Apley's Concise System of Orthopaedics and Fractures, Third Edition

419 Pages·2005·47.85 MB·English

by  Louis Solomon

APLEY’S CONCISE SYSTEM OF
ORTHOPAEDICS
AND FRACTURES
This edition of the Concise System is dedicated
to the memory of Alan Graham Apley, whose
teaching has inspired us throughout the work
APLEY’S CONCISE SYSTEM OF
ORTHOPAEDICS
AND FRACTURES
THIRD EDITION
Louis Solomon MB ChB MD FRCS FRCSEd
Emeritus Professor of Orthopaedic Surgery, University of Bristol
David Warwick MD BM DIMC EDHS FRCS FRCS(Orth)
Consultant Orthopaedic Surgeon, Southampton University Hospitals; and
Honorary Senior Lecturer, University of Southampton
Selvadurai Nayagam BScMCh(Orth) FRCS(Orth)
Consultant Orthopaedic Surgeon, Royal Liverpool Children's Hospital
and Royal Liverpool University Hospital, Liverpool
Hodder Arnold
AMEMBER OF THE HODDER HEADLINE GROUP
First published in Great Britain in 1988 by Butterworth Heinemann
Revised reprint 1989
Reprinted 1991, 1992, 1993
Second edition 1994
Reprinted 1997 (twice), 1998, 1999, 2000 (twice), 2001, 2003
This third edition published in 2005 by
Arnold, a member of the Hodder Headline Group,
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ISBN-10: 0 340 80984 1
ISBN-13: 978 0 340 80984 6
1 2 3 4 5 6 7 8 9 10
Commissioning Editor: Joanna Koster
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CONTENTS
Preface ix
Acknowledgements xi
PART 1 GENERAL ORTHOPAEDICS 1
1 Diagnosis in orthopaedics 3
2 Infection 17
3 Rheumatic disorders 26
4 Gout and pseudogout 37
5 Osteoarthritis and related disorders 41
6 Osteonecrosis and osteochondritis 47
7 Metabolic and endocrine disorders 53
8 Genetic disorders, dysplasias and malformations 72
9 Tumours 84
10 Neuromuscular disorders 97
11 Peripheral nerve injuries 109
12 Principles of operative treatment 122
PART 2 REGIONAL ORTHOPAEDICS 139
13 The shoulder 141
14 The elbow 154
15 The wrist 159
16 The hand 167
17 The neck 178
18 The back 185
19 The hip 201
20 The knee 220
21 The ankle and foot 238
PART 3 FRACTURES AND JOINT INJURIES 255
22 Management of major injuries 257
23 Fractures and joint injuries 266
24 Fractures – principles of treatment 281
25 Complications of fractures 292
26 Injuries of the shoulder and upper arm 303
27 Injuries of the elbow and forearm 317
28 Injuries of the wrist and hand 329
29 Injuries of the spine and thorax 342
30 Fractures of the pelvis 354
31 Injuries of the hip and femur 361
32 Injuries of the knee and leg 371
33 Injuries of the ankle and foot 380
Index 391
SOUTHERN SUDAN, 2001. The population of the cattle camp at Keny walk toward the polio vaccinators as soon as they arrive (Maper Payem area. Rumbek District).
© Sebastiao Selgado/Amazonas/nbpictures
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PREFACE
When the Concise System of Orthopaedics and As before, the book is divided into three major
Fractures was conceived ten years ago, it was sections: General Orthopaedics, which comprises
designed to answer the needs of advanced medical the main categories of clinical examination, special
undergraduates, newly qualified doctors and investigations and the important musculoskeletal
especially surgeons-in-training who were still disorders such as infection, arthritis, metabolic
learning to master the principles and practices of bone disease, developmental abnormalities,
orthopaedic surgery. It would exclude the tumours and neuromuscular conditions. This ends
extended descriptions and surgical detail of the with a chapter on the principles of operative
larger, well-established Apley System of orthopaedics and other methods commonly used
Orthopaedics and Fractures (now in its 8th in treating patients with musculoskeletal
edition) on which it was based. By following the complaints. The second section, Regional
same layout and order of subjects, it would be easy Orthopaedics, deals with the common conditions
to refer to the larger edition where more detail was affecting each of the major joints and the spine.
needed. The final section, Fractures and Joint Injuries,
Within a year of its first appearance we were covers the principles of skeletal trauma and the
delighted to find that the Concise System appealed common fractures encountered in each region.
to a much wider range of readers than we had at Each section is liberally illustrated. Most of the
first envisaged: trainees in other surgical old black-and-white pictures of earlier editions
specialties, experienced general practitioners, have been replaced by coloured illustrations which
physiotherapists, occupational therapists and even lend an added degree of clarity. Alan Apley always
– at the other end of the spectrum – practising believed that a good picture – especially a
orthopaedic consultants and teachers who wanted composite picture that tells a story – is worth a
a reasonably short, up-to-date review of subjects thousand words. Students have often told us that
with which they were already familiar. the pictures and their captions alone constitute a
While satisfying this wide readership, the new kind of ‘quick-revision manual’.
edition is only slightly longer than its predecessors; Sadly, Alan Apley is no longer with us for the
concise as it is, we have avoided any lapse into present edition. In rewriting the text we have paid
‘notebook’ writing or ‘telegraphese’. In a short silent homage to his engaging style and simplicity of
volume covering one of the largest specialties in expression. As principal co-author in the past, he
medicine, there must necessarily be omissions; would refuse to accept any sentence that sounded
nevertheless we have covered all the common – more erudite than the context required; even, in
and some of the less common but important – some cases, individual words that were not
conditions that might be encountered in an commonly used in everyday speech. He was proud
orthopaedic practice. Indeed, some readers have to be known as someone whose preference was for
complained, of previous editions, that we have four-letter words: look, feel, movebecame the Apley
included too much; diseases such as poliomyelitis trademark for systematic clinical examination. If
and tuberculosis, they say, are ‘hardly ever seen some quality of this great teacher is still recognisable
nowadays’. Hardly ever in industrially advanced in the present edition we shall be well satisfied.
countries, perhaps, but we are deeply conscious of
the suffering that these disorders still inflict on less L.S
privileged societies in the wider world; our D.J.W.
frontispiece bears witness to their plight. D.N.