Leading a Surgical Revolution: The AO Foundation – Social Entrepreneurs in the Treatment of Bone Trauma

395 Pages·2019·15.53 MB·English

by  Jean-Pierre Jeannet

Jean-Pierre Jeannet
Leading a
Surgical Revolution
The AO Foundation –
Social Entrepreneurs
in the Treatment of Bone Trauma
Leading a Surgical Revolution
Jean-Pierre Jeannet
Leading a Surgical
Revolution
–
The AO Foundation
Social Entrepreneurs in the Treatment
of Bone Trauma
Jean-PierreJeannet
ProfessorEmeritusBabsonCollege
Wellesley,MA,USA
ProfessorEmeritusIMDInstitute
Lausanne,Switzerland
ISBN978-3-030-01979-2 ISBN978-3-030-01980-8 (eBook)
https://doi.org/10.1007/978-3-030-01980-8
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Foreword
Thetitleofthisbookreflects,inafewlines,theessenceoftheAOFoundationand
what it stands for. With the invention of a disruptive surgical procedure it
revolutionized the world of trauma, reducing pain and disabilities of patients with
broken bones and bringing them back into normal social and working life within
days,insteadofmonths.Intheprocess,itsavedtheworld’shealthsystembillionsof
dollars—a dream of today’s health experts confronting escalating health costs.
Practically unnoticed, a worldwide medical device industry developed around this
surgicalprocedureanditssurgicalinstrumentsandimplants—alsodevelopedbythe
pioneerAOsurgeonstogetherwithasmall-scaleindustry.Thesocialentrepreneur-
ship of a nonprofit organization with changing industrial partners leveraged the
disseminationgloballyonanunprecedentedscale.
The idea to present this extraordinary story came out of a research project of
ProfessorJeannet who identifiedexceptional success stories ofsmalland medium-
sized Swiss enterprises, among them Synthes and Mathys, only to realize the
interconnection and further develop the story into a separate book detailing the
roleoftheAOFoundationinthissuccessstory.
Intoday’sworld,withhealthcarecostsexploding,asimilarapproachcombining
disruptiveinventionsandinnovationswithacost-effectiveorganizationmightoffer
ideasforothersuccessfulpartnershipsorprivateinitiativestoremedyillnesses.
The AO Foundation continues to extend its successful work into low-income
countries where the burden from injuries and disabilities has assumed epidemic
proportions and where treatment methods and care are largely comparable to what
thepioneeringAOsurgeonswereconfrontedwith60yearsagoinSwitzerland.
The60thanniversaryoftheAOFoundationisanappropriatemomenttopresent
its history. This book by Professor Jeannet describes the AO history in a compre-
hensiveway,withspecialattentiontothebusinessaspects,makingitofinterestalso
forabroader,nonmedical,public.
AOFoundation,Biel,Switzerland NikolausRenner
AOFoundation,Biel,Switzerland RolfJeker
v
Preface
ThisbookprojectcamemywaywhenIwaslookingforsupportforadifferent,but
related,projectonSwisssmallandmedium-sizedexportingcompanies(SMEs)with
global success in specific niches. I planned to include Mathys, Straumann, and
Medartis, all companies with strong connections to the AO Foundation. However,
the AO indicated that they would rather welcome a book on the AO itself with a
particularemphasisonitsindustrialimpact.WouldIbeinterested?TheAOassured
that I would have complete independence as to the approach I would choose.
Initially, I hesitated to entertain the idea, since I possess neither a medical nor an
engineeringbackground.
Mybackgroundasabusinessschoolfacultymember,however,wasofinterestto
theAOleaderssincepreviousbookshadbeenwrittenlargelybysurgeonsormedical
historians. And so it came that I, with only a cursory acquaintance of the AO,
acceptedtotacklethechallengeofwritingabookthatwouldgivespecialemphasis
to the AO industrial achievements and impact. My contacts at the AO Foundation
board convinced me that my lack of medical training did not disqualify me from
writingabouttheAOandits60-yearhistory.Thereadersofthisbookwillhavetobe
thefinaljudgesofthisdecision.
Iapproachedtheprojectinlinewithmybusinesscaseresearchexperiencegained
from writing scores of cases at IMD (Lausanne) and Babson College (Wellesley,
MA,USA).ThismeantthatIdidnotimmersemyselfonlyintothearchivesofthe
AO, but instead focused on a large number of in-depth interviews with many
individuals who had been associated with this enterprise since its inception. While
delvingintomemoriesaboutpastevents,itwastobeexpectedthattherewouldbe
conflictingperceptionsofthewhatandwhyofevents.Naturally,Imadefulluseof
thepublicationswrittenpreviously,someofwhichwerecrucialtocreatingthestory
line I wanted to build, and some helped deal with conflicting memories from
interviewpartners.
AsIgoteverdeeperinvolvedintheAOhistory,IcametorealizethatIshouldnot
only write a book covering the period since 2002, the year the last book was
published. Instead, I needed to tell the entire history of the AO from its inception
using theparticular lenses that came from mybusinessschool facultybackground.
Atfirst,thismeantcreatingatimelineofthe60yearsoftheAOandidentifyingthe
criticalpointsinitsdevelopment,beitmedical,engineering,orbusiness-related.
vii
viii Preface
Delvingdeeper,Isawthattherewasbothasocialentrepreneurshipstorycentered
around the medical aspects of the AO’s achievements, as well as a business
entrepreneurshipstorythat focusedontheindustrialachievementstriggeredbythe
AO and its purpose. Identifying the two types of entrepreneurial endeavors, social
and business, allowed me to approach the AO history from two different angles
whileusingtheconceptuallensesfrommybusinessschoolexperienceforlabeling
thekeyevents.Thesebusinesslenseswereattheoriginofmanyofthechaptertitles
andsubtitles.Manyoftheseconcepts,partofthemodernbusinessvocabulary,did
notexistwhentheAOwasstarted.Throughoutthetext,Ihavetakenthelibertyto
pointouttheorganizationalandbusinessachievementsfromearlierperiodswithout
the access to a technical infrastructure we take for granted in today’s business
environment.
TheintentistoreachanaudiencebeyondtheAOcommunity.Reflectingonthe
potentialreadersofthisbook,Iwascognizantofthefactthatobviouslythistextis
not intended or suited as a manual for surgeons interested in the AO approach to
traumacare.Andyet,themedicalinformationpresentedhadtofindapprovalofthe
surgeons involved in trauma care, a constant challenge that was confronting me
throughoutthetwoyearsofworkingonthisproject.Ihopethistextwillbereadbya
general audience, including the large number of patients who have benefited from
theresultoftheseefforts,aswellasinterestedreadersfromthebusinessandresearch
communitywhomightfindinspirationintheAOapproach.
Whilethisbookwaswrittenbaseduponextensiveresearch,itwasnotintendedas
anacademicexercise.Instead,theaimwastotellthestoryoftheAOFoundationand
oftheindividualswhowereinstrumentalincreatingthisenterpriseandtodosoina
captivating, interesting, and also personal way. The AO’s tenacity to push ahead
with Osteosynthesis for trauma care when confronted with strong opposition from
the medical establishment, and to do so with limited resources, could serve as an
inspirationforothersuchprojects.
ThroughtheresearchontheAO,Ibecameawareoftheenormousimpactofthe
organization. Millions of people walk the streets having benefited from the
breakthroughs achieved by the AO, and yet few members of the general public
haveanyideawhowasorisbehindtheseachievements.Inthatsense,Iamhappyto
haveacceptedthechallengetowritethis storyandtorender it, Ihope,ina wayto
bringittotheattentionofawideraudience.
Belmont,Switzerland Jean-PierreJeannet
August2018
Acknowledgements
Thisbookwouldnothavebeenwrittenwithoutthegenerousandactivesupportof
theAOFoundationanditsGovernance.TheAOFoundationBoard,particularlyits
PresidentKlausRenneranditsCEORolfJeker,activelyworkedtoopendoorsand
obtainaccesstocountlessdocumentationandofferedhelpwithsecuringinterviews.
Asmallsteeringcommitteedealingwith60thanniversaryissueswasalwaysready
to provide guidance. Important financial support for this project was provided
throughtheBLIInstituteattheUniversityofLucerne,assuringthatthebookproject
could also find a reputable publisher. Most important, however, was the hands-off
approachoftheAOleadershipallowingtheauthortoexpresshisownopinionwhile
givingamplesupportthatalltherelevantfactscouldberenderedcorrectly.
The development of this book benefited from very capable authors of earlier
worksontheAOFoundation,especiallyfortheperiodsuptoabouttheyear2000.In
particular,thepublicationswrittenbyRobertSchneiderandUrsHeimontheearly
part of the AO history, Eugen Kuner on the development of the Osteosynthesis
approach, Thomas Schlich on the medical history of the AO and its treatments,
JosephSchatzker’sbiographyofMauriceMüller,aswellasthehistoryofAOVET
editedbyJörgAuerandhiscolleagueswereaconstantguideduringtheresearchand
writing of this manuscript. All of these authors are extensively cited throughout
thebook.
Enormousgratitudeisowedtoabout60individualswhowerewillingtositdown
forinterviews,typicallylastingonetotwohours.Theysharedfreelyoftheirexperi-
ence, history withtheAO,eventstheywitnessed,and stories theyremembered,and
offeredtheirreflectionontheAOorganization,inthepast,today,orthefuture.The
summaryoftheseinterviewsallowedmetogainamuchdeeperunderstandingofthe
importance and impact of the AO, both in medical and business terms. Where
appropriate, I have referenced these conversations in footnotes. A complete listing
ofallpersonsinterviewedisprovidedintheListofInterviewees.
I am thankful to the surgeons who took the time to explain the intricacies of
Osteosynthesis to this not medically trained author, in particular Peter Matter,
Reinhold Ganz, and Teddy Slongo who spent extra time with me and reviewed
part of the manuscript. The technical issues surrounding the AO Instrumentarium
andimplantswerepatientlyexplainedtomebyRobertMathys,Jr.,andRobertFrigg
whoalsoreviewedpartofthemanuscriptaswellasOrtrunPohler,whoworkedwith
ix
x Acknowledgements
meonthematerialscienceissues.Andfinally,RolfJekerspentmanymeetingsand
phonecallswithmeexplainingtheintricaciesoftheAOgovernance.Withouttheir
helpIwouldnothavebeenabletocover,absorb,andorganizetheentireAOhistory
inonesinglebook.
Iwouldliketoexpressmyappreciationtothemanyinstitutions,individuals,and
copyrightholderswhoallowedustoillustrateimportantaspectsoftheAOhistory.
The AO Publication team contributed their skills to converting the many exhibits
into publishable visuals for the book. Finally, a special thank you goes to Anita
Husseywhoeditedaroughmanuscriptintoapublishablestory.
Last but not least, I would like to thank my wife, Christine Jeannet, who has
patientlylistened over thepast two years to thecountlessstories I unearthedabout
theAOFoundation,hasdebatedmanyaspectsofthemanuscriptanditsorganization
withme,andthuscontributedimmenselytothestorypresentedinthisbook.
Contents
1 Prologue:OrchestratingACastofThousands. . . . . . . . . . . . . . . . 1
Davos,EarlyonaDecemberMorning. . . . . . . . . . . . . . . . . . . . . . . . 1
DavosHospital,onaDecemberMorning. . . . . . . . . . . . . . . . . . . . . . 2
Solothurn,Switzerland,ontheSameDecemberMorning. . . . . . . . . . . 5
WhoOrchestratesThisCastofThousands?. . . . . . . . . . . . . . . . . . . . 6
PartI LaunchingaSurgicalRevolution
2 OsteosynthesisExplained. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Reference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3 ABriefOverviewoftheAOOrganization. . . . . . . . . . . . . . . . . . . . 15
WhatDoesAOStandFor?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
AHumbleBeginning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4 TreatmentofBoneFracturesPriorto1960. . . . . . . . . . . . . . . . . . . 21
Davos,AnotherWinterDay,inthe1950s. . . . . . . . . . . . . . . . . . . . . . 21
HowConservativeTreatmentConqueredtheWorld. . . . . . . . . . . . . . 21
NegativeExperienceswithConservativeMethod. . . . . . . . . . . . . . . . 23
EarlySurgicalApproachestoBoneFractures. . . . . . . . . . . . . . . . . . . 24
ANailingInnovationfromBoston,PickedupinEurope. . . . . . . . . . . 24
NailingRodfromGermanyMadeItAroundtheWorld. . . . . . . . . . . . 24
ExperimentswithCompressionPlatesinBelgiumRemainedaLocal
Affair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
TheSurgeonWhoCoinedtheTermOsteosynthesis. . . . .. . . .. . . . .. 26
TheBelgianSurgeonWhoBroughtOsteosynthesistotheAttentionofa
WiderAudience. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
WhyOsteosynthesisInitiallyLostOuttoConservativeTreatmentinthe
RaceforGlobalDominationofFractureCare. . . . . . . . . . . . . . . . . . . 29
TheMedicalWorldReactsNegativelytothePracticeof
Osteosynthesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
xi