Lecture Notes: Orthopaedics and Fractures

257 Pages·2010·7.18 MB·English

Lecture Notes: Orthopaedics and Fractures

Lecture Notes
Orthopaedics and
Fractures
T Duckworth
BSc (Hons), MBChB (Hons), FRCS (Eng)
Emeritus Professor of Orthopaedics
University of Sheffi eld
C M Blundell
MB, ChB, BMedSci (Hons), FRCS (Eng), MD, FRCS (Tr&Orth)
Northern General Hospital
Sheffi eld, UK
Fourth edition
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2010, © 2010 by T Duckworth and CM Blundell
Previous editions: 1980, 1984, 1995
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Library of Congress Cataloging-in-Publication Data
Duckworth, T.
Lecture notes. Orthopaedics and fractures / T. Duckworth, C.M. Blundell. – 4th ed.
p. ; cm.
Rev. ed. of: Lecture notes on orthopaedics and fractures / T. Duckworth. 3rd ed. c1995.
Includes index.
ISBN 978-1-4051-3329-6
1. Orthopedics–Handbooks, manuals, etc. 2. Fractures–Handbooks, manuals, etc. I. Blundell, C. M. (Chris M.)
II. Duckworth, T. Lecture notes on orthopaedics and fractures. III. Title. IV. Title: Orthopaedics and fractures.
[DNLM: 1. Orthopedic Procedures–Handbooks. 2. Fractures, Bone–Handbooks. WE 39 D836L 2010]
RD732.5.D83 2010
616.7–dc22
2009046372
ISBN: 9781405133296
A catalogue record for this book is available from the British Library.
Set in 8 on 12 pt Stone Serif by Toppan Best-set Premedia Limited
Printed and bound in Singapore
1 2010
Contents
Contributors vi 13 Infections 100
Preface to fourth edition vii 14 Metabolic diseases of bone 109
Preface to fi rst edition viii 15 Examination of the musculoskeletal
system 116
Part 1: General Principles
Part 2: Regional Orthopaedics
1 Musculoskeletal structures and function 3
2 Soft-tissue injuries and healing 12 16 The forearm, wrist and hand 123
3 Nerve injuries and repair 20 17 The elbow 139
4 Fractures and healing 25 18 The shoulder and upper arm 148
5 Fractures—principles of management 32 19 The spine 157
6 Complications of fractures 44 20 The pelvis 172
7 Major trauma 49 21 The hip and thigh 176
8 Congenital and developmental conditions 52 22 The knee and lower leg 188
9 Generalized orthopaedic conditions 66 23 The foot and ankle 201
10 Infl ammatory conditions 74 24 Orthopaedic techniques 218
11 Degenerative conditions 87
12 Neoplastic conditions of bone and soft Appendix 233
tissue 92 Index 237
v
Contributors
Stephen Bostock Paul Haslam
Consultant Orthopaedic Hand Surgeon Consultant Orthopaedic Surgeon
Sheffi eld Orthopaedics Ltd Doncaster and Bassetlaw Hospitals NHS Trust
Sheffi eld, UK Doncaster, UK
Stan Jones
Ashley Cole
Consultant Orthopaedic Surgeon
Consultant Orthopaedic Spinal Surgeon
Sheffi eld Orthopaedics Ltd
Sheffi eld Orthopaedics Ltd
Sheffi eld, UK
Sheffi eld, UK
David Stanley
Richard Gibson Consultant Orthopaedic Surgeon
Consultant Orthopaedic Surgeon Sheffi eld Teaching Hospitals NHS Trust
Sheffi eld Teaching Hospital NHS Trust Sheffi eld, UK
Sheffi eld, UK
Simon Till
Consultant Rheumatologist
Bob Grimer
Sheffi eld Teaching Hospitals NHS Trust
The Royal Orthopaedic Hospital
Sheffi eld, UK
Birmingham, UK
Rob Townsend
Andrew Hamer Consultant Microbiologist
Consultant Orthopaedic Surgeon Department of Microbiology
Sheffi eld Orthopaedics Ltd Northern General Hospital
Sheffi eld, UK Sheffi eld, UK

vi
Preface to fourth edition
Medical training is constantly changing. Surgical and then to refer to each region in turn (Part 2).
training is becoming shorter and the decision With the advent of sub - specialization, this is how
about which branch to follow is being asked at an the subject is often now encountered. The regional
evermore junior level. It is only possible to make section is further sub - divided into four areas:
an informed career choice by having a suffi cient examination, adult pathology, paediatric pathol-
grasp of the relevant speciality and, wherever pos- ogy and trauma.
sible, having some exposure to it. We hope we have achieved our goal in creating a
Orthopaedics is a changing speciality. Sub- book which is broad enough in scope to cover most
specialization has become commonplace and the pathologies whilst covering the more common
‘ general ’ orthopaedic surgeon is now rare. This conditions in suffi cient depth to allow a compre-
book attempts to introduce most aspects of ortho- hensive understanding.
paedics at a level which will satisfy medical stu-
dents, students of professions allied to medicine T Duckworth
and general practitioners alike. C M Blundell
This fourth edition has been rewritten to make it
easier to study the basis of orthopaedics (Part 1)
vii
Preface to fi rst edition
At fi rst sight there would appear to be little diffi - In the absence of clear guidance from the medical
culty in compiling a short textbook of orthopaed- faculties about what their end - product, the newly
ics and fractures to meet the needs of medical qualifi ed doctor, is supposed to be, it seemed rea-
students, general practitioners and others with a sonable to try to produce a book which would
non - specialist interest in the subject. They are all attempt to provide answers, albeit often brief and
likely to require a quick and reliable source of refer- incomplete ones, to most of the questions the
ence and some practical advice on management. interested and intelligent student and postgradu-
But how much material, how much detail and how ate would be likely to ask about the subject.
much practical advice? In doing so, emphasis has been placed on the
Many medical schools have reduced the time principles of diagnosis and management and on
available for the study of disorders of the musculo- classifi cation. It is hoped that the latter will be an
skeletal system. The medical student is now lucky aid to understanding relationships and also
if he/she can gain experience in the techniques of perhaps to memory. Common conditions have
clinical examination, let alone become familiar been allocated relatively more space, and some
with those common orthopaedic conditions which details of the management of such conditions,
occupy so much of the average general practition- which might be of value to junior staff, are
er ’ s time and encroach on every branch of included, with short sections on orthopaedic and
medicine. operative procedures. Rarities are either excluded
It would be a short textbook indeed which or simply receive a brief mention to make the
covered only the contents of this type of course. student aware of their existence. Inevitably, some
Students often complain that they are given no sections will appear too condensed and others too
guidance as to how far their reading should detailed. The section on ankle fractures, for
take them beyond the confi nes of their limited example, is perhaps more appropriate for a trainee
clinical experience. They often ask in desperation orthopaedic surgeon than a student, but here, as in
for a syllabus or a list of reading material: how other places, it was felt that the subject could
much do we need to know? Unfortunately, become almost meaningless if less detail was
although examiners may be prepared to confi ne included.
themselves within pre - determined limits, patients The layout of the book may be found convenient
rarely do so. They present with obscure problems, by some readers, irrational and perhaps irritating
or, worse still, common problems in familiar by others. This particular arrangement has been
guises. No matter how well he/she has been chosen so that answers will be easy to fi nd, embed-
taught and has understood the principles of ded in related information which will make the
diagnosis and management, no textbook can subject more of a whole. The regional chapters
provide the new doctor with what will become provide an alternative approach to the same infor-
his/her most valuable asset — experience. It can mation, and cross- references have been provided
however provide him/her with other people ’ s to avoid repetition.
experience and also with something almost equally The content is, of course, the author’ s choice,
valuable —a n awareness of what are the possibili- based on experience of what has been found useful
ties. Without this awareness, a diagnosis can rarely and of interest to students. Orthopaedics is a
be made. strongly clinical subject with a high visual content.
viii