Orthopaedics is a medical specialty that focuses on the diagnosis, care, and treatment of patients with disorders of the bones, joints, muscles, ligaments, tendons, nerves, and skin. These elements make up the musculoskeletal system. The physicians who specialize in this area are called orthopaedic surgeons or orthopaedic surgeons.

Orthopaedic surgeons are involved in all aspects of heath care pertaining to the musculoskeletal system. They use medical, physical, and rehabilitative methods as well as surgery.

Typically, as much as 50 percent of the orthopaedic surgeon's practice is devoted to no surgical or medical management of injuries or disease and 50 percent to surgical management. Surgery may be needed to restore function lost as a result of injury or disease of bones, joint, muscles, tendons, ligaments, nerves, or skin.

The orthopaedic surgeon also works closely with other health care professionals and often serves as a consultant to other physicians. Orthopaedic surgeons play an important role in the organization and delivery of emergency care. They are members of the teams that manage complex, multi-system trauma.

Orthopaedics is a specialty of immense breadth and variety. Orthopaedic surgeons treat a wide variety of diseases and conditions, including

• fractures and dislocations
• torn ligaments, sprains, and strains
• tendon injuries, pulled muscles, and bursitis
• ruptured disks, sciatica, low back pain, and scoliosis
• knock knees, bow legs, bunions, and hammer toes
• arthritis and osteoporosis
• bone tumors, muscular dystrophy and cerebral palsy
• club foot and unequal leg length
• abnormalities of the fingers and toes and growth abnormalities

Great advances have occurred in the surgical management of degenerative joint disease. For example,

Orthopaedic surgeons can replace a diseased joint with a prosthetic device (total joint replacement).

• Arthroscopy, the application of visualizing instruments to assist in the diagnosis and surgical treatment of internal joint diseases, has opened new horizons of therapy.
• Research is progressing on "growing" articular cartilage in joints, which may one day reduce the need for some people to get joint replacements.
• Exciting cellular research may enable orthopaedic surgeons to stimulate the growth of ligaments and bone in patients someday in the future.

The Greek roots of orthopaedics are ortho (straight) and pais (child). Much of the early work in orthopaedics involved treating children who had spine or limb deformities. Orthopaedic surgeons continue to treat children, as well as diseases prevalent in the elderly.

Some orthopaedic surgeons confine their practice to specific areas of the musculoskeletal system, such as the spine, hip, foot, or hand. Many generalists have a special interest in a specific area, but still treat most injuries or diseases of the musculoskeletal system.

• 32 percent of orthopaedic surgeons designate themselves as "general orthopaedic surgeons"
• 37 percent consider themselves "general orthopaedic surgeons with specialty interest"
• 31 percent consider themselves "specialists within orthopaedic surgery"

If you are considering a career in orthopaedics, you need a high scholastic aptitude, mechanical ability, a high degree of manual dexterity, and excellent three-dimensional visualization skills.

In addition, orthopaedic surgeons generally are action-oriented individuals. Many have an interest in athletics and may serve as team physicians at the high school, college, or professional level.

To become an orthopaedic surgeon you must:

• complete four years of college
• complete four years of medical school
• complete five years of accredited graduate medical education

Most approved orthopaedic residency programs now provide for four years of training in orthopaedic surgery and an additional year of training in a broad-based accredited residency program such as general surgery, internal medicine or pediatrics. A few programs require two years of general surgery prior to three years of clinical orthopaedic studies. Salaries of orthopaedic residents are similar to other graduate medical education opportunities.

To be certified as orthopaedic specialist by the American Board of Orthopaedic Surgery, a candidate must:

• complete the orthopaedic residency
• practice orthopaedic surgery for two years
• pass written an oral examinations offered by the Board

Orthopaedics is an extremely competitive field. There are approximately 650 residency programs available each year in the 170 accredited programs. Candidates for orthopaedic residencies generally graduate at the top of their medical school classes. Most have completed a full orthopaedic rotation in medical school. About 7 percent of current orthopaedic surgery residents are women; about 20 percent are members of minority groups.

Research experience is encouraged in many programs, and clinical rotations may occur in one or more affiliated hospitals for basic or special educational needs such as pediatric orthopaedics or rehabilitation. There are many areas of special interest that orthopaedic surgeons can choose as a focus for their practice, and many physicians spend and additional six months to a year in training in a particular field of interest. Fellowships are available in areas such as hand surgery, pediatric orthopaedics, reconstructive surgery, spine, foot and ankle, shoulder, and sports medicine.

There are approximately 20,400 actively practicing orthopaedic surgeons and residents in the United States. Orthopaedic surgeons typically practice in one of three settings.

• Solo practitioners work for themselves, although they may share office space and clerical help with other orthopaedic surgeons or other physicians.
• Orthopaedic groups often consist of two to six orthopaedic surgeons working together. They share the costs for the office, see each other's patients, provide continual "coverage" in hospital rounds, and work together in other ways as well. In many groups, there are both generalists and specialists who focus on a particular area such as the hand or spine.
• Multi-specialty groups involve a number of orthopaedic surgeons working with other specialists such as internists, family practitioners, and cardiologists. Generally, the larger the multi-specialty group, the more specialties are represented.

Many orthopaedic surgeons practice in managed health care and alternative health care delivery systems such as health maintenance organizations (HMOs), independent practice associations (IPAs) and preferred provider organizations (PPOs). Such health care options provide physician services for a fixed or agreed-upon rate, rather than the traditional fee-for-service arrangement.

Many orthopaedic surgeons are also involved in education. Some are full-time members of a medical school faculty. They treat patients, supervise resident education and conduct research. Others are part-time teachers of medical students and residents in the private practice setting. Members of the American Academy of Orthopaedic Surgeons also serve in the military and work in administrative positions for government or health care providers.

During the past 20 years, scientific and technological advances have enabled orthopaedic doctors to use medical and surgical treatments never before possible. Future opportunities in orthopaedics will be influenced by several major trends, including:

• an aging population (increasing numbers of fractures and reconstructive surgeries)
• trauma treatment protocols
• injuries in sports and the workplace
• changes in the way health care is organized and delivered
• continuing advancements in technology, gene therapy and medical management of disease