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than patients of normal weight for musculoskeletal injuries like fractures in the lower extremities, meniscal tears, rotator cuff tendonitis, heel bone fractures, and ankle injuries. Low-energy falls can lead to spontaneous knee dislocations, which could lead to other complications. Ankle fractures are more frequent and more severe in obese patients than in normal-weight individuals. Trauma Adequate imaging of patients in the trauma setting with above-normal BMI is difficult. Patients with obesity who sustain injury in motor vehicle collisions or other blunt trauma are more likely to have an increased risk for medical complications, longer hospital stays, increased mortality rates and a higher likelihood of multi-organ failure. In addition, these patients have a higher risk of hardware failure, experience slower wound healing after surgical repair of a fracture, and deep venous thrombosis. Compared to normal-weight pediatric trauma patients, pediatric trauma patients with obesity are more likely to sustain fractures in areas of the bone near a joint (distal). This includes the wrist (distal radius), shinbone (distal tibia), and thighbone (distal femur). Children with obesity have significantly increased odds of sustaining lower extremity injuries and pain compared to normal weight children. Although complication rates increase as the BMI increases, orthopaedic surgical interventions can offer patients with obesity significant bone and joint pain relief and function improvement. The AAOS recommends patients with morbid obesity (BMI of 40 or higher) take the following steps prior to undergoing elective orthopaedic surgery: • Discuss with their physician(s) and consider carefully the impact of their weight on possible complications and results after surgery. • Speak with their physician(s) about resources available to help them lose weight before surgery. A delay in surgery is not a judgmental statement, but rather a risk reduction tool to avoid potentially serious and life-changing complications. • If it is in the patient’s best interest, consider delaying certain surgeries, such as joint replacement, where losing weight could improve the outcome of treatment, to provide time to take interventions for obesity. • Participate in a weight-loss program before undergoing TJA or replacement. • Develop a plan to manage comorbidities. • Assess nutritional status and address any deficiencies. Patients with obesity have a high incidence of altered nutritional status, and poor nutrition may contribute to comorbidities such as diabetes, in which blood sugar should be brought to reasonable levels to reduce risk. • Talk about rehabilitation protocols with their physicians and determine their ability and commitment level to follow them. • Consider signing a commitment letter to lose weight, to exercise and eat better to demonstrate responsibility for personal health. Even after surgery, patients must make an ongoing commitment to keep weight down for their overall health and for issues such as the longevity of TKAs. Developed by the AAOS Workgroup on Obesity. References: 1. Flegal KM, Carroll MD, Ogden CL, et al: Prevalence and Trends in Obesity among U.S. Adults, 1999-2008. Journal of the American Medical Association, 303(3): 235-41, 2010. 2. Ogden CL, Carroll MD, Kit BK, Flegal KM: Prevalence of obesity among Orthopedic surgery Laura M.B. Gehrig, M.D.* Bone, Spine and Sports Clinic 225 N 7th Street, Bismarck, ND 58501, USA Abstract. Orthopedic surgery is a specialty of surgery dedicated to the prevention, diagnosis, and treatment of diseases and injuries of the musculoskeletal system in all age groups. Careers in orthopedic surgery span the spectrum from general orthopedics to those of subspecialty expertise in orthopedic trauma, hand, pediatrics, total joint, foot and ankle, sports medicine, and oncology to name a few. © 2011 Elsevier Inc. All rights reserved. KEYWORDS: Orthopedic surgery; Musculoskeletal medicine; Subspecialty; Bones Orthopedic surgery as a specialty has its roots in 2 Greek words: orthos, which means straight and free of deformity and paedios meaning a child. The 1st textbook of musculoskeletal medicine was written by Nicolas Andry in 1740. He wrote a book titled Orthopaedia in the last year of his life at the age of 83. He wrote this book as a way to teach others how to correct the deformities of children. From this small book grew a specialty out of the world of science and medicine that has its goal of understanding how physical factors affect living systems.1 Over time, this thirst for knowledge has specialized into a surgical specialty, orthopedics, which focuses on the processes involving the bone, muscles, tendon, and ligaments of the skeleton. Protecting and shaping the growth of this skeleton allows human locomotion and function. Without this specialty, broken bones may not heal or heal with deformity, muscles may not fire, and ligaments and tendons may not work properly. All information gained regarding bone and skeletal homeostasis is involved in orthopedics with the following goal: to preserve the form and function of human locomotion and movement in the best way possible. To this end, Orthopedics is dedicated to the prevention, diagnosis, and treatment of diseases and injuries of the musculoskeletal system in all age groups. Not only does this specialty protect human locomotion by protecting the
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