. : Since Archimedes, nobody had had a name starting from a screw. How did you arrive from there there?

H.T.: It is necessary to go back to the beginning of my career of csotcina.comedist, at one time when the places were expensive and competitions to obtain good very strong posts. I did not have any specific support and I told myself that it was necessary that I become expert in a field. I did not have any idea of that of which I was to be an expert. Then incidentally, I had three consecutive patients who had a complex fracture of the scaphoid. I found myself one night with a fracture-luxation of the scaphoid which was a true nightmare. And that ended in the ablation of the scaphoid. At the time nobody could precisely what make for these fractures. Then I decided to become an expert of the scaphoid and, fifteen days afterwards, I had read all that had been published hitherto on the scaphoid. And I was already an expert! We were with beginning of the year 70 and one started to be interested in osteosynthesis of the scaphoid, in particular thanks to work of the , and with their boxes of osteosynthesis for the articular fractures. They had in particular developed the concept of the fixing and the early mobilization of the articular fractures. It is a concept in which I believed all my life: the articular fractures must be fixed in a strict way and must be mobilized as quickly as possible.

. : Where were you at the time?

H.T.: At that time, I was in csotcina.comedic formation with St Georges in London and I worked with , a very known csotcina.comedist in this time. I was very influenced by his ideas on the fractures. I.e., on the importance to avoid the least immobilization of the hinges. I had already understood that it the stable fractures from the unstable fractures and that had to be fixed firmly all the unstable fractures were necessary to differentiate. I made my first exposed on the fractures of the scaphoid in front of the Royal Society of Medicine, and I gained a price for this work. During the weeks which followed, I was surprised to receive from a little everywhere problems of fractures of the scaphoid, while at the same time I was only one surgeon junior. I thus tried to fix these fractures of the scaphoid since I said that it had to be done, but obviously, there is a difference between telling and to make and I had terrible vexations with the screws with spongy of the , which was the screws that one used at that time.

 

. : But why didn't you use the pins?

H.T.: The pins are very useful to fix heaps of things but they do not give any compression. I was perhaps a little fanatic but I was convinced that compression was the genuine key to success of the consolidation of the fractures. By using the pins, you did not have compression and you were obliged to put a plaster whereas the hinge had been open; you had the disadvantages of the two processing!

To be able to improve my screwing, I did some work on the corpses. I realized rather quickly whom if I wanted to fix the scaphoid by using the screws at spongy , it for me was necessary a sight with compression or forceps making it possible to aim. I thus worked on the realization of a forceps-sight with an engineer of the csotcina.comedic department which manufactured the orthotic devices. I still have a whole collection at home various models of forceps-sights created, but the problem it is that they were too large because, whatever the size of the sight, he was necessary to let pass the famous person of m of the screw to spongy of the . I succeeded in with me being useful about it on some patients but overall, it was not adapted. I thus came to the conclusion which had to be used a smaller implant. I finished by me persuading that it was the head of screw which posed the most problem and which if one could have a set screw, one could descend up to m diameter from screw. This was done in one evening of work with the engineer. I told him: “If one removed the head?”. He answered me “That will not hold” and I told him: “And if there were two thread cuttings?”. He answered whereas it was an good idea but that there would be no compression, and that would maintain simply the fragments separate. I was persuaded that the idea of a set screw was good and I could not accept that he tells me not. And then, I reflected well during at least an hour by swallowing pints of beer and I finished by him telling: “And if the screw pitches of each thread cutting were different?”. There remained quiet during at least a minute and he told me: “Fantastic, that it is an very good idea”. We were very excited. We made mathematical calculations and apparently, the idea could go.

 

. : Had you already thought of the extensions towards other fractures?

H.T.: Yes, of course! I realized quickly that the screw could be used for everywhere to fix the intra-articular lesions, but I always worked on the forceps-sight for the fractures of the scaphoid and the new screw enabled us to develop a forceps-sight much smaller. Indeed first forceps-sight, planned for the screws of the , was too large, even if it had been put on the market in England that it was sold twelve of them! Extremely fortunately, I had the good idea to take a patent on the idea of the set screw to two pitches and the mark was thus deposited. It is as at that time as I left for Australia. Indeed although having become an expert be-scaphoid, I did not have an interesting post in England. The health system was hardly flourishing and there was not much opportunity. A post of “ Senior” had been released in Australia. My request was accepted and I thus left for Australia then to the right in the middle the development my screw.

 

. : How was this post in Australia?

H.T.: I must acknowledge that it was not exactly what I had hoped for… I was at the University of Wales News of the South in the Instructor who had worked much in Kenya and which was known for its multiperforate nail, very specific. It was an interesting man but in this context, it was not easy for me to continue my own work. Nevertheless at the University of Wales News of the South, there was a department of “bio-engineering” which developed the hardware of for the surgery of the scoliosis. It is there that I met a young student engineer who was called Fischer. It was a guy extremely shining and I explained my idea to him and it was quickly filled with enthusiasm for the project. I made him an introduction to the techniques of the surgery, and work on corpses, which a little nauseated it at the beginning; but it adapted very quickly. We worked initially on the focusing of large screws and then quickly, we told ourselves that it was necessary to pass to screws for the scaphoid. It took nails of , took them along in its garage where it had its hardware and it machined them to make the first screws which you know. Sterilized they were done and they were established. I put 25 of them the first year. It is as with him as one developed a new very elegant and very practical forceps-sight. It is thus with him that I published my first paper on the scaphoid. It continued to publish much and he is now the departmental manager of the department of “bio-engineering”.

. : Were you satisfies of your first installations?

H.T.: Completely. In addition, I believed so much in compression that, even in the nonunions, I was satisfied to put the screw without graft. I quickly reported myself that it was necessary, for the nonunions, to make some a little more. I developed since the use of the graft and the screw. But nothing is absolute in surgery. One of the very first patients who had a sclerous pseudarthrosis and at which I put live without Clerc's Office, was lost sight of the fact and I re-examined it five years ago, i.e. ten eight years after osteosynthesis. The screw was twisted a little, being out of steel of nail of , with any consolidation of the fracture, but without more. It was absolutely delighted since its scaphoid had become stable.

 

. : What do you make after these first cases?

H.T.: One sent to me intricate cases of scaphoid of all Australia of the South and I found myself in front of a dilemma. It was necessary that I keep my idea for me and to thus increase my recruitment or was necessary he on the contrary that I make the it available to greatest number. The dilemma was fast to slice because the product should of course be developed. However when you have a license on a product, it is not very expensive the first year but it becomes quickly out of price. You need, it to protect, the support of a large company. Therefore, obviously, one needed a business development of the idea.

 

. : How did you proceed?

H.T.: The first company of which I thought, in fact of course the had an exchange rate in Sydney at that time. I thus met the tenors of the and I explained my idea to them. They appeared interested and they asked me some specimens of the screw to test it at the laboratory of the . I was to go on a journey in Europe and I benefitted from it to pass by Switzerland. I did not see Maurice who was the Owner at the time, but I had an appointment with the person responsible for the laboratory. It finished by me saying that my screw was astute but that it was not an excellent idea. “We already tested this kind of screw, that does not walk. You do not have me enough compression and in our opinion, should drop to you” has it says me.

 

. : Why?

H.T.: I do not know. The technicians of the had a large laboratory and they claimed that they had measured compression and that did not go. I, obviously, was terribly shocked, but a posteriori, I believe that they did not plan to develop another thing only Swiss ideas. After some other inspections with the firms well-known at that time, I finally met in Sydney a guy who was the person responsible for in Australia and which managed to be sent to , Indiana to speak to the people responsible for . I spent there 2 days and all was organized perfectly. I had six or seven interviews during which I sat down in a small part and where I exposed each time, of the beginning to the end, my history. All my listeners were charming and found my idea interesting but as it then was explained to me, none did not want to wet oneself because their career could be concerned if that did not go. The following day, there were two more people to meet and there I told: “Not, that is enough! I would not make any more that only one presentation and I would do it in a part where will have to be held the people implied in the final decision”. I believe that the aforementioned was a a little dangerous strategy, and my request was difficult to satisfy, but finally they yielded there. I thus made my presentation in front of all the decision makers. At the end of the presentation, everyone scrawled its papers but nobody spoke. Then I asked each one of them: “Honestly Tell me what you think of my idea?”. They tergiversated much but ended up recognizing unanimously that the idea appeared good. Thus all started.

 

. : In which year was this?

H.T.: In 1976 and that made five years that I worked on this idea. They thus bought up the licenses and we signed a contract. I asked, because of the distance, so that work be done in collaboration with my friend Fischer in Australia and they accepted. That was also one of the determining conditions of success. Finally, the first set became available on the US market in 1978.

 

. : Was the screw out of titanium?

H.T.: Since the beginning, I wanted that this live is out of titanium, because, in my idea, the screw was to remain in place a whole life. Titanium appeared to me more adapted because with the steel screws which end up oxidizing, there are inevitably problems. But titanium was relatively new in csotcina.comedy. It was posed some there a little bit in the hips but I did not have any proof of his long-term tolerance. At , they were not very hot for this option, perhaps because of the cost. Little time after the contract is signed, they told me: “Listen, us will not make the titanium screw, we will do it out of steel”. At this point in time I made a new important decision. I answered them: “If you made not this titanium screw, I believe that does not have any interest and in this case, the contract is broken; it is titanium or anything else”. I did that with the . I did not have any scientific proof, but it was a personal conviction which appeared impossible to circumvent to me.

 

. : You imagined well that with titanium, there were problems of machining?

H.T.: Of course, but it was their problem not mine. I knew that one could make it but that to manufacture titanium screws, they were necessary for them to buy new machines. Finally, I gained and they also because they turned over this investment to their advantage. At the time of the marketing promotion told: “We are the first company able to make screws of this titanium size”. They were then very effective in the way of marketing the product. Nobody could have a set of screw without to have attended a practical exchange rate, and the product was not available before the large American teams did not test it and adopted. Promotion was carried out with much serious. They often invited me to make conferences and especially, all the large American hand surgeons, but really all, had had the screw between their hands and had appreciated it. That gave a very important commercial whiplash. It is as that which the screw became very famous in the United States.

 

. : Where were you in Australia?

H.T.: My implantation in Australia was not very easy, perhaps because I was English, and that I had not made my studies in Australia. At that time, the population of Australia was of less than illion, and obviously, they had sufficient Australian surgeons. I had come with all my family to Australia with the very open spirit, because we wanted to live there. We were ready to acclimatize us, but we found a way of life rather different from that of Europe. Moreover, a post had me to be found where I can find the poles of interests of my formation in London. Unfortunately, this post at the university consisted much of administrative tasks of no importance. However, in same time, I could train students and young surgeons, which always impassioned me. But I finally left the university for a post which corresponds to the surgery which interested me. That was particularly difficult, because with each time I found a post interesting, that locked. There were people who considered that I was not qualified, although I had dealt much with the preparation of the interns with the final examination of csotcina.comedy. Finally, I had of another choice to only leave to install me into private. This being, the installation in the private one was not so terrible that because the csotcina.comedic surgeons were very and they sent the majority if not all to me their problems of wrist. But, it is always difficult to continue its work and its search, without the support of an academic institution.

Finally, later, I ended up having an honorary post at the Hospital of Sydney, the oldest training institute medical of the university of Sydney. It had a small English side and I was very happy to be there. My activity was intense since I was csotcina.comedist general practitioner and that I did all. I made the first uncemented hip prosthese, among the first knee arthroscopies and of the heaps of very interesting things. At the same time, I continued my clinical work on the scaphoid and the wrist; I travelled enormously, I gave conferences and I was going to take part in practical exchange rates a little everywhere in the world. And then my private practice took much time to me, because in deprived, you must do everything yourself, whereas to the hospital, one provides you all the personnel to relieve you of the tasks, in particular of the personnel management, which is a thing that I never saw in England.

 

. : How did your activity in Australia evolve/move?

H.T.: I gradually could completely specialize me in the hand surgery and in the wrist and, in 1986, after one particularly difficult period (all the csotcina.comedic surgeons in Sydney have to give their resignation of the hospitals public, because of the administrative conflicts). I had fortunately opportunity of joining to me at a surgery department of the hand in gestation at the Hospital of Sydney, under management of a general surgeon: . It had made its studies in America with , one of the first truths hand surgeons in the world. With another esthetic surgeon, who also made his studies in , Kentucky we developed an important activity with more and more of the patients which came from everywhere to Australia, and even from abroad. I was likely to be able to continue my specific guideline on the wrist; at the same time, because I often travelled, I became acquainted with the hand surgeons of the whole world. It was one very interesting time, and I had also opportunity of creating a training program in hand surgery, which accommodated young surgeons of everywhere.

But already at that time, there were commercial conflicts. I would like to speak to you about that which led to the description of the screw of Herbert-Whipple. , with Richmond in Virginia, one of was associated with and worked with a company of . He wanted a screw .

 

. : You had thought of your screws?

H.T.: Of course, that appeared in my patent. I had thought of it since the beginning. It was so obvious. did not want to make a small screw because they thought that it was too delicate. had made screws for the large hinges but forever desired to exploit the potential of the small screws. Take the example of the fracture of the internal malleolus; one of the problems with the conventional screws it is that they should be withdrawn since the head obstructs. It would have been so simple to make a screw intern without head which would be hidden in the bone. At all events, had asked for its company of make screws to be able to use them in . One of the points that I had specified in my patent was that the diameter of the body of the screw was to be lower than that of the head, which is obvious because it is the place where that slips and where must be made compression. then drew a screw whose diameter of the median party was the same one as that of the head. It was the only way circumvent the patent. At the same time, buys this company and finds the screw in cartons. They wrote to me to think that they planned to stop the production of the screws of Herbert to support the production of the screws of . I was very disappointed because these screws had never been tested and that they had never been the subject of the least publication. In more one had obviously not asked me my opinion. I answered them: “I had asked you for a screw and you were never able to do it to me and now you have of them one which is bad in all, in its drawing, in its design and you want to use it without evaluation!”. We had a rather muscular epistolary exchange and, finally, we arrived at a satisfactory arrangement. They made me meet , we discussed it. accepted the idea that its screw was a copy of the and we arrived at the following compromise: I continued to work on the standard screw conventional Herbert and him, was going to be able to continue with its screw; that it would make all the experimental research tasks and the publications to prove its interest and me swaps some, I would put my name on his new screw. This being, I must acknowledge that I tested its live from time to time in the scaphoid and that I stopped: that does not function, it is not adapted for that.

 

. : Since one is with anteriorities of patent, why is your forceps-sight called the sight of and not that of Herbert?

H.T.: Here what occurred. When I started to work on the forceps-sight, I received a letter of an American csotcina.comedic surgeon, John , who made surgery of the sport in California. In its letter, he told me that he was very interested by my forceps-sight for the scaphoid, that he worked itself on a forceps-sight of scaphoid and that he would like to have a specimen of the . We were to meet to discuss it. We had in fact of the rather different designs since my instrument was made for initially former channels, with a set screw, while it his was conceived for initially side channels, using a normal screw. We swapped several mails and I finished by him saying that its forceps-sight was not adapted because I believed only neither the capscrew, nor the initially side channel were not good for the scaphoid. Finally, one stopped being written. And a day, society prevents me that my forceps were henceforth to be called the guide of and that in my publications and my communications it is this name of guide of which I should use. In fact, had taken a patent on my operative paragraph and had prosecuted them. Although my sight was the first, one was wedged. thus paid very expensive the guide of while at the same time my sight and my technique was completely different. I am furious because main criticisms of the use of the screw of Herbert, it is that the guide is not adapted. wrote to me that it had never used it. And he even wrote me by telling me that one day, it would be necessary that it visits me to see how I made use of it!

 

. : You do not use plaster with your synthesis?

H.T.: It was my creed since the beginning: a good fixing and you can mobilize your wrist. Of course, at the beginning of my experiment, it sometimes happened to me to have the impression that the behavior was insufficient. This moment I warned the patient to be very careful but I always authorized a mobilization. Even with the bone graftings, I believe that it is necessary to move to allow one reorganized of the graft. And then, if you want that your screw holds, he is not necessary that the fragments become osteoporotic, and if you put the patients in a plaster, you quickly have an osteoporosis of immobilization and the quality of your fixing decreases. I give you an example:

I had to discuss a professional cricketer which had a terrible nonunion, already operated, pole of the scaphoid. I succeeded in rebuilding to him his scaphoid with many difficulties and I had evil to obtain a stable Clerc's Office. I made the decision to avoid the use of the plaster, while asking the guy to be very careful, to carry a splint safe to wash itself by explaining to him that there was 50% of chances so that consolidates. When I re-examined it at the 6th week, I was very anxious. But its radios were beautiful, the screw had not moved, I had the impression which the scaphoid could consolidate and I thus told him that it could start to make some a little more with its wrist, to even start to play all with the cricket gently. It is there that he told me: “I must honestly acknowledge you that I started again to play 4 weeks ago, and on the previous day I played during 4 hours and I made more than 100 passages”. All this to tell you that I do not put plaster and that I believe that is not used for nothing. I have only one case of which I remember a failure of fixing in the first weeks, it was a cow-boy who made rodeo and it succeeded in breaking his screw during a fall. For me, if fixing is good, the immobilization of the wrist is contra-indicated.

 

. : Didn't you observe rooms of mobility around the screw?

H.T.: Of course, that can arrive from time to time, but in my opinion it is the result of a failure of consolidation of fracture, in connection with a primary failure of fixing. For example, in upright I strongly believed that, in the fibrous nonunions, a simple compression would be sufficient to obtain the consolidation; I was mistaken, because I observed a good half of failures with loss of fixing, and that taught me the importance from the graft in the nonunions of the scaphoid.

 

. : Which channel initially do you prefer, palmar or dorsal?

H.T.: With my direction, that depends on the localization of the fracture line. If I must make a rebuilding of the scaphoid, the initially former channel appears preferable to me. In the fresh fractures, if the fracture is very moved, I prefer the former channels because I sometimes had interpositions in the fracture line, or of size reductions difficult to control by posterior channel. In the little moved fractures, I direct myself especially towards percutaneous fixing. That is due to my formation: if I make a surgical reduction, I need a good exhibition, to have an anatomical reduction, and a solid fixing what supposes to use a bone grafting so necessary. On the other hand, I always prefer the dorsal channel for the fractures of the proximal part of the scaphoid. Some prefer this approach for any fracture type, because fixing is easier, but, in my opinion the lack of day over the entire length of the scaphoid is a main drawback.

 

. : Necroses it is what scaphoid exists?

H.T.: Yes, certainly, but as you surely noticed, I am very attached within the meaning of the words. wants to say that it there does not have blood and necroses wants to say necrotic i.e. more living tissues. In this case, there is anything else to make only put the scaphoid in the bucket, you cannot fix it and it cannot consolidate. But an ischemic pole of scaphoid is very frequent. It is like a fragment of cortical, but you can fix it and it is likely certain to consolidate. When says that one necroses scaphoid can consolidate, I answer him: “Show me how, because in the strict acceptance of the word, this is impossible!

 

. : What pushed you with all to give up and to leave for Australia?

H.T.: It is necessary to return at the beginning. I come from Europe, and I always remained attached to the European way of life. Even at the best times of my life in Australia, I always had the feeling to be a little foreign in this continent, so far from my native land. Although we always have our family home in Australia, and that all our children remained over there, me and my wife, who is Austrian, had the desire to more and more frequently turn over to Europe, and finally we made the decision to buy a secondary house in France. At the same time, I made the decision to leave my post in Australia at the 55 years age, and to benefit from free time to devote me to my other passions, i.e., to make a round the world tour on sailing ship, to study music etc a little… With my opinion, the surgical life can, too easily, to darken the normal life and family, and I believe that it is seriously necessary to reflect on this fact. The life is too short, and the world forwards so many interesting things!

 

. : In practice, how do you spend your time?

H.T.: As I have just said it, I have much of center interests and . I make classical music and jazz, I study the manifold and I belong to an small group, the European jazz band of the hand surgeons! And then I have a property in the VAr, in Mons a very beautiful small village between the mountains and the sea; and me, I adore the mountains, and I am impassioned by the sea. Moreover, when I have time I arrange on my property; I test with some difficulties in learning French.

 

. : Why to have chosen France?

H.T.: I chose France because I believe that it is probably the country most pleasant to live. Since my childhood, I always adored this country, and I always felt a little “at home” here. What is very interesting it is that if one goes up the one of my family one realizes that there are 4 or 5 centuries we were of French. We came from Normandy, it is perhaps a return to my roots. At the time of one of my voyages in Provence I discovered this absolutely marvellous place and I said myself it is really there that it is necessary that I come and it is there that it is necessary that I have a house.

 

. : Finished the surgery?

H.T.: I am too young to forget the surgery completely. My retreat is a good opportunity to continue my search, my publications and my conferences. I am delighted greeting which I received by my fellow-members here in France, in England and everywhere in Europe, more especially as these friendships enabled me to remain with the current development of the hand surgery. I always remain (finally, almost!) available to discuss the difficult problems of the wrist with my colleagues, and to make exchange rates with the young surgeons.

At the same time, I can devote myself to ideas that I had not had time to develop. In this moment I work on various projects with , which is a German company which does many products for traumatology. In particular on a subject which holds me with core, a prosthesis of cubital head which badly does not have success in Europe in this moment. I also made with of the screws of the Herbert type, but , as they had been always asked to me, but that forever made society. Moreover these screws have different compressive forces, because the compression ratio of the original screw was always criticized. Although Fischer and I naps arrived after many tests at a drawing which seemed to us ideal and which clinical outcomes confirmed our options, if the surgeons want screws with more compression, let us give their what they ask. Therefore, there are now 2 types of screw: one with a usual compression and one with a compression 2 times stronger. Of course, today everyone can do as much of it since the patent fell into the public domain.

 

. : What would you tell to young csotcina.comedists who dream to invent their hardware?

H.T.: The life taught me three lessons. The first: it is not to be frightened by the change, to have the open mind, to call in question all that one learned and all that one makes concerning the surgery.

The second: it is to have a solid formation because it is with a good reputation that one can start to develop something.

The third, and it is probably most important, it is that it is necessary to believe absolutely in its ideas, to be extremely persevering, and to follow them without letting itself discourage by criticisms and the failures: a negative answer is never an definitive answer and it is necessary to continue across a refusal or a reverse.

Lastly, I would like to add that it is never, never easy. Good courage, and good luck, because it is necessary to have an abundance of the latter if one wants to have success!