A Contribution to Wrist Surgery

The story of hand surgery began in France with Marc Iselin. He was the first to head a unit devoted only to hand surgery at the Nanterre Hospital, near Paris, in 1955. He also wrote the first book on hand surgery in 1928, but the wrist was not really in the scope of hand surgeons at that time. Then the French Society was created by four surgeons and an anatomist: R. Tubiana, R. Vilain, J. Michon, J. Duparc, and P. Rabischong, respectively. It was first called the GEM (Groupe d'étude de la Main)—Group for Study of the Hand—that changed to French Society for Surgery of the Hand.

During my surgical training as resident and chief resident, I had the opportunity to obtain my specialization in orthopedics and traumatology and also in plastic surgery. It was very useful when I concentrated my practice on hand surgery where the two specialties converge. During my stay of 3 years as a chief resident in the unit of my mentor Dr. Raymond Vilain (1970 to 1973), he had the idea to create the first hand emergency unit in Europe called SOS-Mains. It was a new concept, and in a few months, we were inundated with a flood of hand and upper limb emergencies. We were on duty every third day, and with the emergence of microsurgery, all the nights were occupied. Subsequently, these types of centers were created in France and then in many European countries. There is now an association called the Fédération Européenne des Services d'Urgence de la Main (FESUM) or European Federation of Emergency Hand Treatment Units.

Subsequently, I have spent as an assistant and then as a surgeon in the hospitals of Paris for 17 years in the unit of R. Vilain. At the same time, I also worked in a private hospital of orthopedics and traumatology, where I was in charge of the upper arm, treating building laborers. There, I had the opportunity to treat 120 cases of the Kienböck disease and a high number of cases of wrist problems such as fractures, dislocations, carpal instabilities, and hundreds of scaphoid problems. I followed the evolution of techniques and went to many meetings in France, Europe, the United States, and Asia. In the beginning of the 1980s, I along with M. Merle, G. Foucher, and A. Gilbert went to China twice in 2 consecutive years as a French mission to study the status of hand microsurgery in the country. We visited the hospitals in Beijing, Shanghai, Guangdong, and Chengdu and discovered a very sophisticated microsurgery practice in this country ahead of the development of microsurgery in the world.

I became a member of the French Society of Orthopedic Surgery and Traumatology and also a member of the GEM in1973. In 1985, I became a member of the American Society for Surgery of the Hand, and since then, I have been attending each of its meetings. Also, I became a member of the British, the Japanese, the Argentinian, and the South American societies.

My interest in wrist surgery began early and, in 1982, I described a technique of replacement of the lunate in the Kienböck disease by the pedicled pisiform. I also published several articles on the wrist and participated and communicated extensively in the French and international meetings. Since the creation of “International Wrist Investigator's Workshop” at the Mayo Clinic in 1984, I have attended it each year and have presented papers at almost each of its meetings.

In 1985, I along with R. Tubiana, A. Gilbert, and R. Lisfranc created the first private group for hand surgery called “French Institute for the Hand.” The group lasted for 10 years, and we were 10 hand surgeons at the end of 1995. For different reasons, the group split and I created the “French Institute for Surgery of the Hand” in Paris and altogether we are now 11 hand and upper arm surgeons. For the last 25 years, we have hand fellows (8 fellows each year) coming from different countries and continents. They spend 6 months with us, and they participate as assistants in the operating room and in the staff meetings and consultations. Several papers were prepared and presented at these meetings during their stay.

I was able to complete my first book in French on “carpal injuries” in 1989 (Springer-Verlag, Paris, France). It was translated in English and in Japanese. Other books that were edited or authored by me or in collaboration are listed in [Table 1]. I was also the Editor-in-Chief of the French Journal for Hand Surgery—Chirurgie de la Main—from 2001 to 2008.

Table 1 Books Edited

Carpal Injuries (In French). Ph.Saffar Paris. Springer-Verlag. 1989. 205 pages.

Arthritis of the Base of the Thumb. Expansion scientifique Française. (In French) Ph. Saffar Paris. 1990. 214 pages

Carpal Injuries. (In English and in Japanese) Ph. Saffar Paris. Springer-Verlag. 1990. 199 pages.

Wrist Imaging(In English). Brunelli, and Ph. Saffar Paris. Springer-Verlag. 1991. 214 Pages

Wrist Arthroscopy (In English). J.Stanley and Ph.Saffar. London. Martin Dunitz Ltd. London. 1994

Handgelenkarthroskopie. J.Stanley and Ph.Saffar. Chapman and Hall. Weinheim. 1994

Fractures of the Distal Radius. Ph.Saffar and W.P.Cooney. London. Martin Dunitz Limited. 1997. 320 pages

Current Practice in Hand Surgery (Medical Book Award by “The Royal Society of Medecine” in London. UK). Ph.Saffar, P.C. Amadio, and G. Foucher London. Martin Dunitz Ltd. 1997. 440 pages

Joint Stiffness of the Upper Limb. S.A. Copeland, N. Gschwend, A. Landi, and Ph. Saffar London. Martin Dunitz Ltd London.1997. 401 pages

This has been my contribution to hand and wrist surgery. I was asked to detail it in an immodest way. I have now stopped my surgical activities but hope to continue to publish.

• References

• 1 Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 1972; 54 (8) 1612-1632
• 2 Saffar P, Semaan I. The study of the biomechanics of wrist movements in an oblique plane: a preliminary report. In: Schuind F, An KN, Cooney Jr WP, Garcia-Elias M, eds. Advances in the Biomechanics of the Hand and Wrist. New York, NY: Plenum Press; 1994: 305-311
• 3 Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am 1980; 5 (3) 226-241
• 4 Brunelli GA, Brunelli GA. [Carpal instability with scapho-lunate dissociation treated using the flexor carpi radialis and scaphoid-trapezoid ligament repair: foundations, technique and results of preliminary series]. Rev Chir Orthop Reparatrice Appar Mot 2003; 89 (2) 152-157
• 5 Comtet JJ, Moyen B, Machenaud A, Schuhl JF. Allongement hémi-épiphysaire du cubitus dans la maladie de Kienböck. Ann Chir Main 1982; 1 (3) 259-261
• 6 Sennwald GR, Lauterburg M, Zdravkovic V. A new technique of reattachment after traumatic avulsion of the TFCC at its ulnar insertion. J Hand Surg [Br] 1995; 20 (2) 178-184