York Orthopaedic Dispensary Research Articles

Dr. Newton Shaffer (1846-1928): Renowned Orthopedic Surgeon and Founder of the American Orthopaedic Association.

An unsung hero of American orthopedic surgery is the largely forgotten Dr. Newton Melman Shaffer (1846-1928). Upon graduating from medical school at New York University, Shaffer began his career training at the Hospital for the Ruptured and Crippled in 1867. Shaffer then went on to practice at St. Luke's Hospital and New York Orthopaedic Dispensary and Hospital where he became chief. Here, Shaffer made major contributions to the field in treating clubfoot and tuberculosis. He then declared orthopedics as a separate entity from general surgery at the 10th International Medical Congress. He helped start the American Orthopaedic Association to push for the recognition of American orthopedics to the international community. In 1900, Shaffer opened the first state-run hospital for underprivileged children requiring rehabilitation. During his career, Shaffer advocated for conservative orthopedic treatments, aided in the invention of medical devices, contributed largely to academic orthopedics, and successfully advocated for the inception of the field of orthopedic surgery.

Stand Up and Be Counted 2008*

It is an honor and pleasure for me to address you as the incoming 121st President of the American Orthopaedic Association (AOA). Today, I will speak to you about the AOA's commitment to leadership and how, through recent changes in its activities, it has embraced the challenge to “stand up and be counted.” But, first, I want to mention how my institution, the New York Orthopaedic Hospital, has been closely associated with the AOA and how I chose the title “Stand Up and Be Counted.” The New York Orthopaedic Hospital and Dispensary was founded in 1866, and there have been nine directors1. The Hospital sold its building in 1950 and became part of the Columbia Presbyterian Medical Center and now New York Presbyterian Hospital and Columbia University. Of the nine directors, three have been presidents of the AOA: Newton M. Shaffer, Harold M. Dick, and myself. Newton M. Shaffer, our second director, was one of the founders of the AOA. As nicely outlined in Dr. Urbaniak's A History of the American Orthopaedic Association, a preliminary meeting to discuss the formation of the AOA was held in Shaffer's New York apartment2. The AOA was formed in 1887 as the first orthopaedic association of its kind, and Newton Shaffer was the second president in 1888, following Virgil Gibney. The third director of the New York Orthopaedic Hospital, Russell A. Hibbs, one of the most famous orthopaedic surgeons in the history of our profession, was initially rejected. It appears that several influential AOA members did not like the manner in which he replaced Newton Shaffer as director of the New York Orthopaedic Hospital, and they blocked his admission. However, he was later unanimously accepted on the merit of his work concerning spinal fusion. Harold Dick was our eighth director …

Coronary Disease of the Hip

Coronary Disease of the Hip

The Classic Non???deforming Club???foot WITH REMARKS ON ITS PATHOLOGY

* Clinical Professor of Orthopaedic Surgery in the Medical Department of The University of The City of New York; Attending Surgeon in Charge of The New York Orthopaedic Dispensary and Hospital; Orthopaedic Surgeon to St. Luke's Hospital, New York.

Lumbosacral junction; roentgenographic comparison of patients with and without backaches.

Chronic lumbar backache continues to be a source of difficulty, both to the patient and to the physician called on for treatment. There is hardly a person who has not, at some time, experienced low backache. The vast majority of the backaches are transitory and will subside with little or no treatment. There are, however, many instances in which these bothersome backaches become chronic and tax the ingenuity and resourcefulness of the physician. In order to determine the relationship between the roentgenographic findings and chronic lumbar backache, a study was made comparing 100 patients with backache and an equal number of persons not bothered by backache. The group of persons with chronic backache included the first hundred who applied for treatment at the New York Orthopedic Dispensary and Hospital in the year chosen for study. They were not screened except that those persons with obvious pathological changes, such as herniation

Enchondroma of the second metacarpal bone; segmental resection of tumor and replacement by bone graft--a case report.

CancerVolume 4, Issue 4 p. 835-838 ArticleFree Access Enchondroma of the second metacarpal bone. Segmental resection of tumor and replacement by bone graft a case report Frederick M. Smith M.D., Frederick M. Smith M.D. Department of Orthopaedic Surgery, College of Physicians and Surgeons, Columbia University, and the Fracture Service, New York Orthopaedic Dispensary and Hospital, Presbyterian Hospital, New York, New YorkSearch for more papers by this author Frederick M. Smith M.D., Frederick M. Smith M.D. Department of Orthopaedic Surgery, College of Physicians and Surgeons, Columbia University, and the Fracture Service, New York Orthopaedic Dispensary and Hospital, Presbyterian Hospital, New York, New YorkSearch for more papers by this author First published: July 1951 https://doi.org/10.1002/1097-0142(195107)4:4<835::AID-CNCR2820040420>3.0.CO;2-XAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Bunnell, S: Surgery of the Hand, 2d ed. Philadelphia. J. B. Lippincott, Co. 1919. 2 Coley, B. L.: Neoplasms of Bone and Related Conditions; Their Etiology, Pathogenesis, Diagnosis, and Treatment. New York. Paul B. Hoeber, Inc. 1949. 3 Geschickter, C. F., and Copeland, M. M.: Tumors of Bone (Including the Jaws and Joints), 2d ed. New York. American Journal of Cancer, 1936. 4 Stout, A. P.: Human Cancer. Etiological Factors; Precancerous Lesions; Growth; Spread; Symptoms; Diagnosis; Prognosis; Principles of Treatment. Philadelphia. Lea & Febiger, 1932. Volume4, Issue4July 1951Pages 835-838 ReferencesRelatedInformation

PSEUDARTHROSIS FOLLOWING SPINE FUSION

A study of the results of all spine-fusion operations performed during the ten-year period from 1936 through 1945, at the New York Orthopaedic Dispensary and Hospital, shows that, of the 1096 patients followed at least one year from the time of spine fusion, the incidence of pseudarthrosis has been 16.6 per cent. The diagnosis of pseudarthrosis can be made, in most cases, after careful clinical and roentgenographic evaluation. In a smaller group of cases, the diagnosis will not be definitely established until the area of fusion has been explored. The benefits of the operation of spine fusion for any disease or deformity of the spine cannot be determined except in patients in whom a successful fusion has been definitely obtained.

Care of the Patient with a Taylor Spine Brace

Jean M. Bailey (Genesee, Rochester, New York) is supervisor at the New York Orthopaedic Dispensary and Hospital, New York City. She has also held positions of staff nurse and head nurse.

RECURRENT DISLOCATION OF THE PATELLA

The treatment of recurrent dislocation of the patella has been a fertile field for the growth and development of surgical ingenuity. As many as sixty different operative procedures have been devised for its correction. This study of 27 dislocating patellas treated at the New York Orthopaedic Dispensary and Hospital confirms my belief that one or two types of procedure, either separate or combined, are sufficient to give a stable symptomless knee. This is true for all types of cases. It is important also to emphasize relatively early operative treatment, since with this condition osteoarthritis is prone to occur sooner than in a normal knee. CLINICAL FINDINGS The group of cases here presented comprises 10 in which the condition was bilateral and 7 in which it was unilateral, or a total of 27 dislocating patellas which were treated by operation at the New York Orthopaedic Dispensary and Hospital in a thirteen

Os Intermetatarseum: Unusual Variant

Os intermetatarseum is described as an accessory bone of rather rare occurrence (1, 2, 5). Almost all of the cases thus far recorded have been rather diminutive osseous bodies lying usually between the bases of the first and second metatarsals. Sometimes the bone appears as spindle-shaped, projecting a half or a third of the distance to the heads of the other metatarsals. One well known authority writes in a recent text (5): “The os intermetatarseum is a small accessory bone lying between the bases of the first and second metatarsal bones; it is sometimes attached to the second metatarsal bone and projects in such a way as to suggest the appearance of a rudimentary metatarsal bone. It is seen only rarely and does not give rise to symptoms.” A search of the literature tends to confirm this observation as to symptoms, though in one case occurring at the New York Orthopaedic Dispensary and Hospital, such a bone occurring between the first and second metatarsals was considered to play an etiologic röle in the production of a hallux valgus (6). The case here presented is of interest because of the unusual situation of an os intermetatarseum; it appears in the space between the fourth and fifth metatarsals, articulates distally with the phalanx, the “true” fourth metatarsal head appearing to be distinctly extra-articular, and tapers to a small proximal end, which appears free. The “true” fourth metatarsal articulates with the tarsus at its base. It would appear that the “true” fourth metatarsal lies below, the accessory metatarsal above. A further anomaly is present in that the fourth toe appears to have only two phalanges. On physical examination the foot appeared to show some increase in thickness in the region of the fourth metatarsal. The fourth toe was shorter than the corresponding toe on the opposite foot. A callus was present over the fourth metatarsal head region on the plantar surface of the foot. The patient, who was a woman fifty years of age and who had been sent for examination to rule out fracture in a case of sprained ankle, gave only an ambiguous history of any previous symptoms referable to the foot. She was questioned further because of an incidental finding of Freiberg's disease (deforming metatarsophalangeal osteochondritis) in the second metatarsal head. If there had ever been an acute phase in the latter condition, the history gave little clue to it. Relative to Freiberg's disease, Hauser (5) makes the comment: “The condition is believed to be the result of mechanical strain and abnormal repeated traumas that occur at the heads of the second and third metatarsal bones. It is usually seen in cases of pes valgoplanus associated with metatarsus latus. “Since the second metatarsal bone is generally the longest, it is exposed to increased weight bearing and trauma.”

ANKLE FUSION FOR CORRECTION OF PARALYTIC DROP FOOT AND CALCANEUS DEFORMITIES

Recent reports have been published concerning the treatment of paralytic drop foot by means of posterior bone block operations. Admittedly, an appreciable percentage of unsatisfactory results has followed the use of this procedure.1Posterior bone block for paralytic drop foot was tried at the New York Orthopaedic Dispensary and Hospital, but the results were not satisfactory. Accordingly, the procedure was abandoned. Ankle fusion was adopted and has been used extensively for both drop foot and calcaneus deformities. During the five year period from 1934 to 1938 inclusive 106 ankle fusions were done in this hospital for the correction of paralytic deformities resulting from anterior poliomyelitis. Ankle fusion was done in 72 instances to correct drop foot deformity and in 34 instances to correct calcaneus deformity. The patients have been observed from year to year in the follow-up clinic, and the end results have been gratifying. DROP FOOT Among the

The decline in incidence of tuberculosis of bones and joints

An actual decrease in the number of patients suffering from tuberculosis of the bones and joints has been observed at the New York Orthopaedic Dispensary and Hospital. The percentage of patients with tuberculosis of bones and joints, as compared with total new patients applying for dispensary care, has fallen from 65.3 per cent to 0.6 per cent during the past seventy years. Similarly the incidence of bone and joint tuberculosis in children, in relation to all new dispensary patients, has fallen during the past twenty-five years from 9.7 per cent to 0.1 per cent. It is emphasized that these figures are unreliable in estimating the general incidence of tuberculosis of bones and joints throughout the country, and it is hoped that other hospitals will make comparable reports. A discussion of factors entering into the decline of tuberculosis of bones and joints has been presented.

DOES OPERATIVE FUSION OF TUBERCULOUS JOINTS PRODUCE TUBERCULOUS MENINGITIS?

Patients with tuberculosis of the joints often die of miliary tuberculosis, the most serious form of which is tuberculous meningitis. This is a problem that has long been troublesome to those who treat tuberculosis of the joints. Regardless of whether the patient is treated by conservative or by radical procedures, there is a certain mortality due to tuberculous meningitis. It is important, therefore, to attempt to determine which of the two phases of treatment of tuberculous joints allows the lowest mortality so far as tuberculous meningitis is concerned. The records of the New York Orthopaedic Dispensary and Hospital lend themselves ideally to such a study because both the conservative and the radical treatment of tuberculosis of the joints have been given long trials at this institution. For over forty years, or from the founding of the hospital in 1866 until 1911, tuberculosis of the joints was treated conservatively. A country

ROENTGENOLOGIC OBSERVATIONS ON VARIOUS TYPES OF CHRONIC ARTHRITIS

Although numerous reports have been published on the roentgenologic observations on various forms of chronic arthritis, the subject has not received the careful attention which it merits from the point of view of differential diagnosis. A considerable number of the studies which have been reported have dealt with the question of tuberculous and pyogenic arthritis, and comparatively little attention has been paid to the much more frequent rheumatoid arthritis and osteo-arthritis. In recent years, however, the increasing tendency to regard rheumatoid arthritis and osteo-arthritis as separate and distinct clinical entities has focused attention on these two varieties of arthritis, and there have been reports of several studies dealing with the roentgenologic observations on the two diseases.1The student of arthritis is particularly referred to the recent comprehensive work of Brailsford,10 with its extensive bibliography. At the arthritis clinic of the Presbyterian Hospital and at the New York Orthopedic Dispensary

ATLANTO-EPISTROPHEAL SUBLUXATIONS

Subluxations of the cervical vertebrae were first described in this country in 1889 by Walton,1who devised the method of manipulative reduction that bears his name. In 1907 Corner2reported twenty cases of atlanto-epistropheal subluxations and dislocations, all of traumatic origin, and gave what is probably the best account of the mechanism of their production. The first report of a case of distention subluxation, i. e., subluxation probably due to effusion in the joints concerned, was made by Jacobs3in 1916. In 1932 Watson Jones4reviewed fourteen cases from the literature and reported two personal cases. The present paper is based on a consideration of twenty cases of distention subluxation and ten cases of related conditions observed from 1923 to 1933 at the New York Orthopaedic Dispensary and Hospital. ANATOMIC CONSIDERATIONS The atlas and epistropheus articulate through four joints: the atlantodental joint between the anterior atlantal

A BENIGN FORM OF OSTEOMYELITIS OF THE SPINE

Although osteomyelitis of the vertebral column generally is considered to be relatively uncommon, numerous case reports and descriptions of the condition have been published. With very few exceptions they have dealt with the very acute form associated with high temperature, marked prostration, frequent paralysis from involvement of the spinal cord, and with a high mortality. The impression is had from reading the textbooks and most of the articles on the subject that this is the generally accepted picture of the disease. Steindler¹describes a milder form of infection, and Kidner²has reported three cases which ran a relatively benign course. From August, 1924, to December, 1932. sixteen cases of osteomyelitis of the spine have been collected from the records of the New York Orthopaedic Dispensary and Hospital and one other was seen in consultation. They indicate the occurrence of a milder form of the disease which, in this

MONARTICULAR ARTHRITIS SIMULATING TUBERCULOSIS

The common occurrence of a type of monarticular arthritis that frequently simulates tuberculosis very closely is indicated by a study of a series of cases in which the patients were treated at the New York Orthopaedic Dispensary and Hospital and the results of which are presented in this paper. Few references to the condition appear in the literature. Friedrich1and Spitzy2mentioned that monarticular arthritis may be mistaken for tuberculosis and that the differential diagnosis is often difficult. A conviction, which has become more firmly established with added experience, that in many instances of chronic diseases of the joints a diagnosis cannot be made without exploratory operation, biopsy and tests on guinea-pigs3has led to the discovery of this group of cases, which presents a number of interesting features. From March, 1924, to January, 1930, twenty-four patients with such cases were operated on in the New York

SLIPPING OF THE UPPER FEMORAL EPIPHYSIS

A condition occurring between the ages of 8 and 17 years is described in the literature as epiphyseal fracture, separation, or slipping, epiphyseal coxa vara, adolescent rickets, pathologic fracture, and femoral osteochondritis of adolescence. It is a disease characterized by weakening of the epiphyseal disk at the femoral head, permitting subsequent displacement of the head on the neck. We are presenting a study of seventy cases of this disease from the New York Orthopaedic Dispensary and Hospital. Sixty-three were seen in adolescence; seven were adult residuals. Thirty-nine were in males, thirty-one in females. In thirty-one cases only the left hip was affected; in twenty-four the right, and fifteen were bilateral. Bilateralism is about as common as in coxa plana and only slightly more common than in frank infections. Of fifty-five patients, 65 per cent were overweight, half of them having endocrine imbalance. Many of the overgrown children were of the

HALLUX VALGUS

During the period covered in this report, from 1917 to 1924, inclusive, about 300 operations for hallux valgus were performed at the New York Orthopedic Dispensary and Hospital. I have been able to review the results in 200 of these operations performed on 108 patients. The statistics in most instances refer to individual feet and not to the patient. The average length of time which elapsed between operation and final examination was twenty-eight months. The work was done by twenty-five different surgeons, fifteen of whom were on the resident staff and ten on.the visiting staff. A little more than half of the operations were performed by the members of the visiting staff. THE PATIENTS Ninety per cent of the patients were women, and 80 per cent were between the ages of 20 and 60. There were seven patients under 20 and three over 60 years of age. In those patients

Congenital dislocation of the hip. A report of three hundred and ten cases treated at New York orthopedic dispensary and hospital: Benjamin P. Farrell, Herman L. Von Lackum and Alan De F. Smith, New York. The Journal of Bone and Joint Surgery, July, 1926

Congenital dislocation of the hip. A report of three hundred and ten cases treated at New York orthopedic dispensary and hospital: Benjamin P. Farrell, Herman L. Von Lackum and Alan De F. Smith, New York. The Journal of Bone and Joint Surgery, July, 1926