About the Book

?All chapters have been thoroughly revised and updated.
?Contents have been tailored to the requirement of a undergraduate medical student and those preparing PG entrance examination.
?The section on clinical methods makes it an “all-in-one” book for medical students and residents.
?The “problem-solving approach” has been further improved for students, teachers and practising doctors.
?The section an “Orthopaedic Terminology” helps to review-at-glance, the meaning of different terms used in orthopaedics.
?A number of diagrams and X-rays have been replaced for better clarity and understanding.

About the Author

Maheshwari MS Orth (AIIMS); Vikram A Mhaskar MS Orth, MCh Orth (UK)

Table of Contents:
CONTENTS 1. Orthopaedic Trauma: Introduction ...................... 1 • Classification of fractures ................................... 1 • Fractures with eponyms ...................................... 2 • Pathological fractures.......................................... 3 • Injuries to joints ................................................... 5 • Injuries to ligaments ............................................ 5 • Injuries to muscles and tendons .......................... 6 2. Anatomy of Bone and Fracture Healing .............. 8 • Anatomy of bone ................................................. 8 • Growth of a long bone ........................................ 9 • Blood supply of bones ......................................... 9 • Fracture healing ................................................. 10 • Healing of cancellous bones .............................. 11 • Primary and secondary bone healing................. 11 • Factors affecting fracture healing ..................... 11 3. Treatment of Fractures: General Principles ..... 13 • Phase I Emergency care ............................... 13 • Phase II Definitive care .................................. 14 • Phase III Rehabilitation of a fractured limb ..... 19 • Management of open fractures ......................... 21 4. Splints and Tractions ............................................ 25 • Splints................................................................ 25 • Tractions ........................................................... 26 5. Recent Advances in the Treatment of Fractures ........................................................... 29 • AO method of fracture treatment ...................... 29 • Changing AO concepts ...................................... 31 • Functional bracing ............................................. 33 • Ilizarov's technique ............................................ 33 6. Approach to a Patient with Limb Injury ............ 36 • Clinical examination ........................................... 36 • Radiological examination ................................... 38 • Old fracture ....................................................... 40 • Approach to a polytrauma patient ..................... 40 7. Complications of Fractures ................................. 42 • Classification ..................................................... 42 • Hypovolaemic shock ......................................... 42 • Adult respiratory distress syndrome ................. 43 • Fat embolism syndrome .................................... 43 • Deep vein thrombosis (DVT) and pulmonary embolism.................................... 44 • Crush syndrome ................................................ 44 • Injury to major blood vessels ............................ 44 • Injury to nerves ................................................. 46 • Injury to muscles and tendons .......................... 46 • Injury to joints ................................................... 46 • Injury to viscera ................................................ 46 • Infection — osteomyelitis ................................. 47 • Compartment syndrome .................................... 47 • Delayed and non-union ...................................... 48 • Malunion ............................................................ 49 • Shortening ......................................................... 50 • Avascular necrosis............................................. 50 • Stiffness of joints .............................................. 51 • Reflex sympathetic dystrophy (Sudeck‘s dystrophy) .................................. 51 • Myositis ossificans (Post-traumatic ossification) ................................................. 52 8. Injury to Joints: Dislocation and Subluxation .. 54 • Relevant anatomy .............................................. 54 • Definitions ......................................................... 54 • Classification ..................................................... 54 • Pathoanatomy .................................................... 55 • Diagnosis ........................................................... 55 • Complications .................................................... 56 • Treatment .......................................................... 56 9. Fractures in Children ........................................... 57 • Relevant anatomy .............................................. 57 • Types of fractures ............................................. 57 • Diagnosis ........................................................... 59 xiv | Essential Orthopaedics • Treatment .......................................................... 59 • Complications .................................................... 59 10. Peripheral Nerve Injuries .................................... 61 • Relevant anatomy .............................................. 61 • Pathology ........................................................... 62 • Mechanism of injury.......................................... 62 • Classification ..................................................... 63 • Diagnosis ........................................................... 63 • Electrodiagnostic studies ................................... 69 • Treatment .......................................................... 71 • Prognosis........................................................... 74 11. Deformities and Their Management .................. 75 • Causes ............................................................... 75 • Treatment .......................................................... 77 12. Treatment of Orthopaedic Disorders: A General Review ................................................. 80 • Non-operative methods of treatment................. 80 • Operative methods of treatment ........................ 82 13. Injuries Around the Shoulder, Fracture Humerus ................................................ 87 • Relevant anatomy .............................................. 87 • Fracture of the clavicle ...................................... 88 • Fractures of the scapula .................................... 89 • Dislocation of the sterno-clavicular joint ........... 89 • Subluxation or dislocation of the acromio-clavicular joint ..................................... 89 • Dislocation of the shoulder ................................ 89 • Fracture of the surgical neck of the humerus ... 92 • Fracture of the greater tuberosity of the humerus .................................................. 92 • Fracture of the shaft of the humerus ................ 93 14. Injuries Around the Elbow ................................... 96 • Relevant anatomy .............................................. 96 • Supracondylar fracture of the humerus ............ 97 • Fracture of the lateral condyle of the humerus .. 103 • Intercondylar fracture of the humerus ............ 104 • Fracture of the medial epicondyle of the humerus ................................................ 105 • Dislocation of the elbow joint .......................... 105 • Pulled elbow .................................................... 105 • Fracture of the olecranon ................................ 105 • Fracture of the head of the radius ................... 106 • Fracture of neck of the radius......................... 107 • Fracture of the capitulum ................................ 107 15. Injuries of the Forearm and Wrist................... 108 • Relevant anatomy ............................................ 108 • Fractures of the forearm bones....................... 109 • Monteggia fracture-dislocation ........................ 110 • Galeazzi fracture-dislocation ............................111 • Colles' fracture .................................................111 • Smith's fracture (Reverse of colles' fracture) .... 114 • Barton's fracture .............................................. 114 • Scaphoid fracture ............................................ 115 • Lunate dislocations .......................................... 116 16. Hand Injuries ...................................................... 117 • Bennett's fracture-dislocation .......................... 117 • Rolando's fracture ........................................... 118 • Fractures of the metacarpals........................... 118 • Fractures of the phalanges .............................. 118 • Dislocation of the metacarpo-phalangeal joints ... 118 • Amputation of fingers: Principles of treatment ..................................................... 119 • Tendon injuries of the hand ............................. 119 • Crush injury to the hand .................................. 120 17. Pelvic Fractures .................................................. 123 • Relevant anatomy ............................................ 123 • Classification ................................................... 124 • Pathoanatomy .................................................. 125 • Diagnosis ......................................................... 125 • Treatment ........................................................ 126 • Complications .................................................. 127 18. Injuries Around the Hip ..................................... 129 • Relevant anatomy ............................................ 129 • Disclocation of the hip .................................... 130 • Posterior dislocation of the hip ........................ 130 • Anterior dislocation of the hip ......................... 131 • Central fracture-dislocation of the hip ............. 131 Contents | xv • Fracture of the neck of the femur................... 132 • Inter-trochanteric fractures............................. 138 19. Fracture Shaft of Femur .................................... 141 • Pathoanatomy .................................................. 141 • Diagnosis ......................................................... 141 • Treatment ........................................................ 141 • Complications .................................................. 143 20. Injuries Around the Knee .................................. 145 • Relevant anatomy ............................................ 145 • Mechanism of knee injuries ............................. 145 • Condylar fractures of the femur ..................... 145 • Fractures of the patella .................................... 147 • Injury to the ligaments of the knee .................. 148 • Tibial plateau fractures .................................... 150 • Meniscal injuries of the knee ........................... 150 • Rare injuries around the knee .......................... 152 21. Injuries to the Leg, Ankle and Foot................. 155 • Fractures of shafts of tibia and fibula ............. 155 • Ankle injuries ................................................... 159 • Fractures of the calcaneum ............................. 164 • Fractures of the talus ...................................... 165 • Injuries of the tarsal bones .............................. 166 • Fractures of the metatarsal bones ................... 166 • Fractures of the phalanges of the toes ............ 167 22. Infections of Bones and Joints .......................... 168 • Acute osteomyelitis.......................................... 168 • Secondary osteomyelitis .................................. 171 • Chronic osteomyelitis ...................................... 171 • Garre’s osteomyelitis ....................................... 175 • Brodie’s abscess .............................................. 175 • Salmonella osteomyelitis .................................. 175 • Septic arthritis ................................................. 175 • Gonococcal arthritis ........................................ 178 • Syphilis of joints .............................................. 178 • Fungal infections ............................................. 178 • Leprosy and orthopaedics ............................... 179 23. Tuberculosis of Bones and Joints ...................... 182 • General considerations .................................... 182 • TB of the spine ................................................ 185 • Pott's paraplegia ............................................... 191 • TB of the hip ................................................... 194 • TB of the knee ................................................. 199 • TB of other joints ............................................ 202 • TB osteomyelitis .............................................. 203 24. Infections of the Hand ....................................... 205 • Classification ................................................... 205 • Aetiopathology ................................................. 205 • Acute paronychium ......................................... 205 • Apical subungual infection .............................. 206 • Terminal pulp space infection .......................... 206 • Middle volar space infection ............................ 206 • Proximal volar space infection ........................ 207 • Web space infection ........................................ 207 • Deep palmar abscess ....................................... 208 • Acute suppurative tenosynovitis...................... 208 25. Congenital Talipes Equino Varus (CTEV) ........ 210 • Relevant anatomy ............................................ 210 • Nomenclature .................................................. 211 • Aetiology .......................................................... 211 • Pathoanatomy .................................................. 212 • Clinical features ............................................... 212 • Treatment ........................................................ 214 26. Congenital Dislocation of the Hip and Other Malformations .................................. 219 • Congenital dislocation of the hip (CDH).......... 219 • Other congenital malformations ...................... 224 27. Poliomyelitis and Other Neuromuscular Disorders .................................. 226 • Poliomyelitis..................................................... 226 • Cerebral palsy .................................................. 229 • Spina bifida ...................................................... 230 • Disorders of the muscles ................................ 232 • Peripheral neuropathies .................................... 233 28. Bone Tumours ..................................................... 235 • Benign tumours ............................................... 235 • Osteoclastoma (Giant cell tumour) ................. 237 • Primary malignant tumours ............................. 239 • Some uncommon malignant tumours.............. 246 xvi | Essential Orthopaedics • Metastasis in bone ........................................... 246 • Tumour-like conditions of bone ...................... 247 • Osteochondroma ............................................. 247 • Aneurysmal bone cyst ..................................... 249 • Fibrous dysplasia ............................................. 249 29. Prolapsed Intervertebral Disc ........................... 252 • Relevant anatomy ............................................ 252 • Pathology ......................................................... 252 • Diagnosis ......................................................... 254 • Investigations................................................... 255 • Differential diagnosis ....................................... 256 • Treatment ........................................................ 256 • Cervical disc prolapse ...................................... 257 30. Approach to a Patient with Back Pain.............. 258 • Low back pain ................................................. 258 • Causes ............................................................. 258 • History ............................................................. 258 • Physical examination ....................................... 260 • Investigations................................................... 261 • Treatment ........................................................ 261 • Major causes of low back pain ....................... 261 • Approach to a patient with back pain .............. 262 • Sciatica ............................................................ 264 31. Spinal Injuries..................................................... 265 • Relevant anatomy ............................................ 265 • Biomechanics of injury .................................... 266 • Classification ................................................... 267 • Clinical features ............................................... 269 • Examination ..................................................... 269 • Investigations................................................... 269 • Treatment ........................................................ 270 32. Traumatic Paraplegia.......................................... 276 • Pathology ......................................................... 276 • Neurological deficit and spinal injuries ............ 277 • Clinical examination ......................................... 277 • Investigation .................................................... 277 • Treatment ........................................................ 278 33. Scoliosis and Other Spinal Deformities ........... 280 • Scoliosis........................................................... 280 • Kyphosis .......................................................... 283 • Spondylolisthesis ............................................. 283 34. Arthritis and Related Diseases ......................... 286 • Definitions ....................................................... 286 • Rheumatoid arthritis ........................................ 286 • Ankylosing spondylitis..................................... 290 • Other rheumatological diseases ....................... 293 35. Degenerative Disorders ..................................... 295 • Osteoarthritis ................................................... 295 • Cervical spondylosis........................................ 297 • Lumbar spondylosis ........................................ 298 36. Affections of the Soft Tissues ........................... 301 • Bursitis............................................................. 301 • Tenosynovitis................................................... 301 • Dupuytren's contracture .................................. 302 • Tennis elbow ................................................... 302 • Golfer's elbow ................................................. 302 • de Quervain's tenovaginitis .............................. 303 • Trigger finger and thumb ................................ 303 • Ganglion........................................................... 303 • Carpal tunnel syndrome ................................... 303 • Frozen shoulder ............................................... 304 • Plantar fascitis ................................................. 304 • Fibrositis .......................................................... 304 • Painful arc syndrome ...................................... 304 • Meralgia paraesthetica ..................................... 305 • Fibromyalgia .................................................... 305 37. Metabolic Bone Diseases.................................... 307 • Constitution of bone ........................................ 307 • Bone and calcium ............................................ 307 • Osteoporosis .................................................... 308 • Rickets and Osteomalacia ................................ 310 • Hyperparathyroidism ....................................... 312 • Fluorosis .......................................................... 314 • Disturbances of organic constituents.............. 315 38. Miscellaneous Affections of the Bone .............. 316 • Generalised bone disorders .............................. 316 • Osteochondritis ............................................... 317 Contents | xvii • Avascular necrosis........................................... 318 • Some other developmental abnormalities of orthopaedic interest ..................................... 319 39. Miscellaneous Regional Diseases ..................... 321 • Torticollis......................................................... 321 • Cervical rib ...................................................... 322 • Observation hip ............................................... 323 • Coxa vara......................................................... 323 • Slipped capital femoral epiphysis..................... 323 • Deformities of the knee ................................... 324 • Popliteal cyst ................................................... 326 • Loose bodies in joints ...................................... 326 • Flat foot ........................................................... 326 • Deformities of the toes .................................... 327 40. Amputations, Prosthetics and Orthotics .......... 328 • Amputations..................................................... 328 • Special features of amputations in children ..... 331 • Prostheses in orthopaedic practice .................. 331 • Orthoses in orthopaedic practice..................... 332 41. Arthroscopic Surgery ......................................... 334 • Advantages ...................................................... 334 • Indications ....................................................... 335 • Procedure ........................................................ 336 • Limitations ....................................................... 336 42. Joint Replacement Surgery ............................... 338 • Hemiarthroplasty ............................................. 338 • Total joint replacement .................................... 339 • Partial knee replacement .................................. 341 • Total shoulder replacement.............................. 341 • Total elbow replacement.................................. 341 Annexures .................................................................. 343 Annexure 1 : Clinical Methods ..................................... 343 Annexure 2 : Orthopaedic Terminology ....................... 367 Annexure 3 : Orthopaedic Instruments and Implants ... 371 Index ................................................................... 377