Bosworth Fracture-Dislocation and Resultant Compartment Syndrome

Abstract

Bill MacAusland was born December 9, 1922, into a rich orthopaedic heritage, as both his father, William R. Sr., and his uncle, Andrew R., were practicing orthopaedic surgeons in the Boston area. Bill was educated at Milton Academy, Harvard College, and Harvard Medical School, graduating with a medical degree in 1947. He and Frances Prescott Baker were married and spent the next two years of his surgical training in Rochester, New York. Their first child was born in 1948, and in 1949 Bill began his training in orthopaedics at the New York Orthopaedic Hospital. His residency partner was John Gartland; they wrote three papers together and became lifelong friends. They were later to serve consecutive terms as Presidents of the American Academy of Orthopaedic Surgeons (AAOS). Bill spent two years as a captain in the United States Air Force at Maxwell Air Force Base in Alabama before returning to Boston to begin the practice of medicine with his father and uncle. His early years in practice were made memorable by the addition of five more children to his expanding family. His boundless energy enabled him to work in several hospitals in Boston and its environs. He loved to “be on service” and work with the residents. One resident commented that Bill “wore his shoes backwards” to get out of the operating room faster and onto his next task! A number of his residents joined him in practice, and all benefited greatly, both personally and professionally, from the association. The large, airy office at 412 Beacon Street easily accommodated two physicians at once, and Bill was readily available to consult on difficult problems and always gave helpful advice. His concern for patients was strong—if one of his patients was hospitalized with a particularly difficult problem, he would often visit that patient several times a day until he was able to figure things out. He did not believe that physicians should be robots or technicians. He performed one or two Independent Medical Examinations per office session, and he encouraged his partners to do the same, so that “honest orthopaedic opinions would be available.” His clinical acumen and intuition were highly developed. A patient who had night pain was assumed to have a tumor until it could be proven otherwise. Once, a patient was referred to him with a draining sinus of the knee. Several doctors had failed to cure the problem. Bill had to leave town and barely had time to assess the situation, but his comment to his partner was “don't forget TB.” It took a few days of tests, but Bill was right—the patient was proven to have tuberculosis. At the time when he first started to practice medicine, it was common for general surgeons to care for patients with fractures, and Bill never missed a chance to take on the most difficult cases to prove to the residents that fractures should be treated by orthopaedists. If called to the emergency room in the middle of the night, Bill was quickly there to help and to teach. He never shied away from the toughest case or complication. As his reputation grew, so did the honors that began to come his way. He was elected as an American Orthopaedic Association-American, British, Canadian (ABC) traveling fellow in 1961 and to membership in the American Orthopaedic Association in 1964. In 1968 he served as a physician for the United States Olympic Team in Mexico City. He and his good friend, Dick Mayo, found time to write and publish a book, Orthopedics; A Concise Guide to Clinical Practices1, in 1965. That same year, he spent six weeks in Nigeria as a member of Orthopaedics Overseas, and he returned with many interesting case histories of diseases that are only seen in that part of the world. Before the questions for the American Board of Orthopaedic Surgeons' (ABOS) examination were standardized, many an unsuspecting applicant for ABOS certification who had gotten too big for his britches would suddenly be faced with the problem of diagnosing an echinococcus cyst of the knee. He and his associate, Dr. Edwin Wyman, became consultants to the Shriners Burns Institute at Massachusetts General Hospital and developed innovative methods for burn surgeons to use when immobilizing patients for skin grafting. Bill and Ed also consulted for the Harvard Health Services where, in a given session, patients might vary from a janitor to a Nobel Prize winner. Bill had academic appointments at Harvard and Tufts University and served as Chief of the Department of Orthopaedic Surgery at Faulkner Hospital from 1976 to 1989. Bill developed a strong interest in the AAOS and served on many of its committees. He believed that an ambulance driver should possess more than a driver's license and, while serving with the Committee on Injuries, helped collate and produce the “Orange Book,” Emergency Care and Transportation of the Sick and Injured, in 1971. He worked closely with the American College of Surgeons and helped to develop and teach many courses for emergency personnel. The specialty of the Emergency Medical Technician (EMT) came into existence from these efforts. If one was out to dinner with Bill, it was not uncommon to see a police officer or a firefighter come by the table and say, “Dr. Mac, how are you?” Bill, who carried a fully equipped first-aid kit in his car at all times, told the story of being first on the scene of a wreck and observing that the driver had a compromised airway. He leaned into the car and held the victim's jaw. The next car stopped and the driver ran up and said, “It's OK, I'll take over now... Oh, Dr. MacAusland, it's you!” It was one of Bill's EMT trainees, who knew exactly what to do. Bill told that story often and with well-deserved pride. Bill's work for the Academy was recognized by his election to the office of Treasurer. He helped to establish an investment program to put the AAOS on a solid financial footing. He was elected Second Vice-President in 1977, and his visionary talents quickly became evident. One of his most important initiatives was to propose that the Academy build a fixed educational facility. It took a number of years, but eventually the Learning Center in Rosemont, Illinois, came to fruition. The Center and a hotel now complement the Academy office, allowing hundreds of surgeons each year to attend courses and learn new techniques and skills. Bill's First Vice-Presidential address, “Crossroads for Orthopaedics,”2 was given at the Annual Meeting of the AAOS in Atlanta in February 1980. He urged the Academy to become proactive in health-care issues. He recognized the wisdom of helping orthopaedic residents learn about the AAOS, and candidate membership was later established. While he was President, the AAOS and the ABOS were at loggerheads over the issue of recertification, and Bill found himself in the middle of the controversy. He suggested that the ABOS do the initial certification and that the AAOS be allowed to preside over continuing education and to create self-assessment methods. Eventually, the differences were settled, and the ABOS now carries out recertification with practice-based oral examinations or examinations in subspecialty areas. Bill had a knack for getting colleagues involved in orthopaedic activities. Often upon his return from Chicago, he would inform one of his partners, “I've got a new job for you.” Bill's expressed confidence left no room for refusal, and the chosen partner usually found that the new task was stimulating and led to the development of new talents. In 1971, Bill's interest in emergency medicine led him to help found a clinic at Stratton Mountain, Vermont, for the care of skiing injuries. The clinic, named the Carlos Otis Stratton Mountain Clinic, became a model for others throughout the skiing world. Bill, Fran, and assorted family members spent many winter weeks in Vermont from 1971 until health issues forced Bill to retire in 2003. A monthly rotation for medical students from Harvard and other schools was instituted, providing the students with a wealth of experience in the acute care of musculoskeletal injuries. Patients with medical emergencies needed care also, and the clinic for many years has been staffed at weekly intervals by volunteer orthopaedic and internal medicine attending physicians from Thanksgiving to Easter. Bill teamed up with Mary Beth Hand, RN, the head nurse since the inception of the clinic, to acquire the latest medical equipment, including the automated external defibrillator (AED), which has saved several lives since its advent a few years ago. A member of the ski patrol, with AED in hand, can reach any spot on the trails in just one or two minutes. Bill was fondly referred to as “The Commander” by the clinic staff. Despite his involvement in a myriad of professional activities, Bill found time for his family. He and Fran had six children—Russ, Steve, Augusta, Ted, Edie, and Sam—and ten grandchildren. He tried never to miss a hockey (field or ice) game or tennis match. Bill and Fran were married for fifty-six years, and she was the glue of the family and his “anchor to windward.” They traveled yearly to the Gaspé Peninsula in Canada, where frequently it was Fran who caught the largest salmon! In addition to being a sports fisherman, Bill was an avid beekeeper, and his friends were the recipients of large jars of “MacAusland Honey” at Christmas. One Sunday afternoon, Bill got a call from a nearby friend who reported that a swarm of bees was in his yard. Bill got on his protective outfit and hopped in the car. He captured the queen, and the swarm followed. He drove home in a car filled with hundreds of angry bees! He also enjoyed tennis and golf and was an avid reader. Bill faced his terminal illness in his typical no-nonsense, straightforward way. His extended family was with him during his final hours on January 15, 2004. A moving Service of Thanksgiving was held at St. Paul's Episcopal Church in Dedham, Massachusetts on January 20th. The depth and breadth of Bill MacAusland's energies, visions, and passions enriched and stimulated all who came in contact with him, and he was instrumental in the growth and development of orthopaedics in the latter part of the twentieth century.