Essential Orthopaedics is the fifth edition of this highly illustrated resource, ideal for undergraduate revision. Each of the 48 chapters has been thoroughly revised and updated, and an MCQs section has been added to the end of each chapter to aid revision. The chapters begin with a brief review of the relevant anatomy, before discussing basic principles and treatment, with various methods and their indications.
The broad range of topics includes anatomy of bone and fracture healing, deformities and their management, bone tumours, spinal injuries and degenerative disorders. Orthopaedic injuries to specific parts of the body are given individual chapters, for example injuries around the elbow, and injuries to the leg, ankle and foot. Essential Orthopaedics provides a chapter on recent advances in the treatment of fractures, offering the most up-to-date information in this constantly changing field. Presenting a practical approach to various common emergencies, enhanced by sections on orthopaedic terminology and over 380 full colour images and illustrations, this book is an invaluable revision resource for undergraduate medical students. Key Points Fifth Edition of orthopaedic revision resource Previous edition published 2012 (9788184655421) MCQ and terminology sections to aid revision 382 full colour images and illustrations
History
Orthopedic surgery or orthopedics, also spelled orthopaedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
Many developments in orthopedic surgery have resulted from experiences during wartime. On the battlefields of the Middle Ages the injured were treated with bandages soaked in horses’ blood which dried to form a stiff, but unsanitary, splint.
Originally, the term orthopedics meant the correcting of musculoskeletal deformities in children. Nicolas Andry, a professor of medicine at the University of Paris coined the term in the first textbook written on the subject in 1741. He advocated the use of exercise, manipulation and splinting to treat deformities in children. His book was directed towards parents, and while some topics would be familiar to orthopedists today, it also included ‘excessive sweating of the palms’ and freckles.[2]
Jean-André Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children’s skeletal deformities. He developed the club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine.
Advances made in surgical technique during the 18th century, such as John Hunter’s research on tendon healing and Percival Pott’s work on spinal deformity steadily increased the range of new methods available for effective treatment. Antonius Mathijsen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. However, up until the 1890s, orthopedics was still a study limited to the correction of deformity in children. One of the first surgical procedures developed was percutaneous tenotomy. This involved cutting a tendon, originally the Achilles tendon, to help treat deformities alongside bracing and exercises. In the late 1800s and first decades of the 1900s, there was significant controversy about whether orthopedics should include surgical procedures at all
Foreword – Essential Orthopaedics
This book written by Dr Maheshwari, is designed to introduce the trainee doctor and the young surgeon to orthopaedic surgery as he will meet it in the developing countries. There have been many good books on orthopaedic surgery and trauma written by experienced authors from Britain and America but their exposure to the real orthopaedic problems experienced in developing countries has often been limited, and today the difference in presentation of orthopaedic surgery in these countries and the presentation of conditions in developing countries like India and Africa is so different that this book, written by a surgeon with a good grounding of clinical experience in India, is most appropriate for the trainee from the developing countries. I have read a number of chapters and have been impressed with the simple text and clarity with which the different conditions are explained. Dr Maheshwari has visited my centre in Nottingham for a period of two months. I was impressed with his clarity of thought and his depth of understanding of orthopaedic conditions. I anticipate that this book will be one of many that he writes in future years and is likely to be a major contribution to orthopaedic training in developing countries.
Preface – Essential Orthopaedics
The unique position of this book is, that it is meant for undergraduate medical students and those preparing for PG entrance exam. We have had temptation to expand various chapters every time we are called upon to revise the book. But, we keep reminding ourselves of a medical student who has to cover so much curriculum while he is in final year or preparing for PG entrance exam, and thus restrain ourselves from adding ‘too much’. Though there are rapid advances in medicine, but only few qualify place in a basic book such as this. Every few years when we look at the book we find that some concepts have changed. What was being practiced in only big cities and was mentioned only for the sake of completion in the earlier edition, has become a routine. Also, since the book has remained a popular choice for those appearing for PG entrance, we have added a section on MCQ’s after each chapter. Like as we would, to add a lot of new information, but all such thoughts go through the mental screening whether it is required for the target audience! We are cognisant of the fact that no change should be made for the heck of it. We hope the essential changes in this new edition would be appreciated by the readers. Feedback welcome.
What was the thought behind this book in 1993 As an undergraduate, though exposed to orthopaedics only for a short period, I was impressed by the ease with which I could understand the wonderful texts I studied. The problems were that their contents did not exactly meet the requirements of an undergraduate, and most of these books, written by authors from developed countries, did not provide adequate information about diseases peculiar to tropical and underdeveloped countries. Above all, I thought that the concepts could be presented with still more clarity, and improved by way of presentation. This feeling continued to haunt me everytime I was called upon to teach undergraduates. A couple of years later, an experience at home helped me give a practical shape to this feeling. My wife, who was preparing for PG entrance examination, expected me to teach her orthopaedics. I tried out my ideas on her, and the result was extremely gratifying. Soon after, many more such occasions of teaching undergraduates gave me further opportunities for refining the material. It was on the request of the students that I decided to give it the shape of a book. The book is primarily addressed to undergraduates and those preparing for the postgraduate entrance tests. Essential Orthopaedics
General practitioners, particularly in the early stage of their practice would find it useful reference. It would enable nurses and physiotherapists to understand the basic concepts in orthopaedics. Junior postgraduates would find it an enjoyable reading. Following are the salient features of the book: 1. Most chapters begin with a brief review of the relevant anatomy. This is because by the time a student comes to clinical departments, he has forgotten most of the anatomy he had learnt in the dissection hall. 2. While discussing treatment of a condition, a brief mention of principles is made first, followed by various methods and their indications. This is followed by treatment plan; a practical plan of treatment which is either being followed or can be developed in an average hospital. A brief mention of recent developments is also made. 3. The book has three additional chapters. These are “Approach to a Patient with Limb Injury”, “Approach to a Patient with Back Pain”, and “Recent Advances in Treatment of Fractures”. Essential Orthopaedics
The first two present a practical approach to handling these frequently encountered emergencies, and the third chapter updates the reader with the latest in this rapidly developing field. Due emphasis has been given to aspects of rehabilitation, considering the recent recommendations of Medical Council of India for including ‘rehabilitation’ in undergraduate curriculum. 4. Simple line diagrams have been used to supplement the text. Most of them have been developed by myself while teaching the undergraduates. Simplified line diagrams, rather than photographs, enable students understand the basic concepts better. 5. Self-explanatory flow charts are made use of wherever they would help to develop a concept in decisionmaking. 6. Tables have been used liberally. These serve two purposes: Firstly, they present the text matter in a concentrated form and allow review at a glance. Secondly, they permit quick and easily understandable comparison between related conditions. 7. Necessary information on instruments and implants commonly used in orthopaedics has been provided as an appendix, purely considering the requirement of such knowledge for final professional examination.
REF – Orthopedics(Wikipedia)
Content – Essential Orthopaedics
- Orthopaedic Trauma: Introduction …………………. 1
• Classification of fractures …………………………….. 1
• Fractures with eponyms ……………………………….. 2
• Pathological fractures…………………………………… 3
• Injuries to joints …………………………………………… 5
• Injuries to ligaments …………………………………….. 5
• Injuries to muscles and tendons …………………….. 6 - Anatomy of Bone and Fracture Healing ………….. 8
• Anatomy of bone …………………………………………. 8
• Growth of a long bone …………………………………. 9
• Blood supply of bones ………………………………….. 9
• Fracture healing …………………………………………. 10
• Healing of cancellous bones ………………………… 11
• Primary and secondary bone healing…………….. 11
• Factors affecting fracture healing ………………… 11 - Treatment of Fractures: General Principles ….. 13
• Phase I Emergency care …………………………. 13
• Phase II Definitive care ……………………………. 14
• Phase III Rehabilitation of a fractured limb ….. 19
• Management of open fractures ……………………. 21 - Splints and Tractions …………………………………….. 25
• Splints………………………………………………………. 25
• Tractions ………………………………………………….. 26 - Recent Advances in the Treatment
of Fractures ………………………………………………….. 29
• AO method of fracture treatment …………………. 29
• Changing AO concepts ……………………………….. 31
• Functional bracing ……………………………………… 33
• Ilizarov’s technique …………………………………….. 33 - Approach to a Patient with Limb Injury ………… 36
• Clinical examination ……………………………………. 36
• Radiological examination …………………………….. 38
• Old fracture ………………………………………………. 40
• Approach to a polytrauma patient ………………… 40 - Complications of Fractures …………………………… 42
• Classification …………………………………………….. 42
• Hypovolaemic shock ………………………………….. 42
• Adult respiratory distress syndrome …………….. 43
• Fat embolism syndrome ……………………………… 43
• Deep vein thrombosis (DVT) and
pulmonary embolism……………………………… 44
• Crush syndrome ………………………………………… 44
• Injury to major blood vessels ………………………. 44
• Injury to nerves …………………………………………. 46
• Injury to muscles and tendons …………………….. 46
• Injury to joints …………………………………………… 46
• Injury to viscera ………………………………………… 46
• Infection — osteomyelitis …………………………… 47
• Compartment syndrome ……………………………… 47
• Delayed and non-union ……………………………….. 48
• Malunion …………………………………………………… 49
• Shortening ………………………………………………… 50
• Avascular necrosis……………………………………… 50
• Stiffness of joints ………………………………………. 51
• Reflex sympathetic dystrophy
(Sudeck‘s dystrophy) ……………………………. 51
• Myositis ossificans (Post-traumatic
ossification) …………………………………………. 52 - Injury to Joints: Dislocation and Subluxation .. 54
• Relevant anatomy ………………………………………. 54
• Definitions ………………………………………………… 54
• Classification …………………………………………….. 54
• Pathoanatomy ……………………………………………. 55
• Diagnosis ………………………………………………….. 55
• Complications ……………………………………………. 56
• Treatment …………………………………………………. 56 - Fractures in Children ……………………………………. 57
• Relevant anatomy ………………………………………. 57
• Types of fractures ……………………………………… 57
• Diagnosis ………………………………………………….. 59
• Treatment …………………………………………………. 59
• Complications ……………………………………………. 59
- Peripheral Nerve Injuries ……………………………… 61
• Relevant anatomy ………………………………………. 61
• Pathology ………………………………………………….. 62
• Mechanism of injury…………………………………… 62
• Classification …………………………………………….. 63
• Diagnosis ………………………………………………….. 63
• Electrodiagnostic studies …………………………….. 69
• Treatment …………………………………………………. 71
• Prognosis………………………………………………….. 74 - Deformities and Their Management ……………… 75
• Causes ……………………………………………………… 75
• Treatment …………………………………………………. 77 - Treatment of Orthopaedic Disorders:
A General Review …………………………………………. 80
• Non-operative methods of treatment…………….. 80
• Operative methods of treatment …………………… 82 - Injuries Around the Shoulder,
Fracture Humerus ………………………………………… 87
• Relevant anatomy ………………………………………. 87
• Fracture of the clavicle ……………………………….. 88
• Fractures of the scapula ……………………………… 89
• Dislocation of the sterno-clavicular joint ……….. 89
• Subluxation or dislocation of the
acromio-clavicular joint ………………………………. 89
• Dislocation of the shoulder ………………………….. 89
• Fracture of the surgical neck of the humerus … 92
• Fracture of the greater tuberosity
of the humerus ………………………………………….. 92
• Fracture of the shaft of the humerus ……………. 93 - Injuries Around the Elbow …………………………….. 96
• Relevant anatomy ………………………………………. 96
• Supracondylar fracture of the humerus ………… 97
• Fracture of the lateral condyle of the humerus .. 103
• Intercondylar fracture of the humerus ………… 104
• Fracture of the medial epicondyle
of the humerus ………………………………………… 105
• Dislocation of the elbow joint …………………….. 105
• Pulled elbow ……………………………………………. 105
• Fracture of the olecranon ………………………….. 105
• Fracture of the head of the radius ………………. 106
• Fracture of neck of the radius……………………. 107
• Fracture of the capitulum ………………………….. 107 - Injuries of the Forearm and Wrist………………. 108
• Relevant anatomy …………………………………….. 108
• Fractures of the forearm bones………………….. 109
• Monteggia fracture-dislocation …………………… 110
• Galeazzi fracture-dislocation ……………………….111
• Colles’ fracture ………………………………………….111
• Smith’s fracture (Reverse of colles’ fracture) …. 114
• Barton’s fracture ………………………………………. 114
• Scaphoid fracture …………………………………….. 115
• Lunate dislocations …………………………………… 116 - Hand Injuries ……………………………………………… 117
• Bennett’s fracture-dislocation …………………….. 117
• Rolando’s fracture ……………………………………. 118
• Fractures of the metacarpals……………………… 118
• Fractures of the phalanges ………………………… 118
• Dislocation of the metacarpo-phalangeal joints … 118
• Amputation of fingers: Principles
of treatment …………………………………………….. 119
• Tendon injuries of the hand ……………………….. 119
• Crush injury to the hand ……………………………. 120 - Pelvic Fractures ………………………………………….. 123
• Relevant anatomy …………………………………….. 123
• Classification …………………………………………… 124
• Pathoanatomy ………………………………………….. 125
• Diagnosis ………………………………………………… 125
• Treatment ……………………………………………….. 126
• Complications ………………………………………….. 127 - Injuries Around the Hip ………………………………. 129
• Relevant anatomy …………………………………….. 129
• Disclocation of the hip ……………………………… 130
• Posterior dislocation of the hip …………………… 130
• Anterior dislocation of the hip ……………………. 131
• Central fracture-dislocation of the hip …………. 131
• Fracture of the neck of the femur………………. 132
• Inter-trochanteric fractures……………………….. 138
- Fracture Shaft of Femur ……………………………… 141
• Pathoanatomy ………………………………………….. 141
• Diagnosis ………………………………………………… 141
• Treatment ……………………………………………….. 141
• Complications ………………………………………….. 143 - Injuries Around the Knee ……………………………. 145
• Relevant anatomy …………………………………….. 145
• Mechanism of knee injuries ……………………….. 145
• Condylar fractures of the femur ………………… 145
• Fractures of the patella ……………………………… 147
• Injury to the ligaments of the knee ……………… 148
• Tibial plateau fractures ……………………………… 150
• Meniscal injuries of the knee ……………………… 150
• Rare injuries around the knee …………………….. 152 - Injuries to the Leg, Ankle and Foot…………….. 155
• Fractures of shafts of tibia and fibula …………. 155
• Ankle injuries …………………………………………… 159
• Fractures of the calcaneum ……………………….. 164
• Fractures of the talus ……………………………….. 165
• Injuries of the tarsal bones ………………………… 166
• Fractures of the metatarsal bones ………………. 166
• Fractures of the phalanges of the toes ………… 167 - Infections of Bones and Joints …………………….. 168
• Acute osteomyelitis…………………………………… 168
• Secondary osteomyelitis ……………………………. 171
• Chronic osteomyelitis ……………………………….. 171
• Garre’s osteomyelitis ………………………………… 175
• Brodie’s abscess ………………………………………. 175
• Salmonella osteomyelitis ……………………………. 175
• Septic arthritis …………………………………………. 175
• Gonococcal arthritis …………………………………. 178
• Syphilis of joints ………………………………………. 178
• Fungal infections ……………………………………… 178
• Leprosy and orthopaedics …………………………. 179 - Tuberculosis of Bones and Joints …………………. 182
• General considerations ……………………………… 182
• TB of the spine ………………………………………… 185
• Pott’s paraplegia ……………………………………….. 191
• TB of the hip …………………………………………… 194
• TB of the knee …………………………………………. 199
• TB of other joints …………………………………….. 202
• TB osteomyelitis ………………………………………. 203 - Infections of the Hand ………………………………… 205
• Classification …………………………………………… 205
• Aetiopathology …………………………………………. 205
• Acute paronychium ………………………………….. 205
• Apical subungual infection ………………………… 206
• Terminal pulp space infection …………………….. 206
• Middle volar space infection ………………………. 206
• Proximal volar space infection …………………… 207
• Web space infection …………………………………. 207
• Deep palmar abscess ………………………………… 208
• Acute suppurative tenosynovitis…………………. 208 - Congenital Talipes Equino Varus (CTEV) …….. 210
• Relevant anatomy …………………………………….. 210
• Nomenclature ………………………………………….. 211
• Aetiology …………………………………………………. 211
• Pathoanatomy ………………………………………….. 212
• Clinical features ……………………………………….. 212
• Treatment ……………………………………………….. 214 - Congenital Dislocation of the Hip
and Other Malformations ……………………………. 219
• Congenital dislocation of the hip (CDH)………. 219
• Other congenital malformations …………………. 224 - Poliomyelitis and Other
Neuromuscular Disorders ……………………………. 226
• Poliomyelitis…………………………………………….. 226
• Cerebral palsy ………………………………………….. 229
• Spina bifida ……………………………………………… 230
• Disorders of the muscles ………………………….. 232
• Peripheral neuropathies ……………………………… 233 - Bone Tumours …………………………………………….. 235
• Benign tumours ……………………………………….. 235
• Osteoclastoma (Giant cell tumour) …………….. 237
• Primary malignant tumours ……………………….. 239
• Some uncommon malignant tumours………….. 246
• Metastasis in bone ……………………………………. 246
• Tumour-like conditions of bone …………………. 247
• Osteochondroma ……………………………………… 247
• Aneurysmal bone cyst ………………………………. 249
• Fibrous dysplasia ……………………………………… 249
- Prolapsed Intervertebral Disc ……………………… 252
• Relevant anatomy …………………………………….. 252
• Pathology ………………………………………………… 252
• Diagnosis ………………………………………………… 254
• Investigations…………………………………………… 255
• Differential diagnosis ………………………………… 256
• Treatment ……………………………………………….. 256
• Cervical disc prolapse ……………………………….. 257 - Approach to a Patient with Back Pain………….. 258
• Low back pain …………………………………………. 258
• Causes ……………………………………………………. 258
• History ……………………………………………………. 258
• Physical examination ………………………………… 260
• Investigations…………………………………………… 261
• Treatment ……………………………………………….. 261
• Major causes of low back pain ………………….. 261
• Approach to a patient with back pain ………….. 262
• Sciatica …………………………………………………… 264 - Spinal Injuries…………………………………………….. 265
• Relevant anatomy …………………………………….. 265
• Biomechanics of injury ……………………………… 266
• Classification …………………………………………… 267
• Clinical features ……………………………………….. 269
• Examination …………………………………………….. 269
• Investigations…………………………………………… 269
• Treatment ……………………………………………….. 270 - Traumatic Paraplegia…………………………………… 276
• Pathology ………………………………………………… 276
• Neurological deficit and spinal injuries ………… 277
• Clinical examination ………………………………….. 277
• Investigation ……………………………………………. 277
• Treatment ……………………………………………….. 278 - Scoliosis and Other Spinal Deformities ……….. 280
• Scoliosis………………………………………………….. 280
• Kyphosis …………………………………………………. 283
• Spondylolisthesis ……………………………………… 283 - Arthritis and Related Diseases ……………………. 286
• Definitions ………………………………………………. 286
• Rheumatoid arthritis …………………………………. 286
• Ankylosing spondylitis………………………………. 290
• Other rheumatological diseases ………………….. 293 - Degenerative Disorders ………………………………. 295
• Osteoarthritis …………………………………………… 295
• Cervical spondylosis…………………………………. 297
• Lumbar spondylosis …………………………………. 298 - Affections of the Soft Tissues ……………………… 301
• Bursitis……………………………………………………. 301
• Tenosynovitis…………………………………………… 301
• Dupuytren’s contracture ……………………………. 302
• Tennis elbow …………………………………………… 302
• Golfer’s elbow …………………………………………. 302
• de Quervain’s tenovaginitis ………………………… 303
• Trigger finger and thumb ………………………….. 303
• Ganglion………………………………………………….. 303
• Carpal tunnel syndrome …………………………….. 303
• Frozen shoulder ……………………………………….. 304
• Plantar fascitis …………………………………………. 304
• Fibrositis …………………………………………………. 304
• Painful arc syndrome ……………………………….. 304
• Meralgia paraesthetica ………………………………. 305
• Fibromyalgia ……………………………………………. 305 - Metabolic Bone Diseases……………………………… 307
• Constitution of bone …………………………………. 307
• Bone and calcium …………………………………….. 307
• Osteoporosis ……………………………………………. 308
• Rickets and Osteomalacia ………………………….. 310
• Hyperparathyroidism ………………………………… 312
• Fluorosis …………………………………………………. 314
• Disturbances of organic constituents………….. 315 - Miscellaneous Affections of the Bone ………….. 316
• Generalised bone disorders ………………………… 316
• Osteochondritis ……………………………………….. 317
• Avascular necrosis……………………………………. 318
• Some other developmental abnormalities
of orthopaedic interest ………………………………. 319
- Miscellaneous Regional Diseases ………………… 321
• Torticollis………………………………………………… 321
• Cervical rib ……………………………………………… 322
• Observation hip ……………………………………….. 323
• Coxa vara………………………………………………… 323
• Slipped capital femoral epiphysis………………… 323
• Deformities of the knee …………………………….. 324
• Popliteal cyst …………………………………………… 326
• Loose bodies in joints ……………………………….. 326
• Flat foot ………………………………………………….. 326
• Deformities of the toes ……………………………… 327 - Amputations, Prosthetics and Orthotics ………. 328
• Amputations…………………………………………….. 328
• Special features of amputations in children ….. 331
• Prostheses in orthopaedic practice ……………… 331
• Orthoses in orthopaedic practice………………… 332 - Arthroscopic Surgery ………………………………….. 334
• Advantages ……………………………………………… 334
• Indications ………………………………………………. 335
• Procedure ……………………………………………….. 336
• Limitations ………………………………………………. 336 - Joint Replacement Surgery …………………………. 338
• Hemiarthroplasty ……………………………………… 338
• Total joint replacement ……………………………… 339
• Partial knee replacement ……………………………. 341
• Total shoulder replacement………………………… 341
• Total elbow replacement……………………………. 341
Annexures ………………………………………………………… 343
Annexure 1 : Clinical Methods ………………………………. 343
Annexure 2 : Orthopaedic Terminology ………………….. 367
Annexure 3 : Orthopaedic Instruments and Implants … 371
Index …………………………………………………………. 377
About the Author
J. MaheshwariMS Orth (AIIMS)
Formerly: Additional Professor of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India, Presently: Director, Knee and Shoulder Clinic, New Delhi, India
Vikram A MhaskarMS Orth, MCh Orth (UK)
Consultant Orthopaedic Surgeon, Knee and Shoulder Clinic, New Delhi, India