OCTAVO GRADO: BREVE HISTORIA DE LA ORTOPEDIA

A BRIEF HISTORY OF ORTHOPEDICS

Since the most remote of times human reaction to physical deformities whether congenital, accidental or caused by armed conflicts, has resulted in the invention of instruments and methods that led to corrections, if at least partially, of the lesion in question.

The Greeks, for example, developed complex manual techniques and devised ingenious mechanical instruments to repair broken bones or to replace missing limbs. Apparently, these procedures utilized opium juice, which anesthetic properties are well known today.

The first to utilize the term orthopedia was Nicolas Andry in 1741 when he published a book about prevention and correction of muscle and bone deformities in children. Until the 19^th century, the majorities of orthopedic treatments were of the mechanical type and were based on the use of clamps, casts and bone manipulation. It was possible to correct bone fractures but joint problems did not have a real treatment up to that point.

It was only until the beginning of the 20^th century that work on joints began. In 1908, Eric Lexer performed knee grafts from one person to another. But his initial success waned as the years passed. In spite of the advancement obtained in joint reconstruction, surgeons rarely attempted hip reconstructions. This was due to this joint’s resistance to great stresses that could go up to 5 times the weight of the body itself.

In 1891, German surgeon Theodor Bluck rebuilt a hip using a marble spherical head, fixing it in place with surgical cement. In 1930 Smith Petersen designed nails that could fasten fractured fragments. Later he created suitable metallic prosthesis to substitute the femoral head.

With the arrival of acrylics, plastics and biologically inert materials, the idea of creating an artificial hip was more feasible.  Several orthopedists including John Wiles, tried to replace hip joints. However, obtaining the appropriate materials, the attachment and the design of the prosthesis frustrated attempts to attain a lasting reconstruction. 

The great moment in hip reconstruction history arrived in 1960; John Charnley, an orthopedic surgery advisor in England, came up with a technique called low-friction artroplasty. Such technique consisted of replacing the head of the femur with a rustproof steel prosthesis and in building a high density polyurethane mold to ensure the necessary resistance. The mold, glued with acrylic cement, allowed for an excellent adherence. This technique’s success permitted its application to other important joint sites such as the knee, the ankle and the fingers.

FROM TRADITIONAL SPLINTS TO POLYETHYLENE PADS

Until a few years ago, orthopedists used casts to protect affected areas.  Utilizing casts was inconvenient in different ways: immobilization of the intervened joint, impossibility of a prompt post-operation follow-up and the lack of hygiene. Currently, splints based on polyurethane thermo plastids are used, they are known as walorup .These splints stay in place using to a system of Velcro belts. These splints allow the adaptation to the morphology of the extremity in each patient. In addition, the pad material remained elastic at different temperatures, it did not break apart or caused any irritations or skin allergies. The pads were also resistant to microbes, fats and solvents that could contain damaging pharmacological products.

COMPREHENSION ACTIVITY

1.       Make a timeline that shows the evolution of orthopedia.

2.       Why do you think it is more difficult to make operation on joints than on bones?

3.       Do you that in the future, it will be possible to replace any bone in the body with a synthetic material? Why or why not?

4.       Why does the fact that the hip supports up to five times the weight of the body makes repairing it so difficult?

5.       What is the purpose of putting artificial pieces in the bones?

6.       What are the reasons to prefer using an elastic polyurethane splint as opposed to a fixed cast?

7.       According to the reading, what did the Greeks use opium juice for?

8.       Why does the utilization of rustproof steel and high density polyurethane led to advancements in hip surgeries?

9.       Do you know of any medical techniques that allows diagnosis of an injury in the skeletal system?

10.    Besides, the one at the hip, what other joints exist in your body?