The Early & the Modern Orthopedics

Thursday, 7 December 2017

Orthopedic surgery has vast and rich history. While the historical term of orthopedics dates back to the primitive age, the modern term orthopedics stems from the older word orthopedia which is the title of a book published in 1741 by Nicholas Andry, a professor of medicine at the University of Paris.

The practice of orthopedics is an ancient art. Fossil evidence suggests that the orthopedic pathology of today, such as fractures and traumatic amputations existed in primitive times. It is important to identify the role of history in orthopedics with regards to progress and advancements for medical students and enthusiasts interested in mastering a particular medical area of expertise.

Early Orthopedics:
While the proof is limited, the practice of orthopedics dates back to the prehistoric era. The union of fractures in fair alignment has also been observed which emphasizes the value of non-operative orthopedics and suggests the early use of splints and healing practices. Many developments in orthopedic surgery have resulted from experiences during wartime on the battle fields of the middle ages the injured were treated with bandages soaked in horse blood which dried to form a stiff but unsanitary splint.

Later civilizations also developed ways to manage orthopedic injuries. For example, the Shoshone Indians, who were known to exist around 700-2000 BCE, made a splint of fresh rawhide that had been soaked in water. Similarly, some South Australian tribes made splints of clay, which when dried were as good as plaster of Paris. Furthermore, bone-setting was practiced as a profession in many tribes, underscoring the importance of orthopedic injuries in early civilizations.

Modern Orthopedics:
Hugh Owen Thomas and Sir Robert Jones can be credited as the pioneers of Modern Orthopedics. Thomas became interested in Orthopedics at a very young age & later went on to start his own practice.He advocated enforced rest as the best remedy for fractures and tuberculosis and created the 'Thomas Splint', to stabilize a fractured femur and prevent infection. He is also responsible for numerous other brilliant medical innovations. Though Thomas worked extremely hard; his efforts weren’t appreciated & it was only until the beginning of World War 1 his techniques came to be used for injured soldiers.

His nephew, Sir Robert Jones, had already made great advances in orthopedics in his position as orthopaedic 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 3 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 managed to establish himself as a successful orthopaedic surgeon.

Did you know? The modern total hip replacement was pioneered by Sir John charley expert in tribology at Wrightington Hospital.

Challenges faced in Orthopedic Research Program and Recent Developments in the Field of Orthopedic Research Program

Wednesday, 9 August 2017

The initiation of research programs need complex decision-making & logistical, directional, financial, and other considerations must be assessed. The greatest barriers in the growth of new basic research facilities include availability of technical skills, space, and finances. In this section we will see the basic infrastructure and equipment requirements for the development of orthopedic molecular biology and bio-mechanical research laboratories, as well as some of the economic considerations required to develop these facilities.

Infrastructure and equipment required for Orthopedic Surgery Research laboratory:

The infrastructure needed to run an Orthopedic Surgery Research laboratory is similar to any other biological laboratory. Fume hoods are necessary to vent noxious and unsafe chemicals. An animal housing facility is needed if work is performed on any number of model organisms. If work is to be done on established or primary cell lines, then a separate cell culture room should be taken into consideration. By separating cell culture facilities, reducing foot traffic in and around the incubators and hoods will help in keeping it free of bacteria and mold. A new part of the laboratory should be set aside for sectioning, processing and staining of histological specimens. This area should be located compulsorily in a “dust-free” area.

Recent advances in the field of Orthopedic Research Program

  • 1.   Autologous chondrocyte transplantation is being used in some clinic centers to provide a better quality of life for and also prevent arthritis in younger patients who have injured their articular cartilage
    2.   Internal fixation of long bone fractures in children decreases the time spent in hospital
    3. Botulinum toxin is beneficial in treating muscle elasticity in children with cerebral palsy

  • The field of orthopedic research will continue to grow in order to address the increasing global burden of musculoskeletal injury and disease. New basic scientific discoveries in biological and mechanical research will continue to advance rapidly, and present opportunities to bring these new discoveries to the clinic. The complex nature of the musculoskeletal system requires multi-disciplinary collaborations between investigators that possess a wide diversity of expertise. Although the development of research laboratories and opportunities require extensive planning and resource development, ultimately basic discoveries have the potential to develop into translational projects that can impact patient care. Several such discoveries have already developed into large-scale multi-national clinical trials, which are the end-goal for basic science research.

    Significant Facts about Knee Arthroscopy

    Friday, 23 June 2017

    The word arthroscopy is derived from the two Greek words “Arthro” which stand for joint, and “Skopein” which means to look at. Arthroscopic surgeries are carried out for numerous different joints including the knee, elbow and shoulder. Knee arthroscopy allows an orthopedic surgeon to visualize, do a diagnosis and treat problems inside the knee joint. Your specialist may recommend knee arthroscopy if you are going through a condition which does not respond to non-surgical (conservative) treatments.

    History of Arthroscopy

    Arthroscopy of the knee was developed in the year 1970s and came into general use in the year 1980s. Moreover, arthroscopic instruments or devices were created and refined for specific surgical tasks during knee surgeries and diagnosis purpose.

    Arthroscopic Knee Surgery

    This process is used in examination and repair of several different types of conditions such as; a meniscal tear, ACL tears with instability, chondromalacia (wear and damage of cartilage cushion), bone spurs formation, synovial tissue damage due to Rheumatoid Arthritis to name a few. In a knee arthroscopy process, the surgeon typically first observes the damaged parts and then may decide to carry out the minor surgical technique to remove the diseased part.

    Indications for Knee Arthroscopy

    According to the American Orthopedic Society for Sports Medicine, more than five million knee arthroscopies are performed worldwide each year.

    Knee arthroscopy is commonly used for:
    • To repair or remove torn meniscal cartilage which cushions the space between the bones in the knee
    • Trim torn pieces of articular cartilage
    • Repair misalignment of the patella (kneecap)
    • Reconstruct a torn ACL (Anterior Cruciate Ligament) or PCL (Posterior Cruciate Ligament)
    • Remove inflamed synovial tissue which lines the knee in patients with rheumatoid arthritis
    • Removal of a swollen bursa (Baker’s cyst) behind the knee that fills with fluid causing inflammation
    • Remove loose fragments/bodies of bone or cartilage
    • Used for arthritis treatment in younger patients.
    Risks and Complications of Knee Arthroscopy

    Arthroscopic knee surgery is safe for the treatment of knee injuries, but there are some risks that we should consider. Risks and complications may include:

    •        Bleeding into the joint (after surgery)
    •      Compartment syndrome
    •      Injury to a blood vessel or nerve
    •      Knee stiffness following the procedure
    •      Blood clot formation in the leg
    •         Damage to the meniscus, cartilage, and ligaments in the knee
    •      Infection in the knee joint
    Recovery Time for Arthroscopic Knee Surgery

    Each person recovers after arthroscopic knee surgery at a different pace. If required, patients use crutches or a walker for one to four days after surgery. If the pain is minimal, then you do not have to use any crutches or a walker. It takes up to six weeks for the knee to restore and get back to normal. There is a high degree of variability in recovery process. Some patients can return to normal activities within two to three weeks.

    Some Common Questions Asked by People After Knee Arthroscopy

    Friday, 16 June 2017

    How long does the surgical procedure take place?

    The actual surgery time is usually about between 30-45 minutes. If extensive work is needed, the procedure may last up to 60 minutes. Most people “go to sleep totally” during surgery with a general anesthetic.

    What is the recovery time?

    Everyone heals from their knee surgery at a different pace. If required, patients use crutches or a walker for two to three days after surgery. If your pain is less then you do not have to use crutches or a walker. It takes up to six to seven weeks for the knee joint to re-establish normal joint fluid after arthroscopic surgery. Due of this, you may not realize the benefits of your surgery for five to six weeks. There is a high degree of changeability in recovery time. Some patients are able to return to their regular activities within two to three weeks, but most require roughly six to seven weeks

    How long do I need to use Bandage?

    The initial bandage usually gets soaked with fluid and blood. Drainage after surgery should slowly decrease after 48 hours, and then Band-Aids are generally sufficient over the small incisions. Once the incisions are totally dry the use of a bandage is optional.

    How long will I be on pain medication?

    You will likely require some form of pain medication for at least three to four weeks. Again, there is a high degree of changeability with some using narcotic medication for less than one week. If you do not have any serious medical problems such as; hypertension, heart disease, kidney or liver impairment, or a history of previous stomach/intestinal ulcers or reflux, it may be useful to take an anti-inflammatory medication in addition to your narcotic medication directly after surgery. Your orthopaedic surgeon will usually advise this at the time of surgery if appropriate.

    Do I need physical therapy?

    Many patients are sent for physical therapy after knee arthroscopy, and this is generally decided at the first post-operative visit. Some patients regain motion very quickly and have minimal swelling, therapy may not be required for them or they may only have to go once or twice to learn simple exercises which they can perform at home. Your surgeon will decide what is best for you.

    Can I exercise with weights?

    Generally it is not advisable for the first three weeks. However, as each person’s strength varies, some patients are able to resume back to their weight training exercises with in three weeks. Use light weights to start with and progress gradually.

    End Your Frozen Shoulder Pain Today

    Tuesday, 2 May 2017

    What causes frozen shoulder?
    Frozen Shoulder has no particular cause but it is more commonly seen in diabetics. It could also result from trauma. The capsule of the shoulder joint becomes tight and contracted in frozen shoulder. That is the reason why it is also called as adhesive Capsulitis.  Frozen shoulder has a pain and stiffness cycle. More pain leads to more stiffness and more stiffness leads to more pain.

    What can be done to get relieve from the pain?
    Treatment should help to relieve the pain and restore your shoulder to normal function. Pain relief strategies include Physiotherapy. Application of ice, taking non-steroidal anti-inflammatory medicine such as ibuprofen or naproxen and, occasionally, an injection of anti-inflammatory steroids in the shoulder joint by your shoulder surgeon can.

    What else can we do to help this injury heal?
    An aerobic exercise program will help to improve the blood flow to the tendon or bursa. This helps to lessen pain. If you’re an active smoker then you should quit smoking, so more oxygen reaches the injured tendon. This will help the injury to heal faster.

    Will I need surgery?
    Sometimes a damage that lasts a long time will cause the tendon to tear. This type of damage may need frozen shoulder surgery

    What specialists treat frozen shoulder?
    They are best treated by shoulder surgeon.

    Is follow-up necessary after treatment/surgery of shoulder?
    Timely follow-up visits to your shoulder surgeon plus following his or her recommendations will allow you to recover faster. In the long run recommended exercises and/or rehabilitation with physical therapy can be done to help in quick recovery and prevent further injury.

    How Partial Knee Replacement and Knee Rehabilitation Help

    Tuesday, 11 April 2017

    Partial Knee Replacement Surgery, also commonly stated to as, Unicondylar Replacement Surgery, or Partial Knee resurfacing is a surgical technique which involves the resurfacing of the worn out bony surface of the knee joint. In a Partial Knee Replacement process either the inside joint (medial); outside parts of the knee (lateral); or area in the middle of the knee cap and the upper front surface of the femur (patellofemoral) is replaced. This means only the injured part of the knee cartilage is changed with prosthesis not all parts as in Total Knee Replacement Surgery.

    Recovery at Home:

    You may feel pain or uneasiness for the first week at home after a partial knee replacement, and you will be given a combination of pain medications and exercises as needed. A prescription for strength painkiller is usually prescribed and should be taken as directed by your Knee surgeon. Taking one every four to seven hours as directed is considered good during the first few days to reduce pain. Swelling in your knee habitually slowly lessens over a span of two to three weeks after operation. There may be some slight bleeding for a few days, but by the time you are released from the clinic, most bleeding should have stopped. If you see swelling or bleeding increases, you should call your orthopaedic surgeons. Physicians generally advise that you avoid activities that give stress to your knee for about two weeks, so that the bones and cartilage can rebuild around the implant. Light walking and stretching will be recommended to start immediately after surgery. 

    Here is what you can expect and how you can cope after an unicompartmental knee replacement:

    • Icing your knee for 30 or 40 minutes a few times a day during the first week after operation which will help to reduce pain.
    • Keep your knee elevated above heart level as much as possible to lessen swelling and aching. Place pillows below the ankle of the operative leg while you are in bed.
    • Range of motion exercises is significant for healing. Recovering full extension is just as significant as bending your knee until you get your stitches or staples removed.
    • To help in speed healing, keep your incision dry for seven to fifteen days. A plastic shower bag can help keep the incision dry while taking a bath. You can buy these bags at a drugstore or surgical supply store. Wait until you can stand easily for 15 or 20 minutes at a time before you take a bath without assistance.
    • Most patients can start again with normal daily activities, driving, and light exercise, like swimming and cycling, within two weeks after surgery.


    Most of the patients can start with physical therapy immediately after operation. In the first few weeks of knee rehabilitation, your physical therapist generally helps you stretch the muscles in your quadriceps, hamstrings, and calves while flexing and extending your knee to repair a full, pain-free range of motion. 

    Important Details about Shoulder Instability Surgery

    Saturday, 11 March 2017

    As we know the shoulder is the most mobile joint in the body and has such a wide range of gesture, it is more likely to displace than any other joint in the body. Dislocations are among the most common hurtful injuries distressing the shoulder. Athletes, non-athletes, kids, and adults can all dislocate their shoulders. They can happen during contact sports and daily accidents, such as falls. Depending on the extent of your damage, your age, and your motion level—or, if physical therapy doesn’t help—shoulder surgery may be required to address the injury to the shoulder.

    What are the symptoms?
    The most distinguishing symptom of shoulder instability is a sense that the shoulder is about to come out of place or that the shoulder has moved back into its socket. This sense may or may not be accompanied by ache, but it is usually painful. Occasionally, an individual may feel coldness or a tingling down the arm. In addition, the patient may know-how clicking, catching or slackness of the shoulder with everyday activities and mainly with sports that need overhead throwing or swimming. Sometimes, the ball of the joint will detached totally from socket, and the ball will not instinctively fall back into place. Severe aching, deformity of the shoulder and a sense of paralysis of the arm may happen as a result. Operating the arm into place may require physician assistance.

    How Can a Physical Therapist Help?

    Following shoulder stabilization operation, your arm will be placed in a sling, usually for 3 to 4 weeks. Right after operation, your shoulder will be aching and stiff, and it might swell. You will be given treatment to help in controlling your pain; icing your shoulder will help lessen both the pain and the swelling. Your physical therapist will help and guide you through your post surgical rehabilitation, which will develop from gentle range-of-motion and strengthening exercises and eventually to activity- or sport-specific exercises. The timeline for your regaining will vary depending on the surgical process and your general state of healthiness, but full return to games, sports, heavy lifting, and other energetic activities might not begin until 6 months after operation. Your shoulder will be very prone to re-injures, so it is tremendously important to keep an eye on the postoperative instructions provided by your shoulder surgeon and therapist. 

    How is it treated?

    The shoulder joint should be put back into place quickly. Instantaneously after the damage, ice and a sling make the patient more at ease. In a young and athletic person the chance of re-dislocation is generally high. This risk decreases with age. Habitually, shoulder instability is subtle and repetitive examinations are required to establish and approve the diagnosis. It is mainly significant for the physician to test the uninvolved shoulder and to match the patient’s normal ligament position to the symptomatic shoulder when coming to a decision regarding cure.

    Can this grievance or condition be prevented?

    Shoulder dislocation may be avoidable. See your physical therapist if you:
    1.   Have discomfort in your shoulder, especially when doing strong activities
    2.   Feel as though your shoulder is “sliding" or “moving”
    3.   Hear a popping sound in your shoulder