Science at the Trustees Meeting 2008

Clinical and scientific working update sessions were held during the recent AO Trustees Meeting.

23 July 2008

Trustees Meeting

The recently held TrusteesMeeting 2008  at the Davos Congress Center may have served as thefocal point for the AO’s 50th year anniversary celebrations, but it was also ameeting of substantial clinical and scientific importance.


The largest ever gathering of AO Trustees attended lectures on importantrecent clinical and scientific developments in five parallel sessions over thethree days of the meeting. This afforded each of the Trustees the opportunityto attend each session (though the sessions were often given by differentlecturers to save any one person having to repeat themselves five times!) Thesessions were held in small groups which facilitated informal questions andanswers, leading to much discussion as well as offering invaluable directaccess to prominent scientists and clinicians.


AO Research Institute involvement

The AOResearch Institute (ARI) also benefitted from this meeting through thecontact generated to the AO clinicians. In the friendly environment of theTrustees Meeting, new perspectives on the most pressing clinical issues werediscussed and possible future directions for AO Research were generated.


The parallel sessions covered the topics of imaging, endoscopic surgery,special trauma surgery, medico-legal aspects of AO practice, and infection. AO Research Institute Davoscollaborators Geoff Richards and Fintan Moriarty were present at each of thesessions related to the topic of infection, as both are closely involved inthis field. They took the opportunity to develop new collaborations and to takepart in the discussions on possible future directions for infection relatedresearch. Geoff Richards also co-chaired two sessions and spoke at two othersessions on the effect of implant design and surfaces upon infectionsusceptibility.

The infection sessions


World renowned scientists and research clinicians attending this sessionpresented state of the art perspectives and research on the problem ofinfection in orthopedic fracture fixation.


The meeting began with the research of Sebastian A J Zaat, from theDepartment of Medical Microbiology at the Academic Medical Center (AMC) inAmsterdam, The Netherlands, who spoke on “Tissue surrounding biomaterials as areservoir for infecting bacteria”. The presentation gave something of a newperspective on device related infection, showing bacteria alive in stasiswithin macrophages at a short distance from the implant. There was greatanticipation among the Trustees as to how these findings relate to orthopedicresearch.


Gerd Schmidmaier from the Charitè University of Medicine in Berlin presentedhis research and clinical experience in a presentation entitled “Intramedullarynailing with antibiotic coatings”. Laboratory findings and animal studies werediscussed, as well as a controlled case series study to evaluate the operativestabilization of closed and open diaphyseal fractures of the tibia usinggentamicin-coated titanium nails (UTN PROtect). The work was shown to havegreat potential for cases where second surgeries were needed and the clinicalcases presented were very impressive.


Jeffrey P Watkins from the College of Veterinary Medicine & BiomedicalSciences at the Texas A&M University, presented his experience of theproblems associated with “Equine Orthopedic Infection”. He outlined how theknowledge he has gained through using different perfusion techniques ofantibiotics may be of interest to the Trustees.


Andrej Trampuz from the Department of Infectious Diseases & HospitalEpidemiology at the University Hospital in Basel, Switzerland, gave a lectureentitled “Diagnosis of implant-related infection: a continuous challenge”. Thetalk was clinically pertinent and of high relevance to clinical laboratorieswhich must ensure that infections are properly detected as missed infectionscan have very serious consequences.


Peter E Ochsner from Liestal, Switzerland, presented on “Histology ofchronic (posttraumatic) osteomyelitis and its clinical relevance”. His speechincluded case studies and conclusions drawn from these complicated cases. In asecond presentation he tackled the issue of “Intramedullary reaming in chronic (posttraumatic)osteomyelitis of long bones”. Here the development of chronic osteomyelitis inthe diaphysis of long bones was explained. Part of the intramedullary reamingtalk introduced a method to flush bacteria from the medullary canal. However,Geoff Richards noticed the whole method could be replaced to remove bacteriafrom the canal, using the new reamer aspirator system, which was partlydeveloped within the AO Research Institute.


German Ochoa from Universidad Militar Nueva Granada, Bogotá, Colombia,presented a talk entitled “Biomaterials in spinal infections” in whichbiomaterials were discussed as bone volume expanders and their performance withrespect to infections of the spine.


Werner Zimmerli, from the University Clinic of Internal Medicine at theCantonal Hospital in  Liestal, Switzerland, presented on his experience of“Risk of Haematogenous Prosthetic Joint Associated Infection”. In his vastexperience, the risk of development of prosthetic joint infection is lifelongand should always be considered.


David Grainger from the University of Utah, Salt Lake City, USA, presentedon “Medical device biofilms: how they form and resist antibiotic treatment”.Implant centered infection was discussed with a particular emphasis on new andfuture possibilities for incorporating anti-infective compounds inorthopedics.


Finally Geoff Richards from the AO Research Institute presented an “Updateon Infection with regards to implant design and surface modification”,presenting laboratory studies as well as a thorough look at animal models forvarious fracture fixation procedures and an evaluation of various developmentsin implant design with respect to resistance to infection.


Overall the infection sessions at the Trustees Meeting were very wellreceived and the small group format worked extremely well. Nikolaus Renner, whowas central to the organization of these sessions, moderated a number of verythought provoking discussions and the session was deemed a success from both aneducational and collaborative standpoint.


As a result of the issues raised at these sessions it is quite likely thatthe topic of infection will become one that is even more investigated andvisible in the near future.


For more general reading on the subject, please see:

Injury, Int J Care Injured (2006) Sup 37Infection in Fracture Fixation: From basic research to diagnosis, toevidence-based treatment.

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