Pinelli jfk2011

History of
Orthopedic Surgery
J.F.M.K.
Parc Chanot, Marseille , 2011

P-O Pinelli
popinelli@gmail.com

Key Periods
• Before Nicolas Andry
• From Andry to « Ether Day »
• Mid XIXth to 1st World war
• Modern Era, Science
• Tomorrow ?

Before From Andry Mid XIXth Modern Era Tomorrow ?
Nicolas Andry to « Ether Day » to 1st World War Science The Future

• For centuries Orthopedic Practice
was limited to the treatment of :
– Bone Fractures
– Dislocations
– Wounds

• Hippocrates (400 bc)
• Galen (130-200)
• A. Paré (1517-1590)
– Major Rules for treatment …


• Bone-Setting …
– Bone-Setter : Empiric practitioner who claims
the power of diagnosing and setting Fractures,
reducing Dislocations, and relieving painful Stiff
Joints
– Art transmitted by « word of mouth »
– No systemic or distantly removed effects are
predicated
– Leave the « care field » as soon as possible
• … gave Famous families of Orthopedic
Surgeons


Nicolas Andry (1658-1742)
→ Birth of Orthopedics (1741)
« L’Orthopédie, ou l’Art de Prévenir et de Corriger dans les Enfants, les Difformités du corps »
« Orthopedics, or the Art of correcting and Preventing Deformities in Children »

 This name (Orthopedics) will focus
attention upon a group of long-
neglected crippling conditions :
 Congénital Deformities
 Infantile Paralysis
 Scoliosis
 Chronic Affections of the Joints
 …etc…


Two Major Problems
1. Post-operative Sepsis (Hospital Grangrene)
2. Absence of Anesthesia
Conservative Treatments by consecutive Splints
→ Jean-André Venel (1740-1791)

Fast and Minimal Invasive Surgical Techniques
such as Percutaneous Tenotomies
→ Jacques-Mathieu Delpech (1777-1832)
1st Achile’s Tenotomy : May 16th, 1816

- Georg Friedrich Louis Stromeyer (1804-1876)
Influenced by Delpech’s works : Achile’s tenotomy in 1831
Pioneer of Orthopedic Surgery in Germany
- William John Little (1810-1894)
Was suffering a Clubfoot condition : Operated on by Stromeyer
Infantile Paralysis as Little desease ; Pioneer in England

- William Ludwig Detmold (1808-1894)
Created the First Hospital for Crippled Children in New York
Considered as the Father of American Orthopedic Surgeons


October the 16th, 1846 : « Ether Day »
Massachusetts General Hospital of Boston


Doctor Gross’
Clinic

Thomas Eakins,
1875

Jefferson Medical
College
Philadelphie


• 1865 : Two open fractures were
operated on by James Syme’s
fellow, Joseph Lister (1827-1912)
– Birth of Antiseptic Method : The
Lancet, 1867 « On a new method of
treating compound fractures , … »
– Influenced by Pasteur’s works

• 1880-1890 : The Aseptic Method
William S. Halsted (1852-1922)
– He visited Volkmann in Europe
– Miss Caroline Hampton’s Affair


Now, hands are definitely free …
One more Major Discovery for
Orthopedic Practice
• Radiology
– Wilhelm Conrad Röntgen (1845-1923)

The Daily Chronicle, January 6, 1896

State of the Art
Just Before World War 1
• Osteotomy
– For Rickets, Ankylosed Joints, …etc…
– William MacEwen (1848-1924)
Pupil of Lister, the « Osteotome »

State of the Art
• Operative Treatment of Fractures
– William Arbuthnot Lane (1856-1943), England
– Albin Lambotte (1866-1956), Belgium
– William O’Neill Sherman (1880-1979), U.S.A.

State of the Art
• Arthroplasty
– Anecdotic Foreign Bodies Implantations
• Themistocles Gluck, Jules Emile Pean (1830-1898)
– John Benjamin Murphy (1857-1916)
1. It is possible to replace an important portionStability is also essential
Movement is important but of the skeleton,
even an enarthrodial joint.
2. To be well tolerated, prostheses must not only be sterile but
also made of nonresorbable (non-reactive) materials.
3. They will be tolerated by the organism provided one carries
out the necessary precautions. have observed these cases
« We
4. This procedure can replace immediate amputation of aare
for so long a time that we limb
when the patient refuses such an operation.correctness of
assured of the
5. In the ordinary large excision, this method had the advantage
this statement. Homo- and
of preventing the immediate collapse of the soft parts.
Hetero-transplants are not
6. Finally, such prostheses can provide a method which permits
the preservation of joint motion uniform in results »


Orthopedics as a Clinical Science
• The Débuts
– Joseph-François Malgaigne (1806-1865)
& Claude Bernard (1813-1878)
Statistics in Medecine

• The Mayo Clinic
– Founders : Charlie & William Mayo
Revitalize contacts between European and American
Physicians, broken during World War 1


Major Advances of the XXth

• Medical Discoveries
– Antibiotics (1928), Heparin (1948)
Immunosupressors (1949)

• Technological Advances
– Biocompatible Materials … (Prostheses)
– Miniaturization
The come-back of Percutaneous Surgery
(Arthroscopy)


Hip Arthroplasty
• First Steps
– Marius Nygaard Smith-Petersen (1886-1953)
– Jean (1905-1995 ) & Robert Judet (1909-1980 )
– Austin Taley Moore (1899-1963)
– George Kenneth Mac Kee (1906-1991)


Hip Arthroplasty

• Charnley’s Era
– Sir John Charnley (1911-1982)
The « Low-Friction Concept »


Knee Arthroplasty

• Problem of Stability
– Hinged Prostheses
Börje Walldius (1913-)
GUEPAR Group in France

– Condylar Prostheses
Scientific Approach
of Knee Kinematics
Frank H. Gunston (1933-)
John N. Insall (1930-2000)


Orthopedics in 2050 ?

• C.A.O.S
– Shall we be operated on
by Computers and Robots ?

• Real Time Information
– We used to travel by the seas …

• Medical Research
– Tissue Engineering, Molecular Biology, …etc…

« Who is Familiar with what were Art and
Science in the Past, is also competent for
judging their Future Advances … »

C. A. Theodor Billroth, 1890

« Our today’s truths are our tomorrow’s
errors and our actual knowledge
is neither better nor worse
than our predecessors’ … »

Maxime Laignel Lavastine, 1950

Thank You very much and …
… Remain close to your Dentist !!

popinelli@gmail.com

Pinelli jfk2011

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