Orthopedics

Until the late 19th century, breaks and fractures were usually treated with simple immobilization and close reduction (i.e. non-surgical repositioning of bone fragments). Orthopedic surgery was avoided due to high mortality rates from blood loss and postoperative infection.¹ The recommended treatment for open fractures (especially those caused by firearms) was amputation, which was the most common type of surgery performed at the time.²Orthopedics, like all medical fields, benefited powerfully from the introduction of and improved access to inhalable anesthesia (circa 1850s), antiseptic technology (circa 1870s), and radiography (circa 1896): diagnosis became more accurate, and surgery became safer and less painful.³ Internal fixation—the process of using implanted screws, nails, plates, and wires to hold bone fragments in place—was developed around 1886.⁴

Elaborate braces, corsets, slings, racks, and casts (often made from plaster of Paris) were used to treat bone deformities in patients with scoliosis of the spine, Little's disease (spastic diplegia), Pott's disease (spinal tuberculosis), clubfoot, and rickets.⁵Rickets—a disease characterized by softening (osteomalacia) and subsequent distortion of bones, especially in the legs—was identified as a separate condition from scurvy in 1859; its cause (usually a deficiency of Vitamin D, sometimes also of calcium or phosphate) was only identified in the 1920s.⁶ It has been suggested that the extraordinary prevalence of rickets in the 19th century may have been a side effect of the Industrial Revolution, specifically of coal dust pollution blocking children's exposure to sunlight.⁷

$Quelques mots sur le traitement des fractures de la jambe par les appareils hémi-périphériques en platre combinés avec la suspension$

Immobilization and suspension of a broken leg, as described by military surgeon Jules Perier in 1859.

An 1871 study on how bones break in cases of firearm injuries, based on observations of soldiers killed and wounded in the Franco-Prussian War.

Osteitis (inflammation of a bone). Both figures show part of a femur amputated from teenage patients, circa 1883.

Bone inflammation (osteitis) is often caused by an infection (osteomyelitis). Figure 4 shows a tissue sample from bone damaged by spina ventosa, a tuberculosis infection of bones and joints in the hand or foot.

Recherches sur l'affection tuberculeuse des os

Tuberculosis, although known mostly as a respiratory disease, can also attack other bones and joints. This is called extrapulmonary TB. From the 1836 thesis of Auguste Nélaton, this cut-away diagram shows a tubercule (i.e. a growth or abscess caused by tuberculosis) affecting vertebrae.

Sur la nature des affections dites tubercules des vertèbres

A tuberculous abscess on the spine. When the Mycobacterium tuberculosis spreads through the bloodstream to other parts of the body, it can infect blood-rich organs and bones like the vertebrae.

The hand above, that of a 23-year-old patient the author calls "L," was badly crushed in a work-related accident in 1853; some bone fragments had to be removed.

$Considérations sur un appareil a fractures de jambe proposé par M. Gaillard, de Poitiers$

A box-like splint for immobilizing fractures of the tibia, originally designed around 1850. At bottom is the author's own modified version of the design, which is more adjustable and includes an extensor rack for stretching the splinted limb.

Technique des Appareils Plâtrés (spécialement pour l'orthopédie)

A vertical self-suspension device with a sling for the head, designed in 1874 by American doctor Lewis Sayre, for straightening the spines of scoliosis patients with gravity.

Doctors apply a hardened corset with a compressor (a rubber balloon that can be injected incrementally with glycerin) to help straighten the spine of a scoliosis patient, circa 1902.

Orthopedic corsets and other devices for the treatment of scoliosis, circa 1883.

Traitement chirurgical & orthopédique de la Maladie de Little

Individualized prostheses for children with Little's Disease (spastic diplegia), circa 1899.

Dissertation sur la Lithototomie, le Tamponnement dans les hémorrhagies utérines, et sur l'usage d'un Bandage nouveau dans la Fracture de la Clavicule

A bandage for fractures of the clavicle, circa 1814.

$Considérations générales sur les fractures obliqûes du corps et du col du femur$

A wooden splint and strap-on cast for immobilizing fractures of the femur, with a special sock or sandal that can be attached to the bed for stretching the leg, circa 1830.

$Traitement des fractures du fémur par l'extension continue au moyen des appareiles à bandelettes agglutinatives$

Treatment of femur fracture by extension, circa 1882.

Contribution a l'étude des extoses multiples de croissance

Multiple extoses, or benign cartilaginous tumors growing on bone.

$Sur l’ Extension continuelle dans les Fractures compliquées et obliques de la jambe, avec la description d’un appareil pour opérer cette extension sans secousses, sans beaucoup de douleur, et à l’aide duquel ou peut réduire et panser seul toutes ces fractures, et transporter sûrement les blesses$

Extension of leg fractures, circa 1815.

$De la guérison des fractures du rocher$

A fracture at the base of the temporal bone.

De l'ostéomalacie chez l'homme et les animaux domestiques<br /><br />

Patients with osteomalacia (softening of bones), a condition that may have several different root causes including Vitamin D deficiency and calcium deficiency. Osteomalacia in children is commonly called rickets.

Dislocations of the elbow, circa 1854.

$l'Ostéosynthèse dans les fractures fermées et récentes du genou (rotule exceptée)$

Surgical placement of screws in a fractured knee, circa 1921.

Quelques considérations sur le céphalotribe et sur la céphalotripsie

Pelvic bones of young women with rickets, circa 1866. Bone-disfiguring diseases like rickets were common in the 19th century, and often complicated pregnancy, labor, and delivery in afflicted women.

$Des fractures du radius et du role physiologique et pathologique du ligament interosseux de l'avant-bras$

Fractures of the radius.

Études expérimentales sur la régénération des tissus cartilagineux et osseux

Microscopic examination of regenerated cartilage. In Figures 3 and 4, old cartilage is marked by the letter 'A.'

Sur une forme spéciale d'abcès des os ou des abcès douloureux des épiphyses

Bone abscess of the epiphyses, or the end portions of long bones, circa 1865.

Résultats et analyse de 200 prothèses totales de la hanche.

Hip prostheses in situ, circa 1971.

Les Séquelles du Rachitisme Carentiel <br /><br />
Étude clinique et radiologique

X-rays show weakened and compromised leg bones in children with rickets, circa 1970.

$Contribution a l’étude du traitement opératoire des fractures récentes et fermées des os longs par le cerclage (bandes de Parham); Technique opératoire; Résultats éloignés$

Treatment of long bone fractures by a technique called cerclage, in which bone fragments are encircled and immobilized with a locking metal ribbon called a Parham band.

Notes

Bartoníček, "Early history of operative treatment," 1385-6.
Bartoníček, "Early history," 1386; see images related to amputation in the Surgery section of this exhibit.
Bartoníček, "Early history," 1386.
Bartoníček, "Early history," 1388-90.
Peltier, Orthopedics, 28, 131, 211; see also Dede and Sturm, "A brief history," 405-407.
Peltier, Orthopedics, 86-89; Mersch, "Rickets."
Hardy, "Rickets in the nineteenth century," 337-8; Peltier, Orthopedics, 94.

Bibliography

Bartoníček, Jan. "Early history of operative treatment of fractures." Archives of Orthopaedic and Trauma Surgery 130.11 (2010): 1385-1396. DOI:10.1007/s00402-010-1082-7.
Dede, Ozgur and Peter F. Sturm. “A brief history and review of modern casting techniques in early onset scoliosis” Journal of Children’s Orthopaedics 10.5 (2016): 405-411. DOI:: 10.1007/s11832-016-0762-4.
Hardy, Anne. "Commentary: Bread and alum, syphilis and sunlight: rickets in the nineteenth century." International Journal of Epidemiology 32.3 (2003): 337-340. DOI:10.1093/ije/dyg175.
Mersch, John. "Rickets (Calcium, Phosphate, or Vitamin D Deficiency)." Medicinenet.com. Last reviewed 12 December 2017. Accessed 3 June 2018. https://www.medicinenet.com/rickets/article.htm.
Peltier, Leonard F. Orthopedics: a history and iconography. San Francisco: Norman Publishing, 1993.