Many of the new members of the Order of Canada may not be known to you, but each has made a significant contribution to Canadian society. Dr. Joseph Schatzker is no exception. Instrumental in developing a revolutionary technique for treating bone fractures, he has played a crucial role in bringing this technique to North America. The story of his success is one of serendipity. While completing his residency in the orthopedic program at U of T, Schatzker was one of the few German speakers in the department, and so was asked to accompany visiting professor Maurice Mueller around Toronto as translator and tour guide.
“It was a marvelous week; it opened my eyes to a great many things,” says Schatzker. “There was a whole world of orthopaedics that we knew very little about and certainly held immense promise.” The young Schatzker was about to embark on a year-long fellowship overseas. Inspired by the sense of promise that the older doctor instilled, Schatzker asked Mueller if he could spend the fellowship with him in Switzerland.
His first task upon arrival was to translate a textbook on new principles and techniques for early surgical treatment of fractures by means of internal fixation. In order to properly understand the concepts he was translating, Schatzker was invited to participate in its development, with Mueller as his mentor.
The Manual of Internal Fixation opened the Swiss AO group to the English-speaking world, spurring controversy in orthopedic surgery. Traditional techniques for treating bone fractures had involved setting the bone in a cast, or placing the patient in traction for up to four months. Surgery wasn’t considered until all other avenues had failed, or if complications were too serious for non-surgical methods.
The new technique, called the “AO method” after the pioneering Swiss internal fixation association (the Arbeitsgemeinschaft fuer Osteosynthese Fragen), uses more assertive surgical techniques. Surgeons implant plates, nails or screws into the injured bone, stabilizing it while allowing the patient to regain mobility. Being mobile soon after the injury is imperative, not just for patient comfort, but also for preventing muscle and cartilage wasting and joint stiffness. Most importantly, it allows patients to be dismissed from hospital after only 10 days.
Although it is now clear that the AO method is more successful than previous methods, at the time, older surgeons were not eager to learn dramatically different techniques or change their conceptions about fracture healing. As a champion of change, Schatzker says he was “looked upon as a sort of maverick.” Since the AO method failed to garner praise from the old guard, Schatzker appealed to younger surgeons. He began speaking at conferences throughout North America, surrounded by a crowd of enthusiastic doctors with questions about the new technique.
In addition to spreading the word, Schatzker demonstrated the new method on patients. Many orthopedic surgeons had patients whose injuries just wouldn’t heal, or were complicated by infection. Schatzker offered to take these patients on, and after two years was able to present over 40 cases healed using the AO method. The tides eventually turned, and Schatzker received recognition as more surgeons adopted the method.
His appointment to the Order of Canada came as a great surprise. When he received the call from the Governor General’s office, his first thought was, “What on earth have I done?” His surprise quickly changed to happiness. “It was a very happy day; not only for me, but for my family.” The Order, which began as a commemoration of Canada’s centennial in 1967, honours Canadians whose lifetime achievements have made a difference to Canada.
While the AO method has revolutionized orthopaedic surgery, improved the quality of patients’ lives, and saved many others, Dr Schatzker recognizes the existing hurdles. Many challenges remain, especially in treating osteoporotic bone in elderly patients and with healing large gaps in bone. He expects that new advances will come not from mechanical solutions, but from biologic ones.
At the end of a successful career, Schatzker offers some advice to young researchers: “I was fortunate to be able to see things from a broader perspective. If you’re doing research […] you may discover something that has far greater implications than you realize.” He stresses the importance of keeping your eyes open for opportunities, but this doesn’t preclude hard work. “If you’re young, and you believe in something, don’t give up easily.”
