Orthopedic surgery





Definition

Orthopedic (sometimes spelled orthopedic) surgery is an operation performed by a medical specialist such as an orthopedist or orthopedic surgeon, who is trained to assess and treat problems that develop in the bones, joints, and ligaments of the human body.


Purpose

Orthopedic surgery addresses and attempts to correct problems that arise in the skeleton and its attachments, the ligaments and tendons. It may also include 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 an accident or injury, or chronic, as in many problems related to aging.

Orthopedics comes from two Greek words, ortho , meaning straight, and pais , meaning child. Originally, orthopedic surgeons treated skeletal 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, orthopedic surgeons extended their role to include surgery involving the bones and related nerves and connective tissue.

The terms orthopedic surgeon and orthopedist are used interchangeably today to indicate a medical doctor with special training and certification in orthopedics.

Many orthopedic 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. Orthopedists treat both acute and chronic disorders. Some orthopedic surgeons 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, pediatricians, or podiatrists (foot care specialists). A rapidly growing area of orthopedics is sports medicine, and many sports medicine doctors are board certified in orthopedic surgery.


Demographics

The American Academy of Orthopedic Surgeons reports that in 2003, there are 15,853 active fellows, 1,829 resident members, and 2,240 candidate members, for a total of 19,922 orthopedic surgeons in the United States.


Description

The range of treatments provided by orthopedists is extensive. They include procedures such as traction , amputation , hand reconstruction, spinal fusion , and joint replacements. They also treat strains and sprains, broken bones, and dislocations. Some specific procedures performed 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 are employed by hospitals, medical centers, trauma centers, or free-standing surgical centers where they 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 an orthopedic 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 surgeons to more nearly duplicate the natural functions of bones, joints, and ligaments, and to more accurately restore damaged parts to their original ranges of motion.


Diagnosis/Preparation

Persons are usually referred to an orthopedic surgeon by a primary care physician, emergency room physician, or other doctor. Prior to any surgery, candidates undergo extensive testing to determine appropriate corrective procedures. Tests may include x rays, computed tomography (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 previously tried. A period of rest to the injured part may be recommended before surgery is undertaken.

Surgical candidates undergo standard blood and urine tests before surgery and, for major procedures, may be given an electrocardiogram or other diagnostic tests prior to the operation. Individuals may choose to donate some of their own blood to be held in reserve for their use in major surgery such as knee replacement , during which heavy bleeding is common.


Aftercare

Rehabilitation from orthopedic injuries can require long periods of time. Rehabilitation is usually physically and mentally taxing. Orthopedic surgeons will work closely with physical therapists to ensure that patients receive treatment that will enhance the range of motion and return function to all affected body parts.


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 materials (pins, prostheses, or wires) are 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 to restore lost function. The degree of success in individual recoveries depends on an individual's age and general health, the medical problem being treated, and a person's willingness to comply with rehabilitative therapy after the surgery.

Abnormal results from orthopedic surgery include persistent pain, swelling, redness, drainage or bleeding in the surgical area, surgical wound infection resulting in slow healing, and incomplete restoration of pre-surgical function.


Morbidity and mortality rates

Mortality from orthopedic surgical procedures is not common. The most common causes for mortality are adverse reactions to anesthetic agents or drugs used to control pain, post-surgical clot formation in the veins, and post-surgical heart attacks or strokes.


Alternatives

For the removal of diseased, non-functional, or non-vital tissue, there is no alternative to orthopedic surgery. Alternatives to orthopedic surgery depend on the condition being treated. Medications, acupuncture, or hypnosis are used to relieve pain. Radiation is an occasional alternative for shrinking growths. Chemotherapy may be used to treat bone cancer. Some foreign bodies may remain in the body without harm.

See also Elective surgery ; Finding a surgeon .


Resources

BOOKS

Bland, K. I., W. G. Cioffi, and M. G. Sarr. Practice of General Surgery. Philadelphia: Saunders, 2001.

Canale, S. T. Campbell's Operative Orthopedics. St. Louis: Mosby, 2003.

Schwartz, S. I., J. E. Fischer, F. C. Spencer, G. T. Shires, and J. M. Daly. Principles of Surgery, 7th Edition. New York: McGraw Hill, 1998.

Townsend, C., K. L. Mattox, R. D. Beauchamp, B. M. Evers, and D. C. Sabiston. Sabiston's Review of Surgery, 3rd Edition. Philadelphia: Saunders, 2001.


PERIODICALS

Caprini, J. A., J. I. Arcelus, D. Maksimovic, C. J. Glase, J. G. Sarayba, and K. Hathaway. "Thrombosis Prophylaxis in Orthopedic Surgery: Current Clinical Considerations." Journal of the Southern Orthopedic Association 11, no.4 (2002): 190–196.

O'Brien, J. G. "Orthopedic Surgery: A New Frontier." Mayo Clinic Proceedings 78, no.3 (2003): 275–277.

Ribbans, W. J. "Orthopedic Care in Haemophilia." Hospital Medicine 64, no.2 (2003): 68–69.

Showstack, J. "Improving Quality of Care in Orthopedic Surgery." Arthritis and Rheumatism 48, no.2 (2003): 289–290.


ORGANIZATIONS

American Academy of Orthopedic Surgeons. 6300 North River Road Rosemont, IL 60018-4262. (847) 823-7186 or (800) 346-2267. http://www.aaos.org/wordhtml/home2.htm .

American College of Sports Medicine. 401 West Michigan Street, Indianapolis, IN 46202-3233 (Mailing Address: P.O. Box 1440, Indianapolis, IN 46206-1440). (317) 637-9200, Fax: (317) 634-7817. http://www.acsm.org .

American College of Surgeons. 633 North Saint Claire Street, Chicago, IL 60611. (312) 202-5000. http://www.facs.org/ .

American Society for Bone and Mineral Research 2025 M Street, NW, Suite 800, Washington, DC 20036-3309. (202) 367-1161. http://www.asbmr.org/ .

Orthopedic Trauma Association. 6300 N. River Road, Suite 727, Rosemont, IL 60018-4226. (847) 698-1631. http://www.ota.org/links.htm .

OTHER

American Osteopathic Association. [cited April 7, 2003] http://www.aoa-net.org/Certification/orthopedsurg.htm .

Brigham and Woman's Hospital (Harvard University School of Medicine). [cited April 7, 2003] <http://splweb.bwh.harvard.edu:8000/pages/projects/ortho/ortho.ht l> .

Martindale's Health Science Guide, 2003. [cited April 7, 2003] http://www-sci.lib.uci.edu/HSG/MedicalSurgery.html .

Thomas Jefferson University Hospital. [cited April 7, 2003] http://www.jeffersonhospital.org/e3front.dll?durki=4529 .

University of Maryland College of Medicine. [cited April 7, 2003] http://www.umm.edu/surg-ortho/ .


L. Fleming Fallon, Jr, MD, DrPH

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Orthopedic surgery is performed by a physician with specialized training in orthopedic surgery. It is most commonly performed in operating room of a hospital. Very minor procedures such as setting a broken bone may be performed in a professional office or an emergency room of a hospital.

QUESTIONS TO ASK THE DOCTOR


  • What tests will be performed prior to surgery?
  • How will the procedure affect daily activities after recovery?
  • Where will the surgery be performed?
  • What form of anesthesia will be used?
  • What will be the resulting appearance and level of function after surgery?
  • Is the surgeon board certified by the American Academy of Orthopedic Surgeons?
  • How many similar procedures has the surgeon performed?
  • What is the surgeon's complication rate?


User Contributions:

Chris
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Nov 19, 2007 @ 9:21 pm
Hello i just had a question.I'm 17 but i'm deciding everything from ,where im going to college all the way to what university i want to go to and what job i want.I want to be a doctor ,something with bones ,so that means physicien right?or is there any other job?and in university i will need bone and joints health right?

please message me to help me out on my quest to be a doctor
Michael Swortz
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Apr 15, 2008 @ 11:11 am
Hey I'm 17 as well and I'm also interested in the skeletal and muscular systems. I would recommend becoming a Doctor of Osteopathy. Or you can specialize in Orthopedics.
samah
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Dec 8, 2009 @ 9:21 pm
hi, i wanted to know whats all the tasks an orthopedic surgeon perform, and what are its responsibilities.
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Jun 28, 2010 @ 10:22 pm
I am 18 years and interested in the anatomy and physiology of the human body. I want to become an orthopedic surgeon, I may specialize in one function but I am thinking about specializing in general orthopedics. Is there a way I can learn more about my field of intrest in depth and learn more about colleges that specialize with them?
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Oct 28, 2010 @ 5:17 pm
Had total right knee replacment 7/1/10. I am now experiencing pain in both knees, and cannot walk properly without difficulty. No pain meds seem to work for any length of time. Shooting pain throughout my body (I have osteoarthritis) after surgery seems common now. Could nerve damage have occurred, and what if anything can I do to relieve my knee and all over body pain? I am 66 yrs old, and always very active. This has put a real crimp in my life. I appreciate any help you can be...I live in Florida. thank you kindly. Pat Englert
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Feb 7, 2011 @ 9:09 am
I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading your post and read the comments. Really a nice post here!



cosmetic plastic surgery advice
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Jul 10, 2011 @ 1:01 am
I will be having a removal of two screws in my right ankle. When the screws are removed they will fill the space with bone grafting.

I am trying to find out the recovery time. How long will it be before I can walk?

What is the success rate of getting out of pain. My Dr. feels that the screws are on the nerve and that is what is causing my pain. Are there any answers out there?
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Oct 29, 2011 @ 9:09 am
I believe what you have said is correct. Men nowadays are continuing to exploring options for them to look good. It’s not just for the physical aspect but for your self esteem also. Can you post more details of men that face post-surgical depression? Do you have the numbers or statistics or perhaps testimonies? Thank you.
James Makker MD & Neurosurgeon
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Jun 21, 2012 @ 2:14 pm
To Chris, contributor #1 Depending on your grades, try to go to the best college you can afford. Then you want to go the the best medical school which will accept you. If your grades are not that good, you may consider Physical Therapy. They work with people who have been injured, or who have had surgery, to help get the muscles strong and the joints mobile. You might also consider physician assistant, or if you like there is an orthopaedic physician assistant. They have recently started a school for such in St Augustine Florida, near where I live.

To Samah, contributor # 3 I am an orthopaedic surgeon. I do general orthpaedics in a small town in Florida. I treat most coinditions involving the arms and legs. Some orthopaedic surgeons specialize, hand, spine, pediatrics orthopaedics, foot and ankle. I fix fractures, sew tendons that have been cut, perform joint replacements.

To Chris and Samah: I have had high school students "shadow" me in the office and operating room as part of their high school program. You might find someone in your area with whom you could spend some time. Talk to the doctors in your area

To Patricia Englert, # 5: There are many causes of continued pain after total knee. Infection is one of the worst. If the parts are not in the correct position the patient may continue to have pain. The parts can work loose. I recommend that you see your doctor and get him to do tests on you
Christine
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Apr 12, 2013 @ 11:23 pm
I aM a 70 year old female, and has just been diagonoised with a 40% tear in a tendon in my shoulder, and arthritis in my AC joint. The tear is where the arm bone connects with the shoulder, that holds everything up. My naturalpath says I need to go to physical therapy for a year, and do everything they tell me too. My son-in law says that I should have surgery, as the tendon will not heal on its own. I am very confused on what to do? Will it heal? or should I have surgery to repair it? I have been in pain since late last summer, so have to assume lifting ties, cantalpe sixed rocks, and scrubbing, and re-finishing cabinets is what caused the tear. How long I have had it I don't know for sure? Right now I have my arm in a sling at the naturalpaths suggestion. I live in ND, and am out in WA state right now where they did a MRI to determine why I have been in so much pain. I live with in a days drive to Mayo Clinic Rochester, would that be a safe place to have this looked at? I don't want to lose the use of my right arm, as I am right handed. At the same time if it will mend on its own, I will do physical therapy, but if my son-in law is right, and it won't heal on its own, then I need to re-think what to do. Thank you for any suggestions, or information.
james watosons
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Jun 1, 2013 @ 5:05 am
Please suggest some places from where i can get orthopedic surgery. I need it urgently so please share with me.

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