AO Dialogue 1|11 by AO Foundation

AO Dialogue 1|11 The newsletter for the AO community

Interview with Rolf Jeker

The new Vice-Chairperson of the AOVA and CEO of the AO Foundation Olga Harrington AO Dialogue

What is so special about the AO Foundation to make you want to do this job?

The AO Foundation is indeed a special organization when you consider how it was brought into being 50 years ago by visionary surgeons who were ahead of their time both professionally and behaviorally; forgoing immediate financial benefit in order to improve patient care. I was very much attracted by the vision of these founders and the AO spirit that must be kept alive; even when external circumstances change and striving for personal material gain is prevalent. With a network of

the best brains and hands in their fields and the necessary organizational and financial resources behind it, I feel the AO Foundation can make a positive impact on patient care. I wish to be associated with this objective and make a contribution to help achieving it in the most efficient manner. What do you hope to achieve during your three year tenure?

In general, I want to improve the effectiveness and efficiency of the Foundation in contributing to patient care but also to actively help the Board of Directors (AOVA) and Specialties to [ continued on page 2 ]

Table of contents Rolf Jeker 1 Markus Rauh 3 AOSEC 4 AOCID In Focus 6 ARI Facilities 12 Specialty Update 14 Norbert Haas 20

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Interview with Rolf Jeker The new Vice-Chairperson of the AOVA and CEO of the AO Foundation shape the future of AO over the coming years. With the recently proposed merger of Synthes with Johnson & Johnson (J&J) this aspect of the role might assume additional importance. We will evaluate the way we do business and its outcomes across our different activities starting with a review of our research activities this year. It is my intention to increase transparency throughout the organization, to provide the basis for potential adaptations and changes where necessary. Strong growth and organizational changes have greatly increased the AO’s complexity and have created overlaps among and across organizational units. We also need to reflect on potential conflict of interest aspects throughout the organization: one cannot be player and referee on the same playing field. Lastly, but maybe most importantly, I want to ensure that we bring the next generation of talent into the AO—talents that share the AO spirit. What challenges do you face in your new role?

First and foremost I have to learn and learn and learn. In order to fully understand the organization I conduct discussions on all levels and directly participate in activities. My most immediate task is to ensure that the AO Foundation remains on a sound financial footing. With the endowment declining and the 2011 budget being highly expansive (+13% over actual) we immediately reviewed and reduced the rate of growth and also fixed an expenditure growth limit to 2% for 2012-2014. The new organizational structure that came about as a result of our strategic review process has brought new challenges. There are still teething problems and emotional stresses in the system that need to be overcome. I will do my best to build bridges and possibly help to more clearly define roles where necessary.

Above all I believe people, not structures, are the decisive factor. Therefore, relationship building through an open discussion culture is key: critical and controversial but not confrontational. We all share the same objective: the best patient care. What positive impact will the Synthes partnership with J&J have on the AO Foundation?

I appreciate the positive manner in which the b question is phrased by focusing on the upside. I fundamentally share this view. Changes need to be seen and used to achieve upsides. The J&J/Synthes deal still needs some time to be completed. In any case the existing agreement between AO and Synthes took b possibility into account so our contractual this agreements are fixed until the end of 2013 and Synthes remains our only partner. We are reviewing the present situation and options for the future in a transparent process including Executive Management, AOVA and Specialties to shape a common view of our best interests. The most immediate impact is a very welcome improvement to our endowment fund, which provides the financial backbone for the continued independence of our organization.

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Three Past-Presidents pay tribute to Markus Rauh A thank you to our recently retired Chairman of the Board (AOVA) From Jim Kellam, Past-President 2004-2006

In 2003 Markus was chosen as Chairman of the AOVA because he was an individual who was recognized by the Foundation leaders as a respected astute businessman who understood non-profit organizations and how to make them successful. Markus assumed this position and had to create a new administrative organization starting with a new Chief Executive Officer and reorganization of many individuals who had previously been involved in the Foundation. At the same time controversy arose within the medical members of the organization as to the foundation future and its role in independent academic pursuits. Markus was able to take both of these issues and provide the Foundation with the leadership necessary for the development of a professional responsible organization able to resolve its conflicts. No sooner had this ended then Markus was faced with issues regarding the antitrust queries concerning the Foundation’s relationship with Synthes. This finally led to the negotiation of a new contract and the formation of the Foundation’s present financial structure. As the leader of the Foundation negotiation team, he understood what the organization meant to the surgeons, what it should be in the future and how this vision must be financially supported. Markus has always demonstrated what it meant to build consensus within a voluntary, non-profit organization. He understood the need for the organization to grow and develop but at the same time to avoid unbridled expense. He was instrumental in assuring an appropriate celebration of the 50th Anniversary of the Foundation. This was done with fiscal responsibility but at the same time provided the Foundation with a highly successful celebration and stimulus for the future that a 50th Anniversary should.

On behalf of the Foundation and me personally, I wish Markus my heartfelt thanks for his leadership, friendship, mentorship and just being Markus. Chris van der Werken, Past-President 2006–2008

Friday the 7th of December 2001, I was introduced to Markus Rauh. We were sitting with a group of AOVA and AcC members at a large round table at a restaurant in Davos and Markus was sitting, seemingly unintentionally, next to me. At that time AO was in troubled waters and I had a serious, even confrontational, first conversation with Markus, discussing several burning “political” and personal issues. That evening I was deeply impressed by his no nonsense analysis of the extremely complex AO structures and the many related problems of that time. “Who was this man?” He is a man with a mission, who takes his job extremely seriously. I had the great pleasure to work closely together with Markus Rauh in the AOVA and as President of the Foundation ovewr ten years. He always impressed me with his exceptional dedication, integrity, loyalty and detailed preparation in every meeting he chaired. From René Marti, Past-President 2002–2004

Markus played an important role in a period in which the AO Foundation was having serious problems. He was the strong businessman, in a certain sense the hardliner able to guide the negotiations with Synthes, the final result of which still forms the base of a strong rather independent medical guided foundation. He integrated very well, participated in all bodies of the foundation, knew everybody and maintained a relationship based on friendship.

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Reports from Haiti and AOSEC Africa: update on financial commitments made by the Trustees at the Lisbon Trustees Meeting 2010

Building orthopaedic trauma capacity in Haiti Report by: Andy Pollack

The January 12, 2010 earthquake in Haiti left hundreds of thousands of people dead or injured. The number of musculoskeletal injuries among survivors was disproportionately high. In caring for the injured, the lack of infrastructure and personnel within Haiti to treat musculoskeletal trauma associated with daily ongoing activities in Port au Prince became apparent. As a result, University of Maryland in partnership with University of Notre Dame du Haiti (UNDH) has proposed to the Haitian Ministry of Public Health and Population (MSPP) and the US Centers for Disease Control a two-year orthopaedic trauma care specialist (OTCS) program to prepare qualified physicians to care for the majority of fractures and extremity injuries presenting to local clinics and emergency departments. OTCS graduates will be accredited by UNDH and MSPP. The program will use a train-the-trainer model with faculty prepared first, followed by the students. International

faculty will spend one to two weeks in Haiti delivering lectures, teaching motor skills labs and operating with the Haitian physicians. The 50-week curriculum will focus on common conditions and those associated with the greatest potential to limit disability through effective intervention. An initial two-day orthopaedic trauma course held in January 2011 at UNDH drew more than 30 Haitian orthopaedic surgeons and residents. AO and Synthes supplied equipment and technical expertise for the course labs. The official start of the OTCS program itself has been delayed pending CDC funding. Initial commitments were withdrawn after learning that the funding source could not be used for surgical programs. We have submitted a formal proposal for funding through an alternate mechanism and are hopeful that the program can start officially before the end of the calendar year. At this time the financial support committed by the AO Foundation at the 2010 Lisbon Trustees Meeting will be of great value.

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Fast pace of change in AOSEC Africa Report by: Jim Harrison

Since the recent meeting of the steering team in Nairobi, Kenya, my inbox has been filling up with reports of the recent AOTrauma Principles Course in Nigeria supported by AOSEC faculty, reports of the first ever AOSEC ORP in Zimbabwe, plans for new work in French speaking Africa including a Faculty Development Program, and requests for new courses and additional non-operative courses in ever needy countries. Almost a year ago the AO Trustees gave AOSEC Africa a financial and motivational fillip by donating their allowances to stimulate and support the work. Over CHF 23,000 was raised and this has spurred an increase in activity in the most orthopedically needy region of the world. Nobody knows how many femoral shaft fractures here heal 5cms short for simple lack of correctly applied traction, or how many elbows remain permanently dislocated because no one recognised the injury or was able to reduce it—but for those of us who live and work in Africa, such things are common place, even ‘normal’. The extra funding has enabled the gathering together of an African steering team in August 2010 and May 2011, with specific development roles and goals in the region. Prof Sylvain Terver, who is responsible for developing AOSEC activities in the French-speaking countries of Africa (FSA) spoke at the May meeting as the AOSEC has a new focus on this region. The Lisbon money has also contributed to the first two regional nurse fellowships in Blantyre, Malawi—creating a platform for the first

ORP in Zimbabwe. The nurses in Malawi are the epicentre of African ORP activities. They have been teaching regionally for five years now, but there remains a pressing need to develop other leading ORP in the region. One of the hindrances to this development has been a difficulty in communication, with a decrepit shared laptop computer barely supporting our tediously slow email and internet facilities! With local nurse salaries approximately US$ 300 per month, and laptops costing more than US$ 600 locally, the hope of a personal laptop is really only a dream for a Malawian nurse. The donated Trustees money has enabled the purchase of a brand new laptop computer to be shared between four Malawi faculty. This has given a major boost to communication as well as providing a facility for preparing powerpoint presentations for courses.

We are currently coordinating plans to host a two-day training program for leading FSA surgeons scheduled in August in Accra, Ghana, this. It is our intention to launch three non-operative courses in French speaking countries in 2012. From there we hope to increase our presence in the region with the addition of at least three new courses annually. These first courses should take place in Senegal, Burkina and Gabon as soon as next year. Others countries who have already shown interest are Democratic Republic of Congo, Ivory Coast and Benin. I would like to offer sincere thanks to the AOVA and the trustees for supporting SEC. We use your funding with great prudence, and our educational activities are relieving the suffering of many—but there is so much more to do!

1. AOSEC Africa steering team with Sylvain Terver 2. New laptop for Malawi ORP faculty 3. ORP Fellow with mentor

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AOCID In Focus Spreading expertise in clinical investigation

AO Certified Study Centers (AOCSC) Author: Diarmuid De Faoite

Background

Over the last decade, AO Clinical Investigation and Documentation (AOCID) has amassed significant experience in the planning and conduct of multicenter clinical studies. AOCID worked with approximately 250 participating study centers in this time frame. It was realized that if clinics around the world all adhered to minimum standards Level when conducting trials, the quality of the clinical studies could be standardized and improved. In adSilver dition, having trained competent and certified centers would empow er all centers, but especially those in the AO Regions, to conduct more Gold clinical studies.

also free to adapt them to ensure conformity with AOCSC guidelines rather than to jettison them completely. Since hospitals vary in both size and focus, three distinct levels of accreditation were developed – see box for further details. Once awarded, certification is valid for three years and can be further extended once a prescribed recertification process is passed. Clinical research abilities

To perform and participate in non-

interventional and retrospective clinical investigations To perform and participate in prospective clinical investigations

Mandated by the AO Board of Platinum All of the above, and experience as Directors (AOVA) in early 2010, a Principal Coordinating Investigator AOCID solicited input from the (PCI) AO Specialties, AOTK, and the AO Regions as to exactly how centers involved in clinical studies could be certified as Benefits “AO Certified Study Centers” (AOCSC) by the One of the reasons for the very broad accepAO Foundation and the AO Specialties. These tance of the AOCSC concept is the spectrum of centers will also become nodes in a scientific benefits that accrue to all parties involved. For network of clinical investigators once a critical example, study centers which achieve AOCSC mass of members is reached. AOCID is tasked Gold or Platinum status are able to conduct with developing and managing the certifica- high quality and sound investigations. The tion project. know-how that is contained in the SOPs and tailored training courses on offer are obviously The program attractive for institutions which wish to bolA core team at AOCID then set about creating ster the quality of their clinical investigation a set of Standard Operating Procedures (SOPs) work. Indeed, for many centers accreditation will represent a formalization of their workrelated to the conduct of clinical studies to be implemented in each center and thereby en- ing relationship with the AO and act as an sure compliance with Good Clinical Practice indication of quality and competency to the (GCP). If SOPs are already in place, a center is wider world.

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New York Denver

Sao Paulo Boston Campinas

Luzern

Homburg Saar

Berlin Zürich

Innsbruck Köln

Tübingen

AOCSC Pilot Centers

For the AO, one of the many advantages is easier identification of suitable sites for future clinical studies. In addition, there should also be cheaper, quicker and better quality study results once trials are running due to more streamlined and careful processes. First clinics accredited

Partners Orthopaedic Trauma Service applied for AOCSC accreditation of two hospital sites in early 2011. Andreas Fäh, AOCID’s Clinical Operations Manager, visited Boston to diligently check the centers’ infrastructure and processes in place for the conduct of clinical research. While on-site, he made presentations on the AOCSC concept and worked through the SOPs (Standard Operating Procedures) already in place. In addition, he gave a training session on the new SOPs required for certification purposes. Implementation of the SOPs is the responsibility of the center in question, although this is done interactively with further support from AOCID as necessary. The clinics in Boston are now certified until 2014. Speaking about the newly achieved Platinum status, Mark Vrahas of Partners Orthopaedic Trauma Services noted, “We are pleased and proud to be the first center to earn AOCSC accreditation. Our program can only flourish if we have a way to ensure that we are following Good Clinical Practice (GCP).”

A bright future

The project is still in its pilot phase and in addition to the clinics in Boston, a further four centers have already been inspected, with five further certification visits scheduled for early summer 2011. Despite not conducting any advertising, word-of-mouth has already ensured that many other clinics outside of the pilot certification phase have signaled their clear willingness to be certified. AOCID is currently developing its network of clinical research experts around the world to ensure that the high demand for accreditation can be met.

Singapore

Hong Kong

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GCP training Training Mark Vrahas of Partners Orthopaedic Trauma Services in Boston

Mike Weaver of Partners Orthopaedic Trauma Services in Boston

Ivo Schauwecker lecturing during the Singapore training

Listening to presentations during the Singapore training

While working on the AOCSC concept, the AOCID team saw that many clinics were clamoring for training courses in the performance of clinical investigations. Eager to assist, many hours of work went into developing a 12 hour site investigator training program. The main objective of the course is to increase quality levels in the conduct of clinical studies at an investigational site. By the end of the course participants will be able to understand and implement the ICH guidelines for Good Clinical Practice (GCP) and the ISO 14155 standard for the conduct of clinical investigations. They will also be aware of ethical principles according to the Declaration of Helsinki, and thanks to the AO’s global network of experts, local input ensures that the regulations specific to their country are also covered in the course. Furthermore, the participants are schooled in the basic scientific principles needed to design and evaluate a clinical study and are introduced to the specific requirements of orthopedic and traumatology clinical studies. Training courses were held in conjunction with AOCSC pilot certifications in Singapore, Hong Kong, Innsbruck in Austria and Tübingen, Germany. For those who are only interested in the educational aspect, the site investigator courses can also be booked independently of an AOCSC site certification. The first stand-alone course was given at an AOSpine course in Brazil in June 2011. The same training will be given at the AO Davos Courses on Friday, 9 December 2011. Accreditation

Further information

Swissmedic, the official Swiss agency for the authorization and supervision of therapeutic products, accredited the AOCSC investigator training program in early 2011. This means that a medical doctor who attends this course has received adequate training to act as an investigator in a clinical study, a requirement which is being introduced to more and more countries. By having an AO certificate in GCP studies, participants can demonstrably prove their fitness to conduct clinical research.

If you would like to know more about the AOCSC project or the site investigator training offered, please contact Ivo Schauwecker by e-mail (Ivo.Schauwecker@aofoundation.org) or telephone (+41 44 200 24 65).

The Swiss Association of Pharmaceutical Professionals (SwAPP) also awarded the training program its own SwAPP/SGPM accreditation.

Aw Swee Eng lecturing during the Singapore training

Participants and faculty at the Hong Kong training

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AOCID Fellow Mohy Taha

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AOCID Fellow Pratik Desai with Beate Hanson

AOCID Clinical Research Fellowship In addition to its main function of running clinical studies around the world, AOCID offers the AO community, through the AO Specialties, an array of valued services. One such offering which has more than proven its worth since its inception in 2005 has been the AOCID Clinical Research Fellowship. To date, 10 surgeons from around the world have been welcomed to the fellowship of 3 months’ duration which takes place at the AOCID offices in Switzerland. In essence, this fellowship allows young surgeons to gain training and experience in all phases of clinical research (study planning, monitoring, data analysis and publication). Although these skills are critical to the success of a clinical study, they are not given prominence in a standard medical training program. Quotes by AOCID Clinical Research Fellows:

“Excellent program, a must for every clinician practicing trauma care.” “The most important things I learned are the importance of collaboration and timely communication, as well as a new respect for the process of statistical analysis.” Successful collaboration with the AO Specialties

AOCID worked closely with AOTrauma, AOCMF and AOSpine on developing a customized fellowship to suit each AO Specialty. All Fellows are supported by an AO associated mentor at their home clinic both prior to and after the fellowship. In parallel to online training courses and personal tuition by CID collaborators, Fellows learn to analyze a study dataset they provide from their own clinical environment and publish the results. Their publication record is quite impressive, currently totaling 16 peerreviewed manuscripts in some of the highest ranked orthopedic journals. A new study is also planned and considered for implementation at the home clinic after the fellowship, thereby directly promoting clinical research within the AO Regions. A survey of all ex-Fellows was carried out at the start of 2011 to ensure the relevance of the fellowship to young surgeons with an interest in research.

Laurent Audigé, AOCID Fellow Philipp Honigmann, and Beate Hanson (from left to right).

Post-fellowship benefits

The Fellows are also putting their knowledge into practice thanks to their involvement in several continuing and new collaborative studies such as one which examines treatment of hallusvalgus deviation osteotomies using an X-plate. The Fellows are improving clinical research around the globe. For example, one Fellow is involved in planning a study to evaluate mortality in hip fracture patients in Latin America. Another is working on a systematic literature review about osteoporosis in the Middle East. Yet another Fellow left Europe for Australia to help build up a clinical research center. An enduring link

Perhaps the greatest triumph of the program is the way it inducts young surgeons, not only into the world of clinical research, but also into the AO community. Although their short tenure at AOCID has ended, the Fellows are now working or assisting the AO in a variety of ways. One Fellow for example is involved in the AOSpine classification project while others are spreading the knowledge they learned during the fellowship by teaching evidence-based orthopedic surgery classes in their home countries. The AO Regions are also pleased to have a local surgeon who has gained experience in the planning, conduct and analysis of clinical research. Another side benefit to have come out of the program is that some of the Fellows can also conduct monitoring of clinical research sites participating in AO studies in their own country.

Further information If you would like to know more about applying for the AOCID Clinical Research Fellowship and to read reports by ex-Fellows, please visit www.aofoundation.org/cid and follow the link to the Fellowship program. Laurent Audigé, the Fellowship coordinator, can be reached by e-mail (laurent.audige@aofoundation.org) or telephone (+41 44 200 2462).

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From the AO Service Units AO Education

(Aoe)

A prestigious journal and a number of recent presentations at international medical education conferences highlighted noteworthy efforts of AO Education and its partner Specialties. Interactive video simulation

Featured in renowned journal Medical Teacher, an article coauthored by AO Education’s Manager of eLearning, Pascal Schmidt, described a pioneering project that looked at error “recovery”, not error “reduction”, as a more effective way to learn and retain the contents of web-based trainings. Entitled “A cognitive perspective on technology enhanced learning in medical training: Great opportunities, pitfalls and challenges”, it discussed a state-of-the-art interactive video on C-arm and radiation produced by AO Education for AOTrauma. The authors asserted that when developing e-learning resources, it is important to bear in mind that “the human brain can only process a very small load of images, audio, and text at one time. The cognitive system is easily overloaded with information” and “e-learning is too often driven by the technology and not the learner.” Competency-based faculty development

AOTrauma, in cooperation with AO Education, presented the newly developed, competency-based faculty development program at the 1st International Conference on Faculty Development in the Health Professions in Toronto, Canada May 10–13, 2011. The breakout session lecture was labeled “A faculty development program for an international surgeon-driven, non-profit organization” and was presented by Michael Baumgaertner (AOTrauma Education Commission), R Clinton Miner (Manager AOTrauma Education), and Miriam Uhlmann (AO Education). The conference brought together international faculty development leaders/educators in the academic health sciences with the aim to share best practices, current research, and foster a global community. The 320 participants came from 28 countries to discuss, share experiences, and forge connections with faculty developers from all over the world.

Planning an orthogeriatrics program

A talk entitled “Role of assessment and patient-centered planning in the development of an orthogeriatrics program for a worldwide audience” was presented during a plenary session at the Annual Meeting of the Global Alliance for Medical Education (GAME) held in Munich, Germany June 6–7, 2011. On behalf of AOTrauma’s Orthogeriatrics program taskforce, Mike Cunningham, a member of the Educational Program Development team, shared AO Education’s key processes and several features of the program with a large audience of international experts in Continuing Medical Education (CME) and Continuing Professional Development (CPD). Data and experiences from three key 2010 initiatives were presented (Scottsdale, US; Seoul, Korea; Davos, Switzerland). For instance, how “backwards planning” can help identify competencies to guide educational offerings. Successful implementation of the AO’s Learning Assessment Toolkit to support live courses was described, and participant data and evaluation of outcomes was shown.

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AO Research Institute Davos

(ARI)

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young scientists. The award will be presented after his keynote speech at ESB2011, Dublin, Ireland.

Extramural Funding

Following on from two recent European funding grants from the European Commission (FP7), the ARI has reached the negotiation phase with a third project in Biodesign—Rational Bioactive Materials Design for Tissue Regeneration with EUR 590,000 granted over three years. Together with AO Clinical Investigation and Documentation (AOCID), ARI are also in the final negotiation stage for FP7 project grant in Health—Development of tools to control microbial biofilms with relevance to clinical drug resistance with EUR 595,000 granted over three years.

In April 2011, Prof Mauro Alini was elected for a two year term as President of the Swiss Bone and Mineral Society. Additionally Prof Geoff Richards will carry out a two year term as the Infection topic committee Chair for the Orthopeadic Research Society from 2011-2013. He will also co-organize a Basic Science Focus Forum at this year’s Orthopaedic Trauma Association (OTA) Annual conference in San Antonio, Texas.

ARI is also pleased to announce that Prof Mauro Alini, Head of Musculoskeletal Regeneration Program, was awarded funding by the North American Spine Society (NASS) 2010 Basic Research US$ 100,000 US for two years for his studies in Stem Cell Based Intervertebral Disc Regeneration-Evaluation in Organ Culture. Further extramural funding has been obtained in the form of an US National Institutes of Health NIH contract through Prof Chris Evans, Harvard. The in vivo study investigates Healing of Segmental Defects of Bone & Gene Transfer Treatment of critical sized large bone defects using genetically modified fat and muscle, and totals US$ 636,336 over five years. In recognition of the high standard of research being performed at the ARI, the Innovationstiftung Graubünden—an innovation foundation in Switzerland—has awarded CHF 632,000 for a new Fluorescence Activated Cell Sorter which will greatly increase the capabilities within the cell and stem cells areas.

FACS The new flourescence activated cell sorter is able to count up to 70,000 cells per second and is able to sort up to 30,000 cells per second based on fluorescent labels and size. This provides the capability to separate and further culture different cells to enable a more accurate assessment of their repair potential.

New Book Release

Martin Stoddart, a Principal Scientist at ARI, is the editor of a new book in the Methods in Molecular biology series. Available through Springer Publishers the newly published book “Mammalian Cell Viability Methods” includes contributions from various ARI contributors. Awards

David Eglin, a Principal Scientist at ARI, has been awarded this year’s Jean Leray Award by the European Society for Biomaterials. This award is given to a researcher under 40, who has demonstrated distinctive achievement and insight in biomaterials research. It is established to recognize, encourage and stimulate outstanding research contributions to the field of biomaterials by

Viability Book A number of ARI members contributed to this collection of protocols which was edited by Martin Stoddart of the Musculoskeletal regeneration program.

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State-of-the-art facilities for the AO Research Institute Davos

New infrastructure provides a supportive and inspiring environment New Preclinical Services Facility

The AO Research Institute Davos (ARI) has over 50 years of experience in preclinical studies. During this time, the required infrastructure has been improved upon on a regular basis to maintain its high quality standards. In 2010, the existing ARI facility was enlarged in order to place all surgery and treatment facilities, CT imaging modalities and housing under one roof. The new surgery area has two state-of-the-art operating theaters and will soon include a separate area for infection studies. The Medical Imaging Focus Area of the Preclinical Services has installed a clinical computed tomography (CT) scanner in a dedicated room of the new facility. The Siemens SOMATOM Emotion 6 CT scanner is the 6-slice configuration with a maximum resolution of 0.6mm. The new CT room is directly accessible from the surgery area. The clinical CT has a gantry size large enough to scan whole and a special feature of the scanner reduces the radiation dose to a strict minimum. This offers opportunities to image not only bones and bone healing, but also vascularization, soft tissues and much more. The team’s long experience with preclinical studies is available to the whole AO family for their research questions. Parallel to this modernization, the ARI is preparing its application for the accreditation by Association for Assessment and Accreditation of Laboratory Animal Care International (AAALAC). AAALAC International is a private, nonprofit organization that promotes the humane treatment of animals in science through voluntary accreditation and assessment programs. By seeking the AAALAC accreditation, the ARI demonstrates its commitment to responsible animal care and use. The ARI volunteers to participate in AAALAC’s program, in addition to complying with the Swiss laws that regulate animal research.

New Musculoskeletal Infection lab

In May 2011 ARI’s new Musculoskeletal Infection Laboratory in the main AO Centre in Davos became operational. The new laboratory was built in what were previously the Biomedical Services cadaver preparation rooms (originally small animal housing units), which were vacated during the modernization and extension of the new preclinical facility. The decision by the AOTrauma Research Commission to nominate Bone Infection as a research focus prompted the move to larger laboratory space as a greater number of internal and collaborative projects on Bone Infection are being initiated. The new infection laboratories feature two new Class II biosafety cabinets which ensure best practices and safety for personnel when working with the bacterial pathogens most commonly encountered in bone infections. New anatomical wet laboratory

With the completion of the new preclinical facilities, the former operation rooms area within the AO center were easily transformed into a state-of-the-art anatomical wet laboratories. Two workplaces are equipped with a radiolucent OR table, a C-arm and balanced LED OR lights to mimic surgical conditions. A high resolution camera system, integrated into the OR light, is available for documentation and educational purposes with larger groups. A new in built freezer for the anatomical specimens lies metres away from this lab. The mechanical test unit is now located adjacent to the “wet-lab” area comprising electro-static, electro-dynamic and hydraulic material test systems for performing biomechanical invitro studies on the prepared specimens. The Biomedical Services Program offers testing protocols and test setups specifically tailored to the research question. Test data can be acquired ranging from radiographic imaging and image processing to 3D motion capturing. A prototype tool shop is connected to the anatomical laboratory dedicated to rapidly and precisely realize spontaneous and matured ideas in the field of osteoynthesis. Together with the expertise of the other ARI groups and the Biomedical Services staff the new infrastructure provides a supportive and inspiring environment for surgeons, implant manufacturers, Expert-Groups and researchers.

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1. State-of-the-art operating theatre 2. Anatomical Wet Lab 3. Bacteriology Lab 4. Clinical CT Room

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From the Specialties The Regional Education Team Training (RETT)

The Faculty Development Program

Training for the RET involves online, face-to-face or interpersonal, and subsequent ongoing activities and assessments. The various Regional Educational Teams are trained by AO’s professional educators working with AOT surgeon educators to provide consistency and quality control.

This initiative provides for consistent, quality faculty education in each of the five AO regions. The program includes extensive online activities and resources, as well as personal coaching. The fundamental principle is for expert chairs to organize and run an effective program, and for faculty to deliver quality educational content to provide the optimum learning experience for course participants.

ORP

AOTrauma

The program comprises three elements: • The Faculty Education Program (FEP) • The AOTruama Course Chairperson Education Program (CEP) • The Regional Education Team Training (RETT) The Faculty Education Program (FEP)

Our FEP is developed to ensure that our faculty excels in delivering high impact lectures, leading interactive discussion groups, and instructing at the table in practical exercises. Motivating learners; receiving and giving appropriate feedback; assessing learner information; awareness of cultural differences; setting reasonable expectations; time and logistics management are all part of the teaching process that faculty need to be aware of to be able to evaluate and improve their teaching methods.

AOT ORP Program Development

The aim of this program is to offer lifelong learning opportunities within AOTrauma to operating room personnel (ORP). The program takes a blended learning approach with courses, eLearning tools and short learning sessions in clinical environments; an essential feature is that each learning element is well coordinated with the others.

This program concept has been introduced only recently and the first AOTrauma Course Chairperson Education Program will be held in 2012. This course is exclusively for experienced AOTrauma faculty, actively involved in regional education activities and, who have ideally participated at tips for trainers’ course and are highly motivated to take on the role of AOTrauma course chairperson.

In designing a program applicable to all ORP worldwide, the AOT ORP community defined the characteristics of their target audience, taking into account regional differences and wide ranging professional challenges. The resulting program is based on defined core competencies for ORP involved in trauma care. General nursing topics are integrated and linked to the AO principles and techniques. A new educational tool, to be used in the clinical environment, will allow ORP and surgeons to organize short learning sessions in their hospitals with the educational material necessary to cover topics theoretically and practically. Local faculty may personalize the tool and integrate actual cases as well as address specific local instrumentation and requirements. Learners will be able to assess themselves before and after a course and this assessment will also provide the learner with information on how to update their knowledge.

CEP meeting during Davos Courses 2010

Discussions during the ORP Program Development

AOTrauma Course Chairperson Education Program (CEP)

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AOSpine

AOCMF

AO Spine’s Knowledge Forums

Clinical Priority Program Imaging and Planning in Surgery

Once more AOSpine leads the global spine care community by fostering innovation and evidence-based clinical practice through the Knowledge Forums. Knowledge Forums are working groups led by key opinion leaders in each of the five pathologies (spinal cord injury, degenerative disease, deformity, tumor, and trauma). These groups are focused on providing a clear understanding of current and future scientific directions and guidance for the production of curricula, materials, registries, and publications in their specific field.

(CPP IPS)

The AOCMF’s Clinical Priority Program (CPP) Imaging and Planning in Surgery (IPS) held its first workshop on May 5, 2011 in Freiburg, Germany. Since its first call for grants in 2009, the CPP IPS is funding 12 projects with a running time of up to three years. This event, which was organized in association with the Advanced Digital Technology conference in Freiburg, attracted 85 attendees and a total of 18 reports were given with all funded projects represented. Projects funded by the Research and Development commission were also represented.

Objectives

The goal of each Knowledge Forum is to generate and disseminate knowledge for a spine pathology by publishing evidence-based recommendations, developing and updating clinical-practice guidelines, and performing clinical studies. This will assist all AOSpine members in clinical decision-making related to prevention, diagnosis, treatment, and prognosis.

The reports were divided into four categories: Rapid prototyping/ virtual planning; Normometrics and 3D; MRI and CT; and Orbit. It was clear from the results presented, that projects funded by the CPP IPS have potential to strongly influence the future of CMF surgery. Included in the program were also presentations from the AO Research Institute in Davos, and AO Clinical Investigation and Documentation.

Who is behind each Knowledge Forum?

Knowledge Forums comprise working groups led by key opinion leaders focused on publishing evidence-based recommendations, developing and updating clinical practice guidelines, and performing clinical studies. Outlook

According to Luiz Vialle, chairperson of AOSpine International, “Knowledge Forum studies will always be based on patient needs and a lack of support from medical literature; therefore it will be likely to develop new device recommendations or modifications to an existing device based on Knowledge Forum findings”. Luiz Vialle presents at the Global Spine Congress

A guest lecture was given by Dr Silvie Testelin from Amiens, France, who spoke about planning complex facial reconstructions including facial transplants. The CPP IPS Committee decided during the event to issue a third call for pre-proposals within Imaging and Planning in Surgery. The call will be issued in summer, with continuation for full proposals towards the end of 2011 and decisions in early 2012.

Prof Sylvie Testelin presenting at the CPP IPS workshop

Michael Ehrenfeld at the CPP IPS workshop

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AOVET Inaugural AOVET course in Thailand

The first AOVET course for practicing veterinarians to be held in Thailand took place at the Kasetsart University Veterinary Teaching Hospital, Bangkok on 18-20 May 2011. Although AO teaching of fracture management in humans has a long history in Thailand, this was the first course exclusively devoted to principles of fracture management in small animals. This successful launch of an AOVET course in Thailand was only possible thanks to the exemplary support of Dr Suthorn Bavornratanavech, one of the AO’s senior trustees. For many years now, Dr Bavornratanavech has been enthusiastically encouraging the veterinarians in Thailand to think about how AO principles could be applied in the treatment of fractures in animals. The chairman of the course, Prof Kenneth Johnson from the University of Sydney Australia was assisted by Dr Monchanok Vijarnsorn, Director of the Kasetsart Veterinary Teaching Hospital in the organization of the course. Other course faculty members came from Switzerland, USA and Northern Ireland.

International and Local Faculty at the AOVET course in Bangkok

In addition to 47 course participants from Thailand, five others travelled from China, Hong Kong, Singapore and Indonesia to attend. So popular was the course that places were filled beyond capacity almost immediately. This is probably not surprising given the high esteem in which Thai people hold animals, with the King being a renowned animal lover. At the Kasetsart Veterinary Teaching Hospital there is an entire floor devoted exclusively to the provision of veterinary care for the King’s own dogs, of which there are more than 120 just in the Bangkok Palace! Even more astonishing, is the fact that the outpatient department of this hospital sees about 450 animal patients per day, seven day of the week. Such is the enthusiasm amongst the veterinarian community in Thailand for becoming new members of AOVET that the presence of AO in this region is likely to expand exponentially in the near future.

AOVET course participants during practical exercises in Bangkok

AOVET Course Chairman opening the AOVET course in Thailand

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Regional highlights AO Asia Pacific (AOAP) Prof Thomas Ruedi “These

courses are getting better

every year. I think the format is very nice, the venue is good and the teachers are of high quality. In the discussion groups, there are very lively discussions. The young residents and less experienced surgeons are active and interested. I think in overall the attitude is excellent. They have very interested participants for the practicals.” Bruce Twaddle

“We are building up Chiangmai Re-

gional Meeting as something for the region to support. Hopefully, in the future we will have more and more people from the region to come to the courses. Thais are naturally polite and they don’t like to argue too much. But when they get used to it, they can contribute more and more in the discussion groups.” Dankward Hoentzsch

“The organization was perfect

and the welcome was very well arranged. The congress center and practical exercise environment is more than perfect. The social events are outstanding. I have the feeling that the participants learn a lot during these courses.” Reto Babst “This

is the third course which I have at-

tended as the international faculty of AO Regional MIO Course and each time the course gets more perfect in respect to the content, facilities and venue and the Northern Thai hospitality is just unbelievable.”

Chiangmai—Successful AOTAP regional courses

AOTrauma Asia Pacific held a set of regional combined courses in Thailand on May 5, 2011. A total of 156 participants from 15 different countries attended the Advances, Pelvic and MIPO courses with 13 international and regional faculty members and 20 local faculty. Prof Thomas Ruedi was the guest of honor in recognition of his contribution to the advancement of AO education in the region. He gave a presentation entitled: “How the AO evolved in The Far East—my personal experience”, detailing the introduction of the AO into the Asia Pacific region by Profs Willengger and Weller, who travelled from one country to the next, in the late 70s, teaching the AO Principles. Prof Ruedi congratulated Asia Pacific on its strong growth in terms of the number of courses for both surgeons and ORPs, number of fellowships and the growing number of AO surgeons who become trustees and participate in the various activities organized by the AO. Some of the international faculty gave an insight into their thoughts on the success of the courses.

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AO Latin America (AOLAT)

In the first session “Quality Education: current directions and initiatives” an update of the current AO Education policies in Latin America was presented by the regional representatives in Specialty Education. In the second session delegates addressed the future of this quality education and the conclusions from this session addressed educational activities, course evaluation and faculty education. Issues highlighted ranged from the need for more courses to answer regional needs, that evaluation is the weakest point of the courses to the need more faculty education activities (the quality of which is considered optimal).

Fourth AOLAT Faculty Retreat

Organized by a team of Regional Educators, Regional Specialty Chairpersons and the AOLAT Regional Director, the Fourth AOLAT Faculty Retreat was held in Punta Arenas, Costa Rica, May 4-7, 2011. Participants came 15 countries across Latin America and comprised 17 CMF, 24 Spine and 49 Trauma faculty. In addition twelve AO Foundation guests, from Switzerland, Germany, USA and Canada also attended. The theme of the retreat was the future of AO Education in Latin America and the main topics of the event were quality of education (current and future directions), the implications of continuing medical education (CME) in Latin America, innovations in AO Education and online educational resources. All these topics were discussed among the Specialties in several forums and activities including a session based on Open Space Technology, in order to delineate the future action points for Education in AOLAT.

In the third module “Continuing Medical Education, implications for AOLAT”, the panel discussed the differences among countries as well as the future of CME in AOLAT. In the fourth module “Innovations in AO Education”, both the presenters and panelists discussed and considered the risks and opportunities that technology offers in educational areas. The basis for innovation that was clearly pointed out was: quality of content, faculty development, and global assessment of all educational activities ie, not only participant satisfaction. After that, the panel focused on the way to innovate also in educational methodology, and not only in technological resources. It was also discussed what, when and how to do it. The fifth session was the looked for the future action points in AO Education in Latin America while the final session addressed the relevance of online Education for the AO Foundation. The advantages, risks and current trends in online medical education were presented and analyzed. The overall conclusion by the retreat organizers was that it was a great meeting which will positively impact on the future of AO education in Latin America, in turn improving patient care in the region.

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AO North America (AONA)

AONA New Governance

In response to a changing environment and in preparation to meet new challenges, AO North America is in the final stages of instituting a new governance structure. A committee comprised of John Wilber (President AONA), Mark Vrahas (Trauma), Greg Evans (CMF), Allen Ruggles (Vet) and Paul Young (AONA GM) has been working closely with the AONA Executive Committee, Trustee Council and legal council for 18 months to create a more comprehensive, inclusive and transparent structure. The challenge was to make the new governance structure: • Compliant with its status as an independent non-for profit organization (501c3 status) • Compatible with the new AO Foundation specialty-based structure • Compliant with the new ACCME updated guidelines • Integrate and support all the specialties and their activities Highlights of the new governance include a specialty based committee structure which parallels the new AO Foundation structure ensuring effective committee support while promoting international interaction and communication. A new Executive Council with representatives from each of the Specialty Councils provides an inclusive and transparent platform for interaction, planning and governance of AONA activities. Also represented on this council will be the chairmen from key “cross specialty” committees such as the CME Advisory Board and the Funding Committee. The final step in completing the transition will be the election of a new Board of Directors by the Trustee Council at the Trustees Meeting in Berlin. This unique board will be comprised of non-conflicted Senior Trustees from North America from each of the specialties in addition to the President and Past President of AONA and an independent member elected by the Trustee Council. This board will have the final oversight of all the functions and activities of AONA. We are extremely pleased and excited with the new governance and are confident that it will allow us to remain successful and productive in the future.

AONA Governance: Operations

Executive Board AONA President 1

AONA Past President 1

AONA President-Elect 1

Funding Panel Chair

Trauma Chair 1,2

CMF Chair 1,2,3

VET Chair 1,2

Appointee of Spine 1,2

Education Committee

Research Committee

Community Development

Post-Graduate Support Chair 2

Immediate Past-Chair (1.5 years)

Immediate Past-Chair (3 years)

Incoming Chair (1.5 years)

Incoming Chair (3 years)

Committees TBD by Spine

CMEAB Chair (CME Advisory Board)

Community Development Chair (Community Dev Board)

1 Voting Member of

Executive Board 2 Voting Member of

Specialty Council 3 CMF “Tripartite”

TRAUMA SPECIALTY

CMF SPECIALTY

VET SPECIALTY

Representative

All rights reserved. Any rep roduction, whole or in part, without the publisher’s written consent is prohibited. Great care has been taken to maintain the accuracy of the information contained in this publication. However, the publisher, and/or the distributor and/or the editors, and/or the authors cannot be held responsible for errors or any consequences arising from the use of the information contained in this publication. Some of the products, names, instruments, treatments, logos, designs, etc. referred to in this publication are also protected by patents and trademarks or by other intellectual property protection laws (eg, “AO”, “TRIANGLE/GLOBE Logo” are registered trademarks) even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name, instrument, etc. without designation as proprietary is not to be construed as a representation by the publisher that is in the public domain.

Impressum AO Dialogue 1|11 Editor-in-Chief: James F Kellam Managing Editor: Olga Harrington Publisher: AO Foundation Design and typesetting: nougat.ch Printed by: Bruhin AG, Switzerland Editorial contact address: AO Foundation, Clavadelerstrasse 8, CH-7270 Davos Platz, Phone: +41(0)81 414 28 14, Fax: +41(0)81 414 22 97, E-mail: dialogue@aofoundation.org Copyright © 2011, AO Foundation, Switzerland

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My view

From the President Norbert Haas talks to AO Dialogue about the Berlin Trustees Meeting Prof Haas, the Trustees Meeting in Berlin is the first of your presidency. It is also an important one because the AO Foundation has just completed a reorganization phase. What are your aspirations for this meeting?

The AO Foundation has already been through a few reorganizations and all of them were important; we are now well positioned. With our four Specialties we can approach the requirements of the surgeons in their individual fields and with our four Service Units—research, clinical investigation, education, and technical commissions—we offer performance, results, and support like no other institution. I wish, and I see the necessity, that the AO now closes rank. I desire a single Foundation, with different specialties and areas, but with a unified approach. What should have been achieved by the end of the Trustees Meeting?

The meeting should reinforce once again the 50 year old “spirit” of the Foundation. Change is essential and smoothes the way for the future, however, the “AO Foundation” brand should be the principle one and be constantly vitalized. Big institutions like Harvard or Siemens also have numerous divisions and locations around the globe, with different target groups, and a large number of different products. However, at the end of the day, what is perceived is the successful Harvard or Siemens brands. Such a common identity for the AO should be evident and this is an ongoing process for us. What do you think makes the “spirit” of the AO so important?

On the one hand, the unity of the AO is important for how we are perceived externally. While on the other hand, this “spirit” eases cooperation inside the AO and our dwindling resources mean we have to collaborate closely and utilize these resources efficiently. This efficiency can be achieved through interaction between the Specialties and Service Units—issues like infection, soft tissue treatment, bone defects, bone healing etc affect the entire AO. At the end of the Berlin Trustees Meeting we should all be aware of this as the AO philosophy again.

James F Kellam Editor-in-Chief james.kellam@aofoundation.org

The announcement in spring that Synthes and Johnson & Johnson (J&J) had agreed to a merger took many by surprise. From the outset, our relationship with the implant producers has been a crucial and important concept in the AO system. This relationship is built upon a sophisticated surgical expert group system and technical commission. It provides quality implants that have been tested and designed by experts in the field. AO Education and Research provide important links with the producers to assure that fracture fixation is applied correctly and that the scientific basis of the treatment is understood. The question is what will the end result of this merger be for us? Will J&J continue to appreciate the role that the Foundation plays in development, research and education and continue their involvement? Regardless of the decision, the AO Foundation and its surgeons must demonstrate their value. The Foundation and its Regional and Specialty affiliates will have to show, in the coming years, that they remain leaders in their field and that they can deliver added value to this new organization. However, should the decision be that the Foundation and its surgeons have no role to play in the newly-merged company the Foundation will still be viable and, with an increased effort, be in an excellent position to maximize its influence. The Foundation will become an independent academic organization which can provide services in development, education and research to all. This will require an increased effort on the part of all of us to prove that we are the best and that AO Foundation, its Regions and Specialties can provide worldwide the appropriate education, research and development that will improve the care of patients in the future. This new merger is welcome news and hopefully will open many more doors to the Foundation, but if not we must be prepared to maintain our leadership role.