Information is provided from the basic and clinical sciences on the mechanisms damaging the brain from trauma or ischemia. New aspects involve the endoplasmic reticulum, mitochondrial failure, pathobiology of axonal injury, molecular signals activating glial elements, or the emerging therapeutical role of neurotrophins. Experimental issues involve a better analysis of the ischemic penumbra, the salvagable tissue. Therapeutic contributions reach from the environmental influence to gene expression, including neuroprotection, such as hibernation - mother nature's experiment - or hypothermia which is reported to induce cell swelling. Treatment issues deal also with thrombolysis and combination therapies, or with the clearance of adverse blood components - LDL/fibrinogen - by a novel procedure using heparin. Other highlights are discussing the specificities of pediatric vs. adult brain trauma, or the evolving role of the Apolipoprotein-E e4 gene in severe head injury. An update is also provided on an online assessment of the patient management during the pre- and early hospital phase in Southern Bavaria. The empirical observation of neuroworsening is analyzed in further details, whether this is a specificity autonomously driving the posttraumatic course. Finally, the unsolved question why drug trials in severe head injury have failed so far in view of the promising evidence from the laboratory is subjected to an expert analysis.

Severe spondylolisthesis/spondyloptosis is still a controversial issue in spine surgery. This book takes an interdisciplinary approach and discusses the state of the art and defines therapeutic strategies. The contributing authors are well-known specialists in the field.

Paris October 10th, 1929 - Kyoto October 15th - 20th, 1978

In this updated edition of the German-language title "Neue Techniken - Kniechirugie", Professor Paessler, an experienced knee surgeon, provides a state-of-the-art survey of the field. In doing so he describes, among other techniques, how to reconstruct the anterior cruciate ligament (ACL), perform ACL revision surgery, manage a recent posterior cruciate ligament tear, treat cartilage lesions with microfracturing, reattach/replace detached cartilage fragment, perform a dome high tibial osteotomy. Professor Paessler is author of more than 150 publications (books and journals) and editor-in-chief of the "European Journal of Sports Traumatology and Related Research". An important resource for all trauma and orthopaedic surgeons and trainees.

"When a thing ceases to be a subject of controversy, it ceases to be a subject of interest. " WILLIAM HAZLITT (1778-1830) This is the fourth volume in a series which we started in 1997. In 1976, Varco and Delaney edited a "surgical bestseller" entitled Controversy in Surgery. This was fol lowed by a second volume in 1985. The immense success of these books among both surgical trainees and experienced surgeons, and their wide international ap peal, supported the editors' notion that a view of controversy is integral to teach ing. However, despite major advances in surgical science and practice, no other similar publication has since been put together with the objective of addressing major controversies in surgery. The aim of this series is to address such deficiency by covering the most crucial current controversies in general, vascular and trauma surgery. Since almost everything is controversial in surgery, we will be able to tackle different issues almost each year. The editors have selected a nationally/internationally recognized authority for each topic. Most books available today are either "North American: ' "British-Com monwealth" or "British-European: ' contributing to the constant transatlantic rival ry. Our series specifically aims to bridge this "culture gap" and includes North American, British, European, and other authors while maintaining a cohesive structure. This will hopefully also broaden the appeal of such a book across both sides of the Atlantic and beyond."

Rodney E. Slater Secretary of Transportation, U. S. Department of Transportation know many of you have traveled great distances to be here. I To me, that shows not only your dedication to the cause, but demonstrates how very important transportation safety is becoming throughout the world. So I am very thankful to the main organizers of this third annual conference -- all of whom are from Sweden: Dr. Hans von Holst of the Royal Institute of Technology; Dr. Ake Nygren of the Karolinska Institute; Dr. Ake E. Andersson of the Institute for Futures Studies; and finally, Dr. Arne Witt16v and Lars Anell from AB Volvo. And let me give a special welcome to our friends from Africa. I will be visiting a number of African nations in January. And while my main mission is to promote trade and investment with the United States, we will be talking about safety, too. Airline safety, for example, is a big concern, as Africa grows and prospers and the demand for air travel expands. We discussed it during recent meetings of the International Civil Aviation Organization in Montreal several weeks ago. And we will do so again during my trip. plan to talk about how my department can help the Also, we many nations of Africa improve highway safety. Africa relies heavily on road transportation. But highway fatalities are very high. And the economic costs are very steep, especially for Africa's fragile, emerging v market economies.

Professor B.G. WEBER has once again and in a very timely fashion produced a superb book on an orthopaedic subject of great importance. "The Extemal Fixator" is the most comprehensive text on the subject in orthopaedic literature to date. Professor WEBER thoroughly discusses extemal fixation with c1arity, organization, profuse illustrations and roentgenograms. Professor WEBER acknowledges that the use of extemal fixation in orthopaedic surgery is not newand traces its history over the years. He points out c1early the fact that though at various times the "method" has experienced periods of disrepute, modem sophistication, improved technology and a better understanding of its philosophy have given the system a newand perhaps permanent place in the armamentarium of the orthopaedic surgeon. All methods of treatment have critics as well as supporters, and not infrequently the strongest criticisms are the result of poor understanding of the philosophy proposed and its proper implementation. Professor WEBER, in his carefully detailed and well illustrated book, has made it abundantly c1ear that the use of extemal fixators in the treatment of fractures must be c1early understood by the orthopaedic surgeon in order to obtain satisfactory clinical results. His discussion of its philosophy, pathomechanics and technology are most comprehensive and leave "no stone untumed" and because of this the book represents a most comprehensive text on the subject.

Professor Philip Bromage From the earliest stirrings of modern surgical anesthesia, novice surgeons struggling to learn from the living what there was a strong intuitive feeling that anesthesia of part they were denied an opportunity to learn from the dead_ of the body would be better for the patient than complete But that is largely nostalgia for a past era_ Today, the visual anesthesia of the whole organism. In 1848, James Young arts and the plastics industry have united to give us superb Simpson spent some time and effort seeking this elusive teaching models and techniques that did not exist a few goal, but after a few ingenious though unsuccessful experi decades ago, and they have developed two- and three ments, he gave up the search and turned back to general dimensional surrogate cadavers that are imbued with a anesthesia as the only practical solution to surgical pain more vivid artistry than ever existed on the marble slabs relief at that time_ amid the formalin reek of our old dissecting rooms_ earl Koller's simple but brilliant application of cocaine to This book is a fresh and highly successful attempt to repair some of the bridges that were burnt with the passing of the the eye in 1884 opened the door to a whole new universe of neural anatomy and pharmacology_ Within a decade or old anatomy days_ Together, the authors have contributed"

During their 20 years of activity members of the Associa tion for the Study of Internal Fixation (AO - ASIF) have made authoritative contributions to the development of internal and external fixation. The close collaboration of surgeons, basic researchers, metallurgists, engineers and the establishment of clinical documentation has made it possible to achieve a solid scientific basis for internal fixa tion. Clear definitions for the standardization of different types of osteosynthesis were possible: interfragmentary compression, splintage and buttressing as well as combina tions of these three techniques. At the same time a scienti fic and workmanlike instrumentation was developed. The idea was to keep diversification within limits but, however, to assemble a comprehensive collection of implants and in struments to answer all the problems presented by the com plexity of bone operations. Osteosynthesis is a difficult and demanding operative method. Its. claims on the surgeon and the theatre staff are high. Therefore plans have existed for a long time to supplement the "Manual of Internal Fixation" with a de tailed description of the AO Instrumentation, its use and maintenance. Our collaborator FRIDOLIN SEQUIN, graduate engineer, has accomplished this task with expert knowledge. He has organized over many years courses for theatre nurses and has been able from the resulting experience to provide helpful suggestions. When RIGMOR TEXHAMMAR R. N. joined AO-International four years ago, it was natural to include her as a co-author."

Surgeons confronted with acute trauma are frequently under great pressure to act quickly. Only a few have an infallible three-dimensional memory as regards the different approaches necessary for treating fractures by inter nal fixation. Thus there is a real need for a reference book on the approaches to the shoulder, arm, pelvis, and leg which is instructive and based on clinical practice. This is true both for the emergency situation and for the "evening before" with the imperative preoperative planning. THOMAS RUEDI, himself a surgeon as well as a gifted illustrator, in coopera tion with ARTHUR VON HOCHSTETTER, a clinical anatomist, and excellently interpreted by the artist ROBERT SCHLUMPF, has created a novel and impres sive atlas. The surgical approaches are depicted in a manner which is ana tomically correct, limited to the essentials, and realistic. In addition, the attractive, black-and-white illustrations of the anatomy are successfully sup plemented by color schematic drawings. This luxuriously prepared edition may become a daily advisor to surgeons dealing with trauma. It deserves a widespread distribution in surgical depart ments and reference libraries.

The German edition of our book entitled "Operative Frakturen behandlung" by M. E. MUELLER, M. ALLGOEWER and H. WILLENEGGER (Springer, Berlin . Goettingen . Heidelberg, 1963) has been out of print now for more than three years. We are planning a new edition which will deal with the collective experience of 14,000 new cases, all treated by internal fixation, and will include the newest developments in the field of internal fixa tion. However, it will be some time before this new edition can be published. Increasing demands for a description of the AO technique of internal fixation has stimulated us to publish this manual. In it we shall describe in a comprehensive but somewhat apodictic mann er the principles and techniques of the AO methods of fracture treatment and reconstructive surgery, which in our hands, have stood the test of time. The book is written in a somewhat abbreviated style. It cor responds in subject matter to the teaching given at the AO courses in Davos, but deals with each subject more thoroughly. We have dispensed with pictures of the instruments, as these may be found in the Synthes Catalogue *. This manual should be regarded as the product of collective experiencc, containing new thoughts and new discoveries from basic research. In considering the risks of mistakes and dangers, we can only reiterate what we have already stated in "Technique of Internal Fixation of Fractures": "Open treatment of fractures is a valuable but difficult method which involves much responsibility.

It is to the great and lasting credit of LORENZ BOHLER and his school that they have in the last decade developed and demonstrated so thoroughly the techniques for the conservative management of fractures. Nevertheless there have always been many, including some from BOHLER'S school, who have found considerable place for surgical management, and with the significant progress in general surgery seen in postwar years, a new stimulus has been given to this part of traumatic surgery, especially since bone injuries have become more complex and frequent. The concept of internal fixation is not new. The serious criticisms that have been levelled at it retain today their basic significance. Progress in the fields of asepsis, corrosion-free metal implants, operative experience and postoperative care has diminished the dangers but has not relieved the surgeon of responsibility. The Association for the Study of the Problems of Internal Fixation (AO) has devoted itself over a number of years to the basic principles and best methods of open treatment of fractures by means of extended clinical and scientific studies in order to determine in each individual case the most promising line of treatment. At the same time a well designed and tested instrument set has been developed with precise instructions for the appropriate techniques. As a result, the new observations about primary bone healing which have emerged from the practice of rigid internal fixation are as interesting as the uses to which they can be put in allowing early mobilization.

This extensive and well-prepared manual is the work product of Klaus and Yvette Draenert, who are deeply interested in cemented total hip arthroplasty and in partic- ular, intensely involved in related research for the past 25 years. Their damage analysis is aimed at cement fixation with the purpose to rule out any risk for the patient. They introduce the theme with a wide review of the literature on the successes and failures of the various types of total hip components. Because of the lack of standardization of the various parameters used in these studies, they do not recommend anyone spe- cial type, and on the basis of this literature study they wonder why there is such a se- arch for new types and (fixation) methods of total hip arthroplasties. Instead of these long-term follow-up studies, the authors plead to carry out syste- matic histological research on retrieved human material as was firstly started and re- T. /. /. H. Slooff commended by the late Sir John Charnley. Their investigations demonstrate that po- lymethylmethacrylate behaves biologically as an inert material that can be integrated into the bone, without a fibrous membrane interface. This could also be assessed in their animal experiments when the appropriate biomechanical conditions are pro- vided. To achieve a connective tissue free bone-cement junction it is important to pre- vent deformation in the bone structures and micromotion between the bone-cement interface.

Progress in traumatology of the vertebral spine has been restrained for a long time by two hindering factors. The first obstacle is presented by the differences in approach and a conflict of competences. The neurosurgeons, considering only the spinal chord, have confined themselves to indications for laminectomy, an insufficient and usually ineffective intervention. The orthopedic surgeons, on the other hand, obsessed by the fear of medullary lesions, have long hesitated to apply the fundamental rules for the treatment of fractures, namely precise reduction followed by strict immobilization, thus depriving themselves of the efficacy of radiculomedul lar decompression and of the protection this procedure affords to these structures when they are themselves involved in the trauma. Taking these facts into account, together with the rather poor results of laminectomy, the specialists have wisely and successfully recommended that one should abstain from treating the initial lesion, but rather attenuate the damage by appropiate nursing care and adequate reeducation. The second hindering factor was the insufficient knowledge of the extreme complexity of the anatomic lesions. This explains the orthopedists' relative caution; one only treats well what one knows well. More precise analysis of the lesions, not only of the bones but also of the joints, i. e., the osteofibrous involvement, is mainly based on strict radiologic semiology, which is rendered difficult because these structures are simultaneously affected. We are greatly indebted to Dr. DOSCH, radiologist at our Center, for having untertaken this difficult task, using all available conventional radiologic techniques."

The second common meeting of the European Section and the Cervical Spine Research Society took place in Marseille (France) from June 12 to 15, 1988 and was organized by Rene Louis. More than 130 specialists from every part of Europe, from America and Asia participated, representing, among others, the fields of Orthopedics, Neurosurgery, Traumatology, Neurology, Anatomy, Rheumatology and Radiology. This meeting again was convincing proof of the growing interest which exists in Europe in research into injuries and diseases of the cervical spine. The main topics of this meeting were the subluxation of the lower cervical spine (chapter 1) and the infectious diseases of the cervical spine (chapter 2). Chapters 3 and 4 of this volume deal with degenerative lesions and the upper cervical spine. In chapter 5 experimental reports are presented, so that a good synopsis is provided of our present state of knowledge of diseases of the cervical spine. The European Section of the Cervical Spine Research Society was founded by Mario Boni in 1984, who unfortunately died in 1986 and was proclaimed Honory President of the European Section. There is a European meeting every summer and one every three years with our colleagues from the United States of America, Canada and Japan organized in Europe. The first combined meeting was organized by Pierre Kehr in Strasbourg (France) in 1985 and the presented papers were published in Cervical Spine I (Springer, Wien-New York, 1987).

Pathological conditions affecting the hip and knee joints occupy a particular place amongst the important orthopaedic entities affect ing the extremities. On the one hand they are relatively frequent and on the other they mean for the patient limitation of his ability to walk, because of their considerable detrimental effects. A purposeful basic treatment of these joint diseases (and here osteoarthritis takes pride of place) is only possible if it stems from a reliable biomechanical analysis of the normal and pathological stressing of the joint in question. Whilst the situation in the hip can be considered to be fundamentally clarified, a comprehensive representation of the knee is still lacking, particularly when taking into account the latest knowledge of biomechanics. Recently our concepts of the kinematics of the knee have been completely changed, but the clinically important question of articular stressing remains unanswered. Dr. Maquet has carried out pioneer work in this field for some years in adapting, by analogy, to the knee joint principles already accepted for the hip joint. Since the knee is not a ball and socket joint, a complicated problem arises for which new thoughts are necessary. The results of the numerous operations carried out by Dr. Maquet according to the biomechanical considerations demon strate that his thinking is fundamentally correct. Above all, it is here again proven (as earlier in the case of the hip) that healing of osteoarthritis depends decisively on reducing and evenly dis tributing joint pressure.

Although the number of published papers on traumatic hip disloca tion in childhood is large, our actual current knowledge on this inju ry in this age group is still full of obscure points and unsolved prob lems. Luxation of the hip of traumatic origin in children is infrequent, and the small number of cases reported by authors and institutions, as well as the usually short follow-up in many cases, are responsible for the many doubts and questions, especially related to complications and outcome following the injury. Consequently the treatment, especially the postreduction management, has not been adequately defined. Dr. Antonio Barquet has made the great effort to analyze the ex perience gained from 38 cases in Uruguay and to review more than 500 references related to the subject, covering more than 1400 cases. He began to study this topic in 1976. It was the subject of his postgraduate monograph in 1979, which was followed by a statisti cal analysis of the major complication, i. e., avascular necrosis of the proximal femoral extremity, which was presented as his doctoral thesis in 1981. In addition, he has published numerous papers deal ing with several aspects of traumatic hip dislocation in children."

Lesions of the brain stem and related disorders of autonomous regulation systems have been the "Leitmotiv" of the scientific work in the Neurosurgical Department of the Giessen University under the leadership of the late Professor Hans Werner Pia. Some of the results have already been published in supplement volumes of Acta Neurochirurgica. The first one of these was Vol. 4 with the monograph written by H. W. Pia on "Die Schadigungen des Hirnstammes bei den raumfordernden Prozessen des Gehirns." Vol. 19 deals with central disorders of temperature regulation, written by G. Lausberg, followed by Vol. 20 with R. Lorenz's monograph on the effects of intracranial space-occupying lesions on blood pressure and heart rate. Shortly before his death Hans Werner Pia had asked me to combine and publish in this series of supplement volumes of Acta Neurochirurgica another five papers by his co-workers, also related to brain stem lesions and also to cerebral blood flow and CSF dynamics. The result is this volume which contains work dealing with the CT -findings of cerebral mass displacements and their clinical correlations (Sch6nmayr), with other lesions of the brain stem (Laun), with the blink reflex and acoustic evoked potentials in brain stem lesions (Klug and Csecsei), with blood flow in brain structures during increased ICP (Zierski) and with the description of a mathematical model for analysis and simulation of the haemodynamics of intracranial CSF (Hoffmann).

Fang Zhi-yang 1. 1 History of Traditional Treatment of Burns in China China is a country of ancient culture. The treatment of burn injury was documented more than 1500 years ago. As early as the Eastern Jin Dynasty, the Handbook of Prescriptions for Emergencies written by Ge Hong (281-341 A. D. ) and in the Southern Qi Dynasty (479-502 A. D. ) Liu J uan-Zi's Remedies Left Over by Ghosts, a book dealing mainly with diagnosis and treatment of traumatic wounds, are the earliest known monographs on "external diseases" in China. They record the treatment of burns with topical agents such as the preparation of a lard ointment of the liquid extract of Angelica anomalea Lallem, Gardenia jasminoides Ellis, Glycyrrhiza uralensis Fisch, Radia salviae miltiorrhizae, and the white cortex of willow. These herbs are found to be astringents and antibiotics. During the Sui Dynasty, a doctor of the Imperial Medical Academy (550- 630 A. D. ), Chao Yuan-fang, was authorized by imperial decree to compile the book General Treatise on the Etiology and Symptomatology of Diseases (610 A. D. ), the first book on etiology and symptomatology in China. This book with its valuable descriptions has been an authoritative and important reference for medical students for more than 1000 years.

This monograph presents a comprehensive review of the clinical experience in surgical repair of cranial defects which the author has gained during a period of over ten years. Particular problems of patients undergoing cranioplasty, such as neurological impairments, EEG changes, variations of intracranial pressure, and sinking skin flap syndrome are described and discussed. The author presents convincing evidence of the importance of cranioplasty in improving the quality of life of patients with large and disfiguring cranial defects. Unfortunately, cranioplasty still ameliorates only to a minimal extent the general condition in patients suffering of major cerebral lesions. I am convinced that this volume will serve the purpose it was designed for : that it will be a most helpful introduction into the problems related to reconstructive surgery. Basel, August 1984 Otmar Gratzl Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 A. History of Cranioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 B. Clinical Aspects of Cranial Bone Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 I. Origin of Cranial Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1. Acquired Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2. Congenital Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3. Demographic and Other Characteristics of Patients . . . . . . . . . . . . . . . . . 9 II. Neurological and Psychic Changes Before and After Cranioplasty . . . . . . . 11 1. Classification of Neurological Deficits and of the Skin Flap Types . . . . . 13 2. The "Sinking Skin Flap Syndrome" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3. The Influence of Cranioplasty Upon Neurological and Psychic Changes 17 III. Electroencephalographic (EEG) Changes in Patients with Cranial Defects 21 1. EEG Recordings and Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. Evaluation of EEG Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 IV. Scintigraphy Findings in Patients with Cranial Bone Defects . . . . . . . . . . . . 26 1. Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2. Results and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

It is interesting to observe the evolution of medical education over the years. The massive textbooks of the past have almost disappeared except as works of library reference. In their place we now find an increasing number of publications which explore the detail of particular specialities and sub-specialities. Once the young surgeon has acquired his basic knowledge of surgery in general (as it is now called), postgraduate education, whilst seeking to maintain the general scientific and humanistic principles of surgery, is forced to provide specialised reference works in a whole variety of fields, amongst which the postgraduate will choose his own future interest. This tendency emphasises the importance of the Conference on Surgery of the Shoulder organised by Professor Kessel and his colleagues. This first inter national gathering of surgeons and others in related disciplines who are interested in the disorders of the shoulder was self-funded under the aegis of the Institute of Orthopaedics and University of London, and it is to be hoped that other Universities, hospitals and medical foundations will give maximal financial and moral support for further ventures of this kind. This volume places on record the concepts and practices of those interested in the injury and disease of the shoulder joint, and thus becomes a reflection of our knowledge in this field in the second half of the twentieth century."

Rapid developments in this successful diagnostic and operative technique have called for a new edition of "Arthroscopy of the Knee Joint." This second edition has been completely revised and retains very little material from the first edition. The diagnostic section has been considerably expanded and elucidated and the operative section adapted to modern technology. The first part of the book presents the external conditions and pre-requisites for diagnostic arthroscopy. The endoscopic anatomy and pathology of the knee joint are covered in detail. Particular emphasis is placed on practical hints for accurate arthroscopic procedures. The second part then discusses operative techniques. The reader discovers step-by-step how and which pathological findings should, in the author's opinion, be treated. Here, too, the problems and possible complications of arthroscopic surgery relevant to the individual techniques are dealt with in detail. Equipped with this book, the reader will be thoroughly informed on all current arthroscopic methods and possibilities.

Percutaneous lumbar discectomy is a new surgical method for treating lumbar disc diseases. The goal of the procedure is decompression of the spinal nerve root by percutaneous removal of the nucleus pulposus under local anesthesia. Probably 20 % of all patients requiring lumbar disc surgery can be successfully treated by this method. During the past two years, percutaneous discectomy has spread rapidly, and it is now performed in most clinical departments engaged in spinal surgery. The first International Symposium on Percutaneous Lumbar Discectomy, held in Berlin in August 1988, covered all current procedures known as "percutaneous discectomy" and the entire range of percutaneous techniques, both clinical and experimental. Its publication is important because of the recency of this new surgical procedure, the outstanding experience of the speakers - including the Japanese, American, and European "pioneers" of the technique - and last but not least the gaps in the knowledge of physicians concerning this topic. This procedure opens up new perspectives in the surgical treatment of degenerative diseases of the lumbar spine.

This book contains the proceedings of an historic sympo sium, the first joint symposium of the Austrian, German and Swiss Trauma Associations and the Orthopaedic Trauma Association of North America. In an effort to bring Euro pean and North American trauma surgeons closer together and foster a free and productive exchange of ideas, these associations chose the meeting of the Austrian, German, and Swiss trauma associations, which was held in Vienna in May of 1991, as the occasion for their first joint session. The Austrian Trauma Association, led by its President, Professor Heinz Kuderna, was the host. The joint symposium of the European and the North American trauma associations, conducted in English, was held concurrently with the regular meeting of the AGS, conducted in German. In order to explore and compare the current concepts in trauma on the two continents, the organizing committee felt that the discussion should focus on an area full of challenge and controversy. Thus the major fractures of the pilon, the talus, and the os calcis were chosen as the topics of discus sion. Each subject was introduced by two keynote speakers, one from Europe and one from North America, who were chosen by their respective trauma associations on the basis of their expertise and distinguished contributions. These presentations were then followed by five or six invited shorter presentations on the subject. At the end of each session, the presenters formed a panel, debated controversial points, and answered questions from the audience."

Following a presentation of basic principles of fracture fixation and biomechanical principles the book turns to practical problemsolving areas, namely, the hand, wrist, elbow, shoulder, hip, knee, ankle and foot, and spine, and special problems in children. Internal fixation, including intramedullary nailing and the use of external fixation are described.
Compound fractures are everyday problems, and the principles of their management and practical solutions deserve separate discussion. The value of microsurgical techniques has been underestimated by orthopaedic experts and the indications, choices, and procedures need to be put into proper perspectives.