A global network of surgeons

Annual Report 2011

Table of contents
Our vision is excellence in the surgical management of trauma and disorders of the musculoskeletal system. Our mission is to foster and expand our network of health care professionals in education, research, development, and clinical investigation to achieve more effective patient care worldwide.
Editorial Letter from the President and the CEO and Vice-Chairman of the AO Foundation Feature storiesa unique global network of surgeons The AOs continuum of excellencefrom innovation to education, patients are the focus At the front line of innovationTK System a unique source of strength to industrial partners Fellowships are a link for lifeexperience informs surgeons practices long after return home Course numbers increase annuallymore surgeons and ORP get an AO education every year

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AO Specialties
AOTraumaa unique community for better trauma care AO SEChaving an impact in French-speaking Africa AOSpinethe largest global network of spine care professionals AOCMFsetting the global standards in education and research AOVETgrowing its education and research activities 16 22 24 28 30

AO Service Units
Education technical innovation drives new delivery channels Research and Developmentbuilding an international reputation for excellence Exploratory Researchthe skill base for next-generation knowledge TK Systemcelebrating 50 years of success Clinical Investigationa leader in evidence-based clinical trials 33 34 37 38 40

Governance
Governancerequires good corporate governance Financestrategic priority setting becoming visible in financial terms Governing bodies of the AO Foundation Addresses 41 42 46 48

Annual Report 2011 Editorial

Letter from the President and the CEO and Vice-Chairman

Dear colleagues and friends, On April 29, 2011 our longstanding industrial partner Synthes announced a merger with Johnson & Johnson. The antitrust authorities in the US and EU have started their in-depth review process and we were consulted with regard to the AOs relationship with Synthes and what impact it might have for the enlarged partnership with Johnson & Johnson. The formalization of this deal is expected to occur during the first half of 2012. Originating from a unique relationship with the AO Foundations farsighted and innovative surgeons, Synthes has developed into a highly competitive multinational company. Totally independent and surgeon-driven, the relationship between the AO and Synthes has been mutually beneficial and of particular benefit to the improvement of patient care. The AO can be extremely proud of its achievements which have been recognized worldwide. Synthes will continue to operate as a discrete entity within Johnson & Johnson and our contractual relationship with Synthes has been extended until 2016. We look forward to a continued good relationship with Synthes while acknowledging that any change brings with it new challenges and opportunities. We may have a larger scope to our activities in the future as a result of this change and have already greatly benefited from the higher value of our investments. The AO has, to date, enjoyed a friendly, largely informal, and generous relationship with Synthes but now we need to prepare ourselves for a new environment. Johnson & Johnson is focused on governance and compliance and, although the organization highly appreciates the reputation and work of the AO, will be less directly involved in our daily activities and will require apparent value for money in this relationship. This new situation obliges us, in our own best interests, to revisit and adjust our internal governance structure for best practice and to review the cost effectiveness and efficiency of our activities to justify value for money to our partners while identifying opportunities for the AO Foundation. The time has come to make these adjustments and then reflect on how our vision and mission can be applied to new areas. Such new fields could be developing new clinical divisions as well as a more direct involvement in developing countries and disaster relief activities. This in turn will improve our brand and reputation further. The year 2011 heralded a new era in the AOs history through this announced merger; 2012 is the year to prepare the AO for this new situation. Our four Specialties have continued to develop intensively: increasing the number of courses on offer, developing specialized curricula and implementing state-of-the-art technologies to deliver world-class teaching. Interdisciplinarity means that Specialties cannot be active in a service field on an individual basis. Clinical divisions formulate common proposals for central topics in research, development, education, and clinical investigation. The AO Foundation is the umbrella brand and, with the common values, acts as a mothership for all Specialties. With this approach the AO has achieved a worldwide reputation as an exceptional global network of surgeons, researchers, and operating room personnel (ORP). The AO has more than 50 years experience delivering high-quality medical education, educating more surgeons and ORP than any other institution in the musculoskeletal field. Since 1960 more than 400,000 surgeons from 124 countries and 160,000 ORP from 74 countries were educated. The year 2011 proved the most successful year to date in the history of AO Education; 694 courses were offered
Norbert Haas and Rolf Jeker

by the four Specialties around the world, an increase of 12.4% on 2010. The AO continues to be active on all continents with increased coverage in Asia Pacific, Latin America, and the Middle East and Africa, following an international trend of growth in the regions. In particular the AO Foundation Davos Courses in December were a great success with nearly 1,700 participants and more than 400 faculty, underlining the importance of Davos as the epicenter of the AO Foundations activities. The AOs Technical Commission System (AOTK), which continues to increase its focus on cross-Specialty fertilization and strategic approaches to innovative treatment options, celebrated its 50th anniversary. With evidence-based research becoming more important, AO Clinical Investigation and Documentation (AOCID) enables us to position ourselves successfully with respect to the competition in this field. In the future, no new technologies or implants will be licensed or paid for by health insurance funds without the necessary evidence. We have the advantage that new developments, which are initiated by our physicians and worked on in collaboration with our partners in industry, are always accompanied by evidence-based research and clinical documentation from the outset. To ensure the highest possible standards of all research supported by the AO Foundation, it was decided that the tasks of reviewing and making funding decisions must be kept strictly separate; thus the AO Research Fund became the AO Research Review Commission in January 2011. In conclusion, we would like to express our gratitude to our volunteer officers for their enormous commitment to spreading the AO Principles, our employees for their dedicated work, and our partners for their loyalty over the past years. Sincerely,

Norbert Haas President of the AO Foundation

Rolf Jeker CEO and Vice-Chairman of the Board of Directors (AOVA) 3

Annual Report 2011 Excellence

The AOs continuum of excellence

From innovation to education, patients are the focus
With continuous, evidence-based advancement of patient care at its core, the AO Foundation represents a continuum of excellence in education, research, development and clinical investigation. Across four dedicated clinical divisionstrauma, spine, craniomaxillofacial and veterinarythe AO is an unparalleled asset to its stakeholders who range from surgeons and operating room personnel (ORP) to industrial partners and, most importantly, patients. The AOs service units support the Specialties medically-guided development of techniques and medical devices, research, and education to improve patient care in musculoskeletal trauma and orthopedics. Every innovation at the AO addresses clinicians needs. With a growing global base of expert, volunteer surgeons and ORP actively engaged in patient care, research, and teaching, the AO operates a strategically-aligned value chain. New development originates with clinical work that has critical links to exploratory research and applied/translational research, clinical investigation and regulatory approval, and continuing medical education. The AOs community of surgeons and ORP, with more than 10,000 members, is a precious resource. Passionately focused on improving fracture care, clinicians advance the AO Principles not only in their own practices but as experts in the AOs Technical Commission System (AOTK), a surgeon-driven and -controlled technique development by independent medical professionals with international reputations. These experts guide the development and clinical testing of new techniques, implants, and instruments in collaboration with industrial partners. This community also drives AOs research activities, and acts as AO course faculty members. In 2011 the AO delivered 694 courses to 38,811 participants in Asia-Pacific, Europe, Latin America, the Middle East and Africa, and North America. In the same year the AO offered more than 350 AO Fellowships through the four AO Specialties, the AO Research Institute Davos (ARI), and AO Clinical Investigation and Documentation (AOCID). Each course and AO F ellowship improves patient care through knowledge transfer, expands the AO network, and sets the stage for the next generation of AO education, research and innovation. AOCID supports this through an active knowledge gained working with more than 280 partner clinics worldwide.

AO faculty member, Prof Norbert Sdkamp, delivering high-quality medical education at state-of-the-art facilities

Annual Report 2011 TK System

At the front line of innovation

TK System a unique source of strength to industrial partners
The TK System (AOTK) is at the front line of the AO Foundations mission, driving the evolution of surgical techniques and medical devices and expertly guiding the development and testing of the new implants and instruments that support them. That surgeon-driven, evidence-based approach to development makes the AO an uncommonly authoritative asset to its industrial partners, say the AO clinicians and research scientists innovating on behalf of patients worldwide. The TK Systems uniqueness is that it is comprised of an international community of expert AO surgeons contributing their knowledge and first-hand clinical experiences to advance the development of new reduction and fixation techniques, said Prof Norbert Sdkamp (University Medical Center Freiburg, Germany), Chairman of the AOTK (Trauma) Upper Extremities Expert Group (UEEG). An early example of the AOTKs power to advance the treatment of trauma patients was the standardization of techniques and tools to fix fractures, he said. The AO Foundation and the AOTK changed all that through standardization of medical education, surgical techniques and instruments, Sdkamp said. This is a worldwide success story of the value AO clinicians and scientists bring to industrial partners. A similar, recent success story is AOTKs role in the development of the MultiLoc Proximal Humeral Nail (MultiLoc PHN) with multiple locking options for the reduction and fixation of simple and complex fractures. Prof Stefaan Nijs (University Leuven, Belgium), a member of the UEEG, said his work on the MultiLoc PHN is motivated by a commitment to his patients. The UEEG deals with the clinical problems that I confront daily and it is an opportunity to contribute something of value to my patients and to patients worldwide, Nijs said. The MultiLoc PHN makes it easier for me to treat three-fragment fractures with no soft tissue damage. I see earlier recovery of simple fractures and, for very complex fractures, fewer osteosynthesis failures. The patient benefits are the real payoff.

Prof Stefaan Nijs using the MultiLoc PHN on a patient in his operating room in Leuven , Belgium

Annual Report 2011 TK System

story continued
Prof Martin Hessmann (Medical Center Fulda, Germany), Medical Leader for the MultiLoc PHN project, and a member of the Intramedullary Nailing Working Group, agreed. We really are on the front lines of solving clinical problems, he said. Most surgeons do not have a chance to influence product development nor, in most cases, does industry have access to the array of expertise and resources the AO offers. This is the first nail that provides good support to the calcar area, and a good example of the direct patient benefits that come from collaboration between AO surgeons, research scientists, and industry. The world-class AO Research Institute Davos (ARI) adds a broad range of expertise from cell biology to biomedical testing of products as a service to the process. As a scientist, I have a role in advancing solutions that will improve patients quality of life through the mechanical and biomechanical testing of implants under development, Markus Windolf, Senior Project Leader, Biomedical Services, at ARI said. In 2012, the development process is poised to advance even further by instituting small case studies to more quickly gauge the success of techniques arising from the TK System. Due to todays regulatory environment, it is quite difficult for our industrial partners to get information about how an implant performs in a patient, said Prof Tim Pohlemann (Saarland University Hospital, Homburg, Germany), Chairman of the AOTK (Trauma) and the supervising TK Executive Board. Small case studies conducted in collaboration with AO Clinical Investigation and Documentation (AOCID) will quickly give us data that our industrial partners can use to fast-track improvements to existing products, for example, and shorten the gap between product development and patient care. Small case studies are one way of triggering faster evidencebased improvements to implants, Pohlemann said, and another way that we put our patients first.

Markus Windolf and Boyko Gueorguiev discussing the MultiLoc PHN test setup at the ARI biomechanical testing facilities

Annual Report 2011 Fellowship

Fellowships are a link for life

Experience informs surgeons practices long after return home
AOTrauma Fellowships are not for the faint hearted. For the fellows, the experience can entail long days, a steep learning curve, and four to eight weeks away from his or her practice. For AO surgeons at AO Fellowship Centers around the world, it means teaching while caring for patients, and all of the related preparations. In the final analysis, though, both fellows and their supervising surgeons say the fellowship experience improves the way they care for patients and reinforces their bonds to the AO and one another. Armenian traumatologist and orthopedist Dr Karen Azizyan was one of 162 AOTrauma Fellows from 41 countries in 2011. His six-week International AOTrauma Fellowship at Kantonsspital Graubnden in Chur, Switzerland, has motivated him to act as an ambassador for the AO community. There is no AOTrauma in Armenia so, since 2009, AOTrauma in Georgia has allowed me to take part in their Principles Courses and seminars, he said. It was at one such course that Azizyan met Prof Thomas P Redi, one of the AO Foundations founders. Inspired to apply for an International AOTrauma Fellowship, Azizyan chose Kantonsspital Graubnden due to its ties to Redi. In Chur, Azizyan practiced under the direct guidance of Prof Christoph Sommer, Co-Chief of Surgery and Head of Trauma Surgery. Ive dreamt of having this opportunity since beginning my career, Azizyan said. The AO is the only international institution that offers young traumatologists such a unique opportunity to explore the subtlety of our complex profession. My AOTrauma Fellowship allowed me to learn and practice many new aspects of modern traumatology and it continues to improve the way I care for patients. I am now committed to developing AOTrauma Principles in Armenia. The value of AOTrauma Fellowships isnt limited to the fellows. Sommer said his role as a teaching surgeon in an AO Fellowship Center allows him to expand his own professional network, become a mentor, and learn about other cultures and ways of treating patients.

Prof Christoph Sommer in his operating room in Chur, Switzerland with his current AO fellow

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Annual Report 2011 Fellowship

story continued
Our fellows come from around the globe, some from countries where they have to solve patients problems with fewer resources than we have here in Chur. Our fellows have taught me some tricks for reducing and fixing fractures, Sommer said. Every fellowship is a chance for us to develop and improve the AOs reputation in the world because our fellows spread the word about the AO when they go home. That was the case for Azizyan, who completed his fellowship at the end of 2011, just as it was the case for Prof Pierre Guy, who took part in an AOTrauma Fellowship in Berlin with Prof Norbert Haas, at the Charit Universittsmedizin Berlin, in 1995. Now an associate professor and clinician-scientist in the University of British Columbias Department of Orthopaedics, Guy said his fellowship was part of a yearlong commitment to gain experience at Europes top trauma centers including time spent learning with Prof Harald Tscherne in Hannover. My AOTrauma Fellowship influences my clinical care, teaching and research, from daily activities of trauma care to morning clinical review of cases, said Guy. The fellowship experience has shaped the opportunities Ive had clinically, academically and personally. The central aim of AO Trauma Fellowships is to improve patient care by instructing fellows on principles, indications, planning, techniques and complications in the areas of trauma and orthopedic surgery performed at the center visited. Guy said there are other benefits, too, including building a network of AO surgeons that he turns to for insights into clinical problems. Just last night, I was emailing CT scans to various AO colleagues and immediately got some helpful responses. The AO network is a presence that will always link us, he said. Wherever we are in the world, we are connected through the AO Principles and our commitment to improving patient care.

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Prof Pierre Guy lecturing to graduate students at the University of British Columbia, Canada

Annual Report 2011 Education

Course numbers grow annually

More surgeons and ORP get an AO education every year

The AO has more than 50 years experience delivering highquality medical education, educating more surgeons and operating room personnel (ORP) than any other institution in the field of orthopedics. Since 1960 more than 400,000 surgeons from 124 countries and 160,000 ORP from 74 countries have been instructed in AO P rinciples. The number of coursesPrinciples, Advances and Mastersdelivered by AO faculty around the world grows annually. The four AO SpecialtiesAOTrauma (including ORP) , AOSpine, AOCMF, AOVET and the AO Socio Economic Committee (AO SEC) increased the number of courses they delivered by 12.3% in 2011 compared with 2010. The significance of this expansion in course-related activities is reflected in increases in numbers of courses offered across the AO regionsAsia Pacific grew by 28.7%, the Middle East and Africa by 14%, and Latin America by 12.6%.

c el mi nn no e o F um ine T rso Ec tte io mi Tra OSp OCM OVE R Pe c AO A A A O So Com a

14

330

122

97

25

79

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courses worldwide

Annual Report 2011 AOTrauma

AOTraumaa unique community for

AOTrauma has more than 50 years experience of innovating in musculoskeletal education, research and community involvement
Rapidly evolving trauma care environment Trauma and orthopedic surgeons are faced with new challenges in their everyday practice. More and more, surgeons, researchers and operating room personnel (ORP) are turning to AOTrauma as a trusted, stable and respected organization, committed to three fundamental values: excellence in trauma care, empowering the next generation and earning trust through transparency and mutual respect. AOTrauma experienced continued growth in its membership in 2011, as an updated and simpler format brought clarity and added value for current and future members. As the practices and needs of trauma and orthopedic surgeons change, AOTrauma recognizes that in order to continue to be successful it must adapt both the assets it offers as well as how they are delivered to the community. The educational portfolio has been expanded, membership benefits revisited, fellowship opportunities substantiated, and access to research grants improved. AOTrauma remains committed to providing excellence based on the main pillars of the AO Foundation: education, research, and community development. As the trauma and orthopedic surgery environments become more complex, AOTrauma proudly delivers trust, value and heritage. The AOTrauma International Board (AOTIB), chaired by Nikolaus Renner (Switzerland), the five Regional Boards, the global commissions, the Country Councils, and the AOTrauma staff remain unwavering in their commitment to the clinical network, officers and faculty. The year 2011 brought clarification, stability and guidance to the Specialty of AOTrauma which was newly-created in 2009. We trust that 2012 will continue in this strategic direction: delivering greater value to the AO Foundation, members, stakeholders, industrial partners, and patients. Transforming adult medical education AOTrauma Education began transforming its thinking, strategy, and portfolio in the year

better trauma care

2011. Up to this point, education offerings had been anchored in face-to-face courses comprising lectures, small group discussions, and hands-on exercises. Today, AOTrauma Education, guided by the AOTrauma Education Commission, targets the evolving needs of its surgeon community by offering a portfolio of education activities and resources for each surgeon group, meeting their requirements at their time and place of need. It is both a strategic and philosophical shift in the three pillars of the education portfolio: faculty development, content development, and delivery of education activities. The Faculty Development Program now includes: Faculty Education Program (FEP), Chair Education Program (CEP) and Regional Education Teams (RET). The Tips for Trainers (T4T) programthat demonstrates best practice to new facultyis part of a comprehensive professional development path for surgeons who want to become long-term members of the AOs elite international faculty. T4T comprises a progression of blended online and face-to-face activities, coaching, and a community of practice-sharing experiences and best practices. A strategic shift expands the AOTrauma Education offerings from traditional face-to-face courses to a comprehensive portfolio of activities and resources that will meet surgeons needs at their time of need. The new educational elements developed will allow practitioners to access education any time, any place but will still retain at its core the face-to-face experiences with the AOTrauma world-class faculty community. The transformation will leverage the latest technologies to support a wide range of just-in-time channels, as well as a wide distribution of live and asynchronous activities to the homes and offices of our community members. Three hundred and thirty AOTrauma courses, including symposia and seminars, were delivered in 2011. More than 20,000 course participants attended these educational activities worldwide.

1 Kodi Kojima, AOTrauma Education Commission Chairperson, speaking at the Davos Courses 2011 2 Nikolaus Renner facilitating at the AOTIB meeting in Davos

1 AOTrauma International Board members meet in Davos

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Annual Report 2011 AOTrauma

Milestone achievements around the world

Clinically-relevant research for improved trauma care Establishing a new Clinical Priority Project (CPP)which tackles the difficult treatment of bone infectionswas the biggest news for AOTrauma Research in 2011. Stephen Kates and his group from Rochester, New York, USA received the CPP funding for the next five years with AO Foundation units, AO Research Institute Davos (ARI) and AO Clinical Investigation and Documentation (AOCID), as partners sharing resources and expertise. Clinically relevant research for better trauma care remains a strategic priority. This is best achieved through well-designed clinical research projects leveraging the support of the global AOTrauma network. The second principal clinical priority is the treatment of fragility fractures which is a growing issue due to aging populations. Various models of orthogeriatric co-management are used globally, but there is no international consensus concerning outcome parameters to evaluate these models of care. A consensus recommendation for the evaluation and comparison of different models of fragility fracture care was defined and submitted for publication in 2011. On the governance front, Frankie Leung from Hong Kong took over as AOTrauma Research Commission (AOTRC) Chairperson in 2011. Since the transition period from the former Specialty Academic Council General Trauma came to an end, the size of the commission was reduced in an attempt to make the governance structure leaner and more functional. Making a difference through Community Development AOTrauma achieved its planned membership target for 2011a 50% increase since its launch in 2010to finish the year with 5,000 members worldwide. While members continue to indicate that they are highly satisfied with the services and benefits of their Specialty membership, AOTrauma remains committed to adapting the service model to meet the emerging needs of its community. A Membership Sponsoring Program was launched in October 2011 to strengthen the ties and the community spirit between mature and developing countries. Raising the AOTrauma profile in 2011 was achieved by: delivering regional courses in Prague, Malta and Dubai; having a strong booth presence at national and international trauma-related congresses and events (DKOU in Berlin, EFORT in Copenhagen, SICOT in Prague and OTA in San Antonio); and demonstrating AOTrauma services and providing members with many positive networking opportunities, for example at the Davos Courses 2011. Europe: transparent succession planning Despite the Eurozone crisis, AOTrauma Europe continued to become a truly integrated regional entity. In March 2011, a country council general assembly facilitated by Paul Szypryt (UK) saw representatives from over 40 European countries agree on a representative voting method. This paved the way for transparent succession planning at the AOTrauma Europe Regional Board. Rami Mosheiff (Israel) was elected Chairperson of the AOTrauma Europe Regional Board and Paul Szypryt was elected Vice-Chairperson. Emanuel Gautier (Switzerland), Education Committee Chairperson, spearheaded the innovative educational concept of Meet the Experts at the European Regional Masters Seminars and Workshops. These teach current concepts at a high level for experienced learn-

Regional activities
ers in orthopedic trauma. Under the direct guidance of course Chairpersons, the 2011 AOTrauma Europe Faculty Event in Davos followed the format established at the 2009 event. This event proved that Europe could come together through education and better learning with the ultimate goal of attracting young faculty. Middle East: the impact of the Arab Spring The Arab Spring uprisings made the course schedule for the Middle East region difficult to guarantee. Still, the AOTrauma Middle East (AOTME) Regional Board and the Education Committee managed to facilitate over 90% of scheduled courses. Dubais AOTME Research Forum in February 2011 attracted many quality submissions. Its objective was to stimulate and educate the AOTrauma community in the Middle East on clinical research. A very wellattended AOTrauma symposium organized in conjunction with the Pan Arab Orthopaedic Association (PAOA) annual meeting was held in Amman, Jordan in November 2011. The continued success of the annual AOTrauma Regional Courses in Dubai reflected the perseverance of the committed faculty and officers from the region.

1 Enrique Quiepo de Llano Jimnez, Marvin Tile, Ren Marti, Thomas Redi at the AOTrauma breakout session at the Trustees Meeting 2 The AOTrauma booth at DKOU in Berlin, Germany

1 Emanuel Gautier, AOTrauma Europe Education Committee Chairperson 2 Use of C-Arm being demonstrated at a regional course

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Annual Report 2011 AOTrauma

Regional activities continued

Latin America: promising indices Fifty AOTrauma courses with close to 3,000 participants took place in AOTrauma Latin America (AOTLA) in 2011, representing a 13% increase in course numbers compared with 2010. In October 2011 AOTLA leaders ran a Research Forum together with representatives from AOTrauma Research Commission (AOTRC), AO Research Institute Davos (ARI) and AO Clinical Investigation and Documentation (AOCID). The objective of this research forum was to demonstrate the need for a regional network of cooperation in clinical trials. Recognition that the mortality for per-trochanteric fractures at the one-year follow-up is between 30 and 40% gave rise to the creation of the first regional multicenter prospective trial in Latin America, supported by AOCID. Although AOTLA had more than 1,000 members in 2011, over 3,000 surgical residents are trained annually in the region. These numbers point to a need for an ongoing strategy to attract the next generation of surgeons to the organization. Fellows were trained at both ARI and AOCID in Switzerland as part of an initiative to nurture surgical talent and encourage them to become members. North America: the momentum builds In 2011, the establishment of the AOTrauma specialty within AO North America (AONA) was completed with Stephen Sims election as Chairperson for a three-year term. Chairs and members for each of the AOTrauma North America (AOTNA) committees were chosen: Mark Reilly, AOTNA Education Committee; Michael Miranda, AOTNA Community Development Committee; Tim Weber, AOTNA Fellowship Committee, and Roy Moed AOTNA Research Chairperson. Committee members were also selected to serve along with each Chairperson. AOTNA increased its focus on faculty development holding their first FEP and CEPs. Sixteen faculty were trained at the FEP held in Chicago in September and eight faculty members participated in the CEP held in Las Vegas in November 2011. AOTNA had a strong presence at the Orthopaedic Trauma Association 27th Annual meeting in San Antonio, Texas in October 2011, with AOTNA and AOTrauma International staff working as part of a joint initiative to spread the AOTrauma message to a wider audience in North America. Asia Pacific: emerging opportunities, continuous growth AOTrauma Asia Pacific (AOTAP) delivered 82 courses in 15 countries in 2011, educating more than 5,400 surgeons and ORP. The Regional Faculty Fellow Program was launched and 16 candidates participated. Forty-nine surgeons and 18 ORP attended four FEPs in China, India and Hong Kong. Fifty regional and international fellowships and seven starter fellowships were granted in 2011. Chris Morrey (Australia) takes over from Tadashi Tanaka (Japan) as the new AOTAP Regional Board Chairperson. Also in 2011 were the first AOTrauma India National Conference (with over 150 participants), the first Chinese Orthopaedic Association/AOTrauma Day (with over 1,000 participants), and the first AOTAP and TK Experts Symposium in Taiwan (with over 180 participants). A wellattended AOTAP Clinical Research Forum was held in Nantong with a seminar and instructional lectures. Ten projects received AOTAP Research Grants in 2011. ORP: an integral part of the surgical team The majority of planned AOTrauma ORP courses were successfully delivered in 2011 despite political and economic challenges. Istanbul hosted the first AOTrauma ORP course ever organized in Turkey. Several ORP participated in FEP and CEP events together with surgeons. Eighteen ORP from eleven countries in Asia Pacific were trained as course faculty following their attendance at an FEP and nine ORP completed AOTrauma ORP Fellowship programs in Europe. Over 1,200 copies of the recently released ORP book were sold in 2011. A video focusing on perioperative preparation of a trauma patient, the first of its kind to be produced by AOTrauma, was created for the ORP audience. In conclusion AOTrauma experienced considerable success, meeting or exceeding its performance goals and continuing to effectively meet the education, research and community development needs of its members. It did so while carefully managing the resources that have been entrusted to it by the AO Foundation. This success occurred in a challenging environment, in which roles, responsibilities, and expectations continue to evolve.

1 The first National Conference of AOTrauma India, attended by Prof Norbert Haas, AO Foundation President

1 AOTAP Pelvic and Minimally Invasive Osteosynthesis Course in Chang Mai, Thailand 2 Practical exercises at a regional course in Prague, Hungary

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Annual Report 2011 AO SEC

AO SEChaving an impact in FrenchInterview with AO Socio Economic Committee (AO SEC) Chairperson John Croser
Projects Africa Cameroon Ethiopia Ghana Kenya Malawi Senegal Tanzania Uganda Zambia Zimbabwe Projects Latin America Brazil Mexico

speaking Africa
in which we work. In the Asia region there has been significant political turmoil in Papua New Guinea and local faculty are no longer able to be contacted. On another note we are now beginning to experience the pains of transition from AO SEC Education to AOTrauma Education in some regions. We always knew that there would be a period of evolution but there remain widely varying standards and resources within the same country and indeed the same region and this makes the timing of transition difficult. In reality it is often necessary to have an overlap of the two systems to ensure that a sector of the community is not disadvantaged. up to this point and that resources are very limited. A lack of access to a x-ray facilities locally is a major limiting factor in successfully treating trauma injuries.
Projects Asia Afghanistan Bangladesh East Timor Fiji India Mongolia Myanmar Nepal Pakistan Papua New Guinea Solomon Islands Sri Lanka

What have been the big success stories for AO SEC in the past twelve months?
AO SEC Africa is becoming more independent and developing its own faculty and course organizers. It has also become the stepping stone for the development of courses in French-speaking Africa (FSA). In December 2011 the first nonoperative fracture management course was conducted in French in Tambacounda, Senegal under the direction of local organizer Abdullaye Bousso and AO SEC representative Prof Sylvain Terver. It was delivered under the auspices of AO SEC FSA and the Orthopaedic Society of Senegal. AO SEC Asia, benefitting from the guidance of Prof Ram K Shah, has organized a number of courses for the first time in the region, including Afghanistan, Sri Lanka and Myanmar. In addition there were seven courses delivered in India and Nepal respectively, four in Pakistan, and one each in both Mongolia and Bangladesh.

Terver joined AO SEC in 2010. It was very important that our entry into FSA be smooth and trouble-free so there was considerable preparatory work completed before education packages were rolled out in the region. Our first priority was to identify key teaching personnel in each of the relevant countries in order to bring them together at a scheduled AO SEC course (in English). This took place in August 2011 in Koforidua, Ghana and at this event the planning strategies for FSA were developed. A second priority was to foster local faculty in all countries to the point where they could become course organizers and maintain the progress of education with minimal external input. This process is working well in both central Africa and northern Asia.

What are your strategic priorities for 2012?

At the AO SEC meeting in Berlin in June 2011 it was decided that the format of the longawaited AO SEC textbook should be changed to reflect more closely the role of AO SEC in developing countries. To this end, the format of the book has been completely changed. The book will now incorporate a number of chapters following the curriculum of the AO SEC nonoperative courses with the content being largely drawn from the highly-regarded AO Foundation education resource, AO Surgery Reference. This format will allow course organizers to select the content of the manual that is used for a given course and once the chapters are in PDF format they can be printed locally. Our second priority for 2012 is to consolidate our foothold in FSA and expand the education program to other centers within countries in that region.

How is the expansion of your mission into West Africa going?

The first French-speaking nonoperative course was conducted in Senegal. There were 25 nominations and a total of 17 attendees from the Tambacounda and Kedougou health regions. The participants were a mix of primary health care nurses and medical officers. It is apparent that the majority of the initial trauma care has been carried out by nurses

1 AO SEC members at Trustees Meeting 2011 in Berlin 2 Prof Ram K Shah demonstrating ex-fix in Yangon, Myanmar

Were there any major disappointments in 2011?

There havent been any major disappointments in 2011 but a number of projects have not been realized and this probably reflects the politically sensitive regions of the world

1 Malawi ORP course tutorial being given in Portugese 2 Plaster application during a non operative course in Ulaanbaatar, Mongolia

What were your strategic priorities?

We have seen the opportunity to extend our activities into FSA come to fruition since

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Annual Report 2011 AOSpine

AOSpinethe largest global network

AOSpine is the leading worldwide academic community for innovative education and research in spine care, inspiring lifelong learning and improving patients lives
Meeting the challenges of the AOSpine network With constant advancement in the field of spine surgery, the main challenge for surgeons today is to keep abreast of the latest breakthroughs and successfully apply this knowledge in their daily practices. To make this task easier AOSpine launched a comprehensive, modular education curriculum in 2011. AOSpine also launched the Knowledge Forums in 2011. Furthermore AOSpine, with the aim of educating, stimulating debate and advancing knowledge about latest developments, organized more than 700 spine care professionals from 72 countries to participate in the 2011 Global Spine Congress (GSC) in Barcelona. With more than 6,400 members worldwide, AOSpine is the largest global network of spine care professionals. The 26% growth in membership in 2011 confirms that AOSpine delivers the value that surgeons, researchers and academics of all ages and expertise levels expect from being part of this leading global academic community. Shaping the future of spine education AOSpine made significant progress in meeting its 2011 objective of delivering the highest quality education to surgeons. This progress was achieved by focusing on the educational integrity of courses, the teaching skills of the surgeons offering the education, and the quality of content delivered. The AOSpine Curriculum The new AOSpine Curriculum was piloted at ten educational courses around the globe. Analysis of pilot results by an advisory group, under the leadership of Germn Ochoa and Bryan Ashman, now guides the broader implementation of the AOSpine Curriculum worldwide. The Davos Courses 2011 saw the first large-scale implementation of this curriculum which provides a framework of competencies and key learning outcomes for several spinal pathologies. The framework guides the delivery of education that meets the needs of spine care professionals at different levels of their careers, enabling them to perform effectively in their practice settings and meet the overall standards of the profession. Delivery of the AOSpine Curriculum is achieved through a combination of face-to-face educational events, distance learning, and self-directed resources, supported by tools that enable measurement of knowledge and skills and the implementation of learning into practice. The quality of AOSpines course faculty is critical to meeting our educational objectives.

of spine care professionals

Following its successful implementation in AOSpine Europe, a new training program for course Chairpersons was adopted for all regions. The program equips Chairs with the skills they need to create and run outstanding courses aligned to the AOSpine Curriculum. AOSpine developed a range of new teaching videos, integrating animation, narration and live surgery with high production values, to enrich course content. Webinars presented for the first time in Europe and North America and new online materials further enhanced course participants learning experiences. Exploratory Research Seven global AOSpine Research Network partners have published 46 peer-reviewed manuscripts (with an average impact factor of 3.5) and delivered more than 130 presentations. Clinical Research The highly regarded Cervical Spondylotic Myelopathy-International Study (CSM-I) has been presented at 20 congresses. The Knowledge Forums (KF) comprise working groups of up to ten opinion leaders in specific spine pathologies aiming to generate and disseminate knowledge by way of clinical studies and publishing of evidence-based recommendations. Three KFs were launched in 2011: KF on Tumor: Clinical studies initiated in 2011: 1) Predictors of mortality and morbidity in the surgical management of primary and 2) Interdisciplinary validity and reliability of the Spinal Instability Neoplasia Score (SINS). KF on Deformity: Supervising the collaboration between AOSpine and the Scoliosis Research Society in a joint multicenter study to evaluate risks associated with Adult Spinal Deformity surgery (Scoli-RISK-1). KF on Spinal Cord Injury (SCI) and Trauma: The first project is to merge data from four of the biggest SCI data collections from the US, Canada, and Europe. This will allow sufficient scientific and statistical power to answer key questions in four focus fields. Experimental Research In 2011, five of the seven Spine Research Network projects, initiated in 2007, completed and four new projects were funded. These newly awarded grants will continue to focus on the regeneration and degeneration of the intervertebral disc; the majority of these are investigating the role of notochordal cells in disc development and how to use stem cells and biomaterial scaffolds for biological repair.

1 Future and current AOSpine International Board Chairpersons Jeffrey Wang and Luiz Vialle 2 AOSpine Europe Chairperson Teija Lund leading a discussion at the GSC

1 AOSpine Research Chair Keita Ito talks to AOSpine Research Manager 2 Global Spine Journal editorial board celebrates the launch of the journal

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Annual Report 2011 AOSpine

Growing the community

A growing global community Further establishing itself as the largest global spine care professional community, AOSpine membership grew by 26% in 2011 to 6,435 members. Members continue to gain value from interactive online case discussions and through established benefits such as the Evidence-Based Spine-Care Journal (EBSJ) and InSpine. A newly launched Global Spine Journal joined EBSJ and InSpine as part of the stable of journal offerings from AOSpine. The Global Spine Journal is an international peer-reviewed quarterly journal which offers readers scientific articles as well as original research, reviews, commentaries, editorials, technical reports, and case studies in all spine fields. The journal aims to promote communications among spine surgeons, orthopedic surgeons, and neurosurgeons by providing an integrated and balanced view of the clinical and basic science studies of spinal disorders. Regional activities North America: dedicated to education and research AOSpine North America (AOSNA) continued to offer unprecedented opportunities in education, research, and evidenced-based patient care advocacy. AOSNA achieved 1,000 members in 2011. Seven continuing medical education-accredited education courses were delivered with Maintenance of Certification sessions, and hands-on labs utilizing human anatomic specimens. AOSNA Research developed specialized Knowledge Forums allowing spine surgeons to ask, and help answer, the major questions confronting the spine Specialty. The SPINE Journal Focus issue on Chronic Low Back Pain, the Young Investigators Awards and several major clinical projects under way offer multiple opportunities for AOSNA members to become actively engaged with the Specialty. Asia Pacific: a year of growth driven by education advances AOSpine Asia Pacific (AOSAP) continued its strong growth, with membership rising from 1,425 members to 2,061 members (a second consecutive year of over 40% growth). Through 34 courses and seminars, 2,250 participants, including many young surgeons, advanced their skills. AOSAP also strengthened its educator base with four Faculty Training and one Tips for Course Chairperson training sessions. AOSAP also established strong cooperation with local spine societies such as the Ho Chi Minh Spine Society, Philippine Spine Society and China Orthopaedic Association (COA). The joint symposium with COA was a major success; more than 650 participants reported that they were highly satisfied with the quality of academic content. Latin America: breaking ground in 2011 AOSpine Latin America (AOSLA) successfully hosted 46 education events, including new courses and seminars in Central America and the Caribbean. Cuba opened its doors to AOSpine for its inaugural seminar, thanks to the efforts of several network members who want to promote and share the knowledge they acquired during AOSpine courses over the years. The Cuban Society of Neurology and Neurosurgery and the Cira Garcia Central Clinic also offered their support. In Research, a call for applications for the 2011 Grants Program was made, awarding funds for projects to be developed over the next two years. New reference centers were approved to assist members who wish to take part in the AOSpine Fellowship and Observership Programs. Europe: reaching for the stars AOSpine Europe (AOSEU) achieved new heights in 2011, serving a community across 47 countries. AOSEU reached over 1,000 surgeons at 40 events and congress symposia

Regional activities
(including cadaveric and live tissue courses). Many faculty completed the new Chairperson training, ready to deliver world-class curriculum-based education. The AOSpine fellowship program was relaunched in 2011, offering tailored education to new fellows. As part of a drive to innovate with new technology, live webinars were introduced in 2011. New officers will be instrumental in building on what has been achieved in 2011 with a first multi center study; regional Knowledge Forums; a first Ibero-Latin America event; and sub-Saharan Africa education. Middle East: going from strength to strength AOSpine Middle East (AOSME) cemented its reputation in 2011 as a leading educational provider for a community spanning 17 countries. A new milestone was reached with more than 300 surgeons participating at education events in five countries. In order to deliver the highest quality education, a new training program for event chairs was implemented, using Educational Advisors and piloting the curriculum. In addition course participants were given hands-on experience in cadaveric courses and live surgery, while a new fellowship program, live webinars and local seminars were all delivered. With a new regional board in place and a growing, engaged presence in all countries, 2012 will see AOSME build on this tremendous progress.

1 AOSNA Fellows Forum in Banff, Canada 2 AOSpine faculty at the Chinese Orthopedic Association Congress

1 AOSpine Course faculty and participant in Davos 2 Reviewing the AOSpine Curriculum at a regional course

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Annual Report 2011 AOCMF

AOCMFsetting the global standards

AOCMF continues to lead in the use of modern computer-assisted techniques to achieve successful patient rehabilitation.
A period of continuous growth Despite turbulence in the global economic situation and political uncertainty around the world, AOCMF expanded its educational activities for the sixth consecutive year, organizing its first global research forum focused on the Clinical Priority Program (CPP) Imaging and Planning of Surgery. AOCMF also saw a growth in membership over the past year. As the term of the current AOCMF Chairperson, Prof Michael Ehrenfeld (Germany), who has led the AOCMF efforts for the last six years, expires in the summer of 2012, AOCMF conducted elections for his successor in November 2011. In a transparent and open election process, Prof Warren Schubert (USA) was elected to the position of Chairperson. The handover of the chairmanship will occur after the 2012 Trustees Meeting in Davos. Education offerings diversify AOCMF increased its educational activities in 2011. It successfully delivered 92 courses for surgeons and 13 for operating room personnel (ORP). This included eleven courses for surgeons and seven for ORP at AO North America. In addition, seven symposia, seminars and workshops were conducted at national and international congresses. This number was achieved despite the unstable political situation in the Middle East that led to some course cancellations. The first AOCMF European Advanced Forum presented and discussed two challenging topics: the construction and reconstruction of the condyle and ascending ramus, and bisphosphonate related osteonecrosis of the jaws (BRONJ). With the success of the first AOCMF Neurotrauma Course in Davos 2010, a major milestone was achieved in terms of the integration of the neurotrauma group within AOCMF. At its inaugural meeting, the AOCMF Neuro Core Group was founded by neurosurgeons from Germany, Spain, Italy, and Austria. This allowed for the repeat presentation of a Craniomaxillofacial Fracture Management course and a Neurotrauma course at the Davos courses 2011. Another first was the use of,Matrix Mandible sets, with the newest plating systems, in the practical exercises for both courses. New teaching videos were produced to support these practical exercises. An indicator of the popularity and importance of AOCMF fellowships to the network was demonstrated by an increase from 29 to 39 in the number of fellowships in 2011. The AOCMF Asian Faculty Forum was held in Hanoi, Vietnam in August 2011. It gave 60 faculty members and guests an opportunity to exchange knowledge and experiences.

in education and research

AO Surgery Reference delivered a cranial/ skull base module in 2011 and CMFline, a CMF clinical evidence database application for the iPhone and Android-based smartphones was launched, providing access to bibliographic information on articles regarding therapy, prognosis, and diagnosis, and enlisting key study results. A growing membership community During 2011, the AOCMF community enjoyed growing international recognition while expanding its membership base to over 1,500 paying members worldwide. The community continues to receive attention from surgeons around the globe. Today, the AOCMF community includes members from 70 countries. The AOCMF Community Development Commission has approved the launch of the new Affiliate Membership Package which will be open to all health care professionals and students who are interested in craniomaxillofacial surgery. AOCMF plans to develop new dynamic programs for membership activities based on feedback from a member survey to be conducted in the first quarter of 2012. AOCMF intends to continue to build on the positive momentum within its community, and to relaunch its portal, welcome new members and include more member benefits in 2012. Significant interest in research activities The first global research forum for all researchers involved in the CPP Imaging and Planning of Surgery was organized in Freiburg, Germany in April 2011. Over 100 participants from around the world participated in this program. This high level of interest encouraged AOCMF to launch an additional call for proposals in this specific area. Twenty-nine applicants submitted pre-proposals, of which nine were then invited to submit full grant applications. Investigators supported by AOCMF in the second research area, Large Bone Defects In Relation To Craniomaxillofacial Surgery presented their results at another important scientific gathering; Where Science meets Clinics, a new conference organized by the AO Exploratory Research Board in September 2011 in Davos, Switzerland. AO Clinical Investigation and Documentation (AOCID) continued to recruit patients for the second year of the three year orbital fracture study and the AO Research Institute Davos (ARI) began initial research work into the topic of BRONJ.

1 AOCMF R&D Commission Meeting, Freiburg, Germany, May 2011

1 AOCMF Community Development Commission Meeting, Prague, Czech Republic, October 2011

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Annual Report 2011 AOVET

AOVETgrowing its education and

AOVETs mission is to advance the practice of veterinary surgery to improve patient outcomes by promoting education and experimental and clinical research and development
Specialty restructuring complete After completing the significant restructuring of AOVET in 2010, 2011 was very successful for the veterinary clinical division. Increasing the number of courses and expanding into new countries and regions continues to be a strategic priority. The new governance structure provides all AOVET officers with clearly defined roles, responsibilities and accountability as well as new interfaces to the AOVET community. As a result of this transparent and lean structure, AOVET has been able to successfully grow its education- and research-related activities. Of particular note is that, with the appropriate resources having been made available, AOVET will expand in the future into Latin America and Asia-Pacific in a more efficient manner. The term of the current AOVET Chairperson, Dr Jean Pierre Cabassu (France), expires in the summer of 2012. In November 2011, AOVET conducted elections to find his successor and in a transparent and open election process, Prof Jrg Auer (Switzerland) was elected as the next AOVET Chairperson. The handover of the Chairmanship will take place after the 2012 Trustees Meeting in Davos. Education leads the way Education is the primary focus of AOVET and the Education Commission continues its efforts to find and create new educational opportunities. To further strengthen this endeavor an official representative of AOVET Latin America joined the Specialty Board and Education Commission in December 2011 ensuring the appropriate communication of the educational needs of Latin America. In addition, at the end of November 2011 a two-day faculty development event was conducted, successfully targeting Latin American faculty with some experience in AOVET. The process of decentralization has been initiated and new regions, such as Asia Pacific and Latin America, will slowly take over the organization of their AOVET educational activities. Australia commenced its activities by delivering a successful Principles in Small Animals Course in 2011. In 2012, an Advances course will be offered as part of a drive to deliver regular AOVET courses in Australia and New Zealand. In Asia Pacific, the courses in Japan are wellestablished and the organization of these courses will gradually be handed over to the

research activities

Japanese AOVET members. The Taiwan and Thailand courses are successful events that need to be offered on a regular basis. The AOVET Fellowship program has been very successfulsix fellows have been offered a stay in AOVET private or academic environments for between one and three months. The Latin American fellows stayed in Italy and Switzerland. Fellows from Europe and India were hosted in the US. One of the important goals of AOVET is to expand fellowships throughout the regions, recruiting new members and potential faculty. There will be new Cadaver Small Animal and Equine Cadaver Maxilla Masters Courses offered at the AO Foundation Davos Courses 2012 while a Principles Small Animal Course in South Africa is being offered for the first time under new management. In Beijing, an inaugural course will also be delivered. The goals of the Education Commission for 2012 are to increase the number of courses, expand in new countries and regions, and establish the AOVET courses as the orthopedic education platform for all specialist veterinary training.

Research initiatives under way Under the direction of Prof Carl Kirker-Head, Chairperson of the AOVET Research and Development Commission, focus topics for future research initiatives were defined. Based on these topics, a first call for research and development pre-proposals was conducted in 2011, resulting in 22 proposals being submitted in the fields of biomechanics of the spine, joint biomechanics and implant design biomechanics. Of these, seven were invited to submit full proposals. Community Development continues to make great strides Under the leadership of Dr Alessandro Piras, the AOVET community endeavors to deliver significant value to its active, contributing members while offering clear and transparent career opportunities for young members. As a result, the AOVET membership grew to more than 600 members in 2011.
1 2

In 2011, a redesign of the existing AOVET portal was delivered and in 2012 a new portal will be launched. A major member benefit that will be on offer when the new portal launches an AOVET Case Discussion Forum.

1 AOVET participants at the Davos Courses 2011 2 AOVET Specialty Board Meeting in Boston

1 AOVET member Ricco Vannini in his clinic in Zurich, Switzerland 2 AOVET participants at the Davos Courses 2011

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Annual Report 2011 Service Units

Strategically aligned value chain

Service Units pursue excellence in patient care
The key focus of AO Service Unit activities is to produce new concepts for improved fracture care, deliver evidence-based decision making, and guarantee rigorous concept and product approval as well as timely and comprehensive dissemination of knowledge and expertise. The following eight pages offer insights into the core processes and activities undertaken by the AO Service Units in 2011. Mobile applications boost usage of AO Surgery Reference The introduction of the AO Surgery Reference (AOSR) iPhone app at the end of November 2010 boosted the overall usage of AOSR stronglyby 52% to 62,615 visits in the following month alone. The great success of this iPhone app led to the development of a version for Android-based smartphones which was launched in August 2011. While the Android app is currently being downloaded at a rate of 70 per day, the iPhone app still dominates with almost 130 daily downloads. Overall AOSR apps were downloaded 72,812 times until end of January 2012. Interestingly enough, AOSR is now accessed more often via mobile devices than via the standard PC/laptop version. Nevertheless, it was not only the launch of mobile versions of AOSR that caused a major boost in usage; the number of visits to the standard PC/ laptop version increased from 44,698 in January 2011 to 70,824 by the end of the year and it is currently visited almost 5,000 times a day. AO Books go digital E-books delivered to consumers in a variety of digital formats through different e-platforms are becoming very popular. During the past six months, all AO books have been converted into e-books and today, 90% are available at the Thieme e-Book Store (http://ebookstore. thieme.com). Each electronic book retains the high-quality illustrations and photographs of

Education
Technical innovation drives new delivery channels
the print version. The Thieme e-Book Store offers users the option to read purchased books both online and offline on their personal computers (PC or Mac). An iPad app to be released in spring 2012 will allow all books purchased from the Thieme e-Book Store to be read on an iPad. Over the next six months, AO books will be converted into additional electronic formats suitable for various reader devices. They will also be made available from other e-book stores, such as Google e-books and the Apple App Store. AO at leading medical education meetings AO Education was invited to present educational research projects and initiatives at various medical education meetings in 2011. Members of the AO Education Faculty Development Program team presented their work at the First International Conference on Faculty Development in the Health Profession in Toronto, Canada in May 2011 to 350 participants from 28 countries. Meanwhile two oral presentations and two poster presentations were accepted at the 16th Global Alliance for Medical Education Conference in Munich, Germany in June 2011. Accepted in peer-reviewed journals were three submissions focusing on the barriers to transferring learning into practice research project, the use of interactive videos in medical education, and the development of assessments in the orthogeriatric program of AOTrauma.

AO value chain

Exploratory research Clinical work

Education

Applied/translational research

1 Mobile and PC download figures for AOSR from 2007 to 2011 2 Pages from an AO e-book on the Thieme e-Book

Mobile and PC download figures for AO Surgery Reference from 2007 to 2011

Approval

Clinical investigation
# daily visits (averaged)

5000 4000 3000 2000 1000 0

Mobile PC/Laptop

2007

2008

2009

2010

2011

2012

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Annual Report 2011 Service Units

Research and Development

Building an international reputation for excellence
Funding The AO Research Institute Davos (ARI ) was awarded two new European Union Framework Program 7 collaborative grants in 2011, to add to the two awarded in 2010. FP7 grants are considered the elite grants in Europe. Together with a grant from the US National Institute of Health, awarded in collaboration with Prof Chris Evans of Harvard University (US), they demonstrate the high international academic standard achieved by ARI. The institute was awarded nearly 3 million CHF extramural funding in 2011, a 33% increase on its 2010 level of extramural funding. In addition, ARI was awarded a grant for 632,000 CHF by a Swiss foundation for innovation, research and development (Innovationstiftung Graubnden). This funding was used for a new fluorescence-activated cell sorter which greatly increases ARIs capabilities within the cell and stem cell research field. Appointments In 2011 Prof Mauro Alini (Head of Musculoskeletal Regeneration Program, ARI) was elected President of the Swiss Bone and Mineral Society. As further society recognition, Prof Geoff Richards (Director, ARI) will chair the Infection Topic Committee for the Orthopaedic Research Society for a term of two years. Richards co-organized a Basic Science Focus Forum (BSFF) at the 2011 Orthopaedic Trauma Association (OTA) annual conference in San Antonio, Texas and co-organized a BSFF OTA session in Baltimore 2010, thus increasing the important collaboration between AO and OTA. In 2011 Richards was also appointed to the Executive Committee of the European Orthopaedic Research Society. Markus Wilke started in September as the new ARI Preclinical Services Program Leader and veterinary surgeon along with manager of AO GCTM Preclinical (Global Clinical Trials Management). Wilke is tasked with moving the facility into Association for Assessment and Accreditation of Laboratory Animal Care and Good Laboratory Practice accreditation along with running all preclinical surgeries. eCM Journal eCM True Open Access Journal, published by AO Research Institute Davos, maintained its lead in the field of musculoskeletal research, achieving an outstanding impact factor of 9.65. eCM was the first scientific journal with transparent review process and governance, including a transparent route to becoming a member of the Editorial Review Board. Publications ARI published 43 peer-reviewed papers in 2011 with an average impact factor (IF) of 3 (our highest average IF to date). As comparative benchmarks, the Journal of Orthopaedic Research (a peer-reviewed medical journal of orthopedics published by the Orthopaedic Research Society) has an IF of 2.976 and Injury (an international journal dealing with all aspects of trauma care and accident surgery) has an IF of 2.269. The reduction in actual number of papers written (originally an average 60-70 annually) is due to the delayed effect of a decrease in total full-time employees and a reduction in funding when the AO Development Institute merged into ARI. On top of the peer-reviewed papers, twelve book chapters, six of which were included within a book edited by Dr Martin Stoddart (Principal Scientist, ARI) on Mammalian Cell Viability, Methods and Protocols (Springer), were also published by ARI in 2011. International Awards David Eglin (Principal Scientist, ARI) has been awarded the 2011 Jean Leray Award by the European Society for Biomaterials. This annual award is given to a researcher under the age of 40 who has demonstrated distinctive achievement and insight in biomaterials research. The award was presented after his keynote speech at ESB2011, Dublin, Ireland. Playground for surgeons A team at ARI, led by Romano Matthys, worked with Emanuel Gautier (a former AO M edical Research Fellow at the ARI with Prof Stephan Perren) on a concept Playgroundfor Surgeons. The playground is a technical hands-on training kit developed for trauma surgeons to develop their skills by practicing specific surgical techniques. It is an innovative way to enhance knowledge about the underlying principles by enabling surgeons to get a feeling for various surgical techniques. In 2004, the playground was launched at a First Swiss Residents Course, Davos. Since then it has been run during various Specialty courses by ARI staff. At the end of 2011 the developed system was passed on to AO Education along with resources and staff so that it may be integrated fully into AO Educations portfolio. ARI is very proud of this success, which enhances the educational offerings of the AO Foundation with a component that is very unique and practical. ARI spin-off The AO Foundation, together with Romano Matthys, started a spin-off from the RISystem developed over the last decade within ARI. The RISystem are standardized defined and reproducible micro implant kits/systems with reproducible biomechanics for research in bone biology with small animals (mice, rats and rabbits) from locking nails, to internal (stable and non-stable) fixation, to external fixation and distraction systems. The website of this new venture is www.risystem.com.

1 MouseFix plate from RISystem 2 Demonstrating biomechanical testing to Ralph Eichler, President of ETH Zurich 3 Markus Wilke (ARI) at work

1 Working on the playground during an AOVET course in Davos 2 Romano Mattys and Reto Nuetzi with the RISystem

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Annual Report 2011 Service Units

Research Review
An independent peer review process
AO Research Review Commission AO Start-Up Grants To ensure that the highest possible standards Following the rule that reviewing and funding are achieved in the research supported by the must be kept strictly separate, the Academic AO Foundation, it was decided that the tasks Council established the Academic Council of reviewing and making funding decisions Grant Committee, in which all Specialties, as must be kept strictly separate; thus the AO well as the AO Exploratory Research Board, Research Fund became the AO Research are represented. This committee acts as the Review Commission (AORRC) in January funding body for the AO Start-Up Grants. In 2011. An independent peer review process 2011, 97 Start-Up Grants were proposed, and was implemented to meet international a total of 22 projects approved for funding. standards of impartiality and expertise, a process Approved projects in 2011: defined in collaboration Number Amount with the AO Foundations Subject of projects in CHF 1000 % funding bodies. A pool of Biomaterials/Metallurgy 3 172 12.9 over 450 experts currently Biomechanical fixation 1 60 4.2 provides independent, exBiomechanical general 1 49 4.2 Biomechanical joints 2 178 3.2 ternal review. This expert Bone healing 6 544 50.3 pool ensures that all AO Clinical 5 226 11.8 research projects are asImplant development 1 57 4.3 Spine 2 90 6.3 sessed and evaluated by Tissue reaction 1 44 1.2 experienced reviewers who are experts in their Total 22 1, 420 100 chosen fields. In this way, the AO Foundation can continue to develop and support the most Berton Rahn Prize Award innovative and clinically relevant projects Each year the best AO Start-Up Grant project possible. Each of the 212 submitted grant is awarded the Berton Rahn Research Fund proposals were independently reviewed by Prize Award. After a rigorous evaluation at least two external experts, and then con- process, Bingyun Li (US) was awarded the solidated by a composite reviewer. The AORRC 2011 prize for his project, A pilot study of discussed all grant proposals and reviews, re- interleukin-12 local delivery for infection sulting in recommendations to the relevant prevention after a traumatic open fracture funding body. (Project F-07-43L).

Exploratory Research
The skill base for next-generation knowledge
The first Where Science meets Clinics (AOERB) invests in consortia of international symposium research teams working collaboratively toIn September AO Exploratory Research wards innovative solutions to clinical prob(AOER) successfully launched its first inter- lems. The aim of CRPs is to achieve proof of national symposium, Where Science meets concept of novel, clinically applicable strateClinics, 2011 at the Congress Center in Davos. gies within six to eight years and to facilitate The event is dedicated to bringing together sci- translational research of AO Specialties. entists and clinicians from multidisciplinary environments with the aim to stimulate The solid footing of the CRP concept was exchange and collaborations. More than 100 confirmed in April 2011 when two new CRPs researchers and clinicians from around the Acute Cartilage Injury and Annulus Fibrosus world joined this first symposium to share Rupture, were added to the well-established their respective achievements, challenges, CRP Large Bone Defect Healing. In early and latest progress in the fields of bone, in- September all research partners, the AOERB tervertebral disc and acute cartilage repair and members and advisors came together in Davos regeneration. for the Annual Program Meetings. The individual meetings were open to participation by AOER lived up to its mission of fostering and all partners, which was highly welcomed and expanding a network of scientific profession- appreciated, resulting in considerable crossals looking for novel approaches and theories fertilization and sharing of knowledge and to solve major clinical issues. The interactive expertise between the three CRPs. sessions during the symposium promoted a significant volume of exchange and collaboration. The overall feedback on the Annual Program The feedback was very positive and many of Meetings was very positive. The interactive the participants expressed their intention to re- style, the ample post-presentation discussions turn to Davos in September 2013 for the second and exchanges during breaks were found to Where science meets clinics demonstrating be extremely valuable. Participants discussed the high interest level the scientific and clinical new research ideas and their steps for a closer communities have in such informal platforms. collaboration amongst the groups. We look forward to the next Annual Meetings, which Collaborative Research Programs will be hosted by the CRP partners Matthias continue to grow Laschke and Prof Michael Menger at their With the Collaborative Research Programs Institute for Clinical Experimental Surgery (CRPs) the AO Exploratory Research Board in Homburg/Saar from November 57, 2012.

1 Bingyun Li presents his findings at the Trustees Meeting Berlin 2 Bingyun Li receives his Berton Rahn Price Award from AORRC Chairperson Prof Mark Markel

1 Active participation and discussions between clinicians and researchers during the Where Science meets Clinics symposium, Davos 2 Exchange during poster session and coffee break at Where Science meets Clinics symposium, Davos

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Annual Report 2011 Service Units

TK System
Celebrating 50 years of success
Cross-Specialty approaches The year 2011 marked the 50th anniversary of the AOTK System. What started as a group called Technische Kommission has evolved into a network of Expert Groups (EGs), Working Groups (WGs), Task Forces and specialized Technical Commissions with 133 clinicians involved as medical group members. The TK System continued to increase its focus on cross-Specialty fertilization and strategic approaches to new and innovative technologies. Consequently the newly appointed Biomaterials Task Force came into effect, subordinated directly to the TK Executive Board. In this group, experts from various Specialties work together on developing techniques to address biomaterial needs for each area of expertise. Specialized groups addressing new areas and fields With the formation of the Latin American Working Group (LTWG), the TK System has successfully channelled specific feedback from surgeons within this region. This new group met for the first time in 2011. It will organize a dedicated Experts Symposium for Latin America in the spring of 2012, will enabling the identification of commonalities and deviations in the AO regions. Recognizing the path that the Knee EG has taken in its achievements in the field of corrective surgery, especially in developing the Tomofix for open wedge osteotomy, the group was restructured to work on new concepts for joint preservation and osteotomies in other areas as well. Finally, after four successful years as a WG, a Neuro Surgery EG was created. The group enhances the TKs current activity scheme addressing all neurosurgical issues including trauma and reconstruction, primarily in the cranial area. Regional differences and similarities As in previous years, a series of Experts Symposia was conducted. In these meetings surgeons discuss their cases with particular focus on clinical issues, problem fractures, complications and limitations, thus helping to expand or limit indications and trigger improvements to existing technology where necessary. With the intention of generating a comprehensive overview on regional differences, similarities and specific solutions, three symposia with the same format and content were held between January and September 2011 in North America, Asia Pacific and Europe. Each event was organized in conjunction with AOTrauma, with 40 to 60 highly experienced surgeons in attendance. The following topics were covered: proximal femur fractures, patella fractures, infection, pseudarthrosis and non-unions in various anatomical regions as well as alternative, non-mechanical strategies to influence bone healing. New surgery developments So far, proximal humerus nailing procedures have been associated with considerable complication rates, mainly due to fracture patterns, compromised vascularity, or poor bone anchorage due to osteoporosis. To address these issues the new MultiLoc Proximal Humeral Nail, a straight nail with innovative screw-in-screw technology which extends indications towards more complex fractures, was developed. The system modularity allows selection of appropriate locking options which are most relevant to the fracture pattern. Another trauma surgery project attracting attention was the Dynamic Locking Screw. Compression Plates with locking screws result in an asymmetric gap closure with less motion at the plate than at the far cortex, hereby suppressing interfragmentary motion. The DLS was designed to address this by providing more flexibility at the cortex without compromising the holding strength. Its two interconnected parts allow for intended micro-movement within the screw without changing the platescrew or the bone-screw interface. For spine surgery, the new Matrix Degenerative System is a comprehensive thoracolumbar pedicle screw system designed as a total solution to complex posterior pathological challenges. It answers the need for smaller, stronger, lower profile constructs that are capable of providing multiple points of fixation to yield stronger stabilization with an enhanced likelihood of successful fusion. The Matrix MIS System allows for rod and screw insertion for thoracolumbar pedicle fixation, using cannulated pedicle screws attached to screw-mounted tissue retractors. Vertecem V+ was introduced for percutaneous injection of PMMA in stentoplasty or vertebroplasty procedures. It offers prolonged working time for the surgeon, better visibility under x-ray and is ready to use directly upon mixing. A series of plates with specific designs, such as trapezoidal and lambda shaped, were introduced to address the specific challenges of fracture in the condylar reion of the mandible. The new Piezoelectric System has been introduced for use in craniomaxillofacial and neurosurgery applications. Its ultrasonic cutting technology can be used for precise osteotomies, osteoplasties, decortication, drilling, and shaping in a broad variety of surgical procedures. Addressing the need for alternatives to cable wiring in thoracic surgery, the sternal ZipFix system was developed. It achieves closure and stability following sternotomy using PEEK implants with a ratcheting mechanism and an inbuilt needle for insertion.
1

1 MultiLoc Proximal Humeral Nail 2 Christoph Sommer and Sean Nork from the Lower Extremity EG present the DLS concept at a Meet the Experts event in Davos 3 Matrix Degenerative System viewed on a spine model

1 Regional TK Membership Distribution 2011 2 Paulo Barbosa, Chairman of the new Latin American Trauma WG

Asia Pacific 11%

Latin America 7%

North America 36%

Europe 46%

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Annual Report 2011 Service Units

Annual Report 2011

Governance

Clinical Investigation
A leader in evidence-based clinical trials
Clinical studies International multicenter studies conducted on behalf of the AO Specialties, the TK System and third parties formed the core of AO Clinical Investigation and Documentations (AOCID) work in 2011. Study phase Idea Planning Monitoring Analysis TOTAL NUMBER OF STUDIES Number of studies 9 11 17 9 46 Audi Accident Research Unit (AARU) AARU and AOCID collaborated closely in 2011, leading to Christian Hainz from Bavaria completing a three-month fellowship with AOCID to analyze data from automobile collisions across medical parameters. The Crash Scene Investigation presentations during the AO Davos Courses were a great success. At these, AARU demonstrated how their technician, psychologist and surgeon analyze data collected on motor vehicle accidents. Training An accredited Good Clinical Practice course was developed and delivered ten times during 2011, enabling over 150 surgeons to learn the theory and guidelines relating to clinical research. Mohy Taha (osteoporosis prevalence) and Kerstin Schneider (displaced femoral neck fractures) were 2011s other AOCID Clinical Research Fellows and worked on their projects with AOCIDs expert help. The fourth AOCID study coordinators meeting in Switzerland gave 14 international participants the chance to learn about clinical research, documentation and electronic data capture systems among other topics. The popular Roadmap of Research course was delivered in both Davos and Dubai in 2011.

Uncompromised clinical guidance

Requires good corporate governance
The uniqueness of the AO as a network based on strict medical guidance and a solid financial footing is also reflected in its organizational setup. The AOs structure mirrors its two functional areas. Focused around the needs of its clinical divisions, the organization receives operational support from service units that conduct research, development, education, clinical investigation and approval of new devices and methods. A major element in upholding AOs integrity is the concept of medical guidance. Under the ultimate leadership of the Board of Trustees, the Academic Council provides scientific guidance while the Board of Directors maintains organizational governance. Every AO body includes a majority of practicing surgeons thus ensuring the clinical relevance of all its activities. Management Boards support, supervise and ensure implementation of the range of AO activities. In the reporting year, the stronger role of the Presidentas it was resolved in the year beforecame into operation. The President chairs the Academic Council, the Presidential Team, and Board of Directors while the ViceChairman and CEO enhances the collaboration between the Executive Management and the Board of Directors. The following pages give a detailed overview of the AO Foundations financial development and strategic priority setting in 2011 as well as its governing bodies.

Publications A record number of presentations (55) were held at medical conferences in 2011 in addition to more than 20 new peer-reviewed publications. Over 400 citations of AOCID research were made in renowned journals, demonstrating interest from the wider scientific community in AOCIDs work. AO Clinical Study Center (AOCSC) program The AOCSC worldwide pilot phase was held during the year. This concept allows clinics to meet defined standards for clinical research and to be approved as such. AOCID provides support through visits and implementation of rigorous processes. Three different categories are available in this program. By year end, some 21 clinics on three continents were qualified or close to it.

Board of Trustees

Academic Council (AcC)

Board of Directors (AOVA) Executive Management (AOEM)

1 Prof Michael Nerlich at the Crash Scene Investigation: Davos presentation

AOTrauma International Board AOSpine International Board AOCMF International Board AOVET International Board AO Exploratory Research Board AO R&D Committee AOCID Committee TK Executive Board AO Education Platform

AOTrauma AOSpine AOCMF AOVET ARI AOCID TK Office AO Education Support Units

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Annual Report 2011 Governance

Finance
Strategic priority setting becoming visible in financial terms
During 2011 AO continued to strengthen its global reach through its regional activities, particularly in the area of education. Financial Overview Overall, the operating result amounted to -30 million CHF in 2011 compared to -26 million CHF in the previous year. With a financial result of 50 million CHF, the net result amounted to 20 million CHF. Consequently, the Foundations equity increased 2 % to 982 million CHF by the end of 2011. Income Statement The consolidated income statement 2011 looks as follows in comparison to previous year:
Income Statement
in million CHF

2010 Actual abs 82.1 56.0 5.4 20.7 14.3 96.4 27.0 5.3 3.1 6.4 31.7 13.1 6.4 3.4 2.7 0.7 96.4 % 85 % 58 % 6% 21 % 15 % 100 % 28 % 5% 3% 7% 33 % 14 % 7% 3% 3% 0% 100 %

2011 Actual abs 89.6 60.0 49.8 -20.2 15.0 104.5 28.0 3.4 3.6 6.8 36.0 13.3 6.4 7.0 6.6 0.4 104.5 % 86 % 57 % 48 % -19 % 14 % 100 % 27 % 3% 3% 7% 34 % 13 % 6% 7% 6% 1% 100 %

Variance 11/10 abs 7.5 4.0 44.4 -40.9 0.7 8.1 1.0 -1.9 0.5 0.4 4.3 0.2 0.0 3.6 3.9 -0.3 8.1 % 9% 7% 822 % n/a 5% 8% 4% -36 % 14 % 6% 14 % 1% 0% 109 % 146 % -38 % 8%

AO Foundation Contribution Collaboration and Support Agreement Contribution Asset Management 2011 Actual abs. 75 105 -30 50 20 982 Variance 11/10 abs. 5 9 -4 45 41 20 % 7% 8% -13 % 822 % n/a 2% Change in Reserves 3rd Party Income Total Income Research and Development Reference Centers and Fellowships Technical Commission Community Development Education General and Administrative * Global and Regional Boards Others AO Connect * Unforeseen Total Expenses
* 2010 restated: All AO Connect project-related IT expenses were moved to AO Connect

AO Financial Overview
in million CHF

2010 Actual abs. 70 96 -26 5 -21 962

Operating Income Operating Expenses Operating Result Financial Result Net Result Equity per 31.12.

Operating income increased by 7 % versus 2010. It includes the income from the Collaboration and Support Agreement with Synthes of 60 million CHF (+7 % versus previous year) and thirdparty income amounting to 15 million CHF (+5 % versus previous year). Operating expenses grew by 8 % versus the previous year to 105 million CHF. Taking into account the 10 % decrease in spending in 2009 versus 2008, the compounded annual growth rate from 2007 to 2011 is 3 %. The main cost categories in 2011 were as follows:
3% 2% 6% 7% 7% 105 million CHF 10 % 21 % 30 %
Personnel Expenses Expenses and Fees Non-Employees Personnel Costs Expenses and Fees Non-Employees Scientific & Regional Expenses Scientific and Regional Expenses Communication &and Education Expenses Communication Education Expenses ITIT Expenses Expenses Administration Expenses Administration Expenses Other Expenses Expenses Employees Other Expenses Material Expenses Expenses Employees Material Expenses

The AO Foundation contribution increased by 7.5 million CHF versus 2010 to 89.6 million CHF (+9%). Thanks to the contribution asset management amounting to 49.8 million CHF, 20.2 million CHF could be allocated to the Foundations reserves which almost compensated the decrease in reserves of 20.7 million CHF in 2010. Operating expenses amounted to 104.5 million CHF which reflects an increase of 8.1 million CHF compared to previous year. Overall, 34% of total expenses were allocated to education (+14% versus 2010), followed by research and development with 27% (+4% versus 2010). Furthermore, expenses for general and administrative and global and regional boards were reduced as a percentage of total annual operating expenses.

14 %

The spending pattern was similar to previous years. Personnel expenses had the biggest stake with 30% of total expenses. Expenses and fees non-employees, having a share of 21 %, was the second largest spending area. This reflects the high involvement of the AO network in the organizations activities.

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Annual Report 2011 Governance

Finance
Strategic priority setting becoming visible in financial terms
Courses Course-related expenses continued to grow steadily in 2011, amounting to 24 million CHF (+10% versus 2010). AOTrauma constituted just over half of all course-related expenses in 2011 while one quarter of the remaining expenditure was accounted for by AOSpine.

Employees The number of permanent staff increased to 244.2 full-time equivalents (FTEs), an increase of 10% versus 2010. This supports the Specialty activities, mainly in the regions, as well as global functions such as AO Education and TK.
Employee Structure by Region FTE weighted permanent International Middle East 2010 Actual abs. 197.7 0.7 3.5 201.9 8.0 9.0 3.5 222.4 in % 89 % 0% 2% 91 % 3% 4% 2% 100 % 2011 Actual abs. 209.6 1.5 4.8 215.9 8.2 9.0 11.1 244.2 in % 86 % 0% 2% 88 % 3% 4% 5% 100 % Variance 11/10 abs. 11.9 0.8 1.3 14.0 0.2 0.0 7.6 21.8

3% Course-related Expenses in million CHF +6% +20% +10% 10% 5%

3% 3%

Europe Total located in Switzerland

2011 Breakdown AOTrauma AOSpine AOCMF AO Foundation AOVET OR Personnel Socio Economic Committee

Asia Pacific Latin America North America Total worldwide

24 million CHF 18 21 24 25% 2009 2010 2011

51%

4% 17 % 2011 FTE Overview by area AO Service Units AO Specialties AO Support Units Others Total 123.6 69.4 42.5 8.7 244.2

244.2 FTE

51 %

The total number of courses increased to 694, reflecting a growth of 12% versus 2010. Overall, the number of participants increased by 11% and participant days increased by 9% in 2011 to 38,811 and 108,425 respectively.

28 %

Actuals AOTrauma AOSpine AOCMF AOVET OR Personnel Socio Economic Committee Total Courses 330 122 97 25 79 41 694

Share 47% 18% 14% 4% 11% 6% 100%

Actuals 20,558 6,060 5,224 1,244 3,994 1,731 38,811

Share 53% 16% 13% 3% 10% 5% 100%

Actuals 64,721 11,792 13,444 4,511 9,960 3,997 108,425

Share 60% 11% 12% 4% 9% 4% 100%

9% 64%

19%

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nitaL

Courses Activities 2011

Number of Courses

Number of Participants

Number of Participant Days

Asset Management The financial result of 50 million CHF reflects an actual return of 5.9% on the underlying financial assets. The total asset value amounted to 937 million CHF by the end of 2011. The positive performance was driven by the remarkable performance of the Synthes share (+25%), with a 28% stake in the portfolio. Excluding the Synthes position, the portfolio achieved a negative return of -1.6%, still better than the benchmark (-4.4%).
eporuE

lanoitanretnI aisA

8% Financial Assets Portfolio Structure in million CHF Shares Bonds Alternative Assets Liquidity Total 596 182 82 77 937

937 million CHF

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Annual Report 2011 Governance

Governing bodies of the AO Foundation

From left to right: Urs Retschi (AO Education) Beate Hanson (AO Clinical Investigation and Documentation) Alain Baumann (AOSpine) Rolf Jeker (CEO and Vice Chairperson AOVA) Claas Albers (AOTK) Lukas Kreienbhl (COO) Tobias Httl (AOCMF and AOVET) Claude Martin (AOTrauma) R Geoff Richards (AO Research and Development)

AO Executive ManagementAOEM The AO Executive Management (AOEM) reports directly to the Board of Directors. It includes the CEO and line managers responsible for operational management within their respective areas.

Board of Trustees The Board of Trustees is the AO parliament, consisting of 165 leading surgeons from around the world, including ex-officio Trustees. The Trustees approve amendments to the charter and elect the members of the Academic Council (AcC). They function as ambassadors for the AO in their countries or regions and communi-

cate the AO philosophy. They transmit AO information to national institutions and other AO surgeons and bring feedback regarding special needs into the AO. Since each Trustee serves for a limited number of years, constant rejuvenation of the Board is guaranteed.

Board of DirectorsAOVA The Board of Directors is responsible for the business conduct of the AO Foundation, ensuring implementation of the goals and proposals of the Academic Council. Its members include a majority of surgeons and non-voting representatives of the AOs industrial partners.
Front row, left to right: Suthorn Bavonratanavech (Pre-President-Elect) Jaime Quintero (President-Elect), Norbert Haas (President and Chairperson AOVA) Paul Manson (Past-President) Rolf Jeker (CEO and Vice Chairperson AOVA) Middle row: Michael Ehrenfeld Jean-Pierre Cabassu Nikolaus Renner Eric Johnson Pierrre Hoffmeyer Michael Janssen Back row, left to right: Ciro Rmer (Synthes Inc.) Lukas Kreienbhl (COO) Roland Brnniman (Synthes Inc.) Urs Weber-Stecher (Minutes) Luiz Vialle Michel Orsinger (Synthes Inc.) Hansjrg Wyss

Front row, left to right: Jaime Quintero Norbert Haas Paul Manson Beate Hanson Second row, left to right: Thomas Redi (Founding Member) Germn Ochoa Tim Pohlemann Jrg Auer Stephan Perren

Third row, left to right: Peter Matter (Founding Member) Frankie Leung Kodi Kojima Mark Vrahas Michael Schtz James F. Kellam Merng Koon Wong Top row, left to right: Urs Retschi Risto Kontio Gregorio Snchez-Aniceto Anders Westermark Tobias Httl Carl Kirker-Head Mark Markel Geoff Richards David Grainger Keita Ito

Academic CouncilAcC The Academic Council (AcC) is responsible for the AO Foundations medical and scientific goals. Elected by the Board of Trustees, it is supported by four Specialty Academic Councils (SAcCs), specialized steering boards, and other ex-officio members.

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Annual Report 2011 Addresses

AO Head Office
AO Foundation Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 28 01 Fax +41 81 414 22 80 foundation@aofoundation.org www.aofoundation.org
Photography: AO Foundation, Communications and Events, Davos, Switzerland Manuel Kurth (pages 1, 8, 48) Vital Noppen and Rik Roels, University Hospital Leuven (page 6) Joe Perez, zone5foto (page 12) Concept, editing, and layout: AO Foundation, Communications and Events, Davos, Switzerland

AO Specialties
AOTrauma Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 21 11 Fax +41 81 414 22 80 info@aotrauma.org www.aotrauma.org AOSpine Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 21 11 Fax +41 81 414 22 80 info@aospine.org www.aospine.org AOCMF Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 25 55 Fax +41 81 414 25 80 info@aocmf.org www.aocmf.org AOVET Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 25 55 Fax +41 81 414 25 80 info@aovet.org www.aovet.org Stettbachstrasse 6 8600 Dbendorf Switzerland Phone +41 44 200 24 25 Fax +41 44 200 24 12 info@aospine.org www.aospine.org Stettbachstrasse 6 8600 Dbendorf Switzerland Phone +41 44 200 24 20 Fax +41 44 200 24 21 info@aotrauma.org www.aotrauma.org

AO Service Units
AO Research Institute Davos Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 22 11 Fax +41 81 414 22 88 sonia.wahl@aofoundation.org www.aofoundation.org/ari AO Clinical Investigation and Documentation Stettbachstrasse 6 8600 Dbendorf Switzerland Phone +41 44 200 24 20 Fax +41 44 200 24 60 aocid@aofoundation.org www.aofoundation.org/cid TK System Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 24 70 Fax +41 81 414 22 90 aotk@aofoundation.org www.aofoundation.org/wps/portal/aotk AO Education Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 26 01 Fax +41 81 414 22 83 aoe@aofoundation.org www.aofoundation.org

Joseph Kaczmarek, Keystone/AP (page 15) Print: Sdostschweiz Print AG, Chur, Switzerland April 2012, AO Foundation This annual report is climate neutral, compensation through www.climatepartner.com Certificate No SC2012040402

*Contact information for Regional Offices can be found on individual Specialty websites

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AO Foundation
Clavadelerstrasse 8 7270 Davos Switzerland Phone +41 81 414 28 01 Fax +41 81 414 22 80 foundation@aofoundation.org www.aofoundation.org