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The History of Traumatology and Orthopaedics Development

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The History of Traumatology and Orthopaedics Development THE HISTORY OF TRAUMATOLOGY AND ORTHOPAEDICS DEVELOPMENT The archaeological evidences, found in many countries of the world show that people have start- ed the treatment of human injuries from the high antiquity times. There are many evidences that trau- mas gained by our remote ancestors during work and in the period of wars were one of the main trig- gers of the folk and later scientifi c medicine formation and development. In the IV century BC (460–356 BC) the great scientist Hippocrates outlined his knowledge in med- icine (“On Fractures”, “On joints”, “On lever”). In the I century AD the Roman doctor Aulus Cornelius Celsus wrote the treatise "De medicina", in which he deepened and complemented the Hippocrates knowledge. Almost at the same time with Celsus scientist Galenus elaborated the issues of deforma- tions and injuries in human skeleton (131–206 AD). The great contribution in the study of injuries and diseases of musculoskeletal system made Avicenna (Ibn Sina 980–1037 AD), Ambroise Pare (1510– 1590), Glisson (1597–1677) et al. In the Ancient Rus until the end of XVII century there was no hospitals, so the medical care was provided by healers. The doctors were only from abroad, they were invited for privileged persons. Eventually some part of healers started to specialize in bones and joints injuries treatment, so folks called them bonese ers. In 1654 tsar Alexey Mykhailovich (Peter’s I father) ordered to establish the bonese er school in Moscow. In one year during the war with Poland the bonese ers of the school was conscripted to provide a medical aid to injured soldiers of the army. In 1707 due to an order of Peter I the building of the hospital was over, the fi rst Medical surgery school in Russia was estab- lished there. It initiated the se ing of hospital wards in the country and medical education institu- tions establishment. The term "orthopaedics" was suggested fi rst in 1741 by the dean of medical faculty in Sorbonne (Paris) Nicolas Andry, who published the book “Orthopaedics or the art of correcting and preventing deformities in children with facilities available for fathers and mothers and all persons, who grow up children”. Describing the process of possible deformations correcting Andry pictured the tree with distort trunk fi xed by a pole and tied to it. Eventually this became the symbol of orthopaedics. The term "traumatology" (the study of injuries) occurred much later, when it became obvious that the number of gained injuries in orthopaedics science is much higher than for congenital or gained diseases, so the discipline was called "Traumatology and orthopaedics". There are 3 periods distin- guishedRESTRICTED in the development of orthopaedics, traumatology and prosthetics during the two and half centuries from the moment of new surgical specialty symbol occurrence. 10 Traumatology Orthopedics THE ESTABLISHEMENT OF TRAUMATOLOGY AND ORTHOPAEDICS AS PART OF GENERAL SURGERY The progressive development of the new discipline components in strict surgical frames was important feature from the middle XVIII till the end of XIX century. During many decades the teachers of general surgery lectured the musculoskeletal pathology diagnostics and treatment issues in universities and Emperor Medical-surgery academy of Russia. At the beginning of XIX century the two country traumatology and orthopaedics schools – Moscow and Saint Peters- burg – have distinguished as part of one surgical discipline. The dean of Moscow University Mukhin A.E. headed the Moscow traumatology school; he was the fi rst in Russia who published thematically thesis “The beginning in bonese er science" (1806). The book was devoted to the issues of fractures and dislocations diagnostics and treatment. It was valued as fi rst textbook in Russian. In Saint Petersburg the ba- Dean of medical faculty in sics of desmurgy and mechanurgy education for military doctors was Sorbonne (Paris) Nicolas Andry (Nicоlas Andry de Bоis-Regard), se led by Bush I. F. – the fi rst surgery department professor in Med- 1658–1742 ical-surgery academy. The fi rst in our country manual for students “Orthopeadics course" was published in 1885 by the docent of Kazan University Studenski N. I. In the fi rst half of XIX century the general principles of patients with bone fractures treatment were established, it was based on many-years-experience of medical aid supply as well was on medical scientifi c achievements worldwide. This included: apposition of frac- tured bone fragments (reposition), restraint of traumatized limb (im- mobilization) for keeping of repositioned fragments for the essential period for recovery of the fracture, prevention of complications de- velopment and treatment directed on limb function recovery. In the early 1850s the Mathijen from Holland and Pirogov con- temporaneously and independently of each other suggested an anes- thesia and one of four existing nowadays methods for bone fractures treatment – single step fragments reposition with further immobili- zation of limb with plaster bandage. This became an achievement of the fi rst period of orthopaedics and traumatology development and found a fast implementation in common the practice of treatment institutions worldwide. Even nowadays some part of patients with bone fractures are treated using this method. Symbol of orthopaedics suggested by Nicolas Andry N. I. Pirogov – the genius scientist, thinker and visionist, the hole epoch of medicine development is connected with him, specifi cally – the study on trauma and trauma disease as general reaction of the organism on mechanical trauma. His papers on traumatology and military fi eld surgery were of high importance, some of them are even still notable. The description of anatomical samples of limb for estimationRESTRICTED of surgical incision topography, ether narcosis, fi rst used in military fi eld conditions, the methods of subcutaneous tenotomies widened the possibilities of trauma treatment, while bone plas- tic amputation of foot is still used nowadays. The history of traumatology and orthopaedics development 11 The further development of fractures studies is connected to sci- entifi c method of traction; a special tools for skeletal, ferrule, glue or leucoplast traction provided fragments reposition and immobiliza- tion of traumatized limb. This fact aff orded ground to surgeons for calling this method as functional as contrast to previous immobiliza- tion. The elaboration of general principles of continuous traction (B. Bardenheuer, 1887) and study on fractured patients functional treat- ment (J. Lucas – L. Championniere, 1889), the introduction to clinical practice the defi nition of medial physiological limbs position (H. Zup- pinger) facilitated the establishment and development of functional methods of fractures treatment. The skeletal method was the best among the methods of continuous traction. However it`s usage tech- nique was elaborated only in the fi rst decade of XX century, in the 2nd E. A. Mukhin (1766–1859) – the founder of Moscow stage of the specialty development. traumatology school Orthopaedics and traumatology has developed as part of the general surgery at the beginning (more than 100 years) in classical evolution way. The quality changes in the development of orthope- dics began to occur at the turn of XVIII and XIX centuries, when spe- cialists of this sphere started to treat musculoskeletal deformations and other diseases not only in children but also in orthopaedics hospitals. In 1888 the orthopaedics hospital was opened in Odessa, in 1896 the hospital for children with diff erent deformations was opened in Kharkiv. In many cities, the enthusiasts traumatologists- orthopaedists worked on the base of hospitals specialized on gen- eral surgery. The distinguishing feature of orthopaedics on its fi rst stage of de- velopment (in the before aseptic era) was mainly usage of conserva- tive methods of patients treatment (redressing, wide usage of casts, tutors and apparatuses for traction or immobilization). In the same Professor N. I. Pirogov years the interest in balneotherapy occurred in orthopedists as well as (1810–1881) to other treatment factors (thermal and mineral waters, sunlight and see positive eff ects, massage, physical activities etc.). The further progress in its development the orthopaedics and traumatology gained in the second part of XIX century at the background of high speed industrialization and social-economical moderniza- tions of the most of developed European countries. So with help of Louis Paster's (France) papers and chemists of many countries the new methods of analgesia and aseptic of operations, surgical instru- ments, surgeon’s hand and operation fi eld was adopted to clinical practice. This enabled to achieve be er anatomical and functional results, shorten terms of children and adults treatment. Such achieve- ments facilitated fast grow of the specialized clinical centers number in Europe, as well as the forma- tion of proper conditions for distinguishing of orthopaedics and traumatology in separate surgical dis- cipline. In the last decade of XIX and fi rst years of XX century the process of diff erentiation started in Europe. One of the fi rst disciplines that have divided separately was orthopaedics and traumatology. The new method of surgical diagnostics X-ray has facilitated this considerably. The usage of X-ray im- provedRESTRICTED the process of determination of features and localization of pathology in bones, it enabled to watch the dynamics of reparative regeneration of bone tissue. 12 Traumatology
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