After 5 years of writing this newsletter, it is time for me to pass the baton off to another OTA member who wants the opportunity to be involved, so we are now taking applications for newsletter editor. This is a great chance for someone to get involved in the OTA and make a significant difference in the organization, or just to inflict your opinions on the membership without (much) fear of reprisal. As is obvious from my experience, you need neither talent nor skill to do an adequate job, and it is even possible to have some fun with it. Contact me if you're interested.

The Kansas City Update course was a blast and got pretty good reviews from the attendants. I want to say thanks to the entire faculty who did such a great job and especially to the planning committee: Borrelli, Buhr, Probe, Teague, Watson, Schmidt and Ostrum. These guys put in a great deal of work for the course and the successful result was due to their contributions.

In my last editorial, I proposed a group of electronic consultants to respond to cases submitted to our Email discussion list, and direct the consultors to literature or other resources to help with patient care in specific cases. Several guys volunteered to do that and have put in some significant time at it; the result has been a flurry of cases submitted and discussed, and an overall increase in volume of Email traffic on the list, which previously was quiet for weeks at a time. Some have expressed annoyance at this ­ we all get too much Email. Others seem to enjoy this discussion and find it useful. I have received some messages that have asked me to moderate or regulate the list and only post messages that have some value so they don't have to weed them out, or restrict it to certain types of messages. Yeah, right. Like I have time to do that! Like anyone is willing to substitute my opinion for their own! Although I am technically the "listowner", the list belongs to those who use it, and while the original purpose was for distribution of newsletter articles to OTA members, there are lots of legitimate uses that may evolve. With liberal use of the "subject" line by senders, and the "delete" button by recipients, the list can be useful for many purposes simultaneously. Your opinions on this are welcome by mail or Email. You can sign onto the discussion list through our website at: www.ota.org.

Jeff

I was surprised and greatly honored to be elected to this office. I am proud to serve you as I recognize that traumatologists, especially orthopaedic traumatologists, are a dedicated and special breed. Among all physician specialties, those committed to the care of people with musculoskeletal emergencies are true practitioners of the Hippocratic Oath. Ability to pay rarely enters the equation in trauma as saving limbs and lives must come first. Terry Canale MD in his AAOS presidential address feels that orthopaedists have become too entrepreneurial and he proclaimed this to the "year of the patient." I agree completely that we must focus on our patients, yet at the same time we must pay attention to the business aspects of our profession. If we are not cost effective in the delivery of orthopaedic trauma care, those practicing our profession will surely dwindle. This will be detrimental to society and our social systems. I feel that orthopaedic traumatologists must be knowledgeable of the "patient and the (health) plan." Continuing medical education should encompass staying on the cutting edge of orthopedic advances and treatments as well as maintaining a competency in practice management. The desire for practice management information and education has been reinforced in responses and evaluations from our members and those attending OTA and AAOS educational courses. It will be my privilege to assist the board of directors in guiding OTA in its business offerings over the next few years. To continue my responsibility as an educator, I plan on making my presidential address a short course on accounts receivable management reporting for physicians. Watch for the top 10 measurement of assessing the health of your accounts' receivable.

Other OTA initiatives

In an effort to foster improved relations between AAOS and Specialty Societies, the Academy's Educational Programming Committee has initiated a program for joint sponsorship with revenue sharing. OTA and the AAOS will be cosponsoring their first course on Marco Island, Florida, May 3-6, 2001.

Our annual meeting in San Antonio is just around the corner. Jack Wilber, Paul Tornetta and the Program Committee have put together an excellent program for our members. They should be commended on working with their colleagues at the AAST to offer our combined sessions.

Congratulations to Jeff Anglen for hosting a terrific Update Course in Kansas City. The course received rave reviews. The course was veritably technophilic as the majority of presentations were digital. This allowed participants to obtain the syllabus and the lectures in digital format on CDs. Participants liked it so well that the course will likely be repeated next year in Lake Placid.

Peter Trafton and Jeff Anglen of OTA's Health Policy and Planning Committee are coordinating our efforts to revalue two dozen CPT fracture codes. Each code surveyed will take about 20-25 minutes. Your help is needed. Please volunteer to survey 3-5 codes with which you are familiar. Though the RVU process is being coordinated by the AAOS (Laura Nuechterlein), at least 30 responses will be needed to validate each surveyed code. Remember it's much better to overestimate your time and the resources required for each procedure than to underestimate them.

Lastly, the Board of Directors and I want to acknowledge our special appreciation for our administrative staff whose help make OTA's initiatives, projects and meetings successful. Special thanks go to Nancy Franzon (executive director), Michele Garrett, Kathleen Caswell and Sharon Moore.

The OTA Board meeting in Orlando was held at the Omni Hotel on Wednesday of the AAOS meeting. A variety of reports were received and business performed, including:

Bill Burman demonstrated the electronic version of the OTA's basic fracture course for residents, which is located in the Internet at: http://www.hwbf.org/ota/bfc. Through persistence, dedication and hard work, he has succeeded in capturing 67 of the 74 lectures in an interactive electronic form. His presentation of this material to the Board included demonstrations of the value of this mode of education and a discussion about the future role of the OTA in pioneering quality Internet education. The Board expressed great appreciation for the excellent job done, requested that the education committee review the material and decide on an editorial process, and endorsed the concept and importance of Dr. Burman's Trauma Register as a means of improving the state of knowledge about orthopaedic trauma.

Received the report of CFO Andy Pollak, which showed an operating fund deficit of approximately $36,000 last year, which was less than expected. Most of the deficit resulted from an increase in management expenses. He noted that we had adequate balance and reserves to tolerate some fiscal deficit for the short term, but will need to increase revenues eventually. The annual meeting, specialty day program and the basic fracture course all made money last year. The research fund continues to do well, and had a $148, 000 excess of revenues over expenses, while awarding over $200,000 in research grants.

Brad Henley and Jeff Anglen reported on the 5-year update process for HCFA's relative value scale. The AAOS has submitted 43 codes to the AMA committee, which are believed to be undervalued in the current system. Of these, 23 are fracture or nonunion treatment codes. The next step will involve collecting data ­ surveys of practicing orthopaedic surgeons to evaluate how much work is involved in each of these codes. Our ability to achieve upgrading of the work valuation for these procedures will depend upon how many surveys are done and what they say. It is very important to complete and return the survey when it is sent to you, even though it takes significant time and effort.

Jeff Anglen reported on the COMSS meeting, including information about the AAOS Internet business plan, and the plans of Dr. Heckman for JBJS to publish yearly subspecialty update articles for each of the specialty societies. The Board suggested that the OTA's president-elect should serve as the author for that annual article, with the Board providing peer review of the content. There was also discussion of the Bone and Joint Decade, the AAOS's new public relations program, and the evidence-based guidelines committee. The OREF report detailed specialty society contributions to the fund over the period 1995-1999; OTA was the second highest contributing society (first was AOSSM), and because of the smaller size of our organization, the highest per capita.

The Board discussed and reviewed plans for Informedix LLC to take over development and support of the OTA's trauma registry software. A non-exclusive license arrangement has been granted for 3 years to allow support. As previously, the software will be free to OTA members. Software will be made available through the website according to the contract.

The Board reviewed approved the report of the nominations committee ­ for results see the business meeting report.

The group discussed the role of international membership, and supported the development of an international committee as suggested by past President Dave Helfet.

Chris Born discussed the involvement of the OTA with the National Disaster Medical System and his activities with the ad hoc committee on Mass Casualty Planning. He identified a number of areas and projects in which the OTA could be active and fit into the NDMS schema. In conjunction with Paul Tornetta, he is planning a joint session with AAST on this topic at the next annual meeting in San Antonio.

Jack Wilber and Paul Tornetta discussed the plans for the program in San Antonio, including joint sessions planned with the AAST. One symposium planned for a combined afternoon session involves the resuscitation algorithms for patients with severe pelvic fracture and hemodynamic instability. Cases and material for this symposium can be accessed through the OTA website (www.ota.org) and cases are being solicited. The importance and difficulty of getting meeting evaluations turned in was discussed. Evaluations from Charlotte were in the agenda book and were reviewed.

The Board discussed the draft of a position paper on Orthopaedic Trauma Service Organization submitted by the Health Policy and Planning Committee. It was felt that the Board and membership should carefully review the document and consider its effect in the field before adopting it as policy. The document will be posted on the website (www.ota.org) for comment.

Larry Webb presented a report on discussions involving incorporation of the OTA's classification system into the AIS 7 digit code. He will serve as the OTA liaison to the AAAM and continue discussions as to how this could be accomplished and how it will work.

Jim Kellam reported on Education committee programs for the coming year, including 2 Trauma Update courses (Kansas City and Calgary) and the resident's basic fracture course. The plan for the future is to partner with the AAOS in putting on their trauma CME course ­ with a co-chair from each organization, serving overlapping 2 year terms. Dave Templeman will be appointed as our pick for co-chair of that course. An update course for December 2001 was discussed.

Chris Born and Paul Tornetta discussed the development of a slide program to go along with the Residency Syllabus in orthopaedic trauma, which should be done and available by the end of the year.

The Board discussed the fellowship application process with some vigorous debate about setting dates before which one could not offer a spot. It was felt to be a good idea, but difficult to enforce, nevertheless the Board recommended adopting a policy that no fellowship bids should be offered before February 11, 2001, and that policy will be published on the website for candidates to see before seeing the list of fellowships. There will be a fellowship day at the start of the annual meeting to allow time for interviews and ease the travel burden for candidates.

The Board approved hiring professional support for our website, and authorized Jeff Anglen to collect bids and hire a consultant to perform that service.

Mike Bosse discussed the research committee's activity and progress on moving ahead with the multicenter open fracture closure study. He reviewed the list of OTA members who had received research grants in the 2000 grant cycle: Anglen, Borrelli, Guyatt, Karunakar, Lane, Latterman, Meyer, Olson, Phiffer, Schmidt and Webb. A draft OTA Policy on fundraising, contributions and relations with industry was presented and discussed.

The total operating fund balance as of December 31, 1999 was $347,784 as compared to $383,784 on December 31, 1998. This reflects a $36,245 operating deficit for operating deficit for 1999. While revenues for the society were stable from 1998 to 1999, a marked increase in the management fees paid to AAOS by OTA as per the terms of our most recent management contract resulted in the difference between a $31,236 operating surplus in 1998 and the current operating deficit. An increase in membership dues and/or meeting registration fees may be necessary to avoid additional operating deficits in future years. The Board of Directors will consider this action at its next meeting (Nancy, please insert date here).

The research fund balance at year-end 1999 was $1,346,104 compared to $1,198,049 at year-end 1998. Revenues for the fund including royalties, contributions from and through OREF, corporate contributions, and interest and gains from investments totaled $ 352,251, and the organization funded a total of $ 204,196 in research grants. Plans for 2000 include spending part of the accrued principle of the endowment to fund a multi-centered clinical trial as recommended by the research committee and approved by the board of directors.

The Membership Committee welcomes Fred Behrens and Bob Probe as newly elected members to serve with Edward Rutledge, Emile Schemitsch and Michael Baumgaertner. It would like to remind all readers that the annual deadline for receipt of completed applications is July first.

Active members should encourage quality individuals who have a primary interest in orthopaedic trauma to apply for membership, and then act as their sponsors. Current associate members should consider applying for full active membership. Although a new application is required, the fee is waived and sponsors are not required. With membership in the OTA comes a free subscription to The Journal of Orthopaedic Trauma and reduced or exempted fees to the Annual Meeting and AAOS Specialty Day.

Requirements for membership and application forms are printed near the end of the annual program booklet; they can be downloaded from the OTA homepage, or they can be faxed to you by contacting Sharon Moore at the OTA EMAIL: smoore@aaos.org, TEL: (847) 698-1631.

The Annual Program Committee met in Chicago on May 1, 2000. From over 400 abstracts submitted, 67 papers were selected for presentation at the Annual Meeting. In addition to these papers, over 100 poster exhibits were also selected. The quality of the submitted abstracts were excellent and an extremely high quality program is anticipated.

This year's Annual meeting will be in San Antonio, Texas on October 12, 13, and 14. This will be a combined meeting with the AAST. The highlights of this program will include a combined session with AAST with scientific papers being presented from both organizations on Thursday afternoon, October 12. There will also be a combined interactive symposium on The Treatment of Pelvic Fractures. A tremendous amount of work has been put in by Bill Burman and a panel has been assembled that will provide a multi-disciplinary approach to the treatment of pelvic injuries. Cases will be posted on the OTA web page. Keynote speakers will also be used to augment the scientific program. As in the past years, case presentations, mini-symposiums and hands on laboratory sessions will be available during the afternoon break.

We are very pleased about this upcoming program and hope everyone is making plans to attend. We look forward to seeing everyone in San Antonio.

Don't forget to designate half of your OREF contribution (at the $1000 or above level) for contribution to your favorite specialty society. The following OTA members contributed to the Research fund in 1999: Anglen, Behrens, Binski, Born, Browner, Chapman, Colburne, Creevy, DeCoster, Duwelius, Edwards, Einhorn, Geel, Goulet, Greenfield, Gruen, Hak, Hansen, Hartzler, Helfet, Heppenstal, Hurwitz, Johnson, Kolb, Koval, Lang, Lange, Maletz, Marcus, Marsh, McKinley, Moehring, Nepola, Oren, Paiement, Pape, Patzakis, Polard, Pontius, Prokuski, Rabin, Reilly, Respet, Santoro, Schmeling, Schmidt, Schwappach, Sirkin, Stover, Swiontkowski, Tornetta, Trafton, Versteeg, Whitbeck, Winquist, Wuest, Yang.

We desperately need OTA members to serve as lab instructors for the Resident's Basic Fracture Course, which we put on in association with the annual meeting. This course is a key component of OTA's educational output and gets great reviews from the 120 residents who take it each year, but we often run a little short of lab instructors. Every OTA member who is attending the annual meeting should try to help out with at least one lab. It's fun, and the food is good too. If you are willing to help out, please contact Jeff Anglen (anglenj@health.missouri.edu) or Dave Templeman (templ015@tc.umn.edu) so we can get you assigned to a lab. Thanks!

Here are the results from the last survey. Thank you for all of the enthusiastic responses!

"The use of irrigation in compound fracture wounds."

1. Do you routinely use irrigation fluid for the grade 2 or 3 compound fracture wounds?

Yes (100%) No (0%)

2. What volume of irrigation fluid do you generally use for these wounds?

1 liter (0%)

3 liters (5%)

5 liters (5%)

7 liters (11%)

9 liters (37%)

10 liters (11%)

>10 liters (5%)

Other (26%): 6-9 liters

3. What do you irrigate with?

Normal Saline (63%)

Antibiotic solution (37%)

Antibiotic in some bags only (which ones?)

- Last bag (56%), All 6 bags (11%) 2nd bag and 3rd bag (11%), 12 of the bags (11%), Unspecified (11%)

Antiseptic solution (0%)

Detergent solution (0%)

Holy water (0%)

Other (0%)

4. How do you irrigate the wound?

Bulb syringe (17%)

Pulsatile irrigator (70%)

Nonpulsatile irrigator (9%)

Other (4%) - Gravity tubing

5. Are you aware of any complications related to the use of orthopaedic irrigation?

Yes (48%) - Description: Increasing flap edema, Pressure causing injury, Excessively forceful lavage, Delayed union, Further soft tissue damage and possibly forcing microscopic particles including bacteria in the bone/marrow, tissue barotrauma and flushing debris further into tissue, and radial nerve palsy

No (52%)

6. Do you redrape the extremity after the irrigation of an open fracture wound, prior to internal fixation?

Yes (50%) No (50%)

7. Do you change any part(s) of your surgical attire after irrigating wounds, prior to internal fixation?

Gown and Gloves (38%) Just gloves (43%) Nothing (19%)

The next topic we have chosen for discussion is: Bone Grafting of Acute Fractures

1. Do you routinely bone graft acute fractures of the tibia, fibula, femur, or radius when there is significant cortical comminution?

Yes No

2. Are you less likely to bone graft a fracture acutely if it is open (compound)?

Yes No

3. What is your preferred type of bone graft?

Autograft Allograft Other:

4. Do you routinely use graft expanders (e.g., collagraft, etc.)?

Yes No

5. What is your preferred site for obtaining autogenous bone graft?

Iliac crest Proximal tibia Olecranon Other:

6. Do you routinely add antibiotic powder (such as tobramycin) to the bone graft when

grafting open (compound) fractures?

Yes No

We look forward to hearing your comments and presenting them in future issues of Fractoids. Please send all completed questionnaires by mail or e-mail to:

Craig S. Roberts, M.D.
Department of Orthopaedic Surgery
University of Louisville School of Medicine
HSC/ACB 3rd Floor Bridge
Louisville, KY 40292

The OTA does not endorse these technical points and formally disclaims any responsibility for their use.