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Annual Report 2018

Download the annual report 2018 as a PDF here. All basic information will be found in the document.

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Today the AO is the leading innovator in the surgical treatment of bone fractures and disorders. Innovation at the AO goes from bench to bedside, including basic research and innovation, product development, and clinical validation.

Innovation at the AO has remained the same, finding solutions to clinical problems—meeting patient treatment needs. What has changed is implementation and the way that innovation is moving forward.
Robert McGuire, President, AO Foundation

At the core of the AO's innovations and approvals process is the AO Technical Commission (AOTK) System. A key part of developing and bringing innovations to market, the AO Technical Commission is central to the AO landscape. It plays a crucial role in quality control and product development, forming an essential link between AO Clinical Divisions, the other institutes, and the AO's global network.

AO Foundation President-Elect Florian Gebhard on innovation

To be an innovation leader in the treatment of trauma and musculoskeletal disorders, the AO itself must be willing to change, develop, and innovate. It is this willingness that will ensure it retains not only its leadership position on the market, but also its long-term relevance to the broader community.

You must know everything in your field, and then you must have a brilliant idea.
AO Foundation President-Elect Florian Gebhard

AO Technical Commission approvals in 2018

In 2018, the AO Technical Commission approved a suite of products that will benefit patient outcomes across all areas in which the AO is active.

Within the AO Technical Commission Trauma, the most recent innovation from the Intramedullary Nailing Expert Group (INEG) is the Femoral Recon Nail (FRN), which enables surgeons to treat a broader range of complex femur fractures in adults and adolescents. It is an advance from previous models; thanks to its enhanced anatomical fit, it allows different surgical entry points and offers a reduced risk of distal cortical impingement.

The FRN comes with streamlined insertion instruments that help ensure that it is correctly placed and that reduce the length and complexity of the surgery involved. This nailing system is the result of six years of intense development in direct response to identified clinical needs and offers real benefits to patient care worldwide.

In 2018, the AO Technical Commission continued its focus on continuous compression implants used in musculoskeletal fixation made from nickel titanium alloy, Nitinol. Nitinol displays super-elastic qualities and shape memory effect; this rubberlike elasticity means Nitinol products offer unique benefits in their medical application to treat fractures. Limited AO Technical Commission approval has been given to the first Nitinol Staples products: Speed, Speed Shift, Speed Arc, Speed Titan, Speed Triad, and Elite.

The Veterinary Expert Group has developed a new plate solution, the Equine T-Plate, for the treatment of physeal fractures of the proximal tibia in foals. The AO Technical Commission-approved locking compression plate (LCP), Equine T-Plate, is an optimum approach to treating active foals and is available in a range of sizes. Among its advantages are versatility: It can be used to treat other injuries of the long bones.

Two new products for CMF treatments were also approved in 2018. The first was a support system to help surgeons plan treatment using patient specific implants (PSI), with patient outcomes at the forefront of this work to improve clinical reliability and workflow efficiency. This includes technique guides and an integrated 3-D virtual approach to the online designing process of TruMatch PSI products.

AOCMF Course—Advances in Medical 3D Planning and 3D Printing
AO CMF Course—Advances in Medical 3D Planning and 3D Printing

The second is the RAPIDSORB Injectable Polymer System (IPS) which has been developed to offer a faster alternative to the fixation of resorbable plates with resorbable screws. This second-generation IPS has been successfully updated to offer greater usability, simplifying fixation to just two steps: drill and fill. It is intended for non-loadbearing applications of the craniofacial skeleton in the pediatric and adult population.

Increasing demand for solutions to improve minimally invasive surgery (MIS) on the spine has led to AO Technical Commission Spine's launch of two new products that help clinicians improve patient outcomes in the treatment of low back pain through fusion surgery. The first is VIPER PRIME, an innovative all-in-one instrument system that eliminates the need for guidewires, Jamshidi needles, and additional pedicle preparation instruments in minimally invasive spinal fusion surgery.

Its unique feature, the self-starting screw tip design and a stylet fully controlled by the screw driver, allows safer procedures and reduces the time needed for these procedures by 33%. Over 1 million cases of lower back pain are treated with fusion surgery around the world each year.

The second is the CONCORDE Clear MIS Discectomy Device. This tool specially designed to enhance MIS discectomy procedures will provide for more efficient disc clearing and endplate preparation in less time than using standard discectomy tools. Surgeons will be able to quantify and estimate the volume removed during the procedure. In 2018, an estimated 140,000 discectomies were performed alongside interbody fusion procedures across Europe, Middle East, and Africa; an increasing proportion of discectomies are minimally invasive.

Individualized treatment pathways

In 2018, the AO Research Institute Davos (ARI), with AO Technical Commission and AO Development Incubator support, continued its development of the AO Fracture Monitor, an implantable biofeedback sensor device for the continuous monitoring of fracture healing status, patient compliance, and the early detection of delayed healing or non-union.

Innovation from the anti-infection task force

Since its inaugural meeting in August 2016, the Anti-Infection Task Force has focused its efforts on pioneering work to improve the diagnosis, prevention and treatment of infection. Chaired by Prof. Michiel Verhofstad (Rotterdam, the Netherlands), the AITF comprises global key opinion leaders in the field of infection, including orthopedic and trauma surgeons, microbiologists, infectious disease specialists, and basic scientists.

Fracture Related Infection (FRI) is a significant global problem, compounded by heterogeneity in diagnosis and treatment due to the lack of evidence-based guidelines. Members of the AITF saw a clear opportunity to address these clinical problems by leveraging the AO's reputation and global reach to bring together key opinion leaders to reach a consensus on the requisite clinical approaches. A broad consensus on diagnosis and treatment principles for FRI was achieved at a meeting held in Zurich, Switzerland in February 2018. Supporting the meeting were 35 experts and key opinion leaders in the field of FRI including trauma surgeons, infectious disease specialists, a plastic surgeon, clinical researchers, and research scientists. Representative organizations included the EBJIS, the Orthopedic Trauma Association (OTA) and the Pro-Implant Foundation.

Recommendations for the diagnosis and treatment of FRI will be published in 2019. Members of the AITF agree that trauma surgeons worldwide need access to a single, reputable site to access these FRI recommendations, and they are looking to develop an app to achieve this aim. The availability of such guiding principles should enable improvements in clinical studies on infection incidence, treatment cost, treatment strategy effectiveness, and patient outcomes.

Members of the international consensus group, Zurich, Switzerland

Identifying and recognizing development potential

AO Trauma's research focus is currently firmly on innovation in education, and in 2018 it established a mechanism by which the application of new technologies in education can be evaluated. New technology and innovative approaches have been incorporated into AO Trauma's Competency Training and Assessment Program which kicked off in 2018.

The AO is constantly looking to identify areas where it can engage with its members, its network, and the broader community to identify and support the development of innovative ideas. In 2018, the first AO Trauma Innovation in Education Award was presented at the AO Davos Courses. It recognized Klaus Dresing and Matthias Süncksen for their work on a virtual reality X-ray simulator. There is no other award in this sector, and this will be awarded annually. This year also saw the launch of the AO Spine Discovery and Innovation Awards.

From left: AO Technical Commission Executive Board US Chair Daniel Buchbinder and AO Technical Commission Innovation Prize winner Karl Stoffel, Basel, Switzerland 2018

The AO Technical Commission Executive Board recognizes individuals or groups for their involvement and innovative contribution to a project. The winner of the 2018 AO Technical Commission Innovation Prize was Karl Stoffel in acknowledgement of his contributions to the Femoral Neck System (FNS) and the Modular Plating System for periprosthetic femur fractures.

The importance of cross-pollination in innovation

The AO's founders understood that the AO is stronger, more innovative, and more likely to succeed when it works collaboratively. The AO's greatest asset remains the breadth of talent and diversity of specialties that it encompasses. Being able to pool resources in this way remains one of the AO's key advantages.

Since the first AO VET courses were offered 50 years ago, AO VET has been integral to these ongoing processes of cross-pollination through the interplay between veterinary and human surgical innovations in the development of solutions for specific patient needs.

Unlike their human health care counterparts, AO VET clinicians and researchers see much greater patient variability even within one species. This is what pushes AO VET to be at the forefront of innovation within the AO.

New frontiers, new formats

In 2018, AO Recon introduced a state-of-the-art Skills Lab to its principles hip and knee arthroplasty courses. As the new practical component of the AO Recon principles course curriculum, it greatly enhances the educational impact by offering the participants a hands-on experience to improve their daily performance in hip and knee arthroplasty surgeries.

AORecon Course, Principles of Total Hip and Knee Arthroplasty
AO Recon Skills Lab station at AO Recon Course—Principles of Total Hip and Knee Arthroplasty in Dubai, UAE

Tasked with developing 3-D surgical videos, AO Technical Commission Executive Board Chair Daniel Buchbinder knew exactly where to go: the Ninth People's Hospital in Shanghai, China. With 16,000 CMF surgical procedures, 100 surgeons, 480 beds, and an even more impressive teaching and training mission, the Ninth People's Hospital was an ideal choice. Filming in 3-D delivers a result that is more realistic and better suited to the demonstration of important procedural steps. Five surgical videos were completed within one week. The videos will be available online in 2019 and will contribute to different education formats (such as the Management of Facial Trauma).

Strength in diversity

Looking to the future, the AO is eager to recognize and respond to the needs of younger generations of health care professionals. A diversity initiative, in which AO VET and AO CMF play a key role, was kickstarted in 2018. Recognizing the large number of women graduating from veterinary and medical schools today, the AO is determined to ensure that there are no barriers to entry or promotion of women up through the organization.

More on innovation at AO in 2018

Innovational Skills Lab upgrades global arthroplasty education

Surgeon's innovation comes to life thanks to AO Development Incubator expertise

Inspired by our past looking to the future