The bones and muscles, together with tendons and ligaments, make up the complex musculoskeletal system upon which the human body depends both to protect its internal organs, and to provide it with mobility and the means to handle objects. Today, if we should encounter a problem with a bone or with one of the associated soft tissues, we can turn to an orthopaedic specialist for help. This, however, was not always the case.
Bone is the product of two processes that continue throughout our lives. Mature bone tissue is continuously being removed by specialised cells known as osteoclasts in a process known as bone resorption. Simultaneously, a second variety of cells called osteoblasts generates new bone tissue to replace it. This process is called ossification. Despite the combined efforts of these two metabolic processes, the results of disease or injury have always drawn the attention of some form of orthopaedic specialist. It is only the extent of their relevant knowledge and skills that have changed over the centuries.
Given their propensity for warfare, plus the absence of any concept regarding health and safety at work, the ancients of Rome, Egypt, and Greece, along with even older civilisations, were exceptionally prone to broken bones. While there is plenty of evidence that the physicians of the time employed primitive splints and casts, their solution was quite often amputation; an option that most probably failed to survive.
However, these early precursors of the modern orthopaedic specialist enjoyed rather more success when using bindings and braces in their attempts to correct spinal deformities in children. Over the centuries, this became a major focus of bone doctors. In fact, it was actually the Greek words “orthos” and “paedia” meaning “child” and “straight” that were eventually adopted to coin the name by which this important discipline of modern medicine is now known.
While many of the early physicians learned their trade from others more experienced, they were not qualified in the sense accepted today. Even following the introduction of the first medical school in 11th-century Italy, anyone with a little knowledge could claim to be an orthopaedic specialist, as there was still no legal requirement for qualification or registration. Until this situation eventually changed, the efforts of both physicians and laymen to address problems with the musculoskeletal system were probably best summarised as bone setting.
From the middle ages onwards, ordinary citizens often chose to earn a living as bonesetters, and many became exceptionally skilled at reducing fractures and dislocations. The skills were passed down from parents to children and, given that their fees were cheaper than those of a licensed physician, this led to the establishment of many successful family businesses over the centuries. While the highly qualified orthopaedic specialist of today has long replaced bonesetters across the developed world, their services are still in demand in many of the poorer countries of Asia, Africa, and South America.
The combination of greater knowledge of the musculoskeletal system, new materials, and new technologies has led to numerous important advances in the discipline. No longer limited to treating fractures, dislocations, and spinal deformities, the 21st-century orthopaedic specialists are already able to replace damaged joints with prosthetic ones, while the future promises many even more amazing achievements in this invaluable field.