Bosworth Fracture-Dislocation and Resultant Compartment Syndrome

Abstract

Bill MacAusland was born December 9, 1922, into a rich orthopaedic heritage, as both his father, William R. Sr., and his uncle, Andrew R., were practicing orthopaedic surgeons in the Boston area. Bill was educated at Milton Academy, Harvard College, and Harvard Medical School, graduating with a medical degree in 1947. He and Frances Prescott Baker were married and spent the next two years of his surgical training in Rochester, New York. Their first child was born in 1948, and in 1949 Bill began his training in orthopaedics at the New York Orthopaedic Hospital. His residency partner was John Gartland; they wrote three papers together and became lifelong friends. They were later to serve consecutive terms as Presidents of the American Academy of Orthopaedic Surgeons (AAOS). Bill spent two years as a captain in the United States Air Force at Maxwell Air Force Base in Alabama before returning to Boston to begin the practice of medicine with his father and uncle. His early years in practice were made memorable by the addition of five more children to his expanding family. His boundless energy enabled him to work in several hospitals in Boston and its environs. He loved to “be on service” and work with the residents. One resident commented that Bill “wore his shoes backwards” to get out of the operating room faster and onto his next task! A number of his residents joined him in practice, and all benefited greatly, both personally and professionally, from the association. The large, airy office at 412 Beacon Street easily accommodated two physicians at once, and Bill was readily available to consult on difficult problems and always gave helpful advice. His concern for patients was strong—if one of his patients was hospitalized with a particularly difficult problem, he would often visit that patient several times a day until he was able to figure things out. He did not believe that physicians should be robots or technicians. He performed one or two Independent Medical Examinations per office session, and he encouraged his partners to do the same, so that “honest orthopaedic opinions would be available.” His clinical acumen and intuition were highly developed. A patient who had night pain was assumed to have a tumor until it could be proven otherwise. Once, a patient was referred to him with a draining sinus of the knee. Several doctors had failed to cure the problem. Bill had to leave town and barely had time to assess the situation, but his comment to his partner was “don't forget TB.” It took a few days of tests, but Bill was right—the patient was proven to have tuberculosis. At the time when he first started to practice medicine, it was common for general surgeons to care for patients with fractures, and Bill never missed a chance to take on the most difficult cases to prove to the residents that fractures should be treated by orthopaedists. If called to the emergency room in the middle of the night, Bill was quickly there to help and to teach. He never shied away from the toughest case or complication. As his reputation grew, so did the honors that began to come his way. He was elected as an American Orthopaedic Association-American, British, Canadian (ABC) traveling fellow in 1961 and to membership in the American Orthopaedic Association in 1964. In 1968 he served as a physician for the United States Olympic Team in Mexico City. He and his good friend, Dick Mayo, found time to write and publish a book, Orthopedics; A Concise Guide to Clinical Practices1, in 1965. That same year, he spent six weeks in Nigeria as a member of Orthopaedics Overseas, and he returned with many interesting case histories of diseases that are only seen in that part of the world. Before the questions for the American Board of Orthopaedic Surgeons' (ABOS) examination were standardized, many an unsuspecting applicant for ABOS certification who had gotten too big for his britches would suddenly be faced with the problem of diagnosing an echinococcus cyst of