Orthopedics

Orthopedics is the branch of medicine concerned with disorders of the musculoskeletal system. It is a broad field dealing not only with the vast array of congenital, traumatic, cancerous, or degenerative processes afflicting bones and joints, but also those of muscles, tendons, nerves and vessels. Orthopedics is also varied in the treatment modalities it employs. While it is generally a surgically oriented specialty, medical management, external stabilization, and rehabilitation therapy are all invaluable non-operative tools in achieving the goal of preserving and restoring function of the trunk and limbs.

It would be hard to overstate the impact that musculoskeletal conditions have on the lives of people affected by them. Orthopedic complaints are the most common reason for seeking medical care, accounting for 131 million office visits per year. Arthritis is the leading cause of disability, while osteoporosis is responsible for 1.3 million fractures every year. Approximately 80 percent of all people will experience some form of back pain in their lifetime. In addition to the loss of function so many individuals suffer at home, work or at play due to loss of mobility or pain, there is an economic toll: musculoskeletal conditions cost the United States economy more than $215 billion a year, and their impact will only grow as the population increases and ages.

Related to the importance of orthopedics is its antiquity. It is arguably the oldest medical field, with evidence of treated fractures from pre-history. However, it was first described as a specialized branch of medicine by Nicholas Andre in 1741. He coined the term “orthopaedia” by combining the Greek terms “orthos” (straight, free of deformity) and “paidios” (child). He proposed that preventing deformity and disability in adults could be accomplished by correcting those of children. As a surgical field, however, orthopedics could only blossom with the advent of modern technologies, such as anesthesia and aseptic technique for operating, and x-ray for diagnosis. Orthopedics was once constrained to emergent (and often fatal) surgery, reducing fractures, reducing dislocations with traction, and treating childhood deformities with bracing, but now includes joint reconstruction, sports medicine, hand surgery, foot and ankle, disorders of the spine, pediatric orthopedics, musculoskeletal trauma, and orthopedic oncology.

Even in this day of sophisticated surgical technique, pediatric orthopedics still to a large degree uses splinting and bracing techniques Nicholas Andre might recognize in an effort to develop “straight children.” For example, congenitally inwardly-bent feet, or club-foot (talipes equinoarus), is corrected by [Page 1295]gradual straightening via a series of casts. This is done before the child can walk, which avoids progressive and debilitating deformity and ulceration that result if club-foot is left uncorrected.

Orthopedics is the branch of medicine concerned with disorders of the musculoskeletal system.

Motor vehicle, sports, and occupational accidents keep emergency rooms busy, and muskuloskeletal trauma is the realm of the orthopedists. There is an astounding variety of fractures, dislocations and tears, and an equal variety in treatment strategy. Fractures must be immobilized to allow bones to mend and the simple yet effective cast is a familiar treatment. However, not all fractures are alike. Surgery is necessary if blood vessels or nerves have been damaged, or if the skin has been breeched by the fractured bone. Orthopedists must also be able to mange and reduce the complications of immobilization such as blood clots and pressure sores. Plates, screws and other fixation devices can reduce stiffness and atrophy associated with casting by allowing early mobility. In the case of femur fractures, a rod is often placed through the center of the bone to provide stabilization during the healing process. Plates and screws are also indicated in repairing flat bones, such as those in the skull, or to address various spinal pathologies.

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