Abstract
At the end of the 19th century, orthopaedists began to systematically measure length, width, circumference, muscle strength, reflexes, body weight and eventually joint motions. This publication presents the development and the use of some of the instruments measuring body mobility.
All clinical measurement methods play a major role in orthopaedics and traumatology in accessing musculoskeletal movements. Accurate measuring instruments are needed for diagnosing, treatment planning, follow-up examinations and comparisons, as well as in scientific research. It took many years until a consistent measuring system was established worldwide.
One of the pioneers in this field is the Swiss orthopaedic surgeon Dr Jules Rippstein. Throughout his professional career, he dealt with the issues of motion measurement. He used, improved and designed measuring instruments, and also collected them. Thanks to his collecting enthusiasm, his accumulation of instruments is probably one of the largest of its kind.
It is to the merit of the authors René Ruepp and René Baumgartner to have saved this unique and medically historic collection from obscurity by making it available to a worldwide audience. The authors expertly photographed and described the entire collection. The layout is functional and user friendly; all images, some in colour, are precise; the text, written in German and French, is clear and concise; and the advantages and disadvantages of the various devices are noted.
The text is sectioned into older and newer instruments. Some of the former include a heel-valgus measuring apparatus, a hand strength Dynamometer, a pelvis scale and more. Newer devices show a variety of tools such as a pinwheel to measure skin sensitivity, an inklometer to measure tibial torsion and an x-ray Goniometer (most popular today) with 4.5-cm-wide shanks made of translucent polyethylene.
The internationally accepted SFTR documentation system (S-sagittal, F-frontal, T-transverse, and R-rotation) is explained. It is a method to measure motions in three planes as well as rotation, which can occur in any of the planes. Larger and smaller versions of this Goniometer are shown.
Then, there is the Plurimeter measuring system by Rippstein. His UR-Plurimeter has a regular and a telescoping shank; his Combi-Goniometer has rotating removable shanks. The rotating shanks allow better positioning, and their removal facilitates the use of a footplate attachment. Rippstein’s Hydro-Goniometer is a one-shank device that has a rotational dial with a water-filled centre and a bubble pendulum. This pendulum always points up regardless of the device’s position. Many drawings show how to measure body motions (spine, shoulders, pelvis, arms and legs) with a one-shank Plurimeter.
The following segments address instruments, which have been designed to measure specific body parts. There is a Kyphometer with two parallelogram shanks, a cervical fan to measure neck rotation, a scoliosis measuring instrument with a centred level and height adjustable side bars. A Gibbosometer, functions like a carpenter’s tool. Parallel pins drop until they attain body contact, establishing the shape which can be traced onto paper. A pelvic-level instrument is placed on both iliac crests. To avoid supporting the shorter side with an underlay, Dr Rippstein added an inch rod. In this way, one can read the exact amount of leg length discrepancy. The Pluri-Cal (caliper) functions like a slide rule, having two adjustable bars. With it, one can measure different body parts. Clear drawings give many examples. Several devices are illustrated to measure pro- and supination, hand strength and functions. Again, precise drawings show how to use these instruments. The end includes a few goniometers for non-orthopaedic use. Among them are one for carpenters and also an Inocon-Goniometer, a Swedish precision instrument measuring 1/10th of a degree.
Last but not least, the Tattometer is introduced (translator’s note: tatterich (dialect) means quiver, tremble, shake). It was found in the book entitled: ‘Erfinder auf Abwegen’ (Inventors Gone Wrong). It is a device to measure the intensity of hand tremors. The Imperial Patent Office issued Patent Nr. 92128 in September 1896.
The last sentence in the booklet reads, ‘What a stroke of luck that our friend Rippstein did not come across this invention. He would have rebuilt, improved and subsequently submitted it for a patent and would have distributed it as Pluri-Tatt’.
I highly recommend this work to all who have to deal with musculoskeletal measurements: physicians, allied health professionals, rehabilitation engineers and also to inventors and the public at large. Anyone of them may come up with additional astounding ideas to achieve the most accurate measurements possible.