Carroll B. Larson

Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis.

1. Surgical intervention in rheumatoid arthritis should he undertaken early, before secondary deformities develop. 2. Flexion deformity of the spine frequently results from delayed surgical treatment of the hips. 3. Such flexion deformity may be sufficiently severe to demand surgical correction. 4. Osteotomy of the spine, performed in a small series of six cases, has yielded satisfactory results.

Treatment of the Residua of Hip Infections by Mold Arthroplasty: AN END-RESULT STUDY OF THIRTY-THREE HIPS

A series of thirty-three Vitallium-mold arthoplasties performed for the residua of pyogenic and tuberculous hip infections has been evaluated and analyzed on the basis of a 100-point hip rating scale. The indications for arthroplasty in this series of patients were to relieve pain, to improve motion, and to correct deformity. Rating each hip preoperatively by the rating scale was an aid in predicting the benefit to be gained from arthroplasty. A postoperative flare-up of infection occurred after 21 per cent of the arthroplasties. A higher incidence of postoperative infection and an increased need for revision occurred in the hips with evidence of active infection at the time of surgery, but the average final result in these patients was not distinguishable from those of the other patients. Revision of the arthroplasty was performed in four patients, three having had flare-ups of infection after the initial arthroplasty. The indications for revision were chronic drainage and loss of motion which was caused by either bone overgrowth or excessive soft-tissue scarring. When all the patients were grouped accoring to their primary indication for arthroplasty, significant improvement occurred in each area. A successful result was dependent neither on the age of the patient nor on the duration of inactivity of the infection. A particularly rewarding degree of improvement from mold arthroplasty was observed in the unilateral pyogenic hips that had not progressed to ankylosis.

Local chemotherapy with primary closure of septic wounds by means of drainage and irrigation cannulae : M. N. Smith-Petersen MD (1886-1953), Carroll B. Larson MD, Williams Cochran MD . The 12th president of the AAOS 1943 (MNS-P).

AbstractMarius Nygaard Smith-Petersen was born in Grimstad, Norway, of a prominent merchant marine family in 1886 [2]. He came to the States with his mother in 1903 and, initially unable to speak English, completed high school in Milwaukee, Wisconsin, in 1906. He then attended the University of Chicago (1906–07) and graduated from the University of Wisconsin (1910) and the Harvard Medical School (1914) [4]. He completed his surgical internship under Harvey Cushing at the Peter Bent Brigham Hospital, then his postgraduate orthopaedic training under Dr. Elliott Gray Brackett, at the Massachusetts General Hospital and became his assistant in practice 1917. In 1922 Dr. Smith-Petersen entered private practice in Boston, working at the Massachusetts General Hospital. He continued working there with a heavy clinic and operating schedule until shortly before his death from a brief illness in 1953 at the age of 67.Dr. Smith-Petersen traveled widely, was active in many national and international societies, and received many international awards and honorary memberships. As with other Presidents during the war years, he faced challenges organizing the annual meeting for 1944, although the number of members and guests attending had increased (to 1,018) compared to 1943 [3]. During his tenure the first volume of the Instructional Course Lectures was published. He had an extraordinary capacity for work and ability to focus [2], reflected in his creativity scholarly productivity.The article we reproduce here reflects not only Smith-Petersen’s innovative thinking, but his willingness to accept challenge with a new approach [7]. In 1934 he began using suction-irrigation cannulae made of glass to allow intermittent irrigation in patients with osteomyelitis in whom the wounds had been tightly closed about the cannulae. For the time, when open packing of chronic osteomyelitis as advocated by Orr was a standard [1], Smith-Petersen’s approach was radical. He commented, “Several members of the Osteomyelitis Service did not look with favor upon this method of treatment, and the orthopaedic surgeon responsible for the treatment did not feel any too confident; consequently, the cases treated in this manner were few and far between, and progress was proportionally slow” [7]. He modified the cannulae design from round to oval to help prevent leakage and began constructing them from vitallium in 1938 to avoid breakage. Initially he used Dakin’s solution, but then tried a silver-pectinate solution, and in the year before publication (1945) began using penicillin. His willingness to continuously modify his approaches (exemplified with other innovations, including the tri-flanged nail [5] and mold arthroplasty [6]) attests to his sense of responsibility and humility. “A great responsibility,” he commented, “rests on the surgeon who introduces a new method of treatment. The desire to have a new idea published is so great that the originator is often led astray, and the method is broadcast before it has proved worthwhile, and before the technique has been perfected” [4]. References1.Campbell WC. Operative Orthopedics. Saint Louis: CV Mosby Co; 1939.2.Dr. M. N. Smith-Petersen, 1886–1953. J Bone Joint Surg Br. 1953;35:482–484.3.Heck CV. Fifty Years of Progress: In Recognition of the 50th Anniversary of the American Academy of Orthopaedic Surgeons. Chicago, IL: American Academy of Orthopaedic Surgeons; 1983.4.Mostofi SB. Whos Who in Orthopedics. London, UK: Springer; 2005.5.Smith-Petersen MN. Intracapsular fractures of the neck of the femur. Arch Surg. 1931;23:715.6.Smith-Petersen MN. Arthroplasty of the hip: a new method. J Bone Joint Surg Am. 1939;21:269–288.7.Smith-Petersen MN, Larson CB, Cochran W. Local chemotherapy with primary closure of septic wounds by means of drainage and irrigation cannulae. J Bone Joint Surg Am. 1945;27:562–571.