* Part I: Basic Principles and Techniques of Operative Fracture Management

This Course is designed to provide the participant with a fundamental knowledge of operative treatment of fractures and nonunions, according to the AO principles. The Course will cover the concepts of absolute and relative stability as applied in context of the soft tissue injury for each limb segment's major fracture types.

Application, patient selection, and preoperative planning considerations for each will be presented. Participants will have the opportunity to carry out the techniques on artificial bones in a bioskills laboratory. Problems and complications, intraoperative difficulties and patient follow-up will be addressed. Concepts of polytrauma care associated with orthopaedic surgery will be discussed. The goal of this course is not to advocate the treatment of all fractures by surgical fixation, but rather to help ensure that when surgery is carried out, it is done properly based upon principles, appropriate preoperative planning, and decision making.

This Advanced Controversies in Fracture Care Course will focus on the treatment of complex fractures and fracture complications. This will be accomplished through didactic presentations and Fireside discussions between the participants and faculty. These group discussions will allow for a close interaction between the faculty and participants.  In addition, the techniques will be practiced on artificial bones.  Topics will include: difficult fractures of upper and lower extremities, fractures of the pelvis and acetabulum and polytrauma.  Participants will have the opportunity to address treatment of malunions and nonunions utilizing preoperative planning and current fixation techniques.

Part III:  Advanced Symposia:  Solutions for Fracture Fixation Problems 

This Symposium is designed for orthopaedic trauma surgeons who are interested in learning new and advanced trauma reconstruction techniques, and will focus on complex long bone fractures and nonunions/ malunions secondary to inadequate internal fixation and implant failure, providing alternative options to successfully manage these problems.  Both complex fracture and malunion/nonunion treatment will be discussed in small groups. An extensive emphasis will be placed on small group discussions, participant-faculty interaction, and maximizing the learning experience.  In addition, discussion of management of failed acetabular and pelvic fixation, introduction of bioregenerative principles in periarticular osteotomy and indirect reduction techniques will be incorporated into this course.

Specialty Courses

Symposium on Surgical Preservation of the Hip

Since the early days of Maurice E. Müller, the University of Bern, Department of Orthopedic Surgery presented annual courses on hip surgery, emphasizing new concepts that had been investigated at the University Clinic and the M. E. Müller Institute.  These observations led to new surgical applications that have had a positive impact on the diagnosis and treatment of hip disease.

Many surgeons in North America did not have the opportunity to travel to Bern to learn these applications firsthand.   There was a very fertile decade in Bern under the leadership of the former Director of the Orthopedic Department, Professor Ganz. New ideas and observations led to changes in the approach to patients with painful hips (in which traditional methods of evaluation led to no clear diagnosis). In the last two years, many of the ideas and principles introduced in the first symposium have been corroborated by further experience and have led to more sophisticated surgical techniques.  We are pleased to present this material. Professor Ganz continues to be active in the field of hip surgery, and willingly shares his knowledge and experiences so that we all benefit from his teaching. The Symposium will be of interest to orthopaedic surgeons who wish to increase their understanding of the conditions that lead to damage of the articular surfaces of the hip joint. This will aid these surgeons in the early detection and treatment of patients with heretofore poorly understood malfunction between the acetabulum and femoral neck. 

This curriculum includes detailed assessment of the osseus, and vascular anatomy of the pelvis, acetabulum, and upper end of the femur.  The understanding of the relationships of these structures leads to identification of abnormal degrees of femoral head— neck offset that can lead to femoroacetabular impingement.  The knowledge of the subtleties of the vascular anatomy gives the surgeon the key to the treatment of this condition, which requires safe execution of surgical dislocation of the hip.  The curriculum also focuses on hip dysplasia in the adult.  This material is not only concerned with patients with deficiency of lateral center edge angle (Wiberg), but also those who display radiographic abnormalities of acetabular retroversion, coxa profunda, and protrusio acetabulae.  Acetabular osteotomy, including pitfalls and problems of surgical execution, will be discussed.  Variations of corrective positioning of the acetabular fragment related to the range of abnormal presentations of the dysplasia will be presented, with discussion of the factors influencing decision making in osteotomies of the acetabulum.  Finally, specific surgical approaches and their applications to other conditions in hip disease will bring further sophistication to the participants, as well as inspiring discussion of the future direction hip surgery may take.  The Symposium will be taught by a Faculty who is familiar with the latest applications and who have all studied with Professor Ganz.

Foot and Ankle Course

This Course is designed to acquaint the surgeon with advances in operative treatment of fractures and dislocations about the foot and ankle.  The objectives of this Course are to focus on all aspects of the diagnosis, treatment and subsequent management of these injuries, including the associated complications.  The technical aspects of both hard and soft tissue surgery and the use of implants and the standard AO techniques will be taught.

Hands-on laboratory exercises will constitute an important segment of the Course instruction.  These laboratories will be implemented by closed circuit television and videotapes.  Each registrant will actively participate in fixation techniques during laboratory sessions.

Ample time and opportunity will be provided for discussion between Faculty and participants.  Small discussion groups will be conducted during the Course.  Participants are required to bring challenging fracture problems to be included in these discussions.

Pelvic and Acetabular Fracture Management Course 

This intensive hands-on course will provide comprehensive information on all aspects of pelvic and acetabular trauma. Topics will include basic science, classification, diagnosis, management and complications, as well as the outcome of treatment. In addition, ongoing controversies of pelvic and acetabular treatment will be discussed in a “debate” format on the final day of the course. A unique feature of this course is the session devoted to cadaver dissection in the labs of the Department of Anatomy at the University of Toronto  The participants will have the opportunity to learn the different surgical approaches, including the indications, techniques, advantages and disadvantages. In the manual skills laboratory, the participant will perform internal and external fixation techniques on various pelvic and acetabular fractures through demonstration and actual stabilization techniques on artificial bones.  There will be a high faculty-to--participant ratio, which will facilitate opportunity for personal interaction and discussion. 

Regional Trauma Summits 

The Regional Trauma Summit is designed for community orthopaedic surgeons who are actively involved in the treatment of patients with fractures.  The Summit is very informal, discussion-based and designed to be highly interactive, with clinical presentations that include tips, tricks and techniques on how the Faculty tackles certain clinical problems.  The Faculty will discuss recent advances in fracture care and share suggestions in approaches and handling of difficult fracture problems.  Each session incorporates an alternating presentation–discussion format, followed by participant case presentations.  All participants are strongly encouraged to bring personal cases for discussion to maximize their personal experience in the Summit.

Hand and Wrist Fracture Course 

This course is designed to teach participants at every level of training and practice to systematically analyze hand and wrist fractures and to apply a treatment methodology based upon fracture management principles rather than upon any one implant, group of implants, or singular universal technique. Hand fractures are analyzed according to the number of fragments, the fracture configuration, displacement, clinical and radiographic deformity, stability, and function, as well as individual patient considerations. Management principles include anatomic or near anatomic fracture position or reduction, adequate stability to control pain and assure healing while allowing simultaneous early active progressive recovery of mobility, and the preservation of soft tissues and circulation to the fracture fragments.  

The majority of hand fractures are undisplaced or minimally displaced. These fractures are stable (do not lose their position spontaneously or with gentle progressive range of motion exercises), and require only protection and rehabilitation. A smaller, but very important, cohort of hand fractures are displaced and unstable, may be irreducible, unstable or both. This course distinguishes the characteristics between these two groups and emphasizes the reliable and, whenever possible, minimally traumatic treatment of those fractures that require fixation. Correct selection of fractures for stable fixation and the proper selection and application of implants will be accentuated. AO principles, as well as implants, will be emphasized and alternative methods will be thoroughly discussed. 

The Course objectives will be met by a balanced program of didactic teaching, hands on laboratory sessions, and interactive discussions. Closed curcuit television and videotapes will be used during the practical exercises, and each registrant will actively participate in fixation techniques. 

Instruction will include emphasis on bone and implant biomechanics, design and metalurgy, atraumatic soft tissue technique, surgical incisions and approaches, stable fracture fixation, treatment of nonunions, corrective osteotomies, arthrodeses, and rehabilitation.

Upper Extremity Course 

This Course will focus on updates in upper extremity trauma and shoulder surgery.  The participants will gain insight into the management of common and difficult traumatic and reconstructive problems of the upper limb, including newer implants for trauma and current methods of minimally invasive techniques for the shoulder.  All participants are urged to bring a personal case on a CD for discussion.