Welcome to the maiden voyage of the Orthopaedic Trauma Association newsletter, named, at the present time, "the Orthopaedic Trauma Association Newsletter". The first order of business is to find a better name, so I am announcing a newsletter naming contest open to all members and their immediate families. We need a name that somehow ties together the essence of what we do with a communications or information slant. I know that many of you are creative and clever types who can come up with some good options. First prize in the contest is appointment to the editorial board, a lifelong free subscription , a commemorative OTA styrofoam coffee cup, and the gratitude of the editor. All suggestions will be published for the amusement of the readership.

This newsletter has been established to improve the communications between members of the Association, to disseminate information from the OTA leadership to the members (particularly those who cannot attend the national meetings), and to increase involvement in the OTA by more members.

We will plan to produce it at least twice a year; more if there is interest and enough copy. Each issue will contain words of wisdom from your president and other officers, committee reports, and information about the last and next OTA meetings. Other possible article topics include: issues of political importance for orthopaedic traumatology, news from other specialty societies, discussions of clinical topics or research projects, reminders about deadlines for abstract or grant application submissions, etc. Please let me know if you have ideas for articles or ways to use the newsletter which would make it more valuable to you. This editorial job is purely amateur, and suggestions from the read ership would be greatly appreciated, and, in all likelihood, followed by an invitation to write the article! If you've had writing or editorial experience, or the desire to get some, please volunteer to help. We are printing and mailing from the University of Missouri at Columbia, on recycled paper. Format and layout is being done by Dan Stapleton of the University's Instructional Materials Laboratory.

We have also started an electronic version of this newsletter to be distributed over the internet by email. For those of you familiar with the internet, this version will be in the form of a Listserv discussion list. That means everyone who signs up will get a copy of each newsletter article (probably longer than the paper version, since we won't have length restrictions) in their email mailbox. They will then have the ability to reply - comment, correct, criticize, question or elaborate on the topic - and their replies will automatically be distributed to the whole list, any of whom can then respond to that, and so on. Hopefully, this will stimulate some lively discussion, as well as give individual members a way to get or share information with a large number of other members simultaneously. Any member of the list can bring up new issues or topics for comment by simply sending an email message to the list. To subscribe to the discussion list send an email message to listproc@lists.missouri.edu. Leave the subject line blank, and the message should read "subscribe ORT-L your name". If you have any problems, send me a message at jeffrey_anglen@surgery.missouri.edu.

Although we don't plan a "letters to the editor" column, I would appreciate your comments and suggestions and will try to include anything educational or entertaining you send.
Jeff Anglen
M562 Health Sciences
1 Hospital Drive
Columbia, MO 65212

The 1995 annual meeting of the OTA will be held in the exciting city of Tampa, Florida on September 28 through October 1. Program chairman Don Wiss and his committee have assembled an outstanding schedule of scientific presentations. Nearly 350 abstracts were submitted for the meeting this year. Dr. Wiss and the committee read and grade the submissions in a totally blinded fashion to prevent any chance of bias regarding investigators or institutions. The final program will contain about 70 papers. As in past years, the papers will be grouped according to topic, and discussed by an invited speaker after every 2 or 3 presentations. This year, the program committee has added 5 to 7 minutes for open floor discussion after each group of papers, in order to allow and encourage audience comment. In addition to the paper presentations, there will be 4 keynote speakers: Dr. Augusto Sarmiento, Dr. Bill Burman, Dr. Alan Levine, president of the OTA, and Dr. Bill Tipton, executive vice-president of the AAOS. The program will also include two symposia; one which will explore the issues surrounding unreamed femoral nailing, and another on the topic of fracture complications in young adults. CME credit will be available through the AAOS.

Attendance is expected to be approximately 700 participants. The meetings will be held at the Tampa Convention Center, on the water in downtown Tampa. Lodging arrangements will be primarily at two hotels, the Wyndham Harbor Island and the Hyatt, both of which have easy access to the convention center. Local host Roy Sanders has arranged for the OTA cocktail party to be held at the new Tampa Aquarium on Friday night. There will be a water taxi set up between the Harbor Island hotel and the Aquarium, providing a short boat ride to the party with a view of downtown Tampa from the water.

Tampa offers a variety of diversions to appeal to all interests. The beautiful gulf coast beaches of Clearwater and St. Petersburg are a 20 minute drive away. For those bringing their families, the Busch Gardens and Adventure Island amusement parks offer fun for all ages, and of course, for those who didn't get enough Disney at the AAOS meeting, Orlando is within an hour drive. Cultural entertainment includes the Tampa Performing Arts center, the historic Tampa Theatre and the M. Venus Dance Institute. The country's longest uninterrupted sidewalk winds along the scenic Bayshore Blvd., offering a 5 mile course for runners or rollerbladers, starting right at the convention center. Shopping in Hyde Park, nightlife in the Ybor City district, and dining at any of Tampa's wonderful seafood restaurants add to the list of activities available in the city. Make plans now to join us for a great meeting in September.

An exciting new addition to this year's addual meeting is a simultaneous resident education course in orthopaedic trauma. Planned and set up by Dr. Robert Winquist and the education committee, this course will utilize the OTA membership as faculty. As Dr. Winquist points out, "The Orthopaedic Trauma Association, including the corresponding members from Europe, represent the world's premier team of educators in the treatment of fractures. Our annual meeting has been a superb teaching format, and the education committee feels it is time to extend this teaching to orthopaedic residents". Dr. Winquist's committee has organized a four day resident course to take place simultaneously with the annual meeting in Tampa.

A large number of OTA members have been tapped to provide lectures in thier individual areas of expertise, or serve as laboratory instructors. Because of the large number of teachers involved, each faculty member's time commitment will be only .5 to 2 hours, allowing them to be involved in other aspects of the meeting program. Any OTA member who would like to be involved but has not received a request from Dr. Winquist should contact him or the OTA office.

Residents at the R-3 level will be invited. The primary goal of the course will be to instruct residents on the operative indications and techniques of fracture treatment. An additional goal expressed by the education committee will be to interest residents in the field of orthopaedic traumatology at an early stage in their careers, through exposure to the knowledge and enthusiasm of OTA members. The course will consist of basic lectures, including pertinent anatomy, as well as 16 motor skills laboratories which have been set up with the assistance of multiple implant companies.

Due to space limitations in the laboratories, only 125 spaces in the resident course exist, and these will be filled on a first-come, first- serve basis. Informationand registration forms have been sent to all program directors. The registration fee, if sent before September 17, is $450.00.

One of the major missions of the OTA is, to quote from our bylaws, "... fostering, developing, supporting, and augmenting investigative knowledge of Orthopaedic trauma..." Toward that end the OTA leadership has worked diligently over the last decade to build an endowment fund which will provide an ongoing source of financial support for worthy research project. The effort has been quite successful, and the fund is presently approaching $700,000. Interest from the fund, in addition to money from corporate donations, has been awarded in the form of peer-reviewed grants to OTA members for the support of research projects pertaining to musculoskeletal trauma topics. The amount awarded annually has gone up each year, beginning in 1992 at approximately $15,000 and reaching over $100,000 this year. In a time of shrinking governmental research funding, the OTA is striving to maintain and increase the availability of research support in this vital, and underfunded, area.

The money for this effort has come from several sources, according the Kenneth Johnson, immediate past president of the OTA. Corporate donations from several companies have strongly supported our research base. Synthes, Ace, Depuy, Howmedica, and AO North America have all donated over $10,000 and have indicated a willingness to continue to contribute. It is hoped that other manufacturers of orthopaedic trauma systems will be interested in being involved in this process. Any members with connections to industry, or who are heavy users of particular implant systems should encourage their local company representatives to become donors on a corporate level. This can be done directly through the OTA, or through the OREF. Corporate donations through the OREF require that the first $10,000 go into the general OREF fund, but contributions above that amount can have the remainder directed to specific funds, one of which is designated for OTA.

Individual donors may also support OTA research programs through their annual donation to OREF. When donating to the OREF at the level of the "Order of Merit" ($1,000), half of the donation can be directed to the OTA research fund simply by checking a box on the back of the donation envelope, and all OTA members are encouraged to utilize this method of supporting trauma research. Of course, individuals may also make tax-deductible contributions directly to the OTA for the research endowment fund.

All OTA members are eligible to apply for research grants. Forms are available from Nancy Franzon at OTA headquarters, and the deadline for each funding cycle is July 1st. The form is identical to the form used in applying for OREF grants to facilitate dual submission. According to Charles Cornell, chairman of the research committee, the purpose of the grants is to help young or previously unfunded researchers begin studies which may attract larger grants from other sources in the future. Most awards are in the range of $10,000 to $20,000, and although they are awarded yearly, some studies have received renewed OTA support for a second year. Examples include Richard Buckley, at Calgary General Hospital for a randomized, prospective, multicenter comparison of open and closed treatment of calcaneal fractures, and Steve Olson at University of California - Davis for an examination of load transmission across the hip joint following acetabular fracture.

Projects which received OTA grant support during the last funding cycle were:

• Baumgaertner, M.R.: "The Efficacy of Gentamicin Impregnated Resorable Calcium Phosphate Cement in Treating Experimental Osteomyelitis in a Rat Model." Yale University School of Medicine. Funds Allocated: $12,000.
  
  
• Behrens, F.F.: "Percutaneous Screw Insertion into the Sacroiliac Complex: Bony Anatomy." University of Medicine and Density, New Jersey, New Jersey Medical School. Funds Allocated: $10,000.
  
  
• Johnson, K.: "Reamed Intramedullary Nailing in the Face of Pulmonary Injury in Sheep." Vanderbilt University Medical Center. Funds Allocated $12,000.
  
  
• Kreder, H.J.: "Randomized Multi-Center Clinical Trial of Distal Radius Fracture Care." Harborview Medical Center. Funds Allocated: $10,000.
  
  
• Olsen, S.A.: "Consequences of Mal-Raduction of Acetabular Fracture on Load Transmission Across the Hip Joint." University of California at Davis. Funds Allocated: $10,000.
  
  
• Voor, M.J.: "Displaced Acetabular Fractures Influence of Surface Displacement on Articular Cartilage and Subchondral Bone Stress Distribution." University of Louisville, Research Foundation, Inc. Funds Allocated: $10,000.

The Orthopaedic Trauma Association has taken as one of its projects the implementation of a standardized fracture classification system. This began six years ago spearheaded by Dr. Mark Swiontkowski. The concept was to develop a standardized commonly acceptable compendium for fracture documentation. This was combined with a minimal set data base so that initial documentation of the orthopaedic trauma patient and their injury could be done. The reason for this was to allow a standardization of data input so that useful outcome measurement data could be obtained. Beginning with the Muller Long Bone Classification System as the basis for itemizing long bone fractures, the Orthopaedic Trauma Association Coding and Classification Committee has extended this to include all other bones of the extremities. With the help of Drs. David Helfet, Emile Letournel, Joel Matta, and Marvin Tile, the pelvic and acetabular fractures have also been added.

This compendium of fractures and dislocations will be published as a supplement to the Journal of Orthopaedic Trauma. A data base was created to evaluate the patient injury characteristics and treatment in the initial phase. Subsequently, a functional outcome and long term follow-up aspect was added. This cumulated in a release of the first Orthopaedic Trauma Data Base, known as 4.2. With further advances in software development and the introduction of windows format, the Trauma Data Base is being re-written to become more user friendly. At present, it is felt that this whole system should be available to the members of the Orthopaedic Trauma Association by the time of its annual meeting in September of 1995.

It must be pointed out that under no circumstances has this data base or its fracture classification meant to prove or validate any given position. This is the beginning of an attempt to create a standardized fracture language so that in the future we will be able to correlate amongst ourselves more meaningful information.

To meet this need, the Orthopaedic Trauma Association's Coding and Classification Committee has a three year revision cycle. Once any program has been released, it will be revised over a three year period and then updated and released again. This will allow the membership to submit either through peer review journals or documentation to the committee problems, changes, or verification of what is already present. This system cannot meet all needs. It is an attempt to reach a minimum common ground. It is the Association's system, not any particular doctor or institutions, and therefore requires all of us to participate in its use so that it can be modified, changed and improved over the years.

With the system, coupled to appropriately validated musculoskeletal functional outcome instrument, it is hoped that the best possible orthopaedic trauma research will be available.

The Orthopaedic Trauma Association Membership Committee is responsible for the selection of OTA member applicants and for assuring that each applicant meets the qualifications for the membership category for which application has been made.

Qualifications for active membership include certification by the American Board of Orthopaedic Surgery or the Royal College of Surgeons of Canada-Orthopaedic, and fellowship in the American Academy of Orthopaedic Surgeons or The Canadian Orthopaedic Association. Additionally, applicants for active membership must conduct at least seventy-five percent of their orthopaedic practice at a designated trauma center or equivalent, and spend fifty percent or more of their time in clinical practice, teaching, or research directly related to orthopaedic traumatology. Candidates for active membership must also meet specific criteria for scientific publications in the field of or related to orthopaedic trauma.

The Board of Directors and members approved the admission of fifteen new active members, nine new associate members, and sixteen new corresponding members last year following the recommendations of last year's Membership Committee, chaired by Eric Johnson, M.D. As of May 30, 1995, sixty new applications for membership have been received. The Membership Committee will begin review of these applications following the application deadline of July 1, 1995. Questions pertaining to membership should be addressed to the Membership Committee in care of the Orthopaedic Trauma Association's administrative office at 6300 North River Road, Suite 727, Rosemont, Illinois 60018-4226.
Submitted By: James A. Goulet, M.D. Membership Committee Chairman

Dr. Bruce Browner, Chairman of the OTA's Health Policy and Planning Committee, also serves on the Board of Governors of the American College of Surgeons. He notes that nearly a third of AAOS members (5000 out of 16,000) hold memberships in the ACS . This means that orthopaedists represent 1/12 of the total ACS fellowship number of 60,000. One of Dr. Browner's goals is to increase the influence and visibility of orthopaedic surgeons in the ACS, and to gain a greater political voice for issues of concern to orthopaedists by increasing communication with the College. For his yearly report to the Board of Governors, he will submit a document prepared by Bob Fine, the Academy's Director of Health Policy, identifying the health policy issues of greatest concern to the Academy over the past year. These issues are: 1) Patient choice and access to specialty care, 2) RBRVS five-year review, 3) RBRVS practice cost issue, 4) Medicare budget cuts and reform, 5)Physician self-referral legislation, and 6) Medical liability reform. The complete text of Dr. Browner's report will be posted to the electronic newsletter in late July. Please see the front page for information on how to access the discussion list in order to get this full document.

Dr. Browner and Dr. Jeff Anglen represented the OTA at Academy headquarters on June 24 in a meeting of the RUC advisory panel. This group, composed of representatives of all the participating orthopaedic specialty societies, is formulating the Academy's input into the AMA/RUC, the committee which will make recommendations to the Health Care Financing Administration regarding physician work values of new and revised CPT codes. The Academy has identified 83 CPT codes which are believed to be substantially undervalued by the present Medicare work scale. In order to make the case for increasing the relative work value for these codes before the full committee, the advisory panel has collected data from surveys of practicing orthopaedic surgeons as well as detailed descriptions of pre-, intra- and postoperative physician work for the identified codes. Dr. Anglen and Dr. Browner specifically dealt with 18 trauma codes, ranging from open treatment of proximal humerus fractures to reduction and fixation of acetabular fractures. The advisory panel will make recommendations to the AMA/RUC, which will in turn send on their recommendations to HCFA by the end of the summer.

As many will be aware, the AAOS commissioned a restudy of the relative value of physician work in 1992, based on the belief that many of the values for orthopaedic services were significantly undervalued by the original Hsiao study. The new data, known as the Abt study, was presented to HCFA later that year, with the response being that the appropriate time to consider that information would be within the normal 5 year review process. The Academy requested the AMA/RUC to use the Abt study in place of the standard survey process for the 5 year review of orthopaedic CPT codes. However, the details of this process could not be agreed upon, so the Academy has had to go through the same survey process for reviewing CPT code work values as all other specialty societies. Surveys were sent to orthopaedic surgeons selected by the orthopaedic specialty society representatives, asking for extensive data about the work involved in the codes which were felt to be undervalued.

In order for the data from the surveys to be convincing to the RUC, there must be at least 30 surveys returned for each CPT code proposed for upgrading. Unfortunately, despite having surveys sent to 100 OTA members, only 20 actually took the time to complete and return them, and the data for upgrading some of our most frequent codes is weaker because of that low turnout. Luckily, some members of other societies, such as the foot and ankle society, hip and knee society and pediatric orthopaedic society were also surveyed regarding some of the same codes, leading to better numbers. Your involvement and support is vitally important in convincing policy makers of the need to value our work appropriately. More information on the five year review process will be on the electronic newsletter at the end of the summer, after the AMA/RUC meets.

Dr. Browner and Dr. Larry Bone helped the AAOS health policy staff prepare a comment document regarding last summer's Physician Payment Review Commission report on payment for Trauma and Critical Care Services. They communicated strong reservations regarding proposals for global payments for physician services for trauma care, and noted that orthopaedic surgeons had not been consulted in development of that recommendation. Among other problems with the concept, they noted that trauma care is too complex and variable for global payments; that the clear definition of injury severity is difficult; that the increased risk of malpractice claims had not been considered, nor had occupational hazards and unpredictable hours of work; and that revision of current physician work values is required.

On behalf of the entire Board of the Orthopaedic Trauma Association I would like to welcome you to the inaugural issue of the OTA Newsletter. As we enter an era of rapid and uncharted changes for not only Orthopaedic Surgery but medicine as a whole, it is critical that we communicate effectively among ourselves with greater frequency than simply at the Association's annual meeting. This newsletter will hopefully be that forum.

The issues confronting all of medicine involving managed care, restriction of access to specialty care and the role of the generalist versus the specialist certainly effect trauma care. The Level I trauma center, despite its success at saving both the lives and limbs of victims of major trauma, represents to the cost conscious providers a very expensive and perhaps unacceptable alternative for both acute and follow-up care. The issue becomes even more focused considering the roles of the general orthopaedic surgeon and the fellowship trained orthopaedic traumatologist in the care of complex injuries. Therefore, I have invited William Tipton, the Executive Vice-President of the American Academy of Orthopaedic Surgeons to be our presidential guest speaker at the annual meeting of the Orthopaedic Trauma Association in Tampa this year. He will address us on the topic of the Academy's vision of orthopaedic trauma care in the 21st century.

These same pressures and others unique to orthopaedic traumatology are taking a toll on the number of applicants to our trauma fellowship programs. Ultimately it may effect the availability of fellowship trained traumatologists to care for the patients and train the next generation of orthopaedic surgeons in the United States. Likewise, retention of traumatologists in the practice of the specialty is a problem. The average duration of practice after fellowship is only five years. The society has formed an ad-hoc committee to look at the issues involved in the recruitment, retention and maturation of the orthopaedic trauma surgeon. The Board is actively looking at these issues as well as innovative solutions to the problems.

We look forward to your participation and interest in these topics both during the annual meeting and as well through the use of this Newsletter as a forum. We welcome Jeffrey Anglen as the Editor of the Newsletter of the Orthopaedic Trauma Association and thank our former President, Ken Johnson for his efforts in making this inaugural newsletter possible. We hope that you will see it as an opportunity for expression and will send your contributions to the editor on time so that this really represents an effort of the entire society.