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Jean-Pierre Jeannet
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Jean-Pierre Jeannet

Leading a
Surgical Revolution
The AO Foundation –
Social Entrepreneurs
in the Treatment of Bone Trauma
Leading a Surgical Revolution
Jean-Pierre Jeannet

Leading a Surgical
Revolution
The AO Foundation –
Social Entrepreneurs in the Treatment
of Bone Trauma
Jean-Pierre Jeannet
Professor Emeritus Babson College
Wellesley, MA, USA

Professor Emeritus IMD Institute

Lausanne, Switzerland

ISBN 978-3-030-01979-2 ISBN 978-3-030-01980-8 (eBook)

https://doi.org/10.1007/978-3-030-01980-8

Library of Congress Control Number: 2018959613

# Springer Nature Switzerland AG 2019

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the
material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, express or implied, with respect to the material contained herein or for any
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This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Foreword

The title of this book reflects, in a few lines, the essence of the AO Foundation and
what it stands for. With the invention of a disruptive surgical procedure it
revolutionized the world of trauma, reducing pain and disabilities of patients with
broken bones and bringing them back into normal social and working life within
days, instead of months. In the process, it saved the world’s health system billions of
dollars—a dream of today’s health experts confronting escalating health costs.
Practically unnoticed, a worldwide medical device industry developed around this
surgical procedure and its surgical instruments and implants—also developed by the
pioneer AO surgeons together with a small-scale industry. The social entrepreneur-
ship of a nonprofit organization with changing industrial partners leveraged the
dissemination globally on an unprecedented scale.
The idea to present this extraordinary story came out of a research project of
Professor Jeannet who identified exceptional success stories of small and medium-
sized Swiss enterprises, among them Synthes and Mathys, only to realize the
interconnection and further develop the story into a separate book detailing the
role of the AO Foundation in this success story.
In today’s world, with healthcare costs exploding, a similar approach combining
disruptive inventions and innovations with a cost-effective organization might offer
ideas for other successful partnerships or private initiatives to remedy illnesses.
The AO Foundation continues to extend its successful work into low-income
countries where the burden from injuries and disabilities has assumed epidemic
proportions and where treatment methods and care are largely comparable to what
the pioneering AO surgeons were confronted with 60 years ago in Switzerland.
The 60th anniversary of the AO Foundation is an appropriate moment to present
its history. This book by Professor Jeannet describes the AO history in a compre-
hensive way, with special attention to the business aspects, making it of interest also
for a broader, nonmedical, public.

AO Foundation, Biel, Switzerland Nikolaus Renner

AO Foundation, Biel, Switzerland Rolf Jeker

v
Preface

This book project came my way when I was looking for support for a different, but
related, project on Swiss small and medium-sized exporting companies (SMEs) with
global success in specific niches. I planned to include Mathys, Straumann, and
Medartis, all companies with strong connections to the AO Foundation. However,
the AO indicated that they would rather welcome a book on the AO itself with a
particular emphasis on its industrial impact. Would I be interested? The AO assured
that I would have complete independence as to the approach I would choose.
Initially, I hesitated to entertain the idea, since I possess neither a medical nor an
engineering background.
My background as a business school faculty member, however, was of interest to
the AO leaders since previous books had been written largely by surgeons or medical
historians. And so it came that I, with only a cursory acquaintance of the AO,
accepted to tackle the challenge of writing a book that would give special emphasis
to the AO industrial achievements and impact. My contacts at the AO Foundation
board convinced me that my lack of medical training did not disqualify me from
writing about the AO and its 60-year history. The readers of this book will have to be
the final judges of this decision.
I approached the project in line with my business case research experience gained
from writing scores of cases at IMD (Lausanne) and Babson College (Wellesley,
MA, USA). This meant that I did not immerse myself only into the archives of the
AO, but instead focused on a large number of in-depth interviews with many
individuals who had been associated with this enterprise since its inception. While
delving into memories about past events, it was to be expected that there would be
conflicting perceptions of the what and why of events. Naturally, I made full use of
the publications written previously, some of which were crucial to creating the story
line I wanted to build, and some helped deal with conflicting memories from
interview partners.
As I got ever deeper involved in the AO history, I came to realize that I should not
only write a book covering the period since 2002, the year the last book was
published. Instead, I needed to tell the entire history of the AO from its inception
using the particular lenses that came from my business school faculty background.
At first, this meant creating a timeline of the 60 years of the AO and identifying the
critical points in its development, be it medical, engineering, or business-related.

vii
viii Preface

Delving deeper, I saw that there was both a social entrepreneurship story centered
around the medical aspects of the AO’s achievements, as well as a business
entrepreneurship story that focused on the industrial achievements triggered by the
AO and its purpose. Identifying the two types of entrepreneurial endeavors, social
and business, allowed me to approach the AO history from two different angles
while using the conceptual lenses from my business school experience for labeling
the key events. These business lenses were at the origin of many of the chapter titles
and subtitles. Many of these concepts, part of the modern business vocabulary, did
not exist when the AO was started. Throughout the text, I have taken the liberty to
point out the organizational and business achievements from earlier periods without
the access to a technical infrastructure we take for granted in today’s business
environment.
The intent is to reach an audience beyond the AO community. Reflecting on the
potential readers of this book, I was cognizant of the fact that obviously this text is
not intended or suited as a manual for surgeons interested in the AO approach to
trauma care. And yet, the medical information presented had to find approval of the
surgeons involved in trauma care, a constant challenge that was confronting me
throughout the two years of working on this project. I hope this text will be read by a
general audience, including the large number of patients who have benefited from
the result of these efforts, as well as interested readers from the business and research
community who might find inspiration in the AO approach.
While this book was written based upon extensive research, it was not intended as
an academic exercise. Instead, the aim was to tell the story of the AO Foundation and
of the individuals who were instrumental in creating this enterprise and to do so in a
captivating, interesting, and also personal way. The AO’s tenacity to push ahead
with Osteosynthesis for trauma care when confronted with strong opposition from
the medical establishment, and to do so with limited resources, could serve as an
inspiration for other such projects.
Through the research on the AO, I became aware of the enormous impact of the
organization. Millions of people walk the streets having benefited from the
breakthroughs achieved by the AO, and yet few members of the general public
have any idea who was or is behind these achievements. In that sense, I am happy to
have accepted the challenge to write this story and to render it, I hope, in a way to
bring it to the attention of a wider audience.

Belmont, Switzerland Jean-Pierre Jeannet

August 2018
Acknowledgements

This book would not have been written without the generous and active support of
the AO Foundation and its Governance. The AO Foundation Board, particularly its
President Klaus Renner and its CEO Rolf Jeker, actively worked to open doors and
obtain access to countless documentation and offered help with securing interviews.
A small steering committee dealing with 60th anniversary issues was always ready
to provide guidance. Important financial support for this project was provided
through the BLI Institute at the University of Lucerne, assuring that the book project
could also find a reputable publisher. Most important, however, was the hands-off
approach of the AO leadership allowing the author to express his own opinion while
giving ample support that all the relevant facts could be rendered correctly.
The development of this book benefited from very capable authors of earlier
works on the AO Foundation, especially for the periods up to about the year 2000. In
particular, the publications written by Robert Schneider and Urs Heim on the early
part of the AO history, Eugen Kuner on the development of the Osteosynthesis
approach, Thomas Schlich on the medical history of the AO and its treatments,
Joseph Schatzker’s biography of Maurice Müller, as well as the history of AOVET
edited by Jörg Auer and his colleagues were a constant guide during the research and
writing of this manuscript. All of these authors are extensively cited throughout
the book.
Enormous gratitude is owed to about 60 individuals who were willing to sit down
for interviews, typically lasting one to two hours. They shared freely of their experi-
ence, history with the AO, events they witnessed, and stories they remembered, and
offered their reflection on the AO organization, in the past, today, or the future. The
summary of these interviews allowed me to gain a much deeper understanding of the
importance and impact of the AO, both in medical and business terms. Where
appropriate, I have referenced these conversations in footnotes. A complete listing
of all persons interviewed is provided in the List of Interviewees.
I am thankful to the surgeons who took the time to explain the intricacies of
Osteosynthesis to this not medically trained author, in particular Peter Matter,
Reinhold Ganz, and Teddy Slongo who spent extra time with me and reviewed
part of the manuscript. The technical issues surrounding the AO Instrumentarium
and implants were patiently explained to me by Robert Mathys, Jr., and Robert Frigg
who also reviewed part of the manuscript as well as Ortrun Pohler, who worked with

ix
x Acknowledgements

me on the material science issues. And finally, Rolf Jeker spent many meetings and
phone calls with me explaining the intricacies of the AO governance. Without their
help I would not have been able to cover, absorb, and organize the entire AO history
in one single book.
I would like to express my appreciation to the many institutions, individuals, and
copyright holders who allowed us to illustrate important aspects of the AO history.
The AO Publication team contributed their skills to converting the many exhibits
into publishable visuals for the book. Finally, a special thank you goes to Anita
Hussey who edited a rough manuscript into a publishable story.
Last but not least, I would like to thank my wife, Christine Jeannet, who has
patiently listened over the past two years to the countless stories I unearthed about
the AO Foundation, has debated many aspects of the manuscript and its organization
with me, and thus contributed immensely to the story presented in this book.
Contents

1 Prologue: Orchestrating A Cast of Thousands . . . . . . . . . . . . . . . . 1

Davos, Early on a December Morning . . . . . . . . . . . . . . . . . . . . . . . . 1
Davos Hospital, on a December Morning . . . . . . . . . . . . . . . . . . . . . . 2
Solothurn, Switzerland, on the Same December Morning . . . . . . . . . . . 5
Who Orchestrates This Cast of Thousands? . . . . . . . . . . . . . . . . . . . . 6

Part I Launching a Surgical Revolution

2 Osteosynthesis Explained . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3 A Brief Overview of the AO Organization . . . . . . . . . . . . . . . . . . . . 15
What Does AO Stand For? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
A Humble Beginning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4 Treatment of Bone Fractures Prior to 1960 . . . . . . . . . . . . . . . . . . . 21
Davos, Another Winter Day, in the 1950s . . . . . . . . . . . . . . . . . . . . . . 21
How Conservative Treatment Conquered the World . . . . . . . . . . . . . . 21
Negative Experiences with Conservative Method . . . . . . . . . . . . . . . . 23
Early Surgical Approaches to Bone Fractures . . . . . . . . . . . . . . . . . . . 24
A Nailing Innovation from Boston, Picked up in Europe . . . . . . . . . . . 24
Nailing Rod from Germany Made It Around the World . . . . . . . . . . . . 24
Experiments with Compression Plates in Belgium Remained a Local
Affair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
The Surgeon Who Coined the Term Osteosynthesis . . . . . . . . . . . . . . . 26
The Belgian Surgeon Who Brought Osteosynthesis to the Attention of a
Wider Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Why Osteosynthesis Initially Lost Out to Conservative Treatment in the
Race for Global Domination of Fracture Care . . . . . . . . . . . . . . . . . . . 29
The Medical World Reacts Negatively to the Practice of
Osteosynthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

xi
xii Contents

5 Enter Maurice Müller (1918–2009) . . . . . . . . . . . . . . . . . . . . . . . . . 33

How Maurice Müller Decided to Pursue a Medical Career . . . . . . . . . . 33
Chance Meetings with First Patients Left a Strong Impression . . . . . . . 34
Looking for Hospital Position as a Junior Resident . . . . . . . . . . . . . . . 35
Pursuing a Gap Year in Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
First Residency in Liestal 1947–1949 . . . . . . . . . . . . . . . . . . . . . . . . . 37
A Second Gap Year: Touring European Orthopedic Centers . . . . . . . . . 38
The Pivotal Visit to Danis (1950) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
A Place to Apply the New Techniques: Fribourg (1950–1952) . . . . . . . 40
Finally, at the Balgrist Orthopedic Clinic . . . . . . . . . . . . . . . . . . . . . . 41
Moving to Private Practice at Hirslanden Clinic . . . . . . . . . . . . . . . . . 41
Müller’s Closing and Opening Doors Experience: The Power of
Persistence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
6 Recruiting a Circle of Friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
When Lecturing Failed to Convince . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Making His First Adherent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Life on the Road as a ‘Star Surgeon’ . . . . . . . . . . . . . . . . . . . . . . . . . 47
Can Anyone Help with a Difficult Orthopedic Hip Case? . . . . . . . . . . . 49
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
7 The AO Kick-Off Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
The Kick-Off Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
What’s in a Name? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
G13: The Group of 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
G5: The Founding Fathers of the AO . . . . . . . . . . . . . . . . . . . . . . . . . 55
Robert Schneider (1912–1990) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Walter Bandi (1912–1997) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Hans Willenegger (1910–1998) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Martin Allgöwer (1917–2007) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Other Founding Members of the AO (G13) . . . . . . . . . . . . . . . . . . . . . 57
The First Meeting Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
8 AO Formulates Its Credo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Drafting By-Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
The Purpose of the AO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
The Role of the AO General Assembly . . . . . . . . . . . . . . . . . . . . . . . . 62
Defining the AO Leadership Positions . . . . . . . . . . . . . . . . . . . . . . . . 62
Membership Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Members’ Privileges and Duties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Adhering to the AO Credo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Bootstrapping the Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Defining AO Treatment Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Restoration of Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Stable Fracture Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Contents xiii

Preservation of Blood Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Early Pain-Free Mobilization of Limb and Patient . . . . . . . . . . . . . . . . 67
Evolution of AO Credo Over Time . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Development of AO Surgical Principles . . . . . . . . . . . . . . . . . . . . . . . 69
AO Built on Four Pillars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
9 Pillar One: Developing the AO Instrumentarium . . . . . . . . . . . . . . . 73
Decision to Develop AO-Specific Instrumentarium . . . . . . . . . . . . . . . 73
Müller Locates Robert Mathys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Agreeing on a Suitable Finance Model . . . . . . . . . . . . . . . . . . . . . . . . 78
From Individual Tools to Standardized Toolsets . . . . . . . . . . . . . . . . . 80
Managing Successfully in “Crossing the Chasm” . . . . . . . . . . . . . . . . 82
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
10 Pillar Two: Teaching Osteosynthesis . . . . . . . . . . . . . . . . . . . . . . . . 85
Teaching at the Core of the AO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Techne Versus Episteme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Preparing for the First AO Course in Davos, 1960 . . . . . . . . . . . . . . . . 87
Inviting VIPs to Davos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
11 Pillar Three: Maintaining Complete Documentation . . . . . . . . . . . . 93
The Early Models of Documentation . . . . . . . . . . . . . . . . . . . . . . . . . 93
Creating a Standardized Documentation System . . . . . . . . . . . . . . . . . 94
AO on the Forefront of Creating a Learning Organization . . . . . . . . . . 97
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
12 Pillar Four: The Research Mission . . . . . . . . . . . . . . . . . . . . . . . . . 99
Research as Part of the AO Mission . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Finding a Research Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
When Reliance on Clinical Results Would Not Suffice . . . . . . . . . . . . 100
Confronting Opposition at Surgical Conferences in Switzerland . . . . . . 101
The Argument Against and for Rigid Fixation . . . . . . . . . . . . . . . . . . . 102
Biomechanics to the Rescue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
The Battle Over Primary Bone Healing . . . . . . . . . . . . . . . . . . . . . . . . 104
Anatomist to the Rescue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
13 Pitching the AO Philosophy to Hostile Audiences . . . . . . . . . . . . . . 107
Pitching the AO Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
First Disputation in Geneva (1960) . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Second Disputation in Berne (1960) . . . . . . . . . . . . . . . . . . . . . . . . . . 108
AO Surgeons in the Role of Disruptors . . . . . . . . . . . . . . . . . . . . . . . . 110
Pitching the AO Philosophy Abroad . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Inviting Guests of Honor to Davos to Overcome Resistance . . . . . . . . . 111
Taking on the Entire Medical Establishment . . . . . . . . . . . . . . . . . . . . 113
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
xiv Contents

14 In Search of a Business Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Trying to Find a Business Arrangement . . . . . . . . . . . . . . . . . . . . . . . 115
A Trusted Advisor Joins the AO Team . . . . . . . . . . . . . . . . . . . . . . . . 116
Creating Synthes AG Chur to Monetize AO Innovations . . . . . . . . . . . 117
Business Model Innovation to Secure Revenue Stream . . . . . . . . . . . . 117
Making a Magnanimous Donation . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
A Single Exception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Arranging for Control of Synthes AG Chur . . . . . . . . . . . . . . . . . . . . . 119
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
15 Broadening the Supplier Base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
A Metallurgist Joins the AO Team . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Crafting an Agreement Between Synthes AG Chur and Producers . . . . 124
Dividing the World in Olten . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
16 A Commission to Steer the Enterprise . . . . . . . . . . . . . . . . . . . . . . . 129
Surgeons Looking for Ways to Control Producers . . . . . . . . . . . . . . . . 129
AOTK as Powerful Focus Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
AOTK Practicing Open Innovation . . . . . . . . . . . . . . . . . . . . . . . . . . 131
AOTK as a Conservative Influence . . . . . . . . . . . . . . . . . . . . . . . . . . 131
AO Activities Serving as Indirect Promotion . . . . . . . . . . . . . . . . . . . . 131
The AOTK as Arbiter for Delicate Business Situations . . . . . . . . . . . . 132
AOTK as a Marketing Forum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
AOTK as a Permanent Fixture at the AO . . . . . . . . . . . . . . . . . . . . . . 133
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
17 AO Vision, Mission, Values, and Strategy . . . . . . . . . . . . . . . . . . . . 135
Accomplishments of First Three Years . . . . . . . . . . . . . . . . . . . . . . . . 135
Vision, Mission, Values, Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

Part II Growing the Organization

18 Growing the Enterprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Moving from Start-up into Growth Phase . . . . . . . . . . . . . . . . . . . . . . 141
The Moment of Lift-off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
The Growth Phase of the AO Enterprise . . . . . . . . . . . . . . . . . . . . . . . 143
19 Mathys: Building an Industrial Company from Scratch . . . . . . . . . 145
Mathys Company Ramping up from Humble Beginnings . . . . . . . . . . . 145
Capacity Expansion of the Mathys Company . . . . . . . . . . . . . . . . . . . 146
Dealing with Manufacturing Complexity . . . . . . . . . . . . . . . . . . . . . . 146
International Expansion at Mathys . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
How Robert Mathys, Sr., Bootstrapped His Company . . . . . . . . . . . . . 149
Mathys Having a Lasting Industrial Impact . . . . . . . . . . . . . . . . . . . . . 150
Contents xv

20 Straumann Assumes Role of Manufacturer . . . . . . . . . . . . . . . . . . . 151

The Rotary Club Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Straumann Leveraging Industrial Experience . . . . . . . . . . . . . . . . . . . . 151
Fritz Straumann Steps In . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Expanding Straumann Internationally . . . . . . . . . . . . . . . . . . . . . . . . . 155
Straumann Industrial and Technological Impact . . . . . . . . . . . . . . . . . 155
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
21 Conquering International Markets . . . . . . . . . . . . . . . . . . . . . . . . . 157
The Experience in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Building a Beachhead in Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Building a Second Beachhead in Austria . . . . . . . . . . . . . . . . . . . . . . 159
Forming a Beachhead in Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
22 Cracking the US Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Establishing a Foothold in North America . . . . . . . . . . . . . . . . . . . . . 163
Surgeons as Marketers in the US . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Creating Synthes USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Enter Hansjörg Wyss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
23 Expanding the Instrumentarium . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Continuous Improvement Process of the Instrumentarium . . . . . . . . . . 171
First Generation of Instrumentarium Centered on Round Hole Plates . . . 172
Second Generation with DCP Plates (1966) . . . . . . . . . . . . . . . . . . . . 174
Introduction of Dynamic Hip Screw (DHS) in 1978 . . . . . . . . . . . . . . 175
Expanding Surgical Cassettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Multiplying Plate Shapes and Sizes . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Screws of All Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Overcoming the Material Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Expansion into Different Types of Trauma Surgery . . . . . . . . . . . . . . . 178
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
24 AOVET: Humans Helping Animals . . . . . . . . . . . . . . . . . . . . . . . . 181
The Animal Lovers Affiliated with the AO . . . . . . . . . . . . . . . . . . . . . 181
Background to Orthopedic Surgery in Animals . . . . . . . . . . . . . . . . . . 182
The Concerned Veterinarian from Berne . . . . . . . . . . . . . . . . . . . . . . . 183
Creating the Waldenburg Circle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
The Story of a Horse Named Maxlie . . . . . . . . . . . . . . . . . . . . . . . . . 184
Creating AOVET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Leveraging Veterinarian Implants for Human AO Implants . . . . . . . . . 186
How a St. Bernard Dog Helps the AOVET Expand into North America . . . 188
Creating Infrastructure for AOVET . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
xvi Contents

25 Entering Other Trauma Segments . . . . . . . . . . . . . . . . . . . . . . . . . . 189

The AO Enters Additional Trauma Segments . . . . . . . . . . . . . . . . . . . 189
Entry into CMF Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
The Evolution of the Spine Specialty Within AO . . . . . . . . . . . . . . . . 191
Differences Between the Creation of AOCMF and AOSpine . . . . . . . . 193
What About Total Hip Replacements? . . . . . . . . . . . . . . . . . . . . . . . . 193
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
26 Carrying the Message: Apostles, Missionaries, Translators, and
Baggage Carriers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Bringing the AO Message to Every Corner of the World . . . . . . . . . . . 197
Apostles as Principal Disseminators of a Revolutionary Message . . . . . 197
From Translators, Drivers, and Suitcase Porters to AO Disciples . . . . . 199
AO Fellowships for Training to Recruit Disciples . . . . . . . . . . . . . . . . 201
Globetrotters Flying on Goodwill Tours . . . . . . . . . . . . . . . . . . . . . . . 202
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
27 Laying the Foundation for a ‘Trauma University’ . . . . . . . . . . . . . . 207
It Started as a One-Off Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
The Persistent Demand for Surgical Instruction . . . . . . . . . . . . . . . . . . 207
The Challenge of Managing a Growing Course Portfolio . . . . . . . . . . . 208
International Expansion of Courses . . . . . . . . . . . . . . . . . . . . . . . . . . 210
The Continued Value of AO Courses . . . . . . . . . . . . . . . . . . . . . . . . . 211
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
28 Publishing the AO Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Instructional Notes at the Beginning . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Manual as ‘Placeholder’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Scientific Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
29 Internationalizing the AO Organization . . . . . . . . . . . . . . . . . . . . . 221
From a Swiss to an International Base . . . . . . . . . . . . . . . . . . . . . . . . 221
The Italians Take the Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Austria and Germany Move Next . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Developing and Charter Local Chapters . . . . . . . . . . . . . . . . . . . . . . . 222
Formal Creation of AO International . . . . . . . . . . . . . . . . . . . . . . . . . 223
Conflict with Spain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Different Purpose for AO International . . . . . . . . . . . . . . . . . . . . . . . . 224
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
30 The Diverse Talents Shaping the AO . . . . . . . . . . . . . . . . . . . . . . . . 227
A Range of Talents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
The Different Professional Cultures Shaping AO Surgeons . . . . . . . . . 227
The Scientists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
The Metallurgists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
The Mechanical Designers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
The Entrepreneurs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Contents xvii

The Legal, Tax, and Financial Talent . . . . . . . . . . . . . . . . . . . . . . . . . 231

The Mix of Talents and Professional Cultures . . . . . . . . . . . . . . . . . . . 231
The Private and Personal Passions of the AO Founders . . . . . . . . . . . . 232
Officers and Gentlemen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
The Sports Enthusiasts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Aviators Among the AO Founders . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Love for Animals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
There Was Always Magic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
A Potent Mix of Professional Cultures and Passions . . . . . . . . . . . . . . 236
31 Summarizing Growth Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

Part III Navigating Turbulence

32 Changing of the Guard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
From Young Turks to Establishment . . . . . . . . . . . . . . . . . . . . . . . . . 241
Triggering Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
Second Generation Members Ask for a Bigger Role . . . . . . . . . . . . . . 243
Producers Raise Their Voices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
33 From Association to Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
The Association Format Had Outlived Its Purpose . . . . . . . . . . . . . . . . 245
Synthes AG Chur Shareholder Changes . . . . . . . . . . . . . . . . . . . . . . . 246
Creating a Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Formal Bodies of the AO Foundation . . . . . . . . . . . . . . . . . . . . . . . . . 248
Struggle for a Different Role for the Industrial Partners . . . . . . . . . . . . 248
Conflicts Emerge Again . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Surgeons Versus MBAs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Reflecting on the Struggle 15 Years Later . . . . . . . . . . . . . . . . . . . . . . 252
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
34 M&A Turbulence Among Producers: First There Were Three,
Then There Was Only One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
The Status of the Producer Base in 1985 . . . . . . . . . . . . . . . . . . . . . . . 253
Growth Continues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Management Buy-Out at Synthes USA . . . . . . . . . . . . . . . . . . . . . . . . 254
Fritz Straumann’s Unexpected Death . . . . . . . . . . . . . . . . . . . . . . . . . 255
Spinning Off the Implant Business . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
Legal Threats to German Market Position . . . . . . . . . . . . . . . . . . . . . . 257
Generational Change at Mathys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Synthes-Stratec Acquires Mathys . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
35 Changing Business Model: From Licensing Fees to Service
Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Initial Business Model to Fund the AO Foundation . . . . . . . . . . . . . . . 263
Crafting a New Agreement: CoSA—in 2006 . . . . . . . . . . . . . . . . . . . . 265
Monetizing the Instrumentarium Owned by Synthes . . . . . . . . . . . . . . 266
xviii Contents

36 From Compression Plates to Anatomically Shaped Internal

Fixators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Development of Less Invasive Surgical Techniques . . . . . . . . . . . . . . . 270
Development of New Plate Generations . . . . . . . . . . . . . . . . . . . . . . . 270
The Limited Contact Dynamic Compression Plate (LC-DCP) . . . . . . . . 271
The Introduction of the PC-Fix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
The Creation of the Less Invasive Stabilization System (LISS) . . . . . . . 272
The Locking Compression Plate (LCP) . . . . . . . . . . . . . . . . . . . . . . . . 273
Anatomically Shaped Plates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Development Achievements of the AO System Until 2005 . . . . . . . . . . 275
The Talent That Drove Implant Development at the AO . . . . . . . . . . . 275
From Instrumentarium Towards Instruments and Solutions . . . . . . . . . 277
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
37 From Eminence-Based to Evidence-Based Research . . . . . . . . . . . . 279
Retracing the Early AO Research Effort . . . . . . . . . . . . . . . . . . . . . . . 279
Focusing Research Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
The Orthogeriatrics Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Evidence-based Versus Eminence-based Research . . . . . . . . . . . . . . . . 283
The Classification Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
38 From Long Bones to All Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Starting Out with Adult Long Bones . . . . . . . . . . . . . . . . . . . . . . . . . 287
Invading the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Entering Craniomaxillofacial (CMF) Surgery . . . . . . . . . . . . . . . . . . . 288
Confronting Orthogeriatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Addressing Children’s Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
39 The Battle Over IP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
IP Issues from the Beginning of the AO . . . . . . . . . . . . . . . . . . . . . . . 293
Müller in the Role of Innovator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Müller in the Role of Chief Developer . . . . . . . . . . . . . . . . . . . . . . . . 295
Donating the IP to Synthes AG Chur and the AO . . . . . . . . . . . . . . . . 297
IP Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Issues with Patent Infringement and Imitators . . . . . . . . . . . . . . . . . . . 299
Patents Are Not the Only Way to Protect IP . . . . . . . . . . . . . . . . . . . . 299
Challenging AOIP Ownership Policy . . . . . . . . . . . . . . . . . . . . . . . . . 300
The 2006 Cooperation Agreement Triggered a Major Lawsuit . . . . . . . 300
Whose IP Is It Anyway? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
40 One Final Merger? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
One More Merger Announcement in 2011 . . . . . . . . . . . . . . . . . . . . . 303
The Developments That Brought Us to This Point . . . . . . . . . . . . . . . . 303
The Growth of Synthes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
Contents xix

Why Divest Synthes Ownership Now? . . . . . . . . . . . . . . . . . . . . . . . . 305

What Is J&J’s DePuy Division? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Impact of Synthes Sale on the AO Foundation . . . . . . . . . . . . . . . . . . 307
Evolution of the Synthes Business Base in Switzerland . . . . . . . . . . . . 309
41 Assessing How the AO Navigated Turbulences . . . . . . . . . . . . . . . . 313
Looking for Cruising Altitude Again . . . . . . . . . . . . . . . . . . . . . . . . . 313

Part IV The AO Foundation Today and Its Impact

42 The AO’s Many Achievements . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
43 The AO Organization in 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
The AO Center: The Tip of the Iceberg . . . . . . . . . . . . . . . . . . . . . . . 319
AO Foundation Organization Today . . . . . . . . . . . . . . . . . . . . . . . . . . 321
AO Foundation Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
The Emergence of the Clinical Divisions . . . . . . . . . . . . . . . . . . . . . . 325
AOTrauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
AOSpine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
AOCMF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
AOVET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
44 The AOTK System Today . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
The AOTK System Today . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Off-Ramp Project Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
45 AO Institutes: Research, CDID, ‘Trauma University,’ and a
Publishing House . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
The AO Foundation, Home to Several Institutes . . . . . . . . . . . . . . . . . 335
AO Research Institute (ARI) Today . . . . . . . . . . . . . . . . . . . . . . . . . . 335
The AO Clinical Investigation and Documentation Institute (AOCID) . . . 336
AO Education Institute: AO’s Own ‘Trauma University’ . . . . . . . . . . . 338
The AO as a ‘Trauma University’ . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
46 AO Innovating into New Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Never Rest on Your Laurels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
AONeuro as a Testing Ground . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
A Different Fate for AORecon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
AO Strategy Fund: Innovating Further Afield . . . . . . . . . . . . . . . . . . . 348
AO Incubator as Next Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
AO Invest for Start-Ups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
Finding Its Way Through the Innovation Space . . . . . . . . . . . . . . . . . . 349
47 AO Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
The Beginning: AO Social-Economic Committee . . . . . . . . . . . . . . . . 351
The Creation of the AO Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
xx Contents

48 Global Health-Economic Impact . . . . . . . . . . . . . . . . . . . . . . . . . . . 357

The Health-Economic Contribution . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Recent Study on Health-Economic Benefits: The Case for Switzerland . . . 359
Making the Case for Global Health-Economic Benefits . . . . . . . . . . . . 361
How About Monetizing Patient Benefits? . . . . . . . . . . . . . . . . . . . . . . 363
49 AO Industrial and Business Impact . . . . . . . . . . . . . . . . . . . . . . . . . 365
Creating a New Industry Sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
The AO-Inspired Industrial Cluster . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
The Global Impact of the Industrial Cluster . . . . . . . . . . . . . . . . . . . . . 366
The Regional Impact of AO and Synthes in Switzerland . . . . . . . . . . . 367
Expanding the Circle: Indirect Industry Impact from AO . . . . . . . . . . . 368
Straumann Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Medartis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Mathys Orthopedics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Thommen Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Drawing a Still Wider Circle by Inspiring a Supply Base . . . . . . . . . . . 373
Appreciating the Industrial Contribution of AO Foundation and Industrial
Partners for Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
50 AO as Creator of Wealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
The Different Forms of Wealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
AO as Creator of Personal Financial Wealth . . . . . . . . . . . . . . . . . . . . 375
The Mathys Family, Continuing in Medical Technology . . . . . . . . . . . 376
The Straumann Family, Enterprising Tradition . . . . . . . . . . . . . . . . . . 376
Rudolf Maag, Stratec Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Hansjörg Wyss, Building Synthes . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Investor Wealth Creation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
AO Endowment as Institutional Wealth . . . . . . . . . . . . . . . . . . . . . . . 378
Social Wealth Created by the AO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
And How About the Surgeons? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
And How About Patient Wealth? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
51 AO as a Philanthropic Force . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Philanthropy or Business? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
AO as Volunteer Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Founders Providing Seed Capital for the AO Organization . . . . . . . . . . 382
Founders Donating Intellectual Capital through Synthes AG Chur . . . . 382
Sponsoring the New AO Center Building in Davos . . . . . . . . . . . . . . . 383
External Philanthropic Activities Related to the AO . . . . . . . . . . . . . . . 384
Maurice Müller and His Family’s Philanthropy . . . . . . . . . . . . . . . . . . 384
The Creation of the RMS Foundation . . . . . . . . . . . . . . . . . . . . . . . . . 386
Hansjörg Wyss and the Wyss Foundation . . . . . . . . . . . . . . . . . . . . . . 387
52 The World Honors AO Foundation and Founders . . . . . . . . . . . . . 391
The Medical World Begins to Take Notice . . . . . . . . . . . . . . . . . . . . . 391
Appointments to Larger Medical Institutions . . . . . . . . . . . . . . . . . . . . 391
Contents xxi

Academic Honors for AO Surgeons . . . . . . . . . . . . . . . . . . . . . . . . . . 392

Honors for the Scientific Members of the AO . . . . . . . . . . . . . . . . . . . 392
Honors and Recognitions for AO Industrial Partners
and Entrepreneurs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Two Exceptional Honors for AO Founders . . . . . . . . . . . . . . . . . . . . . 393
Recognition by Society at Large? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394

Part V Conclusion
53 Mission Accomplished? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Did the AO Accomplish Its Mission? . . . . . . . . . . . . . . . . . . . . . . . . . 397
54 Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Does the AO Represent a Unique Case? . . . . . . . . . . . . . . . . . . . . . . . 399
Could It Be Done Again Today? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Is the Job of the AO “Done”? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
What Will the Future Hold for the AO as an Organization? . . . . . . . . . 400
About the Author

Jean-Pierre Jeannet served on the faculty of Babson

College, USA (1974–2013), where he last held the FW
Olin Distinguished Professorship, while simultaneously
serving on a joint appointment at the IMD Institute,
Switzerland (1981–2010). His teaching and research
focused on marketing, strategy, and globalization. He
holds the title of Professor Emeritus from both Babson
College and the IMD Institute.
He was a frequent consultant in management devel-
opment and strategic development with companies in
Europe, North and South America, and Asia. His con-
sulting practice spanned many industry sectors and
included multiple assignments in the healthcare and
life science industries.
Professor Jeannet is the author or coauthor of a
number of books, including Managing with a Global
Mindset, Global Marketing Strategies, Global Account
Management, and From Coal to Biotech: The Transfor-
mation of DSM with Business School Support.

xxiii
List of Interviewees

The Surgeons
Max Aebi, Switzerland
Janine and Ueli Aebi-Müller, Switzerland (Maurice E. Müller family)
Suthorn Bavonratanavech, Thailand (President 2014–2016)
Michael Blauth, Austria
Chris Colton, UK (President 1996–1998)
Reinhold Ganz, Switzerland
Christian Gerber, Switzerland
Norbert Haas, Germany (President 2010–2012)
David Helfet, US
James Kellam, US (President 2004–2006)
Paul Manson, US (President 2008–2010)
Peter Matter, Switzerland (President 2000–2002)
Robert McGuire, US (President 2018–2020)
Joachim Prein, Switzerland
Jaime Quintero, Columbia (President 2012–2014)
Nikolaus Renner, Switzerland (President 2016–2018)
Thomas Ruedi, Switzerland
Joseph Schatzker, Canada (President 1998–2000)
Theddy Slongo, Switzerland
Marvin Tile, Canada (President 1992–1994)
Chris van der Werken, Netherlands (President 2006–2008)

The Veterinarians
Jörg Auer, Switzerland
Jean-Pierre Cabassu, France
Gerhilde Kása, Germany
Brigitte von Rechenberg, Switzerland

The Scientists & Developers

Robert Frigg, Switzerland
Stephan Perren, Switzerland
Ortrun Pohler, Switzerland

xxv
xxvi List of Interviewees

Entrepreneurs and Managers

Fritz Fahrni, Switzerland, ex. Sulzer/Balgrist
Amos Gazit, Distributor, Israel
Jim Gerry, US, retired, Synthes
Jürg Oehy, Switzerland, ZimmerBiomet,
Robert Mathys, Jr., Switzerland, RMS Foundation
Ciro Römer, DPS, USA
Felix Scherrer, Switzerland, ex. Sulzer
Thomas Straumann, Switzerland, Straumann Dental
Hansjörg Wyss, Switzerland, retired, Synthes
Sven Zybell, DPS, Switzerland

AO Executive and Administrative Staff

Claas Albers
Andreas Fäh
Claudio Gubser (retired)
Beate Hanson (ex AO)
Tobias Hüttl
Urs Jann (retired)
Margrit Jaques (retired)
Rolf Jeker
Alexander Joeris
Urban Langer
Christoph Nötzli
Markus Rauh (retired)
Geoffrey Richards
Urs Rüetschi
Stephan Zeiter

The Legal & Financial Experts

Georg Messmer (Curia, retired)
Andrea von Rechenberg (Curia)
Urs Weber (Wenger & Vieli)
Jean-Claude Wenger (retired, Wenger & Vieli)
Prologue: Orchestrating A Cast
of Thousands 1

Davos, Early on a December Morning

A curious sight can be observed early on a December morning in the mountain resort
town of Davos, Switzerland. There, on a typical workday before the sun rises above
the peak of Pischahorn, and with the street noise muffled by fresh snow, one can see
a stream of people walking the streets, all in the same direction. The crowd is much
larger than one would expect at this hour, especially in a resort town. These people
are not dressed to go skiing or hiking; instead they are wearing comfortable sports
clothes, dressed warmly enough for the typical cool mountain air of the season. This
stream of humanity, coming out of the various hotels, appear wholly unconnected to
all the snow that covers the ground. Instead of skis, they are equipped with computer
shoulder bags, books, and folders. These men and women give the impression of
young professionals and are, apparently, from all over the world. What are all of
these hundreds of people doing in the middle of the Swiss Alps, in winter, if not to go
skiing? (Exhibit 1.1)
Following the crowd, along where the stream swells, the people start to head
toward the Davos Congress Center, flags draped all over its entrance and giving way
to the purpose of this early congregation. This is an annual meeting of the AO
Foundation’s Davos Courses (AO stands for Association pour l’Ostéosynthèse in
French; Arbeitsgemeinschaft für Osteosynthesefragen in German; Association of
Osteosynthesis in English), which is held each December to expose yet another
generation of early and mid-career surgeons to the principles of bone trauma care
and related injuries, known the world over as Osteosynthesis. Before the sun rises
(which happens in the winter sometime after 08:00), the nearly 1000 participants and
instructors split into groups, review bone fractures, discuss surgical approaches,
learn from experienced colleagues, and become experts at treating bone trauma for
patients anywhere in the world applying Osteosynthesis techniques. Bending over
artificial models of limbs, skilled and experienced surgeons will teach their younger
colleagues how to place sophisticated implants to join broken bones, how to apply

# Springer Nature Switzerland AG 2019 1

J.-P. Jeannet, Leading a Surgical Revolution,
https://doi.org/10.1007/978-3-030-01980-8_1
2 1 Prologue: Orchestrating A Cast of Thousands

Exhibit 1.1 Davos, Winter. Copyright by AO Foundation, Switzerland

screws to keep them in place, and how to use specially-designed surgical instruments
to achieve the best results for patients. The participants will stay inside the confer-
ence center, huddled over their simulated operations and bone injuries, until late in
the afternoon. By the time they leave the Conference Center, the sun has disappeared
and the Davos sky begins to sparkle, the stars becoming clearly visible. This routine
will be repeated for the next four days (Exhibit 1.2).
This sight has repeated itself every year since 1960, and over these almost
60 years about 65,000 surgeons and several thousand operating personnel have
graduated from the Davos program, becoming skilled at applying the medical
technology of Osteosynthesis to bone trauma (not including the approximately
600,000 surgeons outside of Switzerland who have participated in similar courses)
(Exhibit 1.3).

Davos Hospital, on a December Morning

Shortly after 07:00, a team of about a dozen surgical staff assembles in the Davos
Hospital to man the three operating theaters, each equipped with state-of-the-art
instrumentation. They ready the various stations for patient intake, take inventory of
medical supplies, and check sterilization stations, as well as the X-ray and anesthesia
equipment needed for the operations. Promptly, at the pre-scheduled time, patients
are wheeled into the operating area: they are received, transferred to an operating
bed, checked, infused, provided with the necessary anesthesia, and moved over into
the operating theater where a team of five professionals are ready to perform a
demanding procedure—requiring either the application of a fracture fixation, or
Davos Hospital, on a December Morning 3

Exhibit 1.2 Davos Conference Center with AO Banner. Copyright by AO Foundation,

Switzerland

Exhibit 1.3 A Davos course. Copyright by AO Foundation, Switzerland

4 1 Prologue: Orchestrating A Cast of Thousands

sometimes the removal of a metal implant that had been put in about a year earlier—
following a complicated fracture, such as of a lower leg or tibia.
The surgeon in charge, helped by an assistant, an operating nurse, and the support
staff for anesthesia, X-ray, and supplies, goes over the procedure using medical
terminology not always easily understood by laymen. Dr. med. Nikolaus Renner
explains:

The patient, having suffered a trauma to the proximal lateral tibia (fracture to the lower leg),
had been originally treated with small cortical screws for inter-fractional compression,
bridged using a LISS PLT Less Invasive Stabilization Plate with Self Tapping Locking
Screws (5.0), and appeared ready for the removal of these implants as the fracture has
sufficiently healed.1

The procedure for removing the plate and screws takes a good hour. The approach
of applying these implants at the time of fracture, and their subsequent removal, are
the same as those exercised each year by the surgeons in the Davos Conference
Center. Today’s procedure called for a removal of an implant. At another time, the
operation might be implantations needed as a result of a fresh bone trauma (Exhibit
1.4).
Elsewhere, on this same December day, hundreds, if not thousands of patients
with bone fractures or trauma will be wheeled into operating arenas all over the
world. On any given day, thousands of interventions are carried out in line with the
procedures taught and practiced in the courses offered in Davos. They may include
bone trauma, or trauma to the spine, skull, or face. In a typical year at New York–
Presbyterian Hospital, some 37,000 Orthopedic and trauma operations are
conducted, with about 8000 being in the area of trauma alone—more than 20 per
day.2
Some of these procedures may be optional, or elective, and yet still contribute
significantly to the improvement of patients’ lives. Other procedures may be the
result of accidents and are actually life-saving. In all cases, however, patients are
treated by highly-skilled teams, specializing in different areas of medicine, ranging
from surgery and anesthesia to X-ray technology; each of these professionals is
focused on contributing to an optimal outcome for their patients.
Whatever the procedure, surgeons and their skilled operating room staffs will rely
on implants, plates, screws, and surgical instruments produced specifically for a
given purpose and situation. Supporting these surgical teams, and invisible to
patients, is a large support staff ensuring that the correct implant is delivered at the
right time, to the right place, and for the right patient. Every day, thousands of
specialists travel to hospitals in order to engage with surgical teams and assure
optimal patient outcomes.

1
Dr. med. Nikolaus Renner, President of the AO Foundation Board, 2016–2018, and Head of
Trauma Surgery at Aarau Cantonal Hospital, Switzerland, reviewing the X-rays.
2
Source: Dr. David Helfet, Chief Emeritus, Orthopedic Trauma Service, New York–Presbyterian
Hospital, 4 December 2017.
Solothurn, Switzerland, on the Same December Morning 5

Exhibit 1.4 X-ray of patient for implant removal, Davos Hospital. By Permission Davos Regional
Hospital, Switzerland

Solothurn, Switzerland, on the Same December Morning

At the same time that the scores of surgeons congregate in Davos to learn how to
apply sophisticated medical implants on trauma patients to perform Osteosynthesis,
a related and not dissimilar movement is taking place in Western Switzerland.
6 1 Prologue: Orchestrating A Cast of Thousands

Looking down from the hills above Solothurn—the capital city of the Swiss Canton
bearing the same name—one can see the busy movements of cars, trains, and other
transport vehicles going toward a number of factories dotted along the Jura mountain
range. Again, it is early morning and the lights of the moving cars and buses are
clearly visible, creating, a long line, hemmed in between the Jura mountain chain to
the West and the River Aare to the East. In this line of vehicles sit thousands of
highly-skilled workers, machinists, engineers, and medical technology experts going
to the many factories that, in this region, have created a competence center for the
production of medical implants needed for Osteosynthesis—an industry, which
supports the surgeries that the teams are performing in Davos, and that the young
surgeons are learning about.
In the factories located around the city of Solothurn, as well as in smaller towns
beyond the MedTech community, with little-known names such as Zuchwil,
Bellach, Bettlach, Grenchen, and Lengnau, a workforce of several thousand are
machining metal and titanium parts to exacting specifications, using highly-
sophisticated machinery. These enterprises reach up and down along the Jura
mountain range, even reaching into the neighboring Canton of Basel-Landschaft,
or Basel-Land. The factories have names such as DPS Synthes, Mathys, and Stryker,
among others. They manufacture surgical implants and instruments that are so
demanding to produce only the most skilled workers will succeed. Their workforces
produce these items with sophisticated machinery, titanium steel, LISS PLT plates
and the required screws, such as the one implanted in the patient at the Davos
Hospital. While the majority of these efforts is concentrated in the Solothurn region,
these same companies maintain operations in other parts of the world where, again,
thousands of employees machine implants to the most precise of specifications.
The workers, factories, and companies in charge of this industrial effort have been
involved in this effort since the early 1960s. When arriving at their workplace for the
first morning shift on this early December day, it is still dark outside. When the
second shift returns home at the end of their workday, it’s dark again. Without the
daily contributions of this dedicated workforce, none of the operational procedures
supporting Osteosynthesis, the method being taught in Davos, would be possible.

Who Orchestrates This Cast of Thousands?

The thousands of surgeons training in Davos, the thousands of workers streaming

towards the factories in the Solothurn area, and the thousands of patients seeking
treatment for their bone trauma in hospitals around the world are not random or
unrelated. The genius behind these activities is not a governmental, or any other,
official body. Instead, this cast of thousands is being orchestrated through the effort
of a private, non-governmental organization, known today by the abbreviation of
AO (which has since taken the legal form of a foundation). It was originally inspired
by a small team of surgeons who came together in Switzerland as colleagues in 1958
and took on the mission to revolutionize the treatment of bone fractures and improve
the life of patients around the world. Through the creation of a fraternity of
Another random document with
no related content on Scribd:
 The wooden slipway and the cradle supports had caught fire and
had been destroyed, and this I was told had caused the keel to
break, so that the hull was now but a derelict mass of steelwork
which could never be floated.

To advance through this jungle called for all the cool, disciplined courage of the
Italian soldier (see page 293)
To face page 298

Had it not been for the satisfaction one felt in gazing on the ruins
of a prospective addition to the Mercantile Navy of the enemy, this
leviathan of wasted industry and material would have appeared quite
tragic.
The companion-way used by the workmen was still in position, so
we clambered up into the gloomy interior and had a walk round, our
footsteps echoing mournfully along the cavernous emptiness of the
decks.
Through a port-hole we got a very fine view of the Carso and the
Italian and Austrian positions in between Monfalcone and Duino;
whilst in the distance, some fifteen miles away, one could distinctly
see with the glasses the white buildings of Trieste, so near and yet
so far!
There was evidently a big fight going on at that moment in the
direction of a hill not far away from Monfalcone, known as No. 144,
which had been frequently referred to in the communiqués, and you
could see the bursting shells and hear the booming of the guns.
It was a panorama of soul-stirring interest, and one could have
spent hours gazing on it; but time was flying and we had to be
thinking of returning.
I had not attached much credence to the statement that the
Austrians had established a sort of precedent as to time with regard
to opening fire every day, but out of curiosity I glanced at my watch
as we started back.
It may have been a mere coincidence, but it was just on eleven
o’clock. Beyond, however, the dull booming of the guns in the
direction of Hill No. 144, there was no sign yet of artillery activity
anywhere near Monfalcone.
We had crossed the pontoon bridge and were making our way
along the canal bank when there was the report of a gun not very far
away in the enemy’s lines, and the screech of a shell passing over
our heads proved beyond a doubt that the “Daily Strafe” was about
to commence.
The shell burst on the outskirts of the town and in the direction in
which we were going. My companion, who was walking on ahead,
called out jocularly that we should be “just in time.”
From now the firing increased every minute, and it seemed to me
that the sole objective of the Austrian gunners was the place where
we had left our car.
We met several groups of soldiers as we went along, and I noticed
that if a shell happened to be coming over just then, the majority of
the men always stopped and crouched down against the protecting
wall of the trench.
 This prompted my asking my companion what he considered to be
the best thing to do when under fire. “Take no notice of it,” was his
laconic reply.
In Monfalcone the streets were nearly deserted, though whether in
consequence of the shelling commencing or some other cause, I
could not tell; anyhow, as there was nothing further to see that day
we returned to Udine “in time for lunch.”
A couple of days later I was back again on the Carso. A big attack
on the Austrian positions at Veliki Hribach, near Doberdo, having
suddenly developed.
Difficulties had to be surmounted here which were totally different
to any previously encountered, as the offensive was made through
close-growing woodland.
An important sector of the Carso district to the north of Trieste
consists of wooded country, and directly bars the Italian advance in
that region. The ground in question was artificially planted by the
Austrian Government some years ago under a scheme to reclaim
the Carso and convert it into forest tracts.
Plantations of fir trees were laid out over a large area, and these
are now grown into the woods, which present a very serious obstacle
to the Italians.
Sheltered by the almost impenetrable cover which the dense
growth of immature trees offers, the Austrians had constructed
Torres-Vedras-like series of fortified positions among the trees along
the ridges that intersect the district. In the Veliki Hribach stretch of
woods alone no fewer than eleven formidable lines of trenches have
been captured.
The trees are of too young growth to stop bullets; and hidden in
their trenches the Austrians could sweep the approaches at ground
level, lying low behind abattis and a mass of wire entanglements.
The whole aspect of the country here reminded me strangely of
parts of the West Australian “bush,” with, of course, the exception
that these are fir trees.
 Still, there was so much resemblance that it would have been as
easy to lose oneself here in the dense growth as it is in the “bush.”
To advance through this jungle called for all the cool disciplined
courage of the Italian soldier. There was no opportunity for a wild
headlong assault on the Austrian trenches; they had to be virtually
“stalked,” as the cover afforded by the saplings was so illusory as to
give practically no protection at all.
The wood in which I made my sketch had been “blazed”
beforehand by a handful of the most daring spirits among the men;
not by “barking” the trees, which would have taken too long, but by
means of whitened stones dropped on the ground at intervals to
indicate the direction the troops were to follow.
The capture of the Veliki Hribach position proved that the Italian
soldier can be relied on under any circumstances, however trying.
The day following the offensive developed in the direction of Nova
Vas, about a mile and a half east of Doberdo, on the heights of San
Grado di Merna, and near Lokvica, with continued success for the
Italians.
The fighting for the position at Nova Vas on September 15th in
particular ended in so dramatic a fashion that it will long be
remembered by all who witnessed it.
After a furious preparatory bombardment for hours by the Italian
heavy guns, to which the Austrians replied vigorously, there was a
sudden cessation of the Italian fire.
The crisis had come: the infantry were to attack. But while waiting
word from elsewhere, there was a brief pause.
Next, suddenly, to the general amazement, within six minutes of
the guns ceasing, one saw hundreds of men abandoning the
Austrian front trenches. They held up their hands and waved
handkerchiefs wildly in token of surrender.
Out they poured, like driven rats stampeded by terriers from a
barn. They came racing across the stretch of “No man’s land”
between the opposing trenches, straight for the Italians, taking their
chance amidst the Austrian shells, still falling briskly.
The spectacular effect of the grey-coated figures, without arms or
accoutrements, running towards them, hands up, and frantically
shouting “Kamerad! Kamerad!” was startlingly dramatic.
The Italian soldiers were so amazed at the sight that, regardless of
the risk of exposing themselves, they showed themselves over their
own parapets and stood gazing at what was taking place.
In all, 2,117 Austrian prisoners mere made that day, including 71
officers.
Torrential rain set in during the night, and the captured trenches
were found to be in so complete a state of ruin and afforded so little
shelter that the troops were brought back to their original positions.
After this offensive the weather showed unmistakable signs of
breaking up; bitterly cold winds with heavy rains every day put a stop
to all military movements of any importance. Although it is certain
that no weather, however bad, will entirely arrest the activity of
General Cadorna for even 24 hours, it was apparent, however, that
the resumption of operations on anything like a big scale would have
to be suspended bon gré mal gré till the early spring.
To spend the winter in Udine, therefore, presented no particular
attraction for me, so I decided to return to London and there await
events, in readiness to go back if necessary at a moment’s notice.
It was certainly with regret that I was leaving the Italian Front, for I
had spent many glorious days with King Victor Emmanuel’s heroic
soldiers, but my regret was softened by the thought that I should
soon be returning to assist at the final victory.
 INDEX

ADIGE, RIVER, 99, 100, 151

Ala, 100
Allessi, Rino, 200
Alpini, the, 41, 42, 43, 45, 49, 75, 85, 86, 105, 121-126, 138, 140,
184, 185
Altopiano, Tableland of, 157, 165
Aosta, Duke of, 238
Aquileia, 144, 145
Arci, Signor, 196
Arsiero, 152, 156, 157, 159, 163, 184
Asiago, 152, 168, 169, 178
Astico, valley of, 157
Austrians, the;
withdraw across the Indrio, 37, 38;
defence at Monte Nero, 40-43;
advance in the Trentino, 151-156;
advance in the Asiago region, 163;
retire from Gorizia, 209-234;
characteristics of, 262, 263, 269
Avostaunis, 121

BACCI, BACCIO, 64, 240, 246, 249

Baldassarre, Signor, 63
Barbarich, Colonel, 153, 276-283
Barzilai, Signor, 63
Barzini, Luigi, 27, 29, 64, 210, 217, 223, 232
Basset, Serge, 65
Bauderesque, M., 65
Beak, Vice-Consul, 20
Beaumont, M., 145
Bedolo, Gino Calza, 65, 66, 104, 119
Belcredi, M., 68
Belluno, 15, 103, 115, 117
Belvedere, 145
Benedetti, M., 163
Berchtold, Count, 3
Bersaglieri, the, 75, 231-238
Berthod, Dr., 33, 132
Bissolati, Leonida, 196, 203-222
Bitetti, M., 240-246
Bologna, 15
Bormio, 79, 80, 82, 92
Boulogne, 46
Brazzano, 133, 134
Brenta, River, 151
Brescia, 15, 64, 67, 68, 71, 72, 78, 97
Brioni, Monte, 78

CADORNA, GENERAL, 15, 37, 44, 97, 98, 135, 137, 149, 150,
152, 158, 163, 179, 183, 189, 237, 238, 255, 256, 281, 282,
 283, 285, 295
Cadorre, 135
Cafarelli, General, 58, 132
Cantalupo Roberto, 189
Capello, General, 190, 196, 203-205
Caporetto, 37, 133, 136, 139
Caprili, 109
Carabinieri, the, 166, 175, 230, 231
Carnia, 135
Carniola, 140
Carrère, Jean, 64, 68
Carso, Operations on the, 134, 141, 143, 196, 196, 223, 239, 240,
255-266, 270, 271, 273, 275, 285, 291, 292
Castalleto, the, 184
Censorship, the Italian, 15, 66, 67, 71, 72, 126, 153, 154, 155,
185, 209, 276, 282
Cenzio, M., 157
Cervignano, 37, 133, 144, 286
Chamonix, 81
Chizzola, 101
Cimone, Mont., 157, 184, 185
Croda, Rosso, 116
Civiedale, 133, 143
Clericetti, Colonel, 156, 199, 209
Col dei Bos, 184
Col di Lana, 105, 106, 107, 108, 117
Colfreddo, 116
Cortina d’Ampezzo, 105, 115, 116, 117
Cormons, 37, 38, 39, 133, 134, 135, 136, 191, 200
Corrada, Monte, 44
Cosich, Monte, 259, 261
Cox, Harold 239
Cristallo, Monte, 103, 116, 197
Cure, Capel, 63

DAILY CHRONICLE, THE, 65

Daily Mail, The, 65
Daily News, The, 65
Daily Telegraph, The, 65
Desenzano, 78
Doberdo, 258, 260, 262, 263, 264, 266, 292, 293
Dolomites, The, 104, 115
Donohoe, Martin, 65
Duino, 291

ELIA, GENERAL, 16

FALZAREGO PASS, 105

Fiera di Primero, 103
Florence, 59, 60, 63
Fogazzaro, Antonio, 159
Fogliano, 258, 259
Folkestone, 4
Forcola, The, 81, 85, 86, 88, 89, 90, 92
Fraccaroli, Arnaldo, 64, 243, 246
Freikoffel, The, 118, 121
Friuli, Plain of, 20, 38, 132, 134

GALLIO, FOREST OF, 165, 166

Garda, Lake of, 73, 76, 77, 78, 151
Garibaldi, Peppino, 22
Gemona, 118, 126, 127, 131
Germany, Italy declares war on, 281
Gobi Desert, The, 270
Gorizia, Italian attack on, 44, 134, 150, 154, 190, 200, 203;
capture of bridgehead, 199, 200;
capture of city, 209-234, 237-240;
the city after capture, 242-250, 255, 256, 270, 281, 284, 285
Gradisca, 44, 142, 144, 240, 256
Grado, 144, 145, 276
Grafenberg, 215, 216, 241, 242, 249
Giudicaria, Valley of, 73

IDRO, LAKE, 79
Illustrated London News, The, 1, 65
Indrio, River, 37
Ingram, Charles, 3, 4, 152
Interrotto, Monte, 167, 171
Isonzo, River, Operations on the, 42, 72, 74, 131-146, 186, 210-
215, 250, 251, 257, 270, 282
Italian Army, The, impressions of, 38, 39, 50, 51, 76, 122, 123,
124, 258, 259, 269;
crosses the Indrio, 37;
 attacks Monte Nero, 40-43;
storms Monte Cristallo, 116;
counter-offensive in the Trentino, 183;
begins attack on Gorizia, 189-192, 195;
captures bridge-head, 199-205;
captures city, 209-234
Italy, War Fever in, 3, 4;
declares war on Austria, 9;
declares war on Germany, 281, 284

JEFFRIES, J. M. N., 65, 119

KUK, MONTE, 134

LAMB, COLONEL, 54
Livinallongo Pass, 105
Lokvica, 293
London, Jack, 270
Lucinico, 210, 211

MACCHIO, BARON VON, 9

McClure, W. K., 65, 68
Marazzi, General, 200, 201, 214, 233
Marmolada, Monte, 104
Massey, W. T., 63
Medea, 37
Miceli, Giovanni, 64, 201
Milan, 79, 153
Molinari, Aldo, 64, 67, 119
Monfalcone, 44, 133, 189, 286-292
Montecroce, 118
Morning Post, The, 65
Mossa, 200, 201

NATHAN, LIEUTENANT, 136

Nero, Monte, 40, 41, 42, 43, 137, 138
Northcliffe, Lord, 239
Novara, 57
Nova Vas, 260, 293, 294

OPPACHIASELLA, 261, 271

Oyetti, Ugo, 216

PADUA, 15
Pal Grande, 118-125
Palmanova, 141, 142, 271, 286
Pal Piccolo, 118, 119
Paluzza, 118
Paris, 4, 6
Pavia, Mayor of, 237
Pilcante, 101
Piva, Gino, 64, 189
Plava, 44, 137
Podgora, 134, 197, 212, 216, 217, 241
Porro, General, 66
Pozzachio, Fort, 99
Prade, Georges, 65
QUARIN, MONT, 134
Quirino, Mont, 37

RANCIO, 123
Rateau, Jules, 65, 79, 86, 88, 92
Redipuglia, 259
Rheims, 288
Riva, 76, 77
Romans, 271
Rome, 9, 10, 11
Rombon, Monte, 140, 141
Ronchi, 286
Roveretto, 99, 101, 151

SABOTTINA, MONTE, 134, 190, 191, 192, 196, 197

Sagrado, 44, 240, 249, 256, 257, 258, 265, 271
San Daniele, Monte, 219
San Floriano, 204
San Gabriele, Mont, 44, 197, 211, 215, 219
San Grado di Merna, 293
San Michele, Mont, 143, 190, 197, 239, 240, 249, 250, 256, 273
San Pietro, 44
Santa Luccia, 44
San Marco, 44
Santa Maria, 44
Santo, Monte, 134, 211, 215, 219
Sdraussina, 249, 250
Savogna, 141, 249
Schluderbach, Valley of, 116, 117
Smith, Ernest, 65
Stelvio Pass, The, 73, 79, 81
Stivo, Hills, The, 101
Subida, 135
Svinjak, 140

TERNOVA, 133, 134

Terzo, 37, 133
Timau, Monte, 118, 121
Times, The, 65
Tofana, 116
Tolmezzo, 118
Tolmino, 38, 40, 136, 137, 141
Trent, 98
Trentino, the Operations in, 97, 114, 135, 151, 155, 183, 184, 189
Trieste, 255, 269, 290, 292
Turin, 7
Tyrol, Austrian, The, 89

UDINE, 15, 20, 21-33, 37, 39, 42, 43, 49, 50-59, 131, 133, 141,
146, 153, 154, 156, 186, 186, 187, 188, 190, 199, 205, 238,
242, 251, 266, 276, 277, 281, 282, 282, 286, 292

VAL SUGANA, 151

Valtellino, Valley of, 79
Vaucher, Robert, 65, 271, 276
Veliki, Hribach, 292, 293
Venadoro, 115, 117
Venetia, 114
Venice, 15, 16, 17, 23
Venzone, 118
Verona, 15, 72, 97, 98
Vicenza, 15, 103, 155, 156
Victor Emmanuel, King, 49, 50, 295
Vipulzano, 190, 197, 202
Vitry-le-Francois, 142

WARREN, WHITNEY, 239

Wells, H. G., 239
Weillschott, Captain, 153
Women carrying barbed wire, 118

ZEBIO, MONTE, 167

TRANSCRIBER’S NOTE
Obvious typographical errors and punctuation errors have been corrected after
careful comparison with other occurrences within the text and consultation of
external sources.
Some hyphens in words have been silently removed, some added, when a
predominant preference was found in the original book. Some missing —
(mdash) separators have been inserted in the Table of Contents.
Except for those changes noted below, all misspellings in the text, and
inconsistent or archaic usage, have been retained.
Table of Contents:
Pg xii: ‘Descenzano’ replaced by ‘Desenzano’.
Pg xiii: ‘305mn. guns’ replaced by ‘305mm. guns’.
Pg xvi: ‘The battlefiield’ replaced by ‘The battlefield’.
Pg xviii: ‘Francesco Guiseppi’ replaced by ‘Francesco Guiseppe’.
Pg xxiv: ‘298’ replaced by ‘270’.

Main text:
Pg 17: ‘of Venetain life’ replaced by ‘of Venetian life’.
Pg 74: ‘unbelieveable that’ replaced by ‘unbelievable that’.
Pg 80: ‘the aclivity was’ replaced by the ‘acclivity was’.
Pg 89: ‘Brobdignagian cliff’ replaced by ‘Brobdingnagian cliff’.
Pg 93: ‘Asti Spamanti’ replaced by ‘Asti Spumante’.
Pg 116: ‘Falzarrego Pass’ replaced by ‘Falzarego Pass’.
Pg 120: ‘incessant fusilade’ replaced by ‘incessant fusillade’.
Pg 125: ‘constant fusilade’ replaced by ‘constant fusillade’.
Pg 126: ‘military tattoo’ replaced by ‘military tatoo’.
Pg 138: ‘retrogade direction’ replaced by ‘retrograde direction’.
Pg 139: ‘a spec of grit’ replaced by ‘a speck of grit’.
Pg 140: ‘Rombon and Svenjak’ replaced by ‘Rombon and Svinjak’.
Pg 149: ‘to develope it’ replaced by ‘to develop it’.
Pg 155: ‘the newpsaper line’ replaced by ‘the newspaper line’.
Pg 157: ‘of the Altepiano’ replaced by ‘of the Altopiano’.
Pg 157: ‘about if from’ replaced by ‘about it from’.
Pg 165: ‘the Altepiano beyond’ replaced by ‘the Altopiano beyond’.
Pg 207: ‘Francesco Guiseppi’ replaced by ‘Francesco Guiseppe’.
Pg 222: ‘Signor Bisolati’ replaced by ‘Signor Bissolati’.
Pg 233: ‘advisd use not’ replaced by ‘advised us not’.
Pg 261: ‘Monte Cossich’ replaced by ‘Monte Cosich’.

Index:
Pg 297: ‘Altepiano, Tableland’ replaced by ‘Altopiano, Tableland’.
Pg 297: ‘Bersagheri, the’ replaced by ‘Bersaglieri, the’.
Pg 298: ‘Descenzano’ replaced by ‘Desenzano’.
Pg 299: ‘Monte Cristello’ replaced by ‘Monte Cristallo’.
Pg 300: ‘Svenjak’ replaced by ‘Svinjak’.
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