Orthopaedic Surgery/Introduction

	Introduction
<<Preface		Authors>>

Orthopedic Surgery is a surgical subspecialty which focuses on maladies of the Musculoskeletal System. Surgeons who specialise in this field are referred to as Orthopaedicians or Orthopaedists or simply Orthopaedic Surgeons. Orthopaedic Surgeons are involved in the diagnosis, treatment, rehabilitation and prevention of injuries or diseases afflicting the spine, pelvis and extremities. Bones, joints, ligaments, tendons, muscles and nerves constitute the muskelosleletal system. The muskuloskeletal system helps us to sit, stand, move, work, play and function as a human being. Orthopaedic surgeons often work closely with other health professionals like Plastic Surgeons, Radiologists, Trauma Surgeons, Anaesthetists, Physical therapists and Orthotists in restoring the diseased patient back to normal function.

Origin

Nicolas Andre was the first to propose the term Orthopaedia in a self-help book he wrote for parents - Orthopaedia: Or, The art of Correcting and Preventing Deformities in Children. He derived the name from the two greek words, Ortho implying straight and free from deformity and Paedia referring to children. At that point of time deformities in children due to poliomyelietis and tuberculosis was rampant and physicians were few or too expensive to afford. Today orthopaedics, as it is commonly referred to, deals with patients from all age groups. Contrary to common belief, the proper spelling is orthopaedic and not orthopedic. However the earliest evidence of care for the injured and deformed can be traced back five thousand years to the Egyptian civilisation.. Over the years physicians and surgeons, both, combined their resources in taking care of the crippled. The discovery of anaesthesia by Horace Wells , recognition of the importance of asepsis by Joseph Lister, bone grafting by MacEwen, and Internal fixation by Arbuthnot Lane, combined with the development of the "magic rays" by William Conrad Röntgen completed the triad of developments that propelled orthopaedics at the turn of the 19th century to establish into a speciality.

Scope

Orthopaedic Surgeons treat a wide range of problems starting from fractures and dislocations, ligament and tendon injuries, low back pain and sciatica, bone tumours, arthritis and osteoporosis, clubfoot and knock knees to cerbral palsy and muscular dystrophy. The range is wide in its length and breadth. Many times, like in other specialitites, the Orthopaedician is part of a large team caring for the patient. Over the past few decades orthopaedics has grown into different subspecialities - Paediatric Orthopaedics, Spine Surgery, Arthroscopy, Trauma, Adult Reconstruction, Hand and Microsurgery. Most of the orthopaedic surgeons practise general orthopaedics but many of them are beginning to branch out and concentrate on an area of sub speciality. To be an orthopaedic surgeon one would require to have a sound theoretical knowledge of the subject, good understanding of mechanics, substantial manual dexterity, and the ability to visualise in three-dimensions. Tremendous advances have been made in the field of Arthroscopy, Spine surgery and Arthroplasty. Cartilage growth and transplant hold a lot of promise for the future. Orthopaedics is a vast evolving speciality. A consultant orthopaedic surgeon divides his time between the out-patient clinics, the operating theatre, teaching and research. A network of societies and associations hold annual meetings and educational courses to keep the surgeon updated.

Market and Orthopaedics

It is only through practicing orthopedics that we can be said to know it. It is through the practice of orthopedic surgery that we challenge the scientific hypotheses that underpin our therapeutic approaches. Indeed in orthopedics, as in any scientifically based discipline, it is through the study of our failures that our science is refined and our practices ultimately improved. Evidenced based medicine, decision analysis and patient centered outcomes analysis serve to augment the organic process of decision making that occurs naturally in the process of practicing orthopedic surgery.The practice of orthopedic surgery like any medical practice involves decision making. The authority, status, respect, and hopefully remuneration that result reflect the quality of our decision making as that quality impacts the success or our interventions in positively influencing the course of our patients confronted with musculoskeletal afflictions. Today the process of knowledge acquisition and marketing are tightly intertwined. When considering a presentation at a meeting the audience is being presented with scientific information as well as a brand message, from the presenter and from any technology purveyor which may be featured in the clinical series. Critical review of presentations and in the case of published data, assessment as to the level of evidence which is being delivered is an essential part of the process. Many of the scientific meetings which purport to be the basis of our education are controlled or managed by market forces. And to be eligible to participate in such a process, a surgeon needs to either pay through his nose or be sponsored by a company.

Need of a Wikibook

In a society where the market forces determine your eligibility to education it is important that we have mechanisms in place that can possibly free us from such restrictive access. There are numerous medical personnel in the world who do not have access to medical resources. There are numerous websites that have made attempts to provide access. This wikibook is also an exercise in providing information on Orthopaedic surgery free of any restrictions. We hope that over a period of time the book will grow into a respectable compendium on orthopaedic surgery.Developing such a body of work requires tremendous effort and in the absence of commercial interests, this is possible in the platform that wikibooks provides. Wikibooks provides for us, you and me, the space to work on, cumulate and evaluate the work with the aid of numerous volunteers from the community. And all this comes at no price. This is not easy work! But we believe this is possible and we are here to prove it. Please join us in making this a success.

Further Reading

• History of Orthopaedics by Vlasios Brakoulias.
• The origins of Orthopaedics and Orthopaedics: Evolution of the speciality by A W Beasley
• Wikibooks and Help
• Medical disclaimer