Current Orthopaedic Practice

Preface
Acknowledgement
Contents
List of Contributors
Contributors to First Edition
About the Author
1: Trauma
	Calculation of Injury Severity Score (ISS)
	Management of Open Fractures
		Classification
		Principles of Management
		Management in the Operating Room
		Wounds with no Skin Loss
		Wounds with Skin Loss
		Evidence for the Management of Open Fractures
	Scapular Fractures
		Classification
		Management
	Glenoid Fractures
		Classification
		Management
	Glenoid Neck Fractures
	Coracoid Fractures
		Classification
		Management
	Floating Shoulder
	Acromioclavicular Joint Injuries
		Classification
		Pathology
		Diagnosis
		Management
	Clavicle Fracture
	Distal Third (Lateral Third) Fractures of the Clavicle
		Classification
		Treatment
	Sternoclavicular Joint Dislocation
		Anterior Dislocation
		Posterior Dislocations
	Dislocation of the Glenohumeral Joint
		Clinical Features
		Imaging
		Management
	Posterior Dislocation
	Fracture of the Proximal Humerus
		Classification
		Hertel Criteria for Humeral Head Perfusion
		Management
			Impacted/Undisplaced Fractures
			Displaced Two-Part Fractures
			Displaced Three-Part Fractures
			Displaced Four-Part Fracture
	Fixation of Three- and Four-Part Proximal Humerus Fractures
		Reverse Total Shoulder Arthroplasty (RTSA) for Osteoporotic Three- and Four-Part Fractures
	Fracture Dislocations of the Shoulder
		Surgical Approach
	Humeral Shaft Fracture
		Classification
		Management
		Plating
		Intramedullary Nail
		External Fixation
	Periprosthetic Humeral Fractures
	Fracture of the Distal Humerus
		Anatomical Types
			Supracondylar Fracture in Adults
			Transcondylar Fractures
			Intercondylar Fractures
			Fracture of Medial or Lateral Humeral Condyle in Adults
			Fracture of the Lateral Epicondyle
			Fracture of the Medial Epicondyle
		Management
		Surgical Approach
		Principles of Surgery
		Complications
	Capitellum Fracture
		Classification
		Management
		Complications
	Elbow Dislocations
		Clinical Assessment
		Management
		Indications for Nerve Exploration
		Complications
		Terrible Triad
		Recurrent Elbow Dislocation
	Coronoid Fracture
		Classification
		Management
		Anteromedial Facet Fracture of Coronoid
	Olecranon Fracture
		Classification
		Management
	Radial Head Fracture
		Classification
		Management
		Indications for Surgery
		Radial Head Replacement
	Radial Neck Fracture
		Classification
		Management
	Essex–Lopresti Fracture Dislocation
		Management
	Monteggia Lesions
		Classification
		Imaging
		Management
	Galeazzi Lesion
		Imaging
		Management
	Fracture of the Radius and Ulna Midshaft
		Management
		Complications
	Fracture of the Distal Radius
		Anatomy
		Classification
		Evaluation
		Management
		Cast
		Manipulation and K-Wire Stabilisation
		External Fixation
		Open Reduction and Internal Fixation
		Complications
	Volar Barton Fracture
	Ulnar Styloid Fractures
	Fractures of the Scaphoid
		Classification
		Treatment
		Complications
	Hip Dislocation
		Classification
	Femoral Head Fractures
	Femoral Neck Fracture
		Anatomy
		Diagnosis
		Classification
		Imaging
		Management
		Timing of Surgery
		Fracture Reduction
		Screw Fixation
		Dynamic Hip Screw
		Hemiarthroplasty
		Total Hip Arthroplasty
		Management Planning
		Management of Anti-Coagulation
		Complications
	Intertrochanteric Fracture
		Diagnosis
		Classification
		Surgical Planning
		Choice of Implant
		Implant Position
		Comparison of Different Implants
	Subtrochanteric Fractures
		Classification
		Management
		Complications
	Femoral Shaft Fracture
		Clinical Evaluation
		Classification
		Management
		External Fixation
		Ipsilateral Femoral Neck and Shaft Fractures
		Intramedullary Nail
		Retrograde Nails
		Floating Knee
		Reamed Versus Unreamed
		Complications of Femoral Fractures
	Distal Femoral Fracture
		Clinical Assessment
		Imaging
		Classification
		Management
	Knee Dislocation
	Patellar Fracture
		Classification
		Management
	Patellar Tendon Rupture
		Management
	Quadriceps Tendon Rupture
		Management
	Tibial Spine Fracture
		Classification
		Imaging
		Management
	Tibial Plateau Fracture
		Imaging
		Classification
		Imaging
		Management
		Surgical Planning
	Tibial Shaft Fracture
		Blood Supply of the Tibia
		Classification
		Clinical Assessment
		Imaging
		Management
		Cast Treatment
		Indications for Surgery
		External Fixation
		Ream Versus Unreamed Nails
		Suprapatellar Versus Infrapatellar Nailing for Tibial Shaft Fractures
		Open Fractures
		Intraarticular Fractures
		Complications
	Tibial Plafond (Pilon) Fracture
		Classification
		Surgical Approach
		Management
		Complications
	Ankle Fractures
		Classification
		Determining Stability of the Ankle Joint
		Normal Radiographic Parameters of Ankle
		Operative vs. Non-Operative Management of Unstable Ankle Fracture
		Isolated Medial Malleolus Fracture
		Lateral Malleolus fractures
		Bimalleolar Fractures
		Injury to the Syndesmosis
		Posterior Malleolus Fracture
		Complications of Ankle Fractures
	Ankle Sprain
		Management
	Chronic Ankle Pain/Instability
		Management
	Achilles Tendon Rupture
		Imaging
		Management
	Talar Fracture
		Blood Supply to the Talus
	Talar Neck Fractures
		Classification
		Management
		Complications
	Calcaneal Fracture
	Classification
		Clinical Features
		Management
	Lisfranc Injury
		Diagnosis
		Classification
		Management
	Metatarsal Fractures
		Fracture of Base of Fifth Metatarsal
	Pelvic Ring Injuries
		Initial Evaluation
		Imaging
		Stability
		Classification
		Management
		Emergency Management
		Management of Urological Injury Associated with Pelvic Fractures
		Definitive Treatment
		Outcome
	Acetabular Fractures
		Classification
		Initial Management
		Non-Operative Management
		Indications for Internal Fixation
		Relative Indications for Primary Total Hip Replacement
		Surgical Approaches
		Management of Different Fracture Patterns
		Postoperative Management
		Total Hip Replacement for Posttraumatic Arthritis Following Acetabular Fracture
		Acute Hip Replacement in Elderly Population for Acetabular Fracture
	Cervical Spine Injuries
		Mechanism
		Imaging
		Management
	Thoracolumbar Spine Fracture
		Compression Fracture
		Burst Fracture
		Flexion Distraction Injury
		Fracture Dislocation
	Spinal Cord Injury
		Emergency Treatment
		Imaging
		Management
		Approaches
		Posterolateral Decompression
		Complications of Surgery
	Sacral Fractures
		Evaluation
		Classification
		Management
	Fractures in Children
		Hip Fracture
			Classification
			Blood Supply to the Femoral Head
			Management
			Complications
	Hip Dislocation
	Femoral Shaft Fracture
		Management
		Spica
		Traction
		External Fixation
		Flexible Intramedullary Nails
		Dynamic Compression Plate
		Antegrade Femoral Nailing
		Complications
	Supracondylar Femoral Fracture
	Distal Femoral Physeal Fracture
	Patellar Fracture
	Tibial Tubercle Fracture
	Tibial Fracture
	Triplane Fracture
	Seymour Lesion
	Humeral Shaft Fracture
	Supracondylar Humerus Fracture
		Classification
		Clinical Assessment
		Imaging
		Management
		Complications of Supracondylar Fractures
	Separation of the Distal Humeral Physis
	Lateral Humeral Condyle Fracture
		Classification
		Management
		Complications
	Medial Epicondyle Fracture
	Radial Head Dislocation
		Imaging
		Management
	Radial Neck Fractures
	Monteggia Fracture
	Radius and Ulna Diaphyseal Fracture
		Management
	Distal Radius Fractures
	Further Reading
2: Shoulder Disorders
	Osseous Anatomy
	Static Stabilisers
	Dynamic Stabilisers
	Scapula
	The Axillary Spaces
	Quadrangular Space
	Triangular Space
	Triangular Interval
	Shoulder Pathology
	The Unstable Shoulder
	Anterior Traumatic Instability
		Natural History and Recurrent Instability
		Acute Management
		Investigations
		Associated Injuries
		Non-Surgical Management
		Surgical Management
	Posterior Shoulder Instability
		Investigations
		Treatment
	Non-Traumatic Instability (Polar Type 3)
	SLAP (Superior Labrum tears Anterior to Posterior) Lesions
	The Painful Shoulder
	Glenohumeral Pain
	Avascular Necrosis
	Frozen Shoulder
		Pathophysiology
		Clinical Presentation
		Investigations
		Management
	Inflammatory Arthritis
	Osteoarthritis
	Rotator Cuff Arthropathy
		Pathogenesis
		Clinical Presentation
		Management
	Subacromial Pain
	Calcific Tendinitis
	Rotator Cuff Tendinosis
		Clinical Presentation
		Imaging
		Treatment
	Rotator Cuff Tears
		Pathology
		Clinical Presentation
		Investigation
		Muscle Changes in Cuff Tears
		Management
	Acromioclavicular Joint Osteoarthritis
	Os Acromiale
	Biceps Tendinopathy
	Scapulothoracic Pain
	Total Shoulder Replacement
	Anatomical Relationships
		Humeral Head
		Glenoid
	Component Design in Total Shoulder Replacement
		Humeral Component Design
		Glenoid Component Design
	Types of Shoulder Replacement Prostheses
		Indications
		Contraindications
		Surgical Considerations
		Glenoid Replacement in Shoulder Osteoarthritis
		Indications for Hemiarthroplasty
		Replacement of Both Shoulder and Elbow in Rheumatoid Arthritis
	Complications of Total Shoulder Replacement
		Early Complications
		Late Complications
	Periprosthetic Humeral Fractures
	Revision Total Shoulder Replacement
	Resection Arthroplasty of the Shoulder
	Shoulder Replacement in Rotator Cuff Tears
	The Reverse Shoulder Prosthesis
	Further Reading
3: Adult Pathology: Knee
	Osseous Anatomy
	Meniscal Injuries
		Classification of Meniscal Tears
		Clinical Features
		Imaging
		Management of Meniscal Tears
		Meniscal Repair
		Meniscal Replacement
		Root Tear of the Meniscus
		Ramp Lesions
		Meniscal Injuries in Children
	Meniscal Cysts
	Discoid Lateral Meniscus
		Management
	Anterior Cruciate Ligament Injuries
		Anatomy
		Function
		Mechanism of Injury
		History and Examination
		Investigations
		Management
		Principles of ACL Surgery
		Rehabilitation
		Complications
		ACL Reconstruction in Paediatric Age Group
		Double Bundle ACL Reconstruction
		Revision ACL Reconstruction
	Posterior Cruciate Ligament Injuries
		Anatomy
		Function
		Mechanism of Injury
		History and Examination
		Investigations
		Management
		Surgery for PCL Injuries
		Rehabilitation
		Complications
	The Posteromedial Corner of the Knee
	Medial Collateral Ligament
		Anatomy
		The Layers on the Medial Aspect of Knee
		History and Examination
		Imaging
		Treatment
	Lateral Collateral Ligament and Posterolateral Corner Injuries
		Anatomy
		Mechanism of Injury
		Examination
		Imaging
		Management
	Multiligament Knee Injuries
		Imaging
		Management
	Articular Cartilage Injury
		Management
	Spontaneous Osteonecrosis of the Knee (SONK)
	Osteochondritis Dissecans
		Treatment
	Patellofemoral Joint
		Clinical Assessment
		Hyperlaxity
		Imaging
		Patella Morphology Classification
		Patella Dislocation
		Assessment
		Treatment
		Recurrent Dislocation
		Reconstruction of the Medial Patellofemoral Ligament (MPFL)
		Realignment
	Trochlear Dysplasia
	Plica Syndrome
	Prepatellar Bursitis
	Shin Splints
	Iliotibial Band Syndrome
	Non-Arthroplasty Treatment for Osteoarthritis of Knee
		General Health
		Medication
		Oral Glucosamine
		Intra-Articular Steroids
		Intra-Articular Hyaluronic Acid
		Synovectomy
		Valgus Bracing
		Arthroscopic Lavage
		Microfracture, Mosaicplasty and ACI
		Osteotomy
	High Tibial Osteotomy
	Distal Femoral Osteotomy
	Pigmented Villo Nodular Synovitis
	Synovial Chondromatosis
	Baker’s Cyst
	Quadricepsplasty
	Further Reading
4: Adult Pathology: Hip
	Avascular Necrosis of Hip
		Etiology
		Classification
		Clinical Presentation
		Imaging
		Treatment
	Bone Marrow Oedema Syndrome
	Hip Dysplasia
	Periacetabular Osteotomy
	Femoro-Acetabular Impingement
	Proximal Femoral Osteotomy
	Protrusio Acetabuli
	Pigmented Villo-Nodular Synovitis of Hip
	Snapping Hip
	Hamstring Injuries
		Clinical Presentation
		Imaging
		Classification
		Treatment
	Further Reading
5: Spinal Disorders
	Spinal Anatomy
	Disc Disease
		Nomenclature for Abnormal Discs
		Clinical Features
		Imaging
		Differential Diagnosis
		Management
		Outcomes
		Lumbar Disc Replacement
	Back Pain
	Osteopenic Vertebral Collapse
	Waddell’s Inappropriate Signs
	Cervical Disc Disease
		Imaging
		Management
	Cervical Myelopathy
	Ankylosing Spondylitis
		Clinical Presentation
		Imaging
		Treatment
	Diffuse Skeletal Idiopathic Hyperostosis
	Rheumatoid Cervical Spine Disease
	Atlantoaxial Subluxation
		Atlanto Dens Interval
		Posterior Atlas and Dens Interval
		Treatment
		Basilar Invagination
		Involvement of the Lower Cervical Spine Joint
		Cervical Spine Myelopathy
	Torticollis
	Scoliosis
		Etiology
		Clinical Evaluation
		Investigations
		MRI
		Classification
		Infantile Scoliosis
		Treatment
		Juvenile Scoliosis
		Treatment
		Adolescent Scoliosis
		Probability of Progression
		Radiographs
		Assessment of Skeletal Maturity
		Curve Measurement
		Curve Patterns
		Curve Types
		Treatment
		Outcomes
	Congenital Scoliosis
		Examination
		Imaging
		Natural History
		Treatment
		Neuromuscular Scoliosis
		Postural Scoliosis
	Scheuermann’s Disease
		Etiology
		Incidence
		Natural History
		Treatment
	Spinal Stenosis
		Classification
		Pathology
		Clinical Features
		Imaging
		Treatment
	Spine Infections
	Pyogenic Osteomyelitis of the Spine
		Risk Factors
		Infective Organisms
		Clinical Features
		Differential Diagnosis
		Imaging
		Management
	Granulomatous Osteomyelitis
		Pathology
		Diagnosis
		Treatment
	Spondylolisthesis
		Classification
		Radiologic Measurement
		Investigations
		Non-surgical Treatment
			Isthmic
		Dysplastic
		Management
			Non-surgical Treatment
		Surgical Treatment
	Further Reading
6: Foot and Ankle
	Hallux Rigidus
		Incidence
		Aetiology
		Radiological Findings
		Classification
		Conservative Treatment
		Surgical Treatment
			Cheilectomy
		Cheilectomy + Dorsiflexion Osteotomy of the Metatarsal
		Cheilectomy + Proximal Phalanx Osteotomy
		Arthrodesis
		Replacement Arthroplasty
		Interposition Arthroplasty
		Keller’s Resection Arthroplasty
	Hallux Varus
	Hallux Valgus
		Aetiology
		Classification
		Assessment
		Management
		Osteotomy
		Fusion Procedures
	Lesser Toe Disorders
		Deformities
		Claw Toes
		MTPJ Correction
		Hammer Toes
		Mallet Toes
		Crossover Toe
	Metatarsalgia
		Primary Metatarsalgia
		Secondary Metatarsalgia
	MTP Joint Synovitis and Instability
		Overload and Plantar Keratosis
	Morton’s Neuroma
		Diagnosis
		Management
		Surgery for Morton’s Neuroma
	Freiberg’s Disease
	Bunionette (Tailor’s Bunion)
	Rheumatoid Foot
		Nonoperative Management
		Surgical Management
	Flat Foot
		Subtalar Fusion
		Radiographic Analysis
		Management
	Posterior Tibial Tendon Dysfunction
		Diagnosis
	Classification
		Management
			Flexible Deformity
		Fixed Deformity
	Diabetic Foot
		Diabetic Ulceration
		Examination
		Ulcer Classification
		Medical Management
		Surgical Management
	Charcot Arthropathy
		Classification
		Stage 1: Fragmentation or Destruction Stage
		Stage 2: Coalescence
		Stage 3: Resolution/Consolidation
		Radiographs
		Brodsky Classification
		Management
	Plantar Heel Pain
	Plantar Fasciitis
	Calcaneal Stress Fracture
	Posterior Heel Pain
	Paratenonitis
	Non-insertional Achilles Tendinosis
	Insertional Achilles Tendonitis
	Retrocalcaneal bursitis and Haglund’s Deformity
	Pes Cavus
	Charcot–Marie–Tooth Disease (Hereditary Sensory Motor Neuropathy)
		Type 1 CMTD
		Type 2 CMTD
		Cavovarus Deformity
		Management
	Ankle Arthritis
		Investigation
		Management
		Arthroscopic Debridement
		Arthrodesis
		Arthroscopic Arthrodesis
		Ankle Replacement
		Distraction Arthroplasty
		Osteotomy of the Distal Tibia
	Ankle Instability
		Investigation
		Management
	Osteochondral Lesion of the Ankle
		Classification
		History and Examination
		Investigation
		Management
		Outcomes of Surgery
	Lower-Limb Amputations
		Syme’s Amputation
		Boyd-Pirogoff Amputation
		Lisfranc Amputation
		Chopart Amputation
		Transmetatarsal Amputation
		Toe and Ray Amputations
	Ankle and Foot Orthotics (AFO)
		Foot and Ankle Prosthesis
	Further Reading
7: Hand
	Extensor Tendon Injury
		Diagnostic Pitfalls
	Extensor Tendon Repair
		Post-Operative
	Management of Closed Tendon Avulsions
		Mallet Finger (Zone 1)
		Boutonniere Deformity (Zone III)
		Treatment
	Fight Bite Injuries
	Extensor Pollicis Longus (EPL) Rupture
	Flexor Tendon Injuries
		Flexor Tendon Nutrition
		Flexor Tendon Healing
		Biomechanics
		Zones of Injury
		Clinical Features
		Principles of Flexor Tendon Repair
		Wound Extension
		Retrieval of Tendon Ends
		Suture Methods for Repair
		Repair
		Avulsion of the Flexor Digitorum Profundus Tendon: Zone 1 Injury
		Zone II–V Repair
	Postoperative Management
		Complications
	Finger Tip Injuries
		Digital-Tip Amputations with Skin or Pulp Loss Only
		Digital-Tip Amputations with Exposed Bone
		Skin Flaps
	Complications
	Structure of the Nail
	Nail Bed Injury
	Hand Infections
		Paronychia (Infection of the Nail Fold)
		Felon (Infection of the Distal Phalanx Pulp)
		Collar Stud Abscess
		Deep Fascial Space Infections
	Flexor Sheath Infection
		Diagnosis
		Treatment
	Septic Arthritis of the Interphalangeal or Metacarpophalangeal Joints
		Diagnosis
		Treatment
	Carpal Tunnel Syndrome
		Anatomy
		Symptoms
		Signs
		Nerve Conduction Studies
		Differential Diagnosis
		Non-operative Treatment
		Operative Treatment
		Open Release Technique
	Chronic Wrist Pain
	Ganglion
	Carpal Instability
		Scapholunate Ligament Instability
	Kienbock’s Disease
		Clinical Features
		Imaging
		Treatment
	Congenital Anomalies of the Hand and Upper Limb
	Radial Hemimelia
	Ulnar Hemimelia
	Madelung Deformity
	Cleft Hand
	Syndactyly
	Polydactyly
	Duplication of the Thumb
	Hypoplasia of the Thumb
	Clinodactyly
	Camptodactyly
	Macrodactyly
	Congenital Trigger Thumb
	Dupuytren’s Contracture
		Pathology
		Etiology
		Anatomy
		Clinical Features
		Conservative Treatment
		Needle Fasciotomy
		Surgical Treatment
			Standard Limited Fasciectomy
		Dermofasciectomy
		Segmental Fasciectomy
		Skin Defects
		Joint Contractures
		Complications
		Postoperative Rehabilitation
		Recurrence
	Hand Osteoarthritis
	Distal Interphalangeal Joint Arthritis
		Clinical Features
		Treatment
	Proximal Interphalangeal Joint Arthritis
		Clinical Features
		Treatment
	Metacarpophalangeal Joint Arthritis
	Trapeziometacarpal Joint Arthritis
		Clinical Features
		Differential Diagnosis
		Imaging
		Staging
		Treatment
		Trapeziectomy
	Wrist Osteoarthritis
		Scaphotrapeziotrapezoid Arthritis
	Radiocarpal Arthritis
	Scapholunate/Scaphoid Non-union Advanced Collapse
	Rheumatoid Hand
		Pathology
		Principles of Surgery
		Extensor Tendons
		Differentiation Between Rupture and Subluxation
		Rupture Versus Palsy
		Flexor Tendons
		Wrist
	Metacarpophalangeal Joint
		Interphalangeal Joint
			Swan-Neck Deformity
		Boutonniere Deformity
		Thumb
	Tendon transfers for Peripheral Nerve Dysfunction
	Low Median Nerve Palsy
		Problem
		Treatment
	High Median Nerve Palsy
		Treatment
	Low Ulnar Nerve Palsy
		Treatment
	High Ulnar Nerve Palsy
		Problem
		Treatment
	Radial Nerve Palsy
		Complications
		Procedures for the Paralytic Hand
	Replantation
		Indications
		Management
	Reattachment
	Post- Replantation
	Hand Transplants
		References
		de Quervain’s Disease
		Clinical Features
		Treatment
	Further Reading
8: Bone and Soft Tissue Tumours
	Assessment of Tumours
	Biopsy and Staging of Tumours
		Indications for Biopsy
		Types of Biopsy
		Surgical Technique for Open Biopsy
		Incision
		Biopsy
		Closure
	Staging of Malignant Bone Tumours
	Classification of Benign Tumours
	A. Benign Cartilaginous Tumours
		Osteochondroma (Exostosis)
			Etiology
			Clinical Features
			Imaging
			Management
		Chondromata
			Enchondroma
			Periosteal Chondroma
			Multiple Chondromata
			Management of Chondromata
		Chondroblastoma
			Clinical Features
			Imaging
			Pathology
			Management
		Chondromyxoid Fibroma (CMF)
			Clinical Features
			Imaging
			Pathology
			Management
	B. Benign Osteoblastic Tumours
		Osteoid Osteoma
			Clinical Features
			Imaging
			Pathology
			Management
		Osteoblastoma
			Clinical Features
			Imaging
			Pathology
			Management
	C. Benign Cystic Lesions
		Unicameral (Simple) Bone Cyst
			Clinical Features
			Imaging
			Pathology
			Management
		Aneurysmal Bone Cyst (ABC)
			Clinical Features
			Imaging
			Pathology
			Differential Diagnosis
			Management
	D. Benign Locally Aggressive Tumours
		Giant Cell Tumour (Osteoclastoma)
			Clinical Features
			Imaging
			Pathology
			Histology
			Differential Diagnosis
			Grading
			Benign GCT
			Recurrent GCT
			Malignant GCT
	E. Malignant Primary Bone Tumours
		Osteosarcoma
			Epidemiology
			Clinical Features
			Imaging
			Pathology
			Laboratory Studies
			Types of Osteosarcomas
			Management
			Chemotherapy
			Prognostic Indicators
		Ewing’s Sarcoma
			Etiology
			Clinical Features
			Laboratory Studies
			Imaging
			Histology
			Management
			Prognostic Indicators
		Chondrosarcoma
			Clinical Features
			Imaging
			Classification
			Management
	F. Soft Tissue Sarcomas
		Incidence
		Clinical Features
		Pathology
		Pathogenesis
		Post-irradiation Sarcoma
		Management
	G. Skeletal Metastasis
		Metastasis Sites
		Tumours Metastasising to Bone
		Pathology
		Clinical Features
		Evaluation
			Radiographs (Whole of Involved Bone and Chest)
			Cross Sectional Imaging
			Isotope Bone Scan
			Magnetic Resonance Imaging
			PET-CT (Positron Emission Tomography—Computed Tomography)
			Blood Tests
		Needle Biopsy ± Imaging Guidance
		Indications for Biopsy
		Preparation for Surgery
		Prediction of Fracture Possibility
		Prognosis
		Clinical Evaluation of the Unknown Primary Tumour
	Non-Surgical Treatment of Bone Metastasis
		Radiotherapy
		Endocrine Therapy
		Radioisotopes
		Management of Bone Pain
		Treatment of Hypercalcemia
	Surgical Treatment of Bone Metastasis
		Pelvic Metastasis
		Femoral Neck Pathologic Fracture
		Peritrochanteric Fractures
		Subtrochanteric Fractures
		Proximal Humerus Metastasis
		Humerus Diaphysis
		Distal Humerus Metastasis
		Spinal Metastasis
	Further Reading
9: Infections
	Acute Osteomyelitis
		Incidence
		Pathogenesis
		Clinical Features
		Investigations
			Blood Tests
			Imaging
		Bone Marrow Aspiration
		Treatment
	Brodie’s Abscess
	Chronic Osteomyelitis
		Investigations
		Treatment
	Septic Arthritis
		Clinical Features
		Blood Parameters
		Imaging
		Aspiration
		Treatment
	Alpha Defensin
	Osteoarticular Tuberculosis
		Clinical Features
		Investigations
		Treatment
	Prevention of Surgical Site Infections
	Prophylactic Perioperative Antibiotics
	Further Reading
10: Non-Union
	Non-union
		Causes
		Types of Non-union
		Diagnosis
		Management
	Management of Tibial Delayed Union and Non-union
		Intramedullary Nailing
		Bone Grafting
		Compression Plate
		External Fixator
		Electrical Stimulation
		Ultrasound
		Bone Morphogenetic Protein
	Management of Bone Loss
	Further Reading
11: Inflammatory Joint Disorders
	Rheumatoid Arthritis
		Clinical Features
		Other Presentations
		Pathogenesis
		Investigations
		Imaging
		Management
	Spondyloarthritis
		Epidemiology
	Ankylosing Spondylitis
		Clinical Features
		Investigations
		Imaging
		Bone Density Scan (DXA)
		Assessment of Disease Activity
		Management
		Drugs Approved for Axial SpA in the UK
		Surgical Treatment
	Psoriatic Arthritis
		Moll and Wright Classification of PsA
		Classification Criteria for PsA (CASPAR)
		Laboratory Investigations
		Imaging
		Management
			Biological and Other Drugs
	Inflammatory Bowel Disease-Associated Spondyloarthritis
	Reactive Arthritis
		Management
	Undifferentiated Spondyloarthritis
	Juvenile Idiopathic Arthritis (JIA)
		Laboratory Investigations
		Imaging
		Management
		Pharmacotherapy
		Surgical Intervention
	Connective Tissue Diseases
	Sjögren’s Syndrome
	Systemic Lupus Erythematosus (SLE, Lupus)
	Scleroderma
	Gout
		Pathophysiology of Gout
		Advances in Pathophysiology of Gout
		Clinical Features
		Laboratory Investigations
		Management
		Acute Gout
		Newer Agents
		Management of Hyperuricaemia
		Xanthine Oxidase (XO) Inhibitors
		Febuxostat
		Uricosuric Agents
			Pegloticase (Uricase)
	Calcium Pyrophosphate Deposition Disease (Pseudogout)
	Further Reading
12: Arthrodesis and Amputation
	Hip Arthrodesis
	Knee Arthrodesis
		External Fixators
		Compression Plates
		Intramedullary Nails
	Ankle Arthrodesis
	Shoulder Arthrodesis
	Elbow Arthrodesis
	Wrist Arthrodesis
	Amputation
	Patient Assessment
	Surgical Technique
	Complications
	Prosthetics
	Further Reading
13: Paediatric Disorders
	Legg–Calvé–Perthes Disease
		Epidemiology
		Aetiology
	Pathogenesis
		Pathology
		Natural History
		Clinical Features
		Differential Diagnosis
		Imaging
		Classification
		Femoral Head ‘At-Risk’ Signs
		Prognostic Factors
		Management
		Bracing
		Adductor Tenotomy and Petrie Cast
		Surgical Containment
		Late Sequelae
	Developmental Dysplasia of the Hip
		Epidemiology
		Aetiology
		Pathology
		Natural History
		Screening
		Clinical Features
		Imaging
			X-ray
			Ultrasound
			Arthrography
			Computed Tomography Scan
			Magnetic Resonance Imaging
		Management
			Closed Reduction with a Pavlik Harness
			Closed Reduction in Traction
			Closed Reduction with Hip Arthrography
			Open Reduction
			Femoral Shortening
			Pelvic Osteotomy
		Salvage Procedures
		Complications
	Clinical Decision Scenarios
		Scenario 1
		Scenario 2
		Scenario 3
		Scenario 4
		Scenario 5
		Scenario 6
		Scenario 7
		Scenario 8
		Scenario 9
		Scenario 10
	Slipped Upper Femoral Epiphysis
		Epidemiology
		Aetiology
		Pathophysiology
		Clinical Features
		Imaging
		Grading of Slip Severity
		Management
		Reconstructive Osteotomies
		Management of the Contralateral Hip
		Long Term Outcomes
		Complications
	Congenital Pseudarthrosis of the Tibia
		Epidemiology
		Clinical Features
		Differential Diagnosis
		Classification
		Management
			Prior to Fracture
			Post Fracture
	Congenital Posteromedial Bow of the Tibia
		Aetiology
		Clinical Features
		Differential Diagnosis
		Imaging
		Management
	Blount’s Disease
		Clinical Features
		Differential Diagnosis
		Imaging
		Classification
		Management
	Internal Torsion of the Tibia or Femur
		Clinical Features
		Imaging
		Management
	Fibular Hemimelia
		Associated Conditions
		Imaging
		Management
	Genu Varum and Valgum
	Congenital Knee Dislocation
	Congenital Patellar Dislocation
	Bipartite Patella
	Thrombocytopenia with Absent Radius (TAR) Syndrome
	Nail Patella Syndrome
	Larsen Syndrome
	Osgood–Schlatter Disease
	Sinding–Larsen–Johansson Disease
	Baker’s Cyst
	Congenital Radial Head Dislocation
	Metatarsus Adductus
		Differential Diagnosis
		Management
	Clubfoot
		Aetiology
			Genetics
			Histologic
			Vascular
			Anomalous Muscles
			Intrauterine Factors
		Pathoanatomy
		Examination
		Prenatal Diagnosis
		Differential Diagnosis
		Associated Conditions
		Imaging
			AP Radiograph
			Lateral Radiograph
		Classification
		Management
		Other Non-operative Measures
		Operative Management
			Timing
			Incisions
			Medial Release
			Posterior Release
			Intraoperative Assessment
			Closure
			Postoperative Management
			Recurrence
			Residual Forefoot Adduction
			Management of Other Residual Deformities
	Tarsal Coalition
		Epidemiology
		Pathology
		Clinical Features
		Examination
		Imaging
		Management
	Cavus Foot
		Causes
		Symptoms
		Examination
		Management
	Accessory Navicular
	Congenital Vertical Talus
		Clinical Features
		Differential Diagnosis
		Imaging
		Management
	Sever’s Disease
	Polydactyly
	Macrodactyly
	Curly Toes
	Torticollis
	Klippel–Feil Syndrome
	Sprengel’s Shoulder
	Congenital Pseudarthrosis of the Clavicle
	Congenital Dislocation of the Radial Head
	Congenital Pseudarthrosis of the Radius and Ulna
	Congenital Radioulnar Synostosis
	Madelung Deformity
	Osteogenesis Imperfecta
		Epidemiology
		Pathogenesis
		Clinical Features
		Antenatal Diagnosis
		Classification
		Management
	Leg-Length Discrepancy
		Causes
		Assessment
			Standing
			Sitting
			Supine
		Imaging
		Prediction of Leg-Length Discrepancy
		Management
		Epiphyseodesis
		Acute Shortening of the Femur
		Lengthening
		Physeal Bar Resection
		Amputation or Rotationplasty
		Lengthening for Short Stature
	Proximal Femoral Focal Deficiency
		Classification
		Management
	The Limping Child
	Cerebral Palsy
		Incidence
		Aetiology
		Neuropathology
		Neurological Classification
			Spastic
			Ataxia
			Athetoid/Dyskinetic
			Hypotonia
			Mixed
		Gross Motor Function Classification System
		Specific Gait Abnormalities in Cerebral Palsy
		Examination
			General Inspection
			Gait
			Spine
			Upper Limbs
			Lower Limbs
			Foot and Ankle
		Management Principles
		Management of Spasticity
		Management of Orthopaedic Problems
			Spine
			Shoulder
			Elbow
			Wrist
			Hand
			Hip
			Knee
			Ankle
			Foot
	Dwarfism
	Further Reading
14: Hip and Knee Replacement
	Total Hip Replacement
		Indications for Hip Replacement
		Contraindications to Total Hip Replacement
		Surgical approach for Hip Replacement
		Preoperative Assessment and Investigations
		Informed Consent
	Cemented Femoral Component Design
		Offset
		Cementing Techniques
		Surface Finish
		Fixation
		Collar
		Centralisers
		Grades of Femoral Cementing
	Cemented Acetabular Component Design
	Cementless Femoral Component Design
	Cementless Acetabular Component Design
		Effect of Head Size
		Trunnion Problems
		Stability in Hip Arthroplasty
	Complications in Total Hip Arthroplasty
		Infection
			Prevention
			Diagnosis
			Investigations
			Treatment
		Dislocation of Hip
			Management of a First Time Dislocation of Hip Replacement
			Management of Recurrent Hip Dislocation
		Venous Thromboembolism
		Heterotopic Ossification
		Leg Length Discrepancy
		Fracture of Femur
		Trochanteric Non-union
		Failure of Components
		Limp
		Nerve or Vessel Injury
		Aseptic Loosening of the Prosthesis
		Modes of Failure of Femoral Component
		Wear of Bearing Surface
			Modes of Wear
			Quantification of Wear
	Choice of Bearing Surface
	Low-Friction Arthroplasty
	Osteolysis
		Clinical Presentation
		Radiological Assessment
	Other Causes of Bone Loss/Radiolucency Around Femoral Implants
	Management of Osteolysis
	Metal on Metal Hip Arthroplasty
	Resurfacing Hip Arthroplasty
		Advantages
		Indications for Hip Resurfacing
		Contraindications for Hip Resurfacing
		Causes of Failure of Hip Resurfacing
		Surveillance of Metal on Metal Bearings
		Failure of the ASR
	Results of Hip Arthroplasty
		Charnley Hip
		Exeter Hip
		Hydroxyapatite-Coated Hip Arthroplasty
	Minimally Invasive/Two-Incision Hip Arthroplasty
	Antibiotic Cover for Dental Procedures After Hip Arthroplasty
	Activity Level After Hip Arthroplasty
	Hip Replacement in Patients Under 50–55 Years of Age
	Total Hip Replacement in Morbidly Obese
	Hip Replacement in Rheumatoid Arthritis
	Hip Replacement in Ankylosing Spondylitis
	Hip Replacement for Femoral Neck Fractures
	Periprosthetic Fractures
	Acetabular Periprosthetic Fractures
	Revision Hip Arthroplasty
		Assessment of Patients for Revision Arthroplasty
		Preparing for Revision Surgery
	Bone Defects
		Classification of Femoral Bone Defects
		Management of Femoral Bone Defects
		Classification of Acetabular Bone Defects
		Management of Acetabular Bone Defects
	Total Knee Replacement
	Patient Assessment
		History
		Examination
		X-Rays
		Contraindications to Knee Arthroplasty
	Surgical Approach for Total Knee Arthroplasty
	Femoral Components: Design and Materials
	Tibial Components
	Patellar Component
	Mobile Bearing Knees
	Posterior Cruciate Ligament in Knee Replacements
		Checking for PCL Tension
	Hinged Knee Replacement
	Cemented/Cementless Technique
	Coronal Alignment in Knee Replacement
	Flexion and Extension Gaps
	Balancing and Sizing of Components
	The Varus Knee
	The Valgus Knee
	Dealing with Extraarticular Deformity
	Range of Motion After Total Knee Replacement
	Stiffness After Total Knee Replacement
	Total Knee Replacement in Presence of Fixed Flexion Deformity
	Total Knee Replacement After Failed High Tibial Osteotomy
	Knee Replacement in Special Situations
	Complications in Knee Arthroplasty
		Infection
			Clinical Features
			Diagnosis
			Treatment
		Wound Problems
		Patellofemoral Problems
		Venous Thromboembolism
		Periprosthetic Fracture
		Vascular Injury
		Nerve Injury
		Stiffness
		Instability After Total Knee Replacement
		Loosening and Wear
	Instability After Total Knee Replacement
		Flexion Instability
		Varus Valgus Instability
		Global Instability
	Long Term Results of Total Knee Replacement
	Unicompartmental Knee Replacement
		Results
		Combined ACL Reconstruction and Unicompartmental Knee Replacement
		Survival of Unicompartmental Replacements
	Patellofemoral Replacement
		Results
	Bilateral Knee Replacement
	Computer-Aided Knee Replacement
	Gender Specific Knee Replacement
	High Flex Knees
	Revision Knee Arthroplasty
		Preoperative Assessment
		Reconstruction Sequence in Revision Knee Surgery
		Bone Defects in Revision Total Knee Arthroplasty
		Management of Bone Defects
		Stemmed Implants
		The Use of Constrained Implants
	Further Reading
15: Nerve Injuries and Neuromuscular Disorders
	Nerve Injury
	Nerve Degeneration and Regeneration
	Classification of Nerve Injuries
	Evaluation of Nerve Injury
	Nerve Recovery
	Investigations
		Electromyography
		Nerve Conduction Studies
		Somatosensory Evoked Potential
	Management of Nerve Injuries
	Nerve Repair
	Results of Nerve Repair
	Neuroma-in-Continuity
	Complex Regional Pain Syndrome
	Entrapment Neuropathies
		Pronator Teres Syndrome
		Anterior Interosseous Nerve syndrome
		Cubital Tunnel Syndrome
		Ulnar Tunnel Syndrome
	Radial Nerve Palsy
		Posterior Interosseous Nerve Compression Syndrome
		Radial Tunnel Syndrome
		Wartenberg Syndrome
	Brachial Plexus Injury
		Classification
		Evaluation
		Specific Injury Patterns
		Imaging
		Treatment
	Neuromuscular Disorders
	Duchenne Muscular Dystrophy
		Treatment
	Becker’s Muscular Dystrophy
	Emery–Dreifuss Muscular Dystrophy
	Facioscapulohumeral Muscular Dystrophy
	Myotonic Dystrophy
	Charcot–Marie–Tooth Disease
		Variants of Charcot–Marie–Tooth Disease
	Spinal Muscle Atrophy
	Friedrich’s Ataxia
	Further Reading
16: Imaging
	Plain Films
	Computed Tomography
	Magnetic Resonance Imaging
		T1 Sequence
		T2 Sequence
		Proton Density Sequence
		Fast-Spin Echo Sequence
		STIR Sequence
		T2* (Gradient-Echo T2)
		Fast-Spin Echo
		Gadolinium-Enhanced Scans
		MR Arthrography
		Whole-Body MRI
		Contraindications to MRI
		Common Applications
	Ultrasound
		Common Applications
	Radioisotope Bone Scan
	SPECT and SPECT/CT
		Common Applications
	Positron Emission Tomography
17: Clinical Examination
	Shoulder Assessment
		History
		Examination
			Inspection
			Palpation
			Range of Motion
			Assessment of the Rotator Cuff
			Subacromial Impingement
			Assessment of the Acromioclavicular Joint
			Testing for Instability
			Assessment of the Biceps
			Tests for Anterior and Posterior Instability
	Elbow Assessment
		History
		Examination
			Inspection
			Palpation
			Movements
	Wrist Assessment
		History
		Examination
			Inspection
			Palpation
			Movements
	Hand Assessment
		History
		Examination
			Inspection and Palpation
			Movements
			Extrinsic Muscles
			Intrinsic Muscles
			Thumb
	Spine Assessment
		History
		Examination in Standing
			Palpation
			Movement
			Neurological Examination
	Hip Assessment
		History
		Examination
			Inspection
			Examination in Supine Position
	Knee Assessment
		History
		Examination
			Inspection in Supine Position
	Foot and Ankle Assessment
		History
		Examination
			Examination in a Standing Position
			Examination in a Sitting Position
			Lateral (from Distal to Proximal)
			Medial (from Proximal to Distal)
			Inversion
			Midfoot Movements
			Forefoot Movements (Metatarsophalangeal and Interphalangeal Joints)
18: Surgical Approaches
	Shoulder: Deltopectoral Approach
		Indications
		Position of Patient
		Incision
		Plane
		Extension
		Structures at Risk
	Shoulder: Anterosuperior Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Shoulder: Lateral Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Shoulder: Posterior Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Humerus: Anterior Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Humerus: Posterior Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Lateral Approach to the Distal Humerus
		Indication
		Position of Patient
		Incision
		Plane
		Structure at Risk
	Elbow: Posterior Approach—Transolecranon
		Indication
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Elbow: Medial Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Elbow: Posterolateral Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Forearm: Anterior Approach for Radius
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Posterior Approach to the Radius
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Approach to the Ulna
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Dorsal Approach to the Wrist
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Volar Approach to the Wrist
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Volar Approach to the Scaphoid
		Indication
		Position of Patient
		Incision
		Plane
		Structure at Risk
	Dorsal Approach to the Scaphoid
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Pelvis: Ilioinguinal Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Hip: Anterior (Iliofemoral or Smith–Petersen) Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Hip: Anterolateral (Watson–Jones) Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Hip: Direct Lateral (Hardinge) Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Hip: Posterior (Moore or Southern) Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Trochanteric Slide
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Trochanteric Osteotomy (Charnley)
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Extended Trochanteric Osteotomy
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Minimally Invasive Hip Replacement
	Two-Incision Hip Replacement
	Direct Anterior Approach (DAA) Hip Replacement
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Knee: Medial Parapatellar Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Knee: Posterior Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Knee: Medial Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Knee: Lateral Approach
		Indication
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Tibia: Posterolateral Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Ankle: Anterior Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Ankle: Posteromedial Approach
		Indication
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Ankle: Posterolateral Approach
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Lateral Approach for Triple Arthrodesis
		Indications
		Position of Patient
		Incision
		Plane
		Structures at Risk
	Further Reading
Index