Henri promoted the shoulder surgery and of the foot in the area of North. He carried out a double career of csotcina.comedic surgeon and anatomist. At the end of a studious professional life, he tells us the vicissitudes and the opportunities caused by his double speciality.

 

 

. : What pushed you to make Médecine?

: There is no doctor in the family, my grandparents were textile workmen weavers, they left to “the factory” at 5 a.m. in the morning and re-entered at 7 o'clock in the evening. My father was lawyer and accountant. He would have liked that I continue in this management and saw me well working in management or becoming notary, but I did not like anything of all that. By probable spirit of opposition, I chose to follow a scientific sector to report myself which I was probably more arts person. Medicine appeared to me to be a best compromise.

 

. : And what led you to become surgeon?

: I was interested as of the beginning by the Anatomy. Then, after a certain interest for gastro-enterology and neurology, I directed myself towards obstetric gynecology and it is what pushed me to pass the boarding school. My route appeared traced, I had been stated in the service and a post of head of private clinic awaited me, I remember my subject of thesis
“ nephropathies”.

 

. : And then?

: In 1964, I left to make my military service. To differentiate me from my elder family which all was of land, I chose the navy. It is as that which I was affected at the Maritime Hospital of Instruction of Rochefort.
There, I met Jean Paul . He was assistant and prepared the aggregation of the Military hospitals. With some called Jean Claude I took part in the preparation of his questions of contest. This meeting and the practice of current traumatology in this Hospital directed me towards csotcina.comedy. When I returned of the military service in 1966, I quickly gave up gynéco-obstetrics, but I could not choose csotcina.comedy-Traumatology bus the service by the old interns. I thus went where I could i.e. in Urology, then general surgery where I failed to stop me. The owner, Georges , were good surgeon, his pleasant team and the excellent agreement between us. The was possible there, whereas work of approach in csotcina.comedy left me perplexed on my future. Did , aggravated by my indecision, then convene me and told “Reflect well, , think that you will pass your life to mend sticks of chair? ” In spite of this warning, the attraction of the ostéo-articular surgery was strongest. Finally the Anatomy fixed my interest on the musculoskeletal system, and I chose csotcina.comedy definitively. But I regretted having given up the general surgery which kept an incredible diversity. I did not have, like some, a beautiful linear trajectory. To my first training course of external in Neurosurgery, we were assigned, with a buddy, in the room of traumatized cranial, the first contact was hard: the types , shouted, did anything or were house plants. Our morning occurred in this universe which deeply depressed me and at midday while leaving, my buddy told me: “You see, me it is neurosurgery that I want to make” and he became neurosurgeon.

 

. : Between did the Anatomy and csotcina.comedy, you put themselves in an undecided position?

: Yes and not, because the destiny imposed some turnings to me. I always had evil to choose because much subjects excited my curiosity as well in pathology as in Anatomy which is a vast discipline. I believed capacity to play on the 2 boards and to claim with a mixed aggregation. At the time, at least in province, this statute was very badly seen surgeons. My owner, Pierre did not like the sharings of activities between csotcina.comédie and Anatomy with the . He estimated, not without reason, that the charges of teaching of the Anatomy were not compatible with an activity in Traumatology. He did not support this dual membership which I wished. Here me is thus aggregate of Anatomy in 1973 but without clinical assignment in csotcina.comedy.

I failed to install me at this time. Thanks to the comprehension of Marius , I was lodged in Pediatric csotcina.comaedics. That attracted me temporarily other troubles, the colleagues pediatric surgeons having evil not to live me like a competitor… This exhausting little game fortunately finished. The solution was to send to me in periphery to into 74 within the framework of Conventions which the Minister for the time tried to support.

I joined some aggregated who had preceded me and one of them divided its service, and I found myself with the head of forty beds. Compared so that I had just lived, it was happiness and I thought of finishing my professional path there.

 

. : It was how ?

: It was a department of traumatology primarily, but the complicity of the doctors and rheumatologists of the corner enabled me to have quickly a varied recruitment of csotcina.comedy. I remember that one day, I had the unfortunate idea to show a file of femoral head necrosis to staff inhabitant of Lille and my owner to say “it is perfect, you transfer it to us” and this patient was operated of a joint replacement with cup by one of my friends, young senior registrar. A rheumatologist opened the eyes to me and told me: “If you continuous like that, I do not send anything any more to you! ”. I thus started the guideline towards csotcina.comedy. The relationship with my agents was simple, and that passed well between us. There was already a profusion of ideas and hardware: cup of , prosthesis of , prosthesis of , nails of for the hip, prosthesis of and on the level of the knee.

The place of traumatology was important, the weight of the urgencies was heavy: highway connecting to us to Belgium and textile industry were
main providers of urgencies. It was hard, but I liked myself it much because I could introduce new techniques like the traumatology of the rachis. I installed an active local society which allowed us to forward our work then to refine them for the for example.

 

. : For which reasons you did reinstate Lille?

: I re-entered at the beginning of 1980 in Lille because the Convention which linked the and the Hospital of had ever been signed by the managing director of the REGIONAL HOSPITAL of Lille. This last was hostile with the policy of Convention. It supported, with one decade in advance, a splitting of the activities of csotcina.comedy in poles: a pole of Traumatology and a pole Rehabilitation-csotcina.comedy-Readjustment. It thus never signed this Convention and a day the Minister for the time Mrs. , put to me in residence to leave to regain my of origin in the nths. Absolute drama because on the one hand I was alone in , and on the other hand I neither was wished, nor waited in Lille. This transitional period was one very hard period of my professional life: I finished my presence with by ensuring the crusher-run aggregate, I continued my course of Anatomy to Faculty and I tried to find my place in csotcina.comedy in Lille. I was likely to find Bernard , one of my former students of conferences, to take again the service of and I was finally accommodated in the service of Antoine during
4 years.

 

. : Which were your fields of predilection?

: While returning to Lille, I could not invest me on the same subjects as my 2 elder, Jean and Antoine , very directed towards the hip and the knee. I was thus interested gradually so that the others forsook as well by curiosity as by freedom to maneuver. I was attracted by the shoulder which I found complex anatomically and physiologically, but this surgery was with its stammerings and was structured later.

In 1980 Jean Pierre responsible for a meeting of the in Lille, was responsible for a roundtable on the disease of . It “had ordered me” an anatomical study on the systematization of the arterial pedicles of the bones of the carpus. During the same meeting, Claude was interested by my work on the distribution of the tendons bungee cords in hand. Once the foot put at the clamp, I was interested in traumatology of the upper limb: The overhaul of the fractures of , , luxations of the inch were forwarded to the annual meetings of the and the .

 

. : And how did you come to the surgery from the foot?

: The surgery of the foot was really the poor party of our speciality. The often short and stereotyped operational acts were done at the end of the program and were often limited to the surgery of the before-foot. I found astonishing that the foot either if forsaken compared to the hand whereas there were so many things to make. One stated exclusive surgeon of the hand proudly, not exclusive surgeon of the foot.

There too, I tackled this subject by the means of traumatology. By looking at the work made by the inhabitants of Lille teams on the fractures of the members, the traumatology of the foot remained badly known and had not been the subject of evaluation apart from the fractures of the discussed by Raising-Enclouage-Chamber-Closed, technique of Jean . I was interested in the fractures of the scaphoid tarsal, luxations perished-astragaliennes and luxations of and subtalar. Thanks to the sponsorship of Jean-Pierre , Antoine Denis and Pierre , I integrated rare society speaking about the foot, and the service was invested in this management: the hollow foot, the flatfeet, the surgery of the before-foot , metatarsalgias static etc I was interested in the “dorsal ” of English, or acquired , which involves a compensation and permanent bending of the métatarso-phalangeal hinge of the big toe enabling him to recover a pulpar support on the ground. The frequent deformation in the children would be of neurological origin by unbalance between the leg former one and side peroneal length, but in the adult it often given or is raised by a defective position of the pallet after arthrodesis of the back foot or the . We amended the technique of , the results are good long-term, but this pathology does not run about the streets…

 

. : You worked on the supernumerary muscles…

: The supernumerary muscles of the foot, it is a natural subject for an anatomist who is interested in the individual variations.

I had this opportunity by reading in a pediatric periodical an item on an atypical . The author gave of it a series, that interested me as an anatomist. I then sought with my younger colleagues all the faults than I could meet, for example at the time of CIVIL ENGINEERINGS of the .

One found some “4th peroneal” then other faults, and a day a bulky additional. To the same time, at the time of a medico-surgical symposium, a doctor forwards a case of retro-malléolaires pains internal with a clinical balance-sheet and radiographic normal completion. I still had in memory this item and I launched: “I believe that it is a supernumerary ”. Everyone disfigured me with surprise. With the intervention, I withdrew a long supernumerary muscular body of at least 6 cm. With the effort this fleshy body inflated in a narrow cabin for him and was put in painful ischaemia.

The techniques described in the literature went from “I do not do anything” with “I remove all” with all the possible alternatives between these two attitudes like the simple of the muscle.

I withdrew the muscle entirely and the patient who practiced the triathlon found his sporting level in a few months.

It is thus completely by chance that I was interested in the anatomy, his variations muscular, those known and being for a long time described by two French anatomists and the Double.

 

. : In parallel you live the development of the shoulder surgery?

: The shoulder under was historically dimensioned with the of Lille: In 4 years of boarding school, I saw only one operated cap. Pierre said “the rupture of the cap, that is rehabilitated” and it was of good tone to leave it there. In addition, an evaluation of the long-term outcomes of the advance of known thorny according to had confirmed this bad name of the surgery. Under the thrust of the rheumatologists, which proposed patients to us that they could not improve any more, I showed my interest for this pathology and the techniques of repair of the cap of the rotators. I had been very impressed by Didier Patte and I followed his development. Only disappointment in the use of its techniques was the Great Former Release. I had associated with his technique a scrap which we use in the massive ruptures. Remotely, the functional results proved to be poor, this technique was erased in front of the best results of repairs.

As for the processing of the instability of the shoulder, the surgeons were divided into 2 clans: “those which made of and those which made stops”. To dissociate me attitude of my elder and convinced by Patte I chose the intervention of .

 

. : And as regards shoulder prosthese?

: The service followed the development of those which were interested in the shoulder with its unhappy joys and its experiments. After having tested old prostheses like that of , we used the prostheses of which gave good performances in the centered . As much, we used them in other indications like the fractures of the upper end of the humerus with less success. We also associated prosthesis and scrap in the offset , but the not very functional scrap could not prevent the increase of the humeral head under the glareshield . I knew
very well , raises of Albert . I had met it at the time of a symposium in Lyon where it had shown me the principles of its osteotomy . Before designing its reversed prosthesis, it started by making anthropological and biomechanical studies very interesting. We were in the first to establish them, but we were disappointed by the rather fast deterioration of the implant. The following versions tried to correct the initial defects, I joined there, but the future of this implant remains for me dubious.

 

. : Who did you meet of other?

: Didier Leg. He was impassioned by the shoulder and communicated his passion when one saw it working that it is with the block or in consultation. At the beginning, I knew it only through his communications; in 1980, I met it, one sympathized and I am regularly turned over to see it. The means of transport not being what they are today and to make Lille-Melun, it was necessary to rise early. But often Patte told me “you can arrive a little later because I will start with a food ”. One made then shoulder surgery and sometimes, when its instrumentalist had left, he asked me to help it for the last of the day. He integrated me into the group when he founded it where I could become acquainted with the members, all impassioned by this new surgery.

The aim of the meetings of this group was not to promote a prosthesis or a hardware but to work together. Didier had drawn aside the big bosses “You understand, if they come, one will not be able nothing to tell and they will want all to control, of the introduction to the conclusion; I need young people”. As I was not any more very young, he added: “you are the upper limit of the group! ” One met regularly, for meetings of bibliography and a profitable exchange of our respective experiments. Unfortunately, the death of Didier Patte caused the dissolution of the group which was partially reconstituted a few years later under the impulse of Gilles .

 

. : Which were in your course, major technological advances?

: Initially osteosynthesis with closed chamber. The allowed enormous progress in traumatology and the locked of Gross and still improved the technique. We use this technique in the realization of certain arthrodeses of ankle. After it is the surgery which revolutionized my time and which will continue to make evolve/move the modern operative procedures. However, for an anatomist, the surgery is frustrating because it reduces the dissection and duration. I like this “preliminary anatomical walk” which obliges us to identify the elements of passage before making the therapeutic gesture. But the not very aggressive character is without discussion more for the patient. In the service, my young collaborators undertake the development of these techniques become impossible to circumvent. My collaborator of always: Carlos takes an active part in of which has an enormous success among our young colleagues. In short, in fact the minicomputer-invasive techniques improved the surgical assumption of responsibility of the patients. On the other hand, I remain perplexed on the practice of the conventional prosthetic surgery by minicomputer-incisions bus that is likely to support the bad positioning of the implants.

 

. : Speak we about your Owners?

: My owner Pierre had an extraordinary logic and a personal way to pose the indications. All its pupils, it gave a philosophy of our trade where it is necessary to know to analyze the situations calmly, to lead to an exact diagnosis, and not to let themselves allure by not tested operative procedures. The maxims that it gave us remained reference marks, such as for example: “It is necessary to leave to the combat on the condition of being victorious! ”. When there were 2 very different indications for the same young patient, it preached the surgical abstention easily. Jean Minne was my other owner: instructor d' Anatomie and surgeon. He learned how to me to make exchange rate in these crammed sands of students whom one appoints amphitheaters: “it is necessary to face” told he. At the time of an uproar, it went up in the lecture theater and did not hesitate to distribute some slaps to the students who heated it too much! ! Finally there was Henri : its charisma, its talents of speaker and its spirit of synthesis were remarkable.

 

. : Do you regret?

: On the technical plan, I regretted having to give up the spine surgery which was with the shoulder and the foot my 3rd pole of search anatomical and csotcina.comedic. During a restructuring of the of Lille, 10 years ago, for budgetary reasons, the administration imposed a choice to us: joint prostheses or spine surgery. The prostheses aroused more the interest of my elder csotcina.comedists and the neurosurgeons more available and very qualified carried the piece. It was the first manifestation of the “” which led the departments of csotcina.comedics to center their activity on certain pathologies or certain anatomical areas. Even if the ceaseless development of knowledge in all the fields of our activity leads to a specialization, I consider it regrettable that the general practitioner activity that I backed up in my service is condemned shortly.

 

. : How do you see the hospital future?

: On the general level, in the years to come, I fear the aggravation of the obstacles to the good walk of the . The competition increasingly keener of the private one which lays out eminent technicians, our former students, and work tools adapted to the missions chosen, combined with the increasing difficulty to train and keep collaborators with the public hospital is not good omen. This endemic evil appears without remedy for the administration of a which is quartered between its various missions. How to deal with all the patients, all pathologies, to form the young generations, to develop often expensive advanced techniques and to be profitable? This easy official report to point out the multiple rescue plans imposed without any coherence having on the other hand a negotiable instrument deeply demoralizing on the actors who we are. The current mode of the public-private reconciliation is perhaps a solution which will make it possible to continue to look after all the patients and to train our young colleagues, but the path is perilous because there is a risk of partition on all the levels: csotcina.comedy private Traumatology public; stripped patients public affluent patients deprived and lists it is not closed. Lastly, I am worried to see that we will miss soon doctors, that it acts general practitioners or specialists, that in the public hospitals there will not be sufficient experts to ensure the basic activities.

 

. : Summers you nevertheless a happy surgeon?

: Yes, technically, progress was important and we have the embarrassment of the choice to find the hardware adapted to each case. Our surgery remains very gratifying in spite of a change of mentality of our more demanding and easily litigious patients become.

 

. : Do you have other passions that the surgery?

: I like much the countryside and I find a great comfort there; that it is in the conversation of my second home or the realization of agricultural work. I arrange much and I like
agricultural work. The proximity of the border probably explains my interest for the foreign languages. I have always much sorrow to note that contrary to our Belgian neighbors or Dutch we have difficulty of expressing us and thus to make known our know-how however so rich.