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Orthopaedics: Introduction
Nicolas Andry coined the word from which the English word orthopaedics is derived when he wrote a
book titled L'Orthopedie in 1741. Orthopaedics is derived from the two Greek words Andry chose: orthos,
meaning straight or free from deformity, and pais, meaning child. Since that time orthopaedics has
expanded to include the evaluation and treatment of all musculoskeletal injury and disorders. Until the
later half of the twentieth century, orthopaedics was predominately the nonoperative treatment of
fractures, treatment of musculoskeletal infections (often tuberculosis), and polio. As we enter the twentyfirst century, orthopaedic surgery includes the replacement of degenerated joints, operative fixation of
fractures, arthroscopic repair of torn meniscus, rotator cuffs, and a whole host of other intra-articular
abnormalities. Musculoskeletal research laboratories have found means of stimulating the body to make
new bones and soon cartilage production will be accomplished. Gene therapies for a variety of
musculoskeletal diseases are on the horizon. Orthopaedics is a dynamic field and orthopaedic surgeons
treat both sexes and all ages of patients with a wide variety of skeletal, ligamentous, and muscular
problems. Orthopaedics are involved in the management of a newborn's dislocated hip, a teenager's curved
spine, an athlete's injury knee, a motor vehicle accident victim, an adult's worn-out joint, and an elderly
woman's fracture hip. 15
The musculoskeletal system is a complex biomechanical organ. It is constantly responding to the demands
of the patient. Bone is in constant turnover. It atrophies when not used, and hypertrophies when stressed.
Overall bone mass is increased until some time between 30 and 35 years of age, after which there is an
overall decrease of bone as a consequence of more resorption than production. Bone can heal without
leaving a scar. Articular cartilage is a special material because it has properties that people have not been
able to reproduce. It is a wonderful shock absorber, yet when sliding with another surface of articular
cartilage bathed in normal synovial fluid, the constant of friction is a fraction of that found with ice-on-ice.
Unfortunately, upon reaching adulthood, the ability to generate new articular cartilage ceases and as it
wears out or is injured, it is not replaced. Repair fibrocartilage, metal, and plastic are the materials
currently substituted for articular cartilage. Skeletal muscle accounts for almost 50% of the body's weight
making it the single largest tissue mass in the human body. There is one basic structural unit in muscle
fiber; however, the arrangement of these fibers varies depending on a particular muscle's function. Muscle
fibers are either parallel or oblique with oblique fibers existing in various configurations.
Skeletal Growth and Physiology
The skeletal system is initially formed as cartilage with the exception of the craniofacial bones and
clavicle. These bones do not have a cartilaginous analogue and are formed directly from membranous
tissue. The process of bone formation without an intermediate cartilage form is called intramembranous
bone formation. The majority of an adult's bone is formed by intramembranous bone formation because
diaphyseal bone grows circumferentially by the apposition of bone by the surrounding periosteum without
cartilage being produced. Enchondral ossifications is the formation of bone through the initial formation
of a cartilage model that then becomes bone. The skeletal system is formed in utero as cartilage; however,
prior to birth, some of these prebone structures are well on their way to bone formation. This happens first
in the middle of the diaphysis, known as the primary center of ossification. Later, at the secondary
ossification center, bone will begin to form at the ends of the prebone structures. The secondary center of
ossification has articular cartilage surrounding it on the side facing the joint and epiphyseal cartilage on
the side facing the primary ossification center. The bone grows in length through the epiphyseal growth
plate, which produces cartilage that undergoes enchondral ossification (Fig. 42-1).
