Orthopedic surgery or orthopedics (
alternatively spelt orthopaedics), is the branch of
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
concerned with conditions involving the
musculoskeletal system
The human musculoskeletal system (also known as the human locomotor system, and previously the activity system) is an organ system that gives humans the ability to move using their muscular and skeletal systems. The musculoskeletal system provid ...
. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal
trauma
Trauma most often refers to:
* Major trauma, in physical medicine, severe physical injury caused by an external source
* Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic i ...
,
spine diseases,
sports injuries
Sports injuries are injuries that occur during sport, athletic activities, or exercising. In the United States, there are approximately 30 million teenagers and children who participate in some form of organized sport. Of those, about three mi ...
,
degenerative disease
Degenerative disease is the result of a continuous process based on degenerative cell changes, affecting tissues or organs, which will increasingly deteriorate over time.
In neurodegenerative diseases, cells of the central nervous system stop wo ...
s,
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
s,
tumor
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
s, and
congenital disorder
A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...
s.
Etymology
Nicholas Andry
Nicolas Andry de Bois-Regard (1658 – 13 May 1742) was a French physician and writer. He played a significant role in the early history of both parasitology and orthopedics, the name for which is taken from Andry's book ''Orthopédie''.
Early li ...
coined the word in French as ', derived from the
Ancient Greek
Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...
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
Ligature may refer to:
* Ligature (medicine), a piece of suture used to shut off a blood vessel or other anatomical structure
** Ligature (orthodontic), used in dentistry
* Ligature (music), an element of musical notation used especially in the me ...
''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
In the history of Europe, the Middle Ages or medieval period lasted approximately from the late 5th to the late 15th centuries, similar to the post-classical period of global history. It began with the fall of the Western Roman Empire a ...
, the injured were treated with bandages soaked in horses'
blood
Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the c ...
, 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
, image_name = Coat of arms of the University of Paris.svg
, image_size = 150px
, caption = Coat of Arms
, latin_name = Universitas magistrorum et scholarium Parisiensis
, motto = ''Hic et ubique terrarum'' (Latin)
, mottoeng = Here and a ...
, coined the term in the first textbook written on the subject in 1741. He advocated the use of
exercise
Exercise is a body activity that enhances or maintains physical fitness and overall health and wellness.
It is performed for various reasons, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic ...
, 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
Jean-André Venel (28 May 1740 – 9 March 1791) was a Swiss doctor and a pioneer in the field of orthopedics.
Venel was born in Morges, the son of a surgeon, Jean-François Venel. He studied medicine in Montpellier, Paris and Strasbourg, an ...
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
A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...
healing and
Percival Pott
Percivall Pott (6 January 1714, in London – 22 December 1788) was an English surgeon, one of the founders of orthopaedics, and the first scientist to demonstrate that a cancer may be caused by an environmental carcinogen.
Career
He was the ...
'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
Antonius Mathijsen (November 4, 1805 – June 15, 1878) was a Dutch army surgeon who first used plaster of Paris to fixate broken bones in a plaster cast.
Biography
Early life and education
Antonius Mathijsen was born November 4, 1805, to a vill ...
, a
Dutch
Dutch commonly refers to:
* Something of, from, or related to the Netherlands
* Dutch people ()
* Dutch language ()
Dutch may also refer to:
Places
* Dutch, West Virginia, a community in the United States
* Pennsylvania Dutch Country
People E ...
military
A military, also known collectively as armed forces, is a heavily armed, highly organized force primarily intended for warfare. It is typically authorized and maintained by a sovereign state, with its members identifiable by their distinct ...
surgeon
In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...
, invented the
plaster of Paris
Plaster is a building material used for the protective or decorative coating of walls and ceilings and for moulding and casting decorative elements. In English, "plaster" usually means a material used for the interiors of buildings, while "re ...
cast
Cast may refer to:
Music
* Cast (band), an English alternative rock band
* Cast (Mexican band), a progressive Mexican rock band
* The Cast, a Scottish musical duo: Mairi Campbell and Dave Francis
* ''Cast'', a 2012 album by Trespassers William
* ...
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
Examples of people who aided the development of modern orthopedic surgery were
Hugh Owen Thomas
Hugh Owen Thomas (23 August 1834 – 6 January 1891) was a Welsh orthopaedic surgeon. He and his nephew Robert Jones have been called "the Fathers of orthopaedic surgery".
Thomas was descended from a line of Welsh bone setters and placed great i ...
, a surgeon from
Wales
Wales ( cy, Cymru ) is a Countries of the United Kingdom, country that is part of the United Kingdom. It is bordered by England to the Wales–England border, east, the Irish Sea to the north and west, the Celtic Sea to the south west and the ...
, and his nephew,
Robert Jones. Thomas became interested in orthopedics and
bone-setting
Traditional bone-setting is a type of a folk medicine in which practitioners engaged in joint manipulation. Before the advent of chiropractors, osteopaths and physical therapists, bone-setters were the main providers of this type of treatment. T ...
at a young age, and after establishing his own practice, went on to expand the field into the general treatment of fracture and other musculoskeletal problems. He advocated enforced rest as the best remedy for
fracture
Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...
s and
tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...
, and created the so-called "Thomas splint" to stabilize a fractured femur and prevent infection. 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
The Thomas test is a physical examination test, named after the Welsh orthopaedic surgeon, Hugh Owen Thomas (1834–1891), to rule out hip flexion contracture (fixed partial flexion of the hip) and psoas syndrome (injury to the psoas muscle) ...
, 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
An osteoclast () is a type of bone cell that breaks down bone tissue. This function is critical in the maintenance, repair, and remodeling of bones of the vertebral skeleton. The osteoclast disassembles and digests the composite of hydrated pro ...
to break and reset bones.
Thomas's work was not fully appreciated in his own lifetime. Only during the
First World War
World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
did his techniques come to be used for injured soldiers on the
battle
A battle is an occurrence of combat in warfare between opposing military units of any number or size. A war usually consists of multiple battles. In general, a battle is a military engagement that is well defined in duration, area, and force ...
field. 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
The Manchester Ship Canal is a inland waterway in the North West of England linking Manchester to the Irish Sea. Starting at the Mersey Estuary at Eastham, near Ellesmere Port, Cheshire, it generally follows the original routes of the river ...
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 Orthopedic 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 Orthopedics, with responsibility for 30,000 beds. The hospital in Ducane Road,
Hammersmith
Hammersmith is a district of West London, England, southwest of Charing Cross. It is the administrative centre of the London Borough of Hammersmith and Fulham, and identified in the London Plan as one of 35 major centres in Greater London.
...
, became the model for both British and
American
American(s) may refer to:
* American, something of, from, or related to the United States of America, commonly known as the "United States" or "America"
** Americans, citizens and nationals of the United States of America
** American ancestry, pe ...
military orthopedic hospitals. His advocacy of the use of
Thomas splint
A traction splint most commonly refers to a splinting device that uses straps attaching over the pelvis or hip as an anchor, a metal rod(s) to mimic normal bone stability and limb length, and a mechanical device to apply traction (used in an a ...
for the initial treatment of
femoral fractures reduced mortality of compound fractures of the
femur
The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with ...
from 87% to less than 8% in the period from 1916 to 1918.
The use of
intramedullary rods to treat fractures of the femur and
tibia
The tibia (; ), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outside of the tibia); it connects ...
was pioneered by
Gerhard Küntscher of
Germany
Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...
. This made a noticeable difference to the speed of recovery of injured German soldiers during
World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
and led to more widespread adoption of intramedullary fixation of
fracture
Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...
s 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
Harborview Medical Center is a public hospital located in the First Hill neighborhood of Seattle, Washington, United States. It is managed by UW Medicine.
Overview
Harborview Medical Center is the designated Disaster Control Hospital for Seat ...
group in Seattle popularized intramedullary fixation without opening up the fracture.
![Hip replacement Image 3684-PH](https://upload.wikimedia.org/wikipedia/commons/2/2f/Hip_replacement_Image_3684-PH.jpg)
The modern total
hip replacement
Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement o ...
was pioneered by Sir
John Charnley
Sir John Charnley, (29 August 1911 – 5 August 1982) was an English orthopaedic surgeon. He pioneered the hip replacement operation, which is now one of the most common operations both in the UK and elsewhere in the world, and created the ...
, expert in
tribology
Tribology is the science and engineering of interacting surfaces in relative Motion (physics), motion. It includes the study and application of the principles of friction, lubrication and wear. Tribology is highly interdisciplinary, drawing on m ...
at
Wrightington Hospital, in England in the 1960s.
He found that joint surfaces could be replaced by implants cemented to the bone. His design consisted of a
stainless steel
Stainless steel is an alloy of iron that is resistant to rusting and corrosion. It contains at least 11% chromium and may contain elements such as carbon, other nonmetals and metals to obtain other desired properties. Stainless steel's corros ...
, one-piece femoral stem and head, and a
polyethylene
Polyethylene or polythene (abbreviated PE; IUPAC name polyethene or poly(methylene)) is the most commonly produced plastic. It is a polymer, primarily used for packaging ( plastic bags, plastic films, geomembranes and containers including bo ...
acetabular component, both of which were fixed to the bone using
PMMA PMMA may refer to:
* para-Methoxymethamphetamine, a stimulant drug
* Philippine Merchant Marine Academy
The Philippine Merchant Marine Academy ( fil, Akademiya sa Bapor Pangkalakalan ng Pilipinas) also referred to by its acronym PMMA) is a ma ...
(acrylic)
bone cement
Bone cements have been used very successfully to anchor artificial joints (hip joints, knee joints, shoulder and elbow joints) for more than half a century. Artificial joints (referred to as prostheses) are anchored with bone cement. The bone ce ...
. 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
Exeter () is a city in Devon, South West England. It is situated on the River Exe, approximately northeast of Plymouth and southwest of Bristol.
In Roman Britain, Exeter was established as the base of Legio II Augusta under the personal comm ...
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
Replacement arthroplasty (from Greek ''arthron'', joint, limb, articulate, + ''plassein'', to form, mould, forge, feign, make an image of), or joint replacement surgery, is a procedure of orthopedic surgery in which an arthritic or dysfunctional ...
(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
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involv ...
patients and later by Gunston and Marmor for
osteoarthritis
Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the w ...
in the 1970s, developed by Dr.
John Insall
John Nevil Insall (1930–2000) was a pioneering English orthopaedic surgeon who contributed extensively to the advancement of orthopedic surgery and total knee replacement surgery. Dr. Insall designed four models of widely used systems inclu ...
in New York using a fixed bearing system, and by Dr. Frederick Buechel and Dr. Michael Pappas using a mobile bearing system.
External fixation of fractures was refined by American surgeons during the
Vietnam War
The Vietnam War (also known by #Names, other names) was a conflict in Vietnam, Laos, and Cambodia from 1 November 1955 to the fall of Saigon on 30 April 1975. It was the second of the Indochina Wars and was officially fought between North Vie ...
, but a major contribution was made by
Gavril Abramovich Ilizarov
Gavriil Abramovich Ilizarov (russian: Гавриил Абрамович Илизаров; 15 June 1921 – 24 July 1992) was a Soviet physician, known for inventing the Ilizarov apparatus for lengthening limb bones and for the method of surgery ...
in the
USSR
The Soviet Union,. officially the Union of Soviet Socialist Republics. (USSR),. was a transcontinental country that spanned much of Eurasia from 1922 to 1991. A flagship communist state, it was nominally a federal union of fifteen nationa ...
. He was sent, without much orthopedic training, to look after injured Russian soldiers in
Siberia
Siberia ( ; rus, Сибирь, r=Sibir', p=sʲɪˈbʲirʲ, a=Ru-Сибирь.ogg) is an extensive geographical region, constituting all of North Asia, from the Ural Mountains in the west to the Pacific Ocean in the east. It has been a part of ...
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. His
Ilizarov apparatus
In medicine, the Ilizarov apparatus is a type of external fixation apparatus used in orthopedic surgery to lengthen or to reshape the damaged bones of an arm or a leg; used as a limb-sparing technique for treating complex fractures and open bone ...
is still used today as one of the
distraction osteogenesis
Distraction osteogenesis (DO), also called callus distraction, callotasis and osteodistraction, is a process used in orthopedic surgery, podiatric surgery, and oral and maxillofacial surgery to repair skeletal deformities and in reconstructive s ...
methods.
Modern orthopedic surgery and musculoskeletal research have sought to make surgery less invasive and to make implanted components better and more durable. On the other hand, since the emergence of the opioid epidemic, Orthopedic Surgeons have been identified as one of the highest prescribers of opioid medications.
The future of Orthopedic Surgery will likely focus on finding ways for the profession to decrease prescription of opioids while still providing adequate pain control for patients.
Training
In the United States, orthopedic surgeons have typically completed four years of undergraduate education and four years of medical school and earned either a
Doctor of Medicine
Doctor of Medicine (abbreviated M.D., from the Latin language, Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a profes ...
(MD) or
Doctor of Osteopathic Medicine
Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become lice ...
(DO) degree. Subsequently, these medical school graduates undergo
residency
Residency may refer to:
* Domicile (law), the act of establishing or maintaining a residence in a given place
** Permanent residency, indefinite residence within a country despite not having citizenship
* Residency (medicine), a stage of postgra ...
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
The United States Department of Labor (DOL) is one of the executive departments of the U.S. federal government. It is responsible for the administration of federal laws governing occupational safety and health, wage and hour standards, unemploym ...
, 3 to 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 sub-specialty is typically one year in duration (sometimes two) and sometimes has a
research
Research is "creativity, creative and systematic work undertaken to increase the stock of knowledge". It involves the collection, organization and analysis of evidence to increase understanding of a topic, characterized by a particular att ...
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
Arthroplasty (literally " e-orming of joint") is an orthopedic surgical procedure 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 i ...
)
* Pediatric orthopedics
*
Foot and ankle surgery
Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of c ...
*
Spine surgery
* Orthopedic oncologist
* Surgical sports medicine
* Orthopedic trauma
* Hip and Knee surgery
*
Osseointegration
Osseointegration (from Latin ''osseus'' " bony" and ''integrare'' "to make whole") is the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant ("load-bearing" as defined by Albrekt ...
These specialized areas of medicine are not exclusive to orthopedic surgery. For example,
hand surgery is practiced by some
plastic surgeons
Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofa ...
, and spine surgery is practiced by most
neurosurgeons
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...
. Additionally, some aspects of
foot and ankle surgery
Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of c ...
are also practiced by board-certified doctors of
podiatric medicine
Podiatry () or podiatric medicine () is a branch of medicine devoted to the study, diagnosis, medical and surgical treatment of disorders of the foot, ankle, and leg.
A Doctor of Podiatric Medicine (DPM), or a podiatrist, is a healthcare p ...
(DPM) in the United States. Some
family practice
Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primar ...
physicians practice
sports medicine
Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the ...
, but their scope of practice is nonoperative.
After completion of specialty
residency
Residency may refer to:
* Domicile (law), the act of establishing or maintaining a residence in a given place
** Permanent residency, indefinite residence within a country despite not having citizenship
* Residency (medicine), a stage of postgra ...
/
registrar
A registrar is an official keeper of records made in a register. The term may refer to:
Education
* Registrar (education), an official in an academic institution who handles student records
* Registrar of the University of Oxford, one of the se ...
training, an orthopedic surgeon is then eligible for board certification by the
American Board of Medical Specialties
Established in 1933, the American Board of Medical Specialties (ABMS) is a non-profit organization which represent 24 broad areas of specialty medicine. ABMS is the largest physician-led specialty certification organization in the United States ...
or the
. Certification by the American Board of Orthopedic 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
The Royal College of Physicians and Surgeons of Canada (french: Collège royal des médecins et chirurgiens du Canada) is a regulatory college which acts as a national, Non-profit organization, nonprofit organization established in 1929 by a speci ...
; in Australia and New Zealand, it is the
Royal Australasian College of Surgeons
The Royal Australasian College of Surgeons (RACS) is the leading advocate for surgical standards, professionalism and surgical education in Australia and New Zealand.
Known by its common acronym RACS, it is a not-for-profit organisation, sup ...
.
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.
Practice
![X ray internal fixation leg fracture](https://upload.wikimedia.org/wikipedia/commons/a/a9/X_ray_internal_fixation_leg_fracture.jpg)
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
Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the ...
and
meniscectomy
# Shoulder
arthroscopy
Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the ...
and decompression
#
Carpal tunnel
In the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the hand.
The tunnel is bounded by the bones of the wrist and flexor retinaculum from connective tissue. Norma ...
release
# Knee
arthroscopy
Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the ...
and
chondroplasty
# Removal of support implant
# Knee
arthroscopy
Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the ...
and
anterior cruciate ligament reconstruction
Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after an injury. The torn ligament can either be removed from ...
#
Knee replacement
# Repair of femoral neck
fracture
Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...
# Repair of trochanteric fracture
# Debridement of
skin
Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation.
Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...
/
muscle
Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...
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bone
A bone is a Stiffness, rigid Organ (biology), organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red blood cell, red and white blood cells, store minerals, provid ...
/ fracture
# Knee arthroscopy repair of both menisci
#
Hip replacement
Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement o ...
# Shoulder arthroscopy/distal
clavicle
The clavicle, or collarbone, is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the rig ...
excision
# Repair of rotator cuff tendon
# Repair fracture of
radius (bone)
The radius or radial bone is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. The ulna is usually slightly longer than ...
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ulna
The ulna (''pl''. ulnae or ulnas) is a long bone found in the forearm that stretches from the elbow to the smallest finger, and when in anatomical position, is found on the medial side of the forearm. That is, the ulna is on the same side of t ...
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Laminectomy
A laminectomy is a surgical procedure that removes a portion of a vertebra called the lamina, which is the roof of the spinal canal. It is a major spine operation with residual scar tissue and may result in postlaminectomy syndrome. Depending ...
# Repair of ankle fracture (bimalleolar type)
# Shoulder arthroscopy and
debridement
Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy.
In p ...
# Lumbar
spinal fusion
Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine (cervical, thoracic, or lumbar) and pre ...
# Repair fracture of the distal part of radius
# Low back
intervertebral disc
An intervertebral disc (or intervertebral fibrocartilage) lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the vertebrae, to act as a ligament to hold t ...
surgery
# Incise finger tendon sheath
# Repair of ankle fracture (
fibula
The fibula or calf bone is a leg bone on the lateral side of the tibia, to which it is connected above and below. It is the smaller of the two bones and, in proportion to its length, the most slender of all the long bones. Its upper extremity is ...
)
# 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. According to the
American Association of Medical Colleges in 2021, the average work week of an orthopedic surgeon was 57 hours.
This is a very low estimation however, as research derived from a 2013 survey of orthopedic surgeons who self identified as "highly successful" due to their prominent positions in the field indicated average work weeks of 70 hours or more.
Arthroscopy
The use of arthroscopic techniques has been particularly important for injured patients.
Arthroscopy
Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the ...
was pioneered in the early 1950s by Dr.
Masaki Watanabe of Japan to perform minimally invasive cartilage surgery and reconstructions of torn ligaments. 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.
Arthroplasty
Arthroplasty is an orthopedic surgery where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by
osteotomy
An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is ...
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
Rheumatology (Greek ''ῥεῦμα'', ''rheûma'', flowing current) is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatolog ...
) 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, has 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 the surrounding bone and contribute to eventual failure of the implant. The 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.
Epidemiology
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.
See also
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Outline of trauma and orthopedics
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Index of trauma and orthopaedics articles
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Bone grafting
Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly. Some small or acute fractures can be cured wit ...
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Orthotics
Orthotics ( el, Ορθός, translit=ortho, lit=to straighten, to align) is a medical specialty that focuses on the design and application of orthoses, or braces. An is "an externally applied device used to influence the structural and functio ...
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List of orthopedic implants An orthopedic implant is a medical device manufactured to replace a missing joint or bone or to support a damaged bone. The medical implant is mainly fabricated using stainless steel and titanium alloys for strength and the plastic coating that is ...
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Orthopaedic Physician´s assistant
References
External links
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{{DEFAULTSORT:Orthopedic Surgery
Surgical specialties