AO Foundation Annual Report 2013

A global network of surgeons Annual Report 2013

Our

vision is excellence in the surgical

management of trauma and disorders of the musculoskeletal system.

Our

mission is to foster and expand

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

more

effective patient care worldwide.

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

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Statistics from the AO Foundation From education to talent management

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Feature stories AONeuro Intiative—improving the outcomes of cranio neurosurgery patients around the world Where Science meets Clinics—symposium’s champions are committed to its future AOSpine Knowledge Forums—pathology-focused working groups expanding global knowledge base

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AO Clinical Divisions AOTrauma—a solid international reputation AOSpine—advancing spine care worldwide AOCMF—achieving its goals and staying ahead AOVET—celebrating its 40th anniversary

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AO Institutes Research and Development—consolidating an international reputation for excellence Exploratory Research—from clinical need to proof of concept Research Review—the independent peer review process Education—from faculty development to online publishing Clinical Investigation—a year of growth AOTK System—innovation with solid roots in evidence-based development

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AO SEC—forging ahead with education

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Governance Finance—focus on efficiency improvement Governance—organizational charts at governance and executive level Governing bodies of the AO Foundation Addresses

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Annual Report 2013 ┃ Editorial

Letter from the President and the CEO and Vice-Chair Dear colleagues and friends, The year 2013 was one of positive change for the AO despite the changing environment and complex times and we would like to update you on some of the noteworthy developments throughout the organization.

There have been significant adjustments made in governance in order to avoid potential confl ict of interest, to guarantee better accountability, improve efficiency and reduce overheads, boards and commissions. The new AO Foundation Board (AOFB), the highest body of the foundation and responsible for its strategy and governance, replaces the Board of Directors (AOVA) and consists of no more than eleven members. Alongside the president, president-elect, immediate past president and vice-chairperson of the AO Foundation, four of the new members bring to the table the experience and competencies of the respective clinical divisions while the three other positions are fi lled by candidates with research, industry and fi nance expertise respectively. The industrial partners and chairs of clinical divisions are no longer members of the board. The CEO and AOFB vice-chairman, as the delegate of the AO Executive Management (AOEM), remains a member but without voting rights. The AOFB continues to have a close relationship with clinical division chairs to ensure alignment and continuing collaboration. The Board of Trustees is renamed the Assembly of Trustees and retains the same rights and obligations as before. The Partnership Coordination Board and the Presidential Team have been abolished while the Nominating Committee has a new form and composition.

The results of the R&D Review also instigated a number of modifications including the creation of a R&D platform (consisting of the major stakeholders in research, to coordinate activities across R&D and support the new AOFB), the cessation of the Academic Council (AcC), the AOCID Committee and the transfer of the AOERB activities to a new advisory committee for ARI and AOCID. We would like to take this opportunity to thank all the members of the AcC, the AOCID Committee and the AOERB for their many years of hard work and commitment to the AO. The new relationship between AO and our industrial partner DePuy Synthes (DPS) continues to develop. AO and DPS aspire to expand our existing collaboration and support agreement, which is valid until 2016; a new agreement will be developed post-2016. Local AO activities will continue to receive their logistical support and DPS aspires to expand our collaboration with new pilot initiatives such as AONeuro and AORECON. It is acknowledged that while the evolving regulatory environment is complex and will necessitate some changes at the AO, there must be room for workable solutions. Key to this positive relationship is that DPS continues to respect the heritage, culture, values and independence of the AO. Phase I of AO Connect was concluded and Phase II was phased out by the end of 2013. These current systems will be stabilized to run for another two to three years while there is an evaluation of off-the-shelf solutions.

The evaluation plan foresees that by the end of 2014 a recommendation for implementation can be proposed to the AOFB. In 2013 the AOFB agreed that the AO will engage to a limited extent in emergency and disaster relief as part of a global relief network, bringing its core competencies in education and training to surgeons providing support in disaster areas. Moreover, increased emphasis shall, in the future, be paid to expanding activities in less-developed countries through a new entity, AO Alliance, expanding and building on AO SEC activities. This initiative was presented to and supported by the trustees at a break out session at the Trustees Meeting 2013.

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Jaime Quintero and Rolf Jeker

The strategic focus of the AO in the last three years has been on governance, effectiveness and efficiency. In the coming years, this will shift to a stronger emphasis on quality and innovation to improve and diversify AO’s activities. The AO Strategy Fund is an example of an innovation initiative launched in 2013 to bring about this change. The AOFB approved the launch of the AO Strategy Fund for the period 2014–2016, with an annual budget of CHF 5 million to support important strategic initiatives. The first call for applications was launched in December with all AO members and AO employees being eligible to submit pre-proposals on behalf of AO boards, steering committees, commissions, other AO units or in their own names. The types of innovative project proposals topics that are encouraged include: new services, new technologies and unmet needs; projects enhancing the organization’s visibility and reach; and ideas to foster cooperation across clinical divisions.

The initial response to the first call was overwhelming with over 100 proposals submitted, demonstrating the great interest in innovation and enhancing the AO brand further.

We would like to take this opportunity to congratulate AOSpine who celebrated their 10-year anniversary, and AOCID who celebrated their 15-year anniversary in 2013.

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

Sincerely,

Jaime Quintero President of the AO Foundation

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

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Annual Report 2013 ┃ Statistics from the AO Foundation

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Annual Report 2013 ┃ AONeuro initiative

AONeuro Initiative Improving the outcomes of cranio neurosurgery patients around the world Worldwide, ten million people are affected each year by traumatic brain injury (TBI), according to US National Institutes of Health estimates. It has been predicted that TBI will become the world’s leading cause of death and disability in the world by the year 2020. So it’s no wonder that the AO Foundation—known for improving patient care in trauma, spine, craniomaxillofacial and veterinary surgery—is now making strides in cranial neurosurgery through its new AONeuro Initiative.

Though the initiative got under way in 2013 with the mission of improving the outcomes of cranial neurosurgery patients around the world, the AOTK System was evaluating implants for craniectomies as early as the 1990s, and neurosurgeons have made significant contributions to the activities of AOSpine since its inception.

Today, according to Prof Geoffrey T Manley, a member of the AOTK’s Neuro Surgery Expert Group, cranial neurosurgery is an area ripe for innovation, research, development and education.

“We need to do the research, development and education to transform neurotrauma patients’ lives.”

Prof Geoffrey T Manley “TBI is a good example. We don’t have any treatments for it today besides surgery and supportive care—the same treatments used 3,000 to 4,000 years ago,” Manley explained. “We need to do the research, development and education to transform neurotrauma patients’ lives—and the lives of their families who are involved in their care.”

Manley said that, like infectious disease, neurotrauma is a particularly international problem, so simply addressing the issue in Europe and North America isn’t the solution.

“Neurotrauma is a growing epidemic, and the AO is uniquely positioned to address it,” he said, adding that strides—like advanced neuro monitoring and minimally invasive approaches—have been made over the last decade but much remains to be done. “The AO Neuro Initiative is an opportunity for the AO Foundation, with its global network of experts, to make a real difference in not only treatment of neurotrauma patients, but also in education and development.”

“All participants were there by choice for a personal, 6

Annual Report 2013 ┃ AONeuro initiative

It is difficult to miss Prof Christian Matula’s sense of urgency when he talks about the AONeuro Initiative and the opportunities it represents. Matula, a neurosurgeon and a member of the AONeuro Initiative Steering Committee, is passionate about the expertise the AO Foundation could bring to the initiative’s mission.

“Time plays a significant role in what we do as neurosurgeons: If you have a victim of severe neurotrauma, we must do something immediately,” he said. “Time is also of the essence for neurotrauma patients and clinicians all over the world who are waiting for the next generation of answers: better treatments, tools and education for clinicians.”

Since 2005 when the AO became actively involved in neurotrauma, a classification system for neurotrauma has been developed, a number of relevant courses have been conducted worldwide, two educational webinars with attendance of more than 200 people have been held, and new surgical tools have been developed. But much more needs to be done, and Matula sees the AO as the perfect vehicle.

“Time is of the essence for neurotrauma patients and clinicians all over the world who are waiting for the next generation of answers.”

Prof Christian Matula “In addition to improving patient care, AONeuro is an opportunity to expand the AO family by welcoming in thousands of new members, and to position the AO as a pioneer in cranial neurotrauma just as it is a pioneer in its existing clinical divisions,” he explained.

Prof Paul Manson, chair of the AONeuro Initiative Steering Committee and former AO Foundation Board of Trustees President, said AONeuro could, indeed, become a fi fth clinical division of the AO. “We hope it will work out that way,” Manson said.

“There is no question of the need,” said Prof Geoffrey T Manley, a member of the AONeuro Steering Committee, added. “Will the AO establish a neuro division and when?

More important than timing is planning: We must plan with a level of support that will support the success of a neuro division.”

A clear AONeuro Initiative roadmap is in place for 2014 on educational courses worldwide. Whether the initiative will continue will be determined based on evaluation by the steering committee and the AO’s industrial partner in mid-2014.

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Prof Christian Matula performing surgery in his operating room in Vienna (AT)

Annual Report 2013 ┃ Where Science meets Clinics

Where Science meets Clinics Symposium’s champions are committed to its future Just three years after its debut, the international scientific symposium, Where Science meets Clinics, has demonstrated its relevance to a broad stakeholder audience and its champions are committed to driving it forward.

Originally conceived as a gathering of scientists and clinicians from multidisciplinary environments with the aim of stimulating exchange and collaboration, the biennial symposium premiered in 2011 under the auspices of AO Exploratory Research (AOER). When the Where Science meets Clinics symposium convened in Davos in September 2013, it had evolved to include the voices of healthcare industry representatives and regulatory authorities in podium presentations and brainstorming sessions about successful translation of innovative science into clinics.

And, though AOER was dissolved last year in a streamlining of the foundation’s research strategy, Where Science meets Clinics will likely fi nd a new home under the broader umbrella of the foundation.

“To really make a difference in the clinical world and ultimately improve patient care, we have to bring science all the way to the market.”

Prof Michael Schütz

“Our mission in 2013 was to address the unsatisfactory situation involving obstacles to translation of tissue engineering protocols into the clinics. To maximize efficiencies, the 2013 symposium—funded by AOER and AOTK— was aligned with meetings of the TK Expert Group chairmen and the AOER Board (AOERB) members,” said Dr Sandra Steiner, Technology Development Officer at the AO Research Institute (ARI) and former Head of AOER. “We brought together more than 100 scientists, clinicians, industry and regulatory officials because it is essential that these groups understand one another’s positions and work together.”

The constellation of a compelling mission, a future-oriented topic, international orientation, and the active participation of thought leaders across the four key stakeholder groups made Where Science meets Clinics 2013 a unique and highly relevant event.

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Researchers and clinicians examining articular cartilage defects and discussing repair options

Annual Report 2013 ┃ Where Science meets Clinics

“To really make a difference in the clinical world and ultimately improve patient care, we have to bring science all the way to the market, and there are a lot of stumbling blocks along the way,” said Prof Michael Schütz, former AOERB chairman and current chairman of the ARI Advisory Committee. “Where Science meets Clinics 2013 was the fi rst time, to my knowledge, that these four highly relevant stakeholder groups had come together to discuss current issues and novel strategies for bone-, intervertebral disc- and articular cartilage repair and regeneration. For me, the meeting was really an eye opener from the perspective of industry—what it takes to bring a therapy to patients and what they look for in ideas.”

Prof Keita Ito, research representative to the AO Foundation Board, said the opportunity for true brainstorming between researchers, clinicians, and industry and regulatory representatives was one of the key highlights of the 2013 symposium.

“Fostering understanding and collaboration across disciplines is essential going forward.”

Prof Tim Pohlemann

“One of the things that struck me was how much consensus there was among leaders in each of the stakeholder groups about what will be the most important issues in relation to the problems they face in their fields,” he said.

Prof Tim Pohlemann, Chairman TK Executive Board and Chairman AOTK (Trauma), believes the symposium helps fi ll gaps in understanding between parties essential to the AO’s mission of improving patient care.

“For example, there is a gap in clinicians’ understanding of the research side, and there is a gap from the other side, too,” Pohlemann explained. “Today, research and the clinical problems are far apart due to the complexities of both research and clinical treatment. Fostering understanding and collaboration across disciplines is essential going forward.”

AOTK System Director Claas Albers is convinced that the symposium has demonstrated its value.

“The TK is committed to doing its part to continue this symposium. It had a lot of value for the TK chairmen,” he said. “I’m positive about its future; it’s just a matter of organizational detail work and determining where the symposium best fits in the AO research strategy.”

The symposium 2013 panel discussions and outcomes have been summarized in a series of papers to be published soon in the AO Foundation’s eCM journal.

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Intense exchange stimulated by symposium presentations

Annual Report 2013 ┃ AOSpine Knowledge Forums

AOSpine Knowledge Forums Pathology-focused working groups expanding global knowledge base For Prof Luiz Vialle, AO Foundation Board member and former chairman of AOSpine International, it was clear: With access to a global pool of leading spine surgeons, a reputation for delivering world-class educational opportunities, and stellar in-house management capabilities the AO had all the tools to do more than deliver knowledge generated by others.

“I realized that despite the great AO teaching method, we were delivering scientific information produced elsewhere. We had among our own members the best and most qualified clinical researchers from all continents,” Vialle explained. “I needed to fi nd a way to bring all these people together to talk about patients’ needs, design studies to fi ll scientific gaps, and then let them do their work.”

Vialle set the concept in motion and today, the AOSpine Knowledge Forums (KF)—pathology-focused working groups acting on behalf of the clinical division—cover all spine-related pathologies including KF Tumor, KF Deformity, KF Spinal Cord Injury and Trauma, and KF Degenerative/Biologics. Each KF is guided by a tenmember steering committee of “the best of the best.”

The KF Review Panel serves as an overarching body to review and approve project proposals.

“It is no coincidence that the KF Steering Committees are made up of the best people in the world,” said AOSpine International Research Manager Peter Langer, PhD. “The members are highly credible, close to the research community and aware of the latest evidence.

Prof Alexander R Vaccaro, Chairman of KF Trauma, said the KFs are a fast, cost-effective way of generating the knowledge necessary to improve patient care.

“The AO already has the infrastructure and it’s a wonderful thing for me to just walk in and start managing research projects,” he said.

Four steering committees oversee 17 projects generating new knowledge on a range of topics, from development of the AOSpine Trauma Classification to a 225-subject, three-year Prospective Evaluation of Elderly Deformity Study (PEEDS).

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“The AO already has the infrastructure and it’s a wonderful thing for me to just walk in and start managing research projects.”

Prof Alexander R Vaccaro, chairman of KF Trauma

Viewing a presentation of the Degen/Biologics online database in University of Southern California (US)

Annual Report 2013 ┃ AOSpine Knowledge Forums

Dr Lawrence Lenke has one goal: to make his next spinal surgery better than his last one, and he believes the KF Deformity project, PEEDS, has the potential to improve outcomes not only for his own patients, but spine patients worldwide.

PEEDS, a study of adults 60 years and older with moderate and severe spinal deformity, seeks to answer questions about patients’ suitability to undergo large spinal procedures—and whether the outcomes justify the risks involved.

“Spines degenerate as we age, yet there is so much we don’t know,” said Lenke, Chairman of the KF Deformity. “Five percent of the over-60 population will have some kind of spinal deformity, even if asymptomatic, on an X-ray. Besides degeneration, we just don’t know the causes of spinal deformity.”

“We need to get the data to answer whether spinal surgery on these elderly patients can be performed with an acceptable complication rate,” he said.

“The PEEDS project has the potential to have a truly global impact on patient care.”

Dr Lawrence Lenke, Chairman of KF Deformity

The study encompasses ten sites in seven countries worldwide, which is critical because spinal deformity in elderly patients is a growing global health issue.

Lenke said the AO is better positioned than any other entity to drive the next generation of spinal deformity research, development and treatment.

“Having a global organization like the AO pioneering research and treatments is key to developing the treatment standardization we need in order to improve patient outcomes,” he said. “The PEEDS project has the potential to have a truly global impact on patient care.”

Jeffrey C Wang, Chairman of KF Degenerative/Biologics said that the Knowledge Forums represent the best clinical research that is both practical and immediately relevant, and will hopefully result in better care for patients.

“On a societal level, we want to improve the lives of our patients who are affl icted with spinal problems. From an organizational standpoint, we want to leverage the global membership of AOSpine and involve every surgeon, in every region to truly represent the best care on an international level,” he said. “We want to enable each member of AOSpine to be able to participate in purposeful clinical research that will ultimately make a difference.”

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Jeffrey Wang reviews a patient case history in his clinic at the University of Southern California

Annual Report 2013 ┃ AOTrauma

AOTrauma—A solid international reputation and dedicated to improving care of patients with traumatic injuries In 2013, AOTrauma’s environment continued to undergo evolutionary change. Activities remained focused on delivering knowledge in trauma and orthopedic surgery directly to the five regions. Resource and financial pressures persist, yet in 2013, more than 23,000 surgeons and Operating Room Personnel (ORP) globally participated in 329 AOTrauma courses for surgeons and 57 courses for ORP.

AOTrauma Chair-elect Jack Wilber

AO Germany Section adopts new bylaws recognizing AOTrauma

In the face of this evolution, AOTrauma remained committed to promoting the drive for excellence in trauma care: The AO Skills Lab was industrialized and was made core content in all Basic Principles Courses; membership grew to nearly 8,000 members; leaner governance was attained; and efficiencies were achieved through better centralization and collaboration with other clinical divisions, institutes and units. The five historical AO Sections (Austria, Germany, Spain, Switzerland, UK) have all embraced AOTrauma as the global AO community for trauma and orthopedic surgeons. Their legal entities and models of operation now reflect the global AOTrauma engagement.

AOTrauma will be undergoing leadership transition in 2014 with a new chair taking over after the AO Trustees Meeting in June 2014. John (Jack) Wilber from Cleveland, Ohio (USA) is an experienced, respected and successful leader who will bring his experience as AO North America (AONA) past-president to the International Board. Outgoing Chair Nikolaus Renner will ensure a comprehensive transition over the course of the year.

AOTrauma’s breakout session at the Trustees Meeting 2013 focused on getting the trustees involved, motivated and excited about AOTrauma. Inspired by a bus sightseeing tour concept, the breakout session was titled “World Café 2013: AOTrauma Land Bus Tour.” More than 80 AOTrauma trustees and guests were asked to identify issues that excited and concerned them about fellowships, governance, community development, education, and the relationship with our industrial partner. Thanks to its creative format and excellent participation, AOTrauma gathered important feedback—both complimentary and critical—to continue to shape its future.

AOTrauma Land Bus Tour at Trustees breakout session in Lima (PE)

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Future outlook Implement evaluation tools/metrics to measure quality and outcomes of AOTrauma activities AOTrauma continues its lean culture, hard-working attitude and drive. For 2014–2016 the shift will be from governance and efficiency to innovation and compliance. The changing landscape of professional medical education, the complexities of performing valid and valued clinical research and maintaining our independence will challenge AOTrauma’s delivery model while making it stronger and better positioned for the years to come.

Innovation in surgeons’ education and their interaction with the AOTrauma community, as well as in AOTrauma’s internal processes, represent a shift in priorities. This is totally aligned with the AO Foundation.

Enhance the AOTrauma Fellowship Program and Fellowship Host Centers Align AOTrauma activities with emerging and less-developed countries’ initiatives

Important qualitative milestones reached in education The curriculum development work of the past few years saw its efforts crowned by the rollout of the new, backward-planned, competency-based curricula for the Basic Principles Course, the Advanced Principles Course, and the new, interdisciplinary orthogeriatrics course. The curriculum for the Basic Principles

AOTrauma Davos Course 2013—Hand and Wrist

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Annual Report 2013 ┃ AOTrauma

course now includes the AO Skills Lab—a ten-station practical lab that focuses on practical skills and hands-on understanding of the fundamental biomechanical principles of osteosynthesis.

Jaime Quintero and Nikolaus Renner: respecting the foundation, improving the clinical division

AOTrauma Fellows at the Fellows Networking Initiative 2013, Davos (CH)

Next to the successful Faculty Education Program (FEP), a Chairperson Training Program was introduced in 2013 to prepare designated chairpersons of the Principles-level courses for their responsible positions. At the top end of faculty education, there is now the five-day Educational Leadership Program (ELP), which deepens educational leaders’ understanding of concepts of adult medical education. The fledgling coaching program was enthusiastically received at courses where faculty was coached.

AOTrauma strives to enhance all its educational offerings, based on the best available evidence. A large-scale quantitative study, the Global Needs Analysis, was used for interpreting changes in educational needs, and two complementary qualitative studies continue to shape the future of AOTrauma Education.

AOTrauma Member Satisfaction Survey gives good results The enhanced AOTrauma website went live in April 2013 delivering better access to educational content, research and network activities. Community development activities in the social media arena were expanded; over 5,300 likes on Facebook and more than 500 Twitter followers are a solid basis for future growth.

Building on its 2012 success, the Fellows Networking Initiative invited 16 AOTrauma Fellows to participate in the Davos Courses 2013.

Membership grew to almost 8,000, with Asia Pacific being the main growth driver. New member benefits were introduced in 2013: two new eBooks and the 3D Anatomy MSK Ultrasound module. The AOTrauma Member Satisfaction Survey showed an average member satisfaction rate of 7.9 (out of 10), with 66 percent of the audience awarding 8 to 10. Of the respondents, 98 percent expect to continue being AOTrauma members. The global Community Development Commission decided to continue to provide financial support for country chapters.

First Current Concept Courses in Shanghai (CN), July 2013

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Bone infection a key research focus AOTrauma recognized the clinical problem of bone infection as one of the most serious and distressing complications of orthopedic procedures. A research consortium led by Stephen Kates,

University of Rochester (US), in conjunction with multiple international clinicians and research partners, began its activities in June 2012. This consortium currently consists of ten projects.

In October 2013, 25 clinicians, researchers and members of the AOTrauma Research Commission met to discuss the progress of the research activities. The first global bone infection registry has been running since mid-year with eleven clinical sites globally.

AOTrauma offered several one-year stand-alone funding grants of up to CHF 8,000 per research grant to allow clinicians to develop innovative projects dealing with trauma, surgery of the musculoskeletal system, and related translational and clinical research.

ORP curriculum continued its development The new AOTrauma ORP curriculum was implemented and the ORP educational portfolio, including face-to-face courses, lectures, videos, handouts, and checklists, continued its development. This builds on the existing educational offerings of the AOTrauma Faculty Development Program which this year was offered regionally. The program was adapted to individual needs and focused on the implementation of the newly established AOTrauma ORP Course. The ORP faculty was supported by two surgeons, excellent educators who collaborate with the team at AO events in their countries.

AOTEU Masters Course, Innsbruck (AT)

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Annual Report 2013 ┃ AOTrauma

Regional activities

AOTrauma Japan 25th Anniversary Jubilee

AOTEU Country General Assembly 2013 in Barcelona (ES)

AOLAT Faculty Retreat 2013, Lima (PE)

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Asia Pacific AOTrauma Asia Pacific (AOTAP), organized a total of 86 courses in 16 countries across the region , educating over 7,000 surgeons and ORP. Highlights included: the Current Concepts Course in Chiang Mai (TH), the first combined course in Shanghai (CN) and the first webinar conducted in Mandarin. During the year Faculty Education Programs (FEPs) were organized in Hong Kong and India. The AOTAP Research Forum in Shenzhen (CN) was attended by 100 Chinese surgeons sharing papers with the AOTAP Research Committee. February 2013 marked the 25th anniversary of AOTrauma Japan. A celebratory event in Fukuoka (JP) attracted AOTrauma dignitaries from all over the world.

Europe AOTrauma Europe (AOTEU) continues to deliver the largest number of educational events of all the AO’s regions: 178 courses across Europe, Israel and South Africa; eleven flagship events, the AOTrauma European Masters Courses and Seminars. AOTrauma had an important presence at the three major annual European congresses: DGU, ECTES and EFORT. A milestone occurred at the Europe Country General Assembly where officers representing 26 countries agreed to form the first AOTEU Education Committee to better coordinate all educational activities in Europe. The AOTEU Board continues its efforts to unite Europe under the leadership of Rami Mosheiff (IL) and Paul Szyprt (UK).

Latin America AOTrauma Latin America (AOTLA) increased from 71 educational activities in 2012 to 82 in 2013 while participants increased from 2,900 to 3,700 and member numbers grew from 750 to 1,050. More than 100 faculty from all four clinical divisions across Latin America participated in the AOLAT Faculty Retreat 2013 in Lima (PE). AOTLA also held its first “Fin de Semana AOTrauma Latin America,” with 22 faculty members attending a Chair Training Program and an anatomical specimen activity demonstrating soft tissue coverage difficulties and challenges.

Middle East Dubai hosted the AOTrauma Regional Courses featuring the first AOTrauma Masters Course—Current Concepts in the Middle East where participants had the opportunity to design their own program on this three-day course. The AOTrauma Middle East

Regional Board Meeting and Committee Meetings and a General Meeting for all country council chairs and regional trustees were also hosted in Dubai. The Jordan Orthopaedic Association, at its ninth conference, hosted an AOTrauma symposium featuring pelvis, pediatric and MIO sessions, with 220 participants from Lebanon, Syria, Iraq, Palestine and Jordan.

North America AOTrauma North America (AOTNA) had 300 faculty delivering 16 courses to over 1,300 residents, fellows, attendees and faculty members in 2013. In addition it held five webinar courses providing free training to over 1,500 participants. AOTNA exhibited at the 29th Annual Orthopaedic Trauma Association meeting in Phoenix, Arizona. AOTNA also supported several research projects for residents focused on clinical applications/solutions and provided grants and educational offerings to 22 trauma fellowship programs in North America. It hosted its second annual fellows reception followed by the AOTNA annual reception with more than 300 members and faculty.

AOTrauma Trustees engage in identifying important strategic issues, breakout session Lima (PE)

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Annual Report 2013 ┃ AOSpine

AOSpine—advancing spine care worldwide AOSpine is the leading worldwide academic community for innovative education and research in spine care, inspiring lifelong learning and improving patients’ lives

Future outlook Continue to provide best-in-class spine surgery education worldwide Develop evaluation tools to measure outcomes of the AOSpine Knowledge Forums Establish the Global Spine Congress as the most valuable event for surgeons worldwide

Celebrating ten years of AOSpine AOSpine marked its tenth anniversary year by continuing to deliver best-in-class educational events, research activities and spine care community development. Notable highlights included: the third Global Spine Congress held in Hong Kong; a new and innovative educational format for the AOSpine Davos Courses; the development of a new thoracolumbar (TL) injury classification system by AOSpine Research; and revitalized efforts to strengthen the AOSpine brand.

Education—surgeons benefit from lifelong learning opportunities AOSpine successfully delivered 167 educational events, a total of 289 education days, to more than 10,000 participants worldwide with 1,500 faculty members sharing their knowledge and experience.

The AOSpine Curriculum, a competency-based framework that focuses on key learning outcomes for each educational level across several spinal pathologies, was implemented in over 100 courses, seminars, and webinars worldwide. The curriculum enhancement process was initiated to evaluate the ongoing needs of the community and to identify possible updates and expansion.

AOSpine’s goal is to boost delivery of the curriculum through improved communication and resources for implementation, and faculty development. New initiatives will continue to be integrated into the curriculum in order to continue to deliver best-in-class education that meets learners’ needs globally.

Research—advances in AOSpine’s latest discoveries AOSpine Research is currently managing eleven translational and 19 clinical studies worldwide. Knowledge Forums (KF)

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are pathology-focused working groups which aim to generate evidence-based knowledge to assist clinical decision making. By adding the KF Degenerative with a special focus on Biologics, AOSpine completed the KF family—now consisting of Degenerative, Tumor, Deformity, Spinal Cord Injury and Trauma. All five KFs have shown merit and the KF Trauma developed a new TL injury classification system which was recently published in Spine.

The translational research program on intervertebral disc, the Spine Research Network (SRN), consists of 27 AOSpine investigators worldwide. Capitalizing on membership of this network, the SRN coauthored a focus issue on disc degeneration in the Global Spine Journal. In addition to carrying out research, the Research Commission is developing a research mentoring program for AOSpine members inexperienced in clinical research.

Community Development—privileged networking opportunities AOSpine Community Development continued to foster and integrate the international community of spine surgeons by supporting research and education that advance spine care worldwide. Highlights included: the Global Spine Journal joining the Evidence-Based Spine-Care Journal in the PubMed Central index; the promotion of a new AOSpine book: The SMART Approach to Spine Clinical Research; enhancing the usability of AOSpine.org; and introducing AOSpine guidelines to ensure consistency of communications and to strengthen the AOSpine brand.

AOSNA’s annual Fellows Forum, Banff (CA)

AOSME group photo with participants

At the core of the international spine care community is the AOSpine Membership Program, which continued to be the main tool for exchanging and increasing knowledge opportunities for more than 6,000 members.

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Annual Report 2013 ┃ AOSpine

Regional activities Asia Pacific AOSpine Asia Pacific (AOSAP) organized 46 educational events for more than 3,000 participants. Key highlights included: the AOSpine Day in Seoul (KR) which took place concurrently with the 15th WFNS World Congress of Neurosurgery and the AOSpine seminar in Minimally Invasive Spine Surgery at the Chinese Orthopedic Association attended by 1,500 participants.

AOSAP sent 48 short-term fellows and three long-term fellows to AOSpine Spine Centers. In addition more than 40 clinical centers from eleven countries will participate in two new regional research projects that were launched in 2013.

Europe and Africa AOSpine Europe (AOSEU) strengthened its position as the leading provider of spine-related education in the region with more than 2,000 surgeons participating in educational events in 17 countries. The quality of AOSpine’s education in Europe remains unparalleled including the unique Training for Chairpersons AOSpine Principles Symposium, Erbil (IQ)

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which prepared faculty to align the AOSpine Curriculum to all educational events in the region. In research, a multicenter study sponsored by AOSEU successfully started the patient recruitment phase. During the year, AOSpine also expanded its activities in Sub-Saharan Africa to Uganda.

AOSpine Advanced Symposium Buenos Aires (AR)

Latin America Significant goals were achieved in the region throughout the year: 54 educational events welcomed 3,160 participants. The second stage of the Continuing Education Program was successfully implemented and the third and final stage will be launched in 2014. With the expansion of the reference centers on the west coast, the region now has ten spine centers that will diversify training options for spine professionals. The thirteen percent growth in membership is a result of the collective work done as a region. It also demonstrates the commitment and dedication of each of those involved in its activities.

Jeffrey Wang presenting at the World Congress of Neurosurgery Korea

North America AOSpine North America (AOSNA) welcomed M Fehlings as regional chairman alongside board members: D Brodke (education); T Mroz (research); N Chutkan (community development); and J Chapman (past chair). Members were offered new webinars on minimally invasive spine surgery and cervicalspondylotic myelopathy. The Research Committee continued to build on its support of clinical research with a new multicenter, randomized study to look at the efficacy and safety of riluzole in acute spinal cord injury (RISCIS). AOSNA was invited to join the Council of Surgical Spine Specialties; this important milestone places the organization among several well-respected spine organizations to participate in shaping the policies and issues of importance to practicing spine surgeons.

Middle East AOSpine Middle East (AOSME) continued to excel as the region’s leading academic society and spine surgeon community, expanding its activities to North Africa. Over 500 surgeons participated in seven AOSpine events and three congress symposia in eight countries. The number of AOSpine Centers in the Middle East doubled, and in 2014 a record number of 21 young surgeons are expected to embark on a fellowship. In research, the AOSME Young Researcher Award was successfully launched. The year also saw the Middle East win the bid to bring AOSpine’s Global Spine Congress to the region for the first time in 2016.

Jeffrey Wang and German Ochoa open the Global Spine Congress (HK)

27

Annual Report 2013 ┃ AOCMF

AOCMF—achieving its goals and staying ahead Member network continues to grow

Future outlook Increase educational offerings in China and India Offer increased faculty development opportunities worldwide Focus on innovative strategic initiatives

Push for education in the Asia Pacific region After seven years of growth in educational activities, 2013 saw a slight decline in the number of courses delivered; political challenges in some regions as well as organizational changes at the AO’s industrial partner were the primary reasons for the decrease. AOCMF increased its focus on educational activities in emerging and developing countries in 2013, a trend which will continue in coming years. Growing demand for AOCMF educational courses in the Asia Pacific region, particularly in China and India, will be addressed by an increased number of educational events being offered in 2014. AOCMF membership grew by 11%, while in keeping with the efficiency strategy of the AO Foundation, AOCMF focused on streamlining its R&D administrative structure.

Challenging educational environment In 2013 AOCMF successfully delivered 106 courses and provided education to over 4,800 participants. This represents a reduction of 11% compared with the previous year, following on from seven consecutive years of growth. All regions, with the exception of Latin America, delivered slightly fewer educational events than in 2012. Political instability in the Middle East triggered a number of cancelled educational events.

Faculty education program Penang (MY)

Asia Pacific Board meeting in Penang (MY)

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Educational event highlights AOCMF Asia Pacific conducted a regional scientific forum on orbital-midface reconstruction in Penang, Malaysia where international experts presented a dynamic platform for clinical strategies and future directions to over 60 participants. A new format AOCMF Principles Course was held in Minnesota (US) whereby lectures were replaced by small group discussions.

Participants were divided into small groups and rotated through discussion sessions; this course was highly rated by all 67 participants. An AOCMF Advances Course in Microsurgery with human specimens was held in Palm Beach (US). The focus was on the application of new diagnostic techniques and improved pre-surgical planning. Hand specialists not only reviewed the already-defined concepts, but also generated new knowledge derived from the contributions of participants. The course was so well received that it will be rerun in 2014.

Craniomaxillofacial Trauma and Reconstruction Journal

Faculty development Following a scientific forum in Penang (MY), over 30 faculty members attended a very successful Faculty Education Program, focusing on practical skills.

Fellowship program developments There was an increase of 30 percent participation in the fellowship program compared with 2012 with 48 fellows from 22 countries taking part which proved just how important this educational offering is to AOCMF. Europe remained the most popular region in which to complete a fellowship program. AOCMF achieved a milestone in 2013 by approving its first fellowship center in the Middle East region, located in Teheran (IR).

Member network grows by eleven percent The AOCMF community strives to provide a common ground for excellence in craniomaxillofacial surgery. In order to further enhance the official membership journal Craniomaxillofacial Trauma and Reconstruction, an editorial board was established to reflect the unique characteristics of its readership. The CMF section of the AO Surgery Reference published additional material that is accessible to members only. With a growth rate of 11% compared to 2012, the AOCMF member community counts 1,880 members worldwide as of December 31, 2013.

Audit of AOCMF research activities AO Foundation’s research activities and structures underwent an external audit. One outcome was the decision to focus research on The Healing of Musculoskeletal Tissue. AOCMF will direct future programs according to this mandate, with a priority given to clinical research.

Warren Schubert hosting a group discussion at the Trustees Meeting

New format AOCMF Principles Course in Minnesota (US)

Clinical Priority Programs update • Large bone defects in relation to craniomaxillofacial surgery (closed in 2013) • Imaging and planning in surgery (to be completed in 2014) • TM Joint, bone and cartilage disorders (started in 2013) • Anti-osteoclastic drugs and their impact on maxillofacial and orthopedic bone biology, disease, diagnosis, surgery, and treatment modalities (new initiative) 29

Annual Report 2013 ┃ AOVET

AOVET—celebrating its 40th anniversary A fully recognized clinical division of the AO Foundation, AOVET continues to grow its member network

Future outlook Focus on educational offerings in Asia Pacific and continue regional expansion Expand faculty development activities Successfully address challenges in compliance and collaboration with industrial partner

Success in the face of challenges AOVET celebrated its first 40 years with the launch of a book, History of AOVET—The First 40 Years, at the Trustees Meeting 2013 in Lima (PE). Written and edited by AO veterinary professionals and founding members, it traces the milestones, history, and key individuals responsible for the formation of AOVET. Positioned as a fully recognized clinical division of the AO Foundation, AOVET continued to grow its network to more than 700 official members. New and enhanced premium benefits were made available to the AOVET community, such as the AO Surgery Reference large animal content and Insights Vet. It was a challenging year for AOVETs educational activities: Some planned courses had to be cancelled for political, economic or compliance reasons. However, more than 1,200 veterinary surgeons were successfully educated in 2013 and some new educational formats, such as webinars, were successfully introduced.

Regional expansion was demonstrated by the establishment of AOVET Latin America under the leadership of Prof Cassio Ferigno.

Educational event highlights Of the 29 AOVET courses that were planned worldwide, 23 were realized. Cancellations occurred primarily due to difficulties with local support structures caused by changes at our industrial partner. Although new compliance rules that resulted in short term adaptations also gave rise to some cancellations, 1,230 participants completed courses in 2013. AOVET also conducted a very well-received first webinar, “Stability matters, but how much is needed—fracture treatment with absolute or relative stability,” by Mike Kowaleski and Rico Vannini. Building on the success of this event (which had the highest attendance of all AO webinars) four webinars are scheduled in 2014. Another educational highlight was the very well-received first equine maxillofacial course on cadaveric specimens at the School of Veterinary Medicine, University of Zurich (CH).

AOVET Small Animal participants at the Davos Courses 2013

Faculty development moves forward In October AOVET held its first Faculty Education Event in Switzerland which included European veterinarians and three craniomaxillofacial surgeons. Subsequent to the training it was decided to continue to offer these events as a joint venture with other clinical divisions across the regions, targeting less experienced faculty

Joerg Auer signing copies of the History of AOVET book at the Trustees Meeting

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Fellowship program continues AOVET awarded four short term fellowships; three European fellows attended US academic institutions while one Brazilian completed a fellowship at private referral practice in Italy.

Special Focus in Small Animal Fracture Management, Davos Courses 2013

New member benefits Now in its third renewal year, the AOVET member community grew in 2013 by 13.35 percent. Besides giving members online access to the book, History of AOVET—The First 40 Years, our members were provided with full-text online access to the journal, Veterinary Surgery. Following a decision of the AOVET International Board, the veterinary section of the AO Surgery Reference was made accessible for members only—emphasizing the uniqueness of the AOVET member community.

AOVET established a mobile application review to inform members about useful and exciting new apps. At the Davos Courses 2013 an iPad app called Insights Veterinary, in which AOVET is an expert partner, was launched. AOVET and Medical Insights AG teamed up to develop this mobile platform, designed specifically to bring related medical content together in one place. Being an expert partner of this innovative mobile information platform, the goals for the future of the AOVET Community Development are set.

Insights Vet featuring exclusive AOVET content

Research and Development change in responsibilities Organizational changes within the AO Foundation, and recognition that AOVET has its own animal research and welfare experts, prompted the AO Foundation Board to capitalize on the AO Veterinary Advisory Committee’s (AOVAC) excellent work.

From 2014, the AOVET R&D Commission will assume responsibility for the activities previously completed by the AOVAC. 31

Annual Report 2013 ┃ Institutes

Research and Development Consolidating an international reputation for excellence

Future outlook Develop ARI innovation technology portfolio, create an ARI intellectual property strategy Foster competitive innovation within the ARI collaborative research consortia Exploit diverse innovative ARI translational research for the economic benefit of AO

EU project GAMBA completed The first EU-funded project with a partner from the AO Research Institute Davos (ARI) was successfully completed in August 2013.

The three year project GAMBA (Gene Activated Matrices for Bone and Cartilage Regeneration in Arthritis) ran under the FP7 funding scheme, “Biomimetic gels and polymers for tissue repair.” GAMBA included seven European partner institutions and was coordinated by Dr Martina Anthon (Klinikum Rechts der Isar, Munich, DE). ARI researchers Mauro Alini, David Eglin, Martin Stoddart and Sibylle Grad were involved in various tasks designed to reach the project goals.

The GAMBA consortium aimed to create a novel gene-activated matrix platform for bone and cartilage repair with a focus on osteoarthritis-related tissue damage. An innovative program of public outreach, actively linking patients and society in general to the evolution of this project, complemented the scientific objectives. The GAMBA platform implemented a concept of spatiotemporal control of regenerative bioactivity on command and demand. The modules included growth factor-encoding gene vectors, mesenchymal stem cells, magnetic nanoparticles, a ceramic matrix, and a biomimetic hyaluronan gel.

While some partners contributed basic research on the biology of bone and cartilage regeneration in order to define the preconditions for the GAMBA platform, the vector and biomaterial engineers within the project assembled the modules to demonstrate spatial and temporal control of reporter gene expression in 3D setups (Figure 1). Ultimately, the GAMBA project successfully created a toolbox of individual elements that will be used in follow-up projects. A particularly successful and exciting part of the project was public outreach in patient and citizen panels which was greatly appreciated by the participating lay persons and scientists alike (see Figure 2 on the next page).

Figure 1. Spatial control of gene expression. Fluorescence microscopic images of Hyaluronan hydrogel (loaded with AdCMVeGFP) and calcium phosphate particles mixed either with mesenchymal stem cells (a and b) or chondrocytes (c and d) three days after colonization. eGFP expressing cells showed successful transduction, whereas cells transfected with lipoplexes exhibited a lower transfection efficiency (red fluorescent cells in b-d).

Courtesy of the GAMBA project partners

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Musculoskeletal Infection As part of the AOTrauma Clinical Priority Program Bone Infection, ARI‘s Musculoskeletal Infection Group was involved in a study investigating nasal colonization in orthopedic surgeons, with multi-resistant bacteria. Throughout the two weeks of the Davos Courses 2013, more than 1,200 surgeons provided anonymous, voluntary nasal swabs to project leader Mario Morgenstern (ARI Fellow) and his team. The results of this study, coming from such a large and geographically diverse population, will ensure that a modern snapshot of global colonization of surgeons will soon be available.

Figure 2. Swiss Citizens Panel in Zurich (CH), June 2012

Project team member Julia Mily (University of Munich, DE) with a participating surgeon at the ARI booth

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Annual Report 2013 ┃ Institutes

AAALAC Accreditation The Preclinical Facility at ARI has received full accreditation

by AAALAC International in March 2013 completing a twoyear application process. The Association for Assessment and Accreditation of Laboratory Animal Care International is a private, nonprofit organization that promotes the humane treatment of animals in science through voluntary accreditation and assessment programs—undertaking one of the highest internationally recognized accreditation programs. ARI is one of only three accredited institutions in Switzerland and one of the few accredited academic research institutes in Europe. AAALAC endorses the use of animals to advance medicine and science when there are no non-animal alternatives, and when it is done in an ethical and humane way. By fulfilling AAALAC requirements we guarantee one of the highest possible international animal welfare standards at ARI‘s Preclinical Facility.

ARI‘s AAALAC Accreditation

Figure BRONJ

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BRONJ Bisphosphonate related osteonecrosis of the jaw (BRONJ) is increasingly presenting in patients who have received long-term bisphosphonate treatment for osteoporosis or as an oncology treatment. As the etiology is poorly understood, the AOCMF R&D Commission dedicated one of its research programs to the development of a preclinical BRONJ model and the study of disease progression and prevention. In collaboration with the AOCMF community, ARI has developed a minipig (Dr Sven Otto, Munich, DE) and a sheep model (Dr Pit Voss, Freiburg, DE) of BRONJ. Studies are now underway in collaboration with Otto, using the minipig model to further dissect the underlying mechanisms of this devastating disease.

Figure Control Clinical development of BRONJ in miniature pigs Clinical signs of BRONJ starts appearing in the bisphosphonate treated animals at about seven weeks after tooth extraction, and reaches stage 3 (Figure BRONJ) by twelve weeks until the end of the study (week 20). Animals undergoing a tooth extraction without bisphosphonate treatment heal without or with only minimal complications.

(Figure Control)

Research and Development Relocation of ARI Prototype Workshop

Computer-generated image of the ARI Prototype Workshop beside the AO Center from the southern perspective

The AO Foundation Board gave the green light for the relocation of the ARI Prototype Workshop to a new purpose-built AO building in mid-2013. When it was first established, the workshop drove innovation for prototype development of new implants and surgical instruments in close cooperation with AO‘s industrial partners. More recently, it has been supporting the development of diverse innovative tools and implants for in vivo and in vitro research in ARI, as well as various activities of the AO spin-offs RISystem and Synbone.

Computer-generated image of the ARI Prototype Workshop beside the AO Center from the northern perspective

Specialized in the production of sophisticated medical devices in close collaboration with the project partners, the ISO 13485-certified workshop is currently involved in the prototype development processes from the very beginning. With its highly trained CNC polymechanics and toolmakers it facilitates complete machining of sophisticated pieces and guarantees high quality, precision work.

The workshop will be relocated to the AO Center area with an architecture that reflects that of the AO Center. New premises will lead to better integration within ARI, shorter communication channels, closer collaboration and more flexibility of activities while maintaining capacity via optimal use of personnel resources.

Preparation work for the new building started in autumn in order that the main phase of construction will commence in April 2014.

The machine park is planned to be moved in autumn 2014 so that the relocation will be complete by November 2014, this is a driver for innovation, creativity, precision and competence to strengthen ARI‘s ability to fulfill the AO‘s goal of translational research and development improving patient care.

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Annual Report 2013 ┃ Institutes

AO Exploratory Research From clinical need to proof of concept

Collaborative Research Programs Interactions within the Collaborative Research Programs (CRPs) Large Bone Defect Healing (LBDH), Acute Cartilage Injury (ACI) and Annulus Fibrosus Rupture (AFR) continued to expand during 2013. AFR partners met in spring at Tokai University (JP) to be trained by Daisuke Sakai on his new rat in vivo degradation model which is used to test the consortium-developed biomaterials.

The ACI partners collaborated on the evaluation of new MRI technologies for continuous in vivo monitoring which will be applied to the minipig proof-of-concept study planned with the ACI developed repair device.

The LBDH partners started consolidating results and exploring funding opportunities after 2014, for the period when AOER consortium funding will have ceased.

Annual CRP Meetings 2013

In September CRP partners and committees met in Davos for the Annual Program Meetings which concluded with a workshop on product development hosted by Elliott Gruskin and his DePuy Synthes team.

Where Science meets Clinics 2013 Following the Annual CRP Meetings the second international symposium, Where Science meets Clinics 2013, was held at the Congress Center in Davos. This year’s event convened a diverse group of over 100 stakeholders involved in clinical translation of orthopedic tissue engineering, including scientists, clinicians, healthcare industry professionals and regulatory agency representatives. For learn more, please see the feature story on pages 10–13.

Where Science meets Clinics 2013

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Outlook As of January 2014 the CRPs are under the overall responsibility of ARI while the ACI and AFR committees continue to monitor progress and provide advice. On June 19–20, 2014 the Annual CRP Meetings will take place at the AO Center in Davos immediately after the eCM XV Conference.

Research Review The independent peer review process Wing-Hoi Cheung, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong (HK)

The AO Research Review Commission (AORRC) continued its mandate to act as independent review board for all research projects supported by the AO Foundation. Each of the 40 grant proposals submitted by clinical divisions were independently reviewed by at least two external experts, which were then consolidated by a composite reviewer. The submitting funding bodies (clinical divisions) were provided with the recommendations and a detailed review report for each project. The final decisions are taken by the respective funding bodies.

The pool of over 450 experts serves as independent external resource and it ensures that all AO research projects are assessed and evaluated by experienced reviewers who are experts in their chosen fields. In this way, the AO Foundation can continue to develop and support the most innovative and clinically relevant projects possible. The applied review process meets international standards of impartiality and expertise. After a pre-screening process, a total of 80 AO Start-up grant applications qualified for the review process. These proposals were reviewed by two members of the AO Research Review Commission. The respective funding body (AO Start-Up Grant Committee) was provided with the reports and a ranked recommendation list.

AO Start-Up Grants The AO Start-Up Grant is an unique funding offer for young researchers or senior researchers submitting high-risk projects.

The AO Start-Up Grant Committee was established as the funding body for this grant category. In this committee, all clinical divisions are represented. In 2013, 19 AO Start-Up Grants were approved for funding. All applicants received a detailed summary of the reviewers’ comments for their consideration.

Mark Markel (US) presents the Berton Rahn Research Prize to Wing-Hoi Cheung

Project support by area:

Subject

Number of projects

Amount in CHF 1000

%

Bone healing

8

774

40.0

Clinical

1

120

6.2

CAOS; 3D reconstruction

1

30

1.6

Implant development

2

236

12.2

Spine

2

202

10.4

Tissue reaction

4

470

24.3

Transplantation

1

103

5.3

19

1,935

100

Total

2013 research grants/geographical distribution Country

Number of projects

Amount in CHF 1000

United States of America

6

651

Germany

5

427

The Netherlands

3

300

Switzerland

1

120

Canada

1

119

Ireland

1

110

Israel

1

120

Italy

1

88

19

1,935

Total

Berton Rahn Research Fund Prize Award Each year the best AO Start-Up Grant project is awarded the annual Berton Rahn Research Fund Prize Award. After a rigorous evaluation, Dr Wing-Hoi Cheung (HK) was awarded the 2013 prize for his project, “Can low intensity pulsed ultrasound accelerate osteoporotic fracture healing?”

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Annual Report 2013 ┃ Institutes

AO Education Institute From faculty development to online publishing

Future outlook Alignment of faculty development programs between all clinical divisions Launch of the AOTrauma online learning hub for residents: AO STaRT Design of an AO Fellowship program in medical education

The new AO Skills Lab was successfully tested during the Davos Courses before the global rollout as a standard part of the AOTrauma Basic Principles Course.

The new highly visual pre- and postcourse reports for faculty and chairperson received very positive feedback.

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In March 2013 the AO‘s clinical divisions decided at the AO Education Platform meeting to align their faculty education programs (FEPs). As a first step, the competency framework at the level of faculty education and programs for chairpersons were agreed upon. The completed initiative will allow clinical divisions to develop shared resources and online modules, and jointly use the pool of educator faculty. The next step will be to analyze the programs for the educational leaders to establish if the highest level education in FEPs can be leveraged throughout the organization.

Assessment and evaluation on the next level For the first time a unified system for learner assessment and course evaluation was tested at the Davos Courses 2013. Data from all events was collected in a standardized way: Sociodemographics and motivation to learn questions were asked in a pre-event online survey; paper-and-pencil forms and the Audience Response System were used during the courses; and a post-event online survey was conducted afterwards. Chairs received reports prior to their events to learn about their audience and their motivation. After the courses, reports were created to provide evidence on the educational outcome as well as the evaluation of faculty and venue. The goal is to roll out the new reporting framework gradually in 2014 and make it available to all clinical division course organizers.

Online and offline publishing In 2013 AOSpine launched its first comprehensive Surgery Reference online module on deformity treatment. This module implemented the proven structure of the AOTrauma Surgery Reference navigating from diagnosis to decision making, followed by guiding through surgical approach, treatment and aftercare.

Over the coming years AOSpine plans to cover all curriculum topics as unique online resources. AOTrauma has successfully published the first comprehensive textbook on periprosthetic fracture management (edited by Michael Schütz and Carsten Perka), demonstrating the true collaboration between the worlds of joint arthroplasty and orthopedic trauma.

SkillsLab goes global The AOTrauma Educational Task Force reviewed the Basic and Advanced Principles Courses globally and decided that the educational tool formerly known as “Playground” will become a mandatory part of the Basic Principles Course. A small group

took on the task of “industrializing” the ten stations to make them available through the standard course support workflow similar to a practical exercise. It was also decided to rename this valuable educational toolset “AO Skills Lab.” The first set was shown during the Davos Courses 2013 and used to train future global faculty and AO Skills Lab Directors. This will be rolled out over the next two years with the support of our industrial partner while at the same time a plan to educate faculty globally will be implemented.

Visible at leading conferences The AO Education Institute actively presented its research and studies at leading international medical education conferences.

Disseminating information, integrating feedback, and increasing the profile of the AO builds academic credibility, ultimately influencing future educational projects. Examples of conference presentations made in 2013 include:

The AO Faculty Development Program will evolve into a cross-clinical division venture sharing concepts, resources and educational faculty.

10th Asia Pacific Medical Education Conference in Singapore, January 19–20: Implementation of a competency-based global faculty education program. Lap Ki Chan, Miriam Uhlmann, Wilson Li. Best Oral Presentation Finalist.

38th Annual Conference of the Alliance for Continuing Education in the Health Professions in San Francisco, January 30–Feb 2: Member Section Meeting—Medical Specialty Societies—Junior Faculty Member’s Guide to Success. Joseph S Green (moderator), Janice Sibley/Marcia Jackson (American College of Cardiology Foundation), Chitra Subramaniam/Katherine Grichnik (Duke Center for Educational Excellence), Miriam Uhlmann (AO Education Institute).

Association of Medical Education in the Eastern Mediterranean Region (AMEEMR) Conference in Riyadh, April 6–10: Global Needs Analysis in Orthopedic Trauma for Practicing Surgeons: The Middle East Perspective. Wa‘el Taha, Kodi Kojima, Mike Cunningham.

The first comprehensive resource on a growing clinical problem: the manual, Periprosthetic Fracture Management

Global Alliance for Medical Education Conference in Barcelona, June 9–11: Conducting a global needs analysis in orthopedic trauma for practicing surgeons. Mike Cunningham, Don Moore.

Development, implementation, and evaluation of a competencybased global faculty education program. Miriam Uhlmann. 2nd International Conference on Faculty Development in the Health Professions in Prague, August 23–25.

Association for Medical Education in Europe (AMEE) Conference in Prague, August 23–25: Perceived value of CME systems in meeting the learning needs of orthopedic surgeons in community hospital. Piet de Boer, Mike Cunningham.

In December 2013 AOSpine joined the successful online AO Surgery Reference family with the first module on deformity correction.

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Annual Report 2013 ┃ Institutes

Clinical Investigation A year of growth

Future outlook Expansion of core clinical research services and clinical research education Development of AO Patient-reported Outcomes Center (AOPOC) and registries Securing external funding

Buoyed by the AO Foundation‘s clear commitment to clinical research, AO Clinical Investigation and Documentation (AOCID) was able to begin ramping up its capacity to provide top quality clinical research services to both internal and external partners. AOCID recruited two new project managers as well as a new data operations and statistics manager. Medical writing capacities in a team led by Alexander Joeris, the new medical and scientific manager, were also strengthened. This increase in both manpower and financing will be carefully rolled out over the next three years to the benefit of clinical research conducted by the AO as a whole.

The total number of peer-reviewed citations of AOCID work topped the 2,000 mark in 2013. There were over 500 peerreviewed citations of AOCID work in 2013 alone. Each scientific article is cited an average of 17 times. As a result of this, AOCID‘s h-index had risen to 25 by the end of the year.

A scene from the Study Coordinator course in Boston

Fifteen years of clinical studies In “The First 15 Years“ since clinical investigation was added to AO Documentation‘s remit leading to the creation of today‘s AOCID, a total of 92 clinical studies have been conducted with over 9,000 patients recruited. AOCID has a research presence in 40 different countries. These studies are conducted against a backdrop of quality, as the ISO 9001 recertification and other third-party audits during 2013, attest to.

A lot of effort was put into finessing the Focused Registry concept in 2013. While a Focused Registry does not yield as high a level of evidence as a clinical study, it can be very useful in providing the first clinical feedback and indicating areas for further investigation. AOCID worked closely with the AOTK to arrive at a clearly defined design. A tailored modular approach which has up to three levels in total is now available for use. By the end of 2013 eleven Focused Registries were actively in use by AOTK Expert Groups.

AOCID’s “The First 15 Years” badge

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AO Patient-reported Outcomes Center (AOPOC) Because it is important to be able to measure treatment effects on patients, patient-reported outcome measures are a common element in clinical studies. However, paper-based questionnaires may be unsuitable for use in the clinic which is why AOCID

Beate Hanson at the Roadmap to Research course in Davos

is developing a practical electronic tool which uses computeradaptive testing to track patients’ outcome progress. Work on the AOPOC program progressed in 2013, in readiness for the initial testing of the system on actual patients in early 2014.

Education A dedicated education manager was appointed to manage the growth in educational courses and programs offered. Highlights included a Study Coordinator Course in Boston, and a sold out Good Clinical Practice course in Hong Kong.

The AOCID stand at the AO Davos Courses 2013

AOCID Director Beate Hanson co-moderated an AOTrauma webinar on “How to write a good grant proposal“ along with Stephen Kates. A pilot version of a Roadmap to Research workbook was tested at the Davos Courses 2013 where the course of the same name was being run for the 20th time. Also at the courses, AOCID reran a short survey originally conducted in 2003. “Finding the evidence—where do surgeons look?” will map changes in attitudes to evidence-based medicine in the intervening decade.

Three young spine and trauma surgeons from Colombia, Iran and Brazil were the clinical research fellows in 2013. AOCID‘s research partner, the Audi Accident Research Unit, sent a surgeon to Switzerland to conduct research on data collected on over 44,000 traffic victims in Germany. Past fellow, Pratik Desai won the AAOS Resident Writer‘s Award for his work conducted with AOCID. Researchers behind the Scoli-RISK-1 study had an awardwinning presentation at the Scoliosis Research Society meeting.

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Annual Report 2013 ┃ Institutes

AOTK System Innovation with solid roots in evidence-based development

Future outlook Development of innovative concepts and solutions towards individualized medicine and improved processes Incorporating today‘s healthcare requirements into workstreams Maintain an innovative system with medically led safety and efficacy assessment in a flexible structure

The AOTK System’s approach to the development of surgical techniques and products, together with the AO’s industrial partner, marks an integral element of the organization’s value to the medical community. The AO‘s longstanding philosophy of introducing a new technique only after it has undergone rigorous quality control has been a key strength of the AO Foundation and anticipated today’s rigorous regulatory processes. Focused Registries are now a standard tool of the AOTK‘s Expert Groups (EGs), helping gather data to assess the potential benefits of new techniques not only in terms of healing time and surgeon handling, but also socioeconomic data. Focused Registries are patient-related datasets collected by healthcare professionals in their hospitals. Due to the ease of use and facility of implementation, they complement existing AOTK processes by enhancing surgeon participation and increasing the number of clinical cases reviewed per product. They are designed to deliver focused medical information contributing to decision making within a short time frame. Implementing this evidence-based development approach, the EGs launched eleven new Focus Registries in 2013 alone.

New AOTK chairman elections Daniel Buchbinder the new chair of the AOTK (CMF), took over from respected former Chair Edward Ellis III. Buchbinder has a strong association with the AO dating back to 1985. Tim Pohlemann, who has been serving as chair of the AOTK (Trauma) since 2009, was reelected.

New AOTK (CMF) Chair Daniel Buchbinder

Tim Pohlemann (L) reelected AOTK (Trauma) Chair

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Approval of technology from new partners This year marked a historic milestone for the AOTK System, as technology which had been submitted by new industrial partners from the greater DPS group (ie, DePuy Spine and Codman) was reviewed and approved. The following were brought for review by the Spine EGs: two pedicle screw systems (Expedium and Viper); two cage systems (Concorde Bullet, Bengal Stackable); a cement

system (Confidence). Over the summer the EGs reviewed the systems‘ surgical technical techniques and clinical indications, and conducted an in depth analysis of the available data, given that these systems were already on the market. In autumn the EGs carried out technical labs to establish whether the systems met the AO clinical criteria outlining areas for improvement. All the systems were approved by the AOSpine TK as standard and some of them were already demonstrated at the Davos Courses 2013.

A large set of devices and medical solutions for neurosurgery also were subject to a similar procedure in preparation for AONeuro Initiative educational events, in particular traumatic brain injury and Neurotrauma content. An in-depth review by the Neurosurgery EG (NTREG) followed on from the approval given by the AOTK (CMF), making Codman only the sixth company to achieve AO product approval.

Innovation Prize 2013/2014 Michael Mayer from Munich (DE) was awarded the AO Foundation TK Innovation Prize 2013 for his outstanding contribution to the development of the Prodisc-C Vivo System. Prodisc-C Vivo was designed to replace a diseased and/or degenerated intervertebral disc of the cervical spine in patients with symptomatic cervical disc disease (SCDD). The implant significantly reduces pain by allowing the removal of the diseased disc while restoring biomechanical stability, disc height, and providing the potential for motion at the affected vertebral segment.

Michael Mayer demonstrating the Prodisc-C Vivo System

The PHILOS Augmentation system

New developments in 2013 The PHILOS Augmentation system offers a new and unique option to improve the fixation of osteoporotic proximal humeral fractures. This add-on system enables surgeons to follow their routine reduction and fixation procedure by augmenting the PHILOS plate and screw fixation with Traumacem V+, a highviscosity PMMA cement, thereby addressing the complications of fixation failure and secondary screw perforation which effect elderly proximal humeral fracture patients with osteoporosis.

The new Radial Head Prosthesis system offers a sound new treatment option for complex cases, helping to prevent proximal migration of the radius, or lateral elbow instability. It also marks another step in the direction of arthroplasty for the AO.

The new Radial Head Prosthesis system

The new Variable Angle LCP Ankle Trauma system was developed to overcome shortcomings in the treatment of complex ankle fractures with poor bone quality. The low-profile plates offer more options for screw placement to address a wider range of fracture patterns and accommodate varied patient anatomies.

The combi holes in the Variable Angle LCP plate shaft combine dynamic compression with variable angle locking.

Although some rib fractures are treated with pain management and bracing, as well as endotracheal intubation and mechanical ventilation when necessary, some patients could benefit from surgical stabilization (osteosynthesis). The Thorax Surgery WG 43

Annual Report 2013 ┃ Institutes

has continued the development of a system which focuses on implants and instruments to provide a new minimally invasive plate osteosynthesis solution for rib fixation.

Among several spine solutions approved in 2013 was the Synflate Vertebral Balloon System, a vertebral augmentation system for the reduction of fractures and/or creation of voids in cancellous bone. It provides pain reduction in vertebral compression fractures originating from osteoporosis, trauma, and osteolytic lesions and can be used alone or in combination with posterior instrumentation.

The new ZERO-P ChronOS is prefilled with the bioresorbable synthetic beta-tricalcium phosphate cancellous bone substitute ChronOS. It is osteoconductive and osteopromotive when perfused with bone marrow.

A new issue of the popular AOTK Innovations magazine was published in December 2013 detailing latest developments.

The popular Meet The Experts sessions continued at the Davos Courses 2013 with first-look demonstrations of latest technology and exchange with the surgeons behind the developments. Video material from these sessions will be available for download soon.

Christoph Sommer demontrates at the Meet the Experts during the Davos Courses 2013

44

AO SEC—forging ahead with education AO SEC directs educational activities at surgeons, ORP and faculty in Africa and Asia

Future outlook Launch the new AO SEC website Planned Faculty Education Program course in Asia Where we are in Africa One of the highlights of 2013 in Africa was the launch of the first Faculty Education Program (FEP) which took place in November in Harare (ZW), in which delegates from twelve African countries participated. A noteworthy feature of this FEP was the bringing together for the first time faculty of English-speaking Africa (ESA) and French-speaking Africa (FSA). It had been on the wish list of AO SEC to conduct a FEP in Africa for several years. Eleven surgeons and seven Operating Room Personnel (ORP), supported by the Regional Education Team (RET) from Europe and Asia and AO SEC faculty, participated in this breakthrough educational event. Following the FEP training the annual regional AO SEC Basic Principles Courses for surgeons and ORP took place. The positive impact that the teaching had made could immediately be measured as most of the FEP participants were involved in the Principles Courses as faculty allowing them to apply what they had just learned.

Offer fellowships for French Speaking Africa

Icebreaker during FEP course, Harare (ZW).

In 2013, ESA had active projects in eleven countries and FSA had six including a first AO SEC course in Ivory Coast.

Progress in Asia and Latin America Vietnam joined the eight other countries in Asia (Afghanistan, Bangladesh, Cambodia, India, Myammar, Nepal, Pakistan, Sri Lanka) offering AO SEC courses. In Latin America the AO SEC Fellowships continue routinely in Brazil.

Personnel changes In spring of 2013 John Croser stepped down as AO SEC chairman and Joachin Prein who has been a key member of the AO SEC committee for many years took over as interim chairman.

AO SEC course in Dhankutta (NP)

What the future holds The AO SEC website will be relaunched in 2014, bringing together all AO SEC related news items, free downloadable nonoperative fracture treatment videos and books, and an AO SEC country map detailing all educational activity around the globe, in addition to a course search engine.

45

Annual Report 2013 ┃ Governance

Finance Focus on efficiency improvement Financial Overview The emphasis in recent years to allocate the financial resources to our core competences continued in 2013.

Operating Income grew by 1% while Operating Expenses remained 1% below previous year. Therefore the Operating Result improved by CHF 2 million compared to 2012 and amounted to CHF -23 million.

The Financial Result of CHF 117 million reflects the highest annual return on the underlying financial assets since the endowment was enlarged by the proceeds from the Asset Purchase Agreement with Synthes Inc. in 2006.

Thanks to this performance, the Net Result reached a level of CHF 94 million, leading to a continued strengthening of the Foundation’s Equity to CHF 1,142 million by the end of 2013.

AO Financial Overview

2012

2013

abs.

abs.

abs.

%

78

79

1

1%

Operating Expenses

103

102

-1

-1%

Operating Result

-25

-23

2

-8 %

Financial Result

92

117

25

27%

Net Result

67

94

27

40%

1,048

1,142

94

9%

in million CHF

Operating Income

Equity per 31.12.

Variance 13/12

Operating income includes the income from the Collaboration & Support Agreement with DePuy Synthes of CHF 64.6 million (+1% versus previous year) and third party income amounting to CHF 14.5 million (+5% versus previous year).

Operating expenses excluding the “AO Connect” project and “Unforeseen” items amounted to CHF 98 million.

Activities related to “Education” and “R&D” represented the biggest stake with 41% and 30% respectively. Overall, operating expenses decreased by 1% compared with 2012, whereas “Education” and “TK System” received a higher funding. The growth in “Community Development” (+9%) was due to a change in accounting treatment; allowing for this, expenses for “Community Development” decreased by 1%. Expenses for both “General & Administrative” and “Global & Regional Boards” were reduced too.

Operating Expenses Breakdown 2013 Actual

Growth versus 2012 Actual

4%

6%

in million CHF

6%

13 % 98 million CHF

41 %

46

+2 %

R&D

-5 %

General & Administrative

-3 %

Global & Regional Boards

-8 %

Community Development

+9 % +3 %

TK System

30 % Education R&D General & Administrative

Education

0 Global & Regional Boards Community Development TK System

10 2013 Actual 2012 Actual

20

30

40

Income Statement The 2013 Income Statement looks as follows in comparison to the previous year: Income Statement

2012

in million CHF

AO Foundation Contribution

2013

Variance 13/12

abs

%

abs

%

abs

%

89.2

87%

87.6

86%

-1.6

-2%

Collaboration & Support Agreement

64.0

62%

64.6

63%

0.6

1%

Financial Result

92.0

89%

116.6

114%

24.5

27%

-66.8

-65%

-93.7

-92%

-26.8

40%

13.9

13%

14.5

14%

0.6

5%

103.1

100%

102.1

100%

-1.0

-1%

30.0

29%

28.4

28%

-1.6

-5%

TK System

3.5

3%

3.6

4%

0.1

3%

Community Development

6.0

6%

6.6

6%

0.6

9%

Education

40.5

39%

41.3

40%

0.8

2%

General & Administrative

13.2

13%

12.8

13%

-0.4

-3%

Global & Regional Boards

6.1

6%

5.6

5%

-0.5

-8%

Others

3.7

4%

3.7

4%

0.1

2%

103.1

100%

102.1

100%

-1.0

-1%

Change in Reserves 3rd Party Income Total Income R&D

Total Expenses

The AO Foundation Contribution at CHF 87.6 million, remained below the previous year (-2%) thanks to higher “3rd Party Income” and lower expenses. The allocation to the Foundation’s reserves amounted to CHF 93.7 million resulting mainly from the Financial Result of CHF 116.6 million.

Operating Expenses at CHF 102.1 million, achieved an underspend compared with the previous year due to lower “R&D” expenses and lower expenses in various operational areas.

Employees The increase of 4.5 full-time equivalents (FTEs) or 2% versus 2012 leads to a permanent staff of 251.1 FTEs. Employee Structure by Region FTE weighted permanent Total located in Switzerland Asia Pacific Latin America North America Total worldwide

2012

2013

Variance 13/12

abs.

in %

abs.

in %

abs.

219.5

89 %

224.0

89 %

4.5

10.0

4%

10.0

4%

0.0

9.0

4%

9.0

4%

0.0

8.1

3%

8.1

3%

0.0

246.6

100 %

251.1

100 %

4.5

FTE Overview by Area 2013 3% 16 %

251.1 FTE

30 %

51 %

AO Institutes AO Clinical Divisions AO Support Units Others Total

128.0 74.7 40.1 8.3 251.1

International Asia Europe Latin

47

Annual Report 2013 ┃ Governance

Finance Focus on efficiency improvement Educational Events Course-related expenses amounting to CHF 26 million, remained at prior year level. The evolution from 2009 to 2013 shows a compounded annual growth rate of 10%.

In 2013 AOTrauma has the biggest share with 51%, followed by AOSpine with 25% and AOCMF with 11% respectively.

Evolution 2009 – 2013 +20%*

+10%*

+10%*

18

21

24

26

2009

2010

2011

2012

in million CHF

+6%*

+0%*

26

2013

*growth vs. previous year

Breakdown 2013 4%

3% 2%

4% AOTrauma AOSpine AOCMF AO Foundation AOVET Socio Economic Committee OR Personnel

11% 26 million CHF 51%

25% International Asia Europe

Course activities by region The number of courses increased to 730 in total, reflecting a growth of 3% versus 2012. The decrease at international level is due to a change in the course structure. Overall, the number of participants slightly decreased by 1% whereas the number of participant days slightly increased by 1%.

Latin

Region

Number of Courses 2013

Vs. 2012

2013

Share

Vs. 2012

Number of Participant Days 2013

Share

Vs. 2012

Asia Pacific

198

27%

0%

13,835

33%

-2%

27,925

26%

-1%

Europe (incl. South Africa)

254

35%

2%

12,297

30%

1%

33,096

31%

3%

Latin America

146

20%

23%

7,663

18%

3%

17,848

17%

6%

Middle East and Africa

59

8%

-6%

2,496

6%

-13%

6’880

7%

-13%

North America

54

7%

-8%

3,602

9%

-8%

12,121

11%

-5%

International

19

3%

-17%

1,643

4%

9%

7,736

7%

10%

730

100%

3%

41,536

100%

-1%

105,606

100%

1%

Total

48

Share

Number of Participants

Asset Management The Financial Result of CHF 116.6 million reflects an actual return of 11.8% on the underlying financial assets amounting to CHF 1,130 million by the end of 2013.

The driver of this strong performance was the double-digit return on the asset class “Shares” with a stake of 64% of the total assets. The cumulative performance of the portfolio since January 2008 amounted to 25.1% by December 31, 2013.

Portfolio Structure

9% 9%

64%

in million CHF Shares Bonds Alternative Assets Liquidity

1,130 million CHF 19%

718 214 101 96

Total

1,130

Equity evolution 2006-2013 Thanks to the very positive development of the financial markets over the last 3 years, the Foundation’s Equity could be continuously strengthened to CHF 1,142 million by December 2013. Therefore the significant equity reduction occured in 2008 due to the financial crisis has been more than compensated meanwhile.

Total shares Bonds

Evolution 2009 – 2013 Alternative assests

in million CHF

Liquidity

1065

1080

946

982

2006

2007

2008

2009

962

981

1048

2010

2011

2012

1142

2013

49

Annual Report 2013 ┃ Governance

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

Decision-taking function Advisory function

Annual General Meeting AOTAG

Annual AO Trustees Meeting

Assembly of Trustees AOF President

AO Foundation Board (AOFB) AOF President

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

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

Institutes Advisory Committee

Platforms

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

Clinical Divisions International Boards

Supervision and guidance of the respective Institute

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

Strategic and financial supervision and measuring CD outcomes

AO Research Institute Advisory Committee

Education Platform President-Elect

AOTrauma International Board

AO Clinical Investigation Advisory Committee

R & D Expert AOFB

R & D Platform

AOSpine International Board AOCMF International Board

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

50

AOVET International Board

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

Executive function AO Foundation Board (AOFB)

Governing function

AOF President

AO Executive Management (AOEM) Vice-Chair and CEO

Institutes

Clinical Divisions

Support Units

Directors

Executive Directors

COO

AOTrauma Intl. Board

AOSpine Intl. Board

AOCMF Intl. Board

AOVET Intl. Board

AOTrauma

AOSpine

AOCMF

AOVET

ARI Advisory Committee

Finance

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

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

Information Technology Communications & Events

Legal

Facility Management

51

Annual Report 2013 ┃ Governing Bodies

Governing bodies of the AO Foundation

Assembly of Trustees The Assembly of Trustees is the “AO parliament,” consisting of 185 leading surgeons from around the world comprising: 76 elected trustees; 72 ex-officio trustees; 25 honorary trustees; four honorary and founding trustees, and eight past-presidents. The Assembly of Trustees is responsible for the approval of the scientific and clinical mission of the AO Foundation, important elections and the modification of the AO Foundation Charter and Bylaws. They transmit AO information to national institutions and other AO surgeons and bring feedback regarding the specific needs of their regions.

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

52

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

Front row: —Suthorn Bavonratanavech (president-elect) —Jaime Quintero (president) —Rolf Jeker (CEO and vice-chair) —Norbert Haas (past-president)

Back row: —Christoph Lindenmeyer (finance expertise) —Florian Gebhard (trauma expertise) —Neal Futran (craniomaxillofacial expertise) —Luiz Vialle (spine expertise) —Keita Ito (R&D expertise) —Jean Pierre Cabassu (veterinary expertise)

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

From left to right: —Urs Rüetschi (AO Education Institute) — Beate Hanson (AO Clinical Investigation and Documentation) —Alain Baumann (AOSpine) —Rolf Jeker (CEO and vice-chair AOFB)

—Claas Albers (AOTK) —Lukas Kreienbühl (COO) —Tobias Hüttl (AOCMF and AOVET) —Claude Martin (AOTrauma) —R Geoff Richards (AO Research and Development)

53

Annual Report 2013 ┃ Addresses

AO Head Office AO Foundation Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 28 01 Fax

+41 81 414 22 80

foundation@aofoundation.org www.aofoundation.org

AO Clinical Divisions

AO Institutes

AOTrauma

AO Research Institute Davos

Clavadelerstrasse 8

Stettbachstrasse 6

Clavadelerstrasse 8

7270 Davos

8600 Dübendorf

7270 Davos

Switzerland

Switzerland

Switzerland

Phone +41 81 414 21 11

Phone +41 44 200 24 20

Phone +41 81 414 22 11

Fax

Fax

Fax

+41 81 414 22 80

+41 44 200 24 21

+41 81 414 22 88

info@aotrauma.org

info@aotrauma.org

sonia.wahl@aofoundation.org

www.aotrauma.org

www.aotrauma.org

www.aofoundation.org/ari

AOSpine

AO Clinical Investigation and Documentation

Clavadelerstrasse 8

Stettbachstrasse 6

Stettbachstrasse 6

7270 Davos

8600 Dübendorf

8600 Dübendorf

Switzerland

Switzerland

Switzerland

Phone +41 81 414 21 11

Phone +41 44 200 24 25

Phone +41 44 200 24 20

Fax

Fax

Fax

+41 81 414 22 80

+41 44 200 24 12

+41 44 200 24 60

info@aospine.org

info@aospine.org

aocid@aofoundation.org

www.aospine.org

www.aospine.org

www.aofoundation.org/cid

AOCMF

TK System

Clavadelerstrasse 8

Clavadelerstrasse 8

7270 Davos

7270 Davos

Switzerland

Switzerland

Phone +41 81 414 25 55

Phone +41 81 414 24 70

Fax

Fax

+41 81 414 25 80

+41 81 414 22 90

info@aocmf.org

aotk@aofoundation.org

www.aocmf.org

www.aofoundation.org/tk

AOVET

AO Education Institute

Clavadelerstrasse 8

Clavadelerstrasse 8

7270 Davos

7270 Davos

Switzerland

Switzerland

Phone +41 81 414 25 55

Phone +41 81 414 26 01

Fax

Fax

+41 81 414 25 80

+41 81 414 22 83

info@aovet.org

aoe@aofoundation.org

www.aovet.org

www.aofoundation.org

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

54

Concept, editing, and layout: AO Foundation, Communications and Events, Davos, Switzerland Manuel Kurth, Graphic Design and Photography

Photography: AO Foundation, Communications and Events, Davos, Switzerland Manuel Kurth (pages 1, 50, 54, back cover) Heinz Steinhäuser (p 8) Hans-Rüdiger Koop (p 10) Keystone, Van Urfalian (p 14) David Zentz (p 16)

Print: BUDAG, Südostschweiz Presse und Print AG, Davos, Switzerland © April 2014, AO Foundation This annual report is climate neutral, compensation through www.climatepartner.com Certificate No SC2014040102

SC2014040102

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