ORTHOPAEDICS

The branch of medicine that mostly deals with the musculoskeletal system is known as orthopaedics.

The speciality of orthopaedics as a branch of medicine is relatively young. In 1741 Nicholas Andy,
the Professor of Medicine in Paris published a book Orthopeadics, or the Art of Preventing and
Correcting Deformities in Children and coined the term from the words "orthos” (straight or free
from deformities) and ’’pais” (child). He expressed the view that most deformities in adults have
their origin in childhood.

 The science includes all ages and consists of the prevention, investigation, diagnosis and
treatment of disorders and injuries of the musculoskeletal system by medical, surgical and
psychical means and, in addition, the study of musculoskeletal physiology, pathology and other
related basic science.

Musculoskeletal deformities are manifested by an abnormal form or shape the affected limb or trunk.
A deformity may be congenital (present time of the time of birth) or it may be acquired during
post-natal life. It is necessary to consider the type and causes of the deformity in various
musculoskeletal structures and think of their correction together with the possible prevention.

In the diagnosis of the musculoskeletal disorders and injuries, the doctor should conduct the
investigation in the following order:

1.       Taking history (e.g. symptoms),

2.       Physical examination (e.g. signs),

3.       Radiographic examination (X-ray signs),

4.       Laboratory examination (of various body fluids as well as of a specimen; or biopsy of the
diseased tissue).

Congenital abnormalities are defined as those defects in development of the body form or function
that are present at the time of birth. They may be caused by a variety of factors including genetic
defects, environmental Influences and a combination of the two (infection - rubella). They may be
localised (as in a single club-foot) or generalised (fragile bones). All localised congenital
abnormalities of the skeleton are a sort of manifestation of one or more of the various types of
disturbances in its normal growth and development. For example a bone may fail to form entirely
(aplasia), or it may fail to grow to a normal size (hypoplasis), or its growth my be abnormal
(dysplasia), or it may overgrow (hypertrophy or local gigantism). Extra parts of the skeleton
(duplications) may also be formed such as extra digits. A disorder of the skeletal system affects
muscles and joints in the area.

Disorders of Joints

The most prevalent disorder of the joints is arthritis, an inflammatory process that can result in
disability. The effects of joint disease and injury are similar: pain and decreased mobility.
Rheumatoid arthritis is a severe inflammation that is now considered to be an autoimmune disease:
the patients develop abnormal antibody reactions in which the body’s immune system attacks its own
tissues. It begins with painful, swollen joints, then fever, a decrease in appetite, weight loss
and fatigue follow. Joint cartilage is destroyed and scar tissue develops within the joint cavity.
The result is joint stiffness and complete immobility (or various deformities). Diagnosis of the
disease is made from the blood samples that will show abnormal protein levels and there li also an
increase in sedimentation rate of erythrocytes. The patients need complete rest and
anti-inflammatory drugs (mainly aspirin).

Rheumatoid spondylitis is an inflammation of joints between the spinal vertebrae. It usually begins
with low back pain and then joints of the hip, shoulder, neck and ribs can become involved.
Arthritis of this type s seen mostly in men under 30 and causes complete ankylosis (immobility) of
the vertebral joints.

Osteo-arthritis is the name for degeneration of joints that occurs with ageing or because of strain
of injury. It seldom causes crippling deformities, but pain and stiffness never subside. Treatment
of the disease is aspirin for relief of pain and local heat to improve joint mobility. A surgical
incision into a joint (to treat arthritis) is called an arthrotomy.

Disorders of Bones

The most common disorders of bones are fractures, infections and tumours.

A fracture is a break of the bone. Fractures are classified as simple, compound and complicated. A
simple fracture is closed without any break in the skin. A compound fracture is open, there is a
break in the skin with one or both ends of the broken bone protruding through the skin and
complicated fractures are those in which the broken ends are out of alignment or in which there is
damage to one or both ends; these are displaced, comminuted (broken in several places) or impacted
(the two broken ends have been jammed into each other and the affected limb is shortened in length)
fractures. They are always serious because there is much soft tissue damaged - muscles, nerves,
blood vessels are torn and the patient usually goes into shock. Another serious type of fracture,
which occurs most often in elderly people due to osteoporosis (demineralised bone), Is a fracture
of the hip.

Every fracture requires reduction (replacement of bone ends in correct alignment), which depends of
its specific type. The reduction may be either closed (by external manipulation) or open (surgical
fixation with a plate, nail, pin, screw or wire). After reduction the bone is immobilized with a
cast, traction or both.

Infection can reach a bone through a compound fracture or a wound or through the blood stream,
travelling from another side of infection. One of the most serious infections of a bone is known as
osteomyelitis. Tho first symptoms are pain, temperature and nausea, and then the redness, oedema
and death of the bone tissue if a quick surgical incision is not made to drain the site. The most
common bacteria are streptococci and staphylococci so antibiotics and bed-rest are also needed, but
the healing is usually slow.

Bones can also be the primary site of a tumour or some malignant calls can metastasise to a bone
from another site, the treatment is a surgical removal with amputation of a limb, if the tumour, is
large followed by chemotherapy and radiation.

Amputation is a removal of a part of the body, which is replaced by prosthesis.