Developmental dysplasia of the hip: a history of innovation.

Developmental dysplasia of the hip (DDH) is a relatively common malady that has profound consequences in the infant if left untreated. Effective and early treatment of DDH has been praised as one of the most successful ventures of modern pediatric orthopedics. Yet, before the modern management of DDH came into existence, there were extensive technological developments in the field of harnesses, casts, and traction methods. This paper aims to identify the centuries-old history of advancement in DDH treatment and the many important people involved. Their devices, thoughts, and ideas continue to have a profound impact on the current practice of orthopedic surgery.

History of traction for treatment of lower limb fractures.

The last two hundred years have seen the development of different systems of traction with effective methods of applying traction to the foot or to the leg for the treatment of fractures of the femur. The success of these methods has been tested during many wars by clinical evaluations but also by means of x-rays since the beginning of the twentieth century. Because of their advantages, these methods of traction were very frequent during the first part of the twentieth century. Crosby, Smith, Buck, Hodgen, Steinmann, Codivilla, Kirschner, and Pearson are names recurring daily on our fracture wards. Their concern for the welfare of their patients led to substantial improvements in the treatment of all patients with fractures.

[Sciatica. From stretch rack to microdiscectomy]. / Ischias. Von der Streckbank zur Mikrodiskektomie.

In ancient times as well as in the Middle Ages treatment options for discogenic nerve compression syndrome were limited and usually not very specific because of low anatomical and pathophysiological knowledge. The stretch rack (scamnum Hippocratis) was particularly prominent but was widely used as a therapeutic device for very different spinal disorders. Since the beginning of the nineteenth century anatomical knowledge increased and the advances in the fields of asepsis, anesthesia and surgery resulted in an increase in surgical interventions on the spine. In 1908 the first successful lumbar discectomy was initiated and performed by the German neurologist Heinrich O. Oppenheim (1858-1919) and the surgeon Fedor Krause (1857-1937); however, neither recognized the true pathological condition of discogenic nerve compression syndrome. With the landmark report in the New England Journal of Medicine in 1934, the two American surgeons William Jason Mixter (1880-1958) and Joseph Seaton Barr (1901-1963) finally clarified the pathomechanism of lumbar disc herniation and furthermore, propagated discectomy as the standard therapy. Since then interventions on intervertebral discs rapidly increased and the treatment options for lumbar disc surgery quickly evolved. The surgical procedures changed over time and were continuously being refined. In the late 1960s the surgical microscope was introduced for spinal surgery by the work of the famous neurosurgeon Mahmut Gazi Yasargil and his colleague Wolfhard Caspar and so-called microdiscectomy was introduced. Besides open discectomy other interventional techniques were developed to overcome the side effects of surgical procedures. In 1964 the American orthopedic surgeon Lyman Smith (1912-1991) introduced chemonucleolysis, a minimally invasive technique consisting only of a cannula and the proteolytic enzyme chymopapain, which is injected into the disc compartment to dissolve the displaced disc material. In 1975 the Japanese orthopedic surgeon Sadahisa Hijikata described percutaneous discectomy for the first time, which was a further minimally invasive surgical technique. Further variants of minimally invasive surgical procedures, such as percutaneous laser discectomy in 1986 and percutaneous endoscopic microdiscectomy in 1997, were also introduced; however, open discectomy, especially microdiscectomy remains the therapeutic gold standard for lumbar disc herniation.

Richard's back: death, scoliosis and myth making.

The body of a mediaeval monarch was always under scrutiny, and Richard III's was no exception. In death, however, his body became subject to new forms of examination and interpretation: stripped naked after the battle of Bosworth, his corpse was carried to Leicester and exhibited before being buried. In 2012, it was rediscovered. The revelation that Richard suffered from scoliosis prompts this article to re-evaluate the historical sources about Richard's physique and his posthumous reputation. This article argues that Richard's death and his myth as 'crookback' are inextricably linked and traces attitudes to spinal curvature in the early modern period. It also considers how Shakespeare represented Richard as deformed, and aspects of performance history which suggest physical vulnerability. It then considers Richard's scoliosis from the perspective of medical history, reviewing classical accounts of scoliosis and arguing that Richard was probably treated with a mixture of axial traction and pressure. It demonstrates from the evidence of Richard's medical household that he was well placed to receive hands-on therapies and considers in particular the role of his physician and surgeon, William Hobbes. Finally, it shows how the case of Richard III demonstrates the close relationship between politics and medicine in the period and the contorted process of historical myth making.

Treatment of singultus by traction on the tongue: an eponym revised.

Sir William Osler (1849-1919) is associated with a long list of contributions and eponymous entities including filaria, maneuvers, nodules, syndromes, and triads. Among the less known ones is the Oslerian pulling of the tongue for termination of obstinate hiccup (singultus). Janet Travell (1901-1977) , physician to two United States presidents, attributed the tongue-pulling maneuver to Osler. Dr. Travell cites Osler's Principles and Practice of Medicine from 1912, where mention of the remedy can be found. The therapy, however, is much older and (perhaps not surprisingly) of French origin. It can be viewed as a spin-off of attempts by Jean Laborde (1830-1903) to resuscitate the "presque morts" (almost dead) via rhythmic traction of the tongue. Lesser known physicians involved in the treatment of singultus by traction of the tongue are Jean Viaud (1862-1946) and Raphaël Lépine (1840-1919).

Prof. Vatroslav Florschütz and the Balkan beam frame.

Prof. Vatroslav Florschütz constructed in 1911 an extension table for repositioning bone fracture fragments of the upper and lower extremities, after which a plaster splint was applied--this later became to be known as the Balkan beam frame. Florschütz's personal insistences of new techniques at the beginning of the 1900 have helped shape war surgery and traumatology.

Management of proximal humeral fractures in the nineteenth century: an historical review of preradiographic sources.

BACKGROUND: The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding of the pathoanatomy and pathophysiology of proximal humeral fractures was obtained, and new methods of reduction and bandaging were developed. QUESTIONS/PURPOSES: I reviewed nineteenth-century principles of (1) diagnosis, (2) classification, (3) reduction, (4) bandaging, and (5) concepts of displacement in fractures of the proximal humerus. METHODS: A narrative review of nineteenth-century surgical texts is presented. Sources were identified by searching bibliographic databases, orthopaedic sourcebooks, textbooks in medical history, and a subsequent hand search. RESULTS: Substantial progress in understanding fractures of the proximal humerus is found in nineteenth-century textbooks. A rational approach to understanding fractures of the proximal humerus was made possible by an appreciation of the underlying functional anatomy and subsequent pathoanatomy. Thus, new principles of diagnosis, pathoanatomic classifications, modified methods of reduction, functional bandaging, and advanced concepts of displacement were proposed, challenging the classic management adhered to for more than 2000 years. CONCLUSIONS: The principles for modern pathoanatomic and pathophysiologic understanding of proximal humeral fractures and the principles for classification, nonsurgical treatment, and bandaging were established in the preradiographic era.

Paralysis as a result of traction for the treatment of scoliosis: a forgotten lesson from history.

STUDY DESIGN: Literature review. SETTING: Europe with special reference to France. OBJECTIVES: To review the treatment of spinal deformity in nineteenth century Europe and explain the high incidence of paralysis as a result of forceful traction of the spinal column to treat scoliosis in France as compared with other European countries. CONCLUSION: Although well described in the nineteenth century French medical literature, the dangers of forceful traction on the spinal column to correct spinal deformity were not recognized in Europe or the USA until the halofemoral traction method of treatment was used in the 1970s.

Management of fractures of the humerus in Ancient Egypt, Greece, and Rome: an historical review.

Fractures of the humerus have challenged medical practitioners since the beginning of recorded medical history. In the earliest known surgical text, The Edwin Smith Papyrus (copied circa 1600 BC), three cases of humeral fractures were described. Reduction by traction followed by bandaging with linen was recommended. In Corpus Hippocraticum (circa 440-340 BC), the maneuver of reduction was fully described: bandages of linen soaked in cerate and oil were applied followed by splinting after a week. In The Alexandrian School of Medicine (third century BC), shoulder dislocations complicated with fractures of the humerus were mentioned and the author discussed whether the dislocation should be reduced before or after the fracture. Celsus (25 BC-AD 50) distinguished shaft fractures from proximal and distal humeral fractures. He described different fracture patterns, including transverse, oblique, and multifragmented fractures. In Late Antiquity, complications from powerful traction or tight bandaging were described by Paul of Aegina (circa AD 625-690). Illustrations from sixteenth and seventeenth century surgical texts are included to show the ancient methods of reduction and bandaging. The richness of written sources points toward a multifaceted approach to the diagnosis, reduction, and bandaging of humeral fracture in Ancient Egypt, Greece, and Rome.

Meurice Sinclair CMG: a great benefactor of the wounded of the First World War.

Major Meurice Sinclair was a Regular Army Medical Officer who revolutionised the management and treatment of gunshot fractures during the First World War, particularly those of the femur which carried the highest mortality. Not only did his methods reduce mortality but they increased the ease of nursing and hence the comfort of the wounded to a marked degree. His system of traction on the Thomas splint, in suspension, gained general acceptance such that he gave lectures and demonstrations to the medical officers of the allied forces, for which he was thrice mentioned in despatches and subsequently appointed CMG. Central to his method was the concentration of the fracture cases within certain hospitals to standardise and improve their management. This he was able to achieve through the good offices of Sir Almroth Wright who was Consultant Physician to the British Expeditionary Force. His methods reduced the death rate in open fractures of the femur from 80% generally, to 7.3% in his own hospital. He left a legacy that bore fruit both in the treatment of civilian fractures after the war but also in the second war of 1939-1945.

Heraklas on knots: sixteen surgical nooses and knots from the first century A.D.

In the first century of our common era, the Greek physician Heraklas wrote a brief essay on how to tie 16 knots and nooses for surgical and orthopedic purposes. His work is reintroduced and discussed here because its place in the origin and evolution of surgery needs to be properly acknowledged and recorded in the current medical literature. To do so, Raeder's definitive Greek edition of the oldest extant manuscripts of Heraklas' essay was studied along with the various illustrated interpretations of his text published over the last six centuries. Moreover, the contemporary literature was searched for current applications of Heraklas' knots by use of a database of surgical knots. It was found that seven of Heraklas' 16 knots and nooses were still applied surgically of late, and that four of these have even been recently rediscovered for such applications. Therefore, it is concluded that Hellenistic, Roman, and Byzantine medicine had a rich knowledge and high standards. Contemporary surgical techniques may be found to be truly ancient if we search deep enough, far enough, and long enough.

Medieval management of spinal injuries: parallels between Theodoric of Bologna and contemporary spine surgeons.

In recent decades there have been revolutionary technological advances in the management of traumatic spinal column injuries. Despite these advances, the basic principles of reduction and stabilization of vertebral fractures and dislocations remain similar to those proposed by ancient and medieval physicians. Theodoric of Bologna, in his text Chiurgica de Theodoric (ca. AD 1267), described an extracorporeal approach to the management of traumatic spinal column misalignments. Surprisingly, his techniques are still used in many instances by contemporary spine surgeons, despite the availability of a more advanced technological armamentarium than that existent in medieval times.

A brief history of therapy for traumatic spinal cord injury.

There are few more devastating injuries that afflict man than those associated with spinal cord injury (SCI). The economic, psychological, and social impact are encompassing and enormous to the individual and society. During the last several years, there has been a renewed interest in the study of SCI, with the hope of finding a cure. It is appropriate, then, to examine the efforts accomplished throughout medical history. With this retrospective view, potential avenues for future treatment become more apparent and clear. As in the past, the integration of basic science and clinical innovation will create the path toward progress for treatment of this disease.

History of posterior thoracic instrumentation.

The term "backbone" appears in many expressions used in modern day society. In any scenario, it has one central meaning: stability. Best defined as a foundation that is able to sustain multiple stressors without adversely affecting integrity, the commonly and appropriately termed backbone of humans is the spinal column. As the central focus of stability in our species, the spine is subject to a great degree of trauma and mechanical forces. A variety of methods have been developed throughout history in the treatment of spinal column injury. Initial treatment involved the use of simple traction devices for the reduction of spinal fractures; these have evolved to include the current insertion of spinal instrumentation. The authors review the historical treatment and development of posterior instrumentation for thoracic spinal injury.