By U. Kurt. Indiana University Northwest.
He had already learned many things Orthopedic Association and served on the Exec- from his association and growing friendship with utive Committee for many years buy fosamax 70 mg visa pregnancy online test. One thing above all he saw dent during the years 1936–1937 and infused the clearly—that the head of a surgical clinic must society with his dynamic leadership order fosamax 35 mg visa menstruation vs estrous. In this ambition before his death he was accorded the rare dis- he achieved an outstanding success, as witnessed tinction of emeritus membership. He was in due by the quality of the men he attracted in turn as course elected as a corresponding or honorary his chief pupils—George Perkins, E. Furlong; and by the inﬂuence he among them the American Orthopedic Associa- exerted on many more who came to sit at his feet tion and the French, German, Scandinavian, for shorter spells. Thomas’, he next looked out beyond the horizon In 1937, he delivered the Hugh Owen Thomas of the orthopedic department of a general hospi- Memorial Lecture in Liverpool, and in 1946, tal to discover a long-stay hospital, without which the Robert Jones Memorial Lecture at the Royal no orthopedic service was complete. By adapta- Regional Orthopedic Consultant, Bristow was tions and new buildings, St. Nicholas’ Orthopedic appointed Consulting Orthopedic Surgeon to the Hospital was gradually transformed into an active army and attained the rank of Brigadier. This was country orthopedic hospital, at ﬁrst limited to his heart’s desire—to recreate the orthopedic children, and later providing adult wards. In the service in the army that Robert Jones had formed Second World War, this hospital became an ortho- during 1914–1918. He was eager to don uniform pedic center under the Emergency Medical again, and, in actual fact, his uniform from the Service, and it is to be known in future as the First World War still ﬁtted him. He gave most Rowley Bristow Orthopedic devoted and distinguished service to the army, Hospital, a ﬁtting tribute to the life and work of organizing the orthopedic sections of the military its ﬁrst surgeon-in-chief. In 1946, the French Government appointed was conducted in and from 102 Harley Street, a him Chevalier of the Legion of Honour and house that contained some beautiful examples of awarded him a Croix de Guerre with palm. Number 102 was the scene steady output of contributions to surgical litera- of bounteous hospitality, dispensed with taste and ture. Two subjects held his interest throughout— 40 Who’s Who in Orthopedics disabilities of the knee joint, and injuries of Morayshire; an Alexander Brodie of Brodie was peripheral nerves. His Robert Jones Memorial Lord of Session in 1649 and his Jacobite descen- Lecture on the latter topic was a masterly exposi- dant, also named Alexander, migrated to London tion of the subject. As a teacher of undergraduates in the earlier part of the eighteenth century. Two of the to the heart of his subject and picking on the grandchildren, Lord Denman and Sir Benjamin essentials with clarity and emphasis. His out- Brodie, rose to eminence in law and medicine, patient clinics at St. Thomas’ were stimulating, one became Lord Chief Justice and the other memorable, and crowded. Thomas’ students will still recall such apho- tainly received a thorough grounding in the clas- risms as “We treat patients, not disease. Part of parental tutoring Rowley Bristow married in 1910, Florence, was the inculcation of industrious habits; the son only daughter of James White, LLD, and they had who became surgeon of St. But it was not all work, there was play-acting, in which young Denman joined, and the pastimes of the countryside. In that year, Napoleon had an army at Boulogne watching out for a favorable moment for the invasion of Britain. There was considerable alarm in England, of which the still standing defensive Martello Towers of the south coast are a symbol. Brodie and his brothers raised a company of volunteers under a commission signed by George III whereby William was appointed Captain and “Our trusty and well- beloved Benjamin Collins Brodie, gent, Ensign in the company. He joined Abernethy’s school of anatomy; here he met William Lawrence, after- wards surgeon to St. Bartholomew’s Hospital, Sir Benjamin Collins BRODIE with whom he formed a lifelong friendship. The 1783–1862 following year he attended the lectures of James Wilson at the Hunterian School of Anatomy in Benjamin Collins Brodie increased our knowl- Great Windmill Street and worked hard at edge of diseases of joints by his prolonged studies dissection. After spending nearly 2 years at of their clinical and pathological manifestations. George’s Hospital as He was born in 1783, the fourth of six children a pupil of Everard Home in 1803.
Joint space narrowing and deformity of the femoral head were also noted in 3 hips (10 fosamax 70mg generic breast cancer basketball shoes. According to the classiﬁcation 35 mg fosamax for sale women's health daily tips, the acute type of SCFE was seen in 4 of 7 hips (57. Clinical classiﬁcation and treatment methods Type of slip Pinning Osteotomy In situ pinning (ARO, VFO) Acute Chronic Acute on chronic Total 11 9 9 ARO, anterior rotational osteotomy; VFO, valgus ﬂexion osteotomy Table 2. Complications Complication Males Females Number (%) Infection Avascular necrosis of (24. Additional operations using bone grafts were performed for avascular necrosis of the femoral head in 2 hips. Case 1 A 12-year-old boy suffered from acute SCFE with a PTA of 65° that was reduced to 22° by skeletal traction for 2 weeks. We performed epiphysiodesis by a cancellous bone screw in this position. Neither defor- mity of the femoral head nor necrosis was found in the ﬁnal follow-up period, and he had an excellent postoperative course (Fig. Posterior tilting angle (PTA) Type of slip Admission Postoperative Final follow-up Acute 54. Acute slipped capital femoral epiphysis (SCFE) in a 12-year-old boy with poste- rior tilting angle (PTA) of 65° on admission (a). We performed epiphysiodesis with cannulated screw ﬁxation, PTA was 20° (b). At 6 months after epiphysiodesis, the cancellous bone screw was removed with excellent results (c) 12 M. We performed an anterior rotational osteotomy (ARO) of the femoral head using an F-system device. A limitation of internal rotation was seen 4 years postoperatively; however, X-rays and clinical examination ﬁndings were excellent during the course (Fig. After anterior rotational osteotomy (ARO) of the femoral head using an F-system device, PTA was 32° (b). Limitation of internal rotation was seen 4 years postoperatively (d) Treatment of Slipped Capital Femoral Epiphysis 13 c Fig. Continued Case 3 A 13-year-old boy suffered from acute SCFE with a PTA of 85°. We performed epi- physiodesis with cannulated screw ﬁxation because the slip had been reduced by skeletal traction for 10 days. We feared the development of avascular necrosis of the femoral head; therefore, we applied a non-weight-bearing brace and observed the patient’s condition. However, we observed ﬂattening of the lateral femoral head after 8 months. We removed the screws 2 years postoperatively and performed strut allograft bone grafting. Twenty years later, the patient was able to walk without pain but had developed a femoral head deformity (Fig. We performed epiphysio- desis with cannulated screw ﬁxation, PTA was 18° (b). We removed the screws 2 years postoperatively and performed strut allograft bone grafting (d). At follow-up at 20 years, he could walk without pain but had developed a femoral head deformity (e) Treatment of Slipped Capital Femoral Epiphysis 15 Discussion For treatment, epiphysiodesis such as in situ pinning was performed for a slight slip of less than 30°. For a more than moderate slip, in situ pinning, rotational Sugioka osteotomy, three-dimensional Southwick osteotomy, Imhauser osteotomy, or a sub- capital osteotomy was performed [1–3]. The strategy of treatment for SCFE in our institution for acute or acute on chronic SCFE is to reduce the slip slowly by skeletal traction. After reduction and stabilization, we perform epiphysiodesis by pinning.
He gradu- the great weight of his authority to keep the ated in 1925 discount 70 mg fosamax visa menstrual depression, became a Fellow of the Royal course steady and the pace even buy cheap fosamax 35mg on-line menstruation 4 times a month. When he spoke College of Surgeons of England in 1928 and at as treasurer of the British Orthopedic Association, about that time turned his attention to orthope- he was no tame book-keeper but a maker of dics. He would have been one of the associa- National Orthopedic Hospital, was appointed tion’s greatest presidents. He had already served assistant surgeon in 1931 and served the hospital with distinction as president of the Orthopedic faithfully until he died. Ellis was wholly free from self-importance and No happier choice could have been made. He was it seems never to have occurred to him to seek no narrow-minded specialist, and it was ﬁtting his own advancement; his thoughts were for that the ﬁrst and moving tribute paid to his the beneﬁt of his patients and of any organiza- memory came from his friend and colleague, tion with which he was connected. It life was distinguished by simplicity and content- was the breadth of his interests that made Ellis ment. Few orthopedic sur- dren and there was a quiet elegance about their geons nowadays can claim to have a proper charming house in a pleasant backwater of knowledge of every aspect of their work, but Ellis Paddington. It was furnished with perfect taste; could and this invested his opinions with unusual there were even tapestries that Ellis himself value. He was very well read and by means of had worked in his odd moments of leisure. The other appointments, as at Lord Mayor Treloar’s garden was his particular delight and he would Hospital, Alton, and at the Heatherwood Hospi- invite the visitor to inspect his 15 varieties of lily, tal, Ascot, he accumulated a vast and varied expe- though his descriptions of their characteristics rience. His versatility was reﬂected in the papers were always punctuated by powerful impreca- he wrote; they were not numerous, just over 20, tions against his only enemies—the stray cats of but each dealt with some important aspect of a Paddington. This Three of his activities as a surgeon are partic- all-round competence in orthopedics was ularly noteworthy. Burns, 95 Who’s Who in Orthopedics his closest friend since they were undergraduates together, wrote Recent Advances in Orthopedic Surgery, an exceptionally valuable book that should have gone into further editions; it revealed the breadth of the authors’ interests. During the war, Ellis was posted to the emergency hospital at Park Prewett in Hampshire, where he worked with unremitting devotion. In 1945, he and Innes published a short but signiﬁcant paper on “Battle Casualties Treated by Penicillin,” based on a study of no less than 15,000 cases. A quotation from this paper reveals his sanity at a time when there was much uncritical enthusiasm: “Penicillin has made no difference to the paramount impor- tance of early and adequate surgery; it has, in addition, produced new difﬁculties in that the effect of penicillin on contaminated wounds obscures the extent of the infection of the tissues, and makes it difﬁcult to judge how radical surgery R. Elmslie spent the whole of his professional immense value in the elucidation of injuries of life as student and surgeon at St. Bartholomew’s the rotator cuff, and his published papers give Hospital and at the Royal National Orthopedic some indication of what might have been Hospital, except during World War I, when he was expected from him, had he lived longer. Ellis had just seen the last patient at strator of pathology and his knowledge of this his fracture clinic at St. As an orthopedic surgeon, Elmslie was one of the greatest of his day, next only to Robert Jones and perhaps Tubby. His ability to think clearly, his wisdom, imperturbability and admirable judg- ment were his powerful assets. Indeed the writer has never worked with anyone whose judgment always proved so sound; it seemed that he was incapable of being wrong. He was a competent and neat operator who devized several ﬁrst-class procedures. His only expressed vanity was to pride himself on sewing skin in, as he put it, “the manner of those who know best how to sew— women. He was in great demand for committee work in his own hospital, government departments, the Royal College of Surgeons (on the council of which he served from 1933 until his death), the British Orthopedic Association, the British Medical Association, the Chartered Society of Physiother- 96 Who’s Who in Orthopedics apy, and the Central Council for the Care of Crip- second year of residency at the Pennsylvania ples. His clear and logical exposition before the Crippled Children’s Hospital in Elizabethtown, Select Committee of the House of Lords is said he decided that working with crippled children to have carried the greatest weight in deciding the was to be his specialty. As a man, Elmslie lacked the warmth Washington, DC area and began his practice, of Robert Jones, whose friend and admirer he which was to continue until his retirement in always was. He started as assistant to another physician, reserve did not prevent him inspiring the greatest but he was impatient to do more work with crip- enthusiasm and devotion in his pupils, which pled children and saw a glaring need for such they still retain. The area had no facilities that special- ized in orthopedic deformities, which were far more common in the past than they are today. Poliomyelitis was a major problem, and club foot, dislocated hips, osteomyelitis, and curvature of the spine also contributed to the need for recon- structive surgeons and long-term hospital care.
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