AO Foundation Annual Report 2014

A global network of surgeons Annual Report 2014

Our

vision is excellence in the surgical

management of trauma and disorders of the musculoskeletal system.

Our

mission is to foster and expand

our network of health care professionals in education, research, development, and clinical investigation to achieve

more

effective patient care worldwide.

Table of contents Editorial Letter from the President and the CEO and Vice-Chairman of the AOFB

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From education to energy AO statistics

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Innovation at the AO AO smart technologies advance patient care AO Strategy Fund enhances the AO’s visibility and reach

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AO Clinical Divisions AOTrauma—stability and flexibility for the largest global trauma network AOSpine—supporting the next generation of leading spine surgeons worldwide AOCMF—advancing craniomaxillofacial surgery AOVET—advancing the practice of veterinary surgery

22 28 32 34

AO Initiatives AONeuro—improving outcomes in neurosurgery AORecon—a successful first year in improving joint preservation

36 37

AO Institutes Research and Development—taking translational research to the next level Research Review—the independent peer review process Education—educating the next generation Clinical Investigation—bringing ideas to clinical evidence AOTK System—smart approaches for evidence-based development

38 41 42 44 46

AO SEC—improving care of the injured in the least developed countries

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Governance Finance Governance Governing bodies of the AO Foundation Addresses

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Annual Report 2014 ┃ Editorial

Letter from the President and the CEO and Vice-Chair of the AOFB Dear colleagues and friends, The year 2014 was one of continued change and development throughout the organization and we would like to update you on some of the high points of the year for the AO. One of the most important milestones in the future financial stability of the AO took place in December when the AO Foundation and its longstanding partner DePuy Synthes developed a new five-year Cooperation Agreement, to take effect in 2016. This agreement recognizes the unique long-term value of this relationship and demonstrates strong collaboration and a commitment to continued partnership between the two organizations. It also illustrates the clear long-term commitment by both AO and DePuy Synthes to enhance their support for surgeon education, improve efficiencies in the healthcare system, and drive better outcomes for patients in a changing and more regulated environment.

A lot of hard work has been done in recent years to improve organizational efficiency and effectiveness throughout the AO and while this valuable work continues in parts of the foundation, the next logical step is to encourage innovation. To address this strategic priority, the AO Strategy Fund was launched in December 2013 with an annual budget of CHF 5 million for the period 2014-2016. To date it has funded a total of 16 projects aimed at developing new services and technologies for unmet needs, enhancing the AO’s visibility and reach, fostering cooperation across the foundation’s four clinical divisions, and boosting operational effectiveness and efficiency. This kind of internal innovation will ensure that the AO remains at the cutting edge and relevant to our network and those we want to engage with in the future.

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In order to strengthen the AO Foundation’s engagement in the least developed countries in the world, it was decided to create the AO Alliance Foundation (a completely separate legal entity with its own governance and management) to build on the valuable work that AO SEC has been conducting for many years. The AO Alliance Foundation (inaugurated in Davos in December 2014) will dedicate itself to improving the care of musculoskeletal trauma and neglected cases in the least developed countries beginning with Malawi, Myanmar, Ethiopia, Ghana, Burkina Faso, Senegal, Bangladesh and Cambodia.

Finally, we would like to express our thanks to our volunteer officers and faculty for their cooperation and enormous assistance and support in all activities, our employees for their committed work, our members for their interest, and our partners for their continued dedication.

Sincerely,

Suthorn Bavonratanavech President of the AO Foundation

Rolf Jeker CEO and Vice-Chair of the AO Foundation Board

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Annual Report 2014 ┃ From education to energy

AO statistics

Courses and participants

Courses and participants

Energy efficiency

by clinical division

by region

There has been a 30.63% reduction in electricity consumption in the AO Center in Davos (CH) since energy saving initiatives began in 2007.

319 20,509

AOTrauma

AOSpine

183 11,330

111 4,956

International

252 12,013

Europe including South Africa

216

AOCMF

Asia Pacific

31 1,636

AOVET

Latin America

72 3,082

Operating Room Personnel

45 2,050

17 1,474

Socio Economic Commitee

150 9,371

78 3,486

Middle East and Africa

48 3,026

14,193 Electricity consumption in kWh

833,096 706,866 577,855

North America

2007 2010 2014 Courses 761 Participants 43,563 Total

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Nationalities of staff in Switzerland Where they come from (in %):

Fellows per clinical division

The carbon neutral AO Trustees Meeting 2014 offset 1,619 tons of carbon emissions. This provided 776 new efficient cook stoves in Peru which saved 661 tons of wood or 850kg per household.

Asia Pacific

68

Fellows per region

104

373 Total

63 49 Middle East

15 26 23 14 22

5 AOVET

Europe

Education PhD Master’s degree Bachelor’s degree Further education Apprenticeship

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52.9 47.1

52 AOCMF

North America

Gender Female Male

International

Italy 2.6 The Netherlands 1.1 Norway 0.4 Portugal 0.4 Romania 0.4 Russia 0.4 Spain 2.2 Sweden 0.4 Switzerland 60.4 United Kingdom 6.3 United States 1.9

163 AOTrauma 153 AOSpine

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Australia 0.4 Austria 0.7 Canada 1.1 China 0.7 Croatia 0.4 Czech Republic 0.4 Finland 0.7 France 1.1 Germany 15.9 Greece 0.7 Hungary 0.7 Ireland 0.7

21,968 liters of oil

2014

37,699 liters of oil 2007

Fellowships

Latin America

Heating oil use There has been a 41.7% reduction in heating oil use in the AO Center in Davos (CH) since energy saving initiatives began in 2007.

Talent management

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Annual Report 2014 ┃ Innovation at the AO

AO smart technologies advance patient care The conventional definitions of innovation range from “the introduction of something new” to “a new idea, method or device,” but at the AO Foundation innovation also means advancing patient care. Well established as a pioneer of methods, devices and education for internal fixation (the surgical implementation of implants for bone repair), the AO is pushing the boundaries of innovation by using smart technology to better monitor bone healing and, consequently, improve treatment outcomes and patients’ quality of life.

“Throughout our nearly 60-year history, the AO has focused on technical innovation as a means of advancing patient care,” said Prof Tim Pohlemann, Chairman TK Executive Board and Chairman AOTK (Trauma). “The AOTK System’s early strategic approach toward evidence-based development has driven the introduction of smart devices.”

The AOTK System is the AO’s internal organization of medical-technical committees responsible for the development and clinical testing of new surgical techniques, implants and instruments, which are then also translated into educational concepts.

AOTK System Director Claas Albers explained that innovation “is at the core of all things AO,” and that the AOTK is an essential driver of innovation at the AO. “It is not just about improving on what already exists in a linear fashion. It’s also about thinking outside of the box, really aiming to improve patient care, and searching for solutions two, five, and ten years into the future,” he said. “Implants are very sophisticated tools used as part of the AO surgical principle of internal fixation. Today we’re asking, ‘How can we develop solutions that demonstrate benefit for patients, surgeons and the healthcare environment?”

The AO has identified the mega trend towards smart technology earlier than others and approaches it on various levels within the parameters of a single strategy driven by the AOTK and executed by in-house and external partners.

The AOTK today is driving various collaboration projects with in-house researchers at the AO Research Institute Davos (ARI), the foundation’s global network of clinicians, and industrial partners some of which are introduced on the following six pages.

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Annual Report 2014 ┃ Innovation at the AO

Moticon OpenGo System

The AOTK’s evidence-based approach has triggered several projects targeting the development of smart solutions which continuously monitor the patient so that they can gather and transmit information on the healing process. Among them is the OpenGo wireless sensing insole that Pohlemann is testing at the University Hospital of Saarland, Homburg/Saar (DE). The insole was developed by Munich-based Moticon, a developer, manufacturer and distributor of products that sense motion and collect data for analysis in the fields of sports and medicine.

“With the data provided by the shoe insole worn by patients, we can see how early healing is commencing and identify non-healing much earlier,” said Pohlemann.

As part of his study of 50 insole wearing patients, Pohlemann’s team is examining the resulting data and creating reference databases logging the typical movement profiles of various patient groups: overweight, large men, small women, active or sedentary, by age, etc.

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Testing of the wearable insole device

Annual Report 2014 ┃ Innovation at the AO

The AO Fracture Monitor

At ARI, under the leadership of Dr Markus Windolf, Focus Area Leader Concept Development, researchers are developing the AO Fracture Monitor, a sensing device that continuously monitors bone healing for up to four months.

Manuela Ernst, Junior Project Leader in the ARI Biomedical Services Program, said the device builds on earlier work by AO Foundation founding father, Prof Stephan Perren.

“In the past, ARI has attached strain gauges directly onto osteosynthesis plates to measure the bending of the implant, but now the technology exists to build something with potential for clinical use,” said Ernst, a human movement scientist. “The uniqueness of the AO Fracture Monitor is that the whole system is implantable and acquires the healing data fully autonomously, so once it is implanted, a clinician can immediately begin accessing data on the patient’s healing process.”

The AO Fracture Monitor can be applied to devices for both external fixation (in which bone fragments are held together by metal pins and one or more connection rods attached to the pins outside the skin surface) and internal fixation. It works autonomously to measure a wide range of inputs, including patient activity. The AO Fracture Monitor is however still some distance from commercial application.

“The next version is under development now, prototypes are expected by late spring 2015, followed by lab testing for sensitivity and additional studies by the end of 2016, and finally, preclinical testing,” explained Ernst.

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From left to right Ronald Schwyn, Markus Windolf, and Manuela Ernst discuss the AO Fracture monitor

Annual Report 2014 ┃ Innovation at the AO

The AO SmartFix

Meanwhile, at the BG Trauma Clinic Tübingen (DE), Prof Dankward Höntzsch is the principle investigator of an observational study of 20 AO SmartFix patients. The AO SmartFix is a “smart” AO external fixator (ex-fix) to which the AO Fracture Monitor has been attached postoperatively—to a connection rod of the ex-fix. The AO SmartFix then measures changes in data generated by the AO Fracture Monitor during bone healing.

Höntzsch said the SmartFix system is very easy to connect, causes no harm to the patient, weighs next to nothing, and changes nothing about the ex-fix, yet it offers many advantages for improving patient care.

“From the data that is continuously collected, we can see how much weight the patient is bearing and how the healing is progressing or not. Today, other than X-rays, we have few means of measuring bone healing,” he said. “During the healing phase, when we see a good response, we can avoid additional X-rays and very importantly we can detect non-healing and intervene early—whether that means re-operating, bone grafting, or something else. Also, we should be able to detect with greater accuracy the right time to remove the ex-fix. When I began practicing trauma surgery in 1981, I would never have dreamt that such a smart device would be available to support patient care.”

“The more data we have, the more informed our patient treatment can be. We will correlate the data to the course of healing,” Pohlemann explained. “The trend today is toward individualized fracture treatment, and it is critical that the AO stays at the forefront of technical solutions to provide as much information as possible to the doctor and the patient.

The smart solutions the AO is testing are, for the first time since the introduction of X-rays 50 years ago, allowing us to add more parameters to bone healing. This is the most exciting development I’ve seen in the last 20 years.”

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Prof Dankward Höntzsch reading data from the AO Smartfix

Annual Report 2014 ┃ Innovation at the AO

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AO Strategy Fund enhances the AO’s visibility and reach At the AO Foundation, innovation is as likely to happen behind the scenes as on the world stage, as evidenced by ambitious projects funded by the new AO Strategy Fund (AOSF).

Launched in December 2013, it is currently funding 16 projects aimed at developing new services and technologies for unmet needs, enhancing the AO’s visibility and reach, fostering cooperation across clinical divisions, and boosting operational effectiveness and efficiency.

With an annual budget of CHF 5 million for 2014–2016, the AOSF welcomes applications (to date 146 from 32 countries) from all AO employees and paying members. Proposals are evaluated by the AOSF Committee and final approval lies with the AO Foundation Board (AOFB). Leaders of approved projects must submit biannual progress reports detailing the milestones completed, challenges faced, delays, current progress toward their project goals, expenditures, and lessons learned. In addition, they are periodically asked to present updates to the AOSF Committee.

Innovation: the next logical step Every AOSF grant proposal is measured against four criteria: innovativeness, strategic impact, feasibility, and how the proposed project fosters collaboration between the AO Clinical Divisions, said Florian Gebhard, AOSF Committee Chair and AOFB member.

“This fund is the first of its kind within the AO because, unlike most calls for proposals, it has no specified topic. Simply, proposed projects should be innovative, long-lasting, and add value to the AO,” Gebhard said. “We want applicants to bring even their wildest ideas, and we have received proposals on a huge range of really interesting, relevant topics. We want to cascade innovative thinking throughout the organization. The success of the AOSF so far tells us that our people have a lot of great ideas.”

So far, the first AOSF-funded projects launched demonstrate the thread of innovative thinking running through the AO, from strengthening preclinical research to creating a Pediatric AO Surgery Reference, to laying the groundwork for the foundation’s entry into virtual surgical simulation. Some of the funded projects are introduced on the following six pages.

Cross section of a trabecular bone containing granules of resorbable cements

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Annual Report 2014 ┃ Innovation at the AO

AO’s preclinical research

A project to optimize the AO’s research methodology is up and running at the AO Research Institute Davos (ARI), thanks to an AOSF grant. This is a two-year, cross-divisional project aimed at strengthening the AO’s preclinical research through the generation of a more uniform, globally-available AO sheep; education and training; and Good Laboratory Practice (GLP) accreditation.

“Preclinical research has made important contributions throughout AO history and it is important to continue to raise the standards for how it is done,” said project leader Stephan Zeiter, DVM, Focus Area Leader Preclinical Services at ARI. Zeiter believes this project has the potential to maximize research output.

“We want to learn whether there would be benefits to using a more homogenous, purpose-bred sheep,” he said. “If so, a next step would be breeding sheep tailored to researchers’ needs and making a more uniform sheep available for research groups worldwide.”

The project’s education component includes developing a residency in laboratory animal medicine, exchange programs for veterinary anesthesiology residents and animal care apprentices, and courses on how to conduct preclinical research.

In the third part of the project, the ARI seeks GLP accreditation to ensure consistency and minimize experimental variables. This is expected in 2016 after a few studies following GLP standards have been completed.

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Christoph Sprecher examining a cortical bone stained with Giemsa-Eosin

Annual Report 2014 ┃ Innovation at the AO

Pediatric AO Surgery Reference

A decade after the widely-used AO Surgery Reference (AOSR) went online, the AO Surgery Reference Editorial College (AOSR EdColl) has AOSF funding to create a comprehensive, open access, internet-based resource on the care of pediatric fractures: the Pediatric AO Surgery Reference (PAOSR). It will be the world’s first comprehensive pediatric surgery reference available on the internet.

“The adult AOSR has been a wonderful success so far, with users spending an average of 18,600 hours a month surfing it in 2014. But it is focused purely on adult fractures,” said Prof Chris Colton, PAOSR General Editor, adding that children represent 27% of fracture care admittances in Europe and North America. “So we know there is a considerable demand for a pediatric surgery reference. Informally, colleagues have said to me, ‘What about kids?’”

The AOSF grant allowed the AOSR EdColl to commence work on the PAOSR in December 2014. The editorial college hopes to have two anatomical modules up and running by the fourth quarter of 2016, and the third module online by the end of the second quarter of 2017.

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Annual Report 2014 ┃ Innovation at the AO

Virtual surgical simulation

For decades, simulation has been used to train novice airline pilots and young drivers, and the AO today is assessing simulation as a means of training surgeons. In the AOSF-funded assessment phase of the Multipurpose Virtual Surgical Simulation Trainer project, AOCMF, AO North America, and the Imperial College London are taking a close look at simulation technology and providers, with an eye to enabling the AO to become a leading player in virtual surgical simulation.

Project leader Tobias Hüttl, MD, said surgical simulation is still in its infancy, but demand is growing.

“Within the approach to surgical training there is a movement away from the classical training model towards the acquisition of technical skills through simulation”, said Hüttl, Executive Director of AOCMF and AOVET. “Prohibitive cost and limited availability of donors make it more and more difficult today to do specimen-based education. At the same time, with increased focus on patient safety, stricter regulations and reduction of duty hours for surgical trainees, the apprenticeship model of training surgeons has become inadequate for ensuring acquisition of sufficient skills.”

The cross-divisional project ultimately will help to fulfill the AO’s mission of improving patient care, he said.

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Using virtual surgical simulation in neurosurgery

Annual Report 2014 ┃ AOTrauma

AOTrauma—stability and flexibility for the largest global trauma network AOTrauma International Board

AOTrauma: a global organization like none other The availability of effective and efficient trauma education, research and a vital network are crucial components of a well-functioning community of practice. AOTrauma enables trauma and orthopedic surgeons, musculoskeletal researchers and operating room personnel (ORP) to execute their craft with confidence as their needs advance. AOTrauma exists to promote improved patient care in the field of musculoskeletal injuries.

AOTrauma membership reached approximately 9,000 members in 2014. Nearly 25,000 healthcare workers participated in 319 AOTrauma courses for surgeons and 62 courses for ORP. AOTrauma hosted ten webinars and three webcasts.

John (Jack) Wilber (US) successfully took over the AOTrauma International Board (AOTIB) in June 2014. Nikolaus Renner (CH), immediate Past-Chair of the AOTIB, was elected to the prestigious position of President-Elect of the AO Foundation.

The AOTrauma 2014 Trustees Breakout Session in Budapest introduced AOTrauma’s strategy to interact with the Trustees, “e to the third power (e3)”: educate, engage and entertain. The AOTIB delivered on solutions to improve AOTrauma. It engaged in a constructive dialogue and entertained with lessons in perseverance and leadership from Gobi runner Stéfan Danis (CA).

The modus operandi of the three C’s: clarify, communicate and coordinate, continues with new executive management leadership. Claude Martin jr has taken the position of Managing Director of the new AO Alliance Foundation. Matthias Dunkel takes over as AOTrauma Executive Director.

Approaches to the Extremities for Surgeons, Geneva (CH)

AOTrauma Europe Masters Course, Graz (AT)

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The year 2014 concluded with yet another successful edition of the AO Foundation Davos Courses, bringing together over 300 international faculties and 1,000 participants. A more inclusive atmosphere, an improved and flexible academic program, and excellent feedback have set the bar high for the 2015 edition.

At the cutting edge in medical education One of the best education assets AOTrauma has developed is its Fellowship Program. Operating unchanged for over 40 years, the AOTrauma Education Committee (AOTEC) launched an enhancement project in 2014. The successful, classical AOTrauma Fellowship program continues. In addition, a new Visit the Expert Fellowship for experienced surgeons, further AO Fellowship sites, and a new online application tool have been introduced.

A Faculty Development Pathway was implemented in 2014 to assist the growing demand from aspiring teachers, with a faculty newsletter FacultyFocus helping to facilitate communication and exchange.

The new 2014 AOTrauma Davos Courses format showcased AOTrauma Education’s ability to embrace change. The 2013 Basic and Advanced Course standardization changes continued in 2014. Freedom for regional adaptation was built into the framework.

AOTrauma Education, through its Education Task Forces, continued to develop and update its scientific content. Two textbooks were published (Casts, Splints, and Support Bandages— Nonoperative Treatment and Perioperative Protection; Fractures of the Pelvis and Acetabulum—Principles and Methods of Management, Fourth Edition), and further enhancements were brought to the Orthogeriatrics project. AOTrauma STaRT (Surgical Training and Assessment for Residents) was honored by the 2014 eHealthcare Leadership Awards (US).

FUTURE OUTLOOK Clear governance model between and within the AOTrauma International Board (AOTIB), Regional Boards and Global Commissions; consolidation of AOTrauma strategy for all regions and competencies Educational optimizations: online education offering enhancements, an event reporting system, promotion/optimization of the AOTrauma Fellowship program, and an AOTrauma Faculty Development pathway and opportunities for young teachers The next clinical priority research project (CPP)

AOTrauma faculty case discussion, Davos Courses 2014

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Annual Report 2014 ┃ AOTrauma

John (Jack) Wilber takes over from Nikolaus Renner (left) as AOTIB Chair

Community development is more than membership AOTrauma membership grew close to 9,000 members, an increase of 12.5% compared to 2013, with Asia Pacific and North America being the main drivers. The second edition of the AOTrauma Member Satisfaction Survey revealed an overall satisfaction score of 7.8 (compared to 7.9 in 2013). An impressive 98% expect to continue being an AOTrauma member.

AOTrauma is the only clinical division, through its Financial Support for Country Chapters Initiative, to give funds back to the country chapters. AOTrauma supported community development projects in 43 countries, covering AOTrauma seminars, member meetings, websites and promotion events.

AOTrauma continued its social media activities; over 6,500 likes on Facebook and more than 1,000 Twitter followers provide a solid basis for growth.

Basic Principles of Operative Fracture Management for Swiss surgeons, Davos (CH)

Klaus Dresing (DE), who was instrumental in establishing the global membership scheme, retired as Chair of the AOTrauma Community Development Commission. Michael Miranda (US) succeeded him as Chair.

Clinical solutions in bone infection research AOTrauma recognized the unsolved clinical problem of bone infection as one of the most serious complications of orthopedic procedures. While the incidence of infection is relatively low in elective procedures (1-2%), for traumatic, open fracture procedures, the risk of infection increases dramatically, with an estimated 27% incidence in civilians and 40% incidence in war injuries. Revision surgeries can have a failure rate as high as 50%. A research consortium led by Stephen Kates, University of Rochester (US), in conjunction with multiple international clinicians and research partners, began activities in June 2012.

The consortium currently consists of 12 projects. In October 2014, 25 clinicians and researchers met to discuss the progress of the research activities.

Clinical Priority Project (CPP) Bone Infection Study Group

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AOTrauma offered several one-year funding grants for clinicians developing innovative projects. In March 2014, the first research education workshop in grant writing took place in Prague (CZ), bringing together 20 participants from eleven countries. Attendees were required to submit a study proposal.

AOTrauma ORP—education at point of contact AOTrauma remains the only clinical division committed to providing education for ORP. Three regions (Asia Pacific, Europe and Middle East) continued to be the focus of educational activity development. Point of contact education began to be prioritized through the AOTrauma ORP Clinical Training Modules (CTM). The first CTM was trialed in six countries, with approximately 140 participants from eight different hospitals. With the CTMs, AO Principles and techniques are taught in small groups by local faculty. This provides education in the learners’ mother tongue, and the ability to relate the training content immediately to their own practice, making these short, low-cost educational sessions attractive and accessible.

AOTME Seminar, Cairo (EG)

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Annual Report 2014 ┃ AOTrauma

Regional activities Asia Pacific The year 2014 was a very successful one for AOTrauma Asia Pacific (AOTAP). 94 courses in 15 countries were organized for over 7,500 participants. A Regional Combined Course held in Chiang Mai celebrated 30 years of AO education in Thailand. In China, combined courses were held in Beijing and in Xian. An important presence at national orthopedic congresses continued, with AOTrauma seminars held in Australia, China, India, Philippines and Taiwan. The second AOTAP Scientific Congress and TK Experts’ Symposium, held in Seoul (KR) drew in 452 participants from 22 countries, where 188 peer-reviewed papers, 59 cases and 46 posters were presented. The third congress will be held in 2016 in Chengdu (CN). Manyi Wang (CN) was elected as the AOTAP Regional Board Chair-elect. He will succeed Chris Morrey (AU) in July 2015.

AOTrauma Europe symposium (DGU, Berlin)

Europe AOTrauma Europe (AOTEU) continues to be the region to deliver the largest number of educational events. In 2014, 118 surgeon courses and 39 ORP courses were held across Europe, Israel and South Africa, including eleven flagship events, and the AOTrauma European Masters Courses and Seminars.

AOTrauma had an important presence at three annual European congresses: DGU, ECTES and EFORT. Paul Szypryt (UK) was elected as the AOTrauma Europe Regional Board Chair.

He took over from Rami Mosheiff (IL), who was involved in AOTEU governance since 2008. The European Masters Courses were enhanced with more anatomical specimens. The AOTEU Education Committee continued its work to better address the needs of the large, diverse European community.

AOTrauma Asia Pacific Regional Combined Course

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Latin America In 2014, AOTrauma Latin America (AOTLA) found the correct balance in meeting participants’ demands for education by providing 80 educational events to 3,700 participants. In addition, a Chair Training Program (CTP) course was hosted for the second time in the region, to prepare faculty to fulfill the rigors of course directorship. In July, William Belangero (BR) began his term as the AOTLA Research Chair, a position previously held

by Jorge Barla (AR). Thanks to the proactive activities in Community Development, AOTrauma membership in Latin America increased from 1,050 to 1,350. In November, the second Fin de Semana AOTrauma Latin America faculty event was held in West Palm Beach (US), demonstrating soft tissue coverage and local flaps.

Middle East AOTrauma Middle East (AOTME) organized a total of 28 educational activities. October marked another successful milestone in the Middle East with more than 250 in attendance at the regional courses in Dubai (AE). For the first time, AOTME organized a regional webinar, providing free online training to over 250 participants. AOTME exhibited at the 7th Annual Meeting of the Society for Progress and Innovation in the Near East (S.P.I.N.E) in Beirut (LB). At this event, AOTME also organized and moderated an AOTrauma symposium. Participants included surgeons from Aleppo (SY). Due to roadblocks, it took some attendees more than 20 hours to arrive by bus to the event.

North America AOTrauma North America (AOTNA) continues to lead with its Advanced Clinical Education Program, supporting the best in fellowship education through grants and educational offerings to 27 trauma fellowship programs. In 2014, AOTNA held 22 courses, training 1,300 residents, fellows, practicing surgeons and faculty members. AOTNA also held nine webinar courses, delivering free training to 350 participants. In addition, over 300 teaching faculty members dedicated time to teaching residents, fellows and practicing surgeons.

AOTrauma Latin America Regional Board

AOTrauma Middle East Regional Board

AOTNA recently exhibited at the 30th Annual Orthopedic Trauma Association meeting in October in Tampa (US). On October 17, AOTNA hosted its third annual fellows reception, followed by the AOTNA Annual Reception, where more than 300 members and faculty enjoyed an evening of networking and celebration.

AOTNA at the Orthopaedic Trauma Association Annual Meeting

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Annual Report 2014 ┃ AOSpine

AOSpine—supporting the next generation of leading spine surgeons worldwide Sharing knowledge and expertise AOSpine continued to prioritize the advancement of its network by delivering high-class educational opportunities to course participants while continuing to train and develop its faculty.

The AOSpine mentoring and fellowship programs ensure that the next generation of spine surgeons receive the best support in their careers from renowned surgeons, and that knowledge and expertise is being shared across cultures and countries.

Leading in spinal education AOSpine successfully delivered 183 educational events to more than 11,000 participants worldwide, with around 1,500 faculty sharing their knowledge and experience. The first module of the AO Surgery Reference Spine was well received. The launch of the second module at the Davos Courses 2014 highlighted its value as an educational tool for all surgeons.

Sadly, AOSpine lost one of its most devoted leaders and dedicated supporters with the passing of Germán Ochoa. His involvement with AO Education for 30 years speaks volumes about his passion and immense experience in the profession. To honor his unparalleled dedication to AOSpine, and his countless achievements, the Germán Ochoa Traveling Fellowship was set-up. Its philosophy is that the selected member will act as an ambassador to promote AOSpine as a global community and a leader in spinal education.

AOSpine Europe Live Tissue Training, Strasbourg (FR)

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FUTURE OUTLOOK Research–advances in spine surgery During the fourth edition of the World Forum for Spine Research, more than 200 registered participants from 35 countries gathered in Xi’an, China, to exchange knowledge on the recent advances on the intervertebral disc.

AOSpine Research is currently managing and/or sponsoring ten translational and 24 clinical research studies worldwide.

The Spine Research Network continued to advance in the field of intervertebral disc regeneration and degeneration. The sponsored network members have published twelve manuscripts and 23 presentations in 2014.

Reinvent AOSpine’s education offering by systematically applying blended learning Measure outcomes of the AOSpine Knowledge Forums and link them to our educational program Establish the Global Spine Congress and the Global Spine Journal as the most valuable resources for surgeons worldwide

The AOSpine Research mentoring program was also launched, where seven young surgeons have been paired with an experienced AOSpine surgeon and are learning how to conduct research under the direction of Dr Daniel Riew.

Community Development–distributing and exchanging knowledge AOSpine Community Development continued to encourage its members to generate, distribute and exchange knowledge through the support and promotion of education and research activities. Through new initiatives such as the AOSpine News App and the AOSpine community video, the 6,000 members and the wider community have remained up-to-date on AOSpine’s educational and research offerings. AOSpine also conducted a survey of its network to gather information on how to further improve its membership program.

The Global Spine Journal and Evidence Based Spine Care Journal continue to be a highly valued membership benefit with survey respondents putting them in the top three of benefits that they would not want to be without.

Current Concepts in Deformity Treatment, Davos (CH)

The first three volumes of the AOSpine Masters Series, in which international masters of spine share their expertise and recommendations on particular topics, were released and very well received among professionals in the field of spine surgery.

Devoted leader and dedicated AOSpine supporterGermán Ochoa

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Annual Report 2014 ┃ AOSpine

Regional Activities Asia Pacific Educational activities continue to flourish across all areas in Asia Pacific; in 2014 there were 54 courses organized with more than 2,800 participants. Key highlights included the AOSpine National Course in Xian (CN) which was attended by more than 450 participants. One of the many other significant events in the region was the Inter-EA Forum held in Taipei (TW) in March 2014 where surgeons from all over the East Asia Region came together to discuss spinal issues. AOSpine Asia Pacific also sent 49 fellows, both short and long-term, to AOSpine Spine Centers.

A participant receives an award at the WFSR in Xian (CN)

Europe and Africa AOSpine Europe (AOSEU) strengthened its position as the leading provider of spine-related education in the region with more than 700 surgeons participating in educational events in 17 countries. Over 900 participants attended AOSpine’s national and regional congress symposia. For the first time, AOSpine collaborated with the EuroSpine Foundation on a joint educational event.

AOSEU Flagship Event, Strasbourg (FR)

The quality of AOSpine’s education in Europe remains unparalleled, in particular the unique Chairperson Training Program which prepares faculty to align the AOSpine Curriculum to all educational events in the region. In research, the multicenter study sponsored by AOSEU continues to recruit patients.

AOSpine also expanded its activities to Namibia.

Middle East AOSpine Middle East (AOSME) continued to excel as the region’s leading academic society and spine surgeon community, pioneering the AO Faculty Education Program in Dubai, as well as Education in Research, in the form of Principles Workshops which have been very well received. Over 365 surgeons participated in ten AOSpine events and two congress symposia in ten countries. This year, 16 young surgeons participated in the fellowship program. In research, the second AOSME Young Researcher Award was successfully launched. The year also saw the Middle East win the bid to bring AOSpine’s Global Spine Congress to the region for the first time in 2016.

AOSME Faculty Training Program, Dubai (AE)

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Latin America AOSpine Latin America developed 56 different types of academic activities in several countries, with over 3,600 participants. The Faculty Training Program certified ten new faculty members, as well as the twelve new Chairpersons qualified through the Chairperson Training Program. In research, new projects were developed, such as the book Education in Research: From the idea to the publication, the online course Access to Information among other projects. The fellowship program has also continued to grow, with rising demand calling for an increase in the number of centers in the region.

North America AOSpine North America (AOSNA) started 2014 by bringing together leaders from AOSNA, AO North America, and AOSpine International in a strategic workshop to formulate the vision for AOSNA and develop the roadmap for achieving that vision.

AOSNA Strategy Planning Workshop, Arizona (US)

In research, leading experts tackled the subject of value-based health care resulting in a focus issue in Spine. With the formation of a new fellowship committee, a comprehensive fellowship curriculum/handbook became available to all AOSNA fellowship programs. Other key initiatives included the launch of a new AOSNA member newsletter and successful members’ reception at the North American Spine Society Annual Meeting in San Francisco.

AOSpine Latin America Advanced Live Tissue Course, Curitiba (BR)

31

Annual Report 2014 ┃ AOCMF

AOCMF—advancing craniomaxillofacial surgery The AOCMF International Board took on a new claim to embrace the entire scope of the clinical division: AOCMF—Excellence in facial surgery across the specialties.

AOCMF membership grew to almost 2,150, an increase of more than 13% compared to 2013. AOCMF delivered 111 surgical and 8 operating room personnel (ORP) courses, providing education to over 5,000 participants, and reflecting a 9% growth for educational events over the previous year. Latin America and Asia Pacific were the main growth drivers.

At the Davos Courses 2014, AOCMF conducted a new advanced course in 3D planning and reconstruction with human anatomical specimens.

Advances in 3D Planning and Reconstruction Workshop, Davos (CH)

FUTURE OUTLOOK Continue successful global activities with a specific focus on educational activities and community development in Asia Pacific and Eastern Europe Emphasize curriculum development activities and the development of new educational formats as well as faculty development programs Future research activities focus on the new program: Anti-osteoclastic drugs and their impact on maxillofacial and orthopedic bone biology, disease, diagnosis, prevention, surgery, and treatment modalities (ARONJ)

32

Educational events All regions contributed to the success of AOCMF Education worldwide. Asia Pacific organized a Principles Course on craniofacial trauma and reconstruction in Hong Kong. The advanced European Forum on Orthognathic Surgery in Stockholm (SE), had over 50% of participants from Northern European countries in attendance. Dubai (AE) hosted the regional advanced course on tempromandibular (TMJ) surgery, facilitated by worldwide topic experts, and including practical exercises on human anatomical specimens. Latin America conducted for a second time its regional course in West Palm Beach (US), which offered a course demonstration on a face transplant. North America held a Pediatric Reconstructive Surgery Course in New Orleans (US), and additionally implemented the Small Group Discussions for Principles Course format.

Faculty development Over 70 AOCMF faculty members attended Faculty Development Programs worldwide, reflecting the importance of these development opportunities. For the first time, AOCMF ran a Faculty Education Program for faculty members from the Middle East and Asia Pacific region. The first Chairperson Training Program, held in Bangalore (IN) helped 18 faculty members to brush up on the course chairman’s profound tasks and responsibilities.

Fellowship program Demand for the AOCMF Fellowship Program remained high, with 52 new fellows assigned, and the Mazumda-Shaw Cancer Center in Bangalore (IN) inducted as a new Fellowship Center.

Community development Community communication increased to highlight course announcements and news items. A new AO Surgery Reference CMF module was published on the correction of posttraumatic deformities, supporting the previously published mandible section. After nearly a decade of development, AOCMF launched the first AO classification system for craniomaxillofacial skeleton fractures together with the AO Comprehensive Injury Automatic Classifier (AOCOIAC) software solution.

Research–Clinical priority programs Imaging and Planning in Surgery, the first Clinical Priority Program launched by AOCMF, successfully concluded after five years. Results from the 15 funded projects were presented at a conference in Prague (CZ) in September 2014. Future research activities will focus on the new program: Anti-osteoclastic drugs and their impact on maxillofacial and orthopedic bone biology, disease, diagnosis, prevention, surgery, and treatment modalities (ARONJ).

Fixation of Complex Midface Fracture, Prague (CZ)

33

Annual Report 2014 ┃ AOVET

AOVET—advancing the practice of veterinary surgery Special Focus Course in Small Animal Fracture Management, Davos (CH)

In 2014 the AOVET membership grew to 820 members, which represents an increase of 20% compared to 2013. The mobile app Insights VET as a new source of information for AOVET members became a huge success. AOVET delivered 31 educational events worldwide providing education to over 1600 Veterinarians which represented a significant increase over the result of the challenging previous year. AOVET awarded five short term fellowships. The AOVET R&D commission issued a call for start-up grants in summer 2014, followed by a call for grants in collaboration with the AO Research Institute (ARI), resulting in three accepted research projects.

Educational highlights Despite 2013’s challenges, over 31 AOVET courses were realized worldwide in 2014, with 1,636 participants registering for educational offerings. This represented a significant increase to last year and proved AOVETs ability to overcome the political, economic and compliance challenges of the recent past.

AOVET hosted its first course in South Korea, which included a Faculty Education Program (FEP) prior to the course. This combination proved to be fruitful for the faculty involved in the course, as they could implement and improve educational activities immediately. As a result, similar efforts were taken at the Beijing (CN) and the Zagreb (HR) course by the international Course Chair, Alessandro Piras. In 2015, more AOVET faculty will be sent to FEPs organized by the AO Education Institute.

Interdental wiring model for practical exercise, Davos (CH)

In addition to its face-to-face courses, AOVET conducted four webinars, covering two small animal and two equine topics. Focus of these webinars (moderator Rico Vannini) was on “Minimally invasive fracture repair—the pros and cons” (faculty: Brian Beale) and “Surgical management of juvenile hip dysplasia” (faculty: Mike Kowaleski). The two equine webinars (moderator: Jörg Auer) addressed “Fracture Management of the Head Region—What can be done?” and “Fracture Management of the Head Region—What can be done? Part II: Face and Skull” (faculty: Anton Fürst).

AOVET fellowships AOVET awarded five short-term fellowships, placing two European fellows and one Indian fellow in US academic institutions, one European in a referral clinic in France, and one Brazilian in an Italian private referral practice.

Talking to a course participant during the Davos Courses 2014

34

FUTURE OUTLOOK Community development In 2014, the AOVET community grew by over 20% to 820 members while the first dog module in the AO Surgery Reference veterinary section was launched. Through advertising promotions on Insights Veterinary, awareness of AOVET has increased significantly, and with 3,800 users, the platform is a success. On the mobile platform, Insights Veterinary, published a new tile design during the year to improve the user experience.

Research and development Under the leadership of its Chair Carl Kirker-Head, the Charter of the AOVET Research and Development Commission was adapted in December 2013, resulting in the election of R&D commission members and a first member meeting being held in spring 2014 at the ACVS Symposium in San Diego (US). In summer, a call for start-up grants commenced, followed by a call for grants in collaboration with the AO Research Institute (ARI) on implant biomechanics, joint biomechanics and biomechanics of the spine. Of the nine ARI proposals, six were invited to submit full proposals. The ten submitted start-up grants were taken-on as proposals. In the first review by the AORCC, four were recommended for funding, three of which were accepted by the AOVET R&D Commission.

Focus on educational offerings with a specific emphasis on Asia Pacific and Latin America Send additional faculty to the faculty educational programs, focus on faculty education with the other clinical divisions Reposition the clinical division to address collaboration and governance changes

Masters in Operative Treatment of CMF Trauma and Reconstruction, Davos (CH)

35

Annual Report 2014 ┃ AONeuro

AONeuro—improving outcomes in neurosurgery FUTURE OUTLOOK 20 educational activities planned worldwide Fellowship and exchange program to be implemented in North America Neurotrauma Curriculum and Skull Base Curriculum to be finalized and implemented

Education–AONeuro events and courses 2014 was a very successful year for the AONeuro Initiative. Under the guidance of the Neuro Steering Committee nine educational events with more than 430 participants were successfully conducted.

Over 100 participants attended two interdisciplinary care neurotrauma courses in China. In Australia, an AONeuro Skull Base Micro Dissection course featured 15 hours of dissection under the guidance of experienced neurosurgeons. Neurotrauma courses in Colombia, Spain, and Italy, were conducted successfully with exciting participants feedback. In the US, two courses were collaboratively organized by AOSpine North America and the AONeuro Initiative.

As in previous years, an AONeuro course was conducted at the AO Davos Courses 2014. The 33 participants from 21 countries showed particular interest in the role of surgical intervention in severely injured patients.

Online, free recorded lectures, distributed to the AO Community interested in the AONeuro initiative throughout the year, proved popular. The Pediatric Traumatic Brain Injuries (TBI) Webinar, the first AO webinar to ever receive CME accreditation by the European Union of Medical Specialists, received very positive ratings.

Management of Traumatic Brain & Spinal Cord Injuries, San Francisco (US)

Curriculum development The AONeuro Curriculum on Neurotrauma was finalized by planning committee members Aurelia Peraud (DE), Christian Matula (AU), José Fernandéz-Alén (ES), Francesco Biroli (IT), and Michael Bierschneider (DE) in 2014. A curriculum peer review was conducted by Rocco Armonda (US), Stephen Lewis (AU), and Yuanli Zhao (CN). The curriculum—which includes a faculty guide, course template, and casebook—serves to further enhance the quality of AONeuro activities.

First Neuro Course in Latin America, Medellin (CO)

36

Annual Report 2014 ┃ AORecon

AORecon—a successful first year in improving joint preservation AORecon taking shape with events and course curriculum In its first year, AORecon strived further in reaching its target to improve patient care in joint preservation and replacement.

In November 2013, AORecon celebrated its debut event at the Chinese Orthopaedic Association’s annual meeting in Beijing.

Since then, a pilot project was launched, a group of key opinion leaders formed the AORecon faculty, and the website went live.

Five educational events in Dubai, Seoul, Rio de Janeiro, Beijing and Davos scored high ratings with participants. AOTrauma and AORecon’s key opinion leaders joined forces to deliver two of the five events. Moreover, an AORecon curriculum development group started work on the first AORecon course. The curriculum is based on the AO Education Principles and is created along the backward planning process. AORecon also places strong focus on symposia. A baseline for the agenda development of symposia is being created to streamline these events.

Looking ahead For 2015, up to eleven educational events will be organized

by AORecon. This will intensify the AORecon presence in Asia and Europe while covering North America, in addition to the regions served in 2014. This summer, the AO Foundation Board will decide on the continuation of the initiative, as well as the roadmap for 2016 onwards. If continued, AORecon will aim at further fulfilling the AO Foundation‘s vision by expanding the AO activities within the fields of joint preservation and replacement globally.

FUTURE OUTLOOK Greatly increase number of educational activities and cover all AO regions Roll out first courses based on the AORecon Curriculum Define scenarios for the future roadmap of the AORecon initiative

Past-President Prof Norbert Haas presents AORecon in Beijing (CN)

37 AORecon Symposium during the Davos Course 2014

Annual Report 2014 ┃ Institutes

Research and Development Taking translational research to the next level

Introduction of the newly developed pneumatic loading frame

Three dimensional rendered CT scan demonstrating tendon reconstruction of syndesmosis rupture

Ankle fractures and the Biomedical Services Program Ankle fractures are among the most common injuries treated in orthopedic and trauma surgery. Although the majority of fractures result in a good short-term outcome, all ankle fractures are at risk for posttraumatic osteoarthritis. Apart from bony stability, other post fracture complications occur. The syndesmosis is a series of strong ligaments that maintain the integrity of the ankle joint, and injury to this structure occurs in approximately 10–13% of all operative ankle fractures. To address the above-mentioned and other problems concerning the foot and ankle, the focus of several recent projects in the Biomedical Services Program has been to develop simulated weight-bearing experiments of the lower extremity. Using a pneumatic loading frame, developed and built at ARI, cadaveric specimens can be placed in a variety of foot positions and loaded ex vivo. Part of this specialized frame is radiolucent at the level of the positioned foot, allowing the researchers to obtain high quality CT scans and radiographs of the specimens during testing.

To date, this setup has demonstrated in finer detail the motion of the fibula in the incisura and its dependence on foot position during simulated weight-bearing, in the intact state, and with sequential sectioning of the ligaments. One of the strengths of the design is that it allows surgeons to perform complex reconstructions on the specimens and then test them in the frame. It is a unique opportunity to compare the reconstructed state to the intact anatomy, instead of relying on comparisons to population norms. It enables researchers to critically analyze reconstructive techniques for the syndesmosis and other injuries.

Analysis is currently ongoing into the necessity to surgically stabilize small fractures of the distal tibia, and determining the amount of bone that can be resected or lost before sacrificing stability of the foot and ankle.

The frame is not limited to the lower extremity either and the team is currently exploring research options in the upper extremity. Due to the success of the current loading frame, work is underway to create a larger, free-standing frame that will allow analysis of the loading of an entire limb. AO surgeons have already begun designing experiments that will surely lead to exciting outcomes in the near future.

Example of an orbital floor implant template generated from clinical computed tomography data to be used for direct 3D printing

38

FUTURE OUTLOOK Highlight from the Musculoskeletal Regeneration Program RAPIDOS The RAPIDOS Chinese-European Joint Research project: “Rapid prototyping of custom-made bone-forming tissue engineering constructs� took off in 2014, strengthening the collaborative work between partners and the scientific realisations. RAPIDOS has been running for 18 months with seven international partners and will continue into 2017.

In Spring 2014, the RAPIDOS team met in Europe and China at workshops focusing notably on additive manufacturing. Senior members of the ARI team as well as all other European and Chinese partners also met in November 2014 in Hong Kong to measure the scientific progress of the project.

Ankle fractures, developing weight-bearing simulation models Sino-European 3D printing of bone-forming Tissue Engineered Constructs Development of realistic preclinical models for bone infection studies

The RAPIDOS project activities have been presented at several international and national conferences, peer-reviewed manuscripts published, and one patent filed. A clinical CT imaging process technology workflow for the development of anatomically relevant and precise custom-made, macro-structured designed implants is one of the scientific achievements of the ARI and its RAPIDOS partners. The development of biomaterial composite formulations for stereolithography and low-temperature rapid manufacturing has already led to the fabrication of the first prototype implants. And finally, the osteopromotive effect of icaritin, a Chinese medicine phytomolecule, which will be included in the patient-specific created implants, has been demonstrated in vitro and in vivo.

The RAPIDOS partners meeting in the Prince of Wales Hospital in Hong-Kong to measure the scientific progress of the project

39

Annual Report 2014 笏オnstitutes

Preclinical research in implant-associated infection Implant-associated infection has been a research topic within the ARI for the past few years, as part of the AOTrauma Clinical Priority Program (CPP) Bone Infection. A number of new preclinical in vivo models have been developed by the Preclinical Services and the Musculoskeletal Infection teams in order to better model the clinical condition.

These projects benefit from interdisciplinary collaboration between the veterinary surgeons and basic scientists working in ARI, as well as interactions with orthopedic surgeons on medical research fellowships and other surgeons in the CPP.

Invivo preclinical models of infection From left to right: mouse femoral plate, rabbit humeral nail, rabbit tibial screw, sheep tibia nail and cement spacer

Intraoperative pictures show the placement of an intramedullary nail into the sheep tibia (left). In the image on the right, we see the placement of an antibiotic loaded cement nail, which is used in a two-stage exchange of infected hardware.

40

Annual Report 2014 ┃Institutes

Research Review The independent peer review process The AO Research Review Commission (AORRC) continues its mandate to act as independent review board for all research projects supported by the AO Foundation. Each of the 36 grant proposals submitted by the clinical divisions was independently reviewed by at least two external experts; these were then consolidated by a composite reviewer. The submitting funding bodies (AO Clinical Divisions) were provided with the recommendations and a detailed review report for each project. The final decisions are taken by the respective funding bodies.

Dr Clare Yellowely-Genetos presents at the Trustees Meeting 2014

The pool of over 450 experts serves as an independent external resource and it ensures that all AO research projects are assessed and evaluated by experienced reviewers who are experts in their chosen fields.

In this way, the AO Foundation can continue to develop and support the most innovative and clinically relevant projects possible. The applied review process meets international standards of impartiality and expertise. After a prescreening process, a total of 89 AO Start-up Grant applications qualified for the review process; these proposals were then reviewed by two members of the AORRC and the respective funding body (the AO Start-Up Grant Committee) provided with the reports and a ranked recommendation list.

Projects support by area Subject

AO Start-Up Grants This grant category remains very popular among both young and senior researchers submitting high-risk concepts. In 2014, the AO Start-Up Grant Committee approved 15 projects, 14 of which were proposed by young researchers and one of which was proposed by a senior researcher. All applicants who submitted a grant application received a summary of the reviewers‘ comments for their consideration.

Bone healing

5

Clinical

1

Implant development

1

Spine

4

Tissue reaction

3

Biomaterials/metallurgy

1

Total

Berton Rahn Research Fund Prize Award Each year the best AO Start-Up Grant project is awarded the annual Berton Rahn Research Fund Prize Award. After a rigorous evaluation, Dr Clare Yellowley-Genetos (US) was awarded the 2014 prize for her project: “Stem cell mobilization for enhanced bone healing”(Project S-10-62Y).

Number of projects

15

2014 research grants/geographical distribution Country

Number of projects

The Netherlands

5

USA

4

Germany

2

Australia

1

Canada

1

China

1

Ukraine

1

Total

15

41

Annual Report 2014 ┃ Institutes

AO Education Institute Educating the next generation

New publications Casts, Splints, and Support Bandages—Nonoperative Treatment and Perioperative Protection covers the principles of casting, guidelines for non-operative treatment, and step-by-step descriptions of 55 individual cast, splint, orthosis, and bandaging techniques. It is relevant for a wide range of medical professionals, from trauma and orthopedic surgeons to cast technicians, rural doctors, residents in training, and ORP. Fractures of the Pelvis and Acetabulum—Principles and Methods of Management, Fourth Edition is a two-volume set of books based on the renowned AO Principles of operative management of fractures. The acute management of pelvic and acetabular fracture patients, the definitive treatment of both fractures by operative approaches for reduction and internal fixation, and extensive analysis of the outcomes of pelvic and acetabular fractures are covered in detail.

AOTrauma Orthogeriatrics app Working with the AO Education Institute (AOEI) to design screen content and navigation pathways, AOTrauma launched in September a new point-of-care educational tool on osteoporosis, delirium, anticoagulation, and perioperative pain. By year-end, 5,230 health care professionals had installed the app.

Initial feedback has been positive and evaluation of its educational value and impact on patient outcomes is underway.

AOTrauma STarT online learning hub

FUTURE OUTLOOK Launch the fourth edition of the “Fractures of the Pelvis and Acetabulum” book classic (Editors: Tile, Helfet, Kellam, Vrahas) Establish an advisory committee to the AO Education Institute Consolidate AO Faculty Development in one center of expertise 42

Enhanced interactivity in subspecialty courses AOTrauma Pediatrics and Foot and Ankle courses in Davos promoted interactivity. Groupings of participants and faculty members at roundtables during the course enabled adaptation to participants’ expertise, clarification, additional complexity, and the ability to address controversial topics. This competency-based curriculum, originating from the Education Taskforce, will be piloted in all AO regions.

Faculty Education Program For the first time, the four AO Clinical Divisions (CDs) successfully conducted a total of 50 faculty development events, training 800 AO faculty members through its Faculty Education Program (FEP). To meet the growing demand for development programs, faculty development will be aligned, with FEP serving as the official program for all regions and CDs going forward.

Research in medical education Increased collaboration with educational task forces and colleagues from the clinical divisions enabled educational research to be showcased in eight presentations, in six posters at leading medical conferences, and in four article and dissertation publications.

AOTrauma STaRT launches and wins two international awards AOEI and AOTrauma launched an online learning hub for orthopedic trauma residents, STaRT—Surgical Training and Assessment for Residents. The interactive learning hub supports self-paced learning and provides direct feedback through video-based case discussions, self-assessment, and AO learning materials. AOTrauma STaRT has achieved international recognition, winning a Platinum Award from the eHealthcare Leadership Awards and a Silver Award from the Web Health Award competition.

Active roundtable discussions during the AOTrauma subspecialty courses in Davos (CH)

43

Annual Report 2014 ┃ Institutes

Clinical Investigation Bringing ideas to clinical evidence

Interesting discussions among the participants on the AOCMF Good Clinical Practice course in Prague (CZ)

Doctors Aprato and Azi, AOCID Clinical Research Fellows, receiving their coveted certificates

AO Clinical Investigation and Documentation (AOCID) kept very busy in 2014, dealing with 45 clinical studies, along with large and focused registries. The institute also launched a number of new courses in clinical research education. Some of these were completely new while others built on modules in courses already available. The year started with the AO Grant Writing course which premiered in the Czech Republic in January. Also debuting were the Medical Writing and Statistics for Surgeons courses which were given in Switzerland and Taiwan. The new Study Set Up course assembles the most important theoretical and practical information needed to begin a clinical investigation.

The institute is at the forefront of technological advances in Patient Reported Outcomes Measures (PROMs). The AO Patient Outcome Center (AOPOC) is a tool for the routine collection of PROMs in clinical practice. This project, which uses computer-adaptive testing to track patients’ progress in a smart and efficient way, successfully moved through testing phases in 2014.

The alpha testing phase took place at four hospital systems in the US at the start of the year and concluded as planned. The AOPOC project then moved into the beta testing phase for the rest of the year. Ten sites were recruiting patients by December 2014. Once all of the testing is complete, the project will be commercially launched in 2015 by a US-based spin-off company.

This project has generated a lot of interest. A possible AOCMF project is under investigation, while AOSpine has already decided to initiate a spine-based project. Even AOVET is appraising the possibility of using the tool by having pet owners as proxies.

Another milestone was passed as the AO Clinical Study Center (AOCSC) concept entered the first round of requalification of hospitals around the world. A particular highlight was the ceremony in Thailand in October to award and of course con-

Suthorn Bavonratanavech accepts the AO Clinical Study Center certificate on behalf of the Bangkok Hospital (TH)

Group picture taken at the first ever AO Grant Writing course

44

FUTURE OUTLOOK gratulate Bangkok Hospital Medical Center and the team there on their AOCSC qualification. In addition to an array of distinguished guests, including AO President Suthorn Bavonratanavech, local press and TV were present to capture the occasion.

AOCID will continue to focus on its core competencies in conducting clinical research

Four surgeons from India, Brazil, Italy and Argentina each completed a three-month fellowship in clinical research at the AOCID offices in Switzerland. These AOTrauma and AOCMF sponsored fellows worked on projects as diverse as posttraumatic bone defects to the socioeconomic burden of acetabular and pelvic fractures.

Innovative use of technology to establish patient reported outcome tools for all clinical divisions

AOCID ran a survey on radiation exposure at the AO Davos Courses. It was taken by 532 surgeons, demonstrating the high level of interest in this topic. A peer-reviewed publication will follow.

AO Clinical Study Center moves to the next phase of requalification along with a networking focus

After twelve years at the helm of AOCID, Beate Hanson decided to move on. Her colleagues at AOCID thank her for all her work and wish her luck in her new role.

Participants getting involved at the AOCMF Good Clinical Practice Course in Prague (CZ)

45

Annual Report 2014 ┃ Institutes

AOTK System Smart approaches for evidence-based development

FUTURE OUTLOOK Addressing changes in the healthcare environment with strategic approaches to research and development Paving the way for smart technology in the surgical treatment of trauma and other musculoskeletal disorders Innovative concepts for medically guided safety and efficacy assessments of surgical techniques and technology

In the light of rapidly changing conditions in healthcare systems all over the world the AOTK System continued to incorporate socioeconomic strategies, technology leadership approaches, and other cross-over opportunities into its work streams. Measurable quality of patient care, patient outcomes and hospital reputations have grown in significance in healthcare, alongside classic treatment outcomes. Another major healthcare focus is smart monitoring technology. Although this might require significant investment at the outset, such techniques will become cost savers in the future, (eg, fewer complications due to early intervention and evidence generation regarding treatment effectiveness). First steps in this direction have already been initiated by the AOTK (see pages 6-13).

Innovation Award 2014 The AOTK Innovation Award 2014 was given to Michael Raschke and Gerhard Schmidmaier for their outstanding achievements in the development of the Expert Tibia Nail with a thin polymer coating. After implantation it releases doses of antibiotic directly into the bone for two weeks thereby reducing the risk of bacterial infection around the implant surface.

New AOTK Chairman election The AOFB elected Maarten Spruit, Nijmegen, Netherlands as the new Chair of the AOSpine TK starting July 2015. He takes over the role from Bob McGuire who has held this position since 2008 and assumes the Presidency of AO North America after the Trustees Meeting 2015.

The TFNA nailing system allows the choice between a Helical Blade and the TFNA Screw. Both head element types have an oblique lateral end such that it lies flush to the lateral cortex of the femur which reduces protrusion into soft tissue

46

New developments in 2014 For trauma the new TFN-ADVANCED Proximal Femoral Nailing System (TFNA) is 15.66 mm in diameter and therefore smaller than other IM nail systems, which helps to preserve bone in the insertion area which is especially beneficial for small stature patients. Furthermore it has a reduced radius of curvature of 1,000 mm to improve the anatomical fit. Another design feature of the nail is a proximal lateral relief cut which is intended to reduce the pressure to the lateral femoral wall and to ease nail insertion without losing reduction. While developing the TFNA, special attention was given to ease the instrumentation and reduce the surgical complexity.

Prof Tim Pohlemann addresses AO Trustees on behalf of the AOTK Executive Board

The Facet Wedge (FW) spinal system, developed for posterior fixation of lumbar motion segments, is less invasive than the commonly used pedicle screws and rods. Its objective is facet fusion through immobilization of the facet joints, with or without bone graft, at single or multiple levels, from L1 to S1. It can be inserted minimally invasively either to augment other fusion techniques or as stand-alone device for cases without segmental instability. The advantages of the FW over Translaminar Facet Screws are direct visualization of the facet joint which supports implantation. Additionally the specific instruments allow for joint preparation to improve likelihood of successful fusion of the facet.

MatrixWAVE MMF is a novel bone borne system for maxillomandibular fixation that combines the strength and rigidity of arch bars with the speed and simplicity of IMF screws. It consists of a wave shaped plate that can be extended horizontally to enable surgeons to avoid tooth roots and nerves when placing screws. Following application and wiring, the wave plate pattern enables surgeons to adjust the alignment of bone segments without repositioning the screws while maintaining optimal dental occlusion. It eliminates the need for interdental wiring, which reduces the risk of tooth loosening.

AOTK Executive Board members with the AOTK Innovation Prize Awardees

MatrixNEURO Preformed Mesh is an anatomically contoured rigid mesh implant for the reconstruction of medium to large cranial defects. It is intended for use in fixation of the cranial bones in procedures such as reconstruction, fracture repair, craniotomies and osteotomies. Unlike contourable reconstruction meshes which must be bent to shape in the OR, the Preformed Mesh is available in a range of anatomic shapes to fit temporal, fronto-tempo-parietal and frontal areas.

Stefano Fusetti demonstrating the new Matrix WAVE to course participants

47

Annual Report 2014 ┃ Institutes

Synthecel Dura Repair is a dural substitute based on biosynthesized cellulose technology. It is designed for the repair of dura mater following traumatic, neoplastic or inflammatory damage.

Comprised of non-woven, interconnected cellulose fibers, it has tensile strength and functions as a mechanical layer to protect and repair dural defects whilst preventing cerebrospinal fluid (CSF) leakage. SYNTHECEL is immunologically inert, allows healing without adhesion formation and avoids the complications inherent to the use of autologous tissue in duraplasties.

The Double/Triple Pelvic Osteotomy plate was developed under the guidance of the Veterinary Expert Group. Although having many similarities to existing bone fixation plates, the DPO/ TPO plate incorporates the following important features, eg, it is contoured for an anatomic fit with left and right configurations as well as three correction angles. The screw trajectory is designed to anatomically optimize screw purchase in the relatively soft bone. Combi-holes allow compression of the osteotomy; cortex screw and locking screw fixation at the discretion of the surgeon. Additional wire holes allow a temporary fixation with K-wires.

The Chairs of the AOTK System at an extraordinary strategy retreat in February 2014

48

Annual Report 2014 ┃ AO SEC

AO SEC—improving care of the injured in the least developed countries A year of firsts and a last The first French-speaking nonoperative courses in Ebolowa (CM), the first English-speaking course in Banjul (GM), and the first seminar on Basic Principles in Vientiane (LA), all took place in 2014. The total number of AO SEC events delivered to surgeons and ORP in 2014 was 45.

AO SEC meeting in Budapest (HU)

The 2014 Ebola epidemic was the largest in history, affecting countries in West Africa. This had a profound effect on AO SEC activities in Nigeria, Senegal, Guinea, Liberia, and Sierra Leone.

The AO Alliance Foundation For over 20 years, the AO has been involved in the developing world. To date the AO SEC has conducted this work, having a presence in 19 less developed countries in Africa, eleven in Asia Pacific and two in Latin America.

In order to strengthen AO engagement in the least developed countries and to take AO SEC activities to the next level, a new entity called the AO Alliance Foundation (AOAF) was created.

The new foundation (a separate legal entity) saw the light in February 2014 when a group of AO surgeons and surgeons from least developed countries came together under the leadership of AO Foundation CEO, Rolf Jeker, to define its purpose and activities. This foundation would dedicate itself to improving the care of musculoskeletal trauma and neglected cases in the least developed countries, initially in Africa and Asia Pacific, through capacity building and sustainable country projects.

AOAF Inauguration Ceremony with AOAF Founding Fathers (front row) and AO SEC members (back row)

Eleven AOAF Founding Fathers—many of whom are Past-Presidents of the AO Foundation and Past-Chairs of the AO SEC— gathered on December 13, 2014 in Davos to establish the AO Alliance Foundation. The last AO SEC meeting took place in Davos on December 14, 2014 with former AO SEC Chairs Jim Hughes, Paul Demmer and John Croser in attendance.

For 2015 one of the challenges lies in integrating AO SEC‘s 2015 activities within AOAF. Continuity is maintained by Joachim Prein, Jim Harrison, Ram Shah and Sylvain Terver.

Basic Principles Course, Dar es Salaam (TZ)

49

Annual Report 2014 ┃Finance

Finance Financial Overview The financial performance continued to be strong despite the challenges posed by increased activity and complex operational demands. With strict cost control, the Operating Expenses remained 4 % below the previous year compensating for a slight 2 % decrease in the Operating Income.

Therefore the Operating Result improved by CHF 3 million compared to 2013 and amounted to CHF -20 million.

The Financial Result of CHF 102 million did not hit the previous year’s record high but reflects and rewards a consistent and long-term pursued investment strategy with a sustainable high return of investment. Due to this performance, the Net Result reached a value of CHF 81 million, further increasing the Foundation’s Equity to CHF 1,223 million by the end of 2014.

AO Financial Overview in million CHF

Operating Income

2013

2014

Variance A14/A13

abs.

abs.

abs. %

79

78

-1

-2 %

Operating Expenses

102

98

-4

-4 %

Operating Result

-23

-20

3

-11 %

Financial Result

117

102

-15

-13 %

94

81

-13

-14 %

1,142

1,223

81

7 %

Net Result Equity per 31.12.

Operating Income includes the income from the Collaboration & Support Agreement with DePuy Synthes of CHF 64.6 million (at the same level as previous year) and third party income amounting to CHF 13.2 million (-9 % versus previous year).

Operating Expenses, excluding “Unforeseen”, “Strategy Fund” and the new initiatives “AONeuro” and “AORecon” amounted to CHF 97 million (-1 % versus previous year). Activities related to “Education” and “R&D”, with 45 % and 27 % respectively, represented the biggest stake. Education spending increased by 7 % versus the previous year to CHF 44.1 million, further strengthening one of our core competencies. This was compensated by further optimization and cost reduction measures in “Community Development” (-18 %), “General & Administrative” (-3 %), and “Global & Regional Boards” (-6 %).

Operating Expenses (excluding “Unforeseen”, “Strategy Fund” and the new initiatives) Breakdown 2014 Actual 6 %

3 %

Growth versus 2013 Actual in million CHF

Education

7 %

+7 %

R&D 13 % CHF 97 m

42 %

-6 %

General & Administrative

-3 %

Community Development

-18 %

Global & Regional Boards TK System

29 % Education R&D General & Administrative

50

-6 %

0 Community Development Global & Regional Boards TK System

-2 % 10 2013 Actual 2014 Actual

20

30

40

Income Statement The 2014 Income Statement, compared with the previous year and budget, looks as follows: Income Statement 2013 Actual 2014 Actual

in million CHF

abs %

AO Foundation Contribution

87.6

abs %

86 %

85.0

Variance A14/A13

abs %

87 %

-2.6

-3 %

Collaboration & Support Agreement

64.6

63 %

64.6

66 %

0.0

Financial Result

116.6

114 %

101.7

104 %

-14.9

-13 %

Change in Reserves

-93.7

-92 %

-81.3

-83 %

12.3

-13 %

14.5

14 %

13.2

13 %

-1.3

-9 %

102.1

100 %

98.2

100 %

-3.9

-4 %

28.4

28 %

26.8

27 %

-1.6

-6 %

3rd Party Income Total Income R&D

0 %

TK System

3.6

4 %

3.5

4 %

-0.1

-2 %

Community Development

6.6

6 %

5.4

6 %

-1.2

-18 %

Education

41.3

40 %

44.1

45 %

2.8

7 %

General & Administrative

12.8

13 %

12.3

13 %

-0.4

-3 %

Global & Regional Boards

5.6

5 %

5.2

5 %

-0.3

-6 %

Others

3.7

4 %

0.7

1 %

-3.0

-80 %

98.2

100 %

-3.9

-4 %

Total Expenses

102.1

100 %

The AO Foundation Contribution at CHF 85 million, remained below budget (-10 %) and the previous year (-3 %) due to a lower “Financial Result”, and “3rd Party Income” as well as lower expenses. The allocation to the Foundation’s reserves amounted to CHF 81.3 million resulting mainly from the Financial Result of CHF 101.7 million. Total Operating Expenses at CHF 98.2 million, was a considerable underspend compared with budget (-8 %) and the previous year (-4 %) due to lower expenses in all operational areas other than Education.

Employees The decrease of 0.1 full-time equivalents (FTEs) versus 2013 leads to a permanent staff of 251.0 FTEs. Employee Structure by Region FTE weighted permanent

2013 Actual

2014 Actual

Var. 14/13

abs.

in %

abs.

in %

abs.

224.0

89 %

223.0

89 %

-1.0

10.0

4 %

10.0

4 %

0.0

Latin America

9.0

4 %

10.0

4 %

1.0

North America

8.1

3 %

8.0

3 %

-0.1

251.1

100 %

251.0

100 %

-0.1

Total located in Switzerland Asia Pacific

Total worldwide 10.2; 4 %

2014 FTE Overview by Area 39.5; 16 %

251.0 FTE Institutes Clinical divisions Support units Others

126.7; 50 %

74.6; 30 %

51

Annual Report 2014 ┃Finance

Finance Educational Events Course-related expenses amounting to CHF 29 million, increased by 11% vs. prior year. The evolution from 2010 to 2014 shows a compounded annual growth rate of 8%.

In 2014 AOTrauma has the biggest share with 49%, followed by AOSpine with 26% and AOCMF with 11% respectively.

Evolution 2010 – 2014 in million CHF

+20%*

+10% *

21

24

2010

2011

+10%*

0%*

+11%*

26

26

29

2012

2013

2014

*growth vs. previous year

Breakdown 2014 4%

3% 2%

5% 11% 28.7 million CHF 49%

AOTrauma AOSpine AOCMF AO Foundation AOVET Socio Economic Committee OR Personnel

26% International Asia Europe Latin

Course activities by region The number of courses increased to 761 in total, reflecting a growth of 4% versus 2013. Overall, the number of participants increased by 5% whereas the number of participant days slightly decreased by 1%.

Region Number of Courses Number of Participants

2014 Share Vs. 2013 2014

Share Vs. 2013

Number of Participant Days 2014 Share Vs. 2013

Asia Pacific

216

28%

9%

14,193

33%

3%

28,433

27%

2%

Europe (incl. South Africa)

252

33%

-1%

12,013

28%

-2%

30,720

29%

-7%

Latin America

150

20%

3%

9,371

22%

22%

19,375

19%

9%

Middle East and Africa

78

10%

32%

3,486

8%

40%

9,515

9%

38%

North America

48

6%

-11%

3,026

7%

-16%

9,670

9%

-20%

International

17

2%

-11%

1,474

3%

-10%

6,945

7%

-10%

761

100%

4%

43,563

100%

5%

104,658

100%

-1%

Total

52

Asset Management The Financial Result of CHF 101.7 million reflects an actual return of 9.5 % on the underlying financial assets amounting to CHF 1,211 million by the end of 2014.

The major driver of the strong “Asset Management” performance was the double-digit return on the “Shares” asset class to which 61 % of the total assets are allocated. All other asset classes also contributed to the positive result. The cumulative performance of the portfolio since January 2008 amounted to 37 % by December 31, 2014.

Portfolio Structure 5% 8%

61%

in million CHF Shares Bonds Alternative Assets Liquidity

1,211 million CHF 25%

Total

745 302 101 64 1,211

Equity evolution 2007-2014 Thanks to the very positive development of the financial markets over the last 3 years, the Foundation’s Equity could be continuously strengthened to CHF 1,211 million by December 2014. Therefore the significant equity reduction occured in 2008 due to the financial crisis has been more than compensated meanwhile.

Total shares Bonds

Alternative assests Liquidity

in million CHF

Evolution 2007 – 2014

1080

946

982

2007

2008

2009

962

981

1048

1142

2010

2011

2012

2013

1211

2014

53

Annual Report 2014 2013 笏ェinance Governance

AO governance level A permanent separation between governing and executive bodies guarantees optimum organizational governance.

Decision-taking function Advisory function

Annual AO Trustees Meeting

Annual General Meeting AOTAG

Assembly of Trustees AOF President

AO Foundation Board (AOFB) AOF President

Main tasks include: approval of vision and mission; setting scientific and clinical goals; election of President, elected Trustees and AOFB; resolutions to change the Charters and Bylaws and the discharge of AOFB members

Highest supervisory and executive body whose main tasks include: strategy; fund allocation to AO units; financial and risk management; compliance and legal structure; election of chairpersons and other key positions; supervision

Institutes Advisory Committee

Platforms

AO Technology AG (AOTAG) Vice-Chairman AOFB Strategy and management of intellectual property, commercial activities and financial assets of AO

Clinical Divisions International Boards

Supervision and guidance of the respective Institute

Support and advise AOFB in its governing tasks and interactions with stakeholders

Strategic and financial supervision and measuring CD outcomes

AO Research Institute Advisory Committee

Education Platform President-Elect

AOTrauma International Board

AO Clinical Investigation Advisory Committee

R & D Expert AOFB

R & D Platform

AOSpine International Board AOCMF International Board

AOTK System Executive Board Strategic and financial supervision and outcome measurement of AOTK

54

AOVET International Board

AO executive level The executive functions of the AO Foundation are directed by the CEO and Vice-Chair of the AO Foundation Board and are divided into three layers (institutes, clinical divisions, and support units) that work closely with each other.

Executive function AO Foundation Board (AOFB)

Governing function

AOF President

AO Executive Management (AOEM) Vice-Chair and CEO

Institutes

Clinical Divisions

Support Units

Directors

Executive Directors

COO

AOTrauma Intl. Board

AOSpine Intl. Board

AOCMF Intl. Board

AOVET Intl. Board

AOTrauma

AOSpine

AOCMF

AOVET

ARI Advisory Committee

Finance

AO Research Institute CID Advisory Committee AO Clinical Investigation AO Education Institute AOTK System Executive Board AOTK System

Human Resources Matrix organization • Execution, supervision and outcome measurement of activities according to direction setting/policies by AOFB, AOEM and international boards of clinical divisions with the support of the AO Foundation • Submission of proposals for decision shaping and strategy development • Installation of transparent, compliant and efficient structure and processes and best use of synergies

Information Technology Communications & Events

Legal

Facility Management

55

Annual Report 2014 ┃ Governing bodies

Governing bodies of the AO Foundation

Assembly of Trustees The Assembly of Trustees is the “AO parliament”, consisting of 189 leading surgeons from around the world comprising: 78 Elected Trustees; 73 Ex-Officio Trustees; 25 Honorary Trustees; 4 Honorary and Founding Trustees; 9 Past-Presidents. The Assembly of Trustees is responsible for the approval of the scientific and clinical mission of the AO Foundation, important elections and the modification of the AO Foundation Charter and Bylaws. They transmit AO information to national institutions and other AO surgeons and bring feedback regarding the specific needs of their Region.

Since each Trustee serves for a limited number of years, constant rejuvenation of the Board is guaranteed.

56

AO Foundation Board—AOFB The AO Foundation Board is the governing body of the AO Foundation. It is responsible for its strategies, target setting and supervision of all executing bodies of the AO Foundation.

Front row: —Rolf Jeker (CEO and Vice-Chair AOFB) —Suthorn Bavonratanavech (President and Chair AOFB) —Jaime Quintero (Past-President)

Back row: —Jean Pierre Cabassu (veterinary expertise) —Christoph Lindenmeyer (finance expertise) —Keita Ito (research & development expertise) —Neal Futran (craniomaxillofacial expertise)

—Nikolaus Renner (President-Elect) —Florian Gebhard (trauma expertise) —Luiz Vialle (spine expertise)

The AO Executive Management—AOEM The AO Executive Management reports directly to the AO Foundation Board. It includes the CEO and line managers responsible for operational management within their respective areas.

From left to right: —Andreas Fäh (AO Clinical Investigation and Documentation) —Irene Eigenmann (COO and CFO) —Urs Rüetschi (AO Education Institute) —Rolf Jeker (CEO and Vice-Chair AOFB)

—Class Albers (AOTK System) —Matthias Dunkel (AOTrauma) —Alain Baumann (AOSpine) —R Geoff Richards (AO Research Institute) —Tobias Hüttl (AOCMF and AOVET)

57

Annual Report 2014 ┃ 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 Clinical Divisions

AO Institutes

AOTrauma

AO Research Institute Davos

Clavadelerstrasse 8

Stettbachstrasse 6

Clavadelerstrasse 8

7270 Davos

8600 Dübendorf

7270 Davos

Switzerland

Switzerland

Switzerland

Phone +41 81 414 21 11

Phone +41 44 200 24 20

Phone +41 81 414 22 11

Fax

Fax

Fax

+41 81 414 22 80

+41 44 200 24 21

+41 81 414 22 88

info@aotrauma.org

info@aotrauma.org

sonia.wahl@aofoundation.org

www.aotrauma.org

www.aotrauma.org

www.aofoundation.org/ari

AOSpine

AO Clinical Investigation and Documentation

Clavadelerstrasse 8

Stettbachstrasse 6

Stettbachstrasse 6

7270 Davos

8600 Dübendorf

8600 Dübendorf

Switzerland

Switzerland

Switzerland

Phone +41 81 414 21 11

Phone +41 44 200 24 25

Phone +41 44 200 24 20

Fax

Fax

Fax

+41 81 414 22 80

+41 44 200 24 12

+41 44 200 24 60

info@aospine.org

info@aospine.org

aocid@aofoundation.org

www.aospine.org

www.aospine.org

www.aofoundation.org/cid

AOCMF

TK System

Clavadelerstrasse 8

Clavadelerstrasse 8

7270 Davos

7270 Davos

Switzerland

Switzerland

Phone +41 81 414 25 55

Phone +41 81 414 24 70

Fax

Fax

+41 81 414 25 80

+41 81 414 22 90

info@aocmf.org

aotk@aofoundation.org

www.aocmf.org

www.aofoundation.org/tk

AOVET

AO Education Institute

Clavadelerstrasse 8

Clavadelerstrasse 8

7270 Davos

7270 Davos

Switzerland

Switzerland

Phone +41 81 414 25 55

Phone +41 81 414 26 01

Fax

Fax

+41 81 414 25 80

+41 81 414 22 83

info@aovet.org

aoe@aofoundation.org

www.aovet.org

www.aofoundation.org

*Contact information for regional offices can be found on individual clinical division websites

58

Concept, editing, and layout: AO Foundation, Communications and Events, Davos, Switzerland Manuel Kurth, Graphic Design and Photography Photography: AO Foundation, Communications and Events, Davos, Switzerland Manuel Kurth (pages 1, 4, 8, 16, 54, 58, back cover) Sabine Kannapin (page 12) Print: BUDAG, Sßdostschweiz Presse und Print AG, Davos, Switzerland Š April 2015, AO Foundation This annual report is climate neutral, compensation through www.climatepartner.com Certificate No SC2014040102

AO Foundation Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 21 11 Fax +41 81 414 22 80 foundation@aofoundation.org www.aofoundation.org