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Osteochondritis Dissecans in Children

1990; Lippincott Williams & Wilkins; Volume: 255; Issue: &NA; Linguagem: Inglês

10.1097/00003086-199006000-00002

1528-1132

William T. Green, Henry H. Banks, Henry H. Banks,

Hip disorders and treatments

William T. Green (Fig. I) was born August 29, 1901. in Waucoma, Iowa. The son of a physician, William L. Green, young William T. entered upon a career of service to his fellow man in his father's footsteps. He received his baccalaureate degree, master's degree, and doctor of medicine degree from the University of Indiana. At the University of Indiana Hospital, he was intern and assistant resident in general surgery. He traveled to Detroit, Michigan, to become resident in general surgery and orthopedic surgery at the Henry Ford Hospital under the tutelage of the famous Dr. Roy D. McClure. He continued resident training at the Peter Bent Brigham Hospital and at the Boston Children's Hospital in 1930 and 193 I and was later appointed to the staff of the Children's Hospital and the Peter Bent Brigham Hospital. Thus, William T. Green began a period of 38 years of work dedicated to the problems of crippled children. His first endeavor was a striking demonstration of the concept that wire, nail, or tendon implants through the center of the epiphysis do not arrest growth in the epiphysis, while compression and screw fixation in the same area cause fusion of the epiphysis. Dr. Green investigated the circulation of the head of the femur in children and described the blood vessels in the retinacula of Weitbrecht. Using investigations of the blood vessels of the hip joint, Green devised a set of principles of closed treatment of congenital dislocation of the hip and open reduction of slipped femoral capital epiphysis. He developed the surgical procedures of fractional lengthening of the gastrocnemius and sliding lengthening of the hamstring tendon. A flexor carpi ulnaris transplant to the extensor carpi radialis longus, described by Dr. Green, is now one of the most useful procedures available for the treatment of the spastic hand. In 1943, Dr. Green presented positive evidence of a direct relationship between neurofibromatosis and congenital pseudoarthrosis of the tibia; he observed that excision of the lesion, leg lengthening, and appropriate application of bone graft could save the leg of a crippled child. Osteochondritis dissecans came to his attention in 1953 when he described the natural course of the disorder before, during, and after the process of dislodgement of the loose body. Green demonstrated that immobilization and nonweight bearing can produce healing and prevent separation of the osteocartilaginous fragment. World recognition of William T. Green's orthopedic service at the Children's Hospital of Boston came when he published monumental studies on the measurement and management of leg-length discrepancies in children. Based on accurate recordings and careful measurements of the rate of growth of the extremities in normal and paralytic conditions, Dr. Green and his associates prepared tables and graphs that enable the surgeon to predict the eventual leg-length discrepancy in adult life. These tables and graphs can be found permanently framed on the walls of orthopedic clinics all over the world, and they save many children from a life on grotesque cork-soled shoes. There is no problem of the crippled child that escaped the attention of William T. Green. In the ability to put a sick baby at ease, to communicate the warmth and kindness of a father, and to introduce a strong sense of discipline with a keen sense of humor into a serious clinical situation, Dr. Green had no peer. His ability to examine a child and see much more than any other physician in a community filled with many other capable physicians, including a large number of his own pupils at Harvard Medical Center, was truly remarkable. He was seemingly inexhaustible on ward rounds and continued long into the evening hours, after physicians on other services had gone home. He had the patience to teach mothers to perform as nurses and physical therapists and to care for their children at home; he emphasized the importance of maintaining correction of a deformity 24 hours a day by exercises of specially prepared supportive measures. William T. Green served as President of the American Board of Orthopaedic Surgery, in recognition of his record of having either directly or indirectly trained more surgeons in orthopedic surgery than almost any other individual in the world. He was elected President of the American Academy of Orthopaedic Surgeons and, in 1958, President of the American Academy of Cerebral Palsy. He helped to establish the first nationwide committee on the evaluation of treatment of cerebral palsy; during his tenure of office, a long-term study on end results was organized. In a Presidential Address entitled “Orthopedic Surgery, Yesterday and Tomorrow,” William T. Green asked: Has orthopedic surgery reached the crossroads where the field of orthopedic surgery is more limited? If we are to be technicians who come into a case when someone else decides that it's time for surgery and then someone else gives postoperative care, will we, in fact, come to know less and less about less and less? Certainly, if we make an analogy with general surgery, it would be an unusual state if, immediately after surgery is over, postoperative care were transferred to some other group. Postoperative care of many orthopedic procedures may last not for a few days following surgery, but for weeks, months and years. Will our surgical judgments in such a functional specialty wither unless we follow the patient's musculoskeletal problems in detail? In no other field do the results depend so much on a continuous, well conceived program. The first Harriet M. Peabody Professorship of Orthopedic Surgery at Harvard Medical School was awarded to William T. Green.