Publications Orthopedics

Fractures: A History and Iconography of Their Treatment by Leonard F. Peltier, M.D.

Fractures: A History and Iconography of Their Treatment Leonard F. Peltier, M.D.

The companion volume to Orthopedics: A History and Iconography, this beautiful book with 270 illustrations is the most comprehensive history ever written about one of the most frequently suffered and commonly treated of all ailments. Surprisingly, it is also the first history of the treatment of fractures since the classic 19th-century writings of Malgaigne and Gurlt.

In contrast to often changing or newly appearing disease processes, such as Legionnaire’s disease or AIDS, the problems posed by fractures and dislocations have not changed since the beginning of recorded history. The skeletal injuries treated by Imhotep, Hippocrates, and Galen were similar to those treated by Paré, Pott, Cooper, Watson-Jones, and Böhler. It is therefore easy for the modern orthopedic surgeon to identify with the great surgeons of the past as he faces the problems of management of fractures and dislocations.

273pp. 270 illus. 8½" × 11". Cloth, dust jacket, acid-free paper. ISBN 0-930405-16-1. 1990. Norman Orthopedic Series, No. 1; Norman Surgery Series, No. 3. NP13310.

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Leonard F. Peltier, M.D.

About the Author

Leonard F. Peltier, MD, PhD, was raised in Lincoln, Nebraska, and graduated from the University of Nebraska. His medical education and specialty training in general surgery and orthopedic surgery were obtained at the University of Minnesota, where he was a Markle Scholar. After serving as Head of the Section of Orthopedic Surgery at the University of Kansas for fifteen years, he moved to Tucson in 1971 and established the orthopedic program at the new College of Medicine of the University of Arizona. There he was the Head of the Section of Orthopedic Surgery for fifteen years and served an additional period as acting head of the Department of Surgery before his retirement in 1990. He died in 2003.

Dr. Peltier served on the Committee on Trauma, the Committee on Postgraduate Education, and the Board of Governors of the American College of Surgeons.

Dr. Peltier published nearly 200 scientific papers and several books, including Fractures: A History and Iconography of Their Treatment (1990) and Orthopedics: A History and Iconography (1993). Many of his papers dealt with the history of surgery. He served on the editorial board of, or as a consultant to, several journals, including Surgery, Journal of Trauma, Journal of Surgical Oncology, Journal of Bone and Joint Surgery, and Clinical Orthopaedics and Related Research. A biography by Lo Vecchio, Reckling and Reckling, “Onward and Upward”: The Career Trajectory and Memories of Leonard F. Peltier, M.D., Ph.D., was published in 2004.


“…[a] well-researched and well-written book. It should be in the library of any serious student of fracture management. It will be enjoyed by anyone interested in the history of medicine.”

—From The Journal of the American Medical Association 264, no. 14 (October 10, 1990), 1879.

“…[a] beautiful new work of art …provides depth and dimension to a dynamic profession …All major medical libraries and orthopaedic libraries should have a copy. Orthopaedic residents and fellows will become remarkably wiser after an evening spent perusing this book.”

—From Journal of Pediatric Orthopaedics 10 (1990):564–565

This is an altogether admirable book, not least because it is written by a practicing surgeon who is also an academic and administrator of distinction and a scholar able to take both a wide and a long view of his subject. From an enormous literature, he has skilfully selected the cardinal accounts, illustrated, even from antiquity, by instantly illuminating pictures: that on the dust cover comments silently that it was no accident that related the Scamnum to the rack. One is constantly reminded of the ingenuity of our predecessors, even as we use it and that of our contemporaries. The study of history teaches those willing to learn, that we are not so clever as we think. Dr Peltier has given this message fresh impetus, backed by authority based upon catholic reading and much experience.

The title is misleading, since the text deals almost entirely with fractures of the long bones and associated dislocations. Fractures of the skull vault are not mentioned, nor are those of the maxillo-facial skeleton, though the classical description of reduction of the temporo-mandibular dislocation is there. Apart from the Egyptian description of traumatic paraplegia, there is little mention of vertebral fractures or of their management.

The standard of production is excellent: paper, type, illustration, general organization, proofreading (though there are slips, e.g., “Geminschaft”), a good index and binding. In sum, the book is a notable addition to the history of fracture treatment.

—J. W. Dickson, Ipswich, Suffolk
From Medical History 35(2): April 1991 (p. 275) ©The Trustee, The Wellcome Trust

Orthopaedists who are familiar with Peltier’s previous writings on eponymic fractures and orthopaedic history might at first think this book to be merely a compilation of those numerous articles, but it contains far more.

There are ten chapters, dealing with bone-setting; the relevant literature; treatment of fractures with occlusive dressings, plaster of Paris, and weight-bearing; treatment of open fractures; internal fixation; traction; external skeletal fixation; treatment of non-unions; fracture-healing; and the impact of Röntgen’s discovery on treatment. The three appendices cover anesthesia during treatment of fractures and dislocations, the fracture-table, and the diagnosis of fractures by auscultation and percussion.

Although Peltier is a practicing orthopaedist, he writes like a historian; he is obviously well aware of the flow of events and their worldwide scope. Very few biographical notes are included, sufficient to orient the physician in time and place.

Most of the references to ancient physicians are well summarized, with only a few direct quotations. There are many interesting bits of information. For example, most orthopaedic surgeons and residents, when asked about the use of plaster of Paris in the treatment of fractures, would immediately state that the Dutch physician Antonius Mathijsen invented it. In reading this book, one finds that a British diplomat had observed the treatment of Fractures with plaster of Paris in Turkey around 1800, some fifty-two years before Mathijsen’s initial note on the method. Peltier gives due credit to Mathijsen, identifying him as the “pioneer of plaster of Paris bandages”. Peltier also cites the work of several other physicians who used plaster long before Mathijsen.

Similarly, orthopaedic surgeons caught up in the current interest in external skeletal fixation of fractures may well credit the American veterinarian Otto Stader with the invention of this method of treatment. They will be astounded to find that Hippocrates conceived such a method and invented a device for external fixation that allowed observation of the wound on the extremity. This, of course, is the principal virtue of external fixation of fractures. True external skeletal fixation probably began with Malgaigne, who used screw-clamps for the treatment of fractures of the patella in the middle of the nineteenth century.

Thus, this book is of great value to the orthopaedist who is interested in “firsts”. It is quite likely to humble those who believe that they have developed a “new” way of management of an injury; they may well discover that a theory, principle, or practice regarded as unique is merely an application of a new technical detail, a product of the technical advances of this century.

Peltier properly devotes an entire chapter to the impact of Röntgen’s work on the treatment of fractures, stating: “Perhaps no example better illustrates the dependence of medical progress on the progress made in the basic sciences than the effect of the discovery of x-rays on the treatment of fractures.” The significance of this discovery may be seen in the publication of some 995 books and articles dealing with x-rays in 1896, the year in which Röntgen’s original report was published in the annals of the Physical Medical Society of Würzburg. Röntgen took no part in the race to develop practical applications for his discovery.

The book is dedicated to Owen H. Wangensteen, Peltier’s mentor at the University of Minnesota, who probably stimulated his interest in medical history in general and in orthopaedic history in particular. This interest was further fostered by Peltier’s many years at the University of Kansas, where Ralph Major had established the Department of the History of Medicine. Many of the book’s extensive illustrations, which include photographs and drawings of devices, came from Peltier’s personal collection.

In summary, this book provides most enjoyable reading for all generations of orthopaedic surgeons and should be of particular interest to the orthopaedic resident. Undoubtedly, the illustrations will be extensively copied and will appear as slides in numerous presentations to local and national orthopaedic meetings as part of historical reviews. This will, of course, be tacit and true admission of the book’s real value.

—James S. Miles, M.D.
From The Journal of Bone and Joint Surgery 72-A, no. 8 (September 1990), 1275.

The first impression one conjures up while perusing this beautiful book is that this has to be a work of love by the author. This book cries out for the medical bibliophile. It is an extensive historical account of what is considered the most frequently suffered and commonly treated of all ailments. Placing the text in historical perspective, it is noted that it is the first history of the treatment of fractures since the classic nineteenth-century writings of Malgaigne and Gurlt. It truly is one of the most well-written, beautifully illustrated, and extensively referenced and researched texts on the subject of fractures.

The book defines itself as a history and iconography of their treatment. The work is arranged thematically into 10 chapters entitled: Bone Setting; The Literature of Fractures; Occlusive Dressings, Plaster of Paris, and the Ambulatory Treatment of Fractures; Treatment of Open Fractures; Internal Fixation of Fractures; Treatment of Fractures by Traction; External Skeletal Fixation for the Treatment of Fractures; Treatment of Ununited Fractures; Healing of Fractures; and The Impact of Roentgen Discovery on the Treatment of Fractures. Three appendices are present: Anesthesia for the Treatment of Fractures and Dislocations; The Fracture Table; and Diagnosis of Fractures by Auscultation and Percussion.

The style of writing is very refreshing. References are quoted and set in italics to stand out conspicuously yet blend in well with the entire presentation of illustrations and text. The book reads also with a sense of excitement of purpose as one becomes further mesmerized by the surrounding pictures of famous contributors in the field of fractures. In a simplistic sense, the book reads almost as if it were a nonfiction novel with its ability to create an almost electricity to keep the reader fixated on the topic. I would recommend this text to anyone interested in the historical perspective of fractures and their significant importance to the field of orthopaedics. It certainly would lend itself to any physical therapist wishing to add a sincerely beautiful work of art in a textbook mode of publication. Perhaps the only distraction from the entire presentation of this book is its significant expense. If one selects this book for its contribution to the field of fractures and wishes to treat oneself to a beautiful gift, then the price becomes secondary.

—Laurence M. Seitz
From The Journal of Orthopaedic and Sports Physical Therapy, 12, 4 (October 1990), 181–182

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