Medical Politics

We can change the health care agenda in Canada

The following President Elect Address was delivered on October 4, 2003 by Dr. Robert M. Hollinshead at the rescheduled COA Annual Meeting held in Winnipeg, MB. We are pleased to share a print version of this speech with our Bulletin readers.

Ed.

• Honored guests

• Visiting presidents

• Fellow colleagues

• Ladies and gentlemen

Thank you, Dr. Bill Rennie, for the kind introduction. I am truly honoured to have been given the opportunity to serve as your President.

Measuring the X-Ray: Problems and Solutions

T. Derek V. Cooke, M.D., MB, BChir, FRCSC
Allan Scudamore, PhD
Kingston, ON

The value of radiographs (X-rays) in musculoskeletal care is beyond dispute, yet the time-honoured technology is cumbersome in terms of film processing, handling, storage and retrieval. Fortunately, digital imaging methods now promise greater convenience and lower costs in the long-term. Currently there are two options: Computer Radiography (CR) using radiosensitive phosphor screens read by laser scanners, and Direct Radiography (DR) where image capture is immediate via sensors “hard-wired” to the computer. These systems, despite their high capital costs for conversion, are being adopted by many institutions. A central feature of them is PACS (Picture Archiving Computer Systems) which manage the data storage and retrieval networks. Apart from the better logistics afforded by these systems, digital images have a range of clinical advantages including better image quality (sharpness, contrast, magnification etc.) and facilitation of metric imaging.

Displaced proximal humeral fractures can lead to significant sequelae if not treated properly. Controversy has existed as to whether these injuries should be treated with or without surgery and if treated surgically with internal fixation or arthroplasty. The dramatic outcomes of surgical treatment have led to increasing use of various treatment alternatives. Each treatment alternative has included a fair proportion of failures, which have required revision. These failures and the increasing demand for normal function have lead to increasing debate as to the most appropriate procedure. Our themes section will discuss this important issue in detail.

Role of Prosthetic Replacement for Proximal Humerus Fractures

Robert G. McCormack M.D. FRCSC
Assistant Professor
University of British Columbia
New Westminster, BC

Damian Musso M.D.
Orthopaedic Fellow
University of British Columbia

Complex fractures of the proximal humerus remain one of the most challenging problems in orthopaedic surgery. There is a significant complication rate, irrespective of how they are managed, and a paucity of data to support one treatment modality over another. Perhaps more than any other injury, the fracture “personality” is the key to determining treatment. Several factors need to be considered, including patient demands and co-morbidities, the fracture pattern, bone quality, soft tissue status and surgeon experience. The average age for proximal humerus fracture is 66 years old and there is a trend for fracture complexity to increase with age. Superimposed on this, almost all patients that fracture the proximal humerus over age 40 have osteopenia, which makes standard ORIF more challenging.

Percutaneous Pinning of Proximal Humerus Fractures

Edward J. Harvey M.D., MSc, FRCSC
Montreal, QC

The myriad of treatment protocols for the proximal humerus fracture means only one thing - this fracture is probably inadequately treated by all modalities1. Percutaneous pinning is possible in almost all fractures of the proximal humerus. Certain steps must be taken in order to ensure the success of the fixation. Bouquet fixation, or the use of flexible nailing systems, are possible choices but these have been associated with frequent complications. A systematic approach (similar to that of Jaberg et al2) to both the reduction of the fracture through stab incisions and the placement of 2.5 mm wires will maximize chances of success. The implant of choice is the 2.5 mm terminally threaded k-wire (easily obtainable from the AO small external fixators set).

Figure 1a Typical axillary view of comminuted proximal humerus fracture in a 65 year old male. Mechanism of injury was a fall from 2nd floor roof.

Don Weber, M.D., FRCSC
Associate Clinical Professor

The Role of Locking Plates in the Treatment of Proximal Humerus Fractures

Tousief Hussain, M.D., BSC, FRCSC
Saskatoon, SK

Proximal humerus fractures represent one of the most common fractures in the elderly. They account for 10% of all fractures in patients over the age of 65 years and are the third most common fracture in the elderly^1,2. Seventy-five percent of these fractures occur in patients > 60 years of age³. The management of these fractures can be a significant challenge especially in the presence of osteoporosis and multiple fracture segments. Treatment options include conservative therapy, fixation, and arthroplasty. A good outcome can be regarded as pain free abduction and elevation of ≈ 90°, external rotation of ≈ 25°, and an internal rotation good enough to touch the L1 vertebra⁴.

The COA Web Site – Request for Input

Myles Clough, M.D., FRCSC
Kamloops, BC
Douglas Thomson, CEO
COA, Toronto, ON

Only a short time ago it was debatable whether our organization needed a web site. It was suspected that orthopaedic surgeons seldom used the Internet for anything serious. Now, we are much more comfortable with the web and 80% of the attendees at the COA Annual Meeting register on-line. Yet the role of the COA web site in the affairs of the organization is seldom considered, and members’ ideas on the subject have not been solicited as often as they should be. This article describes the current structure and content of the web site, reviews the current editorial arrangements, and describes other options which the COA web site could offer. It is also an urgent plea for input from the membership on this subject.

Robert Turcotte, M.D., FRCSC
Chairman, Division of Orthopaedic Surgery, McGill University
Chief, Department of Orthopaedic Surgery, MUHC
Montreal, QC

Michael Tanzer, M.D., FRCSC
Programme Director, Division of Orthopaedic Surgery, McGill University
Montreal, QC

Orthopaedic surgery at McGill University is organized as such since the 1930’s. At that time, there were two independent training programmes. One based at the Royal Victoria Hospital (RVH) that included the Montreal Shriners Hospital. Paediatric orthopaedic trauma was done at RVH, which had a paediatric ward until 1973. The other training programme was based at the Montreal General Hospital (MGH) and the Montreal Children’s Hospital (MCH).

The AOA-Kellogg Leadership Series

A Must Attend Series for Orthopaedic Leaders

Committee Update – National Standards

Edward J. Rumble, M.D., FRCSC, Co-Chair
Hans J. Kreder, M.D., FRCSC, Co-Chair
Toronto, ON

On a recent Saturday in Toronto, members of the COA’s National Standards Committee met to discuss the installment of some recommendations with respect to standards for orthopaedic practice in Canada. Specifically, the Committee considered two main areas: 1) the number of orthopaedic surgeons in the country and 2) the resources available to support orthopaedic surgeons in practice. The statement “We don’t have enough orthopaedic surgeons in Canada and we don’t make good use of the ones we have” defines these two areas. The complete report of the Committee will be issued at the Annual Meeting in June, giving details and recommendations for the Board to consider.

Timothy R. Daniels, M.D., FRCSC
President, The Canadian Orthopaedic Foot and Ankle Society
Toronto, ON

The second anniversary of the Canadian Orthopaedic Foot and Ankle Society (COFAS) will be celebrated at the 59^th Annual Meeting of the Canadian Orthopaedic Association (COA) in Calgary this June. Over the past two years, the Society has made significant advancements and has achieved national and international recognition. During the inaugural meeting in June of 2002 in Victoria, BC, the following Mission Statement was developed:

The COFAS is a group of orthopaedic surgeons who aim to promote excellence in clinical foot and ankle care in Canada by:

1. Serving as the primary organization dedicated to foot and ankle clinical care, education and research in Canada.

2. Functioning as the leading resource for education of the Canadian public, orthopaedic surgeons, the general medical community, government, and industry on foot and ankle care.

3. Promoting research in foot and ankle care.

4. Serving the members as a forum for discussion of problems unique to foot and ankle care in Canada.

5. Developing resources that will help Canadian orthopaedic foot and ankle surgeons in addressing local practice-related issues such as quality improvement, coding, reimbursement, legislation, cost of care and access to care.

Close to the Bone: Surgeons and Chefs

Richard W.C. Hu, M.D., FRCSC
Calgary, AB

Culture is what your butcher would have if he were a surgeon

Mary Pettibone Poole

It’s only natural – orthopaedic surgery and anatomy mixed with culinary techniques and cuts of meat. Put it together into a TV show and you have Close to the Bone: Surgeons and Chefs.

Bone & Joint Decade Update

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

The National Action Network for the Bone & Joint Decade in Canada has continued to be very active. Our third newsletter, focusing on trauma, has just been published. You should have received a print copy of the newsletter; if you didn’t receive your copy you can see it on our web site at www.bjdcanada.org.

A Case of Fundamental Justice
Health Care Delayed is Health Care Denied

Robert Hollinshead, M.D. FRCSC
President, The Canadian Orthopaedic Association
Calgary, AB

Our Focus is on Our Volunteers- Join Us on the Last Sunday In May!

Paul H. Wright M.D., FRCSC
President, The Canadian Orthopaedic Foundation
Burnaby, BC

The 13^th annual Hip Hip Hooray Walk in support of the Canadian Orthopaedic Foundation is right around the corner. This year, the event will be held in over 50 cities across the nation. A complete list of sites and date details can be found by visiting the Foundation’s web site: www.canorth.org.

The 2004 Walk has been organized through the efforts of Ms. Angelique Berg and her team at the COF, who have put an important emphasis on our volunteers - giving them a stronger voice in how the Walk is conducted across the country. A newly instituted Volunteer Advisory Board has met by teleconference several times this year and has been instrumental in setting policy and providing much needed input into Foundation affairs. The Advisory Board is made up of experienced Hip Hip Hooray volunteers from every province of Canada. Hip Hip Hooray, however, is not a “cookie-cutter” affair. Indeed, one of the strengths of the Walk is how each community adds regional flair and creativity to their events. Varieties of food, refreshments, activities for children, and entertainment differ across the nation and make each Walk unique in its own way.

Our volunteers make a special investment to improving orthopaedic care in Canada. Proceeds from the Walks are invested locally and nationally – powering solutions in communities and across the nation.

Bassam A. Masri, M.D., FRCSC
Chair, Exchange Fellowships Committee
Vancouver, BC

Wouldn’t experiencing orthopaedics at different centres throughout North America or the world be a wonderful opportunity? How about if we also tell you that you will be treated like royalty? You will be the honored guest of Department Chairmen all over the world, you will be asked for your opinions on your areas of expertise, and you will lecture many very interested audiences. In return, you will learn about the research activities of the various centres that you visit. This may sound too good to be true, but it isn’t.

The Canadian Orthopaedic Association has set up a number of travelling fellowships specifically for this one reason: to allow and encourage interactions with colleagues all over the world. The Exchange Fellowships Committee of the COA has been charged with organizing these fellowships in collaboration with the American Orthopaedic Association.

1930 - 2004

Martin Austin, beloved and loving husband of Terry, passed away at home in his sleep on Monday, March 22, 2004 at the age of 73 years. He is survived by his loving children, Lucy (Adrian Wright), Kate (Jim Parker), Toby (Heather Lee), Tom (Jacqui Dunkley), and William (Susan McLeay); his sister Joy (Brian Pannaman) in England; and his grandchildren whom he loved dearly and was looking forward so much to see grow up, Bronwyn and Simon; Quinn, Oliver, Georgia, and Elliott; Benjamin and Jennifer; Dominique, Olivia, and Gabrielle; and Daniel and Donald. Born and raised in England, Martin immigrated with Terry and their five children to Canada in 1965 settling in Calgary where he pursued his career as an orthopaedic surgeon. He adjusted easily to retirement in 1995 and remained, as always, busy and energetic as he pursued his many other interests including gardening, golf, military history, and skiing. He will be greatly missed by his family and friends. Memorial tributes may be made directly to the Heart & Stroke Foundation of Alberta, 1825 Park Road S.E., Calgary, AB T2G 3Y6 (Telephone 403-264-5549 www.heartandstroke.ca). In living memory of Martin Austin, a tree will be planted at Fish Creek Provincial Park.

Alfred Earnest Deacon, M.D., FRCS

1902 - 2004

Dr. Ihor I. Mayba
Department of Bone & Joint Surgery
Winnipeg, MB

Dr. Alfred E. Deacon passed away peacefully at Victoria Hospital on Thursday, February 19, 2004, in his 102^nd year, with Janet, his devoted wife of 72 years, holding his hand.

Dr. Deacon took his orthopaedic training at the Mayo Clinic, Rochester, Minnesota from 1932 -1935. He obtained a Master of Science from the University of Minnesota in 1935. He returned to Winnipeg and joined an orthopaedic clinic in the Medical Arts Building with Dr. W.A. Gardner and Dr. K.C. McGibbon. He was on the orthopaedic staff at Winnipeg Children’s Hospital and Grace Hospital in 1936 and Winnipeg General Hospital in 1940. He was surgeon to the Winnipeg Shriners’ Hospital from 1952 to 1968. He was Assistant Professor in orthopaedics at the University of Manitoba.

He was a founding member of the Winnipeg Orthopaedic Society in 1948 and was a long time member of the Canadian Medical Association, American Academy of Orthopaedic Surgeons, and a member of the Canadian Orthopaedic Association since 1947.

In 1968 he was given Senior Membership in the COA and Emeritus Membership in the AAOS. He retired from practice in 1968.

He will be greatly missed.