Pioneers In orthopaedics

How were fractures treated by operation at the end of the last century? Most surgeons preferred bone suturing, which simply consisted of bringing the bone surfaces together. It was al this time: that Lambotte, a Belgian surgeon of great talent, made his debut on the surgical stage.
In the light of his considerable experience he recommended osteosynthesis for the treatment ot fractures, and was the first to use this term in his book entitled " l'intervention operatoire dans les fractures recentes et anciennes " which recounts in detail 185 surgical operations.
Lambotte had realised that in osteosynthesis it was not only vital to reduce the fracture accurately but also, more importantlyl it was essential to render the anatomical segment perfectly stable by means of metal to produce what is now called rigid fixation.
The conseyuences of this new fundamental notion were considerable. Osteosynthesis in future would allow early functional recovery, would limit any aftereffects and would lead to better healing. In this strict form Lambotte"s principles of osleosynthesis are still valid today.
Lambotte, however, encountered two main stumbling blocks. The first concerned technical aspects. " I made a special eftort to simplify the task Ihr those to be won over to osteosynthesis by drawing up the operating procedures in detail: above all. I produced the surgical instruments appropriate for this specialised type of surgery."
Among the instruments Lambotte designed, and which are still in use today. are rasps, hooks and bone pincers. For the osteosyntheses themselves, Lamhotte invented and tried everything: simple screwing, screwing with plates, wiring clasping, nailing and bolting. He also had recourse to external screws and was also the inventor of external fixation but, unfortunately, after some frustrating disappointments, this procedure fell into disuse.
Today, however, it has new-found indications and methods, but its origin goes back directly to Lambotte's work.
The second considerable difficulty at the time was the problem of infection.
Here Lambotte was intransigent.
" What causes most danger of infection are operations which are poorly conceived and badly carried out, when a surgeon, unsure of the technique, spends too long prodding and infects all the crannies of the wound with his fingers. By reducing the length of the operation, making it mathematically precise, eliminating fumbling and uncertainty, the chances of asepsis are increased. It is worth saying and repeating that fracture surgery is often difficult. It requires considerable preparation on the part of the surgeon and a very special training. It should not be undertaken without all the necessary equipment and a perf`ect knowledge of the technique."
In 1924 Lambotte went even further. We addressed the problem of the bone surgeon's special training and the general conditions for treatment:
"All fracture cases should be treated in specially designated establishments."
"What can one say about tractures occurring in the country, treated by isolated practitioners with none of the equipment required for such lesions."
"Gonsiderable experience is required to treat the great variety of fractures and luxations successfully."
"What can one expect of a doctor presented with an occasional fracture and who, after many years' practice, would only have treated a few dissimilar fractures and a handful of sprains.''
These sentences are familiar to us today and these major concerns have lost none of their pertinence. So much for the surgeon, but there wasalso Lambotte the man and it is diffficult to separate the two. He acquired both his surgical training and his manual dexterity in his own workshop. It was there that he made wooden models of his instruments and if the need arose. he would take off his jacket and show the smith or the workman how each new instrument should be made.
We brought the same enthusiasm to sculpture and to painting, but above all he loved music and bravely persevered in learning to play the violin.
He took his interest even further and became an instrument maker, constructing violins, violas and cellos. Experts declared his violins to be remarkable and the Conservatories of Paris. Brussels and Antwerp have some of his instruments in their collections.
The teachings and experience of this great Belgian master and creator make his story an integral part of the history of modem osteosynlhesis.
The illustrations come from the book -"Les Debuts de l'Osteosynthese en Belgique " -published by the Imprimerie des Sciences in 1971. A reprint of this hook is planned for the spring of 1995.

ΑΡΧΗ ΣΕΛΙΔΑΣ ΕΠΙΛΕΓΜΕΝΑ ΚΕΙΜΕΝΑ
Greek OrthoWeb. History of Orthopaedics

H σελίδα κατασκευάσθηκε από τον Νικο Βαχαβιόλο E-mail: niva@scorpion.diavlos.forthnet. gr και είναι ενημερωμένη την 3 - 5 -1996