In October 1943, the members of the Montreal Orthopaedic Association decided to form a national association. The Founding Committee, consisting of Drs. J.C. Favreau, R.I. Harris, A.P. MacKinnon, J.A. Nutter and J.É. Samson drafted the by-laws eight months later. The first Scientific Meeting of the fledging bilingual Canadian Orthopaedic Association (COA) was held in Montreal in June 1945. Twenty-four members attended, some still in armed services uniforms. Orthopaedic education was deemed a priority and training programmes were started in Montreal, Toronto and Vancouver.

Dr. R.I. Harris, in conjunction with the COA, initiated the first Combined Meeting of the Orthopaedic Associations of the English-speaking World in Quebec City in 1948. Dr. Harris also helped to establish the prestigious ABC Travelling Fellowship. These projects have been highly successful and continue to this day.

Ever since its inception, the COA has enjoyed an international reputation. Liaison officers are appointed to participate in and maintain our affiliation with national and worldwide orthopaedic institutions.

The COA maintains close ties with the Royal College. The training, education and qualification of orthopaedic surgeons have been within the purview of both our Association and the College. The co-operation between these two institutions has been exemplary over the years, both acknowledging their respective mandates and compatibility.

In the face of increasing sub specialization, the COA has avoided fragmentation by forming subspecialty committees within the parent organization. Thus, the Association speaks with a united voice on behalf of the orthopaedic community in Canada. Such major activities include: Continuing Medical Education, the organization of orthopaedic training centres across Canada and collaborating with the Royal College/College of Physicians of Quebec on issues involving orthopaedic surgeons.

History of the COA Seal

During the fifth Annual Meeting of the COA at Devil's Gap Lodge, Kenora, Ontario in June 1949, Dr. Alexander Gibson presented a design for the Crest and the Seal of the Association for which provision existed in the Act of Incorporation.

The design "emphasizes the nature of the specialty of orthopaedic surgery and the dual nationality, French and English, from which Canadians stem".

This Seal received approval in 1950, the year that Dr. Gibson served as President of the Association.

History of the Jewel of Office

During the Combined Meeting of the Orthopaedic Associations of the English-Speaking World held in London in 1952, Her Majesty Queen Elizabeth The Queen Mother presented the Jewel of Office as a gift to the Canadian Orthopaedic Association.

For the Canadian Jewel of Office, the central motif depicts the well-known twisted tree trunk, which appeared in a book written in 1741 by Nicholas Andry, an eminent French physician. The two cherubs posing adjacent to the crooked trunk, on a dark green background, were designed by a craftsman, and represent humanity and the spiritual basis of healing, a spirit that must be shared by both physician and patient. The materials used were sterling silver and 9 Kt. gold with vitreous enamel for the background.

Atop the Jewel of office is a clasp comprising elements of the Seal adopted by the COA on the initiative of Dr. A. Gibson in 1948: a fleur-de-lis super-imposed on a maple leaf which is attached to a gold ribbon and suspended from the neck as a pendant. At the base were engraved the Canadian version of the Greek words ORTHE PAEDEIA. Immediately adjacent to these words was the engraved notation "Founded MCMXLVIII".

History of the COA Coat of Arms

Designed by Robert B. Salter, O.C., M.D., a member of the Heraldry Society of Canada, and presented in June 1981.

The Canadian Orthopaedic Association crest of our coat of arms depicts a knight's helmet on which rests the universally acknowledged orthopaedic tree adorned with red Canadian maple leaves; its trunk bound to a post by a gold cord. The middle upper part of the shield shows the new Canadian flag, the red maple leaf, superimposed by the gold fleur-de-lis on a common stem (from our original Seal) on a white centre, which is flanked on each of the two red borders by an open book edged in dark blue and supported by a gold cover (a time-honoured heraldic symbol of teaching and learning). The lower part of the shield shows two gold symbols on a dark blue background: the first, a femur, complete with its joint surfaces represents skeletal tissues with which we work and hence is symbolic of orthopaedic patient care; and the second, a "skeleton" key which can serve as a symbol of research and is an ancient heraldic symbol of a closed mystery and a way in which to unlock or solve that mystery.

Our chosen motto, translated into Latin is: "Pietate, Arte et Scientia Corrigere" which requires a little explanation.

"Pietate" means "with compassion" as would be exemplified by the compassion of The Good Samaritan - from the biblical story written by St. Luke the Physician. "Arte" is "skill" and in our motto it refers to the surgical dexterity and precision which are so important in orthopaedic surgery. "Scientia" is "knowledge", especially scientific knowledge which forms the basis for orthopaedic diagnosis and judgement. The verb "Corrigere", which comes at the end of the Latin motto, means "we correct, straighten or set things right." This, of course, is the essence of orthopaedic treatment. Thus, the complete motto, "Pietate, Arte et Scientia Corrigere", means "With compassion, skill and knowledge we correct, straighten or set right".

History of Orthopaedics

The practice of orthopaedics has long been a tradition. However the word orthopaedics did not exist until 1751, when Nicolas Andry published in Paris his three volume work entitled "Orthopaedics or the Art of Correcting Body Malformation in Children".

Orthopaedics was originally formed of two greek words - ORTHOS, which means "Straight" and "PAIDION" which signifies a child.

The basic objective of orthopaedics at its inception, was the prevention or correction of children's deformities. Its emblem is a crooked tree tied by a rope to a supporting post. The analogy is the knowledge to correct deformity. The image of the crooked tree has been adopted by local, national and international orthopaedic societies.

The Evolution of Orthopaedics

Traditionally one invariably relates to Hippocrates (460BC - 355BC) and the Hippocratic writings (circa 430BC) for the initial links to medical conditions which might relate to musculo-skeletal problems. One readily recognizes our present day "Hippocratic method" for reduction of dislocated shoulders. Hippocrates' work was continued by Galen who was a dedicated student of anatomy and physiology. It was not until the Renaissance era that a resurgence in truly scientific study resumed. Vesalius published his great treatise on anatomy in 1543. Ambrose Pare (1517-1590) not only described the surgical ligation of vessels, but also congenital dislocation of the hip. However, the surgeon, particularly one afflicted with the reputation as "orthopaedic surgeon" was considered nothing more than a "mechanician".

The 18th century brought new light and life to orthopaedics with new discoveries and memorable names like Percival Pott, John Hunter, Astley Cooper and Nicholas Andry. Surgery eventually became safer and less painful with the introduction of anaesthesia by Morton in 1846, antisepsis by Lord Lister in 1876, bone grafting by Macewen in 1879 and internal fixation of fractures with plates and screws by Lane in 1892. One of the great advances before the turn of the century was Roentgen's discovery of x-rays and radiographs which were used in the management of the devastating problems encountered in fracture treatment. Surgical advances thenceforth became phenomenal and vastly encompassing. Surgery of the locomotor system, child or adult, be it bones, joints, nerves, muscles, ligaments or tendons gradually became the domain of the orthopaedic surgeon. Classic textbooks by Whitman and Bradford and Lovett failed to include fractures, nerve injuries or amputations; however, it was in these times that Arbuthnot Lane, an English general surgeon, advocated the "no-touch technique" in surgery, an aseptic technique combined with screw-plate internal fixation which dramatically altered the results of fracture treatment.

With the turn of the century, little progress was being made with the management of tuberculosis. Most children's hospitals had a formidable patient load of tuberculous bones and joints and poliomyelitis was not only rampant but ravaging. This was the era of Hugh Owen Thomas (treatment of joint tuberculosis and traumatic injuries to the extremities) and his nephew, Sir Robert Jones, (care of crippled children, orthopaedic injuries and rehabilitation).

World War I may be considered the pre-Renaissance era of orthopaedic surgery as a specialty unto its own. Advanced techniques in the management of open and closed fractures, amputations and nerve injuries were introduced. Contractures, adhesions and deformities brought the introduction of rehabilitation skills and retraining resulting in great improvements for the treatment of the wounded and a significant advance in trauma management in general. The field of orthopaedics progressively opened up encompassing such fields as: the study of bone grafting techniques, spinal surgery, congenital deformities, reconstructive surgery of joints, club foot reconstruction, peripheral nerve repair, country hospitals for tuberculous patients, joint arthrodeses and management of poliomyelitic deformities.

In perspective, the Canadian Orthopaedic Association (COA) was conceived in an era of subsiding turmoil following World War II. It was a time of discoveries and technological advancements, coupled with a desperate need for educational enlightenment and a Canadian platform to share in the well-established orthopaedic societies already in existence internationally.

The Origins of Orthopaedics in Canada

With the gradual recognition of orthopaedic skills in fracture treatment following World War I and the need for veterans' hospitals in Canada, there followed a parade of Canadian surgeons focusing interest on musculoskeletal problems. As there were no "Canadian schools" of orthopaedic surgery in those times, expertise was acquired from centres in England, Continental Europe and the USA. The subsequent lessons of World War II not only witnessed remarkable medical advances, but spurred further interest in orthopaedics as a specialty of general surgery.

It was during a discussion in October 1943 involving members of the Montreal Orthopaedic Society (President: J.É. Samson) that it was proposed that an Association of Canadian orthopaedic surgeons be considered. A Provisional Founding Committee was struck to represent the Provisional Executive Committee until legally constituted. Dr. J. Édouard Samson was identified as the first founder of the COA. Dr. J. Appleton Nutter (Montreal) was appointed the first President; Vice-Presidents were Drs. Robert I. Harris (Toronto); Andrew P. MacKinnon (Winnipeg) and J. Édouard Samson (Lévis, Quebec). Secretary-Treasurer was Dr. J. Calixte Favreau (Montreal). The Provisional Founding Committee met on May 24, 1944 during the Annual Meeting of the Canadian Medical Association.

The newly formed Canadian Orthopaedic Association arranged its initial annual meetings in conjunction with the Canadian Medical Association. The first official meeting of the COA was held in Montreal, June 12-13, 1945, at the Mount Royal Hotel.

The 1946 meeting in Banff and the 1947 meeting in Winnipeg were held in conjunction with the Annual Meeting of the CMA. The 1948 meeting in Quebec City was the first of the Combined Meetings of the English speaking Orthopaedic Associations (British, Canadian and American Orthopaedic Associations). Except for the repeated sequence of Combined Meetings, and an associational joint meeting with the AOA, the COA has met annually as a singular body.

Orthopaedic Practice in Canada

Orthopaedic surgery has developed more than any other surgical specialty and has particular appeal to dynamic young surgeons who are impressed by the reconstructive nature of the work; by the satisfaction of achieving dramatic improvements for painful joints and by enabling the disabled to walk.

Like many branches of medicine, we are having to do more with less. We would like to ask for your understanding and patience when you have to wait a long time for clinic appointments and surgery.

Emergencies occur at unpredictable times and can disrupt planned clinics and operating lists, making delays in your appointment or admission necessary.

We are sorry about the huge waiting lists for orthopaedic surgery in almost all Canadian hospitals. We have tried to do as many procedures as possible on an outpatient basis but the demand for our care is such that the system is being overwhelmed. Our nation cannot afford, at present, increased resources for health care and unfortunately, we are losing some of our (best) surgeons, who have felt powerless to intervene. We hope you will bear with us as we try to give you the most modern and effective surgery available in the world.

Research to improve our ability to deliver even better care for you never ceases. At the annual Canadian Orthopaedic Association convention, 200 papers on clinical or scientific research are delivered by Canadian orthopaedic surgeons. These are selected from the research performed in Canadian hospitals and universities. Every year, we deliver many papers and lectures at major international conferences through which our surgeons and research partners have made pioneering contributions to the fundamental advances in orthopaedic surgery. For example, the operation to treat birth defects of the hip, donor bone grafting to substitute for absent joints, probing analyses on the outcome of surgical procedures and the development of new joints. It was a Canadian surgeon who introduced the arthroscope to North America. He has been listed in Sports Illustrated as one of the 20 individuals who have had the greatest influence on sport this century.