"हाडजोर्नी शल्यचिकित्सा" का संशोधनहरू बिचको अन्तर

'''Orthopedic surgery''' or '''orthopedics''' (also spelled '''orthopaedics''', see below) is the branch of [[surgery]] concerned with [[Acute (medical)|acute]], [[Chronic (medicine)|chronic]], [[Physical trauma|trauma]]tic, andर overuse [[injury|injuries]] andर other disorders of the [[musculoskeletal system]]. Orthopaedic surgeons address most musculoskeletal ailments including arthritis, trauma andर congenital deformities using both surgical andर non-surgical means.

In the United States andर Canada orthopedic surgeons (also know as orthopedists) complete a minimum of 13 years of [[postsecondary education]] andर clinical training. This training includes obtaining an [[undergraduate education|undergraduate degree]], a medical degree, andर then completing a 5-year [[Residency (medicine)|residency]] in orthopedic surgery. The 5-year [[Residency (medicine)|residency]] consists of one year of general surgery training followed by four years of training in orthopaedic surgery.

Many orthopedic surgeons elect to do further subspeciality training in programs known as 'fellowships' after completing their residency training. These fellowships typically last 1-2 years andर usually have a [[research]] component involved with the clinical andर operative training. Examples of orthopedic subspeciality training in the US are:

#Shoulder andर elbow surgery

#Foot andर ankle surgery (Not to be confused with [[podiatry]])

Hand surgery is the only truly recognized sub-specialty within orthopaedic surgery. The other sub-specialities are informal concentrations of practice. To be recognized as a hand surgeon, a practitioner must have completed a fellowship andर obtained a Certificate of Added Qualifications (CAQ) which requires an additional standardized examination.

Orthopaedic surgeons address most musculoskeletal ailments including arthritis, trauma andर congenital deformities using both surgical andर non-surgical means. According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopaedic surgeons are as follows:

#Knee [[arthroscopy]] andर menisectomy

#Shoulder [[arthroscopy]] andर decompression

#Knee [[arthroscopy]] andर chondroplasty

#Knee [[arthroscopy]] andर [[anterior cruciate ligament]] reconstruction

#Shoulder [[arthroscopy]] andर débridement

*Hands andर upper extremity: 8.7%

*Foot andर ankle: 3.1%

A typical schedule for a practicing orthopaedic surgeon involves 50-55 hours of work per week divided among clinic, surgery, various administrative duties andर possibly teaching and/or research if in an academic setting.

[[Jean-Andre Venel]] established the first orthopedic institute in [[1780]], which was the first hospital dedicated to the treatment of children's skeletal deformities. He is considered by some to be the father of orthopedics or the first true orthopedist in consideraton of the establishment of उनका hospital andर for उनका published methods.

Many developments in orthopedic surgery 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. [[Traction (orthopedics)|Traction]] andर [[Splint (medicine)|splinting]] developed during [[World War I]]. The use of [[intramedullary rod]]s to treat fractures of the [[femur]] andर [[tibia]] was pioneered by Dr. Kunchner of [[Germany]]. This made a noticeable difference to the speed of recovery of injured German soldiers during [[World War II]] andर led to more widespread adoption of intramedullary fixation of [[bone fracture|fracture]]s in the rest of the world. However, traction was the standard method of treating thigh bone fractures until the late [[1970s]] when the [[Seattle Harborview]] group popularized intramedullary fixation without opening up the fracture. External fixation of fractures was refined by American surgeons during the [[Vietnam War]] but a major contribution was made by [[Gavril Abramovich Ilizarov]] in the [[USSR]]. He was sent, without much orthopedic training, to look after injured Russian soldiers in [[Siberia]] in the [[1950s]]. With no equipment he was confronted with crippling conditions of unhealed, infected, andर malaligned fractures. With the help of the local [[bicycle]] shop he devised ring external [[fixator]]s tensioned like the spokes of a bicycle. With this equipment he achieved healing, realignment andर lengthening to a degree unheard of elsewhere. His [[Ilizarov apparatus]] is still used today.

David L. MacIntosh pioneered the first successful surgery for the management of the torn [[anterior cruciate ligament]] of the [[knee]]. This common andर serious injury in [[skiing|skiers]], field athletes, andर [[dance|dancers]] invariably brought an end to their athletics due to permanent joint instability. Working with injured [[American football|football]] players, Dr. MacIntosh devised a way to re-route viable [[ligament]] from adjacent structures to preserve the strong andर complex mechanics of the knee joint andर restore stability. The subsequent development of ACL reconstruction surgery has allowed numerous athletes to return to the demands of sports at all levels.

Modern orthopaedic surgery andर musculoskeletal research has sought to make surgery less invasive andर to make implanted components better andर more durable.

The use of [[arthroscopy|arthroscopic tools]] has been particularly important for injured patients. Arthroscopy was pioneered by Dr. Watanabe of Japan to perform [[minimally invasive surgery|minimally invasive cartilage surgery andर re-constructions]] of torn ligaments. Arthroscopy helped patients recover from the surgery in a matter of days, rather than the weeks to months required by conventional, 'open' surgery. Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today andर is often combined with meniscectomy or chondroplasty--both of which are removal of a torn cartilage.

The modern total [[hip replacement]] was pioneered by Sir John Charnley in England in the 1960s{{fact}}. He found that joint surfaces could be replaced by metal or high density [[polyethylene]] implants cemented to the bone with [[methyl methacrylate]] cement. Since Charnley, there have been continuous improvements in the design andर technique of joint replacement ([[arthroplasty]]) with many contributors, including W. H. Harris, the son of R. I. Harris, whose team at Harvard pioneered uncemented arthroplasty techniques with the bone bonding directly to the implant.

Knee replacements using similar technology were started by McIntosh in [[rheumatoid arthritis]] patients andर later by Gunston andर Marmor for [[osteoarthritis]] in the 1970's. The modern [[knee replacement]] was developed by Dr. John Insall andर Dr. Chitranjan Ranawat in New York{{fact}}. Uni-compartment knee replacement, in which only one side of an arthritic knee is replaced, is a smaller operation andर has become popular recently.

Joint replacements are available for other joints on a limited basis, most notably shoulder, elbow, wrist andर ankle.

The treatment of children with muscoloskeletal problems remains an integral part of modern orthopaedic surgery. Many fractures andर injuries occur in children due to their high activity level andर unique immature skeleton. Treatment of fractures in children is different than adults due to active [[growth plate|growth plates]] in their bones. Damage to the growth plate can lead to significant problems with later bone growth, andर at-risk fractures have to be monitored with care.

The treatment of [[scoliosis]] is a mainstay of pediatric orthopaedics. For poorly understood reasons, curvature devlops in the spine of some children, which if left untreated leads to undesireable deformity andर may progress to cause chronic pain andर breathing problems. The treatment of scoliosis is quite complicated andर often involves a combination of bracing andर surgery.

Children have other unique musculoskeletal conditions that have been a focus of orthopedics since Hippocrates, including conditions such as [[club foot]] andर [[congenital]] [[dislocation of hip]] (also known as [[hip dysplasia|developmental dysplasia of the hip]]). In addition, [[infections]] in bones andर joints ([[osteomyelitis]]) in children are common. In the US, specialized hospitals such as the [[Shriners]] hospitals have provided a substantial portion of treatment for children with musculoskeletal deformities andर diseases.

[[Nicholas Andry]] coined the word "orthopaedics", derived from [[Greek language|Greek]] [[word]]s for "correct" or "straight" ("orthos") andर "[[child]]" ("paidion"), in [[1741]], when at the [[Ageing|age]] of 81 he [[Publishing|published]] ''Orthopaedia: or the Art of Correcting andर Preventing Deformities in Children''.

In the U.S. the spelling ''orthopedics'' is standard{{fact}}, although the majority of university andर residency programs{{fact}}, andर even the [http://www.aaos.org/ AAOS], still use Andry's spelling. Elsewhere, usage is not uniform; in Canada, both spellings are common; ''orthopaedics'' usually prevails in the rest of the Commonwealth, especially in Britain; see also [[spelling differences]].

Garrett, WE, et al. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, Certification Examination. The Journal of Bone andर Joint Surgery (American). 2006;88:660-667.

* [http://www.sicot.org/ The International Society of Orthopaedic Surgery andर Traumatology]