Although orthopedic surgery and sports medicine sometimes exist as independent specialties (there are Sports Medicine family practice physicians who don’t perform surgery, and Orthopedic Surgeons who focus their practice in areas other than sports injuries), the two are inextricably linked. Weekend warriors incur injury that limits their ability to return to their regular jobs and sometimes even activities of daily living. Modern day sports are our gladiatorial events, and injuries of all varying severity are the all-too-common result. From recreational to professional, multitudes of athletes take the field, the court, and the ice to compete and challenge their opponent and themselves.
Sports Medicine is a large, general umbrella which encompasses all injury and illness which might be associated with sports participation, from staph infections of the skin resulting from communal showers and the close body contact inherent with many sporting activities to more acute injuries of the musculoskeletal system that can take the place of sprains or strains, ruptured ligaments or tendons, joint dislocation, or even fractures of the bones themselves. It is the orthopedic surgeon, though, who is called on to render interventional care incurred as a result of sports participation whether that is repair or even reconstruction of a damaged or destroyed stabilizing ligament or tendon, or fracture care which may require casting while the bone heals or surgical stabilization to promote bone healing.
Not all injuries incurred as a result of participation in sports requires surgery. In point of fact, statistics indicate that approximately 85% of sports injuries can be cared for without surgical intervention. The orthopedic surgeon has specialized knowledge in the many varied areas of sports and sports related injury to help and determine which injuries would be more amenable to nonoperative management, and which would benefit from (and in some cases, require) surgical intervention.
Ligamentous injury is one example of such a sports-related injury. Consider the football player who injures the ligamentous structure of a wrist when he falls onto an outstretched hand to break his fall when leaping over a pile of defenders for a game-winning touchdown. X-rays indicate no fracture of the bones, but the pain and disuse still won’t allow the team’s star to return until it has time to heal. The orthopedic surgeon can evaluate the extent of the injury and offer options. Surgery may or may not be one of them. Rehabilitation, either following any necessary surgery or as an independent, nonsurgical alternative, is often prescribed and can greatly accelerate the athlete’s return to play.
Another such example could be an ice hockey goaltender injured by a hard slapshot that finds its way through his padding to break a finger, or perhaps the clavicle (collar bone). Such fractures are commonly encountered, and may or may not call for surgical stabilization. If the fracture is considered stable, the goalie may be out for a month or two while the fracture heals. If the fracture is unstable (unlikely to heal unless surgery is used to align the fracture and hold it in place until it heals), a plate and screws or other form of fixation may be required to be placed via surgery. In either option, the focus is on the patient; presenting the risks and benefits of different options, and helping the patient to arrive at an election that is best for his (or her) particular situation.
Many decades ago, healers became doctors. Interested doctors became surgeons. Surgeons with a particular interest in injury of the musculoskeletal system became orthopedic surgeons. The most recent twenty years or so has seen the further subspecialization of orthopedic surgeons into various areas of additional concentration; some choosing to focus on hip and knee replacement, others on injury and repair unique to pediatric orthopedic injury and dysfunction, and still others on sports related orthopedic injury. Even more recently, some sports medicine orthopedic surgeons have even chosen to focus specifically on particular body parts, such as shoulder, knee, or foot and ankle problems. The point is, although all orthopedic surgeons go through many years of training on the surgical and nonsurgical care of musculoskeletal injury, there is almost always an orthopedic subspecialist whose practice focuses just on the particular area of injury in question. So even if we do not perform a high volume of the procedure for your choice of orthopedic surgical care, we can certainly find a colleague who is.
In the specialty of orthopedic surgery, great advancements have been made. We are, however, still and ever shall be learning. As alluded to before, what is past may well be only the prologue to what is yet to come for even greater advances in orthopedic surgery and sports medicine. What the future brings we shall discover together, as patient and surgeon.
Christopher Blair, DO, MBA
Texas Orthopedic Surgery Consultants