No. 94 August 2005President John C.Y. Leong

2002-2005

NewsletterNewsletterPresident John C.Y. Leong 2002-2005

SICOTSOCIÉTÉ INTERNATIONALE de CHIRURGIE ORTHOPÉDIQUE et de TRAUMATOLOGIETHE INTERNATIONAL SOCIETY OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY

LE 10 OCTOBRE 1

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NDÉE À PARIS

SICOTSociété Internationale de Chirurgie Orthopédique et de Traumatologie

International Society of Orthopaedic Surgery and Traumatology w w w. s i c o t . o r g

In this issueEvidence based 2orthopaedics

Editorial by 3Prof John C.Y. Leong

Country to country: 4Orthopaedics in Estonia

On the web: 6The SICOT Portal and AIC in Buenos Aires

Society life: 8A report from the Trainees’ Meeting

Young surgeons: 9Support Global Recommendations for IMC

Worldwide news: 10Internationalism

Worldwide news: 11An interview with Dr Zamudio

SICOT_94_august2005 18/07/05 10:26 Page 1

Surgical versus non-surgical treatmentfor acute anterior shoulder dislocation

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Background:Acute anterior shoulder dislocation isthe commonest type of shoulder dislocation.Subsequently, the shoulder is less stable and moresusceptible to re-dislocation, especially in activeyoung adults.Objectives: We aimed to compare surgical versusnon-surgical treatment for acute anterior dislocationof the shoulder.Search strategy: We searched the CochraneMusculoskeletal Injuries Group specialised register(August 2003), the Cochrane Central Register ofControlled Trials, MEDLINE (1966 to Septemberweek 3 2003), conference proceedings and referen-ce lists of articles.Selection criteria: Randomised or quasi-rando-mised controlled trials comparing surgical withconservative interventions for treating acute ante-rior shoulder dislocation.Data collection and analysis: Selection of the in-cluded trials was by all three reviewers.Two revie-wers independently assessed methodological quali-ty and extracted data.Where appropriate, results ofcomparable studies were pooled.Main results: Five studies were included.These in-volved a total of 239 young (mainly aged around 22years) active and mainly male people, all of whomhad sustained a primary (first time) traumatic ante-rior shoulder dislocation.Methodological quality wasvariable, but notably there was insufficient informa-tion to judge whether allocation was effectivelyconcealed in all five trials.Two trials, involving 115 par-ticipants,were only reported in conference abstracts.One trial involving military personnel reported thatall had returned to active duty.Another trial repor-ted similar numbers in the two intervention groupswith reduced sports participation,and a third trial re-ported that significantly fewer people in the surgicalgroup failed to attain previous levels of sports acti-

vity. Pooled results from all five trials showed thatsubsequent instability, either redislocation or sub-luxation, was statistically significantly less frequentin the surgical group (relative risk (RR) 0.20).Thisresult remained statistically significant (RR 0.32) forthe three trials reported in full. Half (17/33) of theconservatively treated patients with shoulder insta-bility in these three trials opted for subsequent sur-gery.The results were more favourable in the surgi-cally treated group. Aside from a septic joint in asurgically treated patient, there were no other treat-ment complications reported.There was no infor-mation on shoulder pain, long-term complicationssuch as osteoarthritis or on service utilisation and re-source use.Authors' conclusions: The limited evidence avai-lable supports primary surgery for young adults,usually male,engaged in highly demanding physical ac-tivities who have sustained their first acute trauma-tic shoulder dislocation.There is no evidence availa-ble to determine whether non-surgical treatmentshould not remain the prime treatment option forother categories of patient. Sufficiently powered,good quality and adequately reported randomisedtrials of good standard surgical treatment versusgood standard conservative treatment for well-de-fined injuries are required;in particular,for patient ca-tegories at lower risk of activity-limiting recurren-ce. Long term surveillance of outcome, looking atshoulder disorders including osteoarthritis is also re-quired. Reviews comparing different surgical inter-ventions and different conservative interventionsincluding rehabilitation are needed. ■

Citation: : Handoll HHG,Almaiyah MA, Rangan A.Surgical versus non-surgical treatment for acute anterior

shoulder dislocation.The Cochrane Database ofSystematic Reviews 2004, Issue 1.Art. No.: CD004325

Evidencebased

orthopaedics

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Message for Istanbul MeetingSeptember 2005

Editorial

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T his will be the last message from me as President of SICOT, asmy term ends with the closing ceremony of the Triennial Congress in Istanbul. It has been a pleasure and privilege to ser-

ve such an august and established institution, with support from the Exe-cutive and other Committees, Board of Directors,National Delegates, theEditorial Board of our Journal, staff at Head Office, and all our members.

People involved with an institution of necessity come and go, but the in-stitution remains, albeit with continued metamorphosis.

Within the constraint of limited financial resources,we have tried to serveour members as best as we can.Thus we have streamlined, modernized,and increased the efficiency of our processes,enabling on-line communica-tions for membership application, payment of dues and access to mem-bership roster; submission of abstracts for scientific meetings and papersfor publication in International Orthopaedics; review of abstracts by ourScientific Board; and special SICOT lectures by international experts.

Other services include partnering with Pharmacia, then Pfizer and nowthe Bone & Joint Decade to project the SICOT World Portal; the SICOTTelediagnostic Website to render opinion for clinical management; thesetting up of SICOT Education Centres; the successful running of the SICOT Diploma Examination; and upgrading of International Orthopae-dics.

Although interest in SICOT has waned in some parts of the world, it haswaxed in other parts, notably in Eastern Europe, the Middle East, parts ofAfrica and Latin America. Although interest in SICOT of some seniororthopaedic surgeons has waned, that of many young surgeons haswaxed, thanks to the effort of the Young Surgeons Committee.Thosewho continue to have an interest in SICOT have a genuine desire to sha-pe orthopaedics on a global dimension, including offering a hand to lessdeveloped parts of the world.This innate yearning for internationalism isin line with the vision of our founding fathers, and will be the cornersto-ne of the continued importance and role of SICOT.

John C.Y. LeongPresident of SICOT

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Estonia is a smallcountry situated inEastern Europe, onthe shores of the Bal-tic Sea.

From 1940 to 1991 Estonia waspart of the Soviet Union. In 1988 ‘TheDeclaration of Independence’ wasaccepted by the State Parliament andby 1991 Estonia became an indepen-dent Republic.

Organised clinical and teaching ac-tivity in the field of surgery has a longtradition in Estonia.The medical facul-ty was established in 1632 when theuniversity was founded.

Estonian orthopaedic history da-tes back to the beginning of the 20thcentury.The teaching process of or-thopaedic pathology in Estonia beganat Tartu University in 1921,when JohnBlumberg, docent of surgery waschairman of the Department of Sur-gical Pathology and Orthopaedic Sur-gery. His best known monographsare “Aus der Chirurgischen Praxis(1922) and “Lehrbuch der Topogra-phischen Anatomie” (1926).His workwas continued by Prof Bernhard Jür-gens,who gave lectures on orthopae-dics with demonstrations on patients.

The first orthopaedic departmentwith 30 beds was founded in Tartu in1944. Amputations and reconstruc-tions of the lower leg and of the hand,including the Krukenberg technique,were performed.Patients with tuber-culosis underwent operations on theknee and hip joints; transposition oftendoris and arthrodesis were per-

formed on patients with poliomyeli-tis.

Nearly all the inhabitants of Esto-nia are covered by the NationalHealth Insurance system. Practicallyall the hospitals are owned by theState and most doctors work for theNational Health Service.Altogether,there are nine orthopaedic depart-ments in Estonia with 380 beds fororthopaedic pathology and for pa-tients with musculoskeletal trauma.The only private orthopaedic unit,with 10 beds, is in the Magdaleenahospital, in Tallinn.Thoracic and abdo-minal trauma, as well as urologicaltrauma are treated in that unit. Inorthopaedic trauma there are cur-rently two main problems: complexintraarticular fractures in multiply in-jured persons and osteoporotic frac-tures in elderly patients.Various de-generative conditions, especially os-teoarthrosis of the large joints andspine, have assumed greater clinicalimportance recently.

Orthopaedic surgery in Estonia

View of Tallinn.Tall Herman,Tallinn.

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Prof Rein Raie | National Delegate of Estonia

Country to

countryseries

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Of the total of 5079 physicians inEstonia 107 have worked in ortho-paedics,mostly in governmental hospi-tals and out-patients departments.The modern treatment of fracture inEstonia began in 1980, when AO im-plants of Polish origin were introdu-ced in most large hospitals. Estonianorthopaedic surgeons adopted theAO method of osteosynthesis andused the original Swiss internal fixa-tion devices from 1993. During thepast three years operations on frac-tures constituted 26%, orthopaedicconditions 35% and other types oftrauma accounted for 39% of all ope-rations.

The Estonian Orthopaedic Socie-ty was founded in 1972. It has 135

A long time ago, bone fractures inEstonia were treated also by generalsurgeons. Orthopaedic education andpractice have been organised better.Since traumatology and orthopaedicswere separated from general surgery.In 1984 a chair of orthopaedic surgeryand traumatology was established atthe Faculty of Medicine at Tartu Uni-versity. Before that there were severalways of becoming an orthopaedic sur-geon.Today,students have to completesix years of general medical trainingwith an additional year if they want tobecome general practitioners.

Orthopaedic residency has exis-ted at the Tartu University clinic since1995 and is mandatory at certain se-lected hospitals for those specialisingin orthopaedic surgery.To access theresidency system the candidate hasto take an entrance examination.Spe-cialist training in orthopaedic surgerytakes five years.Before graduating theresident can take the final exam ofthe medical specialty diploma.

members. A national congress of orthopaedic surgeons is held everythree years. Under the communistregime contact with foreign coun-tries was rather restricted, but orthopaedics has developed satisfac-torily. Now there are far more possi-bilities for co-operation with foreigninstitutions and departments withmodern orthopaedics.

We maintain close contacts withcolleagues from all our neighbouringcountries and take an active part inregional and international meetings.The SICOT Estonian Section is com-posed of five members. ■

u Country name: Estonian Republic

u Location: Eastern Europe, with a Baltic sea coast,

borders with Russia and Latvia

u Population: 1.4 million inhabitants

u Capital: Tallinn

u Size of country: 45,215 km2, surface area contains

4,132.7 km2 of islands and 2,130 km2 of lakes

u Type of government: democratic republic

u Language: Estonian

u No. of doctors: 5079

u No. of orthopaedic surgeons: 107

u No. of medical schools: 1

u No. of SICOT active members: 5

Tallinn

Another view of Tallinn.

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Fourth SICOT/SIROT Annual InternationalConference - 23-26 August 2006Buenos Aires,Argentina

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Venue Conference PresidentHotel Hilton, Buenos Aires Prof Bartolome T.Allende

23 August 2006 (all day) SICOT Trainees’ Meeting (*)

Opening ceremony and Welcome reception24 August 2006 (morning) SIROT

(afternoon) SICOT 25 August 2006 (all day) SICOT

President’s Dinner26 August 2006 (all day) SICOT

Closing ceremony and Farewell party(*) The SICOT Trainees’ Meeting offers residents, trainees and registrars from around the world a unique opportunity to attendtop class postgraduate courses and lectures and to present their work to an international audience of orthopaedic experts. In ex-change for a small registration fee participants in the Trainees’ Meeting are granted access not only to the Trainees’ Meeting butalso the whole SICOT Annual International Conference.To qualify as trainees participants should supply evidence that they areunder 40 years of age and they have enrolled in a training programme.

Call for Abstracts

Abstracts may be submitted on line from 05 September 2005 at http://www.sicot.org/?page=buenosairesfor the following topics:

SICOT SIROT Bone loss Non-union Biomaterials and tissue engineeringCervical spine Open fracture BiomechanicsDegenerative hip disease in young adults Paediatric orthopaedics Fracture healingFoot and ankle Polytrauma Stem cells, genes and growth factorsHand Sports medicineInfection

No faxed or e-mailed submissions please! Deadline for abstract submission: 15 February 2006

Exhibitors and sponsors relations

SORELCOMM (1985) Inc.625 avenue President-Kennedy, suite 1010Montreal, Quebec, Canada H3A 1K2Tel: +1 514 499 8920 - Fax: +1 514 499 8921Email: info@sorelcomm.cahttp://www.sorelcomm.ca

Scientific programme and registration

SICOT aisblRue Washington 40 – b.9

1050 Brussels, BelgiumFax: +32 2 649 8601

Email: info@buenosaires.sicot.orghttp://www.sicot.org/?page=buenosaires

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SICOT Internet Portal gets total upgrade

On the web

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The SICOT World portal is taking on a whole new look.

Rebuilt from scratch, thenew portal offers threelevels of access: the firstlevel is open access andprovides a window to thepublic; the second levelcontains distinctive edu-cational content and re-quires log-in with nameand e-mail address; and

the third level contains exclusive SICOT memberpages, specifically designed and managed by our staff.The portal homepage is linked in with the Bone andJoint Decade’s central musculoskeletal site whichserves to facilitate our web collaboration with theinternational organisation.

This new website is, in effect, the upshot of deve-lopments with the Musculoskeletal eCooperativeproject,MSeC. SICOT was one of the first and conti-nues to be one of the key organisations in the MSeCproject, from the development phase through to thepresent.The original MSeC partnership was essen-tial in the development of a unique and successfulnetwork of several national and international mus-culoskeletal societies including the BJD, SICOT, ILAR(International League of Associations for Rheumato-logy), NOF (Nordic Orthopaedic Federation), SBR(Sociedade Brasileira de Reumatologia), both Britishnational associations for Orthopaedic Surgery andRheumatology (BOA, BSR) and in Sweden (SOF,SRF) for educational content production. Neverthe-less, it is clear that the design and structure of the‘old’ portal is outdated and not flexible to the needsof our on-line community.This was revealed by ausability survey of SICOT members which partly

lead to our decision to join the BJD in the develop-ment of an enhanced, state-of-the-art musculoskele-tal web portal.

Made up of several satellite sites with the BJD asthe umbrella site, each sub-portal is original in termsof society identity, society-specific content, ownmenu and own administration.This way each sub-portal is a community of its own, but also contribu-tes to, and shares material from, the greater BJDnetwork. Content programming includes news fea-tures, eLectures, Faculty Reading Lists, thesis library,and conference highlights, to name just a few.Thenew portal hosts state-of-the-art technologies thatcan effectively deliver selected items right to a SI-COT member’s PC desktop such as musculoskeletalnews throughout the network of societies and theirmembers.This, combined with an improved naviga-tion, ensures that SICOT members will find the newportal an altogether more user-friendly and dynamicwebsite. In addition the portal can now be manageddirectly by our staff.

Member login will also become easier, as it wasdecided to abandon the rather unfriendly system ofusernames and transfer to a more modern approachof logging in with e-mail address, which is used by allleading medical and news sites today. Logging in willgive you access to a wide range of material publi-shed by SICOT, the Bone and Joint Decade, and anyof the other participating musculoskeletal societies.There will also be a secure area dedicated to SICOTmembers only, containing SICOT-specific material.We invite you to have a look at the new portal, viathe address www.sicotworld.org, and look forwardto hearing your feedback! ■

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Report on the l4th SICOT Trainees’Meeting in Budapest

Prof. M. Szendrôi | Head of the Organising Committee

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Society life

The organizing committee: Prof M. Szendrôi, Dr J. Kiss, Dr I. Antaland Dr Gy. Szöke

The Auditorium Hall

The place and date were decidedat the SICOT Congress in Cuba, inSeptember 2004, so the organi-sers had only eight months to pre-pare the program, send out the in-vitation letters and so on.About1000 letters and e-mails with themain topics and time schedule ofthe Meeting were sent to the Eu-ropean Members of SICOT in Oc-tober 2004.The main topics were:paediatric trauma, paediatric or-thopaedics and bone tumours inchildhood.

The scientific level of the Trainees’Meeting was ensured by the verydistinguished invited speakers andexperts from Hungary. Prof RainerKotz, the immediate Past Presi-dent of SICOT, delivered a lectureabout pitfalls of biopsies in bonetumours: Prof Said, the Vice Presi-

dent, and Prof Vilmos Vécsei, theChairman of the Trauma section ofSICOT gave lectures about thetreatment of fractures in children:Prof Cody Bünger,Vice Presidentand Chairman of the EuropeanSection of SICOT, presented twolectures about the treatment ofscoliosis and its results. From theHungarian side, Prof K. Fekete andDr E. Hargitay delivered lectureson paediatric traumatology, Dr G.Szöke and Prof T. Illés on paedia-tric orthopaedics, and Dr I.Antal,Prof K. Karlinger, Prof M. Szendrôion paediatric bone tumours.

94 registered participants from 20countries took part in the mee-ting. For six colleagues from Ukrai-ne the SICOT Foundation coveredthe congress fee and the organi-sers took care of their accommo-

dation. Sixteen trainees gave oralpresentations, 58 posters werediscussed.The organisers presen-ted the best poster award to DrKároly Pap and his co-authors,Hungary and the best lectureaward to Dr Aleh Sakalouski andhis co-authors, Ukraine.The cong-ress fee was refunded for the firstauthors.Apart from the scientific program,the trainees had the possibility tomake new friends during the ban-quet, which was followed by a shiptour in the heart of Budapest. OnFriday evening a “violent” folkloreprogram was celebrated by theHungarian State Ensemble.

We all hope that the 14th SICOTTrainees’ Meeting in Budapest willlong remain a good memory forthe participants. ■

The 14th SICOT Trainees’ Meeting took place in Budapest, from 5-6 May 2005.

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SICOT Young surgeons Support Global Recommendations forImproved Musculoskeletal Curriculum

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Young surgeons

Musculoskeletal conditions are thenumber one cause of severe long-termpain and physical disability affectinghundreds of millions of people aroundthe world.More than 20% of all consul-tations in primary care are due to

musculoskeletal conditions.We recognise the latter,yet education in medical schools does not reflect it.

According to Prof Anthony Woolf, member of theBone and Joint Decade (BJD) International SteeringCommittee (ISC):“The experience gained by medicalstudents today in relation to these conditions is inade-quate. In the examinations, students are seldom asses-sed for their competency to take an appropriate his-tory and to examine the musculoskeletal system”. Re-ducing disability is a WHO ‘Health for All’ target, yet itseems that today many of the 350,000 students whoannually graduate from medical school are not com-petent at assessing musculoskeletal conditions.

Surveys in several countries assessing the deficit ofthe musculoskeletal curriculum in current medicaltraining provide evidence of this. In 1998, Freedman etal, found that 82% of graduates of US medical schoolsfailed a musculoskeletal examination; and in Australia61% of graduates failed the same examination (Broad-hurst, 2003). Despite the growing relevance of thesubject matter, the current curriculum is letting stu-dents down: in the US only 25 of 122 medical schoolshave a musculoskeletal clerkship as a requirement (Di-Caprio el al, 2003).

The BJD Task Force on Education has developedrecommendations on how to improve musculoskele-tal training.Their work outlines the skills which alldoctors should have at the point of graduation fromany medical school (Woolf AD et al.“Global Core Re-commendations for a Musculoskeletal UndergraduateCurriculum.” Annals of Rheumatic Disease. 2004; 63:517-524), the recommendations detail the contents of

an estimated six-week course which should emphasi-se training in basic knowledge of the diagnosis andtreatment of musculoskeletal conditions and essentialclinical skills.

All medical students irrespective of their futurespeciality, should have a minimum level of competencein musculoskeletal conditions comparable to that of,for example, management of cardiovascular condi-tions or diabetes.These recommendations define thatlevel of competence.They provide a reference for me-dical school faculty on the priorities and educationalareas that need to be considered when developing anundergraduate curriculum.

The curriculum recommendations were developedby experts in orthopaedics, rheumatology, osteoporo-sis, rehabilitation and education from 29 countries re-presenting all regions of the world who make up theBJD Undergraduate Curriculum Development Group.They were developed with the support of SICOT,EFORT, the AAOS, along with many other internatio-nal and national societies.

The SICOT Young Surgeons Committee is concer-ned about this issue and we believe, based on our affi-liation to an international organisation, that we arewell placed to help introduce the concept of settinginternational standards which serve to optimise thequality of musculoskeletal education which ultimatelywill result in better patient care. So effectively, the SI-COT Young Surgeons Committee recommends joi-ning this international campaign but with a unique bot-tom-up approach in the education system:We believethat we can influence the uptake of the recommenda-tions through direct advocacy within our medical uni-versities and academic centres. ■

For further information, contact: Cyril Toma, M.D.Chairman,Young Surgeons CommitteeEmail: cyril.toma@meduniwien.ac.at

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How international shall SICOT be?

Mohamed Lemseffer | National Delegate of Morocco

Africa boasts several devoted members of inter-national stature who have relentlessly promoted SICOT in the region and involved the region in SICOT activities. Four combined regional meetingsin Kenya, Saudi Arabia and Morocco (2) and one Annual International Conference in Egypt testifiedto the enormous interest SICOT attracts in the re-gion and to the awareness the region aims to create.At a time when membership numbers are dropping,Africa offers an untapped reserve of members whoare just awaiting an opportunity to participate in de-cisions and responsibilities and to demonstrate theirown dynamism and creativity.

How far shall SICOT stretch its internationalreach in Istanbul? To quote President Leong “asmembers of the world orthopaedic fraternity, it isup to all of you to maintain and enhance this [the SICOT] internationalism”.We count on all of you!

■

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SICOT originated in Euro-pe and, not surprisingly, un-til 1978 when Dr Dholakiabecame President, it hadbeen ruled exclusively byrepresentatives of two re-gions, Europe and the Ame-ricas. Some years laterwinds of change were per-

ceived and President Yamamuro felt – as he recalls inthe interview published in SICOT Newsletter N° 90- that “the time was coming close to break throughthis historical regime” and he strongly advocatedthe need to “involve as many groups as possible intoSICOT from the Third World”.

In 1999, in Sydney, it was suggested to rotate thepresidency from one continent to the other and,after Canada (Prof Sorbie), we have had Austria(Prof Kotz), Hong Kong (Prof Leong) and the U.S.A.(Dr Smith). It is our firm belief that one should righ-tly wish the future president who will be elected inIstanbul to be chosen from the Africa, North andMiddle East section.

Jacques Rogge, Presidentof the InternationalOlympic Committee re-ceiving the SICOT Ho-norary Member Medalfrom our Secretary Ge-neral, Maurice Hinsen-kamp at the H.Q. of theIOC in Lausanne.This recognition was conferred at the initiativeof our immediate Past President, Rainer Kotz,during our XXII Triennial World Congress in SanDiego.

Jacques Rogge He was born on May 2, 1942. He is a Belgian orthopaedic surgeon and has been the presidentof the International Olympic Committee (IOC)since 2001. Born in Ghent, living in Deinze, Roggecompeted in yachting in the 1968, 1972 and 1976Summer Olympics, and played on the Belgian rug-by team. Rogge served as president of the BelgianOlympic Committee from 1989 to 1992, and aspresident of the European Olympic Committeesfrom 1989 to 2001. He became a member of theIOC in 1991 and joined the Executive Board in1998. Rogge was elected as president of the IOCon July 16, 2001 at the IOC session in Moscow asthe successor to Juan Antonio Samaranch, whohad led the IOC since 1980.

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Worldwidenews

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An interview with Dr Leonardo Zamudio

last two editions I called on some of my formerresidents to give me a hand.

I have been told you are a great writer of poems.As an orthopaedist can you explain your need towrite? Why poems?

I have written five poetry books.They came toexistence at a particular moment in my life when Ifelt like writing poetry. I have also written fivebooks of short stories and essays and they alsocontain poems.Why poems? Words came to meand I wrote them down.

You have your own private clinic. Could you tell ushow this came about?

It is not really a clinic. I would call it a large office.There are no beds, but there are several cubicles,seven in total and at the time there were three x-rayapparatus. I made my residents rotate through myoffice so they could see what private practice was.

We have heard that a school is attached to yourclinic.The purpose of this school is to train ortho-paedists.Why did you decide to found this kind ofschool?

There is no school attached to the office. I havehad 102 residents from different places aroundLatin America (from Mexico city and from manyprovinces, from Spain, Guatemala, El Salvador,Panama, Bolivia) and 20 visitors for short periods.In 1987, I founded the Metropolitan Library ofOrthopaedics that it has many periodical publica-tions now from around the world and some oldbooks of interest. Some were written by Lorenz,Jones, Putti, Bohler, Leveuf, Steindler or Codman. ■

You were president of SICOT from 1990 to 1993.What will you rememberfrom this time?

I enjoyed meeting nice andimportant people from dif-ferent countries. I tried tounderstand what theythought of orthopaedicsurgery and life itself. I was

also given the opportunity to help the young ones,especially those coming from poorer countries.

How did you become President of SICOT?

I became member of SICOT in 1960 and I atten-ded a meeting for the first time in 1963 in Vienna.In 1966, when Mexico was appointed for the orga-nisation of the XI SICOT meeting to be held in1969, President Dr Juan Farill nominated me asSecretary General and during that period, I becamewell acquainted with SICOT. I haven't missed a sin-gle triennial meeting since 1975. I became the firstLatin American President and the first coming fromthe Spanish-speaking world.

You have published a book entitled “Ortopedia yTraumatología” (Orthopaedics and Traumatology), abook that has been a great success because it wasreprinted for the fourth time this year. Can you tellus more about this?

40 years ago, I was a lecturer in OrthopaedicSurgery at the National University and in thosedays, I used to go to my studio regularly after lunchand write down the well-prepared lecture I hadgiven in the morning. Later on, I reviewed thosewritings and the book came into existence. For the

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