Orthopedic surgery or orthopedics (alternative spelling orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.
Etymology
Nicolas 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. The word was assimilated into English as orthopædics; the ligature æ was common in that era for ae in Greek- and Latin-based words. 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 programmes, 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" is the normal spelling in the UK in line with other fields which retain "ae".
History
Early orthopedics Many developments in orthopedic surgery have 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, if unsanitary, splint. Originally, the term orthopedics meant the correcting of musculoskeletal deformities in children. Nicolas Andry, a professor of medicine at the University of Paris, coined the term in the first textbook written on the subject in 1741. 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 Percivall Pott's work on spinal deformity steadily increased the range of new methods available for effective treatment. Robert Chessher, a pioneering British orthopedist, invented the double-inclined plane, used to treat lower-body bone fractures, in 1790. Antonius Mathijsen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. 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.
Modern orthopedics
In 1887, the Hospital for Special Surgery founded the first orthopedic residency program in the United States. Young doctors in training would apply for one-year positions as assistant. They became known as residents, a term recognized as a doctor in training. Examples of people who aided the development of modern orthopedic surgery were Hugh Owen Thomas, a surgeon from Wales, and his nephew, Robert Jones. Thomas became interested in orthopedics and bone-setting after establishing his own practice, expanding the field into the general treatment of fracture and other musculoskeletal problems. Thomas's collar to treat tuberculosis of the cervical spine, Thomas's maneuvere for assessing hip fracture, and the Thomas test are procedures credited to his innovations. Robert Jones was 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. 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 Association 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 from 1916 to 1918. The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Gerhard Küntscher of Germany. Traction was the standard method of treating thigh bone fractures until the late 1970s, though, when intramedullary fixation without opening up the fracture became a standard procedure.
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