HWB Foundation Annual Meeting Minutes
11.30 a.m. – 2.00 p.m. March 23rd 2006
E 266 McCormack Place, Chicago IL

Board Members Attending:

Richard Ghillani, M.D.
Bradford Henley, M.D.
David Karges, D.O.
Henry Mankin, M.D.
Jeffrey Mast, M.D.
Augusto Sarmiento, M.D.
Marc Swiontkowski, M.D.
Edward Yang, M.D.

Officers Attending:

Robert Brookbanks
William Burman, M.D.
Rory Gleadhill
Ronald Hoering

Other Attendees:

Philip Wolinsky, M.D.
Carole Mankin
Amir Jamali, M.D.
Michael Dohm, M.D.
Jack Goldstein, M.D.
Gregory Della Rocca M.D., PhD
Myles Clough, M.D
Leif Havelin, M.D. PhD.
Geir Hallan, M.D.
Jonas Fevang, M.D.
Lars Engebretsen, M.D. PhD.
Michael Redies, MA
Brett Crist, M.D.
Beatte Hanson, M.D.

Meeting started at 11.30 a.m. The business section ended promptly at 11:45 and the members approved the minutes and the finances of the company.

Dr. P. Wolinsky – UC Davis Orthopaedic Trauma Registry

Dr. Wolinsky presented his long experience in the use of the Trauma Registry and his latest involvement in introducing it into the Orthopaedic Dept. at the University of California - Sacramento. He then showed how he would enter a hip fracture case on the TR and as he was doing it he explained the residents were using it and would enter the basic patient information. As the attending he is responsible for entering the specific injury details. He finds it very quick, but stated that it seems a lot of clicking to begin with. If one needs only the CPT codes and ICD 9 codes this can be done with 3 clicks, but it does not provide the specificity for subsequent review.
There were a number of questions during his presentation – Can the pop- up windows be printed? Not at this time.

Elmhurst also has the residents do the basic entry and the attending surgeons add the specific injury details. Furthermore the residents at Elmhurst find the fact that the CPT codes and ICD 9 information is captured is now very useful for their submission for the review of the cases they have seen during the residency. Can a second resident be added to the surgery notes as this is often the case? Yes.
In clicking through the case Dr. Wolinsky said he never knew the neck angle and length of the distance from the fracture to the apex of the head and the lateral edge of the trochanter – Dr. Swinkowski said the length distances had proved to unimportant and could be safely omitted.

Dr. A Jamali – UC Davis Adult Reconstruction Registry

The talk really focused on “how to go it alone”, he is attempting to capture all his own Total Joint Cases, so that at some date in the future he will be able to do research. He explained that the data today is unable to provide the specificity of information, while The Norwegian Total Joint Registry has been a model of cooperation, the end-point is simply revision, yet there are many reasons that a revision may not be done – health of patient, unwilling to undergo another major procedure etc.

Collecting of patient data and it use in the public domain as a result of the HIPPA rules is complicating research significantly. At UC Davis, he has received permission to collect this data prospectively, when he wants to review the data for publication he must get an IRB approval for the study and then go back and ask permission from the patients to use their information in the study. He has classified this as a prospective study he will do retrospectively. There were many questions from the floor, some surgeons explained at their institutions they were able to obtain IRB exceptions for their research varying from 1 – 3 years before renewal, but he explained that UC Davis had decided to resolve the issue in this way.

Dr. G. Hallan – Norwegian Arthoplasty Registry.

Dr. Hallan presented the method that is used to collect the data and the extraordinarily high cooperation they obtained across the country. Significant in Norway is that every patient has a National ID number so they can easily be followed as they move to different areas. Every surgeon fills out the form along with his operative notes, the form takes only a couple of minutes to complete. The forms are then collected by a secretary and sent once a month to the center of the project in Bergen. Key to obtaining surgeon support was the fact that no details are released that can identify the surgeon, although individual hospitals can be identified. The purpose of the study was to identify a poor prosthesis and several have been identified including a poor quality cement.

Dr. Havelin M.D. PhD. – Norwegian Arthroplasty Registry

Dr. Havelin who was one of the original founders of this registry spoke on some of the past challenges and the future ones. The form had to simple and quick to complete and a philosophy has been the larger the population you are trying too capture information on the less the data you can collect. Every hospital has a representative, but there are only 80 hospitals in Norway and population of 4.5 mil. Norwegian surgeons were prepared to limit the number of implants that they would use. They are funded by funds from a national lottery (50%) and the Bergen local health authority, and while offered industry support, they have persistently declined it. They have system of returning incomplete forms back to the original surgeon, there a 2 secretaries involved full-time, a statistician and a 4 surgeons in Bergen who play and advisory role. They have looked at trying to modernize the system to become paperless but the issues are extremely complex from computers which cannot share information to obtain permission to transfer and report data.

J. Fevang M.D. – Norwegian Hip Fracture Registry

Following the success of the Arthroplasty Registry, the Norwegian have embarked on a hip fracture registry. Hip fractures are seen at 55 hospitals and there are approx. 9,500 fractures a year. The registry started in 1st Jan 2005 and they collected information on about 5,500 cases. Compliance has been high at large hospitals but not so good at the smaller ones. They are following the patient until they die and will record all subsequent operations. The patients are also expected to fill in the SF 36 form and so far about 1/3 of the patients are unable to do this due to dementia etc. The information is a little more expensive to collect costing about $50 a record.

L. Engebretsen M.D. PhD. – Norwegian ACL Injury Registry

This study is supported by the lottery and the motivation to undertake the study was the high number of ACL injuries in Norway among young girls because of the huge popularity of volleyball. The study started in 2002? And so far they have compliance rate among surgeons of about 60%. In a similar manner to the other two studies physician specific results are not released. In response to a question on the lower compliance from surgeons Dr. Engebretsen said it was a due to it being a different and younger surgeon population. He said their initial impression of the results to date is that the patients who had ACL repair have done very poorly compared to patients who were not operated on with regard to pain and development of osteoarthritis.

C. Mankin – MGH Treadwell Electronic Library

Carole Mankin, due to the lack of time, graciously stepped forward and declined to present her work. We were disappointed but look forward to hearing it next year.

M. Redies – AO Foundation Education Web Portal

The AO has decided to pull all of its information and make it available on-line in a very comprehensive and flexible format. Currently, they have produced 5 segments (Forearm, Wrist, Upper Tibia, Lower Tibia and Proximal Humerus) and hope to complete the whole anatomy by the end of this year. A demonstration of the site was given and it was most impressive. Every segment has a number of lead authors and it is their responsibility to ensure the data presented is current. There is no charge for physicians to use the site, but they hope in the future to charge a annual of per use fee for physicians in first world countries and provide it free to the rest of the world.

The meeting was adjourned at 1.57 p.m.