Orthopedics is the branch of medicine that specializes in diseases of and injuries to bones. French physician Nicholas Andry coined the term "orthopedia" in his 1741 book on the prevention and correction of muscular and skeletal deformities in children. He united the Greek word "orthos," meaning straight, with "pais," meaning child. The term orthopedics has remained in use, though the specialty has broadened beyond the care of children.
Bone is a living and functioning part of the body. A broken bone will generate new growth to repair the fracture and fill in any areas from which bone is removed. Therefore, a bone that is deformed from birth can be manipulated, cut, braced, or otherwise treated to produce a normal form. A broken bone held in alignment will heal with no resulting physical deformity.
Humans have had to contend with broken or malformed bones since prehistory. Ancient Egyptian hieroglyphics (system of writing in which pictures or symbols represent words or sounds) depict injured limbs wrapped and braced to heal normally. As wars were waged on a larger scale and weaponry became more efficient and deadly over time, fractures and other bone injuries became more common. Physicians soon developed simple prostheses (pronounced pros-THEE-sees; artificial limbs) to replace limbs that were amputated as the result of a wound. A hand, for example, was replaced with a hook attached to a cup that fit over the wrist.
Early orthopedists (orthopedic physicians) concentrated on the correction of birth defects such as scoliosis (abnormal sideways curvature of the spine) and clubfoot (deformed foot marked by a curled or twisted shape). Gradually orthopedists included fractures, dislocations, and trauma to the spine and skeleton within their specialty.
For many years, orthopedics was a physical specialty. The orthopedist manipulated bones and joints to restore alignment, and then applied casts or braces to maintain the structure until it healed. Fractures of the hip, among other injuries, were considered untreatable and were ignored. The patient was simply made as comfortable as possible while the fracture healed on its own. Often the healing process was not complete, and the patient was left with a lifelong handicap that made walking or bending difficult.
In the 1930s, a special nail was developed to hold bone fragments together to allow them to heal better. A few years afterward, a metal device was invented to replace the head of a femur (thigh bone) that formed part of the hip joint and that often would not heal after being fractured. Later, a total artificial hip joint was invented. It continues to be revised and improved to allow a patient maximum use and flexibility of the leg.
Current orthopedic specialists continue to apply physical methods to align fractures and restore a disrupted joint. Braces and casts are still used to hold injured bones in place while they heal. Now, however, the physician can take X rays to be certain that the bones are aligned properly for healing to take place. X rays also can be taken during the healing process to make sure that the alignment has not changed and that healing is occurring swiftly.
Clubfoot: Deformed foot marked by a curled or twisted shape.
Prosthesis: Artificial device to replace a missing part of the body.
Scoliosis: An abnormal sideways curvature of the spine.
Orthopedists treat crushed bones (which have little chance of healing on their own) by transplanting bits of bone from other locations in the body to fill splintered areas. The operating room in which an orthopedic procedure takes place resembles a woodworking shop. The orthopedist uses drills, screwdrivers, screws, staples, nails, chisels, and other tools to work the bone and connect pieces with each other.
At present, virtually any bone deformity can be corrected. Facial bones that are malformed can be reshaped or replaced. Bone transplants from one individual to another are commonplace. A patient who loses a limb from a disease such as cancer can have a normal-appearing prosthesis fitted and can be taught to use it to lead a near-normal lifestyle.
Orthopedists are also trained to treat several degenerative diseases such as arthritis, osteoporosis, carpal tunnel syndrome, and epicondylitis (tennis elbow). Treatment options may vary from diet changes to medications to steroid injections to exercise. Surgical procedures and hormone replacement therapy are additional options.
Recent technological advances such as joint replacement and the arthroscope (a specially designed illuminated surgical instrument) have benefitted orthopedic patients. Many orthopedic surgical procedures no longer require an open incision to expose the joint fully. Now, flexible arthroscopes can be inserted through a small incision in the skin and then into a joint, such as the knee, and then can be manipulated through the joint to locate and identify the nature of the injury. Arthroscopy can be used to look into many joints of the body. These include knees, shoulders, ankles, wrists, and elbows.
[ See also Skeletal system ]