As a young man he dreamed of becoming a medical missionary, healing the sick and spreading his practical Christian faith in foreign fields, patient by patient and soul by soul. Instead, Robert Salter became one of the most famous orthopedic surgeon in the world, making a difference on a grand scale by healing the deformed and injured limbs of millions of children, inventing surgical methods and equipment that revolutionized orthopedic surgery, circling the globe to impart his medical know-how in more than 30 countries and training hundreds of visiting doctors at the Hospital for Sick Children in Toronto so that they could take his mentoring, his procedures and his practices home with them.
During a more than 50-year career as a pediatric orthopedic surgeon, Dr. Salter developed a surgical procedure to fix congenital deformities of the hip. It was called the Salter innominate osteotomy for hip dysplasia (although he preferred to call it the "no name, no fame" operation). Dr. Salter over-rode centuries of medical theory that said broken limbs needed to be immobilized in rigid casts for prolonged periods and he invented a postoperative apparatus called the continuous passive motion machine (CPM), which to date has been used by nine million patients. Besides the Salter-Harris classification of growth plate injuries, he wrote the authoritative orthopedic textbook, Disorders and Injuries of the Musculoskeletal System, which is used throughout the world. Dr. Salter was making revisions for the fifth edition when he died, aged 85, from complications of Parkinson's disease in Toronto on May 10.
He was "the late 20th-century icon" of orthopedic surgery, says John Wedge, former surgeon-in-chief at the Hospital for Sick Children and one of some 300 surgical fellows who came to Toronto specifically to train under Dr. Salter. A decisive, determined and driven individual, Dr. Salter was also inspiring, quick witted and humble enough to tell stories on himself. "Everything he did was for a purpose and it was always for a noble purpose," said Dr. Wedge. In the end, he wanted to be remembered "as a surgeon who treated children," a doctor who helped children overcome congenital deformities and grow straighter and taller after devastating injuries.
One of those patients was Colleen Beanish, now a special-education consultant with the Ottawa Catholic School Board. Born in 1961 in Ottawa with a congenital dislocated hip, she was confined in a body cast from 18 months until she turned 3. By the time she was 10, she was limping and in pain. After a failed procedure, she was sent to Dr. Salter the following year. "I trusted him completely from the first," she said of the surgeon who operated on her several times over the ensuing years, including a hip replacement at age 30. "He always spoke to the child before the parents," she said. "He explained everything, he never lied and he always held my hand while the anesthetic was taking effect." Today she "gives him credit for being able to walk unassisted," but what she remembers more than anything was the way he always made time for her and her children and the way he said goodbye at the end of each medical appointment. "Friends for life," he invariably said, a mantra he exchanged with each and every one of his small patients.
As a young resident from Saskatchewan in the early 1970s, Dr. Wedge saw his future mentor in action at a major conference in the United States. Dr. Salter was making a presentation on growth-plate injuries to illustrate the principles of the Salter-Harris classification system. The patient, a four-year-old boy from rural Ontario, had been run over by a lawn mower, suffering devastating injuries to his lower leg and ankle. Fixing the broken bones and damaged joints was one thing, but Dr. Salter also devised an unorthodox treatment that allowed the bones to grow normally so that the little boy, who at best should have become lame, walked normally on legs of equal length.
Even before the slide show was finished, the audience roared with enthusiastic applause, all except a rival researcher from Harvard who was "not familiar with being upstaged," according to the eulogy Dr. Wedge delivered for his supervisor-turned-friend. "Salter, you were very lucky to get away with how you treated that boy - you must have a four-leaf clover up your ass," Dr. Wedge recalls him saying in the panel discussion that followed the presentation. To which Dr, Salter flashed back: "No, we Canadians excel in practical solutions based on principles established from careful research. ... It isn't a four-leaf clover stuck up there, but rather ... a maple leaf."