Orthopedic surgery

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Orthopedic surgery_table_infobox_0

OrthopedicsOrthopedic surgery_header_cell_0_0_0
MeSHOrthopedic surgery_header_cell_0_1_0 Orthopedic surgery_cell_0_1_1

Orthopedic surgery or orthopedics, also spelled orthopaedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgery_sentence_0

Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders. Orthopedic surgery_sentence_1

Etymology Orthopedic surgery_section_0

Further information: International scientific vocabulary and List of Greek morphemes used in English Orthopedic surgery_sentence_2

Nicholas Andry coined the word in French as orthopédie, derived from the Ancient Greek words ὀρθός orthos ("correct", "straight") and παιδίον paidion ("child"), and published Orthopedie (translated as Orthopædia: Or the Art of Correcting and Preventing Deformities in Children) in 1741. Orthopedic surgery_sentence_3

The word was assimilated into English as orthopædics; the ligature æ was common in that era for ae in Greek- and Latin-based words. Orthopedic surgery_sentence_4

As the name implies, the discipline was initially developed with attention to children, but the correction of spinal and bone deformities in all stages of life eventually became the cornerstone of orthopedic practice. Orthopedic surgery_sentence_5

Differences in spelling Orthopedic surgery_section_1

As with many words derived with the "æ" ligature, simplification to either "ae" or just "e" is common, especially in North America. Orthopedic surgery_sentence_6

In the US, the majority of college, university, and residency programs, and even the American Academy of Orthopaedic Surgeons, still use the spelling with the digraph ae, though hospitals usually use the shortened form. Orthopedic surgery_sentence_7

Elsewhere, usage is not uniform; in Canada, both spellings are acceptable; "orthopaedics" usually prevails in the rest of the British Commonwealth, especially in the UK. Orthopedic surgery_sentence_8

History Orthopedic surgery_section_2

Early orthopedics Orthopedic surgery_section_3

Many developments in orthopedic surgery have resulted from experiences during wartime. Orthopedic surgery_sentence_9

On the battlefields of the Middle Ages, the injured were treated with bandages soaked in horses' blood, which dried to form a stiff, but unsanitary, splint. Orthopedic surgery_sentence_10

Originally, the term orthopedics meant the correcting of musculoskeletal deformities in children. Orthopedic surgery_sentence_11

Nicolas Andry, a professor of medicine at the University of Paris, coined the term in the first textbook written on the subject in 1741. Orthopedic surgery_sentence_12

He advocated the use of exercise, manipulation, and splinting to treat deformities in children. Orthopedic surgery_sentence_13

His book was directed towards parents, and while some topics would be familiar to orthopedists today, it also included 'excessive sweating of the palms' and freckles. Orthopedic surgery_sentence_14

Jean-André Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. Orthopedic surgery_sentence_15

He developed the club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine. Orthopedic surgery_sentence_16

Advances made in surgical technique during the 18th century, such as John Hunter's research on tendon healing and Percival Pott's work on spinal deformity steadily increased the range of new methods available for effective treatment. Orthopedic surgery_sentence_17

Antonius Mathijsen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. Orthopedic surgery_sentence_18

Until the 1890s, though, orthopedics was still a study limited to the correction of deformity in children. Orthopedic surgery_sentence_19

One of the first surgical procedures developed was percutaneous tenotomy. Orthopedic surgery_sentence_20

This involved cutting a tendon, originally the Achilles tendon, to help treat deformities alongside bracing and exercises. Orthopedic surgery_sentence_21

In the late 1800s and first decades of the 1900s, significant controversy arose about whether orthopedics should include surgical procedures at all. Orthopedic surgery_sentence_22

Modern orthopedics Orthopedic surgery_section_4

Examples of people who aided the development of modern orthopedic surgery were Hugh Owen Thomas, a surgeon from Wales, and his nephew, Robert Jones. Orthopedic surgery_sentence_23

Thomas became interested in orthopedics and bone-setting at a young age, and after establishing his own practice, went on to expand the field into general treatment of fracture and other musculoskeletal problems. Orthopedic surgery_sentence_24

He advocated enforced rest as the best remedy for fractures and tuberculosis, and created the so-called "Thomas splint" to stabilize a fractured femur and prevent infection. Orthopedic surgery_sentence_25

He is also responsible for numerous other medical innovations that all carry his name: Thomas's collar to treat tuberculosis of the cervical spine, Thomas's manoeuvre, an orthopedic investigation for fracture of the hip joint, the Thomas test, a method of detecting hip deformity by having the patient lying flat in bed, and Thomas's wrench for reducing fractures, as well as an osteoclast to break and reset bones. Orthopedic surgery_sentence_26

Thomas's work was not fully appreciated in his own lifetime. Orthopedic surgery_sentence_27

Only during the First World War did his techniques come to be used for injured soldiers on the battlefield. Orthopedic surgery_sentence_28

His nephew, Sir Robert Jones, had already made great advances in orthopedics in his position as surgeon-superintendent for the construction of the Manchester Ship Canal in 1888. Orthopedic surgery_sentence_29

He was responsible for the injured among the 20,000 workers, and he organized the first comprehensive accident service in the world, dividing the 36-mile site into three sections, and establishing a hospital and a string of first-aid posts in each section. Orthopedic surgery_sentence_30

He had the medical personnel trained in fracture management. Orthopedic surgery_sentence_31

He personally managed 3,000 cases and performed 300 operations in his own hospital. Orthopedic surgery_sentence_32

This position enabled him to learn new techniques and improve the standard of fracture management. Orthopedic surgery_sentence_33

Physicians from around the world came to Jones’ clinic to learn his techniques. Orthopedic surgery_sentence_34

Along with Alfred Tubby, Jones founded the British Orthopaedic Society in 1894. Orthopedic surgery_sentence_35

During the First World War, Jones served as a Territorial Army surgeon. Orthopedic surgery_sentence_36

He observed that treatment of fractures both, at the front and in hospitals at home, was inadequate, and his efforts led to the introduction of military orthopedic hospitals. Orthopedic surgery_sentence_37

He was appointed Inspector of Military Orthopaedics, with responsibility for 30,000 beds. Orthopedic surgery_sentence_38

The hospital in Ducane Road, Hammersmith, became the model for both British and American military orthopedic hospitals. Orthopedic surgery_sentence_39

His advocacy of the use of Thomas splint for the initial treatment of femoral fractures reduced mortality of compound fractures of the femur from 87% to less than 8% in the period from 1916 to 1918. Orthopedic surgery_sentence_40

The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Gerhard Küntscher of Germany. Orthopedic surgery_sentence_41

This made a noticeable difference to the speed of recovery of injured German soldiers during World War II and led to more widespread adoption of intramedullary fixation of fractures in the rest of the world. Orthopedic surgery_sentence_42

Traction was the standard method of treating thigh bone fractures until the late 1970s, though, when the Harborview Medical Center group in Seattle popularized intramedullary fixation without opening up the fracture. Orthopedic surgery_sentence_43

The modern total hip replacement was pioneered by Sir John Charnley, expert in tribology at Wrightington Hospital, on England in the 1960s. Orthopedic surgery_sentence_44

He found that joint surfaces could be replaced by implants cemented to the bone. Orthopedic surgery_sentence_45

His design consisted of a stainless steel, one-piece femoral stem and head, and a polyethylene acetabular component, both of which were fixed to the bone using PMMA (acrylic) bone cement. Orthopedic surgery_sentence_46

For over two decades, the Charnley low-friction arthroplasty and its derivative designs were the most-used systems in the world. Orthopedic surgery_sentence_47

This formed the basis for all modern hip implants. Orthopedic surgery_sentence_48

The Exeter hip replacement system (with a slightly different stem geometry) was developed at the same time. Orthopedic surgery_sentence_49

Since Charnley, improvements have been continuous in the design and technique of joint replacement (arthroplasty) with many contributors, including W. H. Harris, the son of R. I. Harris, whose team at Harvard pioneered uncemented arthroplasty techniques with the bone bonding directly to the implant. Orthopedic surgery_sentence_50

Knee replacements, using similar technology, were started by McIntosh in rheumatoid arthritis patients and later by Gunston and Marmor for osteoarthritis in the 1970s, developed by Dr. John Insall in New York using a fixed bearing system, and by Dr. Frederick Buechel and Dr. Michael Pappas using a mobile bearing system. Orthopedic surgery_sentence_51

External fixation of fractures was refined by American surgeons during the Vietnam War, but a major contribution was made by Gavril Abramovich Ilizarov in the USSR. Orthopedic surgery_sentence_52

He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s. Orthopedic surgery_sentence_53

With no equipment, he was confronted with crippling conditions of unhealed, infected, and misaligned fractures. Orthopedic surgery_sentence_54

With the help of the local bicycle shop, he devised ring external fixators tensioned like the spokes of a bicycle. Orthopedic surgery_sentence_55

With this equipment, he achieved healing, realignment, and lengthening to a degree unheard of elsewhere. Orthopedic surgery_sentence_56

His Ilizarov apparatus is still used today as one of the distraction osteogenesis methods. Orthopedic surgery_sentence_57

Modern orthopedic surgery and musculoskeletal research have sought to make surgery less invasive and to make implanted components better and more durable. Orthopedic surgery_sentence_58

Training Orthopedic surgery_section_5

In the United States, orthopedic surgeons have typically completed four years of undergraduate education and four years of medical school. Orthopedic surgery_sentence_59

Subsequently, these medical school graduates undergo residency training in orthopedic surgery. Orthopedic surgery_sentence_60

The five-year residency is a categorical orthopedic surgery training. Orthopedic surgery_sentence_61

Selection for residency training in orthopedic surgery is very competitive. Orthopedic surgery_sentence_62

Roughly 700 physicians complete orthopedic residency training per year in the United States. Orthopedic surgery_sentence_63

About 10% of current orthopedic surgery residents are women; about 20% are members of minority groups. Orthopedic surgery_sentence_64

Around 20,400 actively practicing orthopedic surgeons and residents are in the United States. Orthopedic surgery_sentence_65

According to the latest Occupational Outlook Handbook (2011–2012) published by the United States Department of Labor, 3-4% of all practicing physicians are orthopedic surgeons. Orthopedic surgery_sentence_66

Many orthopedic surgeons elect to do further training, or fellowships, after completing their residency training. Orthopedic surgery_sentence_67

Fellowship training in an orthopedic subspecialty is typically one year in duration (sometimes two) and sometimes has a research component involved with the clinical and operative training. Orthopedic surgery_sentence_68

Examples of orthopedic subspecialty training in the United States are: Orthopedic surgery_sentence_69

Orthopedic surgery_unordered_list_0

  • Hand and upper extremityOrthopedic surgery_item_0_0
  • Shoulder and elbowOrthopedic surgery_item_0_1
  • Total joint reconstruction (arthroplasty)Orthopedic surgery_item_0_2
  • Pediatric orthopedicsOrthopedic surgery_item_0_3
  • Foot and ankle surgeryOrthopedic surgery_item_0_4
  • Spine surgeryOrthopedic surgery_item_0_5
  • Orthopedic oncologistOrthopedic surgery_item_0_6
  • Surgical sports medicineOrthopedic surgery_item_0_7
  • Orthopedic traumaOrthopedic surgery_item_0_8

These specialised areas of medicine are not exclusive to orthopedic surgery. Orthopedic surgery_sentence_70

For example, hand surgery is practiced by some plastic surgeons, and spine surgery is practiced by most neurosurgeons. Orthopedic surgery_sentence_71

Additionally, foot and ankle surgery is practiced by board-certified doctors of podiatric medicine (DPM) in the United States. Orthopedic surgery_sentence_72

Some family practice physicians practice sports medicine, but their scope of practice is nonoperative. Orthopedic surgery_sentence_73

After completion of specialty residency/registrar training, an orthopedic surgeon is then eligible for board certification by the American Board of Medical Specialties or the American Osteopathic Association Bureau of Osteopathic Specialists. Orthopedic surgery_sentence_74

Certification by the American Board of Orthopaedic Surgery or the American Osteopathic Board of Orthopedic Surgery means that the orthopedic surgeon has met the specified educational, evaluation, and examination requirements of the board. Orthopedic surgery_sentence_75

The process requires successful completion of a standardized written examination followed by an oral examination focused on the surgeon's clinical and surgical performance over a 6-month period. Orthopedic surgery_sentence_76

In Canada, the certifying organization is the Royal College of Physicians and Surgeons of Canada; in Australia and New Zealand, it is the Royal Australasian College of Surgeons. Orthopedic surgery_sentence_77

In the United States, specialists in hand surgery and orthopedic sports medicine may obtain a certificate of added qualifications in addition to their board primary certification by successfully completing a separate standardized examination. Orthopedic surgery_sentence_78

No additional certification process exists for the other subspecialties. Orthopedic surgery_sentence_79

Practice Orthopedic surgery_section_6

According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopedic surgeons are: Orthopedic surgery_sentence_80

Orthopedic surgery_ordered_list_1

  1. Knee arthroscopy andOrthopedic surgery_item_1_9
  2. Shoulder arthroscopy and decompressionOrthopedic surgery_item_1_10
  3. Carpal tunnel releaseOrthopedic surgery_item_1_11
  4. Knee arthroscopy and chondroplastyOrthopedic surgery_item_1_12
  5. Removal of support implantOrthopedic surgery_item_1_13
  6. Knee arthroscopy and anterior cruciate ligament reconstructionOrthopedic surgery_item_1_14
  7. Knee replacementOrthopedic surgery_item_1_15
  8. Repair of femoral neck fractureOrthopedic surgery_item_1_16
  9. Repair of trochanteric fractureOrthopedic surgery_item_1_17
  10. Debridement of skin/muscle/bone/ fractureOrthopedic surgery_item_1_18
  11. Knee arthroscopy repair of both menisciOrthopedic surgery_item_1_19
  12. Hip replacementOrthopedic surgery_item_1_20
  13. Shoulder arthroscopy/distal clavicle excisionOrthopedic surgery_item_1_21
  14. Repair of rotator cuff tendonOrthopedic surgery_item_1_22
  15. Repair fracture of radius (bone)/ulnaOrthopedic surgery_item_1_23
  16. LaminectomyOrthopedic surgery_item_1_24
  17. Repair of ankle fracture (bimalleolar type)Orthopedic surgery_item_1_25
  18. Shoulder arthroscopy and debridementOrthopedic surgery_item_1_26
  19. Lumbar spinal fusionOrthopedic surgery_item_1_27
  20. Repair fracture of the distal part of radiusOrthopedic surgery_item_1_28
  21. Low back intervertebral disc surgeryOrthopedic surgery_item_1_29
  22. Incise finger tendon sheathOrthopedic surgery_item_1_30
  23. Repair of ankle fracture (fibula)Orthopedic surgery_item_1_31
  24. Repair of femoral shaft fractureOrthopedic surgery_item_1_32
  25. Repair of trochanteric fractureOrthopedic surgery_item_1_33

A typical schedule for a practicing orthopedic surgeon involves 50–55 hours of work per week divided among clinic, surgery, various administrative duties, and possibly teaching and/or research if in an academic setting. Orthopedic surgery_sentence_81

Arthroscopy Orthopedic surgery_section_7

Main article: Arthroscopy Orthopedic surgery_sentence_82

The use of arthroscopic techniques has been particularly important for injured patients. Orthopedic surgery_sentence_83

Arthroscopy was pioneered in the early 1950s by Dr. Masaki Watanabe of Japan to perform minimally invasive cartilage surgery and reconstructions of torn ligaments. Orthopedic surgery_sentence_84

Arthroscopy allows patients to recover from the surgery in a matter of days, rather than the weeks to months required by conventional, "open" surgery; it is a very popular technique. Orthopedic surgery_sentence_85

Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today, and is often combined with meniscectomy or chondroplasty. Orthopedic surgery_sentence_86

The majority of upper-extremity outpatient orthopedic procedures are now performed arthroscopically. Orthopedic surgery_sentence_87

Arthroplasty Orthopedic surgery_section_8

Main article: Arthroplasty Orthopedic surgery_sentence_88

Arthroplasty is an orthopedic surgery where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. Orthopedic surgery_sentence_89

It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis (rheumasurgery) or some other type of trauma. Orthopedic surgery_sentence_90

As well as the standard total knee replacement surgery, the uni-compartmental knee replacement, in which only one weight-bearing surface of an arthritic knee is replaced, is a popular alternative. Orthopedic surgery_sentence_91

Joint replacements are available for other joints on a variable basis, most notably the hip, shoulder, elbow, wrist, ankle, spine, and finger joints. Orthopedic surgery_sentence_92

In recent years, surface replacement of joints, in particular the hip joint, have become more popular amongst younger and more active patients. Orthopedic surgery_sentence_93

This type of operation delays the need for the more traditional and less bone-conserving total hip replacement, but carries significant risks of early failure from fracture and bone death. Orthopedic surgery_sentence_94

One of the main problems with joint replacements is wear of the bearing surfaces of components. Orthopedic surgery_sentence_95

This can lead to damage to surrounding bone and contribute to eventual failure of the implant. Orthopedic surgery_sentence_96

Use of alternative bearing surfaces has increased in recent years, particularly in younger patients, in an attempt to improve the wear characteristics of joint replacement components. Orthopedic surgery_sentence_97

These include ceramics and all-metal implants (as opposed to the original metal-on-plastic). Orthopedic surgery_sentence_98

The plastic chosen is usually ultra high-molecular-weight polyethylene, which can also be altered in ways that may improve wear characteristics. Orthopedic surgery_sentence_99

Epidemiology Orthopedic surgery_section_9

Between 2001 and 2016, the prevalence of musculoskeletal procedures drastically increased in the U.S, from 17.9% to 24.2% of all operating-room (OR) procedures performed during hospital stays. Orthopedic surgery_sentence_100

In a study of hospitalizations in the United States in 2012, spine and joint procedures were common among all age groups except infants. Orthopedic surgery_sentence_101

Spinal fusion was one of the five most common OR procedures performed in every age group except infants younger than 1 year and adults 85 years and older. Orthopedic surgery_sentence_102

Laminectomy was common among adults aged 18–84 years. Orthopedic surgery_sentence_103

Knee arthroplasty and hip replacement were in the top five OR procedures for adults aged 45 years and older. Orthopedic surgery_sentence_104

See also Orthopedic surgery_section_10

Orthopedic surgery_unordered_list_2

Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Orthopedic surgery.