The Basics of Orthopedic Surgery

History
Orthopedic surgery is the field of medicine dealing with injuries to the musculoskeletal system. This includes bones, joints, muscles, tendons, ligaments and nerves. Musculoskeletal symptoms are the second-most common reason that patients seek medical attention. The term "orthopaedic" was first coined by the French physician Nicholas Andry, from the Greek roots "orthos" (straight) and "paideia" (rearing of children). He published the first book on orthopaedics in 1741. Originally, the field of orthopaedics dealt mainly with the straightening of children's joints, such as the treatment of clubfoot, polio or scoliosis. The traditional symbol of orthopaedics is a crooked tree braced against a post to make it grow straight. This reflects the early use of braces to correct deformities. Some of you may remember orthopaedic shoes used for clubfeet. Even now, braces are still used in the treatment of scoliosis. Today, the field has expanded to include sports injuries and arthritis.

Anatomic Definitions
Movements are often named in relation to the anatomic position. In the anatomic position, the body is standing with elbows, knees and fingers straight. The palms are facing forward, the feet are together, and the arms are resting at the side of the body. Most locations or motions can be thought of in pairs.

Anterior/posterior--anterior is towards the front of the body; posterior is towards the back of the body.

Medial/lateral--medial is towards the vertical midline; lateral is away from the vertical midline.

Proximal/distal--proximal is towards the heart; distal is away from the heart.

Flexion/extension--flexion is bending or "flexing" the joint; extension is straightening of the joint.

Abduction/adduction (occurs in the plane of the body)--abduction is moving away from the body; adduction is moving towards the body. Think of the motions doing jumping jacks.

Internal/external rotation--rotation is in reference to a joint (shoulder/hip) in anatomic position; internal rotation is rotation towards the body. It occurs at the shoulder when the hand is brought to the belly or in the hip when the toes turn inwards. External rotation is rotation away from the body.

Pronation/supination of the forearm--pronation is rotating the palms posteriorly; supination is rotating the palms anteriorly.

Pronation/supination of the foot--pronation flattens the arch of the foot; supination elevates the arch.

Ankle dorsiflexion/plantarflexion--dorsiflexion is flexing the ankle away from the ground (e.g. stepping off the gas); plantarflexion is flexing the ankle towards the ground (e.g. stepping on the gas).

Ankle inversion/eversion--ankle inversion is rolling the sole of the foot towards the vertical midline; ankle eversion is rolling the sole of the foot away from the vertical midline.