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orthopedics(ôrthəpē`dĭks), medical specialty concerned with deformities, injuries, and diseases of the bones, joints, ligaments, tendons, and muscles. Most of the early advances in orthopedics were made by practicing physicians, many of them surgeons, to correct deformities such as clubfoot and to provide supports for broken or diseased bones. The first institute for correcting skeletal deformities was opened in Switzerland in the 18th cent. The development of bone grafting, the advent of surgical methods for treating fractures, and other advances led to the recognition of orthopedics as a distinct medical specialty by 1920. Clubfoot, the aftereffects of poliomyelitis, fractures, spinal deformities, and arthritic disorders are among the conditions that require the attention of an orthopedist. Treatment provided by an orthopedist may include manipulation, the fitting of braces or other appliances, exercising, and surgery.
a medical discipline concerned with the diagnosis, prevention, and treatment of deformities and injuries of the musculoskeletal system. In the USSR and some other countries, orthopedics and traumatology constitute a single medical specialty, although the histories and specific concerns of the two disciplines remain distinct.
The science of orthopedics was established by the French physician N. Andry (1658–1742), who published a two-volume work dealing with the prevention and treatment of deformities in children. The works of Hippocrates contain classical descriptions and some treatments of dislocations, fractures, clubfoot, and spinal curvature. A. Paré was the first to attempt to make a distinction between the discipline of treating bodily curvatures and that of surgery, but orthopedic medical institutions did not appear until the end of the 18th century. In Europe, the first use of plaster to set a fractured extremity was in 1814; the same procedure was first performed in Russia by the physician K. Gibental’ in 1815.
In the early stages of orthopedic science, conservative methods were widely used, for example, redressement, traction for fractures of the extremities, plaster casts, massage, and calisthenics. With the development of antisepsis, asepsis, general anesthesia, and—later—roentgenography, surgical procedures came into use, for example, osteotomy, osteosynthesis, arthrodesis, and muscle and tendon transplantation. Among the major contributors to the perfection of these surgical techniques were the British surgeon P. Pott, the Italian A. Scarpa, the Frenchman G. Dupuytren, the Austrian A. Lorenz, and the German A. Hoffa.
The appearance of E. Mukhin’s Beginnings of Orthopedic Science (published 1806) initiated the development of orthopedic surgery in Russia. N. I. Pirogov’s treatise on tenotomy of the Achilles tendon (written 1840) was the first scientific work in Russian on orthopedics. N. Ellinskii (1834) published a manual of desmotomy, and N. I. Studenskii prepared his Course in Orthopedics (published 1885). In 1839 the Russian physician I. V. Rklitskii performed the first subperiosteal resection of a bone. As early as 1791,1. P. Kulibin constructed a hinged-frame prosthesis for leg and thigh amputees; better prostheses of this type were invented in the 1830’s and described in 1855 by R. Chernosvitov.
Major contributions to the development of Russian orthopedics were made by I. A. Bredikhin (1862), whose work dealt with the regeneration of bone from the periosteum; S. F. Feoktistov (1863), who developed a technique of periosteal amputation; and N. P. Nikol’skii (1870), whose experimental studies advanced osteoplastic surgery. N. I. Nosilov (1875) proposed a technique of osteosynthesis that utilized a “Russian lock,” and V. I. Kuz’min (1893) was the first to fix bone fragments with nickel-plated steel pins. K. F. Vegner (1910) was the first surgeon in Russia to apply constant skeletal traction.
In 1900, G. I. Turner organized Russia’s first subdepartment of orthopedics and orthopedic clinic in the Military Medical Academy in St. Petersburg. The first institute of orthopedics was organized at the same academy in 1906 under the direction of R. R. Vreden. The Institute of Medical Mechanics was organized in Kharkov in 1907, becoming the M. I. Sitenko Kharkov Institute of Prosthesis, Traumatology, and Orthopedics in 1966. Turner’s school encouraged thorough clinical study of orthopedic diseases, while Vreden’s school emphasized orthopedic surgery; orthopedic devices were also developed in Kharkov. Russian and Soviet orthopedics have since strongly emphasized clinical study, orthopedic surgery, and the use of orthopedic devices.
N. N. Priorov was the founder of the system of orthopedic and traumatological care in the USSR. In 1921, Priorov organized in Moscow the Institute of Medical Prosthesis, which was reorganized in 1940 into the Central Institute of Traumatology and Orthopedics. The institute was named after Priorov in 1971 and is the administrative center for the 19 research institutes of traumatology and orthopedics that have been established in large cities of the USSR.
One of the achievements of Soviet orthopedics is the development of a system by which orthopedic diseases can be prevented and quickly treated from the early postnatal period on; congenital dislocation and clubfoot are examples of conditions that can be treated in the early postnatal period. Among the pioneers of new techniques of osteosynthesis with special compression and compression-distraction devices were O. N. Gudushauri, G. A. Ilizarov, K. M. Sivash, M. V. Volkov, and O. V. Oganesian; these techniques are widely used today. Soviet orthopedists, including Volkov, A. S. Imamaliev, and M. I. Panova, were the first to develop plastic operations using preserved homologous tissues to correct bone, joint, tendon, and muscle defects. Other Soviet orthopedists developed alloplastic methods to replace joints, and Sivash designed internal metal prostheses for the hip joint. V. A. Poliakov, G. G. Chemianov, and Volkov were among those who received the State Prize in 1972 for work on ultrasonic cutting and joining of bones.
A separate orthopedic section was organized for the first time at the 17th Russian Congress of Surgeons in 1925. The first Soviet scientific society of orthopedic surgeons was organized in Leningrad in 1926, and the first society of orthopedists, traumatologists, and workers in prosthetics appeared in Moscow in 1932. The All-Union Society of Traumatologists and Orthopedists was founded in 1963.
Among the leading foreign orthopedic institutions are the clinic of the University of Padua, headed by Professor C. Casuccio; Professor G. Monticelli’s clinic in Rome; the Cochin Hospital in Paris; and the largest clinic in the United States, the Mayo Foundation in Rochester, Minn., whose orthopedic department is directed by E. Henderson.
The International Society of Orthopedic Surgery and Traumatology was organized in 1929; Soviet scientists joined in 1963. Various aspects of orthopedics are discussed in the journal Ortopediia, travmatologiia i protezirovanie (Orthopedics, Traumatology, and Prosthesis; Kharkov, since 1927) and in such foreign publications as Revue d’orthopédie (Paris, since 1890), Zeitschrift fur orthopädische Chirurgie (Stuttgart, since 1891), and Journal of Bone and Joint Surgery (Boston, Mass., since 1919).
REFERENCESVreden, R. R. Prakticheskoe rukovodstvo po ortopedii. Leningrad, 1936.
Zatsepin, T. S. Ortopediia detskogo i podrostkovogo vozrasta. Moscow, 1956.
Chaklin, V. D. Ortopediia, books 1–2. Moscow, 1957.
Krupko, I. L. Osnovy ortopedii Leningrad, 1967.
Mnogotomnoe rukovodstvo po ortopedii i travmatologii, vols. 1–2. Moscow, 1967–68.
Trubnikov, V. F. Ortopediia i travmatologiia. Moscow, 1971. (Contains a bibliography.)
M. V. VOLKOV