By Z. Moff. Baldwin-Wallace College. 2018.

He was granted his AB degree at Subsequent reports of this operation included a Randolph-Macon College in 1915 and his MD at careful follow-up of the first patients on whom he Johns Hopkins in 1920 buy lanoxin 0.25 mg online. Elizabeth’s Hospital in Rich- patients were seen 30 and 35 years following their mond lanoxin 0.25 mg discount, he began in 1921 a 16-year association operation and were always available for presen- with the Hospital for the Ruptured and Crippled tation at medical meetings lanoxin 0.25 mg visa. At the same time he started his academic lowing fracture of the femoral neck purchase lanoxin 0.25 mg on-line, sometimes association at the College of Physicians and Sur- called the trochanteric reconstruction operation cheap lanoxin 0.25mg fast delivery, geons of Columbia University where he was Clin- which “consists essentially of severing the ical Professor of Orthopedic Surgery from 1935 muscles attached to the greater trochanter very to 1937. Colonna accepted the invi- close to their insertion to the bone, care being tation to become Professor and Chairman of the taken to leave a fibromuscular layer covering the Department of Orthopedic Surgery at the Univer- region of the greater trochanter. He remained then divided close to the femur and the loose head there until 1942, when he went to Philadelphia as fragment is removed. After the greater trochanter Professor and Chairman of the Department of has been placed deeply within the acetabulum, the Orthopedic Surgery at the University of Pennsyl- abductor muscles are then transplanted downward vania, succeeding Dr. Colonna was very young to the elderly and he was as much at widely known for the design of two surgical pro- home on the children’s ward as he was at the cedures on the hip joint, one for unreduced con- bedside of an 80-year-old patient. Both of these genital dislocation in children, and the other for operations were developed and subsequently 78 Who’s Who in Orthopedics described with definite boundaries as to their indi- founded. Colonna recog- his teaching, he would illustrate the endless nized these and frequently pointed out that the variety of details these principles could include. Colonna was an orthopedic surgeon’s ship of orthopedic surgery to the biological orthopedic surgeon. Most of his patients in his sciences in contrast to the mechanical sciences. In later years, both the young child with a congeni- it he stated that “the rehabilitation of our patients tal hip problem and the elderly patient with a hip will be improved... He spent no time considering what believed in this principle and demonstrated it the treatment might have been, but studied the daily in his work. Colonna permitted himself no time to work wasted no time in pushing forward to its solution. He loved the seashore and in the He continuously taught both by his words and by rather infrequent off-duty hours, he and his wife, his actions that the surgical procedure was only a Rita, spent time there. He was a skilled surgeon his wife, Rita, two daughters, Alice and Mary, who, with little loss of motion or time, got down survive him. Although his professional activities to the hip and the work to be done even though had been lightened to a small degree for the past the anatomical parts were grossly distorted from several years, on Monday, June 6, he had made the original process or by previous attempts to his usual rounds at the Hospital of the University correct them. His assistants quickly realized that of Pennsylvania, visited patients on whom he had this dexterity was due to the fact that not only had recently operated, and exchanged his usual greet- he been through this exercise many times before, ings with other members of the hospital staff. Although his manual devoted his full energy to what he loved, the prac- skill was admired by his assistants and associates, tice of orthopedic surgery. Colonna PC: Congenital Dislocation of the Hip in His rounds of ward and private patients alike were Older Subjects. Colonna PC: A New Type of Reconstruction Oper- operative and postoperative management and it ation for Old Ununited Fracture of the Neck of the was here that he was most effective in his teach- Femur. Surgical experiences were never dramatized 1935 but were always properly placed in relation to an entire program of physical, mental, and economic rehabilitation. Colonna was a member of a number of medical societies, local, national, and interna- tional. In 1955, he was elected President of the American Orthopedic Association and presided at the annual meeting of that association when it met that year in Banff. He was a founding member of the Orthopedic Research Society and remained vitally interested in its proceedings. Colonna stressed the broad, general principles upon which all surgery is 79 Who’s Who in Orthopedics Sir Astley Paston COOPER Frederic Jay COTTON 1768–1841 1869–1938 Sir Astley Paston Cooper was the leading surgeon of London in his day. He was probably John Frederic Jay Cotton was born in Newport, Rhode Hunter’s most prominent pupil and Guy’s Hospi- Island, and educated at Harvard. Although Paré his Doctor of Medicine degree in 1894, he studied described fractures of the hip, his observations bacteriology in New York and spent 2 years in the other than diagnostic were not contributive. His career Cooper not only described the fracture but added was spent in Boston where he was a professor of the classic discussion of its major problem, the surgery at Tufts College Medical School. I was Chief of Surgery at Walter Reed Army With subsequent editions of his long-lasting Hospital. His major interest throughout his career book, A Treatise on Dislocations and Fractures, was in injuries of the musculoskeletal system. He Cooper would add notes from his very popular actively collaborated with Charles L.

Patients with acontractile bladders are the most suitable candidates for ISC generic lanoxin 0.25mg with amex, though hyperreflexic detrusor activity is not a contraindication provided it is well controlled with anticholinergic therapy discount lanoxin 0.25 mg on-line. A “clean” but not sterile technique is employed order lanoxin 0.25mg visa, using 12–14Ch Nelaton catheters order 0.25mg lanoxin overnight delivery. Although commercially available coated single use catheters are popular in hospitals buy lanoxin 0.25mg low price, Nelaton 60 catheters with applied lubricating gel are significantly cheaper in the community. There is a small risk of urethral trauma and 50 subsequent stricture associated with re-usable catheters. However, patients appear no more vulnerable to infection by 40 using such catheters, and in developing countries (provided they can be washed in clean water) re-usable catheters should 20 be the first choice. The long-term results of ISC compare favourably with other 20 forms of bladder management, and the incidence of infection and stone formation is considerably less than in those patients 10 with long-term indwelling catheters. Ultrasound (US) This is the most useful non-invasive technique to monitor Box 7. The catheterisation combination of plain abdominal radiography with US has • Minimal detrusor activity superseded routine intravenous urography for annual review, • Large capacity bladder and most of the important changes to the upper tracts, • Adequate outlet resistance especially dilatation, parenchymal scarring, and stone • Manual dexterity formation, can be diagnosed on US. When abnormalities are • Pain-free catheterisation detected, other imaging modalities may be required. The cystometrogram relates the filling pressure to bladder volumes, and identifies and quantifies unstable contractions and abnormalities of compliance. The simultaneous contrast radiological study allows screening of the bladder and urethra. This is an important part of the investigation and is video-recorded or the images digitised. In many patients with a suprasacral cord lesion, detrusor contractions are associated with a simultaneous contraction of the distal sphincter mechanism—the void is obstructed due to the “dyssynergic” Figure 7. Dyssynergic high pressure voiding frequently causes autonomic dysreflexia, a potentially serious and occasionally fatal autonomic disturbance resulting in severe hypertension. Although the distal sphincter eventually relaxes, the unstable “voiding” detrusor contraction usually fades away before the bladder has emptied properly, leaving a significant residual. This encourages infection and stone formation, and ongoing unstable contractions often lead to vesico-ureteric reflux, hydronephrosis, and pyelonephritis. The contrast part of the study helps characterise many aspects of these extremely important complications, and enables appropriate (often surgical) action to be taken before irreparable damage takes place. Isotope renography/nuclear medicine DMSA renography is a sensitive indicator of renal scarring and differential renal function, and is indicated when US studies Figure 7. DTPA and MAG 3 renography are useful investigations to characterise upper tract obstruction, and also to monitor the progress of the kidney after treatment for vesico-ureteric reflux. Vesico-ureteric Recurrent urinary reflux tract infections Biochemistry w w Hydronephrosis Pyelonephritis Routine baseline serum creatinine, urea and electrolyte w estimations are performed, and should be repeated annually Chronic renal failure until the clinician in charge is certain that the urinary tract is completely stable on definitive management, and with no significant radiological or urodynamic prognostic risk factors. Later management In many patients the early management of the urinary tract merges with the long-term plan. With the increasing use of suprapubic catheters at an initial stage, many tetraplegic patients are discharged into the community content not to alter this method of bladder management. However, both suprapubic and urethral catheters should be discouraged where safer methods are available, especially in paraplegics. In those men whose penis will retain a condom, sheath drainage is an Figure 7. Some aspire to continence and freedom from indwelling Renal scarring catheters. Others are unwilling to self-catheterise, and will not Accurate and reproducible in long-term follow-up relinquish their suprapubic catheters. Tetraplegics with poor Tc-DTPA and MAG3: Diagnosis and follow-up of uretero-pelvic hand function have fewer choices available to them, and junction or ureteral obstruction Indirect cystography for vesico-ureteric reflux avoidance of autonomic dysreflexia and freedom from infection Differential renal function may be the dominating influences in their personal choice. Indirect measurement of GFR After the first year, many paraplegic and a few incomplete Cr-EDTA GFR: Serial assay is a sensitive index of small changes in GFR tetraplegic patients wish to explore alternatives that allow freedom from permanent catheterisation, and restoration of continence. Patient awareness and lifestyle aspirations are increasing the demand for complex lower urinary tract reconstruction. Surgical options are tailored for each individual, and the urologist advising spinally damaged patients 36 Urological management Figure 7. In particular, the above T6 involvement of specialist nurse practitioners and • Renal damage due to stomatherapists at an early stage in planning treatment is —obstruction emphasised.

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Our initial concept and technique over many years have remained unchanged order lanoxin 0.25mg. We have studied and looked into the problems of biological fixation with the goal of improving our long-term results in hip joint replacement quality lanoxin 0.25mg. Still effective 0.25 mg lanoxin, we must consider the relative merits of cemented and cementless technique for each patient buy generic lanoxin 0.25 mg online, but in the case of the cementless primary hip replacement buy 0.25mg lanoxin, proximal load transfer and high axial and rotational stability were defined as the key charac- teristics for our “Bicontact”-philosophy. These requirements meanwhile, after 19 years experience, are well accepted today and we use them before many others. We have added to our earlier concepts the methods of contemporary cementing tech- niques, press-fit cup arthroplasty, and advanced hip joint articulation. Implant exten- sions also met additional requirements of implant sizing in primary and revision surgery. We have seen remarkable change within our patient community, with an increase of elderly people—and a more disadvantageous increase of many young patients—receiving total replacement as a first and primary choice. This change must lead our attention to an individual decision, that is, whether to select the cemented or noncemented technique, which choice quite often has to be made intraoperatively. The Bicontact Hip System fulfills all these aspects and thus justifies the catalogue of requirements we initially have laid down. After more than 19 years of Bicontact hip replacement, a statement on the correct- ness of our considerations relating to design and performance of the entire Bicontact philosophy can be made. This self-critical appraisal is based on the experiences of our own prospective study results, other published Bicontact results, and multiple worldwide experience reports. Many constructive thoughts and developments in the field of hip arthroplasty have been communicated, implemented, and introduced in clinical practice during the last few decades (46 years since Charnley). In many respects, these have resulted in visible and fundamental improvements concerning basic implant design, materials, and clinical results [4–10]. The cemented fixation of the prosthetic components introduced by Charnley (1959/1960) with his low-friction principle of the joint implant had a fundamental influence and promoted its growing use in clinical medicine. Over the years, however, we had to realize and observe certain disadvantages in context with the extended use of cement, especially in the increasing numbers of revisions. The introduction of so-called cementless, “biological implantation” techniques during the past two decades has heralded a new era in hip replacement. With the development and introduction of the “Bicontact Hip Endoprosthesis System” in 1986–1987, we, at that time, did not intend to add another version to the numerous innovations of the most diverse types of hip implants. Much more, it has been our intention to react adaequately to the demands imposed with regard to the overall concept of a hip joint replacement, which had and still have changed considerably during recent years under the effect of modified initial conditions as a result of changes in demographic structures such as the aging population, an increasingly younger patient stock, and, in some cases, long-term results with many complications. Joint-Preserving and Joint-Replacing Procedures Compared 141 Looking back, we distinguish two time periods (Figs. According to a large number of communications, both personal and those from the literature, the pendu- lum of opinion concerning the advantages and disadvantages of cementless and cemented surgical methods for hip and other prostheses in certain countries still continues to swing in favour of the cemented technique (above all, in Anglo-American countries). In the majority of central European countries, in Asia, and in more and more other regions worldwide, however, the situation has changed and is still changing. Many challenging experiences with difficult situations following cement-anchored hip endoprostheses, especially among younger patients, speak in favour of a cement- less implantation whenever possible because of their greater life expectancy and potential for several future revisions. The basic problem of long-term survival of endoprostheses, especially regarding a long-term bond between living tissue and a nonorganic (dead) material in principle, has not yet been solved. Therefore, we are still obliged in the future to decide indi- vidually and, insofar as possible, intraoperatively between a cementless and cemented implantation method depending on the particular case, especially according to the patient’s age and life expectancy and the quality and load-bearing capacity of the bone stock (osteoporosis). Time Period 1970–1985 1986–2006 We have learned from experiences of the past and must react consequently! Two time periods that demonstrate “learning from experiences” with consequent reaction Fig. First period (1970–1986): increasing number of hip revision procedures after aseptic implant loosening, and changes in demographic structure towards elderly patients, but also younger and more active patients who received total hip arthroplasty (THA) 142 S. Weller While discussing a new concept and philosophy from a clinical point of view, fol- lowing the demands for an endoprosthetic system based on earlier experiences and socioeconomic constraints (1970–1986), we set up a list of priorities to be achieved and fulfilled. List of priorities: • Medical experience and facts (results and studies) • Medicotechnical progresses (decision-making, biological, and material aspects) • Demographic changes (age distribution) • Expectations and demands of patients (society) • Socioeconomic aspects (expenses, etc. Clinical and surgical demands: • Universal applicability (cemented, cementless, revision, etc. In addition and as a future perspective of our focus, the following factors have been adopted to improve implant survival results: • Improvement of direct, cementless anchorage of the endoprosthesis in living bone stock (interface aspects, osseointegration) • Improvement of cement composition, chemical hardening process, and cement- ing techniques • Surgical performance (e. It is assumed today, and can be underlined by literature reports, that an endopros- thetic system—on the basis of comprehensive and detailed follow-up examination of a maximum number of cases—allows a statement of quality after around 10 to 15 years at the earliest.

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He deserves entirely what he himself hoped for in the case of his late master Lambotte: “that he should still live in our minds lanoxin 0.25 mg free shipping. Henning WALDENSTRÖM 1877–1972 Henning Waldenström was born in Stockholm Börje WALLDIUS and began his orthopedic career in the same city lanoxin 0.25mg lowest price. In 1936 purchase 0.25 mg lanoxin otc, he became professor of orthopedics at 1913– the Karolinska Institute order 0.25mg lanoxin overnight delivery. In 1938 cheap 0.25 mg lanoxin with amex, Waldenström suggested that the term Börje Walldius was born in 1913 in Kristianstad orthopedics be changed to orthopedic surgery, in southern Sweden. In 1909, college in 1932, he attended the medical school Waldenström described a condition of the hip at the University of Lund, receiving his medical joint in children that he called “the upper tuber- degree in 1942. He then process never passed over to the joint and was moved to the department of orthopedics at the prevented from doing this by the joint cartilage, Karolinska Hospital in Stockholm, with which he which formed an impenetrable cover. It was while he was of the condition was enigmatic and controversial, there that he obtained his PhD degree from the and Waldenström suggested the name coxa plana Karolinska Institute in 1957. Gornas Hos- Waldenström in 1938 to the American Academy pital in Stockholm, where he remained active of Orthopedic Surgeons, is one of the first until his retirement in 1978. Waldenström Knee Using an Endoprosthesis,” is an important became an honorary member of the American document because it is the first report of a group Academy of Orthopedic Surgeons, the British of patients treated with a hinged prosthesis. Orthopedic Association, the Société Française de Chirurgie Orthopedique et Traumatologique, and the Deutsche Orthopädische Gesellschaft. Waldenström played an important role in the future development of Swedish orthopedics. In testimony to his leadership, all of his disciples 345 Who’s Who in Orthopedics Frederick Oldfield WARD At this time he also speculated in many small patents and it is said that unsuspecting tradesmen 1818–1877 paid dearly for their infringement of forgotten patent rights of his inventions. In 1854, on the Frederick Oldfield Ward entered the medical recommendation of Lord Palmerston, Ward was school of King’s College in October 1833, when appointed commissioner of sewers and evolved a he was 15 years of age. The theory was time in Camberwell and his early education had acknowledged to be excellent, but was said to be been gained with a Dr. His impossible of execution: it was described as the career as a student appears to have been success- “quart-into pint-pot” plan. Political unrest at this ful enough and we know that he gained a medal period, combined, maybe, with his advanced and in chemistry in 1835 and a silver medal in botany eccentric ideas, caused him to lose his office, in 1837. While still a student, he wrote Human though he apparently continued his investigations Osteology, which was published in 1838. In into the subject of water supply, for in September the preface he said that his book was the result 1856 he addressed the International Congress of “partly of researches in the museum and dissect- Public Health in Brussels and in the same year ing room, prosecuted at intervals during the last prepared the second edition of Human Osteology. Apart from this, nothing is known of his activities for almost 20 years, though Sir John But holding that true brevity consists not in expressing Simons, Medical Officer of Health for London, ideas in a small space but in conveying them in a short who had been a fellow student at King’s College, time, I have not thought it inconsistent with this design mentions in his “Personal Recollections” that to dilate freely upon some obscure and difficult points before his death Ward suffered “enfeeblement. Whatever contradictory statements came under my notice in the course of this comparision Human Osteology. His mental and physical were noted down, and made the subject of careful powers deteriorated to such an extent that he research in several extensive anatomical collections entered St. Ward’s experiments to show the nature and The book is of small dimensions. The pages composition of bone provide interesting conclu- of the first edition measure only two and three- sions. On quarters by four and a half inches, the volume page 370 of Human Osteology, Ward illustrated being one and three-quarters inches thick. Though the triangle in the neck of the femur with which it cannot be said to present the attractions of the his name is still associated. A similar area is to be modern textbook, its text and illustrations achieve found in the calcaneum. He made this observation: qualifying medical examination, but we know that for some years he practiced as a surgeon. His The arrangement of the cancellous tissue in the ends of interests extended far beyond the confines of the femur is very remarkable; and, as it illustrates the medicine. In the lower who introduced him to Edwin Chadwick, both extremity of the bone, it consists of numerous slender of whom were pioneers of the new medicolegal columns, which spring on all sides from the interior group of sanitary reformers. Fired with their surface of the compact cylinder, and descend, con- enthusiasm, Ward wrote at this time a number verging towards each other, so as to form a series of of popular articles in which he criticized water inverted arches, adapted by their pointed form to supply and hygiene and proposed control under sustain concussion or pressure transmitted from below. These converging columns not only meet but decussate 346 Who’s Who in Orthopedics each other; and they are further strengthened by innu- succeeded in performing the first arthroscopic merable connecting filaments and laminae, which cross meniscectomy. Many of the world’s finest sur- them in all directions, so that no single arch could break geons, including Dr. Richard O’Connor, visited Tokyo Teishin Hospi- Hence, notwithstanding the tenuity and brittleness of tal to learn arthroscopy.

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