Orthopaedic surgeons deal with deformity, diseases of bones and joints, and injuries to the musculoskeletal system. Because these are among the commonest things to affect humankind there must always have been orthopaedic surgeons of one kind or another, even in the most primitive communities. Wherever there was a witch doctor or medicine man dealing with illness and disease, as general practitioners and physicians do now, somewhere there would have been a ‘bone setter’ treating fractures and straightening limbs.

Despite these ancient origins, the word ‘orthopaedic’ is a recent introduction derived from the title of a book published by a French physician, Nicolas Andry, in 1741: Orthopaedia, or, The Art of Correcting and Preventing Deformities in Children: By such Means, as may easily be put in Practice by Parents themselves, and all such as are Employed in Educating Children.

The word itself is derived from the Greek orthos pais and means only ‘straight child’, but orthopaedic surgery has expanded from the correction of deformities in children to embrace every aspect of musculoskeletal surgery. Apart from coining the word orthopaedics, Andry also designed the symbol that has now become the worldwide logo of orthopaedic surgery. The ‘Tree of Andry’ is taken from an engraving in Orthopaedia that showed a crooked tree tied to a stake in order to straighten it (Fig. 1.1). The fact that it is virtually impossible to straighten a crooked limb by tying it to a straight splint has not affected the popularity of the symbol, which has been adapted for many purposes (Fig. 1.2).

In some countries, the work of the bone setter was willingly carried out by physicians, and Hippocrates himself is credited with the development of a technique for reducing dislocated shoulders which stood the test of time until general anaesthesia made it easy to overcome muscle spasm. Hippocrates is also said to have treated recurrent dislocation of the shoulder by applying a flaming torch to the axilla, but this treatment has not survived.

Physicians were not always as enlightened as Hippocrates. The bone setter, who earned his living by his ability to manipulate broken limbs, was often regarded with disfavour by the established medical profession, and this was certainly true in Britain. When the Medical Act of 1858 restricted the use of the title ‘Doctor’ to those who had passed certain recognized examinations, bone setters were excluded and became unregistered practitioners; however, this did not stop them practising, and their success remained a source of continual irritation to the medical profession. Orthopaedic hospitals existed in London and other large cities during the middle of the 19th century but they remained under the direction of registered medical practitioners.

The medical profession might have been denied access to the ‘black arts’ of the bone setters altogether if it had not been for Evan Thomas, renowned as the last of the great Welsh bone setters, who decided to put all five of his sons through medical school. One of these sons was the legendary Hugh Owen Thomas (1834–1891), who trained in Edinburgh but qualified with the London MRCS in 1857 (Fig. 1.3). It is ironic that when Hugh Owen Thomas joined his father’s practice in Liverpool, they found themselves unable to work together and quickly parted.

Hugh Owen Thomas had an enormous impact on the development of orthopaedic surgery in Britain, both by his own effort and through his influence upon his nephew Robert Jones (1857–1933). Between them, Hugh Owen Thomas and Robert Jones laid the foundations of British orthopaedic surgery so successfully that it is easy to forget that less than a century ago much of its present work was carried out by practitioners regarded as charlatans by the rest of the profession.

As orthopaedic surgery became established, it attracted much the same attention from factions within the medical profession as the profession had shown the bone setters of the previous century. In 1918, 12 surgeons founded the British Orthopaedic Association. Also in 1918, the Royal College of Surgeons in England found time in a busy schedule to ‘view with mistrust and disapprobation the movement in progress to remove the treatment of conditions, always properly regarded as the main portion of the General Surgeon’s work, from his hands and place it in those of “orthopaedic specialists”.’ The general surgeons were right to be worried; they are now almost outnumbered by orthopaedic surgeons and the gap is closing fast.

The wide range of conditions and different types of patients makes orthopaedic surgery an unusually interesting specialty which offers ‘something for everybody’, but there is also the satisfaction of knowing that the majority of patients can be helped. Patients with disabling arthritis are made more comfortable, deformities can be corrected or prevented; few orthopaedic patients are ‘ill’ in the true sense of the word, and malignant disease is rare. Trauma patients, in particular, are usually healthy individuals plucked from the community at random, quite literally by accident, and restoring them to full fitness is very rewarding.