By Q. Murat. The Mayo Foundation.

The passage of time has altered only the treatment of this injury and not more than 20 years have passed Colles’ Law since a satisfying technique has emerged discount 10mg toradol visa sacroiliac pain treatment options. Colles was established as a great clinical surgeon by this In 1837 Colles published a book entitled Practi- paper purchase toradol 10mg without prescription sports spine pain treatment center hartsdale ny. At the time he wrote it, he had not been cal Observations on the Venereal Disease and on able to verify his observations by dissection and the Use of Mercury. There is use of mercury in syphilis in opposition to a pre- scarcely a reference to this common injury in the vailing tendency among surgeons to employ less literature before 1814. But in using it he maintained it believed that it was a dislocation of the carpus. In a chapter dealing with syphilis in surgeons, has not, as far as I know, been described by any author; indeed, the form of the carpal extrem- infants, he made an observation that later became ity of the radius would rather incline us to question known as Colles’ Law: its being liable to fracture. The absence of crepitus and of other common symptoms of fracture, together One fact well deserving of our detention is this: that a with the swelling which instantly arises in this, as child born of a mother who is without any obvious 76 Who’s Who in Orthopedics venereal symptoms and which, without being exposed him; yet he was cautious in interpreting what he to any infection subsequent to its birth, shows this observed, and this quality of mind often pre- disease when it is a few weeks old, this child will infect vented him from speculative reasoning about the the most healthy nurse, whether she suckle it or merely behavior of disease. He made a substantial con- handle and dress it; and yet this child is never known tribution to knowledge, added to which the “out- to infect its mother, even though she suckle it while it standing feature of his character was his strict has venereal ulcers on the lips and tongue. It was that the reading of his papers gives a peculiar nearly 70 years later that the Spirochaeta pallida pleasure even today. Failing health had com- plary and efficient manner in which you have pelled him to resign the professorship of surgery filled this Chair for 32 years, has been a principal 1 year before his observation. He had already cause of the success and consequent high charac- vacated the Chair of Anatomy in 1827 at a time ter of the School of Surgery in this country. He other surgeon of Ireland holds so secure a place continued at Steevens’ Hospital until 1841, where in the history of British surgery. In 1830 be was References elected for the second time President of the Royal College of Surgeons in Ireland, and 9 years later Anonymous (1915) Abraham Colles. Surgery 2:351 He died on December 16, 1843, and “his funeral Bettany GT (1887) Dictionary of National Biography 11:333 was attended by a huge concourse of medical Colles A (1818) On the Distortion termed Varus, or men, students and friends. Dublin Hospital Reports 1:175 For the last 20 years of his life he had the most Colles A (1844) Lectures on the Theory and Practice of lucrative surgical practice in Dublin and this in Surgery. Dublin, SJ Machen spite of the demands of his professorship and hos- Kelly EC (1940) Medical Classics 4:1027 pital duties. He lived during most of his life at Kirkpatrick TP (1931) Irish Journal of Medical Science 21 Stephen’s Green, having married Sophia, 66:241 Widdess JDH (1949) An Account of the Schools of daughter of the Rev. Jonathan Cope, Rector of Surgery, Royal College of Surgeons, Dublin, Ahaseragh, County Galway. Edinburgh, E & S Livingstone, Ltd dren; the eldest son, William, became Regius Pro- fessor of Surgery at Trinity College and was elected President of the Royal College of Sur- geons in Ireland in 1863. Colles was an indefati- gable worker all his life; he was often in his dissecting room before six o’clock in the morning, and at Steevens’ Hospital at seven. A critical contemporary speaks of him as “without many books, and paying less attention to their contents, he is still the laborious, shrewd, observing, matter-of-fact and practical surgeon. As an operator he has many equals, and some superiors; but in advice, from long experi- ence and a peculiar tact in discovering the hidden causes of disease, he has scarcely a rival. In 1932, he published a description of his operation for unreduced congenital dislocation of the hip. Then a long plaster spica was applied to the unaffected side and moleskin traction of 25–35 pounds was maintained on the dislocated side. Several weeks later, when the head had been reduced to the level of the acetabulum, the child was prepared for operation. The greater trochanter with its attached muscles was chiseled through and turned upward, and the capsule cov- ering the head was rather easily dissected free from the surrounding tissues. When the isthmus of the capsule was reached, it was cut through and the head of the bone inspected through this aper- ture. Paul Crenshaw COLONNA With the Doyen reamer, a capacious acetabulum 1892–1966 was formed as near the original site as the pre- liminary traction had made possible. The head of Paul Crenshaw Colonna was born in Norfolk, the bone with its covering of capsule was then Virginia, on December 19, 1892, the son of placed in the newly formed acetabulum and, with Samuel and Alice Colonna. His primary educa- the limb in abduction, the greater trochanter was tion was obtained in the public schools of Rich- sutured back into place. He was granted his AB degree at Subsequent reports of this operation included a Randolph-Macon College in 1915 and his MD at careful follow-up of the first patients on whom he Johns Hopkins in 1920. Elizabeth’s Hospital in Rich- patients were seen 30 and 35 years following their mond, he began in 1921 a 16-year association operation and were always available for presen- with the Hospital for the Ruptured and Crippled tation at medical meetings. At the same time he started his academic lowing fracture of the femoral neck, sometimes association at the College of Physicians and Sur- called the trochanteric reconstruction operation, geons of Columbia University where he was Clin- which “consists essentially of severing the ical Professor of Orthopedic Surgery from 1935 muscles attached to the greater trochanter very to 1937. Colonna accepted the invi- close to their insertion to the bone, care being tation to become Professor and Chairman of the taken to leave a fibromuscular layer covering the Department of Orthopedic Surgery at the Univer- region of the greater trochanter. He remained then divided close to the femur and the loose head there until 1942, when he went to Philadelphia as fragment is removed. After the greater trochanter Professor and Chairman of the Department of has been placed deeply within the acetabulum, the Orthopedic Surgery at the University of Pennsyl- abductor muscles are then transplanted downward vania, succeeding Dr. Colonna was very young to the elderly and he was as much at widely known for the design of two surgical pro- home on the children’s ward as he was at the cedures on the hip joint, one for unreduced con- bedside of an 80-year-old patient.

Surgical treatment 1Center for Joint Disease discount toradol 10mg with amex home treatment for uti pain, Chonnam National University Hwasun Hospital cheap 10mg toradol amex pain heel treatment, 160 Ilsimri, Hwasuneup, Hwasungun, Jeonnam 519-809, Korea 2Department of Orthopedics, Chonnam National University School of Medicine, Gwangju, Korea 3Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, Korea 4Department of Orthopaedic Surgery, School of Medicine, Wonkwang University, Iksan, Korea 117 118 T. When performing THA on young patients, a high rate of failure has been reported [1–5]. On the other hand, various head preservation procedures have been reported, typi- cally core decompression, which reduces bone marrow pressure [6,7], proximal femoral osteotomy, bone graft [9,10], and trochanteric or transtrochanteric rota- tional osteotomy [11,12]. Sugioka’s transtrochanteric rotational osteotomy as treatment for osteonecrosis of the femoral head in young patients is an effective head preservation procedure. We report here the clinical results of a modified transtro- chanteric osteotomy for osteonecrosis of the femoral head. Materials and Methods Materials We reviewed 82 hips in 75 patients with osteonecrosis of the femoral head in whom follow-up was possible for more than 1 year. Fourteen were classified as Ficat stage 2, 55 as stage 3, and 13 as Ficat stage 4 (Table 1). The causes of osteonecrosis were excessive alcohol consumption in 30 hips, steroid use in 26, idiopathic in 17, and posttraumatic in 9. The direction of rotation was anterior in 77 cases and posterior in 5 cases. We performed a simple modified rotational osteotomy in 16 cases, a combination of osteotomy and simple bone grafting in 7 (Fig. Surgical Technique The lateral approach was used with dissection of the joint capsule to expose the femoral head. The short external rotator muscles were completely transected, pre- serving the quadratus femoris, and being wary of injury to the medial circumflex artery above the lesser trochanter, and then the joint capsule was exposed. Classification of cases on the basis of the Ficat stage and operation procedure Stage Only Transtrochanteric Transtrochanteric rotational Total transtrochanteric rotational osteotomy with MPBG rotational osteotomy osteotomy with bone graft II III 12 4 39 55 IV 0 0 13 13 Total 16 7 59 82 MPBG, muscle-pedicle-bone graft Modified TRO for Femoral Head Osteonecrosis 119 Fig. Radiographs of a 42-year-old man who had transtrochanteric rotational osteotomy with bone graft for osteonecrosis of the femoral head (Ficat stage II) (A, B). Radiographs 14 months postoperatively show good union of the osteotomy site and good incorporation of grafted bone at the necrotic area (C) Fig. Radiographs of a 19-year-old woman who had transtrochanteric rotational osteotomy with muscle-pedicle-bone graft for osteonecrosis of the femoral head (Ficat stage IV) (A, B). Radiographs 18 months postoperatively show no progression to degenerative osteoarthritis (C) 120 T. The femoral head (arrow) was rotated anteriorly depending on the necrotic area in this case In contrast to Sugioka’s traditional technique, the greater trochanter is not detached (Fig. The femoral head was then rotated anteriorly or posteriorly, depending on the location of necrotic area, and stabilized using two or three cannulated screws (Figs. Methods Clinical evaluation was performed with use of the Harris hip score (HHS). A clinical score was considered to be excellent if it was above 90 points, good if between 89 and 80 points, fair if between 79 and 70 points, and poor if 69 points or less. If there was progression of osteonecrosis or THA was performed in the follow-up period, the results were considered as a “failure. Fixation for the rotational osteotomy was accomplished by two cannulated screws Radiologic evaluation was performed with bone scan 3 weeks after the operation to assess revascularization or vascular injury. Also, periodic anteroposterior and lateral roentgenograms were taken to monitor for femoral head collapse or degenera- tive change. If there was no progression of necrosis on the newly formed weight- bearing surface, evidence of union could be found on the osteotomized site, and no collapse of femoral head greater than 2mm and no degenerative change of joint space narrowing occurred, we defined the operation as a radiologic success; otherwise, it was considered a failure. Results Five of 82 cases who underwent modified transtrochanteric rotation osteotomy were revised by THA at final follow-up and were thus considered to be clinical failures; overall viability was 94%. Among the failed 5 cases, 3 cases failed because of severe pain related to further collapse of the head, 1 case failed because of a pathologic sub- capital fracture, and 1 case failed due to fixation failure. Among the surviving 77 cases, the average HHS was 72 points (61–84) preoperatively and improved to 91 points (69–100) at last follow-up. Excellent results were obtained in 47 hips, good in 22, fair in 5, and poor in 3. The 3 hips with a poor result were the result of inadequate blood supply to the femoral head. Including the 3 cases that were classified as poor, the overall clinical survival rate was 90%. All Ficat stage II, 52 (96%) of 55 stage III, and 8 (62%) of 13 stage IV had no pro- gression of osteonecrosis. The overall radiologic success rate was 90%; 28 (93%) of 30 patients with alcoholic abuse and 23 (88%) of 26 patients who had used steroids were prevented from progression.

Said goodbye to formal education and mainstream medicine and went into the alternative buy toradol 10mg low cost low back pain treatment guidelines. These key encounters and experiences are important because it is through them that alternative ideology is more deeply internalized by the individual purchase 10mg toradol pain management for dogs with osteosarcoma. In other words, an individual’s “commitment to a healer/client relationship,” in particular, is instrumental in the adoption of alternative belief systems (Deierlein 1994:180). Deepening commitment to alternative ideology is, in turn, what propels people along the continuum of identity change. For example, it was the intensity of Marie’s belief in alternative therapies that inspired her to become an alternative practitioner: “I became a certified reflexologist because I believe in those things so much” (emphasis mine). CHANGES IN SELF-PERCEPTION Adopting a healer identity was one type of self-change experienced by the people who took part in this study; however, it was not the only one. For many informants, participation in alternative therapies, and adoption of alternative health and healing ideologies, led to changes in their subjective perceptions of self. In particular, it allowed them to re-define aspects of personal identity, that “unique collection of life history items that comes to be attached to the individual” (Goffman 1963:57). That participation in alternative approaches to health care can have this effect has been observed in other research on the users of alternative therapies (Csordas 1983; Easthope 1993; Glik 1988 1990; McGuire 1983, 1987; Pawluch et al. For instance, in describing the use of creative visualization among participants in a metaphysical healing group (MHG), Glik (1988:1201) reports that “In MHGs images of light emanating from and surrounding the self protected from dark forces and to some degree transformed self and others” (emphasis mine). According to Natalie, “I heard about that [course] through the healing circle; somebody mentioned to me that they were going to take it. Some told me that using alternative therapies altered their entire lives or their whole selves. Others perceived these changes to self to have occurred primarily on the level of their value systems or their personalities. For instance, some informants felt that using alternative approaches to health and healing impacted on their lives in some fundamental and per- vasive way. In Hanna’s words, The idea is that since you’re affecting the whole nervous system and hence the whole body you can have profound physical and emotional change happening. If I have a holistic perspective I know that I’m also working with someone’s emotions and their whole self.... It’s not like you’re just doing a physical thing: you change them emotionally and you change their attitude. Natalie also told me that her alternative therapies are oriented towards healing a person’s whole life: “Their life, mentally and physically and spiritually. For example, Roger told me the following: Alternative Healing and the Self | 87 I quickly saw that it had applications for the work I was doing with the handicapped people, just for working on the general organization of the nervous system, the musculature, the organization of the person in general. One of the reasons I think that the Feldenkrais work touched me so personally when I experienced the work were some of the effects on just balancing and organizing the system, the nervous system, the person. Changes in Personality Almost all of the people who spoke with me felt that their use of alternative therapies resulted in changes to one or more aspects of their personalities. For instance, Laura felt she had gained confidence and become a more assertive person through her use of alternative therapies: “At the time I wasn’t a very assertive person, I don’t believe that any more about myself.... For example, Pam believed that an alternative approach resulted in what she saw as a remarkable change in her daughter’s entire personality: I removed all the wheat that you could just see, the bread, the buns. And within three weeks there was a remarkable change, change in personality, the temper tantrums left, the disorganization left. Hanna also believed that several aspects of her personality had changed and that she had become a calmer, more tolerant, more contented, and a less worried person: I’m a lot more level. When you do yoga for several years you go through different levels of experiences and you learn not to question what’s happening to you.... It means more contentment because you’re not 88 | Using Alternative Therapies: A Qualitative Analysis worried. I feel a lot more self-sufficient, I don’t worry about the future any more. Similarly, Brenda believed she had become a more patient and tolerant person, less argumentative and judgmental, more honest with herself, and, in general, happier: I don’t judge anybody; the other thing is happiness. Also relationships, I was always angry with something, I was never satisfied, everything was wrong. Our lives were just bitching and complaining at each other and now we don’t ever. The changes Betty saw in her personality included becoming more confident and calmer, as well as less fearful and worried. She told me, “Things don’t bother me nearly as deeply or the same as they would have.

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