schooling he showed special talent for languages and art. He graduated with highest honors from the medical school at the University of Bern in 1865. He sought postgraduate training in surgery in Berlin in Langenbeck’s clinic, but this was impossible because of his Swiss nationality. After prolonged visits to Berlin, London, Paris, and Vienna, he returned to Bern where he obtained a position in the surgical clinic.
The medical school in Bern was relatively new, having been founded in 1835. The first professor of surgery, Hermann Demme, was a product of the German educational system, as was the second professor, Albert Lucke, a student of Langenbeck. When Lucke accepted a more prestigious position in Strassburg in 1871, Köcher applied for the position in Bern. The largely German faculty of the medical school recommended Franz Konig, another student of Langenbeck, who later became the professor of surgery at the Charite in Berlin. The junior faculty and students rallied behind the cause of the ethnic Swiss candidate, as did the local Bern physicians.
After a careful investigation of his qualifications, the Board of Regents of the University chose Köcher. He served as professor of surgery for 45 years and built the reputation of the Department of Surgery and the Medical School in Bern to a very high level.
Köcher’s interests in surgery were broad and included important work on fractures and dislo- cations, ballistics, abdominal surgery, and neuro- surgery. It was in the field of thyroid surgery, however, that he made his greatest contribution, and for which he was awarded the Nobel Prize in medicine in 1909; he was the first surgeon to be so honored.
Köcher had a significant role as a teacher of medical students, house officers, and practi- tioners. His most famous student was Harvey Cushing, who worked in Köcher’s laboratory for 5 months in 1900–1901. In addition to his numer- ous papers, Köcher’s Text-Book of Operative
Surgery was also influential, going throughnumerous editions and translations. Köcher was the first to emphasize the importance of design- ing an operative approach that utilized the inter- space between groups of muscles innervated by different major nerves.
His description of a posterolateral approach to the hip joint was designed primarily for resection of the hip for tuberculous disease. A modification of previous incisions described by others, Köcher’s incision too has been modified by suc-
ceeding surgeons and is used now primarily for the repair of fractures of the hip and acetabulum and for total joint replacement.
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Who’s Who in Orthopedics
Gerhard KÜNTSCHER
1900–1972
Many American orthopedic surgeons had the pleasure of meeting Professor Küntscher for the first time in 1957 when he came to Chicago to speak at the American Academy of Orthopedic Surgeons meeting. His vitality and youthful appearance made it difficult to believe that he was the same Küntscher who had introduced the cloverleaf nail for medullary nailing of fractures of the femoral shaft during the 1930s.
Although his name in the medical community had become synonymous with medullary nailing, Küntscher worked steadily at improving the tech- nique of the operation. In Chicago, he demon- strated his method of performing closed nailing of fractures of all the long bones, using flexible cannulated reamers passed over a guide pin under fluoroscopic control. He reported the successful use of medullary nails of maximum size in hundreds of patients.
It is not generally appreciated that even in
his earliest application of the medullary nail,
Küntscher routinely attempted to insert the nail
without exposing the fracture. The new arma-
mentarium that he presented in Chicago simpli-
fied the procedure and facilitated its application
over a wide range of orthopedic problems. His
achievements made him the most internationally renowned German bone surgeon of the twentieth century.
The tribute that follows is an abridged transla- tion of the obituary published in the Deutsche medizinische Wochenschrift of March 9, 1973. It was written by a surgeon who worked closely with Küntscher for many years.
Gerhard Küntscher was born December 6, 1900 in Zwickau, Saxons, the son of a factory director.
He studied medicine and the natural sciences at the universities of Würtzberg, Hamburg, and Jena. He passed the state examination in Jena in 1925 with the highest marks and was awarded the degree of doctor of medicine, summa cum laude, in 1926.
After an assistantship in radiology, Küntscher joined the University Surgical Clinic at Kiel in 1930. He became qualified as a senior surgeon, and in 1942 he was elevated to the rank of professor.
During World War II, Küntscher served as a surgeon on the Eastern Front. In 1946, he took charge of the surgical division of Kreis Hospital, Schleswig-Hesterberg. From 1957 until his statu- tory retirement in 1965, he was medical director of Hafen Hospital in Hamburg. After establishing a center for nailing in Spain in 1966, he became a visiting physician at St. Franziskus Hospital, Flensburg, where he continued to work until his death.
Küntscher wrote over 260 scientific papers and several books, which were also published in translation. He was the recipient of numerous awards, including the Danis prize of the Interna- tional Society of Surgeons, the gold medal of the University of Santa Maria, Brazil, and the Paracelsus medal and honorary citizen of El Paso, Texas. He was also an honorary member of 12 German and foreign scientific societies and a cor- responding member of numerous specialty groups within Germany and abroad.
At the 64th meeting of the German Surgical Society in 1940, he attracted unusual attention with his report, “Medullary Nailing of Fractures,”
which has been regarded as an important mile- stone in the operative treatment of fractures. From that time, the name of Küntscher was associated with a specific surgical technique. The Küntscher nail must be included among the most ingenious inventions that German surgery brought forth in the last decades.
Küntscher’s life work, with which I was asso- ciated for over 20 years, can only be imperfectly evaluated. The war and the post-war period produced unfavorable conditions that severely limited and hampered his creative activities. The Schleswig period was characterized by intensive scientific investigations, animal experiments, and technical improvements of the instrumentation for closed medullary nailing. He was able to perform animal research outside the university only through considerable personal sacrifice. He managed to obtain the apparatus he needed through his friendly relationship with the Pohl Company. During his stay in Schleswig, his oper- ative technique was standardized so that the same instruments and operative methods could be applied for all the long bones. A decisive advance in the technique of closed medullary nailing was the development of the guided flexible reamer.
This obviated the problem of impaction of the medullary nail and improved the efficiency of the fixation. Plaster casts were unnecessary and the extremity could quickly become functional and bear weight.
The callus problem, the healing of fractures, pseudarthrosis, the infected fracture, the malu- nited fracture—were all subjects with which he intensely concerned himself. His application of closed medullary nailing to the treatment of pseudarthrosis signified another trail-blazing accomplishment. Through a stab wound, widen- ing of the medullary canal and the introduction of a thick medullary nail were performed and a pseudarthrosis healed usually without opening the fracture site. The development of the image intensifier fluoroscope with remote viewing on a television screen during the 1950s made closed nailing considerably easier.
In his Hamburg period, Küntscher made two more important contributions to bone surgery. He developed the distractor, which made it possible to do closed nailing of malaligned pseudarthroses and old fractures. The internal medullary osteo- tome was the final culmination of his work in the field of closed bone surgery. After many years of effort, Küntscher could now do a closed osteot- omy with the medullary osteotome. This pioneer- ing achievement gave a new impetus to closed surgery. During the Hamburg period Küntscher produced an abundance of scientific papers, including his book Practice of Medullary Nailing.
After his superannuation, Küntscher continued to work on new inventions and on modifications of his old ones.
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Who’s Who in Orthopedics
Who’s Who in Orthopedics Unfortunately, only in his very late years did
Küntscher’s accomplishments and work earn widespread recognition and respect. It disap- pointed him that his operative methods were regarded sceptically at first. Now he spoke at numerous conventions at home and abroad, drawing large audiences with his extemporaneous lectures, which were as entertaining as they were informative. The publication of a new book on fracture callus, The Callus Problem, drew favor- able attention. Despite all this work, he never omitted his daily plunge in the sea in all kinds of weather.
Küntscher was a modest, kind, yet strong- willed man who lived a quiet, retiring life. He was an ingenious medical investigator, an exceptional surgeon, and an exemplary physician. He was also an outstanding draughtsman, engineer, and physicist. To his juniors he was a generous teacher and sympathetic chief, always available to his colleagues who sought his advice.
On December 17, 1972, Professor Gerhard Küntscher died suddenly at his home in Glücks- burg, West Germany. Death overtook him at his desk, as he worked on the completion of the man- uscript of the new edition of his book, Practice of
Medullary Nailing.181
