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David Ip Orthopedic Principles ± A Resident's Guide David Ip Orthopedic Principles ± A Resident's Guide 1 2 David Ip MBBS (HKU), FRCS (Ed) Orth, FHKCOS, FHKAM (Orthopaedic Surgery), LFIBA (UK) Director of Division of Rehabilitation, Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong Deputy Governor, American Biographical Institute Research Association, Deputy Director General, International Biographical Centre, Cambridge ISBN 3-540-23259-1 Springer Berlin Heidelberg New York Library of Congress Control Number: 2004113413 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provi- sions of the German Copyright Law of September 9, 1965, in its current version, and per- mission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer is a part of Springer Science+Business Media springeronline.com ° Springer Berlin ´ Heidelberg 2005 Printed in Germany The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Editor: Gabriele M. Schræder, Heidelberg, Germany Desk Editor: Irmela Bohn, Heidelberg, Germany Production: Pro Edit GmbH, Heidelberg, Germany Cover: Frido Steinen-Broo, eStudio Calamar, Spain Typesetting: K+V Fotosatz GmbH, Beerfelden, Germany SPIN 11013594 24/3130Di 5 4 3 2 1 0 ± Printed on acid-free paper Dedication This book is dedicated to: n My loving wife Esther without whose support this book would not have been a reality n All my mentors, including Professor John Leong, Professor Luk, and Drs F.K. Ip and S.H. Yeung n All my teachers in different fields of orthopaedics, including Professors Jesse Jupiter, Charles Court-Brown, John Wedge, Rorabeck and William Harris About the Author Dr. Ip is a graduate of Hong Kong University Medical School. Since his graduation (1985), he developed an interest in the field of orthopaedics and traumatology. He is the fellow of multiple professional organisations, including the Royal College of Surgeons of Edinburgh and the Hong Kong College of Orthopaedic Surgeons. He has published multiple jour- nal articles in peer-reviewed journals in the fields of total joint surgery, paediatric orthopaedics and traumatology. He is the winner of the Inter- national Health Professional of the Year 2004 Award and received the Universal Award of Accomplishment for Year 2004. He was also awarded the International Peace Prize by United Cultural Conventions of USA, among other awards that include the Man of the Year Award 2004, the Key Award (leader in science), Lifetime Achievement Award and 21st Century Award for Achievement, etc. His biography has been included in famous biographical works, such as Marquis Who's Who in Science and Engineering, Marquis Who's Who in the World, Great Minds of the 21st Century, Leading Intellectuals of the 21st Century, 2000 Outstanding Scientists of the 21st Century and the Cambridge Blue Book. His main interests include total joint replacement, osteoporosis and fragility fractures of the hip in elderly. Foreword The scope of orthopaedic knowledge has expanded to such a degree that it has become increasingly difficult to maintain a fundamental grasp of the required knowledge base. Add to this the time constraints of adult learning, with the student or practitioner facing ever-increasing demands on their time. Dr. David Ip has laboured intensively to produce a much-needed re- source of orthopaedic knowledge that will prove useful not only to those in training but also in the ever-increasing demand of certification and re-certification examinations. Organized into eight chapters extending from basic science to every speciality of orthopaedic surgery ± including hand, foot and ankle, sports medicine and spine, just to name a few with information provided in outline form ± the reader will find it quite easy to locate information on a specific subject for direct patient care, conferences or rounds, or examination review. Alternatively, the organisation of each chapter facili- tates on overall review of the subject matter. The chapters are well illus- trated with 120 figures throughout the text. By virtue of its succinct style of presentation of information, I am confident that this text will prove to be most useful to students and practitioners throughout the world. Jesse B. Jupiter, M.D. Director, Orthopaedic Hand Service Massachusetts General Hospital Hansjærg Wyss/AO Professor Harvard Medical School Preface The aim of writing this book on orthopaedic principles was manifold. This book helps to arouse interest in the field of orthopaedics and high- light important points or concepts the reader might have overlooked during his reading of the subject matter in other large, thick standard textbooks. It is not meant to be a shortcut. The author feels that it is most useful to read this book after studying the standard texts and also useful to review the subject before professional examinations, grand rounds and vivas, even the long case of clinical examinations, since most examiners nowadays stress on asking clinical principles rather than dig- ging into details of how to perform a difficult operation. The second ma- jor aim of this book was that it aims at a wide readership, including surgeons-in-training, practitioners, surgeons requiring re-certification and, in particular, surgeons in developing and under-developed countries where division into speciality or sub-speciality subjects is the exception rather than the rule. It may also prove useful for the orthopaedic sur- geon who had specialised in a field for many years, but wishes to know the latest concepts of orthopaedic management in other fields of orthopaedics. Lastly, the author wishes to express his gratitude to the world-re- nowned Professor Jupiter of Harvard University for writing a Foreword to this book. Happy reading! Hong Kong, November 2004 David Ip How to Use this Book This section highlights the pearls to make reading of this book more fruitful for the reader. Please be reminded that the author expects the reader to know the classifications used for most of the common orthopaedic conditions mentioned in this book, the detailed description of which is outside the scope of this book. Chapter 1 deals with orthopaedic basic science, with clinical examples taken from many of the common sports injuries. Other common sports injuries not mentioned, such as shoulder dislocation, etc., will be covered in a forthcoming textbook written by the same author on the field of Trauma- tology. Discussion of biomaterial science can be found in Chapter 6. Chapter 2 deals with paediatric orthopaedics. The author recommends the reader to read textbooks written by Mercer Rang from the famous Hospital for Sick Children in Toronto before beginning clinical rotation to a paediatric orthopaedic service for training. Also, since this field of orthopaedics is sometimes more difficult to understand, this chapter has many illustrations. Chapter 3 deals with hand surgery. The author strongly recommends the reader to read the books and articles published by Lister and Jupiter as a general reference. Quite lengthy description on management of the rheumatoid hand was given together with more illustrations, since this topic is more difficult to understand. Chapter 4 deals with foot and ankle surgery. The author notices that many trainee surgeons consider gait analysis to be very difficult. This is not the view of the author. Gait analysis is an interesting yet important walk of orthopaedics, and a thorough understanding of pathological gait in different orthopaedic conditions is important. The books listed in the reference section for Chap. 4 provide a good basis for understanding this topic. Many an examiner expects the candidate to diagnose the patient just by looking at their gait. Chapter 5 deals with spine surgery. There are many good articles on the degenerate spine, especially in the Japanese literature on the topic of XII How to Use this Book cervical myelopathy, which the reader should know. There are also many good articles on scoliosis published by eminent professors such as Pro- fessor John Leong and Professor Luk and Cheung of Hong Kong Univer- sity. Also the famous works of McMaster, Robert Winter and the Scolio- sis Research Society should be noted. Chapter 6 deals with total joint surgery. Owing to the size constraints of the book, it is impossible for the author to include a lengthy discussion on revision of total knee and total hip surgeries. I strongly advise the reader to read the works of Professor Rorabeck when it comes to revision of total knee surgery and the works of Rosenberg, Harris, Calla- ghan and Jasty ± as well as Paprosky ± when it comes to revision of total hip surgery. Chapter 7 deals with orthopaedic infections. Infections in the pres- ence of an orthopaedic implant is a common clinical problem as well as examination question. I strongly advise the reader to read the articles written by Gristina, Parry, Oga and also refer to the important animal studies coming from great works done in Case Western University. Chapter 8 deals with tumour surgery. I advise the reader to read the books and articles published by Enneking. Limb salvage is quite a hot topic nowadays, but detailed discussions are outside the scope of this book. Many articles published in Clinical Orthopaedics and Related Re- search are worth reading, as are the great advances made in this field thanks to the marvellous works from the Mayo Clinic.