Etiology of Congenital Dislocation of the Hip: Carl E. Badgley MD (1893–1973) The 11th President of the AAOS 1942

Dr. Carl E. Badgley was born in 1893, the son of a Presbyterian minister [2]. He received his medical degree at the University of Michigan in 1919, and became interested in orthopaedic surgery owing to Drs. Hugh Cabot and LeRoy Abbott. He was appointed as an instructor of surgery in 1920 and was appointed professor and head of the Section of Orthopaedic Surgery in 1932, an appointment he retained until 1963 when he retired. Dr. Badgley, devoted to his home state, was active in organizing institutions and organizations within Michigan. These included the Rackham Arthritis Research Unit within the hospital devoted exclusively to arthritis research and the Michigan Crippled Children Commission. He was active in the Board of Control of Intercollegiate Athletics. As President of the AAOS in 1942, he faced challenges organizing the 1943 meeting owing to the war years and many parts of the social program, particularly for the spouses, were eliminated [3]. (Travel was limited in part due to rationing of gas and a reduction in some public transportation since the war effort had priority on petroleum products.) Of the 235 members and 461 guests attending the 11(th) Annual Meeting in 1943, 203 of the men were in the military service. Nonetheless, during his year of Presidency of the AAOS, Instructional Course Lectures (13 courses) were introduced at the 1942 annual meeting (at a cost of $1.00 per course) and were an immediate success [3]. They were first published the following year (1943) by J.W. Edwards Co., of Ann Arbor, Michigan (who continued to publish the ICL through 1958), under the editorship of a future AAOS President, Dr. Tommy Thomson. The article we reproduce here details the two major theories of congenital dislocation of the hip: “a primary germinal fault…(and)…a defect of development of environmental origin” [1]. As a true scientist, he commented, “The most commonly accepted theory of developmental abnormality is a primary failure of proper formation of the acetabulum, particularly a germinal failure of development of the posterior superior buttress of the ilium…It is difficult to see how an observer, unless influenced by the weight of pre-existing statements and concepts, can authoritatively state a hypothesis as an accepted fact. The author denies dogmatically, for example, that there is scientific evidence of a primary genetic developmental fault of the posterior superior portion of the acetabulum. He does not refute the existence of such a lesion, but contends that no satisfactory evidence has been submitted that this lesion is the primary developmental fault.” How often do we make our judgments based on the “weight of preexisting statements,” rather than compelling observations and data? Also as a true scientist, his thorough review leads to and ends with a hypothesis: “Congenital dislocation and congenital dysplasia of the hip may be regarded as the result of faulty development, due to environmental factors extrinsic to the hip joint. An inherited fault in the timing of development may produce these extrinsic changes… Heredity can play an important part in altering the growth and time factors.” Despite astonishing technical advances, we have the same working hypothesis today and DDH may indeed be related to the timing of genetically controlled events in conjunction with external factors; the details of the genetic factors are being explored with tools not available to Dr. Badgley, but we seem no closer to the larger answer. [Figure: see text] References 1. Badgley CE. Etiology of congenital dislocation of the hip. J Bone Joint Surg Am. 1949;31:341–356. 2. Carl E. Badgley, M.D. 1893–1973. J Bone Joint Surg Am. 1973;55:1112–1113. 3. Heck CV. Fifty Years of Progress: In Recognition of the 50th Anniversary of the American Academy of Orthopaedic Surgeons. Chicago, IL: American Academy of Orthopaedic Surgeons; 1983.