Lucy! Where are the rest of your bones?

Slide1Every natural history and anthropological museum in the world seems to have a skeletal replica of Lucy, our 3.2 million year-old human predecessor. The discovery of her bones and close study of their shapes  have provided a crucial observation regarding human development. Lucy proves that our ancient ancestors first stood up and walked, and only later did they develop large brains. This was a monumental observation, widely discussed.

My monumental observation, kept to myself until now, did not require any close study but did lead to unsettling questions. Five ribs, not twelve? Only one finger and one toe? Half a pelvis? Lucy, how could you walk with less then one leg? Read more

Distraught wife, traveling salesman revolutionize arthritis surgery. Part II

The previous post describes Englishman John Charnley’s early efforts, mostly failures, to develop a total hip replacement. Although a patient’s squeaking artificial hip, which annoyed his wife, motivated Charnley to do better, finding the right material from which to make the cup component continued to elude him.

Not too long after Charnley recognized the shortcomings of PTFE (Teflon), one day in 1962, a salesman stopped by Charnley’s  hospital selling plastic gears, which came from Germany and were being introduced into machinery used in the weaving industry. He left a chunk of the little-known specialized plastic, polyethylene, an extremely hard and dense form, with the hospital’s supply officer, who passed it on to Charnley’s lab director. The investigator began immediately to test its wear properties even though Charnley’s initial response, after digging his thumb into it, was that the lab director was wasting his time. After 24/7 testing over three weeks, however, the material showed less wear than the PTFE had shown in one day. Charnley noted later, “We were on.”

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Distraught wife, traveling salesman revolutionize arthritis surgery. Part I

Slide1For millennia, many people lucky enough to survive into their 60s and 70s have developed wear-and-tear arthritis, also known as degenerative joint disease or osteoarthritis. When this type of aging occurs in fingers, the joints became stiff and knobby and perhaps painful, but with ten digits on two hands and neither hand having the duty to bear body weight, people seem to manage.The state of affairs has always been quite different, however, if the disease affects the hips and grinds away the cartilage there. Read more

When Bone Piles Became Cash Cows

bone piles and box carWhat do 30 million American bison, the completion of the transcontinental railroad, and the discovery of superphosphate fertilizer have in common? A lot, as it turns out. In 1868 they became critical elements in the formation of an entire industry, one that thrived for over 20 years. It helped finance the settlement of the Great Plains, ensured solvency of numerous new railroad lines servicing the settlers, and provided vital fertilizer for crops across the entire continent. Read more

The Second Bone Industry: Jewelry Boxes

Slide4Bone buttons made and sold in large quantities appeared in the 13th Century. It is not clear whether any of the button manufacturers themselves became wealthy, but somebody was getting rich, because a market developed for small “caskets”—actually jewelry boxes—that were most often given as engagement gifts. Here the betrothed could keep her gems, love letters, and other precious items. Read more

The First Bone Industry: Buttons

In the 19th Century, women wore corsets cinched so tightly that they distorted their rib cages and forced their abdominal organs into their chests. It was certainly not comfortable or healthy, but it was the price many paid for stylish, wasp-like waists. “Whalebone” stays in the corsets contributed to the effect, but the stays were not bone, rather they were the same flexible connective tissue that constitutes our hair and nails. Read more

Notable Biblical Bones

18-03-06 Genesis woodcut cropped for blogBones are mentioned in the Bible 92 times.  The first, and most famous instance comes early on:  So the Lord God caused a deep sleep to fall upon the man, and while he slept took one of his ribs and closed up its place with flesh. And the rib that the Lord God had taken from the man he made into a woman …   Genesis 2: 21-22

The merciful absence of broken bones is mentioned in several places, and after that, the context varies considerably. Read more

Who named our bones? What were they thinking?

18-02-27 scapula and acromion for WPAll of our 200+ bones have names, which facilitates describing them when we cannot actually hold them or point directly at them. It might be easier to remember the names if they were familiar ones like Robert, Sally, and Kevin, but no such luck. Latin was the original language of science, so the bones received Latin names. Some of those were derived from Greek. All were purely descriptive and widely understood, providing that you spoke Latin. For example, the shoulder blade is mostly flat and triangular. An anatomist picked one up, pondered a bit, and decided it resembled the blade on a shovel or spade. He named it scapula, Latin for shovel. Read more

Heightened Stature, Longer Arms for Short People

The “built” world is constructed for people around 5’6″ tall, give or take five to six inches. Those of us in that range never think about the height of a step, chair, or counter, nor do we have difficulty adjusting the car seat in order to reach the foot controls and steering wheel. Everything is designed for the average person.18-02-20 ex fix Scaduto AE HS

Extremely tall people, however,  can’t sleep in standard beds, can’t sit comfortably in theater seats, and have to duck going through doorways. People less than five feet tall have another set of concerns. In addition to possible issues regarding self-esteem, they cannot reach into overhead cabinets, sit in chairs with their feet on the floor, or control a car without special mechanical adaptations.

Once Dr. Ilizarov’s technique of bone lengthening caught on with surgeons world-wide (discussed in the last three blog posts), they began thinking about applying this technique to make extremely short people taller. Read more

Stretching a Forearm into Shape

My blog posts the past two weeks have described the pioneering work of Dr. Gavriil Ilizarov, who made lemonade out of lemons when confronted with problematic fractures and limited resources in the Russian hinterlands. His external fixators (pins placed into the bone and then secured to one another by a metal scaffolding outside the skin) are most often applied to the leg bones. These are the bones that are quite vulnerable to high-energy, devastating damage. Motorcycle injuries and war wounds are common causes.  If it were not for external fixators, which can correct alignment and stabilize fracture fragments to allow for healing, many of these severely injured limbs would have to be amputated.

18-02-13 forearm Ilizarov case xr and clinical photoThe techniques that Ilizarov perfected can also be applied to upper extremity bone problems. Take for example, this young man who broke his wrist when he was ten. He was casted, the fracture healed, and he resumed normal activities. A problem, however, was lurking. Read more