Frank F. A. Ijpma

The Early History of Tubulation in Nerve Repair

The first experiments for bridging peripheral nerve gaps using nerve tubulation emerged in the 19th century. Because Gluck (1853–1942) is said to have performed the first animal experiment of nerve tubulation in 1880, it is interesting to explore the background and veracity of this claim. The original documents on nerve tubulation in the 19th century were studied. We conclude that the conduit that was initially used for nerve tubulation was derived from a resorbable decalcified bone tube developed for wound drainage by Neuber (1850–1932) in 1879. Gluck proposed the use of the bone tube as a guided conduit for regenerating nerves in 1881 but stated briefly that his experiments failed because of scar formation. Vanlair (1839–1914) documented the first successful application of nerve tubulation using a bone tube to bridge a 3 cm sciatic nerve defect in a dog in 1882.

Bilateral round ligament varicosities mimicking inguinal hernia during pregnancy

Round ligament varicosities during pregnancy have not been reported extensively. The swelling mimics an inguinal hernia and should be considered in the differential diagnosis of a groin swelling during pregnancy. We report a case of a pregnant woman with bilateral round ligament varicosities. At 22 weeks of pregnancy she was operated on based on the clinical suspicion of a painful inguinal hernia on the right side. Surgical exploration revealed varicosities of the round ligament, and resection was performed. Four weeks later the same diagnosis was made by duplex sonography of a painful swelling in the left groin. Increased pain necessitated surgical exploration and resection of the varicosities on the left side. The postoperative course on both sides was uneventful and without pain during the rest of her pregnancy, during labor or post partum.

Are eponyms used correctly or not? A literature review with a focus on shoulder and elbow surgery

Background Eponymous terms are used frequently in daily patient care and scientific literature. They remind us of our predecessors in surgery. It is debatable whether eponymous terms are reliable in case of information transfer. The aim of our study was to investigate whether the original meaning of eponymous terms in shoulder and elbow surgery has been preserved in its use in contemporary literature. Objective To evaluate whether eponymous terms were used correctly, we analysed the use of frequently encountered eponymous terms from January to December 2014. Study selection By means of a PubMed search, articles with eponymous terms were identified and analysed for the way an eponymous term was used, and we compared it with the original description. The original description was traced back to the index publication. The use of the eponymous term was scored as similar, divergent or undefined. In the search for eponymous terms, we included those eponymous terms that were used more than 10 times in the English, German and Dutch literature of 2014. 6 eponymous terms were eligible for analysis: Bankart lesion, Bristow-Latarjet procedure, Essex-Lopresti injury of the forearm, Galeazzi fracture, Hill-Sachs lesion and Monteggia fracture. Findings We analysed 96 articles with the listed eponymous terms, of which 27 (28%) were scored divergent, 32 (33%) undefined and 37 (39%) similar. Bristow-Latarjet scored lowest, with 0% descriptions similar to the original, meaning that all articles had an undefined or divergent eponym, and Essex-Lopresti scored highest with 82% similarity. Conclusions Eponymous terms in shoulder and elbow trauma and surgery are used inadequately and inconsistently. The use of eponymous terms probably cannot be avoided, but since the majority of eponymous terms are not used properly and understanding of its meaning and content varies from surgeon to surgeon, we should be keen on explaining the meaning of eponymous terms when using them.

Sir Charles Alfred Ballance (1856-1936) and the introduction of facial nerve crossover anastomosis in 1895

Sir Charles Ballance (1856-1936) was the first surgeon in history to perform a facial nerve crossover anastomosis in 1895. Although, recently, several papers on the history of facial nerve surgery have been published, little is known about this historically important operation, the theoretical reasoning behind the operation or the surgical perspective in which Ballance developed this method. An original document on the operation, dated in 1895, is not known. The earliest report of the operation is a paper by Ballance, published in 1903. Study of this 1903 paper reveals that Ballance stopped performing the operation after his first attempt in 1895 until he resumed in December 1901. What was the reason for this interruption? Why did Ballance start doing it again in 1901? Between 1895 and Ballances 1903 paper, several other surgeons had published the results of their facial nerve crossovers. Were they inspired by Ballances operation from 1895 to do the same or did they invent the method independently? To enhance our knowledge about the early history of facial nerve surgery, the original manuscripts by Ballance and his contemporaries have been studied. Ballances first facial nerve crossover from 1895 is described in the surgical perspective of the end of the 19th century. The theoretical reasoning for the operation is discussed. It was discovered that Ballances operation was first recorded in St. Thomass Hospital Report of 1895, which was published in 1897. However, this report was probably hardly known by Ballances contemporaries and consequently could not have stimulated them to perform the operation themselves. Jean Louis Faure (1863-1944), from France, appears to have been the first to have performed the operation until Ballances 1903 paper was published. In 1903, after Ballances paper had been published, many other accounts of this method were reported in the literature. At that moment facial nerve crossover seems to have been widely regarded as a potential successful technique, a technique which, a century later, is still part of our repertoire.

An Early Observation on the Anatomy of the Inguinal Canal and the Etiology of Inguinal Hernias by Petrus Camper in the 18th Century

The famous Dutch medical doctor Petrus Camper (1722–1789) was appointed professor of anatomy and surgery at the University of Franeker, Amsterdam, and Groningen. As Praelector Anatomiae of the Amsterdam Guild of Surgeons, he gave public anatomy lessons in the Anatomy theatre in Amsterdam. During the mid 18th century he performed dissections on corpses of children and adults to investigate the anatomy and etiology of inguinal hernias. The concept that a hernia was caused by “a rupture of the peritoneum” was common at that time. Camper concluded that this was incorrect and provided a clear description of the etiology of hernias in children and adults. For the treatment of inguinal hernias, he designed a truss based on the geometrical proportions of the pelvis. This “truss of Camper” was much used and internationally renowned. His anatomical studies and perfect, self-drawn illustrations contributed to a better understanding of the anatomy of the inguinal canal, on the national as well as international level. Camper’s “Icones Herniarum” is his most widely known work on inguinal hernias and included a series of outstanding anatomical illustrations. Petrus Camper should be considered one of the pioneers in the field of inguinal hernias.

Surgical Treatment of Snapping Scapula Syndrome Due to Malunion of Rib Fractures

This report describes a case of snapping scapula syndrome (SSS) caused by malunited rib fractures. Abrasion of the deformed ribs was performed with good results. SSS as a cause of shoulder pain after thoracic trauma has to be considered and can be treated by a surgical abrasion technique.

The design, production and clinical application of 3D patient-specific implants with drilling guides for acetabular surgery

An innovative procedure for the development of 3D patient-specific implants with drilling guides for acetabular fracture surgery is presented. By using CT data and 3D surgical planning software, a virtual model of the fractured pelvis was created. During this process the fracture was virtually reduced. Based on the reduced fracture model, patient-specific titanium plates including polyamide drilling guides were designed, 3D printed and milled for intra-operative use. One of the advantages of this procedure is that the personalised plates could be tailored to both the shape of the pelvis and the type of fracture. The optimal screw directions and sizes were predetermined in the 3D model. The virtual plan was translated towards the surgical procedure by using the surgical guides and patient-specific osteosynthesis. Besides the description of the newly developed multi-disciplinary workflow, a clinical case example is presented to demonstrate that this technique is feasible and promising for the operative treatment of complex acetabular fractures.

High diagnostic accuracy of white blood cell scintigraphy for fracture related infections: Results of a large retrospective single-center study

INTRODUCTION White blood cell (WBC) scintigraphy for diagnosing fracture-related infections (FRIs) has only been investigated in small patient series. Aims of this study were (1) to establish the accuracy of WBC scintigraphy for diagnosing FRIs, and (2) to investigate whether the duration of the time interval between surgery and WBC scintigraphy influences its accuracy. PATIENTS AND METHODS 192 consecutive WBC scintigraphies with 99mTc-HMPAO-labelled autologous leucocytes performed for suspected peripheral FRI were included. The golden standard was based on the outcome of microbiological investigation in case of surgery, or - when these were not available - on clinical follow-up of at least six months. The discriminative ability of the imaging modalities was quantified by several measures of diagnostic accuracy. A multivariable logistic regression analysis was performed to identify predictive variables of a false-positive or false-negative WBC scintigraphy test result. RESULTS WBC scintigraphy had a sensitivity of 0.79, a specificity of 0.97, a positive predicting value of 0.91, a negative predicting value of 0.93 and a diagnostic accuracy of 0.92 for detecting an FRI in the peripheral skeleton. The duration of the interval between surgery and the WBC scintigraphy did not influence its diagnostic accuracy; neither did concomitant use of antibiotics or NSAIDs. There were 11 patients with a false-negative (FN) WBC scintigraphy, the majority of these patients (n = 9, 82%) suffered from an infected nonunion. Four patients had a false-positive (FP) WBC scintigraphy. CONCLUSIONS WBC scintigraphy showed a high diagnostic accuracy (0.92) for detecting FRIs in the peripheral skeleton. Duration of the time interval between surgery for the initial injury and the WBC did not influence the results which indicate that WBC scintigraphy is accurate shortly after surgery.

Surgical Versus Nonsurgical Treatment of Adults With Displaced Fractures of the Proximal Humerus: The PROFHER Randomized Clinical Trial.

To the Editor: Rangan et al performed a randomized, multicenter clinical trial on patients who suffered from a displaced proximal humerus fracture to assess whether surgical treatment predispose to an improved functional outcome over nonsurgical treatment at 2-year follow-up. There was no significant difference between those 2 groups at final follow-up. We commend the authors for completing a well–thought-out and designed study, however, there are 2 issues that we do not feel were fully addressed in the article. First, with an average age of the studied population of 66 years, it is not clear from the data available how younger patients faired with surgical and nonsurgical management. Many surgeons would consider a 35-year-old with a completely displaced fracture to be very different than an elderly patient with a minimally or partially displaced fracture. Because the patient population had a mean age of 66, it is difficult to extrapolate the results presented to younger patients with displaced injuries. We believe that further study is warranted in this patient population. Second, the low study recruitment may cause substantial selection bias, which might further cloud their results. Of 1250, only 250 patients were enrolled which represents a fifth of the screened population. We recognize the inherent difficulty in enrolling patients in a randomized surgical trial; however, the low recruitment and possible selection bias makes it more difficult to apply the results of this study to the general population with proximal humerus fractures.

Bidloo’s and De Lairesse’s early illustrations of the anatomy of the arm (1690): a successful collaboration between a prominent physician and a talented artist

Govard Bidloo (1649–1713) was trained as a surgeon at the Amsterdam Guild of Surgeons, and later in his career, he became a professor of anatomy in The Hague and Leiden. At the end of the 17th century, he performed dissections on the corpses of executed criminals to teach and study anatomy. Based on his findings, he published a magnificent anatomical atlas in 1690, entitled Ontleding des Menschelijken Lichaams (Dissection of the Human Body). The talented painter Gerard De Lairesse, a pupil of Rembrandt, made the drawings of the anatomical dissections for the atlas in close collaboration with the dissector. The drawings of Bidloo and De Lairesse represent, in a unique and artistic way, an early series of anatomical preparations of the arm and hand from more than 300 years ago.