Early orthopedics Many developments in orthopedic surgery have 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, if unsanitary, splint. Originally, the term orthopedics meant the correcting of musculoskeletal deformities in children.
Nicolas Andry, a professor of medicine at the
University of Paris, coined the term in the first textbook written on the subject in 1741. He advocated the use of exercise, manipulation, and splinting to treat deformities in children. His book was directed towards parents, and while some topics would be familiar to orthopedists today, it also included 'excessive sweating of the palms' and freckles.
Jean-André Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. He developed the club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine. Advances made in surgical technique during the 18th century, such as
John Hunter's research on
tendon healing and
Percivall Pott's work on
spinal deformity steadily increased the range of new methods available for effective treatment.
Robert Chessher, a pioneering British orthopedist, invented the double-inclined plane, used to treat lower-body bone fractures, in 1790.
Antonius Mathijsen, a Dutch military surgeon, invented the
plaster of Paris cast in 1851. Until the 1890s, though, orthopedics was still a study limited to the correction of deformity in children. One of the first surgical procedures developed was percutaneous tenotomy. This involved cutting a tendon, originally the Achilles tendon, to help treat deformities alongside bracing and exercises. In the late 1800s and first decades of the 1900s, significant controversy arose about whether orthopedics should include surgical procedures at all.
Modern orthopedics , a pioneer of modern orthopedic surgeryExamples of people who aided the development of modern orthopedic surgery were
Hugh Owen Thomas, a surgeon from
Wales, and his nephew,
Robert Jones. Thomas became interested in orthopedics and
bone-setting at a young age, and after establishing his own practice, went on to expand the field into the general treatment of fracture and other musculoskeletal problems. He advocated enforced rest as the best remedy for
fractures and
tuberculosis, and created the so-called "Thomas splint" to stabilize a fractured femur and prevent infection. He is also responsible for numerous other medical innovations that all carry his name: Thomas's collar to treat tuberculosis of the cervical spine, Thomas's maneuvere, an orthopedic investigation for fracture of the hip joint, the
Thomas test, a method of detecting hip deformity by having the patient lying flat in bed, and Thomas's wrench for reducing fractures, as well as a so-called "osteoclast" implement to break and reset bones. Thomas's work was not fully appreciated in his own lifetime. Only during the First World War did his techniques come to be used for injured soldiers on the battlefield. His nephew, Sir Robert Jones, had already made great advances in orthopedics in his position as surgeon-superintendent for the construction of the
Manchester Ship Canal in 1888. He was responsible for the injured among the 20,000 workers, and he organized the first comprehensive accident service in the world, dividing the 36-mile site into three sections, and establishing a hospital and a string of first-aid posts in each section. He had the medical personnel trained in fracture management. He personally managed 3,000 cases and performed 300 operations in his own hospital. This position enabled him to learn new techniques and improve the standard of fracture management. Physicians from around the world came to Jones' clinic to learn his techniques. Along with Alfred Tubby, Jones founded the
British Orthopedic Society in 1894. During the First World War, Jones served as a
Territorial Army surgeon. He observed that treatment of fractures both at the front and in hospitals at home, was inadequate, and his efforts led to the introduction of military orthopedic hospitals. He was appointed Inspector of Military Orthopedics, with responsibility for 30,000 beds. The hospital in Ducane Road,
Hammersmith, became the model for both British and American military orthopedic hospitals. His advocacy of the use of
Thomas splint for the initial treatment of
femoral fractures reduced mortality of open fractures of the femur from 87% to less than 8% in the period from 1916 to 1918. The use of
intramedullary rods to treat fractures of the femur and
tibia was pioneered by
Gerhard Küntscher of Germany. This made a noticeable difference to the speed of recovery of injured German soldiers during World War II and led to more widespread adoption of intramedullary fixation of fractures in the rest of the world.
Traction was the standard method of treating thigh bone fractures until the late 1970s, though, when the
Harborview Medical Center group in Seattle popularized intramedullary fixation without opening up the fracture. The modern total
hip replacement was pioneered by Sir
John Charnley, expert in
tribology at
Wrightington Hospital, in England in the 1960s. He found that joint surfaces could be replaced by implants cemented to the bone. His design consisted of a
stainless steel, one-piece femoral stem and head, and a
polyethylene acetabular component, both of which were fixed to the bone using
PMMA (acrylic)
bone cement. For over two decades, the Charnley low-friction arthroplasty and its derivative designs were the most-used systems in the world. This formed the basis for all modern hip implants. The
Exeter hip replacement system (with a slightly different stem geometry) was developed at the same time. Since Charnley, improvements have been continuous 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 1970s, developed by
John Insall in New York using a fixed bearing system, and by Frederick Buechel and Michael Pappas using a mobile bearing system. External fixation of fractures was refined by American surgeons during the
Vietnam War, but a major contribution was made by
Gavriil 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, and misaligned 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, and
lengthening to a degree unheard of elsewhere. His
Ilizarov apparatus is still used today as one of the distraction osteogenesis methods. Modern orthopedic surgery and musculoskeletal research have sought to make surgery less invasive and to make implanted components better and more durable. On the other hand, since the emergence of the opioid epidemic, orthopedic surgeons have been identified as one of the highest prescribers of opioid medications. Decreasing prescription of opioids while still providing adequate pain control is a development in orthopedic surgery. == Training ==