The Annual Meeting is over and everyone is patting themselves on the back saying "What a success". Nevertheless, was it a success? What did people think of our meeting? You all fill out our CME evaluations, but you never learn the results. I thought you might find it interesting what the participants thought of our meeting.

First, the quality of papers was felt to be less than previous years. There was a cry for better papers. People thought nothing new was presented and few controversies existed. The participants noted the lack of hypothesis-driven prospective randomized trials. There was definitely an interest in the Orthopaedic Trauma Association leading the way in the development of protocols for randomized prospective trials to answer impact questions. Another concern were the discussors. The participants wanted a discussion that was useful. They complained that often the discussor wasted time rehashing the paper or on excessive criticism of the scientific inadequacies of the study, but failed to give information that would be useful for their practice. Maybe this was because of the noncontroversial papers, but I think that perhaps we need to rethink our discussion of papers. Obviously discussion of the scientific validity and merit of the paper must be done, but perhaps we are becoming too vindictive. The practicing orthopedic surgeon who is attending this meeting obviously wants some useful clinic information to apply to his practice. If the paper has some valid information, then we need to put this into clinical relevance for our participants.

As is typical, these are the comments of a few. It is a shame that not all of us, and in particular the members of this organization ( including the President), took the time to do an in-depth evaluation of our meeting. I would only request that from now on that we take up the responsibility of membership and evaluate what we are really doing so that we can produce an even better meeting.

On another topic, the recent discussion on our email discussion list (ort-l) regarding guidelines for orthopaedic trauma coverage on a non teaching Level 1 Trauma Unit has identified an opportunity for OTA leadership. We do not presently have guidelines or answers to this question. The American College of Surgeons has the Optimal Resource Document, now in the revision process. Hopefully, this will give us some guidelines. The Orthopaedic Trauma Association should be acutely aware of this deficiency. As one who is in a teaching institution with Residents, I feel that it is difficult to enforce our criteria and guidelines on individuals who do not have the luxury of Resident Staff. As your President, I would request anyone who has any information or thoughts on this, be it academic or non-academic, to please let me know either through our E-mail discussion list (to subscribe, send an email message reading "subscribe ort-L your name" to listproc@lists.missouri.edu) or our association office or my office. We need this information to be able to move forward to achieve the best possible delivery system for orthopaedic care within the trauma system.

According to the OREF Foundation newsletter, OTA members contributed $29,600 through the OREF's designated giving initiative, which allowsdonors of $1000+ to direct any portion over $500 to the specialty society. The only society which had a higher total was the American Orthopaedic Society for Sports Medicine at $87,385. AOSSM has 1200 members, while the OTA has under 300, giving us the lead in per capita giving - $98 to $73.

Dr. John Border was the first honorary member of the Orthopaedic Trauma Association. He died in November 1996. Dr. Border was a pioneer in trauma research and patient care for the multiply injured patient. A graduate of Harvard Medical School, he came to Buffalo in the early 60's for his general surgical residency. At that time the general surgeons still managed half of the fractures at the Regional Trauma Center, alternating call nights with the orthopaedic service. Dr. Border became interested in fracture care and how it related to management of the whole patient. In the late 60's ARDS was called shock lung and Dr. Border saw its effect in many of his multiply injured patients with long bone fractures. He would note, that those patients in the ICU, in traction, would often have written in the progress notes . . . "patient doing well, patient doing well, patient died". With extensive NIH funding, Dr. Border was able to study the pathophysiologic response to the patient with multiple trauma. His work clearly showed the beneficial effect of early fracture care and stabilization in preventing serious complications, such as ARDS and multiple system organ failure.

As a resident in general surgery from 1973 to 1978, I was privileged to work closely with Dr. Border, whose influence on me was significant. The Prospective Study on Early Femur Fracture Stabilization that Dr. Johnson and I performed in Dallas in the mid-80s was a direct result of John's influence and his work.

Dr. Border received many honors during his outstanding career. He was honored by the American Association for Surgery of Trauma with their annual Fisck Lectureship. He was past-President of AO North America and a founding member of the AO Foundation. His C.V. is too extensive to even begin to honor, but he had well over 200 publications and lectured throughout the world. One of his major contributions to the area of trauma was as the co-editor and major contributor to a superb book: Blunt Multiple Trauma: The Comprehensive Pathophysiology and Care, co-authored with Professor Allgower, Dr. Hansen and Dr. Ruedi.

John was a general surgeon by training, but a trauma surgeon by practice. He cared for and understood the entire patient. While many of you younger surgeons may not know of Dr. Border, he has certainly influenced many of the older trauma statesmen in the audience, such as past-Presidents Ken Johnson, Bruce Browner, Mike Chapman, and Peter Trafton; and trauma giants such as Andy Burgess, Ted Hansen, and Bob Meek, as well as others. He crossed the border and boundary between general surgery and orthopaedic surgeons. He showed the general surgical traumatologists the importance of proper fracture care and he showed the orthopaedic traumatologists the importance of team work and how their fracture management affected the patient. It is both fitting and appropriate that we honor this outstanding trauma researcher, teacher, and mentor by establishing the John R. Border Memorial Lectureship.

The OTA Board met during the annual meeting in Louisville on October 16, 1997. The meeting was called to order by President Kellam. Highlights of the meeting included: Secretary's report: Dr. Goulet presented the minutes from the March meeting of the Board, and from a conference call meeting in May. These were approved.

Committee Appointments: Dr. Kellam reported that Brad Henley would continue to represent the OTA on the AAOS' CPT coding committee. This committee has been exempted from required turnover by the Academy, due to the complexity of the issues and training required. Jeff Anglen will serve as an "understudy" representative for the OTA, to insure that we have two members with the knowledge to function on that committee. Four members were appointed to the AAOS' trauma committee - Bosse, Templeman, Staheli and Anglen.

Old Business: Dr. Bill Burman has proposed a project to develop a CD-ROM containing "Grand Rounds in Orthopaedic Trauma". This will involve videotaping sessions from the OTA annual meeting, and then adding questions, commentary, discussion and interactivity. It will be aimed at educating the general orthopod. Initial sessions scheduled include limb deformity assessment/ osteotomies by Dr.s Mayo and Mast, and complications in pelvic and acetabular surgery by Dr. Johnson. OTA has set aside $10,000 to support this project. The financial and educational aspects of the project were discussed.

President Kellam announced that the Specialty Day Program was in place and that a syllabus would be provided with the program, so that participants would have something to take home. A plan was discussed to make the syllabus materials available on the OTA website to lessen reproduction costs. He reported that the member dinner in New Orleans would be at the same restaurant that was used last time the meeting was in that city.

Dr. Alan Levine gave a report from COMSS and discussed his new role as editor of the JAAOS. We would like our COMSS representatives to be the president and past president, serving overlapping 2 year terms. It is not clear if that fits into the way COMSS wants to operate. The JAAOS will be asking each specialty society to provide articles on topics which they (the societies) think are important. The societies will pick the topics and authors.

Chief Financial Officer: Dr. Henley presented balance sheets, and reported that the income and expense levels were right on our budgetary target. His goal is to keep one year's worth of expenses in the operations account, and transfer the remainder at year end into the research account. As of the September 30 balance sheet, the research endowment had toped the $1 million dollar mark, but that is prior to paying out for grants awarded in this cycle. The research committee has recommended $193,000 worth of grant awards this year. OKU-Trauma has sold 4300 copies and brought us $64,000 in two years; the Newport Trauma Update Course made $14,000, Pittsburgh broke even.

Committee Reports:

Tom Varecka (Program) - 425 abstracts were submitted for the Louisville meeting, 61 were accepted, and 2 were withdrawn. 101 posters were selected from the 125 abstracts submitted. The preregistration for the meeting was 580, with an additional 140 registered for the Kuntscher Society. The committee plans to take up the issues of how to increase basic science presentations, appropriate format for the program, and the possibility of separates sessions for members only.

Peter O'Brien (Bylaws) - The proposal to change the current membership category of "corresponding" to "international active" and "international research" was discussed and approved. These groups will pay dues, get the Journal of Orthopaedic Trauma, and have a reduced fee for meeting registration, where the corresponding members previously paid no dues, got no journal, and paid full ticket for meetings. The concept of a membership category called "active - allied specialties" was discussed and referred back to committee.

Mike Bosse (Research) - The research committee recommended funding 7 projects totaling $182,000. They are proposing a "study group" concept to increase the quality of the research project proposals submitted. These groups would be organized by the Research committee who would identify important questions and ideas for projects, then help get them started. (Somebody must have read the editorial in the last newsletter! - ed) Possible study group topics include: DVT prophylaxis in the trauma patient, closing open fracture wounds - when can it be done, a prospective study of complex pilon fractures, treatment of pediatric femur fractures, timing of orthopaedic surgery in the head injured patient, antibiotic duration in open fracture treatment, special morbidity and mortality in elderly patients with fractures.

Jim Goulet (Membership) - The committee recommends 5 for active membership (out of 7 applicants), 8 of 10 for associate membership, 6 of 9 applicants going from associate to active, 6 of 7 for corresponding, and 2 of 2 for research membership.

Chris Born (Fellowship and Career Choices) - the committee has been working on several projects regarding resident and fellow education. A draft of the general guidelines for orthopaedic trauma fellowships has been completed and submitted to the Board for review. It is not a curriculum per se, but rather a guideline attempting to help better structure fellowship programs. A preliminary resident curriculum for orthopaedic trauma has been drafted which consists of over seventy topics to be covered in a two year period. It is drawn from several sources including various courses, OKU, textbooks and curricula already in use. After revision of the present draft, it should be available for general membership review in the spring. The comittee is also working on compiling a bibliography of classic fracture references, formatting bioskills and anatomy labs, reviewing ortho trauma radiology training and updating the fellowship booklet.

Bob Winquist (Education) - The resident course was discussed, noting improvement in the quality of the labs, increase in the number of lab instructors and institution of a handout. This could also be made available on the OTA website so that participants could have it prior to the course. The Board of Directors expressed support for continuing the course, and gratitude to Bob and Dave Templeman for the nice job done. It was noted that this program is unique among the specialty societies. Trauma Update courses were discussed and the possibility of going to one course a year was mentioned. At present, the plan is to continue two courses yearly. Atlanta will be the site of one course in 98, and Kansas City in 99. Seattle will be a site in 98 or 99. Discussion for 2000 included New York City and Phoenix.

Jim Kellam (Coding, Classification and Outcomes) - Ortho 95, the OTA-sponsored database is becoming the widespread standard for such a product. Requests to use the software are coming from worldwide.

Peter Trafton (Health Policy and Planning) - Discussion of our involvement with the Coalition for American Trauma Care, and coordination of our efforts in this arena with larger bodies such as ACS and AAOS. While we have the expertise in our area, the political clout comes from the larger organizations and we need to be influential in their policies which relate to orthopaedic trauma issues.

Peter O'Brien (Annual Meeting) - The Vancouver meeting will run « day Thursday (10/8), full days Friday and Saturday (10/9, 10/10) The Resident Course will run 10/7-10/10. The 1999 meeting will be in Charlotte, and 2000 in San Antonio, in association with AAST. There was discussion of how and why to run combined meetings with other societies. San Diego was discussed for 2001, and Toronto for 2002.

Roy Sanders (Journal of Orthopaedic Trauma) - The volume and quality of submitted manuscripts is up substantially; current acceptance rate is 45-50%. Manuscript turnaround time is improved due to an increased editorial board. Several international societies are now involved with the Journal, including several European organizations and the Japanese Fracture Society. The Journal is working with the program committee to encourage and "fast track" papers from the OTA meeting into the Journal. There was discussion about publishing results from OTA-funded research projects in the Journal, possibly in abstract or summary form, to keep the members informed about what their research fund money is producing.

How does orthopaedic trauma get handled at your institution? Is the care organized appropriately for optimum patient care? Is there fairness in workload and compensation among the surgeons? Is there a coordinated orthopaedic trauma service, or is every surgeon an independent agent? Is traumatology recognized as an important and separate sub-specialty? Does the institution provide enough support in terms of facilities and ancillary personnel? Do you suspect that it might be done better at other places, and wonder how it is organized elsewhere?

So do we. Everybody seems to be grappling with the issues of how to organize and deliver orthopaedic trauma services in their own hospitals, how to provide the best care for the injured patient, and a livable system for the docs in the trenches. Many of us are engaged in negotiations with hospital administrators about what it takes to support an orthopaedic trauma service, but there are no standards or guidelines like those that exist for the level 1 trauma center certification. Most of us know little beyond the system where we trained and the ones where we have worked, and few of us have experience in different types of hospitals - public, private, academic, military, urban, rural, large and small.

We would like to make a start toward fixing this problem by collecting information on these topics. We need you to help, by taking a few moments to fill out the information on the enclosed questionnaire and mail it (or email it) back. Finding out where we are now is the first step towards determining where we should be. The membership of the OTA represents the people who are doing the work of orthopaedic trauma care in this country, in all types of institutions and under all types of conditions. Tell us how you are doing it at your place, what problems you have solved, and which ones you need help with. This is the stuff I hear you all talking about at the meetings, courses and in the exhibit halls - please take the time to share your experience. The data will be reported to the group either in this newsletter, or in a Journal of Orthopaedic Trauma article, or at the annual meeting.
Jeff Anglen
jeffrey_anglen@surgery.missouri.edu

New Members of the Orthopaedic Trauma Association

The following surgeons were approved for new membership or change in membership category at the Louisville meeting.
ACTIVE (5)
Paul Dougherty
James Hutson
Joseph Lane
Steven Rabin
Thomas Shuler
ASSOCIATE (9)
Daniel Burchfield
John Catalano
Peter Cole
John Gorczyca
Gregory Konrath
Kevin Pugh
Michael Sirkin
Scott Smith
Matthew Weresh
ASSOCIATE TO ACTIVE (6)
Frederick Bennett
Mitchel Harris
Mark McFerran
Steven Olson
Paul Tornetta
Philip Wolinsky
CORRESPONDING (5)
Leif Ceder
Axel Ekkernkamp
Wolfgang Ertel
Christopher Oliver
Juraj Strmen
RESEARCH (2)
Stephen Belkoff
Neil Sharkey

The Board of Directors approved the Research committee's recommendations for research project awards at the Louisville meeting. The total amount awarded was $182, 989 for 8 projects. The OTA members receiving awards were: Jeff Anglen (University of Missouri), Fred Behrens (New Jersey Medical School), Theodore Miclau (University of California - San Francisco), William Holmes (University of California - Davis), Susan Jaglal (Sunnybrook HSC), Kalia Sadasivan (LSU Medical Center) and Marc Swiontkowski (University of Minnesota). Awards ranged from $9,500 to $43,6000.

Mike Bosse, Chair of the Research committee, reports that 30 pre-proposals were submitted this year, and 19 of those were selected by the committee to present full proposals for review. Sixteen were submitted and reviewed, and eight projects were funded. The committee found that several grant proposals had not been previously reviewed by the appropriate institutional research committee, and decided to make that a requirement for future years. They are interested in finding and funding more clinical research projects, or basic research which represents prliminary work for major grant applications.

The Research committee has been directed by the Board of Directors to investigate the possibility of developing working groups within the OTA that would be assigned clinical projects that are determined to be major areas in need of "evidence based research methodology". It is possible that the OTA would develop and support the working group with methodological, statistical, or data collection expertise and with core funding. Input from the membership regarding this concept and possible topics is solicited - contact Mike Bosse with ideas or feedback.

Specialty Day, March 22, 1998

Welcome -James F. Kellam, MD, OTA President
Prophylasic for Pulmonary Emboli in Orthopaedic Trauma Patients Is Unnecessary
YES James F. Kellam, MD
NO David L. Helfet, MD
Open Reduction and Internal Fixation of Pelvis Is Injurious to Patients
YES John L. Marsh, MD
NO Berton R. Moed, MD
One View of the Cervical Spine Is Adequate to Clear the Cervical Spine
YES Alan M. Levine, MD
NO Paul A. Anderson, MD
Non Life Saving Orthopaedic Surgery in the First 24 Hours of Care Kills Patients
YES Michael J. Bosse, MD
NO Kenneth D. Johnson, MD

Orthopaedic Trauma Association Highlight Papers
Moderator: Thomas F. Varecka, MD

Edwin G. Bovill Award Presentation

OTA Business Meeting - Introduction of New Members

Presidential Guest Lecture:
What is an Orthopaedic Surgeon in the Twenty-first Century?
Edward N. Hanley, Jr., MD

Panel discussion: Managed Care and Trauma

Upper Extremity Fracture Symposium
Moderator - Mark Vrahas, MD
Distal Radial Fractures - Who Needs Surgery?
Jesse B. Jupiter, MD
The Radial Head - To Save Or Not?
Michael McKee, MD
Arthroplasty for Elbow Fractures
Shawn O'Driscoll, MD
Humeral Shaft Fractures - What about the Nail?
Barry L. Riemer, MD

Minimally Invasive Fracture Surgery
Moderator - David Helfet, MD
Arthroscopy and Its Role in Fracture Care
Kenneth Lambert, MD
Indirect Reduction: The Why and the How
TBD
Percutaneous Plating Techniques
Roy W. Sanders, MD
The Future

Please assist us in gathering data with which to develop guidelines for designing an orthopedic trauma service.

Institution:
Hospital size: __________ beds.
Location: urban suburban rural
Population service area: 100,000 - 200,000; 200,000 - 600,000; >600,000;
Trauma center level: I II III Designated by: State ACS Both Neither
Emergency dept. visits per year: 10,000 - 30,000; 30,000 - 70,000; 70,000 - 150,000; >150,000
Total trauma admissions per year: <500 500 - 2000 2000 - 20,000 >20,000
Total orthopedic trauma cases per year: <300 300 - 600 600 - 2,000 2,000 - 10,000 >10,000
What percentage are high energy, or multiply injured or high grade open fractures vs. isolated?

Type of hospital: Private non profit Private for profit Public University
Do you have orthopedic residents? How many?
How many orthopedic surgeons do you have on your hospitals orthopedic staff? _______
How are they organized? (example: multiple private groups, single private group, single academic department, etc.)

How many of these surgeons take trauma call?_______
How many of your orthopedic surgeons are trauma fellowship trained? _______
How many full time orthopedic trauma surgeons are on staff?_________
How many of your orthopedic surgeons are salaried by the hospital? __________
How many of your orthopedic surgeons are salaried just for orthopedic trauma? ______

Do you have an orthopedic trauma service? ______
Do you have a separate financial arrangement with your orthopedists for taking trauma call? (e.g. contracts; guaranteed minimum reimbursement for trauma procedures; educational stipends for taking trauma call; income sharing; staff orthopedists are salaried employees with incentives for taking trauma call; etc)

Do you have a staffed operating room on standby 24hrs a day for trauma cases?
At what distance is the nearest level I or Level II trauma center?
How are trauma patients assigned in your hospital? (e.g. whoever is on call vs. subspecialty expertise)

Do you have an orthopedic trauma service director? _______
If so, what are the duties and function of that position?

What is the number and funding source of non-physician staff (PAs, nurses, nurse- practitioners, etc) of the Orthopedic Trauma Service?