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Bunnell's surgery of the hand. Fifth edition
Volume 3 Number 4
BOOK REVIEWS
entirely separating the condyles of femur and tibia. In this position it could not escape bearing the whole of the weight through the medial half of the joint. The movements of the menisci are neatly illustrated in a superior view of the tibia1 plateau. The three-dimensional micro-anatomy of bone is very vivid. The periosteum is seen as an intensely vascular membrane from which many vessels leave to penetrate the cortex. The structure of the Haversian systems and the crossing grains of their lamellae, like tubular plywood, are excellently shown. On the other hand, only scanty attention is paid to ossification. The book gives no description, for example. of the radiographic appearances of the wrist or elbow at any age between the 5-month foetus and the adult. A knowledge of the epiphyses in childhood is a daily requirement-in the care bf injuries. The well known style of illustration which has survived from much earlier editions cannot be improved upon for bones, muscles, and joints. In many other places, however, new and more versatile colour printing is now enhancing the value of this book. J. H. HICKS
Atlas of Arthroscopy. By M. WATANABE, M.D., S. TAKEDA, M. D., and H. IKEUCHI, M.D. (Tokyo).
10:~ 74 in. Pp. 176, with 134 illustrations. Tokyo : Igaku Shoin Ltd. $26.50. THIS
is the second
1969.
of the Small Atlas of by Dr. Watanabe in 1957. The original illustrations were painted from direct observation, but this edition contains 800 colour photographs taken during endoscopic examination of the knee-joint. It is beautifully produced and illustrated and one of the most delightful clinical textbooks I have ever read. The few complications associated with this examination appear to have been overcome by the introduction of the No. 21 arthroscope, and the author gives very clear indications for the use of this procedure and an honest appraisal of its value. The major advantage over arthrotomy is the complete absence of quadriceps inhibition and the minimal morbidity following examination. In spite of its cost, I am sure that any centre dealing with a large number of knee disorders would find this book a most valuable diagnostic aid. D. WAINWIUGHT Arthroscopy
edition
of the Knee produced
The Medical Annual, 1971. Edited by Sir RONALD BODLEY SCOTT, K.C.V.O., M.A.,D.M., F.R.C.P., and R. MILNES WALKER, C.B.E., M.S., F.R.C.S., F.A.C.S.(Hon.), F.R.C.S.(Edin.) (Hon.). 8+X 5&in. PD. 554txxiv. with 102 illustrations.
1571. Bristol : John &ight & Sons Ltd. Section on Orthopaedics-and Traumatology, pp. 307-327. bv R. ROAF, M.A., M.Ch.Orth., F.R.C.S:, F.-R.C.S.(Edin.j, D.Obst.R.C.0.G. CONSTITUTIONAL bone disorders are reviewed in the light of difficulties of classification. Radiological classification has certain defects but Maroteaux recognizes three major types of constitutional bone disorder each subdivided into groups, and this seems to give a good working classification.
283
Ross’s article (1970) on fat embolism is reviewed and the diagnostic feature of a fall in blood PO, without sign&cant rise in Pcoa is stressed. There are brief notes on chronic osteomyelitis and the effect of torsion on the intervertebral jointsscoliosis, lordosis, and stenosing vaginitis. At the end of the book there is an excellent list of Books of the Year under each specialty. This is a very useful book for hospital libraries as it has something to offer to all specialties. H. PROCTOR Outline of Orthopaedics. By J. C. ADAMS, M.D., M.S., F.R.C.S. Second edition. S$X 52. Pp. 480, with 331 illustrations. 1971. Edinburgh and London: Churchill Livingstone. E2.25. THE fact that this is the seventh edition, plus several reprints, speaks for its popularity. Some sections have been rewritten in this edition, mainly those on arthritis, gout, and spina bifida. It is well written, easy to read and understand, and well illustrated. It starts with details of a full orthopaedic examination and then goes on to a general survey of orthopaedics before dealing with specific orthopaedic disabilities on a regional basis, which makes for easy reference. My only criticism is that where drugs are mentioned, especially when they are specific for a disease, the dosage would be helpful, particularly for such conditions as tuberculosis. At the end of the book there is an excellent bibliography, again on a regional basis, which saves the reader much extra work if he wishes to make a more detailed study of a given condition. It is an excellent book and well worth the price, ideal for students and useful to the medically qualified who have forgotten their training or failed to keep up with orthopaedic progress. H. PROCTOR Bunnell’s
Surgery of the Hand. Fifth edition. Edited by J. H. BOYES, M.D.(America). 10X 7 in.
Pp. 728, with 797 illustrations. 1970. Philadelphia: J. B. Lippincott Co. Price not stated. THE fifth edition of Bunnell’s classic has now been revised by Joseph H. Boyes since the author’s death in 1957. It maintains the magnificent standard of previous editions and though much more material is incorporated in the new edition, the actual size of the whole volume is not much increased because it has been printed in smaller type more closely spaced. Most of the original illustrations have been maintained and there are some new ones but, no doubt for reasons of economy, coloured illustrations have been dropped except for one single page which has a drawing of the brachial plexus on one side and the coloured illustrations of a median nerve repair on the other. This is no great loss as the line drawings and the photographs are of very high quality through the whole of the book. The amount of space devoted to references has been greatly increased in comparison with earlier editions, and after the chapter on nerve injuries, for instance, there are now 257 references in comparison with the 92 devoted to this subject in the second edition. The references are conveniently grouped at the end of each chapter, and where the chapter has dealt
284
INJURY:
THE
BRITISH
JOURNAL
with more than one subject, the references are subdivided into headings according to the different aspects, which makes for easier use. The sections devoted to trauma are all admirable and comprehensive, with clear descriptions of procedures and quite orthodox management of all common injuries and complications. There is an excellent account of the aetiology, development, and treatment of ischaemic contracture and the section on nerve injuries is very up-to-date, with greater emphasis on the possibilities of primary repair than is usual in some post-war writings. When dealing with reconstruction of the thumb there is a good deal of rather old material about tube pedicles and the reconstruction of insensitive pillars, but the author corrects the whole impression in an excellent r&urn6 at the end where he argues that a shorter thumb with good sensibility is better than a longer one without proper stereognosis. He rightly emphasizes that pollicization is of special value when one can transfer a partly damaged digit rather than a completely sound one. As in previous editions there is a good deal of material outside the scope of the hand itself but in
ABSTRACTS BURNS Enzyme Changes in Healing of Bums This is a study of the histological and histochemical (alkaline phosphatase, acid phosphatase, leucine aminopeptidase, and non-specific esterase) changes following a thermal burn of the shaved skin of the young adult guinea-pig. Both the central and peripheral zones of the lesion were studied. In the central irea, characterized by necrosis, there was a decrease in the content of all the enzymes studied within the first hour after burn. In the peripheral zone, however, increases in enzyme content were detected and it is suggested that these changes prelude healing. The changes in enzyme content were detectable much earlier than the histological changes. Local antiseptic therapy had no effect on the changes in enzyme content. MALIK, M. 0. A. (1971), ‘ Enzyme Changes in the Early Phase of Healing Skin Burns in Guinea-pigs ‘, Br. J. exp. Path., 52, 345. Local Treatment for Bums
A controlled clinical trial was carried out to compare the treatment of burns by exposure in warm dry air with the use of locally applied antibacterial substances. The incidence of bacterial colonization was significantly lower in burns that were treated than in burns that were exposed. The antibacterial measures were 4 per cent silver nitrate compresses and II.2 per cent mafenide (Sulphamylon) cream. Silver nitrate gave generally the better protection but Ps. aeruginosa was found as often with mafenide as with silver nitrate. There was less mortality in each group than was expected from a probability chart based on the previous work of the unit but the difference was not wgnificant.
OF ACCIDENT
SURGERY
Amil
Injury 1972
some way related to hand function, with a whole chapter devoted to the shoulder and elbow only. The chapter on fractures does not give as much space as some surgeons do to the value of internal fixation in managing severely smashed hands, and the new small-fragment set of internal fixation implants devised by the A0 group cannot have reached the author in time for this edition, though he will no doubt be using them before the next one. The chapter on infections is a little disappointing in that the author has not studied Bailey’s monograph on the subject and continues to advocate hockeystick. alligator mouth. and this kind of incision for pulp. abscesses which have been superseded in the more enereetic units that treat hand infections frequently. Altogether this book is beautifully produced, very comprehensive and though it is not of much use for students or occasional hand surgeons, it is a magnificent reference volume and should be available to every surgeon who deals at all frequently with hand injuries. R. L. BATTEN
Mafenide caused pain sufficient to prevent most of the patients on whom it was used from completing the course of treatment, but only one patient developed acidosis. Silver nitrate caused acidosis, diarrhoea, and low serum sodium in some patients. A trial of 1 per cent silver sulphadiazine cream on smaller burns showed that daily application gave better protection against bacteria than application every 3 or 4 days and that protection was the same when the burns were dressed as when they were exposed. The difference between these results and others reported from Stockholm and from Cincinnati are discussed and are probably due to differences in staffing and the nature of the admissions. It is emphasized that, for all the prophylactic value of silver nitrate and mafenide, infection can still occur and call for the use of standard therapeutic drugs. LOWBURY,E. J. L., JACKSON,D. M., LILLY, H. A., BULL, J. P., CASON,J. S., DAVIES, J. W. L., and FORD, P. (1971), ‘ Alternative Forms of Local Treatment for Burns ‘, Lancet, 2, 1105. Mortality Due to Burns The probability of death from burns of givenextent in persons of given age was worked out by probit analysis in 1944 and found to have remained almost unchanged for 20 years. Following the introduction of 0.5 per cent silver nitrate solution for preventing bacterial invasion, mortality-rates improved considerablv and a new table of urobability has been constructed. BULL, J. P. (1971), ‘ Revised Analysis of Mortality due to Burns ‘, Lancet, 2, 1133. In Search of the Cause of Hypermetabolism in Burns Experiments with waterproof films to cover the burns suggested that the increased metabolic rate was not stim&ted by evaporative cooling. ZAWACKI. B. E.. SPITZER. K. W.. MASON. A. D., jun., and JOHNS,’ L. A. (1970), ‘Does Increased Evaporative Water Loss cause Hypermetabolism in Burned Patients? ‘, Ann. Surg., 171, 236.
BOOK REVIEWS
entirely separating the condyles of femur and tibia. In this position it could not escape bearing the whole of the weight through the medial half of the joint. The movements of the menisci are neatly illustrated in a superior view of the tibia1 plateau. The three-dimensional micro-anatomy of bone is very vivid. The periosteum is seen as an intensely vascular membrane from which many vessels leave to penetrate the cortex. The structure of the Haversian systems and the crossing grains of their lamellae, like tubular plywood, are excellently shown. On the other hand, only scanty attention is paid to ossification. The book gives no description, for example. of the radiographic appearances of the wrist or elbow at any age between the 5-month foetus and the adult. A knowledge of the epiphyses in childhood is a daily requirement-in the care bf injuries. The well known style of illustration which has survived from much earlier editions cannot be improved upon for bones, muscles, and joints. In many other places, however, new and more versatile colour printing is now enhancing the value of this book. J. H. HICKS
Atlas of Arthroscopy. By M. WATANABE, M.D., S. TAKEDA, M. D., and H. IKEUCHI, M.D. (Tokyo).
10:~ 74 in. Pp. 176, with 134 illustrations. Tokyo : Igaku Shoin Ltd. $26.50. THIS
is the second
1969.
of the Small Atlas of by Dr. Watanabe in 1957. The original illustrations were painted from direct observation, but this edition contains 800 colour photographs taken during endoscopic examination of the knee-joint. It is beautifully produced and illustrated and one of the most delightful clinical textbooks I have ever read. The few complications associated with this examination appear to have been overcome by the introduction of the No. 21 arthroscope, and the author gives very clear indications for the use of this procedure and an honest appraisal of its value. The major advantage over arthrotomy is the complete absence of quadriceps inhibition and the minimal morbidity following examination. In spite of its cost, I am sure that any centre dealing with a large number of knee disorders would find this book a most valuable diagnostic aid. D. WAINWIUGHT Arthroscopy
edition
of the Knee produced
The Medical Annual, 1971. Edited by Sir RONALD BODLEY SCOTT, K.C.V.O., M.A.,D.M., F.R.C.P., and R. MILNES WALKER, C.B.E., M.S., F.R.C.S., F.A.C.S.(Hon.), F.R.C.S.(Edin.) (Hon.). 8+X 5&in. PD. 554txxiv. with 102 illustrations.
1571. Bristol : John &ight & Sons Ltd. Section on Orthopaedics-and Traumatology, pp. 307-327. bv R. ROAF, M.A., M.Ch.Orth., F.R.C.S:, F.-R.C.S.(Edin.j, D.Obst.R.C.0.G. CONSTITUTIONAL bone disorders are reviewed in the light of difficulties of classification. Radiological classification has certain defects but Maroteaux recognizes three major types of constitutional bone disorder each subdivided into groups, and this seems to give a good working classification.
283
Ross’s article (1970) on fat embolism is reviewed and the diagnostic feature of a fall in blood PO, without sign&cant rise in Pcoa is stressed. There are brief notes on chronic osteomyelitis and the effect of torsion on the intervertebral jointsscoliosis, lordosis, and stenosing vaginitis. At the end of the book there is an excellent list of Books of the Year under each specialty. This is a very useful book for hospital libraries as it has something to offer to all specialties. H. PROCTOR Outline of Orthopaedics. By J. C. ADAMS, M.D., M.S., F.R.C.S. Second edition. S$X 52. Pp. 480, with 331 illustrations. 1971. Edinburgh and London: Churchill Livingstone. E2.25. THE fact that this is the seventh edition, plus several reprints, speaks for its popularity. Some sections have been rewritten in this edition, mainly those on arthritis, gout, and spina bifida. It is well written, easy to read and understand, and well illustrated. It starts with details of a full orthopaedic examination and then goes on to a general survey of orthopaedics before dealing with specific orthopaedic disabilities on a regional basis, which makes for easy reference. My only criticism is that where drugs are mentioned, especially when they are specific for a disease, the dosage would be helpful, particularly for such conditions as tuberculosis. At the end of the book there is an excellent bibliography, again on a regional basis, which saves the reader much extra work if he wishes to make a more detailed study of a given condition. It is an excellent book and well worth the price, ideal for students and useful to the medically qualified who have forgotten their training or failed to keep up with orthopaedic progress. H. PROCTOR Bunnell’s
Surgery of the Hand. Fifth edition. Edited by J. H. BOYES, M.D.(America). 10X 7 in.
Pp. 728, with 797 illustrations. 1970. Philadelphia: J. B. Lippincott Co. Price not stated. THE fifth edition of Bunnell’s classic has now been revised by Joseph H. Boyes since the author’s death in 1957. It maintains the magnificent standard of previous editions and though much more material is incorporated in the new edition, the actual size of the whole volume is not much increased because it has been printed in smaller type more closely spaced. Most of the original illustrations have been maintained and there are some new ones but, no doubt for reasons of economy, coloured illustrations have been dropped except for one single page which has a drawing of the brachial plexus on one side and the coloured illustrations of a median nerve repair on the other. This is no great loss as the line drawings and the photographs are of very high quality through the whole of the book. The amount of space devoted to references has been greatly increased in comparison with earlier editions, and after the chapter on nerve injuries, for instance, there are now 257 references in comparison with the 92 devoted to this subject in the second edition. The references are conveniently grouped at the end of each chapter, and where the chapter has dealt
284
INJURY:
THE
BRITISH
JOURNAL
with more than one subject, the references are subdivided into headings according to the different aspects, which makes for easier use. The sections devoted to trauma are all admirable and comprehensive, with clear descriptions of procedures and quite orthodox management of all common injuries and complications. There is an excellent account of the aetiology, development, and treatment of ischaemic contracture and the section on nerve injuries is very up-to-date, with greater emphasis on the possibilities of primary repair than is usual in some post-war writings. When dealing with reconstruction of the thumb there is a good deal of rather old material about tube pedicles and the reconstruction of insensitive pillars, but the author corrects the whole impression in an excellent r&urn6 at the end where he argues that a shorter thumb with good sensibility is better than a longer one without proper stereognosis. He rightly emphasizes that pollicization is of special value when one can transfer a partly damaged digit rather than a completely sound one. As in previous editions there is a good deal of material outside the scope of the hand itself but in
ABSTRACTS BURNS Enzyme Changes in Healing of Bums This is a study of the histological and histochemical (alkaline phosphatase, acid phosphatase, leucine aminopeptidase, and non-specific esterase) changes following a thermal burn of the shaved skin of the young adult guinea-pig. Both the central and peripheral zones of the lesion were studied. In the central irea, characterized by necrosis, there was a decrease in the content of all the enzymes studied within the first hour after burn. In the peripheral zone, however, increases in enzyme content were detected and it is suggested that these changes prelude healing. The changes in enzyme content were detectable much earlier than the histological changes. Local antiseptic therapy had no effect on the changes in enzyme content. MALIK, M. 0. A. (1971), ‘ Enzyme Changes in the Early Phase of Healing Skin Burns in Guinea-pigs ‘, Br. J. exp. Path., 52, 345. Local Treatment for Bums
A controlled clinical trial was carried out to compare the treatment of burns by exposure in warm dry air with the use of locally applied antibacterial substances. The incidence of bacterial colonization was significantly lower in burns that were treated than in burns that were exposed. The antibacterial measures were 4 per cent silver nitrate compresses and II.2 per cent mafenide (Sulphamylon) cream. Silver nitrate gave generally the better protection but Ps. aeruginosa was found as often with mafenide as with silver nitrate. There was less mortality in each group than was expected from a probability chart based on the previous work of the unit but the difference was not wgnificant.
OF ACCIDENT
SURGERY
Amil
Injury 1972
some way related to hand function, with a whole chapter devoted to the shoulder and elbow only. The chapter on fractures does not give as much space as some surgeons do to the value of internal fixation in managing severely smashed hands, and the new small-fragment set of internal fixation implants devised by the A0 group cannot have reached the author in time for this edition, though he will no doubt be using them before the next one. The chapter on infections is a little disappointing in that the author has not studied Bailey’s monograph on the subject and continues to advocate hockeystick. alligator mouth. and this kind of incision for pulp. abscesses which have been superseded in the more enereetic units that treat hand infections frequently. Altogether this book is beautifully produced, very comprehensive and though it is not of much use for students or occasional hand surgeons, it is a magnificent reference volume and should be available to every surgeon who deals at all frequently with hand injuries. R. L. BATTEN
Mafenide caused pain sufficient to prevent most of the patients on whom it was used from completing the course of treatment, but only one patient developed acidosis. Silver nitrate caused acidosis, diarrhoea, and low serum sodium in some patients. A trial of 1 per cent silver sulphadiazine cream on smaller burns showed that daily application gave better protection against bacteria than application every 3 or 4 days and that protection was the same when the burns were dressed as when they were exposed. The difference between these results and others reported from Stockholm and from Cincinnati are discussed and are probably due to differences in staffing and the nature of the admissions. It is emphasized that, for all the prophylactic value of silver nitrate and mafenide, infection can still occur and call for the use of standard therapeutic drugs. LOWBURY,E. J. L., JACKSON,D. M., LILLY, H. A., BULL, J. P., CASON,J. S., DAVIES, J. W. L., and FORD, P. (1971), ‘ Alternative Forms of Local Treatment for Burns ‘, Lancet, 2, 1105. Mortality Due to Burns The probability of death from burns of givenextent in persons of given age was worked out by probit analysis in 1944 and found to have remained almost unchanged for 20 years. Following the introduction of 0.5 per cent silver nitrate solution for preventing bacterial invasion, mortality-rates improved considerablv and a new table of urobability has been constructed. BULL, J. P. (1971), ‘ Revised Analysis of Mortality due to Burns ‘, Lancet, 2, 1133. In Search of the Cause of Hypermetabolism in Burns Experiments with waterproof films to cover the burns suggested that the increased metabolic rate was not stim&ted by evaporative cooling. ZAWACKI. B. E.. SPITZER. K. W.. MASON. A. D., jun., and JOHNS,’ L. A. (1970), ‘Does Increased Evaporative Water Loss cause Hypermetabolism in Burned Patients? ‘, Ann. Surg., 171, 236.