What is Orthopaedic Surgery?

This frequent question embodies other implicit questions. Those who ask this question might be asking “what services can an orthopaedic surgeon offer to my benefit?’ or “what are the qualifications of an orthopaedic surgeon and how is an orthopaedic surgeon constrained to practice within his capacities?”. There is yet another, more oblique, question which is “what can an orthopaedic surgeon find out about me which I may not be aware of?”


In attempting a definition the dynamic nature of professional healthcare and orthopaedic surgery needs emphasis.


Originally orthopaedic surgeons had little training, and their skills were evolved empirically. The “fathers” of modern orthopaedic surgery were intellectually impoverished by today’s standards. However, orthopaedic surgery evolved, along with other healthcare specialities, to become highly scientific, and well regulated both by the orthopaedic community and by statutory legislation.


Currently, in developed urban areas, the science of orthopaedic surgery had diverged into numerous sub-specialities and in there is now no such thing as an “orthopaedic surgeon”. Instead there are at least 12 sub-specialities which include spinal surgery, surgery of the hand, the management of peripheral trauma, paediatric orthopaedic surgery, microsurgery and re-implantation surgery, geriatric orthopaedic surgery and more. Naturally, the more distant the orthopaedic surgeon is from urban centres, so the more generalized he would be expected to be and such “general orthopaedic surgeons” can be exceedingly capable and diverse in their skills.


Many of the specialities mentioned can overlap with the fields which have other designations. For example many plastic surgeons are involved in surgery of the hand and neurosurgeons will overlap with orthopaedic surgeons in the management of vertebral pathology. Microsurgery has evolved from a large number of different specialities. The name given to the type of surgeon is probably irrelevant provided that in their ascendency into a super-speciality that individual is appropriately trained. It might matter little whether the individuals with a backgrounds in orthopaedic surgery or neurosurgery, manage vertebral pathology, given that proviso.


The foundation treatment of orthopaedic surgeons is one of the general physician. Orthopaedic surgeons are, first and foremost, “doctors”. Thereafter they would train (ideally) as surgeons in the broad sense with capacities in general surgery and other realms such as plastic surgery or neurosurgery. Only after that would the orthopaedic surgeon begin “post-graduate” training in a super speciality, such as those listed. The period of training a super specialist orthopaedic surgeon may well be 15 or more years.


Therefore the entrance gate to orthopaedic surgery is selection into a medical school. Because the profession has prestige and expectations of high income, competition to enter a medical school has been exceedingly high. One can therefore expect that these individuals are pre-selected for superior capabilities.


Since the attractions of entering healthcare are great, it is to be expected that there would be many “Johnny-come-lately” aspirants. Some of these have not succeeded in gaining admission to formal medical schools or might choose an easier (and cheaper) route. After (sometimes fierce) jostling, these “alternative” practitioners have often succeeded in becoming recognised as “legitimate” health carers. One example is chiropractic and the reader is recommended to explore the origin and evolution of this field.


Another parallel with orthopaedic surgery is the overlap between the super speciality of orthopaedic foot and ankle surgery with podiatry.


The advantage that the orthopaedic surgeon has over other competitors for healthcare is the training as a general physician. The reason why this is a benefit to the patient is to counter the superficial belief that the treatment of a particular region of the body can be done in isolation of the patient as a whole.

That is wrong. Body-wide illnesses can percolate into every system of the body and a sound knowledge of broad-based general medicine is, many would say, imperative. For example pain in the foot might originate from a brain tumour, an autoimmune disease, a cyst in the spinal cord, a parasitic infection and much more.


There are also some curiosities. One might wonder why there has been no attempt by the “parallel” specialities to undertake surgery of the hand. This has happened in surgery of the foot (with the evolution of the podiatrist). Why not the hand?   One reason might be the misconception that the intricacy and the delicacy of the hand are such that it could not be entrusted to anyone other than a fully medically trained super specialist, whereas the foot would be considered a relatively simple arena. This is also fallacious since the complexities and importance of the feet probably exceed that of the hand (or so say those who are trained as super specialists in both hand surgery and foot surgery).