BASIC ORTHOPAEDIC SCIENCES This page intentionally left blank BASIC ORTHOPAEDIC SCIENCES The Stanmore Guide Edited by Manoj Ramachandran BSc(Hons) MBBS(Hons) MRCS(Eng) FRCS(Orth) Paediatric and Young Adult Orthopaedic Fellow Royal National Orthopaedic Hospital Stanmore, UK Associate Editors Deborah M Eastwood MB FRCS Consultant Orthopaedic Surgeon Great Ormond Street Hospital for Children, London; and Royal National Orthopaedic Hospital, Stanmore, UK Dishan B Singh FRCS(Orth) Consultant Orthopaedic Surgeon Royal National Orthopaedic Hospital, Stanmore, UK John AM Skinner MBBS FRCS(Eng) FRCS(Orth) Consultant Orthopaedic Surgeon Royal National Orthopaedic Hospital, Stanmore, UK Hodder Arnold A MEMBER OF THE HODDER HEADLINE GROUP Hodder Arnold A member of the Hodder Headline Group First published in Great Britain in 2007 by Hodder Arnold, an imprint of Hodder Education and a member of the Hodder Headline Group, 338 Euston Road, London NW1 3BH http://www.hoddereducation.com Distributed in the United States of America by Oxford University Press Inc., 198 Madison Avenue, New York, NY10016 Oxford is a registered trademark of Oxford University Press © 2007 Edward Arnold (Publishers) Ltd All rights reserved. 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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-10 0 340 885 025 ISBN-13 978 0 340 885 024 1 2 3 4 5 6 7 8 9 10 Commissioning Editor: Sarah Burrows Project Editor: Francesca Naish Production Controller: Joanna Walker Cover Design: Nichola Smith Indexer: Laurence Errington Typeset in 9.5/12 pt Berling by Phoenix Photosetting, Chatham, Kent Printed and bound in Spain by Graphycems What do you think about this book? Or any other Hodder Arnold title? Please visit our website: www.hoddereducation.com For Joanna. Everything I do is for you and you only. This page intentionally left blank Contents Contributors ix Foreword xi Preface xiii Acknowledgements xv 1 Statistics 1 Manoj Ramachandran, David Little and Fares Haddad 2 Genetics 15 Peter Calder and Aresh Hashemi-Nejad 3 Skeletal embryology and limb growth 22 Rick Brown and Deborah Eastwood 4 Orthopaedic pharmacology 31 Manoj Ramachandran and Natasha Rahman 5 Inflammation and infection 40 Vikas Khanduja and Manoj Ramachandran 6 Imaging techniques 49 Manoj Ramachandran, Navin Ramachandran and Asif Saifuddin 7 Orthopaedic oncology 61 Nimalan Maruthainar and Stephen Cannon 8 Ligaments and tendons 71 Cheh Chin Tai and Andrew Williams 9 Meniscus 80 Vijai Ranawat and John Skinner 10 Articular cartilage 85 Tim Waters and George Bentley 11 Nerve 95 Caroline Hing and Rolfe Birch 12 Skeletal muscle 108 Michael Fox and Simon Lambert 13 Basics of bone 115 Peter Bates and Manoj Ramachandran 14 Bone injury, healing and grafting 123 Peter Bates and Manoj Ramachandran 15 Intervertebral disc 135 William Aston and Rajiv Bajekal 16 Basic concepts in biomechanics 139 Manoj Ramachandran viii Contents 17 Biomaterial behaviour 146 Subhamoy Chatterjee and Gordon Blunn 18 Biomaterials 154 Subhamoy Chatterjee and Gordon Blunn 19 Biomechanics and joint replacement of the hip 164 Mark Mullins and John Skinner 20 Biomechanics and joint replacement of the knee 170 Alister Hart, Richard Carrington and Paul Allen 21 Biomechanics of the spine 180 Amir Ali Narvani, Brian Hsu and Lester Wilson 22 Biomechanics and joint replacement of the shoulder and elbow 187 Mark Falworth and Simon Lambert 23 Biomechanics of the hand and wrist 197 Nicholas Saw and David Evans 24 Biomechanics and joint replacement of the foot and ankle 210 Rohit Madhav, Deborah Eastwood and Dishan Singh 25 Friction, lubrication, wear and corrosion 219 Gurdeep Biring, Marcus Bankes, Jay Meswania and Gordon Blunn 26 Gait 238 Pramod Achan and Fergal Monsell 27 Prosthetics 246 Manoj Ramachandran and Linda Marks 28 Orthotics 254 Manoj Ramachandran and Lisa Bellows 29 Inside the operating theatre 263 Manoj Ramachandran and Alan White Appendix: common bone disorders 270 Peter Bates and Manoj Ramachandran Index Contributors Pramod Achan FRCS(Orth) Peter Calder FRCS(Orth) Consultant Orthopaedic Surgeon Consultant Orthopaedic Surgeon Royal London Hospital, London Royal National Orthopaedic Hospital, Stanmore Paul Allen MBBS FRCS Stephen R Cannon FRCS Consultant Orthopaedic Surgeon Consultant Orthopaedic Surgeon, Clinical Director Princess Alexandra Hospital, Harlow and Chair of the London Bone and Soft Tissue Tumour Unit William Aston BSc MRCS(Ed) Royal National Orthopaedic Hospital, Stanmore Specialist Registrar in Trauma and Orthopaedics Royal National Orthopaedic Hospital, Stanmore Richard Carrington MBBS FRCS FRCS(Orth) Consultant Orthopaedic Surgeon Rajiv Bajekal MCh(Orth) FRCS(Orth) Royal National Orthopaedic Hospital, Stanmore Consultant Orthopaedic Surgeon Barnet General Hospital, London Subhamoy Chatterjee MBBS MRCS(Ed) MSc (Distinction) Specialist Registrar in Trauma and Orthopaedics Marcus Bankes BSc(Hons) MBBS(Hons) FRCS(Orth) University College Hospital, London Consultant Orthopaedic Surgeon Guy’s and St Thomas’ Hospital, London Deborah M Eastwood MB FRCS Consultant Orthopaedic Surgeon Peter Bates BSc MRCS Great Ormond Street Hospital for Children, London; Specialist Registrar in Trauma and Orthopaedics and Royal National Orthopaedic Hospital, Stanmore Royal National Orthopaedic Hospital, Stanmore Lisa Bellows BSc(Hons) David Evans FRCS Orthotist Consultant Hand Surgeon and Clinical Director Great Ormond Street Children’s Hospital, London The Hand Clinic, Windsor George Bentley ChM FRCS Mark Falworth FRCS(Eng) FRCS (Orth) Professor of Orthopaedics (retired) and locum Specialist Registrar in Trauma and Orthopaedics consultant Royal National Orthopaedic Hospital, Stanmore Royal National Orthopaedic Hospital, Stanmore Michael Fox BSc MRCS Rolfe Birch MChir FRCS Specialist Registrar in Trauma and Orthopaedics Professor of Orthopaedic Neurological Surgery Royal National Orthopaedic Hospital, Stanmore Royal National Orthopaedic Hospital, Stanmore Fares Haddad BSc MCh(Orth) FRCS(Orth) Dip Sports Med Gurdeep Biring BSc MBBS MRCS MSc (Ortho Eng) FRCS Consultant Orthopaedic Surgeon (Orth) University College and Middlesex Hospitals, London Specialist Registrar in Trauma and Orthopaedics Royal National Orthopaedic Hospital, Stanmore Alister Hart MA FRCS(Orth) Specialist Registrar in Trauma and Orthopaedics Gordon Blunn BSc PhD Royal National Orthopaedic Hospital, Stanmore Head, Centre of Biomedical Engineering Institute of Orthopaedics and Musculoskeletal Aresh Hashemi-Nejad MBBS FRCS FRCS(Orth) Science, Stanmore Consultant Orthopaedic Surgeon Royal National Orthopaedic Hospital, Stanmore Rick Brown MA FRCS(Orth) Consultant Orthopaedic Surgeon Cheltenham General Hospital, Cheltenham