The late 1940s saw the culmination of the random development of fracture fixation devices starting in the mid 19th century, an eclectic mix of implants from a great variety of surgical "authors", none designed to complement the others. The biology of bone healing had not been investigated scientifically and knowledge was sparse.
In 1949, a Belgian surgeon, Robert Danis, published a book entitled Théorie et Pratique de l'Ostéosynthèse. This, his second book on fracture fixation, documented his concepts of early functional rehabilitation following rigid fracture fixation.
Danis' observation that, with anatomical reduction and rigid fixation, diaphyseal bone healed without external callus attracted the attention of a young, innovative Swiss surgeon, Maurice E. Müller, who visited Robert Danis in March 1950. This auspicious meeting fired the mind of Dr. Müller and he gathered about him a small group of Swiss surgeons who shared his interests, namely Robert Schneider, Hans Willenegger and Martin Allgöwer.
The decision was reached to form a study group, Arbeitsgemeinschaft für Osteosynthesefragen, or AO, to conduct research in bone healing, with particular reference to the influence of the mechanical environment of the fracture upon its healing pattern. Along with a group of surgeons, who first met together in March 1958 at Chur, this embryonic AO took a number of initiatives.
Establishment of a Laboratory for Experimental Surgery
Laboratory for Experimental Surgery
at the Obere Strasse in Davos.
The first undertaking was the establishment of a Laboratory for Experimental Surgery (Forschungsinstitut) in Davos by Martin Allgöwer. Herbert Fleisch was appointed its director in 1963, and Stephan Perren in 1967. The early work that was conducted, together with that of Drs Schenk and Willenegger, laid the foundation for the current knowledge of the direct and indirect healing of fractures, as well as the influence of rigid fixation upon the healing of non unions. Their classical landmark experiments are known to fracture surgeons throughout the world.
Secondly, the early AO pioneers forged a strategic alliance with the Swiss precision engineering discipline and worked closely with Robert Mathys to develop an integrated system of implants and instruments. Some time afterwards Fritz Straumann, a metallurgical specialist, was included. These instruments and implants would enable surgical fracture fixations to fulfill the biomechanical priniciples which were the consequence of the experimental work. This fruitful collaboration led to the evolution of the AO instrumentarium and of the surgical techniques for its use.
The third arm of this endeavor followed the decision to document carefully their surgical cases so that lessons could be learned from the clinical application of the emerging technology; hence the Documentation Center.
All these elements of the original AO grew on a parallel basis and this led to the need to restructure the whole organization. In December 1984 the AO Foundation was constituted, which took on the responsibility of the various commissions for research, development, education, documentation and international affairs.
Constitution of AO Foundation at Davos in December 1984.
Aims of the AO pioneers
The AO Center in Davos, Switzerland.
The aims of the AO pioneers were not to popularize the indiscriminate use of surgical fixation, but rather to evaluate scientifically its place in the care of the injured and, where appropriate, to refine surgical practice so that the outcome for the victim of injury could be optimized. The entire laboratory, as well as the Foundation, moved to a custom built AO Center on the outskirts of Davos in 1992.
Increased growth in certain regions of the world led to the setting up of AO Regions in order to provide more localized support. There are now three AO Regions with over 450 members. These regions are Asia Pacific, Latin America, and North America. These regions are forging ahead with making the AO more relevant in their regions. This is all done with specialized support from the AO Center in Switzerland.
The AO broadens its scope
Participants on an AOSpine course.
By the 1990s the world of surgery was changing and in response the AO broadened its scope. By 1996 the AO was involved in Computer Aided Surgery. The year 2003 saw the founding of AOSpine, a unit dedicated to improving the quality of medical service provided to spine patients through education, research, documentation, and communication. The opportunities provided by the changing medical world led to a shift into the field of biotechnology with the setting up of the AO Biotechnology Advisory Board in 2003. In 2004 the Academic Council approved the launch of four Clinical Priority Programs, an initiative to focus research and development on issues relevant for the surgeon.
The engagement in new media eventually led to strategic cooperation with BrainLAB in the field of computer-assisted surgery, resulting in the introduction of the first CAS/MIS trauma modules in 2005.
AO Surgery Reference being used in the
AO Surgery Reference, a unique online reference tool designed for everyday clinical life was introduced in 2006. It was launched with 6 anatomical modules which are continually being added to, making AO Surgery Reference a dynamic reference tool.
Perhaps the greatest change of recent times came in 2006 when the AO and Synthes agreed to new contracts under which Synthes will acquire existing “Synthes” trademarks, brands, and intellectual property from the AO. Further cooperation also forms part of the agreement.
In 2008 the AO celebrated its 50th anniversary. Such longevity is only possible thanks to the unique ‘AO Spirit’ and valuable contributions from its members.