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Orthopaedic surgery

BMJ 2003; 326 doi: (Published 01 March 2003) Cite this as: BMJ 2003;326:030362
  1. James Carmichael, senior house officer1
  1. 1Royal Hampshire County Hospital, Winchester, Hampshire

James Carmichael explains that this expanding specialty is much more than DIY

A combination of diagnostic skills and surgical technique is essential in surgery. It is this combination of skills that appeals to those who, in addition to the usual intellectual challenges of medicine, relish the physical and dextrous skills required.

The word “orthopaedics” derives from the Greek for “straight child.” This refers to the specialty's origins principally in the management of crippled children. Orthopaedics has now grown to encompass the elective and emergency surgical treatment of disorders of all aspects of the musculoskeletal system.

As in all surgical specialties, detailed knowledge of the anatomy and physiology of the patient is essential for safe practice. A thorough understanding of applied anatomy allows surgeons to predict the forces applied around a joint or fracture to plan the correct treatment. An additional challenge is the gross disruption of usual anatomy that may occur in trauma.

The structural nature of the problems encountered explains why imaging is an integral part of orthopaedic surgery. Correct interpretation of plain radiographs or computed tomograms or magnetic resonance imaging scans allows operations to be planned before the surgeon starts to work and ensures the greatest chance of a successful outcome from what is often a highly complex problem.

Finding an abnormality on a radiograph is not an immediate indication for surgery. A careful history must be taken to assess the impact that the disease has on the patient so that his or her management can be planned properly. Not all problems are immediately apparent on radiographs. Examination skills are essential to diagnose accurately the many different disorders encountered and to plan early treatment.

Many of the techniques in orthopaedics use established engineering principles. For example, the fixation of a fractured olecranon or patella is based on the …

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