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.
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.
Differences in spelling
As with many words derived with the "æ" ligature, simplification to either "ae" or just "e" is common, especially in North America.
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.
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.
Many developments in orthopedic surgery have resulted from experiences during wartime.
Originally, the term orthopedics meant the correcting of musculoskeletal deformities in children.
He advocated the use of exercise, manipulation, and splinting to treat deformities in children.
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.
Jean-André Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities.
He developed the club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine.
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.
Until the 1890s, though, orthopedics was still a study limited to the correction of deformity in children.
One of the first surgical procedures developed was percutaneous tenotomy.
This involved cutting a tendon, originally the Achilles tendon, to help treat deformities alongside bracing and exercises.
In the late 1800s and first decades of the 1900s, significant controversy arose about whether orthopedics should include surgical procedures at all.
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.
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.
Thomas's work was not fully appreciated in his own lifetime.
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.
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.
He had the medical personnel trained in fracture management.
He personally managed 3,000 cases and performed 300 operations in his own hospital.
This position enabled him to learn new techniques and improve the standard of fracture management.
Physicians from around the world came to Jones’ clinic to learn his techniques.
Along with Alfred Tubby, Jones founded the British Orthopaedic Society in 1894.
During the First World War, Jones served as a Territorial Army surgeon.
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.
He was appointed Inspector of Military Orthopaedics, with responsibility for 30,000 beds.
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.
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.
He found that joint surfaces could be replaced by implants cemented to the bone.
For over two decades, the Charnley low-friction arthroplasty and its derivative designs were the most-used systems in the world.
This formed the basis for all modern hip implants.
The Exeter hip replacement system (with a slightly different stem geometry) was developed at the same time.
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.
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.
He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s.
With no equipment, he was confronted with crippling conditions of unhealed, infected, and misaligned fractures.
With the help of the local bicycle shop, he devised ring external fixators tensioned like the spokes of a bicycle.
With this equipment, he achieved healing, realignment, and lengthening to a degree unheard of elsewhere.
Modern orthopedic surgery and musculoskeletal research have sought to make surgery less invasive and to make implanted components better and more durable.
In the United States, orthopedic surgeons have typically completed four years of undergraduate education and four years of medical school.
Subsequently, these medical school graduates undergo residency training in orthopedic surgery.
The five-year residency is a categorical orthopedic surgery training.
Selection for residency training in orthopedic surgery is very competitive.
Roughly 700 physicians complete orthopedic residency training per year in the United States.
About 10% of current orthopedic surgery residents are women; about 20% are members of minority groups.
Around 20,400 actively practicing orthopedic surgeons and residents are in the United States.
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.
Many orthopedic surgeons elect to do further training, or fellowships, after completing their residency training.
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.
Examples of orthopedic subspecialty training in the United States are:
- Hand and upper extremity
- Shoulder and elbow
- Total joint reconstruction (arthroplasty)
- Pediatric orthopedics
- Foot and ankle surgery
- Spine surgery
- Orthopedic oncologist
- Surgical sports medicine
- Orthopedic trauma
These specialised areas of medicine are not exclusive to orthopedic surgery.
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.
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.
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.
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.
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.
No additional certification process exists for the other subspecialties.
According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopedic surgeons are:
- Knee arthroscopy and
- Shoulder arthroscopy and decompression
- Carpal tunnel release
- Knee arthroscopy and chondroplasty
- Removal of support implant
- Knee arthroscopy and anterior cruciate ligament reconstruction
- Knee replacement
- Repair of femoral neck fracture
- Repair of trochanteric fracture
- Debridement of skin/muscle/bone/ fracture
- Knee arthroscopy repair of both menisci
- Hip replacement
- Shoulder arthroscopy/distal clavicle excision
- Repair of rotator cuff tendon
- Repair fracture of radius (bone)/ulna
- Repair of ankle fracture (bimalleolar type)
- Shoulder arthroscopy and debridement
- Lumbar spinal fusion
- Repair fracture of the distal part of radius
- Low back intervertebral disc surgery
- Incise finger tendon sheath
- Repair of ankle fracture (fibula)
- Repair of femoral shaft fracture
- Repair of trochanteric fracture
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.
Main article: Arthroscopy
The use of arthroscopic techniques has been particularly important for injured patients.
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.
Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today, and is often combined with meniscectomy or chondroplasty.
The majority of upper-extremity outpatient orthopedic procedures are now performed arthroscopically.
Main article: Arthroplasty
Arthroplasty is an orthopedic surgery where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure.
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.
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.
Joint replacements are available for other joints on a variable basis, most notably the hip, shoulder, elbow, wrist, ankle, spine, and finger joints.
In recent years, surface replacement of joints, in particular the hip joint, have become more popular amongst younger and more active patients.
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.
One of the main problems with joint replacements is wear of the bearing surfaces of components.
This can lead to damage to surrounding bone and contribute to eventual failure of the implant.
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.
These include ceramics and all-metal implants (as opposed to the original metal-on-plastic).
The plastic chosen is usually ultra high-molecular-weight polyethylene, which can also be altered in ways that may improve wear characteristics.
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.
In a study of hospitalizations in the United States in 2012, spine and joint procedures were common among all age groups except infants.
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.
Laminectomy was common among adults aged 18–84 years.
Knee arthroplasty and hip replacement were in the top five OR procedures for adults aged 45 years and older.
- Outline of trauma and orthopedics
- Index of trauma and orthopaedics articles
- Bone grafting
- List of orthopedic implants
Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Orthopedic surgery.