Orthopedic surgery or orthopedics spelled orthopaedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections and congenital disorders. Nicholas Andry coined the word in French as orthopédie, derived from the Ancient Greek words ὀρθός orthos and παιδίον paidion, published Orthopedie in 1741; the word was assimilated into English as orthopædics. Though, as the name implies, the discipline was developed with attention to children, the correction of spinal and bone deformities in all stages of life became the cornerstone of orthopedic practice; as with many words derived with the "æ" ligature, simplification to either "ae" or just "e" is common in North America. In the US, the majority of college and residency programs, the American Academy of Orthopaedic Surgeons, still use the spelling with the digraph ae, though hospitals use the shortened form.
Elsewhere, usage is not uniform: in Canada, both spellings are acceptable. Many developments in orthopedic surgery have resulted from experiences during wartime. On the battlefields of the Middle Ages the injured were treated with bandages soaked in horses' blood which dried to form a stiff, but unsanitary, splint; the term orthopedics meant the correcting of musculoskeletal deformities in children. Nicolas Andry, a professor of medicine at the University of Paris coined the term in the first textbook written on the subject in 1741, he advocated the use of exercise and splinting to treat deformities in children. His book was directed towards parents, while some topics would be familiar to orthopedists today, it included'excessive sweating of the palms' and freckles. Jean-André Venel established the first orthopedic institute in 1780, the first hospital dedicated to the treatment of children's skeletal deformities, he developed the club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine.
Advances made in surgical technique during the 18th century, such as John Hunter's research on tendon healing and Percival Pott's work on spinal deformity increased the range of new methods available for effective treatment. Antonius Mathijsen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. However, up until the 1890s, orthopedics was still a study limited to the correction of deformity in children. One of the first surgical procedures developed was percutaneous tenotomy; this involved cutting a tendon the Achilles tendon, to help treat deformities alongside bracing and exercises. In the late 1800s and first decades of the 1900s, there was significant controversy about whether orthopedics should include surgical procedures at all. Examples of people who aided the development of modern orthopedic surgery were Hugh Owen Thomas, a surgeon from Wales, his nephew, Robert Jones. Thomas became interested in orthopedics and bone-setting at a young age and, after establishing his own practice, went on to expand the field into general treatment of fracture and other musculoskeletal problems.
He advocated enforced rest as the best remedy for fractures and tuberculosis and created the so-called'Thomas Splint', to stabilize a fractured femur and prevent infection. He is responsible for numerous other medical innovations that all carry his name:'Thomas's collar' to treat tuberculosis of the cervical spine,'Thomas's manoeuvre', an orthopedic investigation for fracture of the hip joint, Thomas test, a method of detecting hip deformity by having the patient lying flat in bed,'Thomas's wrench' for reducing fractures, as well as an osteoclast to break and reset bones. Thomas's work was not appreciated in his own lifetime, it was only during the First World War that his techniques came to be used for injured soldiers on the battlefield. His nephew, Sir Robert Jones, had made great advances in orthopedics in his position as Surgeon-Superintendent for the construction of the Manchester Ship Canal in 1888, he was responsible for the injured among the 20,000 workers, he organized the first comprehensive accident service in the world, dividing the 36 mile site into 3 sections, establishing a hospital and a string of first aid posts in each section.
He had the medical personnel trained in fracture management. He managed 3,000 cases and performed 300 operations in his own hospital; this position enabled him to improve the standard of fracture management. Physicians from around the world came to Jones’ clinic to learn his techniques. Along with Alfred Tubby, Jones founded the British Orthopaedic Society in 1894. During the First World War, Jones served as a Territorial Army surgeon, he observed that treatment of fractures both at the front and in hospitals at home was inadequate, his efforts led to the introduction of military orthopedic hospitals. He was appointed Inspector of Military Orthopaedics, with responsibility over 30,000 beds; the hospital in Ducane Road, Hammersmith became the model for both British and American military orthopedic hospitals. His advocacy of the use of Thomas splint for the initial treatment of femoral fractures reduced mortality of compound fractures of the femur from 87% to less than 8% in the period from 1916 to 1918.
The use of intramedullary rods to treat fractures of the femur and tibi
Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, is a protective response involving immune cells, blood vessels, molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, initiate tissue repair; the five classical signs of inflammation are heat, redness and loss of function. Inflammation is a generic response, therefore it is considered as a mechanism of innate immunity, as compared to adaptive immunity, specific for each pathogen. Too little inflammation could lead to progressive tissue destruction by the harmful stimulus and compromise the survival of the organism. In contrast, chronic inflammation may lead to a host of diseases, such as hay fever, atherosclerosis, rheumatoid arthritis, cancer. Inflammation is therefore closely regulated by the body. Inflammation can be classified as either chronic.
Acute inflammation is the initial response of the body to harmful stimuli and is achieved by the increased movement of plasma and leukocytes from the blood into the injured tissues. A series of biochemical events propagates and matures the inflammatory response, involving the local vascular system, the immune system, various cells within the injured tissue. Prolonged inflammation, known as chronic inflammation, leads to a progressive shift in the type of cells present at the site of inflammation, such as mononuclear cells, is characterized by simultaneous destruction and healing of the tissue from the inflammatory process. Inflammation is not a synonym for infection. Infection describes the interaction between the action of microbial invasion and the reaction of the body's inflammatory response—the two components are considered together when discussing an infection, the word is used to imply a microbial invasive cause for the observed inflammatory reaction. Inflammation on the other hand describes purely the body's immunovascular response, whatever the cause may be.
But because of how the two are correlated, words ending in the suffix -itis are sometimes informally described as referring to infection. For example, the word urethritis means only "urethral inflammation", but clinical health care providers discuss urethritis as a urethral infection because urethral microbial invasion is the most common cause of urethritis, it is useful to differentiate inflammation and infection because there are typical situations in pathology and medical diagnosis where inflammation is not driven by microbial invasion – for example, trauma and autoimmune diseases including type III hypersensitivity. Conversely, there is pathology where microbial invasion does not cause the classic inflammatory response – for example, parasitosis or eosinophilia. Acute inflammation is a short-term process appearing within a few minutes or hours and begins to cease upon the removal of the injurious stimulus, it involves a coordinated and systemic mobilization response locally of various immune and neurological mediators of acute inflammation.
In a normal healthy response, it becomes activated, clears the pathogen and begins a repair process and ceases. It is characterized by five cardinal signs:An acronym that may be used to remember the key symptoms is "PRISH", for pain, immobility and heat; the traditional names for signs of inflammation come from Latin: Dolor Calor Rubor Tumor Functio laesa The first four were described by Celsus, while loss of function was added by Galen. However, the addition of this fifth sign has been ascribed to Thomas Sydenham and Virchow. Redness and heat are due to increased blood flow at body core temperature to the inflamed site. Loss of function has multiple causes. Acute inflammation of the lung does not cause pain unless the inflammation involves the parietal pleura, which does have pain-sensitive nerve endings; the process of acute inflammation is initiated by resident immune cells present in the involved tissue resident macrophages, dendritic cells, Kupffer cells and mast cells. These cells possess surface receptors known as pattern recognition receptors, which recognize two subclasses of molecules: pathogen-associated molecular patterns and damage-associated molecular patterns.
PAMPs are compounds that are associated with various pathogens, but which are distinguishable from host molecules. DAMPs are compounds that are associated with host-related cell damage. At the onset of an infection, burn, or other injuries, these cells undergo activation and release inflammatory mediators responsible for the clinical signs of inflammation. Vasodilation and its resulting increased blood flow causes increased heat. Increased permeability of the blood vessels results in an exudation of plasma proteins and fluid into the tissue, which manifests itself as swelling; some of the released mediators such as bradykinin increase the sensitivity to pain. The mediator molecules alter the blood vessels to
Flexibility or limberness refers to the range of movement in a joint or series of joints, length in muscles that cross the joints to induce a bending movement or motion. Flexibility varies between individuals in terms of differences in muscle length of multi-joint muscles. Flexibility in some joints can be increased to a certain degree by exercise, with stretching a common exercise component to maintain or improve flexibility. Quality of life is enhanced by maintaining a good range of motion in the joints. Overall flexibility should be developed with specific joint range of motion needs in mind as the individual joints vary from one to another. Loss of flexibility can be a predisposing factor for physical issues such as pain syndromes or balance disorders. Sex and genetics are important for range of motion. Exercise including stretching and yoga improves flexibility. Many factors are taken into account when establishing personal flexibility: joint structure, tendons, skin, tissue injury, fat tissue, body temperature, activity level and sex all influence an individual's range of motion about a joint.
Individual body flexibility level is measured and calculated by performing a sit and reach test, where the result is defined as personal flexibility score. The joints in a human body are surrounded by synovial membranes and articular cartilage which cover and nourish the joint and surfaces of each. Increasing muscular elasticity of the joint's range of mobility increases flexibility. Ligaments are composed of two different tissues: yellow; the white fibrous tissues are not stretchy, but are strong so that if the bone were fractured the tissue would remain in place. The white tissue allows subjective freedom of movement; the yellow elastic tissue can be stretched while returning to its original length. Tendons are not elastic and are less stretchy. Tendons are categorized as a connective tissue. Connective tissue supports and binds the muscle fibres, they contain both non-elastic tissue. The areolar tissue is extensively distributed throughout the body; this tissue acts as a general binder for all other tissues.
Muscle tissue is made of a stretchy material. It is arranged in bundles of parallel fibres. Stretch receptors have two parts: Golgi tendons. Spindle cells, located in the center of a muscle, send messages for the muscle to contract. On the other hand, Golgi tendon receptors are located near the end of a muscle fiber and send messages for the muscle to relax; as these receptors are trained through continual use, stretching becomes easier. When reflexes that inhibit flexibility are released the splits become easier to perform; the splits provide a complete stretch. Flexibility is improved by stretching. Stretching should only be started when muscles are warm and the body temperature is raised. To be effective while stretching, force applied to the body must be held just beyond a feeling of pain and needs to be held for at least ten seconds. Increasing the range of motion creates good posture and develops proficient performance in everyday activities increasing the length of life and overall health of the individual.
Dynamic flexibility is classified as the ability to complete a full range of motion of a joint. This is a release of energy with proper timing for the muscles to contract, it controls movement as the speed increases while stretching parts of the body. This form of stretching prepares the body for physical exertion and sports performance. In the past it was the practice to undertake static stretching before exercise. Dynamic stretching increases range of movement and oxygen flow to soft tissues prior to exertion. Coaches and sports trainers are aware of the role in dynamic stretching in improving performance and reducing the risk of injury. Static-active stretching includes holding an extended position with just the strength of the muscles such as holding the leg in front, side or behind. Static-active flexibility requires a great deal of strength. Ballistic stretching is separate from all other forms of stretching, it does not include stretching, but rather a bouncing motion. The actual performance of ballistic movements prevents lengthening of tissues.
These movements should only be performed when the body is warm. Each individual is born with a particular range of motion for each joint in their body. In the book Finding Balance by Gigi Berardi, the author mentions three limiting factors: Occupational demands, movement demands and training oversights. Movement demands include strength and range of motion. Training oversights occurs. Internally, the joints, muscles and ligaments can affect one's flexibility; as mentioned, each part of the body has its own limitations and combined, the range of motion can be affected. The mental attitude of the performer during the state of motion can affect their range. Externally, anything from the weather outside to the age of the performer can affect flexibility. General tissues and collagen change with age influencing the individual; as one ages, performing activities of daily living without pain becomes much harder. By stretching one can maintain a level of musculoskeletal fitness that will keep them feeling well.
Performers should be aware of over-stretching. Basic things such as clothing and equipment can affect a performance. Dance surfaces and lack of proper shoes can affect a performer's ability to perform at his/her best. Stretching for too long or too much can give way to an injury. For most activities, the nor