The orthopedy is the surgical discipline relating to the treatment of the lesions of the locomotor apparatus. It includes the Traumatologie which treats the traumatic lesions more particularly.

History

The practice of orthopedy is a tradition which goes back to one remote time. However, the word “orthopedy” exists only since 1741.

This term was created starting from two Greek words: “orthos” which mean “right” and “paidon” which wants to say “child.

In the beginning, the objective was to prevent and correct the deformities of the body in the children. Its symbol is a twisted tree retained with a tutor by a cord.

fourth century BC

The first traumato-orthopedic apparatuses appear in IVe century before J. - C. with Hippocrates (a doctor Greek, born on the island of Cos in 460 before J.C and died in Arissa into 360 before J.C, which devoted its life to medicine). In orthopedy, it develops a wood bench which reduces luxations and the fractures. The principle of this apparatus is to immobilize the bone or the articulation so that it is resoldered or is positioned back according to the case.

One must in Hippocrates the current principle to also reduce a luxation of the shoulder.

18th century

In 1741, Nicolas Andry de Boisregard, professor in medicine with the royal college of Lyon, invents the word “  orthopedy  ” with its book: “ orthopedy or art to prevent and correct the deformities of the body in the children; the whole by means with the range of the fathers and mothers and all the people who have children to raise. ” '. The Greek roots ortho (right) and feed, paidos (child) come from what the purpose of orthopedy was, at the beginning, to rectify the twisted young girls (see the symbol of the “twisted tree” (twisted) of the book of Nicolas Andry which is used currently as symbol to the orthopedists) and to install the club-foot, etc another possible etymology associates the Greek roots " ortho" and " paiden" (I walk) what assigns for original intention with orthopedy of " to go droit" !!

Orthopedy is exerted at XVIIIe and the beginning of the XIXe centuries only by doctors in institutes specialized like those of Venel (1740-1791) in Switzerland, of Delpech to Montpellier, Pravaz in Paris then with Lyon, etc

In 1779, Jean-Pierre David written Essay on the effects of the movement and the rest in the surgical Diseases , which will be traditional orthopedy. (translated into English in 1790)

19th century

In 1830 appears the fashion of the ténotomies to rectify the club-feet (first subcutaneous tenotomy of the tendon of Achilles for club-foot in 1816 by Delpech), and even of the ténotomies for scoliosis and various vicious attitudes. But the term of surgery joined to orthopedy remains held for the child or the teenager, and appears truly only after 1850 with the remarkable work of Parisian of Saint-Germain. For Saint-Germain, the orthopedic surgery corrects all the deformations of the child, of the hare nozzle to the hypospade, while passing by the genu valgum .

• At the 19th century, Louis Xavier Edouard Léopold Ollier is born in Vans, in Ardeche on December 2nd, 1830 and dies in Lyon on November 25th, 1900. His/her father and his grandfather are both doctors. Since 1858, Ollier dedicates its life with the problems of ossification. It is indicated as ostéo-articular surgeon or practitioner the repairing surgery. It follows the example of its professor Amédée Bonnet (death in 1848) and practical the osseous surgery with apparatuses of rectification. These apparatuses guide the bones so that they take the form which it is necessary.

• Until 1860, the term of orthopedist is reserved for the Bandagiste S, manufacturers of Corset S and Sabot S for club-feet.

• the corset righting the spinal column. It treats the scolioses (twisted spinal column) and kyphoses (round back).
• the shoe for club-foot (invertebrate foot) mussel the deformation without correcting it but allows a painless and easier step.
• the bindings immobilize or protect the fragile articulations and reduce luxations.
• Always at the XIXe century, Doctor Pravaz of Lyon, doctor orthopedist obtains thanks to carriages and apparatuses of extension, reductions of the luxation of the hip.
• In 1881, the general surgeon British Arbuthnot Lane recommends a surgical technique for the treatment of the fractures: osteosynthesis. It consists in fixing on the bone of the plates with screws to immobilize it while waiting for that the bone is resoldered.
• In 1890, Gluch develops the first Prothèse intern of the knee. It is out of ivory and functions with a hinge.

20th century

• 1914-1918 : The direction of orthopedy reserved for the child disappears with the war. The surgeons of children, on the battle field, prefer preserving treatments the systematic amputations. Stone-block, surgeon with Berck, create the term of “orthopedic Surgery of war”. It flat applies the receipts of setting articulations of children to war wounded. As always, the war is synonymous with medical and surgical progress.

From now on, even if Ombredanne deplores it, there will be infantile orthopedists (later pediatric) and orthopedists for adults. It is besides in 1918 qu ' is created the Orthopedic French company of Surgery and Traumatologique called SOFCOT (). Founded for the promotion and the development of knowledge in this surgical speciality, the purpose of it is also to relieve and improve the functional state of the patients following a traumatism or an affection of the musculo-skeletal system at all the ages of the life. The SO.F.C.O.T gathers more than 3000 specialized surgeons; its organization is divided into three sectors:

- the Academy of Orthopedy and Traumatology (AOT) directs the scientific activities and organizes the annual convention of the company which in 2007 is with its 82ème edition. With this occasion, for a few years the surgeons members of the SOFCOT have organized free conferences on broad topics of public health and answer the questions of the public.

- the French College of Orthopedic and traumatologic Surgery (CFCOT) whose objectives are teaching and the formation with the speciality for the surgeons. - the National union of the Orthopedic surgeons (SNCO) ensures the defense of the professional interests and implies itself in all that relates to the exercise of the orthopedic surgery

• In 1919, one creates Prothèse S which make it possible to replace a missing member. At the beginning, they are only pieces of wood but they develop with great steps.

the idea to replace an articulation by an internal apparatus is very old but it was really applied to the level of the hip in 1945 by the Judet brothers.

• In 1947, the Judet brothers produce a total prosthesis of acrylic resin hip.
• In 1947, Magnoni D' Intignamo designs a total prosthesis of the knee even more sophisticated than that of the Judet brothers.
• It is in November 1962, following many work on the cemented fixing of the implants in the bone that John Charnley (1911-1982) establishes his first total prosthesis of hip (also called PTH). For the first time, it cements in the cavity of the bone, a cup out of polyethylene in which comes to articulate a steel ball of gauge 22,25 Misters Cela defines “Low Friction Arthoplasty” of John Charnley (also called LFA).

There were 582 establishments carried out with Writington of November 1962 in December 1965 what represents approximately 200 prostheses per annum.

Thirty-six years later, this PTH is always regarded in the world as one of the best PTH. Its longevity is very large. Its success was immediate and its fast development and important. There was approximately 1 million establishments carried out in the world and the copies were numerous also.

• In 1963 is invented the hybrid fixer of Sheffield.

It was conceived like a simple system allowing a maximum immobilization of the bone or articulation.

Of the pins ensures a great stability, even in the articulations. It is besides this characteristic which is at the origin of its use successfully in the articular fractures.

Four pins retained by a ring ensure a very strong stability. They can support very unstable fractures.

the rings are connected between them by threaded rods.

the hybrid fixing kit of Sheffield is composed of reinforced rings and circles able to support to four pins.

• Always in 1963, the Institute of Montreal introduces in Canada a compressed-air prosthesis. The following year, it is the first, in North America, to use and improve the myoelectric prosthesis.

the mandate of this institute is entrusted to Doctor Gustave Gingras. This one was born in Montreal in 1918. It is physiâtre and first specialist in the readjustment at the medical college of Montreal. It creates the Institute of readjustment in 1949 and sets up other centers similar to Morocco, Venezuela and to Vietnam.

• In 1970, C. Neer recommends the patching of glene with a polyethylene implant cemented for the prostheses of the shoulder.

This system makes it possible to solve erosions of glene. There are two motivations: first is to avoid worsening the osseous erosion of glene, second is to facilitate the reorientation and the stabilization of the prosthesis of the shoulder.

the same year, the Guépard group produces a prosthesis with hinges of the knee, very interesting and always used today.

At the time of the last years, the vertebral instrumentations knew an important evolution.

• Dwyer is the first to be proposed in 1969 an instrumentation for the treatment of the scolioses using a cable of compression.

• the recent period was marked by the development of several instrumentations containing stems like the systems of Dunn and Kanéda which treat the vertebral fractures and deformations.
• However, the instrumentation of Dunn was withdrawn from the market because of the internal bleedings which it produced.
• improved version HAFS:
• It answers the principles of stability of the assembly and the deviations of the back. This instrumentation is usable for all the deformations.
• Description of the system:
• system HAFS is composed of two or several titanium or stainless plates aimed on the spinal column.
• Technical of installation:
• the instrumentation starts with the positioning of the plates on the vertebrae of the curve. The stem is installation and is fixed by screws on the plates.
• the principle of the system:
• the stem is “elastic”: it leans to regain its initial right shape and involves with it the spinal column which becomes right in its turn.

Method of exploration in orthopedy:

Orthopedic affections

See too

• Traumatology
• Rhumatologie
• Prosthesis

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