History of Traumatology and Orthopedics

Antiquity and the Renaissance

For a long time, the treatment of injuries and musculoskeletal pathologies relied on the works of ancient thinkers. The Roman physician Aulus Cornelius Celsus (1st century BC) significantly supplemented Hippocrates' teachings in his treatise "De Medicina". He not only described various bone diseases but also detailed surgical approaches: bone scraping, cauterization, and resection (which he recommended performing until "a small amount of blood" appeared). Celsus made an enormous contribution to the study of traumatic brain injury (TBI), clearly outlining its symptoms: loss of consciousness and confusion, delirium, speech, sleep, and appetite disorders, as well as muscle rigidity. In addition, he was one of the first to point out that the treatment of children should differ from that of adults.

The doctrine of the skeleton received further development in the works of Galen (approx. 130–200 AD). He deeply investigated bone deformations and injuries, introducing classical terms into medical practice: lordosis, kyphosis, and scoliosis. Galen also emphasized the peculiar course of diseases and deformations in childhood.

The discipline made a significant leap during the Renaissance thanks to Ambroise Paré (1510–1590), who is called the "father of modern surgery". He proposed many innovative methods: the use of rigid corsets for spinal curvatures, special shoes for clubfoot, and the development of prosthetics. For the treatment of open fractures, Paré invented metal splints with holes, which allowed doctors to dress wounds without disrupting limb immobilization.

Development of the discipline in the 19th century

In the pre-antiseptic period, the conservative approach unconditionally prevailed in traumatology. Despite research interest in surgical interventions, surgical activity was minimal due to the catastrophically high risk of infectious complications.

The situation began to change in Europe and Russia in the 19th century. The French surgeon G. Dupuytren detailed the fracture of the medial malleolus and the lower third of the fibula. Dupuytren's contracture—a finger deformity resulting from scar changes in the palmar aponeurosis—is also named after him.

At the same time in Russia, two leading scientific and practical schools were formed:

1. St. Petersburg (Orthopedic) School — led by H.H. Salomon.
2. Moscow (Traumatological) School — headed by Professor E.O. Mukhin.

A special place in the history of Russian and world medicine is held by N.I. Pirogov (1810–1881). His contributions encompass both military field surgery and fundamental anatomy. In frontline conditions, he was the first to use ether anesthesia, introduced plaster casts for reliable immobilization, and developed the technique of osteoplastic shin amputation. In the field of anatomy, Pirogov studied the synovial sheaths of the limbs and investigated the relationship of articular surfaces in various positions using an innovative method of topographic anatomical sectioning of frozen corpses.

The era of antisepsis and the evolution of osteosynthesis

The late 19th century was marked by two events that forever changed traumatology and orthopedics:

• The onset of the antiseptic era (from the 1870s), which allowed surgeons to transition to active surgical interventions without the fear of fatal infections. Reconstructive surgery of the musculoskeletal system was enriched with new techniques.
• The discovery of X-rays by W.K. Röntgen in 1895, which made a breakthrough in the intravital diagnosis of fractures and bone tissue pathologies.

By the 1970s, a definitive transition to active treatment methods had occurred. The surgical connection of bone fragments — osteosynthesis — became widespread. Various materials for internal fixation and external fixation devices began to be used, which proved particularly effective in treating complex injuries and pseudoarthrosis.

Conditions for fracture consolidation (healing): Regardless of the chosen method, three factors are historically and clinically required for successful bone healing:

1. Tight contact of bone fragments.
2. Firm retention of fragments in the correct position.
3. Prolonged rest (immobilization).

These basic conditions are most fully realized when using modern compression treatment methods.

Class and exam questions

What else to study on this topic

• Features of traumatic brain injury in the works of Aulus Cornelius Celsus.
• Anatomical studies by N.I. Pirogov: the topographic anatomical sectioning method.
• Development of external fixation devices and metal osteosynthesis.
• Principles of compression methods for treating fractures and pseudoarthroses.
• Dupuytren's contracture: the anatomical nature of changes in the palmar aponeurosis.

Other topics in "CHAPTER 10. GENERAL ISSUES IN TRAUMATOLOGY"

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