Dr. Robert Meek was Canada’s first surgeon to specialize exclusively in adult orthopaedic trauma, transforming the way that trauma care is delivered and setting a standard that continues to guide the field today.
“I loved my work. I never actually considered it work,” Dr. Robert Meek told former Member of Parliament and Mayor of White Rock Gordie Hogg on Hogg’s podcast, Community Connections with Gordie Hogg.
“When I worked at the old Super Valu in White Rock, I’d go in there at 9:00 in the morning and I’d be looking at the clock to see if it was time for coffee break, and then again to see if it was lunch break, but when I was working in orthopaedic trauma, I’d be in there at 6:00 in the morning and by 6:00 in the evening, I’d realize I was hungry and think ‘I guess it’s time to go home.'”
“What Bob Meek modeled from the outset was a level of patient-focused thinking, decision-making, and demeanor that sets the standard that we are all striving for,” said Dr. Kelly Lefaivre, UBC Associate Professor and Vancouver Coastal Health Orthopaedic Trauma Surgeon.
“Through his career, he fought to build a system that allowed emergency and trauma patients to have a high level of care in a system that met their needs and met the needs of the providers delivering that care. He did all that at a time when that work required a high degree of self-sacrifice.”
“I’ll only do it if I can do trauma.”
It has been sixty years since The Honourable W. A. C. Bennett, premier of British Columbia from 1952 to 1972, launched the BC Medical Plan, the first government-funded medical care program in British Columbia. During this early period, surgery as we know it today was being reimagined, first by leaders like Dr. Frank Patterson and Dr. Kenneth Morton, with major advances in the latter half of the twentieth century.
“As a resident surgeon, virtually everyone was a generalist,” Dr. Meek recalls. Dr. Meek completed his residency at Vancouver General Hospital between 1970 and 1974; he was appointed Chief Resident for the 1973/74 academic year. “In May of my last year, I was walking with Dr. Morton at VGH, and he asked me what I might like to do next.”
Dr. Meek saw that the future of orthopaedic surgery was specialization. Inspired by Dr. Michael Bell, whose groundbreaking work in pediatric orthopaedic surgery paved the way for surgeons to hone their skills in specific areas, and by Dr. Stephen Tredwell, who had also advocated for specialization as a paediatric orthopaedic surgeon, Meek felt that the time was right to advance his vision for the field.
“Dr. Morton asked me if I’d consider coming to work at VGH,” recalls Meek. “I said I’d only do it if I could do trauma. At the time, paediatrics had broken off to form its own subspecialty, and hand and spine specialties were emerging. The system was changing.”
Appointed by Dr. Kenneth Morton, Dr. Robert Meek became the first surgeon in Canada to specialize exclusively in adult orthopaedic trauma in 1975. Change was coming, but to invent the future he imagined, he had to take his time.
“When I was a student, there were at least 12 orthopaedic surgeons taking call and one assigned to cover the ER each day. Naturally, the quality of care and interest in trauma care of individual surgeons varied,” said Dr. Meek. “When I started, I was officially on call 1 in 13, which wasn’t enough to make a living nor to become ever more proficient.”
With no desire or power to remove people from the call list, Dr. Meek kept his calendar open. By filling in for other surgeons and taking calls at all hours, Dr. Meek worked his way up to lead trauma for the Division of Orthopaedic Surgery, eventually recruiting three additional surgeons and developing a training program for trauma specialists. When Orthopaedics broke off from the Department of Surgery to become the Department of Orthopaedics in 1984, Orthopaedic Trauma became a Division of the Department.
“I solved the problem by always being available and by taking others’ calls when they wanted a day off or if they wanted off call,” said Dr. Meek. “In addition, because of my interest, many surgeons from around the province began to send difficult cases directly to me.”
Dr. Meek recruited Dr. Peter O’Brien in 1985 and Dr. Piotr Blachut shortly after; together, they initiated the Orthopaedic Trauma Fellowship and devoted considerable time and effort to building a robust infrastructure for training trauma specialists.
“Dr. Meek proposed the idea of establishing an orthopaedic trauma database to record all our inpatient interactions, including diagnoses, treatments, and complications. This was quite revolutionary at the time,” said Dr. O’Brien. “He believed we needed to enter all the data ourselves for the database to be accurate. Consequently, we dedicated about half a day each week to inputting patient data. Initially, we thought the database would serve primarily as a research resource, but it ultimately proved very useful for administration and education.”
The First Real Trauma Program in Canada
Dr. Meek understood early on that bone fractures require treatment as quickly as possible to heal properly. People who have to wait for surgery are at risk of complications from longer use of pain medications, blood clots, and further tissue damage.
The trouble was that there was always a waiting list for elective surgeries, and no one had plans to quickly treat patients needing orthopaedic trauma care, so patients with fractures would arrive at the emergency room but may not be seen in the operating room until after scheduled surgeries were completed, sometimes later in the week.
To put the scope of the need in context, more than 300,000 surgeries (all kinds) are performed in British Columbia each year: more than half are emergency or unscheduled procedures.
“Contrary to earlier thinking that the multiply injured patients were too sick to have the added burden of acute fracture stabilization,” Meek and colleagues knew that “the multiply injured patients were too sick NOT to have acute fracture stabilization.”
With a specialization in trauma and an emerging team of orthopaedic trauma surgeons, Dr. Meek began pushing for trauma patients to receive the same standard of care as elective patients.
To ensure consistency in a program with a very high volume, Dr. Meek and his colleagues built the Division of Orthopaedic Trauma at UBC, ultimately establishing the first standalone clinical and academic orthopaedic trauma unit in Canada. The orthopaedic trauma team provided specialist care available 24 hours per day, seven days per week, and advocated and practiced the need to proceed rapidly with fracture fixation of long bones even in the presence of multiple injuries.
Dr. Peter O’Brien became the first Head of the Divisions of Orthopaedic Trauma at UBC and VGH. By that time, Dr. Meek had been appointed Chief of the Medical staff at VGH, but remained actively engaged with orthopaedic care and training.
Early leaders within the Division recognized the importance of high standards of care and data collection for quality improvement and research, which have now become fundamental to research in orthopaedic trauma, including Randomized Controlled Trials and the use of validated Patient Reported Outcome Measures (PROMs). The research publications and advances in surgical training that followed have revolutionized the field of orthopaedic trauma surgery throughout the world.
Dr. Robert McGraw was Department Head in the 1980s when he got a call from hospital leadership in Toronto to settle a problem.
“In Toronto, orthopaedic surgery was not separate from general surgery, so there was no protected time in the operating room for fractures. We had solved a similar problem in BC, but I said that I would only go on one condition: I was bringing Bob Meek,” said McGraw.
“Bob McGraw’s medical practice was all about hip and knee replacements for arthritis, so he took me along because I had been instrumental in setting up a new and better system for looking after injured patients who needed urgent but not immediate surgery,” said Dr. Meek. “Many of these were older people who had broken their hips. The Toronto hospital was tending to prioritize elective patients who had been on the waiting list, and did the hip fracture patients later.”
“So the two Bobs went in there—‘these guys always come in pairs,’ the hospital president said—and Dr. Meek couldn’t wait to tell them how unfair it was that fractures received second-class care,” said Dr. McGraw.
“As I understand it, after our visit, the hospital there brought in policies similar to ours and solved their issue,” said Dr. Meek, who would later participate in reviews of other trauma programs, including Chilliwack General, University of Western Ontario Hospitals, Royal Columbian Hospital, and University of Calgary’s Foothills Hospital.
Dr. Guy recalls Dr. Meek saying that, unlike elective surgery, the patient doesn’t choose which day they get injured. “He said we need to have someone able to care for them any day they come in.”
“As far as a program of dedicated trauma-only surgeons, where no matter what day of the year, or what time of the day you get severely injured, anywhere in the province, there is someone with the skill set to care for any and all of the most complex orthopaedic injuries,” said Dr. Kelly Lefaivre. In fact, the Orthopaedic Trauma Clinic at Vancouver General Hospital has repeatedly ranked among the best in the world.
“He not only offered that level of care to the patients that came through VGH, but he continued to be a voice internationally through his teaching, through invited lectures, and in the research that our unit produced around that concept,” said Dr. Lefaivre. “So much so that the clinic has become known internationally for providing the best patient care possible with top-trained clinicians, nurses, and staff.”
- 1964
Dr. Meek graduates from UBC with a degree in Mathematics and Zoology
- 1970
Completes orthopaedic residency at VGH
- 1973
Chief Resident
- 1975
Becomes Canada’s first surgeon to specialize exclusively in adult orthopaedic trauma
- 1985
Launches Canada’s first Orthopaedic Trauma Fellowship
- 1986
Publishes influential study on fracture treatment and mortality
- 1990s
Stable fixation becomes global standard of care for major fractures, driven by Meek’s advocacy and research.
- 2008
Retires from clinical practice; begins developing CurvaFix implant.
- 2023
CurvaFix closes $39M Series C; device gains FDA approval.
Standardizing Trauma Care
In 1966, the United States National Academy of Sciences described accidental death and disability as the “neglected disease of modern society.” In Canada, trauma is the third leading cause of death overall, responsible for approximately 20,597 deaths in 2023, and is the leading cause of death in young people.
In the emergency room, Dr. Meek would treat patients with injuries from car accidents, falls, and other traumatic events. These injuries often involved multiple body areas and systems, so injuries were treated in order of severity. The Injury Severity Score is medical standard used to assess trauma severity across body systems. Over time, Dr. Meek and colleagues began to notice a pattern, and designed a research project with the Intensive Care Unit (ICU) at VGH to assess outcomes in patients with multiple injuries and who had been treated for major fractures.
In the 1970s and 80s, fractures were commonly treated with either casts and skeletal traction, which required long periods of immobilization, or with surgery (stable fixation with intramedullary nails, plates, and screws inserted into the injured bones to stabilize fractures).
“We realized, looking at the data, that unhealed bones can lead to serious complications and illness well after the initial injury,” said Dr. Meek. “Looking at more than 70 ICU patients, the mortality rate for those treated with casts and traction was five times worse than those treated surgically. The only difference was in the type of orthopaedic care.”
Meek, R. N., Vivoda, E. E., & Pirani, S. (1986). Comparison of mortality of patients
with multiple injuries according to type of fracture treatment—a retrospective age- and
injury-matched series. Injury, 17(1), 2–4. doi.org/10.1016/0020-1383(86)90003-3
He presented his initial findings at the annual meeting of the Canadian Orthopaedic Association in June 1980. In 1986, Meek and colleagues published their results, Comparison of mortality of patients with multiple injuries according to type of fracture treatment—a retrospective age- and injury-matched series. By the 1990s, largely driven by the work of Dr. Meek and colleagues, stable fixation became a worldwide standard of care.
Advocacy for trauma patients and care teams would become a defining feature of Dr. Meek’s academic career and international engagement.
Engineering More Than a Career in Orthopaedic Trauma Surgery
Dr. Robert Meek grew up as the youngest of five kids, moving between a float camp near Holberg, Vancouver Island, and White Rock in the lower mainland. It was sports day in the fifth grade at Ray Shepherd Elementary School when he lined up to run with his peers, only to be told to run with the sixth graders.
“I had been in a grade 5/6 split class with my brother, but no one had mentioned to me that I’d skipped a grade. I was in grade 6, I had skipped grade 2,” Meek laughs. By age 11, he had skipped two grades. At Semiahmoo High School, he won male Athlete of the Year (1960) and captained the basketball team to second place in the BC Provincial Finals (1961)
Dr. Meek went on to earn an undergraduate degree in mathematics and zoology from UBC in 1964. Upon entering medical school, he didn’t know what orthopaedics was; after his third year, he completed a summer internship at Lions Gate Hospital where he found his interest in surgery. Though he found his passion as a trauma surgeon, he was also very curious about engineering. His first office at VGH was next door to a team of engineers; there he became friendly with Jim Fort, an engineer recruited by Dr. Frank Patterson for prosthetic work for amputation.
Meek was deeply influenced by his relationships with Drs. Patterson and Hans Willenegger, a founder of the Switzerland-based Arbeitsgemeinschaft für Osteosynthesefragen (Association of the Study of Internal Fixation), known as AO. AO provides education and training for surgeons and operating staff, and supports innovation in surgical instruments and implants. Today, AO is a global network of surgeons and the leading organization for education, innovation, and research in trauma and musculoskeletal surgery.
Dr. Meek was invited to join the association as instructor in orthopaedic trauma with AO in the late 1970s. He remained active in the group teaching AO techniques around the world. Later, he was invited to join the AO Board of Trustees. He is currently an AO Senior Trustee and was asked to give the opening talk at the meeting Vancouver in 2022 about the history of Vancouver and BC and Orthopaedic trauma in Vancouver.
Meek was always looking for a better way to help trauma patients recover and regain function. When he retired from clinical practice at VGH in 2008, with a lingering fascination with engineering, he decided to pursue an idea for an invention that he’d been toying with for ages.
“As a fellow in 1996, I remember him describing a fixation system as we finished a case of symphysis plating. He was asking me to imagine an implant that would loop around to fix the entire pelvis, starting from the symphysis, around to the sacrum, and back to the symphysis,” said Dr. Pierre Guy, Head of the Division of Orthopaedic Trauma. “It would be flexible, but you could cinch it to fix it in place.”
“He had this idea that he could make something flexible but ultimately lockable that could be inserted into a fractured pelvis,” said Dr. Lefaivre. “It started as these stainless-steel rounded pieces that he had on a metal wire, and he would walk around at the hospital with them in his pocket. I remember him asking ‘did I show you this?’ and he’d pull them out and show them off and tell me what he was thinking.”
Falls and fall-related injuries account for up to 15% of emergency room visits and cause 95% of hip fractures in those aged 65 years and older. In addition to acute injury, falls can contribute to reduced mobility, which in turn can contribute to loss of independence, cognitive decline, and increased risk of subsequent falls. Repairing hip fractures and restoring as much mobility as possible is essential to preserving an individual’s quality of life and ability to live independently. In British Columbia, all hip fractures must be treated within 48 hours as a standard of care to reduce complications and lower mortality rates.
To Dr. Meek, it seemed logical that similar standards of care should be applied to elderly patients with pelvic fractures, but the surgical implants used for other fractures were never explicitly designed for the pelvis, the bones of which are curved. Retirement from clinical practice offered an opportunity to focus on a solution, which he imagined might be a curved device that could fit inside the pelvic bones and support an individual’s standing weight. In 2008, he shared his idea with Dr. Tom Oxland, who encouraged Dr. Meek to explore the idea further.
Working with a machinist in a garage in downtown Vancouver, Meek developed the prototype for what would eventually become the CurvaFix implant.
The CurvaFix implant is a stainless-steel device placed inside the bone to help fix pelvic fractures. It has a threaded, self-tapping end, a top feature for applying torque, and a locking mechanism that converts the implant from flexible to rigid after it is in place.
“Usually, we would use two such devices to sort of ‘sew’ a broken pelvis back together,” explained Dr. Meek.
The CurvaFix device drew interest from the University Industry Liaison Office (UILO), who connected him with Robin Coope, who was the Instrumentation Group Leader at the BC Cancer Agency’s Genome Sciences Centre and had a mandate to support inventors with the Faculty of Medicine at UBC. Eventually, the device caught the attention of venture capital firms. With a $150,000 grant from Genome BC, $150,000 in seed funding from Intellectual Ventures, and $300,000 in CIHR start-up funding matched by $300,000 from Intellectual Ventures, Meek and colleagues were able to raise the funds to start their company. CurvaFix Inc. formally spun out of UBC in 2017, and closed their Series A funding round in 2018.
In 2023, the company closed a $39 million USD Series C; today, its premier device has FDA approval and is available in major trauma centers across the United States.
A Globally Influential Crowd Favourite
Dr. Robert Meek has been many things throughout his career: from Chief Resident at VGH to founding Head of the Division of Orthopaedic Trauma, to serving as Chief of Medical Staff at VGH, to Clinical Professor Emeritus at UBC, to AO Senior Trustee, to inventor, and to Chair of the Surgeon Advisory Board at CurvaFix. His influence is international in scope, and his contributions to orthopaedic surgery in BC remain the standard for surgeons worldwide.
“You know, he’s larger than life. Always has been,” said Dr. Lefaivre. “It was a rite of passage to work with him. He had high standards, but he was very efficient. Legend has it that if you were supposed to join him in the OR for a DHS, which is a standard hip fracture procedure, you had to be on time. If you were 12 minutes late, the case would be done.”
“‘Well, you aren’t any good, but you sure are slow!’ was one of his favourite bits of feedback to give residents and fellows at the end of a case,” said Dr. Guy. “I saw that as a motivation to get better.”
“But people loved him. He had really strong working relationships with all of the nurses in the OR,” said Lefaivre. “He has always been a crowd favourite. It’s not a common thing to see at a surgeon’s retirement, but essentially the entire department of anesthesia showed up for him.”
Dr. Meek’s influence has had unprecedented global impact in redefining the quality and standard of care for the injured patient. He has also trained generations of surgeons, from UBC Orthopaedic residents and fellows to international audiences through his work with the Canadian Orthopaedic Association, the Orthopaedic Trauma Association and AO.
UBC Orthopaedics remains in high demand for learners as residents continue to come to VGH to learn and practice fracture and polytrauma care. Because of the vision of Dr. Robert Meek and colleagues, the Orthopaedic Trauma Fellowship at VGH draws international applicants every year seeking a strong clinical, surgical, and research program with exposure to a diverse range of complex traumatic pathology.
“He has had, through his whole career, such an ability to form his teaching and interactional style and engagement to learners at every level. It didn’t matter if you were a fourth-year medical student or a fellow. He could speak your language, no matter what.”
“That’s actually a really special skill set,” she continued. “To really be able to do it across all levels speaks to what an excellent teacher he has been.”
