Surgery for Injury
By our nature, human beings are physically active. Many occupations require physical exertion and an individual’s livelihood often depends upon his (or her) ability to perform with their body. In addition, people often feel the need to be physically active and participate in competitive or non-
All these physical activities puts the individual at risk. Add to this the various modes of transport which now exist, the various forms of domestic and other types of violence which are prevalent, accidental falls and other mishaps; and the stage is set for people to suffer a wide variety of physical injuries.
It is the Orthopaedic surgeon’s concern to treat those injuries which affect the bones, the muscles, and the tendons of the body.
Injuries to the muscles, tendons and ligaments may sometimes be dealt with by simple suture but, if there is extensive tissue loss, or if important ligaments are not functioning, special methods to restore or replace their function are necessary. These specialised techniques required for severe injuries of the soft tissues are considered in the Reconstruction section. The considerations of bone injuries, however, are usually those which concern the Orthopaedic surgeon most.
A broken bone is generally painful to the affected individual and this discomfort will last until the healing process is established. During this period there will, of necessity, be some limitation of the person’s physical ability and this can last for several weeks. Any injury will cause swelling of the involved and surrounding tissues which can then become fibrosed. In addition, disuse of the limb may lead to weakness of the muscles. The combination of these factors –
In moving, different forces, of various magnitudes and directions, act upon the bones to move the limbs. The bones of the body are designed to sustain a certain amount of load and, in order for a fracture (or break) to occur, the bone is subjected to a force greater than it can hold. This is a relative event, as the bones weaken with age. It therefore takes less force to break a bone in an elderly individual than a young person.
Fractures of the bones and dislocations of the joints have, for centuries, been treated by manipulation and external support following the principles of the ‘bone setters’ of the past. These techniques have been refined over time and external support, such as with a cast or splint, is still a very useful way of treating fractures today. Similarly, as a temporary measure or in those areas where the more specialised operative techniques are not available, TRACTION can be a very helpful and effective method of treating many fractures, even many of the more complex injuries.
Nevertheless, over the last 50 to 70 years a whole range of specialised surgical techniques have been devised. These include the use of various wires, screws, specialised plates and intra-
Instrumental in the development of these specialised surgical techniques is the AO Foundation which, in its preamble to the management of injury, states –