up experiments at the invertebral disc bioreactor in Davos

Sibylle Grad, ARI’s Principal Investigator, Musculoskeletal Regeneration, said her interest in AFR research goes beyond the laboratory. “I know people who have AFR; they suffer severe pain for which medication and therapy often prove ineffective,” she said. “I am excited about every small step we collaborators make toward a treatment.” AO Exploratory Research will host a symposium, “Where Science Meets Clinics,” in Davos in 2011. The event will address the repair of bone, cartilage and intervertebral disc from the perspective of clinicians and scientists.

Section of a bovine disc, with annular fibrosis rupture, where the nucleus has naturally protruded (arrow)

Annual Report 2010

Education Feature Story

AO Surgery Reference goes mobile Just-in-time educational tool a hit with surgeons The acclaimed AO Surgery Reference— containing 16,000 medical illustrations and more than 8,000 pages outlining hundreds of surgical procedures across 20 anatomical areas—is now available in mobile format allowing surgeons instant access to the information they need, when they need it. “I use AO Surgery Reference for iPhone as I prepare for surgery, to understand the character of a fracture and the find suggested treatments,” said Markus Loibl, former AO research fellow and a third-year resident at Spital Davos. “It is priceless; many books worth of information in a mobile format.”

ubiquitously available,” said Trafton, who worked with AO Education’s Michael Redies to develop AO Surgery Reference. “In some countries, lack of computer access is filled by mobile phones and third-generation wireless internet connections. The mobile app is a just-in-time educational tool that meets the needs of surgeons worldwide.” AO Education’s Surgery Reference Manager Tobias Hövekamp said AO Surgery Reference, which meets the needs of both AOTrauma and AOCMF and soon also AOVET, in mobile format is a direct response to clinicians’ needs.

“In just five months, the AO Surgery Reference mobile app has been downloaded 26,088 times.” Tobias Hövekamp, Manager AO Surgery Reference AO Surgery Reference has been online since 2005, and the release of the application for iPhone and other smart phones in November 2010 was a natural next step, said Prof Peter Trafton, one of four executive editors responsible for AO Surgery Reference content. “AO Surgery Reference in both its online and mobile forms is a living document that is constantly updated as new knowledge becomes available. The advantages of the mobile app are that it is portable and almost

An editorial meeting to discuss the AO Surgery Reference iPhone app development

“The surgeons and their needs really drive the continued development of the AO Surgery Reference,” Hövekamp said. “The Müller AO Classification of Fractures—Long Bones (the standard classification used by trauma surgeons and physicians dealing with skeletal trauma worldwide) app was released in early November 2010, and AO Surgery Reference mobile app was launched shortly after. In just five months, AO Surgery Reference mobile app has been downloaded 26,088 times.”

Screen from the Müller AO Classification of Fractures — Long Bones iPhone app

Annual Report 2010

Education Feature Story

Harnessing technology to teach Webcasts now part of the AO Education continuum For Prof Thomas Sough, faculty member and consultant orthopedic surgeon at the University of Abuja Teaching Hospital in Abuja, Nigeria, traveling 4,000 kilometers to Davos for an hour-long course with an expert AO surgeon was just not an option. But thanks to AOTrauma’s groundbreaking use of live webcast technology—made possible with the support of AO Education—Sough and 174 other surgeons in a similar position were able to participate in the 2010 Davos webcast, “Surgery for Displaced Intraarticular Calcaneal Fractures,” without needing to leave home.

Schelkun said the AO is uniquely positioned to provide the highest quality educational opportunities for surgeons, and webcast technology offers an exciting platform to do just that. “We have the best network of expert surgeon faculty in the world. Our information is well organized, evidence-based, presented in a professional manner and backed by the latest in adult learning methodology,” Schelkun explained. Pre- and post-course assessments determine practice gaps and participant knowledge levels before and after courses.

“AO webcasts are another link in our continual professional development.” Steven Schelkun, AOTEC Chair Steven Schelkun, Chair AOTrauma Education Commission (AOTEC), said the live webcast of this AOTrauma Davos course was a direct response to surgeons’ needs and represented a new twist on distance learning.

Webcast topics are determined by the AOTEC based on input from the surgical community and guidance from AO educationalists, and webcasts are produced with the support of AO Education’s Video Services team.

“Surgeons tell us they want short courses focused on topics relevant to their practices. For many, it’s not possible to attend five days of courses, but by offering short, interactive educational encounters, we can give them what they need, when they need it,” Schelkun said. “AO webcasts and webinars are another link in our continual professional development.”

Prof Rick Buckley, head of Orthopedic Trauma at the University of Calgary in Alberta, Canada, delivered the 2010 AOTrauma webcast which included course objectives, a preoperative plan, an overview of soft tissue issues, instruments, implants, the surgical procedure with participants’ questions answered throughout and a review of all course elements at the end.

Prof Rick Buckley delivering the AOTrauma webcast, “Surgery for Displaced Intraaricular Calcaneal Fractures”

Checking sound levels during the “Surgery for Displaced Intraaricular Calcaneal Fractures” webcast

story continued... “By having rehearsed the surgery with the whole team of operating room personnel and the video production crew, we could offer a seamless, engaging and inclusive educational experience,” Buckley said. “If a webcast participant garners two or three useful points in a one-hour course, that’s a positive learning experience that will bring participants back for other courses. Continuing professional education is a bit-by-bit climb that occurs over a lifetime, and our webcasts contribute to surgeons’ expanding bases of knowledge.”

webcast requires up to two months of preparation and on the day of broadcast can involve as many as 15 people—surgeons, Operating Room Personnel (ORP), moderators, camera operators, editors, technicians, and information technology experts—being present in the operating room. “The interactive element, giving participants the opportunity to ask questions about the surgery by using text chat, means participants learn from both the faculty member and from

“If, by participating in a webcast, I improve my skills just one percent, my patients will benefit greatly.” Prof Thomas Sough, University of Abuja Teaching Hospital In preparing to deliver the live webcast course, Buckley said he had received valuable support from the AO Foundation Video Services team—particularly Video Services Manager Robin Greene.

one another’s questions,” he said. “Webcasts are an increasingly important educational tool because we can reach people all over the world and offer them a valuable, interactive learning opportunity.”

“Backward planning was an important part of preparing for this webcast because it allowed us to plan everything around what Prof Buckley needed to demonstrate and to ensure that neither he nor the participants were ever distracted by the technical aspects of the webcast delivey during the course,” Greene said. “AO Foundation Video Services is there to be of service to the surgeon while he delivers the course and this, in turn, supports the participants’ learning experience.”

For the 175 surgeons who participated in AOTrauma’s live webcast, “Surgery for Displaced Intraarticular Calcaneal Fractures,” during the 2010 Davos Courses, the new learning platform offers direct benefits.

Rudolf Elmer, AO Education Project Manager e-Learning and Visual Media, said a live

As a member of AOTrauma, Prof Thomas Sough can easily access webcasts from the Specialty website

“I have never performed surgery for displaced intraarticular calcaneal fracture, but at some point I will have patients who need that surgery,” Sough said. “If, by participating in a webcast, I improve my skills just one percent, my patients will benefit greatly. I also value the fact that the webcast is available on the AOTrauma website for future reference.”

Surgeons and ORP assisting Prof Rick Buckley during the AOTrauma webcast

Annual Report 2010

Education Feature Story

Lifelong learning AOSpine Curriculum implementation underway Developed over several years and geared to provide spine surgeons with new skills and knowledge throughout their professional lives, the new AOSpine Curriculum for Lifelong Learning is a structured, consistent framework for delivering educational activities based on agreed competencies. The Curriculum kicks off with a slate of twelve pilot events in 2011. “The Curriculum is the culmination of many years of work and describes what we believe should be delivered based on patient problems, learner needs, and our mission and vision,” said AOSpine International Chair Luiz Vialle and AOSpine Education Commission (AOSEC) Chair (2008–2010) Jeff Wang.

These competencies are used to align four key components (educational plan, faculty development, resources, and assessment) to ensure that spine specialists’ educational needs are addressed. “Underpinning Curriculum design and delivery are the four AOSpine Principles considered to be the foundation for proper spine management: stability, alignment, biology, and function.” said AOSpine Asia Pacific Chair Bryan Ashman. “Since AOSpine is working with AOE, shared approaches are being leveraged and best practices in curriculum development customized to the Specialties’ specific needs,” said Urs Rüetschi, Director of AOE, adding that “the

“Underpinning Curriculum design and delivery are the four AOSpine Principles.”

Bryan Ashman, AOSpine Asia Pacific Chair

“The basis of our approach to developing the AOSpine Curriculum was the involvement of expert surgeons, educationalists, and target learners,” says AO Education (AOE) Program Developer Mike Cunningham. “By using backward planning, we ensured that all Curriculum content is based on the patient problems that spine surgeons must diagnose and manage.” Competencies identified for each area of pathology (spinal trauma, degeneration, tumor, deformity, infection, and metabolic/inflammatory/genetic) are the bedrock of the Curriculum.

Backward planning begins with a spine surgeon in his clinic diagnosing a patient problem

high-level framework of the Curriculum makes it adaptable to all Specialties.” AOE continues to provide support as implementation gets under way, producing outcome metrics, delivering and supporting online components (eg, assessments and forums), and evaluating data and feedback. Ashman and newly appointed AOSEC Chair Germán Ochoa are leading a dedicated Curriculum group and will work closely with Chairs, Education Directors, and Faculty during pilot course implementation in 2011. The data gathered will help finalize the Curriculum for broader dissemination.

Germán Ochoa and Bryan Ashman discuss the AOSpine Curriculum during a planning meeting

Annual Report 2010

Strategy

“We forged ahead with the restructuring

process of our clinical divisions”

A talk with Norbert Haas, President of the AO Foundation, and Markus Rauh, Chairman of the AO Board of Directors (AOVA) and CEO What strategic milestones shaped the development of the AO Foundation in 2010? In 2010, we forged ahead with the restructuring process of our clinical divisions, the Specialties, at the same time as securing core funding and a promising future for our Service Units. We also established a professional Research Review Board, and allocated the funding from the previous Research Fund to the clinical divisions and the Academic Council. Haas In developing the Specialties we acted too quickly at times and some fine-tuning is now required, as we have already achieved in the area of research; increasing interdisciplinarity means that Specialties cannot be active in research on an individual basis. Clinical divisions now formulate common proposals for central research topics that we focus on and work through in conjunction with external research associations. This process of concentration is providing a significant boost to our efficiency. Start-up grants are being used as a means of attracting younger people to work with the AO Foundation. Rauh

Education is an important pillar of the AO Foundation. What recent progress do you see in further education and training? Education influences the reputation of the entire AO Foundation and we introduced innovative new education projects in 2010. We know very well that the medical education market has become considerably more competitive over the past few years. Our strategic project “AO Connect,” for instance, will bundle all our further educational activities on a single standardized platform and make them available online. We are pooling our strengths, and making it possible to significantly improve our task planning and implement the necessary checks of our results. I believe we are becoming even more competitive. Rauh

Haas Our major aim is to map the whole clinical

system as a series of process flows. While we can already offer this for the operative part, we are working together with partners in the fields of diagnostics, analysis, follow-up examinations and monitoring. Rauh The development of new curricula has always played a fundamental role. Nowadays, it is a question of using modern technology and providing the various elements of the curricula in formats such as blended learning and e-learning, giving learners a broad range of options from which to select the right package to suit their individual circumstances.

Have classical educational formats lost some of their significance? Not at all. We regard the element of personal contact and the furthering of skills that courses bring as highly valuable. Reducing the working hours of junior surgeons also reduces the amount of practical activity they do. One way in which we make up for this is with the “PlayGround,” a sort of fitness trail to improve and train manual dexterity. However, it’s important that we complement our range of courses with lifelong learning elements, and that surgeons are always involved in continuing education via the Internet. This adds to the experience they gain through the courses. Our Education Platform plays a key role here; it guarantees that education techniques and services are developed centrally, and ultimately benefit all the Specialties. Rauh Although people wrote textbooks off a long time ago, the demand for them continues to rise and we have once again published a number of volumes. On the other hand, interest in videos, which become obsolete relatively quickly, has fallen. These formats are being replaced by services such as webcasts, which move with the times. Haas

Markus Rauh, Chairman of the Board of Directors

“Clinical evidence” is a buzzword in the Haas In the future, no new technologies or health sector. What is the AO Foundation’s implants will be licensed or paid for by health position on this? insurance funds without the necessary eviEvidence-based research is becoming ever more important and I believe that, with the Clinical Investigation and Documentation Center (AOCID), we have been able to position ourselves successfully with respect to the competition in this field. Rauh

dence. We have the great advantage that new developments, which are initiated by our physicians and worked on in collaboration with our partners in industry, are always accompanied by evidence-based research and clinical documentation right from the start.

Annual Report 2010

Strategy

“Cohesion is very important to the AO”

There’s also the fact that we have made fundamental changes to our TK System—the Technical Commission. This development and licensing commission was removed from the authority of the Specialties and combined into a service-type unit. Thus we have a clearer leadership structure and greater financial transparency. Rauh

The new bylaws were approved at the Trustees Meeting. How have these been operating to date?

Two issues must be emphasized: Firstly, we realized that we might have to make a subsequent amendment to modify slightly the process of directly electing the next President as defined in the bylaws. The second issue concerns bolstering the AO Foundation’s clinical leadership. We have taken the first important steps toward meeting this requirement by transferring chairmanship of the Board of Directors (AOVA) to the President and by defining the new role of Vice-Chairperson. Rauh

Mr Rauh, what changes or challenges will arise when you transfer your current responsibilities to Rolf Jeker in the new role of Vice-Chairperson? Rauh By combining the role of Vice-Chairperson

with the responsibilities of CEO of the organization, we expect to simplify our structures considerably, and to improve cooperation and the information-sharing process between Executive Management and the Board of Directors (AOVA). I have had the privilege of serving under five Presidents of this Foundation, and it has always worked well. Now, the system must be further developed and the President who takes over leadership of AOVA must endeavor to structure this heterogeneous group in a clear and forward-looking manner.

To what extent have the clinical divisions succeeded in meeting the requirements of their communities? The efforts that were made to fulfill the needs of their communities may have brought about too much decentralization. As mentioned earlier, we are in the process of remedying this. After all, this is also what the individual employees want—to have the “AO family,” the Foundation, as the overarching unit. Rauh Yes, by depicting ourselves once again as a unit, we have made significant progress in this regard. I believe that the clinical divisions AOCMF and AOVET understand their communities’ needs very well. At AOSpine, the involvement of neurosurgeons, a process which has recently proved very successful, has brought about a certain shift in priorities. At AOTrauma, we are only just discovering what exactly the needs of that community are and how we can respond to them. Haas

What are the next steps in the reorganization announced last year, that sees the Regions finding their new Specialties’ home?

Rauh There has been a vast amount of progress

and, generally speaking, things have worked well. However, we have been forced to acknowledge that, in the case of the very highly developed Regions or Sections such as AO North America and AO Germany, the time is not right for integration into the Specialties, and that key questions still need to be answered before new discussions are held. Haas It was important for us to clarify the role and function of the Foundation. Without a doubt, a lot of work remains to be done in the regional units and in the Specialties. This is an ongoing process, which requires fine-tuning. Rauh Of course, it’s not a case of just fine-tuning everywhere. For example in Europe, where new countries from Eastern Europe have joined us, integrating them into a unit, so that they can have access to appropriate funding and can develop activities, is a major project that we still need to tackle. Haas Cohesion is very important to me—and it is something that is very clear in the Specialties, too—in identifying the AO Foundation as the “parent company” of the Specialties.

Do you think members of AOVA should be independent physicians who do not represent a particular clinical division? Rauh That is a large-scale project that is on our

agenda. I am assuming that it will be at least two years before the bylaws are amended. Haas Yes, there will be a retreat in 2011 to discuss the restructuring of AOVA so that a solution can be found for this issue too. As chairman of AOVA and President, I would very much like to take this opportunity to sincerely thank Markus Rauh, not just officially but personally, too, for everything he has done for the AO Foundation. He was always available—24 hours a day, 365 days a year—and the AO Foundation owes him a great debt of gratitude. Rauh Thank you very much.

Norbert Haas, President of the AO Foundation

Annual Report 2010

Strategy

Continued growth of clinical relevance and Clinical divisions meet stakeholders’ needs through membership programs and collaboration with Service Units

Following on from the strategic initiatives pursued in 2009, in 2010 the AO Foundation has further strengthened its clinical guidance and the relevance of its offerings to and services for the surgical community. The changes in the Bylaws, which were approved by the Board of Trustees in July 2010, put the clinical leadership on a firm footing (see Governance on pages 48 and 49).

1 Norbert Haas takes over the presidency from Paul Manson 2 AOSpine Curriculum for Lifelong Learning

Clinical Divisions The 2009 strategic initiative to establish an AOTrauma Specialty—with its full complement of Education, Research and Community Development commissions—became a restructuring process in 2010, delivering a consistent structure within the international and regional operations. The transition period for AOTrauma comes to an end at the Board of Trustees meeting in July 2011. Since membership programs are a strategic asset

in understanding and serving the surgical communities’ needs, all of the AO Specialties bolstered their competitive advantage during the past twelve months: the AOTrauma membership program went live, AOSpine simplified existing membership levels while the development of the AOCMF membership network far exceeded expectations and a new AOVET community was officially inaugurated. Service Units Progress was made in providing core funding to the AO Foundation’s Service Units in order to secure their role as collaboration partners for the clinical divisions. The strategic goal behind this initiative is to foster an interdisciplinary and cross-Specialty approach in education, research and innovation. Across the Service Units, further attention was paid to internal customer focus and to determining

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guidance the value propositions for the Specialties and the Foundation. The newly formed AO Research Review Commission (AORRC) launches its operations on January 1, 2011, with the primary aim of ensuring the highest possible quality of research supported by the AO Foundation. In order to remain at the cutting-edge of education and to extend the AO Foundation’s competitiveness, the AO Education Platform was further developed as a body for strategic direction setting in educational initiatives. Operationally, AO Education delivered a series of key services and projects, especially in e-learning and blended learning environments. Strategic projects The strategic project to plan, design and implement a single technological platform, which connects all AO stakeholders and employees to both the aggregated knowledge and business processes and applications of the Foundation, progressed significantly in 2010 with the involvement of key contributors

and users. Using a modular approach, building blocks in the areas of membership, education and research will be made available online, starting with a step-by-step rollout mid-2011. The involvement of both the AO Foundation’s Clinical Divisions and Service Units ensures the platform’s clinical relevance and attractiveness to the surgical community, guaranteeing further improvement in the global competitiveness of the AO. Personnel news During the Lisbon Trustees Meeting in July 2010, Norbert Haas was elected President of the AO Foundation and took over office from Paul Manson. In addition to the Chairmanship of the Academic Council and the Presidential Team, the new President—based on the Bylaws—assumed Chairmanship of the Board of Directors (AOVA) as well, a move which will foster the clinical guidance of the Foundation. Claude Martin Jr joined the AO Executive Management (AOEM) as the new Executive Director of AOTrauma in the last quarter of 2010.

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1 Adrian Sugar hands over the AORRC chair to Mark Markel 2 Chair Education Program (CEP) in Cairo, Egypt

Annual Report 2010

AOTrauma

AOTrauma—delivers the best patient care

in musculoskeletal trauma

AOTrauma creates a dynamic environment fostering change through its state-of-the-art education and research, and a global interactive community A year of leadership transformations The year 2010 was a challenging and exciting year for AOTrauma, its regional and international boards and global commissions. Several factors—including the decentralization of key operational decisions and budgets to the five Regions— heightened adjustments, improvements and adaptations for the newly created clinical Specialty, AOTrauma. There was demand to be accountable for the efforts and money spent in areas where the AO Foundation and AOTrauma excel: medical education, research, clinical investigation and documentation. In October 2010, AOTrauma consolidated its management team with Claude Martin Jr, an AO fellowship trained hand surgeon, joining as Executive Director and Christoph Volz as the Community Development Manager. Michael Wagner, Chairperson of the AOTrauma International Board, as well

as its members, regional representatives and commissions continued to provide excellent leadership and steady operational expertise. The AOTrauma Transition Board became the AOTrauma International Board, having established a fully functional clinical Specialty. Nikolaus Renner was nominated by the AOTIB as Chairperson-Elect, and then approved by the Board of Directors (AOVA) in Davos in December 2010. A stronger presence AOTrauma is committed to empowering the next generation of trauma and orthopedic surgeons and related health care professionals, and to driving its academic excellence and community spirit. AOTrauma defines how musculoskeletal trauma professionals can join a distinguished international organization with distinct benefits for potential members and, most importantly, the patients they treat. In fulfilling its mandate, AOTrauma integrates its activities very closely with all AO stakeholders. Prudent economic policies, attainable budgets, and member-focused orientation allow it to carry out its principal duties: providing state-of-the-art musculoskeletal and trauma education, research, and community development. Building a strong network in Community Development Creating an interactive network that adds value to a community is an important and challenging task. In a year marked by change,

AOTrauma took a bold step and launched its global membership scheme designed to create a stronger and more present network of trauma specialists and collaborators. On September 1, 2010, the membership program went live, introducing valuable and tangible benefits for AOTrauma members. Legacy memberships, including AO Alumni Association with its worldwide Country Chapters, Country Sections, Trustees and others, were incorporated into the AOTrauma membership. Within months of its launch, the community attracted nearly 1,000 new members who were proud to belong to, share and commit to advancing the ideals of AOTrauma and the Foundation. At the AO Foundation Davos Courses 2010, the impact of change was evident in the latest technical developments and innovations showcased by AOTrauma. The year 2011 will be a stimulating year for the AOTrauma membership and community development program as it endeavors to continuously improve— integrating established members into the new program and creating a cross-cultural mix that moves forward to be an active community of excellence. Making a rapid transition in Education As the new AOTrauma Specialty was maturing in 2010, surgeons and ORPs indicated that AOTrauma Education (AOTE) should be: focused on clinical problems; practice relevant; evidence-based; driven by surgeons; adapted to regional content needs; able to leverage

technology; just-in-time; versatile; and taught by the best faculty. In order to deliver these requirements, teams of surgeons and educationalists used the best educational practices in backward planning (beginning with patient problems from expert surgeons as the central method of defining curriculum content) to develop solutions. A new Faculty Development Program, integrating online activities and discussions, face-to-face microteaching and exercises, and coaching and mentorship, was developed. AOTE accommodated regional differences, addressed time specific needs and global access by way of: 1. E-learning modules: in imaging, radiation hazards, bone healing, and reduction 2. Mobile apps: Müller AO Classification of Fractures and AOTrauma Surgery Reference 3. Educational gaming: Müller AO Classification of Fractures methodology 4. Interactive video: as an educational tool in collaboration with AO Education 5. Webcasts/webinars: for active, live participation of registered participants 6. AOTrauma video library: expansion and conversions to podcast and download formats 7. Online forums and communities of practice: for registered participants to share cases, clinical problems, and meet experts online 8. Blended courses: offering online modules prior to courses so as to increase hands-on practice and interaction with peers and experts at the course.

AOTrauma International Board (AOTIB)

AOTrauma Community Development Commission (AOTCDC)

AOTrauma Research Commission (AOTRC)

AOTrauma Education Commission (AOTEC)

Chairperson: Michael Wagner

Chairperson: Klaus Dresing

Chairperson: Nikolaus Renner

Chairperson: Steve Schelkun

Regional Chairperson AOTAP

Regional Representatives AOTEU

Regional Chairperson AOTLA

Regional Chairperson AOTME

Tadashi Tanaka

Rami Mosheiff Hans-Jörg Oestern

Sergio Fernandez

Mamoun Kremli

Regional 3 Commission Representatives Chairpersons AOTNA

AOTrauma Transition Research Commission Nikolaus Renner AOTrauma Transition Community Development Commission Klaus Dresing

Chairperson AOTEU Community Development Committee

Chairperson AOTLA Community Development Committee

Chairperson AOTME Community Development Committee

Chairperson AOTNA Community Development Committee

Juan M Concha

Kamel Afifi

Cliff Turen

Chairperson AOTAP Research Committee

Chairperson AOTEU Research Committee

Chairperson AOTLA Research Committee

Chairperson AOTME Research Committee

Chairperson AOTNA Research Committee

Representative AOTK

Frankie Leung

Michael Blauth

Mauricio Kfuri

Hazem Abdel Azeem

Michael Stover

David Helfet

Rodrigo Pesantez

Peter Messmer

David Stephen Mark Vrahas

Chairperson AOTAP Education Committee

Chairperson AOTEU Education Committee

Chairperson AOTLA Education Committee

Chairperson AOTME Education Committee

Chairperson AOTNA Education Committee

Representative ORP Committee

Bruce Twaddle

Emanuel Gautier

Kodi Kojima

Wa’el Taha

Michael Baumgaertner

Martin van Dijen

Jack Wilber Peter Trafton

AOTrauma Transition Education Commission Steve Schelkun

Executive Director: Claude Martin

Chairperson AOTAP Community Development Committee

Miles de la Rosa

Matej Cimerman

Community Development Manager: Christoph Volz

Representatives:

Research Manager: Philipp Büscher

Education Manager: Clint Miner

Annual Report 2010

AOTrauma

Creating a global interactive network

1 AOTrauma partner, Human Anatomy, shows a 3D model at the Davos Courses 2 M üller AO Classification of Fractures iPhone app

Evidence-based research

The next “big ticket item” in Research The goal of AOTrauma Research is to define and implement evidence-based guidelines and to find and introduce new treatment methods. To reach that goal, the Specialty aligns resources and focuses on select research topics.

als discussed and identified specific topics for further research studies. This allows AOTrauma Research to be more clinically relevant and to bring greater value back to the AOTrauma Specialty and ultimately to patients and surgeons.

As efforts continue to be directed towards addressing fragility fractures and fracture fixation in osteoporotic bone, trauma and orthopedic surgeons are universally concerned about postoperative infections. Despite best practices in antibiotic therapy, pre-operative planning, careful technique, meticulous tissue manipulation and wound management, competent fracture fixation can be severely undermined by such an infection. A clinical priority project (CPP) began in 2010 to shed some light on this devastating clinical problem with an expert meeting to corroborate key research questions and encourage experienced researchers to propose quality projects. It will take the better part of 2011 to get this CPP— planned for 2012—off the ground.

Innovative solutions to clinical problems in the TK System In 2010, the TK System concentrated on the thorough definition of clinical problems as compared to technical modifications. Transspecialty task forces were implemented in biomaterials, thorax/sternum, and cables/ cerclage wires. This new approach—screening of ideas for potential application in corresponding clinical areas—has made innovation open to unexpected solutions. A prioritization process was set up for optimal use of engineering resources to accelerate development and throughput time. The goal remains to develop universal solutions suitable for relevant clinical situations.

ed for a wide range of trauma and reconstructive indications. The Slipped Capital Femoral Epiphysis Screw Set allows standardized treatment options for rare, but significant pediatric problems. The Proximal Femoral Nail Antirotation (PFNA) can now be used in conjunction with augmentation using Traumacem V+, a Polymethylmethacrylate(PMMA)-based cement with improved biocompatibility and higher stability compared to standard PMMA. The Expert Tibia Nail is now available in a gentamicin-coated version to reduce the risk of infections. This new concept required an extended approval process with the regulatory authorities. Existing sets have been enhanced: the Variable Angle Locking Clavicle Set by medial and lateral plates, the Philos by suture hole options, the LCP Paediatric Hip Set by 130º and 140º plates, and the 3.5 mm LCP Proximal Tibia Set by low bend and high bend versions. In computer-assisted surgery, the Trauma Module 3.0 for 2D fluoroscopy image-based navigation has been completed.

TK System highlights The 2.4 mm Variable Angle Locking Intercarpal Fusion Set for posttraumatic medio-carpal collapse after various carpal injuries was introduced in 2010. The 2.4/2.7 mm Variable Angle LCP Forefoot/Midfoot System is intend-

Moving forward with Operating Room Personnel (ORP) AOTrauma ORP held 99 courses in 2010 with 5,555 participants learning AO Principles. In Tunisia, Oman and Kuwait, this was a first-time occurrence. Another twelve ORP events, with

To gain exposure to clinical problems which may require a dedicated research focus, AOTrauma organized several regional research forums in 2010. Participating clinicians, researchers and other health care profession-

576 attendees, were held in AO Socio Economic Committee (AOSEC) countries while eight ORP were awarded fellowships of varying durations in Europe. July 2010 saw the release of the enthusiastically received “Techniques and Principles for the Operating Room” by Matthew Porteous and Susanne Bäuerle. This book was welcomed as a valuable tool for all ORP as well as residents starting careers in orthopedic trauma care. In September 2010, the international AOT ORP task force met for the first time to create a new global AOT ORP curriculum. A first draft of the program focusing on face-to-face teaching, including pre- and post-course assessments, is under development. New teaching methods, including e-learning modules, will be implemented. The entire program will allow ORP interested in trauma to pursue selfdirected learning at their convenience.

2 1

Twenty-five ORP from 22 different countries were invited to be trained as course faculty. Due to the newly established AO activities for ORP in certain countries, many ORP have only recently become involved with the AO. This education program has been specifically designed to support competent ORP in becoming better adult educators.

1 E xpert meeting on bone infection in Chicago 2 Intercarpal Fusion System 3 AOTrauma ORP international program editors

Annual Report 2010

AOTrauma

Regional activities

1 AOTAP Clinical Research Forum participants in Hong Kong 2 AOTAP Faculty Training Course in South Korea

Asia Pacific: good to great! Over 60 AOTrauma Principles, Advances and Specialty courses, including ORP courses, were conducted in the Asia Pacific region (AOTAP) in 2010. Given the growing demand for courses, faculty development is a major focus of AOTAP education development with three education programs for faculty organized last year in China and South Korea. Varying from four to eight weeks of both face-to-face and asynchronous learning, these programs provided surgeons with opportunities to enhance their knowledge and skills as educators. Additionally during 2010, seven starter fellowships and 21 regional and international fellowships were awarded.

Cliff Turen, Chairperson, 2010 AONA meeting, said, “Our goal is to bring the Specialties into one cohesive group and to reinforce the unity of purpose within AONA. The interactive discussions and featured networking opportunities capitalized on the strength of each specialty and encouraged ample discussion, thought-provoking ideas and solutions for attendees to apply to their practice.” The exhibit floor hosted participants eager to see the newest products and solutions from top vendors in the industry. “The Magic of Synergy: Challenges in Fracture Care across Disciplines” has already been scheduled for early 2012 in Florida.

The AOTAP Clinical Research Forum was held in Hong Kong in September 2010 bringing together the region’s research expertise to demonstrate and showcase research work and achievements within the region. Six one-year stand-alone research grants were awarded to support projects dealing with trauma, surgery of the musculoskeletal system and related basic and clinical research.

Latin America: a stronger presence AOTrauma Latin America (AOTLA) increased its focus on faculty development by introducing three Faculty Education Programs in Mexico, Brazil, and Argentina attended by 45 faculty members and future course chairpersons in the regions. On the organizational side, a new AOTLA chairperson and three members of the AOTLA Regional Board will commence their terms in 2011.

North America: strong debut for crossdiscipline meetings The new multi-specialty meeting, “The Power of Synergy—Working Together for a Stronger Tomorrow,” made a strong debut in Phoenix, Arizona in November 2010. Over 200 surgeons, fellows, residents and exhibitors came from all over the world to make contacts and explore the latest approaches from renowned thought leaders and AO North America (AONA) faculty.

AOTLA supported over 70 educational activities, including courses and conferences (with a budget allocation similar to that of 2009) through careful definition of faculty and efficient operating cost control. Countries like Brazil, Argentina, Mexico, Colombia, Peru, and Chile continued their leadership in educational events, while Columbia and Brazil saw a rise in the number of new AOTrauma members. In recent years, AOTLA began

financing its own research fellows at the AO Research Institute Davos. During 2010, a fellow who had gained valuable international experience returned home to Latin America to take on a clinical faculty position in Brazil.

Final Program

AOTrauma Clinical Priority Program (CPP) workshop

communities. Five seminars and five cadaveric workshops are planned as special education events in 2011.

Bone Infection July 23, 2010 Boston, USA

Europe: moving forward AOTrauma Europe (AOTEU) continued to grow in 2010 with further integration of legacy members and alumni. The membership launch was well received by the 2,000 existing members from European countries. At the AOTEU Country General Council Assembly in London in August 2010, a largely decentralized governance structure was recommended as being the best way to proceed and progress. Community Development, Education and Research officers were nominated and the regional committees of Education and Community Development have been very active throughout 2010. Home to Trauma & Orthopaedics

Europe continued to account for nearly 45% of all AOTrauma course participants, globally. The highlight education events included successful regional AOTrauma courses in Malta, and a European faculty retreat that provided knowledge exchange and opportunities for collaboration among the faculty and surgeon

Middle East: a cohesive emerging group AOTrauma’s newest region, AOTrauma Middle East (AOTME) became more cohesive and assumed a prominent position within AOTrauma International. With Mamoun Kremli as Chairperson of the Middle East Regional Board, the first AOTME country chair council convened in Dubai in October 2010 with 13 countries represented. The chairpersons discussed requirements at the country level, how to align the needs and share resources, as well as how to grow the AOTrauma community in the Middle East. Educational events were held in two new locations, Iraq and Kuwait. The annual regional courses in Dubai received great praise for the quality of the faculty and the best-practices of the educational content. Challenges for the region in 2011 will be demand outstripping supply of educational capacity. Enthusiasm and awareness remain strong in this emerging region for AOTrauma International.

1 AOTME Chairman Mamoun Kremli presenting at the Lisbon Trustees Meeting 2 AOTEU Cadaver Lab in AMTS, Lucerne, Switzerland

Annual Report 2010

AOSEC

AOSEC—2010 was a watershed year Interview with AO Socio Economic Committee (AOSEC) Chairperson John Croser

Projects Africa Cameroon Ethiopia Ghana Kenya Malawi Tanzania Uganda Zambia Projects AO Latin America Brazil Mexico

1 John Croser, new AOSEC Chairperson 2 A OSEC Chairmanship handover from Paul Demmer to John Croser

Tell me about your strategic priorities in 2010? This was a watershed year for AOSEC as it saw the end of Paul Demmer’s tenure as Chairperson, a position that he made his own over his nine years in office. The challenge for AOSEC was to manage this transition, particularly in Africa where Paul had also held the role of Africa representative, and his contacts within the medical and orthopedic communities were invaluable to us. Fortunately we were able to negotiate a transition to this role by Jim Harrison who already has an excellent track record in Malawi, especially in the field of education, while I took over the Chairperson position with a less hands-on role. The organization is also fortunate in gaining Joachin Prein as a member of the AOSEC Committee, thus recognizing the value of his contributions and contacts in his previous capacity as an ex-officio advisor. Another priority has been to look at where we’ve been, where we are and where we are going. We are considering the winding down of activities where we have been able to hand over financial support and management to organizations such as the East-Central-Southern African Orthopaedic Association (ECSAOA), and this will be an ongoing process. I can also report that we have developed a good working relationship with AOTrauma (AOT) in 2010, particularly with respect to AOTrauma Asia Pacific (AOTAP), resolving situations where

there was overlap between these two parts of the AO Foundation. In particular I would like to mention the debt of gratitude we owe Susanne Bäuerle. Susanne is an incredibly effective liason between AOSEC and AOT and is central to our development of ORP in developing countries. She brings her experience of staff development in AOTrauma to AOSEC, from which we benefit greatly. We are very grateful that AOTrauma recognizes our need and continues to provide support.

What have been the big success stories for AOSEC in the past twelve months? We are now seeing locally recruited and trained medical practitioners in Africa organizing and becoming educators on courses at a local level. This process is also taking place in the same way throughout the Indian subcontinent. It is our mission for this evolutionary process to happen in all our Regions, until such time as the AOSEC can withdraw and future training devolves to AOTrauma. I would like to make a special mention of an event that took place at the 2010 Trustees Meeting whereby a large number of the Trustees donated their per diems to AOSEC and in particular to the Malawi fund under the auspices of Jim Harrison. These generous donations made a significant difference and were used to very good effect. Such contributions are always appreciated and provide great benefits in the countries in which AOSEC is

active. We would love to see this noble gesture become an annual occurrence.

Have there been any major disappointments this year? Integrating our activities into the overall AO Foundation financial model is always a challenge. In African countries, for example, it happens that courses get moved from one quarter to another for a variety of reasons. When this happens, particularly toward the end of the financial year, the courses then run the risk of losing their funding. Unfortunately this occurred with three courses last year that were moved to the following year. Obviously we continue to have problems with unstable political situations in Africa and a number of countries in the Asia Pacific Region and it’s not safe for us to bring faculty and equipment into these countries in order to deliver courses. As we expand into Francophone West Africa this issue has to be factored in to our planning.

ing courses in Central Africa. They will then be able to go back and plan and deliver courses in their own countries. Developing AOSEC’s operations in West Africa continues to be a strategic priority for us in 2011.

What are your other big plans for 2011? In addition to continuing to provide courses in Central Africa and South East Asia, we are undertaking to finish the AOSEC Manual. Planning for this publication began a number of years ago but changing needs and a requirement to focus on different regions have resulted in an amended plan. We now have new funding and AOSEC is planning to bring this project to fruition. Paul Demmer and I will act as editors and the textbook will focus on delivering good trauma care with limited facilities in developing countries, covering non-operative techniques which are not included in the existing AO Manual. We will be referencing the operative resources of the online AO Surgery Reference.

How is the expansion of your mission into West Africa going?

What is your message for the network of AO Foundation surgeons?

Sylvain Turner, a French surgeon, was elected to AOSEC in 2010 to help develop our expansion into the Francophone Region of Africa. Sylvain has already done a lot of the groundwork by identifying the key people in the relevant countries and putting forward proposals for courses. In the next phase these key people will need to be brought up to speed by attend-

We are grateful for the continuing support of the AO network. We are always eager to know about new projects that surgeons establish in countries in which we operate. We want to ensure that we do not overlap; we are all working for the same cause and with transparency we should be able to avoid duplication and wasting of resources.

Projects AO Asia Pacific East Timor Fiji Papa New Guinea Solomon Islands Projects Indian and Asian Subcontinent Bangladesh India Nepal Pakistan

1 Jim Harrison, new Africa Representative for AOSEC 2 AOSEC ORP Course held in Zambia

Annual Report 2010

AOSpine

AOSpine—the global leader in cutting-edge AOSpine is composed of surgeons, researchers, ORP, and health care professionals from all continents providing educational, research, consulting, and networking opportunities Significant accomplishments in 2010 The launch of the AOSpine Knowledge Forums, the development of the AOSpine Curriculum and the continuous growth of the community further established AOSpine’s position as the leading global academic community for innovative education and research in spine care. In 2011, AOSpine’s innovative drive in education, research and community development will be reflected at the Global Spine Congress and events worldwide.

1 Discussions during the World Forum for Spine Research 2010 2 AOSpine Membership

Breaking new ground in Research AOSpine successfully launched the Knowledge Forum concept where working groups lead by key opinion leaders in specific spine pathologies aim to generate and disseminate knowledge by publishing evidence-based recommendations, developing and updating clinical practice guidelines, and performing clinical studies, which will assist all AOSpine members in clinical decision-making. The first Knowledge Forum on tumor was launched in Davos in 2010 focusing on a clinical study to determine predictors of local recurrence and survival in the surgical management of primary tumors of the spine. Moving forward, AOSpine is evaluating the needs and options for the remaining pathologies. Research—experimental Up until the end of 2010, more than 30 peer-reviewed papers have been published, and more than 90 articles presented from the Spine Research Network. The Research

Commission decided to continue the success of this Clinical Priority Program with its focus remaining on Intervertebral Disc Degeneration and Regeneration. Research—clinical Scoliosis Research Society (SRS) cooperation project

AOSpine initiated a clinical project in conjunction with the Scoliosis Research Society. The goals of this prospective, multi-center study will be to establish the risk of neurological injury related to surgical correction of adult spinal deformity and to identify characteristics associated with increased risk of neurological complications related to the surgery. Cervical Spondylotic Myelopathy—International Study (CSM-I)

The CSM-I study reached a critical milestone: the end of the patient recruitment period. With almost 500 patients, this project is one of the most extensive prospective clinical studies in the field of spine. World Forum for Spine Research The World Forum for Spine Research (WFSR) was held in Canada in July 2010. This event focusing on intervertebral disc was a significant success for AOSpine with more than 175 participants who benefitted from the expertise shared. Based on the positive feedback and experience of the Montreal WFSR, the AOSpine Research Commission decided to organize another in 2012 in Helsinki, Finland.

Member No. 10203

education and research Education—major steps forward A strategic education workshop with representatives of all key stakeholder groups was held in Rio de Janeiro, Brazil. The goal of the workshop was to set the long-term strategic direction of AOSpine’s educational programs by achieving the following key strategic objectives: • Creating a strategic vision for education • Identifying key factors of change • Developing innovative educational tools and formats • Working toward positive cultural change, becoming an even stronger learning organization • Building stronger learning communities and communities of practice • Supporting creative, visionary leaders in education AOSpine Curriculum

Development of the AOSpine Curriculum for Lifelong Learning, a significant step for AOSpine, began in 2010. This innovative and sustainable competency-based model puts AOSpine in a position to plan, implement, and measure quality education. Under the guidance of Jeffrey Wang and Bryan Ashman, the AOSpine Education Commission drove this project by developing essential competencies for each of the six spinal pathologies—what surgeons need to effectively perform in their practice settings and meet the standards of the profession. This is what drives our educational programs and forms the framework for all educational activities—face-to-face courses, e-learning modules, videos. Work on the Curriculum culminated in December

with a pilot module element included in the Davos Advances Course, featuring pre- and post-course assessments and a faculty support package. The next crucial step will be to roll out the Curriculum globally and gradually integrate all our educational activities. The AOSpine Education Commission (AOSEC), led by recently elected Chairperson Germán Ochoa, will drive this process, integrating input and direction from the regions based on local needs and implementing several curriculum-aligned courses worldwide during 2011. Continued growth in AOSpine Community Development AOSpine’s Community Development mission is to attract spine care professionals to advance AOSpine’s mission. Accomplishments such as the simplification of the Membership Program, the rollout of a more effective communications strategy, and the introduction of the Evidence-Based Spine-Care Journal (EBSJ), a new journal with a directive to enhance the quality of evidence in spine; and Scolisoft, an interactive library of adolescent idiopathic scoliosis cases, were instrumental in achieving a 23 percent increase in AOSpine Membership in 2010. In 2011 AOSpine plans to enhance its website—www.aospine.org—in order to provide a valuable and persistent connection for members. The aim is to quickly and smoothly connect members with knowledge that is organized and managed to be used effectively, and to connect them with each other. The community epitomizes the essence of AOSpine, where members can improve patient outcomes through knowledge sharing, collaboration and communication.

Valid to 04/11

Ziya Gokaslan A member of AOSpine in North America

EXELLENCE IN SPINE

The AOSpine community—together we lead the improvement in the outcome and cost effectiveness of spine surgery. Neurosurgeon

1 The AOSpine International Board 2 AOSpine Curriculum competency-based model

Annual Report 2010

AOSpine

Leading the way New approved products from the TK System In 2010 the Spine TK introduced several new products, some of which are detailed here. The Matrix System is a non-cervical spinal fixation device intended for use as posterior pedicle screw fixation system (T1-S2/ilium), a posterior hook fixation system (T1-L5), or as an anterolateral fixation system (T8-L5). The new Matrix 5.5 MIS allows placement of cannulated pedicle screws and the Matrix MIS rod in a mini-open non-visual or percutaneous approach. This system will complement the existing interbody fusion systems as supplemental fixation for lateral, anterior, posterior or posterior transforaminal fusions using a minimal incision and preserve the soft tissue.

2 1

1 Prodisc-C Nova implant lateral x-ray 2 AOSME Regional Meeting 3 AOSAP Course in Beijing, China

The new Prodisc-C Nova is intended to replace a diseased and/or degenerated intervertebral disc of the cervical spine in patients with symptomatic cervical disc disease (SCDD) allowing for the removal of the diseased disc while restoring biomechanical stability and disc height, and providing the potential for motion at the affected vertebral segment. It offers improved MRI and multi-level capability as well as simple one-step keel cutting. The vertebral body stent (VBS) system is an expandable metal scaffolding that can be inflated from inside a vertebral body, thus addressing the procedural drawbacks of common treatment options like vertebro- and kyphoplasty. Regional activities Asia Pacific: a year of growth and progress AOSpine Asia Pacific (AOSAP) achieved a membership growth of 40% mainly driven through the Neurosurgeon Engagement Pro-

Regional activities gram for China and Korea. The region also saw an increase in the number of education events (from 26 to 36) and the number of participants (from 1,780 to 1,860). The East Asia Council and the Regional Board elected new officers, with Bryan Ashman leading the regional board for the next three years. All new officers were inducted, resulting in better succession continuity and program strategies that are better aligned and implemented between region and country councils. Europe: recognizing diversity While building on past successes, by working to ensure strength in each country, the following highlights in AOSpine Europe (AOSEU) were noted in 2010: • 25 educational events in 18 countries, with flagship courses in Palermo and Strasbourg • A community of nearly 1,500 members, guided by a new regional board • The relaunch of a region-wide spine center network and development of a new research strategy In 2011, we will leverage deep local relationships while developing faculty to ensure consistently high quality education; lead the way in implementing the AOSpine Curriculum, innovative e-learning tools and expanded use of wet labs; and ensure our network is a genuine community enabling all to get involved. Middle East and North Africa: achieving critical mass The strategic focus of AOSpine Middle East (AOSME) in 2010 included: planning future expansion from three educational events in 2010 to six in 2011, country chapter regeneration and expansion across the region, while ensuring

the ongoing development of a successful fellowship program. Continuing into 2011 and with changing political situations in the Region, we will embed the AOSpine brand by raising education standards through widespread application of the AOSpine Curriculum, expanding the reach of local educational activities and identifying new markets. North America: raising our profiles AOSpine North America (AOSNA) investigators completed the two year follow-up of 278 patients with cervical spondylotic myelopathy (CSM). The comprehensive study, which has garnered several prestigious awards, has contributed key knowledge with important implications for everyday practice and health policies. A leading academic journal, Spine, published two AOSpine Focus Issues on “Complications” and “Trauma” in 2010. The “Complications” issue outlined major patient safety issues combining formal evidencebased review methods and clinical experiences. The “Trauma” issue represented the collective efforts of the Spine Trauma Study Group, summarizing and critically evaluating many of the key controversies related to the management of spinal trauma and cord injury. The revised course curriculum for the Principles of Spine Surgery for Residents will be introduced in 2011. AOSNA will be offering help with the mandatory Maintenance of

Certification required for practicing spine surgeons. Latin America: a remarkable year This year saw the milestone of 1,000 members in AOSpine Latin America (AOSLA) reached and a notable increase in educational activities (15 courses and 32 seminars with 1,830 participants). An additional highlight was the gathering of 40 delegates from across the region at the Latin American Education Meeting where the main objective was to strengthen and improve Faculty teaching skills and to enhance the quality of AOSpine educational activities. Some Regional Officers reached the end of their term giving Osmar Moraes (Chairperson), Roberto Postigo (Education Ortho), Marcelo Valacco (Community Development) and Andrés Rodríguez (Spine Centers and Fellows) the opportunity to lead the Region. Looking forward to 2011, AOSLA will implement the AOSpine Curriculum and the AOSpine Principles in a comprehensive program combining an innovative online platform with traditional education activities. In addition the Region will establish faculty and event organizer guidelines to streamline the delivery of educational courses and ensure roles are clarified. Furthermore, a new Observership Program will be designed to encourage greater collaboration and the exchange of experience across the Region.

1 AOSAP Chairmenship handover 2 AOSME Course 3 AOSLA Education Meeting in Rio de Janeiro, Brazil

Annual Report 2010

AOCMF

AOCMF—a global driving force in innovative AOCMF uses modern techniques to achieve successful patient rehabilitation. In 2010, education flourished and membership grew to unexpected levels Building on last year’s successes Despite the impact of natural disasters and unstable political situations in some parts of the world, the scope of AOCMF educational activities has broadened for the fifth consecutive year and major progress has been made on the implementation of a three-year Mid-Term Course Planning process. The development of the AOCMF membership network far exceeded expectations while the AOCMF Clinical Priority Program created a high level of awareness and participation within the CMF network with peer reviewed projects of the highest scientific quality well under way.

1 AOCMF Principles Course, Tehran, Iran 2 AOCMF Strategy Retreat, Miami, USA 3 Orbital Course & AOCMF Symposium, Mallorca, Spain

Defining the best way forward in AOCMF Education For the AOCMF Specialty Board, defining the Global Education Strategy during the Miami Education Retreat was a major milestone. Strategic decisions were taken to ensure the quality and relevance of educational offerings by revisiting content offerings; evaluating educational quality on a regional level and conducting pre- and post-course assessment (a pilot was launched by AOCMF North America). AOCMF Education will use new promotional channels (the AOCMF journal, website and associated events) to market their courses. It was further agreed that Operating Room Personnel courses are of high importance to the Specialty and will continue to be offered as part of the education portfolio. Innovation was high on the agenda with the integration of new communication and information technologies seen to be key. A

task force has been mandated to evaluate the integration of e-learning content into AOCMF Principles Courses. At the AOCMF European Faculty Retreat, faculty development and the implementation of the strategic education priorities within Europe was discussed by 70 European faculty members. A major 2010 landmark achievement was the first AOCMF Neurotrauma course in Davos attended by 33 participants from 16 countries. AOCMF courses worldwide reported another successful year delivering 72 courses for surgeons, ten for ORP and four symposia at national or international congresses, while the number of fellowships remained stable at 29. Milestone year for the AOCMF membership community By April, the community had already exceeded its year-end goal of 900 paying members. One month later, we welcomed our 1,000th member. AOCMF also reached the milestone of having its first round of membership renewals in 2010. Overall, AOCMF achieved a healthy member retention rate of 67% and the year ended with a final tally of 1,333 paying members worldwide. The successful growth of the AOCMF member network enabled the Community Development Commission (CDC) to negotiate additional benefits to our members. In July 2010, access to five new scientific journal subscriptions was made available. In addition, a new

education and research database containing summary information on published clinical CMF trauma evidence is currently under development and will be offered to members in 2011. The CDC’s first election cycle was in November 2010 and it was determined that, in August 2011, Gregorio Sanchez-Aniceto will succeed Nils-Claudius Gellrich, who has chaired the Commission since its inception in mid-2007. Fruitful collaborations continue After the successful launch of the Clinical Priority Program (CPP) “Imaging and Planning of Surgery” the decision was made to continue the program in 2010 by granting support to seven additional grant applications (out of 13 full grant applications submitted to AOCMF). Overall there are 19 studies in nine countries in both the “Imaging and Planning of Surgery” and “Large Bone Defects in Relation to CranioMaxilloFacial Surgery” supported by AOCMF. The AOCMF R&D Commission and the CPP Committee members monitor the ongoing studies on a regular basis and offer advice when necessary. The first publications resulting from supported projects have either been accepted or are being prepared. The planned workshop to be held in 2011 in “Imaging and Planning of Surgery” will present an ideal opportunity for researchers to share their outcomes with others working in the same or similar fields of interest. AO Clinical Investigation and Documentation and the AO Research Institute Davos (ARI) continued their AOCMF supported studies. The clinical study on orbital fractures was successfully launched and patient recruitment continues. In cooperation with ARI, a new call for projects in the area of “Bisphosphonate-

Related Osteonecrosis of the Jaw” is in preparation and will be launched in 2011. New TK approved products In 2010 the CMF TK completed the family of previously developed craniomaxillofacial Matrix Systems which are available for midface and neuro procedures with the finalization of the new Matrix Mandible System. The plates in the system have rounded profiles and edges and an improved “angle plate” designed to reduce stress in critical areas. In keeping with previously released Matrix Systems, all screw diameters in the set can be used with all the plates in the system. The Matrix Mandible System will also provide the basis for future developments to continuously ensure state-ofthe-art patient care, ie, a preformed (anatomical) reconstruction plate. Just like its sibling for trauma indications, the new Norian Reinforced Fast Set Putty is a moldable, biocompatible, calcium-phosphate bone cement, with added reinforced fibers, that sets at body temperature. It is indicated for repairing or filling craniofacial defects and craniotomy or augmentation of bony contours of the craniofacial skeleton. To avoid cracking during the setting phase caused by dural pulsations, reinforcing fibers were added to the formula of the existing Norian. Furthermore the new Curvilinear Distraction System is an internal distraction osteogenesis device that gradually advances mandibular fragments along a curved trajectory of distraction. It addresses the clinical need for an internal mandible distractor that lengthens the mandible in both vertical and horizontal planes.

1 The Matrix Mandible System 2 The Curvilinear Distractor 3 AOCMF Faculty Retreat, Montereggione, Italy 4 Paul Manson presenting the AOCMF journal

Annual Report 2010

AOVET

AOVET—education leads the way AOVET’s mission is to advance the practice of veterinary surgery to improve patient outcomes by promoting experimental and clinical research, education and development

Jean-Pierre Cabassu AOVET Chairman

1 Faculty and participants Equine Principles Course, Sao Paolo, Brazil 2 AOVET Faculty at Principles Course, La Jolla, USA

Structural changes forge ahead AOVET has undergone significant changes in 2010. In an effort to expand the value of its network of veterinary surgeons and rejuvenate the membership, the decision was taken to adopt a new set of guidelines that established AOVET as an AO Specialty in its own right. These guidelines were submitted to the members of the previous AO Vet Association in November 2010 and, with an overwhelming approval rate of 92%, the new AOVET community was officially inaugurated. As a consequence the original AO Vet Center, as an administrative unit, was closed and integrated into the AOVET Specialty structure. The former Director of the AO Vet Center, Joerg Auer, was thanked for his continuing dedication and commitment to the community over the last several decades by the AOVET International Specialty Chairman Jean-Pierre Cabassu. In order to determine the future strategic direction of AOVET, the AOVET Specialty Board conducted a strategy retreat in 2010. There, it was decided that going forward the AOVET Specialty will focus on emphasizing its global reach, and multi-specialty character. Furthermore, high quality educational output (CME, faculty development programs, conceptual teaching with highest quality implants/ instruments) will be the key focus. AOVET as a community will aim to deliver significant

value to its active, contributing members as well as clear and transparent career opportunities for young members. Furthermore AOVET will follow a partnership oriented approach with other scientific societies to further foster its reputation and importance. Rejuvenation of a community AOVET is seeking to strengthen its position as a global community of veterinary orthopedic specialists, focused on surgeon education. Therefore, in mid-2010 the AOVET Specialty Board reviewed and redefined the existing AOVET membership scheme with the aim of expanding the network and providing colleagues worldwide with clear value and improved benefits, while maintaining the strong community spirit. In order to make the AOVET community accessible to young members while preserving the prestigious character of the existing membership, the new program seeks to address the new social and communications needs of these members, without compromising the high value of the existing network. It is focused on a lean and efficient central administration, while making it easier for members to build personal relationships. The new scheme makes a distinction between four categories of members (Affiliate, Active, Ambassador, and Acknowledged), each of which has different

prerequisites and benefits attached to it. As valued contributors to the AOVET community, existing members have been invited to join the new AOVET membership at the level of an AOVET Ambassador. Under the auspices of the Community Development Commission, AOVET officially launched the new program in July 2010 at the European College of Veterinary Surgeons congress in Helsinki, Finland. In a few short months since its launch the number of new members has almost doubled while the majority of pre-existing members of the AO Vet group have been transferred to the new AOVET community. One of the principal advantages of this program is the improved educational and professional opportunities offered to members throughout their professional career. It has become clear that web-based communications will have an increased importance in achieving this. In return for their commitment to the AOVET community, our members now have access to several online scientific subscriptions as well as AOVET-specific educational materials. In December 2010, AOVET members were given the opportunity to participate in live webcasts of several lectures given during the annual Davos Courses. Education to lead the way Education continues to lead the way as the primary activity for the Specialty with the Education Commission working to create new educational opportunities. There were 23 AOVET courses delivered around the world

in 2010. Of particular note were first time courses launched in Latin America (Brazil) and Asia Pacific. Meanwhile in Europe the time-honored tradition of the annual small and large animal course in France is still flourishing after an impressive 22 years. This thrust to increase the number of teaching activities in the Regions continues in 2011 with a soonto-be-launched first time course in Thailand in 2011, while the AOVET Davos courses will be refreshed with new formats and approaches. The number of courses and participants will be significantly increased within the coming years. Also, the role of AOVET Education as part of the specialist training in several countries worldwide will be fostered. The AOVET Education Commission is currently working on establishing: • Continuous pre and post course evaluation worldwide, with quality and relevance of the course objectives and content being of the highest priority • Faculty development activities • Strategic course planning • AOVET specific Fellowships The Research and Development Commission was established at the end of 2010 and gaining a veterinary representative in the AO’s extensive R&D network is a significant milestone for the AOVET Specialty. The R&D Commission is currently identifying focus fields for future grants and there will be a call for proposals in 2011 for projects with a commencement date in 2012.

1 AOVET Faculty Advances Course, Sao Paolo, Brazil 2 Participants at Principles Course, La Jolla, USA

Annual Report 2010

Service Units

Strategically aligned value chain

Service Units pursue excellence in patient care The key focus of AO Service Unit activities continues to be on producing new concepts for improved fracture care, delivering evidencebased decision making, guaranteeing rigorous concept and product approval as well as timely and comprehensive dissemination of knowledge and expertise. The following eight pages offer insights into the core processes and

AO value chain

activities undertaken by the AO Service Units in 2010. Joint projects between AO Service Units and clinical divisions, with a unique Specialty focus, are reported on in the dedicated Specialty sections from pages 18â&#x20AC;&#x201C;39. An overview of Foundation-wide strategic initiatives implemented in 2010, can be found on pages 22 and 23.

Exploratory research Clinical work

Education

Approval

Research and Development

Applied/transÂlational research

Good news for ARI In 2010 the AO Research Institute Davos (ARI) published 61 papers with an average impact factor of 2.95. This year was the 10th anniversary of the eCM True Open Access Journal which received an Impact Factor of 5.378, making it the number one trauma research journal, surpassing 10,000 registered readers, with an average of 6,000 monthly visits, and 3,000 monthly direct links/paper downloads made from PubMed. Musculoskeletal Regeneration Program Polymers. The potential applications of the thermoreversible hyaluronan hydrogel platform developed in ARI are investigated in this program. In the field of bone, cartilage and spine repair, the tailored hydrogels could be valuable as injectable cell and drug delivery systems and as a biodegradable antibacterial carrier for controlled delivery of antibiotics. Stem Cells. A combination of human bone marrow derived stem cells and gene transfer offers huge potential for the repair of traumatic musculoskeletal injuries. Gene therapy is still in its infancy but some of its perceived negative side effects, such as potential immunological reactions, could be offset by the immunosuppressive nature of stem cells. In addition, this research has optimized 3D gene transfer in order to obtain the same level of transgene expression, while using less than 5% of the gene vector. This would also reduce any immunological risks. The developed

The future of trauma research method could be simply applied within an operating theater. Intervertebral Disc. Large scale gene expression profiling of human intervertebral disc cells identified new cell surface markers that can potentially be used for targeted delivery of biological agents to the disc. It was found that the expression of these surface markers on human nucleus pulposus cells may vary with aging and/or degeneration grade of the disc. Modulation of these molecules may thus be considered for therapeutic application. Methods have been developed to deliver cell suspensions in the thermoreversible hyaluronan hydrogel into large animal discs ex-vivo. Cells embedded in the hydrogel survived well in the disc space, confirming the potential of the hyaluronan hydrogel as a cell carrier. Bone Defects. The lack of implant neo-vascularisation in the treatment of large size bone defects still is an unsolved problem impairing the success of the healing process. Our aim is to develop a pre-cellularized/pre-vascularized implant based on the combination of a synthetic scaffold (eg, polyurethane) and autologous cells, both Endothelial Progenitor Cells (EPC) and Bone Marrow Mesenchymal Stem Cells (BMSC), in the presence of autologous growth factors, Platelet Rich Plasma (PRP). The in-vitro studies show that the association of EPC with BMSC within a polyurethane scaffold promotes the formation of tubular structures that are positive for key endothelial cell markers within the 3D implant.

Clinical investigation

1 Innovation presentation to the AcC members 2 Discussions during the eCMXI conference, Davos

Annual Report 2010

Service Units

The future of trauma research Musculoskeletal Infection Group The limited penetration of systemically delivered prophylactic antibiotics to poorly vascularized tissues is a risk factor for the development of infection. In collaboration with the polymer team, an antibiotic loaded degradable hydrogel has been developed and tested that may be applied to an open wound or applied as an implant coating or as filler for dead spaces. The gel continuously delivers effective concentrations of antibiotic upon gel degradation and does not require any removal surgery. Innovations Group The team started a new approach to support onsite continuous education of orthopedic trauma surgeons with an osteosynthesis training kit (OSKIT). This kit does not require a special setup, can be reused and is inexpensive. OSKIT permits practice between courses to help develop and maintain a surgeon’s skills and understanding of fundamental principles.

1 Osteosynthesis Training Kit (OSKIT) 2 Poster presentation at EORS in Davos, Switzerland

Biomedical Services Program Boyko Gueorguiev-Rüegg became Biomedical Services Program Leader in autumn and redefined the research and service work within Biomechanical R&D, Concept Development and Prototyping. Biomechanical testing facilities—with tailored models, setups and protocols for a variety of anatomical regions—offer in-situ and ex-vivo experimentation to answer clinical questions. State-

of-the-art computer simulations are applied in order to assess biomechanical behavior; these techniques increase the efficiency in terms of time, material and effort for implant optimization and mechanical testing. Concept development solutions for musculoskeletal healthcare are driven by efficiency, simplicity and clinical relevance. GCTM PreClinical Division In 2010, Global Clinical Trials Management AG (GCTM), PreClinical Division studies conducted included long- and short- term tissue reactions to bone filling materials in cancellous bone and iliac wing defect models, ISO10993-6 studies to test soft tissue reactions to novel implant materials; cartilage regeneration studies in goats; histological analysis of dental implants; tissue engineering solutions for the treatment of long bone defects; a GLP-like study to test osseointegration of novel implant materials; ex-vivo analysis of novel augmentation techniques; and testing of new orthopedic devices. Overall in 2010, 24 projects with a turnover close to 1 million CHF were subcontracted to the ARI which provided the required personnel, facilities, and equipment. Congress organization The Eleventh eCM Conference was held in Davos in June 2010 attracting 150 participants. The organization into single sessions and the 14 highly recognized keynote speakers optimally promoted exchange of

expert knowledge in the field of traumatic and degenerative disc and cartilage diseases. ARI also hosted the 18th conference of the European Orthopaedic Research Society (EORS) in Davos during the summer. EORS was attended by more than 300 researchers and clinicians and featured a strong scientific program with 100 oral presentations in three parallel sessions, 140 posters and 17 invited keynote lecturers. The presence of ARI and AOTrauma as scientific conference partners underlined the strong position of the AO within orthopedic research and education in Europe.

The AO Research Fund (AORF) In 2010 a total of 90 grant applications requesting over 8 million CHF in research funding were received. All applications were subject to a rigorous vetting procedure by

AO Research Fund Projects support by area:

an appointed pool of experts, and 22 new projects were approved. The AORF currently supports 32 projects costing 1.8 million CHF. This was the final year in which the AORF was responsible for reviewing the Start-Up Grant applications and making funding decisions. According to the AO Foundation’s peer-review policy, from 2011 onward the tasks of reviewing and making funding decisions must be strictly separated; thus the AO Research Fund Commission becomes the AO Research Review Commission. This new commission is responsible for implementing the centralized peer review process for all research projects supported by the AO Foundation. In addition, it will be responsible for launching calls for AO Start-Up Grant applications and administering the approved projects. The decision-making body for the AO Start-Up Grants is the newly established Academic Council Grant Committee, in which all Specialties as well as the AO Exploratory Research Board are repre% sented. The committee will be chaired by the AO Foundation’s 18.0 past President. 3.8

Subject

Number of projects

Amount in CHF 1000

Biomaterials/Metallurgy Biomechanical fixation Biomechanical joints Bone healing Clinical Implant development Maxillofacial Spine Tissue reaction Transplantation

5 1 2 8 8 2 1 2 2 1

277 58 121 421 261 118 60 90 78 53

Total

1’537

100

7.9 27.4 17.0 7.7 3.9 5.9 5.1 3.4

Berton Rahn Prize Award Each year the best AORF project is awarded the annual Berton Rahn Prize Award. After a rigorous evaluation, Teppo Järvinen of Finland was awarded the 2010 prize for his project

1 Cellular network formation involving both endothelial progenitor cells and bone marrow mesemchymal stem cells 2 Berton Rahn Prize award presentation to Teppo Järvinen 3 Poster evaluation at EORS in Davos, Switzerland

Annual Report 2010

Service Units

Exploratory Research

Where science meets clinics Collaborative Research Programs AO Exploratory Research (AOER) continued the implementation of its consortium funding strategy and its international collaborative research programs (CRPs). In 2010 two open calls for proposals were issued, one of them addressing the clinical problem of “Annulus Fibrosus Rupture” (AFR) and the other “Acute Cartilage Injury” (ACI). Following a thorough screening of pre-proposals and subsequent peerreviewed full proposals, the AOER program committees selected five AFR and four ACI research partners, respectively. The teams will start working collaboratively with the AO Research Institute Davos (ARI) in 2011 toward solutions to these important clinical problems. Together with the already established CRP “Large Bone Defect Healing (LBDH),” the three AOER programs now address all the AOER focus fields (ie, bone, disc and cartilage repair and regeneration).

Clinical Investigation

1 Research network partners in discussion during the LBDH meeting in Boston 2 Presenting research findings during the LBDH meeting in Boston

Large Bone Defect Healing The CRP LBDH, which includes seven research partners from Canada, Germany, and the US plus two research groups from ARI, started its second funding round in January 2010. The Fifth Annual LBDH Meeting held in September 2010 was hosted by Prof Chris Evans from Harvard Medical School, Boston, US. The venue included an introduction and guided tour of Evans’ research facilities, followed by progress updates from all research partners. For the first time two well-known experts in the field of bone healing, Prof Thomas Einhorn and Prof Steve Goldstein, were invited as keynote speakers, an addition

to the agenda that was very well received by the LBDH CRP meeting participants. AOER board members Prof Michael Schütz and Prof Steven Buchman, who are assigned by the AOER board to monitor program progress and to provide direction setting, also actively participated in the meeting. Annulus Fibrosus Rupture The two year funding of the CRP AFR (which includes five external research partners from Ireland, Japan, the Netherlands, Switzerland and the US and two research groups from ARI) commences in April 2011. The AOER board assigned Prof Brigitte Vollmar and Prof Keita Ito to monitor program progress and to provide direction setting as appropriate. Acute Cartilage Injury The two year funding of the CRP ACI (which includes four external research partners from Germany, Spain and the US and two research groups from ARI) also begins in April 2011. The AOER board assigned Prof Peter Roughley and Prof Takeshi Sawagucchi to monitor program progress and to provide direction setting as appropriate. Outlook AOER is hosting its first “Where Science meets Clinics” symposium on September 2–3, 2011, at the Congress Center in Davos, Switzerland. This biennial event provides an international platform for scientists and clinicians to come together and discuss, in a multidisciplinary environment, current issues and novel strategies for bone, disc and cartilage repair and regeneration.

A leader in evidence-based clinical trials

Service orientation in 2010 Steps were taken to better serve the AO Specialties and external customers in 2010. All of AO Clinical Investigation and Documentation’s (AOCID) clients are now assigned a dedicated contact person. Further improvements were made possible through an AOVAapproved core funding concept and a retainer fee from AOCID’s main industrial partner. The first-ever AOCID customers’ day was so successful that it will now be held annually. AOCID was also recertified (ISO 9001:2008) until 2013.

Clinical Research Fellowship Pratik Desai from Florida, USA, became AOCID’s ninth clinical research fellow. Two peer-reviewed publications resulted from his work in Switzerland.

Supporting the AO Regions The situation for clinical research in China and Latin America was assessed. Awareness of surgeons’ educational needs in these countries incentivized AOCID to develop e-learning modules in the field of evidence-based medicine. They are currently in development and surgeons worldwide will benefit from these packages once they are launched.

Studies of note in 2010 The SI Screw final report was released. This randomized multicenter trial evaluated the precision of sacroiliac screw placement using computer-assisted navigation compared to the conventional technique.

Notable changes in AOCID personnel David Helfet, who molded AOCID into its current form over the past decade, stepped down as AOCID Chairman to be replaced by Mark Vrahas. In Davos, employee Riitta Schmid retired after 16 years at AOCID. Certified Study Center concept AOCID was mandated to develop a system for hospitals involved in clinical studies to be certified on behalf of the AO Specialties. Processes were developed, pilot runs were conducted, and a full global launch is slated for 2011.

Davos Courses Besides giving several lectures at the annual courses, AOCID took more than 300 balance measurements at its stand in Davos. The data will be analyzed to see what correlations exist between surgeons’ balance, sporting activity and operating experience.

Studies currently recruiting include the Midfoot Fusion Bolt (MFB), a randomized controlled multicenter study to assess the effectiveness of surgical treatment with MFB in the early stage of diabetic-neuropathic Charcot feet. Orbita3 is a prospective multicenter study to compare the accuracy of orbital reconstruction after fractures of the medial orbital wall and/or orbital floor with preoperatively preformed versus non-preformed orbital plates. Twenty-five peer reviewed publications were published in 2010, and over 30 presentations on scientific work currently being conducted by AOCID were given at pretigious international conferences.

1 Pratik Desai receiving his clinical research fellowship certificate from AOCID Director Beate Hanson 2 Steve Schelkun, AOTEC Chair testing his body balance by V-skiing during the Davos Courses 2010

Annual Report 2010

Service Units

TK System

A year of planned change Fully integrated TK System As planned, the organizational and management structure of the TK System was changed with particular focus on the integration of the Spine TK into the overall framework. All four AO Specialties are now directly represented in the TK System with Trauma, Spine and CMF having their own Technical Commissions for the approval of products developed with AO’s industrial partners. At the same time collaboration with AO’s clinical divisions and service units intensified and direct communication lines were defined. This generates more efficient use of pre-clinical and clinical research services and ensures the effective integration of new techniques into the educational activities of the AO Specialties. Consequently the TK System is now considered a Service Unit. In order to provide optimal services for all groups and individual members of the TK System, new personnel were hired and new responsibilities and roles within the TK management were defined.

Education

1 Participants of the Asian TK Experts Symposium 2010 in Shanghai, China 2 T im Pohlemann (Chairman, right) and Claas Albers at a meeting of the TK Executive Board

Challenges & structural changes With growing regulatory requirements, product development in the field of medical devices is facing new challenges. This has led the TK System to put more emphasis on the systematic definition of clinical problems and to evaluate its priorities across all medical divisions. The Spine TK already implemented structural changes in 2009: Maintaining the same number of Expert Groups (EGs), the current structure is more effective in treatment-related development and allows for a closer alignment with the producers’ activities. Following this example the CMF TK replaced its former anatomical differentiation

with EGs that define their tasks and projects on the base of their members’ Specialty and experience. Focus fields and knowledge acquisition In addition to the defined EGs, new crossSpecialty Task Forces (TF) were initialized: Looking for ways to improve the treatment of periprosthetic fractures, wiring, cerclage and cable techniques were evaluated by one TF; the CT Database TF evaluated what kind of centrally stored image data and metadata is necessary for development of surgical techniques, while the Biomaterials TF was appointed to provide a clinical perspective on product development efforts in this area. The TK Experts Symposia are used to screen clinical problems at an early stage in order to expand or limit the indications, trigger further developments and support education by identifying tips and tricks. With the intention of generating a worldwide overview of regional differences, similarities and specific solutions, three symposia with the same format and content were held in Asia, Europe and North America. Each involved 40–60 highly experienced surgeons. For the first time a comparison could be made between three different regions. In 2010 the TK System consolidated its activities to remain one of the key pillars in the AO Foundation’s activities, supporting the AO’s essential role in global knowledge exchange and conveyance of new treatment aspects. More information on the products which were approved in 2010 can be found in the clinical divisions’ chapters.

Entering new areas in distance education iPhone apps, interactive videos, blended e-learning modules, and educational online games—the AO Education production teams entered a new era in technology-enabled distance education. In particular the AOTrauma Education Commission put strategic emphasis on new delivery methods and channels in education. Launched in mid November 2010, the “AO Surgery Reference” iPhone app was downloaded 11,152 times by the end of December while the Müller AO Classification 8,070 times in the same six week period. For the first time in their history the AOTrauma Davos Principles and Advances Courses were delivered with blended online modules to be worked through prior the face-to-face course. Building an entire curriculum from scratch The newly installed AO Education Program Development Group was invited by AOSpine to facilitate the building of a completely new curriculum focused on pathologies and different levels of experience of AOSpine surgeons. With the involvement of surgeons from all of the Regions, representing the diverse clinical challenges in spine surgery, AOSpine now owns a competency-based curriculum which allows them to align and build all future educational offerings on a common base. This enables AOSpine to integrate new topics and developments faster and in a highly targeted fashion into future educational activities. In AOTrauma Asia Pacific the newly founded Program Development support rebuilt the program for education in othogeriatric fracture care and aligned the AOTrauma Principles and Advances Program, adding new blended elements to the established face-to-face events.

Major new education initiatives Innovation, research, and strategic initiatives The AO Education Platform (the education representatives from all of the AO’s clinical divisions under the guidance of the AO Foundation’s President-Elect Jaime Quintero) met twice in 2010. Three new educational research initiatives were implemented, focusing on performance improvement measurement, learning patterns of surgeons, and the efficiency of technology-enabled education for surgeons. Several projects and initiatives especially dealing with new technologies and new delivery channels were discussed and organizationally aligned between the Specialties. With its mandate to look at mid- and longterm trends, innovations, and developments in medical education, the Education Platform has established its role as an educational think tank and visionary body.

1 Blended learning module concept 2 AO Surgery Reference iPhone app

Postcourse eLearning

Course

Precourse eLearning

Annual Report 2010

Governance

Enhancing the clinical guidance of the AO

Foundation

Amended Bylaws strengthen the role and authority of the surgeons

With the approval of the amended Bylaws at the Board of Trustees Meeting in Lisbon, the AO Foundation’s Trustees further enhanced the clinical leadership of the organization, which was established by Swiss surgeons more than 50 years ago. The Board of Trustees resolved on the role of the President of the AO Foundation, who will not only chair the Academic Council (AcC) and the Presidential Team as before, but who will—in addition—assume Chairmanship of the Board of Directors (AOVA). In line with the stronger leadership through clinicians, the Presidential Team became the only group authorized to nominate a candidate for the PresidentElect to the Nominating Committee.

to the President of the AO Foundation and the Board of Directors in all governance, compliance, business and management matters. Since the role of the ViceChairperson is also combined with the tasks and responsibilities of a CEO, this change is expected to further improve the collaboration between Executive Management and the Board of Directors.

The role of the former Chairman was changed to the one of a Vice-Chairperson of the Board of Directors. This person will act as an advisor

The following pages give an overview of the AO governing bodies and the AO Foundation’s financial development.

Shared Values set standards for employees and officers In parallel with the Bylaws of the AO Foundation, the Board of Trustees approved the Shared Values as behavioral guidelines for all AO employees and officers.

Board of Trustees

Academic Council (AcC)

Board of Directors (AOVA) Executive Management (AOEM)

AOTrauma International Board

AOTrauma

AOSpine International Board

AOSpine

AO CMF International Board

AOCMF

AO VET International Board

AOVET

AO Exploratory Research Board AO R&D Committee

ARI AOCID TK Office

AOCID Committee

AO Education

TK Executive Board

Support Units

AO Education Platform 48

Annual Report 2010

Governance

Finance Financial reporting aligned with new organizational structure The new structure of the AO Organization— with its three pillars of the Specialties, Service Units and Support Units—was fully reflected during the whole 2010 financial year. Financial Overview Overall, the operating result amounted to -26 million CHF in 2010 compared to -22 million CHF in the previous year. With a financial result of 5 million CHF, the net result amounted to -21 million CHF. Consequently, the Foundation’s equity decreased 2% to 962 million CHF by the end of 2010. AO Financial Overview 2009 abs.

2010 abs.

Variance 10/09 abs.

Operating Income Operating Expenses Operating Result Financial Result Net Result

66 88 -22 58 36

70 96 -26 5 -21

5 9 -4 -53 -57

Equity per 31.12.

982

962

-21

in million CHF

Operating expenses grew by 10% versus the previous year to 96 million CHF. Taking into account the 10% decrease in spending in 2009 versus 2008, the compounded annual growth rate from 2007 to 2010 is 1%. 6%

3% 2% 18%

AO Foundation Contribution Cooperation & Support Agreement Contribution Asset Management Change in Reserves Third-party Income Total Income R&D Reference Centers and Fellowships Technical Commissions Education Community Development General and Administrative Global and Regional Boards Others

Total Expenses

82 56 5 21 14 96 27 5 3 32 6 14 6 3

237 FTE

96 million CHF

14%

53%

27% 28%

Expenses by main activity Education R&D General and Administrative Community Development Global and Regional Boards Reference Centers and Fellowships Technical Commissions Others Edu RD

Gen

2010 Actual in million CHF

Full-time Equivalents

33%

CommDev

Profit & Loss Statement 2010 AO Total

Edu

Operating income increased by 7% versus 2009. It includes the income from the Cooperation Agreement with Synthes of 56 million CHF (+8% versus previous year) and other third party income amounting to 14 million CHF (+5% versus previous year).

Employees The number of employees increased by ten full-time equivalents (FTEs) versus 2009 and reached a level of 237. Overall 26 employees were fully dedicated to regional activities.

Global

33% 28% 14% 7% 7% 6% 3% 2%

2010 in %

International * Asia Pacific Europe * Latin America Middle East * North America

211 8 4 9 1 4

89% 3% 2% 4% 1% 1%

Total

237

100%

Employee Overview (Full-Time Equivalents by year-end) Service Units Specialties Support Units Others incl. Exploratory Research

year end

International, Middle East and Europe are based in Switzerland

126 63 43 5

service

Total

Others

237

Spec Support Units Others

The spending for educational activities had the biggest stake with 33% of total expenses. Overall 618 AO courses took place in 2010 with almost 35,000 course participants globally. AO Course Activities 2010

Trauma Spine

263

Operating Room Personnel

107

Asset Management With an actual return of 0.4% on the underlying financial assets, the financial result was 5.4 million CHF below the benchmark of 3.4%. The total asset value amounted to 898 million CHF by the end of 2010. The underperformance was driven by the negative performance of the Synthes stake, with a 32% share in the portfolio. Excluding the Synthes position, the portfolio achieved a return of 4% well in line with the benchmark. Looking at the Foundation’s portfolio performance since January 2007, the total actual return amounted to -4.2% versus the benchmark of -9.6% for the same period.

115 9%

Craniomaxillofacial

Socio Economic Committee

Veterinary

12%

898 million CHF 20%

Total Courses Total Course Participants Total Participant Days

618 34,852 99,709

59%

Financial Assets Portfolio Structure in million CHF Shares Bonds Liquidity Alternative assets Total

531 177 108 82 898

Annual Report 2010

Governance

Governing bodies of the AO Foundation Board of Trustees The Board of Trustees is the “AO parliament,” consisting of 165 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.

Academic Council—AcC The Academic Council (AcC) is responsible for the AO Foundation’s medical and scientific goals. Elected by the Board of Trustees, it is supported by four Specialty Academic Councils (SAcCs), specialized steering boards, and other ex-officio members. Front row, left to right: —Beate Hanson —Rolf Jeker (CEO and Vice Chairperson AOVA from January 1, 2011) —R Geoff Richards —Norbert Haas — Peter Matter (Founding Member) — Thomas Rüedi (Founding Member) Middle row: —Gregorio Sanchez —Thiam Chye Lim — Hansjörg Wyss (Founding Member) —Tim Pohlemann —Steven Schelkun —Nikolaus Renner — Jaime Quintero — Keita Ito

Back row: —Michel Orsinger (Permanent Guest) —Defino Helton —Ian A Harris —Tobias Hüttl —Jörg Auer —Mark Markel —James F Kellam —Adrian Sugar —Mark Vrahas —Jeffrey Wang

AO Executive Management—AOEM The AO Executive Management (AOEM) reports directly to the Board of Directors. It includes the CEO and line managers responsible for operational management within their respective areas. From left to right: —Rolf Jeker (CEO and Vice Chairperson AOVA from January 1, 2011) —Urs Rüetschi, AO Education — Beate Hanson, AO Clinical Investigation and Documentation —Alain Baumann, AOSpine —Markus Rauh, CEO and Chairman AOVA —Claas Albers, AOTK —Lukas Kreienbühl, COO —Tobias Hüttl, AOCMF and AOVET —Claude Martin, AOTrauma —R Geoff Richards, AO Research and Development

Board of Directors—AOVA The Board of Directors is responsible for the business conduct of the AO Foundation, ensuring implementation of the goals and proposals of the Academic Council. Its members include a majority of surgeons and nonvoting representatives of the AO’s industrial partners. Front row, left to right: —Jaime Quintero (President-Elect) —Paul Manson (Past-President) —Markus Rauh (Chairman AOVA and CEO) —Norbert Haas (President) — Hansjörg Wyss Middle row: —Rolf Jeker (CEO and Vice Chairperson AOVA from January 1, 2011) —Pierre Hoffmeyer —Michael Ehrenfeld —Suthorn Bavonratanavech —Luiz Vialle —Roland Brönnimann (Synthes Inc.) —Michael Janssen Back row: —Michael Wagner —Eric Johnson —Ciro Römer (Synthes Inc.) —Lukas Kreienbühl (COO) —Michel Orsinger (Synthes Inc.) —Urs Weber-Stecher (Minutes) —Jean-Pierre Cabassu

Annual Report 2010

Addresses

AO Head Office AO Foundation Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 28 01 Fax +41 81 414 22 80 foundation@aofoundation.org www.aofoundation.org

AO Specialties, International Headquarters*

AO Service Units

AOTrauma

AO Research Institute Davos (ARI)

Stettbachstrasse 6

Clavadelerstrasse 8

8600 Dübendorf

7270 Davos

Switzerland

Phone +41 44 200 24 20

Phone +41 81 414 22 11

Fax ++41 44 200 24 21

Fax +41 81 414 22 88

info@aotrauma.org

sonia.wahl@aofoundation.org

www.aotrauma.org

www.aofoundation.org/ari

AOSpine

AO Clinical Investigation and Documentation (AOCID)

Stettbachstrasse 6

8600 Dübendorf

Switzerland

Phone +41 44 200 24 25

Phone +41 44 200 24 20

Fax ++41 44 200 24 12

Fax +41 44 200 24 60

info@aospine.org

aocid@aofoundation.org

www.aospine.org

www.aofoundation.org/cid

AOCMF

TK System

Clavadelerstrasse 8

7270 Davos

Switzerland

Concept, editing, and layout:

Phone +41 81 414 25 55

Phone +41 81 414 24 70

AO Foundation, Communications and Events, Davos, Switzerland

Fax +41 81 414 25 80

Fax +41 81 414 22 90

info@aocmf.org

aotk@aofoundation.org

Photography:

www.aocmf.org

www.aofoundation.org/wps/portal/aotk

AO Foundation, Communications and Events, Davos, Switzerland Keystone (p 14–15)

AOVET

AO Education

Clavadelerstrasse 8

7270 Davos

Switzerland

Phone +41 81 414 25 55

Phone +41 81 414 26 01

Fax +41 81 414 25 80

Fax +41 81 414 22 83

info@aovet.org

aoe@aofoundation.org

www.aovet.org

www.aofoundation.org

Print: Südostschweiz Print AG, Chur, Switzerland © May 2011 AO Foundation This annual report is climate neutral, compensation through www.climatepartner.com Certificate No SC2011041203

*Contact information for Regional Offices can be found on individual Specialty websites

AO Foundation Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 28 01 Fax +41 81 414 22 80 foundation@aofoundation.org www.aofoundation.org