Orthopedics

Orthopedics (sometimes spelled orthopaedics) is a surgical specialty focused on the musculoskeletal system. Orthopedic surgeons treat a wide range of conditions—including trauma, spinal diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders—using both surgical and non-surgical methods.

The term was coined in French by Nicolas Andry, a professor of medicine at the University of Paris, in his 1741 textbook *Orthopedie*. He derived it from the Ancient Greek words *orthos* (“correct” or “straight”) and *paidion* (“child”). The English version, *orthopædics*, originally referred to correcting musculoskeletal deformities in children. Andry’s book, aimed at parents, covered topics like exercise, manipulation, and splinting, but also included unrelated issues such as excessive palm sweating and freckles. The first hospital dedicated to treating children’s skeletal deformities was established by Jean-André Venel in 1780, where he developed a club-foot shoe and methods for spinal curvature.

Early orthopedics was shaped by wartime experiences. In the Middle Ages, battlefield injuries were treated with bandages soaked in horses’ blood, which dried into stiff but unsanitary splints. Advances in the 18th century—such as John Hunter’s research on tendon healing, Percivall Pott’s work on spinal deformity, and Robert Chessher’s invention of the double-inclined plane for lower-body fractures—expanded treatment options. In 1851, Dutch military surgeon Antonius Mathijsen invented the plaster of Paris cast. Until the 1890s, orthopedics remained largely focused on childhood deformities, and one of its first surgical procedures was percutaneous tenotomy, which involved cutting a tendon (often the Achilles) to aid correction with bracing and exercises. Debate persisted into the early 1900s over whether orthopedics should include surgery at all.

Modern orthopedics began to take shape in 1887, when the Hospital for Special Surgery established the first orthopedic residency program in the United States. Young doctors served one-year assistant positions and became known as “residents.” Key figures included Welsh surgeon Hugh Owen Thomas, who expanded orthopedics into general fracture treatment and musculoskeletal problems, and his nephew Robert Jones. Jones served as surgeon-superintendent during the construction of the Manchester Ship Canal in 1888, organizing the world’s first comprehensive accident service for 20,000 workers. He personally managed 3,000 cases and performed 300 operations, attracting physicians from around the world to learn his techniques. In 1894, he co-founded the British Orthopaedic Association with Alfred Tubby. During World War I, Jones served as a Territorial Army surgeon and, after observing inadequate fracture treatment, helped establish military orthopedic hospitals from 1916 to 1918.

The use of intramedullary rods for femur and tibia fractures was pioneered by Germany’s Gerhard Küntscher. However, traction remained the standard for thigh bone fractures until the late 1970s, when intramedullary fixation without opening the fracture became routine. The modern total hip replacement was developed by Sir John Charnley in England in the 1960s. He found that joint surfaces could be replaced with implants cemented to bone, using a stainless steel femoral stem and head with a polyethylene acetabular component, fixed with acrylic bone cement. For more than two decades, the Charnley low-friction arthroplasty and its derivatives were the most widely used systems worldwide.