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.

Biographical sketch: John Royal Moore, MD 1899-1988.

This biographical sketch on John R. Moore corresponds to the historic text, The Classic: Cartilaginous-cup Arthroplasty in Ununited Fractures of the Neck of the Femur (1948), available at DOI 10.1007/s11999-011-1974-z.

Fractures in late medieval skeletal populations from Serbia.

Bone fractures were analyzed from skeletal remains of 861 adult individuals from six cemeteries dating to the Late Medieval period in Serbia. Results of the study were compared to other cemetery populations (635 individual skeletons) of the same date and region in an attempt to understand fracture patterns. The association of types of fractures and their prevalence with sex, age at death, cemetery site, and information deriving from historical sources are discussed. Results showed that the long bone fracture frequency was 0.7%, and the majority of the fractures were the result of direct force. This rate is similar to some studies of contemporary British skeletal samples. However, it is much lower than for some other Old World sites. Cranial vault fractures had a rate of 6.7%, and of the facial skeleton, 1.3%; the frontal bone was the most affected of bones of the cranial vault. Injuries were more common on the upper extremities (0.8%) compared to the lower (0.6%). However, the fibula was the most fractured bone (2.8%), followed by the ulna (2.4%). This pattern is similar to three of six Late Medieval urban sites in Britain. These findings suggest that this rural community was exposed to a low risk of trauma, probably related mostly to accidents sustained during farming, and rarely to interpersonal violence.

The classic. Ununited fractures in children. James Paget, 1891.

James Paget (1814-1899) entered St. Bartholomew's Hospital, London, as a medical student in 1834. He never left. Like Pott, his whole professional life was spent in service to the hospital and its school of medicine. His career began in the preanesthesia, pre-Listerian era, and he lived to see the introduction of X-rays into medical practice. He is best remembered as a teacher and as a surgical pathologist. As a freshman medical student, he observed and described the cysts of Trichina spiralis in the diaphragm of his cadaver. His observations on ununited fractures in children were published in 1891. The years between were filled with an active and distinguished career as a teacher, investigator, and surgeon.