Orthopedic Surgeon

Introduction Orthopedic Surgeon

Orthopedic surgeon, often known as orthopedics (also written orthopedics), is the area of surgery dedicated to treating disorders of the musculoskeletal system.

Orthopedic surgeons treat congenital problems, degenerative diseases, infections, malignancies, musculoskeletal trauma, and spine ailments using both surgical and nonsurgical methods. The specialty of orthopedics, also referred to as orthopedic surgeon, involves the treatment of the skeleton and its supporting structures.

These components consist of the following: joints, muscles, and bones. The specialty of orthopedics, also referred to as orthopedic surgery, involves the treatment of the skeleton and its supporting structures.

These sections consist of the following:

• bones
• muscles
• joints
• tendons
• ligaments
• nerves

Orthopedists might be classified as either noninvasive or surgical. Orthopedic surgeons are those who do surgery, whereas physiatrists and physical medicine and rehabilitation experts are nonsurgical orthopedists.

Part of a wider orthopedic care team is frequently comprised of orthopedists. On this team might be:

• physician assistants
• nurse practitioners
• occupational and physical therapists
• athletic trainers

Etymology Orthopedic Surgeon

The Ancient Greek terms orthos (“correct”, “straight”) and paid (“child”) are the source of the French word orthopédie, which Nicholas Andry first used. Orthopedic, also known as Orthopaedia.

The Art of Correcting and Preventing Deformities in Children was first published in The term entered English as orthopædics; at that time, ae in Greek and Latin nouns frequently had the ligature æ. Orthopedic practice was

founded on the repair of spinal and bone defects in all stages of life, but the name suggests that the discipline was first formed with children in mind.

Differences in spelling

Like many words formed from the “ae” ligature, “ae” or plain “e” are frequently simplified, particularly in North America.

Hospitals often use the abbreviated version, although most US colleges, universities, residency programs, and even the American Academy of Orthopaedic Surgeons still spell it with the digraph ae.

Usage varies elsewhere; in Canada, both spellings are permitted; in the UK, “orthopedics” is the standard spelling in keeping with other areas that keep the “ae”.

History Orthopedic Surgeon

Early orthopedics

The experiences of battle have led to several advancements in orthopedic surgery. Medieval bandages drenched with horse blood were used to cure wounded soldiers on the battlefield. When the bandages dried, they formed a firm, although unhygienic, splint.

Orthopedics originally referred to the treatment of pediatric musculoskeletal abnormalities. The phrase was initially used in the first textbook on the topic, which was created in 1741 and was authored by Nicolas Andry, a medical professor at the University of Paris.

He supported treating children’s abnormalities using splinting, manipulation, and exercise. Although his book was aimed at parents, it covered themes that modern orthopedists would be familiar with, such as freckles and “excessive sweating of the palms.

“The first orthopedic institute, founded by Jean-André Venel in 1780, was the first medical facility devoted to treating bone abnormalities in infants. He created the club-foot shoe for babies with birth abnormalities and several techniques for treating spinal curvature.

The variety of novel approaches to successful treatment grew during the 18th century because of developments in surgical skills, including tendon healing research by John Hunter and spinal deformity research by Percival Pott.

The double-inclined plane was created in 1790 by the innovative British orthopedist Robert Chessher and is used to heal fractures of the lower limbs.

In 1851, Dutch military physician Antonius Mathijsen created the plaster of Paris cast. However, orthopedics remained a field of research confined to correcting childhood deformities until the 1890s. Among the first surgical techniques, tenotomy was created.

In addition to bracing and exercises, this involves chopping a tendon, originally the Achilles tendon, to assist cure abnormalities. There was a great deal of debate over the inclusion of surgical operations in orthopedics during the late 1800s and early 1900s.

Modern Orthopedics

Two notable figures who contributed to the advancement of contemporary orthopedic surgery are Welsh physician Hugh Owen Thomas and his nephew Robert Jones.

Early interest in orthopedics and bone-setting led Thomas to broaden the discipline into the general treatment of fractures and other musculoskeletal issues after starting his own practice.

He developed the so-called “Thomas splint” to support a fractured femur and prevent fractures, and he promoted enforced rest as the best treatment for fractures and TB infection.

Other medical innovations that bear his name include the Thomas test, which involves having a patient lie flat in bed to detect hip deformity, Thomas’s wrench, which reduces fractures, and an osteoclast, which breaks and resets bones.

Thomas is also the creator of the cervical spine tuberculosis treatment device known as the Thomas’s collar. It was not during Thomas’s lifetime that his work was completely acknowledged. His methods were not used to wounded troops on the front lines until the First World War.

Sir Robert Jones, his nephew, had already made significant strides in orthopedics while serving as surgeon-superintendent for the Manchester Ship Canal construction in 1888.

He oversaw the 20,000 employees’ injuries, set up the world’s first all-inclusive accident service, divided the 36-mile site into three regions, and built a hospital. and a series of blogs about first aid in every area. He had fracture treatment training given to the medical staff.

In his own hospital, he personally oversaw 3,000 cases and carried out 300 surgeries. In this role, he was able to advance the field of fracture care by learning new methods. International medical professionals visited Jones’ clinic to acquire his methods.

In 1894, Jones and Alfred Tubby established the British Orthopedic Society. Jones was a surgeon in the Territorial Army during World War I.

His efforts resulted in the establishment of military orthopedic facilities when he saw that fractures were not being adequately treated at both home and front-line hospitals. He was given the position of Inspector of Military Orthopedics, overseeing 30,000 beds.

The military orthopedic facilities in the United States and Britain were modeled after the Ducane Road facility in Hammersmith. Between 1916 and 1918, the mortality rate for open femur fractures decreased from 87% to less than 8% as a result of his advocacy for the use of Thomas splints as the first line of therapy.

Gerhard Küntscher of Germany was the first person to treat femur and tibia fractures with intramedullary rods.

Due to this, German troops who were injured during World War II recovered far more quickly, and intramedullary treatment of fractures became increasingly commonplace worldwide.

Up until the Seattle group Harborview Medical Center developed intramedullary fixation without opening up the fracture in the late 1970s, traction was the conventional treatment for thigh bone fractures.

In the 1960s, Sir John Charnley, a tribology expert at Wrightington Hospital in England, invented the contemporary complete hip replacement. He discovered that implants affixed to the bone might replace joint surfaces.

His design included a polyethylene acetabular component and a stainless steel, one-piece femoral stem and head that were cemented to the bone using PMMA (acrylic) bone cement.

The Charnley low-friction arthroplasty and its variant designs dominated global usage for more than 20 years. This served as the model for every hip implant made today.

Simultaneously created was the Exeter hip replacement system, which has a slightly different stem shape.

With several contributions, notably W. H. Harris, the son of R. I. Harris, whose team at Harvard pioneered uncemented arthroplasty procedures with the bone attaching directly to the implant, advancements in joint replacement (arthroplasty) design and technique have been ongoing since Charnley.

Similar technology was used to develop knee replacements, which were first used by McIntosh in patients with rheumatoid arthritis and later by Gunston and Marmor for osteoarthritis in the 1970s.

In New York, John Insall developed a fixed bearing system, while Frederick Buechel and Michael Pappas developed a mobile bearing system.

American surgeons during the Vietnam War improved the external fixation of fractures, but Gavril Abramovich Ilizarov in the USSR made a significant contribution. In the 1950s, despite having no orthopedic training, he was dispatched to Siberia to tend to the wounded Russian soldiers.

He was faced with debilitating circumstances of unhealed, infected, and misaligned fractures without any equipment. He developed ring external fixators that were tensioned like a bicycle’s spokes with assistance from the neighborhood bike shop.

He was able to achieve healing, realignment, and lengthening with this technology to a level never before seen. His Ilizarov device is one of the distraction osteogenesis techniques that is being employed today.

Contemporary orthopedic surgery and musculoskeletal research have aimed to reduce surgical morbidity and improve the quality and longevity of implanted components.

Conversely, orthopedic surgeons have been shown to be among the doctors who prescribe the most opioid drugs since the start of the pandemic.

The future of orthopedic surgery is probably going to be about figuring out how to reduce the amount of opioids prescribed while still giving patients appropriate pain management.

Training

Orthopedic surgeons in the US usually have a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree after completing four years of undergraduate study and four years of medical school.

Following graduation from medical school, these individuals pursue orthopedic surgery residency training. Orthopedic surgery residency training is categorized and lasts for five years. There is fierce competition for admission to orthopedic surgery residencies.

In the US, around 700 doctors finish orthopedic residency training each year. Currently, women make up 10% of orthopedic surgery residents, while those from minority groups make up 20%.

In the United States, there are about 20,400 orthopedic surgeons and residents who are currently practicing. In the most recent edition of the US Department of Labor’s Occupational Outlook Handbook (2011– 2012), orthopedic surgeons make up 3-4% of all practicing doctors.

After finishing their residency program, many orthopedic surgeons choose to pursue fellowships or further training. A research component may occasionally be included in the clinical and operational training of a one-year (or sometimes two-year) orthopedic subspecialty fellowship.

In the US, some instances of orthopedic specialist training are:

• Foot and ankle surgery
• Hand and upper extremities
• Hip and knee surgery
• Orthopedic oncologist
• Orthopedic trauma
• Osseointegration
• Pediatric orthopedics
• Shoulder and elbow
• Spine surgery
• Surgical sports medicine
• Total joint reconstruction (arthroplasty)

Orthopedic surgery is not the only specialty in medicine that falls within these categories. For instance, the majority of neurosurgeons do spine surgery, but certain plastic surgeons specialize in hand surgery.

In addition, board-certified podiatric physicians (DPMs) in the US do certain portions of foot and ankle surgery themselves. Sports medicine is a nonoperative area of practice for certain family practice doctors.

An orthopedic surgeon can become eligible for board certification by the American Board of Medical Specialties or the American Osteopathic Association Bureau of Osteopathic Specialists upon completion of their specialized residency or registrar training.

When an orthopedic surgeon is certified by the American Board of Orthopedic Surgery or the American Osteopathic Board of Orthopedic Surgery, it indicates that they have fulfilled the standards set out by the board for examination, assessment, and education.

The procedure calls for passing a written exam that is standardized and then an oral exam that focuses on the surgeon’s clinical and surgical performance during a six-month period.

The Royal Australasian College of Surgeons is the certifying body in Australia and New Zealand, and the Royal College of Physicians and Surgeons of Canada is the organization in Canada.

By passing a different, standardized test, experts in hand surgery and orthopedic sports medicine in the US can get a certificate of additional credentials on top of their board’s main certification. There isn’t a separate certification procedure for the other subspecialties.

Practice

Applications for board certification from 1999 to 2003 show that, in order of frequency, the top 25 operations done by orthopedic surgeons are as follows:

• Knee arthroscopy and meniscectomy
• Shoulder arthroscopy and decompression
• Carpal tunnel release
• Knee arthroscopy and chondroplasty
• Removal of support implant
• Knee arthroscopy and anterior cruciate ligament reconstruction
• Knee replacement
• Repair of femoral neck fracture
• Repair of trochanteric fracture
• Debridement of skin/muscle/bone/ fracture
• Knee arthroscopy repair of both menisci
• Hip replacement
• Shoulder arthroscopy/distal clavicle excision
• Repair of rotator cuff tendon
• Repair fracture of radius (bone)/ulna
• Laminectomy
• Repair of ankle fracture (bimalleolar type)
• Shoulder arthroscopy and debridement
• Lumbar spinal fusion
• Low back intervertebral disc surgery
• Incise finger tendon sheath
• Repair of ankle fracture (fibula)
• Repair of femoral shaft fracture
• Repair of trochanteric fracture

An orthopedic surgeon in practice often works 50–55 hours a week, split between clinic, surgery, different administrative tasks, and, if they work in an academic environment, teaching and/or research.

In 2021, the American Association of Medical Colleges reported that an orthopedic surgeon worked an average of 57 hours per week.

However, this is a fairly low estimate, since data from a 2013 study of orthopedic surgeons who considered themselves to be “highly successful” because of their well-known positions in the profession showed that they worked an average of 70 hours or more each week.

Arthroscopy

For patients with injuries, the application of arthroscopic procedures has proven very crucial. Masaki Watanabe of Japan invented arthroscopy in the early 1950s to do minimally invasive cartilage surgery and restore broken ligaments.

Arthroscopy is a very common procedure that allows patients to recuperate from surgery in a matter of days, as opposed to weeks or months as required by conventional, “open” surgery.

One of the most popular procedures orthopedic surgeons undertake these days is knee arthroscopy, which is frequently paired with meniscectomy or chondroplasty. Nowadays, arthroscopic surgery is used for the majority of upper-extremity outpatient orthopedic operations.

Arthroplasty

In an arthroplasty, an osteotomy or other operation is used to replace, rebuild, or realign the articular surface of a musculoskeletal joint. It is an elective operation used to repair damaged joints caused by trauma or arthritis (chemosurgery).

The goal is to reduce pain and restore joint function. In addition to normal complete knee replacement surgery, a common option is uni-compartmental knee replacement, which replaces only one weight-bearing portion of the arthritic knee.

Other joints—most notably the hip, shoulder, elbow, wrist, ankle, spine, and finger joints—can also be replaced with prosthetic devices.

Joint surface replacement, particularly for the hip joint, has gained popularity recently among younger, more active patients.

Although there is a greater chance of early failure due to fracture and bone death with this kind of procedure, it does not replace the necessity for a more conventional, less bone-conserving complete hip replacement.

Wear on component-bearing surfaces is one of the primary issues with joint replacements. This may result in harm to the surrounding bone and ultimately cause the implant to fail.

In an effort to enhance the wear properties of joint replacement components, the usage of substitute-bearing surfaces has grown recently, especially in younger patients.

These include implants made entirely of metal (as opposed to the initial metal-on-plastic ones) and ceramics. Ultra-high molecular weight polyethylene is often used as the material; however, it can also be modified in ways that could enhance its wear properties.

Epidemiology

In the United States, the percentage of operating room (OR) operations conducted during hospital stays that were related to musculoskeletal conditions rose sharply between 2001 and 2016, from 17.9% to 24.2%.

All age groups, with the exception of babies, often underwent spine and joint surgeries, according to a 2012 research on hospitalizations in the United States.

One of the top five OR operations across all age groups, with the exception of adults 85 years of age and younger newborns, was spinal fusion.

Laminectomy was prevalent in people between the ages of 18 and For persons 45 years of age and above, the top five OR operations were hip replacement and knee arthroplasty.

The medical discipline of orthopedics focuses on treating diseases and injuries affecting the musculoskeletal system. Certain problems are inherited, while others could develop as a result of trauma or aging-related wear and tear.

In addition to physician assistants, nurse practitioners, athletic trainers, and occupational or physical therapists, orthopedicists frequently collaborate with other members of a larger orthopedic team.

When combined, they aid in the diagnosis, treatment, and rehabilitation of patients with musculoskeletal disorders or injuries.

To get a medical license, orthopedists are required to complete a rigorous training program. To keep it, they need to keep attending to continuing education and training.

FAQ

Author: Arjun Sharma