Orthopedic surgeries are broadly of two types, trauma, and cold orthopedic surgeries.
Trauma Surgery repairs or reconstructs damaged musculoskeletal structures like bones, tendons, nerves, blood vessels and ligaments. Trauma surgeries often follow a timeline, within or after which the surgery is scheduled. This can be as early as within 6 hours in case of injury to nerves and blood vessels while some injuries like knee or ankle fractures may need a week to become operable. Trauma surgeries are also typically the ones where the patient does not have much leeway to explore multiple options by taking a second or third opinion.
Complex trauma surgeries may require multiple specialists like neurosurgeons, general surgeons, orthopedics and plastic surgeons. Re-implantation of completely severed hands is one of the complex traumatic surgeries that are now successfully done in select centers. Surprisingly emergency orthopedic surgeries are fewer, except in cases of open injuries, polytrauma or those done to salvage neuro-vascular structures.
Cold orthopedic surgery corrects non-traumatic conditions like arthritis, infection or tumor surgery. Most cold orthopedic surgeries are scheduled at the convenience of the patient and the surgeon, allowing enough time to optimize patient health before the procedure. These surgeries are also mostly elective in nature and provide sufficient time to the patient to seek additional opinions on whether to undergo it or delay it. Most common example of such surgeries includes the knee replacement surgery and hip replacement surgery.
A variety of skill-sets are used in Cold Orthopedic Surgery and often orthopedic surgeons sub-specialize in a particular type. Interestingly some parts of the world like America and Australia see surgeons mastering a particular skill-set like trauma, joint replacement or key-hole joint surgery. In other regions of the world, like Europe, orthopedic surgeons sub-specialize according to an area like hip, knee, hand, shoulder & elbow, foot & ankle. They believe it is more important to understand the function of that region in depth and then use various skill-sets like joint replacement or key-hole surgery to treat different conditions. Therefore, you may find joint replacement surgeons working on various joints, or you may find knee surgeons who do different types of surgery but restrict themselves to the knee. It just reflects the different trends in training.
While orthopedic surgery looks and sounds like a crude carpenter work, the error margin is often not more than 2 mm. Therefore best results are obtained when operative teams are well rested. Since bones do not react well to infection, orthopedic surgeons tend to be very paranoid about aseptic precautions during surgery. It also means that surgeons take up to 30-45 minutes to start surgery after anesthesia while the part is cleaned again and again to prevent infection. However, nature is kind to the orthopedic surgeon as bone is one of the few tissues that doesn’t scar, but can form bone again. What worries them is soft tissue, hence the adage: Only dogs look at bones, orthopods look after soft tissues!
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