 Orthopedic surgery or orthopedics (also spelled orthopedics, see below) is the branch of surgery concerned with acute, chronic, traumatic, and overuse injuries and other disorders of the musculoskeletal system. Orthopedic surgeons address most musculoskeletal ailments including arthritis, trauma and congenital deformities using both surgical and non-surgical means.
Training
Orthopedic surgeons (also known as orthopedists) complete a minimum of 10 years of postsecondary education and clinical training. In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will admit students with as little as two years of undergraduate education), an allopathic degree or osteopathic degree (4 years), and then completing a five-year residency in orthopedic surgery. The five-year residency consists of one year of general surgery training followed by four years of training in orthopedic surgery.
Many orthopedic surgeons elect to do further subspecialty training in programs known as 'fellowships' after completing their residency training. Fellowship training in an orthopedic subspecialty is typically one year in duration (sometimes two) and usually has a research component involved with the clinical and operative training. Examples of orthopedic subspecialty training in the US are:
- Hand surgery (also performed by Plastic Surgeons)
- Shoulder and elbow surgery
- Total joint reconstruction (arthroplasty)
- Pediatric orthopedics
- Foot and ankle surgery (Also performed by podiatry)
- Spine surgery (Also performed by neurosurgeons)
- Musculoskeletal oncology
- Surgical sports medicine
- Orthopedic trauma
These are also the nine main sub-specialty areas of orthopedic surgery.
Practice
Orthopedic surgeons address most musculoskeletal ailments including arthritis, trauma and congenital deformities using both surgical and non-surgical means. According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed 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 débridement
- Lumbar spinal fusion
- Repair fracture of the distal part of radius
- Low back intervertebral disc surgery
- Incise finger tendon sheath
- Repair of ankle fracture (fibula)
- Repair of femoral shaft fracture
- Repair of trochanteric fracture
Of orthopedic 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 orthopedics: 54.8%
- Spine surgery: 11.3%
- Sports medicine: 10.8%
- Hands and upper extremity: 8.7%
- Adult reconstructive: 3.9%
- Pediatric orthopedics: 3.4%
- Foot and ankle: 3.1%
- Trauma: 2.6%
- Musculoskeletal oncology: 1.3%
Arthroscopy
The use of arthroscopic tools has been particularly important for injured patients. Arthroscopy was pioneered in the early 1950's by Dr. Masaki Watanabe of Japan to perform minimally invasive cartilage surgery and 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 and 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[citation needed]. 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 and 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 and later by Gunston and Marmor for osteoarthritis in the 1970's. The modern knee replacement was developed by Dr. John Insall and Dr. Chitranjan Singh Ranawat in New York[citation needed]utilizing a fixed bearing and Dr Frederick Buechel and Dr Michael Pappas utilizing a mobile Bearing. Uni-compartment knee replacement, in which only one side of an arthritic knee is replaced, is a smaller operation and has become popular recently.
Joint replacements are available for other joints on a limited basis, most notably shoulder, elbow, wrist, ankle, and fingers.
In recent years, surface replacement of joints, in particular the hip joint, have become more popular amongst younger and more active patients. This type of operation delays the need for the more traditional and less bone-conserving total hip replacement, but carries significant risks of early failure from fracture and bone death.
One of the main problems with joint replacements is wear of the bearing surfaces of components. This can lead to damage to surrounding bone and contribute to eventual failure of the implant. Use of alternative bearing surfaces has increased in recent years, particularly in younger patients, in an attempt to improve the wear characteristics of joint replacement components. These include ceramics and all-metal implants (as opposed to the original metal-on-plastic). The plastic (actually ultra high molecular weight polyethylene) can also be altered in ways that may improve wear characteristics.
Pediatric orthopedics
The treatment of children with musculoskeletal problems remains an integral part of modern orthopedic surgery. Many fractures and injuries occur in children due to their high activity level and 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, and at-risk fractures have to be monitored with care.
The treatment of scoliosis is a mainstay of pediatric orthopedics. For poorly understood reasons, curvature develops in the spine of some children, which if left untreated leads to undesirable deformity and may progress to cause chronic pain and breathing problems. The treatment of scoliosis is quite complicated and often involves a combination of bracing and surgery.
Children have other unique musculoskeletal conditions that have been a focus of orthopedics since Hippocrates, including conditions such as club foot and congenital dislocation of hip (also known as developmental dysplasia of the hip). In addition, infections in bones and joints (osteomyelitis) in children are common. In the US, specialized hospitals such as the Shriners Hospitals for Children have provided a substantial portion of treatment for children with musculoskeletal deformities and diseases.
Please see links below for further informaiton:
 Ankle Fusion Operation - Arthodesis
Ankle- Broken Ankle
Degenerative Disc Disease
Discectomy - Slipped Disc
Dupuytrens Contracture - Partial Fasciectomy
Epidural
Femoral Shaft Fracture - Internal Fixation
Foot - Club Foot Repair
Foot - Joint Stabilization
Foot - Webbed Toes
Foot- Bunionectomy
Ganglion Excision - Foot
Ganglion Excision - Wrist
Hands - Carpal Tunnel Surgery
Hands - Dupuytrens Contracture
Hands - Range Movement
Hands - Rheumatoid Arthritis
Herniated Disc Treatment
Hip - Replacement
Hip - Resurfacing
Knee - Kneecap Removal
Knee - Replacement
Knee - Stabilisation
Knee- ACL Stabilization
Knee- Arthroscopic Surgery
Laminectomy
Leg - Adjustment Surgery
Pelvic Fixation
Posterior Cruciate Ligament (PCL) Reconstruction
Radius And Ulna Fracture - Internal Fixation
Rheumatoid Arthritis
Rotator Cuff Tightening
Shoulder - Replacement
Shoulder - Rotator Cuff Repair
Shoulder Arthroscopy
Shoulder Tendon Repair - Rotator Cuff
Spinal Bone Spur Treatment
Spinal Stenosis Operation
Spine - Disc Removal
Spine - Kyphoplasty
Spine - Spinal Fusion
Spine - Total Disc Replacement (TDR)
Spine - Vertebroplasty
Spine- Artificial Discs
Stenosis Treatments
Tendon Repair - Achilles Tendon
Tendon Repair - Extensor
Tendon Repair - Flexor
Thoracoplasty For Scoliosis
Toe Fusion - Arthodesis
Toe Nail Removal
Wrist - Replacement
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Treatments
