February 2007 issue of the SICOT newsletter (No. 103)

SICOTSOCIÉTÉ INTERNATIONALE de CHIRURGIE ORTHOPÉDIQUE et de TRAUMATOLOGIETHE INTERNATIONAL SOCIETY OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGYwww.sicot.orgSICOTSociété Internationale de Chirurgie Orthopédique et de TraumatologieInternational Society of Orthopaedic Surgery and TraumatologyNewsletterA journey to the SICOTEducation Centre in LahoreIn this issueEvidence based orthopaedics 2Editorial by Prof Rocco P. Pitto 3Country to country: Venezuela 4On the Web: Internet2 6Committee life:The SICOT Finance Committee Report 8Hospital under fire: the experienceof the Western Galilee Hospital in Israel 9A journey to the SICOT Education Centre in Lahore, Pakistan 10No. 103February 2007

EvidencebasedorthopaedicsArthroplasties with and without bonecement for proximal femoral fracturesin adultsBackground: Numerous types of arthroplasties maybe used in the surgical treatment of a hip fracture(proximal femoral fracture). The main differencesbetween the implants are in the design of the stems,whether the stem is fixed in place with or withoutcement, whether a second articulating joint is includedwithin the prosthesis (bipolar prosthesis) or whethera partial (hemiarthroplasty) or total whole hipreplacement is used.Objectives: To review all randomised controlledtrials that have compared different arthroplasties forthe treatment of hip fractures in adults.Search strategy: We searched the Cochrane Bone,Joint and Muscle Trauma Group Specialised Register(December 2005), the Cochrane Central Registerof Controlled Trials (The Cochrane Library Issue 4,2005), MEDLINE, EMBASE and the UK NationalResearch Register.Selection criteria: All randomised and quasi-randomisedcontrolled trials comparing differentarthroplasties and their insertion with or withoutcement for the treatment of hip fractures.Data collection and analysis: Two review authorsindependently assessed trial quality, by use of a tenitemchecklist, and extracted data.Main results: Seventeen trials involving 1,920patients were included. One trial involved two comparisons.Cementedprostheses,when compared withuncemented (six trials, 549 participants), were associatedwith less pain a year later (16/52 versus 28/52;RR 0.51, 95% CI 0.31 to 0.81) and a tendency tobetter mobility. No significant difference in surgicalcomplications was found.A comparison of unipolarhemiarthroplasty with bipolar hemiarthroplasty(seven trials, 857 participants, 863 fractures) showedno significant differences between the two types ofimplant.Two trials involving 232 patients compareduncemented hemiarthroplasty with a total hip replacement.Both studies reported increased pain forthe uncemented prosthesis and one study foundbetter mobility and a lower long-term revision ratefor those treated with a THR.Two trials involving214 participants compared cemented hemiarthroplastyversus total hip replacement. Both trials generallyfound little difference between prostheses.THR was associated with a slightly longer surgicaltime but a tendency to better functional outcome inone trial.Authors' conclusions: There is limited evidencethat cementing a prosthesis in place may reduce postoperativepain and lead to better mobility.There isinsufficient evidence to determine the roles ofbipolar prostheses and total hip replacement.Furtherwell-conducted randomised trials are required.Citation: Parker MJ, Gurusamy K.Arthroplasties (with and without bone cement)for proximal femoral fractures in adults(Cochrane Review).The Cochrane Database of Systematic Reviews 2006,Issue 3.■page 2

The SICOT Newsletter:a steady communication toolEditorialLast August, the 100th edition of the Newsletter was distributedto all SICOT members throughout the world.The first issue ofthe Newsletter was published in October 1985 and its initialfunction was to remedy the lack of communication between membersduring the long three-year period between the World Congresses.Theadvent of the electronic era and the development of the SICOT Portalon the Web markedly changed the way we keep in contact and worktogether. However, the Newsletter remains the most direct and effectivetool of communication for our Society.The look of the Newsletterchanged over time following to some extent the same trends ofcontemporary periodicals. In recent years, improvements in the designand contents including the Evidence based orthopaedics section, theCountry to country series of the National Delegates, the AnnualReports of the Committees, and the Young surgeons section enliventhe Newsletter. This is the combined result of a joint effort by the EditorialOffice, and the members of the Publication and CommunicationsCommittee.Accordingly, the content of the Newsletters reflects theprogress of our Society and records its main events.Thus, it is a vitalchronicle of the most recent history of SICOT.I would like to thank the staff at the Headquarters in Brussels for thededication and commitment to the Newsletter.There is some good news also from the Board of International Orthopaedics:the number of papers submitted for peer-review is steadilyincreasing.At this stage, there are more than 100 accepted paperswaiting for publication. From now on, the peer-review work will beeven more selective; subsequently, the overall scientific quality of thepublished papers will increase, and this will foster the impact of theJournal. I extend my compliments to the Editor and the members ofthe Editorial Board.Rocco P. PittoEditorial Secretarypage 3

Orthopaedic Surgeryin VenezuelaIn Venezuela, medicalstudies can be undertakenin the followingofficial universities:Central University ofCaracas (UCV) with 2 medical campuses,one at the Razzetti school locatedin the University City and theother at the Vargas School locatedin the north-west of Caracas;OrientUniversity, situated in the easternpart of the country, with differentcampuses in Barcelona, Cumana,Maturin and Ciudad Bolivar;AndesUniversity (ULA) in Merida and SanCristobal; Carabobo University(CU) in Valencia and Maracay; Center-OccidentalUniversity (UCO-LA) (Lisandro Alvarado) in Barquisimeto;Zulia University (LUZ) in Maracaibo,the second most populatedcity; Francisco de Miranda University(FMU) located in Coro. All ofthem are government-owned universities.After medical studies have beencompleted, the graduate must doone year of rural medicine and thengo to an accredited hospital to receivetrauma training. A specialtymust be done in an accredited certifiedhospital and lasts for threeyears.These hospitals either belongto universities, the Social SecurityInstitute (IVSS), the Government, orthe Municipalities.Very few are private.Trainingconsists mainly of traumaand adult orthopaedics withlittle paediatric orthopaedics.Afterending the three-year training, thegraduate can either apply for a certifiedsubspecialty in Hand Surgeryor Paediatric Orthopaedics or do aone- or two-year Fellowship in,among other things,Arthroscopy,Foot and Ankle, Spine, or EmergencyTrauma. Due to its proximity,most graduate orthopaedic surgeonsgo to the United States forFellowships and a smaller numbergo to Europe.Thus, in terms of specialisttraining, the influence of theUnited States is more importantthan that of Europe.The number of orthopaedic surgeonsregistered at the “SociedadVenezolana de Cirugía Ortopédicay Traumatología” (SVCOT), thenational Trauma and OrthopaedicSociety, is 1,606, according to lastyear’s records. SVCOT has differentgrades of membership.There areAn Andean valley387 Adherent members, who areresidents or starting to practise;1073 Effective members, who havehad less than six years in practice;276 Associate members, with morethan six years in practice; 93 Titularmembers, with more than 12 yearsin practice and after having presentedwork in a General Assembly; 36Honorary members, who are awardedthis membership according totheir curriculum after outstandingpractice; and finally 70 Jubilee members,who are retired orthopaedicsurgeons and traumatologists.In 1997, the population withsome form of insurance reached15,665,235 (65% of the total population).57% of them belonged tothe IVSS.The National Health Ministry(MSDS) takes care of about80% of the population. Despite thefact that public hospitals shouldtheoretically be capable of offeringsufficient health services, part ofthe population relies on being treatedat private hospitals or clinicsfor reasons such as long waitinglists, unsatisfactory treatments,overcrowded hospitals, lack of certainmedication and surgical items,inoperative X-ray machines, laboratories,etc.These are problems outsidedoctors’ control.Thus, qualifiedspecialist work can be found in boththe public and private health sectoror only in private practice.page 4

Prof Federico Fernandez-Palazzi |First Vice President of SICOT and National Delegate of VenezuelaCountrytocountryseriesColonial style Catholic church in Falcon stateAccidents and violence caused12.5% of the total number of deathsin 1999. In the same year, accidentsoccupied fourth place in causes ofdeath (7.5%), with a mortality rateof 32.8 per 100,000 inhabitants.Thesex ratio of mortality due to accidentswas 320 males per 100 females.In 1989, the rate was 39.5 per100,000.Traffic accidents, which represented60% of all causes of death,were the third cause of death formales and sixth for females. In 1999,suicides and homicides represented5% of all deaths, ranking seventh incauses of death and fourth in causesof male mortality (78.4%).The mortalityrate for homicides and suicideswas 11.7 per 100,000 inhabitantsin 1998 and 16.9 in 1999.Thepopulation most at risk was menfrom 15 to 44 years of age (430.2per 100,000). In the first trimesterof 2000,homicides and suicides werethe fifth cause of death, 83% (7,908)being homicide cases. In 1999, it was76% (5,860 cases).When there is a trauma of anykind, multiple fractures, accidents,firearm wounds – which occurs veryoften on weekends – fires, road accidents,etc., the patient is broughtto an emergency hospital that isusually overcrowded. If possible, thepatient will receive an initial medicalevaluation. If surgery is required butcan possibly be postponed, the patientis admitted to a hospital warduntil the surgery can be performed.Thus, emergency hospitals, but alsothe referral hospitals, are mostlyfilled with patients needing urgentsurgery that has been delayed.As aresult, less elective surgery is performedand creates a long waitinglist.This is the main reason why peopleat present choose to attend privatepractice… but what the futurewill offer… we do not know!!■u Country name: Venezuelau Capital: Caracas (over 5,000,000 people)u Location: north coast of South Americau Population: 26,128,898 (13,127,351 males and13,001,547 females; 93% urban and 7% rural)u Age structure: under 14: 34.04%; 15-64: 61.51%; above 65: 4.44%)u Size of country: 916,446 km 2 ; formed of 23 states, one Capital Districtand one Federal Dependency consisting of 311 islandsu Population density: 28.93 inhabitants per km 2u Growth rate: 17.22 per 1,000 populationu Birth rate: 22.31 per 1,000 populationu Death rate: 5.89 per 1,000 populationu Infant mortality rate: 16.82 per 1,000 live birthsCaracasu Ethnic features: 67% mixed origin, 21% white,10% black, and 2% Indianu Religion: 92% Catholicu Official language: Spanishu No. of doctors: 48,000u No. of orthopaedic surgeons registeredat SVCOT: 1,606u No. of hospital beds: 9 per 10,000 populationu No. of medical schools: 12u SICOT active members: 8page 5

Internet2Mr W. Edward Johansen | Organiser of the California Orthopaedic Research NetworkMuch has happened since Dr ChadwickF. Smith, then Congress President andnow President of SICOT, asked me inFebruary 2002 to organise a programmeon technology applications to orthopaedicsurgery for the SICOT/SIROT 2002 TWC.Dr Wayne H.Akeson, then President of SIROT andnow Chairman of the SICOT/SIROT Research Commission,Dr Smith and I met in Los Angeles in April ofthe same year. On 2 July, orthopaedic surgeons andinformation technologists from the University ofSouthern California (USC), Stanford University, Universityof California - San Diego (UCSD), and Universityof California - Los Angeles (UCLA), formedthe California Orthopaedic Research Network(CORN). On 29 August, Dr Akeson moderated asymposium, entitled “Internet2 Applications to OrthopaedicSurgery”, which later led to the formationof the Orthopaedic Surgery Working Group (OSWG)of Internet2 on 28 October. Internet2 appointed DrSmith as Chairman of OSWG. Members of OSWGand CORN organised a live telecast, at 11.0 megabitsper second, of hand surgery from an operating roomat UCLA and virtual hand surgery from SUMMIT,Stanford University, for an audience attending the Fall2002 Internet2 Member Meeting in Los Angeles anda group of medical students attending the VisualizationPortal at UCLA. During the AAOS Annual Meetingthat was held on 5 February 2003, Dr Smith announcedthe planned expansion of CORN throughoutthe Western Hemisphere. On 12 September2003, members of OSWG and CORN presented asymposium, entitled “Internet2 Applications to OrthopaedicSurgery,” at the Second SICOT/SIROT AICin Cairo, where they also met with representatives ofthe Egyptian University Network, the Library ofAlexandria, and the National Training Institute.Arthrex sponsored the live telecast of arthroscopic shoulder surgeryat Columbia University Medical Center (photographer: JanZanetis,Tandberg USA)Progress at this point was halted as there wereseveral missing pieces of the puzzle which only appearedin 2005. In April, the World Bank joined Internet2.In July, David Gray on behalf of the Global DevelopmentLearning Network (GDLN) for the LatinAmerican and Caribbean Region (LAC) signed a Memorandumof Understanding with Dr FlorencioUtreras, Executive Director of CLARA (Internet2 ofLatin America). Internet2, CLARA and GDLN/LACpresented a programme from Washington, D.C., toseveral countries in South America in October andthen met on 10 November to form the e-HealthTask Force, which aimed to create ten programmesto be transmitted to Latin America as a pilot seriesentitled “Delivering Healthcare Programs to LatinAmerica via Internet2, CLARA and GDLN”. Thefourth programme, entitled “Infusing InformationTechnology into Orthopaedic Surgery”, was presentedat the Fourth SICOT/SIROT Annual InternationalConference in Buenos Aires on 24 August 2006. Itmarked the formation of the Orthopaedic Researchand Education Network of the Americas (ORENA),which includes orthopaedic surgeons, radiologists,page 6

On the Webinformation technologists and educators at researchuniversities in the Western Hemisphere.The Global Forum on Road Traffic Trauma beganon 5 December 2006 and on the following day DrLouis U. Bigliani moderated a live telecast of two arthroscopicshoulder surgeries from the operatingrooms at Columbia University to 16 cities on fourcontinents, including a conference room in Cairo, aspart of the Annual Meeting of the Egyptian OrthopaedicAssociation. Dr Hatem Galal Said moderatedthis telecast from Cairo.Dr Hatem Galal Said: “[...] Two simultaneous surgerieswere being performed, one on arthroscopic rotatorcuff repair and the other on arthroscopic shoulder instabilityrepair.The session lasted two hours and the camerasinterchanged between the operating rooms. [...] Thequality of the video and audio transmission was verygood, so no operative details were missed.This kind oflive interaction brought many benefits at very little costto a large group of doctors.We look forward to manymore sessions using the same technology to deliver orthopaediceducation all around the world.”Also on 6 December, Prof Charles Sorbie, Chairmanof the SICOT Education Committee, Dr JosephBosco from NYU-HJD and Dr Smith were amongthe participants in a forum on international orthopaediceducation.Prof Charles Sorbie: “I was pleased to be able tocommunicate directly and clearly with my colleagues inother countries in real time. It was like seeing themacross a table. [...] While there is an important knowledgebank available on the Internet at existing sites, thevalue of direct communication with colleagues and teachersis immense as it allows discussion and debate.Thepossibilities for using Internet2 to raise the quality of surgicalcare across the globe now exist in many forms butI am sure that this is only the beginning of what will beachievable as we learn about its full potential. [...]”With the completion of the ten programmes,Internet2, CLARA, GDLN (World Bank) and SICOTagreed to operate ORENA in order to generate 50healthcare programmes throughout Latin Americaand the Caribbean. On behalf of Dr Smith, Mr Gray,Dr Utreras, and Dr Michael McGill of Internet2, I invitenot only members of SICOT, but also membersof other orthopaedic associations, to help ORENAmeet its goal in Latin America. Expansion of ORE-NA has already begun with programmes havingbeen sent to Pakistan, India, Egypt and China. Amongthe participating institutions in the United Statesand Canada are USC, UCLA, Stanford, UCSD, JohnsHopkins Medical Institute, Columbia University, theNational Library of Medicine, Indiana University -Purdue University Indianapolis, the University of Torontoand Queen’s University (Kingston). ■Dr Louis U. Bigliani moderating the arthroscopic shoulder surgeryfrom the videoconference room, as seen on a Tanberg 6000Videoconference System (photographer: Jan Zanetis,Tandberg USA)Additional information can be found at:http://health.internet2.edu/WorkingGroups/OrthopaedicSurgery.htmlandhttp://www.firstmile.us/events/conf/spr06/agenda.phppage 7

CommitteelifeThe SICOT Finance Committee ReportDr Thami Benzakour | Chairman of the Finance CommitteeThe present"SICOT FinanceCommittee" wasappointed in Istanbulin September2005. This committeeis composedof five statutory members: ProfMaurice Hinsenkamp as SICOT SecretaryGeneral, Prof Patricia Fucsas SICOT Treasurer, Prof Rocco P.Pitto as Editorial Secretary, ProfJean-Pierre Courpied as Editor ofthe International OrthopaedicsJournal and Prof Cody Bünger asPresident Elect.The three additionalmembers appointed among theSICOT National Representativesare Prof Bartolome T.Allende, ProfKeith D-K Luk and Prof GershonVolpin.The role of the Finance Committee,as indicated in the Constitutionand bylaws, is to review thefinancial implications and consequenceson the treasury of all activitiesand projects of the Societyand to assess the budgets ofSICOT, the SICOT Foundation, andthe SICOT Conferences andCongresses.The committee alsohas to review the use of funds, theinvestments and the transactions,as well as making recommendationsto the Board of Directorsand to the International Council.Procedures: the Finance Committeeis used to working closelywith the SICOT Head Office tokeep itself informed of major businessdevelopments and to improvethe quality of reporting and financialcontrol as recommended bythe International Council.The first Finance Committeemeeting was held in Buenos Airesbefore the 2006 Annual InternationalConference. Referring to ouragenda, we reviewed the SICOTannual statements for 2005 andthe SICOT budget for 2007.For the 2006 Treasury report,we had to look into the Society’sfinancial accounts and statementswhich KPMG had previously auditedfor 2005.Globally, the result for 2005 wasa profit of EUR 24,875; and the totalbalance sheet representedEUR 2,306,839. The operatingresults and the total revenues hadimproved. However, the expectedoperating surplus was not reached.Thus, SICOT has been unable tocontinue investing in initiatives toimprove membership.Meanwhile, the congress activitiescontributed to a reduction ofthe operating deficits. Thus,without any congress activity, theglobal operating deficit would havebeen EUR 134,210 higher. Thisamount represents the differencebetween the congress income andthe congress expenditure.Therefore,it seems obvious that"organizing meetings remains a viableactivity for SICOT; and withcautious and thrift management, itrepresents a reliable source ofmuch needed income”.The portfolio of EUR 1,268,298invested over the last four years isaimed at ensuring protection frommarket fluctuations. Our reservesare quite stable at EUR 1,840,489.The 2007 operating budget aimsat restoring the financial balanceand containing costs. More detailedinformation can be found in the reportsof the Treasurer and the SecretaryGeneral.In conclusion, the Finance Committee’stask is to analyse the incomestrategy, working methodsand staffing policies,as well as othertrends and issues to avoid any deficitand to ensure a healthy SICOTfinancial state.■The recommendationsof the Finance Committeemembers:1. Reduce operating expenses> Head Office> Revisit travel subsidies> Revisit presidential dinnersubsidies2. Increase income> Reduce risk and increase return byengaging other banks for our investment> Increase membership> Ensure a positive balance for allscientific meetings through strictbudgetary controlpage 8

Hospital under fire: the experienceof the Western Galilee Hospitalin IsraelProf Gershon Volpin | National Delegate of IsraelWorldwidenewsWestern GalileeHospital of Nahariyais located innorthern Israel,about 10 kilometresfrom theborder with Lebanon.Weserve 450,000 residents ofthe Western Galilee, 50% of whomare Jews and 50% are Muslims,Christians and Druze.Over the past 30 years, ourhospital has been threatened manytimes by rockets launched into northernIsrael.Four years ago, we constructeda new surgery building and underneathit an underground hospital.The underground hospital has a capacityof 450 beds and an undergroundnetwork of roads enablesambulances to access the hospitalfacilities. Most of the undergroundfacilities are also protectedagainst biological and chemicalwarfare with an elaborateair filtering system.When the war startedon 12 July 2006 and therockets began falling, all patientswere evacuated tothe underground hospitalwithin three hours. Duringthe month-long war, 800rockets fell on Nahariyaalone and several fell in thefields surrounding ourhospital.On 28 July,a rocket hit the fourthfloor of the surgery wing, causingsevere damage to the ophthalmologydepartment, leaving a gapinghole in the wall and destroying patients’rooms and medical equipment.Thedamage was estimatedat about USD 200,000. Fortunately,there were no injuries since all patientsand medical staff had beenevacuated to the underground facilities.Despite the constant sirens andattacks, we managed to continuewith routine medical and surgicalcare.About 2,400 patients wereadmitted to our hospital duringthat month. Some of the orthopaedicpatients were elderly peoplewho had fallen while running toshelters and had to be admitted tohospital with various types of injuries.Patients being treated in the underground hospital1,858 patients were treated bythe hospital staff during the monthlongwar.All patients were transferredfrom ambulances or helicoptersto special trauma emergencyrooms, according to theseverity of the injury. 947 of them(about 51%) had symptoms ofpsychological trauma and weretreated in a special emergencyroom, separated from the physicallyinjured patients.The remainingpatients had various degreesof injuries as follows: 839 patientshad mild injuries such as shrapnellacerated wounds of the body orclosed simple fractures of limbs; 42patients had moderate injuries suchas open comminuted fractures oflimbs, extensive soft tissue injuries,amputation of limbs; and 18 patientshad multiple trauma includingchest and abdominal injuries,vascular and head injuries.Some had associated compoundfractures of limbs.Twelve patients,two of themfrom the same family, diedof rocket injuries.For contact:volpinger@yahoo.com■page 9

A journey to the SICOT Education Centreat the King Edward Medical University in LahoreProf Maurice Hinsenkamp | Secretary GeneralAfter the inaugurationof the SICOTEducation Centrein Lahore in January2004 and in additionto all the activitiesorganisedlocally by Prof Dr Syed Awais,I wantedto give significant support tothis centre using Institutional Grantsand at no additional cost to SICOT.The most accessible source for mewas the Ministry of Cooperation inBelgium which promotes cooperationbetween universities in Belgiumand universities in developingor emergent countries.After twoyears of negotiation, the projectwas finally accepted and, within thenext four years, 14 six-month scholarshipswill be attributed to postgraduatestudents of orthopaedicsurgery at the Orthopaedic Departmentof Erasmus Hospital –Brussels University; and four scholarshipsfor PhD students who willbe able to share their work withpartner universities.Also, a NationalBone and Tissue Bank will becreated at the King Edward MedicalUniversity (KEMU).Altogether, agrant of EUR 361,000 was attributedto the four-year programme.The project got underway in July2006 when two postgraduate studentsfrom Lahore started theirtraining in Brussels.The secondevent includes the arrival of twoPhD students, one in orthopaedicsurgery and one in engineering.Selection of the candidates stillneeds to be done. It was within theframework of this project that mypresent mission to Lahore wasorganised. I landed in Lahore on 5December 2006 at 4.55 a.m. and,after a short rest, Prof Dr SyedAwais and I were interviewed byone of the main Pakistani TV networks,namely ARY One.The interview was immediatelyfollowed by the founding meetingof the Multidisciplinary InteruniversityResearch Group (MIRG) whichwill promote and enforce interdisciplinarycooperation in the field ofOrthopaedic Research.The firsttask of this new group will be to selectthe PhD students who will workon improving the technique of externalfixation developed locally byProf Dr Syed Awais and study theincidence of different frame configurationson bone healing.The evening was devoted to avideo conference arranged by theHigher Education Commission ofPakistan and Internet2, which gatheredseveral universities fromaround the world.The topic wastraffic trauma, prevention, triageand treatment. On the same evening,I was invited to a dinner by MrIkram Rana (former Health Ministerof Punjab) at the GymkhanaClub.The next morning, at the invitationof the Dean, Prof Dr MuhammadArfi Butt, one of the foundingmembers of the MIRG, I gave a lectureon biomaterials and the evolutionof orthopaedic implants at theInstitute of Chemical Engineeringand Technology.After visiting Lt Gen ArshadMahmood,Vice-Chancellor of theUniversity of the Punjab and co-signatoryof the scholarship programme,we went to the SICOTEducation Centre where Prof DrSyed Awais, who was recently promotedPro-Vice-Chancellor of hisUniversity, introduced his differenteducational and training programmesand evaluation proceduresin orthopaedic surgery.The centre appears to be veryactive and well attended not only byorthopaedic students and specialistsfrom Pakistan and the neighbouringcountries but also by otherrelated scientists.We were also introducedto the team of very activesocial workers led by Mr Ghiasuddin,also known as Mr Babajee, whomakes the impossible happen formany of the poorest patients whocannot afford expensive treatment.Since its establishment, the SICOTEducation Centre in Lahore haseach year hosted on average 126lectures for undergraduate studentsof the local faculty,18 lectures/seminarsfor postgraduate residents frompage 10

Worldwidenewsa visiting faculty, 13 courses for theprofessional development of nursesand paramedics, and six workshopson different topics, which lastedbetween one day to two weeks andwere aimed at postgraduate students.TheEducation Centre is alsohosting evaluations of postgraduateresidents (formative conducted bythe department and summativeconducted by the university).Through its computer network of18 terminals, library, museum andskill centre, the centre is also providingbasic requirements for the departmentto provide good trainingand clinical services. During this initialperiod of three years, the centrehas not only been visited eachyear by experts from different universitiesin Pakistan but also by expertsfrom Europe, United States,Canada,Afghanistan, India, Bangladesh,Nepal and Iran.In the afternoon, there was anothervideo conference organised byInternet2 on shoulder arthroscopy,which was moderated by Dr LouisBigliani, our National Delegate forthe United States.Afterwards, wemet with Prof Dr Muntaz Hassan,Vice-Chancellor of the King EdwardMedical University, anotherco-signatory of the scholarship programme.After an enjoyable supper withProf Naseer M.Aktar, former Headof the Orthopaedic Department atKEMU and the father of modern orthopaedicsurgery in Pakistan, a newInternet2 forum was held on InternationalOrthopaedic Education andSICOT Education Centres. TheSICOT officers were especially wellrepresented by Prof Charles Sorbieas the moderator in Kingston, DrChadwick Smith in Los Angeles, ProfGalal Zaki Said and Dr Hatem GalalSaid in Cairo, and Prof Dr Syed Awaisand myself in Lahore.On the third day, we were welcomedby the Governor of Punjab,Lt Gen Khalid Maqbool, who hasbeen a strong supporter of the projectsince the early days. He is activelypromoting training in orthopaedicsurgery as well as educationand research in the health sciences,as improving the socio-economicaldevelopment of Pakistan and thewell-being of the population are majorissues. Following the meeting,we drove to Islamabad with Prof DrSyed Awais, at the invitation of ProfDr Muktar Ahmed, member of theoperations and planning at theHigher Education Commission(HEC), to discuss a huge new projectto establish a Federal Universityof Health Sciences in Islamabad.In the evening, after a short visitto the family of Dr Jamshed (a traineepresently in Belgium), Prof DrSyed Awais and I were invited bythe Ambassador of Belgium,Mr Goffin,foran enjoyable dinner with ProfMuktar Ahmed (HEC) and Mr T.Bargfrede from the EuropeanUnion.The way back to Lahore at nighton the Grand Trunk Road was aninteresting experience, as improvingthe road infrastructure is apreliminary step in preventing traffictrauma before starting to educatethe population.We ended the“day” with a late discussion withProf Dr Syed Awais on the programmefor PhD students.On the last morning, at the invitationof the Governor, I visited theUniversity of Health Sciences in Lahore,whileProf Dr Syed Awais flewto Kathmandu for the OrthopaedicAssociation of the South AsianCountries (OASAC) Meeting.I tookmy flight back to Brussels that afternoon.In conclusion, I believe theSICOT Education Centre in Lahoresets a prime example for otherinitiatives aimed at improving orthopaedicsurgery in Pakistan. Itshould be the profile for futureSICOT Education Centres aswell as the flagship centre for theadvancement of health science,research and treatment.Obviously, all this could not havehappened without the dynamismand inexhaustible energy of Prof DrSyed Awais, our National Delegatefor Pakistan. I thank him very muchfor his warm hospitality. ■page 11

Fifth SICOT/SIROTAnnual International Conference 2007Marrakech, MoroccoPROVISIONAL PROGRAMME AT A GLANCE*Time AMBASSADORS ROOM FES 1 ROOM FES 2 ROOM KARAM 1 ROOM EXHIB. HALL18.3008.00-10.0010.00-10.3011.00-12.3014.00-15.3015.30-16.0016.30-17.3008.00-10.0010.00-10.3011.00-12.4513.45-15.3015.30-16.0016.30-17.30O P E N I N G C E R E M O N Y and W E L C O M E C O C K T A I LAdult Hip Disorders Sports Medicine Spine: SRS / SICOT SIROTP L E N A R Y L E C T U R E : Lars LIDGREN (Sweden)Hip Joint Replacement Sports Medicine Spine: SRS / SICOT Bone HealingHip Trauma Sports Medicine Spine: SICOTP L E N A R Y L E C T U R E : Laurent SEDEL (France)Coffee BreakHip Trauma Internet2 in Orthopaedics Spine: SICOTPaediatrics SICOT / IFPOSP L E N A R Y L E C T U R E : Lowell GILL (USA)Paediatrics SICOT / IFPOSPaediatrics SICOT / IFPOSPaediatrics SICOT / IFPOS(ends at 18.00)Friday, 31 August 2007SICOT / SMACOT TraineesMeeting: General Orthopaedics / FootTraumaSICOT / SMACOT TraineesMeeting: General Orthopaedics /TraumaSICOT / SMACOT TraineesMeeting: KneeP L E N A R Y L E C T U R E : Tomihisa KOSHINO (Japan)SICOT / SMACOT TraineesMeeting: KneeWednesday, 29 August 2007Thursday, 30 August 2007Coffee BreakLunch / Workshop / SICOT General Assembly in FES 1 ROOMCoffee BreakAnkleLunch / WorkshopCoffee BreakBone TumoursBone TumoursSICOT / SIROTResearch CommissionSICOT / SIROTResearch CommissionOsteoporosisBone Loss / Non-unionShoulder / Elbow / HandGeneral Orthopaedics / TraumaPOSTERSPOSTERS08.00-10.3011.00-12.3014.00-15.3015.30-16.15* at 24 January 2007Road Traffic InjuriesRoad Traffic InjuriesSMACOT Symposium:Ankle TraumaSMACOT Symposium:Ankle TraumaAdult Knee DisordersCoffee BreakSymposium: Current Statusof TKA (ends at 12.00)KneeLunch / WorkshopNavigationMini Invasive SurgeryBest Free Papers Infections Knee Arthroplasties Neurology in OrthopaedicsC L O S I N G C E R E M O N YNB - Times are subject to changeSaturday, 1 September 2007POSTERSEditorial DepartmentFor more information, please visit:http://www.sicot.orgEditorial Secretary: Prof Rocco P. PittoExternal Affairs: Nathalie PondevilleRue Washington 40-b.9, 1050 Brussels, BelgiumTel.: +32 2 648 68 23 - Fax: +32 2 649 86 01E-mail: edsecr@sicot.org - Website: http://www.sicot.org