Emile LETOURNEL1927–1994

Who’s Who in Orthopedics He developed the Leinbach screw for fractures

of the olecranon, modified the Gosset femoral head–neck prosthesis for the treatment of defi- ciencies of the femoral neck, and invented the

“femur jack,” an instrument that is very helpful in exposing the femoral neck during reaming of the medullary canal. He performed more than 3,000 primary and revision total hip arthroplasties.

He was a founding member of both the Hip Society in the United States and the International Hip Society. In 1966, he received the Governor’s Award as Florida Physician of the Year, and he was selected as Citizen of the Year by the St.

Petersburg City Council. In 1993, he received the Lifetime Achievement Award from the Joint Implant Surgery and Research Foundation, in commemoration of 60 years of surgery.

Dr. Leinbach decided to study medicine because it deals with human life, and he derived a lot of pleasure from life. In his office hung a small plaque with the inscription: “The funda- mental principle of medicine is love.” Thousands of patients benefited from his commitment and dedication.

He died on January 12, 1994, after a brief illness, in St. Petersburg, Florida. He was 86 years old. He had been working regularly in the out- patient clinic of the Bay Pines Veterans Adminis- tration Hospital until a few days before his death.

Dr. Leinbach was survived by his wife, Alice;

three daughters: Jenni Adams of Orlando, Judy Meserve of St. Petersburg, and Troy Kassing of Indianapolis; eight grandchildren; and five great- grandchildren. His only son, Tyler, died in a tragic cave-diving accident in 1960. Dr. Leinbach once said: “I have flown high enough to enjoy looking down on the clouds, and my great wife has been the wind beneath my wings.”

191

Emile LETOURNEL

1927–1994

Professor Emile Letournel was the contemporary icon of pelvic and acetabular surgery in the world and a great friend, teacher, instructor and member of the AO family. The importance of this man and his monumental achievements in surgery of the pelvis and acetabulum is unrivaled in modern trauma surgery. Professor Letournel was recog- nized as the conclusive source of extensive experience and innovative techniques in the management of severe pelvic and acetabular trauma. His lifelong contributions to the under- standing of the complex acetabular fractures and techniques required to treat these difficult injuries have defined the predominant principles of surgi- cal excellence of fracture surgery.

Professor Letournel was the guest of honor at the English-speaking, basic and advanced courses in Davos, Switzerland in 1982. The presentation of his experience in the development of diagno- sis and surgical management of acetabular frac- tures was extraordinary. It was given to a packed audience in the advanced course upper lecture room of the Kongress Halle in Davos. The par- ticipants were in awe of his surgical technique and ability to reduce difficult and extensive fractures.

His presentation included numerous examples of anatomic reduction of complex associated acetab- ular fractures with excellent 10–20 year results.

These radiographs demonstrated long, twisted

reconstruction plates curving around areas of the

pelvis (that the majority of the course participants

had never visualized), creating a singular educa-

tional experience and a standing ovation. Emile continued to be an immutable participant in the advanced courses in Davos and participated in countless AO courses throughout the United States, Europe and Canada. His unique personal- ity and energy were legendary, and he was always available to answer the most trivial question from any course participant. His passion and love of teaching extended worldwide as his results became universally acknowledged. Emile’s per- sonality and professional camaraderie were quintessential Letournel, and his dedication to teaching his techniques to conferences all over the world was the underlying virtue of this great man.

There are many instances in the history of orthopedic surgery in which an individual surgeon has made a significant contribution to a particular area of surgery that has stood the test of time. There are very few instances of a sur- geon contributing to the specialty of orthopedic and trauma surgery in the complete and life- long manner that was characteristic of Emile Letournel. His contributions began with descrip- tion of the correct radiographic and anatomic diagnoses of acetabular fractures and progressed to a logical classification of these injuries into ele- mentary and associated fracture types. This work continued with development of two major surgi- cal exposures, reduction techniques, instruments and implant designs used in every operating theater in the world today. Though there have been refinements over time and contributions by other authors in the field, Letournel’s original description, diagnosis, classification and surgical techniques have remained the ubiquitous standard of care of acetabular fractures for the past 25 years. Professor Letournel developed the base of the statistical data of both immediate and long- term results of operative management of acetab- ular fractures. His thesis published in 1961,

“Fractures du Cotyle. Etude d’une serie de 75 cas,” contained the initial description of the clas- sification developed by Emile Letournel and Robert Judet and has achieved worldwide accept- ance. This system has greatly facilitated surgical education in the understanding of the complex nature of acetabular fractures. He published three major textbooks on acetabular surgery, all with coauthor Robert Judet.

The first of these textbooks was in French,

English, Fractures of the Acetabulum in 1981, and the third, Fractures of the Acetabulum in 1993, with Robert Judet as a posthumous author.

These latter two textbooks are the primary sources of information on surgery of the acetab- ulum in the English literature and are considered the “Bibles” of acetabular surgery. His work has resulted in a complete transformation of our understanding and treatment of fractures of the acetabulum.

Emile Letournel was born on the French island of St. Pierre et Miquelon, situated between New Foundland and Nova Scotia, on December 4, 1927. He never spoke English while growing up and after finishing secondary school in St. Pierre he obtained a scholarship to the French Institute in London. During this time period, the war in Europe was at a climax and for safety reasons the French Institute was moved to Hullswater Lake, Cumberland Scotland, near Edinburgh for the duration of the war. Emile left St. Pierre et Miquelon alone at the age of 16 on July 27, 1944 to cross the Atlantic and attend school in Scotland. At the time of his departure, he did not speak English and had never seen a train or a big city. He took a small boat from St. Pierre, “Le Cap Bleu,” to Nova Scotia (24 hours) and then to Montreal by train (36 hours). He left Montreal on August 7, 1944 in one of the largest convoys of the war consisting of over 200 ships. On his ship,

“The Jamaica Planter,” no one spoke French and all his personal belongings were confiscated until the boat arrived in Scotland 28 days later. He studied for a year at the French Institute and received his Premier Bacalaureat. After the war he left England for France, where he studied at the Lycee Chaptal and received his Second Bacalaureat. He was admitted to the Faculty of Medicine of Paris from 1946 to 1960 and became a registrar in 1956.

As he developed an interest in orthopedic surgery, it became necessary for him to apply for a postgraduate position to continue his education.

This process required the applicant to visit all professors who were offering training positions.

Being from St. Pierre, Emile had no letters of support to compete adequately for an orthopedic position. A friend suggested he contact Professor Robert Judet and he did this out of desperation without any hope of obtaining a position. The meeting with Robert Judet was very brief. Pro- fessor Judet asked Emile for his letters of recom- mendation, of which he had none, but Emile indicated to him his sincere desire to train with Judet. Professor Judet asked him where he came from and Emile responded “St. Pierre et Miquelon.” Judet looked in his agenda book and

Who’s Who in Orthopedics

offered Emile a 6-month opening the following year. The 6-month position lasted 12 months and Emile subsequently became Judet’s assistant.

Emile stayed with Robert Judet until his retire- ment in 1978. During this period, Emile advanced to associate professor and finally professor in 1970. He became head of the Department of Orthopedic Surgery at the Centré Medico Chirurgical de la Port de Choisy in southeast Paris. He remained at the Choisy hospital until his retirement from academic medicine in October 1993. In addition to his interest in acetabular and pelvic fractures, he performed over 6,000 total hip arthroplasties, developed implant designs and sur- gical techniques for management of calcaneal fractures and had extensive expertise in the sur- gical treatment of bone infection. His position at Choisy provided him an unlimited exposure to orthopedic disease and created the environment to further his investigation of acetabular fractures.

The Choisy Medical Center is a nonprofit hospi- tal, and Professor Letournel never charged a surgeon’s fee to any patient throughout his entire career at Choisy for his services. He was admit- ted to the French Academie de Medicine et Chirurgie in 1981 and received the “Legion d’Honneur” from President Mitterrand of France in 1988. These honors were very special to Emile and were public recognition of his stature in French medicine and his accomplishments in the field of orthopedic trauma surgery. Following his death, the elected officials of St. Pierre et Miquelon passed a resolution naming a street on the island of his birth, “Emile Letournel.”

Professor Letournel organized the first acetab- ular fracture educational course in Paris in 1984.

His Paris courses were famous for the exposure participants received to his wealth of surgical knowledge and skill, his superb hands-on cadav- eric dissection and above all his boundless enthu- siasm and energy. The few fortunate surgeons who have been able to study with him at the

“Letournel School of Acetabular Surgery” gained tremendous insight into his diagnostic and surgi- cal acumen and the steadfastness with which he pursued every acetabular fracture to obtain “the perfect reduction.” He was acknowledged as the most skillful acetabular fracture surgeon in the world and shortly before his death, he completed his 1,050th surgically treated acetabular fracture.

A symposium was published in August 1994 in

icated to Professor Letournel and his significant contributions to orthopedic surgery. This tribute

is bestowed on a physician who has made pro- found contributions to orthopedic surgery that have significantly altered the practice of the specialty. This honor is customarily reserved for posthumous recognition. Professor Letournel qualified uniquely for this honor as he was still alive when the commission was given to pay tribute to his life achievements in fracture surgery.

Unfortunately, he died 2 weeks before this journal was published with his dedication issue.

Professor Letournel’s personality was robust, rugged and energetic and he lived life with great eagerness and excitement. His mere presence in the operating theater created movement. As he would scrub for surgery, his intensity to take on his worthy fracture adversary would bubble forth as he would review in his mind the preoperative plan of surgical approach and internal fixation.

His silhouette completely covered from head to foot in his French blue surgical gown was a rare sight to observe and revere. His distinctive vocal commentary (always in French) on a particularly stubborn fragment reduction or repeated failed surgical maneuver or the worthlessness of a par- ticular instrument to perform its function would create absolute silence from the operating theater staff until a universal sigh of relief would resound throughout the room when he was finally satisfied with his reduction. Of special mention is Profes- sor Letournel’s most trusted medical assistant, Remy Ser, who was the master of the Judet frac- ture table. He could position any extremity on the fracture table into the desired position during the most critical time of a procedure and always underneath all the sterile surgical drapes. His routine response to any request from Professor Letournel was “Oui, Messier.” He was the

“Charge d’affaires” of Letournel’s operating suite and was primarily responsible for patient problem solving before, during and after the surgical pro- cedure. Remy Ser was an extremely dedicated professional and stayed with Emile for over 15 years until the day he died. He was an integral part of the Letournel team perpetuating the excellence that was the hallmark of Professor Letournel’s surgery.

Professor Letournel never used a depth gauge.

He would merely place his finger on the drill bit at the appropriate length of penetration, show the drill bit to his scrub nurse and promptly receive the correct length of screw. He would continually vocalize to himself all the possibilities and con- sequences of his technique while performing his surgical maneuvers. His genius had an enormous

Who’s Who in Orthopedics

Who’s Who in Orthopedics

ability to comprehend spacial relationships, leading him to understand quickly the complexi- ties of a particular fracture and develop a plan of reduction based on his extensive experience. He was a masterful surgeon who knew well his abil- ities and limitations. His brilliance as a technician was evident in his surgical results. His personal- ity was always warm and endearing.

He lived for the difficult trial, whether it was in the operating room or performing the ritualistic decapitation of a bottle of Dom Perignon with a saber, he was always the same wonderful man.

His admirers encompassed the entire world of orthopedic and trauma surgery. His presentations were legendary and as uncommonly entertain- ing as his own form of English (an ingenious Letournel dialect), which created within the audience a profound awareness of the complexity of acetabular fractures and the importance of his pioneering original and lifelong contributions to acetabular fracture surgery.

This remarkable individual was not enormous in physical stature, but he was immense in per- sonality and had no equal in his field. He was hap- piest in the operating theater struggling with a difficult fracture or enjoying personal moments with his loved ones and close friends. He espe- cially enjoyed entertaining the participants of his Parisien acetabular courses at the evening banquet by singing his favorite boyhood song

“Les Prunes” escorted by his “band” playing champagne bottle instruments. His patient list read as a “Who’s Who Directory” of French society, yet he would treat the most common citizen with the same respect and care as any high-profile patient.

Professor Emile Letournel died unexpectedly after a brief illness on August 16, 1994, at his home in Paris, France.

194

Jacques LEVEUF

1886–1948

Leveuf was born in Limoges and studied in the School of Medicine in Paris. After the usual junior intern appointments he was for many years an assistant in the surgical clinic of Pierre Delbet. He worked with Delbet in the early attempts to nail fractures of the femoral neck under x-ray control.

This experience no doubt largely determined his choice of the surgery of bones and joints as his life work. In due course he achieved the coveted status of “surgeon to the hospitals of Paris” and became surgeon-in-chief at the Bretonneau Hospital. In 1942, on the retirement of Professor Ombrédanne, Leveuf was chosen as his successor at the Clinique des Enfants Malades and in the Chair of “Infantile and Orthopedic Surgery”—the blue riband of Paris orthopedics. In the new surgical clinic designed by Ombrédanne, Leveuf began to work with ever-increasing intensity on the problem of the treatment of congenital dislo- cation of the hip by open reduction. Before the war he had carried out a survey of the late results of manipulative reduction in the province of Brittany, where the deformity was exceedingly common, and had been impressed by the high proportion of poor results. During the last 2 years he had established a center in Brittany for the diagnosis and treatment of this deformity.

Arthrography, a technique in which he was a

master, was practiced on the newly born, and

many interesting observations had already come

to light. His aim was to recognize those disloca-

tions in which an interposition of soft tissues

existed that would prevent concentric reposition