Annual Report 2005

Annual Report 2005

AO Vision

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

AO Mission

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

Table of contents

Introduction 2

Interview with the President and the Chairman 2

Overview 5

AO Surgery Reference: surgeons’ gateway to quick online reference 5

Clinical Priority Programs: focused to achieve maximum clinical impact 6

The AO network: spanning the globe with AO exper tise 8

Specialties 10

General Trauma: a year of conceptual innovation 10

AOSpine in full motion 11

Setting the basis for CMF’s future development 12

On the path to more choice for veterinary surgeons 13

ORP activities steadily on the rise 14

Networking 15

Commitment to the AO cause around the globe 15

AO Alumni Association: bringing the world together 18

Enabling and sustaining self-suf ficient healthcare systems 20

Trustee Meeting 2005: taking stock and envisaging the future 22

Key activities 24

Creating the state of the ar t in postgraduate medical education 24

Finding answers to clinically relevant challenges 26

Developing concepts for fracture fixation in osteoporotic bone 28

TK-System: regionalization put into practice 29

Growing demand for clinical research 30

AORF: a triple win for researchers, AO, and the patient 32

Governance 33

Organizational development and finance 33

Governing bodies of the AO Foundation 34

Abbreviations 36

Addresses 37

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

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

Has the reorganization of the Academic Council in 2004 brought its desired effect?Kellam: We are much more responsive with a more effective decision-making process and more productive meetings. The estab-lishment of Specialty Academic Councils in December has opened up access to the scientific part of the Foundation for more surgeons.Rauh: We set up a new professional support structure for the Academic Council. All decisions now have a clear time and money line, and follow-through is ensured.

Dr. Kellam, at the beginning of your pres-idency in mid-2004, you emphasized the need for AO to regain relevance for the prac-ticing surgeon. What has been achieved so far?James Kellam: We have established the concept of Clinical Priority Programs as a reality. The Degeneration and Regeneration of the Intervertebral Disc program has been suc-cessfully executed and is under review as to its future. The Fracture Fixation in Osteo-porotic Bone program has started, and the Large Bone Defect Healing program is in peer review. The heart of each program is an unresolved clinically significant prob-lem with an epidemiological dimension and a severe impact for the patient. These clinically driven programs will make us more relevant to both surgeons and pa-tients.

What is the status of the fourth program?Kellam: The Craniomaxillofacial specialty has chosen image analysis as an aid to pre-operative planning of complex craniofacial deformity correction as its program. This topic has not only broad support within the CMF community but is also relevant for other specialties. I am optimistic that it can be launched by the end of 2006.

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

Specialties Networking Key activities GovernanceIntroduction Overview2 Annual Report 2005

“We act more like a team now.”

James Kellam

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

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

Who will benefit from this new reference?Rauh: Living up to our vision of spreading excellence in the surgical management of trauma and disorders of the musculoskel-etal system, we will grant access to surgeons and ORP worldwide, not only AO mem-bers. Our own members, however, will

“The regions’ enthusiasm is truly contagious.”

Markus Rauh

James Kellam

President of the AO Foundation

Markus Rauh

Chairman of the Board of Directors

Specialties Networking Key activities GovernanceOverviewIntroduction Annual Report 2005 3

“Our stakeholders credit us for our strong beliefs.”

James Kellam

have free access. We are currently redefin-ing our membership scheme. Once this is ready, we’ll decide on the different access levels and financial conditions applicable from 2007.

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

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

it was put to the test almost immediately as the devastating earthquake hit Pakistan in October.Kel lam: We’re continuing our efforts in Africa, Asia, and Latin America through the Socio Economic Committee, with edu-cation as the primary goal. All our courses, fellowships, and mentorships are long-term and involve local officials and governments. It’s about enabling the infrastructure, and this must be appropriately financed and monitored.

In early 2005, AO conducted a global repu-tation survey. What were the main findings?Rauh: We collected statistically relevant data that clearly shows AO has a strong reputa-tion across all regions, specialties, and age groups. We now know that our reputation capital lies mainly in our services and that our stakeholders rate our education and research and development excellent. They also credited that we are an organization with strong values and emphasize methods and principles over products. But we were also made aware of some areas where we are vulnerable. These findings are consid-ered in all our strategic initiatives, such as our reinforced regionalization efforts and the development of a new membership concept.

What are your main goals for 2006?Kellam: The first goal will be further stan-dardizing our processes. Second, we must maintain the momentum in our Clinical Priority Programs but not neglect our other stakeholders’ benefits such as a state-of-the-art education. Third, the definition of a new global membership scheme will be impor-tant for the organization.Rauh : Developing a sustainable funding strategy under a new contract with Syn-thes is high on my agenda. And, of course, taking the Surgery Reference public is also an important milestone.

AO Foundation and Synthes,

Inc. agree to new contract

On March 14, 2006, shortly prior

to publication of this report,

the AO Foundation and Synthes,

Inc. agreed to continue their

successful cooperation under

a new contract. Synthes, Inc. will

acquire the Synthes trademarks

and brands and substantially all

of the intellectual property from

AO at approximately CHF 1 billion.

This transaction will provide a

solid financial basis for AO and

strengthen its position as an inde-

pendent academic and scientific

organization. In a separate agree-

ment, AO and Synthes, Inc. agreed

to continue their long-standing

cooperation for the benefit of

patients and surgeons worldwide.

The closing of the transaction is

subject to regulatory approval.

Specialties Networking Key activities GovernanceIntroduction Overview4 Annual Report 2005

Surgeons worldwide can now tap into a unique pool of specialized knowledge that supports them throughout the entire surgical management process.

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

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

From surgeons, for surgeonsMore than fifty of the world’s most renown-ed surgeons and younger talents with a successful publishing record are contrib-uting to AO Surgery Reference. Combining the know-how from 20 countries ensures that the rigorous AO standards are met while keeping in mind local particularities.

The modules were tested extensively with closed AO user groups. In three phases, they were rolled out to AO Trustees, Alumni, and Faculty members. Based on their feed-back, AO Knowledge Services continually enhanced the solution for maximum usabil-ity.

More anatomical regions lined upThe introduction of another half-dozen anatomical regions is expected for 2006. In addition to general trauma, development of CMF modules is underway, with spine modules planned next.

In line with AO’s vision and mission, the Board of Directors decided in December to extend free subscriptions to institutional and individual users from both inside and outside the AO community until the end of 2006. It will then decide on the final subscription model. As a nonprofit orga-nization, AO sees the main payback of its investment in the application of its prin-ciples by potentially 250,000 surgeons—for the benefit of patients worldwide.

www.aofoundation.org/surgery

AO Surgery Reference: surgeons’ gateway to quick online reference in daily clinical life

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

1 AO Surgery Reference grants

the surgeon quick access to

detailed knowledge including

the appropriate patient prepara-

tion and surgical procedures.

2 Surgeons are guided through

the surgical management

process step-by-step, or they

can shor tcut to a specif ic piece

of information via the naviga-

tion bar.

1 2

Introduction Overview Specialties Networking Key activities Governance Annual Report 2005 5

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

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

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

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

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

Content and status of the Clinical Priority Programs (CPPs)

Fracture Fixation in Osteoporotic Bone: Execution of this program, with the support of Stephan Perren, under the guidance of surgeon champion Michael Blauth and scientists Jörg Goldhahn and Norber t Suhm, star ted in 2005. It aims to develop and evaluate new concepts for the treatment of fractures in osteoporotic bone and addresses the problem of implant anchorage in poor-quality bone stock.

Large Bone Defect Healing: Under surgeon champions Mark Vrahas and James Kellam, and scientists Mauro Alini and Erich Schneider, this program aims to develop an of f-the-shelf, multifactor biologically active solution for implantation into 3- to 5-cm defects. The proposal went into peer review at the end of 2005.

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

Introduction Overview Specialties Networking Key activities Governance6 Annual Report 2005

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

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

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

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

Spine

General Trauma

CMF

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

2 3 4 5 6 7

Problem identification

Clinical priority definition

Program details

Peer review AcC/AOVA approval

Execution Reevaluation

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

1

a hec

b

d

gf

Research & Development

Clinical Investigation

ClinicalInvestigation

EducationTK-System


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

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

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

North America

Alumni Chapter

North America

Latin America

Alumni Chapters

Argentina

Bolivia

Brazil

Chile

Colombia

Costa Rica

Ecuador

Mexico

Peru

Paraguay

Uruguay

Venezuela

Introduction Overview Specialties Networking Key activities Governance8 Annual Report 2005

Spain

Slovenia

Sweden

Switzerland

Turkey

UK

Asia Pacific

Subregions

AO East Asia

AO Oceania

Alumni Chapters

Australia

China

Hong Kong

India

Japan

New Zealand

South Korea

Sri Lanka

Taiwan

ThailandMiddle East

Alumni Chapters

Egypt

Iran

Jordan

Lebanon

United Arab Emirates

Africa

Alumni Chapter

South Africa

Alumni Chapters

Ireland

Israel

Italy

Netherlands

Norway

Portugal

Russia

Austria

Bulgaria

Czech Republic

Estonia

France

Germany

Hungary

Sections

AO Austria

AO Germany

AO Spain

AO Switzerland

AO UK

Europe


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

High visibility at congressesThe AO symposia at major international congresses, including EFORT in Portugal, SICOT in Turkey, and DGU/DGOOC in Ger-many reinforced AO’s leading position in trauma education. AO was also invited to organize a symposium at the annual meet-ing of the British Orthopaedic Association (BOA).

The regions left no doubt they are an increasingly important driver of trauma education. The August Advanced Course held in Ribeirão Preto, Brazil, was rated excellent by both faculty and participants, upping the benchmark.

Following the introduction of numerous innovations, 2006 will be a year of consoli-dation at the conceptual level. The Trauma SAcC, a result of the recent reorganization of the Academic Council, is already pro-gressing and will further enhance the innovation process.

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

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

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

1 AO symposia at major inter-

national congresses, including

EFORT in Lisbon, Por tugal, were

well at tended emphasizing

AO’s leading posit ion in trauma

education.

2 The par tnership with BrainLAB

resulted in the f irst computer-

assisted surgery (CAS) course

modules at the Davos Courses.

3 Through its presence at major

trauma congresses, AO keeps

in touch with the global trauma

community.

1 2 3

Introduction Networking Key activities GovernanceSpecialtiesOverview10 Annual Report 2005

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

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

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

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

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

Strong surgeon involvement and member benefitsThe AOSpine Technical Commission (AOSTK) was created in 2005 with four Expert Groups focusing on spine. This enables greater involvement of spine sur-geons to ensure medical guidance in the development of new treatment options. AOSTK has advanced minimally invasive surgery (MIS) and focused on non-fusion technology to preserve patients’ spinal motion. AOSpine looks forward to partnering with BrainLAB to develop computer-assisted surgical procedures. Clinical teams have initiated outcome studies in North America and Europe, and similar activi-ties are planned in Latin America and Asia in 2006.

In 2005, 20 AOSpine Country Chapters were founded to drive activities and mem-ber services at the local level. Recruitment has been high as local surgeons feel excited and empowered to get involved. AOSpine’s 4,500 members now benefit from numerous new products such as InSpine magazine, Evidence Based Spine Surgery Journal, and the Spine Principles book, as well as new web-based services and faculty train-ing courses.

AOSpine in full motion

New AOSpine leadership Michael Janssen (lef t) took over from Max Aebi as Chairperson of AOSpine International (AOSI) af ter Max Aebi had completed his term. Max Aebi signif icantly contributed to AOSpine’s recognition within the spine community. One of Michael Janssen’s first priorities is to restructure the AOSI Board to better fit the future challenges of running a global organization.

1 AOSpine moving the lecture

room into the operating room

with live tissue training.

2 Marinus de Kleuver explains

how AOSpine is a global organi-

zation to course par ticipants.

3 The launch of InSpine maga-

zine is yet another example of

increasing benefits for AOSpine

members.

2 31

Introduction Networking Key activities GovernanceOverview Specialties Annual Report 2005 11

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

Advancing strategic projectsAO CMF also advanced other projects of strategic importance. To provide the global CMF community with a tailor-made networking platform, four regional repre-sentatives were given the mandate to submit a proposal for an AO CMF Alumni Associa-tion. It aims for a close cooperation with the AO Alumni Association while catering for the specific education, networking, and information need of CMF surgeons.

The decision to relaunch the “Journal of Craniomaxillofacial Trauma” in mid-2006 is another important measure to strengthen the CMF network. The journal, to be pub-lished by Thieme Medical Publishers, will be the official organ for AO CMF and its alumni association.

In Asia, the two educational groups of East Asia South and the Far East merged success-fully to constitute the new CMF East Asia Board. Building regional structures will remain high on the agenda, in particular in the Middle East, Southern Africa, and Asia Pacific.

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

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

Faculty development forum as catalystThe international CMF Faculty Develop-ment Forum in Brazil in August marked an important milestone in 2005. At the event, the AOTK (CMF) held its constituting meet-ing. Members from Europe, the Americas, as well as Asia are now represented in a more balanced way.

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

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

1 Representatives of AO CMF

and AO Publishing discuss the

relaunch of the “Journal of

Craniomaxillofacial Trauma.”

2 The newly constituted CMF

East Asia Board suppor ts AO

CMF’s intensif ied regionalization

ef for ts.

3 Educational activit ies developed

well with another strong increase

in courses and seminars planned

for 2006.

2 31

Introduction Networking Key activities GovernanceOverview Specialties12 Annual Report 2005

Strengthening its value proposition for members, expanding its educational offering, and advancing its development projects were the main focuses of the AO Veterinary specialty (AO Vet).

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

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

Other events included an LCP workshop at the Surgical Summit of the American Col-lege of Veterinary Surgeons in San Diego. This was complemented with two fellow-ships in veterinary clinics and the revival

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

Innovations well on trackDevelopment of the new TPLO (Tibial Pla-teau Leveling Osteotomy) plate with LCP features was concluded and has entered clinical testing. This plate will benefit larger dogs diagnosed with cruciate ligament rup-tures. The 3.5 LC-DCP broad (Low Contact Dynamic Compression Plate) was well received, opening up a host of applications for the benefit of large dogs. Further mate-rial and end-clamp design improvements are underway for the Clamp Rod Internal Fixator (CRIF).

AO Vet continued to pursue its vision of high-quality implants specifically designed for animal surgery. The planned Specialty Academic Council (SAcC) for AO Vet will further strengthen AO’s veterinary com-munity.

On the path to more choice for veterinary surgeons

Interdisciplinary workshop on animal modelsAO Vet took the lead in organizing a workshop on “Experi-mental Animal Models in Musculoskeletal Research” in Davos in February 2006. It was at tended by leading Euro-pean veterinary and human surgeons, researchers, legal and ethics exper ts, and animal rights organizations. They explored new paths in solving ethical issues and defined concer ted action to achieve more ef fective and morally acceptable animal research.

1 The novel one-day member

event preceding the Davos

Courses created a new plat form

for informal knowledge sharing.

2 The USA saw the revival of AO

Vet student courses with a f irst

course held at Texas A&M Uni-

versity.

3 The student courses give stu-

dents access to AO expertise

while still in veterinary school.

1 2 3

Introduction Networking Key activities GovernanceOverview Specialties Annual Report 2005 13

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

vary strongly by country and that in many cases, the standards of practice are undergo-ing major changes, making harmonization even more challenging.

On track for exciting ORP development optionsWith an extended team, ORP leadership has been significantly strengthened to devise new strategies for growing the network and creating exciting development perspectives for ORP within AO.

The ORP Alumni Chapter founded in 2003 to link very active members of the ORP fac-ulty grew to 52 specialists in 19 countries. This number is bound to grow steadily with new learning, teaching, and networking opportunities scheduled for 2006. The regional Educators’ Seminar in Thailand in April and the Educators’ Seminar in Davos in December will be ideal platforms for further faculty development. Another important event in 2006 will be the partici-pation of ORP in the joint meeting of the German, Swiss, and Austrian AO Alumni Chapters in Germany in May, which may well lead to the recruitment of new ORP faculty members.

A record number of 91 AO ORP Courses in 34 countries testifies to the ever-growing thirst of operating room personnel (ORP) for specialized training. Among the main course highlights in 2005 was an ORP Course in Goettingen, Germany, where virtual x-raying was introduced as a novel technology. It allows ORP to start with a dry run at x-raying in front of the monitor before handling the c-arm, all of which is done without actual radiation. This type of training is conducive to three-dimen-sional thinking, which is crucial to ensure that the surgeons get good-quality x-rays when inserting an implant. Demand for the course exceeded the number of spots available by far, and the course was very well rated by the participants.

Several other ORP Courses were run in par-allel with courses for surgeons. This allowed both courses to exploit the common syner-gies in course content and logistics. For the first time, such parallel courses were held in Germany. In the Bochum ORP Course, particular attention was given to hands-on exercises, which was very much appreciated by the participants.

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

1 ORP Alumni members from 19

countries at tended the Triennial

AOAA Symposium in Sardinia.

2 Vir tual x-raying was introduced

as a novel technology at the ORP

Course in Goet tingen, Germany.

3 Training session for the Swiss

ORP faculty team in Davos.

2 31

Introduction Networking Key activities GovernanceSpecialtiesOverview14 Annual Report 2005

Commitment to the AO cause around the globe2005 saw a growing level of activities in all of AO’s established regions and sections. The development of new and locally adapted educational formats, increasing investments in faculty development, closer cooperation with the Alumni Chapters, and a growing interest in research activities were some of the main themes.

The new AOLAT Trustee Council provides overall guidance. The reorganized AOLAT Executive Board now comprises representa-tives from all specialties and, together with the three Specialty Boards, is responsible for the region’s activities. Their work will be supported by the new regional director hired in early 2006 as part of AO’s global regionalization strategy.

A backbone of AOLAT’s growth is the development of AO Alumni Chapters. Membership rose from 328 in 1998 to 709 in 2005. The growing educational activities in Central America increase the potential for the creation of new chapters in the com-ing years.

An Executive Strategic Retreat held in Phil-adelphia in March resulted in numerous important decisions for AO North America (AONA), including a new one-year fellow-ship program to be launched in 2006. It aims to develop new faculty by enabling an intensive exchange with experienced fac-ulty for up to ten talented young surgeons per year. Clinical research activities will also be stepped up, leveraging the expertise of the AO Clinical Investigation and Docu-mentation (AOCID) resources opened in New York in 2004.

To best support these and other strategic initiatives, the organizational structure of AONA was adapted, establishing new specialized committees for fellowships and postgraduate education, clinical and scientific research, as well as international educational affairs.

News from the regionsThe first-ever AO seminar in Vietnam took place in Ho Chi Minh City in April. It marks a further step in the continuous efforts of AO East Asia (AOEA) to involve additional countries. A first AO Principles Course will follow in 2006. The first Indonesian AO Advanced Course on Fracture Management held in Bali in August was equally impor-tant and may lead to the formation of a local Alumni Chapter in the near future.

The first AO Regional Combined Course with Advanced, Pelvic, Minimally Invasive Surgery, and Masters courses will be held in Thailand in April 2006. It will be preceded by an AO Tips for Trainers (TfT) Course—a premier in AOEA and an important step in the region’s faculty development efforts.

The reorganization of the TK-System has resulted in a steep increase of Asian mem-bers in the Expert Groups, which recognizes the expertise and importance AOEA has within the AO network.

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

Important steps were taken in advanc-ing the region’s organizational structure.

1 The f irst Tips for Trainers (TfT)

Course in Por tuguese in São

Paulo, Brazil, was a resounding

success.

2 Guest of honor James Kellam

at the Annual General Meeting of

AO East Asia in Kyoto, Japan.

3 The Executive Strategic Retreat

in Philadelphia, USA, paved the

way for impor tant educational

and scientif ic init iatives of AO

Nor th America.

21 3

Introduction Specialties Key activities GovernanceNetworkingOverview Annual Report 2005 15

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

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

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

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

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

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

speeches worldwide, 360 publications, as well as numerous textbooks have made him a legend in trauma.

On the educational front, AO Germany (DAO) successfully piloted a new format for its Annual Meeting in May. The chair-men of the Expert Groups from Germany provided participants with an update on trends. In addition, two presentations fo-cused on recent findings from AO’s research activities. This early access to new and partly unpublished information was greatly appreciated by the 140 participants. The close cooperation with the German Alumni Chapter was continued. Today, Alumni members account for about 25% of Ger-man teaching activities.

To professionalize research funding, a Ger-man AO Research Fund was established. It supports scientific clinical research in an innovative approach. DAO provides not only funding but also methodological and infrastructure support, delivered by five associated research competence centers. This ensures an optimal return on funds invested and helps avoid duplication of efforts. Two projects were already success-fully concluded.

In March 2006, DAO opened a national branch office in Berlin, in the building that houses most other major German surgical associations. This facilitates networking and creates synergies. The office’s main tasks are to provide support to the course chair-men and manage member administration and services.

AO Spain (AOE) has engaged more mem-bers as international faculty, in particular with teaching activities in Davos and Latin

1 The December 2005 death of

Jörg Böhler, Honorary Member

of AO Austr ia and Honorary

President of the Austr ian Society

for Traumatology, presented a

severe loss to the f ield.

2 A stone’s throw from the Charité,

Berlin, AO Germany’s new

branch of f ice is housed in the

same building as most German

surgical associations.

3 Swiss surgeon Marc Lot tenbach

during his reverse fellowship

in Eritrea in 2005, with surgeon

Teclegiorgis Semere and scrub

nurse For tunat Wunesh. The

prior year, the Eritreans had been

received in Fribourg, Switzerland.

4 Fulvio Urso-Baiarda (right) re-

ceives the 2005 AOUK Research

Prize from Anthony Cross.

5 With the death of Rafael Orozco

(foreground, at 25th anniversary

of AOE in 1996), AO Spain lost

one of its founding and honorary

members.

6 Anthony Cross (lef t) hands over

the presidency of AOUK to John

O’Dowd.

21

Introduction Specialties Key activities GovernanceNetworkingOverview Key activities Governance

3

16 Annual Report 2005

America. Teaching activities in Spain remained stable. A high need has been identified for courses for operating room personnel (ORP). A first ORP Course was run in 2005, and three more are planned for 2006 to cater for the growing demand. In September 2006, the first AO Masters Course will take place, marking a new era in AOE’s educational activities.

AOE has further strengthened its coop-eration with the Spanish Alumni Chapter. All four new AOE members were recruited from among the Alumni, who traditionally remain members in the Alumni Chapter.

A painful loss to the section was the death of Rafael Orozco, who was a founding and honorary member of AOE and one of the key drivers of its successful development. Rafael Orozco also cofounded the Maurice E. Mül-ler Foundation in Spain and coauthored several books on fracture care including the “Atlas of Internal Fixation.”

The main educational event of AO Swit-zerland (AOCH) was its second Senior Swiss Resident Course on the topic of foot fractures. Based on earlier feedback, the interactive part of the course was extended and new formats piloted which foster more controversial case discussions between lecturers and participants. A new feature was the combination of the course with an anatomical specimen module.

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

Within the scope of AO’s Reverse Fellowship Program, two Swiss surgeons completed a reverse fellowship in Eritrea. In 2004, an Eritrean surgeon and a scrub nurse had completed a fellowship in Switzerland. Further two-way exchanges have been approved for 2006.

This year’s highlight for AOUK was its An-nual General Meeting at Alton Towers in November. 140 faculty members gathered at the event, which featured a number of group and faculty meetings. It also marked the handover of the presidency from An-thony Cross to John O’Dowd.

Educational activities decreased slightly from 2004 due to some special courses tak-ing place only every second or third year. The course administration has been reor-ganized and is now the responsibility of the AOUK Education Department, a standalone educational facility. Course activities will increase sharply in 2006 due to cyclical and new courses, such as a shoulder and a pedi-atric course.

This year’s AOUK Research Prize was awarded to Fulvio Urso-Baiarda from Mount Vernon Hospital, Middlesex, for his paper on “The Modified Hand Injury Severity Score as a Predictor of Return to Work.”

4

Introduction Specialties Key activities GovernanceOverview NetworkingIntroduction

5 6

Annual Report 2005 17

AO Alumni Association: bringing the world together2005 marked another year of intense activity and growth of the AO Alumni Association (AOAA) with a special event highlight in September: The Triennial AOAA Symposium presented an excellent networking opportunity for a record number of 280 attendees from over 50 countries.

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

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

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

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

Thrilling activities in Brazil2005 was a particularly busy year for Brazil, where membership rose to 237 members. Many were excited to join in the bustling activity of both scientific meetings and

1 Lively discussions were a com-

mon sight at the Triennial AOAA

Symposium in Sardinia.

2 A record number of 280 Alumni

from over 50 countries at tended

the Triennial AOAA Symposium

in September.

3 The breaks allowed for intense

networking with colleagues from

all over the world.

4 Alumni members are eager

to test the pilot CAS modules

developed with AO’s new indus-

tr ial par tner BrainLAB.

5 Antonio Pace, AOAA President

(lef t), with former AO President

and founding member Mar tin

Allgöwer.

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

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

1 2

Introduction Specialties Key activities GovernanceNetworkingOverview18 Annual Report 2005

solution and will benefit many more prac-ticing surgeons worldwide. There was also a lot of evidence of increasing cooperation between the Alumni Chapters and the AO regions and sections.

In addition, Alumni were the first to try the new trauma modules in computer-assisted surgery (CAS) developed with AO’s new industrial partner BrainLAB. Many of them had not been confronted with this promising technology until the Triennial AOAA Symposium in Sardinia, Italy, from September 18–21. The reactions were truly exciting.

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

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

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

The reports from former AO Fellows on their experiences in host clinics around the world was another highlight. Their account was encouraging to others and gave a good understanding of the possibilities for improving professional knowledge through fellowship education.

Leisure activities and a banquet dinner on the last evening topped off this interna-tional event, with many looking forward to upcoming regional gatherings and the next Triennial AOAA Symposium, which will take place during AO’s fiftieth-anni-versary year in 2008.

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

4 53


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

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

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

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

Intensive short trainingsUnder the SEC Reverse Fellowship Pro-gram, trained surgeons reside for several weeks in the target community, where they undertake training of local surgeons

1 SEC is faced with a poor infra-

structure and ill -maintained

equipment at most of the clin-

ics where it is active in Afr ica.

2 Local and international faculty

members receive a one-day

training prior to the ORP Course

in Blantyre, Malawi.

3 Nonoperative treatment is

an important addition where

preconditions for operative

fracture care are nonexistent.

4/5 Practical exercises with SEC-

sponsored equipment are an

impor tant emphasis of the

training in Malawi.

6 SEC Chairman Paul Demmer

gave an update at the Trustee

Meeting on ongoing projects in

the developing world.

Successful sponsorship for orthopedic/trauma training

The five-year trainee sponsorship for Linda Mbekeane, a young Malawian doctor to become a trained or thopedic surgeon, was continued successfully in 2005 with Linda passing Par t I of the annual Orthopaedic Specialist Examination of the College of Surgeons of East, Cental, and Southern Africa.

James Munthali and Maundo Chowa successfully f inished their surgical training in Lusaka, Zambia, and Emmanuel Makasa and Emmanuel Simwanza are in their second year of training in the Lusaka Teaching Hospital.

All are sponsored by SEC under the condition that they remain in their home coun-tries at the end of their training.

1 2 3

Introduction Specialties Key activities GovernanceNetworkingOverview20 Annual Report 2005

African surgeons. The successful candidates spend one year in recognized orthopedic/trauma units in South Africa and complete the fellowship with a diploma examination. Two candidates passed in 2005 and four will be taken in the program in 2006.

The successful Ribeirão Preto project in Brazil was continued, where on average two orthopedic surgeons from lesser devel-oped areas of Brazil spend four weeks at the project hospital each month. Since the program’s inception in 2000, the number of trained fellows has risen to 82. They bene-fited from attending operations, workshops with synthetic bones, case discussions, and lectures and seminars. To sustain the initiative, the senior orthopedic surgeons who acted as mentors during the fellows’ stay will keep in touch with them and dis-cuss cases via the Internet. This program could not be extended to Rio de Janeiro as planned. However, a first call for fellows is expected for São Paulo in 2006, and activi-ties are underway for Mexico.

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

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

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

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Introduction Specialties Key activities GovernanceOverview Networking Annual Report 2005 21

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

AO education (Robert Fox, Joe Green), the AO Research Fund (Adrian Sugar), and Ver-tical Expandable Prosthetic Titanium Rib (Robert M. Campbell, Jr.).

During the “Meet the Expert Groups” ses-sion, the Trustees met with the Expert Groups of the TK-System to discuss new concepts and developments applicable to their practices and regions. They learned about the surgeon-industry interface that is most fruitful for the innovation process.

For the first time, the Trustees were able to attend two of five breakout sessions in-stead of one. Eric Johnson, Brett Bolhofner, Christian Krettek, Richard Lange, René Marti, Jeffrey Mast, and Keith Mayo ran a course on problem fractures. Steve Schelkun and Michael Redies, Don Webb, and Andy Weymann focused on the advantages of e-Learning. Mark Vrahas, Mauro Alini, Jürg Gasser, Erich Schneider, Margarethe Hof-mann, and Brigitte von Rechenberg led a session on clinically relevant information on bone and bone healing for the practic-ing surgeon. Joe Green, Piet de Boer, John Frodel, and Lisa Hadfield-Law focused on maximizing the effect of teaching. Finally, Beate Hanson, David Helfet, and Michael Suk presented a session on how to choose an outcome measure.

The General Assembly received reports from President James Kellam, Chairman of the Board of Directors Markus Rauh, and CEO Gregor Strasser. It elected five new Trust-ees, honored four outgoing Trustees, and appointed two new Honorary Members. Jaime Quintero was reelected to the Board of Directors. The revised charter and bylaws of the AO Foundation, which stipulate the

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

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

Exploring new developments and conceptsOther plenary sessions focused on building a research network (Robin Poole), non-fusion spine surgery (Max Aebi, Norbert Boos, Michael Janssen), entrepreneurship (Stefan Vilsmeier, BrainLAB), 20 years of AO education in Thailand (Suthorn Bavon-ratanavech, James Kellam), the future of

1 The parallel breakout sessions

provide ample room for inten-

sive discussions.

2 The Trustees discuss the latest

concepts and developments

with members of the Exper t

Groups of the TK-System.

3 James Kellam (second from

right) honors the outgoing

Trustees (from lef t to right):

Kenneth A. Johnson, USA,

Got t fr ied Köberle, Brazil, and

Lutz-Peter Nolte, Switzerland.

Not present in picture: Kerong

Dai, China.

4 The Trustees at the General

Assembly.

5 Many impor tant decisions are

taken by AO Trustees with the

help of the Audience Response

System.

6 Members elected in 2004 at tend

their f irst Trustee Meeting.

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Introduction Specialties Key activities GovernanceOverview Networking22 Annual Report 2005

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

Newly elected Trustees

Kodi Kojima, Brazil

Claudio V. Lamartina, Italy

Antonio Barquet, Uruguay

Shantharam M. Shetty, India

Bingfang Zeng, China

New Senior Trustees

Gottfried Köberle, Brazil

Lutz-Peter Nolte, Switzerland

Kenneth A. Johnson, USA

Kerong Dai, China

New Honorary Members

Reinhold Ganz, Switzerland

John Webb, UK

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

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

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

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

Early appointment of well-connected local contacts will ensure quick release of the aid material to the af fected region. All requests for support will be rigorously scrutinized to most ef fectively leverage the resources invested. As a principle, cri-sis management support will be restricted to major natural disasters for a limited amount of time.

54 6


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

Tailoring courses to learners’ needsA precourse needs assessment pilot was also successful for other AO Courses, including an AOSpine Course in Brazil and a Pelvis Course in Germany. The online assessment helped enroll the participants in the right-level course and adapt the content to their needs. It is planned to incorporate a pre-course needs assessment module into the AO Principles and Advanced Courses, which will be piloted at four courses in 2006. The pilot project focusing on the evaluation of the Davos Courses in 2004 has been sim-plified and was tested in the 2005 Davos Courses, using the Audience Response Sys-tem. Revisions will result in a more concise module, which will be available for major regional courses in 2006.

Additional postcourse eLearning modules were added that will allow course partici-pants to test their knowledge and earn CME (Continuing Medical Education) credits.

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

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

Education as backbone of regional development: The example of AOLATMost activity occurring in the regions relates to educa-tion. The first Latin American AO Course dates back to 1971. The following years, structures were built around a few enthusiastic local faculty members. From 1994, growth was spurred by the founding of twelve national AO Alumni Chapters which exist today within Latin Amer-ica. The idea for a formal AOLAT region was initiated by

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

1 Hands-on training remains an

impor tant pillar of AO education.

2 Davos Course par ticipants get

acquainted with the theory and

practice of the latest concepts

and techniques.

3 AO Educat ion introduced a

course module blending com-

puter-assisted surgery (CAS)

and minimal invasive osteo-

synthesis (MIO), which are

becoming increasingly impor-

tant.

4 In 2005, some 50 teaching

videos were issued in DVD

format with a sophisticated

navigation scheme.

5 AO Education is continually ex-

tending its reach. In April 2005,

AO held its f irst-ever seminar

in Vietnam.

6 The combination of 3-D anima-

tions and real clinical footage

underscores the stronger clinical

focus of AO teaching videos.

1 2 3

Introduction Specialties Networking GovernanceKey activitiesOverview24 Annual Report 2005

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

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

sis (MIO) and computer-assisted surgery (CAS). The latter was developed in collabora-tion with BrainLAB. The computer-assisted surgery focused on two practical modules—sacroiliac screw fixation in the pelvis and the reduction of a femoral fracture for nail-ing. The creation of more teaching modules incorporating CAS is under development.

Through its presence at major congresses, AO was highly visible in the surgical com-munity around the world. Its symposia on osteoporotic fractures at the SICOT World Congress in Istanbul, on intramedullary nailing at the EFORT Congress in Lisbon and the first Joint Congress of the DGU/DGOOC in Berlin were attended by more than 600 participants in total. AO was pres-ent with its own booth, which featured presentations of the latest innovations in-cluding the online AO Surgery Reference. This involvement led to important new contacts and resulted in numerous appli-cations for the AO Alumni Association membership.

With its manual on Internal Fixators, AO Publishing will launch the first manual fo-cusing on the indications and techniques of the new Locking Compression Plate

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

* includes all specialties and seminars2003

5

2004 2005 2006 (plan)

6

Principles Advanced Pelvic Hand Foot CMF VeterinarySpine

100

80

60

40

20

0

ORP*

4

Introduction Specialties Networking GovernanceKey activitiesOverview Annual Report 2005 25

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

Preventing soft-tissue adhesion to implantsAn international research network led from within ARI, including the Swiss Federal Institute of Technology in Zurich, the University of Glasgow, the Robert Mathys Foundation, and Synthes, Inc., explored the causes of soft-tissue adhesion to titanium implants, a major cause of tendonitis, ten-don ruptures, and reduced hand motion. Tests have shown that titanium surfaces, like stainless steel, must be polished to inhibit soft-tissue adhesion. With this knowledge, plates from titanium and tita-nium alloys, one of the most biologically advanced metals, present a new treatment option for patients in the hand as well as other areas of internal fracture fixation.

Another project demonstrated the superior-ity of Locking Compression Plates (LCPs) over Dynamic Compression Plates (DCPs) in fixing fractures in poor-quality bone. In a study investigating distal humerus fractures, it was shown that LCPs create a construct that is significantly stronger than with DCPs. Clinicians now have evidence that allows them to extend this indication into higher degrees of osteoporosis—for the benefit of millions of patients worldwide.

Combined expertise for best results2005 was a year of reorientation for AO Research. With the introduction by the Aca-demic Council of Clinical Priority Programs for the entire organization, AO Research is increasingly focusing its resources in the areas of bone defects and disc degenera-tion. The expertise available through ARI

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

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

1 Preparation of stem and endo-

thelial cell co-cultures.

2 A distal humerus plate is f ixed

in an experimental setup.

3 An interver tebral disc is care-

fully inser ted into a bioreactor

container.

4 New research into the character-

ist ics of various metal sur faces

helps prevent tendon adhesion

to implants.

5 The 6th International Con-

ference on Sur face and Tissue

Interaction (BIOSURF VI) in

Lausanne, which was coorga-

nized by the AO Biotechnology

Advisory Board and the AO

Research Institute, drew

an international audience of

160 specialists.

21


Biotechnology Advisory Board promotes new researchThe BAB instituted a new research initia-tive into the use of osteoinductive factors to improve treatment strategies for defects in the locomotor system. Its third global research call resulted in some 30 applica-tions, of which eight were chosen for full proposal submission in a rigorous peer-review process. Three projects were finally selected for financial support. BAB members Margarethe Hofmann and David Grainger as well as Geoff Richards from ARI coorga-nized the 6th International Conference on Surface and Tissue Interaction (BIOSURF VI) in Lausanne, where the AO Foundation played a prominent role.

is complemented with internal and external partners. These include the AO Research Fund (AORF), the AO Biotechnology Ad- visory Board (BAB), AO’s international research networks, including the Collab-orative Research Centers (CRCs), and the AOSRN. Funds will be increasingly allo-cated on a project basis with clearly specified outcomes, as opposed to baseline funding. This model also helps resolve financial and intellectual-property issues.

The results of workshops and meetings on fracture treatment and osteoporosis, attended by internal medicine, orthopedic, and traumatology experts, were published in a supplement to Osteoporosis International Journal. This publication essentially sum-marizes the contribution of AO Research in osteoporotic fractures. In December 2004, a scientific meeting was organized by ARI and the TK-System on the use of antibi-otics on implants. It will result in a similar publication in 2006.

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

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

53 4


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

ADI’s competence in mechanical, hard-ware-based solutions was essential in complementing augmentation technique with innovative measurement tools to intraoperatively determine the cases where implant augmentation will allow for maxi-mum patient benefit.

Joining forces with renowned institutionsMajor success factors of AO’s Clinical Pri-ority Programs are integrated research, clinical, and teaching networks. In the area of mechanical measurement and augmen-tation technique, ADI strengthened its links in particular with Innsbruck Medical Uni-versity, University of Heidelberg, University of Bern, and University of California at San Francisco. To ensure implementation of its concepts in products, ADI established a close relationship with the Task Force Osteopo-rosis of Synthes, Inc.

In addition to its focus on osteoporosis, ADI ran smaller projects with universities and the other AO institutes. Demand in 2005 was particularly high for its database of CT scans, for which use by further industrial and nonprofit organizations is now being investigated.

The focus of the AO Development Institute (ADI) in 2005 was on concept development for a standardized augmentation technique to enable better implant anchorage in osteo-porotic bone. What started as a strategic initiative in 2003 to develop new compe-tencies has become an integral part of AO’s Clinical Priority Program “Fracture Fixa-tion in Osteoporotic Bone.”

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

1/2 While the conventional r igid

implant cuts through the

osteoporotic bone (1), the aug-

mentation technique helps keep

the implant firmly in place (2).

3/4 ADI’s standardized augmen-

tation technique achieves more

homogeneous distr ibution

of bone cement around the

implant (3) than preexisting

techniques (4).

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

1 2 3 4

Introduction Specialties Networking GovernanceOverview Key activities28 Annual Report 2005

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

New TK-approved productsDespite this reshuffling, the TK-System approved no less than 43 new products in General Trauma, 29 in Spine, 14 in CMF, and four in Veterinary. The new family of expert intramedullary nails is now almost complete, the line of external fixators has been complemented with small and medium fixators, and the range of anatomically precontoured plates has been expanded. TomoFix, the implant family for corrective osteotomy, was further expanded, which has led to an actual revival of that tech-nique.

All major developments were accompanied by international user meetings. These meet-ings allow for an open exchange of first clinical experience and user-friendly com-munication of the latest novelties.

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

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

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

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

1 The new External Fixation

Working Group af ter its f irst

meeting and Theddy Slongo

from the Pediatric Exper t Group

(second from right, front row).

2 The winners of the TK Recognition

Award 2005 (from left to right):

Christoph Sommer, Switzerland,

Anselmo Reyes, Mexico, Theera-

chai Apivat thakakul, Thailand,

and Tim Weber, USA, together

with Norber t Haas, Head of the

TK-System.

1 2


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

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

The prospective bone-substitute study initi-ated in 2004 now includes more than the expected 60 cases. It was decided to extend the study to 12 months as the impact of the “chronOS Inject” bone substitute will be easier to evaluate.

Current studies and first FDA trialWith five new studies and six studies completed in 2005, AOCID is currently supervising 22 studies. A hallmark study initiated in 2005 is a US Food and Drug Administration (FDA) trial of the bone sub-stitute P15. It is run in collaboration with the University of Washington in Seattle, the leading epidemiological university in the USA. Randomized FDA trials are consid-ered among the most difficult studies. AO may leverage its expertise from this experi-ence as the healthcare market is expected to request more randomized studies in the future.

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

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

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

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

1 AOCID has been publishing

extensively on study results

and methods in peer-reviewed

journals.

2 The progress of patient treat-

ment is carefully recorded and

then evaluated by the AOCID

team.

3 Demand in 2005 was par ticu-

larly high for training sessions

on evidence-based or thopedic

surgery (EBOS).

4 AOCID booths are an impor-

tant plat form for knowledge

exchange and consulting.

21


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

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

Cost-benefit analysis: Conservative vs operative fracture treatment The importance of cost-benefit analysis is high as health-care systems worldwide are struggling to contain cost. Where possible, the analysis includes a comparison of the benefits of operative versus nonoperative fracture treatment or other treatment options. Factors considered include the severity of the fracture type, the sof t-tissue situation, and the socioeconomic situation of the patient.

As a rule, AO adopts the viewpoint of the patient. Studies are restricted to simple fractures for which the outcomes of operative and conservative treatments are identical. For example, the pioneer study in Chile from 2003 to 2005 showed that patients whose type-A tibia fracture was treated operatively were able to return to work

(RTW) on average 85 days prior to conservatively treated patients. The extra cost for this reduction in RTW is USD 4,000. Decision makers use these results in combination with socioeconomic data. With an average local monthly salary of USD 100, the Chilean society, for example, is unlikely to opt for faster RTW.

A trend is emerging here toward more comprehensive health technology assessments (HTA), which go beyond cost-benefit analysis to include the standpoints of all players in a society. With its proven track record, vast expertise, and service orientation, AOCID is well posi-tioned to be a preferred project par tner.

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

43

Distribution of study types

2003 2005

Handling tests

Case series

Comparative studies

Randomized controlled trial (RCT)

0 2 4 6 8 10 12 14 16


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

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

2006: geared to AO’s clinical prioritiesWhile still awarding Start-up Grants of up to CHF 60,000 p.a. for up to two years to young researchers and scientists, a new Focus Grant category has been created to support projects within AO’s Clinical Priority Pro-grams. These will be for up to CHF 100,000 p.a. for a maximum period of three years. For the first time, more experienced and proven researchers are eligible to apply. The Commission members and their network of scientists and surgeons will continue to review applications. For Focus grants within the field of tissue engineering, they will be joined by reviewers from the AO Biotechnology Advisory Board (BAB).

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

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

At the Trustee Meeting in June 2006, the AORF Commission will award the first AORF Prize of CHF 10,000 to the best completed project and, in addition, will recognize one highly commended project. The winner will give a lecture on their work to the AO Trustees.

With Stephen Ferguson and Mark Markel joining in 2006 in addition to Steve Krikler, the Commission has been expanded to include a second person from spine and one person from the veterinary team, better representing AO’s specialties on this board. All members now also contribute to the monitoring of the progress of projects.

Geographical distribution of

funded studies 2005

Number Amount inCountr y of projec t s CHF 1,000 %

Australia 1 60 2

Austr ia 1 57 2

Canada 3 124 5

Denmark 1 11 <1

Finland 1 31 1

Germany 14 718 27

Greece 1 46 2

Hong Kong 2 79 3

Singapore 1 46 2

Sweden 1 40 1

Switzerland 9 435 16

Turkey 1 6 <1

UK 5 270 10

USA 18 759 28

Subjec t of projec t s in CHF 1,000 %

Biomaterials/Metallurgy 2 100 3.7

Biomechanical 3 142 5.3

Biological 11 510 19.0

CAOS, 3-D reconstruction 1 33 1.2

Clinical 11 450 16.8

Implant development 2 80 3.0

Maxillofacial 8 354 13.2

Spine 4 196 7.3

Tissue reaction 16 761 28.4

Transplantation 1 56 2.1

Total 59 2,682 100

Projects supported by technical area

Number Amount


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

In 2005, the AO Foundation spent a total of CHF 69.1 million, of which CHF 13.2 million was contributed to research, CHF 5.4 million to development, CHF 13.2 million to educa-tion, and CHF 5.1 million to quality assurance. CHF 12.3 million was assigned to the AO specialties AOSpine (CHF 11.4 million) and CMF (CHF 0.9 million). For regional as well as Foundation and Trustee activities, CHF 15.2 million was spent in total. The AO Center accounted for CHF 3.6 million. Unforeseen expenses amounted to CHF 1.1 million. In addition, an important allocation could be made to the reserve pool. From a functional point of view, 27% was spent on personnel costs, 65% on operating costs, and 8% on investments.

In 2005, the AO Foundation placed particular emphasis on biotechnology, spine, knowledge services, IT projects, and community commu-nication. The collaboration with BrainLAB in the field of computer-assisted surgery (CAS) was intensified in the year 2005. BrainLAB is becoming an increasingly important partner of the AO Foundation in research, develop-ment, as well as education.

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

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

Research 33%

Development 14%

Quality assurance 10%

Education 21%

Spine 2%

CMF 1%

Regionalization 4%

AO Center 9%

Administration 6%

North America 52%

Europe 29%

Asia Pacific 12%

Latin America 3%

Middle East 3%

Africa 1%

Distribution of headcount at year-end

Source of funds by geographic region

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Unforeseen

Foundation and Trustee activities

AO Center

Regionalization

CMF

AOSpine

Education

Quality assurance

Development

Research

70

60

50

40

30

20

10

0

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

Introduction Specialties Networking Key activities GovernanceOverview Annual Report 2005 33

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

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

Board of Directors (AOVA)The Board of Directors implements the goals and proposals of the Academic Council. Its 12 members include three representatives of the licensed manufacturer of Synthes products.

Markus Rauh, Chairman *

James Kellam, President

Christian van der Werken, President-Elect

Max Aebi ***

Roland Brönnimann, Synthes, Inc. **

James Gerry, Synthes, Inc. **

Eric Johnson

Paul Manson

Bruno Noesberger

Tim Pohlemann

Jaime Quintero

Ciro Römer, Synthes, Inc. **

Gregor Strasser, CEO **

Urs Jann (Advisory Member) **

Urs Weber (Minutes) **

* casting vote

** non-voting members

*** not present in pic ture

Introduction Specialties Networking Key activitiesOverview Governance34 Annual Report 2005

Academic Council (AcC)The Academic Council lays down the AO Foundation’s medical and scientific goals. Elected by the Board of Trustees, it has 17 members and is supported by four Specialty Academic Councils (SAcCs), specialized steering boards, and other ex-officio mem-bers.

James Kellam, President

Christian van der Werken, President-Elect

René Mar ti, Past-President

Max Aebi, SAcC AOSpine

Brian Alper t

Jörg Auer, SAcC AO Vet **

Michael Ehrenfeld, SAcC CMF

David Grainger, Biotechnology Advisory Board * **

Norber t Haas, Head of TK-System *

David Helfet, Documentation & Publishing Board * **

Jesse Jupiter, Education Board *

Cléber Paccola

Pietro Regazzoni, Development Board *

Norber t Südkamp, Research Board *

Peter Traf ton

Michael Wagner

Tobias Hüt tl (Executive Secretary) *

* non-voting members

** not present in pic ture

AO Executive Management (AOEM)

Gregor Strasser, CEO

Heike Grahlow, Head of Communications

Beate Hanson, Director AOCID

Urs Jann, Director Finance & Administration

Michael Piccir il lo, Director AOSpine

Joachim Prein, President AOI (from July 2005)

Thomas Rüedi, President AOI (until June 2005)

Erich Schneider, Director ARI

Philip Schreiterer, Head of TK Of f ice

Norber t Suhm, Director ADI

Introduction Specialties Networking Key activitiesOverview Governance Annual Report 2005 35

Abbreviations

Organizational terms

AcC Academic Council

ADI AO Development Institute

AO Stands for the German “Arbeitsgemeinschaf t für Osteo-

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

AOA AO Austr ia (section)

AOAA AO Alumni Association

AOCH AO Switzerland (section)

AOCID AO Clinical Investigation and Documentation

AOE AO Spain (section)

AOEA AO East Asia (region)

AOEM AO Executive Management

AOI AO International

AOLAT AO Latin America (region)

AONA AO Nor th America (region)

AORF AO Research Fund

AOSI AOSpine International

AOSRN AOSpine Research Network

AOSTK AOSpine Technical Commission

AOTK AO Technical Commission

AOUK AO United Kingdom (section)

AOVA Board of Directors (from the German “Verwaltungsausschuss”)

ARI AO Research Institute

BAB AO Biotechnology Advisory Board

CPP Clinical Priority Program

CRC Collaborative Research Center

CSEG Computer-Assisted Surgery Exper t Group, within the

TK-Sys m

DAO AO Germany (section)

EG Exper t Group, within the TK-System

SAcC Specialty Academic Council

SEC Socio Economic Commit tee

TfT Tips for Trainers (faculty development course)

Technical terms

ABC Activity-based costing

CAOS Computer-aided or thopedic surgery

CAS Computer-assisted surgery

CME Continuing Medical Education

CMF Craniomaxillofacial

CRIF Clamp Rod Internal Fixator

CT Computed tomography

DCP Dynamic Compression Plate

EBOS Evidence-based or thopedic surgery

ESIN Elastic Stable Intramedullary Nailing

ETNS Exper t Tibial Nail System

HTA Health technology assessment

HTO High tibia osteotomy

IM Intramedullary

LC-DCP Low Contact Dynamic Compression Plate

LCP Locking Compression Plate (System)

MIO Minimal invasive osteosynthesis

MIS Minimally invasive surgery

MoDAD Modular Distal Aiming Device

NFT Non-fusion technology

OCO Or thopedic Clinical Of f icer

ORIF Open Reduction and Internal Fixation

ORP Operating room personnel

PFNA Proximal Femoral Nail Antirotation

PFxM Principles in Fracture Management

PQM Project and qualit y management

RCT Randomized controlled tr ial

RIA Reamer-Irr igator-Aspirator

RTW Return to work

TPLO Tibial Plateau Leveling Osteotomy

36 Annual Report 2005

AO Latin America (AOLAT)

President

Dr. Fiesky A . Nunez Vasquez

Regional Director

Luis Javier Parra

Calle 134 No. 13-83 Of. 809

Bogotá

Colombia

Phone +57 1 520 09 20

E-mail [email protected]

Web www.aolat.org

AO North America (AONA)

President

Prof. John Howard Wilber

P.O. Box 1658

West Chester, PA 19380

USA

Phone +1 610 344-2000

Fax +1 610 344-2001


Web www.aona.org

AO Spain (AOE)

President

Víctor Manuel Alvarez Fernandez MD

Dept. of Or thopaedic Surgery &

Traumatology

Hospital de Jove

Avda. Eduardo Castro

E-33290 Gijón

Phone +34 985 32 0308

Fax +34 985 31 5710

E-mail

[email protected]

Web www.aoes.org

AO head office

AO Foundation

Clavadelerstrasse 8

CH-7270 Davos Platz

Switzerland

Phone +41 81 414-2801

Fax +41 81 414-2280

E-mail

[email protected]

Web www.aofoundation.org

Alumni

AO Alumni Association (AOAA)

Clavadelerstrasse 8

CH-7270 Davos Platz

Switzerland

Phone +41 81 414-2690

Fax +41 81 414-2283


Web

www.aofoundation.org/aoi/alumni

Regions and sections

AO Switzerland (AOCH)

President

Prof. Dr. med. Roland P. Jakob

Clavadelerstrasse 8

CH-7270 Davos Platz

Switzerland

Phone +41 81 414-2700

Fax +41 81 414-2284

E-mail

[email protected]

AO UK (AOUK)

President

Mr. John K. O‘Dowd, MD, FRCS

AOUK

c/o AO International

Marlborough House

York Business Park

Nether Poppleton

York, YO26 6RW

GB

Phone +44 1904 787767

Fax +44 1904 787767


Web www.aouk.org

AO Austria (AOA)

President

Prof. Dr. Michael Wagner

Head of the Depar tment of

Traumatology

Wilhelminenspital

Montlear tstrasse 37

A-1160 Vienna

Austr ia

Phone +43 149 150-4301

Fax +43 149 150-4309


AO East Asia (AOEA)

President

Dr. G. On Tong

P.O. Box 53

Laksi

Donmuang

Bangkok 102 10

Thailand


AO Germany (DAO)

President

Prof. Dr. Hans-Jörg Oestern

Langenbeck-Virchow-Haus

Luisenstraße 58-59

D-10117 Berlin

Phone +49 30-28004420

Fax +49 30-28004429

E-mail unfallchirurgie.

[email protected]

Web www.ao-deutschland.de

Addresses

Annual Report 2005 37

AO FoundationClavadelerstrasse 8CH-7270 Davos PlatzSwitzerland

Phone +41 81 414-2801 Fax +41 81 414-2280 E-mail [email protected] Web www.aofoundation.org

Concept and editing:

AO Foundation, Communications, Davos, Switzerland

Enzaim Communications AG, Zurich, Switzerland

Layout:

nougat Grafik und Illustration GmbH, Basel, Switzerland

Print:

Budag AG, Davos, Switzerland

© 4/2006 AO Foundation

Documents

Annual Report 2005