Formation | 1958 Biel, Switzerland |
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Type | not-for-profit |
Purpose | Treatment of trauma and disorders of the musculoskeletal system |
Key people | Maurice Edmond Müller, Robert Schneider, Hans Willenegger, Martin Allgöwer |
Website | aofoundation.org |
The AO Foundation is a nonprofit organization dedicated to improving the care of patients with musculoskeletal injuries or pathologies and their sequelae through research, development, and education of surgeons and operating room personnel. The AO Foundation is credited with revolutionizing operative fracture treatment and pioneering the development of bone implants and instruments. [1] [2]
The foundation has its origins in a Swiss study group named Arbeitsgemeinschaft für Osteosynthesefragen (Association of the Study of Internal Fixation), commonly referred to as the AO, that was founded in Switzerland in 1958 [3] [4] as a society. The AO became a foundation in December 1984. [3]
On March 1, 1950 Maurice Müller, one of the founding members of the AO, visited a 70-year old Belgian surgeon named Robert Danis in Brussels, who had been experimenting and treating fracture patients surgically for 25 years. At the time Dr. Müller was 32 years old, and had been practicing medicine for 6 years. [5] The standard of treatment for fractures at the time was the method usually called "conservative treatment," as originally documented and popularized by Lorenz Böhler. This approach focused on reducing fractures and stabilizing them with splints and plaster, followed by traction. [6] By the time of Müller's visit, Danis had already published 2 books on osteosynthesis, Technique de l'Ostéosynthèse (1932, Paris), and Theorie et pratique de l’osteosynthese (1949, Paris). [7]
The one day that Maurice Müller spent in Brussels with Dr. Danis was a significant moment for Müller's subsequent work, who said that Danis' 1949 book was one of the most important works that he had ever read; he also took samples of Danis' own instruments, including one plate and screws, along with the contact information of the manufacturer in Belgium. He quickly developed his own ideas on how to improve the techniques he had seen from Danis. [8] Between 1951 and 1957, Müller performed numerous surgeries in which he applied what he had learnt from surgical treatment of fractures as well as techniques he developed by himself, first at the General Hospital of the Canton of Fribourg, where he worked as Chief Resident, later at the Balgrist Orthopedic Clinic, and later at the private Hirslanden Clinic. [9]
Maurice Müller had an agreement with the Balgrist Orthopedic Clinic, through which he enjoyed a day off every week that he used to travel around the region visiting hospitals and other like-minded surgeons. This helped Müller develop a network, which, paired with his reputation of a very talented surgeon, got him recommended and requested to operate on difficult cases in hospitals around the country. In December 1957, Maurice Müller delivered a lecture at the University of Zürich, upon receiving his PD (private lecturer) degree. During his lecture he presented a set of orthopedic surgery principles that he developed, which would soon evolve to become the AO Principles of Fracture Management. In 1958, Müller and some of his close colleagues met and agreed to create a school of thought for surgical orthopedic techniques. It was agreed to call the group the Arbeitsgemeinschaft für Osteosynthesefragen, shortened to the AO.
In the frame of the Swiss Surgical Society meeting in Bern in November 1958, Müller organized the first meeting of the AO, which 12 other surgeons would attend. The meeting took place at the Hotel Elite in Biel/Bienne, and the agenda for the day included a presentation of Müller's Instrumentarium, a set of implants, screws, and tools he developed and fine-tuned first with Zulauf, a woodworking tools manufacturer, and later in collaboration with Robert Mathys, a mechanical engineer from the city of Bettlach, in Switzerland, who owned a small shop specialized in designing and producing stainless steel screws. [10] The agenda also included a discussion on who would manufacture the implants and tools. Successive meetings covered the AO's legal statutes and by-laws. [11]
The various instruments that Müller and other AO founders had been using until 1958 was an assortment of existing tools and parts which didn't always match or work well together. The first AO efforts consisted of developing a standardized toolset that was easy to use and had a full tool-implant compatibility. The first version of the AO Instrumentarium consisted of a set of six color-coded aluminium cases, containing pre-sterilized screws, plates, and tools. The AO team ordered 20 of these sets from Mathys, which would be first tested by the AO surgeons, and later used for the first AO course to be held in Davos in December 1960. The AO had decided that surgeons who wanted to purchase the AO Instrumentarium would first have to be trained in its proper use, as well as the latest surgical fracture techniques that the AO founding surgeons decided to teach. [12]
The AO developed a business model that would provide funding for all AO research activities, the funding of an AO Documentation Center, and the AO educational activities, via licensing fees that the instrument producers would pay. To manage the administration of this industrial area of the AO, Müller recommended to create a company, which would be called Synthes AG Chur.
From 1963 to the early 1980s, the AO developed new implants, tools, and devices; appointed new manufacturers for the AO-developed solutions; and assigned distributors throughout most of the world. The AO Instrumentarium grew from around 200 items in 1961 to over 1,200 items in the early 1980s, and licensing fees in 1982 amounted to over 10 million Swiss Francs, by 1985 it was 13 million Swiss Francs. [13]
Toward the end of the 1980s, the AO Instrumentarium was being manufactured and marketed by 3 companies: Mathys (privately owned by the Mathys family), Stratec (privately owned by the Straumann family), and Synthes US (privately held and majority owned by Hansjörg Wyss [14] ). Synthes US acquired the business from the Straumann family in 1999, and the newly formed Synthes-Stratec company acquired the Mathys business 4 years later, in 2003. [15]
The AO changed its legal status from an association to a foundation in 1984. The significant sales growth of the AO Instrumentarium enjoyed from the 1980s through the 2000s had resulted in royalties payments growing from 14 million Swiss francs in 1986 to 84.1 million Swiss francs in 2004. Some surgeons—leaders in the AO organization—were concerned about the over-marketing of AO products, while others were concerned that they shouldn't profit from the sales of the implants and the devices they used in surgeries for their patients. These concerns, coupled with an increasingly competitive global business landscape in the implant business and a consolidated, single manufacturer and distributor of the AO-approved products, pushed the AO and Synthes to devise a new operating model.
In 2006, the AO sold and transferred the Synthes brand, all its patents to the AO Instrumentarium, and all rights to the products usages to the producer Synthes, for a one-off payment of 1 billion Swiss Francs. Additionally the manufacturer would pay a fixed yearly fee of 50.7 million Swiss Francs, and the AO would in exchange organize a number of educational courses, during which only AO Instrumentarium products would be used. With successive adjustments and negotiations, this has been the operating model under which the AO has continued to cooperate, first with Synthes, and later with Depuy Synthes (renamed after the 2011 acquisition by Johnson & Johnson) [16] [17]
The AO Foundation has several pillars of activity:
ARI focuses on pre-clinical research. Scientists working in the AO research facilities located in the Swiss city of Davos conduct fundamental and applied research in the fields of biomechanics and biology of bone, disc and cartilage (including tissue engineering and musculoskeletal infections), and biomaterials science (such as degradable polymers and polymer-based transport systems). The institute also conducts research in the field of new surgical techniques, tools, and devices, such as "smart" implants, and intracorporeal navigation and tools for surgical teams and surgeons. [18]
The institute, led by Geoff Richards since 1991, employs over 100 scientist and PhD students from all over the world, and is considered the largest institute of its kind. [19] It is partially funded by the AO Foundation as well as external grants.
The AO Education Institute is responsible for the development of each educational product curriculum as well as creating educational tools and media. It is also in charge of AO faculty development, evaluating and assessing educational outcomes, [20] and designing and performing medical education research. [21] [22]
This division includes the AO Technical Commission, which develops and tests new devices, which will eventually find their way to the market. Other key areas within the Innovation Translation Center include Technology Transfer, which offers seed funding for innovation in the field of surgeon education or other areas of a muskuloeskeletal disorder patient's treatment journey, a development incubator department, and the Clinical Operations and the Clinical Science departments, which focus on clinical research, from management and research execution through outcomes publication. [23]
The different anatomical and pathology areas are covered by different working groups, task forces, and commissions, split into the following 5 clinical specialties
The main operation of daily activities at the AO Foundation lies in the organization and delivery of educational events, comprising symposia, webinars, seminars, and courses aimed at orthopaedic surgeons, neurosurgeons, craniomaxillofacial surgeons, operating room personnel, and other health professionals. These include hands on experience of using the latest implants, as well as lectures from expert surgeons and discussions. [24] [25]
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peripheral nervous system.
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
Back injuries result from damage, wear, or trauma to the bones, muscles, or other tissues of the back. Common back injuries include sprains and strains, herniated discs, and fractured vertebrae. The lumbar spine is often the site of back pain. The area is susceptible because of its flexibility and the amount of body weight it regularly bears. It is estimated that low-back pain may affect as much as 80 to 90 percent of the general population in the United States.
A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.
Oral and maxillofacial surgery is a surgical specialty focusing on reconstructive surgery of the face, facial trauma surgery, the oral cavity (mouth), head and neck, and jaws, as well as facial cosmetic surgery/facial plastic surgery including cleft lip and cleft palate surgery.
A cervical fracture, commonly called a broken neck, is a fracture of any of the seven cervical vertebrae in the neck. Examples of common causes in humans are traffic collisions and diving into shallow water. Abnormal movement of neck bones or pieces of bone can cause a spinal cord injury, resulting in loss of sensation, paralysis, or usually death soon thereafter, primarily via compromising neurological supply to the respiratory muscles as well as innervation to the heart.
A burst fracture is a type of traumatic spinal injury in which a vertebra breaks from a high-energy axial load, with shards of vertebra penetrating surrounding tissues and sometimes the spinal canal. The burst fracture is categorized by the "severity of the deformity, the severity of (spinal) canal compromise, the degree of loss of vertebral body height, and the degree of neurologic deficit." Burst fractures are considered more severe than compression fractures because long-term neurological damage can follow. The neurologic deficits can reach their full extent immediately, or can progress for a prolonged time.
Jack Elliot Zigler is a Board Certified orthopedic surgeon specializing in spine surgery at the Texas Back Institute in Plano, Texas. He is best known for being the first surgeon to perform a ProDisc artificial disc replacement surgery in the United States, on October 3, 2001.
The Le Fortfractures are a pattern of midface fractures originally described by the French surgeon, René Le Fort, in the early 1900s. He described three distinct fracture patterns. Although not always applicable to modern-day facial fractures, the Le Fort type fracture classification is still utilized today by medical providers to aid in describing facial trauma for communication, documentation, and surgical planning. Several surgical techniques have been established for facial reconstruction following Le Fort fractures, including maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF). The main goal of any surgical intervention is to re-establish occlusion, or the alignment of upper and lower teeth, to ensure the patient is able to eat. Complications following Le Fort fractures rely on the anatomical structures affected by the inciding injury.
Synthes Holding AG is a multinational medical device manufacturer based in Solothurn, Switzerland and West Chester, Pennsylvania, United States. It is the world's largest maker of implants to mend bone fractures, and also produces surgical power tools and advanced biomaterials.
Maurice Edmond Müller was a Swiss orthopedic surgeon who was instrumental in the development of internal fixation techniques to treat bone fractures and who also significantly advanced the development of the hip prostheses. For his work in these areas he has been honored with numerous awards. On 24 August 2002, the International Society of Orthopaedic Surgery and Traumatology (SICOT) named him the "Orthopedic Surgeon of the Century" at a congress in San Diego.
A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate trauma, there is a risk of spinal cord injury if the fracture is unstable, that is, likely to change alignment without internal or external fixation.
Mathys Ltd Bettlach, is a Swiss family business with headquarters in Bettlach, Switzerland. The company develops, produces and distributes implants for artificial joint replacement in the areas of hip, knee and shoulder as well as biomaterials for surgical treatment of bone defects With an innovative implant for ACL healing, the family company also gained ground in the area of sport orthopaedics at the beginning of 2013.
Limb-sparing techniques, also known as limb-saving or limb-salvage techniques, are performed in order to preserve the look and function of limbs. Limb-sparing techniques are used to preserve limbs affected by trauma, arthritis, cancers such as high-grade bone sarcomas, and vascular conditions such as diabetic foot ulcers. As the techniques for chemotherapy, radiation, and diagnostic modalities improve, there has been a trend toward limb-sparing procedures to avoid amputation, which has been associated with a lower 5-year survival rate and cost-effectiveness compared to limb salvage in the long-run. There are many different types of limb-sparing techniques, including arthrodesis, arthroplasty, endoprosthetic reconstruction, various types of implants, rotationplasty, osseointegration limb replacement, fasciotomy, and revascularization.
The following outline is provided as an overview of and topical guide to trauma and orthopaedics:
Orthopedic surgery is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal injuries, sports injuries, degenerative diseases, infections, bone tumours, and congenital limb deformities. Trauma surgery and traumatology is a sub-specialty dealing with the operative management of fractures, major trauma and the multiply-injured patient.
The Müller AO Classification of fractures is a system for classifying bone fractures initially published in 1987 by the AO Foundation as a method of categorizing injuries according to therognosis of the patient's anatomical and functional outcome. "AO" is an initialism for the German "Arbeitsgemeinschaft für Osteosynthesefragen", the predecessor of the AO Foundation.
The American Society of Maxillofacial Surgeons (ASMS) is a professional organization focused on the science and practice of surgery of the facial region and craniofacial skeleton. The organization is involved in education, research, and advocacy on behalf of patients and maxillofacial surgeons.
Globus Medical, Inc. is a publicly traded medical device company headquartered in Audubon, Pennsylvania, United States. Globus is focused on the design, development, and commercialization of products that enable surgeons to promote healing in patients with musculoskeletal disorders.
Colonel Robert G. Hale, DDS is an oral and maxillofacial surgeon and former Commander of the US Army Dental and Trauma Research Detachment. Hale lectures worldwide on craniomaxillofacial battle injuries and regenerative medicine. He is a researcher and public advocate for the advancement and benefits of regenerative medicine.