Leslie V Rush

Leslie Vaughan Rush, MD, FACS (February 16, 1905 – February 8, 1987) was an American orthopaedic surgeon, mechanical innovator, and surgical pioneer whose groundbreaking introduction of dynamic intramedullary pinning fundamentally transformed fracture osteosynthesis in the twentieth century. Practicing in Meridian, Mississippi, at the Rush Memorial Infirmary (later Rush Foundation Hospital), he performed the first known intramedullary bone pinning in the United States in September 1936, fashioning a pre-curved stainless steel rod with a beveled “sled-runner” tip to stabilize a severely shattered ulna. In collaboration with his brother, Dr. Hakewill Lowry Rush, he systematized the biomechanical principle of dynamic three-point fixation, demonstrating that a resilient, round metallic pin acting as an internal leaf spring could resist angular and shearing displacement while preserving physiological axial micro-motion and protecting endosteal blood supply. His invention of the self-guiding Rush pin, the founding of the Berivon Company to manufacture specialized instrumentation, and the publication of his globally acclaimed Atlas of Rush Pin Technics established a versatile, tissue-preserving surgical system that was adopted by the United States Armed Forces during the Korean War and remains an foundational pillar of elastic intramedullary fracture fixation.

1. The Shoulders of Giants: Historical Context & Significance

In the early twentieth century, the operative management of skeletal trauma was fraught with severe technical limitations, dogmatic conservatism, and devastating clinical complications. For fractures of the long bones—most notably the femur, tibia, humerus, and forearm—orthopaedic practice was dominated by prolonged external immobilisation. Patients with displaced diaphyseal fractures were subjected to continuous skeletal traction, heavy Thomas splints, or cumbersome plaster of Paris spicas spanning multiple joints. This enforced recumbency often lasted three to six months. In agricultural communities such as rural Mississippi during the Great Depression, long hospital confinements inflicted catastrophic financial ruin upon working families. Furthermore, prolonged immobility exacted a severe physiological toll: recumbency pneumonia, pressure decubitus ulcers, profound muscle atrophy, severe joint arthrofibrosis (“fracture disease”), deep vein thrombosis, and fatal pulmonary embolism were pervasive hazards.

Early attempts at open internal fixation provided little salvation. Rigid metallic plates, such as those introduced by Albin Lambotte and Sir William Arbuthnot Lane, required extensive open exposure, devitalizing stripping of the periosteum, and substantial soft-tissue dissection. In the pre-antibiotic era, this extensive surgical exposure produced catastrophic deep infection and chronic osteomyelitis rates exceeding twenty percent. Furthermore, early metallurgical alloys were chemically reactive and brittle, leading to rampant screw loosening, plate breakage, and nonunion. When internal fixation failed, the resulting infected nonunions frequently necessitated limb amputation. Orthopaedic surgeons were trapped between the disabling morbidity of chronic traction and the catastrophic infection risks of extensive open plating.

“If I have seen further, it is by standing on the shoulders of giants.”

Sir Isaac Newton (1675) / Bernard of Chartres

Leslie Vaughan Rush pioneered a radical conceptual breakthrough that bridged this historical chasm: dynamic intramedullary fixation. While European contemporaries like Gerhard Küntscher in Germany were working toward rigid, massive intramedullary nailing that relied on reaming the endosteal canal to jam a large cloverleaf nail into cortical bone, Rush recognized the profound biological advantages of a flexible, resilient, unreamed metallic rod. Operating in a community hospital in Meridian, Mississippi, Rush understood that biological bone healing does not require absolute rigidity or the destruction of the medullary vascular tree. Instead, he proposed that a pre-bent, elastic round rod could be inserted through a minimal, remote cortical window, guided across the fracture site without disturbing the osteogenic fracture hematoma, and seated to provide dynamic three-point elastic stability.

Rush’s surgical philosophy prioritized the preservation of skeletal biology. By preserving the periosteal sleeve and sparing the endosteal circulation from aggressive reaming, his method stimulated exuberant, rapid secondary periosteal callogenesis. Patients who had previously faced six months of skeletal traction or disabling plaster casting were able to mobilize adjacent joints immediately and bear weight within days of surgery. Rush’s work laid the conceptual and biomechanical foundation for modern biological osteosynthesis, anticipating by decades the development of flexible elastic stable intramedullary nailing (ESIN) and unreamed locked nailing. Modern orthopaedic trauma surgeons practicing closed, biology-preserving fracture care stand directly upon the shoulders of Leslie V. Rush.

2. Early Life, Formative Education & Career Milestones

Leslie Vaughan Rush was born in Meridian, Mississippi, on February 16, 1905. He was born into an illustrious Southern medical dynasty established by his father, Dr. Jesse Hackley Rush (affectionately known as “Dr. Hack” Rush), and his uncle, Dr. James Calvin Rush. On February 15, 1915—the day preceding Leslie’s tenth birthday—Dr. Hack Rush founded Rush’s Infirmary in downtown Meridian, establishing the first private surgical hospital in east-central Mississippi. Growing up within the environs of the hospital, Leslie was immersed in the realities of surgical practice from early childhood, developing a natural mechanical aptitude and a profound empathy for the hardworking agrarian population of the Deep South.

Following primary and secondary education in Meridian, Rush enrolled in the Tulane University School of Medicine in New Orleans, Louisiana, one of the premier centers of surgical training in the United States. At Tulane, Rush distinguished himself academically and socially, joining the Sigma Alpha Epsilon fraternity and the Phi Chi medical fraternity. He graduated with his Doctor of Medicine (MD) degree in 1927. Rather than pursuing an academic surgical appointment in a major metropolitan center, Rush returned home to Meridian in 1927 to join his father and his elder brother, Dr. Hakewill Lowry Rush (1891–1965), on the surgical staff of Rush’s Infirmary.

The partnership between Leslie and H. Lowry Rush proved exceptionally fertile. The brothers functioned as a seamless surgical team, confronting high volumes of complex acute trauma resulting from sawmill injuries, railroad accidents, and agricultural mishaps. Recognizing the acute shortage of trained nurses in Mississippi, Leslie Rush collaborated in 1944 with hospital superintendent Catherine Hovious and Meridian Public Schools superintendent Dr. H. M. Ivey to establish a joint collegiate nursing program with Meridian Junior College. This initiative created the first junior college and hospital-affiliated nursing training program in Mississippi, establishing a pipeline of skilled surgical nurses that elevated regional clinical standards for decades.

Throughout the 1930s, 1940s, and 1950s, Dr. Rush expanded Rush’s Infirmary into a major regional tertiary care referral center, which was subsequently renamed the Rush Foundation Hospital. Despite operating outside the traditional university academic orthopaedic elite, Rush’s relentless mechanical ingenuity, clinical documentation, and meticulous follow-up transformed Meridian into an international destination for surgeons seeking to master the principles of intramedullary fixation. Rush maintained an active clinical practice and research output until his retirement, remaining a dedicated Fellow of the American College of Surgeons (FACS) until his death in Meridian on February 8, 1987, at the age of eighty-one.

3. Core Orthopaedic Breakthroughs, Eponymous Innovations & Surgical Philosophy

The Genesis of the Rush Pin: The September 1936 Breakthrough

The turning point in Leslie V. Rush’s surgical career occurred in September 1936. A thirty-one-year-old surgeon at the time, Rush was presented with a young local farmer who had sustained a severe, highly comminuted fracture of the proximal third of the ulna associated with extensive soft-tissue contusion and acute instability. Traditional closed reduction and plaster splinting were completely incapable of controlling the shattered ulnar fragments, while conventional open plating carried an unacceptable risk of devitalizing the bone fragments and causing acute wound breakdown.

Confronted with this dilemma, Rush retreated to his workshop. He selected a length of solid, malleable stainless steel wire rod, ground one end into a gentle, beveled “sled-runner” point, and fashioned a hooked driving head at the opposing end. Operating through a small incision over the subcutaneous surface of the olecranon apophysis, Rush drilled an oblique cortical hole into the medullary canal. He introduced the beveled rod down the canal, using gentle mallet taps to steer the pin across the comminuted fracture zone under fluoroscopic and tactile guidance. The sled-runner tip glanced smoothly off the endosteal cortices without penetrating the opposite bone wall, threading the shattered fragments onto the metallic rod like beads on a string. The hooked head was seated securely against the proximal olecranon cortex.

The clinical result was sensational: the patient experienced immediate relief of muscular spasm, the comminuted fragments were perfectly aligned, and no external plaster cast was required. The patient began active flexion and extension of the elbow on the first postoperative day and achieved solid radiographic osseous union within six weeks, returning to heavy farm labor without joint stiffness or deformity. In 1937, Leslie and H. Lowry Rush published this landmark case in The American Journal of Surgery under the title “A reconstruction operation for comminuted fracture of the upper third of the ulna,” marking the inaugural publication and clinical demonstration of dynamic intramedullary pinning in North American surgical history.

Biomechanical Principles: Dynamic Three-Point Fixation vs. Rigid Reamed Nails

Following their initial ulnar success, the Rush brothers systematically extended intramedullary pinning to other long bones, refining both the implant metallurgy and the fundamental mechanical principles governing its function. Leslie Rush articulated the governing biomechanical concept: Dynamic Three-Point Fixation. He recognized that a round metallic pin introduced into a cylindrical, curved medullary canal must not attempt to fill the canal completely or lock rigidly through endosteal reaming. Instead, by pre-bending the elastic pin into a parabolic curve prior to insertion, the implant acts as an active internal leaf spring.

Upon insertion across the fracture site, the pre-curved pin establishes continuous, resilient contact at three distinct biomechanical points:

• Point 1 (Cortical Entry Portal): The angled entry portal, where the hooked head exerts compressive force against the near cortex;
• Point 2 (Fulcrum of the Opposite Cortex): The apex of the pre-bent curve, which presses firmly against the opposite endosteal cortex at or immediately adjacent to the fracture zone;
• Point 3 (Distal Cortical Contact): The distal endosteal cortex of the opposing fragment, where the sled-runner tip anchors firmly against the far wall.

This three-point spring load generates continuous dynamic radial pressure that counteracts bending and shearing forces. Crucially, because the rod is smooth and round, it allows physiological axial loading and controlled micro-motion across the fracture gap during early weight-bearing. In accordance with Wolff’s law and Perren’s strain theory, this controlled axial micro-motion stimulates robust, circumferential periosteal callogenesis. Unlike the rigid cloverleaf nail of Gerhard Küntscher, which required extensive medullary reaming that destroyed the nutrient artery and endosteal microcirculation, Rush pinning preserved the endosteal blood supply, virtually eliminating the dreaded complications of reamer-induced thermal cortical necrosis and widespread intramedullary sepsis.

Anatomical Applications: From the Ulna to the Femur, Humerus, and Distal Radius

Between 1937 and 1955, Leslie Rush expanded the application of the Rush pin across virtually every major bone of the human appendicular skeleton, designing specialized diameters, lengths, and pre-curvature profiles for each anatomical site:

• The Femur: For diaphyseal and distal femoral fractures, Rush pioneered dual opposing pinning. By introducing one pre-curved pin through the medial femoral condyle and a second through the lateral femoral condyle, the two rods crossed in the distal shaft and diverged proximally, creating an elastic triangular truss that provided exceptional rotational and angular stability for distal third supracondylar fractures. In 1968, Rush published his thirty-year retrospective in Clinical Orthopaedics and Related Research, demonstrating superior union rates and minimal joint stiffness in over three decades of femoral pinning;
• The Humerus: For proximal humerus fractures and unstable humeral shaft injuries, Rush introduced retrograde pinning through the lateral supracondylar ridge and antegrade pinning through the greater tuberosity. His techniques preserved the rotator cuff footprint and avoided radial nerve injury, achieving predictable healing in complex osteoporotic fractures;
• The Forearm (Radius & Ulna): Rush perfected antegrade olecranon pinning for the ulna and retrograde styloid pinning for the radius. His methods restored the radial bow and interosseous space without requiring wide surgical exposure of the interosseous membrane, preserving full forearm pronation and supination;
• The Distal Radius (Colles’ Fracture): In 1954, Rush described closed medullary pinning of unstable Colles’ fractures, utilizing a small pre-curved pin driven percutaneously from the radial styloid into the proximal diaphysis to prevent dorsal collapse and radial shortening in elderly patients;
• The Clavicle & Fibula: Rush pins provided minimally invasive, percutaneous stabilization for displaced midshaft clavicle fractures and lateral malleolar fibular fractures, preventing soft-tissue complications over subcutaneous bony prominences.

The Berivon Company, Military Adoption in the Korean War, and Global Dissemination

To ensure absolute metallurgical purity and precise dimensional tolerances, Dr. Rush founded the Berivon Company in Meridian, Mississippi. The company name was a poignant familial portmanteau derived from the names of his two children: Beryl and Vaughan. Operating as a specialized family enterprise with fewer than ten dedicated craftsmen and no commercial sales force, Berivon manufactured cold-drawn Type 316L stainless steel Rush pins, specialized driving mallets, impactors, awls, countersupport benders, and hook extractors. Despite its modest operational footprint, Berivon shipped tens of thousands of pins annually to hospitals across North America, Europe, Asia, and Latin America.

A pivotal national milestone occurred during the Korean War (1950–1953). United States military surgeons stationed in field evacuation hospitals were inundated with high-energy combat casualties suffering severe blast and ballistic extremity fractures. Traditional management with prolonged continuous skeletal traction on Thomas splints was tactically impossible during air and sea evacuation, leading to frequent loss of reduction, pin-site infections, and severe joint contractures. In 1951, the United States Department of Defense officially adopted Rush pins for military combat casualty care. Forward surgical teams utilized Rush pins to rapidly stabilize femoral, tibial, and upper extremity fractures under field conditions, permitting immediate, secure evacuation of wounded soldiers without bulky skeletal traction rigs.

In 1955, Dr. Rush codified his lifetime surgical experience in his definitive monograph, Atlas of Rush Pin Technics: A System of Fracture Treatment. Illustrated with hundreds of meticulous hand-drawn anatomical diagrams, intraoperative photographs, and serial radiographs, the atlas became an instant international classic. It was translated into German and published by Springer-Verlag in 1957 as Atlas der Intramedullären Frakturfixation nach Rush, establishing Rush as one of the preeminent international authorities on fracture care and cementing his legacy across both hemispheres.

4. Master Class Pro-Tip: Surgical Pearls for Dynamic Intramedullary Pinning

Intraoperative Pearls for Three-Point Dynamic Pinning: Successful intramedullary stabilization with a flexible round rod demands strict adherence to three fundamental mechanical rules: entry portal geometry, parabolic pre-curvature, and tactile rotational control. First, the cortical entry portal must always be created at an oblique angle of thirty to forty-five degrees relative to the long axis of the diaphysis; a perpendicular entry hole will cause the advancing pin to impinge against the far cortex and buckle or shatter the cortical cortex upon insertion. Second, never insert a straight pin; the rod must be manually contoured into a smooth, gentle parabolic curve prior to driving. The degree of curvature should be calculated such that the apex of the curve contacts the opposite endosteal cortex directly at the level of the fracture, creating an elastic spring load that continuously compresses the fracture gap and prevents angular toggle. Third, always utilize the beveled sled-runner tip to guide the pin across the fracture zone under gentle mallet taps; never force an unyielding rod across an unreduced cortex. If resistance is encountered, rotate the driving head one hundred eighty degrees to allow the beveled sled-runner to glance off the endosteal wall and glide smoothly into the opposing medullary canal. Finally, ensure the hooked head is seated flush against the cortical entry portal without proud protrusion to prevent painful soft-tissue impingement and bursa formation beneath overlying subcutaneous tissues.

Master Class Surgical Pearl: Dynamic Intramedullary Pinning & Three-Point Fixation

5. Landmark Publications & Primary Bibliography

• Rush LV, Rush HL. A reconstruction operation for comminuted fracture of the upper third of the ulna. Am J Surg. 1937;38(2):332-333. doi:10.1016/s0002-9610(37)90442-2. [DOI]
• Rush LV. Dynamic intramedullary fracture-fixation of the femur: Reflections on the use of the round rod after 30 years. Clin Orthop Relat Res. 1968;60:21-27. doi:10.1097/00003086-196809000-00004. [DOI]
• Rush LV. Atlas of Rush Pin Technics: A System of Fracture Treatment. South Med J. 1956;49(7):800. doi:10.1097/00007611-195607000-00026. [DOI]
• Rush LV. Atlas der Intramedullären Frakturfixation nach Rush. Berlin, Heidelberg: Springer-Verlag; 1957. doi:10.1007/978-3-642-93602-9. [DOI]
• Weseley MS, Barenfeld PA. Rush pin intramedullary fixation for fractures of the proximal humerus. J Trauma. 1977;17(1):29-37. doi:10.1097/00005373-197701000-00004. [DOI]
• Mostofi SB. Leslie V. Rush 1905–. In: Mostofi SB, ed. Who’s Who in Orthopedics. London: Springer-Verlag; 2005:291-292. doi:10.1007/1-84628-070-2_218. [DOI]

6. Biographical Provenance & Acknowledgments

This historical biography was synthesized for the OrthopaedicsOne Knowledge Network as part of A Who’s Who of Orthopaedics, adapted and expanded from the foundational biographical directory Who’s Who in Orthopedics (Springer-Verlag London) edited by Seyed B. Mostofi, BSc, MBBS, FRCS (Ed).