Edinburgh Orthopaedic Trauma Unit
History of Edinburgh Orthopaedic Trauma Unit
The Edinburgh Orthopaedic Trauma Unit was formed in the mid-1980’s from the old "Wards 5 and 6" in the Royal Infirmary of Edinburgh. The first consultants with a sub-specialty interest in trauma were appointed about 
1984. It was the responsibility of earlier ‘trauma consultants’ to run the Accident and Emergency Department. The first full-time orthopaedic traumatologist was not appointed until 1994. This was followed by a redistribution of the clinical duties of existing consultants so that some of them could undertake full-time trauma management.
However even by 1996 the Trauma Unit was handling about 4,000 operations annually with the equivalent of only 2.4 consultants. Fortunately the Lothian Health Board and the Royal Infirmary of Edinburgh NHS Trust management recognised the mismatch between the workload and the resources and appointed two further full-time orthopaedic traumatologists.
At the same time the University of Edinburgh allowed one of their senior lecturers to become a full-time trauma surgeon and the result is that there are now six orthopaedic traumatologists responsible for the primary management and secondary reconstruction of all orthopaedic trauma cases.
The split between elective and traumatic orthopaedics is now complete. The two units now work well together sharing junior staff rotas and postgraduate training but the clinical separation has allowed for increased sub-specialisation and improved patient management.Historically the United Kingdom has always had a poorly developed system for dealing with orthopaedic trauma.
This is not the situation in continental Europe where there has been a well developed trauma system since the time of Napoleon. Germany, Switzerland and Austria in particular have sophisticated trauma systems and employ large numbers of trauma surgeons.
In the United Kingdom orthopaedic trauma was predominantly treated by general surgeons until the 1950’s with orthopaedic surgeons treating elective conditions. Gradually trauma became the province of orthopaedic surgeons but the responsibility of managing injured patients was merely added to the duties of the orthopaedic surgeons and adequate resources were never provided. The United Kingdom has produced world famous orthopaedic trauma surgeons such as Ernest Hey Groves and Reginald Watson Jones but it has never formulated a trauma system either at local or national level.In recent years the British Orthopaedic Association and the Royal College of Surgeons of England have produced a number of reports dealing with the management of orthopaedic trauma. Unfortunately these have, as yet, had little effect and it has been left to individual units and surgeons to organise their trauma services appropriately.
As yet this has only been achieved in Edinburgh and Oxford and it is likely that these units will act as models for the rest of the United Kingdom.A recent survey carried published in the British Journal of Bone and Joint Surgery (Court-Brown and McQueen, 1997) has illustrated the problems in the United Kingdom. It was found that only 8% of orthopaedic surgeons have an interest in the management of orthopaedic trauma whereas the discipline comprises about 50% - 55% of the orthopaedic workload. A survey carried out by the Orthopaedic SAC has shown that only 2% of surgeons over 55 years of age have a major interest in orthopaedic trauma. As it is these surgeons who tend to be politically influential it is clear that orthopaedic trauma is considerably disadvantaged.
History of the Royal Infirmary In 1729 The Edinburgh Infirmary opened as a charitable institution for the relief of the sick poor. Subscriptions came from many sources and the Infirmary had particularly strong support from Edinburgh Town Council through the Lord Provost, George Drummond, and from the Royal College of Physicians and the Royal College of Surgeons. The medical faculty of the University of Edinburgh was established in 1726 and the teaching of medical students was an important aspect of the Royal Infirmary from the beginning. The Royal Charter was granted in 1736. The School of Nursing was established in 1872 in accordance with the principles laid down by Florence Nightingale. The Royal Infirmary moved to its present site in 1879, designed to have the medical hospital situated on the south side and the surgical hospital on the north, with common support services in the middle. Further expansion and extensions were completed in the 1930’s to allow for new and growing services and departments. In 1948 the Infirmary ceased to be a voluntary hospital and became past of the NHS and from 1974, became a Directly Managed Unit of the Lothian Health Board. As from 1 April 1994 the Royal Infirmary of Edinburgh and Associated Hospitals Unit was granted Trust status and became the Royal Infirmary of Edinburgh NHS Trust. Chalmers Hospital was also a voluntary hospital, opened in 1894. It came under the Infirmary’s management in 1970. The Edinburgh Dental Hospital was opened in 1860, becoming established as the Edinburgh Dental Hospital and School in 1878. The Princess Alexandra Eye Pavilion was opened in 1969. The Princess Margaret Rose Orthopaedic Hospital was the first purely orthopaedic hospital to be opened in Scotland, originally planned as a centre for the treatment of crippled children. It was opened in June 1932. The City Hospital was opened on its present site in 1903 and closed during 1997. Services will be transferred to Royal Infirmary and Western General Hospital. The Infirmary and its associated hospitals throughout their whole history to the present day have established a world-wide reputation in the fields of clinical practice, teaching and innovations in medical techniques. The Edinburgh Orthopaedic Trauma Unit moved to the New Royal Infirmary on 1st May 2003.
©Edinburgh Orthopaedic Trauma Unit 2007