reading

Cover
Foreword
Preface
CHAPTER 1: General Overview
1. Introduction
2. Epidemiology
3. Definitions
4. History
5. Examination
6. Reading radiographs
7. Common fracture classifications
8. Principles of fracture fixation
9. Principles of fracture management
10. Complications of fractures
11. Education and training
12. Future of trauma and orthopaedics
13. Further reading
CHAPTER 2: Epidemiology of Musculoskeletal Disease
1. Introduction
2. Osteoarthritis and joint replacement
3. Osteoporosis, trauma, and fractures
4. Further Reading
CHAPTER 3: Orthopaedic Investigations
1. Introduction
2. Radiological imaging
3. Ultrasound
4. Nuclear medicine
5. Neurophysiological tests
6. Laboratory investigations
7. Further reading
CHAPTER 4: Orthopaedic Trauma
1. Introduction
2. Polytrauma
3. Early total care versus damage control orthopaedics
4. Fracture pathology
5. Fracture terminology
6. Basic principles of fracture management
7. Stabilisation of fractures
8. Nonoperative versus operative management
9. Special situations
10. Trauma radiology
11. Further reading
CHAPTER 5: Management of Adult Fractures
1. Causes
2. Upper‐limb fractures
3. Lower‐limb fractures
4. Others
5. Further reading
CHAPTER 6: Shoulder and Elbow
1. Anatomy of proximal humerus
2. History
3. Symptoms
4. Examination
5. Investigations
6. Subacromial impingement
7. Calcific tendinitis
8. Rotator cuff tears
9. Supraspinatus tear
10. Adhesive capsulitis (frozen shoulder)
11. Instability
12. Proximal humeral fractures
13. Glenohumeral osteoarthritis
14. Elbow conditions
15. Further reading
CHAPTER 7: Hand and Wrist
1. General clinical assessment
2. Elective conditions
3. Traumatic conditions
4. Physical examination
5. Nerve compression syndromes
6. Tendon compression syndrome
7. Other tendon compression syndromes
8. Degenerative conditions
9. Wrist injuries
10. Further reading
CHAPTER 8: Pelvis and Acetabulum
1. The pelvis
2. Acetabulum
3. Further reading
CHAPTER 9: The Hip
1. Anatomy
2. History
3. Clinical examination
4. General conditions
5. Hip fractures
6. Extracapsular hip fractures
7. Intracapsular neck of femur fractures
8. Outline of hip fracture guidance
9. Osteoarthritis of the hip
10. Total hip replacement
11. Inflammatory arthritis of hip
12. Avascular necrosis of hip
13. Trochanteric bursitis
14. Labral tear
15. Femoroacetabular impingement
16. Further reading
CHAPTER 10: The Knee
1. Anatomy and function
2. History and examination
3. Osteoarthritis
4. Sports injuries
5. Meniscal tears
6. ACL tears
7. Extensor mechanism rupture
8. Anterior knee pain
9. Further reading
CHAPTER 11: Foot and Ankle
1. Anatomy
2. Pain
3. Hallux valgus (bunion)
4. Hallux rigidus
5. Metatarsalgia
6. Morton’s neuroma
7. Claw, hammer, and mallet toe deformities
8. Plantar fasciitis
9. Acquired adult flat foot (plano‐valgus)
10. Cavus Foot (cavo‐varus)
11. Ankle arthritis
12. Foot arthritis
13. Achilles tendon disease
14. Ankle fractures and dislocation
15. Calcaneal fractures
16. Acknowledgements
17. Further reading
CHAPTER 12: Spine
1. Introduction
2. Anatomy
3. Examination
4. Structural spinal pathology
5. Slipped disc and discogenic back pain
6. Sciatica
7. Spinal narrowing (stenosis)
8. Facet joint arthropathy
9. Spondylosis, spondylolysis, and spondylolisthesis
10. Low mechanical back pain
11. Deformity
12. Tumours of the spine
13. Infections of the spine
14. Spinal trauma
15. Fractures
16. Further reading
CHAPTER 13: Paediatric Orthopaedics
1. Anatomy of a paediatric bone
2. Injuries during childbirth
3. Fractures during childhood
4. Nonaccidental injury (NAI)
5. Cerebral palsy (CP)
6. Spina Bifida
7. Metabolic Bone Disease
8. Bone dysplasias
9. Paediatric Hip Disorders
10. Transient synovitis
11. Paediatric knee disorders
12. Foot and ankle disorders
13. Metatarsus adductus
14. Further reading
CHAPTER 14: Orthopaedic Emergencies 14.1 Emergency: Dislocated Hip
1. Introduction
2. Mechanism of injury
3. Examination
4. Imaging
5. Management
6. Further reading
CHAPTER 14.2: Emergency: Locked Knee and Dislocation
1. Locked knee
2. Meniscal injuries
3. Loose bodies
4. Chondral or osteochondral fragments
5. Nonmechanical locking
6. Treatment
7. Rehabilitation and follow‐up
8. Knee dislocations
9. Acknowledgements
10. Further reading
CHAPTER 14.3: Emergency: Acute Shoulder Dislocation
1. Anterior dislocation
2. Reduction
3. Posterior dislocation
4. Treatment
5. Further reading
CHAPTER 14.4: Emergency: Supracondylar Fractures of Distal Humerus in Children
1. Introduction
2. Relevant anatomy
3. Clinical assessment
4. Management
5. Further reading
CHAPTER 14.5: Emergency: Septic Arthritis
1. Introduction
2. Microbiology
3. Further reading
CHAPTER 14.6: Compartment Syndrome
1. Introduction
2. Definition
3. Pathophysiology
4. Diagnosis
5. Treatment
6. Further reading
CHAPTER 14.7: Emergency: Cauda Equina Syndrome
1. Further reading
CHAPTER 15: Orthopaedic Procedures
1. Joint injection and aspiration
2. Common orthopaedic surgical approaches
3. Further reading
CHAPTER 16: Prevention and Postoperative Care
1. Fragility fractures of the hip
2. Complications in postoperative recovery
3. Immediate complications
4. Early/medium‐term complications
5. Late/long‐term complications
6. Further reading
CHAPTER 17: Osteoarthritis
1. Introduction
2. Prevalence
3. Aetiology
4. History
5. Examination
6. Investigations
7. Treatment options
8. Further reading
CHAPTER 18: Inflammatory Diseases
1. Rheumatoid arthritis
2. Seronegative spondyloarthropathies
3. Ankylosing spondylitis
4. Other inflammatory arthritides
5. Further reading
CHAPTER 19: Bone and Joint Infections
1. General aspects of infection
2. Acute osteomyelitis
3. Subacute osteomyelitis
4. Chronic osteomyelitis
5. Prosthetic joint infection
6. Tuberculosis (TB)
7. Poliomyelitis
8. Discitis
9. Further reading
CHAPTER 20: Metabolic Bone Diseases
1. Background
2. Osteoporosis
3. Paget’s disease
4. Gout
5. Renal osteodystrophy
6. Further reading
CHAPTER 21: Bone and Soft Tissue Tumours
1. Presentation
2. NICE guidelines for referral
3. Bone tumours
4. Soft tissue tumours
5. Treatment strategies
6. Further reading
CHAPTER 22: Peripheral Nerve Injury (PNI)
1. Structure
2. Anatomy
3. Nerve injury
4. Clinical evaluation
5. Further reading
CHAPTER 23: Orthopaedic Biomechanics
1. Biomechanics
2. Biomaterials
3. Further reading
CHAPTER 24: Tools of the Trade
1. Theatre design and considerations
2. Implant types
3. Implant sciences
4. Cement
5. Plates, screws, Kirschner (K‐wires)
6. Sutures
7. Wound management
8. Postoperative weight‐bearing status
9. Acknowledgement
10. References
Index
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List of Tables

Chapter 01
1. Table 1.1 Orthopaedic history
2. Table 1.2 Common fracture classifications
Chapter 03
1. Table 3.1 The effective radiation dose of various forms of imaging (values given in millisieverts (mSv))
2. Table 3.2 The use of imaging to determine site‐specific orthopaedic pathology
3. Table 3.3 Radioactive tracers and their biological markers used in nuclear medicine scans. Half‐life is expressed in minutes (m), hours (h) or days (d)
4. Table 3.4 Comparing the differences in EMG results for myogenic and neurogenic pathological processes
5. Table 3.5 Biopsy techniques employed in orthopaedic surgery
6. Table 3.6 Specific details of history and examination that should arouse suspicion of cancer
7. Table 3.7 Analysis results for normal synovial fluid, septic, inflammatory, haemorrhagic, and osteoarthritic effusions
8. Table 3.8 Specific blood tests used in orthopaedic surgery
Chapter 04
1. Table 4.1 Primary survey in ATLS
2. Table 4.2 Estimated median fracture healing time in children and adults
Chapter 05
1. Table 5.1 Colles’ vs. Smith’s fractures
2. Table 5.2 Ottawa ankle rules
3. Table 5.3 Gustilo Anderson classification of open fractures
Chapter 06
1. Table 6.1 Diagnostic algorithm of common shoulder conditions
Chapter 07
1. Table 7.1 Common causes of hand or wrist pain
2. Table 7.2 Essential history for hand surgery patient
3. Table 7.3 Examination of the hand
4. Table 7.4 Neurological testing motor function of the hand
5. Table 7.5 Examination and tests for carpal tunnel syndrome
6. Table 7.6 Arthritis in the hand
7. Table 7.7 Ganglia occur in four locations and account for half of all hand swellings
8. Table 7.8 Flexor sheath infection
9. Table 7.9 Human/animal bites include fight bites
Chapter 08
1. Table 8.1 Anatomical inclusions within Judet views
Chapter 09
1. Table 9.1 History of hip symptoms
2. Table 9.2 Special tests for hip examination
3. Table 9.3 General hip conditions according to age groups
4. Table 9.4 National NOF targets
Chapter 10
1. Table 10.1 Anatomy and functions of knee ligaments
2. Table 10.2 Osteoarthritis – Relevant history/symptoms
3. Table 10.3 Important issues to highlight in the history
4. Table 10.4 Sports Injuries: History and Management
5. Table 10.5 Indications for meniscal repair
6. Table 10.6 Special tests for knee examination
7. Table 10.7 Pathologies at different anatomical sites
8. Table 10.8 Surgical management of patella instability
Chapter 11
1. Table 11.1 Some causes of pain in foot and ankle
2. Table 11.2 Medical conditions predisposing to hallux valgus
3. Table 11.3 Myerson’s modification of Johnson & Strom’s classification for Tibialis Posterior dysfunction
Chapter 12
1. Table 12.1 Myotomes of limbs
2. Table 12.2 Limb reflexes
3. Table 12.3 Sources of metastatic spread to spine
Chapter 13
1. Table 13.1 Salter and Harris injury classification
2. Table 13.2 Red flags for suspecting NAI
3. Table 13.3 Injuries suggestive of NAI
4. Table 13.4 Gross motor and functional classification system
5. Table 13.5 Management options for cerebral palsy
6. Table 13.6 Classifications of SCFE
7. Table 13.7 CAVE deformities for clubfoot
Chapter 14-2
1. Table 14.2.1 Mechanical vs. nonmechanical causes of locked knee
2. Table 14.2.2 Vascular zones of the meniscus
Chapter 14-4
1. Table 14.4.1 Modified Gartland classification of supracondylar fractures
Chapter 14-5
1. Table 14.5.1 The Kocher criteria for a child with a painful hip include
Chapter 15
1. Table 15.1 Complications of joint injections and arthrocentesis
2. Table 15.2 Procedure for joint injection/aspiration
Chapter 16
1. Table 16.1 Criteria for BPT
2. Table 16.2 Falls risk assessment
3. Table 16.3 Risk factors for fractures independent of age and BMD
4. Table 16.4 Complications of fractures
5. Table 16.5 Preventative measures of possible postoperative complications
6. Table 16.6 Definitions relating to bone union
7. Table 16.7 Precautions to protect hip
Chapter 17
1. Table 17.1 Nonmodifiable risk factors for development of OA
2. Table 17.2 Important issues to address when taking a history
3. Table 17.3 Modifiable lifestyle risk factors for the development of OA and conservative management
Chapter 18
1. Table 18.1 Classification criteria for RA
2. Table 18.2 Indications for DMARDs
3. Table 18.3 Indications for biological agents
4. Table 18.4 Clinical manifestations Of SpA
5. Table 18.5 Features of inflammatory back pain
6. Table 18.6 Other conditions with intestinal involvement and arthritis
7. Table 18.7 Patterns of joint involvement in psoriatic arthritis
Chapter 19
1. Table 19.1 Common orthopaedic infections
2. Table 19.2 Clinical features of prosthetic joint infections
3. Table 19.3 Preventing infection in orthopaedics
4. Table 19.4 Clinical features of extra‐pulmonary TB
5. Table 19.5 Miscellaneous soft tissue infections
Chapter 20
1. Table 20.1 Common risk factors for osteoporosis and underlying mechanisms
2. Table 20.2 Common osteoporotic fracture sites
3. Table 20.3 Implications of a hip fracture
4. Table 20.4 FRAX tool
5. Table 20.5 Dual‐energy X‐ray absorptiometry (DXA) scan
Chapter 21
1. Table 21.1 Modes of presentation for bone and soft tissue tumours
2. Table 21.2 NICE guidelines for sarcoma referrals
3. Table 21.3 Tumour matrix types
4. Table 21.4 Aggressive appearances include
5. Table 21.5 Cell of origin with benign and malignant subtypes
Chapter 22
1. Table 22.1 PNI classification systems
2. Table 22.2 Clinical examination of the brachial plexus
3. Table 22.3 Common PNI scenarios
Chapter 24
1. Table 24.1 Implant composition
2. Table 24.2 Indications for different types of sutures and clips
3. Table 24.3 Different types of mobility aids post operatively and their uses
4. Table 24.4 Types of immobilisation devices for fractures or for postoperative use

List of Illustrations

Chapter 01
1. Figure 1.1 (a) Human skeleton and (b) movement of the body
2. Figure 1.2 Orthopaedic examination
3. Figure 1.3 Displacement in three planes
4. Figure 1.4 AP and lateral radiograph of the right tibia and fibula
5. Figure 1.5 AP and lateral radiograph of the right tibia and fibula of a skeletally immature patient
6. Figure 1.6 General principles of fracture management
7. Figure 1.7 Multimedia online platform
8. Figure 1.8 Holography‐assisted learning in orthopaedics (HALO)
Chapter 02
1. Figure 2.1 Epidemiology of fractures by age and sex (Court‐Brown & Caesar, 2006)
Chapter 03
1. Figure 3.1 Graphical demonstration of the sagittal, coronal, and axial planes
2. Figure 3.2a and b These AP and lateral radiographs of a wrist stress the importance of obtaining two views when assessing bones and joints. To the untrained eye the AP view (a) may not appear overtly abnormal, especially due to artefact from the plaster cast. The lateral view; (b) reveals that there is a fracture‐dislocation of the wrist
3. Figure 3.3a, b, and c An AP, lateral, and axial (skyline) view of a normal knee
4. Figure 3.4a, b, and c Sagittal, coronal, and axial CT images of a normal knee
5. Figure 3.5a, b, and c Sagittal and coronal MRI images of a knee. Image (a) is T1‐weighted, used to help differentiate fat from water. Image (b) is T2‐weighted (fat suppressed), particularly efficient at demonstrating oedema and fluid. Image (c) is a also a T2 weighted fat suppressed coronal view. Please refer to Box 3.1
6. Figure 3.6 Nuclear medicine bone scan of the whole skeleton. Dark areas signify increased uptake of the radioactive marker, indicating hypervascular lesions or areas of increased osteoblastic activity. In this example, it is specifically seen in the left knee and right elbow, due to osteoarthritis
7. Figure 3.7 A bilateral hip SPECT/CT scan. The central image is reconstructed using data from the SPECT scan (top) and the CT scan (bottom)
Chapter 04
1. Figure 4.1 Trauma call being attended by multiple personnel
2. Figure 4.2 Fracture healing
3. Figure 4.3 Fracture patterns
4. Figure 4.4 Principles of fracture reduction
5. Figure 4.5 Principles of fracture holding
6. Figure 4.6 Principles of fracture fixation
7. Figure 4.7 External fixator for wrist fracture
8. Figure 4.8 Principles of rehabilitation
9. Figure 4.9 CT traumagrams showing base of skull and cervical spine with 3D reconstruction
Chapter 05
1. Figure 5.1 Clavicle fracture with shortening
2. Figure 5.2 ORIF of mid humerus with plates and screws
3. Figure 5.3 Holstein‐Lewis fracture of the distal humerus
4. Figure 5.4 Colles’ fracture: a) clinically and b) radiologically (or more accurately a dorsally tilted distal radius fracture)
5. Figure 5.5 Rules of 11 for wrist joint: Anatomical relationships to observe around the distal radius. UV (ulnar variance = neutral), RH (radial height = 11 mm), RI (radial inclination = 22°), VI (volar inclination = 11°)
6. Figure 5.6 Wrist ORIF
7. Figure 5.7 Intramedullary nail
8. Figure 5.8 Tibial plateau ORIF
9. Figure 5.9 Schatzker classification for tibial plateau
10. Figure 5.10 Radiograph showing trimalleolar fracture
11. Figure 5.11 Open fracture of leg
12. Figure 5.12 Ilizarov frame
13. Figure 5.13 Leg fasciotomy wound
14. Figure 5.14 Vancouver classification of femoral periprosthetic fracture
Chapter 06
1. Figure 6.1 Bony anatomy of proximal humerus
2. Figure 6.2 Musculoskeletal anatomy of the shoulder
3. Figure 6.3 Muscle wasting secondary to chronic rotator cuff tear
4. Figure 6.4 Popeye sign
5. Figure 6.5 Distal biceps tendon rupture
6. Figure 6.6 Reduced external rotation
7. Figure 6.7 MRI scan of supraspinatus tendon tear
8. Figure 6.8 Painful arc in shoulder abduction
9. Figure 6.9 Calcific tendinitis
10. Figure 6.10 Neer classification for proximal humeral fractures
11. Figure 6.11 PHILOS plate
12. Figure 6.12a & b Shoulder replacement (arthroplasty)
13. Figure 6.13 Area of tenderness with tennis and golfer’s elbow
14. Figure 6.14 Arthroscopic view of loose body elbow joint
Chapter 07
1. Figure 7.1 Movements of the fingers and thumb
2. Figure 7.2 Innervation of hand and wrist
3. Figure 7.3 (a) Testing for FDS; (b) Testing for FDP
4. Figure 7.4 Cross section of the carpal tunnel
5. Figure 7.5 Atrophic thenar eminence
6. Figure 7.6 Trigger finger pathology
7. Figure 7.7 de Quervain’s pathology
8. Figure 7.8 Dupuytren’s contracture
9. Figure 7.9 Digital osteoarthritis
10. Figure 7.10 Base of thumb OA
11. Figure 7.11 Radiograph showing base of thumb OA
12. Figure 7.12 Palmar wrist ganglion presenting between the flexor carpi radialis tendon and the radial artery
13. Figure 7.13 Finger tips: (a) radiograph of bony mallet injury: (b) tuft fracture; (c) nail anatomy; and (d) subungual haematoma
14. Figure 7.14 Radiographs showing (a) Bennett’s fracture; (b) Rolando fracture; and (c) reverse Bennett’s fracture
15. Figure 7.15 Radiographs of scaphoid fracture (a) at initial injury; and (b) 6 months later showing nonunion
Chapter 08
1. Figure 8.1 Anatomy of the bony pelvis: (a) anterior and (b) lateral
2. Figure 8.2 Ligaments in the pelvis
3. Figure 8.3 AP radiograph of the pelvis: Normal AP radiograph of the pelvis: Several important lines and structures are annotated on the left. Unannotated counterparts can be seen on the right. Purple lines = sacral arcuate lines; blue line = iliopectineal line; red line = ilioischial line; orange line = “Shenton’s line”; green line = anterior acetabular wall; yellow line = posterior acetabular wall; solid black lines = compressive trabeculae of the femoral neck; dotted black lines = tensile trabeculae of the femoral neck; diagonal arrows = obturator fat stripe; dotted arrow = gluteus (minimus) fat stripe; solid horizontal arrow = iliopsoas fat stripe; OF = obturator foramen
4. Figure 8.4 (a) Radiographic landmarks of the acetabulum on the anteroposterior view of the pelvis. 1, iliopectineal line; 2, ilioischial line; 3, teardrop; 4, roof; 5, anterior rim of the acetabulum; 6, posterior rim of the acetabulum. The iliopectineal line, the anterior rim, and teardrop are landmarks of the anterior column; the ilioischial line and posterior rim are landmarks of the posterior columns. (b) Obturator oblique view of the hemipelvis, obtained by turning the injured side 45° toward the X‐ray beam. The obturator ring is seen en face, and the iliopectineal line is also present. 1, Area of the anterior column; 2, posterior rim of the acetabulum. Posterior wall fractures are best seen on this view. (c) Iliac oblique view, obtained by rotating the injured side away from the X‐ray beam. The iliac wing is seen en face, and fracture lines extending into the iliac wing are often best seen on this view: 1, the greater sciatic notch is seen on this view, and represents the posterior column; 2, the anterior rim of the acetabulum is best seen on this view
5. Figure 8.5 Axial CT view of the pelvis
6. Figure 8.6 The Burgess and Young classification system: (a) Lateral compression fracture. (b) Open book fracture – anterior‐posterior compression. (c) Vertical sheer fracture
7. Figure 8.7 Avulsion fractures: (A) = ASIS (sartorius origin); (B) = AIIS (rectus femoris origin); (C) = ischial tuberosity (hamstrings origin); (D) = parasymphyseal pubis (hip adductors origin); (E) = femoral lesser trochanter (iliopsoas insertion); (F) = femoral greater trochanter (gluteus minimus and medius insertions); (G) = iliac crest (abdominal obliques attachments)
8. Figure 8.8 ABC Pelvic Assessment Protocol and treatment options
9. Figure 8.9 Correct placement of pelvic binder
10. Figure 8.10 Pelvic binder replaced with anterior external fixator
11. Figure 8.11 A radiograph demonstrating a symphysis diastasis of greater than 2.5 cm
12. Figure 8.12 The inverted Y two‐column acetabulum
13. Figure 8.13 Corona Mortis: Illustration of the commonly occurring small calibre anastomoses between the obturator and external iliac systems (a). Illustration of the true corona mortis, aberrant origin of the obturator artery from the external iliac system (b).
14. Figure 8.14 Plain radiographs demonstrating (a) obturator oblique and (b) iliac oblique
15. Figure 8.15 Judet‐Letournel classification of acetabular fractures: There are 10 fracture types, divided into five elementary patterns and five associated patterns. The elementary patterns are: (a) posterior wall; (b) posterior column; (c) anterior wall; (d) anterior column; (e) transverse. The associated patterns are as follows: (f) posterior column and posterior wall; (g) transverse and posterior wall; (h) T‐shaped; (i) anterior column (or wall) with associated posterior hemitransverse; (j) both‐column
Chapter 09
1. Figure 9.1 Hip anatomy
2. Figure 9.2 Blood supply to the femoral head (LFCA: lateral femoral circumflex artery; MFCA: medial femoral circumflex artery)
3. Figure 9.3 Hip examination
4. Figure 9.4 Common radiographic angles. Shenton’s line. Acetabular angle (of Tonnis) or Sourcil angle normal value 0–10 degrees. Vertical centre edge angle (of Wiberg) normal value ≱25 degrees; Sharp's acetabular angle (between Sourcil's angle and pelvic tear drop) < 38 degrees, if higher than signifies dysplasia. Note small cam lesion of left hip
5. Figure 9.5 Plain radiographs of hip fractures: (L) intracapsular fracture, (R) extracapsular fracture
6. Figure 9.6 Hip fracture patterns
7. Figure 9.7 Radiographs of (L) dynamic hip screw, (R) intramedullary nail for treatment of extracapsular hip fracture
8. Figure 9.8 Garden classification of intracapsular hip fractures. This classification was used to describe intracapsular neck of femur fractures but more recently has been simplified to displaced or undisplaced. Classification is for historical reference
9. Figure 9.9 Management options for NOF fractures
10. Figure 9.10 Radiograph of a cemented hemiarthroplasty for treatment of a displaced intracapsular hip fracture
11. Figure 9.11 Radiographs of (L) osteoarthritis (OP ‐ osteophyte; JS ‐ loss of joint space; SS ‐ subchondral sclerosis; SC ‐ subchondral cyst) of the hip. (R) uncemented total hip replacement
12. Figure 9.12 Avascular necrosis of the right hip
13. Figure 9.13 Femoro‐acetabular impingement: The cross‐over sign in acetabular retroversion. (a) Preoperative film shows cross‐over sign, dotted line represents anterior rim of acetabulum. (b) This patient was treated successfully for a pincer lesion with acetabular rim resection and labral refixation. The anterior dotted line and posterior solid line meet at the edge, as they should in normal hips. (c) A schematic demonstrating pincer and cam lesions
Chapter 10
1. Figure 10.1 Knee anatomy: (a) Supporting structures of the anterior and posterior knee (b) Cross‐section of the knee joint showing the menisci and cruciate ligaments
2. Figure 10.2 Unhappy triad of O’Donoghue: (a) Torn superficial and deep components of the MCL and ruptured medial capsule. (b) ‘Unhappy triad of O’Donoghue: torn ACL, MCL, and medial meniscus (which could have occured at the time or subsequent to injury)
3. Figure 10.3 Patellofemoral joint anatomy and extensor mechanism of the knee
4. Figure 10.4 Examination steps
5. Figure 10.5 Radiographic evidence of knee osteoarthritis
6. Figure 10.6 Management options of knee OA
7. Figure 10.7 Plain radiograph of TKR
8. Figure 10.8 (a) Medial UKR (b) Patellofemoral joint replacement
9. Figure 10.9 Common causes contributing to sports injuries
10. Figure 10.10 ACL reconstruction
11. Figure 10.11 Causes contributing to patellar instability
12. Figure 10.12 Radiograph demonstrating Osgood‐Schlatter Disease
13. Figure 10.13 (a) Sagittal T2 MRI – revealing increased uptake in the distal quadriceps tendon (b) Sagittal T1 MRI – revealing increased uptake in the proximal patellar tendon
14. Figure 10.14 Prepatellar bursitis
Chapter 11
1. Figure 11.1 Anatomy of (a) foot and (b) ankle
2. Figure 11.2 Hallux valgus: deformity showing medial deviation of the first MT and lateral deviation and pronation of the hallux. The preoperative radiograph shows an inter‐metatarsal (IM) angle greater than the normal 9° and the hallux valgus is greater than 15°. The sesamoids are subluxed. The postoperative radiographs show a scarf and akin osteotomy with improvement of angles
3. Figure 11.3 Hallux rigidus: a clinical photograph with corresponding radiograph showing the classical dorsal osteophyte that grows like a rhinoceros’ horn
4. Figure 11.4 Metatarsalgia: hard skin (callus) forms underneath the metatarsal heads due to uneven weight distribution as the patient overloads his metatarsal heads
5. Figure 11.5 Morton’s Neuroma: a demonstration of a Mulder’s click for a neuroma in the third web space – squeeze the metatarsal heads together whilst pinching the webspace between index finger and thumb. The neuroma is visible at time of surgery
6. Figure 11.6 Plantar fasciitis: a clinical photograph of a patient with a tight gastrocnemius muscle. Presenting with a Haglund’s bump, retro‐calcaneal bursa, plantar fasciitis and metatarsalgia with metatarsal callosities
7. Figure 11.7 Flatfoot deformity: This patient had bilateral symptomatic plano‐valgus. The left side has been operated on and he is awaiting surgery on the right. The surgery involved a calcaneal osteotomy to change the vector force of the tendo‐Achilles, a lateral column lengthening to recreate the medial arch, a gastrocnemius lengthening, and a tendon transfer to compensate for the weak tibialis posterior (FDL was used)
8. Figure 11.8 Ankle replacement: This is a third‐generation ankle replacement. It is anatomically shaped, unconstrained, and cementless. Results suggest a 90% 10‐year survival rate
9. Figure 11.9 Clinical photograph showing absence of outline of the left Achilles tendon
10. Figure 11.10 Weber and Lauge‐Hansen classifications for ankle fractures
11. Figure 11.11 Plain radiographs showing (a) Weber B and medial malleoli avulsion fracture with talar shift and (b) ORIF with plate and screws
12. Figure 11.12 Management options of Weber fracture classification
Chapter 12
1. Figure 12.1 Anatomy of spine (a) entire column (b) single‐level cross section of the lumbar vertebra
2. Figure 12.2 Dermatomes of limbs
3. Figure 12.3 Spinal examination
4. Figure 12.4 Schematic diagram of the spine showing a normal vertebral unit with examples of structural abnormalities
5. Figure 12.5 (A) Schematic of slipped disc and (B) Disc protrusion (a) Sagittal T2 weighted (T2w) image of the lumbar spine. (b) Axial T2w images show an L5/S1 left paracentral disc protrusion impinging on the left S1 nerve root. Note the degenerative vertebral endplate changes, loss of disc height and disc dehydration at this level
6. Figure 12.6 Cauda equina compression. Sagittal T2‐weighted MRI showing a large L5/S1 disc protrusion causing compression of the thecal sac and cauda equina
7. Figure 12.7 Spinal stenosis (lumbar spine). The second image highlights the vertebral canal available for the cauda equina (blue). The areas for the transiting nerve roots (or lateral recesses) are coloured red. In a normal spine, both the blue and the red areas would be much larger, giving much more space for the neurological structures
8. Figure 12.8 Cervical myelopathy from spondylosis. Sagittal MRI images showing spinal cord compression by a horizontal osteophyte at the C5–C6 (arrow) and C6–C7 levels. At those levels the spinal cord is abnormally hyperintense in these T2‐weighted images
9. Figure 12.9 Degenerative listhesis. Lateral radiograph (a) shows grade 1 (25%) slip of L4 on L5; (b) the sagittal T2W MRI shows reduction in the calibre of the spinal canal as a result of the degenerative listhesis (c.f. in lytic listhesis the canal is increased in diameter)
10. Figure 12.10 Scoliosis: the spine curves and rotates
11. Figure 12.11 (a) Sagittal T2W MRI showing loss of disc height and ↑ disc signal at the L4–5 level (b) Sagittal T1W MRI showing eroded, ragged end‐plates (arrows) in a patient with thoracic osteomyelitis. Blood cultures revealed Staph. aureus
12. Figure 12.12 The three anatomical columns: SLL, supraspinatus ligament; PLL, posterior longitudinal ligament; ALL, anterior longitudinal ligament
Chapter 13
1. Figure 13.1 Paediatric bone anatomy
2. Figure 13.2 Brachial plexus paralysis: (a) Erb’s Palsy due to an upper brachial plexus lesion on the left involving the C5, 6, and 7 roots. The arm hangs at the side internally rotated at the shoulder, with elbow extended and pronation of the forearm producing the so‐called “waiter’s tip” posture (courtesy of Rolf Birch FRCS); and (b) Klumpke‐type paralysis due to lower brachial plexus avulsion earlier in childhood. A marked disturbance of subsequent growth especially affects the clavicle, scapula, and humerus. Horner syndrome was present. Nerve transfer operations have restored some hand grasp. Nonetheless, the residual weakness is characteristic with paralysis of wrist flexion and a claw hand (courtesy of Rolfe Birch FRCS)
3. Figure 13.3 Salter‐Harris classification of paediatric fractures
4. Figure 13.4 Cerebral palsy
5. Figure 13.5 Types of spina bifida
6. Figure 13.6 Rickets
7. Figure 13.7 Achondroplasia
8. Figure 13.8 Barlow and Ortolani tests for DDH
9. Figure 13.9(a) Pavlik harness
10. Figure 13.9(b) Hip spica
11. Figure 13.10 Radiograph showing Perthes disease
12. Figure 13.11 Slipped capital femoral epiphysis (a) radiograph and (b) measurements
13. Figure 13.12 Radiograph showing Osgood–Schlatter disease
14. Figure 13.13 Clubfoot pathology
Chapter 14-2
1. Figure 14.2.1 Meniscal tear patterns
2. Figure 14.2.2 Meniscal tear leading to locked knee
3. Figure 14.2.3 Treatment protocol for locked knee
4. Figure 14.2.4 Radiograph showing a left dislocated knee (a) AP view and (b) lateral view
5. Figure 14.2.5 Fasciotomy for compartment syndrome and ExFix for knee dislocation
Chapter 14-3
1. Figure 14.3.1 Anterior fracture dislocation
2. Figure 14.3.2 Attempted reduction of anterior fracture dislocation
3. Figure 14.3.3 Radiographs showing (a) ‘Y’ view of posterior dislocation, (b) Light bulb sign and (c) Axial view of posterior fracture dislocation
4. Figure 14.3.4 (a) Bankart and (b) Hill‐Sachs defects
Chapter 14-4
1. Figure 14.4.1 Gartland 3 extension type supracondylar fracture
2. Figure 14.4.2 (a) anterior humeral line, (b) Baumann angle and (c) anterior and posterior fat pads
3. Figure 14.4.3 Examples of different wiring techniques: (a) crossed and (b) divergent K‐wires
Chapter 14-5
1. Figure 14.5.1 Common sites of septic arthritis
2. Figure 14.5.2 Common pathogens causing septic arthritis
Chapter 14-6
1. Figure 14.6.1 Vicious circle: Pathophysiology of compartment syndrome
2. Figure 14.6.2 Sites of fasciotomy incisions in the leg and its compartments
Chapter 14
1. Figure 14.1.1 Classic position of lower limb in posterior dislocation of the hip. Slight flexion, adduction, and internal rotation
2. Figure 14.1.2 Left hip joint dislocation
3. Figure 14.1.3 Dislocated left hip prosthesis
Chapter 15
1. Figure 15.1 Subacromial bursa injection site
2. Figure 15.2 Acromioclavicular joint injection site
3. Figure 15.3 Elbow injection sites: (a) lateral epicondyle and (b) elbow joint
4. Figure 15.4 Carpal tunnel injection site
5. Figure 15.5 Relationship of dorsal wrist tendons to carpus and appropriate site for injection or aspiration of wrist joint: APL, abductor pollicis longus; EPB, extensor pollicis brevis; ECRL, extensor carpi radialis longus; ECRB, extensor carpi radialis brevis; EPL, extensor pollicis longus; EDC, extensor digitorum communis; EIP, extensor indicis proprius; EDM, extensor digiti minim; ECU, extensor carpi ulnaris
6. Figure 15.6 Knee joint (a) injection entry site and (b) synovial fluid aspiration
7. Figure 15.7 Ankle joint and relationship of anterior tendons and anterolateral and anteromedial injection or aspiration sites
8. Figure 15.8 Shoulder arthroscopic portal sites
9. Figure 15.9 Knee arthroscopic portal sites
10. Figure 15.10 Surface anatomy of the palm of the hand and landmarks used for carpel tunnel surgery
Chapter 16
1. Figure 16.1 Various stages of care in hip fracture surgery
2. Figure 16.2 Osteoporosis
3. Figure 16.3 Grade 4 pressure sore
4. Figure 16.4 Right leg DVT
5. Figure 16.5 Right hip AVN
Chapter 17
1. Figure 17.1 Radiological signs of knee OA
2. Figure 17.2 (a) Knee arthroscopy – probe examination showing a tear in the anterior horn of lateral meniscus (b) Knee arthroscopy – external view
3. Figure 17.3 (a) Anatomical models showing medial unicondylar (unicompartmental) and total knee replacements (b) Postoperative wound for open knee surgery
4. Figure 17.4 Triple arthrodesis – talonavicular, subtalar, and calcaneocuboid joints fused as a last resort
5. Figure 17.5 High tibial osteotomy
6. Figure 17.6 Plain radiograph showing left Girdlestone procedure
7. Figure 17.7 Computer‐assisted orthopaedic surgery
Chapter 18
1. Figure 18.1 Radiograph demonstrating severe erosions affecting the base of MCPs and PIPs
2. Figure 18.2 Rheumatoid hands: ulnar deviation with rheumatoid nodules
3. Figure 18.3 Boutonniere deformity of the fifth finger, swan neck deformity of middle and ring finger
4. Figure 18.4 Radiographs showing (a) subluxation of the first and second MTP. Bones are osteopaenic. There is also a hallux valgus deformity, (b) post‐op forefoot arthroplasty 1st MTP joint fusion and basal osteotomy of the 1st metatarsal
5. Figure 18.5 Systemic manifestations of RA
6. Graph 18.1 Management of rheumatoid arthritis
7. Graph 18.2 Management of SpA
8. Graph 18.3 Management protocol of SpA
9. Figure 18.6 “Pencil in cup” deformity is a feature of psoriatic arthritis
10. Figure 18.7 Psoriatic arthritis with dactylitis and active psoriasis. There is also nail pitting and onycholysis
Chapter 19
1. Figure 19.1 Foci of infection in children and in those older
2. Figure 19.2 Destructive changes from osteomyelitis
3. Figure 19.3 MRI images of (a) vertebral osteomyelitis in adult spine, and (b) high signal in the proximal tibia due to infection
4. Figure 19.4 Plain radiograph of a Brodie’s abscess
5. Figure 19.5 The coronal and sagittal views of a Brodie’s abscess on MRI
6. Figure 19.6 Radiographs of infected tibial fracture nonunions (a) without internal fixation and (b) with an intramedullary tibial nail
7. Figure 19.7 A computerised tomography scan show an intracortical sequestrum, (a) coronal and (b) axial image
8. Figure 19.8 Case Study: Distal femoral chronic osteomyelitis. (a) plain radiograph; (b) CT scan; (c) following bone excision; (d) bone more proximal bone being transported; and (e) the bone docking distally with new bone formation following behind
9. Figure 19.9 Radiographs of (a) first‐stage revision with a temporary antibiotic spacer; (b) an excision arthroplasty; (c) hip arthrodesis; and (d) second‐stage revision total hip replacement
Chapter 20
1. Figure 20.1 Bone metabolism
2. Figure 20.2 Radiograph showing left pubic ramus fracture
3. Figure 20.3 Lateral radiograph showing vertebral fracture
4. Figure 20.4 Radiograph (AP pelvis) showing a fracture of right extracapsular neck of femur
5. Figure 20.5 Summary of NOGG recommended algorithm for assessment of patients at risk of fracture
6. Figure 20.6 Pharmacological treatment of osteoporosis
7. Figure 20.7 Limb deformity with bowing (sabre) tibia
Chapter 21
1. Figure 21.1 Multiple pedunculated osteochondromata in association with diaphyseal aclasia
2. Figure 21.2 Osteoid osteoma (CT)
3. Figure 21.3 Maffucci's syndrome with multiple enchondromata and soft‐tissue haemangiomas
4. Figure 21.4 MR image demonstrating cortical breakthrough of an aggressive chondroid lesion
5. Figure 21.5 Fallen leaf sign in a lytic, pathologically fractured unicameral bone cyst (arrow indicating fallen fragment)
6. Figure 21.6 Ground‐glass appearance of fibrous dysplasia in the rib
7. Figure 21.7 Target sign (arrow) and taper sign in a schwannoma (arrow head)
Chapter 22
1. Figure 22.1 Neurone
2. Figure 22.2 Brachial plexus
3. Figure 22.3 PNI surgical options
Chapter 23
1. Figure 23.1 Free‐body diagram of two brothers on a seesaw, with b2 being twice the weight of b1, before and after calculation the moment arms to achieve equilibrium
2. Figure 23.2 Free body diagram of the hip
3. Figure 23.3 Vector used to resolve the joint reaction force
4. Figure 23.4 Deforming forces on the hip
5. Figure 23.5 Stress strain curve showing the elastic limit a. The hatched section represents the elastic region and the shaded section the plastic deformation region
Chapter 24
1. Figure 24.1 Traction table
2. Figure 24.2 Patient should be in beach chair position for shoulder surgery
3. Figure 24.3 (a) Hip hemiarthroplasty implant (b) Total hip replacement implant
4. Figure 24.4 (a) Dynamic hip screw (DHS) (b) Radiograph of a dynamic hip screw (DHS)
5. Figure 24.5 (a) Intramedullary femoral nail (b) X‐ray of intramedullary nail fixation
6. Figure 24.6 (a) Knee replacement implant (b) X‐ray of a knee replacement
7. Figure 24.7 (a) Reverse total shoulder replacement implant (b) Radiograph of a (reverse total) shoulder replacement
8. Figure 24.8 Plate applied to bone
9. Figure 24.9 Screws with specific purposes
10. Figure 24.10 Two types of K‐wires
11. Figure 24.11 Vacuum‐assisted closure

ABC of Orthopaedics and Trauma

Foreword

Contributors

Preface