In this article, I am using the example of the introduction of osteosynthesis into surgical routine practice to analyze the use of the notions of art and science in medical innovation. The examination of the renegotiations of power and responsibility associated with the introduction of this new technique shows that proponents and critics actively linked their arguments to more fundamental epistemological and social issues. The proponents claimed to manage the uncertainties of innovation through making surgery more scientific, drawing on the ideals of control, rationality, objectivity, and predictability. The critics mobilized another discursive pattern. They considered surgery an art and emphasized the individuality, contingency, and situatedness of medical practice. I investigate the discursive function of these argumentative patterns and how they played out in the concrete example of this surgical technique.
Allgöwer, M. 1964. Osteosynthese und primäre Knochenheilung. Langenbecks Archiv für Chirurgie 308:423–34.
2.
Allgöwer, M. 1971. Weichteilprobleme und Infektionsrisiko der Osteosynthese. Langenbecks Archiv für Chirurgie 329:1127–36.
3.
Allgöwer, M.1978. Cinderella of surgery—Fractures?Surgical Clinics of North America58: 1071–1093.
4.
Allgöwer, M., and P. G. Spiegel. 1979. Internal fixation of fractures: Evolution of concepts. Clinical Orthopaedics and Related Research138:26–29.
5.
Anderson, L. D., T. D. Sisk, R. E. Tooms, and W. I. Park. 1975. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. Journal of Bone and Joint Surgery57-A: 287–297.
6.
Anderson, W.1992. The reasoning of the strongest: The polemics of skill and science in medical diagnosis. Social Studies of Science22:653–684.
7.
Badger, F. G.1959. Principles of the treatment of fractures. In Modern trends in accident surgery and medicine, edited by R. Clarke, F. G. Badger, and S. Sevitt, 123–139. London: Butterworth.
8.
Bagby, G. W.1977. Compression bone-plating: Historical considerations. Journal of Bone and Joint Surgery59-A:625–631.
9.
Beck, U. 1986. Risikogesellschaft. Auf dem Weg in eine andere Moderne. Frankfurt: Suhrkamp Verlag.
10.
Berg, M.1995. Turning a practice into a science: Reconceptualizing postwar medical practice. Social Studies of Science25:437–476.
11.
Berg, M.1997. Rationalizing medical work: Decision support techniques and medical practices. Cambridge, MA: MIT Press.
12.
Berg, M.1998. Order(s) and disorder(s): Of protocols and medical practices. In Differences in medicine: Unraveling practices, techniques, and bodies, edited by M. Berg and A. Mol, 226–246. Durham, NC: Duke University Press.
13.
Berkin, C. R., and D. V. Marshall. 1972. Three-sided plate fixation for fractures of the tibial and fermoral shafts. Journal of Bone and Joint Surgery54-A:1105–1113.
14.
Böhler, L. 1963. Die Technik der Knochenbruchbehandlung, supplementary volume of the 12th and 13th German ed. Vienna: Maudrich.
15.
Buff, H. U.1971. Bemerkungen zur Behandlung der Unterschenkelfrakturen bei Erwachsenen. Praxis. Schweizerische Rundschau für Medizin60:1193–1196.
16.
Buff, H. U.1975. Der Arzt als freier Beruf. In Freiheit: Aktuelle Hinweise und Beiträge aus verschiedenen Gebieten zum Problem der Freiheit, edited by B. Staehlin, S. Jenny, and S. Geroulanos, 185–198. Zurich: Editio Academica.
17.
Burri, C., G. Bartzke, J. Coldewey, and E. Muggler. 1979. Fractures of the tibial plateau. Clinical Orthopaedics and Related Research138:84–93.
18.
Bürkle de la Camp, H.1963/1964. Comment given in discusssion at the annual conference of the German Surgical Society in 1963, Published in Langenbecks Archiv für Chirurgie305:47–48.
19.
Bynum, W. F.1994. Science and the practice of medicine in the nineteenth century. Cambridge, UK: Cambridge University Press.
20.
Chapman, M. W., and M. Mahoney. 1979. The role of early internal fixation in the management of open fractures. Clinical Orthopaedics and Related Research138:120–131.
21.
Clancey, G. J., and S. T. Hansen. 1978. Open fractures of the tibia: A review of one hundred and two cases. Journal of Bone and Joint Surgery60-A:118–122.
22.
Cooter, R.1993. Surgery and society in peace and war: Orthopaedics and the organization of modern medicine, 1880–1948. New York: MacMillan.
Danis, R.1949. Théorie et pratique de láostéosynthèse. Paris: Masson et Cie.
25.
Dodge, H. S., and G. W. Cady. 1972. Treatment of fractures of the radius and ulna with compression plates. Journal of Bone and Joint Surgery54-A:1167–1176.
26.
Epstein, S.1996. Impure science: AIDS, activism, and the politics of knowledge. Berkeley: University of California Press.
27.
Ganz, R., R. J. Thomas, and C. P. Hammerle. 1979. Trochanteric fractures of the femur: Treatment and results. Clinical Orthopaedics and Related Research138:30–40.
28.
Geiser, M.1963. Beiträge zur Biologie der Knochenbruchheilung. Zeitschrift für Orthopädie97, suppl 2.
29.
Gigerenzer G., 2002. Reckoning with risk: Learning to live with uncertainty. London: Penguin.
30.
Gigerenzer, G., Z. Swijtink, T. Porter, L. Daston, J. Beatty, and L. Krüger. 1989. The empire of chance: How probability changed science and everyday life. Cambridge: Cambridge University Press.
31.
Gögler, E.1962. Unfallopfer im Strassenverkehr. Basel: J.R. Geigy S.A.
32.
Gordon, D. R.1988. Clinical science and clinical expertise: Changing boundaries between art and science in medicine. In Biomedicine examined, edited by M. Lock and D. Gordon, 257–295. Dordrecht: Kluver.
33.
Groh, P. 1968. Die Behandlung von Frakturen langer Röhrenknochen mit der AO Osteosynthesemethode und ihre Ergebnisse. MD thesis, University of Saarland.
34.
Hampton, O. P., and W. T. Fitts. 1959. Open reduction of common fractures. New York: Grune & Stratton.
35.
Hicks, J. H.1959. Internal fixation of fractures. In Modern trends in accident surgery and medicine, edited by R. Clarke, F. G. Badger, and S. Sevitt, 196–213. London: Butterworth.
36.
Howell, J. D.1995. Technology in the hospital: Transforming patient care in the early twentieth century. Baltimore: Johns Hopkins University Press.
37.
Jones, D. S.2000. Visions of a cure: Visualization, clinical trials, and controversies in cardiac therapeutics, 1968–1998. Isis91:504–541.
38.
Laros, G. S., and P. G. Spiegel. 1979. Editorial comments: Rigid internal fixation of fractures. Clinical Orthopaedics and Related Research138:2–22.
39.
Lawrence, C.1985. Incommunicable knowledge: Science, technology and the clinical art in Britain 1850–1914. Journal of Contemporary History20:503–520.
40.
Lawrence, C.1992. Democratic, divine and heroic: The history and historiography of surgery. In Medical theory, surgical practice: Studies in the history of surgery, edited by C. Lawrence, 1–47. London, New York: Routledge.
41.
Lawrence, C.1998. Still incommunicable: Clinical holists and medical knowledge in interwar Britain. In Greater than the parts: Holism in biomedicine, 1920–1950, edited by C. Lawrence and G. Weisz, 94–111. New York, Oxford: Oxford University Press.
42.
Löwy, I.1996. Between bench and bedside: Science, healing, and interleukin-2 in a cancer ward. Cambridge, MA: Harvard University Press.
43.
Marks, H. M.1993. Medical technologies: Social contexts and consequences. In Companion encyclopedia of the history of medicine, vol. 2, edited by W. F. Bynum and R. Porter, 1592–1618. London, New York: Routledge.
44.
Marks, H. M.1997. The progress of experiment. Science and therapeutic reform in the United States, 1900–1990. Cambridge, New York: Cambridge University Press.
45.
Maurer, G., and F. Lechner. 1963. Allgemeines über Knochen und Gelenke sowie Frakturen und Luxationen. In Handbuch der gesamten Unfallheilkunde, vol. 1, 3rd ed, edited by H. Bürkle de la Camp and M. Schwaiger, 482–479. Stuttart: Ferdinand Enke.
46.
McNeur, J. C.1970. The management of open skeletal trauma with particular reference to internal fixation. Journal of Bone and Joint Surgery52-B:54–60.
47.
Müller, J., U. Plaas, and H. Willenegger. 1971. Spätergebnisse nach operativ behandelten Malleolarfrakturen. Helvetica Chirurgica Acta38:329–337.
48.
Müller, M. E., M. Allgöwer, and H. Willenegger. 1963. Technik der operativen Frakturenbehandlung. Berlin: Springer-Verlag.
49.
Müller, M. E., M. Allgöwer, and H. Willenegger. 1969. Manual der Osteosynthese: AO-Technik. Berlin: Springer-Verlag.
50.
Nicoll, E. A.1974. Closed and open treatment for tibial fractures. Clinical Orthopaedics and Related Research105:144–153.
51.
Olerud, S.1972. Operative treatment of supracondylar-condylar fractures of the femur: Technique and results in fifteen cases. Journal of Bone and Joint Surgery54-A:1015–1032.
52.
Olerud, S., and G. Karlström. 1972. Tibial fractures treated by AO compression osteosynthesis: Experiences from a five year material. Acta Orthopaedica Scandinavica (supp. 140).
53.
Olesko, K. M.1988. Commentary: On institutes, investigations, and scientific training. In The investigative enterprise: Experimental physiology in nineteenth-century medicine, edited by W. Coleman and F. L. Holmes, 295–332. Berkeley: University of California Press.
54.
Pettavel, J.1955. Considérations sur le traitement des fractures transverses du tibia. Helvetica Chirurgica Acta22:435–461.
55.
Pickstone, J. V.1992. Introduction. In Medical innovations in historical perspective, edited by J. V. Pickstone, 1–16. Houndmills, Basingstoke: McMillan.
56.
Polanyi, M.[1958] 1973. Personal knowledge: Toward a post-critical philosophy. London: Routledge and Kegan Paul.
57.
Porter, T. M.1995. Trust in numbers: The pursuit of objectivity in science and public life. Princeton, NJ: Princeton University Press.
58.
Rehn, J. 1965. Unfallschäden an Unterschenkel und Fuß. In Handbuch der Gesamten Unfallheilkunde, vol. 3, 3rd ed., edited by H. Bürkle de la Camp and M. Schwaiger, 448–523. Stuttart: Ferdinand Enke.
59.
Richards, E.1988. The politics of therapeutic evaluation: The vitamin C and cancer controversy. Social Studies of Science18:653–701.
60.
Rittmann, W. W., and S. M. Perren. 1974. Corticale Knochenheilung nach Osteosynthese und Infektion: Biomechanik und Biologie. Berlin: Springer-Verlag.
61.
Rittmann, W. W., M. Schibli, P. Matter, and M. Allgöwer. 1979. Open fractures: Long-term results in 200 consecutive cases. Clinical Orthopaedics and Related Research138:132–140.
62.
Rockwood, C. A., and D. P. Green. 1975. Fractures, 2 vols. Philadelphia: J. B. Lippincott.
63.
Rüedi, T., J. K. Webb, and M. Allgöwer. 1975. Experience with the dynamic compression plate (DCP) in 418 recent fractures of the tibial shaft. Injury7:252–257.
64.
Rüedi, T. P., and M. Allgöwer. 1979. The operative treatment of intra-articular fractures of the lower end of the tibia. Clinical Orthopaedics and Related Research138:105–110.
65.
Schatzker, J.1974. Compression in the surgical treatment of fractures in of the tibia. Clinical Orthopaedics and Related Research105:220–239.
66.
Schatzker, J., and D. C. Lambert. 1979. Supracondylar fractures of the femur. Clinical Orthopaedics and Related Research138:77–83.
67.
Schlich, T.2002a. Surgery, science and industry: A revolution in fracture care, 1950s–1990s. Houndsmill, Basingstoke: Palgrave.
68.
Schlich, T.. 2002b. Degrees of control: The spread of operative fracture treatment with metal implants. A comparative perspective on Switzerland, East Germany and the USA, 1950s–1990s. In Innovations in health and medicine: Diffusion and resistance in the twentieth century, edited by J. Stanton, 106–125. London and New York: Routledge.
69.
Schlich, T.. 2006. Risk and medical innovation: A historical perspective. In The risks of medical innovation: Risk perception and assessment in historical context, edited by T. Schlich and U. Tröhler, 1–19. London and New York: Routledge.
70.
Sturdy, S., and R. Cooter. 1998. Science, scientific management, and the transformation of medicine in Britain c. 1870–1950. History of Science36:421–466.
71.
Timmermans, S., and M. Berg. 2003. The gold standard: The challenge of evidence-based medicine and standardization in health care. Philadelphia: Temple University Press.
72.
van der Linden, W., and K. Larsson. 1979. Plate fixation versus conservative treatment of tibial shaft fractures. Journal of Bone and Joint Surgery61-A:873–878.
73.
Wade, P. A.1970. ASIF compression has a problem. Journal of Trauma10:513–515.
