Trauma & Orthopaedic Surgery
A Career In Trauma & Orthopaedic Surgery
Introduction
Orthopaedic surgery is concerned with the locomotor systems, the largest of the body. It covers a greater range of conditions than any other surgical specialty. The work is largely reconstructive and often curative. The majorities of treated patients either return to normality or have significant long-term relief of their pain or disability.
Orthopaedics encompasses patients of all ages from the pre-natal period. When musculoskeletal abnormalities may be detected by antenatal screening techniques, to the elderly, for whom the treatment of a fracture or degenerative disorder may allow return to independence and comfort.
Orthopaedic pathology is as varied as the anatomical areas and ranges of the patients. It includes congenital, traumatic, infective, neoplastic and metabolic conditions as they affect the locomotor systems.
The practice of orthopaedic surgery demands all skills of a physician in clinical diagnosis aided by the use of investigations that are often highly specialized. It needs clinical judgement in selecting those patients who will benefit from the enormous range of operative and non-operative treatments available. It requires organizational abilities to coordinate other groups of professionals. Finally, if surgery is indicated, high levels of operative skills are necessary.
Orthopaedics is expanding faster than any other specialty. More patients are demanding our services, and the range of treatments is constantly increasing. To support this expansion, research and development of new technologies proceed simultaneously with the day-to-day management of patients. The future of the specialty is extremely bright.
Much of orthopaedic work is not strictly surgical as many patients can be treated medically or non-operatively. However, to do this successfully demands high levels of clinical skills, including those of manipulation of bones and joints, plus a sound knowledge of both traditional and modern methods of casting, traction, splinting and appliances.
Also, prevention and early detection of disease and deformity is a vital and rewarding part of the job. How much better is it for the newborn or young infant to have hip disease diagnosed by a simple examination followed by gentle splintage, thereby offering a high chance of a normal hip, than to be presented with a young limping child with an established dislocation who might require several operations with no guarantee of a normal hip.
The different areas of work
In adult elective orthopaedics there is a vast array of diseases to tackle. The surgery to heal the deformity and distress of arthritis has progressed tremendously. Bioengineering advances allow us successfully to replace many joints, especially the hip and knee.
Spinal surgery has also advanced. Although we are still working to solve many causes of back pain, we cannot as yet offer treatments that would reliably and routinely improve the lot of all patients. However, there are selected incidences such as lumbar disc prolapse, when great relief can be obtained by surgery. There are also continuing improvements in operations for correcting the deformed, injured or infected spine.
In knee surgery and shoulder surgery the advent of the arthroscope has allowed new perspectives inI investigation and treatment. Such minimally invasive procedures are also being applied to other joints such as the hip, ankle, elbow and wrist. Elbow arthroscopy is becoming a very regularly undertaken treatment.
In children's orthopaedics we may be called upon to diagnose and treat a variety of congenital and inherited disorders such as clubfoot, congenital dislocation of the hip and such neuromuscular disorders as cerebral palsy, muscular dystrophy and spina bifida. Knowledge of genetics for counseling and research is often needed. Infectious disease as a whole has declined over the years. However, osteomyelitis, septic arthritis and tuberculosis still occur. They need recognising and treating if deformity and disability is to be avoided.
Fractures and soft-tissue injuries are a major problem, especially osteoporotic fractures in the elderly. Trauma is the major worldwide cause of morbidity and mortality in young people. The socioeconomic implications of hip fractures in the elderly and absence through disability from work or school in the otherwise young and fit are enormous to society, not to mention the individual's pain and suffering. Orthopaedics practiced to the highest standard can do much to alleviate these problems.
The care of the injured is a team effort in organizational skill as well as in urgent surgery. When modern methods of pre-hospital care, transport, resuscitation and early definitive surgery followed by well-organized rehabilitation are applied effectively, the saving of life, relief of suffering, avoidance of disability and rapid return to activity, are gratifying. It is unnecessary for many patients to remain in hospital for long periods. Moreover, it is realistic to expect a return to normal function in most cases.
Training
It is sometimes depressing to think that training as a doctor only really begins after five or six years in medical school. Orthopaedics is no different from any other specialty in that it requires a demanding training to become a consultant.
Elective periods are increasingly popular due to changes in undergraduate teaching. There is no prerequisite for someone wanting a career in orthopaedics to have undertaken an orthopaedic elective, but such an experience is worthwhile, considering it might involve travel to observe orthopaedic practice in developed and developing countries.
The foundation years are compulsory. Orthopaedic jobs at this level can offer a constructive combination of surgery, management of pre-existing medical problems, especially in the elderly, and resuscitation and post-operative management of injured patients.
If you wish a career in the surgical specialties, it is necessary to spend three years after foundation jobs in surgical training. This involves rotating through posts to gain experience in general surgery, orthopaedics, accident and emergency, and at least one other surgical specialty. Then you must take the MRCS examination in the principles of surgery in general.
After basic surgical training, it is necessary to get a career registrar appointment to an approved post in orthopaedic surgery. In practice, before you complete basic surgical training, you should make contact with orthopaedic consultants or heads of training well in advance, to ask for career advice and express an interest in the specialty.
Higher surgical training at present consists of six years spent as a specialist registrar on an organized training programme recognized by the Specialist Advisory Committee in Trauma and Orthopaedics, a subcommittee of the Joint Committee on Higher Specialist Training. The period of training is spent gaining experience in all aspects of orthopaedics. This includes the management of patients with all manner of conditions, and the surgical and non-surgical treatment of those conditions.
The eligibility to become a consultant depends on the completion of an approved training programme and success in the Trauma & Orthopaedic Fellowship examination, taken after four years as a specialist registrar.
The quality of training is closely monitored and provided by established consultants who have been selected for their abilities to train and give good experience for their trainees. Each head of programme has the responsibility to ensure the standards of training are met. All the training programmes are inspected at intervals to ensure each trainee receives good training, and is given the opportunity to pursue research and attend courses and meeting.
The British Orthopaedic Trainees Association (BOTA) helps ensure that orthopaedic training reaches the highest standards. Membership is open to all higher surgical trainees. There are representatives in all parts of the country to protect the interests of the orthopaedic trainee. BOTA is involved at all levels from local hospitals through to the Royal Colleges and British Orthopaedic Association.
Conclusion
In summary, orthopaedics is a huge, expanding, exciting and rewarding specialty; we can set children on the best possible road to normal life, restore injured people to normality, relieve much of the suffering of arthritis, and palliate and make comfortable the aged and terminally ill. There can be no better career in medicine.
Want more information?
For further information and details take a look at the following websites:
> British Orthopaedic Association
> Royal College of Surgeons of England
Last updated 25/12/06
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