The impact of the AO Foundation on fracture care: An evaluation of 60 years AO Foundation.

OBJECTIVES: Sixty years ago, the Association of Osteosynthesis (AO) was founded with the aim to improve fracture treatment and has since grown into one of the largest medical associations worldwide. Aim of this study was to evaluate AO's impact on science, education, patient care and the MedTech business. DESIGN/METHODS: Impact evaluations were conducted as appropriate for the individual domains: Impact on science was measured by analyzing citation frequencies of publications promoted by AO. Impact on education was evaluated by analyzing the evolution of number and location of AO courses. Impact on patient care was evaluated with a health economic model analyzing cost changes and years of life gained through the introduction of osteosynthesis in 17 high-income countries (HICs). Impact on MedTech business was evaluated by analyzing sales data of AO-associated products. RESULTS: Thirty-five AO papers and 2 major AO textbooks are cited at remarkable frequencies in high ranking journals with up to 2000 citations/year. The number of AO courses steadily increased with a total of 645'000 participants, 20'000 teaching days and 2'500 volunteer faculty members so far. The introduction of osteosynthesis saved at least 925 billion Swiss Francs [CHF] in the 17 HICs analyzed and had an impact on avoiding premature deaths comparable to the use of antihypertensive drugs. AO-associated products generated sales of 55 billion CHF. CONCLUSION: AO's impact on science, education, patient care, and the MedTech business was significant because AO addressed hitherto unmet needs by combining activities that mutually enriched and reinforced each other.

Orthopedic surgery.

Orthopedic surgery is a specialty of surgery dedicated to the prevention, diagnosis, and treatment of diseases and injuries of the musculoskeletal system in all age groups. Careers in orthopedic surgery span the spectrum from general orthopedics to those of subspecialty expertise in orthopedic trauma, hand, pediatrics, total joint, foot and ankle, sports medicine, and oncology to name a few.

The internet and the physician-patient relationship.

BACKGROUND: Since the emergence of the public Internet in the early 1990s, the healthcare industry has been struggling to understand how best to utilize this resource. During the last decade there has been an increase in both the interest and participation by healthcare providers in the Internet space, but many observers continue to push for more development of healthcare resources to better support the provider-patient relationship. QUESTIONS/PURPOSES: This paper will review the historical development of the Internet, the core concepts that have driven the emergence and evolution of the Internet as a mass medium of information exchange, and how the healthcare industry can harness the Internet to improve the provider patient relationship. WHERE ARE WE NOW?: The healthcare industry continues to lag behind other industries that have been transformed by the Internet. Numerous industries including travel, real estate, retail sales, and banking have migrated both comprehensive information resources and transactions to the Internet in order to improve efficiency and customer satisfaction. That same process is occurring now in the healthcare industry. Credible and comprehensive Information resources are beginning to mature. Transactions are still in their infancy, reflecting a continued concern about privacy and security. WHERE DO WE NEED TO GO?: We need to improve information resources to educate and inform patients. Improving the availability and credibility of information resources will empower patients to make better healthcare decisions and I contend will ultimately reduce the cost of delivering care. HOW DO WE GET THERE?: Orthopaedists must first recognize the value of information resources to the patient. Effective communication with patients is a critical component of providing healthcare services. All healthcare providers should reflect on the importance of developing an effective communications strategy for their own practice and consider the benefits of participating in efforts by professional organizations to improve existing information resources.

[Consolidating the medical model of disability: on poliomyelitis and constitution of orthopedic surgery and orthopaedics as a speciality in Spain (1930-1950)]. / Consolidando el modelo médico de discapacidad: sobre la poliomielitis y la constitución de la traumatología y ortopedia como especialidad en España (1930-1950).

At the beginning of the 1930s, various factors made it necessary to transform one of the institutions which was renowned for its work regarding the social reinsertion of the disabled, that is, the Instituto de Reeducación Profesional de Inválidos del Trabajo (Institute for Occupational Retraining of Invalids of Work). The economic crisis of 1929 and the legislative reform aimed at regulating occupational accidents highlighted the failings of this institution to fulfill its objectives. After a time of uncertainty, the centre was renamed the Instituto Nacional de Reeducación de Inválidos (National Institute for Retraining of Invalids). This was done to take advantage of its work in championing the recovery of all people with disabilities.This work aims to study the role played in this process by the poliomyelitis epidemics in Spain at this time. It aims to highlight how this disease justified the need to continue the work of a group of professionals and how it helped to reorient the previous programme to re-educate the "invalids." Thus we shall see the way in which, from 1930 to 1950, a specific medical technology helped to consolidate an "individual model" of disability and how a certain cultural stereotype of those affected developed as a result. Lastly, this work discusses the way in which all this took place in the midst of a process of professional development of orthopaedic surgeons.

The evolution of clinical gait analysis part III--kinetics and energy assessment.

Historically, clinical applications of measurements of force and energy followed electromyography and kinematics in temporal sequence. This sequence is mirrored by the order of topics included in this trilogy on the Evolution of Clinical Gait Analysis, with part I [Sutherland DH. The evolution of clinical gait analysis part I: kinesiological EMG. Gait Posture 2001;14:61-70.] devoted to Kinesiological EMG and part II [Sutherland DH. The evolution of clinical gait analysis part II - kinematics. Gait Posture 2002;16(2):159-179.] to Kinematics. This final review in the series will focus on kinetics as it relates to gait applications. Kinematic measurements give the movements of the body segments, which can be compared with normal controls to identify pathological gait patterns, but they do not deal with the forces controlling the movements. As a major goal of scientifically minded clinicians is to understand the biomechanical forces producing movements, the objective measurement of ground reaction forces is essential. The force plate (platform) is now an indispensable tool in a state-of-the-art motion analysis laboratory. Nonetheless, it is not a stand-alone instrument as both kinematic and EMG measurements are needed for maximum clinical implementation and interpretation of force plate measurements. The subject of energy assessment is also given mention, as there is a compelling interest in whether walking has been made easier with intervention. The goals of this manuscript are to provide a historical background, recognize some of the important contributors, and describe the current multiple uses of the force plate in gait analysis. The widespread use of force plates for postural analyses is an important and more recent application of this technology, but this review will be restricted to measurements of gait rather than balance activities. Finally, this manuscript presents my personal perspective and discusses the developments and contributors that have shaped my thoughts and actions, and which I have found to be particularly noteworthy or intriguing. Just as in parts I and II, emphasis has been placed on the early development. All subtopics and important contributors, in this third and certainly most challenging of the review papers, have not been included. Some may find that my perceptions are incomplete. I accept responsibility for all deficiencies, as none were intended. Letters to selected contributors and their responses reveal how each contributor built on the work of others. The level of cooperation and sharing by these early investigators is extraordinary. Had they wished to withhold information about their own work, clinical gait analysis would have been severely delayed.

History of spinal surgery: one neurosurgeon's perspective.

Spinal surgery has advanced from decompression procedures to complex spinal reconstruction and internal stabilization within the last 25 years, as a result of a broad-based technological boom that began in the 1970s with the advent of spinal computerized tomography and magnetic resonance imaging. These technological advances have coincided with, and developed as a result of, the concomitant rise of a complex, economically driven consortium of innovative surgeons and researchers, academic institutions, government agencies, and private industry, to form a Medical-Industrial Complex (MeIC). A major growth industry has formed, resulting in an overall societal benefit. Nevertheless, it has impacted graduate medical education and has significantly increased the cost of treating spinal disorders. Back pain and spinal disorders are a major societal health problem that is associated with a high demand for treatment services. There is a potential for abuse as well as a benefit in offering these services. The MeIC has contributed to the overall rise in the cost of health care insurance and in the migration of manufacturing jobs abroad as a solution for lowering production costs. The increased cost has had a negative impact on local and regional economies.

[History of 1906 census of handicapped patients]. / Die Geschichte der Reichskrüppelzählung von 1906.

The census of cripples ("Reichskrüppelzählung") in the German Reich plays a central role in the development of orthopaedic surgery. Local censuses conducted by protestant ministers had already pointed out the great number of disabled children without appropriate care. It was the achievement of Konrad Biesalski, who was an orthopaedic surgeon, and of Eduard Dietrich, a Prussian government official, that a nation-wide census for disabled people was conducted. The concerns of the Reich-health-administration, which had complained about the way the survey was to be made, were neglected. These concerns were not all unjustified. Both the planning of the census itself and the technical interpretation of the obtained numbers were full of errors. The number of cripples in need of a place in an asylum were very exaggerated. Biesalski is to be held responsible for this systematic error. For him the census was only a way to influence the public opinion and had no scientific value. The public was worried by the great numbers of cripples in need of medical care and the foundation of asylums for cripples was added to the social political agenda. Along with these asylums came the promotion of orthopaedic surgery. The law, which laid the foundation for these institutions, the "law for the welfare of the cripples in Prussia" of 1920, would have never been passed, if it had not been for Biesalski's manipulated numbers. One can say that the artificially inflated numbers of the "Reichskrüppelzählung" were a lie for a good cause.

[Johann Georg Heine--treatment leeway for technical specialists after Bavarian medical reform in the early 19th century]. / Johann Georg Heine--Handlungsspielräume für handwerkliche Spezialisten nach der bayerischen Medizinalreform im frühen 19. Jahrhundert.

Various technical professions such as orthopedics and dentistry were introduced into the universities of Bavaria in the early 19th Century. The representatives of these professions were craftsmen who first had to legally become "doctors" before they could regularly take part in specialized treatment technology and firmly establish their originally technical discipline in an academic setting. A case study is used to paradigmatically illustrate how this course of developments subsequent to the Bavarian Medical Reform of 1808, which was intended to bridge all gaps for these marginal professions, ever became possible and to describe the role of the State in the establishment of technical specialties. It turned out that some of the newly formed fields that were formerly specialized technical trades did not fit into the rigid medical legislative system. This led to great uncertainty about various legal positions in the sector where medical and police regulations did not apply. In this "unlegislated sector", government jurists--not medical boards--made decisions regarding the further development of the new specialty. Economics and public health policies became important factors in view of the demand for services in the new specialty field. This created more freedom of action for "technical" medical specialties that were in great demand.

History of the AO and its global effect on operative fracture treatment.

In 1958 a group of Swiss general and orthopaedic surgeons established the AO (Arbeitsgemeinschaft für Osteosynthesefragen) or the Association of the Study of Internal Fixation (ASIF) to strive to transform the contemporary treatment of fractures in Switzerland. This association was revolutionary in development of instruments and implants for operative fracture treatment. The first instructional course for teaching the use of these instruments and implants occurred in Davos, Switzerland, in the newly founded Laboratory of Experimental Surgery in 1960. Through a process of internal quality control (AO documentation) the clinical success of these new techniques and implants became evident. Operative fracture treatment gained acceptance throughout Europe and finally worldwide. AO/International (AOI) was founded in 1972 to expand education and the teaching programs for surgeons and operating personnel on an international basis. In 1984, the AO/ASIF Foundation was created with an AO Board of Trustees comprising 90 leading trauma surgeons from throughout the world. Continuous research, implant and instrument development, clinical documentation, and multifaceted educational opportunities are coordinated by the AO/ASIF Foundation to maintain its position as the international authority in the treatment of trauma. The medical community recognizes today the enormous positive global effect that this respected and ever changing organization has had by continually improving operative fracture treatment.