Humans have been prone to injury ever since they first appeared on the planet and one can be reasonably certain that there have been individuals attempting to treat these injuries for almost as long. Later, penetrating wounds were generally cauterised with red hot metal objects, while fractured arms and legs are known to have been splinted, at least, since the time of the Ancient Egyptians. While the physicians of that time could not really justify the title of bone specialist, together with the Greeks and Romans, they did, however, lay a lot of the groundwork that would eventually give rise to the modern medical discipline we know as orthopaedics.
In practice, the said discipline takes its title from the fusion of two Greek words, “orthos” and “paedion”, meaning “straight” and “child” respectively. This is a reference to what was the main focus of many of the early bone specialists and which involved the application of techniques to straighten spinal deformities encountered in children. The term first appeared in a textbook by one Nicolas Andry in 1741.
In parallel, splints, and later, casts continued to be used to stabilise fractures once the broken ends had been re-united by the process known as reduction. Together, these tasks constituted the bulk of the responsibility for these early bone doctors. In fact, from mediaeval times, the latter task was often carried out by people with practical experience but no medical qualification. Nevertheless, these so-called bonesetters were often highly skilled at their job and, to many of their customers, they were the nearest thing to a genuine bone specialist during those times.
It might surprise many to learn that these bonesetters continue to ply their trade until this day in some of the world’s poorer countries where formal health services remain minimal. Elsewhere, the practice was only outlawed following Britain’s Apothecaries Act of 1815. The Act called for anyone who wished to practice as a surgeon to first complete the same formal medical training required by a physician and would eventually lead to the first qualified bone specialist. One curious consequence of this imposed change has been that, despite holding extensive medical qualifications, even today, surgeons in Britain have retained the title of mister rather than doctor, to distinguish them from their physician colleagues.
It was only towards the end of the nineteenth century that fracture care began gaining the same attention as spinal deformities in children. Consequently, the British Orthopaedic Society was formed. At that time, a prominent Welsh orthopaedic surgeon named Hugh Owen Thomas perfected a new kind of splint that was eventually used to treat injured soldiers during WW1. Not long after, the “Thomas Splint” was adopted by other bone specialists around the world.
Most of the major advances in this field took place during the twentieth century and innovation has continued to be a hallmark of orthopaedics. First, the X-ray machine simplified the process of locating and evaluating the treatment of fractures, while 1919 saw the first use of an arthroscope to perform a live inspection of the interior of a knee joint. Arthroscopy has since proved to be not just one of the most important diagnostic tools of the orthopaedic surgeon but also a means for the bone specialist to perform minimally invasive surgical procedures that avoid exposing the entire joint.
That said, there can be little doubt that, to date, the greatest breakthrough achieved by these specialised medical professionals has been arthroplasty – the replacement of the damaged or diseased parts of a joint with a prosthesis. After a number of failures and partial successes, new materials and improved surgical techniques have seen total and partial hip and knee replacements widely accepted as the most successful procedure undertaken by orthopaedic surgeons, ever. That there are even greater achievements, ahead, for these bone specialists seems inevitable.
If you wish to learn more about this specialised field or wish to make an appointment with Dr Jan de Vos, contact us at 012 807 0335 or send an email to admin@drdevos.co.za.