Download Trauma and Orthopaedics at a Glance

Trauma and Orthopaedics at a Glance pdf

Trauma and Orthopaedics at a Glance is an easy-to-read, highly visual guide to orthopaedics. It comprehensively covers relevant basic science and clinically-oriented anatomy of the musculoskeletal system, and the diagnosis and management of trauma, sports injuries, paediatric orthopaedics, degenerative disease, and musculoskeletal tumours. Although primarily aimed at junior doctors and senior medical students, it is also useful for physiotherapists and nurse practitioners.

Trauma and Orthopaedics at a Glance:

• Provides thorough coverage of diagnosis, investigation and contemporary treatment options of commonly encountered orthopaedic conditions;
• Features a section on what to expect as a Foundation doctor in orthopaedics, including how to present cases in trauma meetings, essential information to survive ‘on-call’ shifts and tips for efficient clerking of trauma admissions;
• Unique ‘how to’ section, comprising guidance on key practical procedures such as aspirating joints, manipulating fractures and applying plaster casts.
• Includes a companion website at featuring 120 multiple-choice questions and 10 case studies

This brand new title presents an overview of all the information relating to diagnosing and treating musculoskeletal conditions, and is ideal while on rotation or revising key concepts.


Preface vii

Acknowledgements viii

How to use your revision guide ix

About the companion website x

Part 1 Basic sciences1

1 Musculoskeletal tissues 2

2 Bone metabolism4

3 Osteoarthritis 6

4 Rheumatoid arthritis 8

5 Imaging in orthopaedics: Xrays 10

6 Imaging in orthopaedics: other modalities 12

7 Infection14

8 Clinical anatomy of the upper limb 16

9 Clinical anatomy of the lower limb19

10 Clinical anatomy of the spine 22

11 Examination of the upper limb24

12 Examination of the lower limb26

13 Examination of the spine28

14 The brachial plexus30

Part 2 Adult orthopaedics33

Upper limb34

15 Shoulder 1 34

16 Shoulder 236

17 Elbow38

18 Wrist and hand 1 40

19 Wrist and hand 242

20 Wrist and hand 344

Lower limb46

21 Hip46

22 Hip replacement48

23 Knee 150

24 Knee 252

25 Foot and ankle 54

26 Spine56

27 Tumours 58

28 Rehabilitation 60

Part 3 Paediatric orthopaedics 63

29 Developmental dysplasia of hip (DDH) 64

30 Other paediatric hip conditions66

31 Paediatric spinal disorders68

32 Paediatric foot conditions70

33 Neuromuscular conditions72

34 Lower limb alignment74

Part 4 Trauma 77

35 General principles 1 78

36 General principles 280

37 Advanced trauma life support (ATLS) 82

38 Upper limb trauma 1 84

39 Upper limb trauma 286

40 Upper limb trauma 388

41 Lower limb trauma 190

42 Lower limb trauma 292

43 Lower limb trauma 394

44 Proximal femoral fracture 196

45 Proximal femoral fracture 298

46 Cervical spine trauma100

47 Thoracolumbar spine trauma 102

48 Trauma in children 1104

49 Trauma in children 2106

50 Compartment syndrome108

51 Nonunion and malunion110

Part 5 Working as a junior doctor in orthopaedics113

52 Being an orthopaedic F2114

53 Assessment of patients116

54 The operating theatre118

Part 6 Practical procedures121

55 Practical procedures 1122

56 Practical procedures 2124


Preface – Trauma and Orthopaedics at a Glance

This compact book provides a general overview of the most common orthopaedic problems encountered on wards and in clinics. It is not an exhaustive tome, but will furnish the reader with key facts on which to base further reading. It is also suitable as a revision guide for medical school finals. Orthopaedics is a fascinating and hugely varied speciality. The  patients range from newborn infants to the elderly. Trauma and Orthopaedics at a Glance

The pathologies vary from minor aches and pains to life‐threatening trauma. Orthopaedic operations are hands‐on procedures, combining knowledge of anatomy and biomechanics. Working as a junior doctor in orthopaedics should be one of the best jobs of the foundation years: there is something for everyone. Those leaning towards a future in general medicine will enjoy managing the many medical conditions encountered on the ward, while those looking to a career as a GP will have the opportunity to learn about the myriad musculoskeletal injuries that we treat. Finally, those intending to pursue a career as a surgeon will have the opportunity to acquire surgical skills in theatre. Sadly, many medical schools still spend far too little time teaching orthopaedics. This speciality is quite different from any other. Trauma and Orthopaedics at a Glance

The nature of the work is unique and the terminology is different. It is often the first time many foundation doctors are given significant responsibility on the wards. In addition, new doctors will be expected to present cases in the morning trauma meetings, invariably a harrowing experience at first. Therefore many junior doctors start their foundation job feeling underprepared. This book addresses that deficit. It is aimed at senior medical students and foundation doctors, though those in other professions such as nurses, physiotherapists and occupational therapists will find it helpful. I would suggest that foundation doctors spend around 15 minutes on each chapter, and read two every day. By the end of the first month you will have read the whole book and have a good understanding of the main conditions you are likely to encounter. I have followed the proven at a Glance format: full‐page illustrations are paired with concise text. There are six sections: basic sciences; adult orthopaedics; paediatric orthopaedics; trauma; a section for a junior doctor in orthopaedics and finally a simple guide on performing a selected range of practical procedures. The last two sections are unique and will be helpful to those starting out in clinical orthopaedics. I have tried to use as many X‐rays as possible throughout, all taken from real patients with genuine problems. The online material consists of multiple‐choice questions and case studies, which will help reinforce knowledge. I hope that this book fuels your interest in orthopaedics and helps you deliver compassionate care to your patients. Good luck and enjoy the job!

Acknowledgement – Trauma and Orthopaedics at a Glance

Many of the X‐rays in the illustrations have been provided by colleagues. Particular thanks are due to Om Lahoti who supplied images for the paediatric section. I am indebted to Matt Stephenson who kindly put me in touch with the publishers. The editorial and production staff at Wiley have been tireless in converting my vision into reality. I am also very grateful to the illustrators who converted my cartoon‐like scrawlings into professional images. Finally, I want to express my gratitude to Chris Ferguson whose critical eye and attention to detail kept my grammar and syntax on the straight and narrow! Material is used from the following source, with permission: Faiz O, Blackburn S & Moffat D. Anatomy at a Glance, 3rd edn, 2011. Wiley‐Blackwell: Oxford.


Bone is living tissue and serves three functions: • Biochemical – calcium and phosphate reservoir. • Haematological – haemopoiesis • Biomechanical – support of the limbs. Bone is composed of 10% cells, 90% matrix. • The matrix provides strength. It is itself composed of: • 40% organic matrix – sheets of collagen that resist tension; • 60% inorganic matrix – crystals of a compound called hydroxyapatite, which is a molecule compound of calcium and phosphate. It is good at resisting compression. • The cells produce and maintain the bone and there are three types: • Osteoblasts – bone‐forming cells, producing collagen. • Osteocytes – as osteoblasts lay down collagen, some become trapped within the matrix. These cells go into a dormant state, only reactivating if needed in the future. • Osteoclasts – bone‐resorbing cells, derived from macrophages; they produce acid to dissolve bone. They are important for normal bone turnover and remodelling after fractures. There are two types of bone in the body: • Immature or woven bone, which is found in children’s growing bones and fracture callus. The arrangement of collagen fibres is random and strength is therefore low. • Mature or lamellar bone, which is normal adult bone. The collagen fibres are highly organised into sheets (called lamellae) and therefore the bone is very strong. Lamellar bone can be subdivided into cortical or cancellous bone: • Cortical bone is the densest and strongest form and makes up the hard outer surfaces of a long bone. The lamellae are arranged in rings called osteons (see Figure 1.3). • Cancellous bone is found in the centre and metaphyseal regions of long bones. It is less strong and less dense, with a ‘spongy’ appearance. It contains many cells. The surface of bones is covered with periosteum. This is composed of an inner cambial layer, which is very vascular and contains many osteoblasts, contributing to circumferential growth. The outer fibrous layer is strong and tough. It is continuous with joint capsules and ligament insertions. In children the periosteum is very thick, which is of clinical relevance when treating fractures.

Cartilage – Trauma and Orthopaedics at a Glance

Cartilage is a connective tissue produced by chondroblasts. There are three main types of cartilage: fibrocartilage; elastic cartilage and hyaline cartilage. Of particular interest to the orthopaedic surgeon is hyaline cartilage, which lines the ends of the bones within a synovial joint. Hyaline cartilage is composed of ground substance and cells. • Ground substance is made up of: • Proteoglycans, which are large molecules consisting of multiple sugar molecules attached to a protein backbone. They are very hydrophilic and attract water to keep the cartilage turgid. • Collagen in an interlinked meshwork of long molecules. This resists shear force and the meshwork is ‘inflated’ by the water‐ attracting proteoglycans to resist compression. • Cells are mainly chondrocytes, which produce the proteoglycans and collagen. Articular cartilage is highly structured and can be divided into distinct zones (see Figure  1.4). This specialised structure resists shear at the surface, and compression at the base. As a compound structure, the cartilage functions to: • reduce friction between joint surfaces; • assist in producing lubricating fluid; • distribute load evenly across the joint surface. Cartilage is avascular, aneural and alymphatic. This means that it cannot heal itself in the event of injury. If the injury is superficial to the tidemark, no healing will occur. If the injury extends below the tidemark, bleeding will occur. The defect will go on to heal with scar tissue, which is unspecialised and poorly structured fibrocartilage. Although not as good as hyaline cartilage, it is better than having a large defect. This is the principle by which microfracture works (see Chapter 3).


The menisci are found within the knee joint (although similar structures are also seen in the sternoclavicular and temporomandibular joints, these are of little clinical relevance to the orthopaedic surgeon). There are two crescenteric menisci in each knee – a medial and lateral meniscus. They are composed of fibres of fibrocartilage, arranged in longitudinal and radial bands. They serve to: • evenly distribute load across the knee joint, especially in flexion; • absorb impact; • aid in stabilising the knee. Menisci can become torn, resulting in locking and clicking of the knee joint. The menisci have a poor blood supply. In adults, only the peripheral third is vascular. Therefore, unless a tear is within this zone, it will not heal. Most meniscal tears are therefore treated by excision of the torn segment. Once part of the meniscus has been lost, greater forces are transmitted to the articular cartilage, increasing the risk of developing arthritis in the future.

Ligaments and tendons

Ligaments connect bone to bone and stabilise joints. Tendons connect muscles to bone and act to convert muscle contraction into movement. Ligaments and tendons are composed of longitudinally aligned collagen fibres and are very strong in tension. Ligaments are slightly more elastic than tendons. Over‐stretching a ligament results in a sprain.


Henry Willmott is Consultant Trauma and Orthopaedic Surgeon, East Sussex Healthcare NHS Trust

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