हाडजोर्नी शल्यचिकित्सा

This fracture of the lower cervical vertebrae, known as a 'teardrop fracture' is one of the conditions treated by orthopaedic surgeons.

हाडजोर्नी शल्यचिकित्सा वा अर्थोपेडिक्स शल्यचिकित्साको एक क्षेत्र हो। यो क्षेत्र एक्युट, क्रोनिक, ट्रमा र ओभरयुज overuse injuries र अन्य मस्कुलोस्केलिटल व्यवस्थाका रोगहरूसँग सम्बन्धित छ। Orthopaedic surgeons address most musculoskeletal ailments including arthritis, trauma र congenital deformities using both surgical र non-surgical means.

Training

Orthopedic surgeons are physicians who have completed additional training in orthopedic surgery after the completion of medical school. According to the latest Occupational Outlook Handbook (2006-2007) published by the U.S. Department of Labor, between 3-4% of all practicing physicians are orthopedic surgeons.

In the United States र Canada orthopedic surgeons (also know as orthopedists) complete a minimum of 13 years of postsecondary education र clinical training. This training includes obtaining an undergraduate degree, a medical degree, र then completing a 5-year residency in orthopedic surgery. The 5-year residency consists of one year of general surgery training followed by four years of training in orthopaedic surgery.

Many orthopedic surgeons elect to do further subspeciality training in programs known as 'fellowships' after completing their residency training. These fellowships typically last 1–2 years र usually have a research component involved with the clinical र operative training. Examples of orthopedic subspeciality training in the US are:

1. Hand surgery
2. Shoulder र elbow surgery
3. Total joint reconstruction (arthroplasty)
4. Pediatric orthopedics
5. Foot र ankle surgery (Not to be confused with podiatry)
6. Spine surgery (Also performed by neurosurgeons)
7. Musculoskeletal oncology
8. Surgical sports medicine
9. Orthopaedic trauma

These are also the nine main sub-specialty areas of orthopaedic surgery.

Hand surgery is the only truly recognized sub-specialty within orthopaedic surgery. The other sub-specialities are informal concentrations of practice. To be recognized as a hand surgeon, a practitioner must have completed a fellowship र obtained a Certificate of Added Qualifications (CAQ) which requires an additional standardized examination.

Practice

Orthopaedic surgeons address most musculoskeletal ailments including arthritis, trauma र congenital deformities using both surgical र non-surgical means. According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopaedic surgeons are as follows:

1. Knee arthroscopy र menisectomy
2. Shoulder arthroscopy र decompression
3. Carpal tunnel release
4. Knee arthroscopy र chondroplasty
5. Removal of support implant
6. Knee arthroscopy र anterior cruciate ligament reconstruction
7. Knee replacement
8. Repair of femoral neck fracture
9. Repair of trochanteric fracture
10. Débridement of skin/muscle/bone/fracture
11. Knee arthroscopy repair of both menisci
12. Hip replacement
13. Shoulder arthroscopy/distal clavicle excision
14. Repair of rotator cuff tendon
15. Repair fracture of radius (bone)/ulna
16. Laminectomy
17. Repair of ankle fracture (bimalleolar type)
18. Shoulder arthroscopy र débridement
19. Lumbar spinal fusion
20. Repair fracture of the distal part of radius
21. Low back intervertebral disc surgery
22. Incise finger tendon sheath
23. Repair of ankle fracture (fibula)
24. Repair of femoral shaft fracture
25. Repair of trochanteric fracture

Of orthopaedic surgeons applying for certification with the American Board of Orthopedic Surgery between 1999 to 2003 these were the percentages of surgeons in each specialty area:

• General orthopaedics: 54.8%
• Spine surgery: 11.3%
• Sports medicine: 10.8%
• Hands र upper extremity: 8.7%
• Adult reconstructive: 3.9%
• Pediatric orthopaedics: 3.4%
• Foot र ankle: 3.1%
• Trauma: 2.6%
• Musculoskeletal oncology: 1.3%

A typical schedule for a practicing orthopaedic surgeon involves 50–55 hours of work per week divided among clinic, surgery, various administrative duties र possibly teaching and/or research if in an academic setting.

History

Jean-Andre Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. He is considered by some to be the father of orthopedics or the first true orthopedist in consideraton of the establishment of उनका hospital र for उनका published methods.

Antonius Mathysen, a Dutch military surgeon, invented the plaster of Paris cast in 1851.

Many developments in orthopedic surgery resulted from experiences during wartime. On the battlefields of the Middle Ages the injured were treated with bandages soaked in horses' blood which dried to form a stiff, but unsanitary, splint. Traction र splinting developed during World War I. The use of intramedullary rods to treat fractures of the femur र tibia was pioneered by Dr. Kunchner of Germany. This made a noticeable difference to the speed of recovery of injured German soldiers during World War II र led to more widespread adoption of intramedullary fixation of fractures in the rest of the world. However, traction was the standard method of treating thigh bone fractures until the late 1970s when the Seattle Harborview group popularized intramedullary fixation without opening up the fracture. External fixation of fractures was refined by American surgeons during the Vietnam War but a major contribution was made by Gavril Abramovich Ilizarov in the USSR. He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s. With no equipment he was confronted with crippling conditions of unhealed, infected, र malaligned 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 र lengthening to a degree unheard of elsewhere. His Ilizarov apparatus is still used today.

David L. MacIntosh pioneered the first successful surgery for the management of the torn anterior cruciate ligament of the knee. This common र serious injury in skiers, field athletes, र dancers invariably brought an end to their athletics due to permanent joint instability. Working with injured football players, Dr. MacIntosh devised a way to re-route viable ligament from adjacent structures to preserve the strong र complex mechanics of the knee joint र restore stability. The subsequent development of ACL reconstruction surgery has allowed numerous athletes to return to the demands of sports at all levels.

Modern orthopaedic surgery र musculoskeletal research has sought to make surgery less invasive र to make implanted components better र more durable.

Arthroscopy

The use of arthroscopic tools has been particularly important for injured patients. Arthroscopy was pioneered by Dr. Watanabe of Japan to perform minimally invasive cartilage surgery र re-constructions of torn ligaments. Arthroscopy helped patients recover from the surgery in a matter of days, rather than the weeks to months required by conventional, 'open' surgery. Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today र is often combined with meniscectomy or chondroplasty—both of which are removal of a torn cartilage.

Joint replacement

The modern total hip replacement was pioneered by Sir John Charnley in England in the 1960s. He found that joint surfaces could be replaced by metal or high density polyethylene implants cemented to the bone with methyl methacrylate cement. Since Charnley, there have been continuous improvements in the design र technique of joint replacement (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 patients र later by Gunston र Marmor for osteoarthritis in the 1970's. The modern knee replacement was developed by Dr. John Insall र Dr. Chitranjan Ranawat in New York. Uni-compartment knee replacement, in which only one side of an arthritic knee is replaced, is a smaller operation र has become popular recently.

Joint replacements are available for other joints on a limited basis, most notably shoulder, elbow, wrist र ankle.

Pediatric orthopaedics

The treatment of children with muscoloskeletal problems remains an integral part of modern orthopaedic surgery. Many fractures र injuries occur in children due to their high activity level र unique immature skeleton. Treatment of fractures in children is different than adults due to active growth plates in their bones. Damage to the growth plate can lead to significant problems with later bone growth, र at-risk fractures have to be monitored with care.

The treatment of scoliosis is a mainstay of pediatric orthopaedics. For poorly understood reasons, curvature devlops in the spine of some children, which if left untreated leads to undesireable deformity र may progress to cause chronic pain र breathing problems. The treatment of scoliosis is quite complicated र often involves a combination of bracing र surgery.

Children have other unique musculoskeletal conditions that have been a focus of orthopedics since Hippocrates, including conditions such as club foot र congenital dislocation of hip (also known as developmental dysplasia of the hip). In addition, infections in bones र joints (osteomyelitis) in children are common. In the US, specialized hospitals such as the Shriners hospitals have provided a substantial portion of treatment for children with musculoskeletal deformities र diseases.

Terminology

Nicholas Andry coined the word "orthopaedics", derived from Greek words for "correct" or "straight" ("orthos") र "child" ("paidion"), in 1741, when at the age of 81 he published Orthopaedia: or the Art of Correcting र Preventing Deformities in Children.

In the U.S. the spelling orthopedics is standard, although the majority of university र residency programs, र even the AAOS, still use Andry's spelling. Elsewhere, usage is not uniform; in Canada, both spellings are common; orthopaedics usually prevails in the rest of the Commonwealth, especially in Britain; see also spelling differences.

References

Garrett, WE, et al. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, Certification Examination. The Journal of Bone र Joint Surgery (American). 2006;88:660-667.

See also

• Bone grafting
• Gait analysis
• Halo system
• Hand surgery
• Orthopaedic nursing
• Traction

External links

• The History of Orthopaedics
• Wheeless' Textbook of Orthopaedics
• The International Society of Orthopaedic Surgery र Traumatology
• American Academy of Orthopaedic Surgeons
• Discussion Forum for Orthopaedic Careers Advice
• Pediatric Orthopaedics