Subspecialization in orthopaedics. Has it been all for the better?

Orthopaedics was long known as the discipline that dealt with congenital, developmental, paralytic, and infectious conditions in children and with infections and posttraumatic deformities in adults. When general surgery split into several subdisciplines, orthopaedics began to enlarge its scope and gradually moved into the care of fractures. Until that time, fractures had been the purview of general surgeons. It took several decades before the care of fractures was transferred completely from general surgery to orthopaedics. Early in the second half of the twentieth century, the specialty of traumatology was created in north central Europe. Traumatologists were physicians trained to provide comprehensive care of acutely injured patients. The specialized training allowed them to assume the care not only of injuries involving the musculoskeletal system but also of traumatic conditions affecting the abdominal cavity, the chest, the genitourinary system, and the vessels and nerves. However, over the years, the care of trauma in those countries has evolved. In many trauma centers, the traumatologist no longer provides comprehensive care for all conditions affecting an injured patient. Abdominal surgeons, chest surgeons, vascular surgeons, neurosurgeons, urologists, and others are summoned to handle problems that fall within their respective expertise. With increasing frequency, traumatologists are limiting their surgical practices to fracture care, arthroscopy, and reconstructive surgery of major joints and the spine. The traumatologists of central Europe are practicing the profession in a manner that is almost identical to that of the American and British orthopaedists of today. The Hand Society was the first musculoskeletal subspecialty society established in the United States. The Society's continuing education courses became popular, and hand surgery became a prestigious and highly sought after subspecialty. Although acute injuries of the skin and tendons and congenital and paralytic afflictions of the hand at first constituted the bulk of the conditions treated by …