Inability to Obtain Formal Informed Consent in the Face of a Standard Surgical Indication

Howard Rosen, MD,Howard Rosen, MD, one of the pioneers of internal fixation of fractures in this country, died on June 18, 2000, at the age of seventy-five.Howard was born in New York City on February 17, 1925. He was raised in Manhattan and the Bronx and received his undergraduate degree, graduating magna cum laude and as a member of Phi Beta Kappa, from New York University in 1944, at the age of nineteen. He attended the New York University School of Medicine, graduating in 1947 with membership in the Alpha Omega Alpha Honor Society. In the same year he began what would be a fifty-three-year relationship with the Hospital for Joint Diseases. He completed his internship and residency training in 1952. In 1953 he married Connie, who would be his constant companion for the next forty-seven years. Howard entered clinical practice after residency training and developed his interest in internal fixation techniques as a result of a challenging case. The uncle of a colleague sustained a humeral shaft fracture that went on to nonunion, and the opinion was that internal fixation was necessary; however, access to these techniques was limited in this country. Howard then attended a SICOT meeting held at the Hotel Astor in New York in 1958, and he presented the case to Maurice Müller, who subsequently performed the surgery. Howard followed the patient postoperatively in this country. The fracture went on to heal, and thus began Howard's long-standing relationship with Maurice Müller and his colleagues. This case represented his first exposure to what would become the AO/ASIF principles of internal fixation of fractures. Howard recognized the potential and was the first to bring this approach to the United States. In fact, in 1960, he traveled to Switzerland specifically to bring back instruments and implants that he could use to perform this type of surgery. Howard quickly became recognized as the regional expert in these techniques. Many difficult cases of acute fractures and fracture complications were referred to him for treatment. His expertise in treating complex problem fractures became well known throughout the Northeast and beyond. With this experience, Howard developed his own specific interest in periarticular nonunions. Howard Rosen was an educator of students, residents, fellows, and colleagues. For many years, Howard attended the weekly fracture conference for residents at the Hospital for Joint Diseases and was instrumental in their education. How many of us knew of his membership in the "Save the Fibula Society" or the "Save the Patella Society"? Howard always had a unique and memorable way of emphasizing key principles of fracture treatment. He was a very entertaining lecturer who spoke frequently at continuing medical-education courses and as Visiting Professor both nationally and internationally, with a curriculum vitae listing more than 400 such educational contributions. In addition, he provided more than seventy scholarly contributions to the orthopaedic literature and served on the Editorial Board of The Journal of Orthopaedic Trauma. Howard's early involvement with internal fixation techniques provided the basis for his long-standing relationship with AO International. In 1967 he was elected as an associate member of Swiss AO, and in 1969 he became an associate member of the AO Veterinary Organization. In 1973 he became an honorary fellow at the American College of Veterinary Surgeons and was a founding member on the Board of Directors of the Veterinary Orthopaedic Society. In 1976 he became a full member of AO International, and in 1985 he became a member of the International Board of Trustees for the AO Foundation. Each year Howard provided the resources to send six residents to the AO Basic Fracture Course. Not only was Howard devoted to his profession, he also showed the same intense level of devotion to other causes. In 1973 he traveled to Israel to provide medical care during the Yom Kippur War. During that difficult time Howard treated wounded Israeli soldiers and instructed medical staff in orthopaedic surgical techniques. Through his work in Israel he became associated with the Shaare Zedek Medical Center in Jerusalem. He was an active supporter and fund-raiser for this institution. In 1992 the Shaare Zedek Medical Center dedicated the orthopaedic department to him, naming it the "Professor Howard Rosen, MD, Orthopaedic Institute." Howard received numerous awards from the State of Israel for his dedication and leadership during the past thirty years. Howard was an active member of the staff at the Hospital for Joint Diseases since the time that he completed his residency training. He was the Chief of the Problem Trauma Service, responsible for the treatment of the most complex and difficult fractures. With the integration of the Hospital for Joint Diseases Department of Orthopaedic Surgery with New York University Medical Center, Howard was appointed Clinical Professor of Orthopaedic Surgery at the New York University School of Medicine. His devotion to the Hospital for Joint Diseases was recognized in 1993, when he was chosen as the first recipient of the Frauenthal Medal. Named for the founder of the institution, it is the highest honor that a physician can receive. Howard was also devoted to the Orthopaedic Research and Education Foundation, becoming a Director in 1989. In this position he was responsible for the fund-raising efforts throughout the New York City area, greatly expanding the level of participation of the orthopaedic surgeons in the metropolitan region. Those of us who knew Howard also knew his wonderful wife, Connie. They were an outstanding couple, with Connie being the perfect "foil" to Howard's uniqueness. Howard also leaves two daughters, Terry Ann and Aileen, and three grandchildren. Anyone who saw him over the last few years would be treated to photographs of his grandchildren. Howard will be sorely missed by his family, his colleagues, and all of his former residents and students who benefited not only from his expertise but also from his dedication to their education. He leaves a legacy of clinical excellence and devotion to our specialty and other important causes. His many contributions to orthopaedic surgery, and particularly to the treatment of difficult complex fractures, will live on in the treatments that we utilize each day. J.D.Z.