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Istituto Ortopedico Rizzoli European Review for Medical and Pharmacological Sciences 2018; 22: 8569-8573 On the shoulders of giants: a history of success and a future of excellence – Istituto Ortopedico Rizzoli P. TOMBA1, A. VIGANÒ1, A. GASBARRINI2 1Scientific Libraries, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy 2Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy Abstract. – In 1896 the Rizzoli Orthopedic In- and that it would be directed by him until his last stitute was inaugurated in Bologna, an import- days1. Unfortunately, this last part of the state- ant hospital whose history is strictly connect- ment would not be fulfilled, as just a few months ed with the development of the orthopedic dis- after his testament, Rizzoli passed away sud- cipline in Italy. The aim of this manuscript was to retrace the history of the institution by analyz- denly on May 24, 1880. Francesco Rizzoli (1809- ing the work of the main personalities who have 1880), who was primarily involved in general contributed to making the Italian Orthopedic In- surgery with particular reference to obstetrics, stitute still famous in the world today. was passionate about treating patients with mu- sculoskeletal deformities, so much so that he Key Words: would go on to design and invent new tools for History of Orthopedics, Francesco Rizzoli, Alessan- that discipline which, according to his correct dro Codivilla, Vittorio Putti. predictions, would be detached from the field of general surgery to become a branch in its own On the 28th day of June in 1896, the inaugura- right. Among his personal instruments, now pre- tion of the Rizzoli Orthopedics Institute took pla- served in the Rizzoli Hospital Library to be ad- ce in Bologna with the attendance of various di- mired, one can find, in addition to forceps and gnitaries and Italian royalty, officially giving other obstetrics instruments, amputation saws, birth to the national development of the orthope- ossivorous pliers and craniotomies and, above dic discipline. Once the home of the ancient San all, what Rizzoli called the “fracturing machine” Michele in Bosco monastery in the hills of Bolo- which he himself had invented and used to shor- gna, Rizzoli had become a newly established ho- ten the healthy limb in case of patients suffering spital characterized by modern equipment for the from limb dystree. This device, defined scientifi- treatment of diseases of the musculoskeletal sy- cally as “osteoclast”, had been designed and used stem. For many centuries, the ancient convent for the first time, with excellent results, on a ni- nestled in the hills had been the home of the Oli- ne-year-old girl, daughter of a prominent figure vetans, a suborder of the Benedictines. The ico- in Bologna on April 24th, 1847. Rizzoli had cau- nic structure also housed some of the greatest sed a fracture in the third distal femur of the he- artists of Italian 16th and 17th century art who althy limb to correct a severe claudication2. It worked there: from Giorgio Vasari to Ludovico must be remembered that all this occurred wi- Carracci to Guido Reni. It would then later be thout the aid of X-rays, whose use was discovered abandoned during the Napoleonic period due to by Roentgen only in 1895. Rizzoli name is also the suppression of ecclesiastical orders. The tran- linked to other innovative surgical interventions sformation of the ancient structure into a treat- such as the treatment of the ankylosis of the jaw, ment center was possible in 1880 thanks to Pro- the resection in the angular ankylosis of the knee fessor Francesco Rizzoli, a renowned surgeon of and the tenotomy of the Achilles tendon to facili- international acclaim, who had established that tate the reduction of fractures of the III lower leg. the ancient convent would be transformed into an He also made contributions to innovating the Orthopedic Hospital bearing his name with the field of medical “aids” with his creation of a par- intention to develop and serve the entire nation ticular orthopaedic bed design3. As described by Corresponding Author: Alessandro Gasbarrini, MD; e-mail: [email protected] 8569 P. Tomba, A. Viganò, A. Gasbarrini Professor Delitala4, the director of the Bolognese create “his tools of the trade” which would have Institute from 1940 to 1950, Francesco Rizzoli made by Lollini Brothers who were manufactu- can be considered as “the pioneer who paved the rers of surgical instruments in Bologna. Codivil- way for the birth of an Institute model”. But it la is also linked to significant innovations and was Pietro Panzeri (1849-1901), a distinguished discoveries in the surgical field. In fact, his tran- Milan surgeon who divided himself between Bo- splant of tendon, tenodesis, syndesmotome and logna and Milan where he was also Director of tenotomy for the surgical treatment of clubfoot the Institute of Rachitici (today known as the Ga- are still to this day remembered and referenced6. etano Pini), who would lead the Rizzoli Hospital His intervention performed on a clubfoot in 1905, in the first years of its birth. Indeed, Panzeri is still applied today in the operating rooms of the enabled the Hospital to flourish, thanks to the Rizzoli Hospital for selected cases. Codivilla’s prestigious reputation he enjoyed as a surgeon, innovative techniques were truly revolutionary at bringing with him a large and wealthy clientele. the time since, until then, this deformity in chil- It was only from 1899 that, after Panzeri, Ales- dren’s feet was treated either conservatively or sandro Codivilla (1861-1912) became the director through the application of braces created by the and the Orthopedic Institute would achieve even famous anatomist and professor of the 18th and greater prestige also on an international level. 19th century, Antonio Scarpa. All the surgical Under the direction of Codivilla, every single attempts made during the nineteenth century had service of the Institute improved; from rehabili- proved to be irreversible before Codivilla7. No- tation facilities to the workshop, from the labora- tably, the progress made by Codivilla on tendon tory to the newly created radiology department. transplants in relation to patients affected by po- The first X-ray performed at Rizzoli took place lio, the great scourge of that period, was also fun- on December 20, 1899 of an elbow in ankyloses5. damental8. But what the most brilliant Bolognese But Codivilla’s greatest achievement was that of orthopedic surgeon is remembered for is, without having brought the pathologies of the muscu- a doubt, the invention he devised in 1902; the di- loskeletal apparatus into the operating room. Ha- rect traction on the skeleton by means of a nail ving acquired significant experience in other ho- used for the treatment of the malconsolidation of spitals where he previously worked on cranial fractures and bone deformities (Figure 1). Codi- and abdominal surgery, he extended his surgical villa fought a scientific battle to reclaim his pa- experience to the injuries of the organs of move- tent rights over the invention against the Swiss ment through daring and innovative interven- Fritz Steinmann who brought his discovery to the tions, which made him deserving of the title of orthopedic world only in 1907. The dispute can the father of Italian orthopedic surgery4. It would be considered to have been settled by the medical be reductive, however, to recognize him only for historian Peltier who stated that Codivilla was being an orthopedic surgeon who, until then, was the first to apply direct traction on the human accustomed to plasters, corsets and mechanical skeleton, while Steinman was the first to apply equipment for the correction of the deformities of this method in the treatment of fresh fractures9. his patients. His great merit was, first, that he Thanks to Professor Codivilla, the name of the “framed, through experimental studies and Rizzoli Institute began to cross local borders to practical applications of the operative technique, become renowned throughout the world. In 1901, an informal subject, codifying it according to the Codivilla would make Italian medical history as laws of muscular Physiology, Bone Biology and being the first Italian surgeon to attend the most Articular Mechanics”3. He was interested in the important medical congresses held in Europe. In treatment of congenital disorders and acquired 1903 Codivilla was nominated as a correspon- deformities, such as the dislocation of the hip and ding member of the then American Journal of the patella; he took care of the pseudoarthrosis, Orthopedic Surgery, one of the most important whether they were congenital or secondary to magazines in the field. Due to his ailing health, fractures or osteomyelitis; he devoted himself to he had to refuse the invitation to go to Washin- the field of scoliosis and osteoarticular tuberculo- gton as an official speaker at the International sis, always in pursuit of a conservative or surgi- Tuberculosis Congress in 1908 but would instead cal solution, not without having carefully studied crossed the ocean in 1910 to go to Buenos Aires the etiology, clinical and radiographic images of to accept the invitation to hold a series of Confe- each morbidity. His ambitious and innovative in- rences there and, on his return, would also stop in terventions led him to design and subsequently Lisbon, Paris and Brussels for dissertations and 8570 Istituto Ortopedico Rizzoli Figure 1. Direct traction on the skeleton by Alessandro Codivilla.
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