Pioneers in Orthopaedics
Vittorio Putti,1880 -1940

P C. Casuccio


The name of Vittorio Putti is well known to orthopaedic surgeons all over the world, and a few notes on his life and his role in the development of our specialty may be of interest. The first, most striking fact is that at the beginning of this century the orthopaedic surgeon was considered, even in Bologna, to be no more than a specialised barber. It was for this reason that Codivilla, the director of the Rizzoli Institute from 1899, had a hard task convincing the young Vittorio Putti to become an orthopaedic surgeon. Putti was a handsome, tall, brilliant man when he tinished his medical studies in 1903, and was multilingual which was quite unusual at that time.
He is remembered in the obituary written by Professor Leriche in 1941 in Presse Medicale:
"Brillant d'une intellågenre pragmatique, beau comme un grand italåen de la renaåssance, ouvert, affable, curieux de tout, seduissant entre tous, Puttå fut un des plus grands orthopedistes de tous les temps." It is worthwhile remembering that in 1941 the Second World War was in progress and Italy was at war with France.
Having fnally been convinced by Codivilla to join his staff at the Rizzoli Institute, Putti's career advanced very quickly. At the age of 32 years he was a full professor and succeeded Codivilla who died in 1912. At that time the concept of orthopaedics was still not too far from the old definition of "art de corriger les deformites. . ". In other words traumá care was excluded. Putti introduced the concept of "pathology of the organs of movement", not only of bones, and in 1936 he won his battle.
In that year the Congress of the International Society (SICO) was held in Bologna. At its opening in his Presidential Address Putti said that orthopaedic surgery was "grown enough and prepared" to include traumatology. Orthopaedic surgery then became synonymous with the surgery of the organs of movement. The General Assembly approved the proposal and SICO became SICOT. Some of the credit for the fact that orthopaedic surgery today includes the care of injuries of the musculoskeletal system must therefore go to Vittorio Putti. His ten golden rules for the treatment of fractures, published after his death, are unbelievably up to date. Let me remind you of the last three. Rule number 8 says that bone needs immobilisation to be for ned. Rule number 9 suggests that the patient be mobilised as soon as possible because the whole organism contributes to healing.
Finally, rule number 10 stresses the need for fixation of an open fracture as soon as possible since infection is favoured by the lack of immobilisation. In addition, Putti was very active in the field of spinal surgery. In his correspondence there is an intriguing story about the pathology of the disc. In 1934 he operated on a patient with a sequestrated disc with- out fully realising what he had done. He was most astonished to f nd this strange whitish material inside the canal and under stood that he was dealing with very interesting and perhaps not yet known pathology. He sent the specimen to one of the most outstanding pathologists in Europe, Professor Erdheim in Vienna. The answer was : `If you could not assure me that you found this material free in the canal and not inside a disc, I would say that it is disc material". Shortly after, in 1934, Mixter and Barr in Boston published their well-known papper desc§bing the first serie of patients operated on for disc prolapse.
Vittorio Putti lectured and gave surgical demonstrations all over Europe and North and South America. He was a close friend of Harvey Cushing of Boston, and of Sir Robert Jones, who f rst visited the Rizzoli Institute during the First World War, as inspector of the British Army. It is certain that his intemational relationships were very valuable in helping him to found the Intemational Society, particularly that with his Ame§can friend Albee.
From their cor respondence it is clear that great effort was required from both to organise the meeting of October 10 1929 in Paris which gave bitth to SICO. Sir Robert Jones was the first President and Vittorio Putti first Vice-President.
One of the major contributions of Vittorio Putti to orthopaedic science was his work on the pathology of congenital dislocation of the hip. His book was published in Italian in 1935, and won the French prize Redard.
Last but not least, in 1918 he presented cases of femoral lengthening of about 10 cm obtained with his - osteotono-, a sort of external fixator. I close with the words of Robert Merle d'Aubigne, speaking in 1980 in Palermo: - Italy is the country in Europe where modern orthopaedic surgery as we now understand it was born, that is surgery of the whole locomotor system including traumatology. In Italy, 50 years ago, visiting Vittorio Putti at the Rizzoli Institute I decided to become an orthopaedic surgeon.-
Vittorio Putti died from a heart attack in the early moming of November 1 1940, at the age of 60, having lectured to his staff up to a few hours before.


Summarised and translated by P. Gallinaro.
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Created on 21-11-1996 at 19.00 by Nicola Vachaviolos