August 2003 Bulletin

Board approves position statement on fragility fractures, clinical guideline on OA of the knee and professional conduct program; establishes Maintenance of Competence Committee

The Boards of Directors (BOD) of the American Academy of Orthopaedic Surgeons and American Association of Orthopaedic Surgeons met June 6-7, 2003 in Rosemont, Ill., and took the following actions:

Unified Research Agenda.

Upon recommendation of the Council on Research and Scientific Affairs, the Board approved the AAOS "Unified Research Agenda," which will be used by leaders in the orthopaedic research community to advance science and research in musculoskeletal care through a unified advocacy strategy. (See related article.)

This document identifies the six leading musculoskeletal research priorities: osteoarthritis; spinal disorders; soft-tissue injuries; major limb trauma; osteoporosis and bone quality; and childhood musculoskeletal disorders. The priorities were recognized for their heavy burden to society, their importance to orthopaedic surgeons and patients and their alignment with the priorities of the U.S. Bone and Joint Decade. This document will be used in meetings with policy makers and legislators, patient advocacy groups, foundations and other potential donors to communicate the most urgent aspects of musculoskeletal research

The goals of the Unified Research Agenda are to:

The AAOS Unified Research Agenda was developed in cooperation with the Council of Musculoskeletal Specialty Societies and the Orthopaedic Research and Education Foundation. It can be found in the Research section of the AAOS Web site.

Summary report of AAOS Research Committee Panel Studies approved. The Board approved "Future Directions in Musculoskeletal Research: A Summary Report of the AAOS Research Committee Panel Studies," a collection of reports on 17 topics in musculoskeletal research prepared by panels of experts convened to create studies on these topics. (See related article on page 54.) Each panel study addresses the scope of the research topic, its clinical significance, its importance to the public health and directions for future research. The document is intended to serve as an educational resource and a resource for research advocacy. It can be found in the Research section of the AAOS Web site.

Guideline on Osteoarthritis of the Knee approved. Upon recommendation of the Evidence-Based Practice Committee, the Board approved an "AAOS Clinical Guideline on Osteoarthritis of the Knee." The guideline was created to improve patient care by outlining appropriate information-gathering and decision-making processes involved in managing osteoarthritis of the knee in adults. It is designed to be used as an educational tool to guide qualified physicians through a series of diagnostic and treatment decisions in an effort to improve quality and efficiency of care.

Position statement on fragility fractures approved. The Women's Health Issues Committee partnered with the World Orthopaedic Osteoporosis Organization (WOOO) to develop the position statement, "Recommendations for Enhancing the Care of Patients with Fragility Fractures," which was approved by the Board. It also has been endorsed by WOOO), the American Society for Bone and Mineral Research, the National Osteoporosis Foundation and the National Association of Orthopaedic Nurses. The statement asserts that fragility fractures affect up to one-half of women and one-third of men over age 50. Such fractures occur most commonly in the hip, spine and wrist. Clinical trials have demonstrated that treatment of patients with fragility fractures can reduce the risk of future fractures by up to 50 percent. Thus, it is important that these patients not only receive treatment for acute fractures, but also for future fracture prevention.

Because orthopaedic surgeons manage most fragility fractures and are often the first and only physician to see the fracture patient, they have a unique opportunity to educate the patient about the need to decrease the risk for future fractures and to advocate for improved fracture care. The AAOS believes that by taking an active role in managing or referring patients with fragility fractures, orthopaedic surgeons can substantially improve the long-term outcome of these patients, reduce the risk of subsequent fracture and thereby mitigate the downward spiral in health and quality of life that often follows these fractures. (Related article) The statement in its entirety can be viewed on the AAOS Web site.

Revised advisory statement on use of lasers approved. Upon recommendation of the Biomedical Engineering Committee, the Board approved a revised advisory statement on the "Use of Lasers and Radiofrequency Devices in Orthopaedic Surgery." Previously titled "Use of Lasers in Orthopaedic Surgery," the statement describes the Academy's position on this issue, which is to endorse a scientific approach toward the use of thermal modalities in orthopaedic surgery and to encourage further clinical and biological study on the potential benefits and hazards of this technology. The statement in its entirety can be viewed on the AAOS Web site.

Revised position statement on animals in research approved. Upon recommendation of the Council on Research, the Board of Directors approved a revised position statement on "Animals in Biomedical Research and Education." Previously titled, "Animals in Biomedical Research," the position statement asserts that the appropriate use of animals in conducting biomedical and veterinary research and education is justified to enhance the quality of life for both humans and animals. The statement can be viewed in its entirety on the AAOS Web site.

Professional Conduct Disciplinary Program approved. A work group chaired by Second-Past President Richard H. Gelberman, MD, and charged with exploring the development of an Academy Professional Conduct Disciplinary Program presented its report. The work group reviewed such programs that exist within other medical organizations. Some focus on education and remediation. The American Association of Neurological Surgeons' (AANS) program, which has received considerable attention within the national medical community, is an ethical/disciplinary program. Dr. Gelberman noted that this is a rapidly evolving issue and presented the following eight-step proposal to address the expert witness issue:

Following extensive discussion, the Board approved the Professional Conduct Disciplinary Program Project Team's recommendations and agreed to allocate up to $45,000 from the Board Contingency Fund for 2003 to further develop and implement such a program. It was also noted that support from the Fellowship would be key to this program's success, especially if a ninth step, i.e., an ethical/disciplinary program like that of the neurosurgeons, were to be considered. Therefore, the Board approved the electronic polling of the members to determine their interest in and support for an Academy-sponsored ethical/disciplinary program like that of the AANS. (See "Across the President's Desk" for further information:

Maintenance of Competence Committee established. The BOD approved establishment of a new standing committee on maintenance of competence. The committee will be chaired by David G. Lewallen, MD; members will include Frank Kelly, MD; Stephen A. Albanese, MD; James R. Kasser, MD; Leslie Altick and William W. Tipton, Jr., MD. This committee will continue the AAOS interface with the American Board of Orthopaedic Surgery (ABOS) to determine the role of the Academy in the ABOS maintenance of certification process, including methods of educating members on professionalism, ethics, and continued maintenance of competence as well as development of a curriculum for cognitive exams.

Team Physician Consensus Statement approved. At the request of the American College of Sports Medicine, the BOD endorsed "Female Athlete Issues for the Team Physician – A Consensus Statement," which was developed earlier in the year during the fifth annual Team Physician Conference. The statement provides an overview of select musculoskeletal and medical issues that are important to team physicians who are responsible for the medical care of female athletes.

The goal of the statement is to assist the team physician in providing optimal medical care for the female athlete. It was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues: AAOS, American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine and the American Osteopathic Academy of Sports Medicine.The statement can be viewed in its entirety on the AAOS Web site.

New committee chairs appointed. The Board approved the appointments of J. Sybil Biermann, MD, as the new chair of the Patient Education Committee and of S. Terry Canale, MD, as chair of the 2004 Nominating Committee.


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