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.
William Burman, M.D.
Philip Wolinsky, M.D.
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
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
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
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
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
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 meeting was adjourned at 1.57 p.m.