The concentration in the room is tangible: around two dozen surgeons and orthopedic surgeons cut, drill and screw to fix a complicated thigh fracture with a titanium plate. Their worktables are packed with scalpels, drill bits and countless screws of different colors. A doctor’s drill slipped away. The fixing pliers don’t want to hold another one – and which of these many screws was the right one again?
Surgery is a complex craft that needs to be mastered well before operating on a patient. That is why the doctors in this training course do not work on real bones, but on imitation thighs made of plastic, which are surrounded by red foam muscles and covered in an imitation leather layer that resembles the skin.
Every surgeon and orthopedist who wants to operate independently must have attended these AO Foundation courses
What young medical professionals learn here at the AO Foundation in Davos is the gold standard in trauma surgery worldwide. «Every traumatologist and every orthopedist who wants to operate independently must have attended these courses of the AO Foundation. That’s just part of it,” says surgeon and course instructor Christian Candrian. This standard was invented by 13 Swiss senior physicians more than 60 years ago.
Invalid due to broken leg
The group of young senior physicians no longer wants to accept the prevailing conditions at the time: in the 1950s, a broken bone could be a bitter stroke of fate, especially with a broken leg. Back then, fractures were simply plastered in and immobilized. In many cases, this leads to lifelong malpositions with inability to work and disability pension.
Legend:
Portraits of the founders: from top left Maurice Müller, Robert Schneider, Walter Schär, Walter Bandi, Walter Stähli, Hans Willenegger and August Guggenbühl.
AO Foundation
The young doctors want to change that. Why shouldn’t people be able to move completely normally again after an injury? In 1958 they set up a group that they quite pragmatically called the “Working Group for Osteosynthesis Questions”, or AO for short. Osteosynthesis is the joining of broken bones. And this connection is what the 13 men are concerned with.
Legend:
Portraits of the founders: from top left Fritz Brussatis, Ernst Baumann, René Patry, Martin Allgöwer, Willy Hunziker and Walter Ott.
AO Foundation
Their idea: use plates and screws to fix the broken bones in such a way that they can be aligned and grow together again in their original position. The approach is not new, but so far there has been a lack of implementation.
Standardization leads to medical revolution
That should change. The working group for osteosynthesis issues developed a standardized method for treating broken bones for the first time. Together with partners from industry, she produces the first standardized instruments.
Standardization was the real medical revolution.
And for the first time, the AO is developing uniform training courses in which the medical specialists learn under supervision how to use the newly developed surgical technique and instruments correctly: there are specifications for every conceivable type of bone fracture which plates, screws and tools should be used. In this way, the chances of success of the operations, which were still controversial at the time, can be continuously improved. “This standardization was the actual medical revolution,” says Hubert Steinke, medical historian at the University of Bern.
Impressions of the first AO courses in Davos
All this is practiced on corpse or animal bones and in constant discussion between the course participants. This is astonishing for that time, because the model that was common at the time looked different: the doctors train their skills by observing the few luminaries at the large hospitals and universities. As a result, the doctors are sometimes untrained in the operating room. The group is fundamentally changing that with its courses.
New method withstands scientific scrutiny
And there is another reason why the new surgical method is ultimately a success: “Doctors focus on empirical research early on. They document, control and analyze all operations seamlessly, collate experiences and evaluate them statistically,” explains Steinke. In short: you turn surgical research into a scientific discipline. For example, they can show early on that bones actually heal under pressure – which is exactly what happens when bones are screwed together with plates.
They document, control and analyze all operations seamlessly.
Nevertheless, some of the prominent doctors of the time are skeptical about the new method. Above all, the fact that the patient has to be cut open to attach the plates and screws, which enormously increases the risk of infection, gives reason to consider. And indeed there are complications at the beginning. The inserted implants rust or are inserted incorrectly. Through the scientific approach, the AO is constantly developing the tools and the appropriate training. Til today.
Training courses are becoming the international standard
The ideas of the founding fathers are still at the center of the AO courses today. Although the program of the three-day course is tightly packed, the participants have the opportunity to exchange their experiences with each other and with experienced surgeons. “What I always find important is the interaction with people from other hospitals,” says a participating senior physician. An assistant doctor adds: “You can put theory into practice right away and you have plenty of time to practice.”
Not everyone can repair bones equally well.
This is also confirmed by course instructor Christian Candrian: “Not everyone can repair bones equally well. You need a very good school for that.” Becoming really good is also a huge challenge. But the courses nowadays are almost perfect for preparing future surgeons and orthopedic surgeons for their future.
Initially, the courses were held exclusively in Switzerland. But thanks to the success of the method and the resulting interest, they quickly became an export hit. The first course was held in North America as early as the 1960s. Today, more than 800 courses are held worldwide, which are attended by almost 100,000 medical professionals every year. But the biggest and most important still takes place in Davos.
At the end of the exercise, everyone managed to correctly screw the plate to the artificial bone. The tools used lie in disorder on the exercise tables. It’s suddenly quiet in the room. And again, the AO Foundation – following the example of its founders – prepared a group of surgeons and orthopedic surgeons for their future in the operating theaters in the middle of the Swiss mountains.