Between Wars
In the post-war period the innovations did not slow down. Dr. Rosset says, “During the 1920s and ’30s we saw advances in traumatology, including osteosynthesis and traction. Many people were experiencing hip problems, but there was no prosthesis available at the time, so surgeons had to do an osteotomy or arthrodesis. But that left patients vulnerable to inflammation and staph infection at a time when there were no antibiotics.”
“During the years of World War II, 1939-1945, orthopedic traumatology grew enormously. We learned more about how to care for open fractures. There were actually no meetings of SOFCOT during the war, but the principles remained the same: get the wounded off the battlefield and treated immediately, use plates and screws, etc. Things shifted massively at the end of the war with the arrival of antibiotics on a large scale.”
Inventing a Scale for Hip Function: Robert Merle d’Aubigné
Without a scale, how can anyone measure, much less treat, musculoskeletal trauma or disease? Impossible, until Robert Merle d’Aubigné.
As a teenage boy during WWI, Robert Merle d’Aubignéwitnessed the war first hand. His school was turned into a hospital and that, more than anything, sparked an interest in medicine. d’Aubignéwent on to serve as an assistant in general surgery for 12 years at the Hôpital de Vaugirard, during which time he developed an interest in orthopedic surgery.
Highlighting the place of orthopedics at that time, d’Aubignérecollected that, “The prestige of visceral surgery absorbed the interest of the senior staff. The lesions of the motor system, numerous accidents, tuberculosis, and arthritis were more or less abandoned to the junior staff.”1
Appointed by General de Gaulle to reorganize the military health services, d’Aubignétraveled to England in 1944 to visit prominent surgeons. He commented, “Pour moi, ce fut une experience inouïe qui bouleversa ma vie professionelle.” (“For me, it was an unbelievable experience that profoundly changed my professional life.”) In 1948 d’Aubignéassumed the chair at the Hôpital Cochin in Paris, where he remained until his retirement in 1970.
This esteemed surgeon gave the world the “Merle d’Aubigné-Postel” rating scale, published in English in the American volume ofThe Journal of Bone and Joint Surgeryin 1954, updating the scales in 1949, 1954, and 1970. d’Aubigné’s scale was first presented at the International Congress of Orthopaedic Surgery in 1948 in Amsterdam. At that time, no widely-used scale for the evaluation of hip function had gained traction in the orthopedic community.2
