Orthopedic surgery or orthopaedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopaedic surgeons use both surgical and non-surgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumours, and congenital conditions.
Nicholas Andry coined the word “orthopaedics”, derived from Greek words for orthos (“correct”, “straight”) and paideia (“rearing” (usually of child)), in 1741, when at the age of 81 he published Orthopaedia: or the Art of Correcting and Preventing Deformities in Children.
In the US the spelling orthopaedics is standard, although the majority of university and residency programs, and even the AAOS, still use Andry’s spelling. Elsewhere, usage is not uniform; in Canada, both spellings are common; orthopaedics usually prevails in the rest of the Commonwealth, especially in Britain.
In the United States and Canada, orthopaedic surgeons have typically completed 4 years of undergraduate education and 4 years of medical school. Subsequently, orthopaedic surgeons undergo residency training in orthopaedic surgery. The five-year residency consists of one year of general surgery training followed by four years of training in orthopaedic surgery.
Selection for residency training in orthopaedic surgery is extremely competitive–candidates for orthopaedic residencies generally graduate at the top of their medical school classes. Approximately 650 physicians complete orthopaedic residency training per year in the US. About 7 percent of current orthopaedic surgery residents are women; about 20 percent are members of minority groups. There are approximately 20,400 actively practising orthopaedic surgeons and residents in the United States. According to the latest Occupational Outlook Handbook (2006–2007) published by the US Department of Labor, between 3–4% of all practising physicians are orthopaedic surgeons.
Many orthopaedic surgeons elect to do further subspecialty training, or ‘fellowships’, after completing their residency training. Fellowship training in an orthopaedic subspecialty is typically one year in duration (sometimes two) and sometimes has a research component involved with the clinical and operative training. Examples of orthopaedic subspecialty training in the US are:
- Hand surgery
- Shoulder and elbow surgery
- Total joint reconstruction (arthroplasty)
- Pediatric orthopedics
- Foot and ankle surgery
- Spine surgery
- Musculoskeletal oncology
- Surgical sports medicine
- Orthopedic trauma
These speciality areas of medicine are not exclusive to Orthopaedic Surgery. For example, Hand surgery is practised by some plastic surgeons and spine surgery is practised by most neurosurgeons. Additionally, foot and ankle surgery is practised by board certified Doctors of Podiatric Medicine (D.P.M.) in the United States. Some family practice physicians practice sports medicine, however, their scope of practice is non-operative..
After completion of speciality residency/registrar training, an orthopaedic surgeon is then eligible for board certification. Certification by the American Board of Orthopaedic Surgery means that the orthopaedic surgeon has met the specified educational, evaluation, and examination requirements of the Board. The process requires successful completion of a standardized written exam followed by an oral exam focused on the surgeon’s clinical and surgical performance over a 6 month period. In Canada, the certifying organization is the Royal College of Physicians and Surgeons of Canada; in Australia and New Zealand, it is the Royal Australasian College of Surgeons.
In the US, specialists in hand surgery and sports medicine may obtain a Certificate of Added Qualifications (CAQ) in addition to their board certification by successfully completing a separate standardized examination. There is no additional certification process for the other subspecialties.