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Definition
Orthopaedic (sometimes spelled orthopedic) surgery is surgery performed by a medical specialist, such as an orthopaedist or orthopaedic surgeon, trained to deal with problems that develop in the bones, joints, and ligaments of the human body.
Purpose
Orthopaedic surgery corrects problems that arise in the skeleton and its attachments, the ligaments and tendons. It may also deal with some problems of the nervous system, such as those that arise from injury of the spine. These problems can occur at birth, through injury, or as the result of aging. They may be acute, as in injury, or chronic, as in many aging-related problems.
Orthopedics comes from two Greek words, ortho, meaning straight and pais, meaning child. Originally orthopaedic surgeons dealt with bone deformities in children, using braces to straighten the child's bones. With the development of anesthesia and an understanding of the importance of aseptic technique in surgery, orthopaedic surgeons extended their role to include surgery involving the bones and related nerves and connective tissue.
Many orthopaedic surgeons maintain a general practice, while some specialize in one particular aspect of orthopedics, such as hand surgery, joint replacements, or disorders of the spine. Orthopaedics treats both acute and chronic disorders. Some orthopaedists specialize in trauma medicine and can be found in emergency rooms and trauma centers treating injuries. Others find their work overlapping with plastic surgeons, geriatric specialists, and paediatricians. A rapidly growing area of orthopaedics is sports medicine, and many sports medicine doctors are certified orthopaedists.
Description
The range of treatments done by orthopedists is enormous. It can cover anything from traction to amputation, hand reconstruction to spinal fusion or joint replacements. They also treat broken bones, strains and sprains, and dislocations. Some specific procedures done by orthopedic surgeons are listed as separate entries in this book, including arthroplasty, arthroscopic surgery, bone grafting, fasciotomy, fracture repair, kneecap removal, and traction.
In general orthopedists work closely with a surgical team including an anesthesiologist and surgical nurse. Orthopedic surgery can be performed under general, regional, or local anesthesia.
Much of the work of the surgeon involves adding foreign material to the body in the form of screws, wires, pins, tongs, and prosthetics to hold damaged bones in their proper alignment or to replace damaged bone or connective tissue. Great improvements have been made in the development of artificial limbs and joints, and in the materials available to repair damage to bones and connective tissue. As developments occur in the fields of metallurgy and plastics, changes will take place in orthopedic surgery that will allow the surgeon to more nearly duplicate the natural functions of the bones, joints, and ligaments, and to more accurately restore damaged parts to their original range of motion.
Preparation
Patients are usually referred to an orthopedic surgeon by a general physical or family doctor. Prior to any surgery, the patient undergoes extensive testing to determine the proper corrective procedure. Tests may include x rays, computed tomography scans (CT scans), magnetic resonance imaging (MRI), myelograms, diagnostic arthroplasty, and blood tests. The orthopedist will determine the history of the disorder and any treatments that were tried previously. A period of rest to the injured part may be recommended before surgery is prescribed.
Patients undergo standard blood and urine tests before surgery and, for major surgery, may be given an electrocardiogram or other diagnostic tests prior to the operation. Patients may choose to give some of their own blood to be held in reserve for their use in major surgery, such as knee replacement, where bleeding is common.
Aftercare
Rehabilitation from orthopedic injuries can be a long, arduous task. The doctor will work closely with physical therapists to assure that the patient is receiving treatment that will enhance the range of motion and return function to the affected part.
Risks
As with any surgery, there is always the risk of excessive bleeding, infection, and allergic reaction to anesthesia. Risks specifically associated with orthopedic surgery include inflammation at the site where foreign material (pins, prosthesis) is introduced into the body, infection as the result of surgery, and damage to nerves or to the spinal cord.
Normal results
Thousands of people have successful orthopedic surgery each year to recover from injuries or restore lost function. The degree of success in individual recoveries depends on the age and general health of the patient, the medical problem being treated, and the patient's willingness to comply with rehabilitative therapy after the surgery.
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