Bone and Joint Decade Canada Goes International

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

The International Steering Committee of the Bone and Joint Decade met on the Gold Coast of Australia on October 13^th & 14^th, 2007. This meeting was preceded, as has been the case in the last three years, by a patients' meeting to address patient-centered issues of significance to the Bone and Joint Decade. Colleen Maloney was present for the patient meeting and participated fully in the Bone and Joint Decade meeting that followed. She was a great representative for Canada and added to our presence at the event.

Care Models to Consider
highlights from the Halifax symposium

Michael J. Dunbar M.D., FRCSC, PhD
Halifax, NS

Eric Bohm, M.D., FRCSC
Winnipeg, MB

Ted Rumble, M.D., FRCSC
Toronto, ON

At this year's symposium at the Annual Meeting in Halifax, speakers presented on a variety of models of health care delivery that have been shown effective in significantly improving patient access.

Prudential Outlooks

Wilfred J. Hahn
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

An experienced market technician once gave us this portfolio advice several decades ago: "Put half your money into a strip coupon, the other half into gold bullion. That way, no matter what happens - an inflationary spiral or a deflation - at least one half of your portfolio will prosper to allow you to retire without worries."

Make Your Plans Now To Attend the Annual Meeting in Québec City

Doug Thomson, CEO
Canadian Orthopaedic Association

Pierre Mercier, M.D., FRCSC
Chair, Local Arrangements Committee

The 2^nd Combined Meeting of the American Orthopaedic Association (AOA) and the Canadian Orthopaedic Association (COA) will be taking place June 4-7, 2008, in Québec City, Québec. As with the first combined meeting of the AOA/COA in Victoria in 2002, this meeting promises to be a unique educational and social event.

Physician Assistants: an idea whose time has surely come
                                                                         

Doug Thomson, CEO
Canadian Orthopaedic Association

Physician assistants (PAs) have been giving surgeons a helping hand since those epic times when Britannia ruled the waves and Napoleon, the battlefields of Europe - wherever casualties were likely to come in great numbers.

Going to the AAOS Meeting in San Francisco?
Don't miss the COA Reception

The Canadian Orthopaedic Association
On the occasion of the 75^th Annual Meeting of the AAOS
San Francisco, California
Presents a:

Reception
Thursday, March 6, 2008
6:00pm - 10:00pm
San Francisco Marriott
Salon 5 & 6
55 Fourth Street
San Francisco, CA  64103

Introduction
The unstable total knee arthoplasty represents a difficult clinical problem. Dr. Markku Nousiainen and Dr. Jamie Howard will debate the indications, advantages and disadvantages of using a condylar constrained implant versus a rotating hinged implant.

Treatment Options for the Unstable Total Knee Arthroplasty - Condylar Constrained

Markku T. Nousiainen, B.A.(Hons.), M.S., M.D., FRCSC
Toronto, ON

One of the most common causes of failure in total knee arthroplasty relates to instability. Instability may develop at any time after the index procedure. Although the causes for instability are varied, they must be identified prior to performing a successful revision procedure. Causes include component loosening and/or wear, bone loss, improper component size or position, prosthesis or bone fracture, collateral ligament failure, or extensor mechanism dysfunction. These problems can lead to malalignment of the biomechanical axis of the limb and/or imbalance between the patellar and femoral components and/or the femoral and tibial components.

The Use of Rotating Hinges in Unstable Total Knee Arthroplasty

James L. Howard M.D., MSc, FRCSC
London, ON

Instability is an important cause of failure following total knee arthroplasty. Recent literature has identified that instability is one of the most common reasons for revision total knee arthroplasty, accounting for approximately 25% of all revision cases^3,12.

Introduction
Anterior curciate ligament reconstruction in the adolescent has always been a controversial intervention because of the risk of physeal injury. Drs. Debra Bartley, Mark L. Burman, and Chantal Janelle will discuss the advantages and disadvantages of the transphyseal reconstruction, the physeal sparing reconstruction, and the conservative approach respectively.

ACL Tears in Children
Physeal Sparing Reconstruction

Mark L. Burman M.D., FRCSC
Assistant Professor
Division of Orthopaedics, Department of Surgery
Sports Medicine Group
McGill University
Montreal, QC

ACL injury in children with significant skeletal growth remaining poses a unique surgical challenge to the orthopaedic surgeon. While adolescents nearing skeletal maturity can usually be treated as their adult counterparts, concern for damage to the physes around the knee makes this younger group of patients a challenge.

ACL Tears in Children
Transphyseal Reconstruction

Debra Bartley, M.D., FRCSC
London, ON

The adolescent with an anterior cruciate ligament (ACL) injury approaching skeletal maturity presents little controversy among surgeons. The risk of growth arrest causing a significant LLD or angular deformity is low and therefore adult ACL reconstructive techniques are considered safe and appropriate^3,4,9,12. Transphyseal reconstruction of the ACL in the skeletally immature athlete remains a subject of debate. The potential risks associated with damage to the physis, including leg length discrepancy (LLD) and angular deformity, lead most surgeons to look for alternative methods of reconstruction. However, transphyseal reconstruction methods are supported in recent literature without a significant incidence of complications leading to growth disturbance. The small number of complications reported have been attributed to correctible technical issues.

ACL Tears in Children
Conservative Management

Chantal Janelle M.D., FRCSC
Assistant Professor, Department of Surgery
Montreal Children Hospital & Shriners Hospital for Children
McGill University
Montreal, QC

Anterior cruciate ligament (ACL) tears in children are increasingly recognized. Shea et al reported an analysis of 8215 insurance claims filed on behalf of six million soccer players (5-18 y.o.). There was a significant increase in ACL injury at the age of 11-12 years¹.

Dear Members of the COA,

We are writing to inform you that in the forthcoming years, the health care sector in Canada could be facing a shortage of Registered Orthopaedic Technologists. This shortage will have a direct impact on your group since your Fracture Clinics will be facing a resulting staffing crisis of qualified Orthopaedic Technologists.

Dear Editor,

RE:    A COA Member's Journey through Orthopaedics and the Manitoba Provincial Election, May 23, 2007 (Ed - Bulletin #78, Fall 2007, pg. 14-15)

A number of exciting initiatives exist in orthopaedic surgery in Manitoba with developments over the last couple of years.

2007 Canadian Orthopaedic Foundation Financial Report
The Endurance Round - back into fighting trim

Doug Thomson, CEO and
Kevin J. Orrell, M.D., FRCSC
Chairman, The Canadian Orthopaedic Foundation

Sharp-eyed readers of the Bulletin may recognize the above title from the May 2002 issue, where we used a boxing analogy to describe a grim financial report from the Foundation for the 2001 fiscal year. It was that year that the Foundation experienced a whopping deficit of over $600K. We said back then, "we may be bruised, but we're still on our feet." "Barely" would have been an accurate modifier to use at that time.

2007 Research Grants & Awards Recipients

Angelique Berg, Executive Director
Canadian Orthopaedic Foundation

Debbie Gates
Special to the Canadian Orthopaedic Foundation

The Canadian Orthopaedic Foundation is pleased to announce the recipients of its 2007 research grant awards. The number of applications funded is dictated by the success of the Foundation's fund-raising programmes during the year, the most important of which is Hip Hip Hooray!

Gifts for Life
Charitable Giving Programmes for Orthopaedic Surgeons and Their Patients

John F. Brown
John Brown Insurance,
Toronto ON
for the Canadian Orthopaedic Foundation

Introduction by Belinda Chun, Business Development Officer
Canadian Orthopaedic Foundation

There is a saying, "People don't give to causes; people give to people with causes".

As we all know, Canada's population comprises of almost ten million baby boomers - these are people born between the years of 1946-1964. Boomers are entering their early 60's with a number of joint, muscle and bone issues arising from improper early prevention, accidents or simply aging.

ABC Fellowship Tour 2007

Alastair Younger, M.D., FRCSC
University of British Columbia
Vancouver, BC

John Antoniou, M.D., FRCSC
McGill University
Montreal, QC

We couldn't believe our good fortune last year when we learned that we were selected to be the 2007 ABC fellows from Canada. Time passed quickly, and after making arrangements and a few phone calls to our fellow travellers from the United States over the Winter and Spring, we finally were able to meet the rest of the fellows in London on April 15^th. We were greeted by Peter Kaye and David Adams from the British Orthopaedic Association and were introduced to the rest of the ABC fellows: Dr. Brian Donley from Cleveland (foot and ankle), Dr. Connie Chu (Pittsburgh - basic science), Dr. Steve Frick (Charlotte - paediartics), Dr. Alan Hilibrand (Rothman institute - spine) and Bill Ricci (St. Louis - trauma).

Introducing the 2008 Anica Bitenc Fellow

We are pleased to introduce Dr. Denis Trsek from Croatia as the 2008 Anica Bitenc fellow. Dr. Trsek will begin his tour of Canadian orthopaedic centres in June next year and will attend the 2008 COA Annual Meeting in Quebec City.

The Anica Bitenc fellowship is sponsored by Dr. Igor Bitenc and hosts one fellow per year on a rotational basis from Slovenia, Croatia and Serbia. To learn more about the goals and origins of this fellowship, visit the eBulletin article called "The Anica Bitenc Fellowship - Learning from colleagues abroad" in Issue 76 in the COA Bulletin section on our web site: http://www.coa-aco.org/. Here's a direct link to copy into your browser:

http://www.coa-aco.org/en/coa_bulletin/issue_76/the_anica_bitenc_fellowship.html

Promote Your Fellowships Through the COA

If you are looking to promote your centre's fellowship programmes, free advertising space in the COA Bulletin is indeed available.  A ¼ page is offered at no charge to Association members who would like to promote the orthopaedic fellowship opportunities in their centres.  We recommend a 100 word summary along with a hospital or university logo.  Privileged rates are also offered to members who would like to secure space larger than a ¼ page.  Please contact Cynthia Vezina: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it   or 514 874-9003 x 3 for details. 

University of Manitoba Fellowships:

The Section of Orthopaedic Surgery at the University of Manitoba offers fellowship training programmes in four orthopaedic subspecialty areas:

• Arthroplasty - University of Manitoba Joint Replacement Group
• Winnipeg Spine Programme
• Sports Medicine and Upper Extremity Reconstruction
• Trauma

University of Ottawa Shoulder Fellowship

The University of Ottawa Shoulder Fellowship will provide an intensive one-year clinical and research experience focusing on all aspects of shoulder pathology. Clinical training will include advanced arthroscopic and open reconstructive technique.

Dr. Robert Noel (Bob) Lofthouse
December 25, 1917 - September 18, 2007

Passed away peacefully at Arbour Creek, Hamilton.

Dr. Borna Meisami-Fard
May 28, 1967 - July 1, 2007

Father, husband, son, brother, and a true Friend, Dr. Borna Meisami-Fard joined Eternity in our hearts on 1 July 2007.