History of AOVet – The First 40 Years

His

tory

of

AoVE

t t

he f

irst 4

0 ye

ars

Jörg A Auerortrun PohlerMartina schlünderferenc KásaGerhilde KásaMarvin olmstead Björn von salisGustave E fackelman

2

Fig 1 Ancient Egyptian cat, 2700 years old (wood) (Museum rietberg, Zurich, switzerland).

Fig 2 trundholm sun Chariot, Denmark, 3400 years old. the horse and the wheels create the association of the rapid motion of the sun.

Since mythological, prehistoric times animals have been a

significant part of human culture and civilization. Historically,

it was an essential step forward in the development of man-

kind, when human beings learned how to tame, breed and

domesticate animals. A wooden Egyptian cat sculpture (Fig 1)

and a depiction of a horse transporting the sun (Fig 2) dem-

onstrate the artistic creation of animal sculptures in ancient

times. Throughout history animals have played different roles

and have had different functions: they were adored, used

for work, food and clothing, and utilized for their specific

skills, which were often considered superior to those of human

being. However, they have also been misused and neglected.

The history of AOVET tells of the unique development of

systematic orthopedic operative fracture treatment in the

veterinary medical discipline on the basis of—and in anal-

ogy to—the methodology developed by AO/ASIF to treat

systematic osteosynthesis in human patients. It shows that

large and small animal veterinary surgeons and ultimately

their patients profited from the clinical experience gained in

the treatment of human patients.

timeline of AoVEt 4

1 setting the field 7

2 How AoVEt started 19

3 the Waldenburg Circle 29

4 osteosynthesis in small animals 33

5 Maxlie the horse 41

6 institutionalizing the Waldenburg Circle:

the foundation of AoVEt and pioneering work 45

7 the hop over “the big pond” 59

8 spreading the word—AoVEt Center Waldenburg 69

9 Consolidating the achievements of the AoVEt founders 77

10 special events 85

11 Epilogue 91

List of AoVEt Presidents 93

references 94

Table of contents

3

4

1958

AO fo

unde

d in

Bie

l, Sw

itzer

land

1967

Björ

n vo

n Sa

lis m

eets

Frit

z St

raum

ann

1968

Wal

denb

urg

Circ

le s

tarts

wor

king

with

AO

ost

eosy

nthe

sis m

etho

ds

1968

1st t

itani

um 4

.5 m

m D

CPs

appl

ied

to a

McI

II os

teot

omy

in a

hor

se (N

ovem

ber)

1968

Mem

bers

of t

he W

alde

nbur

g Ci

rcle

par

ticip

ate

in th

e hu

man

AO

cou

rses

in D

avos

(Dec

embe

r)

1969

AOVE

T fo

unde

d in

Wal

denb

urg

(Aug

ust 3

1. 1

969)

with

Bjö

rn v

on S

alis

as 1

st P

resid

ent

1969

Key

Amer

ican

sur

geon

s pa

rtici

pate

in th

e hu

man

AO

cou

rses

in D

avos

(Dec

embe

r)

1970

1s

t AO

VET

cour

se in

Bet

tlach

, Sw

itzer

land

(Jan

uary

)

1970

1st A

OVE

T co

urse

at O

hio

Stat

e U

nive

rsiti

y in

Col

umbu

s, in

itiat

ed b

y Br

uce

Hoh

n (M

arch

)

1971

1st E

nglis

h AO

VET

cour

se in

Dav

os

1972

AOVE

T ac

cept

ed in

to A

O In

tern

atio

nal

1973

1st F

renc

h AO

VET

cour

se in

Dav

os (t

his

was

follo

wed

by

the

annu

al c

ours

es in

Cou

rche

vel f

rom

198

7 on

war

ds)

1974

1st s

mal

l ani

mal

vid

eos

deve

lope

d in

Dav

os a

nd C

olum

bus

1975

1st A

OVE

T Fo

ndue

Par

ty a

t the

Dav

os c

ours

es

1976

Die

ter P

rieur

take

s ov

er a

s Ex

ecut

ive

Secr

etar

y of

AO

VET

and

Dire

ctor

of t

he A

OVE

T Ce

nter

at t

he S

traum

ann

Inst

itute

in W

alde

nbur

g

1977

1st e

quin

e vi

deos

for p

ract

ical

exe

rcise

s de

velo

ped

in C

olum

bus

1982

1st G

erm

an A

OVE

T co

urse

in G

iess

en, G

erm

any

1982

1st E

quin

e AO

VET

Man

ual b

y G

usta

ve F

acke

lman

and

Dav

id N

unam

aker

is p

ublis

hed

tiM

ELin

E o

f Ao

VEt

5

1984

1st S

mal

l Ani

mal

AO

VET

Man

ual e

dite

d by

Wad

e Br

inke

r, Br

uce

Hoh

n, a

nd D

iete

r Prie

ur is

pub

lishe

d

1986

1s

t AO

VET

chap

ter e

stab

lishe

d in

Ger

man

y w

ith F

eren

c Ká

sa a

s ch

airp

erso

n1988

Fritz

Stra

uman

n di

es

1991

Die

ter P

rieur

retir

es a

s Ex

ecut

ive

Secr

etar

y of

AO

VET

and

Dire

ctor

of t

he A

OVE

T Ce

nter

1991

Mon

ika

Gut

sche

r sta

rts a

s Se

cret

ary

of th

e AO

VET

Cent

er in

Zür

ich

1992

The

AOVE

T Ce

nter

is m

oved

from

Wal

denb

urg

to th

e U

nive

rsity

of Z

üric

h un

der J

örg

Auer

, who

also

take

s ov

er a

s Ex

ecut

ive

Secr

etar

y of

AO

VET

1992

The

1st A

OVE

T m

embe

r is

elec

ted

to th

e Bo

ard

of T

rust

ees

of th

e AO

Fou

ndat

ion

(Jör

g Au

er)

1995

Th

e 1s

t ele

ctro

nic

AO M

anua

l inc

ludi

ng C

D-R

OM

is p

ublis

hed

by A

O P

ublis

hing

: AO

Prin

cipl

es o

f Equ

ine

Ost

eosy

nthe

sis1999

30-y

ear A

OVE

T ce

lebr

atio

n

2000

The

1st A

O M

anua

l is

publ

ished

by

AO P

ublis

hing

: AO

Prin

cipl

es o

f Equ

ine

Ost

eosy

nthe

sis

2003

AOVE

T re

ceiv

es th

e “D

istin

guish

ed E

duca

tor A

war

d” fr

om th

e Am

eric

an A

ssoc

iatio

n of

Equ

ine

Prac

titio

ners

2003

Brig

itte

von

Rech

enbe

rg re

ceiv

es th

e Re

cogn

ition

Priz

e fro

m A

OTK

2005

Synt

hesVET

is e

stab

lishe

d as

par

t of S

ynth

es In

c.

2008

AOVE

T be

com

es th

e 4t

h cl

inic

al d

ivisi

on w

ithin

the

AO F

ound

atio

n (J

une)

2008

Jörg

Aue

r rec

eive

s th

e Re

cogn

ition

Priz

e fro

m th

e AO

Fou

ndat

ion

(the

hig

hest

AO

aw

ard)

2008

50-y

ear f

estiv

ities

of t

he A

O F

ound

atio

n2009

40-y

ear c

eleb

ratio

n of

AO

VET

2009

Jean

-Pie

rre

Caba

ssu,

Pre

siden

t of A

OVE

T is

elec

ted

to th

e AO

VA

6

1 Setting the Field

7

sEtt

inG

tH

E fi

ELD

1

8

1 Setting the Field

Traditionally, in recent centuries in rural settings veterinar-

ians were mainly occupied with the treatment of horses and

cattle, which were mostly working and/or food-producing

animals. If necessary they also took care of “small animals”,

such as cats and dogs, as well as other domesticated animals.

Expensive treatments were not afforded to cats and dogs as

replacement was so natural and inexpensive. In the mid-

nineteenth century the disappearance of horses as working

animals and the advent of industrialization with increasing

introduction of machines, such as tractors, had a strong impact

on veterinarians not only regarding their professional iden-

tity but also economically [1–9]. Since then, horses have been

primarily used for pleasure riding or various sports activities,

such as racing, dressage, and show jumping, while cattle

have been kept as food and fiber-producing animals.

At the same time, particularly in the growing cities, small

animals increased in large numbers. These animals were kept

by their owners as pets, the most popular being cats and dogs

[10, 11]. The emotional attachment to these animals resulted

in the increasing commercialization of a pet’s life. Pets might

have been economically unimportant for their owners but

they had an economic value for breeders, the pet food

industry, and for veterinarians. While at the beginning of

the twentieth century small animal practitioners could be

found only in small numbers and only in large cities, their

numbers started to increase during the 1950s and 1960s and

now dominate veterinary medicine and surgery [1, 2, 12].

Because pet owners have been ready to spend an increasing

amount of time and money for their beloved, emotionally

highly valued animal companions, veterinarians have been

able to apply more demanding treatments.

9

The drastic modification of their patient population from

large animals to small animal pets confronted veterinarians

with new treatment regiments. Traditionally veterinarians

had been trained on the basis of the functional pragmatism

that ruled the lives of working animals [13–16]. In the context

of pet ownership, however, the veterinarian’s mission changed.

It was no longer about curing inexpensively or otherwise

killing the sick animal. The treatment of pets closely followed

the model of human medicine instead, something that was

increasingly expected by pet owners. Veterinarians thus

switched from a functional pragmatism to an “economy of

love” as a basis for their work. This change, however, con-

fronted veterinarians with the fact that they often did not

know how to treat an animal according to human medical

practice.

10

1 Setting the Field

Insufficiency in operative fracture treatmentThese problems were of particular relevance for veterinary

surgery, especially in the field of trauma and orthopedic sur-

gery. Modernization and industrialization had led to a rapid

increase in the numbers of motor vehicles and, consequently,

to growing numbers of animals injured in traffic accidents

[19]. The injuries they suffered were more complicated than

those caused by a simple accident, fall, or kick by another

animal. Thus, the veterinarians were challenged quantita-

tively with more fractured bones and qualitatively with more

complicated fractures. Whereas previously the injured animals

would have been euthanatized, now their owners expected

effort to be made to heal and save the lives of their pets. In

the 1950s and 1960s, however, veterinarians’ knowledge

and treatment options for dogs, cats, and horses with broken

bones were limited, although certain adoptions from human

trauma surgery had been made [17–24]. For operative fracture

treatment in small animals, the most popular approach in

Germany and Switzerland (as well as in other countries) was

intramedullary nailing corresponding to the Küntscher tech-

nique (Fig 3a–d) [25, 26] and modifications thereof, like the

Rush-pin application and the stacked pin nailing. The use of

these elegant but somewhat tricky surgical methods was

relatively widespread during that era, even though they had

their limitations. In dogs intramedullary nailing was more

demanding than in humans, since the cortex of the dog bone

is thinner and more brittle, the diameter of the medullary

space more diverse than in humans. Instability and subse-

quent complications, such as nonunions, pseudarthroses,

and implant failures, were frequently the result. Also, the

anatomy of long bones varies considerably among different

breeds, making this technique difficult to standardize [27].

One of the German small animal surgeons of the 1950s, Dr

Heinrich Müller, who studied intramedullary nailing tech-

niques, blamed a blatant lack of accompanying scientific

research and the ensuing lack of knowledge flow between

the fields of human and animal fracture treatment for the

poor results [28, 29]. Joint and near-joint fractures are dif-

ficult to stabilize with nailing techniques or with pins and

cerclage techniques, except for some special methods that

have been developed over time. Conservative fracture care

with plaster of Paris casts and bandages as practiced in hu-

man medicine is rarely suitable for small animals, since the

11

Fig 3a–d a Mrs Willenegger’s dog named Kai.b suffered a mid-shaft femoral fracture.c in the 1940s, Drs Knoll and Willenegger assisted Dr. Jacques Jenny insert a Küntscher nail into the

medullary cavity, which led to complete healing of the fracture.d 14-week follow-up x-ray after complete fracture healing with the nail still in place (left) and x-rays

2 weeks later after nail removal (right).

a b

c d

patients usually destroy such applications. Thus, fracture

treatment in small animals during the 1950s and 1960s was

problematic and had many shortcomings.

12

1 Setting the Field

In large animals operative fracture treatment was extreme-

ly difficult, although occasionally attempts were undertaken.

Dieter Prieur refers to an early case [27] from 1891, in Cairo,

Egypt, where a city police horse that had suffered a broken jaw

was successfully treated with a drilled wire suture (cerclage).

After 10 months the horse was back to work. A publication

in 1966 [30] reports on the osteosyntheses of fractures of the

lower jaw in cattle by means of compression-plate applica-

tions, carried out in collaboration by a veterinary surgeon

together with an experienced human surgeon.

A brief look at human trauma surgery in the mid-1950s

indicates that at this time many unsolved problems existed

in the operative treatment of fractures. Many trauma surgeons

characterized their field as the “Cinderella of modern surgery”

[31, 32]. Trauma surgery and fracture care had not partici-

pated in the triumph of modern surgery in the late nineteenth

and early twentieth centuries. One reason why fracture treat-

ment was relatively unattractive to most surgeons was its

conservative character. Most patients with fractured bones

were treated with immobilizing techniques, such as plaster

casts and traction. Operative fracture care was extremely

demanding in terms of operative techniques, implant design

and quality and asepsis. The associated risk of bone infection

made it unsuitable for large-scale use. Complications occurred

frequently but their reasons were rarely analyzed or under-

stood. Only a few surgeons tried to make operative fracture

care a viable option. Even in human fracture surgery not

much systematic scientific research was conducted. Knowl-

edge was usually based on personal experience of individual

surgeons and not on larger systematic clinical or laboratory

research. Aside from Gerhard Küntscher, who improved and

expanded the intramedullary nailing technique, there were

the esteemed surgeons Albin Lambotte and Robert Danis

who applied their novel ideas to stabilize fractures with ex-

ternal transfixation devices and with screws and plates [33].

13

Systematic approach to osteosynthesis in human surgery developed by the AO group The breakthrough and spread of a systematic operative frac-

ture treatment occurred with the founding of the Arbeits-

gemeinschaft für Osteosynthesefragen (AO) that took place

on November 6, 1958, in Biel, Switzerland [1]. Based on

private individual interest and driven by the search for

improved and dependable osteosynthesis techniques, the five

surgeons of the core group who initiated the formation of

the AO (Maurice Müller, Martin Allgöwer, Hans Willenegger,

Robert Schneider, and Walter Bandi) (Fig 4a–e) had met

numerous times between 1952 and 1956 to exchange their

experiences, concerns, and new concepts [33]. They concen-

trated increasingly on collaboration, systematic work, and

the analysis of clinical problems. By 1957 they formulated

essential preconditions for successful operative fracture treat-

ment stressing the importance of a functional view of osteo-

synthesis. In December 1957 they decided on the formation

of an “Association pour Osteosynthèse” [33, 34]. At an inter-

nal meeting in March 1958 they demonstrated and evaluated

all osteosynthesis equipment available at that time. The results

were disappointing and the five surgeons decided to develop

their own instrument and implant systems and surgical methods

for the different fracture types and orthopedic interventions.

Professor Maurice Müller, the most highly motivated and

most active of the group, presented an overview of the “aims

and general principles of modern osteosynthesis in adults”

that sounded almost like an AO program [44]. Among other

aspects the following characteristic points were included:

Basic Principles:

• Continuity of asepsis from accident to healing;

postoperative wound drainage; careful anatomical

operation, reconstruction and reduction

• The fractured area should be transformed into a

stable block by the osteosynthesis

• Where possible fragments should be set under

compression for increased stability

• Pseudarthroses tend to heal quickly under

compression, but the source for the pseudarthroses

should be detected and treated if required. The

implant materials must be biocompatible

Aims:

• Early postoperative mobilization and activation of

near-fracture joints and muscles; this is very

effective but must not be forced too much

• Reconstruction of the anatomical conditions; this is

a precondition for functional results

14

1 Setting the Field

The various aims and concepts were followed up meticu-

lously, with astonishing momentum and personal engage-

ment. To implement the agreed development of instruments

and implants, Professor Müller visited Robert Mathys in spring

of 1958 in his production company in Bettlach where he was

working with stainless steel.

Mathys started immediately to design and manufacture pro-

totypes, so that the first samples of the 4.5 mm screws with

the corresponding (round-hole) plates and implantation

instruments were available already at the founding meeting

in November of the same year. Thus, Mathys was the first

manufacturer of AO implants and became the first exclusive

producer of AO products (later to become Synthes products)

and contributed substantially to the development of the

equipment.

The AO surgeons were highly successful because they ap-

proached operative fracture treatment on an unusually broad

and systematic basis and, at a point in time, when important

new techniques in various fields like metallurgy, physics,

aseptic surgical techniques, and perioperative antibiotic man-

agement were developed and became available to solve ma-

jor problems of bone surgery. They developed implants,

instruments, surgical techniques, and after-care protocols

simultaneously. They studied the biomechanics of the normal

skeleton and of the injured and treated bones, and they

investigated osteogenesis, and bone healing mechanisms

under various conditions histologically and metabolically.

In 1959 the AO Research Institute for Experimental Surgery

was established in Davos through the particular initiative of

Fig 4a–e the principal founders of Ao: (a) Martin Allgöwer, (b) Walter Bandi, (c) Maurice Müller, (d) Hans Willenegger, and (e) robert schneider.

a db ec

15

Professor Martin Allgöwer and supported by the financial

donations of the AO members. The Documentation Center

for the clinical cases of the AO members was moved there,

and a tissue culture laboratory was soon installed. This lab-

oratory also addressed the question of metal toxicity and led

to the early studies of biocompatibility of implant materials

and their components by Dr Lotte Hulliger and Ortrun Pohler

[35, 36]. Professor Herbert Fleisch led the AO Research

Institute during the early years. His special research interests

were bone biochemistry and metabolism, as well as bone

pathology and the development of medications for bone dis-

orders. From 1967 onwards Professor Stephan Perren led

the Research Institute as its director and constantly expand-

ed its facilities in addition to its organization, engagements,

and the subjects of research at the highest level. He imple-

mented biomechanical, biological, and mechanical testing

and analyses, histological and clinical research, cell and

organ culturing, and biocompatibility studies, as well as the

development of implants and instruments. The AO Research

Institute also provided enormous teaching and operative

support for the annual Davos courses. The accumulated

knowledge and expertise of the AO Research Institute con-

tributed tremendously to the success of the AO concepts and

the AO Foundation.

After the Straumann Institute in Waldenburg was contacted

by the AO in 1960 (see next chapter), it became instrumen-

tal in developing implant materials that possessed the required

biocompatibility, corrosion resistance, and variability in me-

chanical properties [32, 33]. Along with other developments,

the Straumann Institute became the second exclusive pro-

ducer in 1962 [34–36]. The collaboration of the surgeons with

the producers, engineers, physicists, metallurgists, biologists,

and scientists contributed to development and progress and

provided specific research techniques. Also, the availability of

antibiotics at that time and improved antiseptic management

reduced the risk of infection and supported the surgical success.

The AO, together with its producers, pursued a strategy of

standardization and quality control of instruments and im-

plants as well as teaching correct equipment handling and

corresponding operative techniques. For this purpose, the

AO established the Technical Commission (TK) in 1961 for

the guidance, testing, and acceptance of new developments

in AO surgical equipment and methods.

16

1 Setting the Field

In so doing, they had organized a system of quality control

and assurance, many years before today’s required interna-

tional quality-management standards (ISO).

The AO members obtained more and more requests from

their colleagues who wanted the AO equipment for their

own surgery. Since the operation techniques were subtle

and the risks of probable complications high, the AO de-

cided to sell the equipment only to surgeons who were well

trained and attended a special instruction course. At the same

time it was agreed with Dr Peter von Rechenberg of Synthes

AG, Chur, that earnings from the sale of the surgical equip-

ment would flow back into the research. In December 1960

The experimental clinical and histological research conducted

by Professor Hans Willenegger (Hospital Liestal near Basel)

and Professor Robert Schenk (University of Basel at that time)

demonstrated that with sufficiently stabilized osteotomies

primary direct bone healing occurs without callus formation

[37, 38]. Stephan Perren showed with his strain gauge mea-

surements on experimental compression osteosynthesis on

sheep in combination with related histological investigations

that no bone resorption occurred with the exerted compres-

sion [39]. These scientific findings, combined with the many

documented successful clinical cases, soon convinced the

surgical orthopedic community. Meticulous documentation

and critical evaluation of the clinical cases, as well as learn-

ing from complications, were important milestones of the

AO philosophy. The yearly spring and fall closed membership

meetings and open scientific sessions provided a forum

for information, exchange of experience, and coordinated

clinical projects.

However, with the propagation of the “compression-osteo-

synthesis technique” where screws and plates created reduc-

tion of the fracture gaps and axial compression at the end of

the bone fragments, the AO surgeons met with opposition

from their colleagues because the common opinion then was

that compression destroyed the bone. Another related con-

troversy arose surrounding the phenomenon of “callus-free

healing”, which was detected in connection with the stable

osteosynthesis techniques. At that time it was generally

accepted that callus formation should be interpreted as a sign

of progressive bone healing. Thus, surgeons concluded

wrongly that the missing callus with stable internal fixations

indicated a lack of bone healing.

17

the first AO course was offered in Davos with lectures and

practical exercises using original implants and instruments

on anatomical specimens. The Davos courses were then of-

fered on an annual basis and have grown in numbers and

diversity of their content. Additional courses expanded in-

ternationally. Corresponding teaching material was developed

and continually updated including videotapes for practical

exercises. The first AO manual with descriptions of the var-

ious operation techniques for typical fracture treatments and

general introductory information was published in 1963 [40].

This was followed by a series of updated editions of AO

manuals [41–44] in different languages (the third edition

contains sections on biomechanics, classifications of fractures,

soft-tissue injuries, and other interesting topics [43]).

The teaching, documentation, classification, interdisciplinary

research, specific surgical equipment and methodology, and

an international radius of action were the important corner-

stones of the AO’s development. However, the essential el-

ement was an unusual willingness to cooperate and exchange

information and experience, sustained by a sincere and

wholehearted human attitude characterized by responsibil-

ity, honesty, and tolerance of each other.

This specific characteristic of AO membership supported the

formation of an AOVET organization, about a decade after

its own founding. AO was generous in sharing its surgical

methodology and scientific knowledge with the fledgling

discipline of veterinary orthopedic surgery. In this way, a

group of veterinary surgeons enabled to develop efficient

and dependable osteosynthesis methods on a systematic

basis for small and large animal fracture treatment. Some of

the AO principles and equipment could be transferred directly

to veterinary surgery, some of them needed adjustment and

modification, and new solutions had to be developed as well.

In addition, the veterinarians had to learn many of the gen-

eral surgical preconditions and skills, which are standard

procedures in the treatment of human patients. Moreover,

the veterinarians had to undergo numerous experiences

similar to those of the AO founders.

18

2 How AOVET started

19

Ho

W A

oVE

t st

ArtE

D

2

20

2 How AOVET started

Several fortunate coincidences led to the formation of the

initial group of veterinarians, human trauma surgeons, and

scientists that eventually resulted in the founding of AOVET.

A horse shot deadWhen Dr Björn von Salis (Fig 5) was a teenager he was taken

to the local horse races. In the middle of a race one of the

horses fell with a broken leg and shot dead on the spot. This

was a crucial experience for the young visitor and it led him

to become a veterinarian. Von Salis told himself that such

things could not be tolerated, and dedicated the rest of his

life to finding solutions to this problem. When he worked as

a senior veterinarian at the Equine Hospital of the Univer-

sity of Bern in the 1950s, he noticed how underdeveloped

the facilities for equine surgery were. Neither adequate

instruments nor surgical techniques were available for equine

trauma surgery. Also, horses could not be anesthetized for

longer than 30 minutes. At that time horses were exclusively

anesthetized with intravenous chloral hydrate. Therefore,

von Salis decided to first examine the problem of anesthesia.

Veterinary anesthesia was more advanced in the UK, where

Leslie Hall was starting to use halothane for inhalation

anesthesia. Intrigued by this work, von Salis decided to go

there and study these new techniques. After returning to

Switzerland he introduced these techniques into the standard

procedures at the Equine Hospital of the University of Bern

and later published an article on equine anesthesia [45]. His

second goal for improving equine surgery was the development

of new transportation facilities for horses after an accident.

Since horses were typically put to death humanely, little

experience existed on how to transport an injured animal

and what kinds of devices were needed to load an injured

horse into a trailer, either in a standing or recumbent posi-

tion. This challenged him to construct an ambulance vehicle

equipped with an x-ray unit and first-aid facilities.

21

In the mid-1960s von Salis left the University of Bern and

moved on to work in a small animal practice in Basel so that

he could complete his specialization degree in small animal

surgery and medicine. There he became friends with Ferenc

(Feri) and Gerhilde (Geri) Kása, small animal veterinarians

who practiced and lived in Lörrach near Basel on the German

side of the Rhine river. Von Salis never forgot the need to look

for adequate implants and instruments for trauma surgery

in horses.

Fig 5 Björn and Cathrin von salis during an Ao function in Davos.

22

2 How AOVET started

Dr Guggenbühl’s huge dogs Before Dr August Urs Guggenbühl became the chief and

general surgeon at the Hospital in Grenchen (near Solothurn)

in 1957, he worked as chief resident at the Liestal Hospital

under Hans Willenegger, one of the AO Founding Fathers,

Guggenbühl was the youngest of the 13 AO founding members

in 1958.

Urs Guggenbühl was the proud owner of seven dogs (Irish

Wolfhounds, a Great Dane, a Bordeaux Dane, a Mastiff, as

well as a Greyhound) who used to accompany him almost

everywhere in his Jaguar convertible (Fig 6). He was renowned

for showing up with all of them in tow. Actually, he had

never planned to have so many (and such huge) dogs. He

had ended up with them by accident but he loved to live

with them. Of course, Guggenbühl was in contact with the

local veterinarian at that time but he was not impressed

by the techniques and equipment used for fracture care in

animals. Therefore, he started teaching the veterinarian the

AO Principles of osteosynthesis. Occasionally, Guggenbühl

himself carried out a surgical intervention with the veteri-

narian’s assistance.

Fig 6 Urs Guggenbühl in front of his house with four of his prize-winning giant dogs.

23

Afterward he discussed these animal cases with his AO

colleagues. Willenegger, who knew about the veterinary

activities in Waldenburg, introduced Guggenbühl to the

veterinarians, which led to his engagement as a veterinarian

teacher.

An animal owner and engineerIn 1954, Dr Fritz Straumann (Fig 7) and his father Professor

Reinhard Straumann established a private research institute

in Waldenburg (near Basel) to facilitate further development,

investigation, and testing of watch-spring materials and

watch-spring designs that the elder Straumann had invented.

The spring metal alloys were sophisticated and their produc-

tion processes required close attention and metallurgical

expertise. Since Fritz Straumann was very interested in all

natural sciences and technology, he expanded their research

beyond the watch industry into other areas as well. The

concept was to invest the earnings from their patents into

their research institute.

Fig 7 fritz straumann giving an address during an Ao function.

In 1960 Fritz Straumann was contacted by Willenegger, who

was seeking assistanceto improve the material quality of AO

implants because there were problems with the corrosion

and failure of plates and screws. Ortrun Pohler (Fig 8) analyzed

the defect implants and found that impurities and an insuf-

ficient composition of the stainless steel were the reason for

the corrosion. The breaking of the implants was caused by

material fatigue where a crack propagates with time through

the material under alternating bending stresses (cyclic load-

ing). Such critical local bending stresses can be generated

under the load bearing of the patient, in cases where bony

defects and instability of the osteosynthesis are present. With

time this phenomenon was studied in depth [46]. Straumann

developed of a stainless steel with high corrosion resistance

and variable mechanical properties that were particularly

suited for clinical applications. This material became the

model for the internationally standardized implant steel that

is currently used. Straumann volunteered to help to the AO

surgeons, and was able to assist in the development of various

techniques to resolve clinical biomedical problems.

Fig 8 ortrun Pohler a scientific member of Ao and an AoVEt member working on a publication.

24

2 How AOVET started

For example, he developed the first bone saw that was able

to cut thin undecalcified embedded bone sections for histo-

logical microscopy. This provided bone histology with a tech-

nique to obtain a more detailed and realistic visualization of

the microscopic bone structure and further understanding

of bone remodeling and healing.

Fritz Straumann was also a passionate horseman. He owned

a number of horses and kept them at stables and an indoor-

riding arena close to a nearby castle called Bechburg

(Fig 9), a place also used for occasional veterinary activities.

Straumann also owned dogs (blood hounds and bassets). In

1967, when one of the dogs became sick, Fritz Straumann

took it to Dr Christoph Uehlinger, a small animal practitioner

in Basel, and there he met Björn von Salis.

25

Fig 9 Bechburg, near Waldenburg, the place where AoVEt was founded.

26

2 How AOVET started

Getting togetherChristoph Uehlinger told von Salis about Straumann’s in-

volvement in the development of instruments and implants

for fracture care in humans, and von Salis immediately rec-

ognized that Straumann could be instrumental in solving his

third problem concerning trauma surgery in horses: the de-

sign of appropriate instruments and implants. Von Salis helped

treat Straumann’s dog and started visiting the dog and its

owner at their home in Waldenburg. He had prepared him-

self very well for his first visit. He took his publications on

horse anesthesia and a Dutch book by Verhaar on operative

fracture management in large animals with him to Walden-

burg [47]. In those days fracture treatment in horses was in

its infancy. The two men got along very well from the start.

Indeed, their first conversation lasted until 3:00 am in the

morning. When von Salis asked Straumann at the end of

their meeting if he could help him with the instrumentation

problem, the engineer promised every kind of help and sup-

port, including the offer to use his laboratories. As a first step

Straumann set his metallurgist, Dr Ortrun Pohler, to work

on the “animal-project”. She was already experienced in the

research and development of AO implants and was in close

collaboration with the AO Research Institute in Davos. They

agreed to meet every Wednesday afternoon at the Institute

in Waldenburg to explore the conditions under which the

AO techniques and equipment could be applied to fracture

management in animals. Björn von Salis attempted to involve

Christoph Uehlinger in the devlopment of implants for the

veterinarians. When he declined, von Salis asked Feri and

Geri Kása (Fig 10a–b) who jumped at the chance because they

previously had a frustrating experience treating a radioulnar

fracture without proper instrumentation and implants. A week

later they joined Björn von Salis on his visit to Waldenburg

as they were searching for more efficient internal fixation

methods to overcome the limitations of the common nailing,

pin, and cerclage techniques they were using so far. Although

they had developed particular skills in nailing fractures in

small birds (Fig 11a–c) [48], this was the start of intense work

on veterinary osteosynthesis in large and small animals.

Fig 10a–b ferenc (a) and Gerhilde (b) Kása, the first small animal surgeons working with Ao techniques.

a

b

27

Fig 11a–c a Preoperative x-rays of a fracture of the distal metaphysis of the tibiatarsus in a canary bird; treated by feri and Geri Kása.b intraoperative picture showing the incision. c Postoperative x-rays following intramedullary pinning of the fracture with a straight needle.

a

b c

28

3 The Waldenburg Circle

29

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3 The Waldenburg Circle

Studies of osteosynthesis in large animalsThe experimental work on horse bones in the Straumann

laboratories began immediately after the key meeting between

Drs Björn von Salis and Fritz Straumann. The primary ques-

tions to be answered were: (1) what type of fractures actu-

ally occur in horses; (2) how could such fractures be stabilized

with already existing AO implants, and what specific implants

and instruments needed to be developed; (3) would such

fixations remain stable under the heavy weight-bearing load

of an adult horse; and (4) would the fracture eventually heal

with the help of internal fixation, and would the attainable

stability suffice?

For this work von Salis collected horse bones from animals

that had to be slaughtered because they had suffered a frac-

ture. X-rays of the bones were taken with the mobile x-ray

unit from his Equine Ambulance. Very soon it became clear

that on the large bones, such as the adult femur and hu-

merus, osteosynthesis would be almost impossible from a

biomechanical point of view. For the other bones of the limbs

there seemed to be possibilities for internal fixation, given

the fractures were not too complicated. With the largest type

of existing AO plates and screws, some of the actual fractures

could be well stabilized. Interestingly, the mechanical load-

ing tests that followed demonstrated that it was extremely

important to apply the compression plates and screws in a

biomechanically optimal way as taught by the AO principles

for human surgery. Also the most precise anatomical fracture

reduction was necessary to achieve sufficient postoperative

stability and immediately allow full weight bearing on the

fractured leg.

Some of the instruments had to be modified because of the

big diameters of the horse bones. The first explorations were

encouraging and suggested that there might be certain types

of common fracture configurations that could be treated

surgically. It appeared that the largest, the 4.5 mm cortex

screw and plate system, would be suitable for the major

applications and other already available implants seemed

useful too. But some new implants and instruments would

have to be developed and others adapted to the dimensions

of the horse bones (Fig 12). Later on, a 5.5 mm large animal

cortex screw was developed by Pohler with improved strength

and good holding resistance in cortical and cancellous bone

[49]. However, the major question remained: would such

31

stabilized fractures really heal, and how long would the healing

process take? How could the horse be placed on and taken

off the surgical table and back on its legs again? This meant

that a substantial amount of research had to be conducted.

Von Salis worked on this project systematically every Wednes-

day afternoon and evening at the Straumann Institute. Dur-

ing more demanding surgery on cadaveric bones and horses

he was assisted by Guggenbühl and another human surgeon,

his friend Dr Peter Dätwyler (Fig 13).

Fig 12 A special fragment distractor developed for Björn von salis by Beat schenk, the son of Professor robert schenk, for equine fracture repair. Each of the two pins for each main fragment had a diameter of 6 mm. the distractor was solidly built and allowed movement of the fragments in any direction. However, it was too heavy and the pinholes too large to be used in clinical work.

Fig 13 Peter Dätwyler, a human surgeon very instrumental in exploratory large animal surgery during the initial organizational period of AoVEt.

The exchange of knowledge The group members complemented each other in an advan-

tageous way. Von Salis was mainly interested in horses and

the development of large animal surgery, even though he

was a small animal veterinarian too. His friends and colleagues

Feri and Geri Kása were specialists in small animal surgery.

In addition, Geri Kása was a veterinary anatomist. However,

none of the veterinarians had the sophisticated surgical skills

needed in the field of osteosynthesis as developed by the AO.

It was the experienced surgeon Urs Guggenbühl who con-

tributed these skills. Straumann and Pohler had worked

together with the human AO surgeons for several years and

were experienced in instrument and implant design, material

development, and research. However, what they all had in

common was a deep and passionate interest in animals and

the desire to heal injured animals and to improve the fate of

the increasing number of animal accident victims. One of

their main goals was to reduce the number of animals that

had to be humanely destroyed because of the lack of viable

fracture treatment techniques.

32

4 Osteosynthesis in small animals

33

ost

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34


After the Kásas joined the Waldenburg Group in 1968, Urs

Guggenbühl started to systematically instruct veterinarians in

surgical techniques (Fig 14). At that time aseptic techniques

were taught at university clinics but not universally applied in

veterinary surgery because the risks of infection were regarded

by many as negligible; an attitude detrimental to bone surgery.

The duration of a surgical intervention had to be recognized

also as a factor contributing to infection risks. In the same way

atraumatic surgical techniques had to be introduced to avoid

additional damage to bone, blood vessels, nerves, and soft tissues

that in turn could cause complications and delayed healing.

Precise anatomical reconstruction of broken bones and joints

had to be learned, as well as how to use the specific reduction

instruments. All these parameters were prerequisites for

successful bone surgery and for achieving the specific goals of

the AO:

Guggenbühl instructed veterinarians in how to read x-rays

of the fractures, how to generate a strategic plan for the

impending surgical procedure, and how to select the ap-

propriate fixation method for each individual case. The AO

had developed different kinds of implants and application

methods for the various types of fractures occurring at the

specific human anatomical locations. Now the veterinarians

had to find out which techniques suited best the particular

fracture problems they experienced with their different

animal patients. One considerable issue was the huge variety

in the sizes of their patients (Fig 15). Analysis of preoperative

x-rays of clinical cases and the selection of suitable fixation

techniques and operative procedures in connection with the

critical evaluation of the operative outcome and the healing

results became important cornerstones in veterinary educa-

tion in osteonsynthesis and the spreading of the AO tech-

niques across the globe. The Kásas were active very early

and generous in communicating their acquired experiences

and knowledge to their colleagues, helping them to learn

the methods of AO fracture treatment.

“optimal anatomical and functional reconstruction of bone and

joints and early pain free motion.”

35

Fig 14 Urs Guggenbühl teaching equine veterinarians during a laboratory session on the management of a third metacarpal bone fracture. Left to right: Urs Jenny, chief assistant at the surgery Clinic of the University of Zurich, a Belgian veterinarian, Dr forr, the assistant of Björn von salis.

Fig 15 Dogs of different sizes: a great dane and a chihuahua.

36


Guggenbühl often assisted in the osteosynthesis of actual

clinical cases of cats and dogs to demonstrate procedures and

also gave helpful advice for the postoperative care. All treated

clinical cases were closely followed up clinically and radio-

graphically and usually turned out to be successful (Fig 16a–c).

The time required for bone healing appeared to be much

shorter in small animals than in adult human patients. This

was seen as a welcome compensation for the problematic

fact that these animals apply full weight on the operated leg

immediately after operation. At the same time it explains

why the concept of stable internal fixation rapidly became

so successful in veterinary surgery. Unfortunately, these

animals also love to lick and destroy their bandages, a prob-

lem that required some ingenuity from the veterinarians if

it was to be overcome.

Besides the encouraging experience of successful cases, it

became obvious very soon that the smaller bones of dogs

and their variable sizes among different breeds required more

variety in implant size than were available in the human

implant sets at that point in time. The proportionally thin

cortices of dog bones with some brittle quality and the rela-

tively wide medullary canals called for certain modifications

in surgical techniques. The Straumann Institute with its flex-

ibility in technical improvisations and problem solving was

the ideal partner to develop prototypes and to adapt human

AO instrumentation and techniques quickly to veterinary

requirements. With time, specific implant designs and dimen-

sions were developed for the animal patients. The develop-

ment of a “broad” dynamic compression plate (DCP) 3.5 in

addition to the standard DCP 3.5 serves as example because

it was particularly helpful in the treatment of certain com-

mon sizes of dogs (see Appendix in Small Animal Maual 2nd

ed) [69]. The broad DCP 3.5 has a cross section like the nor-

row DCP 4.5 and is considerably stronger. Often the smaller

versions of implants were also welcomed by the human AO

surgeons, such as the special 3.5 mm cortex screw with

finer threads and a thicker core, that was developed for dogs

and became the conventional Synthes 3.5 mm cortex screw

of today [49, 68] (see chapter 8).

37

Fig 16a–c one of the first documented cases treated (february 3, 1969) with Ao implants. the owner of this spitz dog returned home from a party and threw the dog out of the window because it had diarrhea and messed up the house. a it broke its femur and its scapula from the fall. the woman drove immediately to the Kása’ small animal

clinic where she encountered Geri Kása–feri was at a meeting and missed this action. in the morning they treated the femur with a four-hole 4.5 mm round-hole plate and the scapula with a five-hole L-plate (not shown here).

b 2-week postoperative x-ray of the treated leg).c 23-week follow-up x-rays of the healed fracture with the plate still in place (left), following plate removal

(middle) and a few weeks later after the drill holes had healed (right).

a

c

b

38


Furthermore, the veterinarians realized that it was necessary

to develop an optimal and reproducible positioning technique,

with standardized x-rays of small animals. The Kásas imme-

diately devoted their attention to this problem and worked

out certain standard procedures [50]. They also worked on

the problems of postoperative care and generated correspond-

ing techniques. The surgical approaches to the fractured bones

had to be studied and An Atlas of the Surgical Approaches to the

Bones of the Dog and the Cat by Don Piermattei and Gordon

Greeley provided invaluable help [51].

The first osteosynthesis cases were shown at veterinary meet-

ings, and soon some nearby veterinarians joined the small

initial study group on Wednesdays, bringing along their

problem cases (Fig 17a–c). Guggenbühl never tired of helping

and explaining. Often operations took place in the evenings

and on weekends in one or the other of the regional veterinary

practices. Up until today all group members still remember

this period—more than 40 years ago—as a time when they

were fascinated by their explorations and the free and suc-

cessful friendship-based collaboration.

39

Fig 17a–c some small animal veterinarians were particularly active in AoVEt during the initial phase: (a) Peter Weber, Biel, involved in a conversation with Cathrin von salis; (b) Pierre and Annie Hauser, Lausanne; (c) Janos Komáromy, Zurich.

b c

a

40

5 Maxlie the horses

41

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42

5 Maxlie the horses

In November 1968 after many preliminary investigations on

isolated cadaveric horse bones conducted by von Salis, it was

time to explore whether an osteotomized bone of a horse

would heal without complications after an internal fixation

had been carried out. Maxlie, a horse saved from the slaugh-

terhouse by Fritz Straumann was chosen to demonstrate it.

Maxlie was anesthetized and maintained in anesthesia with

the first BOC “to and fro” portable anesthesia machine used

on horses, a novel practice at that time. A transverse oste-

otomy was performed on the third metacarpal bone with the

special atraumatic, oscillating AO bone saw developed by

the Straumann Institute. The application of this device, which

avoids soft-tissue damage, appeared as useful in large and

small animal surgery as when performed on human patients.

Although surgical intervention on Maxlie was carried out in

a horse barn (Fig 18a), the preparations of the surgeons, the

patient, and the surgical field with its surroundings were

similar to those applied in human surgery. At that time

Stephan Perren was studying the feasibility of titanium plates

for use in human fracture management at the AO Research

Institute in Davos. Implanting these plates in a horse was

therefore a welcome test. The osteotomy was performed by

Professor Stephan Perren, Peter Dätwyler, Urs Guggenbühl,

Björn von Salis, and Fritz Straumann. Paul Gysin and Jacques

Furrer, employees at the Straumann Institute assisted as

“operating room” personnel. Maxlie recovered rapidly and

after the bone had healed all the implants were removed

(Fig 18b−c). Upon investigation, the implants showed neither

damage nor wear and tear. Maxlie spent the rest of his life

healthy and without any negative effects. This successful

osteosynthesis paved the way for internal fixation in the first

clinical equine cases in von Salis’ recently opened equine

clinic in Frauenfeld (Fig 19a–b). (At that time there were no

equine clinics in Switzerland aside from the equine hospitals

at the veterinary schools at the Universities of Zurich and

Bern). The surgical interventions had to always be conducted

in the evenings or over holidays because during the day the

two assisting human surgeons, Guggenbühl and Dätwyler,

had to take care of their human patients. One night when

lightning struck an electrical distribution center in the area

causing loss of electricity in the whole region, the final sutures

of a surgical intervention on a horse had to be performed

with the help of automobile headlights.

43

Fig 18a–c the first osteotomy on a live horse, Maxlie, carried out in a barn. a intraoperative x-rays of the osteotomy. b immediate postoperative photograph of Maxlie, following recovery from anesthesia.c 35-week postoperative x-ray showing the healed osteotomy with the plates still in place.

Fig 19a–b one of the first clinical equine cases treated by Björn von salis with internal fixation according to Ao principles.a Dorsopalmar (left) and lateromedial (right) x-rays of a nondisplaced,

biarticular, sagittal fracture of the proximal phalanx. b 14-week postoperative, dorsopalmar radiograph of the healed

fracture, which was treated with three interfragmentary cortex screws inserted in lag fashion (compression).

a

a

b

b

c

44

6 Institutionalizing the Waldenburg Circle: the foundation of AOVET and pioneering work

45

inst

itU

tio

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iZin

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46


The founding of AOVETShortly after the successful osteosynthesis on Maxlie and on

a series of small animals, members of the Waldenburg Circle

participated in the human AO courses in Davos in December

1968. During those courses, a proposal began to take shape

for the formation of an AO group for veterinarians with the

aim to study and introduce osteosynthesis corresponding to

AO principles into veterinary medicine. After reviewing the

work done thus far by the Waldenburg Circle and recognizing

the generally poor state of bone surgery in veterinary med-

icine, the AO board agreed to form an AO veterinary group,

and transfer AO techniques and knowledge to the veterinary

discipline.

On August 31, 1969, AOVET was founded at an official

ceremony carried out by Hans Willenegger in the city hall

of Waldenburg (Fig 20). In addition to the founding members

(Fig 21) a number of Swiss, German, French, Dutch, and US

veterinarians were present, together with some friends from

the AO and the Straumann Institute. Björn von Salis became

the first president of AOVET. Ortrun Pohler was asked to act

as secretary. The constitution of the AO was adopted by

AOVET with certain modifications, in particular regarding

the criteria for membership. The AOVET group intensified

and systemized their work enthusiastically. The clinical

cases treated by the AOVET members were documented in

Waldenburg on cards with pertinent data and copies of the

x-rays. The surgeons obtained copies of those cards from

their cases. Similiar to the AO, spring and autumn meetings

were organized each year with clinical and administrative

membership sessions. Maurice Müller asked Urs Guggenbühl

officially to take over the responsibility that the veterinarians

carry out their osteosyntheses properly in accordance with

the AO principles. Fritz Straumann continued to provide

support and access to the laboratories of his institute. Pohler

worked systematically with other employees for the internal

and external organization of AOVET, the development of

implants and instruments for large and small animals, the

performance of testing and research, and preparation of teach-

ing aids. Through her, AOVET was also–first indirectly, later

directly–represented in the Technical Commission (TK) of

the AO.

47

Fig 20a–b festivities following the opening ceremony of AoVEt on August 31, 1969, at the restaurant Bechburg near Waldenburg.

Fig 21a–h the founding Members of AoVEt; top row left to right: Björn von salis, fritz straumann †, ortrun Pohler, Hans Willenegger †; bottom row: Urs Guggenbühl†, Peter Dätwyler†, Geri Kása, feri Kása.

a

a

e

b

f

c

g

d

h

b

48


Pioneering work of AOVETLater in 1969 small instruction workshops started, offering

lectures and practical exercises with implants and instruments

(Fig 22). In the years that followed, veterinary workshops were

also offered abroad and during the AO course weeks held

every year in December in Davos. Guggenbühl expanded on

his instructions and developed a whole lecture series on var-

ious surgical and clinical topics (in time these lectures were

also given in French and English). Von Salis and the Kásas

started to present lectures on AO techniques at professional

veterinary meetings and AOVET courses. In October 1969 at

the veterinary school of the University of Zürich during a

German Veterinary Medical Society (DVG) convention two

lectures were given: one by Guggenbühl and von Salis on AO

osteosynthesis, and one by the Kásas and Paul Hutzschenreuter,

on osteosynthesis in small animal medicine. Following these

lectures there were heated discussions about compression

osteosynthesis because at that time their colleagues believed,

as did human surgeons 10 years before, that compression

causes bone resorption. However, the results of the AO re-

search, and the successful and well-documented clinical small

animal cases of the AOVET members, refuted these doubts

within a short period of time. In December 1969, some AOVET

members attended the human AO course in Davos and met

a group of veterinarians, Wade Brinker, Hugh Butler, Bruce

Hohn, Jacques Jenny, and Don Piermattei, who came from

the US and were very interested in osteosynthesis. An exchange

of experiences and ideas took place, and the ground was paved

for an extensive cooperation. More details on the AOVET

development in the US are given in chapter 7.

In January 1970, a Swiss AOVET course took place in Bettlach

(Fig 23). In the same month the Kásas gave a lecture during

the annual meeting of the DVG in Duisburg in which they

showed a series of AO osteosyntheses on small animals. This

caught the attention of the German veterinarians and they

started participating in AOVET events. Inspired through the

attendance of the recent human AO course in December,

Professor Bruce Hohn (Fig 24) organized the first course on

the internal fixation of fractures and nonunion at Ohio State

University (OSU) in Columbus, Ohio in March 1970. In the

same year the AO TK accepted the first veterinary small

animal equipment set with round-hole plates of particularly

small dimensions for the small screws. Later on those plates

were also integrated in the human standard sets.

49

Fig 22 feri and Geri Kása teach-ing small animal veterinarians the technique of axial compression of a fracture on cadaver legs, with the help of the tension device.

Fig 23 Participants of the first AoVEt course organized in January 1970 in Bettlach, home of Mathys AG. some of the participants are identified by numbers, left to right. (a) 1: Jan Gajenthan, 2: Arnold Müller, 3: Herbert Post, 4: Prof Paul Hutzschenreuter, 5: Urs Jenny, 6: reto scartazzini, 7: robert schenk, 8: Karl Gabrisch, 9: Peter Dätwyler, 10: Peter Bartels, 11: Geri Kása, 12: Margrit Jaques, 13: feri Kása, 14: Pierre Gonin, 15:Pierre Hauser, 16: Gianpietro togni, 17: Urs Guggenbühl, 18:Axel Bubloz, 19:Gottfried Ueltschi, 20: “Arco” von salis, 21: Margrit Diehl, 22: György Halmos, 23: freek Meutstege, 24: Christoph Uehlinger, 25: Janos Komáromy, 26: Mario ferrari, 27: thomas David, 28: Laszlo Lakatos; 29: Hans-Georg niemand, 30: unidentified; 31: rudolf Zeller, Hannover; 32: Hans-Georg stihl; 33: ortrun Pohler, 34: Carsten rosenhagen, 35: oswald Padrutt; 36: Liesbeth Mathys, 37: fridolin séquin, 38: robert Mathys; (b) 39: Jacques furrer, straumann institute; 30: Björn von salis.

50


In January 1971 AOVET held its first veterinary course in

English, in Davos along with the human courses. Parts of

the scientific human lectures were included in the veterinary

program. Professors Hohn and Jenny, a Swiss veterinarian

teaching at the University of Pennsylvania, (Fig 25) were fac-

ulty members. Professor Sakki Paatsama, a well-known small

animal surgeon (Fig 26) from Finland, was a guest lecturer.

From then on AOVET courses were offered annually in Davos

in parallel with the human courses in December. In March

1971 Hohn again organized a course at OSU which led to

the creation of the present-day courses in Columbus, tradi-

tionally held each year.

Fig 24 Professor Bruce Hohn of ohio state University during the first small Animal Course in Davos, December 1970. Practical exercises on cadaveric dog bones in the basement of the Congress Center.

Fig 25 Professor Jacques Jenny, University of Pennsylvania (left), and Howard rosen, Clinical Professor of orthopedic surgery at the nyU school of Medicine/Mount sinai school of Medicine in new york City, a treasured friend of the veterinarians (right).

Fig 26 Professor sakki Paatsama of the University of Helsinki during an early Ao function.

51

Fig 27 Professor Ulrike Matis, Director of the Veterinary surgery Clinic at the University of Munich, the first female chairperson of AoVEt.

Fig 28 Professor roberto Köstlin of the University of Munich was of particular help as a faculty member with spanish language skills at AoVEt courses during the early days.

In spring 1972 an instruction course again took place at the

Mathys company in Bettlach. At the Medical-Technology

Congress 1972 in Stuttgart two AOVET lectures were

presented: one by Feri Kása on “Frakturbehandlung und

Korrekturosteotomy beim Kleintier” (Fracture management

and corrective osteotomy in small animals), and one by von

Salis on “Frakturbehandlung und Arthrodese beim Grosstier”

(Fracture management and arthrodeses in large animals). In

the same year von Salis gave a lecture on his findings and

experiences on operative AO techniques in horses at the

annual Convention of the American Association of Equine

Practitioners in San Francisco [52]. In 1973 an AOVET pub-

lication on stable internal fixations on dogs [53] was published

and in 1974 at the DVG Annual Meeting in Mannheim the

Kásas lectured on the treatment of humeral fractures. In the

same year, Professors Ulrike Matis (Fig 27) and Roberto Köstlin

(Fig 28) of the University of Munich published a paper on

compression osteosynthesis on the femur of cats and dogs

[54]. The expansion of the different osteosynthesis treatments

during the second half of the 1970s is reflected in two

publications by Ulrike Matis, who performed small animal

osteosyntheses in a wide range of applications [55, 56]; and

in two papers by Geri and Feri Kása, [57, 58] the latter was

given at a human AO course. Further papers on the applica-

tions of osteosynthesis in small animals were published in

the 1980s [59–62]. In 1986 the Kásas published a series of

toy breed cases, which because of their very delicate small

bones represent a special challenge in small animal fracture

management [63].

52


Many members of the AO were very generous and supportive

in contributing lectures on special topics at the various vet-

erinary courses. Robert Schenk (Fig 29), scientific AO mem-

ber and director of an excellent histological laboratory at the

University of Basel, later vice-director of the Anatomical

Institute of the University in Bern, became a very valued

and good friend of the verterinarians. He was always ready

to lecture on subjects of bone structure—metabolism, and

bone healing. In time, interesting research projects were

developed with him. For decades he lectured at the veterinary

courses in Columbus, and Davos. Stephan Perren (Fig 30)

always had an open ear for the problems of the AOVET mem-

bers and was a supportive friend, accommodating their

courses in Davos as well as scientific projects. He appreci-

ated the veterinarians’ common sense and quick realization

of AO concepts and new research results. Until his death,

Hans Willenegger was a staunch supporter of AOVET in

various aspects. He was a tireless lecturer on AO principles

and developed several slide presentations for these one-on-one

teaching sessions (Fig 31). After these sessions he presented

the slides to the recipients of these lectures.

Increasingly, the veterinarians learned to treat all the relevant

bone injuries and skeletal corrections [64, 68–70] in small

animals in much the same way as in human patients, although

they frequently had to improvise. They also acquired the

skills to apply their operation techniques to injured exotic

animals like birds or polar bears (Fig 32a–e) [65]. In large

animals, osteosynthesis was also performed with astonishing

results; however, possibilities remained restricted because

of the large size of the animals, as well as their anatomical

and biomechanical conditions.

During AOVETs pioneering days, one practical aspect that

had to be kept in mind was the financial costs. When the

veterinary activities on AO osteosynthesis started, private

practices, even university clinics were not equipped for the

performance of osteosynthesis corresponding to AO human

clinical standards. Decisions to include such AO open fracture

treatment techniques into the clinical routine of veterinary

practices or clinics required considerable investment in tech-

nology (eg, high- quality x-ray and sterilization equipment),

implants and instruments, and probable additions of rooms

and assisting personnel. Thus osteosynthesis appeared to

veterinarians like an expensive hobby. Also, performing the

Fig 29 Professor robert schenk, a true friend of the veterinarians, with one of his favorite stress releases, his “schwiizer Örgeli”—a special swiss accordion.

53

Fig 30 Professor stephan Perren, since 1967, Director of the Ao research institute Davos. He supported the veterinarians strongly.

Fig 31 Professor Hans Willenegger and his long-term secretary Elisabeth spicher during one of their frequent slide sorting sessions at his home in schauenburg near Liestal, 4 weeks before his death in 1998.

Fig 32a–e A female polar bear at the Karlsruhe Zoo broke its maxilla. the Kása’s repaired it with two 3.5 mm DCPs and a reconstruction plate 2.7. the plates were removed after the fractures had healed. a Preoperative picture of the polar bear’s head.b intraoperative picture during the repair (the commercially available drill shown here was gas sterilized, a novelty at

that time.c 16-week intraoral postoperative x-ray of the repaired maxilla showing the implants used. d the still anesthetized patient was transported with the help of a fork lift back into its cage. e the the patient shortly after recovering from anesthesia, still slightly uncoordinated in its cage.

a

d

b

e

c

54


surgical interventions was still very time-consuming because

an economic routine was yet lacking. Furthermore, there were

no reimbursements from health insurance plans—neither

for small nor large animals—unlike the insurance policies

for human patients, and so the animal owners could not be

asked to pay for the actual costs. Consequently, veterinarians

had to try to carry on their practices with other clinical treat-

ments. Only slowly, with the increase in successful osteo-

syntheses and the growing attitude of animal owners to

consider their pets as members of the family with the re-

sponsibility to provide them with the best possible medical

treatment were veterinarians able to obtain adequate reim-

bursement for their work. There exists some trade-off in so

far as the stable internal fixation techniques allow very

early postoperative discharge of the animal patients from the

clinics, which reduced some treatment costs.

International activities of AOVETAOVET enjoyed an immediate international response. In the

early 1970s, in addition to the courses in the US and Davos,

courses were offered in Sweden—encouraged by Harry Pet-

tersson—Finland, and England, as well as in France—encour-

aged by Pierre Hauser. These courses offered the same con-

tent because the course faculties (lecturers and instructors)

remained almost the same in Europe and in North America.

The course faculties soon realized the importance of their

united approach. They organized meetings throughout the

year where the courses were prepared, critical discussions

took place, and new concepts for courses were planned. An-

nual AOVET membership meetings were held in connection

with the Davos courses and provided further opportunities

for organizational activities and planning. In the US the an-

nual meetings of the Veterinary Orthopedic Society (VOS)

were also events where AOVET members met and organized

their own additional workshops. The basis for this type of

cooperation was the supporting structure of the AO organi-

zation as well as the friendship and loyalty among the vet-

erinarians themselves, who had a common goal in develop-

ing systematic operative fracture treatment in veterinary

medicine. Elaboration of the multitude of surgical treatments

for different fracture types and orthopedic corrective inter-

ventions in different anatomical areas as they are shown in

the small and large animal manuals [66–70] are the result of

this fruitful cooperation.

55

In the US the veterinarians had no intention to form a na-

tional AOVET group. Therefore they became individual mem-

bers of the existing AOVET organization. The same type of

individual AOVET membership was arranged for members

from other countries. In 1972 AO International (AOI) was

established with Hans Willenegger acting as president. Already

nominated in 1977, AOVET was confirmed as an official AOI

member in 1979. Certain national groups or smaller circles

were also active. For example, Professor Freek Meutstege

(Fig 33) led a working circle in the Netherlands. In the early

1970s the French AOVET members began offering an an-

nual veterinary course in France in (Fig 34). In 2004 the

courses were moved to different locations in the French Alps,

such as Les Deux Alpes. The organization of parallel courses

in diagnostic imaging filled quickly and attracted many par-

ticipants, exhibitors and sponsors. Professor Klaus Bonath

(Fig 35) offered successful AOVET courses at the University

in Giessen, Germany, beginning in 1982. From the start the

Swiss and German AOVET members undertook joint pro-

grams. In 1986 a German AOVET group was established with

Feri Kása as president who had very good connections to the

AOVET group and the AO in Germany. The Austrian AOVET

members together with the Swiss members cooperate close-

ly with the German AOVET group and organize joint an-

nual meetings. Annual 1-day student workshops have been

organized at the University of Vienna by Dr Norbert Kopf

(Universitätsdozent) (Fig 36) since 1997. In cooperation Dr

Günther Schwarz offers every second year an AOVET course

for veterinary practitioners in Salzburg, Austria. In Berlin,

Professor Leo Brunnberg (Fig 37) has offered student work-

schops since 1998. From 1972 on, Feri Kása was active at

the Veterinary Medical University of Budapest, Hungary,

establishing operative fracture treatment corresponding to

AO principles. In 1991 he was awarded an honorary profes-

sorship in recognition of his teaching.

Fig 33 Professor freek Meutstege, University of Utrecht, third AoVEt President and a dedicated faculty member of AoVEt courses from the beginning.

56


Fig 34 four prominent members of the organizing committee of the french AoVEt Courses, left to right: Michel Baron, a past president of AoVEt; Jacques Drapé, La rochelle; Didier fontaine, nantes; Jean-Pierre Cabassu, Marseille, france. not shown yves Latte, Grenoble, france.

Fig 35 Professor Klaus Bonath of Giessen, the organizer of the first German AoVEt Courses and student workshops at his university.

Fig 36 Professor norbert Kopf of the University Vienna, one of the first Austrian small animal veterinarians involved in AoVEt.

Fig 37 Professor Leo Brunnberg of the University of Berlin, an early collaborator of AoVEt.

a b

57

Bruce Hohn of the Veterinary School of OSU established a

nucleus of AOVET activities in the US. Human surgeons from

the local hospitals liked to participate in veterinary courses.

The AO research appeared to inspire a wave of clinical stud-

ies at different veterinary schools and human medical insti-

tutions in the US. In turn, surgeons and scientists from Eu-

rope enjoyed meeting and collaborating with their colleagues

in the US. Schenk introduced histological research techniques

to the laboratories at OSU. Straumann sponsored a surgery

unit at the Veterinary Clinics of OSU to enable clinical re-

search independent of routine clinical work. In the following

chapter a short review is given of the development of AOVET

on the other side of the Atlantic Ocean, in the US. Again,

the search for improved operative fracture treatment in

animals, a series of special circumstances—a hidden network

of correlations—and human openness led to the introduction

of systematic AO osteosynthesis in the US.

58

7 The hop over “the big pond”

59

tHE

Ho

P o

VEr

“tH

E Bi

G P

on

D”

7

60


Dr Bruce Hohn was engaged in a private mixed practice for

much of his early career in Minnesota. In a life-changing

event, he was able to secure a 1-year fellowship in orthope-

dic surgery at the Mayo Clinic in Rochester, Minnesota. In

the mid-1960s he left private practice to become head of

Small Animal Surgery at the Animal Medical Center (AMC)

in New York. Hohn’s connection with the AO started the

day a Saint Bernard was presented to him with a commi-

nuted fracture of the femur. He had heard about a certain

Dr Howard Rosen in New York, who was using metal plates

and screws to stabilize fractures in people with great success.

Howard Rosen heard about the techniques the “crazy Swiss

surgeons” (as the AO founders were called in the US) were

promoting to manage fractures. Intrigued by these techniques,

he wanted to purchase the equipment. However, at that time

the instruments and implants were only sold to doctors that

participated in a special course in Switzerland, where their

proper use was instructed by the founders. Howard Rosen

didn’t wait long, signed up for the next course and returned

to the US with all the instruments and as many implants as

available at that time—everything packed into his suitcase.

Rosen at that time was the only MD surgeon in North Amer-

ica who applied AO principles and soon became one of the

course instructors in Davos. At that time, there were no such

courses taught to MDs in North America.

Bruce Hohn contacted Rosen and asked him if he could bor-

row this marvelous equipment to repair the dog’s fracture.

Howard Rosen asked if he knew anything about using plates.

Of course Hohn had never seen a plate before but he was

sure he could figure it out. So Rosen suggested to Hohn that

he would bring his equipment to the AMC and they could

work on the fracture together. That was, as they say, the

start of a lifelong friendship. Throughout the rest of his life,

Howard Rosen, a soft spoken gentleman and one of the most

prolific, charismatic and distinguished teachers of AO tech-

niques maintained a special interest in AOVET members and

their patients. He was invited to numerous AOVET courses

and meetings of the Veterinary Orthopedic Society (VOS) to

speak on his favorite topic “Complications”. He cherished

his contacts with the veterinary group and inspired many

young residents to pursue a career in veterinary orthopedic

surgery.

61

In December 1969 Bruce Hohn and four other veterinarians

from North America went to Davos to a human AO course.

Professor Wade Brinker (Fig 38), who would later become

the second President of AOVET and the first North American

President, was a member of that group. Another distinguished

member of the group was Professor Jacques Jenny, actually

a Swiss expatriate, who was teaching equine surgery at the

University of Pennsylvania at the New Bolton Center. Previ-

ously in 1943, as a resident at the University of Zürich, Jacques

Jenny assisted Dr Knoll and Dr Willenegger in the first clinical

intramedullary nailing in a dog (see Fig 3). Unfortunately,

Jacques Jenny died after the Davos course in 1972, much

too early. However, before his death, Professor Jenny had

established the use of AO techniques at his school. The last

horse Jenny performed surgery on before he died was “Hoist

the Flag”, who broke its proximal phalanx (comminuted

fracture) and the adjacent third metatarsal bone (condylar

fracture) of the right hind leg. The surgery took 6 hours with

Dr Delahanty of Cornell University assisting. At the end of

the surgery the first ever fiberglass cast was applied to the

injured limb. John Alexander and David Nunamaker did the

cast changes and the horse survived. Unfortunately “Hoist

the Flag” bit off its grooms thumb in their presence—it was

not a nice, well-mannered horse.

Fig 38 Professor Wade Brinker of Michigan state University served as the second AoVEt President. He promoted the systematic internal fixation technique in small animals. He was an avid downhill skier.

During the Davos courses in 1969 Bruce Hohn met Fritz

Straumann and Ortrun Pohler. At that time, Hohn had left

the AMC and was a professor at OSU in Columbus, Ohio. He

left Davos knowing that he wanted to organize and chair an

AO course at OSU, so in March 1970, 99 veterinarians and

faculty were present at the first annual course on “Internal

Fixation of Fractures and Non-unions.” This course was co-

sponsored by OSU and AO. The following year the veterinary

course was combined with a human AO course—the first

human AO course to be offered in the US. An equine course

was also added to the event with the help of Professor Jenny.

As previously mentioned he passed away a year later and

could therefore not reap the full harvest of his work.

62


Fig 39

faculty of the Colum

bus Courses 197

7; left to right, back row (standing): M

olm

stead, unidentified, D M

cLean, P Call,

W B

etts, G C

ormack, t D

ueland, D Pierm

attei, unidentified, M H

erron, L Wallace, W

reed; fourth row (standing): t Lenahan,

s turner, A van de Water (Johnson), G

sumner-sm

ith, P Call, f r

heinlander, H B

uttler, G fackelm

an, t Braden, B

Hull, W

Daily,

C n

ewton, C

Knecht; third row

(sitting): unidentified, unidentified, W B

rinker, unidentified, W r

iddle, H rosen, B

Hohn, D

rudy, J stoyak, r G

urevitch, s Crain, D

Crow

, unidentified; second row (stitting): t turner, B

Buttler, s stoll, E trotter, r shank, B

slocum,

B H

orne, M D

eAngelis, Jt A

lexander, W H

oeffle, E Craig, unidentified; front row

(standing): D Prieur, A G

uggenbühl, t rüedi, H

Willenegger, o

Pohler, r schenk, B von salis, and B

rahn.

63

Fig 40 Professor Marvin olmstead, of the ohio state University, co-chairperson of the ohio Courses. After Bruce Hohn passed away, olmstead succeeded him as General Program Chairperson.

Fig 41 Professor Gustave (Bud) fackelman of the University of Pennsylvania was a strong and avid promoter of the application of Ao techniques in large animals. to his right Andi Kása, the son of feri and Geri, who eventually took over responsibilities at the small animal clinic in Lörrach, Germany.

Fig 42 Jörg Auer, at that time of texas A&M University in College station, tx, together with Len Langlands, a small animal veterinarian from Johannesburg, south Africa, who organized the first small animal AoVEt courses in his home country and attended the Davos Courses every year just to be with the AoVEt group.

These were different times, when lectures were given with

old-fashioned slide projectors. Text slides were white letters

on a solid blue background and not multicolored with inter-

esting backgrounds as they are today. In the early 1970s

Bruce Hohn and Marvin Olmstead were responsible for de-

veloping teaching videos for practical exercises in the small

animal courses following the AO guidelines. In 1977 Profes-

sor Gustave (Bud) Fackelman (Fig 41) took his young resident

Dr Joerg Auer (Fig 42) to Columbus before the courses to

prepare the first teaching videos for the equine course.

From then on the courses in Columbus were offered annually

(Fig 39) with Bruce Hohn as General Program Chairperson

(see Fig 24); in 1997 Professor Marvin Olmstead (Fig 40) be-

came co-chairperson. The equine courses were chaired by

Professor Al Gabel with Dr Larry Bramlage as co-chairperson.

64


The Veterinary College at OSU established itself as the center

for AOVET activities in North America, with Bruce Hohn as

the leader. On the small animal side, Hohn was supported

by Professors Wade Brinker and Terry Braden of Michigan

State University, Professor Geoff Sumner-Smith, Professor

Don Piermattei of Colorado State University (Figs 43 and 44),

Professor Larry Wallace of the University of Minnesota (see

Fig 33), Professor Robert Leighton of the University of Cali-

fornia Davis, Professor Tass Dueland of the University of

Minnesota, and Professor David Nunamaker of the Univer-

sity of Pennsylvania (Fig 45). The equine side of AOVET in

North America was mainly promoted by Al Gabel of OSU,

and Gustave Fackelman of University of Pennsylvania. In

time younger faculty emerged among whom Marvin Olm-

stead, Larry Bramlage (Fig 46), and Jörg Auer followed in the

footsteps of their teachers.

In 1979 the human AO course was moved to Sun Valley,

Idaho, a location near a ski resort. This allowed the veterinary

course to increase the number of participants and expand

from basic small animal and equine courses to advanced

courses in each discipline. These courses grew over the years

to annually host between 350 and 400 veterinarians and

an international faculty of over 50 veterinarians, medical

doctors, and scientists. Following Bruce Hohn’s untimely

death in 1986, Marvin Olmstead became General Program

Chairperson and shortly after Larry Bramlage was named

co-chairperson for the equine courses. Olmstead remained

in that position until just before retirement from OSU in

2002. From these courses, veterinary fracture management

according to AO techniques spread throughout the US to all

university veterinary schools and colleges. The courses are

now a standard element in the education of veterinary stu-

dents, interns, and residents. Every spring from 1970 until

1988 AOVET courses were taught at OSU in Columbus in

their continuing education facility, the Fawcett Center for

Tomorrow (Fig 47). From 1989 onward the courses were

moved first to the Hyatt Regency Hotel in downtown

Columbus and in 2005 to the Hilton Easton Mall, still in

Columbus. For years the Continuing Education Credits were

provided by OSU. Since 2002, Kenneth Johnson (Fig 48) of

Sydney, Australia (former professor at OSU), acts as small

animal chairperson and Larry Bramlage, together with Alan

Ruggles (Fig 49) of Rood & Riddle Equine Hospital, Lexington,

65

Fig 45 Professors David nunamaker of the University of Pennsylvania (the second equine specialist past AoVEt President), Larry Wallace of the University of Minnesota, Minneapolis, and freek Meutstege of the University of Utrecht (third past AoVEt President). in the background Len Langlands during an AoVEt function in Davos.

Fig 46 Dr Larry Bramlage, co-chairperson of the Columbus Equine Courses, here addressing the AAEP audience after he became President-Elect in 2003— one of the key large animal surgeons who was instrumental in the progression of equine fracture repair.

Fig 43 Professor Geoff sumner-smith, a past AoVEt President, in deep discussion on Ao teaching videos with Geri Kása during a Davos Course dinner.

Fig 44 Professor Don Piermattei, a past president.

66


Fig 47 faculty of the Columbus courses 1985, left to right, back row: t turner, r Kaderli, W Hoeffle, L Wallace, J Auer, G fackelman, D Prieur, D nunamaker, r Vannini, r Boudrieau, r fingland, D Deyoung, W Betts; third row: J Dee, D rudy, s roe, r ringwald, B Hohn, M olmstead, A van de Water (Johnson), t fossum, M shamis, L shamis; second row: r Copeland, s Payne, W read; front row: t Lenahan, t Braden, CW Mcilrwaith, o turner, f Meutstege, s stevenson, L Bramlage, r schenk, A Gabel, o Pohler, W Brinker, D Piermattei, r schneider, P Montavon, and r Emberson.

Fig 48 Professor Kenneth Johnson, presently of the University of sydney, took over as chairperson of the Columbus small Animal Courses from Marvin olmstead.

Fig 49 Dr Alan ruggles, co-chairperson of the Columbus Equine Courses.

67

Kentucky (former OSU faculty members), serve as co-chair-

persons of the equine courses. These are now run by the

Education Division of AO North America, which also provides

the CME credits. Recently, additional Small Animal Basic,

Advanced, and Master courses were organized in San Diego,

California, during the summer months. Also, in alternate

years, an Equine Master Course was added, resulting in a total

of six to seven AOVET courses being organized annually in

the US. Workshops dealing with specific AOVET applications

are frequently organized at national and regional meetings

throughout the US.

It was Bruce Hohn’s idea to establish an AOVET Residency

Program at OSU. Willenegger supported this idea and was

helpful in establishing a special fund at OSU for the purpose

of financially supporting this residency. Money was donated

from different sources. The three surviving AO founders,

Professors Müller, Allgöwer, and Willenegger, donated part

of the prize money received with the prestigious 1987 Swiss

“Benoist Prize,” to the Hans Willenegger Residency Fund.

AOVET also supported the fund with a free membership

account. The endowment supported a 2 to 3-year residency

at OSU for a European veterinarian, interested in orthopedic

surgery, enabling the resident to acquire expertise not read-

ily available in Europe. It was planned that these residents

would then return to Europe to teach what they had learned

in the US. As increasing inflation reduced the value of the

fund, it was clear that the initial capital provided was not

enough to sustain a 3-year residency. Additional funds were

provided by OSU for some time.

Every 3 years the AOVET board received applications from

a number of European candidates, who were preselected by

the faculty at OSU. All residents had specialized in small

animal surgery, with the exception of two special equine

(1-year fellowship) recipients. The residency is still offered;

however, as most of the money comes from OSU, its faculty

now makes the final selection decision.

68

8 Spreading the word—AOVET Center Waldenburg

69

sPrE

ADin

G t

HE

Wo

rD—

AoVE

t C

EntE

r W

ALD

EnBU

rG

8

70


To support the expansion of AOVET, an AOVET Center was

established in Waldenburg in 1976 and Dr Dieter Prieur

(Fig 50) was asked to lead it. Ortrun Pohler (appointed as

scientific member of the human AO in 1973) transferred

responsibilities for the organization of the AOVET secretariat

to Prieur since she had started to work at the Metallurgical

Institute and with the Veterinary School at OSU and with

other US-based technical organizations, commuting between

Switzerland and the US. The Straumann Institute provided

office space for the AOVET Center with assistants, infrastructure,

working materials, and other help, while other parts of the

budget were supplemented by the AO. Dieter Prieur became

the first executive secretary of the AOVET organization. He

prepared the official and educational meetings, coordinated,

and organized the increasing numbers of local and interna-

tional AOVET courses. He taught and lectured at interna-

tional veterinary conferences, and published on the subject

of internal fixation [27, 61, 68, 71, 72]. He furthered the de-

velopment of AOVET instrumentation and operation tech-

niques. With the Mathys company he developed the double-

hook plate with the corresponding instruments for the

correction-osteotomy procedure on the proximal femur of

dogs. He supported his veterinary colleagues in various ways

and generated fruitful collaborations internationally. Hence,

he helped to create an active core of membership within

AOVET.

Fig 50 Dr Dieter Prieur (left) served as Executive secretary of the AoVEt Center in Waldenburg from 1976 to 1991. Dr Gary Clayton-Jones (right), a past president of AoVEt and a valued long-term faculty member from UK.

71

The formation of the AOVET Center led to an increased

structuring of the AOVET organization and the spreading of

veterinary operative fracture treatment. The function of the

executive secretary provided continuity and stability. AOVET

introduced an office term of 2 years for the elected president.

However, before the new president takes office he/she surves

2 years as “president-elect” and after his/her 2 years in office

he/she would remain 2 years as “past-president.” This latter

presidential turnover protocol contributed to the organiza-

tional continuity as well. In 1980 Professor Wade Brinker

was elected as the successor of Björn von Salis who held the

presidency for over 10 years. All the AOVET presidents (see

Epilogue) have been dedicated, active AOVET members,

linked through friendship to many of their colleagues in the

organization. Similar to the AO, commissions for research

and education were also introduced.

During the reorganization of the AO Technical Commission

(TK) in 1982, the veterinarians received their own individ-

ual AOVET-TK subcommission chaired by Pohler, who had

continued to support AOVET interests. In addition to the

previously mentioned 3.5 mm cortex screw, other examples

of cooperation and exchange between the AO and AOVET

were small plates to be used with 2.7 mm screws that had

been developed for small animal surgery. These implants

were subsequently successfully applied in craniomaxillofacial

(CMF) surgery. The mechanical properties and measured

performance characteristics of the 3.5 mm screws developed

for veterinarians were documented by Pohler [49, 68]. By

1982 some of the veterinary clinics had many well docu-

mented cases without any complications or failures of those

screws. Therefore, when the advantage of this type of screw

was discovered by the human surgeons, the data generated

by the small animal veterinarians provided adequate proof

of their superior functionality. Consequently, after a short

pilot testing phase, AO TK was able to release this screw

directly for application in human surgery. It became the con-

ventional 3.5 mm cortex screw successfully applied today.

Such implant design transfers were possible because the

typical veterinary implants were produced from the same

standardized high-quality implant material and underwent

the same demanding technical manufacturing processes as

the implants for human surgery. The same is true for the

instruments.

72


To support the AOVET courses on the small animal fracture

management and give veterinary surgeons some basic intro-

duction to internal fixation techniques, a booklet for internal

use was created by Geoff Sumner-Smith, Dieter Prieur,

Terry Braden, and Wade Brinker on “AO Techniques in Small

Animal Orthopedic Surgery.” For years this booklet was kept

continuously updated. Comprehensive presentations of the

systematic AO osteosynthesis techniques that had been

developed for orthopedic corrections and for the operative

treatment of the various fracture types at the different ana-

tomical locations in large and small animals were provided

in specific manuals. In 1982 the Manual of Internal Fixation

in the Horse was published by Fackelman and Nunamaker in

collaboration with Björn von Salis (Fig 51) [66]. A second

revised edition followed in 2000 [67] edited by Gustave E

Fackelman, Jörg Auer, and David Nunamaker in cooperation

with Larry Bramlage, Dean Richardson, and Björn von Salis

(Fig 52). In 1984 the Manual of Internal Fixation in Small Ani-

mals was published by its editors Wade Brinker, Bruce Hohn,

and Dieter Prieur (Fig 53) [68]. Twenty additional contributors

were included in the production of this manual, clearly dem-

onstrating the effective collaboration among the veterinary

surgeons. In addition, this work had a positive effect on the

clarification and unification of the methodical AOVET prin-

ciples, and triggered further working projects. In 1997, there

followed a revised second edition of the Manual of Internal

Fixation in Small Animals [69] where Marvin Olmstead had

reliably substituted the late Bruce Hohn as a co-editor. And

in 2005 the first version of AO Principles of Fracture Manage-

ment in the Dog and Cat was published by Ann L Johnson,

John EF Houlton, and Rico Vannini [70]. The editing, layout,

and typesetting were completed by AO Publishing and pub-

lished by Thieme Verlag (Fig 54).

73

Fig 51 the 1st edition of the Ao Manual of internal fixation in the Horse.

Fig 52 the 2nd edition of the Ao Principles of Equine osteosynthesis. this represents the first Ao Manual of the new era containing video clips of basic principles on a CD-roM. the manual was published by the newly formed Ao Publishing under rainer Egle.

Fig 53 the 1st and 2nd enlarged editions of the Ao Manual Manual of internal fixation in small Animals.

Fig 54 the 3rd edition of Ao Principles of fracture Management in the Dog and Cat.

74


The AOVET has always closely followed new AO concepts

and developments, adapting and integrating them into their

programs. The limited contact dynamic compression plate

(LC-DCP), point contact fixator (PC-Fix), and in particular

the locking compression plate (LCP) became in many varia-

tions part of the AOVET equipment. As a matter of fact AOVET

members were actively involved in some steps in the devel-

opment of the forerunners of the LCP and PC-Fix. The first

clinical trial following research studies on sheep with the

PC-Fix were conducted on large animals at the University

of Zurich. Experiences gathered with these implants led to

the development of the PC-Fix II, which was initially tested

as 3.5 mm implants on small animals at the University of

Zurich again. Eventually the implants were released for use

on human humeral fractures. The specific veterinary tibial

plateau leveling osteotomy (TPLO) plate makes successful

use of the locking screw principle where a fine thread at the

lower portion of the screw head interlocks with a thread in

the plate hole. In plate shafts bridging severely comminuted

fracture zones, locking screws can stabilize the length pre-

cisely. The veterinarians changed the design of their LCPs to

incorporate a stacked locking hole on one side of the plate

associated with a round edge instead of the tapered and

pointed end as seen in the human plates. This allows inser-

tion of locking head screws closer to the articular margin

without having the tapered end protruding over the joint

margin (Fig 55).

The increasing emphasis placed by the AO on atraumatic

operation techniques and “biological” osteosynthesis con-

cepts, as expressed by Perren [43, 73], were of particular

interest to AOVET members. Observations by Matis [74]

of certain complications in smaller dogs with comminuted

fractures, where the small size of fragments cannot be well

stabilized with screws without damaging vitality, could be

explained. Clinical investigations by key AOVET members

on osteosyntheses carried out according to biological concepts

demonstrated that it is advantageous to keep the vitality of

comminuted fracture segments intact [75, 76].

Fig 55 one end of the veteri-nary locking compression plate (LCP) is pointed and tapered like a regular LCP, whereas the other end is rounded and contains a stacked combi-hole that allows placement of a locking head screw much closer to the joint. this prevents protruding of the tapered end when a locking head has to be placed near the joint. the stacked combi hole also al-lows insertion of a cortex screw.

75

The bridging fixation of such bone defects requires certain

plate properties. The plate strength and rigidity must be such

that neither lasting-bending deformation nor too much elas-

tic bending occurs. The latter could induce implant failure

under alternating-bending stresses. Excessive cross sections

of plates could cause irritation of the soft tissues and render

closure of the soft tissues over them difficult.

To assess what type of plate would be best for a bridging

fixation of a comminuted fracture defect in certain sizes of

patients, Matis initiated an extensive mechanical testing

project with the AO Research Institute (ARI) in Davos. In

an unstable defect model, which simulated a bridging fixa-

tion, 18 different types of AO plates were tested under bend-

ing and torsion loads until plastic deformation began. From

the data obtained, the bending and torsion stiffness as well

as the loads at the elastic limits were determined [77].

Minimally invasive osteosynthesis techniques also gained in

popularity among AOVET members. However, these tech-

niques are easier to apply in small animal surgery than in

equine patients.

When in 1984 the AO modified its organizational structures,

becoming the AO Foundation (Fig 56) with additional func-

tional groups, the AOVET became an integral part of this

Foundation.

Fig 56 the birth of the Ao foundation in 1984: left to right, top of table: Peter von rechenberg, CEo; front row: Martin Allgöwer, Maurice Müller, robert schneider, Hans Willenegger; back row: thomas rüedi, Peter Matter, fritz straumann, robert Mathys, stephan Perren, Hans-Jörg Wyss.

76

9 Consolidating the achievements of the AOVET founders

77

Co

nso

LiD

Atin

G t

HE

ACH

iEVE

MEn

ts

of

tHE

AoVE

t fo

Un

DEr

s

9

78


Fig 57 Monika Gutscher started her new job with AoVEt november 1, 1991, and took over as secretary after the AoVEt Center moved from Waldenburg to Zurich.

After the untimely death of Fritz Straumann, the support of

the veterinarians in Waldenburg was continued by his son

Thomas Straumann and Ortrun Pohler. Soon a management

buyout occurred and Ruedi Maag took over the orthopedic

section of the Straumann Institute and renamed it Stratec

Medical, while Thomas Straumann continued to lead the

dental implant section that remained under the name of

Straumann Institute. With this, the support Straumanns

had given to AOVET and the AOVET Center was lost. When

Dieter Prieur retired as executive secretary of AOVET at the

end of 1991, the AOVET Center was moved from Waldenburg

to the Veterinary Surgery Clinic at the University of Zurich,

which was directed by Jörg Auer who returned from the US

in 1989 to take over as Professor of Veterinary Surgery. His

decision to return to his alma mater was also influenced by

his desire to be more involved with the AO Foundation, a

wish that became true shortly after his arrival in Switzerland

when he was elected as successor of Dieter Prieur. The lead-

ership of the AO Foundation was happy to see the AOVET

Center being strongly supported by the leader of a Swiss

university clinic and offered generous financial support, which

included the employment of a secretary for AOVET at the

executive secretary level. It was understood from the begin-

ning that working at the AOVET Center did not keep the

secretary 100 % busy and that she could accept work related

to other business deemed appropriate by Professor Auer,

while being paid fully by the AO Foundation. This was seen

as a win-win situation, by having AOVET affiliated with an

academic institution and with that institution profiting from

AO Foundation.

For the secretary role, Professor Auer knew of a school friend

of his wife, who was involved in hotel management and was

returning home to Switzerland after opening the Swisshotel

in Beijing, China. Monika Gutscher (Fig 57) was looking for

a job in Switzerland and when Auer asked her if she would

be interested in something new and exciting, she accepted.

Gutscher was the right person because of her management

and language skills. For her, it was appealing as she did not

have to work evenings or weekends, as in the hospitality

industry. It was clear that she needed to familiarize herself

with the medical terminology. To prepare for her new job,

Monika started to work for AOVET on November 1, 1991.

She learned quickly and was accepted by everybody. She

79

participated in the Davos Courses the following month, which

allowed her to get to know many of the AOVET and AO

Foundation members. Soon she was asked to be part of the

front desk team at the Davos Courses.

In 1979, AOVET had been placed under the supervision of

AO International and continued to be a member after the

AOVET Center moved to Zurich. In 1992, AO International

was directed by Professor Peter Matter and later by Professor

Thomas Rüedi. As a member of AO International, the AO

Foundation started to support AOVET financially and gradu-

ally increased the financial support.

Full financial responsibility of AOVET through the AO Foun-

dation that started on January 1, 1992, with the move to

Zurich, came about through the AOVET Center. Therefore,

the executive secretary and his secretary turned in the bud-

get and allocated all the funds. The AOVET Association itself

was only responsible for the money gathered through the

yearly membership fees. These funds were accumulated un-

less a special cause was proposed by the AOVET board and

voted on by the membership. The AOVET Center team got

involved in the organization of AOVET courses, first mainly

in Europe. Through Dieter Prieur’s efforts good connections

were established with various universities across Europe and

with time, yearly courses were organized in France, Italy,

Austria, and Germany. Other countries followed and these

arrangements were continued after the move of the AOVET

Center to Zurich. The courses offered in OSU were inte-

grated into AOVET’s annual course plan and slowly the

courses expanded to Latin America and Asia Pacific.

In 1992, Auer was elected as chair of the Veterinary Techni-

cal Commission (TK), which was later renamed the Veterinary

Expert Group (VEEG). Through this he was elected as an ex

officio member to the Board of Trustees of the AO Founda-

tion. Being part of the executive office of the AO Foundation

led to good connections with the leaders of the Foundation

across the world. Slowly the stature of AOVET rose and with

the help of the President of AO International, Professor

Peter Matter representation of AOVET on the Board of

Trustees was doubled by granting the President of AOVET

an additional ex officio membership. This increased repre-

sentation was a big advantage in moving forward the AOVET

cause for official recognition.

80


Unfortunately, there was inadequate recognition of AOVET

from Stratec Medical and Mathys Inc. Only Synthes USA

actively supported AOVET aside from the AO Development

Institute. Despite these facts, Ortrun Pohler, who continued

to work for Stratec Medical following the management buy-

out that occurred after Straumann’s death, supported AOVET

whenever possible. To be fair, it has to be kept in mind that

the producers were under constant pressure to produce an

adequate amount of implants, instruments, and new devel-

opments to satisfy the rapidly expanding human market,

which resulted in a less than optimal support for AOVET.

At each trustee meeting Jörg Auer was asked to report on

the activities of the AOVET TK but in most instances the

meeting ran behind schedule, so that he was asked to keep

it short. On most occasions he did that, except in 1996 in

Gleneagles, Scotland. When he was asked by the moderator

to “keep it short,” Auer went to the podium and told the

audience that he was about to use all of his allotted 15 min-

utes of speaking time. During his presentation he pointed

out all the achievements AOVET had contributed to the AO

Foundation. He also mentioned that the veterinarians were

only supported by Synthes USA and that Mathys AG and

Stratec Medical no longer contributed to the development

of new implants and instruments. At the end of his presen-

tation he posed the key question to all trustees: “Do you

want AOVET to continue to be part of the AO Foundation?”

He added that if the answer was “yes, we want AOVET to

continue,” then it must also be properly supported in the

future. On the other hand, if the answer was “no,” AOVET

would quietly pack its bags and leave the AO Foundation.

The trustees responded to this question with a unanimous

standing ovation. As an immediate reaction to this presenta-

tion, AOVET representation on the Board of Trustees was

increased, with the President-Elect becoming an ex-officio

member during his/her 2-year term, followed by a 2-year

term as President and ending after the first year as Past Pres-

ident, resulting in a 5-year membership on the Board of

Trustees. The increased number of AOVET members on the

Board of Trustees resulted in better visibility and better ac-

ceptance of the “fledgling” but “oldest” clinical division

within the AO Foundation. Shortly afterward Jörg Auer was

elected to the Academic Council. During the Schatzalp II

Specialty Reorganization project, AOVET was officially

81

voted in as one of the four AO Foundation clinical divisions,

along with AOTrauma, AOSpine, and AOCMF. The last piece

of the puzzle was added at the Trustee Meeting in Chicago

in 2009 when the membership had to vote on the new

bylaws. These bylaws contained a provision that the Chair-

persons of all the clinical divisions were also members of

the Board of Directors (AO Verwaltungsausschuss—AOVA);

however, the Chairperson of AOVET was not included. Chris

Colton, a Past President of the AO Foundation, noticed this

discrepancy, which was also obvious to all veterinarian trust-

ees, and he proposed that the Chairperson of AOVET also be

included as a member of the AOVA. This proposal was

subsequently accepted unanimously together with the new

bylaws. Therefore, Jean-Pierre Cabassu (Fig 58), Chairperson

of AOVET and an esteemed small animal practitioner from

Marseille, France, became the first AOVET member to be a

member of the AOVA, a supplementary duty that he had

not planned on when he accepted the nomination to be

Chairperson of AOVET a few months earlier. Nevertheless,

he fulfilled his term on the AOVA very successfully, earning

the full respect of his fellow AOVA members.

Fig 58 Dr Jean-Pierre Cabassu with his family left to right: Julien, also a specialist veterinary surgeon, Beatrice, his wife and veterinary ophthalmologist, Laurent, Jean-Pierre, and Antoine.

82


Being accepted as an equal among the clinical divisions led

to a complete restructuring of AOVET according to the guide-

lines established in the other clinical divisions and a substantial

increase in the annual budget.

At that time the VEEG membership consisted of three small

animal and two equine veterinarians. Most activities within

the VEEG dealt with new implants for small animals but it

was important not to forget the few projects supported by

the equine members. It was the duty of the VEEG chair to

assure adequate time for both groups. With the acceptance

of AOVET as the fourth clinical division and increased funds,

it was possible to get more members involved in key posi-

tions. Therefore, in 2008 Jörg Auer passed the leadership of

the VEEG on to Professor Jeffrey Watkins (Fig 59) of Texas

A&M University, again an equine specialist. He established

himself as an objective VEEG Chairperson, one who could

listen to different arguments and suggest solutions that could

be accepted by all members. He was the right choice, despite

the fact that it was again an equine specialist that led the

VEEG.

Fig 59 Professor Jeffrey Watkins during the practical exercises of the Equine Course in 2004. He took over leadership of the VEEG in 2008. He presently still acts as Chairperson of the joint Equine and small Animals subgroups, a demanding task.

83

With the reorganization of the AO TK, the other three clinical

divisions could establish their own TKs. However, the VEEG

was assigned to the AOTrauma TK. In addition one small

animal and one equine member were added to the VEEG.

In 1999 Synthes USA took over Stratec Medical and formed

the company Synthes-Stratec headquartered in Waldenburg.

In 2003 Synthes-Stratec and Mathys AG completed their

merger. Subsequently, the company acquired the Synthes

trade name and was from then on named Synthes Inc with

its headquarters in Solothurn, Switzerland. The company

established contracts with the different clinical divisions and

it was decided that AOVET needed to organize at least elev-

en courses per year. Ever since that decision the number of

courses organized by AOVET rose continually to the present

number of more than 26 worldwide courses. Initially, the

courses were mainly concentrated in Europe and the US but

recently AOVET has expanded the course organization into

Latin America and Asia Pacific. In the future, the number of

courses offered in these regions, particularly in Asia Pacific,

has to be expanded while the number of courses offered in

Europe may have to be reduced, especially if funding cannot

be significantly increased.

In 2005 Hansjörg Wyss, owner of Synthes Inc, reacted favor-

ably to the request of the AOVET Trustees during the Trustee

Meeting in Venice and established a special unit dealing only

with veterinary issues, specific veterinary instruments and

implants, many of which were identical to their human coun-

terparts but equipped with special veterinary order num-

bers—SynthesVET. This unit works closely with the VEEG,

a section of the AO Trauma TK-System, in developing new

implants and instruments.

Since 2009, which marked its 40-year anniversary, AOVET

is fully recognized and viewed as an equal, valuable partner

in the AO Foundation’s daily activities. We all look forward

to a joint and mutually successful future.

84

10 Special events

85

sPEC

iAL

EVEn

ts

10

86

10 Special events

Since the early years of AOVET Courses in Davos, one event

remains a special tradition even today: the AOVET fondue

party! It was Geri Kása’s original idea to create an event

where the faculty and the course participants could get to

know each other a little better. The fondue party was a great

success from the beginning (Figs 60 and 61). When Jörg Auer

and Monika Gutscher took over the reins of the AOVET Cen-

ter, this tradition was continued and expanded over the years.

Some AO Foundation members, AO Research Institute staff,

AO Foundation staff, Synbone staff, and friends of AOVET

were invited to the AOVET fondue party. Another tradition

gradually developed where Jörg Auer presented fun gifts to

selected participants (Fig 62). Every year the AOVET fondue

party is always held on the evening of the first course day.

Traditionally, the AO Foundation President participates, Chris

van der Werken called the AOVET fondue party the “real”,

official opening of the Davos Courses, a self-explanatory and

justified expression.

In 1999, the 30-year AOVET Jubilee was celebrated with a

special dinner at the Hotel Flüela (Fig 63). During the evening,

Björn von Salis, Feri and Geri Kása, and Dieter Prieur were

honored as Honorary AOVET Members. In 2009, a similar

party was held to celebrate 40 years of AOVET.

Fig 60 Geri Kása (left) who introduced the AoVEt fondue Party during the Davos AoVEt Courses, at one of the first such events. Joining her are ortrun Pohler (middle) and fridolin séquin (right).

87

Fig 61 Björn von salis celebrating the tradition of the AoVEt fondue Party.

Fig 63 some of the participants of the 30-year AoVEt celebration in 1999 at the Hotel flüela; Davos, left to right: front row: Jörg Auer, Cathrin von salis, Björn von salis, Uschi nunamaker, David nunamaker; middle row: Peter Dätwyler, Geri Kása, Urs Guggenbühl, rosemarie Widmer, ortrun Pohler; back row: roberto Köstlin, feri Kása.

Fig 62 Jörg Auer presenting a bottle of premium italian wine called no. 1 (nummero uno in italian) to two number 1s during the 2004 AoVEt fondue Party: Ao foundation President James Kellam, and newly installed CEo of synthes inc. Michel orsinger.

88

10 Special events

The American Association of Equine Practitioner (AAEP)

bestowed the “Distinguished Educator Award” (Fig 64) to

AOVET in recognition of its pronounced impact on teaching

fracture management in horses around the world. During

its 2003 Annual Meeting in San Francisco, California, Auer

personally accepted this award from the AAEP President,

Tom Lenz (Fig 64).

Brigitte von Rechenberg, the daughter of the first AO Foun-

dation CEO and frequent faculty member of early AOVET

small animal courses, was instrumental in organizing the

Biotechnology Advisory Board (BAB) of the AO Foundation

in 2003. The BAB was responsible for evaluating novel

technologies that were important to the AO Foundation. It

consisted of top-level scientists across the world—including

one veterinarian (David M Nunamaker of the University of

Pennsylvania) and set the stage for modern evidence-based

research in the AO Foundation. Because of her exceptional

visionary input, von Rechenberg was honored with the TK-

Recognition Prize at the 2004 Davos Courses (Fig 65).

Fig 64 the American Association of Equine Practitioners (AAEP) presents its “Distinguished Educators Award 2003“ to AoVEt. Jörg Auer accepts the award in the name of AoVEt from AAEP President Dr tom Lenz.

Fig 65 Dr Brigitte von rechenberg (left) receiving the recognition Prize of the technical Commission in 2003, while Urs Jann, secretary of the Ao foundation was installed as Honorary Member of Ao Latin America.

89

During the 50-year Golden Jubilee celebration of AO in 2008,

the AO Foundation bestowed its Recognition Prize on Jörg

Auer for his “outstanding achievements on behalf of the AO

Foundation” (Fig 66). Up to then, this prize had been award-

ed to a total of seven recipients, either research groups or

individuals, all of which belonged to the clinical divisions

for human medicine.

For the 50-year Celebration of the AO Foundation during

the Trustees Meeting in Davos in 2008, all the past presidents

of AOVET and their spouses were invited. It was very refresh-

ing to meet with our former and present leaders and discuss

all the changes that have occurred over the past 39 years.

Unfortunately, David Nunamaker could not participate. Aside

from the two past presidents who have left us forever,

Wade Brinker and Bruce Hohn, all other past presidents were

present (Fig 67).

Fig 66 Ao foundation President Chris van der Werken (left) and Chairperson of the technical Commission norbert Haas (right) presented Jörg Auer with the “Ao recognition Prize” (the highest award of the Ao foundation) during the 50-year-Jubilee trustee Meeting in Davos 2008.

Fig 67 AoVEt past presidents and participants at the 50-year Ao foundation Celebration in Davos during the trustees Meeting 2008; left to right: Ken Johnson, 2002–2004; Geoffrey sumner-smith, 1986–1988; Don Piermattei, 1990–1992; John Houlton, 2000–2002; Gary Clayton Jones, 1988–1990; Ulrike Matis, 1996–1998; Michel Baron, 1992–1994; Donald Hulse, 2006‒2008; rico Vannini, 2004–2006; Jean-Pierre Cabassu, 2008–2012; Jeffrey Watkins, Chair VEEG, Jörg Auer, Executive secretary; Björn von salis, founding president 1969–1980; frerenç Kása, founding member; Urs Guggenbühl, founding member.

90

11 Epilogue

91

EPiL

oG

UE

11

92

11 Epilogue

In general, this short history of AOVET has been structured

chronologically. This may vary in order to maintain the con-

tinuity of certain processes or tendencies; however, this should

not be interpreted as errors in the text. To give a flavor of

the early pioneering days of AOVET, the corresponding sec-

tions are longer and casual in content compared with other

sections. Some of the very early history of the AO is mentioned

to highlight AOVET’s background and to illustrate the simi-

lar driving forces behind the creation of both organizations.

The publications referenced are limited; manuals are listed

to provide sources of information to those interested. Other

publications cited in the text were selected to show the state

of the art within a certain time frame. With much regret it

must be noted that it was not possible to include more of the

extensive veterinary literature related to orthopedic surgery

and fracture treatment in the reference list.

Unfortunately, given the text limitations it was also not

possible to mention all AOVET members who contributed

in friendship and with enthusiasm to the development

of AOVET. Many good memories are connected with our

membership past and present, without them the establishment

of AOVET would not have taken place.

93

1969−1980

1980−1982

1982−1984

1984−1986

1986−1988

1988−1990

1990−1992

1992−1994

1994−1996

1996−1998

1998−2000

2000−2002

2002−2004

2004−2006

2006−2008

2008−2012

von Salis Björn Switzerland LA

Brinker Wade † United States SA

Meutstege Freek Netherlands SA

Piermattei Don United States SA

Matis Ulrike Germany SA

Nunamaker David United States LA

Houlton John United Kingdom SA

Johnson Kenneth United States SA

Vannini Rico Switzerland SA

Hulse Donald United States SA

Cabassu Jean Pierre France SA

Hohn Bruce † United States SA

Sumner-Smith Geoffrey Canada SA

Clayton Jones Gary United Kingdom SA

Baron Michel France SA

Olmstead Marvin United States SA

LA = large animal practitioner SA = small animal practitioner

AOVET Presidents

94

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34. Schneider R. 25 Jahre AO-Schweiz. Arbeitsgemeinschaft für Osteosynthesefragen 1958−1983. Biel: Gassmann; 1983.

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38. Schenk RK, Willenegger H. Zur Histologie der primären Knochenheilung. Langenbecks Archiv für klinische Chirurgie. 1964;308(1):440–452.

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History of AOVet – The First 40 Years

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