With this issue, we start the second year of the OTA newsletter. I would appreciate any thoughts or suggestions anyone may have for improvement. I would also like to ask for volunteers - anyone who would like to help with the writing or development of the newsletter. I have discussed with Dr. Bone the idea of developing an informal "communications committee" of members to help with writing the newsletter, explore the possibility of putting together a Web page, and continue the development of the email discussion list - which, by the way, now has nearly a hundred subscribers. The main role would be to come up with ideas for articles of interest to the members, collect the information, and write it. This is a good way to begin to get involved in the OTA, especially for new members.

Also in this issue, we have included a survey from the membership committee. We are trying to collect an accurate email and fax directory to aid in member communication. Please take time to fill out the survey, fold and stamp, and mail it back to headquarters. This information will be kept reasonably confidential and used only for OTA business.

If you haven't signed on to the email discussion list and wish to do so, send an email message which says "Subscribe ORT-L your name" to Listproc@lists.missouri.edu. Leave the subject line blank. If you don't put your name in where it says "your name", it won't work and you will get an error message. .

The OTA's Specialty Day Program, entitled "Problems in Fracture Management and Posttraumatic Reconstruction", was presented in Atlanta's Omni Hotel on February 25. The program was organized by Dr.s Levine, Browner, Jupiter, Trafton and Wiss. Designed to be of value for both the traumatologist and the general orthopaedist, attendees earned 7.5 credit hours of CME through the Academy. There were 256 non-member physicians, 157 resident/fellows, and 26 allied health professionals who registered, along with 152 members of the OTA.

The morning session included a symposium on "Management Problems in the Pelvis and Femur" featuring a debate between Dr.s Jim Kellam and David Helfet on the topic "Do we fix complex acetabular fractures only to supply bone stock for total hip replacement?" Taking the affirmative position, Dr. Kellam pointed quoted the clinical experience of Dr. Letournel, and pointed out that, even in the hands of the most experienced surgeon, over 25% of operative reductions are imperfect, and thus cannot be expected to do well. Only in 2 of the 10 fracture types (posterior wall, posterior column) can over 90% of cases achieve perfect reduction. He also noted that there are significant percentages of fair and poor results reported even with perfect reduction. Moving from clinical reports to the basic science, Dr. Kellam discussed studies showing how impact, delay, and incongruent reduction damage cartilage cell viability. He noted that the natural history of osteoarthritis is progression of the disease. Argueing from essentially the same literature, Dr. Helfet took the opposite tack and pointed out that only 20% of Letournel's patients had a "poor" radiographic result due to AVN, cartilage necrosis, or osteoarthritis, while clinical results were at least "good" in 80%. He reported in his experience of over 450 acetabular fractures with 1-10 year followup, only 21 had required arthroplasty. Quoting Letournel, Dr. Helfet stated that the age of the patient is not a contraindication to fixing the acetabulum, and he reminded us of Dr. Matta's finding that, controlling for other factors, patient age does not decrease the clinical result. He stated that the most significant prognostic factor for a poor result was malreduction, which is more common with surgical team inexperience.

Following this discussion, Dr. Dana Mears gave a talk on problems with total hip arthoplasty following pelvic and acetabular fracture. He noted certain fracture factors which predict clinical failure and the later requirement of arthoplasty: femoral head abrasion or impaction, femoral neck fracture, acetabular surface impaction (in his experience, if there is 20-40% surface impaction, there is a 100% failure rate), massive comminution, late presentation, and obesity. At his institution over the past decade, they have moved away from doing extensile exposures (82% -> 8%), believing that such soft tissue stripping is very damaging. In 67 THAs performed following acetabular fracture, he had a >50% failure rate by 2.5 years, 20% due to cup loosening, which he believes is due to acetabular avascularity.

Also in this session, Dr. Larry Bone talked about nonunion of the distal femur and discussed prevention by thinking about biological as well as mechanical goals early, respecting vascularity with indirect reduction techniques, such as the use of implants to reduce as well as stabilize the fracture. Dr. David Templeman talked about nonunions and malunions of the pelvis and Dr. Richard Kyle discussed the increasingly frequent problem of periprosthetic fracture and treatment options.

Other sessions during the program included Complex Upper Extremity Problems, moderated by Dr. Jesse Jupiter, Don't Forget the Spine, moderated by Dr. Alan Levine, and Reconstruction of the Tibia, Ankle, and Foot, moderated by Dr. Peter Trafton. The presidential guest lecture was given by Dr. Maurice Muller, and concerned the topic of fracture classification. Dr. Muller discussed the history of fracture classification and his efforts in that important arena over many years, and illustrated with numerous examples the use of his system.

The nine best papers from the 1995 OTA annual meeting were presented at the Specialty Day "Highlight Papers" session. During that session we learned from Dr. Moed that dynamiting a tibia at 15 weeks may lead to a false negative ultrasound exam for healing. Also during that session Dr. Michael Chapman presented the Edwin G. Bovill Award for the best paper at the annual meeting to Dr. J. Spence Reid of Pennsylvania State University for his paper "Safe Placement of Proximal Tibial Transfixion Wires with Respect of Intracapsular Penetration". Other highlight papers and their presenters (see the meeting program for all co-authors) were:

• Berton R. Moed: Ultrasound for the Early Diagnosis of Tibial Fracture Healing after Unreamed Static Interlocked Nailing.
• Michael J. Bosse: Comparison of ARDS, Pneumonia, and Mortality Rates in MIP with Pulmonary Injury and Femur Fracture Acutely Treated with either Reamed IM Nails or Plates.
• J. Tracy Watson: Transcutaneous Oxygen Tension Monitoring in the Preoperative Evaluation of soft Tissue Injuries in closed Fractures about the Ankle.
• R. Dale Blasier: External Fixation of Femoral Shaft Fractures in Children.
• Paul J. Benca: Randomized Prospective Study of Humerus Fixation: Nails vs. Plates.
• Margaret M. McQueen: Unstable Fractures of the Distal Radius: A Prospective Randomized comparison of Four Treatment Methods.
• Dana C. Mears: total Hip Arthroplasty for Post-Traumatic Arthritis following Acetabular Fractures.
• Kenneth J. Koval: Does Blood Transfusion Increase the Risk of Infection after Hip Fracture?

The OTA Board of Directors met at the Omni Hotel on the evening before the Specialty Day Program to receive reports from the officers and committee chairmen. Some actions and highlights from that meeting:

The Board received and approved minutes from the 9/95 Board meeting and the 11/95 conference call submitted by Secretary Jim Carr.

Received the report of Chief Financial Officer Brad Henley for fiscal year 1995. Briefely, the independent auditors'report showed that s of December 31, 1995, the OTA's total assets were aproximately $931,000, with $653,500 designated for research grants ($593,600 invested in market securities). Revenue and expense report revealed a net gain of $40,700 from operations in 1995, which compared with a net gain of $66,300 in 1994. Dr. Henley noted that he anticipated a net positive revenue of approximately $13,000 in 1996. He reported that we have received $157,500 in direct corporate contributions, and $40,000 in indirect contributions (OREF), with $53,800 in accounts receivable from OREF. Dr. Henley also reported to the Board on comparison of management fees under the new contract, and on research funding. The Board passed a motion to assess no overhead fees on research fund management.

Received a report on the recent Council of Musculoskeletal Specialty Societies meeting were reviewed by Dr. Levine, which was held in conjunction with the AAOS Board of Councilors in October. The minutes from that meeting, and it was announced that Richard Kyle will serve as President of COMSS next year, giving us two orthopaedic traumatologists on the Council (the other being our representative, Alan Levine)

Received a final version of the committee system restructuring which has been in progress over the last year. This plan, which will require bylaws changes which will be submitted to the members at this meeting, stipulates that all committee apointments will be for a three year term, beginning on Specialty Day ant the annual Academy meeting. The appointments to all committees, except membership which is an elected committee, will be made by the President -elect. The Board accepted the proposal, and then received a list of committee appointments from President-elect Bone, which were also accepted with minor amendments.

Received updates on the planning for Specialty Day 1996, the Trauma Update Course in Dallas and annual meetings: Boston 1996, Louisville 1997 (with the Kuntscher Society), Vancouver 1998, Nashville 1999, Dallas 2000, and Baltimore 2001. The format and timing of the annual meeting was discussed - it was felt that 2.5 days was the appropriate length and that the meeting should include « Thursday, Friday and Saturday when located on the West coast or Friday, Saturday, and « Sunday when on the East coast. Evaluations of the Regional Trauma Update Courses were reviewed and proposed future sites of Trauma Update courses were selected: LA and Atlanta in 1997, Seattle and Pittsburgh in 1998, Boston and Denver or Phoenix in 1999.

Received the report of Jim Kellam regarding the Orthopaedic Trauma database software and the fracture compendium, which should be distributed in the spring with the Journal of Orthopaedic Trauma.

Dealt with several new business items, including a proposal to send a representative to the SICOT committee on documentation meeting in Milan (Dr. Kellam will represent us), introduction of the new editor of the Journal of Orthopaedic Trauma ( Roy Sanders),discussed the task force on EMS and Allied Health Education, a proposal to develop CD-ROM teaching materials, and a proposal tohelp fund development of a musculoskeletal function assessment tool.

Received reports from the committee chairmen:

• Fellowship and Career Choices -- Chris Born reported on a presentation to the Academic Orthopaedic Society at it's Washington meeting making them aware of numerous institutional factors which negativley influence recruitment and retention of orthopaedic traumatologists. This presentation was made by OTA members Alan Levine, Peter Trafton, Andrew Burgess and Chris born. Dr. Born recommended that the OTA consolidate those presentation into a single document for publication to raise the general level of awareness of these problems. He talked about his committee's work on a standard curriculum in orthopaedic trauma that could be used by residency and fellowship directors. Paul Tornetta has been asked to lead this task force.
• Research -- Chip Cornell gave the list of funded research projects for 1996. Nine projects were funded by the committee for a total of $149,063. Thirty seven grant proposals were reviewed by the committee in this funding cycle.
• Membership -- Jim Goulet announced the induction of 37 new members. He also discussed the results of the membership survey distributed at the Tampa meeting which concerned changing the membership requirements. There was a wide variety of opinions expressed by the membership, without a clear concensus about where the organization should go, particularly in regards to the publication requirement for membership. Dr. Goulet felt that we need to change, but should proceed cautiously, and need to educate our members about the benefits of expansion. The Board directed the membership committee to collect some statistics on the changes in membership numbers over the last few years.
• Bylaws -- Peter O'Brien detailed the changes in the Bylaws which would be presented to the membership at this meeting in order to enact the new committeee structure. The Board thanked the committee for it's work on this project.
• Program -- Don Wiss discussed the process and time line for the Program committee's work. He pointed out how this process is very seasonally intensive, involving review of an increasing number of abstracts by the deadline. Ken Koval was approved as the next chairman.
• Education -- Bob Winquist reviewed the success of the Resident's Course in Tampa and the plans for improving the program for Boston, including having more OTA members function as table instructors, and having handouts for all the lectures. He discussed the regional update courses, and reported that the OKU - Trauma is now out and available, seems to be selling well

Alan Levine called the general membership meeting to order at 12:45 pm on February 25, 1996. Minutes from the Tampa meeting were presented and approved. The CFO report was given by Brad Henley. 37 new members were presented by the membership committee, including 17 active, 13 associate, 7 corresponding and 2 research. Reports were given by Peter Trafton (concerning the annual meeting plans for Boston), and Bob Winquist (reviewing the efforts at the annual residents' course). Chris Born discussed the the efforts and plans of the Fellowship and Career Choices committee, including their presentation to the AOS and the work on a trauma core curriculum. Don Wiss reminded members about the final abstract submission deadline of March 8, 1996. Jim Kellam reviewed the efforts of the Coding and Classification committeee, and Jeff Anglen asked for volunteers to help with the newsletter.

The members voted to approve the recommendations of the Bylaws committee (report given by Peter O'Brien) and of the nominations committee, which recommended Jim Kellam for President-Elect and Jim Goulet, Paul Duwelius and Tom Varecka as Members-at- large.

AO North America was formalized in 1992 as an organization of AO Course Faculty Members and former AO Fellows residing in the US and Canada. Funding for AONA comes from the AO/ASIF Foundation, a non-profit organization based in Switzerland. The Foundation, responsible to an international board of surgeon trustees, is supported by royalties paid by the producers and distributors of AO/ASIF instruments and fracture fixation devices. AONA represents part of an effort of the Foundation to decentralize its activities promoting research, teaching, and development of treatments for musculoskeletal injuries and related disorders. AONA's governing body, its Steering Committee, comprises the North American trustees of the AO/ASIF Foundation.

Once funding became available, the AONA leadership chose to attack the dearth of support for musculoskeletal trauma research in North America. We directed a significant portion of our resources toward encouraging scientific investigations in skeletal traumatology, and closely related fields. The goal was to issue a number of Aseed money@ grants, in hopes of developing momentum that might help gain better academic recognition for orthopaedic traumatologists, and lead to more successful competition for grants from other organizations, like OREF and federal agencies.

From 1993 through the Spring of 1995, AONA awarded $432,000 in support of 23 grant applications. These were selected from a much larger number of applications through a peer-review process supervised by the AONA Steering Committee. Many of the grant winners are members of the OTA. The AONA grant application process was structured to be similar to that of the OTA, using forms that were patterned after those developed by the OTA's Research Committee.

AONA is proud of its effort to stimulate orthopaedic trauma research. We hope that the initial stimulus we provided will have the desired effects. Recently, AONA has chosen to focus more on improving education in musculoskeletal traumatology, and upon supporting its members' collaborative projects. This will necessarily reduce the funds and efforts which AONA can allocate toward direct support of independent research studies. Furthermore, we recognize the OTA's very successful peer-reviewed research funding program, and wish not to duplicate it, but to support its growth and development. Therefore, AONA requested that the OTA take over its research-funding efforts. We are grateful that the OTA Board of Directors agreed with this proposal. In exchange for a contribution from AONA ($75,000 in 1995), the OTA will consider research grant applications from AONA members, whether or not they are in the OTA. Grants will be awarded independently by the OTA, according to its customary guidelines. AONA is certain that the high standards set by the OTA Research Committee and Board will ensure optimal use of still-scarce support for skeletal trauma research. We hope to continue supporting the OTA research effort at appropriate levels well into the future. AONA wishes to point out that the AONA contribution is in addition to that directly granted to the OTA by the AO/ASIF Foundation for the Synthes-AO/ASIF Research Awards.

Dr. Henley, Chief Financial Officer, has reported the corporate donations for 1995 research funding to be:

Direct contributions

• Howmedica $ 20,000
• AO/ASIF Foundation $ 40,000
• Synthes/Wyss $ 22,500
• A O North America $ 75,000

Subtotal $157,500

Indirect contributions (OREF)

• Ace/DePuy $ 35,000
• Zimmer $ 5,000
• Smith &Nephew $ 15,000
• Sofamor Danek Group $ 15,000
• Synthes/AO $ 22,500

Subtotal $ 92,500

Total $250,000

For the first year, individual donors to OREF at the "Order of Merit " level were allowed to designate up to half of their contribution to be directed to specialty societies. The following individuals specified OTA should receive half of their donation to OREF. The total amount raised through this sourcewas over $19,000 for the OTA's research endowment. All OTA members are encouraged to remember this mechanism when they make their OREF committment.

• Jeffrey D. Angel, M.D.
• Jeffrey O. Anglen, M.D.
• Dr. & Mrs. James C. Binski
• John H. Bowker, M.D.
• Dr. & Mrs. Michael W. Chapman
• Dr. & Mrs. Price M. Chenault
• Dr. & Mrs. Frederick G. Dalzell
• Dr. & Mrs. Thomas A. DeCoster
• Paul J. Duwelius, M.D.
• Dr. & Mrs. Johns R. Edwards
• Dr. & Mrs. Larry S. Eisenfeld
• Dr. & Mrs. Gerald Q. Greenfield, Jr.
• Dr. & Mrs. Douglas P. Hartzler
• David L. Helfet, M.D.
• Dr. & Mrs. Edward T. James
• Dr. Clyde & Mary Kernek
• Dr. & Mrs. Edward C. Lang
• Gerald J. Lang, M.D.
• Richard H. Lange, M.D.
• Dr. & Mrs. Kevin W. Luke
• John P. Lyden, M.D.
• Dr. & Mrs. Frank W. Maletz
• Tobert L. Messenbaugh, M.D.
• Michael P. Naeve, M.D.
• Dr. & Mrs. Glenn E. Oren
• David M. Ott, M.D.
• James Pape, M.D.
• Andrew H. Patterson, M.D.
• Howard Rosen, M.D.
• David Seligson, M.D.
• Peter B. Slabaugh, M.D.
• Dr. Phillip & Carol Spiegel
• Paul R. Sweterlitsch, M.D.
• Dr. & Mrs. Marc F. Swiontkowski
• Thomas F. Varecka, M.D.
• Daniel M. Zinar, M.D.

After reviewing the 38 grant applications submitted by OTA members, the research committee made the following awards for the 1996 granting cycle:

• Helfet, Borelli: Development of an In-Vivo Die Punch Model 12,000
• Thomas, Urahas: In Vitro Contact Stresses and Stability of Hip After Acetabular Fractures 16,500
• Piendl, Bosse: Assessment of Reamer Systems 14,595
• Nepola, Delcore: Effects of Applied Intermittent Vibration upon Fracture Healing 18,628
• Rubash, Vogt: Effectiveness of Unipolar vs Bipolar Hemiarthroplasty 16,000
• Zimmerman, Behrens: Does BMP Accelerate Fracture Healing in Distraction 17,740
• Finnegan: Effects of Nicotine on Tibial Fracture Healing 20,000
• Pollack, Burgess: Acute Lung Injury Associated With Femur Fractures 18,900
• Miclau, Lindsey: In-Vivo Effect of Aminoglycosides on Bone Healing 14,700

Total :149,063

As most will have noticed, the editorship of the Journal of Orthopaedic Trauma has passed from Phil Spiegel to Roy Sanders. Phil has done a wonderful job with the Journal and deserves the thanks of the OTA. Congratulations to Roy; we anticipate a continuation of the high standards and quality that have made the JOT a success.

The 1996 annual meeting will be at the Boston Marriott - Copley Place in Boston MA. The scientific meeting will be September 27 -29, with a concurrent Resident's Course in Basic Fracture Care on September 26-29, utilizing OTA members as faculty. The preliminary program has been selected by the program committee and includes sessions on hip and femur fractures, foot and ankle, tibia, the scientific basis of fracture care, spine and pediatrics, pelvis and acetabulum. There will be the usual outstanding speakers, hands on labs, and social events. Mark yourself out of the office now and book those low-fare Valujet tickets to Boston.

The OTA will put on a Trauma Update Course in Newport Beach California on April 18 and 19, 1997. The Chairman will be Steve Olson.

Your Board has just completed the Spring Board Meeting. As you see from the Secretary's report, last year was an extremely successful year thanks to the leadership of Dr. Alan Levine. We remain financially stable as we develop greater resources for funding our research. A special thanks goes out to Dr. Robert Winquist for his efforts as Chairman of our Education Committee and the development of the Resident Course this past year.

The Board has just seen the program for our Annual Meeting in Boston September 27-29th. Dr. Donald Wiss and the Program Committee have once again put together an outstanding program. With the help of Dr. Peter Trafton, our local host, I am looking forward to a very exciting and educational meeting.

The Board once again tackled the issue of membership. A recent poll of the OTA membership showed a nearly 50/50 split regarding the issue of publication as a requirement for membership. I met last February with past-presidents of our Association and the Board in May and it has been decided that the publication requirement for membership will stay. However, it is our desire to identify those surgeons who would rightfully qualify for membership in the OTA. I would like to see a membership drive go forward this year. I would like you, the members of OTA, to identify orthopaedic trauma surgeons in your departments and communities who fulfill the 50% trauma or trauma-related requirement and who you think should be members of the Orthopaedic Trauma Association. If you and one other active member of the Association invite such a surgeon to become a member, we would encourage them to apply for membership at your recommendation, with or without the publication requirement. The Membership Committee, under the guidance of Dr. Jim Goulet and this Board, would like to identify those surgeons who you believe belong in the Association. In addition, we would like to identify the young orthopaedic surgeons who should fulfill the publication requirement. Please send us the names of your young staff and trauma fellows, both for this year and next, so that we may encourage them to publish and become members of the Association. In addition, the Association has been greatly improved with the addition of our corresponding members. Their participation in our annual meeting has broadened our educational mission. If you have personal knowledge of trauma surgeons in South America and the Pacific Rim that you feel would enhance our Association, please let the Membership Committee know so that we may invite them to be corresponding members.

I would like to take this opportunity to thank the membership for allowing me to serve as your President. I look forward to the upcoming year and will do my best to uphold the tradition of leadership to this Association that the twelve presidents before me gave.