Joint stiffness of the upper limb

According to the authors, two Canadian trained surgeons now practising in the USA, this book arose from their frustrations with the standard of radiography in their own institutions, which had failed to match that of the centres in which they had undertaken hand fellowships. Their aim was to provide a manual for the technologist (radiographer) that would “save ourselves telephone calls and personal trips with the patient lo the radiology department while saving the patients the repeated X-ray exposure and cost.” They claim that it is not their intention to educate the technologist in radiography but to provide precise directions for the technologist to produce reproducible and informative views of the hand and wrist. A clinical practice that strives to minimize contact with investigative departments or to obtain quality radiography by showing a radiographer photocopies of the pages in this manual might explain the frustration from which the project apparently originated. The use of the book in the manner recommended would be unappealing to many British: European and, I suspect, many North American surgeons The manuai comprehensively covers the positions that may be used to obtain radiographs of specific bones and joints in the hand and wrist. On the left-hand page there is a description and line drawings showing the positions with brief comments, most stating the obvious or selfevident, -while on the right hand page is a picture of the radiograph that would be produced. UnfortunateEy, many of these are of poor quality suggesting that it was the radiography rather than the reproduction that was at fault. After photocopying, as the authors suggest, many become indiscernible. Radiographers in my own hospital also expressed disappointment at the poor standard of the reproductions and their view was that this manual would not replace any of the reference volumes they currently use for positioning. This is a view with which I agree and despite its modest price I do not see this volume being a useful addition to either the hand clinic or department of radiology. M.

As with so zany multi-author books, ~;z~articuiar!y when the authors come from different countries, I have found this book particularly difficult to review. There are good parts and bad parts. What 9 have done is to consider problems with which T am very familiar. and to see if the book heiped me, and then to consider an area of surgery which is unfamiliar to see if the book is useful in advising me when and how to do a new procedure. 1 first arbitrarily chose proximal interphalangeai joint stiffness. There is a very good chapter on intrinsic causes which is spoilt by poor editing. There are many spelling mistakes and the use of katln terminology now extinct. The following chapter on intrinsic causes of stiffness would have been much clearer with more and better diagrams. The chapter on the treatment of stiKness would again have been much helped by diagrams raiher than by_ the occasional photograph, and there is also a lack of precise information, in such statements as “PIP prostheses provide worse results than M prostheses”. This statement is not supported by figure or even a reference. For my second topic, of which I have no previous experience, B picked “Shoukler joint repiacemen:“. This is covered in two and a half pages of text which concisely give the history, indications and contraindications but without an outline of the technique, or any advice on the surgical technique. The last chapter in the book is “As overview of reflex sympathetic dystrophy” by Dr Lynn Parry which should be read by all prospective authors for its c1arir.y and by all surgeons who deal with the upper limb for its information. So where is the place for this book? Not, 1 think, in an individual surgeon’s library, where having been read once it is unlikely to be referred to again. It is however a useful book for surgeons preparing for the higher examinations in orthopaedic or Flastic surgery, and I would recommend it for a specialist departmental library.

This unusual 5304 approaches the description of hand surgical procedures from a novel perspective deeaiied coverage of a limited set of operations that will interest the experienced surgeon. The stated aim is to describe in depth the assessment. indications and technique of operations that are demanding with regard to selection for surgery or operative technique. The reader is invited to “‘look over the shouider” of the master surgeon in the