The COA Web Site
A real benefit for members

Emil H. Schemitsch, M.D., FRCSC
Editor in Chief

In this electronic age, the ability to communicate and obtain information quickly has become increasingly important. With this in mind, the COA web site has undergone a major renovation and transformation over the past year. This has occurred under the leadership of Drs. Christian Veillette, Myles Clough, Doug Thomson, and Cynthia Vezina at the COA's headquarters. Along with the COA Bulletin, the web site has become a major tool for communication and information transfer for members.

Temper of the Times
our new strategic plan needs your input

Douglas C. Thomson
CEO, Canadian Orthopaedic Association

In 2000, the COA embarked on a process of self-renewal by updating its strategic plan, which was presented to the membership in early 2001. That plan set a new Mission for the COA:

• achieve excellence in orthopaedic care for Canadians

Compiling the Best Wait-Time Strategies
Bone and Joint Decade Canada

James P. Waddell, M.D., FRCSC
Coordinator, Canadian National Action Network
for the Bone and Joint Decade

Bone and Joint Canada, part of the Bone and Joint Decade National Action Network for Canada, convened a meeting in Toronto in November 2006. We had excellent participation from across Canada with every region and most individual provinces represented. A significant number of representatives from the larger population provinces were present as well. In addition, we had participation from the Arthritis Society, Osteoporosis Society and the Canadian Orthopaedic Foundation.

Embracing Efficacy
better results, faster and cheaper

Dennis Jeanes
Special to the Canadian Orthopaedic Association

So it begins. This year, the first cohort of Baby Boomers turns sixty. And for the next half-century or so, the largest generation in Canadian history (some nine million strong) will inexorably grow old and frail. And in keeping with the expected epic proportions of their health needs, to paraphrase Churchill, never before will so many elderly patients depend on so few health professionals for so much.

The COA's 2007 NATF Fellow
Dr. George S. Athwal

Dr. George S. Athwal of London, ON has been selected as the COA's 2007 North American Travelling Fellow (NATF). Dr. Athwal obtained his M.D. at the University of British Columbia and went on to complete his residency at Queens University. He pursued subspecialty training in upper extremity at the Hospital for Special Surgery in New York, NY and at the Mayo Clinic in Rochester.

Welcome to the New Climate

Douglas C. Thomson
CEO, Canadian Orthopaedic Association

What just happened here?

The recent conversion of Prime Minister Harper to a full fledged Environmentalist is an event that even the most seasoned observer of the Canadian political landscape could not have foreseen a mere six months ago. For the first time since the Exxon Valdez ran onto the Bligh Reef in 1989, the environment eclipses health care as the number one issue for Canadians according to a number of recent polls. The environment has surfaced as a primary issue for the electorate in previous polling cycles, but it often lost to other overriding issues. This time it looks to be different.

Introduction
Subtrochanteric hip fractures are highly unstable and still represent a difficult fracture to treat. Dynamic Condylar Screw Plating or cephalomedullary nailing are the two most common treament modalities. Dr. Paul Duffy and Dr. G. Yves Laflamme will discuss the pros and cons of each of these treatment modalities.

DCS Plating for Unstable Subtrochanteric Fractures

Paul Duffy, M.D, FRCSC
Calgary, AB

Accounting for between 7-34% of femoral fractures and classified as extending five centimetres below the lesser trochanter, this injury has a bimodal distribution with high energy mechanisms in the younger population and low energy in the elderly¹.

Treatment of Unstable Subtrochanteric Fractures:
Cephalomedullary Nailing

G. Yves Laflamme, M.D., FRCSC
Montréal, QC

Cephalomedullary (CM) nails are antegrade femoral intramedullary nails designed for fixation into the femoral head and neck. Their main use is to treat selected, complex proximal femoral fractures. In the 1970's, Zickel was one of the first to design a short, double-curve intramedullary device for subtrochanteric (ST) fractures. He reported one of the highest union rates and one of the lowest implant failure rates for the time¹.

When Your Patients Need a Little Encouragement
Ortho Connect puts surgery in perspective

Dennis Jeanes
Special to the Canadian Orthopaedic Foundation

"Every day, we get calls from waiting surgery patients who are anxiously seeking reassurance that they've made the right decision," says Debbie Gates, the Canadian Orthopaedic Foundation's Communications Manager. "Who better, then, than someone who's undergone and benefited from the surgery to allay your fears and put things in perspective?"

The Anica Bitenc Fellowship
Learning from colleagues abroad

Debbie Gates
Communications & Education Manager
Canadian Orthopaedic Foundation

Every year, a young orthopaedic surgeon from Slovenia, Croatia or Serbia is sponsored by the Anica Bitenc Fellowship and the Canadian Orthopaedic Foundation for a two-week fellowship.

Advances in the Treatment of Cancer Metastatic to Bone

Marc Isler, M.D., FRCSC
Montreal, QC

I will not address the general principles underlying current guidelines for treatment of appendicular and axial metastatic disease, but rather concentrate on some of the newer forms of therapy.

Osteosarcoma

Robert E. Turcotte, M.D., FRCSC
Division of Orthopaedic Surgery and Department of Oncology
McGill University Health Centre
Montreal, QC

Osteosarcoma is defined by the production of osteoid by malignant cells and represents the most common primary malignant bone tumour. Its incidence is estimated at only 1.6 per million per year representing 50 new cases yearly across Canada. It affects mainly teenagers and young adults but can occur at any age. The cause of osteosarcoma remains unknown. Studies have shown multiple chromosomes and gene anomalies to occur in this tumour but have failed to pinpoint any specific pattern. Most osteosarcoma arise de novo from normal bone but in rare instances, it may develop following a benign condition such as fibrous dysplasia or Paget's disease.

Advances in the Treatment of Giant Cell Tumour of Bone

Peter C. Ferguson, M.D., FRCSC
Assistant Professor of Surgery, University of Toronto
Division of Orthopaedic Surgery, Mount Sinai Hospital
Department of Surgical Oncology, Princess Margaret Hospital
Toronto, ON

Giant cell tumour (GCT) of bone is considered a benign aggressive tumour that occurs in the epiphyseal-metaphyseal region of long bones, most commonly the distal femur, proximal tibia and distal radius¹. Other less common sites include the proximal humerus, proximal femur, distal tibia and sacrum¹. GCT presents as a painful lytic lesion, may have an effusion in the adjacent joint, and may have a soft tissue mass. Approximately 30% of patients with GCT in the lower extremity present with pathologic fractures² (Figure 1). GCT has a low, but definite risk of metastasis, with lung being the most common site¹.

Issues in Soft Tissue Sarcoma Management

Robert S. Bell, M.D., FRCSC
President and CEO of University Health Network
Princess Margaret Hospital
Toronto, ON

The past decade has seen limb sparing surgery become the standard of care for most patients with bone and soft tissue sarcomas. This has been accompanied by a growing emphasis on functional outcome and quality of life^2,4,9. In soft tissue sarcoma (STS) treatment, radiotherapy (RT) has been instrumental in controlling local recurrence in the context of more limited surgery designed to preserve function². However the combination of radiation and limb salvage has created its own set of complications and our investigations have concentrated on reducing complications of treatment and enhancing functional outcome.

Cartilage Neoplasia

Jay S. Wunder M.D., MSc, FRCSC
Surgeon-in-Chief
Head, Division of Orthopaedic Surgery
Rubinoff-Gross Chair in Orthopaedic Oncology
Mount Sinai Hospital, and The University of Toronto
Toronto, ON

Cartilage tumours are common throughout the skeleton and present a wide biological spectrum. Patients with benign enchondromas may only require a diagnosis whereas those with chondrosarcoma require multidisciplinary management by a team including a musculoskeletal surgeon, radiologist and pathologist to ensure the best outcomes.

See you in Halifax, Nova Scotia!

In the coming year, the Canadian Orthopaedic Association elevates multitasking to new heights! It will be our great pleasure to welcome you to Halifax for the 62^nd Annual Meeting of the COA combined with the 41^st Annual Meeting of the Canadian Orthopaedic Research Society as well as the 33^rd Annual Meeting of the Canadian Orthopaedic Residents' Association. You don't want to miss any of these meetings - and now you don't have to.

The 2007 Halifax Meeting Programme

Dear COA Members and Guests,

We hope to whet your appetite with this message from the Programme Committee and encourage you make plans to visit Halifax to be treated to some of the best orthopaedic education that money can buy!

Travel & Accommodations

Getting Here
Halifax, Nova Scotia where the best living history in Canada, countless festivals & events, and succulent seafood combine with first-rate facilities and cosmopolitan flair to make a unique and unforgettable vacation destination.

Getting here is easy, with convenient connections by air, sea and land to major travel hubs world wide, we're more accessible than you may think!

Visit Halifax
This is the place you dreamed of. History. Culture. Beauty. Friendly. Fun. Relaxing. Welcoming. Everything from charming rural retreats, seaside B&Bs, cozy Inns and upscale hotels are found in the Halifax region. From the tranquility of a peaceful hike along a sandy beach, to crashing surf at the most photographed lighthouse in Canada, to fine dining and bustling nightlife, take your time experiencing our region.

FAQs About Halifax

Q. How many Cruise Lines will call on Halifax in 2006?

A. 15 Cruise Lines will be calling on Halifax during the 2006 season, including industry giants, Carnival Corporation, Royal Caribbean International, Princess Cruises, Cunard and Norwegian Cruise Line. 2006 will see more than 185,000 cruise passengers visit Atlantic Canada's marquee Port of Call - Halifax. All passengers will be treated to an award winning welcome programme featuring the Town Crier and world champion pipers & drummers of the 78^th Highlander Regiment of the Halifax Citadel.

Some Highlights You Can't Afford to Miss!

Halifax Citadel National Historic Site
High above Halifax sits a star shaped citadel, one of the great British fortifications of the 19^th century. It's one of the most visited National Historic Sites in Canada. Animators of the 78^th Highland Regiment on sentry duty greet visitors as they cross the drawbridge. Don't miss your opportunity to have your picture taken with these animators reenacting life of the 1860's. Be sure to catch the firing of the noon day gun which happens atop the ramparts, every day except Christmas Day.
http://www.pc.gc.ca/

Halifax Trivia
Did you know these fun facts about Halifax?

Dr. Cecil E.G. Caines
1943-2006

Dr. Glen A. McDonald
1926 - 2006
Unexpectedly on November 25, 2006 with his family by his side, at St. Joseph's Health Centre, Toronto. Glen will be missed by his wife Violet, his sons, Christopher and Paul and his daughter, Sam. Glen graduated from the University of Toronto Medical School in 1949. He continued his training to obtain Diplomas in both General and Orthopaedic Surgery. Glen's career specializing in orthopaedics spanned over four decades while holding positions on the staff of St. Joseph's Health Centre and at Queensway General Hospital (now Trillium Health Centre, Queensway site). Among his numerous contributions, he served as Chief of Orthopaedics at St. Joe's and as Clinical Teacher, Department of Surgery, U of T. Glen was passionate about his work and was committed to providing quality orthopaedic services. He enjoyed the physical aspect of his specialty and the variety of working with patients of all ages. Glen was also defined by his deep love of the outdoors and of physically challenging sport. He enthusiastically immersed himself into yacht racing, tennis, skiing and field dog trials. In his 70's, Glen took up snow boarding. After retirement in 2000, Glen moved to his favourite retreat in the Muskokas. He occupied himself by analyzing the markets, exploring vegetarian cooking, gardening, training his dogs, listening to jazz and to the wind rushing through the pines. If desired, donations in Glen's memory may be made to Medecins Sans Frontieres/ Doctors without Borders by calling 1-800-982-7903 and speaking with Donor relations. Messages of Condolence may be placed at http://www.ridleyfuneralhome.com/.