The development of musculoskeletal radiology for 100 years as presented in the pages of Acta Radiologica.

During the last 100 years, musculoskeletal radiology has developed from bone-only radiography performed by everyone to a dedicated subspecialty, still secure in its origins in radiography but having expanded into all modalities of imaging. Like other subspecialties in radiology, it has become heavily dependent on cross-sectional and functional imaging, and musculoskeletal interventions play an important role in tumor diagnosis and treatment and in joint diseases. All these developments are reflected in the pages in Acta Radiologica, as shown in this review.

The Iron Man of the Renaissance: the contribution of Girolamo Fabrizi d'Acquapendente.

PURPOSE: To highlight the most relevant contributions of the Italian Renaissance surgeon Girolamo Fabrizi d'Acquapendente in the field of orthopaedics and traumatology. METHODS: An extensive research on the life and achievements of Girolamo Fabrizi was conducted on University Libraries as well as on electronic databases like PubMed. RESULTS: Girolamo Fabrizi d'Acquapendente is known for his embryology and physiology studies, particularly on sensory organs and blood circulation. He founded the world's first permanent anatomical theater established at the University of Padua and inaugurated in 1595. His most notable publications include surgical and definitely orthopedics works such as "De fracturis" (On fractures) and "De luxationibus" (On joint displacement). He outlined some principles of treatment that are still valid nowadays such as anatomical reduction and stabilization of the fracture, that were applied using the equipment available at that time. He described and illustrated maneuvers and instruments, such as pulleys, winches, splint, and bandages. He further depicted the famous "Oplomochlion" ("the armored man"), which is actually a collection of all of the braces used at the time to correct congenital and post-traumatic deformities. CONCLUSION: Bracing and prosthetic replacements have accompanied medical history throughout the centuries, from Ancient Egypt to the present, but it was the ingenuity of Renaissance surgeons that pushed biomedical technology to new heights: Girolamo Fabrizi d'Acquapendente was one of the most illustrious contributors to these great achievements.

Ideal xenograft or a perfect bone substitute?-A retrospective review and analysis of the historical concept of ivory implants in orthopaedics.

PURPOSE: Surgical treatment of fractures has evolved with the development of anaesthesia in 1846. Experiments with different implants both organic and non-organic had led to introduction of sometimes extremely peculiar materials coming from different species like ox bone or elephant's ivory. The aim of this article is to present not widely known concept of ivory use in bone surgery that set its foot in the history of orthopaedics and laid foundations for orthobiologic reconstructions. METHODS: Retrospective analysis of articles and books published between 1846 and 2017 that describe various examples of ivory application in the treatment of fresh fractures, non-unions and reconstruction of joints. RESULTS: Our research shows that ivory to the surgical world was introduced by Friedrich Dieffenbach, founder of the modern plastic surgery. It was also used with different rate of success by many of the famous surgeons of the nineteenth and twentieth century to include Trendelenburg, Billroth, Volkmann, Paget and Hey Groves. Ivory was immensely popular in bone surgery and became material of choice demonstrating amazing biological properties and very low rate of infections. CONCLUSION: Ivory has served well in successful treatment of various orthopaedic conditions for over 100 years. In this article, we are using history as a stepping stone to examine material that is not rejected by the body and promotes bony healing without increased infection or other complications. It is worth considering further analysis of historically acquired specimens for further development of materials for further orthopaedic fracture and reconstructive techniques.

The history of bone marrow in orthopaedic surgery (part I trauma): trepanning, bone marrow injection in damage control resuscitation, and bone marrow aspiration to heal fractures.

PURPOSE: One of the oldest procedures performed by man is trepanning of the bone and yet it was only in the last 40 years that bone marrow aspiration has been used to treat nonunion disorders. MATERIAL AND METHODS: These advances were possible due to improvements in instruments and in techniques to make holes in the bone, an history that began with skull trephinations around 8000-10,000 years ago, and continued with sternum bone marrow injection for trauma resuscitation in the beginning of the twentieth century; this procedure had improved at the beginning of the twenty-first century to allow pelvis bone marrow aspiration for the treatment of nonunion. RESULTS: Trephined skulls from antiquity have been found in many parts of world, showing that trephining was ancient and widespread. Beginning with Neolithic period and the pre-Columbian Andean civilizations, the authors have traced the development of this surgical skill by describing the various surgical tools used to perform holes in the skull. These tools (trephines or trepan) were proposed at the end of the nineteenth century to study the bone marrow. At the beginning of the twentieth century, the sternum became the center of interest for the "in vivo" study of the bone marrow and the fluid injection in the sternum's bone marrow was described for resuscitation from shock during the World War II. With the introduction of plastic catheters and improved cannulation techniques, the need for intraosseous infusion as an alternative route for intravenous access diminished and sometimes abandoned. However, during the mid-1980s, James Orlowski allowed renaissance of the use of intraosseous infusion for paediatric resuscitation. Since then, this technique has become widespread and is now recognized as an alternative to intravenous access in adult emergencies; particularly, the intraosseous access has received class IIA recommendation from the Advanced Trauma Life Support program supported by the American College of Surgeons Committee on Trauma and bone marrow infusion is now recommended for "Damage Control" resuscitation. Although the pelvis bone contains half of the body's marrow volume, it was only in 1950 that the pelvis was proposed as a source for bone marrow aspiration and bone marrow-derived mesenchymal stem cells to improve healing of fractures. CONCLUSION: It will be many years before doing holes in the bone as orthopaedic trauma procedure will be relegated to the annals of history.

Revisiting traumatic injury risk and agricultural intensification: Postcranial fracture frequency at Cerro Oreja in the Moche Valley of north coastal Peru.

OBJECTIVES: In Lambert and Welker (2017) we explored the association between subsistence economy and postcranial fracture prevalence, finding that low-intensity agriculturalists exhibited significantly lower fracture rates than foragers or high-intensity agriculturalists. Here, we explore the impacts of sampling strategy on fracture rates in a sample of high-intensity agriculturalists from the Moche Valley, Peru, and further test the hypothesis that postcranial fracture risks are higher for intensive agriculture. MATERIALS AND METHODS: The long bones and clavicles of 102 individuals from an Early Intermediate Period cemetery (400 B.C.-A.D. 200) at Cerro Oreja were examined for healed fractures. Sample composition was manipulated in six ways to investigate the effects of age and element completeness on estimates of fracture prevalence. Fracture rates at Cerro Oreja were then compared to those for other high-intensity agriculturalists. RESULTS: Both skeletal element completeness and age composition were found to influence fracture rate estimates, reflecting the greater likelihood of identifying healed fractures on better-preserved bones and the accrual of injuries with age. The fracture rate of 3.4% at Cerro Oreja was the median value among seven high-intensity agriculturalist samples. The fracture distribution at Cerro Oreja was most similar to that observed at Kulubnarti, Sudan (Kilgore et al., 1997). DISCUSSION: Skeletal element completeness and age composition can impact fracture rates estimated for skeletal samples and should be considered when conducting comparative analyses. All rates calculated for Cerro Oreja are within the range of those obtained for other high-intensity agriculturalists and support previous findings that traumatic injury risk is higher for high-intensity agriculturalists. Similarities between Cerro Oreja and Kulubnarti suggest that rugged terrain may exacerbate fracture risk for agriculturalists, illustrating the costs of intensive agriculture in suboptimal environments.

Common Upper Extremity Fracture Eponyms: A Look Into What They Really Mean.

Eponyms, whereas commonly used in hand surgery, are perhaps misused as often as they are used correctly. Many commonly used eponyms, such as Colles fracture, Barton fracture, Smith fracture, and Bennett fracture, were actually described decades before the development of radiographs. The goal of this article is to revisit the original descriptions of commonly used eponymous terms for distal radius and first metacarpal base fractures to provide clarity and enhance understanding of what these eponyms actually mean.

Abulcasis (936-1013): his work and contribution to orthopaedics.

AIM OF THE STUDY: The purpose of this historic review is to summarize the life and work of Abulcasis (936-1013) and his contribution to surgery and orthopaedics. METHOD: We conducted an extensive search in libraries as well as online in PubMed and Google Scholar. RESULTS: Abulcasis in his work combines the knowledge of ancient Greek and Roman physicians and surgeons with the extensive knowledge of Arabic medicine and pharmacology. He also pioneered surgical technique with the invention of numerous surgical instruments and with several revolutionary surgical techniques. CONCLUSION: Abulcasis made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and innovations in his work remained a work of reference in the West and East for many centuries to come.

Traumatic injury risk and agricultural transitions: A view from the American Southeast and beyond.

OBJECTIVES: Bioarchaeological research has documented a general decline in health with the transition from foraging to farming, primarily with respect to changing patterns of morbidity. Less is known about changes in injury risk, an aspect of health more obviously tied to particular landscapes and behaviors associated with different subsistence regimes. The purpose of this research is to evaluate several hypotheses emerging from the ideal free distribution model (Fretwell & Lucas, ) that predict injury risk based on subsistence-specific practices and land use patterns. MATERIALS AND METHODS: Postcranial fracture frequencies for long bones and clavicles in human skeletal remains from three Southeast U.S. regions permit examination of variability in injury risk among low-intensity (floodplain) farmers. Published data on six hunter-gatherer samples, four low-intensity agriculturalist samples, and six high-intensity agriculturalist samples comprise a comparative sample for examining variability in injury risk across three distinct subsistence traditions. Differences are evaluated using Z scores and the Fisher Exact test, Chi-Square test, and Mann-Whitney U test. RESULTS: While statistically significant differences are apparent among low-intensity farming groups in the Southeast sample, in the global comparison postcranial fractures are significantly less common in low-intensity agriculturalists than in hunter-gatherers or high-intensity agriculturalists. DISCUSSION: The results of this study support the hypothesis that, with respect to traumatic injury risk, low-intensity farming is a risk-averse subsistence strategy in comparison with full-time foraging or high-intensity agriculture. These data suggest that it is not agriculture per se that predicts an increase in this health risk, but rather the mode and intensity of agricultural production, findings that have important ramifications for our understanding of the health consequences of major subsistence transitions.

History of external fixation for treatment of fractures.

Surgery in the first 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 influenced by three major inventions: anaesthesia (1846), antisepsis (1865) and X-rays (1895). The first to use external fixation is traditionally considered to be Malgaigne (1843). However, his devices cannot be really considered as external fixation. The external fixation device invented by Lambotte in 1902 is generally thought to be the first "real fixator". In America it was Clayton Parkhill, in 1897, with his "bone clamp" who started the process. Both Parkhill and Lambotte observed that metal pins inserted into bone were tolerated extremely well by the body. Mainly on the basis of their research findings, many external fixation devices have been and are being developed.

Early history of scapular fractures.

The first to use the term Scapula was Vesalius (1514-1564) and thus it has remained ever since. Probably the oldest injured scapula, from 250 million years ago, was described by Chinese authors of a skeletal examination of a fossilised remains of a dinosaur Yangchuanosaurus hepingensis. In humans, the oldest known scapular fractures date back to the prehistoric and early historic times. In ancient times, a fracture of acromion was described in the treatises of Hippocrates. Early modern history of the treatment of scapular fractures is closely interlinked with the history of the French surgery. The first to point out the existence of these fractures were Petit, Du Verney and Desault in the 18th century. The first study devoted solely to scapular fractures was published by Traugott Karl August Vogt in 1799. Thomas Callaway published in 1849 an extensive dissertation on injuries to the shoulder girdle, in which he discussed a number of cases known at that time. The first radiograph of a scapular fracture was published by Petty in 1907. Mayo Robson (1884), Lambotte (1913) and Lane (1914) were pioneers in the surgical treatment of these fractures, followed in 1923 by the French surgeons Lenormat, Dujarrier and Basset. The first internal fixation of the glenoid fossa, including a radiograph, was published by Fischer in 1939.

Eponyms in elbow fracture surgery.

Eponyms are common in medicine and in orthopaedic surgery. For future reference and historical considerations, we present common eponyms in elbow fracture surgery. We describe in short the biography of the name giver and give, where possible, the original description on which the eponym was based. Whether eponyms should continue to be used is a question that remains unanswered, but if we use them, knowledge of the original description can prevent confusion and knowledge of the historical background sheds light on the interesting roots of our profession.

Early history of operative treatment of patellar fractures.

The presented overview shows that the first efforts to address patellar fractures by operative treatment, although sporadic, emerged in the pre-antiseptic era. Introduction of Lister's antiseptic method in Great Britain, Germany and the USA in 1877-1882 contributed to a new, progressive trend in the treatment of fractures of the patella as well as of other bones. The authors, using Lister's antiseptic method, evaluated three basic aspects in their operations, namely healing of the surgical wound without infective complications, achievement of bony union and a good functional outcome, i.e. restoring the range of motion in the knee, even if limited in most cases. The majority of them used a longitudinal incision and fixation by a silver wire.

[Tutankhamun: evidence-based paleopathology versus "curse of the pharaoh"]. / Tutanchamun: Evidenzbasierte Paleopathologie vs. "Fluch des Pharao".

AIMS: Several speculations exist regarding possible diseases of the juvenile Pharaoh Tutankhamun. In this review published paleopathological findings and artificial alterations as well as suggestions regarding underlying diseases were characterized. MATERIAL AND METHODS: A selective search of the literature was carried out in the PubMed data base in an arbitrary time interval from 1960 to 2013 (search terms: Tutankhamun, Pharaoh, paleopathology and mummy) and additional supplementary literature. RESULTS: Many artificial changes were a result of embalming and the examinations which have been performed since exhumation in 1922. Evidenced pathologies are craniofacial dysmorphia, bilateral alterations of the feet, malarial disease and an acute traumatic fracture of the knee. The cause of the knee fracture could no longer be reconstructed. Other trauma (e.g. skull fractures) or familial transmission of an eighteenth dynasty syndrome could not be confirmed. CONCLUSION: In addition to many artificial post-mortem alterations, chronic and acute diseases could be verified in Tutankhamun, although the underlying causes are partially unknown.

[A literature review on the Messerer's fracture]. / Über den Messerer-Bruch--eine Literaturstudie.

The characteristic wedge-shaped fracture was first described by Messerer (1880) and Bruns (1884) after performing experiments on long bones. Not much later, Messerer (1885) formulated the forensic significance of the direct bending fracture for the detection of the location and direction of blunt impact trauma. He developed the basic biomechanical theory of the origin of this fracture type, which is therefore called Messerer's fracture in the German-speaking world. In the following decades, the findings concerning the origin, specificity and forensic usability of Messerer's fractures were confirmed and supplemented by experiments and case studies. For forensic examinations, it is important to bear in mind that there are exceptions to the rule according to which the level of the wedge-shaped fracture corresponds exactly to the point of impact. The possibility of "false" or "reversed" wedges must also be considered. Already in the 19th century, authors had pointed out the mechanism of indirect formation of wedge-shaped bone fragments. That is why a forensic examination always has to consider the investigation results and medical findings in their entirety. Autopsy of traffic victims is of paramount importance. It must include a thorough examination of clothing, skin, soft tissues and skeletal system using special preparation techniques. The examination of bone injuries in living victims also requires special expertise. If properly applied, valuable results can be obtained by the forensic expert from the wedge-shaped fracture. Until recently, Messerer's fracture was a typical injury sustained by pedestrians hit by vehicles with protruding frontal elements. In modern car production, not only the dimensions of cars have been changed, but the front-end structures have also been modified, e. g. by integrated bumpers. These constructional changes are likely to reduce the frequency of narrow points of impact in collisions. However, further research on the frequency and significance of Messerer's fractures in road traffic accident victims is required.

The Balkan beam - Florschütz frame and its use during the Great War.

We remember the military medical practice of Croatian surgeon, Vatroslav Florschütz (1879-1967), known for his invention of the traction frame for repositioning bone fracture fragments of the upper and lower extremities. The method, known as the Balkan frame / beam or Balkan splint, was introduced and published in 1911 and used in war medicine thereafter. The memory of this invention adds to our orthopaedic heritage and sheds light on its creator working under the most demanding war circumstances. On the occasion of the 100th anniversary of the outbreak of World War I, reminiscence of Florschütz's war experience, his orthopaedic innovation and other innovations contributes to our understanding of human efforts to save lives and restore bodily function of the wounded during wars.

Orthopedic surgery in ancient Egypt.

BACKGROUND: Ancient Egypt might be considered the cradle of medicine. The modern literature is, however, sometimes rather too enthusiastic regarding the procedures that are attributed an Egyptian origin. I briefly present and analyze the claims regarding orthopedic surgery in Egypt, what was actually done by the Egyptians, and what may have been incorrectly ascribed to them. METHODS: I reviewed the original sources and also the modern literature regarding surgery in ancient Egypt, concentrating especially on orthopedic surgery. RESULTS: As is well known, both literary sources and the archaeological/osteological material bear witness to treatment of various fractures. The Egyptian painting, often claimed to depict the reduction of a dislocated shoulder according to Kocher's method, is, however, open to interpretation. Therapeutic amputations are never depicted or mentioned in the literary sources, while the specimens suggested to demonstrate such amputations are not convincing. INTERPRETATION: The ancient Egyptians certainly treated fractures of various kinds, and with varying degrees of success. Concerning the reductions of dislocated joints and therapeutic amputations, there is no clear evidence for the existence of such procedures. It would, however, be surprising if dislocations were not treated, even though they have not left traces in the surviving sources. Concerning amputations, the general level of Egyptian surgery makes it unlikely that limb amputations were done, even if they may possibly have been performed under extraordinary circumstances.