A Brief History of Orthopaedics
Origin of the Word
The modern term orthopedics stems from the older word orthopedia, which was the title of a book
published in 1741 by Nicholas Andry, a professor of medicine at the University of Paris. The term orthopedia is a composite of 2 Greek words: orthos, meaning “straight and free from
deformity,” and paidios, meaning “child.” Together, orthopedics literally means straight child, suggesting the importance of pediatric injuries and deformities in the development of this field. Interestingly, Andry’s book also depicted a crooked young tree attached to a straight and strong staff, which has become the universal symbol of orthopedic surgery and underscores the focus on correcting deformities in the young. While the history of the term is relatively recent, the practice of orthopedics is an ancient art.
Ancient History of Orthopedics
While the evidence is limited, the practice of orthopedics dates back to the primitive man. Fossil
evidence suggests that the orthopedic pathology of today, such as fractures and traumatic amputations, existed in primitive times. The union of fractures in fair alignment has also been observed, which
emphasizes the efficacy of non-operative orthopedics and suggests the early use of splints and
rehabilitation practices. Since procedures such as trepanation and crude amputations occurred during the New Stone Age, it is feasible that sophisticated techniques had also been developed for the
treatment of injuries. However, evidence continues to remain limited.
Later civilizations also developed creative 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 or reductions was practiced as a
profession in many tribes, underscoring the importance of orthopedic injuries in early civilizations.
The ancient Egyptians seemed to have carried on the practices of splinting. For example,2 splinted
specimens were discovered during the Hearst Egyptian Expedition in 1903. More specifically, these
specimens included a femur and forearm and dated to approximately 300 BCE. Other examples of
splints made of bamboo and reed padded with linen have been found on mummies as well. Similarly,
crutches were also used by this civilization, as depicted on a carving made on an Egyptian tomb in 2830 BCE.
The Greek’s in particular had a great deal of orthopedic knowledge with respect to fractures and
dislocations. The School of Hypocrites wrote books describing traction, casting and bandaging. They
even recommended early mobilization for fractures. Clubbed feet were treated with strong bandages
leading to overcorrection which was maintained for a significant period of time. The Greeks also
recognized scoliosis as a problem and tried many prolonged but often unsuccessful treatments. Galen understood that the brain sent out signals to the muscles by means of the nervous system.
During the middle ages, Italy maintained medical knowledge and it was the major center in Europe with the University of Bolgnia being founded in 1113. It still functions until this day as a medical school. John Hunter became the father of modern surgery with the study of anatomical specimens. Lister developed asepsis in the mid-1800s and William Warton discovered ether anesthesia in 1876.
The Modern Era
In the 20th century, rapid development continued to better control infections as well as develop and
introduce novel technology. For example, the invention of x-ray in 1895 by Wilhelm Conrad Rontgen
improved our ability to diagnose and manage orthopedic conditions ranging from fractures to avascular necrosis of the femoral head to osteoarthritis. Queen Isabella of Spain had organized the first field
hospitals which were known as ambulances in 1487 but these truly came into their own following the
two world wars, particularly in the Korean War and then in Vietnam. By significantly decreasing the
amount of time between the injury and treatment, many lives were saved. This advance along with the development of antibiotics made delayed primary wound closure and skin grafting of wounds a
Spinal surgery also developed rapidly with Russell Hibbs describing a technique for spinal fusion at the New York Orthopedic Hospital. Similarly, the World Wars serve as a catalyst in the development of the subspecialty of orthopedic trauma, with increasing attention placed on open wounds and proficiency with amputations, internal fixation, and wound care. Dr. Smith Peterson at Harvard designed the three phalanged nail which made possible the mobilization of people with hip fractures. In 1942, Austin
Moore performed the first metal hip arthroplasty, also for the treatment of hip fractures. The field of
joint replacement was subsequently advanced by the work of Sir John Charnley at the University of
Manchester in the 1960s.
For more extensive information on the moderate era of orthopaedics, see the website of The American Journal of Orthopedics this information is derived from.
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