Transcript December 2011, Budapest

Report of the Historian
Andreas Gohritz
FESSH Council Meeting
November 27th, 2011, Budapest
J Hand Surg E Volume
Otfrid Foerster
(1873-1941) –
a widely unrecognized
self-taught pioneer
of peripheral nerve
reconstruction
Andreas Gohritz, Lee A. Dellon*,
Peter M. Vogt
Hannover Medical School, Germany
John Hopkins University, Baltimore, USA *
Historical Evolution and
Pioneers of
Tetraplegia Hand Surgery
Andreas Gohritz,
Jan Fridén
Sterling Bunnell, USA
“Surgery of the Hand“,
1948 (2nd edition)
C6/7 patients with wrist extension
treated by tendon transfers
(BR-to-flexors) and tenodeses
New Developments
Combined =
Alphabet Procedure
Microsurgery –
the past
Andreas Gohritz,
Medizinische Hochschule Hannover
Plastische, Hand- und
Wiederherstellungschirurgie
Spring Meeting, Nürnberg 2011
Who was really the first ?
Jesus „replanted“ the ear of
Malchus (= his last wonder)
„And he touched his ear
and healed it (Lk 22,51)
Nikolaus Rüdinger (1832-1896) –
from apprentice
barber to anatomy
professor and his
description of joint
innervation in 1857
Andreas Gohritz
DAM Meeting, Vienna 2011
Invited publication in Plast Chir, Dec 2011
Introduction
Ca. 300 000 joint prostheses in Germany / y !
Selective denervation =
palliative therapy of
joint pain of multiple origins
•
•
•
•
Lee A. Dellon
Albrecht Wilhelm
Wrist,
Shoulder, elbow, finger / CMC 1 joint
Knee, ankle
Temporo-mandibular joint
„The joint nerves of
the human body“ (1857)
In all textbooks, there is only here and there a short
mentioning of a nerve branch going to a joint . . .
Unique career
1832
1846
1850
1856
1863
1864
1868
1870
1880
1881
12th child, half orphan
Apprentice barber
Anatomy helper
Promotion (Joint nerves)
Adjunct (order of Ludwig II.)
4th request for habilitation
Old South Cemetery,
refused !
Honorary professor (J. Liebig) Munich
Extraordinarius (Ludwig II.)
Professor, 2nd conservator of Anatomy
Chairman of Anatomy LMU München
Autopsy / Enbalming of Ludwig II.
(1845-1886) „The Fairy-Tale King“
„Nowhere there are any superficial injuries visible,
especially no abrasions on the skin of the neck or
eace ... “ (until today theories of assassination !)
The dead King, St. Michael church
Death mask, Herrenchiemsee
Joseph Albert (1825-1886)
Photographer of the Royal Court = R.‘s co-worker,
Inventor of Light Printing
1st photo of ossicles in
anatomy book (?)
Anatomische Anstalt München =
„Birth place of Joint Innervation“
• Working place of Rüdinger
• Studies by A. Wilhelm (*1924)
guided by Titus von Lanz (1897-1967)
Titus von Lanz
Ulrich Lanz
Albrecht Wilhelm
Comparing Rüdinger‘s Studies /
Modern Joint Denervation
Knie-Innervation nach Rüdinger 1857
Knie-Innervation nach Dellon 1992
• Nerve anatomy (almost) completely revealed by R.
• Differences in terminology
(Branch of muscle branch of Vastus ext. vs. Lat. retinacular nerve)
Comparing Rüdinger‘s Studies /
Modern Joint Denervation
• Exact description of
joint innervation by R.
• No figures / frequency rates
(unclear number of dissections)
• Idea of denervation and
addition of important details
(regarding operations) by
Rüdinger‘s successors
(above all Albrecht Wilhelm and Lee Dellon)
Anterograde and retrograde finger joint
Innervation described by Wilhelm in 1958 / 1966
Innervation of the Hip Joint
(from 4 different nerve sources)
Only in Germany ~ 200 000 hip prostheses / year !
A New Chance for Denervation ?
Schreibekrampf = writing cramp
F. Runge,
Berlin Medizin Wochenschr (1873)
[…] a point near the external epicondyle, exactly where the
supinator longus, extensor carpi und digitorum communis
have their origin, a small spot, which is not only painful, but
also triggers violent reflex movements when pressed upon.
= 1st description of elbow epicondylitis ?
…. I applied on the painful spot a cauterium which destroyed
all the skin … with this scarring also occurred, as i
suppose, a destruction of the deeper vessels and a
complete remission of the painful periosteal spot.
= 1st description of sclerotherapy ?
Dr. Runge – German pioneer of
sclerosing therapy in
epicondylitis
Knobloch K, Gohritz A.
published in Brit J Sports Med
On the historical development
of muscle and nerve transfer
operations in the
late 19th / early 20th
century in Germany
Andreas Gohritz,
Jan Fridén, Peter M. Vogt
German Hand Society Meeting 2010
German-Austrian Plast Surg Congress 2011
Introduction
Our standard techniques = mostly concepts
created around end 19th / early 29th century,
Above all by German surgeons / orthopaedics
- Treatment of poliomyelitis
- Therapy of gun shot wounds (WW1)
Group of shoulder,
Elbow / upper arm
Gun shot wounds
During treatment
Flail („floppy“)
shoulder
due to polio
Oskar Vulpius (1856-1934)
2012: Centenary of VulpiusKlinik, Rappenau Germany
Frank Unglaub
Andreas Gohritz
Peter Hahn
Historical article in
Handchir Mikrochir Plast Chir
Book chapter on
history of hand surgery
Martin Langer
Andreas Gohritz
Horst Haferkamp
Influence of Hand Disease on
Life and Work of Famous
Musicians and Painters
Clara Schumann – Overuse Pain Syndrome / Focal Dystonia ?
Robert Schumann – Focal Dystonia, PIN Compression ?
Nicolo Paganini / Sergej Rachmaninoff – Marfan Syndrome
Django Reinhard – Burn Contractures of Fingers
Paul Wittgenstein, Rick Allen – Upper Arm Amputation
Peter Paul Rubens, Auguste Renoir – Rheumatoid Arthritis
Paul Klee - Scleroderma
Guillaume Dupuytren (1777-1835) –
a colourful character behind a
disease‘s name
Dupuytren‘s
statue in Paris
Invited presentation
Hamburg, Jan 2012
Thank you
for your
kind attention !
... and a little historical
dicovery in my parents‘
cellar for Zsolt