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J Wrist Surg 2013; 02(03): 199-205
DOI: 10.1055/s-0033-1350061
Perspective
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Wrist in My Three Lifetimes

Yves Allieu
1   Montpellier Institute of Surgery for the Hand and Upper Limb, Clinique Clémentville, Montpellier, France
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Publikationsdatum:
05. September 2013 (online)

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My First Lifetime

In 1970, at the age of 33, I became an associate professor of orthopedic surgery and plastic surgery at the Montpellier School of Medicine (the oldest active medical school in the Western world; [Fig. 1]). My double training as an orthopedic and plastic surgeon made me turn toward a specialization in the hand, wrist, nerves, and upper limb. I was nominated as a Member of the Groupe d'Étude de la Main (GEM) in 1970, which ultimately became the French Society of Hand Surgery. The GEM had been founded in 1963 by four surgeons (Raoul Tubiana, Jacques Duparc, Raymond Vilain, and Jacques Michon) and one anatomist (Pierre Rabischong), who introduced me. This was the beginning of a long relationship, because from 1982 to 1988 I was General Secretary of the GEM and, later, its President in 1992 and 1993 ([Fig. 2]).

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Fig. 1 The main entrance to the Montpelllier School of Medicine.
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Fig. 2 The author dressed as a pirate at the GEM congress in Montpellier presided by Pierre Rabischong in 1974. The eye patch on the left side was a bad omen!

Under Rabischong's guidance, the first national course in Hand Surgery was created in Montpellier. The faculty included Vilain, Michon, Rabischong, and myself. The courses in Montpellier, Tubiana's renown, and the meetings of the GEM were at the origin of the development of hand surgery as a specialty in France. We expanded this to give overseas courses in a variety of countries as far away as Iran, China, and Japan ([Fig. 3]).

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Fig. 3 From right to left: Jacques Michon, Raymond Vilain, the author.

At the Montpellier Academic Hospital and, likewise, at the School of Medicine, I was an associate professor of orthopedic surgery and plastic surgery and head of the hand surgery department ([Fig. 4]). In this first lifetime I was very involved in surgery of the upper limb, including the hand, wrist, elbow, and shoulder. I trained many French and foreign assistants and hosted several visiting professors.

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Fig. 4 The Montpellier School of Medicine. The auditorium during the presentation of a thesis.

I became particularly interested in brachial plexus surgery, and in 1970 I performed the first brachial plexus operation in France.[1] [2] [3] I also concentrated on microvascular surgery. I became a member of the American Society for Surgery of the Hand (ASSH) and I presented a paper on the treatment of congenital pseudarthrosis of the forearm by free vascularized bone grafting at the ASSH meeting in New Orleans in 1976. I was a member of the GAM (French Group for Advancement in Microsurgery) and president during its congress in 1980. The main theme was free vascularized bone grafts of the upper limb, a topic I have continued to study throughout my career.[4]

Starting in 1981, I became interested in reconstruction of the upper limb for quadriplegia, and, stimulated by meeting Dr. Eric Moberg at a conference on Kienböck disease, I was instrumental in developing this discipline in France. Along with several colleagues I cofounded the Propara center in 1983. This center was the first of its kind to specialize in the treatment of spinal cord injuries. Our pioneering work attracted many overseas visitors, including the most prominent international specialists in the field of quadriplegia. This work has remained one of my main interests, and I am currently the president of the International Federation of Societies for Surgery of the Hand (IFSSH) quadriplegia committee.

I had two particular interests in wrist surgery: surgery for the rheumatoid wrist and carpal instability.

The Rheumatoid Wrist

I was quite involved in the treatment of the rheumatoid hand and wrist[5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] thanks to close collaboration with the renowned rheumatology department of the Montpellier hospital. This involvement in rheumatoid polyarthritis led to a meeting with Alfred Swanson in 1975 at a round table discussion on metacarpophalangeal arthroplasty at the International Society for Plastic Surgery meeting in Paris. Following this I met with him on a regular basis and had the pleasure of hosting him and his wife, Genevieve, in Montpellier. I also became a highly active member of the European Rheumatoid Arthritis Surgical Society (ERASS), which ushered in another important chapter of my life. The ERASS was founded by Norbert Gschwend from Zurich, who had also founded the Schulthess Klinik, specializing in the treatment of rheumatoid polyarthritis. I was the general secretary of the ERASS from 1980 to 1984, vice-president from 1984 to 1987, and president from 1999 to 2000, and presided over the ERASS congress in Montpellier in October 2001. Thanks to the ERASS, more patients were treated in Europe than in the United States at several specialized centers such as the one in Finland founded by Dr. Kauko Vainio.

Alfred Swanson ([Fig. 5]) and Bill Clayton were the only active American members of the ERASS. However, I visited Drs. Nalebuff and Millender, who were the specialists in surgery of the rheumatoid hand in Boston, and learned a great deal from them. I became aware of the importance of preserving wrist motion in the rheumatoid wrist but realized the problem of the failure of fixation of a total wrist prosthesis in fragile bones. At that time, I had performed 603 rheumatoid wrist procedures from 1968 to 1994, which consisted mostly of synovectomies and stabilization procedures.[12] I also used the Swanson wrist implant, but I had to abandon it on account of silicone synovitis. However, I never gave up on trying to develop a reliable implant to restore wrist motion. Because of the problem of fixation with a conventional total wrist arthroplasty, I focused on developing an interposition arthroplasty, which became a reality only after the development of pyrocarbon.

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Fig. 5 Norbert Gschwend and Alfred Swanson with Monique Allieu in the center.

 

Carpal Instability and Adaptive Carpal Malalignment

After reading works by Landsmeer, Fisk, Guilford, and Linscheid, I began to work on carpal instability.[17] [18] [19] [20] [21] [22] [23] [24] [25] [26]

In 1984 I was a visiting professor at the Mayo Clinic. I was invited by Dr. Michael Wood, who was my host along with his wife, Marilee (an excellent cook who proved to me that any reticence the French may have about American cookery was entirely unjustified). I met the late James Dobyns, who, like me,[34] was interested in sports-related hand and wrist injuries. I also met Ronald Linscheid, who took me on a plane trip, flying all over Rochester, Minnesota, and the surrounding areas. It was in the winter in subzero temperatures, and I nearly froze my ears off because I hadn't thought to wear a hat! ([Fig. 6])

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Fig. 6 Ronald Linscheid and Yves Allieu.

Rochester is the complete opposite of the French Riviera: there is nothing to do there but work! I was amazed by the organization of the Mayo Clinic as well as the uniqueness of the excellent surgeons and their remarkable work. Following my trip to the Mayo Clinic, I organized a round table on carpal instability at the GEM, at which Ronald Linscheid and Geoffrey Fisk were my guest speakers. I was especially interested in adaptive carpal instability. I made a clear distinction between carpal instability due to ligament injury, adaptive carpal malalignment secondary to a malunited distal radius fracture (which was later included in the wrist terminology classification of the International Wrist Investigators Workshop [IWIW], developed by Gilula et al[25]), and intracarpal malalignment caused by a change in the shape and volume of the carpal bones.

At 1:30 pm on July 14 (Bastille Day), 1988, at the age of 51, my career was brutally interrupted by a terrible scuba diving accident. I was testing a new spearfishing gun, which misfired, and a harpoon penetrated through my left eye and into my brain. Considering the severity of my injuries, I can only say it is a miracle that I am here to recount the tale today! During the coma I had a near-death experience, but, as Kipling would say, that's another story.

Thanks to my wife and four daughters, I was able to go on living. I am eternally grateful to them for their help and support while I relearned how to walk, write, and speak. My career, however, was placed on hold for 3 years while I recovered.