Lecture Notes: Orthopaedics and Fractures

1 Lecture notes : Orthopaedics and FracturesLecture NotesOrthopaedics and FracturesT DuckworthBSc (Hons), MBChB (Hons), FRCS (Eng)Emeritus Professor of OrthopaedicsUniversity of Sheffi eldC M BlundellMB, ChB, BMedSci (Hons), FRCS (Eng), MD, FRCS (Tr&Orth)Northern General HospitalSheffi eld, UKFourth editionA John Wiley & Sons, Ltd., PublicationThis edition fi rst published 2010, 2010 by T Duckworth and CM BlundellPrevious editions: 1980, 1984, 1995 Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell s publishing program has been merged with Wiley s global Scientifi c, Technical and Medical business to form offi ce: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UKEditorial offi ces: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USAFor details of our global editorial offi ces, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at right of the authors to be identifi ed as the authors of this work has been asserted in accordance with the Copyright, Designs and Patents Act rights reserved.

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3 It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be of Congress Cataloging-in-Publication DataDuckworth, T. Lecture notes . Orthopaedics and Fractures / T. Duckworth, 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.]

4 2. Fractures , Bone Handbooks. WE 39 D836L 2010] 2010 dc22 2009046372 ISBN: 9781405133296A catalogue record for this book is available from the British in 8 on 12 pt Stone Serif by Toppan Best-set Premedia LimitedPrinted and bound in Singapore1 2010vContributors viPreface to fourth edition viiPreface to fi rst edition viiiPart 1: General Principles 1 Musculoskeletal structures and function 3 2 Soft-tissue injuries and healing 12 3 Nerve injuries and repair 20 4 Fractures and healing 25 5 Fractures principles of management 32 6 Complications of Fractures 44 7 Major trauma 49 8 Congenital and developmental conditions 52 9 Generalized orthopaedic conditions 6610 Infl ammatory conditions 7411 Degenerative conditions 8712 Neoplastic conditions of bone and soft tissue 92 Contents13 Infections 10014 Metabolic diseases of bone 10915 Examination of the musculoskeletal system 116 Part 2.

5 Regional Orthopaedics16 The forearm, wrist and hand 12317 The elbow 13918 The shoulder and upper arm 14819 The spine 15720 The pelvis 17221 The hip and thigh 17622 The knee and lower leg 18823 The foot and ankle 20124 orthopaedic techniques 218 Appendix 233 Index 237vi Contributors Stephen Bostock Consultant orthopaedic Hand Surgeon Sheffi eld Orthopaedics Ltd Sheffi eld, UK Ashley Cole Consultant orthopaedic Spinal Surgeon Sheffi eld Orthopaedics Ltd Sheffi eld, UK Richard Gibson Consultant orthopaedic Surgeon Sheffi eld Teaching Hospital NHS Trust Sheffi eld, UK Bob Grimer The Royal orthopaedic Hospital Birmingham, UK Andrew Hamer Consultant orthopaedic Surgeon Sheffi eld Orthopaedics Ltd Sheffi eld, UK Paul Haslam Consultant orthopaedic Surgeon Doncaster and Bassetlaw Hospitals NHS Trust Doncaster, UK Stan Jones Consultant orthopaedic Surgeon Sheffi eld Orthopaedics Ltd Sheffi eld, UK David Stanley Consultant orthopaedic Surgeon Sheffi eld Teaching Hospitals NHS Trust Sheffi eld, UK Simon Till Consultant Rheumatologist Sheffi eld Teaching Hospitals NHS Trust Sheffi eld, UK Rob Townsend Consultant Microbiologist Department of Microbiology Northern General Hospital Sheffi eld, UK vii Preface to fourth edition Medical training is constantly changing.

6 Surgical training is becoming shorter and the decision about which branch to follow is being asked at an evermore junior level. It is only possible to make an informed career choice by having a suffi cient grasp of the relevant speciality and, wherever pos-sible, having some exposure to it. Orthopaedics is a changing speciality. Sub - specialization has become commonplace and the general orthopaedic surgeon is now rare. This book attempts to introduce most aspects of ortho-paedics at a level which will satisfy medical stu-dents, students of professions allied to medicine and general practitioners alike. This fourth edition has been rewritten to make it easier to study the basis of Orthopaedics (Part 1) and then to refer to each region in turn (Part 2).

7 With the advent of sub - specialization, this is how the subject is often now encountered. The regional section is further sub - divided into four areas: examination, adult pathology, paediatric pathol-ogy and trauma. We hope we have achieved our goal in creating a book which is broad enough in scope to cover most pathologies whilst covering the more common conditions in suffi cient depth to allow a compre-hensive understanding. T Duckworth C M Blundell viii Preface to fi rst edition At fi rst sight there would appear to be little diffi -culty in compiling a short textbook of orthopaed-ics and Fractures to meet the needs of medical students, general practitioners and others with a non - specialist interest in the subject.

8 They are all likely to require a quick and reliable source of refer-ence and some practical advice on management. But how much material, how much detail and how much practical advice? Many medical schools have reduced the time available for the study of disorders of the musculo - skeletal system. The medical student is now lucky if he/she can gain experience in the techniques of clinical examination, let alone become familiar with those common orthopaedic conditions which occupy so much of the average general practition-er s time and encroach on every branch of medicine. It would be a short textbook indeed which covered only the contents of this type of course. Students often complain that they are given no guidance as to how far their reading should take them beyond the confi nes of their limited clinical experience.

9 They often ask in desperation for a syllabus or a list of reading material: how much do we need to know? Unfortunately, although examiners may be prepared to confi ne themselves within pre - determined limits, patients rarely do so. They present with obscure problems, or, worse still, common problems in familiar guises. No matter how well he/she has been taught and has understood the principles of diagnosis and management, no textbook can provide the new doctor with what will become his/her most valuable asset experience. It can however provide him/her with other people s experience and also with something almost equally valuable an awareness of what are the possibili-ties. Without this awareness, a diagnosis can rarely be made.

10 In the absence of clear guidance from the medical faculties about what their end - product, the newly qualifi ed doctor, is supposed to be, it seemed rea-sonable to try to produce a book which would attempt to provide answers, albeit often brief and incomplete ones, to most of the questions the interested and intelligent student and postgradu-ate would be likely to ask about the subject. In doing so, emphasis has been placed on the principles of diagnosis and management and on classifi cation. It is hoped that the latter will be an aid to understanding relationships and also perhaps to memory. Common conditions have been allocated relatively more space, and some details of the management of such conditions, which might be of value to junior staff, are included, with short sections on orthopaedic and operative procedures.