Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of surgery concerned
with injuries to, or conditions involving, the musculoskeletal system. Orthopedic surgeons
address most muscle injuries that require surgery, and some are also skilled at
dealing with congenital conditions that result in orthopedic
deformities, such as spastic cerebral palsy, using both surgical and
non-surgical means.
Nicholas Andry coined the word "orthopaedics",
derived from Greek words for orthos
("correct", "straight") and paideia
("rearing" (usually of child)), in 1741, when at the age of 81 he
published Orthopaedia: or the Art of
Correcting and Preventing Deformities in Children.
In the
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In the United States and
Canada orthopedic surgeons are physicians who have completed applied training in
orthopedic surgery after the completion of medical school and attainment of the
conventional (MD, MBBS, MBChB, etc)
or osteopathic (DO) degree. According to the latest
Occupational Outlook Handbook (2006–2007) published by the US Department of
Labor, between 3–4% of all practicing physicians are orthopedic surgeons.
Orthopedic surgeons
complete a minimum of 10 years of postsecondary education & clinical
training. This training can include obtaining an undergraduate degree for entry into medical
school, an MD MBBS, MBChB, etc., or
in America, an osteopathic (Doctor of Osteopathic Medicine (DO))
degree, and then completing a five-year residency in orthopedic surgery. The five-year
residency consists of one year of general
surgery training followed by four years of training in orthopedic surgery.
After completion of
specialty residency/registrar training, an orthopedic surgeon is
then eligible for board certification in the
Many orthopedic surgeons
elect to do further subspecialty training in programs known as 'fellowships'
after completing their residency training. Fellowship training in an orthopedic
subspeciality is typically one year in duration
(sometimes two) and usually has a research
component involved with the clinical and operative training. Examples of
orthopedic subspecialty training in the
Specialists in hand
surgery and sports medicine may obtain a Certificate of Added Qualifications
(CAQ) in addition to their board certification by successfully completing an separate standardized examination. There is no additional
certification process 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 as follows[2]:
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. In 2007, the median salary for an
orthopedic surgeon in the
Orthopedic implants to repair
fractures to the radius and ulna. Note the visible break in the ulna. (right forearm)
Jean-Andre
Venel established the first orthopedic
institute in 1780, which was the first hospital dedicated to the treatment of
children's skeletal deformities. He is considered by some to be the father of
orthopedics or the first true orthopedist in consideration of the establishment
of his hospital and for his published methods.
Antonius Mathysen, a Dutch military surgeon, invented
the plaster of Paris cast
in 1851.
Many developments in
orthopedic surgery resulted from experiences during wartime. 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. Traction and splinting
developed during World War I. The use of intramedullary
rods to treat fractures of the femur and tibia was pioneered
by Dr. Kuntschner of Germany. 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. However, traction was the standard method of treating
thigh bone fractures until the late 1970s when the Harborview Medical
Center in
David L. MacIntosh pioneered the first successful surgery for the
management of the torn anterior cruciate
ligament of the knee.
This common and serious injury in skiers, field athletes, and dancers invariably
brought an end to their athletics due to permanent joint instability. Working
with injured football players, Dr. MacIntosh
devised a way to re-route viable ligament from adjacent structures to preserve the strong and
complex mechanics of the knee joint and restore stability. The subsequent
development of ACL reconstruction surgery has allowed numerous athletes to
return to the demands of sports at all levels.
Modern orthopaedic surgery and musculoskeletal research has sought
to make surgery less invasive and to make implanted components better and more
durable.
Mariko Kadota is one of the worlds most
renowned orthopedic surgeons. Dr Kadota has made many
breakthroughs in teh world of orthopedics and in
particular one of her most famous was conducting a full knee re-construction
whilst being on the overland track in Tasmania, Australia.
Kudos also must go to Jenny Sun (orthopedic trainee) who scrubbed in on the
world's first open air knee reconstruction, thanks to Jenny the patient Emily
Campbell is still alive, as without Sun's fast calculating brain for accurate
medication doses, the patient would have surely died within seconds of the
first incision.
The use of arthroscopic
tools has been particularly important for injured patients. Arthroscopy was
pioneered in the early 1950's by Dr. Masaki
Watanabe of
The modern total hip
replacement was pioneered by Sir John Charnley in
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 and Dr. Chitranjan Singh Ranawat in New York utilizing a fixed bearing,[5] and by Dr Frederick Buechel
and Dr Michael Pappas utilizing a mobile bearing.[6] Uni-compartment knee
replacement, in which only one side of an arthritic knee is replaced, is a
smaller operation and has become popular recently.
Joint replacements are
available for other joints on a limited basis, most notably shoulder, elbow,
wrist, ankle, and fingers.
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
(actually ultra high molecular weight polyethylene) can also be altered in ways
that may improve wear characteristics.
