See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/41850069
Early history of operative treatment of fractures
Article in Archives of Orthopaedic and Trauma Surgery · March 2010
DOI: 10.1007/s00402-010-1082-7 · Source: PubMed
CITATIONS
READS
18
1,193
1 author:
Jan Bartonícek
Military University Hospital Prague
165 PUBLICATIONS 994 CITATIONS
SEE PROFILE
Some of the authors of this publication are also working on these related projects:
Posterior malleolus fractures, Scapular fractures View project
All content following this page was uploaded by Jan Bartonícek on 20 August 2015.
The user has requested enhancement of the downloaded file.
Arch Orthop Trauma Surg (2010) 130:1385–1396
DOI 10.1007/s00402-010-1082-7
TRAUMA SURGERY
Early history of operative treatment of fractures
Jan Bartoníbek
Received: 29 December 2009 / Published online: 9 March 2010
© Springer-Verlag 2010
Abstract Surgery in the Wrst half of the nineteenth century
was primarily dominated by pain and fear of lethal infections.
Therefore, the absolute majority of fractures and dislocations
were treated non-operatively. Development of operative treatment of fractures was inXuenced by three major inventions:
anaesthesia (1846), antisepsis (1865) and X-rays (1895). The
Wrst to use external Wxation is traditionally considered to be
Malgaigne (1843). However, his devices cannot be considered
as external Wxation. Von der Höhe, in 1843, Wxed a non-union
of the femur by inserting into both fragments a couple of
screws transversely connected outside the wound. Von
Langenbeck in 1855 treated a non-union of the humerus with
screws connected by a devise designed for this purpose. A
predecessor of nailing of acute diaphyseal fractures may be
considered to be Wxation of diaphyseal non-unions of the
femur, humerus and tibia with ivory intramedullary pegs, performed by DieVenbach in 1846. Nevertheless, until 1885,
osteosynthesis was still a Cinderella having at its disposal
mainly wires, ivory pegs and very primitive types of external
Wxation. During the following 35 years (1886–1921), operative treatment of fractures witnessed an unprecedented revolution. Radiology became an integral part of bone and joint
surgery. All types of osteosynthesis, i.e. plates (Hansmann
1886), external Wxation (Parkhill 1897) and intramedullary
nails (Schöne 1913) were introduced into clinical practice.
Basic experiments were undertaken, surgical approaches
described and the Wrst textbooks on osteosynthesis published.
J. Bartoníbek (&)
Department of Surgery, 1st Faculty of Medicine of Charles
University and Thomayer University Hospital,
Videnska 800, 140 59 Prague 4, Czech Republic
e-mail: bartonicek.jan@seznam.cz
Keywords History of osteosynthesis · Plates ·
External Wxation · Intramedullary nails ·
Surgical approaches
Introduction
The history of the operative treatment of fractures is a fascinating story that has engaged many authors [3–7, 14–18,
22, 27, 29, 37, 40, 73, 80–82, 87, 88, 103, 104]. The recent
50th anniversary of the foundation of AO (Arbeitsgemeinschaft für Osteosynthesenfrage) was the occasion for its
recapitulation. To understand the development of osteosynthesis, it is important not only to become acquainted with
the chronological sequence of individual facts, but also to
analyze the causes, implications and consequences of individual events, based on original sources.
Operative treatment of fractures in the Wrst half
of the nineteenth century
In the Wrst half of the nineteenth century, the foundations
were laid for the modern treatment of injuries of bones and
joints, mainly thanks to the textbooks by Pierre-Joseph
Desault (1738–1795), Sir Astley Paton Cooper (1768–
1841) and Joseph François Malgaigne (1806–1865), published and translated both in Europe and North America
[19, 20, 23, 24, 66–69]. However, but for a few exceptions,
fractures and dislocations were treated non-operatively and
discussions concentrated primarily on the position of the
limb during reduction, the manner of its performance and
immobilization of the injured limb. The main obstacles to
the development of operative treatment were the pain associated with surgery and, particularly, concern about infection
123
1386
and its potentially fatal consequences. As a result, the
most frequent operation at that time was limb amputation,
mainly for war injuries and open fractures, with few cases
of surgically treated non-unions or acute fractures [6, 10,
24, 25, 29, 33, 36, 93]. The absence of anaesthesia and
asepsis were compensated for by the speed and skill of
surgeons.
The Wrst textbook to deal with osteosynthesis “Traité de
l’immobilisation directe des fragments osseux dans les
fractures” was published in 1870 [10]. Its author, Laurent
Jean Baptiste Bérenger-Féraud (1832–1900), the French
chief naval physician and admiral of the French Navy, summarized from literature more than 400 cases of fractures
that were operated on. At that time, the problem of anaesthesia had already been solved and the Wrst steps were taken
in the prevention of intraoperative infection. BérengerFéraud described, in total, six types of direct Wxation of
bone fragments, the most progressive of which were wire
cerclage and the Wrst prototypes of external Wxation known
at that time. However, in general, operative treatment of
fractures was at that time still in its infancy.
Discovery of anaesthesia, antisepsis and X-rays
(1846–1895)
Surgery in the Wrst half of the nineteenth century was
primarily dominated by pain and fear of lethal infections. Surgeons were, to a great extent, inXuenced by their “blindness”
resulting from the absence of a method that would allow an
accurate diagnosis of fractures and dislocations, or monitoring
the course of healing, outcomes and complications of the
treatment. All this changed radically within 50 years.
On 16 October 1846, William Thomas Green Morton
(1819–1868), an American dental surgeon, described for
the Wrst time the administration of inhaled ether vapour as
an anaesthetic during operation. In the space of a few
months, this method had also spread to Europe.
The British surgeon Joseph Lister (1827–1912), who
lived and worked in Edinburgh and later moved to London,
was inXuenced by Pasteur’s teaching and addressed the prevention of surgical infection [14]. In 1865, he treated
successfully an open femoral fracture in an 11-year-old boy
using an antiseptic carbolic acid spray. In 1877, he performed osteosynthesis of a closed fracture of the patella,
under carbolic acid spray, using a silver wire [65]. This
operation became an important part of the history of surgery. In Germany, the Listerian method was actively propagated by Richard von Volkmann (1830–1889) from Halle
as early as in 1872 and its use quickly spread all over
Germany [37, 102]. In 1886, Ernst Gustav Benjamin von
Bergmann (1836–1907) from Berlin introduced asepsis
(steam sterilization). Prevention of infection improved also
123
Arch Orthop Trauma Surg (2010) 130:1385–1396
thanks to the introduction of rubber surgical gloves in the
1890s by William Stewart Halsted (1852–1922) in the USA
and subsequently by Emil Theodor Kocher (1841–1917) in
Europe.
Wilhelm Conrad Röntgen (1845–1923) made his discovery of X-ray imaging on 8 November 1895 and published it
in the Wrst week of January 1896. The Wrst clinical radiograph, showing a projectile in the wrist of a 12-year-old
boy, was published in Lancet as early as 22 February
1896!!! One of the Wrst radiographs appeared for instance
in the “Atlas of Fractures”, published in 1897 by Heinrich
Helferich (1851–1945) from Greifswald [42]. The Wrst
book on fractures, which had been diagnosed and treated on
the basis of radiographic examination, was published by
Carl Beck (1856–1911), an American surgeon of German
origin, working in New York, in 1900 [8].
The decisive era of 35 years (1886–1921)
In 1885, osteosynthesis was still a Cinderella having at
its disposal mainly wires, ivory pegs and very primitive
types of external Wxation. After World War I, the situation changed radically. During 35 years (1886–1921),
operative treatment of fractures witnessed an unprecedented revolution. Radiology had become an integral part
of the bone and joint surgery. Introduced into the clinical
practice were all types of osteosynthesis, i.e. plates,
external Wxation and intramedullary nails. Basic experiments were undertaken, surgical approaches described
and the Wrst textbooks on osteosynthesis published. This
extremely fruitful period was split by Roentgen’s invention into two diVerent parts: the pre-radiological and
radiological eras.
Pre-radiological period (1886–1895)
Due to the “blindness” of surgeons, operative treatment Wrst
focused on “subcutaneous” fractures, i.e. fractures more
easily diagnosed by sight and palpation (patella, olecranon,
tibia, clavicle and mandible), as well as fractures resisting
non-operative treatment (proximal femur, diaphyseal fractures of the forearm). In spite of this “blindness”, several
signiWcant publications appeared in this period.
Carl Hansmann (1853–1917), a German surgeon from
Hamburg, was the Wrst to publish in 1886 Wxation of fractures by a plate (Fig. 1) [38].
Heinrich Bircher (1850–1923), a Swiss surgeon from
Bern, published in 1887 an extensive article on intramedullary osteosynthesis of diaphyseal fractures of the femur and
tibia by means of pegs, and of the metaphyseal fractures of
the tibia by ivory clamps (Fig. 2) [12].
Arch Orthop Trauma Surg (2010) 130:1385–1396
Fig. 1 Hansmanns’ plate (Verh Dtsch Ges Chir 15:134–137, 1886)
1387
Nicholas Senn (1844–1908), an American surgeon from
Chicago, dealt in detail in 1893 with the then known methods of osteosynthesis [92]. He studied “absorption of aseptic ivory and bone in the living tissues” and developed a
“hollow perforated intra-osseous splint” of which he
assumed “absorption in a comparatively short time”. For
oblique diaphyseal fractures, he designed an extramedullary “bone ferrule”. He successfully used this absorbable
osseous sleeve, made from ox bone, in three patients with
non-unions of the femoral, humeral and tibial shafts
(Fig. 3). Thus, Senn can be called the father of biodegradable implants. His ferrule was predecessor of the PuttiParham bands.
Pietro Loreta (1831–1889), an Italian surgeon and personal physician of Garibaldi, was probably the Wrst in the
world to perform, in 1888, an open osteosynthesis of a nonunion of the femoral neck, using multiple cerclage [1].
Julius Dolinger (1849–1937), a Hungarian surgeon from
Budapest, Wxed an acute extracapsular fracture of the femoral neck by open osteosuture using silver wire, in 1891 [26].
Fig. 2 Bircher’s intramedullary ivory peg and clamp
(Langebeck’s Archiv 34:410–
422, 1887)
Fig. 3 Senn’s “hollow perforated intra-osseous splint” (a)
and an extramedullary “bone
ferrule” (b, c) (Ann Surg
18:125–151, 1893)
123
1388
Willy Meyer (1858–1932), an outstanding American
surgeon of German origin and Trendelenburg’s pupil, was
the Wrst to treat in the USA a non-union of the femoral neck
with two nails in 1892 [71].
Elie Lambotte (1856–1912), a Belgian surgeon and
brother of Albin Lambotte, was probably the Wrst to treat an
oblique fracture of the tibial shaft with screws, in 1890
[55].
William Arbuthnot Lane (1856–1943), a British surgeon
from London, advocated in articles published in 1893–1895
operative treatment of fractures “of such a bone as the
patella, tibia, Wbula, clavicle, jaw and olecranon”. He Wxed
fractures by wire sutures and later by screws [57–59].
Radiological period (1896–1921)
The discovery of X-ray imaging provided bone surgeons
with a tool for diagnosing fractures and dislocations, as
well as for monitoring fracture healing, evaluation of the
Wnal outcome and of any complications.
Frederic Jay Cotton (1869–1938) from Boston, the
author of an outstanding textbook, wrote in 1910 [21]: “We
are fortunate today not only in having the X-ray as an
accessory method of diagnosis, but in having, as a result of
this diagnostic method and of a vast array of observations
made directly at operation, a material for deductions not
accessible to previous generations. Wisdom did not begin
with this generation, but we have had an unusual opportunity to learn”. Similarly, in 1912 Emil H. Beckman stated:
“The use of the X-ray Wrst showed us how very inferior our
bone repair work has been” [9].
The development of osteosynthesis was gaining momentum and the number of published articles on this subject
was growing, both in Europe and in the USA [9, 13, 28, 31,
32, 34, 35, 39, 49–52, 64, 70, 72, 76–79, 83–85, 89, 94, 95,
97, 98, 100]. Some authors, such as Nienhansen Preston,
Schöne and Sherman, became famous in this Weld, on the
basis of only one or two publications [76, 83, 84, 89, 95,
96]. Others such as Lane, Lambotte and Hey Groves dealt
systematically with operative treatment of fractures and
published their work in a book form [44, 46, 55, 56, 60, 63].
This period was symbolically rounded oV with the second
edition of Hey Groves’ book in 1921 [46].
The development of implants in the late nineteenth
and early twentieth centuries
One of the Wrst problems brought about by the introduction
of operative treatment of fractures was a total lack of suitable implants and instruments. Therefore, those who
wanted to treat fractures operatively tended to develop their
123
Arch Orthop Trauma Surg (2010) 130:1385–1396
own implants. It was a period of testing of suitable materials and the search for adequate surgical approaches.
Materials
EVorts were concentrated on Wnding a suitable implant
material. The oldest implants for internal Wxation of fractures were made from various materials, mainly ivory, bone
and metal (bronze, lead, gold, copper, silver, brass, steel,
aluminium). Ivory and bone pegs were used for intramedullary Wxation [2, 11, 25]. Silver was used for cerclage wires,
plates and intramedullary pins. However, the Wrst plates
were made from nickel-coated sheet steel [38], and later
from silver [98], high carbon steel [60, 63], vanadium steel
[95], aluminium [55, 56] or brass [13]. Nevertheless, all the
metals were highly problematic from the viewpoint of their
mechanical properties and corrosion. This problem was
solved by the use of stainless steel. Although it was
invented before WWI, it was not used for the production of
implants until much later [101].
Experiments
Many authors tested their ideas experimentally. One of the
Wrst was Ferdinand Riedinger (1844–1918), a German surgeon from Würzburg. His article of 1881, dealing with nonunions of the forearm, included a number of experiments
on rabbits and dogs [86]. While the implanted intramedullary ivory pegs and bone blocks integrated into the bone
without problem, the wooden and rubber implants caused
infections. The article was supplemented also with microscopic drawings not only of integrated ivory pegs, but also
of the adjacent physis (Fig. 4).
An outstanding researcher was Nicholas Senn, who in
1889 published a book on experimental surgery [91]. He
not only studied the healing of intracapsular fractures of the
femoral neck [90], but veriWed in dogs “the feasibility,
safety and utility of direct fracture Wxation with bone ferrules” [92].
Harry M. Sherman (1854–1921), an American surgeon
from San Francisco, studied experimentally in 1914 several
signiWcant issues, including: “Are screws and plates tolerated inside a joint?” and “What are the early and late eVects
of well, and insuYciently, countersunk screws”. Among
other things, he found out that “The use of two diVerent
metals in these screws and plates does not change the
results in the articulation, except so far as the possible electrical reaction is concerned in the staining of the tissues”
[94].
The most extensive and comprehensive experiments
were made from 1914 by Hey Groves [44]. In most of his
100 experiments, he studied on the cat tibias and femurs the
healing of fractures Wxed by plates, intramedullary pegs
Arch Orthop Trauma Surg (2010) 130:1385–1396
1389
Fig. 4 Riedinger’s experiments: a ivory peg (a) incorporated in medullary channel,
b physis of operated on bone,
c physis of control contralateral
bone, the diVerence in the height
of both physes is clearly visible
(Arch Klin Chir 26:985–993,
1881)
(ivory, steel, metallic magnesium, wire spirals, bone, decalciWed bone) and external Wxators. He also studied Wlling of
bone defects with bone pieces or chips and regeneration of
bone after subperiosteal removal of a piece of its entire
thickness. The results of his experiments were illustrated by
“skiagrams”, and photographs of microscopic specimens
and microscopic sections. His conclusions are valid to this
day. He thereby anticipated much of the experimental work
of AO by more than 40 years.
Cerclage
Wire cerclage was one of the earliest methods of internal
Wxation [1, 10, 26, 29, 65, 71, 81, 82]. Improvement of this
technique was published almost simultaneously by three
authors. Robert Milne, an American surgeon, described in
1912 cerclage using Xexible threaded pins [72]; Vittorio
Putti (1880–1940), an Italian orthopaedic surgeon, presented in 1914 cerclage with a narrow metal band [85].
Two years later (1916), a similar method was published by
Frederick William Parham (1856–1927), an American surgeon from New Orleans [77]. The implant spread worldwide under the name Putti-Parham bands and in various
modiWcations it is occasionally used today.
Plates
The Wrst to publish his experience with plate osteosynthesis
was Carl Hansmann, in 1886, as mentioned above [39].
Hansmann used plates from nickel-coated sheet steel in 20
cases, 15 times in fractures (8 fractures of the tibia, 3
fractures of the femur, 1 fracture of the radius, 1 olecranon
fracture and 2 fractures of the mandible) and 5 times in
non-unions (humerus, ulna, radius, femur, tibia). Part of the
plate, and the shanks of the screws that Wxed it to the bone,
protruded from the wound and could be therefore removed
percutaneously. Hansmann kept the surgical wound strictly
aseptic and used washable external rubber splints. He did
not mention any complications and removed the plates after
4–8 weeks. Neither in Germany nor elsewhere in Europe
did Hansmann have a successor for a long time. It was only
after a 14-year interval that other publications in this Weld
appeared, mainly in the USA.
Lewis W. Steinbach (1851–1913) from Philadelphia in
1900 treated four cases of fracture of the tibia with a silver
plate of his own design, Wxed to each of the fragments by
two steel screws [98]. He also described in detail the operative technique, including the use of drainage tubes. It was
the Wrst publication to use radiography to document the
injury, the plate Wxation and the Wnal outcome after implant
removal.
Edward Martin (1859–1938), also from Philadelphia,
published in 1906 radiographs of fractures of the femoral
shaft, and the tibial shaft and metaphysis, treated with
plates and monocortical screws [70]. Among radiographs
published by Martin was also a healed fracture of the distal
shaft of the radius treated with plate and bicortical screws
by John Ashhurst (1839–1900) 7 years before publication
of Martin’s article, i.e. in 1899!
William Lawrence Estes (1855–1940), from South
Bethlehem, in 1912 in an article on fractures of the femoral
shaft, discussed in detail the operative technique, stating:
“In 1886 the writer devised a plate for direct Wxation of
fractured bones. It has been used in his clinic with good
results ever since. It is a modiWcation of the early Schede
plate. It is made of soft steel, nickel plated. It has been
known to bend a little but has never broken while in use”
[28]. This indicates that Estes developed the plate simultaneously with Hansmann! Unfortunately, no details could be
traced.
Joseph Augustus Blake (1864–1937) of New York
reported 106 surgically treated fractures in 1912 dealing in
detail with plate osteosynthesis [13]. From 1905, he used
plates of his own design, made mostly of silver, and also
occasionally of brass or steel. He later applied the Lane
plates to the treatment of fractures of the shafts of the
humerus, ulna, radius and femur.
Emil H. Beckman (1872–1916) from the Mayo Clinic in
Rochester was probably the Wrst to publish, in 1912, a
radiograph of a fracture of the medial malleolus Wxed with
a plate [9].
William O’Neil Sherman (1880–1979) from Pittsburgh
was a strong proponent of internal Wxation in the USA and
contributed to signiWcant improvements in plate design. As
he worked for Carnegie Steel Company, he had optimal
conditions for experimenting with both the material and
123
1390
design of plates. He published his results in 1912 [95]. His
sophisticated plates, designed on the basis of mechanical
principles, were made of vanadium steel, using self-tapping
monocortical screws. Later, in 1926, he dealt in detail with
plate osteosynthesis of diaphyseal fractures of the femur,
attaching the plates with bicortical screws [96].
In 1914, Miller Edwin Preston (1879–1928) from Denver
designed the Wrst angled blade plate for osteosynthesis of
femoral neck fractures, although he used it probably only in
a few cases [83].
At the beginning of the twentieth century, plate
osteosynthesis started spreading in Europe, mainly due to
William Arbuthnot Lane and Albin Lambotte, who were
followed several years later by Ernest William Hey Groves.
Albin Lambotte stated in the 1907 Wrst edition of his book
that from 1900 he had treated various diaphyseal fractures
with plates made of aluminium, which he Wxed by self-tapping monocortical screws [55]. In the second edition of his
book, published in 1913, he described three diVerent types of
plates, one of which was contoured [56]. Albin Lambotte
also used plates for the Wxation of fractures of the distal
humerus, distal femur, proximal tibia and the mandible.
William Arbuthnot Lane published, in 1907, a successful
Wxation of diaphyseal fracture of the femur using a pair of
plates [61]. The second edition of his book in 1914 was
devoted primarily to plate osteosynthesis [63]. Lane Wxed
carbon steel plates of his own design with monocortical
screws. Their disadvantage was their Ximsiness and the
necessity to immobilize postoperatively the limbs with external splints. Lane used plates for the Wxation of all diaphyseal
fractures of the clavicle, humerus, radius, ulna, femur, tibia
and Wbula, and also of both malleoli, olecranon and scapula.
Henry S. Souttar (1875–1964), an outstanding surgeon
from London, who later became famous for his operation for
mitral stenosis, published in 1913 his own design of a plate
Wxed with a Wnely threaded screw [97]. He considered the
vascular impact of the plate on the bone and tried to reduce
its “footprint” on the bone in order to not impair healing.
Ernest William Hey Groves dealt in detail with plate
osteosynthesis, including experiments on animals [44]. For
instance, he designed curved plates or plates with T-shaped
ends. He compared the mechanical properties of the Lane
and Lambotte plates, as well as Wxation properties of
“wood” and “metal” screws. Hey Groves also used interfragmentary Wxation and bolted plates.
Due to the eVorts of the above-mentioned authors, plates
became, at the beginning of twentieth century, the most frequently used implants for internal Wxation of fractures.
External Wxation
The Wrst to use external Wxation is traditionally considered
Malgaigne (Fig. 5) [16, 81, 82]. In 1840, Malgaigne used
123
Arch Orthop Trauma Surg (2010) 130:1385–1396
Fig. 5 Malgaigne’s “external Wxators”: a pointe métallique, b griVe
métallique (Traité des fractures et des luxations. JB Baillière, Paris
1847)
and in 1843 published pointe métallique, by which he
percutaneously Wxed fractures [66]. However, this device
cannot be considered as external Wxation [18]. The same
applies to griVe métallique, which Malgaigne designed in
1843 and described in 1847 [66]. GriVe métallique was
subsequently modiWed by Rigaud in 1850 and Chassin in
1852 [10]. It was not a typical external Wxator and was
intended only for fractures of the patella [10, 18, 66].
Povacz [82] in “Historie der Unfallchirurgie” ascribed
the Wrst application of external Wxation to Carl Wilhelm
Wutzer (1789–1863) from Bonn, Germany. In 1843, Wutzer allegedly used the Wrst external Wxator to treat a nonunion of femur persisting for 11 years [82]. But the reality
is diVerent. Geller [33] in his dissertation thesis in 1847
brieXy mentioned that C. Claus von der Höhe Wxed in 1843
at Wutzer’s clinic a non-union of the femur by inserting
into both fragments a couple of screws transversely connected outside the wound. However, the patient died.
Therefore, Wutzer in 1846 treated a non-union of the femur
by resection of the ends of the fragments and use of a goldwire cerclage, and the operation was successful [33].
Bernhard Rudolf Konrad von Langenbeck (1810–1887)
from Berlin in 1855 treated a non-union of the humerus
with screws connected by a devise designed for this purpose [30]. Due to infection, the Wxator had to be removed
after 12 days and the non-union was left to heal conservatively.
Arch Orthop Trauma Surg (2010) 130:1385–1396
1391
Fig. 7 Parkhill’s external Wxator (Ann Surg 28:552–570, 1898)
Fig. 6 Heine’s external Wxators: Fig. 1 and 2 “ivory pins” Wxator,
Fig. 3 and 4 “pin-less” external Wxator. (Langebeck’s Archiv 22:472–
495, 1878)
An original and today quite unknown concept of external
Wxation was developed by Carl Wilhelm v. Heine (1839–
1877), who worked in Innsbruck and later in Prague [41].
In 1872, Heine Wxed a non-union of the femur by two ivory
pins inserted transversely through both cortices of each
fragment, threaded at the end to accommodate the end cap.
Each of the pins was transversely connected to the bar. The
other end of the bar was Wxed in an arch, the arms of which
were integrated into the plaster bandage (Fig. 6). However,
this Wxation proved to be inadequate. Therefore, in the
patients with non-union of the humerus, tibia and femur,
the fragments were directly Wxed by bone clamp jaws
resembling a pin-less external Wxator. The clamp protruded
from the surgical wound and was connected by a transverse
bar Wxed again in the plaster bandage (Fig. 6). In this way,
Heine healed only the non-union of the humerus, while the
other cases required amputation.
External Wxation, as we know it today, started to develop
as late as at the turn of the twentieth century. In the USA, in
1897–1898 Clayton Parkhill (1860–1902) from Denver
designed external Wxation clamps and used them for diVerent types of fractures (Fig. 7) [78, 79]. His early death,
caused by acute appendicitis when he refused operation,
prevented him from developing this method, which was
then further developed by his colleague Leonard Freeman
(1860–1935). In 1911, Freeman described the detailed
operative technique, including various tips and tricks [31].
In 1919, he introduced the “turnbuckle” to facilitate reduction, which was a highly sophisticated precursor of the AO
femoral distractor [32]. Howard Lilienthal (1861–1946),
from New York, who later became an outstanding thoracic
surgeon, used external Wxation of his own design in diaphyseal fractures, including the infected ones in 1912 [64].
In Europe, Albin Lambotte became the father of external
Wxation. He developed his own external Wxator clamps,
independently of Parkhill. The design of the Lambotte Wxator was highly sophisticated and was very similar to the
current AO tubular Wxator. The screws were self-threading
and self-tapping and the clamps provided the Wxator with
diVerent degrees of freedom. Lambotte used it successfully
from 1902 for all diaphyseal fractures [55, 56].
In 1916, Ernest Hey Groves described diVerent types of
external Wxator clamps for intraoperative reduction of fractures, allowing both distraction and compression of fragments. For stabilization of diaphyseal fractures of the femur
and tibia, he used external Wxator frames [44].
Although external Wxation was not used as frequently as
plates, it was relatively widespread both in Europe and the
USA during the study period.
Intramedullary nailing
A predecessor of nailing of acute diaphyseal fractures may
be considered to be Wxation of diaphyseal non-unions of the
femur, humerus and tibia with ivory intramedullary pegs,
performed by the prominent Berlin surgeon Johann Friedrich DieVenbach (1792–1847) and published in 1846 [25].
The same method for a non-union of tibia was used in
1861 by the German surgeon Theodor Bilroth (1829–1894),
123
1392
who worked at that time in Zurich [11]. He removed the
ivory grafts 2 weeks after operation, examined them microscopically and found their partial resorption. His method
consisted in opening the medullary cavity of both diaphyseal fragments with a drill.
The ivory grafts inserted subsequently served as biological stimulators, rather than as mechanical Wxation. Antisepsis was not known at that time and thus the wound always
became infected and the pegs had to be removed after
1–3 weeks. However, the subsequent inXammatory hyperaemia often resulted in healing of the non-union.
The superWcial resorption of ivory pegs by macrofags
was described also by Emanuel Aufrecht (1844–1933),
from Magdeburg. In 1877, Aufrecht microscopically examined ivory pegs, which an outstanding German surgeon
Werner August Hagedorn (1831–1894), had used to Wx a
non-union of the tibia under antiseptic conditions [2].
Carl Wilhem v. Heine described in 1878, in an article
published after his death [41], a successful Wxation of
diaphyseal non-union of humerus and ulna with ivory pegs.
Ferdinand Riedinger studied experimentally internal Wxation with ivory pegs in 1881 [86]. Heinrich Bircher treated
successfully in 1887 diaphyseal fractures of the femur and
tibia with intramedullary pegs [12]. A similar type of intramedullary Wxation was the intraosseous splint described by
Nicolas Senn in 1893 [92].
Metallic nails were initially used to Wx fractures of the
articular ends of bones, particularly in fractures of the femoral neck [71, 74, 93]. The Wrst operation in this respect
was performed by Langenbeck in 1858 [93]. Paul Niehans
(1848–1912) from Bern, in 1904, described treatment of a
supracondylar humeral fracture in a child [76]. The author
performed open reduction and nailing in six cases, from the
Kocher radial approach after temporary osteotomy of the
olecranon!
The Wrst successful “closed” nailing of a diaphyseal
fracture was described by Georg Schöne (1875–1960)
working in Greifswald in 1913 [89]. Under Xuoroscopic
control, he treated a total of seven diaphyseal fractures of
the ulna or radius, using percutaneously inserted silver
pins (Fig. 8).
A highly signiWcant, although until now not fully recognized, contribution to intramedullary nailing was made by
Ernest William Hey Groves. He conducted a series of
experiments with intramedullary pegs and nails made of
bone, ivory and metal [44, 46]. Hey Groves also tested
diVerent designs of nails. In 1918, he treated two cases of
gunshot fracture of the femoral shaft by a steel nail [45].
Unfortunately, Hey Groves’ remarkable contribution to
intramedullary osteosynthesis has been rather overshadowed by the eminence accorded to Gerhard Küntscher.
Despite all eVorts, nails did not win recognition in the
treatment of diaphyseal fractures at the beginning of the
123
Arch Orthop Trauma Surg (2010) 130:1385–1396
Fig. 8 Schöne’s intramedullary nailing of forearm fractures (Münch
Med Wschr 60:2327–2328, 1913)
twentieth century. One of the main obstacles was the lack
of a suitable material.
Surgical approaches
It is surprising that the authors of this period paid such little
attention to operative approaches in their books and articles. The Wrst book containing a more detailed description
and Wgures showing operative approaches was Operationslehre (Textbook of Operative Surgery) published in 1907
by Theodor Kocher, a Swiss surgeon from Bern [50].
Kocher described therein a number of approaches that
today bear his name (hip, elbow and calcaneus).
The very Wrst publication dealing in detail with operative
approaches to long bones was the 1918 article by James
Edwin Thompson (1863–1927) [99]. This English surgeon
and anatomist, who moved to Galveston in Texas [17], deWned the requirements for operative approaches that are valid
till today:
•
•
•
•
ease of access,
preservation of all nerves, both sensory and motor,
prevention of unnecessary injury to muscles,
preservation of the vascular supply.
Subsequently, he described a number of approaches to all
the long bones, including their articular ends. Of the whole
article, history remembers merely the posterolateral
approach to the radial shaft that is today named after him.
It was not until 1945 that the Wrst two comprehensive
textbooks of operative approaches were published. The Wrst
of them was “Extensile exposure applied to limb surgery”
written by Arnold Kirkpatrick Henry (1886–1982) [43].
This Irish surgeon and anatomist, an outstanding representative of the Dublin surgical school, formulated the concept
of extensile approaches in internervous planes. In addition
to general principles, he described also a number of
approaches, the best known of which is Henry’s volar
approach to the radius. A comprehensive “Atlas of surgical
Arch Orthop Trauma Surg (2010) 130:1385–1396
approaches to bones and joints” containing also approaches
to the spine, pelvis, mandible and temporomandibular joint
was published by TouWck Nicola (1894–1987), an American orthopaedic surgeon from New York [75].
Luminaries of bone surgery of the Wrst half
of the twentieth century
Outstanding from the above-mentioned authors, who more
or less contributed to the development of osteosynthesis,
are three extraordinary personalities especially worthy of
mention.
William Arbuthnot Lane (1856–1943), the British surgeon working in London, was a pioneer of internal Wxation who treated closed fractures operatively from 1892.
His Wrst publications may be considered as the Wrst declaration rationally defending operative treatment of fractures [57–59]. In 1905, he published the book “The
operative treatment of fractures” [60]. In 1907, he added
also plates of his own design [61]. These plates appeared
as a preferred method only in the second edition of his
book in 1914 [62]. Lane was an excellent surgeon with a
profound knowledge of anatomy. He was the originator
and a strong proponent of the “no touch” technique, for
which he developed a number of dedicated instruments
[15, 70, 78]. As a result, he had a very low incidence of
infective complications. He was in close contact with the
German Surgical Society, and regularly attended its
congresses at the beginning of the twentieth century. His
concepts became very popular, particularly in the USA
[39, 62].
Albin Lambotte (1866–1955), a Belgian surgeon from
Antwerp, was a true genius of bone surgery, who at the
beginning of the twentieth century extraordinarily inXuenced its development [27, 73, 81]. His contribution is
remarkable mainly due to the comprehensiveness of the
methods he used. Plates, external Wxation, cerclage, screws
and nails, all of which he used for various types of fractures. In addition, he invented or improved a number of
instruments. In 1907, he published the book “L’intervention opératoire dans les fractures récentes et anciennes
envisageé particuliérement au point de vue de l’ostéo-synthèse” [55] the title of which presents for the Wrst time the
term “osteosynthesis”. The revised edition of 1913 is a
work, which to date remains fascinating by virtue of its
scope of coverage [56]. Unfortunately, it has been translated into neither English nor German.
Both editions contain a detailed documentation of a great
number of his surgical cases. Lambotte used radiographs as
a standard for diagnosis, as well as for monitoring the
course of healing. He carefully recorded the radiograph
documentation of each of his patients in the form of sche-
1393
matic drawings made from X-rays using a pantograph,
sometimes including functional results. The technique of
his operations and their results were well ahead of his time.
Although Lambotte was well known in the English-speaking surgical world, due to the language barrier his ideas
could not spread as did those of Lane.
Ernest William Hey Groves (1872–1944) from Bristol is
nowadays unjustly neglected in the history of osteosynthesis. During World War I, in 1916, he published a textbook
that is almost unknown today “On modern methods of
treating fractures” [44]. A second edition followed in 1921
[46]. The textbook surprises by its comprehensive coverage
of the given issue and many of its concepts are almost the
same as in current textbooks on bone trauma. The reader
will also Wnd here three extensive chapters dealing with
operative treatment, showing in detail how the author used
plates, nails and external Wxation. His extensive experiments on animals using all these implants are unique. A
large space was devoted to mechanical properties of diVerent types of plates and screws suitable for the cortical bone.
In fractures of the femur, he introduced nailing from the tip
of the greater trochanter, as well as retrograde nailing from
the fracture site [45]. In some cases, the author Wxed intramedullary pegs by transversely inserted screws, which
anticipated the concept of locking nailing. Hey Groves was
a universal bone surgeon. He studied also the application of
solid bone grafts and used them to treat fractures of the
femoral neck [48]. He signiWcantly inXuenced reconstructive surgery of the hip and, in 1927, designed an ivory hip
replacement, similar in form to the later Judet prosthesis
[47]. In spite of this, Hey Groves’ historical contribution to
operative treatment of fractures has not yet been fully
appreciated.
Contribution of individual surgical schools
British surgical school
Throughout the nineteenth century and in the early twentieth century, British surgeons were pioneers in the Weld
of closed and operative treatment of fractures. Lister,
Lane and Hey Groves could rely on the foundations laid
by Sir Astley Cooper, and the Dublin and Edinburgh surgical schools [4–6, 19]. Lister succeeded in reducing
infection [14]. Lane became a respected proponent of
osteosynthesis and the “no touch technique”, not only in
Great Britain, but also in Germany and the USA [15].
Hey Groves studied all types of osteosynthesis, including
experimental ones; he published the Wrst modern textbook on closed and operative treatment of fractures and
contributed also to the development of reconstructive hip
surgery [44–48].
123
1394
German surgical school
In the second half of the nineteenth century, the Germanspeaking surgeons became strong advocates of the operative
treatment of fractures and promptly accepted the Listerian
principles as early as in 1872 [14, 37]. In addition, many
of them gained experience from the Prussian–Austrian
(1866) and German–French (1870) wars. As a result, in the
70s and 90s of the nineteenth century, German surgery had
the edge over the rest of the world. In 1847–1913, German
surgeons published key original articles on external Wxation, plate osteosynthesis and intramedullary nailing
[25, 30, 33, 38, 41]. Unfortunately, none of these German
authors dealt systematically with operative treatment of
fractures. This was the main cause for the gradual decline
of German bone surgery from its position of pre-eminence
at the beginning of the twentieth century. The only signiWcant proponent of operative treatment in Germany in the
Wrst decades of the twentieth century was Fritz König
(1866–1952), the son of the well-known German surgeon,
Franz König (1832–1910) [51–54, 104]. Fritz König was
also the author of the Wrst German book on osteosynthesis,
published as late as in 1931 [54].
French surgical school
In the Wrst half of the nineteenth century, the French school
of bone surgery, represented by Dupuytren, Larrey and
mainly Malgaigne, reached its climax. However, BérangerFéraud’s book of 1870, dealing with osteosynthesis, was an
epilogue of this era [10]. Its author had no successor in
France for many years. The situation radically changed
with Albin Lambotte, a Belgian surgeon with links to
French surgery and writing in French, whose contribution
was cardinal [55, 56].
American surgical school
At the beginning of the nineteenth century, surgeons in
the USA had established close contacts with the English,
German and French surgical communities. Clayton Parkhill
signiWcantly inXuenced the development of external Wxation, both in the USA and around the world. Also, the
development of plate osteosynthesis was extraordinary in
the USA, from the very beginning of the introduction of
this method. It is amazing how many interesting articles
dealing with operative treatment of fractures, published by
a signiWcant number of authors, appeared in the Wrst few
years of the twentieth century [9, 13, 28, 34, 49, 64, 83, 94,
95, 100]. Writers discussed in detail operative techniques
and many other related topics. Most of the articles were
amply documented by radiographs and drawings. This
period culminated around 1912. Sherman plates subse-
123
Arch Orthop Trauma Surg (2010) 130:1385–1396
quently spread all over the world. Many of the above-mentioned authors excelled also in other surgical disciplines
(thoracic surgery, neurosurgery, andrology), but in fact
none of them was a “full-time” specialist in bone and joint
surgery. This was probably one of the reasons why a textbook on internal Wxation of fractures did not appear in the
USA until as late as 1947 [101].
Epilogue
It is fascinating how aptly Preston deWned the main problems of internal Wxation of fractures as early as in 1916
[84]: “There is no branch of surgery in which nature is
more exacting then bone work. To be successful in this
Weld, the cases must be carefully selected, the most rigid
asepsis should be observed, the surgeon must possess a
good working knowledge of anatomy and fully appreciate
the laws of stress, strain and leverage. The internal Wxation
of a fracture is decidedly an engineering problem, as well
as a surgical procedure, and it is probable that a larger percentage of failures have resulted from violation of
mechanical laws than have been due to faulty surgical
asepsis.”
After World War I, the way opened for operative treatment of fractures to spread successfully all over the world.
Plate osteosynthesis, particularly, became highly popular
both in Europe and in the USA. However, the Wrst generation of advocates of osteosynthesis was no longer as active
in publishing works on bone surgery as hitherto. As a
result, internal Wxation of fractures, in many cases, passed
into the hands of unprepared surgeons, whose knowledge
was insuYcient to understand the principles deWned and
respected by their predecessors. Over a short period, a large
number of catastrophes occurred to swing the pendulum of
specialized public opinion in favour of conservative treatment, for many years. This, however, cannot change the
fact that in a historically very short period of 50 years
(1870–1921), solid foundations were laid for operative
treatment of fractures, many of which we continue to
respect to this day.
Acknowledgments This article could not have appeared without
the extraordinary help in collecting original sources, oVered by
Ms. Ludmila Frajerová from the Klementinum (Czech National
Library) and Ms. Mirka Plecitá from the 3rd Faculty of Medicine,
Charles University, Prague and Arsen Pankovich, MD. I also wish to
thank Ms. Ludmila Bébarová and Chris Colton, MD for editing the
English version of the manuscript.
References
1. Anonymous (1888) Treatment of ununited fracture of the neck of
femur. Brit Med J1443:446
Arch Orthop Trauma Surg (2010) 130:1385–1396
2. Aufrecht E (1877) Ueber Riesenzellen in Elfenbeinstiften,
welche zur Heilung einer Pseudoarthrose eingekeilt waren.
Centrallblat Med Wissensch 15:465–467
3. Bagby GW (1977) Compression bone-plating. J Bone Joint Surg
A 59:625–631
4. Bartoníbek J (2002) History of fractures of the proximal femur.
Contribution of the Dublin Surgical School of the Wrst half of
19th century. J Bone Joint Surg B 84:795–797
5. Bartoníbek J (2002) Internal architecture of proximal femur –
Adam’s or Adams’ arch? Historical mystery. Arch Orthop Trauma Surg 122:551–553
6. Bartoníbek J (2004) Proximal femur fractures—the pioneer era of
1818 to 1925. Clin Orthop Rel Res 419:306–310
7. Bartoníbek J, Cronier P (2010) History of the treatment of scapula fractures. Arch Orthop Trauma Surg 130:83–92
8. Beck K (1900) Fractures: with an appendix on the practical use
of the Roentgen rays. Saunders, Philadelphia
9. Beckman EH (1912) Repair of fractures with steel splints. Surg
Gyn Obst 14:71–76
10. Bérenger-Féraud LJB (1870) Traite de l’immobilisation directe
des fragments osseux dans les fractures. Adrien Delahaye, Paris
11. Bilroth Th (1861) Ueber Knochen—resorption. Langebeck’s
Archiv (Arch Klin Chir) 2:118–132
12. Bircher H (1887) Eine neue Methode unmittelbarer Retention bei
Fracturen der Rohrenknochen. Langebeck⬘s Archiv (Arch Klin
Chir) 34:410–422
13. Blake JA (1912) The operative treatment of fractures. Surg Gyn
Obst 14:338–345
14. Bonin JG, LeFanu WR (1971) Joseph Lister 1827–1912. A bibliographical biography. J Bone Joint Surg B 49:4–23
15. Brand RA (2009) Sir William Arbuthnot Lane, 1856–1943. Clin
Orthop Rel Res 467:1939–1943
16. Broos PLO, Sermon A (2004) From unstable internal Wxation to
biological osteosynthesis. A historical overview of operative
fracture treatment. Acta Chir Belg 104:396–400
17. Burns OR, Campbell HG (1999) The extraordinary inXuences of
two British physicians on medical education and practice in
Texas at the turn of the 20th century. Vesalius 5:79–84
18. Colton CL (2009) The history of fracture treatment. In: Browner
BD, Jupiter JB, Levine AM, Trafton PG, Ch Kretek (eds) Skeletal trauma. Saunders, Philadelphia, pp 3–31
19. Cooper AP (1822) A treatise on dislocations and on fractures of
the joints. Longman, Hurst, London
20. Cooper BB (ed) (1851) A treatise on dislocations and on fractures
of the joints by Sir Astley Cooper. Blanchard and Lea, Philadelphia
21. Cotton FJ (1910) Dislocation and joint fractures. Philadelphia,
Saunders
22. Crawford RR (1973) A history of the treatment of nonunion of
fractures in the 19th century, in the United States. J Bone Joints
Surg A 55:1685–1697
23. Desault PJ (1798) Oevres chirurgicales, ou tableau de la doctrine
et de la pratique dans le traitement des maladies externes par Xav.
Bichat. Desault, Méquignon. Devilliers, Deroi, Paris
24. Desault PJ (1805) A treatise on fractures, luxations and other
aVections of the bones. In: Bichat X (ed) Fry and Kammerer.
Leatitia court, Philadelphia
25. DieVenbach JF (1846) Neue sichere Heilmethode des falschen
Gelenkes oder der Pseudoarthrose mittels Durchbohrung der
Knochen und Einschlagen von Zappfen. Casper’s Wochenschriftt Gesam Heilk 46–48:727–734, 745–752, 761–765
26. Dollinger J (1891) Schenkelhlasbruch geheilt mit Silberdrahtnaht. Centrallblat Chir 18:456–457
27. Elst VE (1971) Les débuts de l’ostéosynthèse en Belgique.
Private publication for Société Belge de Chirurgie Orthopédique
et de Traumatologie, Imp des Sciences, Brussels
1395
28. Estes WL (1912) End results of fractures of the shaft of the femur. Ann Surg 56:162–184
29. Evans PEL (1983) Cerclage Wxation of fractured humerus in
1775. Fact or Wction? Clin Orthop Rel Res 174:138–142
30. Fock C (1855) Pseudoarthrosis humeri sinistri mit gleichzeitiger
Fract. colli humeri dextri und Querbruch im unteren Drittheil
desselben Oberarmes. Volständige Heilung. Deutsche Klinik
314–315
31. Freeman L (1911) The treatment of oblique fractures of the tibia
and other bones by means of external clamps inserted through
small openings in the skin. Trans Am Surg Assoc 29:70–93
32. Freeman L (1919) The application of extension to overlapping
fractures, especially of the tibia, by means of bone screws and
turnbuckle, without open operation. Ann Surg 70:231–235
33. Geller FCHJ (1847) De resectione pseudoarthroseos e femoris
fractura ortae. Dissertatio inauguralis chirurgica. Lechner, Bonn
34. Gerster JCA (1912) The reduction of fragments in fractures of the
long bones. Ann Surg 57:769–779
35. Gerster JCA (1913) A further note on reduction of fragments in fractures of the long bones at open operation. Ann Surg 58:656–658
36. Gurlt E (1860) Handbuch der Lehre von der Knochenbrüchen.
Medinger Sohn and Co., Frankfurt
37. Hach W, Hach V (2001) Richard von Volkmann und die Chirurgie and der Friedrichs-Universität in Halle von 1867 bis 1889.
Zentralbl Chir 126:822–827
38. Hansmann H (1886) Eine neue Methode der Fixierung der Fragmente bei complicierten Fracturen. Verh Dtsch Ges Chir 15:134–
137
39. Harrigan AH (1919) The use and value of the Lane plate. Ann
Surg 69:161–170
40. Heim UFA (2001) The AO phenomenon. Huber, Bern
41. Heine C (1878) Ueber operative Behandlung der Pseudarthrosen.
Langebeck⬘s Archiv (Arch Klin Chir) 22:472–495
42. Helferich H (1897) Atlas und Grundriss der traumatischen
Frakturen und Luxationen. 3 AuXage. Lehmann, München
43. Henry AK (1945) Extensile exposure applied to limb surgery.
Longman, London
44. Hey Groves EW (1916) On modern methods of treating fractures.
Wood and Co, New York
45. Hey Groves EW (1918) Ununited fractures with special reference
to gunshot injuries and the use of bone grafting. Brit J Surg
6:203–247
46. Hey Groves EW (1921) On modern methods of treating fractures.
Wood and Co/Wright, New York/Bristol
47. Hey Groves EW (1926–1927) Some contributions to reconstructive surgery of the hip. Br J Surg 14:486–517
48. Hey Groves EW (1930) Treatment of fractured neck of the femur
with especial regard to the results. J Bone Joint Surg 12:1–14
49. Huntington TW (1912) The operative treatment of recent fractures of the femoral shaft. Ann Surg 56:420–431
50. Kocher T (1907) Chirurgische Operationslehre. Fisher, Jena
51. König F (1902) Aussprache zu: Knochennaht. Verh Dtsch Ges
Chir 31(I):36–39
52. König F (1905) Ueber die Berichtigung frühzeitiger blutiger
EingriVe bei subcutanen Knochenbrüchen. Arch Klin Chir
76:725–777
53. König F (1924) Die operative Behandlung der Knochenbrüche.
Arch Klin Chir 133:380–388
54. König F (1931) Operative Chirurgie der Knochenbrüche. I:
Operationen am frischen und verschlepten Knochennbruch.
Springer, Berlin
55. Lambotte A (1907) L’ intervention opératoire dans les fractures
récentes et anciennes envisagées particuliérement du point de vue
de l’ostéosynthèse. Lambertin, Brussels
56. Lambotte A (1913) Chirurgie opératoire des fractures. Masson,
Paris
123
1396
57. Lane WA (1893) On the advantage of the steel screw in the treatment of ununited fractures. Lancet 142:1500–1501
58. Lane WA (1895) Some clinical observations on the principles
involved in the surgery of fractures. Clin J 5:392–400
59. Lane WA (1893–1894) A method of treating simple oblique fractures of the tibia and Wbula more eYcient than those in common
use. Trans Clin Soc London 27:167–175
60. Lane WA (1905) The operative treatment of fractures. Medical
publishing Co, London
61. Lane WA (1907) Clinical remarks on the operative treatment of
fractures. Brit Med J 1:1037–1038
62. Lane WA (1909) The operative treatment of fractures. Ann Surg
50:1106–1113
63. Lane WA (1914) The operative treatment of fractures, 2nd edn.
Medical Publishing Co, London
64. Lilienthal H (1912) Safety in the operative Wxation of infected
fractures of long bones. Ann Surg 56:185–191
65. Lister J (1883) An address on the treatment of fracture of the
patella. Br Med J 855–860
66. Malgaigne JF (1847) Traité des fractures et des luxations. JB
Baillière, Paris
67. Malgaigne JF (1855) Traité des fractures et des luxations. Atlas
de XXX planches. JB Baillière, Paris
68. Malgaigne JF (1850) Die Knochenbrüche und Verrenkungen.
Erster Band: Knochenbrüche. Rieger’sche Verlagsbuchhandlung, Stuttgart
69. Malgaigne JF (1859) A treatise on fractures. Lippincott, Philadelphia
70. Martin E (1906) The open treatment of fractures. Surg Gyn Obst
3:258–271
71. Meyer W (1893) Old ununited intracapsular fracture of neck of
femur treated by nail Wxation. Ann Surg 18:30–32
72. Milne R (1913) Remarks. Clin JB Murphy 2:229–234
73. MostoW SB (2005) Who’s who in orthopaedics?. Springer,
London
74. Nicolaysen J (1897) Lidt om Diagnosen og Behandlingen af
Fractura Colli Femoris. Nordiskt Medicinskt Arkiv 8:1–19
75. Nicola T (1945) Atlas of surgical approaches to bones and joints.
The Macmillan Company, New York
76. Niehans P (1904) Zur Fracturbehandlung durch temporäre
Annagelung. Arch Klin Chir 73:167–178
77. Parham FW (1916) Circular constriction in the treatment of fractures of the long bones. Surg Gyn Obst 23:541–544
78. Parkhill C (1897) A new apparatus for Wxation of bones after
resection and in fractures with a tendency to displacement. Trans
Am Surg Assoc 15:251–256
79. Parkhill C (1898) Further observations regarding the use of the
bone-clamp in ununited fractures, fractures with malunion, and
recent fractures with a tendency to displacement. Ann Surg
28:552–570
80. Peltier LF (1988) The treatment of forearm fractures with pins.
Professor Georg Schöne. Clin Orthop Rel Res 234:2–4
81. Peltier LF (1990) Fractures: a history and iconography of their
treatment. Norman Publishing, San Francisco
123
View publication stats
Arch Orthop Trauma Surg (2010) 130:1385–1396
82. Povacz E (2007) Geschichte der Unfallchirurgie. 2 AuXage.
Springer, Heidelberg
83. Preston ME (1914) New appliance for the internal Wxation of
fractures of the femoral neck. Surg Gyn Obstet 18:260–261
84. Preston ME (1916) Conservatism in the operative treatment of
fractures. Colo Med 13:83–88
85. Putti V (1914) Un nuovo metodo di osteosintesi. Clin Chir
22:1021–1024
86. Riedinger F (1881) Ueber Pseudarthrosen am Vorderarm mit
Bemerkungen über das Schicksal implantierter Elfbein- und
Knochenstifte. Arch Klin Chir 26:985–993
87. Schatzker J (1996) Osteosynthesis in trauma. Int Orthop (SICOT)
20:244–252
88. Schlich T (2002) Surgery, science and industry. A revolution in
fracture care, 1950s–1990s. Palgrave Macmillan, New York
89. Schöne G (1913) Zur Behandlung von Vorderarmfrakturen mit
Bolzung. Münch Med Wschr 60:2327–2328
90. Senn N (1883) Fractures of the neck of the femur. Trans Am Surg
Assoc 1:333–453
91. Senn N (1889) Experimental surgery. Chicago
92. Senn N (1893) A new method of direct Wxation of the fragments
in compound and ununited fractures. Ann Surg 18:125–151
93. Senftleben H (1858) Beiträge zur Kenntinss der Frakturen an den
Gelenken. Annalen des Charité-Krankenhauses 8:98–143
94. Sherman HM, Tait D (1914) Fractures near joints. Fractures into
joint. Surg Gyn Obst 19:131–141
95. Sherman WO (1912) Vanadium steel bone plates and screws.
Surg Gyn Obst 14:629–634
96. Sherman WO (1926) Operative treatment of fractures of the shaft
of the femur with maximum Wxation. J Bone Joint Surg 8:494–
503
97. Souttar HS (1913) A method for the mechanical Wxation of transverse fractures. Ann Surg 58:653–655
98. Steinbach LW (1900) On the use of Wxation plates in the treatment of fractures of the leg. Ann Surg 31:436–442
99. Thompson JE (1918) Anatomical methods of approach in operations on the long bones of the extremities. Ann Surg 68:309–329
100. Van Meter SD (1911) The open treatment of fractures. J Am Med
Assoc 56:863–867
101. Venable CS, Stuck WG (1947) The internal Wxation of fractures.
Thomas, SpringWeld
102. Volkmann von R (1878) Die Behandlung der complicierten
Fracturen. In: Volkmann R (ed) Sammlung Klinischer Vorträge
in Verbindung mit Deutschen Klinikern. Bd II, Nr 117,118.
Breitkopf und Härtel, Leipzig, pp 923–976
103. Watson-Jones R, Adams JC,. Bonnin JG, Burrows HJ, King T,
Nicoll EA, Palmer I, vom Saal F, Smith H, Trevor D, VaughanJackson O J, Le Vay AD (1950) Medullary nailing of fractures
after Wfty years. J Bone Joint Surg B 32:694–729
104. Ch Weisser (2001) Fritz König (1866–1952) Wegbereiter der
Osteosynthese und seine EinXüsse auf die Unfalheilkunde.
Zenbtralbl Chir 126:237–242