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This fracture of the lower cervical vertebrae, known as a 'teardrop fracture' is one of the conditions treated by orthopaedic surgeons.
This fracture of the lower cervical vertebrae, known as a 'teardrop fracture' is one of the conditions treated by orthopaedic surgeons.
This image, taken in September 2006, shows extensive repair work to the right acetabulum 6 years after it was carried out (2000). Further damage to the joint is visible due to the onset of arthritis.
This image, taken in September 2006, shows extensive repair work to the right acetabulum 6 years after it was carried out (2000). The acetabulum is a concave surface of the Pelvis. The head of the femur meets with the pelvis at the acetabulum forming the hip Joint Further damage to the joint is visible due to the onset of arthritis.

Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of surgery concerned with acute, chronic, traumatic, overuse injuries and other disorders of the musculoskeletal system. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental In Medicine, an acute disease is a disease with either or both of a rapid onset a short course (as opposed to a chronic course In Medicine, a chronic disease is a Disease that is long-lasting or recurrent Treatment of physical trauma is described here and in First aid. Injury or bodily injury is Damage or Harm caused to the Structure or function of the Body caused by an outside agent or The musculoskeletal system (also known as the locomotor system is an organ system that gives Animals the ability to physically move using the Muscles and Orthopedic surgeons address most musculoskeletal ailments including arthritis, trauma and congenital deformities using both surgical and non-surgical means. Arthritis (from Greek arthro-, joint + -itis, inflammation plural arthritides is a group of conditions involving damage to the Joints of the body Treatment of physical trauma is described here and in First aid. A congenital disorder is a disease or disorder that is present at birth 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. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly A word is a unit of Language that carries meaning and consists of one or more Morphemes which are linked more or less tightly together and has a Phonetic Year 1741 ( MDCCXLI) was a Common year starting on Sunday (link will display the full calendar of the Gregorian calendar (or a Common year

In the US the spelling orthopedics is standard, although the majority of university and residency programs, and even the AAOS, still use Andry's spelling. Elsewhere, usage is not uniform; in Canada, both spellings are common; orthopaedics usually prevails in the rest of the Commonwealth, especially in Britain.

Contents

Training

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. A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health Doctor of Medicine ( MD or MD, from the Latin Medicinæ Doctor meaning "Teacher of Medicine" is a doctoral 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 (also known as orthopedists or orthopods) complete a minimum of 10 years of postsecondary education and clinical training. Higher education is Education that is provided by universities, vocational universities, Community colleges Liberal arts colleges In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will however admit students with as little as two years of previous undergraduate education), either an MD MBBS, MBChB, etc) or osteopathic (DO) degree, and then completing a five-year residency in orthopedic surgery. In some Educational systems undergraduate education is Post-secondary education up to the level of a Bachelor's degree. Medical education A medical school or faculty of medicine is a Tertiary educational institution—or part of such an institution—that teaches Medicine Doctor of Medicine ( MD or MD, from the Latin Medicinæ Doctor meaning "Teacher of Medicine" is a doctoral Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a Medical degree ( MD The five-year residency consists of one year of general surgery training followed by four years of training in orthopedic surgery. Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a Medical degree ( MD

After completion of specialty residency/registrar trainng, an orthopedic surgeon is then eligible for board in the United States. Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a Medical degree ( MD A specialist registrar or SpR is a doctor in the United Kingdom who is receiving advanced training in a specialist field of Medicine in order eventually The American Board of Medical Specialties ( ABMS) is a non-profit Physician -led Umbrella organization for 24 of the 26 approved medical specialty In Canada it leads to eligibility for Certification by and Fellowship of the Royal College of Physicians and Surgeons of Canada. The Royal College of Physicians and Surgeons of Canada, (RCPSC is a national private nonprofit organization established in 1929 by a special Act of Parliament In Australia and New Zealand it leads to eligibility for Fellowship of the Royal Australasian College of Surgeons. The Royal Australasian College of Surgeons (RACS is the body responsible for training and examining Surgeons in New Zealand and Australia.

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. Research is defined as Human activity based on Intellectual application in the investigation of Matter. Examples of orthopedic subspecialty training in the US are:

These are also the nine main sub-specialty areas of orthopedic surgery. Arthroplasty (literally "formation of Joint " is an operative procedure of orthopaedic surgery performed in which the arthritic or dysfunctional joint surface

Hand surgery and, more recently, Sports Medicine are the only truly recognized sub-specialties within orthopaedic surgery by the Accredited Council of Graduate Medical Education (ACGME). The other sub-specialities are informal concentrations of practice. To be recognized as a hand surgeon or sports surgeon, a practitioner must have completed an ACGME-accredited fellowship and obtained a Certificate of Added Qualifications (CAQ) which requires an additional standardized examination.

Practice

Orthopedic surgeons address most musculoskeletal ailments including arthritis, trauma and congenital deformities using both surgical and non-surgical means. According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopaedic surgeons are as follows:

Of orthopedic surgeons applying for certification with the American Board of Orthopedic Surgery between 1999 to 2003 these were the percentages of surgeons in each specialty area:

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 United States is $388,784. [1]

History

Orthopedic implants to repair fractures to the radius and ulna. Note the visible break in the ulna. (right forearm) Photo: Peter Battaglia
Orthopedic implants to repair fractures to the radius and ulna. Note the visible break in the ulna. (right forearm) Photo: Peter Battaglia

Jean-Andre Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. Year 1780 ( MDCCLXXX) was a Leap year starting on Saturday (link will display the full calendar of the Gregorian calendar (or a 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. The Netherlands ( Dutch:, ˈnedərlɑnt is the European part of the Kingdom of the Netherlands, which consists of the Netherlands the Netherlands A military is an Organization authorized by its Nation to use force usually including use of Weapons in defending its Country (or by attacking Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental The term plaster can refer to plaster of Paris Lime plaster, or Cement plaster. An orthopedic cast is a shell frequently made from Plaster, encasing a limb (or in some cases large portions of the body to hold a broken Bone 1851 ( MDCCCLI) was a Common year starting on Wednesday (link will display the full calendar of the Gregorian Calendar (or a Common year

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. Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells such as nutrients and oxygen—and transports Waste products Traction and splinting developed during World War I. In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the Skeletal system. A splint is a medical device for the immobilization of limbs or of the spine. World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Dr. The femur is the thigh bone In Humans, it is the longest, most voluminous and strongest Bone. The tibia, shinbone, or shankbone is the larger and stronger of the two Bones in the Leg below the Knee in vertebrates and connects Kuntschner of Germany. Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe. 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. World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including A bone fracture (sometimes abbreviated # or Fx or Fx) is a medical condition in which a Bone is cracked or broken However, traction was the standard method of treating thigh bone fractures until the late 1970s when the Harborview Medical Center in Seattle group popularized intramedullary fixation without opening up the fracture. This article is about the Decade 1970-1979 For the Year 1970 see 1970. Harborview Medical Center, located on Seattle 's First Hill, is a public hospital in King County Washington and is managed by the University of 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. The Vietnam War, also known as the Second Indochina War, or the Vietnam Conflict, occurred in Vietnam, Laos and Cambodia Gavriil Abramovich Ilizarov (Гавриил Абрамович Илизаров 15 June 1921 &ndash 24 July 1992) was a Russian The Union of Soviet Socialist Republics (USSR was a constitutionally Socialist state that existed in Eurasia from 1922 to 1991 He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s. Siberia (Сиби́рь Sibir) is the name given to the vast region constituting almost all of Northern Asia and for the most part currently serving The 1950s Decade refers to the years of 1950 to 1959 inclusive With no equipment he was confronted with crippling conditions of unhealed, infected, and malaligned fractures. With the help of the local bicycle shop he devised ring external fixators tensioned like the spokes of a bicycle. The bicycle, cycle, or bike is a pedal-driven, human-powered vehicle with two wheels attached to a frame, one behind With this equipment he achieved healing, realignment and lengthening to a degree unheard of elsewhere. Distraction osteogenesis, also called callus distraction, callotasis is a surgical process used to reconstruct skeletal deformities His Ilizarov apparatus is still used today as one of the distraction osteogenesis methods. The Ilizarov apparatus is used in a surgical procedure that can be used to lengthen or reshape limb bones Distraction osteogenesis, also called callus distraction, callotasis is a surgical process used to reconstruct skeletal deformities

David L. MacIntosh pioneered the first successful surgery for the management of the torn anterior cruciate ligament of the knee. The anterior cruciate ligament (or ACL) is one of the four major Ligaments of the Knee. The knee is the lower extremity Joint connecting the Femur, Patella, and the Tibia. This common and serious injury in skiers, field athletes, and dancers invariably brought an end to their athletics due to permanent joint instability. Snow skiing is a group of sports utilizing Skis as primary equipment Dance (from French danser, perhaps from Frankish) is an Art form that generally refers to movement of the body usually rhythmic Working with injured football players, Dr. American football, known in the United States and Canada simply as football, is a competitive Team sport known for mixing strategy with 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. In Anatomy, the term ligament is used to denote three different types of structures Fibrous tissue that connects Bones to other bones 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.

Arthroscopy

The use of arthroscopic tools has been particularly important for injured patients. Arthroscopy (also called arthroscopic surgery) is a Minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the Arthroscopy was pioneered in the early 1950's by Dr. Masaki Watanabe of Japan to perform minimally invasive cartilage surgery and re-constructions of torn ligaments. Minimally invasive surgical procedures avoid open invasive surgery in favor of closed or local surgery with less trauma Arthroscopy helped patients recover from the surgery in a matter of days, rather than the weeks to months required by conventional, 'open' surgery. Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today and is often combined with meniscectomy or chondroplasty.

Joint replacement

The modern total hip replacement was pioneered by Sir John Charnley in England in the 1960s. Hip replacement, also hip Arthroplasty, is a surgical procedure in which the Hip joint is replaced by a prosthetic implant. Sir John Charnley (born August 29, 1911 &ndash August 5, 1982) was a British orthopaedic surgeon. [2] He found that joint surfaces could be replaced by metal or high density polyethylene implants cemented to the bone with methyl methacrylate cement. Polyethylene or polythene ( IUPAC name poly(ethene) is a Thermoplastic commodity heavily used in consumer products (notably the Methyl methacrylate is an Organic compound with the formula CH2=C(CH3CO2CH3 Since Charnley, there have been continuous improvements in the design and technique of joint replacement (arthroplasty) with many contributors, including W. Arthroplasty (literally "formation of Joint " is an operative procedure of orthopaedic surgery performed in which the arthritic or dysfunctional joint surface 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 1970's. Rheumatoid arthritis ( RA) is a chronic systemic autoimmune disorder that causes the Immune system to attack the Joints, where Osteoarthritis ( OA, also known as degenerative Arthritis, degenerative joint disease) is a clinical syndrome in which low-grade inflammation The modern knee replacement was developed by Dr. Knee replacement, or knee Arthroplasty, is a common surgical procedure most often performed to relieve the pain and disability from degenerative arthritis most commonly John Insall and Dr. Chitranjan Singh Ranawat in New York utilizing a fixed bearing,[3] and by Dr Frederick Buechel and Dr Michael Pappas utilizing a mobile bearing. Chitranjan Singh Ranawat is an eminent orthopaedic and knee surgeon. [4] 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.

Pediatric orthopaedics

The treatment of children with muscoloskeletal problems remains an integral part of modern orthopaedic surgery. Many fractures and injuries occur in children due to their high activity level and unique immature skeleton. Treatment of fractures in children is different than adults due to active growth plates in their bones. The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline Cartilage plate in the metaphyses of children and Damage to the growth plate can lead to significant problems with later bone growth, and at-risk fractures have to be monitored with care.

The treatment of scoliosis is a mainstay of pediatric orthopaedics. Scoliosis is a medical condition in which a person's spine is curved from side to side and may also be rotated For poorly understood reasons, curvature develops in the spine of some children, which if left untreated leads to undesirable deformity and may progress to cause chronic pain and breathing problems. The treatment of scoliosis is quite complicated and often involves a combination of bracing and surgery.

Children have other unique musculoskeletal conditions that have been a focus of orthopedics since Hippocrates, including conditions such as club foot and congenital dislocation of hip (also known as developmental dysplasia of the hip). A clubfoot, or talipes equinovarus (TEV is a Birth defect.TEV is classified into 2 groups Postural TEV or Structural TEV A congenital disorder is a disease or disorder that is present at birth A dislocated hip is a condition that can be Congenital or Acquired. In addition, infections in bones and joints (osteomyelitis) in children are common. An infection is the detrimental Colonization of a host Organism by a foreign Species. Osteomyelitis is an Infection of Bone or Bone marrow, usually caused by Pyogenic Bacteria or Mycobacteria. In the US, specialized hospitals such as the Shriners Hospitals for Children have provided a substantial portion of treatment for children with musculoskeletal deformities and diseases. Shriners Hospitals for Children is a network of 22 pediatric Non-profit Hospitals across North America that provide all care at no charge

References

  1. ^ Average Orthopedic Surgeon Salary. Orthopedic Surgeon Job, Career Education & Unemployment Help from Salary. com
  2. ^ Wroblewski, B. M. (2002). "Professor Sir John Charnley (1911–1982)". Rheumatology 41 (7): 824-825. The British Society for Rheumatology via Oxford Journals.  
  3. ^ Ranawat, C. S. (2002). "History of total knee replacement.". J South Orthop Assoc 11 (4): 218-226.  
  4. ^ Hamelynck, K. J. (2006). "The history of mobile-bearing total knee replacement systems.". Orthopedics 29 (9 Suppl): S7-12.  

See also

External links


The field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or Upper extremity (commonly from the In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the Skeletal system. Unicompartmental knee arthroplasty is a Surgical procedure used to relieve Arthritis in one of the Knee compartments in which the damaged parts of the knee
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