Apley's System of Orthopaedics and Fractures, 9th Edition PDF
Preview Apley's System of Orthopaedics and Fractures, 9th Edition
Apley’s System of Orthopaedics and Fractures Alan Graham Apley 1914–1996 Inspired teacher, wise mentor and joyful friend Louis Solomon MD FRCS Emeritus Professor of Orthopaedics Bristol UK David Warwick MD FRCS FRCSOrth Eur Dip Hand Surg Consultant Hand Surgeon Reader in Orthopaedic Surgery University of Southampton Southampton UK Selvadurai Nayagam BSc MChOrth FRCSOrth Consultant Orthopaedic Surgeon Royal Liverpool Children’s Hospital and The Royal Liverpool University Hospital Liverpool UK Apley’s System of Orthopaedics and Fractures Ninth Edition iv First published in Great Britain in 1959 by Butterworths Medical Publications Second edition 1963 Third edition 1968 Fourth edition 1973 Fifth edition 1977 Sixth edition 1982 Seventh edition published in 1993 by Butterworth Heineman. Eight edition published in 2001 by Arnold. This ninth edition published in 2010 by Hodder Arnold, an imprint of Hodder Education, an Hachette UK Company, 338 Euston Road, London NW1 3BH http://www.hodderarnold.com © 2010 Solomon, Warwick, Nayagam All rights reserved. Apart from any use permitted under UK copyright law, this publica- tion may only be reproduced, stored or transmitted, in any form, or by any means, with prior permission in writing of the publishers or in the case of reprographic production, in accordance with the terms of licences issued by the Copyright Licensing Agency. In the United Kingdom such licences are issued by the Copyright Licensing Agency: 90 Tottenham Court Road, London W1T 4LP Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN-13 978 0 340 942 055 ISBN-13 [ISE] 978 0 340 942 086 (International Students’ Edition, restricted territorial availability) 1 2 3 4 5 6 7 8 9 10 Commissioning Editor: Gavin Jamieson Project Editor: Francesca Naish Production Controller: Joanna Walker Cover Designer: Helen Townson Indexer: Laurence Errington Additional editorial services provided by Naughton Project Management. Cover image © Linda Bucklin/stockphoto.com Typeset in 10 on 12pt Galliard by Phoenix Photosetting, Chatham, Kent Printed and bound in India by Replika Press What do you think about this book? Or any other Hodder Arnold title? Please visit our website: www.hodderarnold.com To our students, trainees and patients, all of whom have helped to make our lives interesting, stimulating and worthwhile; and also to our wives and children (and grand-children) who have tolerated our absences – both material and spiritual – while preparing this new edition. Dedication This page intentionally left blank Contributors ix Preface xi Acknowledgements xiii List of abbreviations used xv PART 1: GENERAL ORTHOPAEDICS 1 Diagnosis in orthopaedics 3 Louis Solomon, Charles Wakeley 2 Infection 29 Louis Solomon, H. Srinivasan, Surendar Tuli, Shunmugam Govender 3 Inflammatory rheumatic disorders 59 Christopher Edwards, Louis Solomon 4 Crystal deposition disorders 77 Louis Solomon 5 Osteoarthritis 85 Louis Solomon 6 Osteonecrosis and related disorders 103 Louis Solomon 7 Metabolic and endocrine disorders 117 Louis Solomon 8 Genetic disorders, skeletal dysplasias and malformations 151 Deborah Eastwood, Louis Solomon 9 Tumours 187 Will Aston, Timothy Briggs, Louis Solomon 10 Neuromuscular disorders 225 Deborah Eastwood, Thomas Staunton, Louis Solomon 11 Peripheral nerve injuries 269 David Warwick, H. Srinivasan, Louis Solomon 12 Orthopaedic operations 303 Selvadurai Nyagam, David Warwick PART 2: REGIONAL ORTHOPAEDICS 13 The shoulder and pectoral girdle 337 Andrew Cole, Paul Pavlou 14 The elbow and forearm 369 David Warwick 15 The wrist 383 David Warwick, Roderick Dunn 16 The hand 413 David Warwick, Roderick Dunn 17 The neck 439 Stephen Eisenstein, Louis Solomon 18 The back 453 Stephen Eisenstein, Surendar Tuli, Shunmugam Govender Contents 19 The hip 493 Louis Solomon, Reinhold Ganz, Michael Leunig, Fergal Monsell, Ian Learmonth 20 The knee 547 Louis Solomon, Theo Karachalios 21 The ankle and foot 587 Gavin Bowyer PART 3: FRACTURES AND JOINT INJURIES 22 The management of major injuries 627 David Sutton, Max Jonas 23 Principles of fractures 687 Selvadurai Nayagam 24 Injuries of the shoulder, upper arm and elbow 733 Andrew Cole, Paul Pavlou, David Warwick 25 Injuries of the forearm and wrist 767 David Warwick 26 Hand injuries 787 David Warwick 27 Injuries of the spine 805 Stephen Eistenstein, Wagih El Masry 28 Injuries of the pelvis 829 Louis Solomon 29 Injuries of the hip and femur 843 Selvadurai Nayagam 30 Injuries of the knee and leg 875 Selvadurai Nayagam 31 Injuries of the ankle and foot 907 Gavin Bowyer Epilogue: Global Orthopaedics 935 Christopher Lavy, Felicity Briggs Index 939 CONTENTS viii Principal Authors Louis Solomon MD FRCS Eng FRCS Ed Emeritus Professor of Orthopaedic Surgery Honorary Consultant Orthopaedic Surgeon Bristol Royal Infirmary, Bristol, UK Selvadurai Nayagam BSc, MChOrth FRCSOrth Consultant Orthopaedic Surgeon Royal Liverpool Children’s Hospital and The Royal Liverpool University Hospital Liverpool, UK David Warwick MD BM FRCS FRCS (Orth) Eur Dip Hand Surg Consultant Hand Surgeon Reader in Orthopaedic Surgery University of Southampton, Southampton, UK Contributing Authors Will Aston BSc, MBBS, FRCS Ed(TR&Orth) Consultant Orthopaedic Surgeon Royal National Orthopaedic Hospital Stanmore, UK Tumours Gavin William Bowyer MA MChir FRCS(Orth) Consultant Trauma and Orthopaedic Surgeon and Honorary Senior Lecturer Southampton University Hospitals Southampton, UK The Ankle and Foot Injuries of the ankle and foot Felicity Briggs MA(Oxon) UK Research Assistant and Graduate Medical Student Epilogue: Global Orthopaedics Timothy William Roy Briggs MD(Res) MCh(Orth) FRCS FRCS Ed Professor and Consultant Orthopaedic Surgeon Joint Medical Director Joint Training Programme Director Royal National Orthopaedic Hospital Stanmore, UK Tumours Andrew Spencer Cole BSc MBBS FRCS(TR&Orth) Consultant Orthopaedic Surgeon Southampton University Hospitals Southampton, UK The Shoulder and Pectoral Girdle Injuries of the Shoulder and Upper Arm and elbow Roderick Dunn MBBS DMCC FRCS(Plast) Consultant Plastic, Reconstructive and Hand Surgeon, Odstock Centre for Burns, Plastic and Maxillofacial Surgery, Salisbury District Hospital Salisbury, UK The Wrist and The Hand: Congenital Variations Deborah Eastwood FRCS Consultant Orthopaedic Surgeon and Hon Senior Lecturer University College London; Great Ormond Street Hospital for Children London, UK Genetic Disorders, Dysplasias and Malformations Neuromuscular Disorders Christopher J Edwards BSc MBBS FRCP MD Consultant Rheumatologist & Honorary Senior Lecturer Associate Director Wellcome Trust Clinical Research Facility Southampton University Hospitals NHS Trust Southampton General Hospital, UK Inflammatory Rheumatic Disorders Contributors Stephen Eisenstein PhD FRCS(Ed) Hon Professor, Keele University; Emeritus Director Centre for Spinal Studies; The Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire, UK The Neck The Back Injuries of the Spine Reinhold Ganz MD Professor and Chairman Emeritus Orthopaedic Department Inselspital University of Bern, Switzerland The Hip: Femoro-acetabular Impingement Shunmugam Govender MBBS MD FRCS FC(Orth) (SA) Professor and Head of Department of Orthopaedics; Director of Spinal Services King George V Hospital; Nelson R Mandela School of Medicine Durban, South Africa Infection The Back: Infections of the Spine Max Jonas MBBS FRCA Consultant and Senior Lecturer in Critical Care Southampton University Hospitals NHS Trust Southampton, UK The Management of Major Injuries Theo Karachalios MD DSc Associate Professor in Orthopaedics, School of Health Sciences, University of Thessalia University General Hospital of Larissa Hellenic Republic The Knee Christopher Lavy OBE MD MCh FRCS Hon Professor and Consultant, Nuffield Department of Orthopaedic Surgery, University of Oxford, UK Epilogue: Global Orthopaedics Ian Douglas Learmonth MB ChB FRCS Ed FRCS FCS(SA)Orth Emeritus Professor, ; Honorary Consultant, University Hospitals, Bristol; Honorary Consultant, North Bristol Trust, UK Total Hip Replacement Michael Leunig MD Head of Orthopaedics, Lower Extremities Schulthess Klinik, Zurich, Switzerland The Hip: Femoro-Acetabular Impingement Wagih S El Masry FRCS FRCP Consultant Surgeon in Spinal Injuries; Director, Midlands Centre for Spinal Injuries President International Spinal Cord Society (ISCOS) RJ & AH Orthopaedic Hospital, Oswestry, UK Injuries of the Spine Fergal P Monsell MSc FRCS FRCS(Orth) Consultant Paediatric Orthopaedic Surgeon Bristol Royal Hospital for Children Bristol, UK The Hip: Disorders in Children Paul Pavlou BSc (Hons) MB BS MRCS Orthopaedic Registrar, Wessex training scheme The Shoulder and Pectoral Girdle Injuries of the Shoulder H. Srinivasan MB BS FRCS FRCS Ed DSc (Hon) Formerly Senior Orthopaedic Surgeon Central Leprosy Teaching & Research Institute Chengalpattu (Tamil Nadu), India; Director Central JALMA Institute for Leprosy (ICMR), Agra (UP), India; and Editor Indian Journal of Leprosy Infection and Peripheral Nerve Disorders: Leprosy Thomas G Staunton MB FRCP(C) FRCP Consultant Neurologist Norfolk and Norwich University Hospital; Consultant Clinical Neurophysiologist Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire, UK Neuromuscular Disorders: Neurophysiological Studies David Sutton BM DA FRCA Department of Anaesthetics Southampton General Hospital Southampton, UK Management of Major Injuries Surendar Mohan Tuli MBBS MS PhD Senior Consultant in Spinal Diseases and Orthopaedics, Vimhans Hospital, New Delhi, India Infection: Tuberculosis of Bones and Joints The Back Charles J Wakeley BSc MBBS FRCS FRCS Ed FRCR Consultant Radiologist, Department of Radiology University Hospital Bristol NHS Foundation Trust Bristol, UK Diagnosis in Orthopaedics: Imaging CONTRIBUTORS x When Alan Apley produced the first edition of his Sys- tem of Orthopaedics and Fractures 50 years ago he saw it as an aid to accompany the courses that he con- ducted for aspiring surgeons who were preparing for the FRCS exams. With characteristic humour, he called the book ‘a prophylactic against writer’s cramp’. Pictures were unnecessary: if you had any sense (and were quick enough to get on the heavily oversubscribed Apley Course) you would be treated to an unforgettable display of clinical signs by one of the most gifted of teachers. You also learnt how to elicit those signs by using a methodical clinical approach – the Apley System. The Fellowship exam was heavily weighted towards clinical skills. Miss an important sign or stumble over how to examine a knee or a finger and you could fail outright. What Apley taught you was how to order the steps in physical examination in a way that could be applied to every part of the musculoskeletal system. ‘Look, Feel, Move’ was the mantra. He liked to say that he had a preference for four-letter words. And always in that order! Deviate from the System by grasping a patient’s leg before you look at it minutely, or by test- ing the movements in a joint before you feel its con- tours and establish the exact site of tenderness and you risked becoming an unwilling participant in a the- atrical comedy. Much has changed since then. With each new edi- tion the System has been expanded to accommodate new tests and physical manoeuvres developed in the tide of super-specialisation. Laboratory investigations have become more important and imaging techniques have advanced out of all recognition. Clinical classifi- cations have sprung up and attempts are now made to find a numerical slot for every imaginable fracture. No medical textbook is complete without its ‘basic sci- ence’ component, and advances are so rapid that changes become necessary within the period of writ- ing a single edition. The present volume is no excep- tion: new bits were still being added right up to the time of proof-reading. For all that, we have retained the familiar structure of the Apley System. As in earlier editions, the book is divided into three sections: General Orthopaedics, covering the main types of musculoskeletal disorder; Regional Orthopaedics, where we engage with these disorders in specific parts of the body; and thirdly Fractures and Joint Injuries. In a major departure from previous editions, we have enlisted the help of colleagues who have particular experience of condi- tions with which we as principal authors are less famil- iar. Their contributions are gratefully acknowledged. Even here, though, we have sought their permission to ‘edit’ their material into the Apley mould so that the book still has the sound and ‘feel’ of a single authorial voice. For the second edition of the book, in 1963, Apley added a new chapter: ‘The Management of Major Accidents’. Typically frank, he described the current arrangements for dealing with serious accidents as “woefully inadequate” and offered suggestions based on the government’s Interim Report on Accident Services in Great Britain and Ireland (1961). There has been a vast improvement since then and the num- ber of road accident deaths today is half of what it was in the 1960’s (Department of Transport statistics). So important is this subject that the relevant section has now been re-written by two highly experienced Emer- gency and Intensive Care Physicians and is by far the longest chapter in the present edition. Elsewhere the text has been brought completely up to date and new pictures have been added. In most cases the illustrations appear as composites – a series of images that tell a story rather than a single ‘typical’ picture at one moment in the development of some disorder. At the beginning of each Regional chapter, in a run of pictures we show the method of examin- ing that region: where to stand, how to confront the patient and where to place our hands. For the experi- enced reader this may seem like old hat; but then we have designed this book for orthopaedic surgeons of all ages and all levels of experience. We all have some- thing to learn from each other. As before, operations are described only in outline, emphasising the principles that govern the choice of treatment, the indications for surgery, the design of the operation, its known complications and the likely out- come. Technical procedures are learnt in simulation Preface courses and, ultimately, in the operating theatre. Writ- ten instructions can only ever be a guide. Drawings are usually too idealised and ‘in theatre’ photographs are usually intelligible only to someone who has already performed that operation. Textbooks that grapple with these impediments tend to run to several volumes. The emphasis throughout is on clinical orthopaedics. We acknowledge the value of a more academic approach that starts with embryology, anatomy, biomechanics, molecular biology, physiol- ogy and pathology before introducing any patient to the reader. Instead we have chosen to present these ‘basic’ subjects in small portions where they are rele- vant to the clinical disorder under discussion: bone growth and metabolism in the chapter on metabolic bone disease, genetics in the chapter on osteodystro- phies, and so forth. In the preface to the last edition we admitted our doubts about the value of exhaustive lists of references at the end of each chapter. We are even more divided about this now, what with the plethora of ‘search engines’ that have come to dominate the internet. We can merely bow our heads and say we still have those doubts and have given references only where it seems appropriate to acknowledge where an old idea started or where something new is being said that might at first sight be questioned. More than ever we are aware that there is a dwin- dling number of orthopaedic surgeons who grew up in the Apley era, even fewer who experienced his thrilling teaching displays, and fewer still who worked with him. Wherever they are, we trust that they will recognise the Apley flavour in this new edition. Our chief concern, however, is for the new readers who – we hope – will glean something that helps them become the next generation of teachers and mentors. LS SN DJW PREFACE xii Fifty years ago Apleys’ System of Orthopaedics and Fractures was written by one person – the eponymous Apley. As the years passed and new editions became ever larger, a second author appeared and then a third. Throughout those years we have always been able to get help (and sometimes useful criticism) from willing colleagues who have filled the gaps in our knowledge. Their words and hints are scattered among the pages of this book and we are forever grateful to them. For the present edition we have gone a step further and enlisted a number of those colleagues as nomi- nated Contributing Authors. In some cases they have brought up to date existing chapters; in others they have added entirely new sections to a book that has now grown beyond the scope of two or three special- ists. Their names are appropriately listed elsewhere but here we wish to thank them again for joining us. They have allowed us to mould their words into the style of the Apley System so that the text continues to carry the flavour of a unified authorial voice. We are also grateful to those colleagues who have supplied new pictures where our own collections have fallen short. In particular we want to thank Dr Santosh Rath and Dr G.N. Malaviya for pictures of peripheral deformities in leprosy, Mr Evert Smith for pictures (and helpful descriptions) of modern implants in hip replacement operations, Dr Peter Bul- lough who allowed us to reprint two of the excellent illustrations in his book on Orthopaedic Pathology, and Dr Asif Saifuddin for permission to use some images from his book on Musculoskeletal MRI. Others who gave us generous assistance with pictures are Fiona Daglish, Colin Duncan, Neeraj Garg, Nikolaos Giotakis, Jagdeep Nanchahal and Badri Narayan. We have been fortunate in having friends and family around us who have given us helpful criticism on the presentation of this work. Caryn Solomon, a tireless internet traveller, found the picture for the cover and Joan Solomon gave expert advice on layout and design. James Crabtree stepped in as a model for some ‘clinical’ pictures. We are grateful to all of them. Throughout the long march to completion of this work we have enjoyed the constant help and collabo- ration of Francesca Naish, Gavin Jamieson, Joanna Walker and Helen Townson (our Editorial Manager, Commissioning Editor, Production Manager and Design Manager respectively) at Hodder Arnold. No problem was too complex and no obstacle too great to withstand their tireless efforts in driving this work forward. Nora Naughton and Aileen Castell (Naughton Project Management) were in the background setting up the page copies, patiently enduring the many amendments that came in over the internet. Their attention to detail has been outstanding. Finally, we want to express our deepest thanks to those nearest to us who added not a word to the text but through their support and patience made it poss - ible for us to take so much time beyond the everyday occupations of family life to produce a single book. L. S. D.W. S. N. Acknowledgements This page intentionally left blank
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