There are a large number of medical devices visible on everyday radiographs and on cross-sectional imaging – computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound exams (US) – as well as Nuclear Medicine studies. Many devices (electrocardiographic leads, pulse oximaters, Foley catheters, and IV lines) are used to monitor a patient’s condition. Other devices (fracture fixation plates and screws, Kirschner wires, and joint arthroplasties) have therapeutic uses (Figure 1.1).
Figure 1.1 Intramedullary tibial nail and fibular Rush rod for stabilization of left distal tibial and fibular fractures
This book and the website www.medapparatus.com are designed to help physicians and other healthcare workers identify and understand the indications and uses for common orthopedic apparatus visualized on everyday imaging studies. The book also identifies and discusses many of the potential complications associated with orthopedic instrumentation.
It is not important to know the specific name for a given device, as the names and the variations for medical apparatus are endless. What is important is to recognize the presence of a medical device and understand its generic function. It is important to be familiar with a device’s normal appearance and be able to identify when it is abnormally positioned, abnormally functioning, or has a life-threatening complication. For more information about a specific illustrated device, please see any associated references listed for the device.
Orthopedics is the surgical specialty devoted to the diagnosis and treatment of diseases and injuries affecting the musculoskeletal system (Orthopedic Surgery/Introduction). The range of conditions addressed by modern orthopedics involves trauma, degenerative diseases, congenital diseases, metabolic diseases, sports injuries, and tumors related to the musculoskeletal system – bones, joints, muscles, ligaments, tendons, and connective tissue supporting structures. Modern orthopedics overlaps with many other surgical and non-surgical specialties, particularly in regard to the treatment of spinal disorders, tumors of the extremities and trunk, and traumatic injuries to the hand.
The French physician and writer Nicholas Andry (1658–1742) coined the word “orthopaedics” from Greek words meaning straight “orthos” and “child” (paideion). In 1741 he published Orthopaedia: or the art of Correcting and Preventing Deformities in Children” (Orthopedics University of Colorado; Nicholas Andry). Until the early part of the twentieth century, orthopedics was part of general surgery, with much of orthopedic treatment devoted toward correcting bony deformities caused by ricketts, tuberculosis, and congenital scoliosis. Treatment of fractures was limited until the introduction of x-rays in the early twentieth century. Internal fixation of fractures did not get widely accepted until the mid-twentieth century through the work of Robert Denis (1880–1962). The first practical use of “rods” and “nails” to treat long bone fractures was by Gerhard Kuntscher (1900–1972) in 1940 while he served in the German army. The Kirschner wire (K-wire) was developed by Martin Kirschner (1879–1942), a German surgeon, who introduced the use of wire skeletal traction in 1909.
There are two common spelling for “orthopedics”: orthopaedics and orthopedics. Both are correct. The shortened form, orthopedics, is favored in the United States, while the more classic form, orthopaedics, is favored in Britain. Many universities and higher education departments in the United States favor the classic spelling as does the American Academy of Orthopaedic Surgeons (AAOS). This website and its associated book have no classical pretensions and will use the common United States spelling for orthopedics.
The devices presented and discussed are categorized by body site (Neck and Spine; Dental Devices) or orthopedic use (Fracture Fixation; Joint Arthroplasty). They are also displayed online as part of a gallery of medical devices which consists of simple radiographs and line drawings that illustrate a multitude of common orthopedic devices found in daily practice. The gallery is designed as a quick reference for those wishing to identify an unfamiliar medical device found on a radiologic study. Sometimes, a specific trademark name is shown for a particular device, but most of the devices illustrated are given generic names which apply to the device shown as well as to similar devices. This gallery can be found at http://medapparatus.com/Gallery/Gallery_Introduction.html.
With regard to the head, neck, and spine, there are few orthopedic devices associated with the skull other than tongs for cervical spine traction (Figure 1.2). However, considerable orthopedic apparatus can be found in the cervical, thoracic, and lumbar spine for treatment of fractures, degenerative spinal conditions, spinal tumors, and spinal infections (Figure 1.3). This apparatus ranges from spinal braces to spinal fixation hardware and spinal cord stimulators.
Figure 1.2 Child with severe intracranial and cervical spine injuries with bilateral cranial stabilization tongs, an endotracheal tube, an oroogastric tube, and a feeding tube entering via the nose.
Figure 1.3 Cervical spine fusion cage and anterior cervical fixation plate.
The largest array of orthopedic apparatus involves fracture fixation (Figure 1.4, Figure 1.5). This ranges from external stabilization with wraps, splints, and casts to internal traction and fixation with wires, pins, plates, screws, rods, and nails. Bone grafts and bone substitute material is extensively used for fracture treatment.
