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Report of the Historian

This report delves into the pioneering work of historical figures such as Otfrid Foerster and Nikolaus Rüdinger in peripheral nerve reconstruction and joint innervation. The study discusses the evolution of surgery techniques, particularly in tetraplegia hand surgery, documenting important milestones and innovations. Through a historical lens, it explores the development of joint denervation procedures and their impact on palliative care for joint pain. The text showcases the long-forgotten contributions of self-taught pioneers like Albrecht Wilhelm in advancing our understanding of joint innervation.

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Report of the Historian

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  1. Report of the Historian Andreas Gohritz FESSH Council Meeting November 27th, 2011, Budapest

  2. J Hand Surg E Volume

  3. Otfrid Foerster (1873-1941) – awidely unrecognizedself-taught pioneer of peripheral nerve reconstruction Andreas Gohritz, Lee A. Dellon*, Peter M. Vogt Hannover Medical School, Germany John Hopkins University, Baltimore, USA *

  4. Historical Evolution andPioneers of Tetraplegia Hand Surgery Andreas Gohritz, Jan Fridén

  5. Sterling Bunnell, USA“Surgery of the Hand“,1948 (2nd edition) C6/7 patients with wrist extension treated by tendon transfers (BR-to-flexors) and tenodeses

  6. New Developments Combined = Alphabet Procedure

  7. Microsurgery – the past Andreas Gohritz, Medizinische Hochschule Hannover Plastische, Hand- und Wiederherstellungschirurgie Spring Meeting, Nürnberg 2011

  8. 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)

  9. 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

  10. Introduction Ca. 300 000 joint prostheses in Germany / y ! Selective denervation = palliative therapy of joint pain of multiple origins • Wrist, • Shoulder, elbow, finger / CMC 1 joint • Knee, ankle • Temporo-mandibular joint Lee A. Dellon Albrecht Wilhelm

  11. „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 . . . ­

  12. Unique career • 12th child, half orphan 1846 Apprentice barber 1850 Anatomy helper • Promotion (Joint nerves) • Adjunct (order of Ludwig II.) 1864 4th request for habilitation refused ! 1868 Honorary professor (J. Liebig) 1870 Extraordinarius (Ludwig II.) • Professor, 2nd conservator of Anatomy 1881 Chairman of Anatomy LMU München Old South Cemetery, Munich

  13. Autopsy / Enbalming of Ludwig II. (1845-1886) „The Fairy-Tale King“ „Nowhere there are 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

  14. Joseph Albert (1825-1886) Photographer of the Royal Court = R.‘s co-worker, Inventor of Light Printing 1st photo of ossicles in anatomy book (?)

  15. 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

  16. Comparing Rüdinger‘s Studies / Modern Joint Denervation Knie-Innervation nach Dellon 1992 Knie-Innervation nach Rüdinger 1857 • Nerve anatomy (almost) completely revealed by R. • Differences in terminology • (Branch of muscle branch of Vastus ext. vs. Lat. retinacular nerve)

  17. 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

  18. Innervation of the Hip Joint(from 4 different nerve sources) Only in Germany ~ 200 000 hip prostheses / year ! A New Chance for Denervation ?

  19. Schreibekrampf = writing crampF. 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. = 1st 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. = 1st description of sclerotherapy ?

  20. Dr. Runge – German pioneer of sclerosing therapy in epicondylitisKnobloch K, Gohritz A.published in Brit J Sports Med

  21. On the historical development of muscle and nerve transfer operations in the late 19th / early 20th century in Germany Andreas Gohritz, Jan Fridén, Peter M. Vogt German Hand Society Meeting 2010 German-Austrian Plast Surg Congress 2011

  22. Introduction Our standard techniques = mostly concepts created around end 19th / early 29th century, Above all by German surgeons / orthopaedics - Treatment of poliomyelitis - Therapy of gun shot wounds (WW1) Group of shoulder, Elbow / upper arm Gun shot wounds During treatment Flail („floppy“) shoulder due to polio

  23. Oskar Vulpius (1856-1934)2012: Centenary of Vulpius-Klinik, Rappenau Germany Frank Unglaub Andreas Gohritz Peter Hahn Historical article in Handchir Mikrochir Plast Chir

  24. Book chapter on history of hand surgery Martin Langer Andreas Gohritz Horst Haferkamp

  25. Influence of Hand Disease on Life and Work of FamousMusicians 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

  26. Guillaume Dupuytren (1777-1835) –a colourful character behind a disease‘s name Dupuytren‘s statue in Paris Invited presentation Hamburg, Jan 2012

  27. Thank you for your kind attention !... and a little historical dicovery in my parents‘ cellar for Zsolt

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