Orthopedic surgery or orthopedics (also spelled orthopaedics, see below) is the branch of surgery concerned with acute, chronic, traumatic, and overuse injuries and other disorders of the musculoskeletal system. Orthopaedic surgeons address most musculoskeletal aliments including arthritis, trauma and congenital deformities using both surgical and non-surgical means.

Training

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Orthopedic surgeons are physicians who have completed additional training in orthopedic surgery after the completion of medical school. According to the latest Occupational Outlook Handbook (2006-2007) published by the U.S. Department of Labor, between 3-4% of all practicing physicians/surgeons are orthopedic surgeons.

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Archives of Orthopaedic and Trauma Surgery (Online Firstâ„¢)

Malunion of the distal radius
Tue, 31 Jan 2012 16:47:02 -0000
Abstract  Fractures of the distal radius are extremely common injuries, which are steadily becoming a public health issue. One of the most common complications following distal radius fractures is still malunion of the distal radius. This review of the literature surrounding distal radius malunion covers the biomechanics of distal radial malunion, treatment options, indications for surgery, surgical techniques, and results. Content Type Journal ArticleCategory HandsurgeryPages 1-10DOI 10.1007/s00402-012-1466-yAuthors Karl-Josef Prommersberger, Klinik für Handchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97615 Bad Neustadt, GermanyThomas Pillukat, Klinik für Handchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97615 Bad Neustadt, GermanyMarion Mühldorfer, Klinik für Handchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97615 Bad Neustadt, GermanyJörg van Schoonhoven, Klinik für Handchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97615 Bad Neustadt, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051
The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach
Tue, 31 Jan 2012 16:47:01 -0000
Abstract Introduction  Minimally invasive total hip arthroplasty has been successfully introduced in the past decade. Nevertheless, standard approaches such as the direct lateral approach are still commonly used in orthopaedic surgery due to easy handling, good intra-operative overview and low complication rates. However, a frequent occurrence of fatty atrophy within the anterior third of the gluteus medius muscle has been demonstrated when using the modified direct-lateral approach (mDL), which may be associated with a reduction in function, limitation of internal leg rotation, gait disorders and pain. The question addressed in this study is whether mDL-approach leads to unfavourable changes in foot progression angle (FPA), gait and to more postoperative pain compared with a minimally invasive anterolateral approach (ALMI). Methods  Thirty patients with primary osteoarthritis of the hip were recruited for this study. All subjects received an uncemented THA (Alloclassic®-Zweymüller stem, Allofit® Cup, FA Zimmer®), 15 through an ALMI-approach and 15 via the mDL-approach. Gait analyses were performed both preoperatively and 3 months after surgery to measure FPA, step length, stance duration, cadence and walking speed. Additionally, the Harris-Hip Score, pain according to the visual analogue scale and the Trendelenburg sign were evaluated. Results  No influence of the surgical approach could be observed on the gait patterns or FPA. Furthermore, neither increased external rotation of the limb nor restriction of internal rotation during walking could be established. Pain and Harris-Hip Score did not differ significantly between the two groups. Conclusion  In comparison with an ALMI approach, the mDL approach did not lead to a change in FPA postoperatively. No detrimental effect could be found on the gait pattern or pain after surgery. Based on these measurements, the minimally invasive anterolateral approach did not appear to provide functional benefits in outcome over the mDL approach. Consequently, both surgical approaches seem to be equally applicable approaches with good to very good functional results. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-7DOI 10.1007/s00402-012-1467-xAuthors Michael Müller, Department of Orthopedics, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, GermanyVerena Schwachmeyer, Julius Wolf Institute and Center for Sports Science and Sports Medicine Berlin (CSSB), Charité-Universitätsmedizin Berlin, Berlin, GermanyStephan Tohtz, Department of Orthopedics, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, GermanyWilliam R. Taylor, Julius Wolf Institute and Center for Sports Science and Sports Medicine Berlin (CSSB), Charité-Universitätsmedizin Berlin, Berlin, GermanyGeorg N. Duda, Julius Wolf Institute and Center for Sports Science and Sports Medicine Berlin (CSSB), Charité-Universitätsmedizin Berlin, Berlin, GermanyCarsten Perka, Department of Orthopedics, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, GermanyMarkus O. Heller, Julius Wolf Institute and Center for Sports Science and Sports Medicine Berlin (CSSB), Charité-Universitätsmedizin Berlin, Berlin, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051
Evaluation of femoral head coverage following Chiari pelvic osteotomy in adolescents by three-dimensional computed tomography and conventional radiography
Tue, 31 Jan 2012 16:47:00 -0000
Abstract Introduction  Currently, the cover of the femoral head was mainly assessed using conventional plain films after Chiari pelvic osteotomy in most studies. The purpose of the current study was to observe whether the femoral head coverage measured by three-dimensional computed tomography (3D-CT) was consistent with the radiographic findings. Patients and methods  A total of 24 patients (24 hips) with an average age of 11.5 years, underwent Chiari osteotomy due to acetabular dysplasia, and 15 subjects (30 hips) of normal control with a mean age of 12 years were involved in the study. The pre- and postoperative coverage of femoral head was measured by using conventional plain film and 3D-CT on the anterior 1/4, middle 1/2, and posterior 1/4 coronal plane. The anterolateral, mediolateral and posterolateral coverage measured by 3D-CT were compared with the coverage measured by plain radiograph, and which were also compared with the normal control individuals. Results  The postoperative anterolateral, mediolateral coverage measured by 3D-CT was significantly smaller than that measured by radiography (P < 0.01). No significant difference was found between the 3D-CT measurements on the posterolateral coverage and the radiographic results. The anterolateral femoral head coverage in the patients following Chiari pelvic osteotomy was also smaller than that in the normal control individuals (P = 0.026). In contrast, the postoperative posterolateral coverage in the patients was more excessive than that in the normal control individuals (P = 0.001). Conclusion  Conventional radiographs may show sufficient cover of the femoral head after Chiari osteotomy, whereas in fact, the cover may be not perfect, especially on the anterolateral part. Therefore, the postoperative 3D-CT is beneficial for evaluating the outcome of Chiari osteotomy, especially when the anterolateral coverage of femoral head is significantly insufficient preoperatively. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-7DOI 10.1007/s00402-012-1464-0Authors LianYong Li, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, ChinaJingYu Jia, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, ChinaQun Zhao, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, ChinaLiJun Zhang, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, ChinaShiJun Ji, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, ChinaEnBo Wang, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051
Predictive factors of cervical spondylotic myelopathy in patients with lumbar spinal stenosis
Wed, 25 Jan 2012 18:07:45 -0000
Abstract Objective  To analyze cervical spondylotic myelopathy (CSM) predictive factors in patients with lumbar spinal stenosis (LSS). Methods  Two hundred thirty-seven patients who visited for low back pain, lower limb pain and/or lower limb numbness and who were diagnosed with LSS were enrolled in this study. The ratio of males to females was 117–120, and the mean age was 68.8 years (range 45–87 years). LSS and CSM were diagnosed by characteristic symptoms, physical findings and MRI. We examined gender, age, Torg-Pavlov ratio (TPR), spondylolisthesis or spondylosis, LSS symptom types and number of stenosis segments with LSS to clarify predictive factors for CSM. Results  There were 21 (8.86%) patients with coexistent CSM among 237 LSS patients. CSM morbidity was significantly more common among males compared with females. TPR was 0.71 Â± 0.09 in the CSM patients and 0.81 Â± 0.10 in the non-CSM patients. TPR of the CSM patients was significantly smaller than that of the non-CSM patients. We analyzed to determine the predictive factors of CSM and TPR was identified. The predictive value of TPR for CSM was 0.78. Conclusion  Torg-Pavlov ratio was the most important predictive factor of CSM in patients with LSS. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-5DOI 10.1007/s00402-012-1465-zAuthors Hideki Iizuka, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, JapanKeisuke Takahashi, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, JapanShinya Tanaka, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, JapanKohei Kawamura, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, JapanYoshitomo Okano, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, JapanHiromi Oda, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051
Computational measurement of joint space width and structural parameters in normal hips
Tue, 24 Jan 2012 18:09:26 -0000
Abstract Introduction  Joint space width (JSW) of hip joints on radiographs in normal population may vary by related factors, but previous investigations were insufficient due to limitations of sources of radiographs, inclusion of subjects with osteoarthritis, and manual measurement techniques. We investigated influential factors on JSW using semiautomatic computational software on pelvic radiographs in asymptomatic subjects without radiological osteoarthritic findings. Methods  Global and local JSW at the medial, middle, and lateral compartments, and the hip structural parameters were measured in asymptomatic, normal 150 cases (300 hips), using a customized computational software. Results  Reliability of measurement in global and local JSWs was high with intraobserver reproducibility (intraclass correlation coefficient) ranging from 0.957 to 0.993 and interobserver reproducibility ranging from 0.925 to 0.985. There were significant differences among three local JSWs, with the largest JSW at the lateral compartment. Global and medial local JSWs were significantly larger in the right hip, and global, medial and middle local JSWs were significantly smaller in women. Global and local JSWs were inversely correlated with CE angle and positively correlated with horizontal distance of the head center, but not correlated with body mass index in men and women. They were positively correlated with age and inversely correlated with vertical distance of the head center only in men. Conclusions  There were interindividual variations of JSW in normal population, depending on sites of the weight-bearing area, side, gender, age, and hip structural parameters. For accurate diagnosis and assessment of hip osteoarthritis, consideration of those influential factors other than degenerative change is important. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-8DOI 10.1007/s00402-012-1463-1Authors Takashi Nishii, Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, JapanToshiyuki Shiomi, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, JapanTakashi Sakai, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, JapanMasaki Takao, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, JapanHideki Yoshikawa, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, JapanNobuhiko Sugano, Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051
Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years
Fri, 20 Jan 2012 07:04:39 -0000
Abstract Background  This study aims to compare radiographic and clinical outcomes of Dynesys and posterior lumbar interbody fusion (PLIF) for the treatment of multisegment disease. Methods  Thirty-five consecutive patients who received Dynesys implantation at three levels from L1 to S1 from November 2006 to July 2007 were studied. A retrospective analysis of the medical records of 25 patients with the same indications who received 3-level PLIF (L1–S1) was also conducted. Radiographic and clinical outcomes between the groups were compared. All patients included in the analysis completed 3-year follow-up. Dynesys stabilization resulted in higher preservation of motion at the operative levels, as well as total range of motion from L1 to S1. A decrease of anterior disc height was seen in the Dynesys group and an increase was seen in the PLIF group. An increase in posterior disc height was noted in both groups; however, was greater in the PLIF group at 3 years. Results  The Dynesys group showed a greater improvement in Oswestry Disability Index and visual analogue scale back pain scores at 3 years postoperatively. There were no differences in complications between the two groups. Conclusion  In conclusion, Dynesys is an acceptable alternative to PLIF for the treatment of multisegment lumbar disease. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-7DOI 10.1007/s00402-012-1460-4Authors Shang-Won Yu, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of ChinaCheng-Yo Yen, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of ChinaChin-Hsien Wu, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of ChinaFeng-Chen Kao, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of ChinaYu-Hsien Kao, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of ChinaYuan-Kun Tu, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

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