No. 100 August 2006

NewsletterNewsletter

SICOTSOCIÉTÉ INTERNATIONALE de CHIRURGIE ORTHOPÉDIQUE et de TRAUMATOLOGIETHE INTERNATIONAL SOCIETY OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY SICOT

Société Internationale de Chirurgie Orthopédique et de TraumatologieInternational Society of Orthopaedic Surgery and Traumatology w w w. s i c o t . o r g

Evidence based orthopaedics 2

Editorial by Dr Chad Smith 3

Country to country:About the earthquake in Indian Kashmir 4

On the web: Another functionality of the new SICOT website 7

Committee life: CSAC 8

Young surgeons: SICOT Fellowship in Assiut University 9

Worldwide news: SICOT Diploma Examination by a winner 11

In this issue

Another functionality of the new SICOT website:the on-line discussion forum about SICOT/SIROT abstracts

Another functionality of the new SICOT website:the on-line discussion forum about SICOT/SIROT abstracts

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Replacement arthroplasty versusinternal fixation for extracapsular hip fractures in adults

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Background: Internal fixation, commonly used forextracapsular hip fractures,may fail particularly in uns-table fractures. Replacement of the hip using arthro-plasty,often used for intracapsular fractures,has beenused as an alternative.

Objectives: To compare replacement arthroplastywith internal fixation for the treatment of extracap-sular hip fractures in adults.

Search strategy:We searched the Cochrane Bone,Joint and Muscle Trauma Group Specialised Register(December 2005), the Cochrane Central Registerof Controlled Trials, MEDLINE, EMBASE, the UKNational Research Register, conference proceedingsand reference lists of articles.

Selection criteria: Randomised and quasi-rando-mised trials comparing replacement arthroplasty withan internal fixation implant for adults with an extra-capsular hip fracture.

Data collection and analysis: Both review au-thors independently assessed 10 aspects of trial qua-lity and extracted data.We requested additional in-formation from trial investigators.Where appropriate,limited pooling of data was performed.

Main results: Two randomised controlled trials in-cluding a total of 148 people, aged 70 years or overwith unstable extracapsular hip fractures in the tro-chanteric region, were identified and included in thisreview. Both had methodological limitations, inclu-ding inadequate assessment of longer-term outco-me.One trial compared a cemented arthroplasty witha sliding hip screw.This found no significant differen-ces between the two methods of treatment for ope-rating time, local wound complications, mechanical

complications, reoperation, mortality or loss of in-dependence of previously independent patients atone year.There was, however, a higher blood trans-fusion need in the arthroplasty group.The other tri-al compared a cementless arthroplasty versus a pro-ximal femoral nail. It also found a higher bloodtransfusion need in the arthroplasty group, togetherwith a greater operative blood loss, and a longerlength of surgery.There were no significant differen-ces between the two interventions for mechanicalcomplications, local wound complications, reopera-tion, general complications, mortality at one year orlong-term function.None of the pooled outcome datayielded statistically significant differences between thearthroplasty and internal fixation, with the excep-tion of the significantly higher numbers of partici-pants in the arthroplasty group requiring blood trans-fusion (relative risk 1.71, 95% confidence interval1.05 to 2.77).

Authors' conclusions: There is insufficient eviden-ce from randomised trials to determine whether re-placement arthroplasty has any advantage over inter-nal fixation for extracapsular hip fractures. Furtherlarger well-designed randomised trials comparing ar-throplasty versus internal fixation for the treatmentof unstable fractures are required. ■

Citation: Parker MJ, Handoll HHG.The Cochrane Database of Systematic Reviews 2006,

Issue 2.Art. No.: CD000086.DOI: 10.1002/14651858.CD000086.

Evidencebased

orthopaedics

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SICOT’s continued efforts Editorial

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Since the last newsletter, your Executive Committee, your President, and the SICOT Foundation have been working dili-gently on your behalf. It is my hope that you will respond with

any positive or negative suggestions to the Brussels Office, any mem-bers of the Executive Committee, or to me at my e-mail address:chadsmithSICOT@gmail.com

We continue to expand our "outreach" programmes.The SICOT/SIROT 2006 Fourth Annual International Conference in Buenos Airesto be held from 23 to 26 August 2006 will strongly benefit from thiscontinued effort, as well as from our relationship with Internet2.Therewill be a broadcast from Buenos Aires on the evening of Thursday 24 August 2006 to the major cities in South America, Mexico, CentralAmerica and North America. In fact the broadcast can be viewed and heard in many cities throughout the world at no charge whereInternet2 is available.

The SICOT Foundation continues to work closely with the MauriceMüller Foundation. We have strengthened our relationship and arevery proud of our SICOT-Müller Fellows. Each of these fellows willspend nine months with a training programme chosen by SICOT andthe Müller Foundation, and will spend one third of the time in Berne,Switzerland. It is our intention to develop other fellowships with otherinternational groups.A sports medicine fellowship with the Internatio-nal Society of Arthroscopy, Orthopaedics, and Sports Medicine is beingcontemplated.

If each member of SICOT will add an additional member this year, all ofSICOT’s problems will disappear! In the earlier days of this organisa-tion, it was felt that only the upper 2% of orthopaedic surgeons wereeligible for membership.Although intellectual achievement is the hall-mark of a SICOT Member, we now have a more egalitarian approachto each application.

Chadwick F. SmithSICOT President

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On 8 October 2005 the Himalayanregion of Kashmir in Southeast Asiawas struck by a massive earthquakemeasuring 7.6 on the Richter scale.The death toll was 89,300 with amuch larger number of injured peo-ple.

A common feature characterisesmass disasters: this is the centralrole of hospitals in the challengingaftermath.The Bone and Joint Sur-gery Hospital is a tertiary care cen-tre located in the city of Srinagaron the Indian side of Kashmir. It hasa 145 bed indoor capa-city and is manned bysix consultants, eight re-gistrars and 20 resi-dents.The nursing staffof the hospital numbers45.The hospital recei-ved a total of 462 pa-tients in addition to itsnormal admissions.Thiscaused a significant mis-match in the patient tostaff ratio as well as for-cing the hospital to use

every possible bit of space for pa-tient admission.

The maximum loss of life occurredin the remotely located areas of Uriand Tangdhar,which are located 100-120 kilometers from the hospital.However the hospital started recei-ving patients in the period immedia-tely after the quake from within a 40 kilometer radius.These admis-sions were mainly constituted by pa-tients who had sustained trauma dueto their jumping out of windows anddoors in response to the shaking of

the ground. Not surprisingly a highpercentage of calcaneal and tibialcondyle fractures was seen. 51 pa-tients were admitted on the first dayand another 411 were admitted overthe next four days.

After receiving preliminary reportsfrom the areas mainly affected thehospital administration decided onan outreach policy.A team of doc-tors from the hospital was sent tothe areas mainly affected.This cau-sed an 87% drop in avoidable refer-rals.The policy of immediate intra-venous of crystalloids in the referralarea aimed at preventing patientssystolic pressure from falling below90 mm Hg reduced the number ofrenal failures to 1.5%.The numberof radiographs per patient droppedby 11% compared to the first day.

In the hospital it was pos-sible to handle such a lar-ge number of patientsbecause of the availabili-ty of five operating thea-tres.All areas within thehospital were convertedinto “indoor” areas bythe procurement of a lar-ge number of extra beds.The three unit patternswere converted to a sin-gle one. Color slips wereattached to the head

Experiences from a tertiary care hospital in a mass disaster

Dr Shabir Ahmed DharDr M. R. Mir, Dr M.A. Halwai, Dr Z.A.WaniThe Bone and Joint Hospital Barzallah

Srinagar, Kashmir

India, 190001

shabirdhar@yahoo.co.in

A scene of destruction from Uri after the quake

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guard personnel provided by thegovernment.

One of the unforeseen problemswas the occurrence of 18 earthqua-ke “aftershocks” during the first fewdays after the major shock.Theycaused panic attacks in the patientsas well as in the hospital personnel.This problem was especially trou-bling in the operating theatres whe-re it took courage to keep going on.

Special stress was laid on the psy-chiatric care of the patients, the staffas well as the attendants.The medi-cal personnel were sensitised to thepossibility of patients wanting toshare their experiences again andagain.They were told this is normalbehavior.

Almost all our patients had no shel-ters to return to.This was especially

board of the beds of thepatients quantifying themby the area injured.Thiswas done to concentra-te the super-specialistadvice.

Before referral to thetheatres all wounds werewashed in the stagingarea with up to 10 litersof normal saline, beforebeing debrided, dressedand immobilised.The badly soiledcondition of the clothes of the pa-tients was immediately viewed as apotential source of infection.All pa-tients received a uniform after asponge bath.All wounds were rede-brided within 24 hours and onetheatre was kept exclusively for re-debridement.

The nursing staff of the hospital wasstretched because of the 300% in-crease in the patient load. Betweentwo-hourly rounds conducted bythe nursing staff, the family mem-bers of the patients were asked toreport any developing symptoms tothe nearest nursing station. 87 ofour admitted patients had no survi-ving family member.This gave rise todifficulty in obtaining informedconsent. Four patients with comple-te neurodeficit due to spinal injuriesneeded to be log rolled by the home

serious for the 87 pa-tients who had lost theirentire families. Dischar-ge and rehabilitation cen-tres were set up in thevicinity of the hospital totake in the patients andunload the hospital.

The aftermathSeveral months after theearthquake the hospitalis still receiving cases of

trauma that were neglected by thepatients at the time of their occur-rence. Neglected distal radial frac-tures, neglected neck of femur frac-tures and neglected calcaneal frac-tures are the main types of injuriesinvolved.

From our experiences it is clearthat a rapid coordinated response isneeded in such situations. In ourcase we learnt that a lack of familymembers in such a large number ofpatients affected the normal pro-cess of admission, the managementof the problem, the discharge andthe rehabilitation.At all these stagesthe mass disaster threw up challen-ges: at admission the lack of space,during management the dispropor-tionately less medical personnel andafter the shocks, the lack of homesand families. ■

Patients being airlifted from Tangdhar to Srinagar for orthopaedic treatment

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APPLICATION FOR MEMBERSHIP

Please complete this page and forward it, together with your curriculum vitae, aphotograph and the list of your main publications, to the Secretary General, SICOTa.i.s.b.l., at the address below. Please print the requested data. Do not send paymentnow! For additional information please see overleaf or visit http://www.sicot.org.

Name and addressFamily name………………….…………………………………..………………….……….…………………………………………..First name…………..………….………………….……………. Initials ………………….…………………………………………..Address……..………………………………………………..……………………………………………………………………………………………………………………………………………………………..………………………………………………………….….….………….…………………………………………………………………………………………………………………………...…………………………………………………………………………………………………………………..…………………………….City………………….…………………………………………… Zip code..………………………………………….……………….Country….…………………………………………….…………………………………………………………………………………..Phone…………………………………………………………... Fax….………....………….……………..…………………….…..Mobile….……………………………………………………..… E-mail…..…….………….………………………………………...Birth date………………………………………………………. Nationality…..…………………………………….……………….

General medical educationInstitution:…………………………………………………………………………..………………..………………………...……….…………………..…………………………………………………………………………………………… Years:…..………………….Institution:……………………………………………………………………………………………….…………………………………………….………………………………………………………………..……………………………….. Years:………………………Last degree obtained:……………………………………………………………………………………. Year: ....………..….……...

Scholarships, awards and fellowships…………………………………….………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………...

National orthopaedic societyAre you a member of a national orthopaedic society? Yes NoIf yes, please specify……………………………………………………………………………………….…………………………….

Hospital(s) to which you are presently attached…………………………………………………………………………………………………………………………………………...……………….……………………………………………………………………………………………………………………………..…

Teaching positions, past and presentPosition:…………………………………………………………...……………………………………..………………………………..…………………………………….…………………………………………………………….………. Years:………..….……….…Position:...…………………………………………………………………………..………………………………………..……………..…………………………………………………………………………………………………………. Years:…………..……..……

Are you applying as an Active member Associate member (under 40 years old)

If you are applying as an Associate member you may stay in this category up to the end of your training and for not morethan six years. Beginning of training: ………………………(year).

Date:…………………………………………………………….. Signature: …………..………….………………………………..

Sponsored by (a SICOT member)Name:…………………………………………………………….Country:…………………………………………………………. Signature:….…………….………………………………...……..

If you are applying as an Active member:National Delegate/Secretary’s (°)name:…………………………………..……………………….. Signature:…………………………….……………………………(°) if you do not have a National Delegate/Secreta ry, please apply directly to the Secretary General.

SICOT publication # AFM000 – March 2003

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Another functionality of the newSICOT website: the on-line discussionforum about SICOT/SIROT abstracts

On the web

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The discussion can take place once the Conferenceor Congress has been held.This is the only way toact as the abstracts (oral or poster) need to be ap-proved before being posted on-line and discussed.

This new functionality is of special importance as itwill enable members to continue discussions held atthe SICOT Conferences or Congresses when time issometimes too limited.With this forum memberswill be able to develop themes that they would liketo see addressed during our meetings, so that this fo-rum will be the direct consequence and continuationof every SICOT/SIROT Conference or Congress.

The SICOT Office is proud to announce that thisnew website will be launched at the SICOT/SIROTFourth Annual International Conference to be heldin Buenos Aires from 23 to 26 August 2006 and thatit is currently being tested by the SICOT ExecutiveCommittee.

■

In the last issue of SICOT Newsletter (No. 99, June2006) we presented one of the most important func-tionalities of the new SICOT website: a forum dedi-cated to SICOT Committee members, enabling themto prepare in advance administrative meetings heldin every SICOT Conference or Congress and to dis-cuss and prepare topics of importance.

A second important functionality, similar to the firstone in the way it is to be used, has also been develo-ped: this is the possibility offered exclusively to everySICOT member to access a forum for discussing theabstracts presented at every SICOT/SIROT Confe-rence or Congress.This new functionality is quitesimple to use: the author of an abstract presents hisor her abstract on-line (see illustration) and SICOTmembers are allowed to ask him or her any questionabout its content.The author can answer the mem-bers’ questions and a real discussion can take place.As for the Committee members who will have theirown forum, we can say that a forum dedicated to ab-stract authors and SICOT members will be set up.

Once again this forum will work in the same way asmost forums, and especially the SICOT Committeesforum, and will be easy to use. Every SICOT memberwill be able to post a question on-line concerning atopic of the abstract for discussion with the authorof the abstract.The author will have the possibility toanswer him or her and a real discussion can take pla-ce between both participants. It is important to st-ress that the forum is not limited to two participantsbut that every SICOT member can participate in thediscussion.The author can choose to answer eachquestion individually or he or she can group thequestions together and reply to several at once.

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AIC Buenos Aires 23-26 August 2006

Prof Cody Bünger | CSAC, Chairman

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Prof Bartolomé T.Allende and histeam have put to-gether an impres-sive scientific pro-gramme featuringa blend of high-le-

vel sessions focusing on bone lossand surgical reconstruction in pae-diatric orthopaedics, new trendsin osteosyntheses, managementof trauma disease in the youngadult, and sports medicine. Distin-guished speakers and panellistsfrom all over the world have beeninvited to contribute to these ses-sions, which also include sophisti-cated “how-to-do” topics and in-dustrial symposia.

The free paper sessions, the SICOT conference’s main core,attracted over 500 submitted pa-pers, which were assessed by twoindependent reviewers and pla-

ced in focused sessions. Awardsfor the best ten papers and bestten posters will be distributedduring the Closing Ceremony ofthe SICOT/SIROT 2006 FourthAnnual International Conference.In an effort further to improve SICOT Congresses and Confe-rences, the Executive Committeeis conducting a survey of the per-ception and level of satisfactionamong congress and conferenceattendees, including industry re-presentatives. During the meetingfor independent interviews, aFrench company, MMR, will add-ress participants and industrial re-presentatives.

We look forward to this ex-tremely interesting conferencethat will provide the world withthe highest calibre of extensiveexperience as manifested by the selected topics of this confe-

rence. Do not miss out! And takea look at http://www.sicot.org forany further information concer-ning the SICOT/SIROT 2006Fourth Annual InternationalConference.

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Comitteelife

The role of the Congress Scientific Advisory Committee(CSAC), chaired by the President-Elect of SICOT, is to make allnecessary recommendations to the Board of Directors and tothe International Council about the quality of SICOT Congres-ses or Conferences and about the scientific activities related tothese Congresses or Conferences.

The CSAC consists of the Congress President, a member of hisCommittee, the Immediate Past, the next Congress President,Conference Presidents and the Past Conference President.

The role of the CSACDr Bartolomé T.Allende

Dr Bartolomé Luis Allende Jr

Dr Christian Allende

Dr Iván Bitar

Dr Luis Lezama

Dr Aberto Macklin Vadell

Dr Carlos Tello

Dr Carlos B.Villalba

Dr Matías Villalba

Local Organising Committee of

Buenos Aires AIC 2006

Prof Cody Bünger (Chairman)

Prof Bartolomé T.Allende

Dr Thami Benzakour

Prof Erdal Cila

Prof John C.Y. Leong

Prof Keith D-K Luk

Dr Cyril Toma

Congress Scientific Advisory Committee

(CSAC)

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SICOT Fellowship in Assiut University,Egypt

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Youngsurgeons

The Postgraduate teaching pro-gramme was meticulously organi-sed.The Department of Orthopae-dics works in three general units,plus a trauma unit and a micro-vas-cular unit. Each unit uses five theat-res on two days every week, andusually manages a total of 15-20operations each day. In addition thetrauma unit has three theatres avai-lable 24 hours a day with an avera-ge of 15 major cases per day.Themicro-surgery unit operates in onetheatre twice a week.There is a se-parate autonomous septic unit withits own dedicated theatre.All typesof operations are performed andportable X-rays and image intensi-fiers are used a great deal.

I learned new operative tech-niques: I learned that a knowledgeof detailed anatomy and minimalsoft tissue dissection are the requi-rements for a successful operation.Having these facilities available hel-ped me to learn that nowadays thebest way to manage most fracturesin adults is by open reduction andinternal fixation.Infections and non-unions can be minimised by ensu-ring good “biological fixation”. I

have learned also that there is anabsolute indication for open reduc-tion and fixation in polytrauma pa-tients, as long as they are haemo-dynamically stable. Careful handlingof the soft tissues and the bonefragments particularly preservingtheir blood supply is vital.

Each orthopaedic surgeon isskilled in his own way and onelearns a variety of ways of opera-ting for the same problem. I wasvery interested to be introducedto surgery in carefully selected pa-tients with Cerebral Palsy, and inchildren with Erb’s Palsy. I was gi-ven a chance of assisting Prof Es-sam in an operation on a congeni-tal hip dislocation which is veryrare in Upper Egypt.

Arthroscopic surgery is ano-ther area in which I was interested.Arthroscopy is continuously deve-

loping so it would be nice to have arefresher course once in a while.Three Egyptian fellows are interes-ted in coming to Ethiopia and gi-ving a course which could last for aweek provided they are sponso-red: Dr Hesham, Dr Abdelhamidand Dr Hatem Galal Said. Micro-surgery and hand surgery is ano-ther area which took my interest.

The weekly Wednesday confe-rence run by Prof Said and Prof Es-sam was unique in its presentation:a great number of postoperativeX-rays of recent orthopaedic andtrauma cases were displayed anddiscussions were rich.A selectionof preoperative cases was also pre-sented at the conferences and thegreat part of discussion created afertile ground for a trainee to havean opportunity to become acquain-ted with a variety of common andoccasionally rare cases.An opinionon the best treatment of problemcases was requested from the sur-geon who had the most relevantexperience.

I am most grateful to Prof GalalZaki Said, Prof Essam El Sherif, MrGeoffrey Walker,Mr Stephen WoodFRCS and Dr Hesham for comingup with the idea of making instru-ments for us to take home so thatwe can carry out what we havelearned. My thanks also go to SICOT and the SICOT Foundation.

■

Dr Woubalem Zewde WoldemedhinOrthopaedic fellow in Assiut University

Addis Ababa University,Ethiopia

Woubalemz@yahoo.com

Operating room

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WOC-SICOT Regional Training Programme

Dr S. Rajasekaran | WOC President

WOC helps to make this happen by liaising betweenthe trainer and trainee. Being in the same country,the pathology and the working conditions are similarand hence the training is of more value to the trai-nee.The trainee is allowed to participate in all clinicalactivities including assisting in surgery and hence thetraining is of immense practical value.

The cost of travel, board and lodging is met byWOC-SICOT Foundation Fellowship Fund. In mostinstances, the senior surgeons subsidise the accom-modation cost so that this scheme can benefit bettera larger number of younger surgeons. Since 2 January2006, 72 surgeons have benefited from travel to acentre of their choice to have hands-on-training un-der the direction of an eminent surgeon. ■

The WOC-SICOT “Regional Trai-ning Fellowship” programme isnow one of the most popular andsought after training fellowshipsin the region.The Fellowship isnot restricted to Indians and hasbeen awarded to surgeons from

Bangladesh, Srilanka, China and Indonesia.The training programme is unique in many aspects.

It caters to surgeons of all age groups without anyrestriction on age so that surgeons from rural areasare able to fill the needs of their practice.The trai-ning is more dependant upon the need than on abrilliant CV.The training centre, trainer and the spe-ciality of training are all chosen by the trainee and

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Bone and Joint Decade is very proud to announce that the new BJD Patient Advocate Leaders (PALs) website hasbeen launched! Please visit it at www.bjdpals.org to see the latest in the musculoskeletal web presence.The objecti-ve of BJD PALs is to provide a dynamic and user-friendly web space dedicated to advocacy in musculoskeletal issueswhere patient advocates can describe their work, voice concerns, exchan-ge stories and experiences, and access resources. BJD has recruited vo-lunteer BJD PALs reporters from each region of the world to contributearticles reflecting issues and opportunities for leadership in patient advo-cacy within their countries.Please join BJD Patient Advocacy Leaders on www.bjdpals.org! If youwould like to get involved, please contact BJD Communications Manager,Sara Martin at smartin@skynet.be.

BJD Patient Advocacy Leaders (PALs) website launched!

We are pleased to inform SICOT members thatchanges occurred in the national representationof several countries. In Austria Prof Dr ReinhardWindhager succeeded in 2006 Prof Dr Karl Knahr,who served from 1997 to 2005. In Israel ProfGershonVolpin has succeeded Prof Jacob Neru-bay, who served from 1987 to 2006. In Japan DrKatsuji Shimizu succeeded in 2005 Prof Shoichi

Kokubun, who was the delegate from 1999 to2005. In Korea Prof Myung-Cheul Yoo succeededin 2005 Prof Se-Il Suk, who served from 1992 to2005. In Sudan, a replacement has not yet beenfound for Dr Adam Fadlalla, deceased. In USA DrLouis U. Bigliani has succeeded Dr Robert D.D’Ambrosia. Dr D’Ambrosia served from 2004 to2006.

Changes in countries’ national representation

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Worldwidenews

The SICOT Diploma Examination,a great achievement

It was a significant step to gothrough the SICOT Diploma Exa-mination procedures and to meetits distinguished panel of exami-ners.This Exam was a very speciallife and career experience. TheExam was run on the FRCS (Orth)format of the UK and Canada.Thewritten, clinical and basic sciencequestions as well as the viva partswere all very well selected and wi-dely distributed over the compre-hensive orthopaedic and traumasyllabus.

The Examiners, who are mostlyeminent clinicians from many coun-tries of all continents, conductedthe Exam parts in a very fair andexperienced way.The candidatessailed smoothly over the course,stopping at all subspecialties andbrowsing through all types of ques-tions in trauma and orthopaedics,covering all general subspecialties.

Even the organisational procedu-res of the Exam were fascinating.Taking such an exit level exam in anew country that the candidate

may be visiting for the first time isquite rewarding. Meeting collea-gues of the profession from all overthe world, who came mostly forthe congress scientific activities,makes the Exam look like part ofthe educational and scientific acti-vity of the profession.

This is all done in a prime luxu-rious spot in the world every timefor very affordable fees of onlyEUR 300, apart from the nominalfees to register to attend the confe-rence.These special treats are onlyallowed for SICOT members.

As I had the honour of passing theExam comfortably by achieving ahigh score and winning the Ger-man SICOT Fellowship Award, Ido recommend this Exam verymuch to all other colleagues. It is afair Exam to take and a bright pro-mising qualification to hold.

Looking around, I could not findany other medical exam by suchan international organisation. Mostof them are exit professional exams

like the one of the American Board,of the Canadian or of the UK thatare only limited to their own coun-tries.The only regional exit examfound is the one conducted byEFORT, even if this one is also limi-ted to the European countries.TheSICOT Diploma Examinationseems to be the most global oneso far.

I think that this Exam should beavailable to colleagues who arenot members of SICOT, maybe forhigher fees. Surely it will be of wi-der benefit.

My membership of SICOT is nowin order and my trip to Germanyis planned for June 2006. Prof Jo-chen Eulert, founder of the Fel-lowship, has organised for me thevisit to three distinguished centresof orthopaedics in Germany.

I look forward to my trip to Ger-many, and look forward to reco-gnition of the SICOT Diploma Exa-mination. I also thank SICOT foradding a global and multiculturalconcern to the profession of or-thopaedic surgeon. ■

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Dr El Basyuni, SICOT Dip, FRCS,MSc (Trauma), MPHConsultant Orthopaedic Surgeon

Kent ME10 1GA

United Kingdom

bonedocb@yahoo.com

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Editorial DepartmentEditorial Secretary: Prof Rocco P. PittoExternal Affairs: Nathalie Pondeville

Rue Washington 40-b.9, 1050 Brussels, BelgiumPhone : + 32 2 648 68 23 - Fax : + 32 2 649 86 01 E-mail : edsecr@sicot.org - Website : http://www.sicot.org

How to join SICOT? Complete the application form:http://www.sicot.org/?page=application

Visit us at SICOT booth 2 at AIC 2006 Buenos Aires

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