Clinical Review

An Overview of the History of Orthopedic Surgery

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Orthopedic surgery has a long and rich history. While the modern term orthopedics was coined in the 1700s, orthopedic principles were beginning to be developed and used during primitive times. The Egyptians continued these practices, and described ways to recognize and manage common orthopedic conditions. The Greeks and Romans subsequently began to study medicine in a systematic manner, and greatly improved our understanding of orthopedic anatomy and surgical technique. After a period of little progress during the Middle Ages, rapid advancement was noted during the Renaissance, including the description of various injuries, improvements in surgical technique, and development of orthopedic hospitals. Collectively, these advances provided the foundation for modern orthopedics. Currently, orthopedic surgery is a rapidly developing field that has benefited from the works of numerous scholars and surgeons. It is important to recognize the successes and failures of the past, in order to advance research and practice as well as improve patient care and clinical outcomes.


 

References

The modern term orthopedics stems from the older word orthopedia, which was the title of a book published in 1741 by Nicholas Andry, a professor of medicine at the University of Paris.1 The term orthopedia is a composite of 2 Greek words: orthos, meaning “straight and free from deformity,” and paidios, meaning “child.” Together, orthopedics literally means straight child, suggesting the importance of pediatric injuries and deformities in the development of this field. Interestingly, Andry’s book also depicted a crooked young tree attached to a straight and strong staff, which has become the universal symbol of orthopedic surgery and underscores the focus on correcting deformities in the young (Figure).1

Figure.
While the history of the term is relatively recent, the practice of orthopedics is an ancient art.

Orthopedic surgery is a rapidly advancing medical field with several recent advances noted within orthopedic subspecialties,2-4 basic science,5 and clinical research.6 It is important to recognize the role of history with regards to innovation and research, especially for young trainees and medical students interested in a particular medical specialty. More specifically, it is important to understand the successes and failures of the past in order to advance research and practice, and ultimately improve patient care and outcomes.

In the recent literature, there is no concise yet comprehensive article focusing on the history of orthopedic surgery. The goal of this review is to provide an overview of the history and development of orthopedic surgery from ancient practices to the modern era.

Ancient Orthopedics

While the evidence is limited, the practice of orthopedics dates back to the primitive man.7 Fossil evidence suggests that the orthopedic pathology of today, such as fractures and traumatic amputations, existed in primitive times.8 The union of fractures in fair alignment has also been observed, which emphasizes the efficacy of nonoperative orthopedics and suggests the early use of splints and rehabilitation practices.8,9 Since procedures such as trepanation and crude amputations occurred during the New Stone Age, it is feasible that sophisticated techniques had also been developed for the treatment of injuries.7-9 However, evidence continues to remain limited.7

Later civilizations also developed creative ways to manage orthopedic injuries. For example, the Shoshone Indians, who were known to exist around 700-2000 BCE, made a splint of fresh rawhide that had been soaked in water.9,10 Similarly, some South Australian tribes made splints of clay, which when dried were as good as plaster of Paris.9 Furthermore, bone-setting or reductions was practiced as a profession in many tribes, underscoring the importance of orthopedic injuries in early civilizations.8,9

Ancient Egypt

The ancient Egyptians seemed to have carried on the practices of splinting. For example, 2 splinted specimens were discovered during the Hearst Egyptian Expedition in 1903.7 More specifically, these specimens included a femur and forearm and dated to approximately 300 BCE.7 Other examples of splints made of bamboo and reed padded with linen have been found on mummies as well.8 Similarly, crutches were also used by this civilization, as depicted on a carving made on an Egyptian tomb in 2830 BCE.8

One of the earliest and most significant documents on medicine was discovered in 1862, known as the Edwin Smith papyrus. This document is thought to have been composed by Imhotep, a prominent Egyptian physician, astrologer, architect, and politician, and it specifically categorizes diseases and treatments. Many scholars recognize this medical document as the oldest surgical textbook.11,12 With regards to orthopedic conditions, this document describes the reduction of a dislocated mandible, signs of spinal or vertebral injuries, description of torticollis, and the treatment of fractures such as clavicle fractures.8 This document also discusses ryt, which refers to the purulent discharge from osteomyelitis.8 The following is an excerpt from this ancient document:9

“Instructions on erring a break in his upper arm…Thou shouldst spread out with his two shoulders in order to stretch apart his upper arm until that break falls into its place. Thou shouldst make for him two splints of linen, and thou shouldst apply for him one of them both on the inside of his arm, and the other of them both on the underside of his arm.”

This account illustrates the methodical and meticulous nature of this textbook, and it highlights some of the essentials of medical practice from diagnosis to medical decision-making to treatment.

There are various other contributions to the field of medicine from the Far East; however, many of these pertain to the fields of plastic surgery and general surgery.9

Greeks and Romans

The Greeks are considered to be the first to systematically employ the scientific approach to medicine.8 In the period between 430 BCE to 330 BCE, the Corpus Hippocrates was compiled, which is a Greek text on medicine. It is named for Hippocrates (460 BCE-370 BCE), the father of medicine, and it contains text that applies specifically to the field of orthopedic surgery. For example, this text discuses shoulder dislocations and describes various reduction maneuvers. Hippocrates had a keen understanding of the principles of traction and countertraction, especially as it pertains to the musculoskeletal system.8 In fact, the Hippocratic method is still used for reducing anterior shoulder dislocations, and its description can be found in several modern orthopedic texts, including recent articles.13 The Corpus Hippocrates also describes the correction of clubfoot deformity, and the treatment of infected open fractures with pitch cerate and wine compresses.8

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