Report of the Historian Andreas Gohritz FESSH Council

Report of the Historian Andreas Gohritz FESSH Council Meeting November 27 th, 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 (2 nd edition) C 6/7 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 1881 12 th child, half orphan Apprentice barber Anatomy helper Promotion (Joint nerves) Adjunct (order of Ludwig II. ) 4 th request for habilitation Old South Cemetery, refused ! Honorary professor (J. Liebig) Munich Extraordinarius (Ludwig II. ) Professor, 2 nd conservator of Anatomy Chairman of Anatomy LMU München

Autopsy / Enbalming of Ludwig II. (1845 1886) „The Fairy Tale King“ „Nowhere there 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 1 st 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. = 1 st 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.

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 19 th / early 20 th 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 19 th / early 29 th century, Above all by German surgeons / orthopaedics - Treatment of poliomyelitis - Therapy of gun shot wounds (WW 1) Group of shoulder, Elbow / upper arm Gun shot wounds During treatment Flail („floppy“) shoulder due to polio

Oskar Vulpius (1856 1934) 2012: Centenary of Vulpius Klinik, 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