As International Orthopaedic Nurses' Day approaches, I would like to take you back in history to reflect on the origin of different orthopaedic terms and practices and the people who were instrumental in advancing orthopaedic practice and orthopaedics as a specialty.
Orthopaedics comes from the Greek words for "straight" and "child." In fact, one of the earliest uses of this word was by the "father of Orthopaedics," the famous Professor Nicholas Andry in 1741. He used this term to describe skeletal deformities, which he regarded as occurring due to faults of posture and shortness of muscles. He was also the illustrator of postural defects using his famous "Tree of Andry."
Much of the work of the orthopaedists of old occurred during the 19th and early 20th centuries, where fractures and surgical procedures were named after the people who identified them. The Tinel sign so frequently used in evaluations of the upper extremity was first described by Jules Tinel, a neurologist in the first World War who percussed the nerve below the site of a nerve injury. "Formication," as he described it, was elicited if nerve fibers were degenerating; poor prognoses were noted if this was absent.
Thomas Porter McMurray, originally from Belfast, Northern Ireland, worked for Robert Jones, a groundbreaking orthopaedist. His surgical precision was unparalleled, and in 1928, he published a paper on internal derangements of the knee where he introduced his assessment sign for a torn meniscus, the McMurray's sign.
Friedrich Trendelenburg, of German descent, is credited with identifying the Trendelenburg sign and the Trendelenburg gait, which was described in association with coxofemoral incompetence in 1895.
Austin T. Moore performed the first metallic hip replacement in 1942. He replaced the entire upper portion of the femur with a vitallium prosthesis a foot long!! His prosthesis has been redesigned over the years, and the procedure has been modified, but the Austin-Moore prosthesis continues to exist and be used today.
Sir Robert Jones was an important figure in orthopaedic history at the turn of the century. He was a nephew of the "father of British Orthopaedics," Hugh Owen Thomas. Robert Jones is credited with publishing the first report of the clinical use of x-ray to locate a bullet in a wrist (http://Orthoteers.co.uk, 2005). He founded many hospitals and orthopaedic associations, most notably the Robert Jones and Agnes Hunt Hospital near Oswestry, England, and was an advocate of tendon transplantation, bone grafting, and other conservative restorative procedures.
Dame Agnes Hunt is considered the founder of orthopaedic nursing. Crippled as a child due to osteomyelitis, she grew up to be a visionary nurse who opened her own convalescent home for crippled children and used the concepts of open-air treatment in caring for the children left in her care. This treatment, though helpful for respiratory diseases, was never proven to be beneficial in orthopaedic care. Her small home in Baschurch, England was renowned for influencing changes in health for those with long-standing disease.
Dame Agnes met Robert Jones in 1903 when she consulted him for her own hip deterioration. He visited her at the convalescent home and the rest, as they say, is history. He began seeing patients there monthly and eventually began operating on children first, military patients later. He evaluated everything from rickets and tuberculosis of the bone to congenital flat-foot deformities. The average length of stay was 13 weeks, 4 days.
In addition to being a caregiver, Dame Agnes was also a teacher. She began teaching well-rounded girls in the care of "crippling diseases." After a year, these pupils went on to a "proper" hospital to gain official nursing certification. Massage was a mainstay in the care of patients who were crippled. In 1910, Hunt contacted the Incorporated Society of Trained Masseuses and registered her home as a school of massage and Swedish remedial exercises. By 1911, the first two nursing pupils obtained diplomas in what is known as physiotherapy. Dame Agnes' efforts led to schools being created for both nursing and physiotherapy.
As World War I began, the home eventually became a military hospital, but they continued to treat children as well, becoming one of the first institutions to use x-rays for diagnostic purposes. In recognition of her work during the war, Dame Agnes received the insignia of the Red Cross; by 1919, the home closed for military patients. Her efforts and the need for a newer building led to the now-known Robert Jones and Agnes Hunt Orthopaedic Hospital, originally known as the "Shropshire Orthopaedic Hospital" (Carter, 2000).
As you can tell, there is a fascinating history to our specialty area. My wish is that this historical overview has inspired you to not only want to learn more about it but also realize that it only takes only one person to create change and achieve greatness within the position. Look around you, identify those who can help you to create change and to showcase all that orthopaedic nursing can offer. See what you can do to assist others to partner with you for continued orthopaedic nursing growth. Happy International Orthopaedic Nurse's Day!!
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