There is ample evidence to confirm that physicians from even the earliest known civilisations attempted to repair fractures of the arm and leg, and with a fair degree of success. However, as this was just one aspect of their overall responsibilities to their patients, they could not really have been described as bone specialists in the accepted sense.
It was probably only during the Middle Ages that untrained individuals first began to focus exclusively on the treatment of fractures and dislocations. This marked the dawn of the professional bonesetter and, in some of the world’s poorer nations, many patients must still rely on the rather basic but notably more affordable services of a bonesetter today.
The bones, however, are just one component of what physicians now refer to as the musculoskeletal system. The system also includes a number of soft tissue elements that may fall within the purview of some modern bone specialists.
Ligaments and tendons are composed of fibrous connective tissue. The former serve to attach adjacent bones to one another, thus providing stability, while tendons act to anchor the muscles required for movement to the bones involved. A second type of connective tissue known as cartilage is found in the joints. Harder than fibrous connective tissue but softer than bone, it forms a smooth buffer between the articulating surfaces of the bones in a joint to prevent friction. When damaged by injury or disease, cartilage will often require the attention of some form of bone specialist. In such cases, he or she will be an orthopaedic surgeon.
The field of orthopaedics, however, is not the exclusive domain of the surgeon. Many of the conditions treated under this heading can be undertaken without resorting to surgical intervention. A simple fracture, for example, can normally be fixed, after the initial reduction, by splinting or stabilising the affected limb with a cast and can be undertaken by a physician with the necessary orthopaedic training. Where a break is more severe, the use of a more invasive procedure known as open reduction and internal fixation (ORIF) will be necessary. Once again, the bone specialists involved will need to be experienced, orthopaedic surgeons.
The procedure in question involves the use of metal pins, screws, plates, and rods in the various combinations required to hold all of the pieces of bone in place and, thereby, ensure a successful repair. In addition, the orthopaedic surgeon is frequently called upon to repair damage to a ligament or tendon and, increasingly, to replace all or part of a joint with an individually designed prosthesis.
While orthopaedic doctors also address problems with the joints of the spinal column, it is also of interest to the bone specialists known as chiropractors. Not medically trained or licensed to prescribe medications, their speciality is the treatment of pain through the physical manipulation of the spine. Their treatments involve manipulations and are predicated on the belief that the alignment and smooth functioning of the spine are important to the health of the neurological and musculoskeletal systems.
While holding similar ideas about the connection between overall health and the musculoskeletal system, osteopaths must hold a formal qualification and treat a wider range of disorders. Many, particularly in the United States, will have earned their right to be considered as bone specialists by obtaining a doctorate in osteopathic medicine. This allows them to supplement their manipulative treatments with medication where appropriate. In other countries, a diploma in osteopathy gives the holder the right to practice, but precludes him or her from prescribing medication. To assist them, both chiropractors and osteopaths often rely on X-rays and MRI scans.
In practice, bone specialists come in a variety of guises. As a consequence, it is probably best to rely on a general practitioner to determine which of these may be the more appropriate choice in any given situation.