Treatments of deformed joints have already been documented in isolated cases among the Hippocrats . However, the term orthopedics was first coined in 1741 with the widespread work Orthopedics by Nicolas Andry , a Parisian pediatrician. He compared the "orthopedic surgeon" to the gardener who ties a crooked tree to a sturdy post. Since then, this allegory has been the trademark of all orthopedic specialist societies.
Modern orthopedics began around 1816 with Johann Georg Heine in Würzburg and only became today's regular university subject in the 1970s. One of the pioneers of orthopedics in France is the anatomist and physiologist Sauveur Henri Victor Bouvier (1799–1877), who, among other things, performed orthopedic treatments for foundlings and in 1840 opened an orthopedic institute.
One of the pioneers of modern orthopedics was Adolf Lorenz , who dealt with "dry surgery" from around 1880.
In 2005, the orthopedics department was merged with the surgical sub-area / focus on trauma surgery . Training to become a specialist in orthopedics is no longer provided for in the further training regulations of the German Medical Association .
Fields of activity
The “classic” orthopedics developed from the (conservative) treatment of tuberculosis sufferers and war invalids . The pioneers were Konrad Biesalski , Gustav Drehmann and Kurt Lindemann . The operative orthopedics was mainly by surgeons advanced. The “interfaces” between orthopedics and trauma surgery are hand surgery , osteotomies and endoprostheses . Dislocations , torn ligaments , tendon tears , Achilles tendon ruptures and patellar tendon ruptures are everyday tasks in both subjects.
Degeneration affects joints and soft tissues and is of great economic importance. Nobody knows what “wear and tear” actually is and who it affects and why. Therefore, in most cases labeled as idiopathic , the wear and tear diseases should also be genetically determined. Tangible reasons are trauma and dysplasia . Thus, the hip dysplasia , deformities of the legs and periarticular fractures prearthrotic deformities.
Whether osteoarthritis is treated with endoprostheses should primarily depend on the patient's level of suffering. In knee osteoarthritis , omarthroses and coxarthrosis conservative therapy often helps to gain time - and the patient premature risk of serious complications to spare. Corrective osteotomies should always be considered, especially for the coxa valga and genu varum .
Malformations mean deficiency management. The so-called Contergan scandal became a sad challenge for orthopedics. The hand malformations gave operative impulses. Mild forms of proximal femoral defects (coxa vara) can sometimes be dealt with with valgization osteotomies, and in adults with endoprostheses. The imperfecta Osteogenesis can long segment (femur) stabilization with homologous substantia compacta make necessary. Fibular hemimelia , which requires decades of care, is not uncommon .
When predisposition or dwindling muscle strength impair the biomechanics of the foot , the common forefoot deformities develop. Surgical correction of hallux valgus , hallux rigidus and hammer toes has become a specialty of surgeons and orthopedists. Osteotomies, arthroplasties , arthrodesis and (at the metatarsophalangeal joint) endoprostheses are possible. Dislocated little toes can also be lined up in rheumatism sufferers (Stainsby).
Infections can occur in the joints as bacterial arthritis , in the bones as osteomyelitis or in the soft tissues e.g. B. occur as an abscess . In addition to bacterial infections, infections caused by viruses or fungi are very rare in orthopedics. The infections can occur directly through an accident, such as an open fracture , through germ transfer via the bloodstream ("hematogenous") or " iatrogenic " as a complication after surgical interventions or medical measures, which can also include joint punctures.
Despite the declining birth rate and improved child check-ups , pediatric orthopedics has not lost its importance. Aseptic bone necrosis , Perthes disease , patellar dislocation , congenital pseudarthroses , epiphyseal detachment of the femoral head , hip dysplasia , congenital hip dislocation and clubfoot are difficult clinical pictures. Operations and aids must be planned in stages and over the long term.
Due to the diagnosis-related case groups , rehabilitation clinics have gained in economic importance, because the flat-rate endoprosthesis patients only remain in the acute clinic for a few days in order to optimize revenue. However, the lower limit of the length of stay is usually reached.
Paraplegia is an extremely complex rehabilitation area . In Germany, between 1,200 and 1,500 new cases occur every year. Relevant cross-sectional centers are the Berufsgenossenschaftliche Kliniken Bergmannstrost Halle , the Berufsgenossenschaftliche Unfallkrankenhaus Hamburg , the SRH Klinikum Karlsbad-Langensteinbach and the Berufsgenossenschaftliche Unfallklinik Murnau . Hans Jürgen Gerner , Jürgen Harms and Gerhard Exner are pacemakers in paraplegiology.
(Non-purulent) arthritis is a domain of surgical orthopedics and orthopedic hand surgery. The mutilating polyarthritis can be countered with synovialectomies , arthrodesis , arthroplasty and radiosynoviorthesis ; sooner or later, however, endoprostheses will be necessary. They are also possible on the metacarpophalangeal joint (and on the thumb saddle joint ). In all cases, specialist internists and occupational therapists must be mutually agreed. There are only a few operative rheumatism clinics in Germany.
Orthopedics is of great importance in social medicine . Most pension entitlements due to reduced earning capacity are based on disc problems and joint wear. Orthopedic reports are correspondingly important for social courts , pension offices and pension funds .
Systemic skeletal diseases
Osteoporosis and osteomalacia fall within the field of osteology . The rickets plays (in Germany) do not matter much. While individual metastases can sometimes be resected , generalized involvement is a matter of palliative medicine .
War invalids , the disabled and amputees need prostheses . Otto Bock is the world's largest and by far the most important group for orthopedic technology. Orthoses stabilize unstable joints. The Chêneau corset and the Milwaukee corset are still of great importance in the treatment of scoliosis . In Scheuermann's disease , some kyphoses can be intercepted with support corsets on the sternum .
Until February 2015, there was only a chair for technical orthopedics in the Münster University Hospital . The last chair holders were René Baumgartner and Hans-Henning Wetz. Since March 1, 2015, the subject has been integrated into the Clinic for General Orthopedics and Tumor Orthopedics. The Heidelberg University Hospital has a department.
Primary malignant bone tumors are rare and usually amenable to resection in adults . On the other hand, osteosarcoma and Ewing's sarcoma pose difficult decisions for parents and treating physicians in childhood, as extensive amputations may be necessary in individual cases. In such cases it is usually necessary to coordinate the individual therapy concept in interdisciplinary cooperation between orthopedic surgeons, pathologists, pediatricians and orthopedic technicians. The treatment of these rather rare childhood malignancies is therefore usually reserved for specialized centers.
In orthopedics, conservative and operative therapy techniques are also used on the spine.
In children and adolescents, scolioses with a Cobb angle of more than 40 ° can be corrected surgically. The nestors of scoliosis surgery were Paul Randall Harrington , Yves Cotrel , Jean Dubousset, and Michael McMaster . Klaus Zielke dedicated himself to transthoracic scoliosis correction at the French Emile Roux hospital and then built up the clinic of the Wicker group in Bad Wildungen, which is known for scoliosis surgery .
Spondylitis and spinal tuberculosis used to mean years of bed rest, plaster bed treatment, paraplegia and death. The introduction of antibiotics and surgical medicine made them less terrifying, but they have remained delicate diseases. This also applies to high-grade spondylolisthesis , which can be stabilized with a spondylodesis . Friedrich Magerl and Jürgen Harms promoted the stabilization of vertebral fractures and discoligamentary damage to the cervical spine .
The ankylosing spondylitis is a serious rheumatic disease. If the spine is stiff and the patient can only look at the floor, a columnotomy should be considered. Such an osteotomy is also possible on the cervical spine.
Herniated discs are mainly treated conservatively, but depending on the findings, they can also be operated on.
As in other specialist areas, diagnosis consists first of all in a thorough anamnesis and clinical examination . This can be supported or safeguarded by imaging procedures, with x-rays , computed tomography , magnetic resonance imaging and sonography playing an important role in orthopedics . The scintigraphy is especially in bone metabolism disorders, bone tumors and infections used and now increasingly by a SPECT ( single photon emission computed replaced). Often a bone density measurement is used to diagnose and monitor the progress of osteoporosis .
In addition, additional examinations are often required by related specialist areas, especially neurology , endocrinology for bone metabolic disorders, oncology for malignant bone and soft tissue tumors and psychosomatics in (conservative) orthopedics.
- Injections (shoulder, knee)
- Anti-inflammatory drugs , immunosuppressants for rheumatism
- Physical therapy
- physical therapy
- Transcutaneous electrical nerve stimulation
- Warmth (ointments, red light)
Major orthopedic surgeons
- Robert Merle d'Aubigné (1900–1989)
- John Charnley (1911-1982)
- Horst Cotta (1928–2011)
- Hermann Gocht (1869–1938)
- Johann Georg Heine (1771–1838)
- Bernhard Heine (1800–1846)
- Georg Hohmann (1880–1970)
- Gavriil Abramowitsch Ilisarov (1921–1992)
- Theodor Kölliker (1852–1937)
- Fritz Lange (1864–1952)
- Max Lange (1899-1975)
- Adolf Lorenz (1854-1946)
- Zdeněk Matějovský (1930-2014)
- Peter Friedrich Matzen (1909–1986)
- Johann von Mikulicz (1850–1905)
- Heinz Mittelmeier (* 1927)
- Maurice Edmond Müller (1918-2009)
- Ignacio Ponseti (1914-2009)
- Raymond Roy-Camille (1927–1994)
- Heinz Wagner (1929-2001)
- Alfred Nikolaus Witt (1914–1999)
When Emperor Franz Joseph I asked the first orthopedic surgeon in Vienna what "orthopedics" was, Adolf Lorenz replied, "Your Majesty, that is the art of straightening the crooked and walking the lame."
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- Fritz Hefti: Pediatric Orthopedics in Practice , 2 volumes, 2nd edition. Thieme, Stuttgart 2006/2008, ISBN 978-3-540-25600-7 .
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- Adolf Lorenz: I was allowed to help. My life and work. L. Staackmann Verlag, Leipzig 1936; 2nd edition, ibid. 1937 (translation and adaptation of My Life and Work, obtained by Lorenz . Charles Scribner's Sons, New York).
- Medical Association, further training regulations of June 25, 2010 ( Memento of January 21, 2012 in the Internet Archive )
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- P. Hippe, W. Blauth, N. Borisch: The resection of the so-called fibular cord with congenital absence of the fibula . 1992
- Treatment of fibular hemimelia . Jumper
- Ärzteblatt MV ( Memento of the original from August 8, 2014 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF)
- Angela Simon, Malchin
- Clinics for the treatment of in Germany, Austria and Switzerland
- Bergmannstrost Halle ( Memento of the original from August 10, 2014 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice.
- BUK Hamburg
- Rüdiger Döhler: Tasks and social aspects of orthopedics . In: Central Gazette for Social Insurance, Social Assistance and Supply , 39, 1985, pp. 366–368.
- Technical Orthopedics (2007)
- Heidelberg University Orthopedic Clinic
- Yves Cotrel (French WP)
- Jean Dubousset (Springer)
- Michael McMaster (Scottish National Spine Deformity Service)
- MJ McMaster: Congenital deformities of the spine (James IV Lecture, 2001) ( Memento of the original from August 8, 2014 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- Werner Wicker Clinic
- Accidental injuries of the spine and spinal cord (SWRZ) ( Memento of the original from August 10, 2014 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- Hans-Joachim Hehne, Klaus Zielke: The kyphotic deformity in ankylosing spondylitis: Clinic, radiology, therapy . Hippocrates, 1990, ISBN 978-3-7773-0965-1 .
- MJ McMaster, JBJS (1997) ( Memento of the original from September 23, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF)
- V. Köllner, S. Rupp: Psychosomatic Aspects in Orthopedics . Der Orthopäde 41 (2012), doi: 10.1007 / s00132-011-1864-9 , PMID 22349371 , pp. 136-146,
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- Adolf Lorenz: I was allowed to help. My life and work. L. Staackmann Verlag, Leipzig 1936; 2nd edition ibid. 1937, p. 149 f. (Lorenz translated and edited My Life and Work. Charles Scribner's Sons, New York).