Who’s Who in Orthopedics

sity and chief of the orthopedic service at Mercy

Hospital in Iowa City.
Steindler’s interest spanned the whole field of
orthopedic surgery, and he wrote important essays
on almost all aspects of the specialty. He adhered
to sound biologic principles; he discouraged fads
but was always on the lookout for new ideas. With
his knowledge of Latin and of most of the western
European languages, together with his enormous
capacity for work, he acquired a vast medical
culture. His medical articles and books comprise
a large bibliography.
Steindler was honored by many of the medical
and surgical societies of North and South America
and of Europe. Among these honors he prized
very highly the presidency of the American
Orthopedic Association in 1933 and his election
as honorary fellow of the Royal College of Sur-
geons and honorary member of the Royal Society
of Medicine in 1954.
Steindler made excellent use of the facilities
Arthur STEINDLER that he developed in Iowa City. An enlightened
1878–1959 state legislature pioneered in the field of a com-
plete public program for the crippled indigent. As
the population of the State of Iowa is fairly stable,
Arthur Steindler was born in Graslitz, a town follow-up of cases and end-result studies of new
north west of Prague, on June 22, 1878. In his surgical procedures were possible. In all his pub-
early youth his family moved to Vienna, where he lications one encounters a rare combination of a
pursued his undergraduate and graduate studies. well-grounded knowledge of basic principles,
He was graduated from the medical school of the sound surgical inventiveness and a careful evalu-
University of Vienna in 1902, and for the follow- ation of long-term results.
ing 5 years took postgraduate work in orthopedics His first publication in 1909 dealt with the
with Edward Albert, Adolph Lorenz, and Free- treatment of scoliosis. He proposed the use of the
lander. In 1907, he came to the United States hip joint and the motion of the leg for the correc-
and, until 1910, practiced orthopedic surgery in tion of deformities of the body by attaching a
Chicago, where he worked also at the Home for thigh piece to the pelvic belt of a body brace. The
Crippled Children and was associated with John thigh piece was connected by a hinge with the
Ridlon. In 1910, he moved to Des Moines, Iowa, brace and braced the leg by means of a padded
and became professor of orthopedic surgery at ring above the knee. In this article we can already
Drake Medical School. In 1914, he married see one of Steindler’s main ideas in the treatment
Louise Junk, whom he had met in Chicago while of scoliosis, which he improved greatly later on;
she was working as a registered nurse at the Home that is, the development of a counter curve in the
for Crippled Children. In that same year Steindler lumbar spine to improve the body alignment in a
became an American citizen. In 1915, he went to child with thoracic scoliosis.
Iowa City to develop the Department of Ortho- In 1917, he described his stripping operation
pedic Surgery of the State University of Iowa. for the treatment of pes cavus. In his forthright
Within a growing university in this small mid- fashion, he recommended this operation “because
western town, he found a congenial intellectual it remedied the trouble to the extent to which the
atmosphere and there spent the rest of his very contracture of the plantar fascia and the superfi-
productive life. He served as professor and head cial layer of the musculature of the sole are
of the Department of Orthopedic Surgery of the responsible.” Steindler studied the architecture
State University of Iowa for 34 years. From 1949 of the foot exhaustively. In The Treatment of
until the time of his death (1959), he was distin- Pes Cavus (1921), he analyzed the muscle imbal-
guished service professor emeritus of the univer- ance that produced claw foot and advocated the
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Who’s Who in Orthopedics
correction of the severe skeletal deformity by of the wrist and the fingers. For the paralytic hand,
cuneiform osteotomy of the dorsum of the foot as he advised tendon transplants about the wrist if
a complementary procedure to the plantar strip- muscles of sufficient strength were available.
ping operation. In a paper in 1928, he drew on his Failing this, he recommended fusion of the wrist.
vast experience of this operation, which almost In cases of thenar paralysis, he favored his oppo-
always was to be combined with some stabilizing nens plasty, which later was replaced by the more
operation for restoration of balance. The defor- efficient method of Bunnell.
mity, he stated, invariably would recur unless Steindler’s book, Operative Orthopedics, pub-
proper measures were taken to restore the balance lished in 1925, was a compilation of the operative
of the foot. In 1923, there appeared his paper enti- procedures in vogue at that time. Most of these
tled The Treatment of the Flail Ankle by Means of procedures were tested by Steindler and his
Panastragaloid Arthrodesis. coworkers in Iowa City, and statistics on the
The histologic study of the muscles of five clinical results follow the description of the oper-
cases with Volkmann’s contracture of the fore- ation. A new book, Orthopedic Operations, was
arm and the hand was published in 1917. The published in 1940. The third part of the book dealt
musculature lesion of Volkmann’s contracture with operative indications and furnished much
was clearly differentiated from the lesion seen in thoughtful information. The systematization of
paralysis following poliomyelitis or peripheral the surgical indications in orthopedic conditions
nerve lesions; in Volkmann’s contracture there is is of invaluable service to the orthopedic surgeon.
interstitial myositis with secondary degenerative In 1926, his first paper on the treatment of sco-
changes of the muscle fibers. liosis by the “compensation method” was pub-
Steindler was particularly interested in recon- lished. His aim was to attain a satisfactory degree
structive surgery of the upper extremity. He of body symmetry and of proper redistribution of
published many monographs on different weight by helping in the development of com-
reconstructive operations. In a paper that pensatory curves of proper extent and degree.
appeared in 1918 in the New York Medical This was to be accomplished without causing
Journal, scarcely a page was devoted to the relaxation of the spinal ligaments.
“forearm plasty of the elbow.” This operation was
to be one of his best-known contributions to Compensation of the scoliosis is a necessary prerequi-
orthopedic surgery. site for maintenance of correction and posture and if
From 1915 to the early 1920s, Steindler devel- compensation can be accomplished, and provided
muscle development is adequate, the spine need not be
oped a department of occupational therapy in
fused. Those spines in which subsequent stabilization
Iowa City. He was one of the pioneers in this field, by operative means will be necessary are by virtue of
and his systematization of exercises and muscle this realignment by compensation without relaxation in
re-education for the upper extremity is of great better position to hold after operation than spines oper-
interest. In his scholarly book, Reconstructive ated upon in a state of decompensation.
Surgery of the Upper Extremity, published in
1923, the functional anatomy of the shoulder, the He never wavered from these ideas, although
elbow, the wrist and the fingers was studied care- occasionally, in front of a rapidly progressive case
fully. This was an important reference book for of idiopathic scoliosis, he would comment sadly
the great development of upper extremity surgery on our great ignorance of the nature of this defor-
in the 1930s and the 1940s. Most of his operative mity. The book, Diseases and Deformities of
indications for the paralytic arm have stood the the Spine and Thorax, published in 1929, is an
test of time. He studied the substitutionary motion excellent compilation of knowledge on the
of the shoulder in cases of complete paralysis of subjects from all available sources. In every one
the deltoid muscle, observing that deltoid paraly- of the chapters there is a thorough discussion
sis was hardly ever strictly isolated. In cases of of the embryology, anatomy, pathomechanics and
permanent inability of abduction and failure to biology before the handling of the clinical
replace the deltoid action by substitutionary description and the treatment.
motion to a degree of satisfaction, he stated that Starting in the mid-1920s, kinesiology was to
the only method that might be relied upon to give be Steindler’s main interest. He studied the
permanent results was the arthrodesis of the kinetic problems of the shoulder joint, the flail
shoulder joint. For the flail elbow he advocated elbow, the pronation contracture of the forearm,
his operation of proximal transposition of flexors and the wrist joint. In 1928 he published the kinet-
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 Who’s Who in Orthopedics
ics of the “pillroller” hand deformities due to graduate students for 30 years. The four volumes,
imbalance of the intrinsic muscles of the hand and under the title Post-Graduate Lectures in Ortho-
advocated the severance of the motor branch of pedic Diagnosis and Indications, appeared from
the ulnar nerve at the hand. What later was to be 1950 to 1952. The volumes were intended to be
called the “intrinsic plus” type of deformity of the about twice their actual size, but, at the insistence
fingers by Bunnell is well described in this paper. of the publisher, they had to be condensed. They
In a paper in 1932, Steindler made a scholarly represent an important résumé of the Steindler
analysis from a biophysical point of view of the teachings. In these books—as in his lectures—he
mechanics of musculature contractures in wrist aimed “to build up in the student a sound ration-
and fingers. He devoted much time to the study ale for the management and treatment of ortho-
of biophysics of locomotion. His book, The pedic disorders.”
Mechanics of Normal and Pathological Locomo- During the last years of his life, Steindler
tion of Man, was published in 1935 and brought worked tirelessly to prepare his Lectures on the
into the English literature, in a concise manner, Interpretation of Pain in Orthopedic Practice.
the great amount of work done on the physiology This book was published after his death; he fin-
of motion by European scientists in the eighteenth ished the correction of the proofs only a few days
and nineteenth centuries. Duchenne, Braune and before he died. Again, an enormous amount of
Fischer, Fick, Strasser, the Weber brothers, Roux, information is gathered in this last book, system-
von Meyer, Wolff, Sherrington and others were atized in different chapters and under different
studied carefully by Steindler, who drew heavily subheadings, so typical of his orderly classifica-
from their works for his book. In Kinesiology of tion of the subjects.
the Human Body, published in 1955, he reduced Spaced among the papers of his more constant
the mathematic calculations of his earlier book to interest were a large number of presentations that
a minimum and incorporated the modern works encompassed most of the orthopedic subjects.
of Pauwel, Hirsch, Saunders, Inman, Slocum, Steindler made good use of his inexhaustible
Evans and many others. energy. He enjoyed particularly teaching his post-
In 1938 Steindler and Luck published an article graduate students. He gave at least one lecture a
entitled “Differential Diagnosis of Pain Low in day, and this he prepared with great care at home
the Back.” In this paper, and in subsequent ones, the preceding evening. He read constantly, always
Steindler tried to differentiate the sciatic radiation making careful notes, which he used in his lec-
caused by root compression of a herniated inter- tures. He read all the orthopedic publications of
vertebral disk or an intraspinal cord tumor from the western world and also read extensively in
the radiating pain observed in myofascial trauma anatomy and physiology. He had an excellent
of the back. In this last instance, Steindler drew memory and quoted extensively from the world
attention to the presence of the “trigger point” in literature.
the back and pointed out that local anesthesia at Steindler was a hard worker, and he demanded
this point would abolish temporarily the local from his staff not only the careful execution of
pain and also the sciatic radiation. He believed the clinical work, but a dedication to reading and
that the “procaine test” was an additional valuable research. He compiled and distributed generously
test in the differentiation of referred from reflex his seminar notes with extensive abstracts of
sciatica. current literature, reports of meetings, seminars,
The treatment of infantile paralysis in the light and statistical and research material. Although
of new knowledge gained in the 1940s on the every member of the staff wrote for the seminar
pathology and the muscle physiology of this notes, Steindler did most of the work. Through his
disease occupied Steindler’s attention, and he kindness and compassion and great personal
contributed some important papers on the subject. responsibility, he succeeded always in developing
A great amount of information is found in his a close relationship with his patients. He trained
book Traumatic Deformities and Disabilities of over 300 orthopedic surgeons—each one of them
the Upper Extremity, published with the collabo- devoted to the “Chief.” He cherished them and
ration of Marxer in 1946. In it he drew on his remained loyal to them.
large experience of orthopedic surgery of the
upper extremity.
In the late 1940s, Steindler worked hard to
compile in book form his lectures delivered to
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