Steel Knuckles

A barber with stiff fingers is a barber without a job; so Barber William D. was desperate when his hands--particularly his overworked right hand--became crippled by arthritis. Last week William D., 52, could again hold his scissors, and was working on a light schedule in an Iowa city. In place of the diseased bone in the middle joints of his right fingers were stainless steel hinges.

The barber's case was one of the most successful among 25 patients in whom Orthopedic Surgeon Adrian E. Flatt has installed a total of 92 steel joints at Iowa City's University Hospitals. Some have been working well for 3 1/2 years. British-born Dr. Flatt got the idea from Colonel Earl W. Brannon, who devised a similar steel hinge for U.S. Air Force accident victims. But Dr. Flatt has modified the hinge and adapted the technique to the knuckle and middle joints, which are most often frozen by arthritis.

To put in hinges, Dr. Flatt cuts back the ends of both bones that form the defective ball-and-socket joint. He also removes any remaining parts of the synovial membrane, which encloses the natural joint, because this is an important site of arthritic disease. He inserts the double-prong ends of the two hinge parts into the squishy centers (marrow canals) of the cut-off bones. Muscles and tendons must then be slipped into their proper places with exquisite care.

At first, Dr. Flatt used a hinge with a single prong at each end, but found that a finger might rotate around this. So he switched to double prongs which cannot twist. Though originally designed for middle joints, the hinges are proving most useful as replacements for knuckles.

There have been a few failures in what Dr. Flatt cautiously insists is still an experimental operation. It is, he estimates, suitable for only about one in eight of the arthritic patients who would have some kind of joint surgery anyway. But other surgeons are trying it hopefully. For patients so crippled that they could not even tie shoes, moderate relief is a boon. A few, like the Iowa barber, are able to write again two weeks after the operation.

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