I was a medical student about 25 years ago when surgery was one subject in MBBS and Orthopaedics was a subspecialty. The specialist training
introduced in Orthopaedics a few years before that and it was recognised as a welcome change, as the skills required in Orthopaedic surgery were significantly different compared to other surgical specialities. As our knowledge and technologies advanced, Orthopaedics itself has become a vast field now, and we are now able to offer a variety of non operative and operative solutions to many orthopaedic problems.
Orthopaedics is now categorised into subspecialties such as Spine surgery, Arthroscopy & Sports medicine, Joint replacements, Trauma management, Paediatricorthopaedics, Hand Surgery, Foot & Ankle operation and so on. Basic training of how to deal with bones, joints and muscles are required in all subspecialties. The skills needed for the surgical treatment aspects of subspecialties of orthopaedics is varied, depending on the subspecialty. Spine surgery involves training with microscopes and endoscopes as most of the spinal operations done with a minimally invasive technique, and training is also required to handle neural tissues. Arthroscopic surgery requires what we call as triangulation and three dimensional spatial orientation, as the surgeon is viewing a monitor while operating on a patient with specialist equipment. Joint replacement requires various bone cement fixation techniques and a thorough understanding of the materials used. Trauma surgery involves an understanding of the forces and effects involved in trauma and also an understanding of various fixation techniques. Paediatric orthopaedics requires knowledge of how to deal with a growing skeleton. Hand surgery requires training in microsurgical methods, as the neurovascular structures in hand are often microscopic. Foot and ankle surgery requires a thorough understanding of gait and its effects on various joints.
A good orthopaedic surgeon should have a basic understanding and treatment possibilities of all the subspecialities of orthopaedics, as many of these problems could coexist across subspecialities. However, it not easy for one person to master all these surgical techniques. Hence, there is a lot of subspecialisation in modern Orthopaedics, and as a patient it is essential to understand the capabilities of your surgeon before subjecting yourself to treatment. Specialist Orthopaedic and Spinal surgery centres should be able to offer you surgeons appropriately trained in different subspecialities of orthopaedics which should give better surgical outcomes.
-Dr S S Kumar
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