Major Alexander William Lipmann-Kessel MBE MC: Surgeon, paratrooper, prisoner of war, and orthopaedic innovator

Simon Hurst, Dylan Griffiths and Roger Emery

Simon Hurst is a Trauma & Orthopaedic surgeon and reservist serving with 144 Parachute Medical Squadron, 16 Medical Regiment. He is currently pursuing fellowship training at Hôpitaux de Paris, Hôpital Avicenne, France, and Shock Trauma, University of Maryland, USA. His doctoral thesis at Imperial College examined the digitalisation of PROMS. He has post-doctoral research interests both at Imperial College, and Université Sorbonne Paris Nord, France. These are in the fields of surgical robotics, and the use of augmented reality headsets to enhance surgeon capability. Simon’s subspecialty interests are in upper limb surgery, and the battlefield forward surgical care of major trauma patients.

Origins and training

Alexander William Lipmann-Kessel was of diverse heritage being born in Pretoria, South Africa in 1914 to a German mother, and a Lithuanian father. ‘Lippy,’ as he was better known was of Jewish heritage, and a practising Jew throughout his life. In early adulthood he moved to London to study medicine at St Mary’s Hospital, Paddington. The LipmannKessel prize day remains an important part of the academic calendar for orthopaedic trainees on the London North West Thames rotation1-4 .

The Parachute Surgical Team

Lipmann-Kessel volunteered for the Airborne Forces shortly after finishing medical school, and passed selection at No 1 Parachute Training School, Ringway, Manchester, (Figure 1). His first operational activity was as part of 16 Parachute Field Hospital, (16 PFA), (Figure 2) during Operation Fustian, an ultimately successful bid to capture the strategically important Primosole Bridge in Sicily.

Fustian saw the first successful deployment of ‘The Parachute Surgical Team (PST)’, (Figure 3). Lipmann-Kessel was a principle pioneer of this concept. Airborne operations allowed for rapid insertion behind enemy lines but, placed troops outside of the normal chain of medical care. The PST included a surgeon, an anaesthetist, and four other para trained members from other ranks with focus on nursing, and other medical training. 80% of cases were operated on within five hours of injury. Musculoskeletal injuries including seven open long bone fractures comprised the majority of cases5 .

The PST has evolved into the modern ‘forward surgical team,’ and continues to be an important capability on contemporary military operations.

Figure 1: No 1 Parachute Training School, Ringway, Manchester – provided training to all 60,000 allied paratroopers in Europe between 1940 and 1946. (Image courtesy of Imperial War Museum, London, UK).

Operation Market Garden 1944

On the afternoon of the 17th September 1944, Lipmann-Kessel and the rest of 16 PFA landed on drop zone (DZ) X en-route to a Dutch hospital in western Arnhem – St Elisabeth’s. Here they treated early casualties from the 10,000 strong Allied airborne forces whose aim was to circumvent German lines through the capture of key bridges (Operation Market) and then hold them until reinforcements

Dylan Griffiths has been a Consultant Orthopaedic Surgeon at Imperial College Healthcare NHS Trust for seven years. His subspecialty interest is in Shoulder and Elbow surgery and he is the clinical lead for Shoulder and Elbow trauma. Dylan has also spent 23 years as part of the British Military, with service in the Parachute regiment and operational tours of Afghanistan, Iraq and Bosnia.

Roger Emery is Professor of Orthopaedic Surgery at Imperial College, London. He graduated in 1979 from St. Thomas’s Hospital Medical School, University of London, and undertook his orthopaedic training in London, Cambridge and Hong Kong. Awarded a Wellcome Surgical Fellowship at the Kennedy Institute of Rheumatology, and the Zimmer Travelling Fellowship by the British Orthopaedic Association in 1989, including later the first SECEC/ ASES Travelling Fellowship by the European Society for Surgery of the Shoulder and Elbow in 1993. He served as President of the British Elbow and Shoulder Society (2003-2005), and ex-officio Member the International Board of Shoulder and Elbow Surgery (2011). He was President of SECEC (2016-2018), International Editor of the Journal of Shoulder and Elbow Surgery (2008-2009), and has been a trustee of the Journal of Shoulder and Elbow Surgery since 2014.

arrived (Operation Garden). By the end of the operation over 3,000 Allied forces personnel had died with none of the key objectives achieved. The outstanding human courage displayed in such a severely flawed operation remains an enduring legacy.

Within 24 hours of landing at the DZ, the hospital was overrun by German forces, and most of his colleagues at 16 PFA were taken prisoner. However, Lipmann-Kessel and his respective surgical team were allowed to remain. His ability to influence their SS captors was all the more remarkable given his Jewish heritage, and even involved him attending an SS mess dinner on invitation. Practical provisions for surgery were often makeshift and included using a Jeep piston tyre pump as a suction device.

Men considered suitably recovered by the SS were most often taken to prison camps. However, under Lipmann-Kessel’s direction many patients escaped to the Dutch resistance.

Figure 2: Lipmann-Kessel’s British army parachute wings and RAMC cap badge in the Airborne Museum Hartenstein, Oosterbeek, Netherlands. (Image courtesy of Simon Hurst, London, UK).

Life with the Dutch resistance

Lipmann-Kessel’s partnership with the Dutch resistance began whilst he was still at St Figure 3: Modern day military parachutists supported by 144 Parachute Medical Squadron, 16 Medical Regiment (16 PFA’s modern equivalent) - training for airborne operations as part of exercise Falcon’s Leap in Ermelo, Gelderland, Netherlands. (Image courtesy of Simon Hurst, London, UK). Elisabeth’s under SS control. This included organising a mock funeral in order to bury in the ground under barns, and other farm small arms, and ammunition for them. buildings. He usually had less than an hour All aspects involved considerable risk to in the fresh air each day. himself. Notably he refused safe passage back to Allied lines provisionally organised Lipmann-Kessel eventually made it back by a senior SS officer. behind Allied lines in February 1945 after utilising a canoe to make his way through His own escape saw months under the the canals and waterways of the Biesbosch protection of the Dutch resistance where in freezing conditions. He had failed only life was extremely tough. Often he lived 24 hours previously due a serious leak in the in what amounted to no more than a hole canoe he was using. >>

Innovation and inspiration

He is probably best remembered by the prothesis which bears his name - ‘the Kessel total shoulder replacement’6. The name is misleading as the implant was in fact an early example of what is now commonly termed a reverse shoulder replacement, (Figure 4). 46 replacements of this type are reported in the literature6,7. Prior to the Kessel prothesis poor results had been achieved with constrained implants using a traditional ball and socket orientation in rheumatoid arthritis. Concerns about the use of cement within the scapula were also starting to emerge. LipmannKessel aimed to address these by reversing the ball and socket position and by having an uncemented glenoid component. Results were mixed with early failure in some patients due to instability, and implant failure. This ultimately limited the implant’s use with none implanted after 1985. However, long term follow-up of these patients has suggested a survivorship similar to conventional anatomic prostheses of the time7 .

Other innovations included a new technique for accessing the shoulder for repair of massive rotator cuff tears – an acromial osteotomy in the coronal plane, with the advantage of avoiding compromise of the deltoid musculature8. Another used a carbon fibre, and free graft of the long head of biceps tendon to close cuff defects. Extensive contributions are also captured in the many books he authored6, 9-12 .

It is likely that he had several influences but perhaps the greatest was Valentine Ellis at St Mary’s Hospital, Paddington, London who is attributed to providing the earliest spark towards Lipmann-Kessel’s life-long interest in the shoulder6 .

Legacy

Every three years since 1980 shoulder surgeons, and other specialists in the field, meet from across the globe at The International Congress of Shoulder and Elbow Surgery (ICSES). This truly global society was conceived by LipmannKessel and has met on most of the world’s continents.

The famous Arnhem film ‘Theirs is The Glory’ ends with the words, “if ever you meet a man from Arnhem, raise your glass to drink with him”13 . On seeing this Lipmann-Kessel is reported to have remarked; “...exciting and wonderous enterprise is more profitably to be found in peaceful construction than in war. Let us not be deluded by the glory and excitement of War – it is a beastly business unbecoming to civilised man.”

Figure 5: Lipmann-Kessel’s final resting place in Municipal Cemetery North and South Oosterbeek (Airborne Cemetery), Netherlands.

(Image courtesy of Simon Hurst, London, UK).

Lipmann-Kessel was a surgeon, first and foremost. He was dedicated to alleviation of human suffering through all means, no matter how austere or dangerous the environment in which he found himself. He was beautifully human, and this quality was made greater by the hardships and challenges he faced. Many professional legacies will continue to endure, but perhaps the greatest is the example that he set (Figure 5).

WE DO NOT FORGET PROFESSOR OF ORTHOPAEDICS SURGEON TEACHER HUMANIST FIGHTER FOR FREEDOM LIPPY: REMEMBERED FOREVER BY ALL WHO LOVED YOU AND THOSE YOU SERVED n

References

References can be found online at www.boa.ac.uk/publications/JTO.