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Orthopedic surgery

Orthopedic surgery or orthopedics (BE: orthopaedics) is the branch of surgery concerned with acute, chronic, traumatic, and recurrent injuries and other disorders of the locomotor system, its muscular and bone parts. Apart from the mechanical considerations, it also is concerned with the pathology, genetics, intrinsic, extrinsic, and biomechanical factors involved.

Orthopedic surgeons are M.D.s or D.O.s in the USA and MBBSs in the United Kingdom, and generally have five to seven years of advanced post-graduate training, and may serve a fellowship for training in any of several sub-specialty areas, such as sports medicine, traumatology, reconstructive surgery, hand surgery, foot & ankle surgery, spine surgery, rheumatological surgery, pediatric orthopedics, geriatric orthopedics, or industrial medicine. In India, they are either D'Ortho, MS(Ortho) or DNB(Ortho) and obtain their degrees following two to three years of post-graduate training.

Orthopedic surgeons treat patients using surgical and non-surgical methods to correct problems. Orthopedic surgeons work closely with many allied health professionals, such as athletic trainers, physical therapists, occupational therapists, physical medicine, rehabilitation physcians, and other physicians in related fields in the treatment of patients.

Many developments in orthopedic surgery resulted from experiences during war time. The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Dr. Kirschner of Germany during World War II. External fixation of fractures was refined by American surgeons during the Vietnam War.

Toronto, Canada, was an early center of excellence in orthopedic surgery, renowned for training and creative development since orthopedics was defined as a distinct surgical specialty by the pioneer surgeon Robert I. Harris in the 1950s. Generations of orthopaedic surgeons graduating from the University of Toronto program since have contributed to many of the important achievements in orthopedics that have improved the lives of people with bone and joint injuries and diseases.

One eminent example is the work of David L. MacIntosh, who 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 had brought an end to their pursuits due to permanent joint instability. Working especially with injured football players in his role as sports surgeon for the University of Toronto, he 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 throughout its range of motion, conferring a fully functional joint. This, for the first time in history, reliably could permit the athlete to return to the demands of (even professional) sport or dance after a period of healing. The two major variants of this repair that MacIntosh developed in the 1960s and 1970s for the torn anterior cruciate ligament still are the operations of choice performed today.

The modern total-hip replacement was developed by Sir John Charnley in England, and the modern condylar total-knee replacement was developed by Dr. John Insall and Dr. Chitranjan Ranawat in New York.

Scoliosis surgery was revolutionized by Dr. Harrington's introduction of hook rods, which could maintain the straightening of the spine long enough for a bone fusion to develop.

Particularly important for injured athletes was the use of arthroscopic tools by Dr. Watanabe of Japan, to perform minimally invasive cartilage surgery and re-constructions of torn ligaments. This advance helped ligament repair patients recover in a few hours instead of a few weeks, as was the case with open-joint surgery.