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Acta Orthopaedica et Traumatologica Turcica  is a  peer-reviewed   medical journal  published bi-monthly by the  Turkish Association of Orthopaedics and Traumatology . It is also the official journal of the  Turkish Society of Orthopaedics and Traumatology . The journal is included in the  Science Citation Index Expanded ,  Index Medicus , and  TUBITAK-ULAKBIM .


Acta Orthopaedica et Traumatologica Turcica  was established in 1962 and published semi-annually until 1974 after which publication was quarterly. The journal has been published 6 times a year since 1988. Articles have been peer-reviewed since 1991.


The journal publishes articles pertaining to  diagnostic , treatment, and prevention methods as well as studies in basic sciences related to  orthopedics  and  traumatology . Article types published are:


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Archives of Osteoporosis   is a  peer-reviewed   medical journal  published by  Springer Science+Business Media . [ 1 ]  It was established in 2006 and is an official journal of the  International Osteoporosis Foundation  and the United States'  National Osteoporosis Foundation . [ 1 ]  The journal is published yearly and covers the specificities of regions around the world concerning  epidemiology , including reference values for  bone density  and  bone metabolism , as well as clinical aspects of  osteoporosis  and other bone diseases. The current  co-editors-in-chief  are John Kanis and Felicia Cosman.


The  Australasian Journal of Bone & Joint Medicine  (originally titled the  Australasian Journal of Musculoskeletal Medicine [ 1 ] ) was a periodical presented in the style of a  scientific journal , published by  Elsevier  but established and funded by pharmaceutical company  Merck . Publication began in 2002, [ 1 ]  and the last issue appeared in 2005. [ 2 ] [ 3 ]  According to  The Scientist :


Merck paid an undisclosed sum to Elsevier to produce several volumes of [ Australasian Journal of Bone and Joint Medicine ], a publication that had the look of a peer-reviewed medical journal, but contained only reprinted or summarized articles—most of which presented data favorable to Merck products—that appeared to act solely as marketing tools with no disclosure of company sponsorship. [ 4 ] [ 5 ]


The publication was not included in the  MEDLINE  literature database and did not have its own website. [ 6 ]


In May 2009, Elsevier admitted that a series of similar industry sponsored publications had been produced, and that "high standards for disclosure were not followed in this instance". [ 3 ]  In a formal statement, the CEO of Elsevier's Health Sciences Division, Michael Hansen, admitted that the practice was "unacceptable", and expressed regret for the publications. [ 7 ]  Merck has denied claims that articles within it were  ghost written  by Merck and has stated that the articles were all  reprinted  from  peer-reviewed   medical journals . [ 8 ]


Several medical experts stated that their names were included in the Honorary Editorial Board of the  Australasian Journal of Bone and Joint Medicine  without their knowledge and consent. [ 9 ] [ 10 ]


There were six such "industry-sponsored" publications brought out by Elsevier without proper disclosure of their nature, and which had the superficial appearance of a legitimate independent journal. [ 11 ] [ 12 ]  The six publications involved were:


Bone  is a bimonthly  peer-reviewed   medical journal  covering the study of  bone biology  and mineral  metabolism . It absorbed two journals,  Metabolic Bone Disease and Related Research  and  Mineral and Bone , during its history. It was once the official journal of the  International Bone and Mineral Society  (IBMS), but has been an independently-published journal since 2012.


The journal has its origins in several journals which merged.


Metabolic Bone Disease and Related Research  was established in 1978, with a different  ISSN . [ 1 ] [ 2 ]


According to the IBMS website, two scientific journals,  Bone [ 3 ]  (with the same ISSN as this journal; 1985 onwards) [ 4 ]  and  Bone and Mineral [ 5 ] [ 6 ] [ a ]  merged under the title  Bone , which became the official journal of IBMS, published monthly, until the relationship between the journal and IBMS ended on 31 December 2012. The website notes that  Bone  went on to become a leading journal in the field, "publishing top-notch, peer-reviewed content on both the basic science and clinical sides". [ 3 ]


As of 2024 [update]   Bone  is published by  Elsevier  and the  editor-in-chief  is Peter Ebeling of  Monash University  in  Melbourne , Australia. [ 7 ]


According to the  Journal Citation Reports , the journal had an  impact factor  of 4.147 in 2019. [ 8 ]


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The Bone & Joint Journal , formerly known as  The Journal of Bone & Joint Surgery (British Volume) , is a monthly  peer-reviewed   medical journal  published by The British Editorial Society of Bone & Joint Surgery. [ 1 ]  It is the flagship journal within the society's 'Bone & Joint Publishing' imprint, which also includes  Bone & Joint Research ,  Bone & Joint Open , and  Bone & Joint 360 .


The journal is the official publication of the  British Orthopaedic Association , Canadian Orthopaedic Association, New Zealand Orthopaedic Association and  Australian Orthopaedic Association .


The journal is indexed in  MEDLINE . According to the  Journal Citation Reports , it has a 2022  Impact Factor  of 4.6. [ 2 ]


Bone & Joint Research  (BJR) is an orthopaedic journal covering the whole spectrum of the musculoskeletal sciences, published by The British Editorial Society of Bone & Joint Surgery, a registered charity in the UK (No. 209299). BJR is a gold open access journal and hence articles published in the journal are available online to anyone, free of charge. Articles are published in a continuous publication model, and collated into monthly issues. First published in 2012, BJR is part of the Bone & Joint series of journals, which also includes  Bone & Joint 360  and the flagship journal  The Bone & Joint Journal  (first published in 1948 as  The Journal of Bone & Joint Surgery (British Volume) ). [ 2 ]


According to the  Journal Citation Reports , BJR received achieved a 2022  Impact Factor  Impact Factor of 4.6. [ 3 ]  The journal is also indexed in  MEDLINE .


Cartilage  is a quarterly  peer-reviewed   academic journal  that covers research in the field of  sports medicine , especially the  musculoskeletal  system with particular attention to  cartilage  repair, function, and degeneration. The  editor-in-chief  is Roy D. Altman. It was established in 2010 and is currently published by  SAGE Publications  on behalf of the  International Cartilage Repair Society .


Cartilage  is abstracted and indexed in  Chemical Abstracts  and  Scopus .


The Cleft Palate-Craniofacial Journal  is a monthly  peer-reviewed   medical journal . It was established in 1964 as the  Cleft Palate Journal , obtaining its current title in 1991. [ 1 ]  The journal is published by  SAGE Publishing  on behalf of the  American Cleft Palate-Craniofacial Association . It covers research on the  etiology , prevention,  diagnosis , and treatment of  cleft palate  and other  craniofacial  anomalies. The  editor-in-chief  is Jamie Perry.


The journal is abstracted and indexed in:


According to the  Journal Citation Reports , the journal has a 2019  impact factor  of 1.347. [ 5 ]


Clinical Orthopaedics and Related Research  is a  peer-reviewed   medical journal . It was established in 1953 as  Clinical Orthopaedics  by the Association of Bone and Joint Surgeons as an alternative to the  Journal of Bone and Joint Surgery , which was the only American orthopaedic journal at the time. The journal obtained its current title in 1963 and its mission is to disseminate knowledge about all aspects of  musculoskeletal  research, diagnoses, and treatment. The journal was established by  Anthony F. DePalma , who was also its  editor-in-chief  from 1953 to 1966. [ 1 ] [ 2 ]


In conjunction with  Clinical Orthopaedics and Related Research , the Association of Bone and Joint Surgeons presents three awards annually including the  Nicolas Andry Award . [ 3 ]


EFORT Open Reviews  is a monthly  peer-reviewed   medical journal , which was first published in January 2016. [ 1 ]   EFORT Open Reviews  is the official journal of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) and is published in partnership with Bioscientifica. [ 2 ] [ 3 ]   EFORT Open Reviews  is a gold open access journal and hence articles published in the journal are available online to anyone, free of charge. Full-text content can also be accessed via  PubMed Central . [ 4 ]


The journal is indexed in  PubMed Central , which hosts full-text content of the complete archive.


EAO asbl , operating as the  European Association for Osseointegration  (EAO) is a non-profit organisation founded in  Munich  in 1991  (34 years ago)  ( 1991 )  to serve as an international, interdisciplinary and independent science-based forum for all professionals interested in the art and science of  Osseointegration . [ 1 ]


Its headquarters are in  Ixelles ,  Brussels ,  Belgium . [ 2 ]


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The  European Spine Journal  is a  peer-reviewed   medical journal  dedicated to  orthopedics  as it relates to all aspects of the human  spine . It was established in 1992 and is published eight times per year by  Springer Science+Business Media . It is the official journal of  EuroSpine , the Spine Society of Europe. The  editor-in-chief  is Robert Gunzburg, a spinal surgeon in private practice in  Antwerp ,  Belgium . [ 1 ]  According to the  Journal Citation Reports , the journal has a 2022  impact factor  of 2.8. [ 2 ]


Foot & Ankle Specialist  is a bimonthly  peer-reviewed   medical journal  that covers the field of  orthopedics . The  editors-in-chief  are Gregory C. Berlet and Lowell Weil, Jr. ( Weil Foot & Ankle Institute ). It was established in 2008 and is currently published by  SAGE Publications .


Foot & Ankle Specialist  is abstracted and indexed in  PubMed ,  Medline ,  EMBASE , and  Scopus .


Geriatric Orthopaedic Surgery & Rehabilitation  is a bimonthly  peer-reviewed   medical journal  that covers the field of  Orthopedics . The journal's  editor-in-chief  is Stephen L. Kates ( University of Rochester Medical Center ). It has been in publication since 2010 and is currently published by  SAGE Publications .


The  HSS Journal , the Musculoskeletal Journal of Hospital for Special Surgery  is a  peer-reviewed   medical journal  published by  Springer Science+Business Media . It covers  musculoskeletal  diseases and  orthopedic surgery . The journal offers free  continuing medical education  articles without registration. [ 1 ]  The  editor in chief  is Charles N. Cornell ( Weill Cornell Medical College of Cornell University ).


The Journal of Bone and Joint Surgery  is a biweekly  peer reviewed   medical journal  in the field of  orthopedic surgery . It is published by the non-profit corporation The Journal of Bone and Joint Surgery, Inc. It was established as the  Transactions of the American Orthopedic Association  in 1889, published by the  American Orthopedic Association . In 1903, volume 16 of the  Transactions  became the first volume of the  American Journal of Orthopedic Surgery , which was renamed  Journal of Orthopaedic Surgery  in 1919 and also became the official journal of the  British Orthopaedic Association . The journal obtained its current name in 1921.  As of 2016, it had a  Journal Citation Reports  impact factor of 4.8 and ranking of 10/197 (surgery), 2/76 (orthopedics). [ 1 ]


The journal became the organ of the newly founded  American Academy of Orthopaedic Surgeons  in 1933. A British volume was established in 1948, using the name under license from the American volume. In 1954, the American journal incorporated itself as a non-profit organization. The British volume was published by The British Editorial Society of Bone and Joint Surgery, a registered charity in the United Kingdom. The American and British volumes were completely independent of each other, and had completely different content. The British volume was renamed  The Bone & Joint Journal  in 2013.


The journal is the official scientific journal of the American Academy of Orthopaedic Surgeons and is affiliated with the  American Orthopaedic Association ,  Eastern Orthopaedic Association ,  Mid-America Orthopaedic Association , and the  Western Orthopaedic Association . [ 2 ]
 The Journal of Bone and Joint Surgery, British volume  (now titled  The Bone and Joint Journal ) was the official journal of the  Australian Orthopaedic Association ,  British Orthopaedic Association ,  British Orthopaedic Research Society ,  Canadian Orthopaedic Association ,  Canadian Orthopaedic Research Society ,  European Federation of National Associations of Orthopaedics and Traumatology ,  European Orthopaedic Research Society ,  Irish Orthopaedic Association ,  New Zealand Orthopaedic Association , and the  South African Orthopaedic Association . [ 3 ]


The  Journal of Cachexia, Sarcopenia and Muscle  is a quarterly  peer-reviewed   medical journal  that covers research relevant to changes in  body composition , especially  cachexia  and  sarcopenia , as consequences of chronic illnesses or of the aging process, respectively. It was established in 2010 and was originally published by  Springer Science+Business Media . As of January 2015, the journal is published by  Wiley-Blackwell  in association with the  Society on Sarcopenia, Cachexia and Wasting Disorders . The founding  editors-in-chief  are  Stefan D. Anker  ( Charité - Universitätsmedizin Berlin ) and  Stephan von Haehling  ( University of Göttingen ). As of November 2016, the journal has two daughter journals entitled  JCSM - Clinical Reports  and  JCSM - Rapid Communications , dedicated to clinical and basic science, respectively.


The journal is abstracted and indexed in  Embase , [ 1 ]   Science Citation Index Expanded , [ 2 ]  and  Scopus . [ 3 ]  According to the  Journal Citation Reports , the journal has a 2017  impact factor  of 12.511. [ 4 ]


The  Journal of Children's Orthopaedics  is a bimonthly  peer-reviewed   medical journal , which was first published in March 2007. It is the official journal of the European Paediatric Orthopaedic Society (EPOS). The  Journal of Children's Orthopaedics  is a gold open access journal and hence articles published in the journal are available online to anyone, free of charge. Full-text content can also be accessed via  PubMed Central . [ 1 ]


The journal is indexed in  Scopus , the  Emerging Sources Citation Index  (via  Web of Science ) and also  PubMed Central , which hosts full-text content of the complete archive.


According to the  Journal Citation Reports , it has a 2019  impact factor  of 1.075. [ 2 ]


The  Journal of Musculoskeletal Research  is a quarterly  peer-reviewed   medical journal  covering clinical and basic research in the  human musculoskeletal system . It was established in 1997 and is published by  World Scientific . The journal covers musculoskeletal disorders,  orthopedics ,  neurology ,  rheumatology , and rehabilitation. The  editors-in-chief  are  Po-Quang Chen ( National Taiwan University Hospital  ) and Li-Shan Chou ( University of Oregon ).


The  Journal of Orthopaedic & Sports Physical Therapy  is a  peer-reviewed   medical journal  covering research about musculoskeletal rehabilitation,  orthopaedics ,  physical therapy , and  sports medicine . It was established in 1979, following the founding of the Orthopedic and Sports Medicine sections of the  American Physical Therapy Association  and resulted from a  merger of the  Bulletin of the Orthopaedic Section  and the  Bulletin of the Sports Medicine Section . Initially published quarterly, the journal is now monthly. It is abstracted and indexed by  PubMed / MEDLINE  and  CINAHL .


The  Journal of Orthopaedic Research  is a  peer-reviewed   medical journal  of  orthopaedics  published by  Wiley-Liss  on behalf of the  Orthopaedic Research Society . It was established in 1983 and the  editor-in-chief  is Dr. Edward M. Schwarz, Ph.D.( University of Rochester ). According to the  Journal Citation Reports , the journal has a 2022  impact factor  of 2.8, ranking it 27th out of 86 journals in the category "Orthopedics". [ 1 ]


The  Journal of Orthopaedic Science  ( ISSN   0949-2658  (print version);  ISSN   1436-2023  (electronic version)), based out of  Tokyo ,  Japan , and published by  Springer Science+Business Media , is the official journal of the  Japanese Orthopaedic Association .  The journal focuses primarily on research and topical debates impacting areas of clinical and experiential orthopedics, but often branches out to other areas of research that directly or indirectly impact orthopedics research.  The format of the journal includes original articles of research, instructional reviews, lectures, and editorials.


Founded in 1926, the Japanese Orthopaedic Association (JOA) is an organization that primarily promotes research, partnerships, and the dissemination of information regarding orthopedics science to the public.  JOA currently has over 19,000 members worldwide.  The association itself conducts studies, holds an annual meeting full of presentations and lectures, as well as coordinates research among several organizations across the globe.


The  Journal of Orthopaedic Surgery and Research  is a  peer-reviewed   open access   medical journal  covering  orthopedic surgery  and the general study of the  musculoskeletal system . It was established in 2006 and is published by  BioMed Central . The  editor-in-chief  is Nicola Maffulli ( Queen Mary University of London ). According to the  Journal Citation Reports , the journal has a 2018/2019  impact factor  of 1.907. [ 1 ]


The  Journal of Orthopaedic Trauma  is a monthly,  peer-reviewed ,  orthopaedic journal  published by  Lippincott Williams & Wilkins . It was established in 1987. The  editor in chief  is Roy W. Sanders. [ 1 ] [ 2 ]


This journal is the official publication of the  Orthopaedic Trauma Association ,  International Society for Fracture Repair ,  Belgian Orthopaedic Trauma Association ,  Japan Fracture Society , and the  Canadian Orthopaedic Trauma Society . [ 3 ]


Topical coverage includes  hard  and  soft tissue   trauma , pertaining to the following types of injuries: ligament, bone, muscle, spinal cord, and tendons. Diagnoses and management of these injuries is also covered. Furthermore, methods and tools are covered such as advancements in surgical instruments, effective diagnostics, and advancements in surgical procedures. Prostheses and implants are also covered by this journal, as well as  bioplastics  and biometals, physical therapy, and rehabilitation. [ 3 ]


The journal is abstracted and indexed in the following databases: [ 2 ] [ 4 ]


The  Journal of Shoulder and Elbow Surgery  is a  peer-reviewed   medical journal  covering  orthopedic surgery  related to the shoulder, elbow, and upper extremities. It is the official journal of multiple shoulder and elbow societies, including the  American Shoulder and Elbow Surgeons , the  European Society for Surgery of Shoulder and Elbow , the  Japan Shoulder Society , the  Shoulder and Elbow Society of Australia , the  South American Shoulder and Elbow Society , the  South African Shoulder and Elbow Surgeons , the  Asian Shoulder Association , the  Korean Shoulder and Elbow Society , the  International Congress of Shoulder and Elbow Surgery , and the  American Society of Shoulder and Elbow Therapists .


The journal was established in January 1991, with  Mosby , now an imprint of  Elsevier , as the publisher. The founding  editor-in-chief  was Robert Cofield ( Mayo Clinic ). In 1997, Robert Neviaser ( George Washington University Medical Center ) took over as editor-in-chief. In 2008,  Bill Mallon  (Triangle Orthopaedic Associates,  Durham, North Carolina ) was named as the third editor-in-chief. [ 1 ]  John E (Jed) Kuhn was named as the fourth editor-in-chief in 2025.  Originally the journal was published bimonthly. In 2010, it began publishing 8 issues per year, increased in 2012 to monthly.


The journal is abstracted and indexed in  PubMed ,  MEDLINE ,  EMBASE , and  Scopus . According to the  Journal Citation Reports , the journal has a 2014  impact factor  of 2.289, ranking it 18th out of 72 journals in the category "Orthopedics", [ 2 ]  17th out of 81 journals in the category "Sport Science", [ 3 ]  and 60th out of 198 journals in the category "Surgery". [ 4 ]


The  Journal of the American Podiatric Medical Association  is a bimonthly  peer-reviewed   academic journal  covering  podiatry , including foot and ankle surgery,  biomechanics , and  dermatology . It was established in 1907 and is the official journal of the  American Podiatric Medical Association . The  editor-in-chief  is Warren R. Joseph.


According to the  Journal Citation Reports , the journal has a 2013  impact factor  of 0.574. [ 3 ]


The  Knee Surgery, Sports Traumatology, Arthroscopy  is a monthly  peer-reviewed   medical journal  published in English covering  orthopaedic surgery , especially related to sports trauma and surgeries, in particular  arthroscopies  and knee surgery.


The journal is the official journal of the  European Society of Sports Traumatology, Knee Surgery and Arthroscopy  . It was established in 1992 with Ejnar Eriksson as founding  editor-in-chief  for the first 16 years. He was succeeded by Jon Karlsson ( Gothenburg University ) and René Verdonk ( Ghent University ) in 2008. In 2012, Verdonk became Senior Editor and Jon Karlsson the sole editor-in-chief. While the journal was originally published as three relatively thin issues in 1993, its publication frequency increased gradually to the current 12 issues per year with about 300 pages per issue. [ 1 ]


According to the  Journal Citation Reports , the journal has a 2014  impact factor  of 3.053, ranking it 7th out of 72 journals in the category "Orthopaedics", [ 2 ]  9th out of 81 journals in the category "Sport Sciences", [ 3 ]  and 31st out of 198 journals in the category "Surgery". [ 4 ]


Neuromuscular Disorders  is a  peer-reviewed   medical journal  that focuses on  neuromuscular disease , including  muscular dystrophy ,  spinal muscular atrophy , and  myasthenia . It is the official journal of the  World Muscle Society . It was established in 1991 and is published by  Elsevier .


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Orthopedics  is a monthly  peer-reviewed   medical journal  covering adult and pediatric  orthopedic surgery  and treatment. It was established in 1978 and is published by Slack.


The journal was established as a bimonthly journal in 1978 with H. Andrew Wissinger as founding  editor-in-chief . [ 1 ]  The current editor-in-chief is Robert D'Ambrosia. [ 2 ]


According to the  Journal Citation Reports , the journal has a 2017  impact factor  of 1.463. [ 8 ]


Osteoarthritis and Cartilage  is  monthly  peer-reviewed   medical journal  covering research in  orthopedics  and  rheumatology . It is an official journal of the  Osteoarthritis Research Society International , published on their behalf by  Elsevier .


Scoliosis and Spinal Disorders  ( ISSN   2397-1789 ) is an international, multidisciplinary  open-access ,  peer-reviewed , online-only  medical journal  addressing all  spine  conditions. The journal encompasses all aspects of research on prevention, diagnosis, treatment, outcomes and cost-analyses of conservative and surgical management of all spinal deformities, disorders and conditions (e.g.  low back pain ,  degenerative disc disease ,  trauma , etc.). Both clinical and basic science reports form the cornerstone of the journal in its endeavor to provide original, primary studies as well as narrative/systematic reviews and meta-analyses to the academic community and beyond. The journal aims to provide an integrated and balanced view of spine research to further enhance effective collaboration among clinical spine specialists and scientists, and to ultimately improve patient outcomes based on an evidence-based spine care approach.  [ 1 ]


Published by  BioMed Central ,  Scoliosis and Spinal Disorders  is the official journal of the  Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT)  and is also affiliated with the  International Research Society of Spinal Deformities (IRSSD) ,  Hellenic Spine Society (HSS) ,  Italian Scoliosis and Spine Study Group (GSS) ,  Italian Physiotherapist Association (AIFI) ,  Study in Multidisciplinary Pain Research (SIMPAR) ,  Chinese Orthopaedic Research Society (CORS) , and the  International Spine and Pain Consortium (ISPC) . [ 1 ]


The journal was initially started in 2006 and was called "Scoliosis". [ 2 ]  In 2016, the journal changed its name to  Scoliosis and Spinal Disorders , and extended its scope to include all spine-related issues and themes. The journal is currently indexed in  PubMed ,  Scopus  and dozens of other search engines. Its editorial board is composed of spine experts located throughout the globe. [ 3 ]


As of 2016, the Editors-in-Chief are  Theodoros B. Grivas  from the Department of Traumatology and Orthopaedics at Tzaneio General Hospital in Piraeus,  Greece  and  Dino Samartzis  from the Department of Orthopaedics and Traumatology,  The University of Hong Kong  in  Hong Kong .


Skeletal Radiology  is a  peer-reviewed   medical journal  published by  Springer Science+Business Media , covering disorders of the  musculoskeletal system , including the  spine . It is the official journal of  The International Skeletal Society . [ 1 ]


The journal is abstracted and indexed in  Current Contents /Clinical Medicine,  EMBASE ,  PASCAL ,  PubMed / Medline ,  Science Citation Index , and  Scopus . [ 2 ]  According to the  Journal Citation Reports , the journal has a 2016  impact factor  of 1.737. [ 3 ]


Spine  is a biweekly  peer-reviewed   medical journal  covering research in the field of  orthopaedics , especially concerning the  spine . It was established in 1976 and is published by   Lippincott Williams & Wilkins . The current  editor-in-chief  is Andrew J. Schoenfeld, M.D.. Spine is considered the leading orthopaedic journal covering cutting-edge spine research. Spine is available in print and online. Spine is considered the most cited journal in orthopaedics. [ 1 ]


The following societies are affiliated with  Spine : [ 2 ]


The Spine Journal  is a  peer-reviewed   medical journal  covering research related to the  spine . It is the official journal of the  North American Spine Society . The journal was established in 2001 and is published by  Elsevier .


According to the  Journal Citation Reports ,  The Spine Journal  has a 2020  impact factor  of 4.166. [ 1 ]


Sports Health : A Multidisciplinary Approach  is a bimonthly  peer-reviewed   medical journal  that covers research in the field of  sports medicine . Its  editor-in-chief  is  Edward M. Wojtys  ( University of Michigan ). The journal was established in 2009 and is currently published by  SAGE Publications  in association with the  American Orthopedic Society for Sports Medicine .


Sports Health  is abstracted and indexed in  CAB International ,  SafetyLit , and  Scopus .


Orthopedic surgery  or  orthopedics  ( alternative spelling   orthopaedics ) is the branch of  surgery  concerned with conditions involving the  musculoskeletal system . [ 1 ]  Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal  trauma ,  spine diseases ,  sports injuries ,  degenerative diseases , infections,  tumors , and  congenital disorders .


Nicholas Andry  coined the word in French as  orthopédie , derived from the  Ancient Greek  words  ὀρθός   orthos  ("correct", "straight") and  παιδίον   paidion  ("child"), and published  Orthopedie  (translated as  Orthopædia: Or the Art of Correcting and Preventing Deformities in Children [ 2 ] ) in 1741. The word was  assimilated  into English as  orthopædics ; the  ligature   æ  was common in that era for  ae  in Greek- and Latin-based words. As the name implies, the discipline was initially developed with attention to children, but the correction of spinal and bone deformities in all stages of life eventually became the cornerstone of orthopedic practice. [ citation needed ]


As with many words derived with the  "æ" ligature , simplification to either "ae" or just "e" is common, especially in North America. In the US, the majority of college, university, and residency programmes, and even the  American Academy of Orthopaedic Surgeons , still use the spelling with the digraph  ae , though hospitals usually use the shortened form. Elsewhere, usage is not uniform; in Canada, both spellings are acceptable; "orthopaedics" is the normal spelling in the UK in line with other fields which retain "ae". [ citation needed ]


Many developments in orthopedic surgery have resulted from experiences during wartime. [ 3 ]  On the battlefields of the  Middle Ages , the injured were treated with bandages soaked in horses' blood, which dried to form a stiff, if unsanitary, splint. [ citation needed ]


Originally, the term orthopedics meant the correcting of musculoskeletal deformities in children. [ 4 ]   Nicolas Andry , a professor of medicine at the  University of Paris , coined the term in the first textbook written on the subject in 1741. He advocated the use of exercise, manipulation, and splinting to treat deformities in children. His book was directed towards parents, and while some topics would be familiar to orthopedists today, it also included 'excessive sweating of the palms' and freckles. [ 5 ]


Jean-André Venel  established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. He developed the club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine. [ citation needed ]


Advances made in surgical technique during the 18th century, such as  John Hunter 's research on  tendon  healing and  Percival Pott 's work on  spinal deformity  steadily increased the range of new methods available for effective treatment.  Robert Chessher , a pioneering British orthopedist, invented the double-inclined plane, used to treat lower-body bone fractures, in 1790. [ 6 ]   Antonius Mathijsen , a Dutch military surgeon, invented the  plaster of Paris   cast  in 1851. Until the 1890s, though, orthopedics was still a study limited to the correction of deformity in children. One of the first surgical procedures developed was percutaneous tenotomy. This involved cutting a tendon, originally the Achilles tendon, to help treat deformities alongside bracing and exercises. In the late 1800s and first decades of the 1900s, significant controversy arose about whether orthopedics should include surgical procedures at all. [ citation needed ]


Examples of people who aided the development of modern orthopedic surgery were  Hugh Owen Thomas , a surgeon from  Wales , and his nephew,  Robert Jones . [ 7 ]  Thomas became interested in orthopedics and  bone-setting  at a young age, and after establishing his own practice, went on to expand the field into the general treatment of fracture and other musculoskeletal problems. He advocated enforced rest as the best remedy for  fractures  and  tuberculosis , and created the so-called "Thomas splint" to stabilize a fractured femur and prevent infection. He is also responsible for numerous other medical innovations that all carry his name: Thomas's collar to treat tuberculosis of the cervical spine, Thomas's maneuvere, an orthopedic investigation for fracture of the hip joint, the  Thomas test , a method of detecting hip deformity by having the patient lying flat in bed, and Thomas's wrench for reducing fractures, as well as an  osteoclast  to break and reset bones. [ citation needed ]


Thomas's work was not fully appreciated in his own lifetime. Only during the  First World War  did his techniques come to be used for injured soldiers on the  battlefield . His nephew, Sir Robert Jones, had already made great advances in orthopedics in his position as surgeon-superintendent for the construction of the  Manchester Ship Canal  in 1888. He was responsible for the injured among the 20,000 workers, and he organized the first comprehensive accident service in the world, dividing the 36-mile site into three sections, and establishing a hospital and a string of first-aid posts in each section. He had the medical personnel trained in fracture management. [ 8 ]  He personally managed 3,000 cases and performed 300 operations in his own hospital. This position enabled him to learn new techniques and improve the standard of fracture management. Physicians from around the world came to Jones' clinic to learn his techniques. Along with Alfred Tubby, Jones founded the British Orthopedic Society in 1894.


During the First World War, Jones served as a  Territorial Army  surgeon. He observed that treatment of fractures both, at the front and in hospitals at home, was inadequate, and his efforts led to the introduction of military orthopedic hospitals. He was appointed Inspector of Military Orthopedics, with responsibility for 30,000 beds. The hospital in Ducane Road,  Hammersmith , became the model for both British and American military orthopedic hospitals. His advocacy of the use of  Thomas splint  for the initial treatment of  femoral  fractures reduced mortality of open fractures of the femur from 87% to less than 8% in the period from 1916 to 1918. [ 9 ]


The use of  intramedullary rods  to treat fractures of the femur and  tibia  was pioneered by  Gerhard Küntscher  of Germany. This made a noticeable difference to the speed of recovery of injured German soldiers during  World War II  and led to more widespread adoption of intramedullary fixation of fractures in the rest of the world.  Traction  was the standard method of treating thigh bone fractures until the late 1970s, though, when the  Harborview Medical Center  group in Seattle popularized intramedullary fixation without opening up the fracture.


The modern total  hip replacement  was pioneered by Sir  John Charnley , expert in  tribology  at  Wrightington Hospital , in England in the 1960s. [ 10 ]  He found that joint surfaces could be replaced by implants cemented to the bone. His design consisted of a  stainless steel , one-piece femoral stem and head, and a  polyethylene  acetabular component, both of which were fixed to the bone using  PMMA  (acrylic)  bone cement . For over two decades, the Charnley low-friction arthroplasty and its derivative designs were the most-used systems in the world. This formed the basis for all modern hip implants.


The  Exeter  hip replacement system (with a slightly different stem geometry) was developed at the same time. Since Charnley, improvements have been continuous in the design and technique of  joint replacement  (arthroplasty) with many contributors, including W. H. Harris, the son of R. I. Harris, whose team at Harvard pioneered uncemented arthroplasty techniques with the bone bonding directly to the implant.


Knee replacements, using similar technology, were started by McIntosh in  rheumatoid arthritis  patients and later by Gunston and Marmor for  osteoarthritis  in the 1970s, developed by  John Insall  in New York using a fixed bearing system, and by Frederick Buechel and Michael Pappas using a mobile bearing system. [ 11 ]


External fixation of fractures was refined by American surgeons during the  Vietnam War , but a major contribution was made by  Gavril Abramovich Ilizarov  in the  USSR . He was sent, without much orthopedic training, to look after injured Russian soldiers in  Siberia  in the 1950s. With no equipment, he was confronted with crippling conditions of unhealed, infected, and misaligned fractures. With the help of the local bicycle shop, he devised ring external  fixators  tensioned like the spokes of a bicycle. With this equipment, he achieved healing, realignment, and  lengthening  to a degree unheard of elsewhere. His  Ilizarov apparatus  is still used today as one of the distraction osteogenesis methods. [ 12 ]


Modern orthopedic surgery and musculoskeletal research have sought to make surgery less invasive and to make implanted components better and more durable. On the other hand, since the emergence of the opioid epidemic, orthopedic surgeons have been identified as one of the highest prescribers of opioid medications. [ 13 ] [ 14 ]  Decreasing prescription of opioids while still providing adequate pain control is a development in orthopedic surgery. [ 14 ] [ 15 ] [ 16 ]


In the United States, orthopedic surgeons have typically completed four years of undergraduate education and four years of medical school and earned either a  Doctor of Medicine  (MD) or  Doctor of Osteopathic Medicine  (DO) degree. Subsequently, these medical school graduates undergo  residency  training in orthopedic surgery. The five-year residency is a categorical orthopedic surgery training.


Selection for residency training in orthopedic surgery is very competitive. Roughly 700 physicians complete orthopedic residency training per year in the United States. About 10% of current orthopedic surgery residents are women; about 20% are members of minority groups. Around 20,400 actively practicing orthopedic surgeons and residents are in the United States. [ 17 ]  According to the latest Occupational Outlook Handbook (2011–2012) published by the  United States Department of Labor , 3–4% of all practicing physicians are orthopedic surgeons.


Many orthopedic surgeons elect to do further training, or fellowships, after completing their residency training. Fellowship training in an orthopedic sub-specialty is typically one year in duration (sometimes two) and sometimes has a research component involved with the clinical and operative training. Examples of orthopedic subspecialty training in the United States are:


These specialized areas of medicine are not exclusive to orthopedic surgery. For example,  hand surgery  is practiced by some  plastic surgeons , and spine surgery is practiced by most  neurosurgeons . Additionally,   foot and ankle surgery  is also practiced by doctors of  podiatric medicine  (DPM) in the United States. Some  family practice  physicians practice  sports medicine , but their scope of practice is nonoperative.


After completion of specialty residency or  registrar  training, an orthopedic surgeon is then eligible for board certification by the  American Board of Medical Specialties  or the  American Osteopathic Association Bureau of Osteopathic Specialists . Certification by the American Board of Orthopedic Surgery or the  American Osteopathic Board of Orthopedic Surgery  means that the orthopedic surgeon has met the specified educational, evaluation, and examination requirements of the board. [ 18 ] [ 19 ]  The process requires successful completion of a standardized written examination followed by an oral examination 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 United States, specialists in hand surgery and orthopedic sports medicine may obtain a certificate of added qualifications  in addition to their board primary certification by successfully completing a separate standardized examination. No additional certification process exists for the other subspecialties.


According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopedic surgeons are: [ 20 ]


A typical schedule for a practicing orthopedic surgeon involves 50–55 hours of work per week divided among clinic, surgery, various administrative duties, and possibly teaching and/or research if in an academic setting. According to the  American Association of Medical Colleges  in 2021, the average work week of an orthopedic surgeon was 57 hours. [ 21 ] [ 22 ]  This is a very low estimation however, as research derived from a 2013 survey of orthopedic surgeons who self identified as "highly successful" due to their prominent positions in the field indicated average work weeks of 70 hours or more. [ 23 ] [ 21 ]


The use of arthroscopic techniques has been particularly important for injured patients.  Arthroscopy  was pioneered in the early 1950s by  Masaki Watanabe  of Japan to perform minimally invasive cartilage surgery and reconstructions of torn ligaments. Arthroscopy allows patients to recover from the surgery in a matter of days, rather than the weeks to months required by conventional, "open" surgery; it is a very popular technique. Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today, and is often combined with meniscectomy or chondroplasty. The majority of upper-extremity outpatient orthopedic procedures are now performed arthroscopically. [ 24 ]


Arthroplasty is an orthopedic surgery where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by  osteotomy  or some other procedure. [ 25 ]  It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis ( rheumasurgery ) or some other type of trauma. [ 25 ]  As well as the standard total knee replacement surgery, the unicompartmental knee replacement, in which only one weight-bearing surface of an arthritic knee is replaced, may be performed, [ 25 ]  but it bears a significant risk of revision surgery. [ 26 ]  Joint replacements are used for other joints, most commonly the  hip [ 27 ]  or  shoulder . [ 28 ]


A post-surgical concern with joint replacements is wear of the bearing surfaces of components. [ 29 ]  This can lead to damage to the surrounding bone and contribute to eventual failure of the implant. [ 29 ]  The plastic chosen is usually ultra-high-molecular-weight  polyethylene , which can also be altered in ways that may improve wear characteristics. [ 29 ]  The risk of revision surgery has also been shown to be associated with surgeon volume. [ 28 ] [ 30 ]


Between 2001 and 2016, the prevalence of musculoskeletal procedures drastically increased in the U.S, from 17.9% to 24.2% of all operating-room (OR) procedures performed during hospital stays. [ 31 ]


In a study of hospitalizations in the United States in 2012, spine and joint procedures were common among all age groups except infants. Spinal fusion was one of the five most common OR procedures performed in every age group except infants younger than 1 year and adults 85 years and older. Laminectomy was common among adults aged 18–84 years. Knee arthroplasty and hip replacement were in the top five OR procedures for adults aged 45 years and older. [ 32 ]


Artificial ligaments  are devices used to replace damaged  ligaments . Today, the most common use of artificial ligaments is in  anterior cruciate ligament reconstruction . [ 1 ]  Although  autotransplantation  remains the most common method of ligament reconstruction, numerous materials and structures were developed to optimize the artificial ligament since its creation in the  World War I  era. [ 2 ]  Many modern artificial ligaments are made of synthetic polymers, such as  polyethylene terephthalate . [ 3 ]  Various coatings have been added to improve the biocompatibility of the synthetic polymers. [ 3 ]  Early artificial ligaments developed in the 1980s were ineffective due to material deterioration. [ 4 ]  Currently, the Ligament Advanced Reinforcement System (LARS) artificial ligament has been utilized extensively in clinical applications. [ 5 ]   Tissue engineering  is a growing area of research which aims to regenerate and restore ligament function. [ 2 ]


Artificial ligament research began in the  World War I  era. [ 2 ]  In the first documented case of an artificial ligament in 1914, Dr. Corner utilized a piece of silver filament as synthetic graft to reconstruct a ruptured  anterior cruciate ligament  ( ACL ). [ 2 ]  A ligament made of silk was used to replace an ACL in 1918. [ 2 ]


In the early 1980s, technological progress in chemistry and materials science promoted the development of medically suitable materials. Doctors utilized these synthetic materials in clinical applications. The  Food and Drug Administration  (FDA) approved an artificial ligament made of  Gore-Tex  for use in ACL reconstruction in 1986. [ 6 ]


The design of artificial ligaments in the 1980s consisted of two major parts: a relatively stiff cable or tape, and silicone rubber cylinders on one or both ends. [ 2 ]  The cable or tape was usually made of  polyethylene ,  nylon  or  carbon fiber . The  silicone rubber  cylinder varied in size to fit different sized patients. [ 2 ] [ 7 ] [ 1 ]  Theoretically, the flexibility of the  silicone rubber  would allow some deformation under relatively low loads, and the artificial ligament would stiffen to maintain its shape under higher loads. [ 7 ] [ 1 ]  Practically, this design never achieved its goal to mimic the property of a natural ligament. [ 8 ]  The mechanical performance of the artificial ligaments was inadequate for widespread clinical application. In the long term, performance loss, complications, and failure occurred. [ 8 ]


Material deterioration contributed to the ineffectiveness of early artificial ligaments. [ 4 ]  Issues would occur in the months and years following treatment. [ 2 ] [ 4 ]  J.E. Paulos indicated in a report about  Gore-Tex  usage in  ACL  reconstruction: "Early results of the  Gore-Tex  prosthesis used for  ACL  reconstruction showed low rates of failure. Unfortunately, with extended follow-up, our rate of complications continues to increase. Mechanical failure, effusions, and infections continue to occur". [ 2 ]  At the time, the materials used in artificial ligaments could not sustain adequate mechanical performance. [ 2 ] [ 4 ]  For many of these materials, their mechanical performance diminished in the long-term. [ 1 ] [ 8 ] [ 4 ]


The primary usage of modern artificial ligaments is in  anterior cruciate ligament reconstruction . Many artificial ligaments seek to mimic or exceed the performance of the native  ACL . [ 5 ]  The mechanical performance of an artificial ligament can be characterized by  abrasion  resistance, withstanding flexural and rotational  fatigue , [ 2 ]  and preventing graft slippage or rupture. [ 9 ]  Biocompatibility is important to the performance of the artificial ligament in vivo. [ 3 ]  Biocompatibility is related to new tissue ingrowth, [ 10 ]  fibroblast migration,  osseointegration  of bone, reduction of  inflammation , preventing scar tissue infiltration, and improving hydrophilicity. [ 3 ]  Tissue ingrowth and fibroblast migration have been shown to improve the mechanical strength of the artificial ligament, [ 10 ]  and osseointegration with the surrounding bone can reduce the likelihood of graft slippage. [ 9 ]  Many artificial ligaments are designed to minimize inflammation and scar tissue infiltration because they can hinder the mechanical strength and can cause graft rupture. [ 3 ]  Artificial ligament design strives to improve hydrophilicity because hydrophobicity can trigger the host's natural response to foreign bodies. [ 3 ]


The Ligament Advanced Reinforcement (LARS) is a leading artificial ligament in ACL repair surgery. They are made of  polyethylene terephthalate  (PET). [ 3 ]  They consist of an intraosseous and an intra-articular portion. The intraosseous section consists of longitudinal fibers bounded by a knitted transverse structure. This knitted structure can help prevent deformation and abrasion. [ 5 ] [ 11 ]  The intra-articular portion is made of longitudinal fibers pretwisted at a 90 degree angle. This section is designed to resist fatigue and promote tissue ingrowth. [ 5 ]  Leeds Keio ligaments consist of a  polyester  mesh structure. It seeks to mimic the mechanical properties of the native ACL. The porous nature of the ligament can promote tissue ingrowth which has been shown to improve mechanical properties. [ 5 ]  The PGA Dacron artificial graft consists of 75% braided biodegradable  polyglycolic acid  and 25% permanent  Dacron  thread. [ 11 ]  The Kennedy LAD artificial ligament is made of  polypropylene  ribbons. It is designed to promote tissue ingrowth and the progressive transfer of load onto the new ligament. [ 10 ]


The native ACL of a human has a  tensile strength  on the order of kilonewtons, [ 3 ]  and an elongation at failure of approximately 10%. [ 10 ]  The mechanical properties of the native ACL vary throughout the human population. The strength of a child's ACL tends to be greater than that of an adult. [ 10 ]  PGA Dacron artificial ligaments have an ultimate tensile strength near 3500 N and a mean ultimate elongation of approximately 20%. [ 10 ]  Kennedy LAD ligaments have a tensile strength at failure of approximately 1500 N and an approximate stiffness of 50 N/mm. [ 10 ]  Leeds-Keio artificial ligaments have an ultimate tensile strength near 2000 N and a stiffness around 250 N/mm after tissue ingrowth. [ 10 ]  LARS artificial ligaments have varying mechanical properties depending on the amount of fibers used. A higher gauged ligament will have a greater tensile strength. During testing, a 60 gauge LARS ligament exhibited an ultimate tensile strength of 2500 N while a 120 gauge ligament exhibited a tensile strength of 5600 N. [ 5 ] [ 12 ]  The ingrown tissue has been shown to improve viscoelastic properties and reduce friction. [ 5 ]


Coatings have been added to artificial ligaments to improve their biocompatibility. 58S bioglass and  hydroxyapatite  coatings have been shown to improve osseointegration and cellular activity in vitro and in animal studies [ 3 ]  when deposited onto PET ligaments using the soaking method. [ 2 ] [ 3 ]  Hydroxypropyl cellulose surface treatments have been shown to improve osseointegration for PET ligaments in animal studies. [ 2 ]  Uncoated PET is hydrophobic, so coatings are designed to improve hydrophilicity. [ 3 ]   Hyaluronic acid  coatings can reduce hydrophobicity and have been shown to reduce scar tissue formation and inflammation in vivo. [ 3 ]  Hyaluronic acid and  chitosan  composite coatings can be deposited onto artificial ligament surfaces by the layer-by-layer technique, and they have been shown to enhance new bone formation at the ligament interface in mice. [ 9 ]  The chitosan is used to reduce hydrophobicity and improve osseointegration and mineral deposition, while the hyaluronic acid promotes cell differentiation and growth. [ 9 ]   Poly(sodium styrene sulfonate)  coatings have been shown in animal studies to improve knee functionality and mimicry of the native ACL. [ 2 ] [ 13 ]


The  anterior cruciate ligament  (ACL) is a frequently injured human body structure that may cause secondary damages to the knees, such as meniscal tears and articular cartilage degeneration, without medical treatment.  ACL reconstruction  is a commonly practiced technique for ACL injury, conducted on 30% of patients, which manages to restore stability to the knee structure. [ 2 ] [ 14 ]  Traditional ACL reconstructions uses autografts or allografts which demand a long rehabilitation time and in most cases, develop donor morbidity in the long term. [ 11 ]


The early interests in artificial ligaments led to the implementation of non-human tissue, such as Proplast ligaments made of  Teflon  and carbon fibers and Polyflex made of  polypropylene . [ 10 ] [ 15 ]  The results demonstrated poor resistance to torsion forces. [ 11 ]  Approved by FDA in 1986 and adopted in clinics later,  Gore-Tex  cruciate ligament prosthesis demonstrated low rates of mechanical failure but high rates of rupture in follow-up. [ 16 ]  Gore-Tex was then abandoned in ACL surgery and  Leeds-Keio  (LK) ligament was then adopted. In the later long term follow-up research, LK ligament demonstrated promising performance at first but still showed low stability rates in 2 years and increased degenerative changes compared with their opposite joint in one decade. [ 17 ] [ 18 ]  In the 21st century, the  Ligament Advanced Reinforcement  (LARS) ligament became the most popular artificial ligament on the market.  LARS ligaments not only provide satisfactory outcomes initially but also do not perform differently in at least 2 years. [ 19 ]  LARS ligaments demonstrate higher stability and lower morbidity rate compared to autograft in short-term research and in a 9-year study, LARS ligament showed a 100% survival rate. [ 5 ]  Synthetic ACL grafts always develop creep, fatigue and failure so the demand for synthetic grafts with sufficient supply, satisfactory mechanical properties, and low morbidity rate is essentially high. [ 5 ]  Currently, the LARS ligament is the most comparable to both autografts and other synthetic grafts. [ 5 ]


Complications that commonly occur in the artificial ligaments after the first ten years are breakage, wear debris, synovitis, recurrent instability, osteolysis and chronic effusions. [ 10 ]  Complications do not commonly surface right after the surgery or after a relatively short term, and in a few cases, start to show up after the first ten years. Follow-up research is required to study the performance of certain synthetic materials for artificial ligament and to monitor the health of patients. [ 10 ]  Rupture rates are usually recorded in 2 to 5 years. [ 10 ]


While the future of artificial ligaments is unknown, leading researchers in  tissue engineering  aim to regenerate and repair the ligament to restore normal function. [ 2 ]   ACL tissue engineering will be based on the healing of the  medial collateral ligament  (MCL), since the ACL does not heal naturally. [ 2 ]   A seed cell will be used in tissue engineering for the repair of ACL ligaments. The seed cell must have qualifications such as: easily available, potent to proliferate, and efficient in elaborating a mature extracellular matrix.  Stem cells such as bone marrow-derived  mesenchymal stem cells , adipose-derived stem cells, perivascular stem cells, and human foreskin  fibroblasts  are commonly used in tissue engineering. [ 2 ]


Bone malrotation  refers to the situation that results when a  bone  heals out of rotational alignment from another bone, or part of bone. It often occurs as the result of a  surgical  complication after a  fracture  where  intramedullary nailing (IMN)  occurs, [ 1 ]  especially in the femur and tibial bones, but can also occur genetically at birth. The severity of this complication is often neglected due to its complexity to detect and treat, [ 1 ]  yet if left untreated, bone malrotation can significantly impact regular bodily functioning, and even lead to severe  arthritis . Detection throughout history has become more advanced and accurate, ranging from clinical assessment to  ultrasounds  to CT ( computed tomography ) scans. Treatment can include an  osteotomy , a major surgical procedure where bones are cut and realigned correctly, or compensatory methods, where individuals learn to externally or internally rotate their limb to compensate for the rotation. Further research is currently being examined in this area to reduce occurrences of malrotation, including detailed computer navigation to improve visual accuracy during surgery. [ 2 ]


Bone malrotation predominantly occurs after an injury where a bone is fractured, however malrotation can genetically occur during  foetal development . It usually occurs during a surgery which involves  intramedullary nailing , which is the insertion of metal rods and nails to stabilise bones. Nailing is used as it requires minimal surgical dissection, less disruption of the fracture  hematoma  and allows faster functionality to a patient post-surgery. [ 1 ] [ 3 ]  However, due to the semi-closed nature of IM, it is impossible to correct under direct vision, so there is less rotational control compared to traditional open methods such as plate fixation. [ 3 ]  As a result, in many cases of intramedullary nailing, the bone is misaligned which causes malrotated regrowth. This torsional error is a major problem for femoral and tibial fractures, and occurs in 17 to 35% of patients who receive these surgeries, [ 4 ]  and up to 40% of femur fracture patients. [ 1 ]


Femoral malrotation is the most significant bone malrotation issue, and these errors cause cosmetic problems but can also cause drastic physical problems. [ 4 ]


Historically, bone malrotation occurred due to a lack of adequate treatment measures, where fixation methods such as  traction ,  casting  and non-locked nails provided poor torsional stability. Currently, the utilisation of locked intramedullary nailing, has reduced the occurrence of rotational malalignment during fracture healing, yet femoral malrotation continues to remain very prevalent due to surgeon's inability to reliably restore the pre-injury alignment during operation. [ 1 ]  A high attention to detail is necessary intra-operatively to avoid this complication when locking the intramedullary device. [ 5 ]  The utilisation of both radiological and clinical assessment techniques to compare with an injured limb would also help prevent bone malrotation, however these can be difficult and inexact methods of assessment, which is why complications are so common. [ 1 ]


It is difficult to assess and diagnose the rotational malalignment of a bone after an operation, and many methodologies have been developed.


Clinical assessment and observation  is one methodology, however it is unreliable, and can lead to complications. For femoral or tibial malrotation, many surgeons use the patient's ankle or patella to symmetrically align them with the injured side or to the floor but this method does not consider the position of the proximal fragment and could be moved during reduction attempts. [ 5 ]  In order to measure femoral malalignment, many doctors will compare the internal and external rotation of both hips, while the patient is supine or prone, and a change in a patient's range of movement indicates malrotation. However, while clinical assessment can indicate the direction of malrotation, it often reports inaccurate measurements of the degree of malalignment, so it is unreliable in determining the potential impacts and necessary treatment methods. [ 3 ]


Another diagnosis methodology sometimes utilised are  radiographs ; however, they are unreliable as they require difficult patient positioning to quantify the rotational deformity. [ 5 ]   This difficulty is due to a patient's restriction in movement, as they may exhibit post-traumatic deformities and severe pain. To determine the level of femoral malrotation, with this method, two radiographs of the pelvis and upper legs must be made. Firstly, an anteroposterior (AP) perspective which shows the degree of difference between the femoral neck and femur, and another view where the hips and knees are both flexed to a right angle, which determines antetorsion. Both of these radiographs are utilised to calculate the angle of anteversion of the femoral neck. [ 3 ]


Ultrasounds  can also be used to measure bone malrotation, and are considered highly reliable. The main issue with utilising ultrasound measurement is that it relies largely on the skills of an ultrasound technician, and consequently is not widely used. When measuring femoral malrotation with ultrasounds, a patient's thighs are fixed symmetrically while the degree of rotation of the femoral shaft is measured. This methodology requires exact positioning of a patient to correctly measure any deformity. [ 3 ]


MRI scans  can be utilised and are proven to be reliable and effective at determining malrotation of bones. However, they are not as readily available as CT scanners, and are also time consuming and very expensive. [ 5 ]


The standard bone malrotation detection practice utilised are  computed tomography scans , which are able to exactly quantify the amount of rotational malalignment. [ 5 ]  It is also considered highly reliable and utilised because of its reproducibility. For femoral malrotation, the scan involves doctors measuring the angle between a line through the axis of the femoral neck and a line tangential to the femoral condyles. The angle difference between the uninjured and injured sides determines the degree of malrotation.  An increase in the anteversion of the femoral neck of the injured side denotes internal rotation, and a decrease means external rotation has occurred. Another advantage of CT scans is that patient positioning does not impact the measurement accuracy of femoral torsion, which is unlike radiographs and ultrasounds.  However, inaccurate measurements of malrotation can still occur in CT scans, but are mostly related difficulty in drawing clear and accurate lines along the femoral neck within the image. To avoid this inaccuracy, there needs to be improved accuracy of the line drawn, and this can be fixed by the utilisation of multi-image superimposed projection of the CT images so a more accurate measurement can be drawn. [ 3 ]


Whilst malrotation of a bone can be tolerated for most cases, it can still cause severe impacts on functional outcome for some patients. Whilst tibial fractures are the most common long bone fractures, it is malrotation of the femur which can cause the most significant impacts on regular functioning. [ 6 ]


If untreated, femoral malrotation can cause considerable gait disturbance and abnormal hip joint pressures. [ 2 ]  Malrotation of the femur in the setting of a mid-shaft fracture has an impact on the axis of the entire leg, which shifts the centre of force in the knee away from its neutral position. Consequently, femoral malrotation has significant impacts on the mechanical axis and force vectors within the knee. This can cause pain in the hip and knee, and patients may be limited in their movement, which can impair their function, especially in physically demanding activities such as walking up stairs and running. [ 3 ]  This can impact a person's satisfaction in life, as they may be physically unable to do things they want and need to, such as for laborious work, leisure activities, or raising a family, which can have significant impacts on their psychological health. Femoral malrotation can also cause an abnormally rotated foot, as the angle of a person's foot is directly related to the angle of the femur. [ 7 ]


Another significant long term consequence of femoral malrotation if untreated is  degenerative arthritis  of the hip and knee. [ 3 ]  This joint arthrosis occurs as there is a proven correlation between rotational error, axis deviation and  arthrosis  of the knee and hip joints. However, the severity of the arthrosis is dependent on the percentage of malrotation. [ 4 ]


Whilst most malrotation problems occurred during surgery, patients with 10° or less difference of malrotation compared with the uninjured side rarely complained of any issues. [ 8 ]  However, patients with differences greater than 15° found noticeable issues, and above 30° malrotation difference resulted in serious complaints. [ 5 ]  External femoral malrotation is usually much better tolerated than internal malrotation. [ 1 ]  However, older studies have found that external rotational deformities are more poorly tolerated, [ 9 ]  which shows the need for more research in this area.


There are two main treatment methods; corrective surgery to fix the malrotation, or compensatory methods where patients learn to compensate for any malrotation when walking.


Many people with bone malrotation, such as femoral malrotation are able to functionally tolerate and learn  compensatory methods , such as externally or internally adjusting their limb. Patients will compensate for even considerable rotational malalignment when they are active.  However, femoral malrotation is more difficult to compensate for and maintain with non-operative treatment methods. [ 5 ]  Patients with femoral malrotation of less than 15 degrees give less complaints than those with higher amounts of malalignment, yet many patients are able to tolerate the deformity well. [ 3 ]


In extreme cases, the malalignment can be treated by means of a derotational  osteotomy  which is a major surgical procedure. [ 3 ]  It can be conducted around the existing intramedullary fixtures, but it usually requires a subtrochanteric osteotomy, which is an invasive surgical approach where bone is cut and realigned. As this is a major procedure, it is beneficial if discovered early, before callus has set, and consequently, patients should be assessed for malrotation in the early post-operative period and a CT scan should occur if abnormalities are found. [ 5 ]  Correct measurement of bone malalignment with a CT scan is vital when considering an osteotomies in fixing rotational deformities, as torsional differences below 15 degrees are often easily compensated for with non surgical treatment. [ 3 ]  Revision surgery should be avoided, if not necessary, as implementing femoral nails for a second time leads to higher rates of problems such as infection, nonunion, or nail destabilisation due to overlapping holes for the interlocking screws. [ 10 ]


There is currently limited clinical attention in the area of bone malrotation and research into more accurate methods, likely due to the complexity of the issue. [ 1 ]  Whilst computed tomography scans are useful in determining the degree of bone malrotation after a surgery has occurred, research is being conducted into how to prevent this deformity occurring at all during surgery. CT scans are impractical intraoperatively due to high cost, lack of equipment portability and increased exposure to radiation. [ 10 ]


Consequently, one area being researched is that of  computer navigation,  which could be utilised during these surgeries to avoid malalignment issues.  Computer assisted surgery  (CAS) matches a patient's anatomy with pre or intraoperatively generated fluoroscopic image data, by using camera detected infrared signals. The computer then calculates the positioning of each component and creates a visual of their position on the monitor. As a result, the surgeon can monitor in real time the position of the surgical instruments in relation to the patient's anatomy and conducts the procedure accordingly. [ 11 ]  The surgeon can plan the torsional adjustment and control the fracture reduction and nail insertion on a touchscreen of the navigation module.


Currently, this navigation may add extra time during surgery, so it is sometimes considered unnecessary in an urgent surgery. However, without computer navigation, the risk of bone malrotation is significantly increased. The benefit of computer navigation means that surgeons are able to view more clearly and restore axial alignment, but also ensure the injured limb and matches the alignment and length of the uninjured limb. [ 2 ]  CAS provides increased surgical accuracy and safety for both patients and surgeons, radiation time is reduced, and it utilises minimally invasive techniques which means less tissue damage, improved wound healing, and reduced infections and scarring for patients. [ 11 ]


Dorsal intercalated segment instability  ( DISI ) is a deformity of the  wrist  where the  lunate bone  angulates to the dorsal side of the hand. [ 2 ] [ 3 ]


The main cause of DISI is [ 4 ]  wrist trauma, with or without a fracture:


This  human musculoskeletal system  article is a  stub . You can help Wikipedia by  expanding it .


The  Drehmann sign  describes a clinical test of examining orthopedic patients and is widely used in the functional check of the  hip  joint.
It was first described by Gustav Drehmann (Breslau, 1869–1932). [ 1 ]


The Drehmann sign is positive if an unavoidable passive external rotation of the hip occurs when performing a hip flexion. In addition, an internal rotation of the respective hip joint is either not possible or accompanied by  pain  when forcefully induced. [ 2 ]


The positive Drehmann sign is a typical clinical feature in slipped capital femoral  epiphysis  (SCFE), the  impingement syndrome of the acetabulum-hip ,  or in  osteoarthritis  of the hip joint. [ 3 ]


EOS imaging  is a medical device company based in  Paris, France , that designs, develops, and markets EOSedge and the EOS system, innovative, orthopedic medical imaging systems, associated with several orthopedic solutions along the patient care pathway – from  diagnosis  to post-operative treatments. The EOS platform targets  musculoskeletal disorders  and  orthopedic surgical care  through 2D  X-ray  scans and 3D skeletal models from stereo-radiographic images of patients in a seated or standing position.


The philosophy of EOS imaging surrounds three main principles: reduction of the  radiation  dose emitted by the technology, relevance and manipulability of calculated clinical parameters, and optimization of the patient care workflow. Currently, over 300 EOS systems are installed in medical centers in 51 different countries, including the United States, Japan, Korea, China, and throughout the European Union.


The EOS imaging technology stems from the scientific findings of  Georges Charpak  ( Nobel Prize in Physics , 1992) concerning radiation detection and  particle physics , especially the  multi-wire chamber . [ 1 ]  Since then, physicists, engineers, radiologists, and surgeons have collaborated to transform these findings into a new technology called the EOS system.


EOS imaging began in 1989 as Biospace Med, a medical company founded by Georges Charpak for the development of his detection technology. In 1999, Marie Meynadier became the CEO of Biospace Med; she developed the company's first subsidiary dedicated to imaging solutions for pre-clinical research – the EOS system.


In 2004, hospitals in Paris, France and Brussels, Belgium finished running clinical tests on the EOS prototype, and in 2005, the first fundraising efforts commenced with the company's first venture capital round.


From 2007 to 2011, the company obtained  CE marking  in Europe and  FDA  approval to market the EOS system and the sterEOS 2D/3D workstation in the United States.


The first installations of EOS in European and North American hospitals and clinics occurred from 2008 to 2010. In 2011, the EOS system was being integrated into clinical routines of medical centers in 10 countries, including the United States, Canada, and Australia.


In 2010, Biospace Med changed its name to EOS imaging.


In 2012, EOS imaging entered the  Euronext Paris  stock exchange (name: EOSI) and had its first installation in Asia.


In 2013, EOS acquired the medical company oneFIT Medical (see Acquisition of oneFIT Medical).
In 2014, EOS provided the EOS system in the Vietnam market (Medic - Medic Hoa Hao) through Bluelight.


In 2015, the CFDA certification in China and the NECA designation in Korea were obtained, allowing the company to further expand its market.


In 2016, the company entered into the Latin American market with the signing of its first contract in Brazil.


In 2019, the company launched EOSedge, its new generation imaging system powered by photon-counting technology.


While based in Paris, France, EOS imaging has five other corporate locations in various regions around the world:  Besançon, France ;  St. Paul, Minnesota , US;  Montreal, Quebec , Canada;  Frankfurt, Germany , and in  Singapore .


In 2013, EOS imaging acquired oneFIT Medical (based in Besançon, France), a  medical software  engineering and manufacturing company dedicated to the development of  surgical planning  software for spine, hip, and knee surgeries and patient-specific orthopedic surgical cutting guides. [ 2 ]


EOS imaging platforms—EOSedge and EOS—deliver unique and specific capabilities that are used in conjunction with EOS Advanced Orthopedic Solutions to generate highly accurate 3D representations of patient anatomy and enable a seamless surgical planning experience.


The EOS examination takes place in an upright scanning cabin where the patient can either stand or sit. With a vertically traveling arm supporting two fine X-ray beams perpendicular to one another, the EOS system acquires frontal and lateral, weight-bearing images of the patient in a functional – standing or sitting – position. These biplanar images are then used to create a 3D model of the patient's skeleton.


The ALARA principle (As Low As Reasonably Achievable) represents a movement to “minimize radiation doses and releases of radioactive materials” by minimizing the time of exposure to radiation, increasing the distance between the human body and the radiation source, and using absorber materials to shield the body from  beta particles , X-rays, and  gamma rays . [ 3 ]


EOS imaging aligns itself with this principle, providing reduced exam times and amounts of radiation in comparison with conventional imaging systems. [ 4 ] [ 5 ]  Furthermore, EOS developed a Micro Dose option that further reduced the radiation exposure by 5.5 times compared to a typical low-dose EOS exam protocol, resulting in a nearly negligible radiation dose. [ 6 ]  Additionally, with Flex Dose technology, EOSedge can deliver up to an 80% overall radiation reduction compared to same acquisition without Flex Dose.


Having reduced-radiation options available for patients has become critical in the world of medical imaging as radiation exposure from artificial sources, such as medical imaging, has increased over the last two decades, [ 7 ]  and many patients require multiple examinations throughout the course of their medical treatment.


The sterEOS workstation enables the generation of patient-specific 3D models of the spine and/or lower limbs from weight-bearing low dose or Micro Dose EOS exams. Once the models are created, clinical parameters are automatically calculated and may be exported as a patient report including 2D images and 3D captures. This report is used by physicians for diagnosis, post-operative assessment, and patient follow-up. sterEOS also enables the exportation of 3D anatomical biomarkers for pre-operative planning.


The EOSapps (kneeEOS, hipEOS, and spineEOS) are online, 3D surgical planning solutions based on the weight-bearing EOS images. Frontal and lateral EOS images are uploaded to the EOS Portal, where the EOS 3DServices team prepares the 3D models and dataset and makes the planning case available online. Surgeons can have access to the patient's anatomy information in 3D, with which they can plan and simulate the effect of different implant selections and positions in 3D. spineEOS is used to plan spine surgeries, hipEOS is used for the planning of  total hip arthroplasty , and kneeEOS is geared towards the planning of  total knee arthroplasty .


Foot Levelers  is a foot care, footwear, and whole body health company based in Roanoke, Virginia, and owned by Kent S. Greenawalt.


Foot Levelers began in Iowa, in 1952, by Chiropractor Monte H. Greenawalt. Greenawalt earned his degree from Lincoln Chiropractic College and began to notice a pattern in patients with foot problems—his adjustments did not hold. Dr. Monte referred these patients to a podiatrist, but their problems persisted.


Monte began to experiment with orthotics, and through trial and error, developed a formula based on 16 unique measurements of the foot. Unlike off-the-shelf orthotics or even those made by podiatrists, Monte’s orthotic was designed to support all three arches of the foot, rather than just one. Through Greenawalt's orthotics invention, his patients began to show positive results and his adjustments held longer.


In Foot Levelers multi-decade history, they have served tens of thousands of doctors and millions of patients [ 1 ]  through their patented orthotic technology. [ 2 ]  They have offices in the U.S., Europe, and Australia and serve customers in over 80 countries.


Foot Levelers holds title sponsorship of "America's Toughest Road Marathon", the  Blue Ridge Marathon , since 2012.


Halo-gravity traction  (HGT) is a type of  traction  device utilized to treat spinal deformities such as  scoliosis , [ 1 ] [ 2 ]   congenital  spine deformities,  cervical instability ,  basilar invagination , and  kyphosis . [ 3 ]  It is used prior to surgical treatment to reduce the difficulty of the following surgery and the need for a more dangerous surgery. [ 4 ] [ 5 ] [ 6 ]  The device works by applying weight to the spine in order to stretch and straighten it. Patients are capable of remaining somewhat active using a  wheelchair  or a walker whilst undergoing treatment. Most of the research suggests that HGT is a safe treatment, and it can even improve patients'  nutrition  or  respiratory functioning . However, some patients may experience side effects such as  headaches  or neurological complications.  The halo device itself was invented in the 1960s by doctors working at the  Rancho Los Amigos hospital . [ 7 ] [ 8 ] [ 9 ]  Their work was published in a paper entitled "The Halo: A Spinal Skeletal Traction Fixation Device." [ 10 ]  The clinician  Pierre Stagnara  utilized the device to develop Halo-Gravity traction. [ 11 ] [ 12 ] [ 13 ]


Halo-gravity traction works by straightening and stretching the compressed  spine . [ 14 ] [ 15 ]  It relies on the  viscoelastic  properties of  vertebrae . This means vertebrae can stretch over time. Doctors will apply weight to the spine, and gradually increase it over time, slowly straightening and stretching it. [ 16 ]  Patients undergoing the procedure will typically spend the entire course of the treatment, which is usually three to eight weeks, in a  hospital . Usually, halo-gravity traction is the first step in the treatment plan for a child with severe spinal deformity. Following the procedure, it is common for a surgical operation such as  spinal fusion surgery  to be performed afterward to permanently mend the issue. [ 14 ] [ 17 ]  It is utilized before the operation to reduce the need for a more dangerous surgery and to reduce the risk of damage to the soft  tissues  or  nerves  that surround the spine during the surgery. [ 15 ] [ 18 ] [ 19 ]  In addition, HGT has also been found to reduce the risk of complications during the following surgery. [ 20 ] [ 21 ] [ 22 ]


To perform halo-traction therapy a surgeon will use six to ten small pins to attach a "halo" made of a metal ring to the patient's skull. [ 23 ] [ 24 ] [ 25 ]  Doctors will typically leave one to two centimeters of distance between the halo and the patient's head. It is common for older patients to be given eight pins while younger patients are given 10. Prior to pin placement, some patients may undergo hair removal. It is not required for successful treatment, but it can help to reduce the risk of pin infection from hair getting caught in a pin or  scalp necrosis . [ 7 ]  The pins will be placed into the  forehead   bones  to prevent the head from moving. Pin placement is determined using a  CT scan . The chosen area will be cleaned with  betadine  swabs. Usually, two to three pins are placed in the  frontal  and  occipital  areas. Pins placed on the occipital area will have to be placed one centimeter above and behind the  auricle  of the ear. Pins placed on the  anterior  of the head will likely be placed one centimeter to above the sides of the eyebrow to avert potential damage to the  supraorbital  and the  supratrochlear nerves , and potential  muscle  damage.  Parietal  placements are generally avoided as the skull around this area is generally softer, which risks the pins puncturing the  temporal artery . Typically, the pins will tightened to a  torque  equivalent to the age of the child using a  torque wrench . Adults can withstand tighter torques than children can. [ 26 ]  Whilst this operation is being performed the child will be given general  anesthesia . [ 7 ]  In  infant  children, significantly less torque is required to tighten the pins. This allows for the pins to be placed in more areas than they could be placed in older patients. [ 27 ]


Afterward, the halo will be attached to a  pulley system  which is attached to the patient's bed,  walker , or  wheelchair . [ 28 ]  Spring-type pulleys are typically used as they allow for the patient to self-regulate the weight applied to the pulley, which improves the safety of the device. [ 29 ] : 390   Spring-based HGT devices are also cheaper and easier to build than other methods of construction. [ 30 ]  It is common for patients to begin the procedure with 5-10 pounds of weight on the pulley system. [ 29 ] : 387   Over the next few weeks, clinicians will add weight to the pulley, which will slowly straighten the patient's spine over time. Eventually, a weight greater than 50% of the patient's body weight may be achieved. [ 23 ] [ 31 ]  Doctors will monitor the movements and strength and will take  x-rays  of the patient to track their progress. They will adjust the amount of weight on the pulley system based on the results. All patients will undergo  cranial nerve  testing during the procedure. [ 23 ]  After the spine has reached its optimal position, spinal fusion surgery will be performed on the patient. [ 15 ]


Whilst undergoing the procedure, patients are encouraged to remain as active as possible. Activities such as low-impact play, walking, or standing can all increase the benefits of halo-traction therapy. However, patients are limited to leaving the traction for only a short time span. They can leave for activities such as repositioning, changing clothes, daily medical care,  showering , or using the  toilet .  Baby shampoo  is required to be used for bathing purposes as other shampoos could contain chemicals that react negatively with the metal halo. Patients will be required to utilize a special bed for  sleeping  whilst in the traction. After ending treatment the patient is required to avoid strenuous activities for a few months as their spine and muscles will still need to recover. Some patients may wear an orthopedic vest or a  halo vest . [ 15 ]


Halo-gravity traction has been found to be almost completely safe. [ 29 ] : 385  [ 32 ]  Patients who have undergone the procedure report that they have a greater ability to stand upright, an increased appetite, and an improved  body image . [ 33 ]  It can improve  respiratory  functioning by relieving pressure on the lungs caused by a deformed spine. [ 13 ] [ 34 ] [ 35 ]  Patients often  gain weight  and have improved  nutrition  following HGT. [ 36 ]  This may occur since HGT can correct issues associated with spinal deformities, such as  exercise ,  comorbid   metabolic disorders , and  gastrointestinal  malformations. These issues are associated with malnutrition and low weight, and HGT can lead to weight gain by correcting them. [ 37 ]  When in combination with surgical release, HGT may improve the  flexibility  of the spine and lead to more spinal correction. [ 38 ] [ 39 ]


Patients may experience pain from the pins, which is usually caused by the loosening of the pins. This can be remedied by tightening them. Up to 20% of patients may experience  infections  at the site where the pins were applied. These infections are typically treated with  antibiotics . One rare, but serious complication of the procedure can be the development of intra-cranial  abscesses  due to  septic  contamination of the pin site. [ 13 ]  Some patients experience  headaches  around the area where the pins were applied for a short while after the halo is attached. It is common for patients to recover from this pain in less than 24 hours. [ 29 ] : 384   Halo therapy will leave small  lesions  in the skin when the pins are first removed. Typically, they will turn into  scabs  after a few days. Patients who have undergone the procedure will also have small  scars  on their foreheads. These scars will typically fade over time. [ 15 ]


If the traction that is applied is greater than the tolerable amount, the patient may feel  cervical pain ,  cranial nerve lesions ,  nausea ,  vertigo , [ 40 ]  or  dizziness . These side effects are treated by lowering the level of weight applied. [ 41 ]  Some patients may suffer from  motor paresis  after the application of the device. Typically it is present in patients with preexisting spinal cord abnormalities. [ 29 ] : 389   Generally, HGT does not cause neurological side effects due to the slow progression of traction. The spine adjusts slowly over time, and as a result, consequences are generally limited. Children are less likely than adolescents or adults to experience neurological side effects, due to the softness and flexibility of their spine, as well as their low weight. [ 42 ]


Erb's palsy  has been identified as a rare neurological side effect of HGT. [ 43 ]  One 2006 study published in the journal "Studies in Health Technology and Informatics" found that in extremely rare cases HGT could induce  Erb's palsy , ulnar nerve paralysis, and  median nerve palsy  in cases. In the seven cases identified by the study, all patients had fully recovered within a few months of treatment. The likelihood of developing Erb's palsy due to HGT is associated with the weight of the traction. [ 44 ]  Another study published in the  Journal of Spinal Disorders & Techniques  found that patients may experience Erb's palsy or  sensory loss  during or after treatment. However, none of the patients who had experienced these side effects reported in this study had permanent neurological loss. [ 45 ]


One 2016 clinical study published in  BioMed Research International  found that HGT resulted in reduced bone density among patients with kyphoscoliosis. [ 46 ]  However, little other research has investigated this potential side effect or found any evidence to support this claim. [ 37 ]


Patients with bone conditions such as  fibrous dysplasia  or  osteogenesis imperfecta  may be unsuitable for treatment if the pins are not capable of safely being applied to the bone. [ 29 ] : 385    Osteoporosis  is considered a contraindication that sometimes may prevent treatment,  however, doctors may avert complications by utilizing more pins with a lower torque. [ 40 ]   Absolute contraindications  for halo-gravity traction include the presence of a  stenotic segment , an  intradural or extradural lesion , lesions in the skull by the sites of pin application, [ 12 ]  any lesion or  tumor  by the spine cord, [ 23 ]  severe skull deformity, and  spine instability . [ 12 ]


Most of the research conducted on HGT found that it is mostly a safe, [ 47 ]  reliable, [ 47 ]  and effective treatment. [ 48 ] [ 49 ] [ 50 ]  The average correction rate of HGT has been shown to be 19.4% for  sagittal curves  and 24.1%  coronal  curvature. [ 12 ]  One 2013 study on 33 patients published in the journal  Spine Deformity  found an average correction rate of 33% for coronal curves and 35% for sagittal. [ 51 ]  According to a  cohort study  conducted on 75 subjects investigating the efficacy of Halo traction therapy found an improvement rate of 31% to 66% for the spine. They found a  coronal  curvature improvement of 19.6% for adolescents, and 12% for adults. Kyphosis had improved at a rate of 23.9% for adolescents. Afterward, spinal surgery performed on people who had undergone the procedure had a greater than 50% chance of success. [ 52 ]


One study conducted on 20 patients with either scoliosis, kyphosis, or kyphoscoliosis found that the most improvement occurred within the first 3 weeks of treatment. According to this study, the spinal curve had improved by 63.7% during the first two weeks, which decreased to 24.3% at 3 weeks, and to 15.9% at 4 weeks. [ 38 ]  Other studies have found similar results. One study conducted on 21 patients found that 45% of improvement occurred within the first 3 weeks. [ 53 ]  Another study on 24 patients found that a mean improvement of 82% occurred during the first three weeks. [ 54 ]


Much of the research utilized as evidence of the efficacy of HGT has been criticized for a lack of a  control group  and a small  sample size . [ 55 ]  Some research has suggested that HGT leads to  statistically insignificant  improvement. [ 56 ]   Paul Sponseller, an  Orthopedic surgeon  at  Johns Hopkins University , claims in his study "The use of traction in the treatment of severe spinal deformity" that his research found "no statistically significant difference in main coronal curve correction (62% vs. 59%), operative time, blood loss, and total complication rate (27% vs. 52%)." However, his data did showcase that people who had not undergone HGT required  surgical resection  30% more often. [ 55 ]  In a study on 25 patients with severe spinal deformities who had been treated with spinal surgery, a mean correction of 44 degrees was found in patients who had not undergone HGT prior to the operation, and a mean correction of 52 was found in patients who had been treated with HGT. The researchers concluded that this difference was not statistically significant, and therefore HGT should not be used as the general treatment for these issues, and should be reserved for specific cases. [ 57 ]


Some research suggests that HGT may be less effective than other forms of traction, such as Halo-femoral traction or Halo-pelvic traction. [ 58 ] [ 59 ]  HGT also has been found to require lengthy hospital stays, which many patients dislike about the treatment. [ 60 ]  In the study by Paul Sponsellor, he found that patients who had undergone HGT spent almost twice the amount of time hospitalized as those who had not received the treatment. [ 55 ]  HGT is significantly safer than other forms of traction. It is less likely to produce significant complications such as  blood loss , [ 59 ] [ 61 ]  neurological side effects, and spine stiffness or degeneration. [ 62 ]  HGT also allows patients to remain social and active, whilst other forms of traction severely restrict movement. [ 63 ]  These reasons have led to HGT becoming the standard preoperative treatment for patients with severe spinal deformities. [ 64 ]


The treatment of broken bones and dislocated joints can be traced as far back as the  Ancient Greeks .  Hippocrates  is credited with a method of reduction of a  dislocated shoulder . 16th century Spanish texts talk about the  Aztecs  use of  reduction  of fractures using fir branches. The modern discipline of orthopaedics in trauma care developed during the course of World War I, but it was not until after World War II that orthopaedics became the dominant field treating fractures in much of the world. Today, the discipline encompasses conditions such as bone fractures and bone loss, as well as spinal pathology and joint disease. [ 1 ]


Several volumes of the  Hippocratic Corpus ,  Articulations or On Joints, On Fractures, On the Instruments of Reduction  discuss  Ancient Greek medicine  relating to orthopaedics, [ 2 ]  and  Hippocrates  is credited with a method of reduction of a  dislocated shoulder .


16th century Spanish texts talk about the  Aztecs  use of  reduction  of fractures, as well  intramedullary  fixation using fir branches. [ 3 ]


Peter Lowe  was the first surgeon to use the term  amputation  in his 1597 book  A discourse of the Whole Art of Chirurgerie . [ 4 ]


Nicolas Andry  has been credited with the term 'orthopaedics', taken from the title of his 1741 book  Orthopédie  on childhood deformity correction. [ 5 ]   The frontispiece of the book bore an engraving of a sapling being splinted with a stake, a symbol now referred to as the  Tree of Andry  and adopted by many orthopaedic associations internationally.


In 1768,  Percivall Pott  published his book  Some Few Remarks upon Fractures and Dislocations  following his compound femoral fracture on the use of  splinting  to avoid  amputation . [ 6 ]   Pott's student,  John Hunter , expanded on the knowledge of bone healing.


Around the same time,  Jean-André Venel  published his work  Orthopaedia, or the Art of Preventing and Correcting Deformities in Children , one of the first surgeons to discuss the practical application for treating  congenital deformities .


Even after the  Medical Act 1858 ,  bonesetters  continued to practice unlicensed within England, with one of the last being Evan Thomas. His son,  Hugh Owen Thomas , is considered by many to be the father of modern orthopaedics in the UK, [ 7 ]  with many published works such as  Diseases of the hip, knee and ankle joints (1876), Principles of the treatment of diseased joints (1883), The principles of the treatment of fractures and dislocations (1886), Fractures, dislocations, diseases and deformities of the bones of the trunk and upper extremities (1887) and Fractures, dislocations, deformities and diseases of the lower extremities (1890)' . The use of his  traction splint  during the  First World War  lead to a dramatic reduction in the mortality following  femoral fractures .


Thomas' nephew,  Robert Jones  continued his work, and was the first person to publish on the use of  radiography  in orthopaedics. [ 8 ]


The developing field of orthopaedics was originally focused on deformities in children, and subsequently adults. The involvement of orthopaedics in trauma care developed in the course of World War I, the interwar period, and World War II. [ 9 ]  It was not until after World War II that orthopaedics became the dominant field treating fractures in much of the world.


Later in the 20th century,  John Charnley  pioneered  hip replacement , [ 10 ]  as well as published on the conservative treatment of fractures.


Orthopedic surgery  is the branch of  surgery  concerned with conditions involving the  musculoskeletal system .  Orthopedic surgeons  use both surgical and nonsurgical means to treat  musculoskeletal injuries ,  sports injuries , degenerative diseases, infections,  bone tumours , and  congenital limb deformities .   Trauma surgery  and  traumatology  is a sub-specialty dealing with the operative management of  fractures ,  major trauma  and the multiply-injured patient.


List excludes anatomical terminology covered in  index of anatomy articles .


Abbreviated Injury Scale
-  Acetabular fracture
-  Acheiropodia
-  Achilles tendon rupture
-  Acromioplasty
-  Adamantinoma
-  Adhesive capsulitis of shoulder
-  Advanced trauma life support
-  Ainhum
-  Akin osteotomy
-  Albers-Schonberg disease
-  Albright's hereditary osteodystrophy
-  Allis test
-  ALPSA lesion
-  Amelia (birth defect)
-  American Joint Replacement Registry
-  Amphiarthrosis
-  Andersson lesion
-  Aneurysmal bone cyst
-  Ankle replacement
-  Anterior cruciate ligament injury
-  Anterior cruciate ligament reconstruction
-  Antley–Bixler syndrome
-  Apert syndrome
-  Apley grind test
-  Apley scratch test
-  Apprehension test
-  Arachnodactyly
-  Arm fracture
-  Arthralgia
-  Arthritis
-  Arthrocentesis
-  Arthrodesis
-  Arthrogram
-  Arthrogryposis
-  Arthroplasty
-  Arthroscopy
-  Arthrotomy
-  Articular capsule
-  Articular cartilage repair
-  Astragalectomy
-  Autologous chondrocyte implantation
-  Avascular necrosis
-  Avulsion fracture


Baastrup's sign
-  Baker's cyst
-  Baksi's prosthesis
-  Ballottement
-  Bankart lesion
-  Bankart's fracture
-  Barlow maneuver
-  Barré–Liéou syndrome
-  Barton's fracture
-  Baumann's angle
-  Beals syndrome
-  Bechterew's
-  Bennett's fracture
-  Bifid rib
-  Bimalleolar fracture
-  Blount's disease
-  Blumensaat's line
-  Blunt trauma
-  Bohler's angle
-  Bone cutter
-  Bone cyst
-  Bone density
-  Bone disease
-  Bone fracture
-  Bone fracture healing
-  Bone grafting
-  Bone healing
-  Bone metastases
-  Bone mineral
-  Bone pathology
-  Bone remodeling
-  Bone resorption
-  Bone tumor
-  Bone
-  Bosworth fracture
-  Bouchard's nodes
-  Boutonniere deformity
-  Boxer's fracture
-  Brachydactyly
-  British Orthopaedic Association
-  Brodie abscess
-  Broström procedure
-  Brown tumor
-  Bruck syndrome
-  Brunelli procedure
-  Bryant's traction
-  Buddy wrapping
-  Bumper fracture
-  Bunion
-  Burst fracture


Calcaneal fracture
-  Camurati–Engelmann disease
-  Cancellous bone
-  Cartilage
-  Cartilaginous joint
-  Catel–Manzke syndrome
-  Cenani–Lenz syndactylism
-  Cervical dislocation
-  Cervical fracture
-  Cervical rib
-  Chalkstick fracture
-  Chance fracture
-  Chandler's disease
-  Charnley prosthesis
-  Charnley retractor
-  Chauffeur's fracture
-  Child bone fracture
-  Chondroblast
-  Chondroblastoma
-  Chondrocyte
-  Chondrogenesis
-  Chondromalacia patellae
-  Chondromyxoid fibroma
-  Chondrosarcoma
-  Chopart's fracture-dislocation
-  Clarke's test
-  Clavicle fracture
-  Clay-shoveler fracture
-  Cleidocranial dysostosis
-  Clinodactyly
-  Club foot
-  Clubbed thumb
-  Cobb angle
-  Codman triangle
-  Cole carpenter syndrome
-  Colles' fracture
-  Combined tibia and fibula fracture
-  Compartment syndrome
-  Complex regional pain syndrome
-  Compression fracture
-  Computer-assisted orthopedic surgery
-  Congenital knee dislocation
-  Congenital limb deformities
-  Congenital patellar dislocation
-  Conradi–Hünermann syndrome
-  Coopernail's sign
-  Cortical bone
-  Cotrel–Dubousset instrumentation
-  Coxa valga
-  Coxa vara
-  Cozen's test
-  Crus fracture
-  Crush injury
-  Crush syndrome
-  Cubitus valgus
-  Cubitus varus
-  Cunningham shoulder reduction
-  Currarino syndrome


Danis–Weber classification
-  Darrach's procedure
-  Darrah procedure
-  De Quervain syndrome
-  Denis Browne bar
-  Denis classification
-  Destot's sign
-  Diaphysis
-  Diffuse idiopathic skeletal hyperostosis
-  Discectomy
-  Discoid meniscus
-  Dislocated shoulder
-  Dislocation of hip
-  Displacement (orthopedic surgery)
-  Distal radius fracture
-  Distraction osteogenesis
-  Drawer test
-  Dupuytren's contracture
-  Durkan's test
-  Duverney fracture
-  Dynamic compression plate
-  Dynamic hip screw
-  Dysplasia epiphysealis hemimelica


Early appropriate care
-  Ecchondroma
-  Ectrodactyly
-  Ectromelia
-  Ehlers–Danlos syndrome
-  Eiken syndrome
-  Elbow examination
-  Elbow extension test
-  Ellis–van Creveld syndrome
-  Enchondroma
-  Enchondromatosis
-  Ender's nail
-  Endochondral ossification
-  Endosteum
-  Enthesis
-  Epiphyseal plate
-  Epiphysiodesis
-  Epiphysis
-  Erlenmeyer flask deformity
-  Essex-Lopresti fracture
-  Evans technique
-  Evans-Jensen classification
-  Ewing's sarcoma
-  Exostosis
-  External fixation
-  Extraskeletal chondroma