Surgical anatomy and pathology for orthopaedic surgeons

Surgical anatomy and pathology for orthopaedic surgeons

Book Reviews 357 aim of providing basic knowledge in biomechanics, muscle physiology, joint structure and co-ordinated muscular function. It consist...

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Book Reviews


aim of providing basic knowledge in biomechanics, muscle physiology, joint structure and co-ordinated muscular function. It consists of twelve chapters. The first three chapters discuss the general principles of the laws of mechanics and their applications, joint design and function and muscle structure and function. The following seven chapters are allocated to spine and extremity joints. Each chapter comprises the functional anatomy of the joint, including the ligaments which provide the stability and muscles which provide the function. The pertinent biomechanics of each joint is well described. The final two chapters are dealing with posture and gait. Each chapter also includes a set of questions under the heading of objectives. This helps the reader to test him or herself and also directs the reader to a better understanding of the subject. The chapters related to individual joints also have an explanation of effects of the injury. This book is well produced and contains excellent diagrams. Nowadays i27.50 is not a high price and I recommend the book to physiotherapists.

E.K. ALPAR Fracture of the Proximal Femur in Children and Adolescents. H. J. Hoekstra. 230 x 170 mm. Pp 122. 1982. Groningen, Bohn Scheltemia & Holkemg. DM 35.

This monograph is an excellent account of the common problems associated with proximal femoral fractures in children and adolescents. This careful follow-up and large series adds significantly to the literature on this difficult subject. Unfortunately there are no radiographs which lessens the impact of the extensive classification used in Injury Type. I am uncertain about the significance of the Garden classilication in children’s fractures. I am also unclear about the time of onset of complications specifically with regard to post-traumatic osteo-arthritis. Despite these minor criticisms I feel there is much valuable information contained in this monograph, and it represents an important contribution to the literature. The references provide a review of the

Continental literature in addition to the literature of the English speaking world. A.G. THOMPSON Shoulder Arthrugraphy: Technique, Diagnosis and Clinical Correlation. Amy Beth Goldman with D. M. Dines and

R. Warren. 280 x 214mm. Pp 172. 1982. Boston, Little Brown. $46.75. Hardback. This short monograph gives a comprehensive account of shoulder arthrography based on the experience gained in over one thousand examinations at the Hospital for Special Surgery, New York. An account of the anatomy involved precedes a detailed description of the technique and examples of normal arthrograms. Succeeding chapters describe the findings in rotator cuff tears, dislocations, problems with capsular deformities, the long head of biceps and a variety of less common problems. The Authors use the double contrast technique, now accepted as standard and they rightly emphasize the need to use no more than 3 to 4 cc of radio-opaque medium for optimal results. Even so, the very wide range of radiographic contrast on the films makes good reproduction difficult: although most are of.high quality, the line drawings accompanying the X-rays are a necessary adjunct though it is fair to say that the clarity achieved by the artist has required a licence extending a little beyond accuracy. More important-is this a useful investigation? Certainly not if not done competently. For those with ambition to acquire this expertise, Dr Goldman’s text is essential reading: the more experienced will benefit more selectively’as there are options on some details of technique and the range of projections required.

Equally important-is this a necessary investigation? In America, it appears that the most common indication for the

examination is the problem of rotator cuff tears with the implication that surgical repair or decompression will be assisted or guided by the findings. Surgical practice in the United Kingdom is less demanding on Radiologists; it relies, apparently, on clinical examination and conventional radiography, sceptical perhaps of the efficacy of surgery in many cases. If this is so, such Surgeons are more likely to be persuaded and should at least consider the extent to which their surgical approach would be modified if the radiological anatomy of e.g. recurrent dislocation was available. Dr Goldman and her colleagues show what can be done by enthusiasm and skill. Plain radiography is a poor guide to the complexities of the shoulder girdle and its malfunctions. Orthopaedic Surgeons are accustomed to the deficiencies of skeletal radiography, clinical skill compensating at least in part. This book, describing conventional techniques applied to the shoulder moves another step towards the soft tissue imaging of the future. Surprisingly it makes little of the potential in fluoroscopic observation and video recording of the movements of this very mobile joint. J.C. MACLARNON Surgical Anatomy and Pathology for Orthopaedic Surgeons. John V. Fowles. 190 x 124mm. Pp. 444. 1983. Baltimore: Williams and Wilkins. This excellent paperback is crammed full of basic information in note and diagram form. John Fowles has managed to condense and distil much of the essential knowledge required in orthopaedic surgery into this very handy small volume. The first half of the book is devoted to surgical anatomy and surgical approaches, which are covered region by region. The coverage is good but necessarily abbreviated and didactic. Nevertheless, there are relatively few contentious statements and the reader who follows the advice given will not go far wrong. The second half of the book is devoted to general surgical pathology. It includes chapters on respiratory and metabolic physiology, fluid balance, nutrition, both hypovolaemic and septic shock, and sepsis. These subjects are all well covered at a basic level. The reader who looks for the pathology of orthopaedic conditions such as diseases of synovium and cartilage, neurovascular disorders and tumours will be disappointed. It would seem that a third section on orthopaedic special pathology should be added to the book, but perhaps the author is intending to cover this in a future companion volume. John Fowles is to be congratulated on this valuable distillation of essential orthopaeclic knowledge. The publishers are equally to be congratulated for producing it in compact paperback form. Although no price is stated I hope it will be such that no orthopaedic resident will have an excuse for not buying it. J. PLEWES Mercer’s Orthopaedic Surgery. 8th Edition. Edited by Robert B. Duthie and George Bentley. 1983. London: Edward Arnold. E75.00. Hardback. The eighth edition of Mercer’s Orthopaedic Surgery has just been published to continue the splendid tradition of the past half-century. Professors Duthie and Bentley are to be congratulated on their comprehensive exposition of basic orthopaedic surgery. The text is well arranged and the only criticism can be that whilst each anatomical region is dealt with separately, the hip has been omitted. Although the various aspects of hip surgery are covered elsewhere, it is a shame they have not been collected together as has been done for the shoulder, the knee and SO on. Each chapter is followed by a good selection of references to both further textbooks and original articles. The book is necessarily didactic, but provides an excellent basic grounding