What is orthopedic surgery?

Indications and Procedures

Orthopedic surgery encompasses a number of different procedures carried out to repair injuries affecting the skeletal system and
joints or to repair tissues associated with these structures. Such surgery may also attempt to correct associated neurological injury. In addition, orthopedic surgery is used to correct musculoskeletal problems that may be congenital in origin.

Among the congenital conditions for which orthopedic surgery may be warranted are
bowlegs (valgus knees) and knock-knees
(varus knees). In the case of bowlegs caused by a congenital malformation, one or both legs are bent outward at the knee. In knock-knees caused by congenital conditions, the knees are curved inward, causing the lower legs to twist away from the body.

Treatment begins with a thorough evaluation of the problem. Based on x-ray analysis, an orthopedic surgeon may make a decision as to whether surgery can be used in the correction of the problem. During the surgical procedure itself, the affected limbs are properly aligned; they are splinted upon completion of the surgery. The chances of success are greatest in younger children. In an analogous situation, if a limb is twisted during fetal development, the child may exhibit misalignment of the structure following birth. Since bone at this stage of life is only beginning its growth, maintaining the limb in a splint may correct the problem. If necessary, the surgeon may decide to realign the limb at the joint through orthopedic surgery.

Tumors that originate in bone are uncommon. If they occur, such growths must be removed as quickly as possible because of the speed with which they spread to adjacent and distant structures in the body if the tumor is cancerous. The first signs of

bone cancer include pain and swelling in the affected region. Spontaneous fractures may occur. X-ray and biopsy analyses are necessary to confirm the diagnosis of cancer. If the tumor is benign, it may be removed through surgery. Osteomas, which are tumors that arise from connective tissue within the bone, may require radiation or chemotherapy in addition to surgical removal.

Commonly, orthopedic surgery is used to correct fractures or dislocations. As with any procedure, a thorough evaluation is necessary prior to a final decision. This evaluation often includes x-ray and computed tomography (CT) analyses. If the injury involves the spine, treatment must both correct the problem and prevent secondary injury to the spinal cord. Fractures to the vertebral column may produce fragments that pose a threat to the spinal cord. Under these conditions, orthopedic surgery is used to immobilize or straighten the spinal column; this may involve external braces or an internal brace such as a Harrington distraction rod. The patient may be immobilized for weeks to months, depending on the extent of the injury and the course of treatment.

Uses and Complications

One of the most common applications of orthopedic surgery is the repair of trauma or fractures to bones. For example, a blow to the face, either intentional or accidental, may result in fractures to the nose or facial bones. Injuries to other skeletal structures, including the spine, may also result from the incident. This is particularly true if the source of the injury was an automobile accident. Upon clinical examination by a physician, it may be apparent that facial bones have been fractured. X-ray analysis may be used to confirm the initial diagnosis. Proper repair and restoration of features will be the primary concern of the orthopedic surgeon, assuming that the injuries are not life-threatening. In the event of facial injuries, damage to teeth and other periodontal regions will also be a consideration. In many cases, wire fixation may be a sufficient course of treatment. If more severe, the fracture may require screw-plate fixation, particularly in complicated fractures.

If uneventful or uncomplicated, the healing of such injuries usually requires about six weeks of immobilization. The procedure and immobilization, however, are inherently uncomfortable. If a muscle tear is severe or significant, resulting in a pull to the bone or joint, an associated fracture may heal improperly because of the dislocation of tissue. Proper evaluation of surgical options, including the use of metallic plates, can limit any such complications.

Although cancers originating in bone tissue are uncommon, they nevertheless present problems for the orthopedic surgeon. Fractures related to tumor development are generally treated in much the same way as uncomplicated breaks. If damage to the bone, either through the tumor itself or as a result of therapy, is severe, even surgical repair may not be sufficient to heal the structure and allow mobility or normal function. If the fracture is near the joint, the bone may require realignment or resection, resulting in a shortening of the structure. In some cases, internal fixation with polymethylmethacrylate bone cement may be used to augment repair.

Perspective and Prospects

The introduction of Computed tomography (CT) scanning technology in the 1970s allowed for much more detailed evaluation of bone and joint injuries. Much of the technology is best applicable in a post-traumatic situation, evaluating the result of injury rather than its cause. Magnetic resonance imaging (MRI) is based on different technology but produces results that are similar to CT scans.

The destruction of bone as a function of aging or of disease is not well understood. Degenerative bone disease as a result of arthritis
is among the most common of arthritic conditions, affecting nearly half of middle-aged adults in some manner. Such conditions, particularly among the elderly, remain to be fully addressed.

The ability to carry out bone transplants, developed extensively in the latter half of the twentieth century, allowed for at least partial replacement of damaged bone. Replacement structures may come from the patient’s own body or from a cadaver. In addition, orthopedic technology has resulted in prostheses for the replacement of most joints in the body.

Joint replacements are dramatic. Individuals with crippling deformities can have nearly normal function restored through replaced joints. The most commonly replaced joints include hips and knees. Other joints can also be replaced. Individuals who have their hips and knees replaced usually start walking on the replaced joint in the first or second postoperative day. Complete rehabilitation requires several months.

Bibliography

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Brotzman, S. Brent, and Kevin E. Wilk. Clinical Orthopaedic Rehabilitation. 2d ed. Philadelphia: Mosby, 2003.

Callaghan, John J., Aaron Rosenberg, and Harry E. Rubash, eds. The Adult Hip. 2d ed. Philadelphia: Lippincott Williams & Wilkins, 2007.

Doherty, Gerard M., and Lawrence W. Way, eds. Current Surgical Diagnosis and Treatment. 13th ed. New York: Lange Medical Books/McGraw-Hill, 2010.

Griffith, H. Winter. Complete Guide to Symptoms, Illness, and Surgery. 6th ed. New York: Perigee, 2012.

Mulholland, Michael W., et al., eds. Greenfield’s Surgery: Scientific Principles and Practice. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2011.

Tapley, Donald F., et al., eds. The Columbia University College of Physicians and Surgeons Complete Home Medical Guide. Rev. 3d ed. New York: Crown, 1995.

McPhee, Stephen J., and Maxine A. Papadakis, eds. Current Medical Diagnosis and Treatment. Los Altos, Calif.: Lange Medical, 2011.

Zollinger, Robert M., Jr., E. Christopher Ellison, and Robert M. Zollinger, Sr. Zollinger’s Atlas of Surgical Operations. 9th ed. New York: McGraw-Hill, 2011.