It was a great meeting in Beantown, and I enjoyed the opportunity to meet several people whom I have known only through email. The program committee and the host committee did a tremendous job putting together a solid scientific and social event. And the sushi bar in the hotel lobby was first rate -chef Hmong made a mean anagi!

Our email discussion list continues to grow and presently we have well over 100 members subscribed to it. We now get the political issues updates from the Coalition for American Trauma Care directly by email and forward it to the entire list, so that our membership can be kept up to date on policy and economic issues. Everyone should attempt to be involved or at least informed about how we can help protect trauma care in this changing environment. In addition, we have had discussions of clinical issues and problems, requests for help with referral and follow-up, and identification of research problems that need addressing. In fact, several members of the list have started a multicenter data collection regarding the risk of infection following dental procedures for patients with implanted hardware, in an attempt to assess whether there is any risk, or whether (as many suspect) it is a myth. Perhaps we will put a nail in the coffin of prophylactic antibiotics.

By the end of the year, we should be on the World Wide Web with the OTA home page. We will be using the new SPARC machine at AAOS headquarters to house our page, and it will no doubt be a primitive affair at first, authored by your humble editor. We hope to use it to make our programs more accessible and improve communication among the members. We will archive the newsletter articles, have a membership directory (alphabetical and geographic), give dates and information on upcoming programs and meetings, and perhaps use it to make lecture notes, syllabi and course transcripts available to meeting participants, thereby saving printing costs and pushing deadlines back. The final address will not be available by press time for this newsletter, but I'll put it out on the email list. Our domain name is "ota.org", so try pointing your browsers at http://www.ota.org.

The OTA Board of Directors met in Boston prior to the annual meeting. Some of the business conducted:

Approved the minutes from their meeting in Chicago on May 23, 1996 as presented by Secretary James Carr. Highlights from that meeting: formation of a Research Endowment task force consisting of the President, CFO and Research Committee chair to examine long term strategic planning of OTA finances and research funding; approved Drs. Nepola, Miller, Swiontkowski and Cornell as representatives to OREF; approved update course sites for 1997 and 1998, and annual meeting site of San Antonio for 2000 (combined meeting with AAST); approved a project for development of a CD-ROM with trauma case studies; agreed to place the proceeds from the OKU - Trauma in the endowment fund.

Received the report of Chief Financial Officer Brad Henley. We have now separated the balance sheets for operations and endowment. Our expenses are pretty much on target for the year, despite unexpected costs from canceling the Dallas update course (due to low registration) and legal expenses (to defend pedicle screw lawsuits, from which we have now been dropped). The OTA made a $23,000 profit on the Specialty Day program and, to date, has earned $24,000 from royalties on sales of OKU-Trauma. The present balance in the endowment fund is $823,699. Total corporate and individual endowment donations in 1995 were $251, 300 (including $16,300 from individuals through OREF). To date in 1996 (that is, as of September), total endowment donations were $123,250.

Dr. Henley presented, at the prior request of the Board, a Research Endowment Fund Pro forma for 1997-2001, in which he projected the fund balance for 5 years, using fiscally conservative assumptions of donations and performance. He predicted a fund balance of $1.08 million by the end of 2001. The Board then discussed the long term investment strategy and appropriate asset mix. They decided to begin moving funds from bonds to equities as the bonds mature, with a mix not to exceed 25% equities in the next 24 months. The CFO was authorized to move funds in periodic increments of $10,000 in a "dollar cost averaging" manner.

Received the report of Alan Levine, COMSS representative. He noted that the Specialty Day schedule is being reviewed, and that the OTA Board's opinion is that Saturday is a better day for Specialty Day than Sunday, in order to allow people to travel just for that part of the meeting if needed. More input is being sought from the specialty societies in evaluation of the Instructional Courses,rather than having it done by the AAOS Instructional Course committee. The Board thought that this would be an appropriate activity for the Education Committee of the OTA, and directed them to organize it.
Reporting on the success of the OKU-Trauma project which he organized, Dr. Levine reported that these books are selling well,- about 200 issues are selling per month, steadily. We have received about $24,000 in royalties and should get another $12-15,000 by November. He also noted that there is a potential for the OTA to become involved in the production of the Academy's biggest selling publication - the "Orange Book" (Emergency Care and Transport of the Sick and Injured). We would need someone with interest, experience and contacts in the EMT community to coordinate it. The Board noted that this activity would have to be profitable for the individual working on it as well as for the organization. Any OTA member who might be willing or interested in this project please contact Dr. Levine or the Board.

Received the report of President Bone on a number of issues. The Specialty Day program for San Francisco is done, and will be presented in the Moscone Center. The Board spent some time discussing the relative merits of producing a syllabus of this program so participants have something to take home. Although many participants want them, most Board members thought they weren't used and were an unnecessary expense. It was felt that having the lectures transcribed and available on the OTA Web site for download by those who want them might be a good way to avoid the expense of printing.
Dr. Bone reported that the OTA has been dropped off all pedicle screw lawsuits by the Plaintiff's Legal Committee.

Received committee appointments from President-elect Jim Kellam. New committee members are: Archives - Marcus; Coding, Classification and Outcome - MacKenzie, Blachut, Harris; Education - Levine, Powell; Fellowship and Career Choices - Born, Sims; Health Policy and Planning - Swiontkowski, Riemer, Anglen; Program - Varecka (chair), Wilber, Albert; Research - Vrahas, Schemitsch, Webb.
Dr. Kellam also presented a draft of the American College of Surgeons Optimal Resource Document chapter on musculoskeletal management. Some Board members suggested we need to develop our own "optimal resource" document in order to set the standards for practice of orthopaedic traumatology.

The following committee chairman reports were given to the Board of Directors in Boston:

Roy Sanders, Editor of the JOT - A number of changes have been instituted at "the Journal" to increase efficiency and to build upon the success of the last few years. There is a new computerized manuscript tracking system and standardized guidelines for manuscript review which has resulted in an initial decision time of about three weeks for submitted papers. A section editor structure has been adopted, a full time statistician hired, and a blinded review process is in place. The acceptance rate since January is 45%. Several additional professional societies are interested in using the JOT as their official publication, including the Japanese Fracture Society, the Belgian OTA and the Swedish OTA.

Mike Bosse, Research Committee - The committee met in Boston to finalize the recommendations for grant funding. Twenty-two submitted grant proposals were reviewed. The committee would like to encourage larger clinical proposals, possibly multi-center in nature, rather than simple biomechanical experiments with little clinical relevance. They plan to develop an OTA "CV" for papers and presentations from projects which we have funded. The Board discussed how we get follow-up on grant results, and asked the program committee to look at various formats for getting progress reports from grant recipients, perhaps having them required to present a paper or a poster at the annual meeting. After discussion, the Board agreed to fund all of the committee's recommendations, for a total of $262,000. (See related story below)

Jim Goulet, Membership Committee - The committee received a total of 72 applications, of which 62 were complete (32/37 Active, 24/24 Associate, 7/10 Corresponding, 1/1 Research). The Board discussed membership criteria, and the concept of "non-published" membership categories. The decision appeared to be to follow the present Bylaws, but allow exceptions to be admitted on a case by case basis by the Board.

The Board discussed the issue of membership for surgeons with a D.O. degree, and felt that if they had completed residency in a DO program and thus were not eligible for ABOS certification, they could still be Associate members of the OTA.

Jim Kellam, Coding, Classification and Outcomes Committee - The compendium of fracture classification has been completed, published and mailed as a supplement to the JOT. The software for the database Ortho-Trauma 95 is completed and ready for distribution. There may be a 1 day course in Charlotte for users of this database. The committee recommends full support of the database, which may include hiring a support person.

Don Wiss, Program Committee - The committee report was presented in the form of the program booklet, and the Board agreed that the committee had done an excellent job and thanked the members for their hard work. Problems with late submissions or alterations of manuscripts was discussed, as well as problems with discussors who fail to meet their commitments and what possible sanctions should be imposed.

Chris Born, Fellowship and Career Choices Committee - The state of orthopaedic trauma fellowships in 1996 was discussed and the results of a survey of fellowship directors presented. Basically, there has been little change in the past year in number of programs, positions or applicants - there were 46 applicants for 50 positions in 29 programs in the US this year. It was suggested that we send our fellowship booklet to all the residents who attend the OTA resident's course. New HCFA regulations for teaching physicians were discussed and the effect on fellowships. Dr. Born presented an in-depth discussion of the concept of unionization of physicians.

Bob Winquist - Education Committee - The resident's course this year was sold out, with a capacity crowd of 125 attending. Dave Templeman will be in charge of next year's course. Regional Trauma Update courses are scheduled for Newport Beach in April 97 (Steve Olson - chair) and Pittsburgh in May 97 (Gary Gruen). In 98, courses are on tap for Seattle (Chip Routt) and Atlanta (Mary Jo Albert).

Bruce Browner, Health Policy and Planning Committee - There is increasing concern about the impact of managed care on trauma care delivery, in particular, how closed panels, payor contracts, and economic pressures may be negatively influencing referrals to trauma centers and unraveling trauma care systems which were incompletely developed in most states. Over the past year we have supported the Coalition for American Trauma Care in their efforts to have appropriate language included in Health Care legislation to support payment for emergency and trauma care services, and maintain trauma care systems. In addition we have been successful, largely through the efforts of Brad Henley on the CPT committee, to develop new CPT codes for treatment of open fracture wounds. Future goals include closer coordination with AAOS and ACS on policy issues affecting trauma care.

Michael Distefano, Archives Committee - A photographic gallery of past OTA Presidents is nearly complete, and a history of the organization has been written. Programs from Trauma Update courses and annual meetings are being collected and kept as part of the formal archives of the organization.

Larry Bone, Annual Meetings, Site Selection Subcommittee - Charlotte has been selected as the first choice for the 1999 meeting, to be held during the 3rd week in October, with Baltimore as an alternative. In 2000, we have agreed to meet in San Antonio in a joint meeting with AAST. There was discussion about selecting a group of 5 or 6 cities to use for our meeting in a repeating rotation, thus making the planning process easier. The cities selected were Baltimore, Toronto, Minneapolis, new Orleans, Tampa, and San Diego.

With 552 participants pre-registered and another 100 on site, this year's meeting was the best attended in our history. Sixty papers were presented, selected from over 365 abstracts submitted to the Program Committee. The program was divided into sessions based on anatomical location (hip and femur, foot and ankle, tibia, spine and pediatrics, upper extremity, pelvis and acetabulum), with an additional session on the scientific basis of fracture care. In addition, 94 scientific posters were presented. The abstracts from this program will soon be available to read and download from the World Wide Web, courtesy of HWB Foundation, through a link on our Web site. Presidential Guest Speakers included Henry J. Mankin, MD, professor of orthopaedics at Harvard; John Silber Ph.D., Chancellor of Boston University; and Pamela Westlin, Chief Operating Officer, Southern California Orthopaedic Institute. Symposia on orthopaedic journals and controversies in fracture management, as well as hands on laboratories and case discussion formats, were used to round out and add variety to the program.

Of the 59 papers presented (1 was withdrawn), 49 were clinical studies and 10 were basic science reports. The clinical papers included 27 retrospective studies, 7 prospective nonrandomized, 8 prospective randomized, 1 radiographic and 6 papers concerned with practice patterns, utilization of resources or cost comparisons. The basic science papers included 5 animal studies, 1 cadaver anatomic study, 2 cadaveric biomechanical studies, 1 biomechanical study using plastic bones, and 1 microbiological study.

There were four papers presented comparing reamed(R) to unreamed(UR) nailing of the femur in a prospective, randomized fashion. Between the four studies there were 302 fractures with adequate follow-up - 142 R, and 160 UR. Two of the studies had rather striking unexplained differences in the distribution of the patients between the two groups, but they were unbalanced in opposite directions. One of the studies looked only at intra-operative factors and had no follow-up information. Two studies found an increased blood loss in group R (but no difference in transfusion requirements). One study found decreased operative time with UR nailing, and one found no difference; two groups reported more technical problems or perioperative difficulties with UR nailing. Two studies found an increased time to union with UR nails (not statistically significant), one found a significant increase in nonunion rate with UR nailing, and two found an increased rate of secondary procedures needed with UR nailing. Comments from the audience after Dr. Chapman discussed these papers pointed out that due to the small numbers in each study, the statistical power of the conclusions was weak, that different implants with different biomechanical characteristics were used for reamed and unreamed applications, that the difference in randomization to the groups was unexplained, and that none of these studies specifically addressed the situation in a patient with pulmonary injury. The fact that at least four groups of investigators had similar ideas for studies at about the same time suggests a possible role for the OTA, perhaps through the research committee, to match up researchers with similar interests and ideas to develop multicenter studies. A sort of "dating service" for research.

The Saturday symposium featured journal editors from JBJS, CORR, JOT, Orthopedics and Am. J. Of Sports Medicine discussing the present state of Orthopaedic journals, their review procedures, appeal processes, and what the future may hold. The Sunday symposium on controversies in fracture management examined different approaches to certain clinical problems in a debate type format. Topics included reamed versus unreamed femoral nailing in the multiply injured patient with chest injury (winner -> reamed), retrograde versus antegrade approach to femur fracture in floating knee (winner -> antegrade), and a rematch of the Kellam - Helfet debate, this time on SSEP monitoring (too close to call).

President Bone called the annual business meeting to order and previous meeting minutes were approved. Chief Financial Officer Henley gave a brief financial report, noting some expenses which were increased this year and reported that about half of our expenses go to AAOS for management services. He noted the income from sales of OKU-Trauma were expected to be around $36,000 for the year, and announced that we will award about $192,000 in research grants this year. Alan Levine gave the COMSS report and asked the membership if anyone would be interested in working on the Academy's "Orange Book" as editor. This would require someone with experience, knowledge and contacts with the EMT field. Mike Bosse gave the Research Committee report and noted the committee's interest in identifying and promoting multicenter clinical studies. Bruce Browner gave a Health Policy and Planning report and made a plea for members to become active on their state level, because many of the decisions regarding trauma care systems are being shifted from federal to state control. Brad Henley repeated his request for suggestions about CPT coding problems or new codes. (see last newsletter for Brad's article) Four new members were elected to the Nominating Committee: Tony Russell, Mitch Harris, Paul Tornetta, and David Lhowe.

The member's cocktail reception was held in the Skywalk on the 50th floor of the Prudential Tower, with great seafood and live music. With a clear night's view, there was a spectacular view of downtown Boston and the lights of Fenway Park.

The following awards were recommended by the Research Committee and approved by the Board:

• Ank Le
  Similarities in the molecular cues mediating bone Formation and repair $11,500
• M. Swiontkowski
  A prospective field trial to assess the reliability, Validity, and responsiveness of the short form Musculoskeletal function assessment instrument $43,682And 1997 renewal $43,682
• J. Wang
  Therapeutic role of granulocyte-macrophage colony stimulating factor in infected fractures of rabbits $19,892
• D. Wheeler
  Mechanical strength of fracture $24,914
• J. Goulet
  Mechanical influences on fracture repair processes $21,500
• S. Olson
  Development of an in-vivo model of long- term consequences of acetabular fracture $19,717
• J. Fleming
  Role of endogenous hormones in the control of Bone blood flow $24,889
• T. McKinley
  Periarticular bone strain changes resulting from Pilon fractures: The effect of cartilage and Subchondral bone loss $15,000

In 1977, a small group of orthopaedic surgeons had lunch in a Vietnamese restaurant in San Francisco to discuss common problems of running trauma hospitals. Drs. Ted Bovill, Ray Gustilo, and Michael Chapman were part of this group. Dr. Gustilo suggested that they form an association of university-affiliated trauma hospitals, which became the Orthopaedic Trauma Center Study Group. The first members of this study group were L.A. County (J. Paul Harvey), San Francisco General Hospital (Edwin Bovill), Harborview Medical Center (Ted Hansen), Denver General Hospital (Renner Johnston), Cook County Hospital (Arsen Pankovich) and Boston City Hospital (David Segal). The following year, Parkland Hospital in Dallas,Shock Trauma in Baltimore, Montefiore Hospital in Brooklyn and the University of Richmond joined.

The first meeting was held in June 1977 at Los Angeles County Hospital. In 1981, at Hennepin County, a more formal association was organized. By 1983 the name was changed to the Orthopaedic Trauma Hospital Association.

In 1985 the group realized the need to organize nationally. Dr. Gustilo was elected the first president with Michael Chapman as President-Elect and John Cardea as Secretary-Treasurer. With the help of a small Board which consisted of Bruce Browner, Joe Schatzker and Ted Hansen, these few members did the bulk of the work to establish the Orthopaedic Trauma Association. Dr. Chapman wrote the By-Laws, incorporated the Association in California and was able to get the OTA recognized by the Academy as representing the subspecialty of orthopaedic trauma on the Academic Council and COMSS. This legitimized trauma as a subspecialty in orthopaedics.

In 1987, Dr. Charles Edwards became President and hosted the first open annual meeting of the Orthopaedic Trauma Association in Baltimore. Alan Levinewas the first Program Chairman.

In 1988 John Cardea became President. Membership of the Association had nearly tripled in three short years, from 48 members in 1985 to 118 members in 1988. A research fund was begun, with the goal of a one million dollar endowment. During Dr. Cardea's tenure, the infrastructure of the OTA as we now know it was completed.

In 1989, Dr. Bruce Browner presented the first research grant for a multicenter study on outcome of polytrauma patients. Dr. Browner brought the Health Policy issue to the Board and established the OTA as the spokes organization for musculoskeletal trauma policy in North America.

In 1990, Dr. Joseph Schatzker, as President, took the OTA international.Dr. John Border and Prof. Maurice Mueller becoming the first Honorary members.. Establishment of corresponding memberships allowed the OTA to expand abroad.

In 1991, President Richard Kyle established the Regional Update Courses, which have made a significant impact on the organization's teaching mission.

In 1992, President Robert Winquist developed the resident education program which was implemented in 1995 at the Annual Meeting in Tampa. This is the second year of the course which has the finest faculty ever assembled and it has been extremely well received.

In 1993, Dr. Peter Trafton reached out to other trauma associations in North America. Dr. Trafton was uniquely positioned to do this due to his membership on the board of the American Association for the Surgery of Trauma, and on the committees on Trauma for both the AAOS and ACS. The Annual Meeting was held in new Orleans with a joint session with the AAST.

In 1994, Dr. Kenneth Johnson presided over the Organization. During that year, an emphasis was placed on research funding. Though Ken's efforts, substantial research funding is now available through the Orthopaedic Trauma Association.

Last year I was honored to be on the Board of Dr. Alan Levine. Alan's contributions to the Organization have been many. As treasurer, he upgraded our finances and developed a budget for the Organization. During his Presidency, the function of the OTA has been streamlined through revision of the committee structure, and development of timelines for each activity.

The Orthopaedic Trauma Association has come from a group of 40 to a membership of over 300. It has met its dream of financial stability, and its educational mission has expanded dramatically. Over $200,000 was granted for research this year. My goal is to continue this tradition with hope of further international expansion and reaching out to those North American trauma surgeons who wish to become members of the Association.

It is an honor and privilege to be able to serve this organization as President. Thank you.