Casualty radiology: A practical guide for radiological diagnosis

Casualty radiology: A practical guide for radiological diagnosis

Book Reviews 359 development and growth, maintenance, breakdown and repair, diagnostic techniques and therapeutic measures, each written by an exper...

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Book Reviews


development and growth, maintenance, breakdown and repair, diagnostic techniques and therapeutic measures, each written by an expert in that field with contributors from several of the English speaking nations. Different readers will doubtless fmd different chapters interesting and helpful. but none will be disappointed. For myself, I was particularly helped by the chapters on electro-diagnosis and investigation of muscle dysfunction, both of which are models of clarity and succinct enough to be remembered. Other chapters are equally clear and will appeal particularly to the surgeon who is weak in that sphere. The subject matter covered is enormous and it would notbe possible to cover comprehensively the whole of the musculoskeletal svstem. However for the person who requires a deeper knowledge of a partitular aspect, there is a long but selected list of references at the end of each chapter. This would be the idea1 starting point for further reading on any subject regarding the scientific principles of the mu~&loskeletal s&&m. This is such a good book that I cannot foresee any accident surgeon, orthopaedic physician or orthopaedic surgeon being without it in the future. It must be essential reading for the accident and orthopaedic surgeon in training. I thoroughly recommend it to all readers of [jury. N.


The Management of Acute Vascnlu Iqjuries. By Malcolm 0. Perry. 254 x 172 mm. Pp. 156. 198 I. Baltimore, Williams and Wilkins. $27.75. This is a slim book of 150 pages. The first section deals briefly with the history of vascular repair, the mechanisms of injury and aetiology. Evaluation of the patient, diagnosis and special diagnostic procedures are also in this section. On priorities of treatment in arterial injuries associated with fractures, the author prefers to complete the arterial repair before fixing the fracture but many vascular surgeons would not agree with this. There is a chapter on adjunctive methods of blood flow promotion where the value of patient heparinization is debated, certainly systemic heparinization in a patient with the possibility of multiple injuries would seem to the writer to be unwise and with this the author agrees. Antiplatelet agents and dextran are mentioned. There is a brief discussion of arterial spasm and its treatment with dilator drugs, although it appears that the author feels that most patients who are thought to have spasm in fact have clots in the vessel. The danger of the confusion of spasm with traumatic arterial thrombosis is not clearly stated. Indeed, traumatic arterial thrombosis which is responsible for many ischaemic limbs in this country does not appear to have much prominence in the author’s series. Section 1 I of the book deals with the diagnosis, exposure and treatment ofarterial injuries of the aortic arch and its branches, carotid subclavian and vertebral

vessels and the visceral arteries. Injuries of the inferior vena cava and the limb vessels are also covered. The book is clearly and well illustrated and there is an up-to-date bibliography. This book might well appeal to the Fellowship candidate or the trauma surgeon, although I feel that the absolute ‘do’s’ and ‘don’ts’ of the treatment of arterial injuries are not sufficiently clearly stated, and the spectrum of injury must be rather different in this country, where gunshot and stabbing wounds are less frequent than in the USA. F.


Management of the Injured Patient. Edited by J. Norm& and M. Molds. 250x 185 mm. Pp. i28. Illustrated, with index. 1978. London, Macmillan. E4.95. This is a small book containing an interesting collection of papers, many of which were originally oublished in the British Journal of Anaesthesia. The Hurst section of four papers covers very well the problems of the initial medical care at the site of the accident, the transport of the casualties to the hospital and the linkina of the health services to enable this to be done swifih and safely. There follow three wellwritten and detailed papers on the early management of the acutely ill patient, his resuscitation and metabolic needs and the hazards of anaesthesia. These can ail be read with great benefit by any doctor having to care for the injured person. The latter papers concern the diagnosis and the problems related to head injuries that are specialist in content and more appropriate reading for the registrar and grades above. This is an excellent book and would be very handy reading in any accident department. T. R.


CasuaIty Radiology: A Practical Guide for Radiological Diagnosis. By Paul Grech. 246 x 188 mm. Pp. 254. 1981. London, Chapman and Hall. fl5.00. This sensible and practical book gives an account of radiological problems encountered by doctors dealing with trauma in casualty departments. After introductory sections, the X-ray manifestations of injuries to the limbs, head, spine, chest and abdomen are described. A short chapter (by Dr Naik) surveys alternative methods of imaging-ultrasonic, scintographic and CAT scanning; more than twice as many pages are devoted to an admirable account of foreign bodies in the last chapter. The disparity in space allocation between these two subjects exemplifies a difficulty which the author has not fully resolvedwhat can be left out? In his preface, he defines his limited aims: ‘obvious fractures are not included but stress is made on the common, not-so-obvious ones. The severe injuries which merit hospitalization. . and specialized radiological investigations. . . are not


Inpry: the Brmh Journal of Accident Surgery Vol. 1 ~/NO. 4

included in this study.’ So joint injuries dominate the sections on the limbs and are copiously illustrated; the lesser radiological problems of long-bone fractures are barely included. The stated aims are soon cheerfully and probably wisely forgotten; even the important though rare traumatic rupture of the aorta is described with an apology for mentioning it: but there are also good accounts of, for example, spinal fractures, diaphragmatic tears and some of the more serious pulmonary manifestations of chest injury. Hardly surprising, for despite his modest preface, the author clearly recognizes that injured patients do not arrive in casualty labelled major or minor; the casualty officer has to learn how to differentiate between the two and if he reads this book carefully, he will be better prepared to do so. Much ofthe ground covered is well-known and welldescribed elsewhere but there are few comparable texts which cover the chosen field succinctly. Many of the more difficult radiographs have the relevant points clearly marked or are supported by line drawings. A series of X-rays of joints at different ages will be of value to the inexperienced. In such well known territory, we all have our own hobby-horses and it is not difficult to quibble with some opinions or emphasized points. Almost a page on rib fractures, but no mention of the fact that radiological pursuit of the clinical fracture is often unrewarding; the importance of soft tissue manifestations of trauma could have been dealt with more fully and the value of isotope examinations in stress fractures are some which come to mind. Good style in writing makes easy reading. It is a difficult art and there are lapses. For example the sentence ‘Chest movements are associated with respiration’ sounds odd and otiose. In other places, a small number of printing and mal-position errors cause confusion. To summarize, the general concept is excellent, the execution falls short of ideal, but the book is likely to be popular with the junior medical staff and has potential for maturity J. C. MACLARNON


Contents of the .foufna/


Arthrography. By Dennis J. Stoker. 246 x 190 mm. Pp. 180.1980. London, Chapman and Hall.

The complexity of the knee joint and injuries of the knee joint are becoming increasingly recognized. It is no longer sufficient to believe that most knee pain is due to torn menisci. There is no substitute for a thorough clinical examination of the knee but two main lines of further investigation have been developed - arthrography and arthroscopy. This is no place to discuss the various merits of these two methods of investigation but suffice to say that both methods require considerable apprenticeship and experience before accuracy is gained. The author of this book is one of the leading exponents of arthrography. The whole subject of arthrography is covered in depth with chapters on anatomy, pathology, technique, normal arthrogram, interpreting the arthrogram, accuracy and result and finally a chapter on chondral and osteochondral lesions. As one would expect from Dr Stoker, it is well and clearly written and makes easy reading. Any radiological book must have good radiographic reproductions and this is a model in that respect. The detail is always clear, even in those which have been considerably enlarged. Accident surgeons will particularly welcome the long list of references at the end ofeach chapter, and for this reason alone it is of value to the accident surgeon as well as the radiologist. This is a beautifully-produced book and deserves to become a classic in its limited field. It stands supreme among its two or three rivals. The author states that it is intended primarily for radiologists but there is no doubt that it will be of considerable value to all those concerned with surgery of the knee, even confirmed and prejudiced arthroscopists. I can recommend it to all those involved in injuries to the knee but it should be remembered that very few local radiologists will ever approach the expertise achieved by Dr Stoker. N. TUBES


Volume 21 Number 6 June 1961 Impaired mineral metabolism in postburn muscle. J Turinskv.

W. A. Gonnerman

and L. D. Loose


Jerry M. Shuck


The combined bum and trauma unit: ten years later. Treatment ofsevere bums with widely meshed skin autograft and meshed skin allografi overlay. J. Wesley Alexander,

Bruce G. MacMillan.

Edward Law and Dilip S. Kittur


Penetrating abdominal trauma index. Ernest E. Moore, Ernest L. Dunn, John B. Moore and Jon S. Thompson


pressure measurements:

an experimental


investigation using the slit catheter.

Cecil H. Rorabeck,

G. S. P. Castle, R. Hardie and J. Logan


Richard E. Welling, Job Kakkasseril and John J. Cranley


structure ofthe alveolar-capillary barrier in 23 autopsies. G. G. Pietra, J. R. Riittner, W. Wiist and W. Glinz


Complete dislocations of the knee with popliteal vascular injury. The lung after trauma and shock-fine