history of orthopaedics

HISTORY OF HISTORY OF ORTHOPAEDICSORTHOPAEDICS

Prof. Nirbhay ShrivastavaProf. Nirbhay ShrivastavaDean , HOD OrthopaedicsDean , HOD Orthopaedics

Gandhi Medical College Gandhi Medical College Bhopal Bhopal

www.esnips.com/web/gohiyawww.esnips.com/web/gohiya

The past is our foundation for future The past is our foundation for future developments, we must build upon it developments, we must build upon it so that we too can act as a stable so that we too can act as a stable foundation for future generations. foundation for future generations.

One must be aware of the way One must be aware of the way surgeons in the past have surgeons in the past have contributed to Orthopaedics.contributed to Orthopaedics.


Primitive ManPrimitive Man Evidence of fractured bones has Evidence of fractured bones has

been found, in some of which been found, in some of which union has occurred in very fair union has occurred in very fair alignment. alignment.

Primitive man created a very Primitive man created a very crude splint, and that from that crude splint, and that from that stage on, its advantages were stage on, its advantages were recognised.recognised.

Primitive man was probably also Primitive man was probably also the first to perform crude the first to perform crude amputations of limbs. amputations of limbs.


Ancient EgyptAncient Egypt Splints have been found on Splints have been found on

mummies and they were made mummies and they were made of bamboo, reeds, wood or bark, of bamboo, reeds, wood or bark, padded with linen. padded with linen.

There is also evidence of the use There is also evidence of the use of crutches, with the earliest of crutches, with the earliest known record of the use of a known record of the use of a crutch coming from a carving crutch coming from a carving made in 2830 BC on the made in 2830 BC on the entrance of a portal on Hirkouf's entrance of a portal on Hirkouf's tomb. tomb.


Ancient EgyptAncient Egypt In the papyrus (a book), the examination In the papyrus (a book), the examination

of peripheral was described. of peripheral was described. In this papyrus, injuries were classified In this papyrus, injuries were classified

according to their prognosis into three according to their prognosis into three categories: categories: • an ailment which they would treat, an ailment which they would treat, • an ailment that they would contend and an ailment that they would contend and • an ailment which they would not treat. an ailment which they would not treat.

The papyrus also mentioned many cases The papyrus also mentioned many cases and the treatment involved. and the treatment involved.


Ancient GreeceAncient Greece Many principles behind Many principles behind

conditions and their treatment conditions and their treatment have been attributed to the have been attributed to the Ancient Greeks. Ancient Greeks.

They could be regarded as the They could be regarded as the first to use a scientific first to use a scientific approach.approach.

They were also the first to They were also the first to document in detail their document in detail their history and developments. history and developments.


HegetorHegetor also of Alexandria, but of 100 BC, also of Alexandria, but of 100 BC, described in detail the anatomical described in detail the anatomical relations of the hip joint, and was the first relations of the hip joint, and was the first to record a description of the ligamentum to record a description of the ligamentum teres. teres.

Corpus Hippocrates. It is named after Corpus Hippocrates. It is named after HippocratesHippocrates who is known as the father of who is known as the father of Medicine Medicine

dislocation of the shoulder was described dislocation of the shoulder was described together with the various methods used in together with the various methods used in reduction and correction of club foot.reduction and correction of club foot.


HippocratesHippocrates had a thorough had a thorough understanding of fractures. He knew understanding of fractures. He knew of the principles of traction and of the principles of traction and counter-traction. He developed counter-traction. He developed special splints for fractures of the special splints for fractures of the tibia, similar to external fixation tibia, similar to external fixation


Roman EraRoman Era

Another respected Greek figure by Another respected Greek figure by the name of the name of GalenGalen (129-199 BC). (129-199 BC). "the father of sports medicine". "the father of sports medicine".

He gave a good account of the He gave a good account of the skeleton and the muscles that skeleton and the muscles that move it. move it.

He first recorded a case of He first recorded a case of cervical ribs. cervical ribs.

He described bone destruction, He described bone destruction, sequestration and regeneration in sequestration and regeneration in osteomyelitis and sometimes osteomyelitis and sometimes performed resection in such cases. performed resection in such cases.


During this Graeco-Roman period, During this Graeco-Roman period, there were also attempts to provide there were also attempts to provide artificial prostheses. artificial prostheses.

It is said that both linen and catgut It is said that both linen and catgut sutures were used for the sutures were used for the procedures. procedures.

Various drills, saws and chisels were Various drills, saws and chisels were also developed during this period.also developed during this period.


Arab EraArab Era

Although the Arab practices were Although the Arab practices were regarded as an extension of those of regarded as an extension of those of the Greeks, the use of plaster-of the Greeks, the use of plaster-of Paris in the l0th century was Paris in the l0th century was significant. significant.

With the addition of water to a With the addition of water to a powder of anhydrous calcium powder of anhydrous calcium sulphate a hard crystalline material sulphate a hard crystalline material was produced.was produced.


It was not until the l2th century that It was not until the l2th century that Europe began to awake gradually Europe began to awake gradually from its Dark Ages from its Dark Ages

until the l6th century, all until the l6th century, all developments remained within the developments remained within the shadow cast by Hippocrates. shadow cast by Hippocrates.


AMBROISE PARE (1510-AMBROISE PARE (1510-1590)1590)

most famous surgical figure most famous surgical figure

of the l6th century and the of the l6th century and the

father of French Surgery father of French Surgery use of ligature for large use of ligature for large

vessels in amputations.vessels in amputations. used a tourniquet in his used a tourniquet in his

amputations, amputations, Pare did design a scoliosis Pare did design a scoliosis

corset and a clubfoot bootcorset and a clubfoot boot


NICHOLAS ANDRY (1658-NICHOLAS ANDRY (1658-1759) 1759)

Father of orthopaedics Father of orthopaedics He gave the term He gave the term

orthopaedics orthopaedics He published a famous He published a famous

book called Orthopaedia: or book called Orthopaedia: or the Art of Correcting and the Art of Correcting and Preventing Deformities in Preventing Deformities in Children Children


PERCIVAL POTT (1714-PERCIVAL POTT (1714-1788) 1788)

He is best known for the fracture He is best known for the fracture that bears his name that bears his name Pott's fracturePott's fracture, , as he was the first to give a good as he was the first to give a good description of this ankle fracture. description of this ankle fracture.

Pott's most famous work is on the Pott's most famous work is on the paraplegia of spinal tuberculosis, paraplegia of spinal tuberculosis, where he stressed that the where he stressed that the condition was not related to spinal condition was not related to spinal cord compression, but associated cord compression, but associated with strumous disorders in the with strumous disorders in the lungs. This is known as lungs. This is known as Pott's Pott's paraplegiaparaplegia. .


JOHN HUNTER (1728-JOHN HUNTER (1728-1793)1793)

His saying Don't Think, try the His saying Don't Think, try the experiment has inspired experiment has inspired generations of modern surgeons generations of modern surgeons

He described how to assess He described how to assess muscle power in a weak muscle. muscle power in a weak muscle.

He believed that healing He believed that healing depended on the body's innate depended on the body's innate power, and that the surgeon's power, and that the surgeon's task was to aid this. task was to aid this.

He studied loose bodies in joints, He studied loose bodies in joints, pseudoarthroses and fracture pseudoarthroses and fracture healing.healing.


WILLIAM HEY (1736-WILLIAM HEY (1736-1819)1819)

Subacute Osteomyelitis of the Subacute Osteomyelitis of the tibia was described by him and he tibia was described by him and he advocated deroofing of the lesion. advocated deroofing of the lesion.

In 1773, Hey banged his knee In 1773, Hey banged his knee getting out of the bath, and many getting out of the bath, and many attribute his subsequent interest attribute his subsequent interest in the knee to this. in the knee to this.

He coined the phrase internal He coined the phrase internal derangement of the knee, and derangement of the knee, and described meniscal injuries.described meniscal injuries.

Hey described loose bodies and Hey described loose bodies and introduced tarso-metatarsal introduced tarso-metatarsal amputation.amputation.


ABRAHAM COLLES (1773-ABRAHAM COLLES (1773-1843) 1843)

He was the first to He was the first to tie the subclavian tie the subclavian artery artery

best known for his best known for his description of Colles' description of Colles' fracture, in 1814 fracture, in 1814


ANTONIUS MATHYSEN ANTONIUS MATHYSEN (1805-1878) (1805-1878) Mathysen was a Dutch Mathysen was a Dutch

military surgeon who in military surgeon who in 1851, invented the plaster 1851, invented the plaster of Paris (POP) bandage of Paris (POP) bandage which was to become so which was to become so important to orthopaedic important to orthopaedic practice. practice.


JOSEPH LISTER (1827-JOSEPH LISTER (1827-1912) 1912)

Lister is known for the introduction of Lister is known for the introduction of antisepsis.antisepsis.

He first applied carbolic acid to a He first applied carbolic acid to a compound fracture in 1965. compound fracture in 1965.

It was soon clear that the practices It was soon clear that the practices had had a dramatic effect in reducing had had a dramatic effect in reducing in particular abscesses.in particular abscesses.

have trialed the application of the have trialed the application of the Penicillium mould directly to wounds.Penicillium mould directly to wounds.


HUGH THOMAS (1834-HUGH THOMAS (1834-1891) 1891) Father of British Orthopaedics. Father of British Orthopaedics.

Hugh Owen Thomas was the eldest Hugh Owen Thomas was the eldest of five sons born to a well-known of five sons born to a well-known bonesetter at that time. bonesetter at that time.

Hugh Owen Thomas could not even Hugh Owen Thomas could not even work with his father and never held a work with his father and never held a hospital appointment.hospital appointment.

He treated all his patients at his He treated all his patients at his home. home.

His practice was so busy that he His practice was so busy that he started his rounds at five or six in the started his rounds at five or six in the morning and never left his home for morning and never left his home for other than professional purposes. other than professional purposes. Thomas would designate Sunday as Thomas would designate Sunday as his free day and hundreds of patients his free day and hundreds of patients from the country would surround his from the country would surround his house in order to be treated. house in order to be treated.


The people of Liverpool knew Thomas as a short The people of Liverpool knew Thomas as a short and quick man. A man who always wore a black and quick man. A man who always wore a black coat buttoned up to the neck and a sailors cap coat buttoned up to the neck and a sailors cap pulled over a damaged eye. A cigarette was also pulled over a damaged eye. A cigarette was also seen constantly in his mouth seen constantly in his mouth

Thomas developed a great number of splints the Thomas developed a great number of splints the cervical collar, metatarsal bar, heel wedge and cervical collar, metatarsal bar, heel wedge and knee splint. Many of these are still in use, such as knee splint. Many of these are still in use, such as the the Thomas splintThomas splint. .

He was the first to demonstrate concealed He was the first to demonstrate concealed flexion of the hip joint and a way of unmasking flexion of the hip joint and a way of unmasking this by performing the this by performing the Thomas TestThomas Test. .


SIR WILLIAM ARBUTHNOT SIR WILLIAM ARBUTHNOT LANE (1856-1938)LANE (1856-1938)

Lane is known for his attempts at Lane is known for his attempts at improving alignment of fractures by improving alignment of fractures by using using internal fixationinternal fixation. .

He started off using silver He started off using silver wirewire, then , then he used steel he used steel screwscrews and this was s and this was followed by the use of followed by the use of platesplates and and screws. screws.


WILHELM CONRAD WILHELM CONRAD RONTGEN (1845-1923) RONTGEN (1845-1923)

Rontgen was a professor of Rontgen was a professor of Physics at Wurzburg, his Physics at Wurzburg, his discovery of X-rays (Rontgen discovery of X-rays (Rontgen rays) and their use has rays) and their use has provided an enormous provided an enormous contribution to Orthopaedics contribution to Orthopaedics

The first radiography that The first radiography that Rontgen took was of his wife's Rontgen took was of his wife's hand on the 22nd of December hand on the 22nd of December 1895. This was allegedly her 1895. This was allegedly her Christmas present. Christmas present.

Rontgen received the Nobel Rontgen received the Nobel Prize for his discovery in 1901. Prize for his discovery in 1901.


THE MODERN ERA (2OTH THE MODERN ERA (2OTH CENTURY ORTHOPAEDICS) CENTURY ORTHOPAEDICS)

The discovery of the X-ray almost The discovery of the X-ray almost marked 1900 and Orthopaedics itself marked 1900 and Orthopaedics itself was only now being seen as a true was only now being seen as a true specialty of its own. specialty of its own.


Sir Robert Jones (1855-Sir Robert Jones (1855-1933) 1933)

Jones was a nephew of the great Hugh Owen Jones was a nephew of the great Hugh Owen Thomas and became one of his apprentices Thomas and became one of his apprentices in Liverpool. in Liverpool.

In 1896, Jones published the first report of In 1896, Jones published the first report of the clinical use of an X-ray to locate a bullet the clinical use of an X-ray to locate a bullet in a wrist.in a wrist.

His textbook Orthopaedic Surgery is said to His textbook Orthopaedic Surgery is said to be the first to have dealt systematically with be the first to have dealt systematically with the diagnosis and treatment of fresh the diagnosis and treatment of fresh fractures. fractures.

In World War I, Jones headed the orthopaedic In World War I, Jones headed the orthopaedic section of the British Forces. Jones was an section of the British Forces. Jones was an advocate of tendon transplantation, bone advocate of tendon transplantation, bone grafting, and other conservative, restorative grafting, and other conservative, restorative procedures. procedures.


World War IWorld War I

It must be noted that war has played an It must be noted that war has played an important part in Orthopaedic history.important part in Orthopaedic history.

Many of our greatest contributors were military Many of our greatest contributors were military surgeons.surgeons.

It is interesting to note that many of the It is interesting to note that many of the achievements during and after World War I were achievements during and after World War I were not related directly to traumatic injuries received not related directly to traumatic injuries received at war.at war.

Orthopaedics was definitely seen as a separate Orthopaedics was definitely seen as a separate specialty after World War I and that this was the specialty after World War I and that this was the first major war where aseptic techniques were first major war where aseptic techniques were saving many more lives than in the past wars.saving many more lives than in the past wars.


In the chain of great surgeons that In the chain of great surgeons that followed Hugh Owen Thomas, came followed Hugh Owen Thomas, came Thomas Porter McMurray (1888-Thomas Porter McMurray (1888-1949)1949),, who worked for Robert Jones. who worked for Robert Jones.

His operative dexterity was renowned, for His operative dexterity was renowned, for he could remove an entire meniscus in he could remove an entire meniscus in five minutes and disarticulate a hip in ten five minutes and disarticulate a hip in ten minutes! minutes!

He introduced his sign for a torn He introduced his sign for a torn meniscus, McMurray's sign. An operation meniscus, McMurray's sign. An operation was also named after him as McMurray was also named after him as McMurray was the first to perform a displacement was the first to perform a displacement osteotomy for un-united fractures of the osteotomy for un-united fractures of the femoral neck and arthrosis of the hip. femoral neck and arthrosis of the hip.


World War IIWorld War II The knowledge learnt in fighting World War I The knowledge learnt in fighting World War I

helped in treating the casualties of World War II.helped in treating the casualties of World War II. In the Second World War, there were less In the Second World War, there were less

amputations performed, there was less gangrene, amputations performed, there was less gangrene, better measures for fixation of fractures.better measures for fixation of fractures.

we must not forget the importance of penicillin we must not forget the importance of penicillin (whose effects were discovered by (whose effects were discovered by Sir Sir Alexander FlemingAlexander Fleming in 1928) in 1928)..

The Germans needed quick measures to restore The Germans needed quick measures to restore their fighters to optimal fighting potential and their fighters to optimal fighting potential and developed a number of nailing procedures during developed a number of nailing procedures during this period. this period.

Together with this the Americans were now Together with this the Americans were now making more contributions than ever before. making more contributions than ever before.


Willis Campbell (1880-Willis Campbell (1880-1941)1941)

Main advocate of Main advocate of interpositional arthroplasty interpositional arthroplasty at that time. Campbell used at that time. Campbell used a free autogenous transplant a free autogenous transplant of fascia lata. of fascia lata.

Campbell was also a key Campbell was also a key figure in bone grafting and figure in bone grafting and performed inlay full performed inlay full thickness grafts for non-thickness grafts for non-union fixed with screws of union fixed with screws of beef bone. beef bone.


Gerhard Kuntscher (1900-Gerhard Kuntscher (1900-1972)1972)

He served in the German army He served in the German army during the Second World War during the Second World War and published his revolutionary and published his revolutionary procedure in the opening procedure in the opening months of the war.months of the war.

His work was concerned with His work was concerned with the intramedullary nailing of the intramedullary nailing of fractures of the shafts of long fractures of the shafts of long bones and his name is bones and his name is associated with the nail. associated with the nail.


Martin Kirschner (1879-Martin Kirschner (1879-1942)1942)

Known for his methods of fixation, in Known for his methods of fixation, in particular for the Kirschner or particular for the Kirschner or K-wire. K-wire.

He also performed the first He also performed the first successful pulmonary embolectomy.successful pulmonary embolectomy.


Sir Reginald Watson-Jones Sir Reginald Watson-Jones (1902-1972)(1902-1972)

During World War II, he was During World War II, he was among the leading teacher among the leading teacher in fracture therapy. in fracture therapy.

Watson-Jones published Watson-Jones published Fractures and Joint Injuries Fractures and Joint Injuries in 1940, which remained a in 1940, which remained a standard reference for standard reference for several decades and was several decades and was translated into many translated into many languages. languages.


Austin T. MooreAustin T. Moore (1899- (1899-1963)1963)

Performed the first metallic hip Performed the first metallic hip replacement. He had replaced, replacement. He had replaced, for the first time, the entire for the first time, the entire upper portion of the femur with a upper portion of the femur with a vitallium prosthesis vitallium prosthesis

Over the years, the design of the Over the years, the design of the prosthesis and the procedure prosthesis and the procedure improved. Consequently, there is improved. Consequently, there is one type of prosthesis called the one type of prosthesis called the Austin-Moore, which is still used Austin-Moore, which is still used today today


After the WarsAfter the Wars In the years following the war, orthopaedic In the years following the war, orthopaedic

surgeons sought to perfect their treatment surgeons sought to perfect their treatment of fractures, in particular with the use of of fractures, in particular with the use of metallic pins and wires for fixation. metallic pins and wires for fixation.

With the introduction of alloys that could With the introduction of alloys that could be used effectively, there was also a new be used effectively, there was also a new wave of prostheses, which are developing wave of prostheses, which are developing for treatment of arthritis as well as for treatment of arthritis as well as problematic fractures. problematic fractures.

Antibiotics have greatly improved and so Antibiotics have greatly improved and so have our diagnostic devices.have our diagnostic devices.


1948, 1948, Knut LindblomKnut Lindblom

Technique of direct injection of the Technique of direct injection of the lumbar intervertebral discs with lumbar intervertebral discs with radio-opaque dye to reproduce the radio-opaque dye to reproduce the symptoms.symptoms.

used pins made of especially used pins made of especially hardened stainless steel for treating hardened stainless steel for treating long bone fractures long bone fractures

H. Lowry Rush (1879-H. Lowry Rush (1879-1965)1965)


Sir John Charnley (1911-Sir John Charnley (1911-1982)1982)

Wrote a classic book on the non-Wrote a classic book on the non-operative approach to fractures, The operative approach to fractures, The “Closed Treatment of Common “Closed Treatment of Common Fractures”. Fractures”.

Charnley is however renowned as Charnley is however renowned as the effective innovator of the the effective innovator of the total total hip replacement. hip replacement.

Development of a self-curing acrylic Development of a self-curing acrylic Bone cementBone cement

Many of the total hip replacements Many of the total hip replacements that he performed in the 1960's are that he performed in the 1960's are still sound and serving their patients still sound and serving their patients effectively.effectively.


Minimal Invasive Surgery Minimal Invasive Surgery (MIS)(MIS) Endoscopy was first described Endoscopy was first described

by by HippocratesHippocrates in Greece (460 – in Greece (460 – 375 BC) He made reference to a 375 BC) He made reference to a rectal speculumrectal speculum

Pioneering work in the field of Pioneering work in the field of arthroscopy began as early as arthroscopy began as early as the 1920s with the work of the 1920s with the work of EugenEugen BircherBircher..

Japanese surgeon Japanese surgeon Masaki Masaki Watanabe,Watanabe, MD receives primary MD receives primary credit for using arthroscopy for credit for using arthroscopy for interventional surgery. interventional surgery. Watanabe was inspired by the Watanabe was inspired by the work and teaching of Dr work and teaching of Dr Richard Richard O'ConnorO'Connor..


Arthroplasty Arthroplasty


ArthroplastyArthroplasty


In some ways, Orthopaedics has lost In some ways, Orthopaedics has lost its way by producing its way by producing surgical surgical technicianstechnicians (surgeons merely content (surgeons merely content to operate) with not enough to operate) with not enough commitment to fundamental commitment to fundamental biomedical research and the biomedical research and the protection of their craft. protection of their craft.


Imagine what these great figures Imagine what these great figures were able to achieve 200 years ago were able to achieve 200 years ago without a formal education or the without a formal education or the Internet.Internet.

Read widely to catch a glimpse of the Read widely to catch a glimpse of the excitement of Science and remain excitement of Science and remain true to your patients, family and true to your patients, family and profession profession

history of orthopaedics

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