Orthopedics

In 1887, the Hospital for Special Surgery founded the first orthopedic residency program in the United States. Young doctors in training would apply for one-year positions as assistant. They became known as residents, a term recognized as a doctor in training.^[7]

Examples of people who aided the development of modern orthopedic surgery were Hugh Owen Thomas, a surgeon from Wales, and his nephew, Robert Jones.^[8] Thomas became interested in orthopedics and bone-setting after establishing his own practice, expanding the field into the general treatment of fracture and other musculoskeletal problems. Thomas's collar to treat tuberculosis of the cervical spine, Thomas's maneuvere for assessing hip fracture, and the Thomas test are procedures credited to his innovations.^{[medical citation needed]}

Robert Jones was 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.^[9] 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 Orthopaedic Association 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 from 1916 to 1918.^[10]

The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Gerhard Küntscher of Germany.^{[citation needed]} Traction was the standard method of treating thigh bone fractures until the late 1970s, though, when intramedullary fixation without opening up the fracture became a standard procedure.^{[citation needed]}

The modern total hip replacement was pioneered by Sir John Charnley in England in the 1960s.^[11] 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 poly(methyl methacrylate) (acrylic) bone cement. For over two decades, the Charnley low-friction arthroplasty and its derivative designs were the most-used systems in the world, forming the basis for all modern hip implants.^{[citation needed]}

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.^{[citation needed]}

Knee replacements for osteoarthritis were developed in the 1970s using a fixed bearing system and a mobile bearing system.^[12] In 1974, a total condylar knee replacement was produced.^[13]

External fixation of fractures was refined by American surgeons during the Vietnam War, but a major contribution was made by Gavriil Ilizarov who achieved healing, realignment, and lengthening to a substantial degree, including the Ilizarov apparatus.^[14]