John P. Dormans, MD Chief Orthopaedic Surgery The Children's Hospital of Philadelphia Professor of Orthopaedic Surgery University of Pennsylvania School of Medicine Goals of the Workshop Carl T. Brighton Workshop on Musculoskeletal Trauma in Low and Middle Income Countries Ahmedabad, India, in December 2007

Carl T. Brighton, M.D., Ph.D. Joined the orthopedic faculty of the University of Pennsylvania and Chair, Department of Orthopedic Surgery from Pioneer in electrical effects of bone biology Dr. Brighton has authored 197 articles, co- authored three books, and has 10 patents issued and seven patents pending. He has won the Kappa Delta Award and the Shands Lecture Award from the Orthopedic Research Society and the Bristol-Myers Squibb/Zimmer Award for Distinguished Achievement in Orthopedic Research.

Thank you Local Host: Manjul Joshipura

Thank you The principle sponsor is the Association of Bone and Joint Surgeons Co-sponsors: –Stryker –Synthes –OREF

Supporters: Bone and Joint Decade Orthopaedics Overseas

Thank you Richard Brand David Spiegel** Mark Vrahas Collette Hohimer Julie Kahlfeldt

“If some infectious disease came along that affected one out of every four children in the US, there would be a huge public outcry and we would be told to spare no expense to find the cure… and to be quick about it” C. Everett Koop, US Surgeon General Before the Subcommittee on Children, Family, Drugs, and Alcoholism, US Senate, February 9, 1989

Goals of the Workshop The proceedings will be published as a symposium in Clinical Orthopaedics and Related Research Other Goals?

Goals Bring together a group of 40 orthopaedic surgeons from different nations to share ideas on improving musculoskeletal trauma care in resource challenged environments. The focus will be on systems issues, on teaching/ training, and on the role of international organizations in improving the delivery of services. Recommendations may help international organizations to expand their current training programs for trauma care, especially in regions with limited resources.

Accidental trauma: 2/3 traumatic deaths among children More deaths than any other causeMore deaths than any other cause 1 fatal lesion : 45 hospital treatments1 fatal lesion : 45 hospital treatments

Prevention measures → Up to 1/3 reduction in trauma-related deaths 1.Education 2.Environmental or product modification 3.Rules & standards From David Farrington, Seville

PREVENTION WORKS 20 years20 years ↓ 40% deaths resulting from unintentional trauma (pediatric)↓ 40% deaths resulting from unintentional trauma (pediatric) From David Farrington, Seville

1) Education 1.Personalized 2.Groups 3.Public From David Farrington 2007, Seville

1) Education a) a) Personalized Promote changes in individual behaviourPromote changes in individual behaviour Advice on prevention measuresAdvice on prevention measures Consulting-room adviceConsulting-room advice POSITIVE EFFECT!!!POSITIVE EFFECT!!! From David Farrington, Seville

1) Education b) Groups*** Education & training of professionals –EG Orthopaedic Societies Messages & attitudes to convey Most effective manner for us? From David Farrington, Seville

1) Education c) Public Brochures, posters & advertisements in the media Specific risk groups vs. population at large Least effective?….does it work? From David Farrington, Seville

2) Environmental and product modification Altering physical environment → ↑ securityAltering physical environment → ↑ security Modifying design of consumer productsModifying design of consumer products Eg Burn prevention (hot water heaters) GREAT INFLUENCE IN THE INCIDENCE OF UNINTENTIONAL INJURIES!!!GREAT INFLUENCE IN THE INCIDENCE OF UNINTENTIONAL INJURIES!!! From David Farrington, Seville

3) Rules and standards Changes in individual behaviourChanges in individual behaviour Changes in manufacturing processesChanges in manufacturing processes Example: AirbagsExample: Airbags EFFECTIVE BUT EXPENSIVE!!!EFFECTIVE BUT EXPENSIVE!!! From David Farrington, Seville

Active vs. passive strategies Active: Require modification of behaviour patternsActive: Require modification of behaviour patterns Passive: Automatic protection independent of individual behaviourPassive: Automatic protection independent of individual behaviour From David Farrington, Seville

Unique opportunity 40 surgeons from 20 countries Farrington mechanism 1b ….active role –Education/groups (orthopedic specialty societies taking global leadership role....) Other mechanisms also important….all (networking/teaching other groups) Friendships networking “A thousand points of light” Governments/NGOs Orthopedic specialty societies Patients/populations

Thank you “If some infectious disease came along that affected one out of every four children in the US, there would be a huge public outcry and we would be told to spare no expense to find the cure… and to be quick about it”