William Ward Plummer

William Ward Plummer, BL, MD, FACS, FAOA (1877–1953) was an influential American orthopaedic surgeon, educator, and national academic leader whose pioneering reconstructive procedures and institutional vision helped establish modern orthopaedic surgery in Western New York and across the United States. Celebrated for co-developing the Bartow-Plummer intra-articular silk ligament stabilization technique for flail paralytic joints in pediatric poliomyelitis, he resolved one of the most agonizing dilemmas in early twentieth-century neuromuscular surgery: how to confer structural stability upon weight-bearing extremities without sacrificing open epiphyseal growth plates through premature arthrodesis. As Professor and Head of the Department of Orthopaedic Surgery at the University of Buffalo School of Medicine, Chief Orthopaedic Surgeon at Buffalo General Hospital and Children’s Hospital of Buffalo, and 1939 President of the American Orthopaedic Association on the eve of World War II, Plummer institutionalized a voluntary clinical faculty model that endured for more than eight decades while championing early advances in internal fracture fixation, joint arthroplasty, and musculoskeletal infectious pathology.

1. The Shoulders of Giants: Historical Context & Significance

In the opening decades of the twentieth century, North American medicine was repeatedly convulsed by devastating epidemics of acute anterior poliomyelitis. Before the mid-century development of the Salk and Sabin vaccines, outbreaks—most acutely the catastrophic 1916 epidemic centered in New York—swept through urban communities with terrifying velocity, leaving thousands of infants and young children permanently disabled. The selective destruction of anterior horn alpha motor neurons in the spinal cord produced asymmetric, flaccid muscular paralysis, suddenly depriving growing limbs of the dynamic muscular forces essential for joint stabilization, joint congruency, and guided skeletal morphogenesis. Children presented to clinical wards with severe “flail” joints: hypermobile, loose extremities that buckled uncontrollably under gravitational load, culminating in progressive pelvic obliquity, severe genu recurvatum, paralytic clubfoot, calcaneocavus deformities, and total loss of independent bipedal ambulation.

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

Sir Isaac Newton (1675) / Bernard of Chartres

For the pioneering orthopaedic surgeon, managing the flail paralytic limb presented a profound and agonizing therapeutic dilemma. In adult reconstructive surgery, joint arthrodesis—rigid surgical bony fusion—served as the gold standard to convert an unstable, floppy joint into a solid, weight-bearing pillar. However, applying osseous arthrodesis to young children was fraught with disaster. Resecting articular cartilage and subchondral bone inevitably violated the open cartilaginous physes (epiphyseal growth plates), causing premature physeal arrest, severe limb shortening, and progressive angular deformities as the child grew. Furthermore, the immature, largely cartilaginous skeleton of young children demonstrated notoriously poor osteogenic fusion potential, frequently resulting in painful pseudoarthroses or recurrent fibrous deformities under the continuous deformational stresses of body weight. Conversely, lifelong dependence upon heavy, cumbersome steel-and-leather braces caused skin ulceration, muscle atrophy, and severe psychosocial disability, while remaining financially prohibitive for impoverished families.

William Ward Plummer, working in close collaboration with his esteemed mentor Dr. Bernard Bartow at the Children’s Hospital of Buffalo, broke through this therapeutic impasse by developing and popularizing the intra-articular silk ligament stabilization technique. By introducing heavy braided silk sutures across carefully drilled trans-osseous tunnels spanning the flail joint, Bartow and Plummer achieved immediate mechanical stability while stimulating an intense fibroblastic response that organized into durable, living pseudoligaments. Crucially, their technique respected articular chondrocytes and spared the epiphyseal growth plates, allowing paralyzed children to stand and ambulate without terminating longitudinal skeletal growth. Beyond his technical ingenuity in post-polio reconstruction, Plummer stood as the premier architect of academic musculoskeletal surgery in Western New York, establishing the orthopaedic department at the University of Buffalo, institutionalizing an eighty-year voluntary clinical faculty ethos, and steering national orthopaedic surgery as President of the American Orthopaedic Association in 1939 on the eve of World War II. Modern pediatric orthopaedic surgeons, ligament reconstruction pioneers, and academic leaders stand firmly upon William Ward Plummer’s shoulders.

2. Early Life, Formative Education & Career Milestones

Education and Formative Surgical Training

William Ward Plummer was born in Buffalo, New York, in 1877, raised in a bustling Great Lakes port city undergoing rapid industrialization and demographic expansion. Displaying an early dedication to classical scholarship, humane letters, and biological inquiry, Plummer pursued his collegiate education at Hobart College in Geneva, New York. There he immersed himself in the liberal arts and natural sciences, earning the degree of Bachelor of Letters (BL) with the Class of 1898. His lifelong allegiance to Hobart College and his subsequent stature as a national surgical authority led the institution to confer upon him the honorary degree of Doctor of Laws (LL.D.) in 1925, honoring his pioneering contributions to orthopaedic surgery and medical education.

Following his graduation from Hobart, Plummer returned to Western New York to matriculate at the University of Buffalo School of Medicine. During this period, American medical training was undergoing a profound scientific renaissance, adopting laboratory rigor, pathology, and formal hospital clerkships. Plummer distinguished himself through meticulous anatomical dissection, diagnostic acumen, and surgical dexterity, earning his Doctor of Medicine (MD) degree in 1902. Following his graduation, he completed demanding post-graduate hospital training in Buffalo, mastering general surgical principles, operative asepsis, and the emerging discipline of musculoskeletal trauma.

Crucial to Plummer’s professional trajectory was his formative association with Dr. Bernard Bartow (1849–1920), widely recognized as the founder of orthopaedic surgery in Western New York. Bartow had been appointed the inaugural attending orthopaedic surgeon at the Children’s Hospital of Buffalo upon its founding in 1892, becoming the first physician in the region to limit his practice exclusively to orthopaedic surgery. Bartow recognized in Plummer an extraordinary clinical intellect and surgical artisan. Entering into an enduring mentorship and clinical partnership, Plummer joined Bartow at Children’s Hospital and Buffalo General Hospital. Together, the two surgeons treated hundreds of children afflicted with congenital deformities, bone and joint tuberculosis, rickets, and post-polio paralysis, forging an innovative clinical research partnership that brought national prominence to Buffalo orthopaedics.

Academic Appointments and Clinical Leadership

In 1911, as Dr. Bartow stepped back from active university duties, Plummer was appointed Professor and Head of the Department of Orthopaedic Surgery at the University of Buffalo School of Medicine. He led the academic department with distinction for more than three decades, guiding the division through its critical transition from an informal surgical subspecialty into a fully integrated, modern academic department. Simultaneously, Plummer served as Chief Orthopaedic Surgeon at Buffalo General Hospital and Chief Orthopaedic Surgeon at the Children’s Hospital of Buffalo, establishing dedicated orthopaedic operating theaters, specialized outpatient clinics, and comprehensive rehabilitation workshops across both institutions.

Under Plummer’s guidance, the University of Buffalo instituted a remarkable academic tradition: the voluntary (unpaid) clinical faculty model. Plummer believed that academic surgeons had a solemn civic and professional obligation to teach medical students and house officers and care for the indigent without imposing a financial burden upon the university. For over eighty years, from Plummer’s foundational appointment through the mid-1960s, the entire orthopaedic faculty at the University of Buffalo served voluntarily without university salaries. This model fostered a culture of pure clinical mentorship, unselfish educational service, and surgical camaraderie that shaped generations of prominent orthopaedic surgeons throughout the United States.

Plummer’s clinical authority and organizational leadership elevated him to the highest echelons of national orthopaedic governance. He was elected a Fellow of the American College of Surgeons (FACS) in its inaugural decades and was an active, influential contributor to the American Academy of Orthopaedic Surgeons (AAOS). In 1939, his peers elected him President of the American Orthopaedic Association (AOA), the most prestigious academic orthopaedic society in North America. Presiding over the AOA on the very eve of World War II, Plummer directed national attention toward trauma preparedness, standardized fracture care, and the organization of orthopaedic military units, ensuring that American orthopaedic surgery was mobilized to confront the unprecedented reconstructive challenges of global conflict.

3. Core Orthopaedic Breakthroughs, Eponymous Signs & Innovations

William Ward Plummer’s scientific and operative legacy encompasses four foundational pillars: the development and clinical validation of the Bartow-Plummer intra-articular silk ligament procedure for paralytic joint stabilization; the original clinicopathologic delineation of primary hematogenous tuberculosis of skeletal muscle; the creation of the Buffalo voluntary clinical faculty educational framework; and the early adoption and championing of revolutionary reconstructive procedures, including Smith-Petersen femoral neck nailing, vitallium cup arthroplasty, Bankart repair, and selective partial meniscectomy.

Hallmark Anatomical, Diagnostic and Operative Contributions

• The Bartow-Plummer Intra-Articular Silk Ligament Stabilization: A pioneering operative technique utilizing heavy braided silk sutures passed through trans-osseous drill tunnels across flail, paralytic joints in poliomyelitis, inducing biological fibrous encapsulation to create durable pseudoligaments while preserving open epiphyseal growth plates in growing children.
• Clinicopathologic Delineation of Hematogenous Skeletal Muscle Tuberculosis (Tuberculous Myositis): The definitive 1934 clinicopathologic characterization of primary hematogenous tuberculosis of skeletal muscle (involving the gastrocnemius), detailing its histopathological hallmarks, clinical course, and diagnostic differentiation from soft-tissue sarcomas.
• The Buffalo Voluntary Clinical Faculty Model & Academic Orthopaedic Infrastructure: The institutional architecture at the University of Buffalo School of Medicine, Buffalo General Hospital, and Children’s Hospital of Buffalo that sustained a high-volume, eight-decade tradition of uncompensated clinical faculty dedicated to resident education, indigent care, and clinical research.
• Pioneering Adoption of Early Internal Fixation, Arthroplasty, and Meniscal Preservation: Early clinical execution and advocacy in Western New York of Smith-Petersen trifin nailing for intracapsular femoral neck fractures (1937), vitallium cup arthroplasty for osteonecrosis (1937), Bankart capsulolabral reconstruction for recurrent shoulder dislocation, and selective partial meniscectomy decades prior to the arthroscopic era.

The technical brilliance of the Bartow-Plummer intra-articular silk ligament procedure resided in its sophisticated understanding of biological tissue response to foreign implants and its strict preservation of skeletal growth biology. Prior to their work, German surgeon Fritz Lange had experimented with extra-articular silk sutures for tendon lengthening and periarticular bracing. Bartow and Plummer recognized that extra-articular placement subjected artificial cords to destructive mechanical abrasion against bony prominences and failed to reproduce the central rotational kinematics of the joint. They boldly introduced heavy braided silk directly through trans-osseous tunnels drilled across the joint articulation, placing the artificial ligaments along the exact isometric axis of the anatomic collateral or cruciate ligaments.

To execute the procedure, heavy braided Chinese or Italian silk was thoroughly boiled in paraffin or bichloride of mercury to maximize tensile durability, eliminate microscopic air pockets, and ensure absolute sterility. Through minimal arthrotomies that avoided stripping the periosteum or destroying the joint capsule, small drill tunnels were placed in adjacent bones. Crucially, Plummer recognized that the drill tunnels had to be positioned entirely within the epiphysis or angled away from the germinal layer of the physis. When the silk cords were threaded across the joint and secured under calibrated physiological tension, they immediately converted a flail, collapsing joint into a stable mechanical hinge. Over subsequent months, the silk scaffold elicited a low-grade, sterile connective tissue proliferation: fibroblasts, histiocytes, and endothelial capillaries infiltrated the interstitial spaces between the silk braids. The implant was gradually encased within dense, parallel collagen bundles, creating a living “pseudoligament” with high tensile strength that permanently stabilized the joint against gravitational subluxation while allowing normal longitudinal physeal growth to proceed unhindered.

Plummer’s scholarly impact was equally profound in musculoskeletal infectious pathology. In 1934, Plummer, together with pathologist Samuel Sanes and W. S. Smith, published in The Journal of Bone and Joint Surgery a landmark investigation entitled “Hematogenous tuberculosis of skeletal muscle: report of a case with involvement of the gastrocnemius muscle.” Striated skeletal muscle is remarkably resistant to mycobacterial colonization due to its high vascular supply, perpetual rhythmic mechanical contractility, high physiological lactic acid concentration, and complete lack of reticuloendothelial tissue. Consequently, isolated hematogenous tuberculous myositis was an exceedingly rare clinical entity that almost invariably deceived the examining surgeon, mimicking a high-grade soft-tissue sarcoma (such as rhabdomyosarcoma or fibrosarcoma), an intramuscular hematoma, or a syphilitic gumma.

Plummer and his colleagues meticulously documented the histopathology of the lesion, illustrating confluent caseating granulomas, Langhans giant cells, and epithelioid histiocytes infiltrating the interstitial endomysium and perimysium, with preservation of adjacent striated muscle fibers until terminal ischemic necrosis occurred. By demonstrating that conservative surgical debridement, tissue biopsy, acid-fast bacillus (AFB) Ziehl-Neelsen staining, and prolonged sanatorium rest could cure the condition, Plummer established an essential diagnostic paradigm that prevented surgeons from subjecting patients with atypical granulomatous muscle masses to unnecessary, mutilating radical limb amputations.

Beyond his reconstructive and pathological breakthroughs, Plummer was a relentless champion of surgical modernization. At Buffalo General Hospital in 1937, Plummer was among the very first surgeons outside Boston to adopt Marius Smith-Petersen’s trifin cannulated nail for intracapsular fractures of the femoral neck, publishing his outcomes in The Journal of Bone and Joint Surgery and transforming the prognosis of elderly hip fracture patients. That same year, he performed early vitallium cup arthroplasties for post-traumatic osteonecrosis of the femoral head and mastered the Bankart procedure for recurrent traumatic anterior glenohumeral instability. Furthermore, during an era when surgeons dogmatically performed total open meniscectomies for internal knee derangements, Plummer advocated removing only the displaced, torn bucket-handle segment of the meniscus while preserving the stable peripheral rim—an intuitive anticipation of modern arthroscopic meniscal-preserving biomechanics by more than fifty years.

4. Master Class Pro-Tip

When managing severe flail joint instability in the pediatric or adolescent neuromuscular limb, the surgeon must vigorously adhere to the biological hierarchy of skeletal preservation. Under no circumstances should formal articular arthrodesis be performed across open epiphyseal growth plates. Violating the physis to obtain osseous fusion in a growing child inevitably produces severe limb length discrepancy, progressive angular deformity, and catastrophic stump-shortening that severely compounds neuromuscular disability.

Stabilization in the skeletally immature patient must remain strictly biological or extra-physeal. When placing trans-osseous fixation, tenodeses, or ligamentous reconstructions across flail articulations, drill tunnels must be strictly mapped under fluoroscopic guidance to avoid the germinal perichondral ring (zone of Ranvier) and the central physeal plate. Calibrate tension in functional weight-bearing alignment—avoiding overconstraint that induces articular chondrolysis—and rely on biological encapsulation to create a stable soft-tissue envelope until skeletal maturity permits definitive osseous reconstruction if indicated.

Similarly, when encountering an isolated, non-tender, expanding intramuscular soft-tissue mass in an extremity, never assume malignancy without formal histopathological confirmation. While soft-tissue sarcoma is the primary differential diagnosis, rare atypical granulomatous infections—most notably primary hematogenous tuberculous myositis—can present identically on physical examination and cross-sectional imaging as a firm, infiltrative mass. Before performing radical compartmental resection or ablative amputation, execute a meticulous open incisional biopsy with frozen section, sending fresh tissue for microbiological acid-fast bacillus staining, fungal smears, and mycobacterial culture. Confirming an atypical infectious granuloma transforms a catastrophic surgical amputation into a completely curable medical and conservative surgical condition.

Master Class Surgical Pearl: Biological Stabilization of Flail Joints and Evaluation of Atypical Musculoskeletal Granulomas

5. Primary Landmark Publications & Bibliography

The foundational contributions of William Ward Plummer are preserved in these original landmark monographs and peer-reviewed surgical literature:

• Bartow B, Plummer WW. The Use of Intra-Articular Silk Ligaments for Fixation of Loose Joints in the Residual Paralysis of Anterior Poliomyelitis. Am J Orthop Surg. 1911;9(1):65-71. [Reprinted in: Buffalo Med J. 1912;67(8):433-439. PMID: 36886371. [PubMed]]
• Bartow B, Plummer WW. Further Observations on the Use of Intraarticular Silk Ligaments in the Paralytic Joints of Poliomyelitis Anterior (Second Paper). Am J Orthop Surg. 1913;10(4):499-518.
• Bartow B, Plummer WW. The Operative Procedures Employed in the Treatment of the Residual Paralysis of Poliomyelitis at the Children’s Hospital, Buffalo, N.Y. Am J Orthop Surg. 1916;14(10):594-598.
• Plummer WW, Sanes S, Smith WS. Hematogenous tuberculosis of skeletal muscle: report of a case with involvement of the gastrocnemius muscle. J Bone Joint Surg. 1934;16(3):631-639.
• In Memoriam: William Ward Plummer (1877–1953). J Bone Joint Surg Am. 1953;35(3):797-798. doi:10.2106/00004623-195335030-00040. [DOI]
• Sinha S, Pal D, Patralekh MK, Roy S, Basak A. Tuberculosis of the triceps muscle. BMJ Case Rep. 2015;2015:bcr2014207032. doi:10.1136/bcr-2014-207032. PMID: 25564636. [DOI] [PubMed]
• Mostofi SB. William Ward Plummer 1877–1953. In: Mostofi SB, ed. Who’s Who in Orthopedics. London: Springer-Verlag; 2005:272.

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, page 272) edited by Seyed B. Mostofi, BSc, MBBS, FRCS (Ed).