Western medical practice has its beginnings in ancient Greece, which was in turn influenced by the Egyptians. One of the descendants of the Greek sun

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1 Title of the exhibition, : The Past and the Present of Orthopaedics Organizers, : The Hong Kong Orthopaedic Association The Hong Kong College of Orthopaedic Surgeons The Hong Kong Museum of Medical Sciences Sponsor 1. The history of orthopaedics Although the term orthopaedics is of comparatively recent origin, diseases afflicting the musculoskeletal system are as ancient as the human race. From time immemorial, prehistoric mankind had been involved with constant struggles for survival with a hostile environment. Injuries due to clashes with wild animals, and fights between individuals resulted in fractures, dislocations, infections, and subsequent deformities or even death. With accumulation of experiences, the treatment methods for such traumas gradually formed the basis of orthopaedics. Page 1 of 1

2 Western medical practice has its beginnings in ancient Greece, which was in turn influenced by the Egyptians. One of the descendants of the Greek sun god was reputed to be Hippocrates of Cos, acknowledged as the Father of Medicine. His oath is still revered as the ethical code of practice by modern medical doctors worldwide. The large collection of writings by Hippocrates and his followers, the Corpus Hippocraticus, contains volumes dealing with bone and joint injuries and diseases that are unsurpassed even today in their accuracy and clinical application. The treatment for dislocations of the shoulder and hip joints has not been bettered since. The word of orthopaedics was first coined by Professor Nicolas Andry in The University of Paris in 1741, signifying straight and free from deformities in children. Similarly in Chinese traditional medicine, dealing with bone and joint diseases is termed Zheng Gu ( ), meaning to straighten the bone to its original position. (The Corpus Hippocratics) 1741 Orthopaedics Orthopaedics Page 2 of 2

3 Figure 1-1: The splinted tree of Nicolas Andry is the universal symbol of orthopaedics. 1-1: Figure 1-2, 1-3: Various methods of close reduction of shoulder dislocation in ancient time, but not much different from the modern days. 1-2, 1-3: Page 3 of 3

4 Figure 1-4: Hippocratic method of fixation of fractures on the leg in ancient time. 1-4: Figure 1-5: To keep the child straight, the meaning of orthopaedics. 1-5: orthopaedics ( ) Page 4 of 4

5 Figure 1-6: Basic modern surgical instruments. 1-6: 2. The history of Chinese medicine in treating bone and joint diseases From Huangdi (Yellow Emperor) to contemporary society, Chinese have accumulated over 3000 years experiences in treating bone and joint diseases. The earliest record of operating surgeries in history is mentioned in Siji (The Records of Grand Historian). Yu Fu, one of the ministers of Huangdi, was very famous in curing people. Siji Bianque Canggong Liezhuan of Siji (The Biography of Bianque and Canggong in the Records of Grand Historian) stated that Yu has operated surgeries for the patients. In Zhou Dynasty (BC ), the Chinese medicine was gradually separated in different divisions, named as Zong Yan (Swelling), Kui Yang (Ulcer), Jin Yang (Trauma) and Zhe Yang (Sprain and break bones). These divisions were the foundation of Chinese orthopaedics. During the late Han dynasty, Hua Tuo, the most outstanding doctor in China, was born. He not only knew the use of medicine, but also operated surgeries for those in needs. Moreover, he created the Wu Qin Xi (Movement of Five Animals), which was the embodiment of modern sports therapy. In Jin dynasty ( ), Ge Hong was a famous Taoist. His doctrine in Jouhou Beijifong (Emergency Prescriptions) has described how to treat the dislocation of chin joint. Nowadays, people still follow his principles. In AD 610 of Sui Dynasty, Chao Yuan Fong finished the Zubing Yuanhou Zonglun (Treaties on the Cases and Symptoms of Illness). It was the first book on human pathology in Chinese history. The Shenji Zonglu (General Catalogue of Divine Assistant) which written by Emperor Hui was the most important medical literary in Song dynasty. Page 5 of 5

6 During the Yuan dynasty ( ), the skills and methods in treating bone and joint diseases were rapidly developed due to the frequent outbreak of wars. Thus, Zheng Gu (to straighten the bone to its original position) together with Jin Cu (to cure trauma) was separated from the surgery division and formed the independent category. The Tai Yi Yuan (Department of Medicine in Palace) in Ming dynasty was based on the foundation of Yuan dynasty. The Zheng Gu and Jin Cu were reorganized and became two independent subjects, which named as Jie Gu (to set the broken bones) and Jin Chung (to cure trauma). In Qing dynasty ( ), Jie Gu was renamed as Zheng Gu. Four chapters of Zhenggu Xinfa Yaojue (Treaties of Straightening the Bone to Its Original) were included in the publication of Yizong Jinjian (Golden Mirror of Medicine) by Emperor Chienlung. Yizong Jinjian is a Chinese medical encyclopedia in which the use of external splint to treat backbone problems was described with illustration. To be brief, the Chinese medicine has a very long history in treating bone and joint diseases, which makes valuable contributions in human society Page 6 of 6

7 ( ) Figure 2-1: Hua Tuo ( ), renowned for conducting operation for the arrow wound of General Guan Yu ( ). 2-1: Page 7 of 7

8 Figure 2-2: Zhubing Yuanhou Zonglun (Treatise on the Cases and Symptoms of Illness): The first book on human pathology in Chinese history. 2-2: Figure 2-3, 2-4: Yizong Jinjian (Golden Mirror of Medicine): A Chinese medical encyclopedia in the Qing Dynasty, in which the use of external splint to treat backbone problems was described with illustration. 2-3, 2-4: 3. The Development of Orthopaedics in Hong Kong With the modernization of Hong Kong and introduction of western medicine, the success of modern orthopaedics was gradually recognized and accepted widely by the vast majority of the local people despite the presence of numerous bone setters in nearly every corner of the city, who are treating patients with similar musculo-skeletal diseases and injuries to various degrees of success. The unique geographic and historic position of Hong Kong features in its linkage between the Western and Chinese cultures. This also makes it a fruitful soil for the growth of modern orthopaedics when western medicine practitioners skillfully and successfully apply modern medical treatment for local endemic diseases. Page 8 of 8

9 Tuberculosis infection of the spine was one of the common diseases affecting local Chinese before Hong Kong s becoming prosperity in the middle of 20 th century. The local experiences in dealing with this disease helped to boost the development of the operation of anterior spinal fusion. The success of this surgery brought about its popularity worldwide and earned its name of the Hong Kong Operation internationally. Similar achievements in hand surgery, neuromuscular disorders and scoliosis have gained Hong Kong a place in the map of orthopaedic world. Page 9 of 9

10 Figure 3-1 to 3-8: The history of The Duchess of Kent Children s Hospital at Sandy Bay is an epitome of the development of Hong Kong orthopaedics : Figure 3-9: Professor Arthur Ralph Hodgson (on the right) and Professor Ming Choy Arthur Yau (on the left) were the pioneers of the Hong Kong orthopaedics. They popularized the Hong Kong operation. 3-9: Figure 3-10: TB spine resulting in severe kyphotic deformity. 3-10: Page 10 of 10

11 Figure 3-11: MRI of Thoracic TB spine. 3-11: Figure 3-12 to 3-15: Preoperative and postoperative X-rays of TB spine and anterior spinal fusion : X Figure 3-16 to 18: Before and after cervical anterior spinal fusion : Page 11 of 11

12 Figure 3-19: Professor Arthur R. Hodgson was demonstrating the examination of a paediatric patient. 3-19: Figure 3-20: a Professor Arthur R. Hodgson was attending a social function. 3-20: Figure 3-21: A patients party. 3-21: 4. Current surgical treatment of fractures: Civilization of a modern society does not make human beings immune to trauma. Traffic accident, industrial accident and violence still remain the main causes of bone fractures today. However modern surgical fixation techniques are able to reconstruct the fractured bone fragments to a stable structure, so the patient can start to use their injured limbs as early as possible. Such early active rehabilitation program dramatically improves the outcome of the treatment. Most patients can regain their maximal functional recovery after severe bone fractures. Page 12 of 12

13 Figure 4-1, 4-2: Plating fixation is commonly used for long bone fracture. 4-1, 4-2: Figure 4-3: Intramedullary nailing for fracture of the humeral shaft 4-3: Page 13 of 13

14 Figure 4-4: External fixation is good for some difficult leg fractures. 4-4: Figure 4-5, 4-6: External fixation for some upper limb fractures 4-5, 4-6: Page 14 of 14

15 Figure 4-7: Preoperative and postoperative X-rays of a patient with supracondylar fracture of the femur and the excellent range of his knee motion after recovery. 4-7: X Figure 4-8: Intramedullary K-wire fixation is new method of internal fixation widely used in paediatric fractures. 4-8: Figure 4-9: A new trend of development in orthopaedic surgery: computer assisted navigation system is used in internal fixation of bone fracture. 4-9: Page 15 of 15

16 5. Nonoperative treatment for fractures Not all fractured bone need surgical fixation. Some fractures can be treated with equally satisfactory result by nonoperative means, e.g. Plaster of Paris, limb splint or traction. It is more commonly used in children patients and for fractures due to low energy trauma. Figure 5-1: A dynacast plaster for leg fracture. 5-1: Figure 5-2: Leg splint for lower limb fracture. 5-2: Page 16 of 16

17 Figure 5-3: Brace used for hand fracture. 5-3: Figure 5-4: Skeletal traction for lower limb fracture. 5-4: Figure 5-5: Immobilization of the fractured limb allows early functional recovery. 5-6: Page 17 of 17

18 Figure 5-6: Active physiotherapy is essential for rehabilitation. 5-6: 6. Surgical correction of spinal deformity: Scoliosis Scoliosis is a spinal deformity with lateral curvature. It prevails in adolescent girls. In mild cases, there is no need for any intervention. But severe cases may create unacceptable cosmetic appearance, back pain, progressive deterioration and compromised cardiopulmonary function. So external bracing or even surgical correction may be warranted. Page 18 of 18

19 Figure 6-1: The methods to make scoliotic deformity more obvious. 6-1: Figure 6-2: Orthosis helps to correct scoliosis. Page 19 of 19

20 Figure 6-3: Surgical correction of scoliosis: preoperative and postoperative X-rays. Figure 6-4: Halo-pelvic traction devices used for scoliosis. 6-4: Figure 6-5: Let s take a fly: halo-pelvic traction allows patients ambulatory while on treatment. 6-5: Page 20 of 20

21 Figure 6-6: Caring for the patient with spinal problem. 6-6: 7. Prolapse of intervertebral disc Prolapse of intervertebral disc (PID) in the lumbar spine is a common cause of sciatica. Typically the patient may have pain in the back and radiating to the lower limb. Majority of the patient can be treated by nonoperative means with oral drugs and physiotherapy. Some patients may need surgical treatment if the symptom is intractable. Page 21 of 21

22 Figure 7-1: The pathoanatamy of PID causing nerve root irritation. 7-1 : Figure 7-2 to 7-5: MRI of PID in saggital and transverse views : Figure 7-6: New implant used for anterior spinal fusion. 7-6 : Page 22 of 22

23 Figure 7-7: Spinal operation in progress. 7-7: 8. Adult joint reconstruction for degenerative joint diseases: THR : Total hip replacement is one of the most successful surgeries in the 20 th century. Hip joint degeneration disease is a common cause for hip pain in adult patients. When the disease is at its advanced stage, the patient may have difficulty in walking due to the hip pain, deformity and stiffness. This operation can give the patient a significant relief of pain and allow them to walk normally and painlessly. The result is most gratifying. Figure 8-1: Sir John Charnley, the pioneer surgeon in total hip replacement surgery. 8-1 : John Charnley Page 23 of 23

24 Figure 8-2 to 8-4: 3D CT scan and X-ray of severe osteoarthritic hip before total hip replacement surgery, and X-ray after the operation : X X Figure 8-5: Prosthetic total hip joint implant. 8-5 : Page 24 of 24

25 Figure 8-6, 8-7: A vascular necrosis of the femoral head is a common condition for total hip replacement in Hong Kong. 8-6, 8-7: Figure 8-9: Surgeons are doing operation of revision total hip replacement. 8-9: 9. Adult joint reconstruction for degenerative joint diseases: TKR : The success of total hip replacement hastens the development of total knee replacement. In Hong Kong primary osteoarthritis of the knee is a common disease; total knee replacement therefore is one of the commonest orthopaedic operations in many local hospitals. Total knee replacement can reduce the patient s knee pain, correct knee deformity and improve the knee motion. Patients are usually very satisfied with the dramatic improvement in their knee pain as they can enjoy a much better quality of life. Page 25 of 25

26 Figure 9-1: Degenerated articular cartilage and torn meniscus of the knee. 9-1: Figure 9-2, 9-3: A patient with severe osteoarthritic knees before and after the total knee replacement operation. 9-2, 9-3: Figure 9-4: Prosthetic total knee implant used nowadays. 9-4: Page 26 of 26

27 Figure 9-5: The operation of total knee replacement was being carried out. 9-5: 10. Minimally Invasive Surgery: Arthroscopy : The use of arthroscopy opens a new area in the orthopaedic surgery. On one hand, the minimally invasive nature of arthroscopy leaves a small surgical scar on the patient and allows them to return to normal functional status much earlier. On the other hand, as most of the arthroscopic surgery is used in treating patients suffering from sport related injuries, it marks a milestone for development of sport medicine. With the new development of technology and accumulation of experiences and knowledge, the scope of arthroscopy is extending constantly. Nowadays arthroscopy is not only widely used in large joints like knee, shoulder, elbow, and hips, but also well accepted as a useful tool in wrist, ankle, and hand surgery. Anterior cruciate ligament tear is one of the commonest sport injuries that require surgical intervention. Reconstruction of the torn ligament helps the patient to restore their performance in sport competitions and to prevent them from early degenerative joint disease. Page 27 of 27

28 : 腂 Figure 10-1: A knee model. 10-1: Figure 10-2: Equipment set of arthroscopy in an operation room 10-2 : Page 28 of 28

29 Figure 10-3: Arthroscopic view of meniscal tear 10-3 : Figure 10-4: Arthroscopic view of a torn anterior cruciate ligament 10-4 : Figure 10-5: A surgeon is reconstructing the anterior cruciate ligament. 10-5: Page 29 of 29

30 11. Paediatric Orthopaedics: Developmental Hip Dysplasia : Developmental hip dysplasia is a congenital abnormal condition of the hip joints. Although it is not common in local people, its late sequelae could cripple many of its sufferers badly. The success of the treatment relies much on its early recognition in the infancy. Leg length discrepancy and delayed ability to walk should prompt the parents to seek medical consultation. Generally speaking, treatment for this disorder is nonoperative for those at a younger age and operative for those at an older age. Patients successfully treated can have a better walking ability in the rest of their life. Figure 11-1: X-ray of congenital hip dislocation. 11-1: X- Page 30 of 30

31 Figure 11-2, 11-3: X-rays of advanced hip dislocation in adult patient. 11-2, 11-3: Figure 11-4: To maximize the functional potential, occupational therapy is important in paediatric orthopaedic patients. 11-4: Page 31 of 31

32 Figure 11-5: A paediatric patient is on walking exercises. 11-5: 12. Flat Foot There are many causes for flat feet. Majority of the patient with flat feet need no any intervention and can have pain-free and functional feet. Some patients may have structural abnormalities in the foot, which usually necessitate detailed examination and investigation to reach the diagnosis. Some may even require surgical intervention. Figure 12-1: Flat foot showing the collapse of the medial arch. 12-1: Page 32 of 32

33 Figure 12-2: X-ray of vertical talus, one of the pathological causes of flat foot. 12-2: X Figure 12-3: CT scan of tarsal coalition: an abnormal connection between two bones resulting in flat foot. 12-3: : Figure 12-4: Severe foot deformity, very disabling and disfiguring 12-4: Page 33 of 33

34 Figure 12-5: Toe reconstruction for congenital toe anomaly. 12-5: 13. Thumb up is always good. The thumb accounts for 50% of the hand function. It is of utmost importance to reconstruct a thumb if it is amputated in an accident. The use of a microscope enables the hand surgeon to repair the hair-sized nerves and vessels. If the thumb is totally lost, one method is to utilize the patient s toe and transfer it to the thumb. A foot with one toe less does not affect the patient s normal life significantly, but a functioning thumb is just indispensable. Page 34 of 34

35 Figure 13-1, 13-2, 13-3: Traumatic amputation of an index finger and open fracture of a thumb and after operations of revascularization and reconstruction. 13-1, 13-2, 13-3: Figure 13-4, 13-5, 13-6: A lost part of a thumb can be reconstructed with a vascular flap from the big toe. 13-4, 13-5, 13-6: Page 35 of 35

36 Figure 13-7 to 13-10: Thumb reconstruction for congenital anomaly : Figure 13-11: Magnification loop helped to visualize the tiny nerves and vessels in surgery : Page 36 of 36

下列病症以身體結構上的客觀徵狀作為準則cda sick leave code.doc

下列病症以身體結構上的客觀徵狀作為準則cda sick leave code.doc 下列病症以身體結構上的客觀徵狀作為準則, 病假的建議依據參考有效康復所需的時日而定 : A) 不定位的肌肉和骨骼病症 Unspecified musculoskeletal Diseases: 1) 單關節痛症 Monoarticular Joint pain (ICD-9-CM 719.40) 必