Editorial
Volume 49, Issue 11, November 2020

Good bones

Chris Wall   
doi: 10.31128/AJGP-10-20-5662   |    Download article
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When the bones are good, the rest don’t matter …

– Maren Morris1

While the words of this country song actually refer to a romantic relationship, orthopaedic surgeons are often jokingly accused of holding this viewpoint. Thankfully, the caricature doesn’t ring true. As pioneering orthopaedic surgeon Paul Brand remarked, ‘The most precious possession any human being has is his spirit, his will to live, his sense of dignity, his personality … Though our profession may be a technical one, concerned with tendons, bones, and nerve endings, we must realise that it is the person behind them who is so important’.2

Orthopaedic surgery derives its name from the term orthopedia, a composite of two Greek words: orthos meaning straight, and paidios meaning child. The term was originally coined in 1741 by Nicholas Andry, a Professor of Medicine at the University of Paris.3 His textbook, Orthopedia, was written ‘to teach the different methods of preventing and correcting the deformities of children’.

Three centuries later, paediatric deformities remain a source of angst for parents and clinicians alike. While angular and rotational deformities of the lower limbs are common in children, the majority are physiological and can be expected to resolve with time. Genu varum or bow legs are common in infants under two years of age, whereas genu valgum or knock knees are common between the ages of three and six years.4 Other common physiological variants include neonatal calcaneovalgus foot deformities, infantile pes planus or flat foot, and torsional deformities presenting with in-toeing. In coming months, Australian Journal of General Practice (AJGP) will publish a series of articles focusing on paediatric orthopaedics. Topics will include developmental dysplasia of the hip in infants and toddlers, lower limb rotational abnormalities and paediatric scoliosis.

From its origin in paediatric deformity correction, the specialty of orthopaedics has expanded in breadth to include management of musculoskeletal pathology of the upper limbs, spine and lower limbs across the lifespan, from the very young to the very old. This issue of AJGP focuses on common orthopaedic conditions affecting the adult population. The breadth of the specialty is reflected in the topics covered, including basal thumb arthritis,5 lateral epicondylitis,6 non-radicular low back pain,7 pre-operative optimisation for hip and knee arthroplasty,8 conditions affecting the Achilles tendon9 and bunions.10

Orthopaedic surgery continues to evolve and advance as a specialty, constantly aiming to improve quality of life for patients with musculoskeletal pathology. Recent advances in orthopaedics are discussed, including the development of data registries, improvements in medical therapy and rehabilitation protocols, and the advent of robotic assisted joint replacement.11

We hope you enjoy the articles in this ‘bones’ issue of AJGP. Because while the rest does matter, it’s important that the bones are good!

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References
  1. Morris M. The Bones. Girl: Columbia Nashville; 2019. Search PubMed
  2. Wilson DC. Ten fingers for God: The life and work of Dr Paul Brand. USA: Paul Brand Publishing, 1996. Search PubMed
  3. Ponseti IV. History of orthopaedic surgery. Iowa Orthop J 1991;11:59–64. Search PubMed
  4. Joseph B, Nayagam S, Loder RT, Torode I. Paediatric orthopaedics: A system of decision-making. London, UK: Hodder Arnold, 2009. Search PubMed
  5. Shridhar V, Williams S. Basal thumb arthritis: Treatment strategies for managing pain. Aust J Gen Pract 2020;49(11):702-06. Search PubMed
  6. Johns N, Shridhar V. Lateral epicondylitis: Current concepts. Aust J Gen Pract 2020;49(11):707–09. Search PubMed
  7. Parr A, Askin G. Non-radicular low back pain: Assessment and evidence-based treatment. Aust J Gen Pract 2020;49(11):724–27. Search PubMed
  8. Wall C, de Steiger R. Pre-operative optimisation for hip and knee arthroplasty: Minimise risk and maximise recovery. Aust J Gen Pract 2020;49(11):710–14. Search PubMed
  9. Touzell A. The Achilles tendon: Management of acute and chronic conditions. Aust J Gen Pract 2020;49(11):715–19. Search PubMed
  10. Aebischer AS, Duff S. Bunions: A review of management. Aust J Gen Pract 2020;49(11):720–23. Search PubMed
  11. Loch A. Advances in orthopaedic surgery. Aust J Gen Pract 2020;49(11):697–99. Search PubMed

Orthopaedics

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