The production of a textbook of the pathology of bone work with isotopic markers to refine their classifica- tion. tumours is a hard task to embark upon, but Andre In this book, the author takes up a firm position Mazabraud has certainly succeeded. about the difference between osteoid osteoma and oste- It is the outcome of a very long experience, provided oblastoma, about "tumoral associations" and about the initially by his hospital training, then by his collabora- so-called malignant forms of disorders described as tion with Rutishauser at the Institut de Pathologie at benign. His personal stamp is evident throughout the Geneva and with Dahlin at the Mayo Clinic. The bonds various chapters. he forged then have never been loosened. Certainly, treatment in the area is rapidly changing Subsequently, his duties as head of the department and advancing, but this book does not risk obsoles- of pathology at the Institut Curie directed him finally cence since treatment is not its focus. The extent and towards tumour pathology. At the Institute, he was not nature of the author's experience explain the essentially satisfied with routine examinations but very soon linked anatomo-pathological orientation taken by this semi- up with the research team and worked especially on nal book. It also provides valuable clinical information Ewing's sarcoma and the problems of ultrastructure, and a good radiological study.

Posttraumatic stump formation and replantation of the severed limb are both reconstructive plastic operations which may lead to the improvement or destruction of a patient's lifestyle. For the primary attending surgeon, the decision whether to undertake such an operation depends on the patient's clinical condition, the operational circumstances, the psychological and social aspects and, last but not least, on the surgeon's own abilities. This monograph is designed as a synopsis of the great number of patho-physiological parameters and surgical and rehabilitational aspects which must be considered in the analysis of complications in major limb replantation. In addition, basic information about the key role of ischemic myopathy and microangiopathy is supplied to encourage further experimental investigations.

Endoprosthetic replacement of the elbow is an operation which is still rarely undertaken. It is indicated in chronic polyarthritic conditions and joint damage due to trauma. A considerable number of different prostheses are commercially available. In this unique collection of papers, the authors discuss methods, implantation techniques, and surgical results and complications. Particular emphasis has been placed on the complications related to the prostheses and surgical revision. In addition, alternative techniques are presented.

An introductory text on bone metastases written by experts from various disciplines. It covers the basic principles of surgery in bone cancer, classification, medical treatment, radiotherapy, surgical treatment, incidence and pain relief. The steady progress in diagnosis and treatment of bone cancer in the last decade has dramatically changed the prognosis of cancer patients, improving significantly the overall survival rate and quality of life. Multidisciplinary treatments that combine surgery, radiotherapy and chemotherapy, as described in this book, show significantly improved results and an above average survival rate. Some hematologic malignancies that involve bone may be cured with systemic chemotherapy or radiotherapy, but for most patients with bone metastases, pain relief is the goal of therapy.

As the incidence of distal radius fractures increases, so too does the importance of this classic volume. Fully revised and expanded, with new illustrations and radiographs and new chapters on the distal radioulnar joint, late complications and future fracture techniques, no orthopaedic surgeon can be without this comprehensive and complete guide to the treatment of what are remarkably complex injuries.

Endoscopic neurosurgical interventions gain in importance. This book gives adetailed description of the recent indi- cations of endoscopic procedures inmodern neurosurgery. They include endoscopic stereotaxy, endoscopic evacuations of intracerebral hematomas, cysts and abscesses as well as endoscopic interventions on brain tumors. An extended over- view about the usable endoscopes and the operative equipment is pointed out

Both the diagnosis and the current therapeutic possibilities of the shoulder joint and the subacromial space are described in explicit detail in this book. The anatomy of the shoulder joint from an arthroscopic viewpoint is also briefly described. The diagnostic part of the book gives a description of the individual structures in the glenohumeral joint as well as the subacromial space with regard to their pathologic changes, and special attention is focused on differentiating between healthy and pathologic struc tures. The therapeutic part gives a detailed description of the Bankart refixation methods successfully applied by the authors which include a suturing technique, a refixation technique using absorbable tacks and an extra-articular screw fixation technique; furthermore the techniques of subacromial decompression, the removal of calcium deposits and the resection of the lateral end of the clavicle are described in detail. From the discussion about the indications for arthroscopy and/or arthroscopic therapy, the book then goes on to convey information on positioning, draping, necessary instruments and, finally, the performing the arthroscopic intervention itself. Thus, all the details which are required for arthroscopy of the shoulder are given."

Joint replacement surgery has seen remarkable progress and development in recent years both in prostheses and in surgical technique. A prime concern has been improved durability, for which a major factor is reduction of the polyethylene wear that leads to osteolysis. This book presents an update on the means by which the problems of wear and loosening are being addressed in total hip arthroplasty (THA) and total knee arthroplasty (TKA). Included are chapters on new surgical techniques for difficult cases, nonpolyethylene interfaces for THA, custom hip prostheses, and computer-assisted surgery. Arthroplasty 2000 also takes up current controversial issues such as posterior cruciate substitution versus retention in TKA. With contributions by eminent specialists in total joint replacement in Asia, Europe, and North America, this volume is a valuable reference for all orthopedic surgeons.

Up until two decades ago, clinical interest in the etiopathogenetic interpretation of lumbo-radicular syndromes was prevalently concentrated on the pathology of the inter vertebral disc. This vision gradually changed and grew as a result of the affirmation of the concept of pathological narrowing of the osteoligamentous vertebral canal as a cause of compression of the lumbar nervous structures. Finally, in the last ten years, lumbar stenosis has become more and more a subject of current interest not only as a result of problems related to nosography, diagnosis, and therapy, but also as a result of the increasing frequency with which vertebral canal or nerve root canal stenosis syndromes are recognized and treated. At the same time there was a tendency to include in stenotic pathology other pathological conditions responsible for lumbo-radicular syndromes. This led to dilation of the concept of stenosis, which perhaps no longer responded to reality, and which was not useful from a practical point of view. The need to define stenotic pathology and to correctly locate it within the vast field of lumbar pathology inspired the writing of this volume. This monograph gathers many diagnostic and therapeutic concepts matured at our In stitution over the years. Some of these concepts have already been defined in scientific meet ings or in publications."

In this volume, world authorities on spinal surgery from the fields of Neurosurgery, Orthopaedic Surgery, and Neuroscience present current data on the basic science and clinical management of the unstable spine. Unique to this book: a frank presentation of controversies in the field.

..". I would recommend this book for an in-depth analysis of the lumbar spine and its degenerative states ... extremely beneficial for the resident early in trainings as he or she attempts to correlate the complex anatomy of the lumbosacral region with associated pathological states ... Journal of Neurosurgery"

We shall not, and those who come after us must not, accept the goals that were not reached yesterday as unsurmountable today or tomorrow. We will strive to render the world of the paralyzed-on-wheels but a transitory stop, and settle for nothing short of optimal recovery. N. Eric Naftchi In man, the process of "encephalization" culminates in almost complete control of the brain over the lower centers. Transection of the spinal cord severs the extensions of its nerve fiber tracts running to and from various brain centers. Although there is some confusion on the meaning of spinal shock, it is supposed to last from two to three weeks or longer in man, compared with less than a few minutes in the frog. This is a testimony to the complexity of the suprasegmental control in higher animals. Since the brain exerts its control over the internal environment through several monoamine, amino acids, and peptide neurotransmitters, it should not be surprising if the metabolism of these transmitters is found to be drastically altered along with other physical and metabolic dysfunctions which ensue following the spinal cord section. In spite of the major strides in rehabilitation of traumatic spinal cord injury, our knowledge of the etiology underlying the diverse neurophysiologic derangements remains limited. For instance, we are just becoming aware of some of the changes in the "milieu interieur.

The question facing anyone contemplating a book on low back pain is: Why write another book? It is certainly true that there are many books on this topic addressing a wide variety of audiences. Some books are all inclusive and scholarly in nature, others are personal descriptions of diagnostic and treat ment philosophies. This book is a combination of these two extremes. It represents our views on the low back problem, supported by scientific data. Most aspects on back pain presented in this book can be found in other texts. The organization of the material is unique, however. Our approach is to start by listening to and looking at the patient. It becomes apparent, then, that patients can be classified into one of the syn dromes described in chapters 4 through 13. We believe that this syndrome classification, which is quite simple to make clinically, will allow you to diagnose and treat your patients more effectively. To set the stage for the syndrome chapters the first three chapters of the book are generic to the remaining chapters. They reviewe the epidemiology, pathology, biomechan ics, etiologic theory, diagnostic methods, and treatment modalities applicable to the low back syndromes. They should be read before the syndrome chap ters. At the end of the book you will find four chapters that are specific to disease entities."

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.

A different kind of book! The clivus of skull base is an area difficult to reach in neurosurgery, otorhinolaryngolo- gy, maxillo-facial surgery, plastic surgery, reconstructive surgery, and orthopedic surgery. It is for this reason that the various specialities gave found different approaches for different operations.

In response to the great demand for an English edition of the standard German handbook, Systematic Musculoskeletal Examination will soon be available. This comprehensive book contains up-to-date information for the orthopedic examination of the locomotor apparatus. In addition to the well-known techniques of the musculoskeletal examination, it also describes in detail the diagnostic techniques used in manual medicine. The numerous examinations are carried out according to five clearly defined examination stages which are the same for each joint and allow a systematic examination of the individual joint structures for functional disorders or disruptive effects (functional structural analysis). The examination is thus logically organized according to an outline, and the indications for each stage are based on the results of the previous stage and the summary of the functionally related body regions. The functions tests take into account the state of the art in biomechanics, and the symptoms requiring radiologic functional diagnosis are depicted. The systematized and streamlined examination procedure makes it possible to obtain and document results in a uniform manner. The all-inclusive nature of the text, guided by a well-designed systematic and methodical approach, will make it attractive to anyone dealing with the musculoskeletal system.

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.

Tradi tionally, the International lTV - Conferences on Biomate rials are focussing on problems in Biomedical Engineering, problems, which are still unsolved, of main interest, and which are of interdisciplinary character. In 1983, the Division of Biomedical Engineering of the Institute of Textile Technology and Chemical Engineering, Denkendorf, started wi th a conference about the use of polyurethanes in biomedicine. Three years later, . in 1986, progress in development and use of polyurethanes was selected as conference topic. It had to be realized that degradation problems were still dominating the discussions. The main discussion topics were: What are the causes for the degradation? How can one prevent them? What are the degradation products, and do they affect the human body? How can one simu late the degradation? How can one accelerate the in vitro tests and how can the results predict the in vivo behaviour of the material? How do in vitro tests correlate with animal tests and the behaviour in the human body? At the third conference in 1989, the speakers focused on the use of textiles in medicine. Again the problem of degradation was discussed intensively and demonstrated by the failure of textile implants, the degradation of aramide polymers or the degradation of resorbable suture materials. The examples make clear, that degradation may be a desired or undesired property of an implant."

Many advances have occurred in the last 5 years especially in understanding genetic susceptibility factors, the role of immune response in chronic arthritis and the relationship between cellular processes that underlie inflammation and tissue damage. All these are dealt with in depth in the individual contributions. Genetics studies included illustrate how studies of HLA genes and genes controlling the autoantibody repertoire may be involved. Environmental factors are believed to be important and studies both in humans and in experimental models on the role of viral and bacterial agents are covered. The fascinating relationship between microbes, dysregulated immune responses and oncogenes are also examined. Since autoimmunity is the key aspect of the immunological response in rheumatoid arthritis, the role of antigens is re-examined as is the part played by immune T and B cells. New areas of clinical application of basic science is well presented in this book, forexample, in examining how markers of cartilage destruction may become important in monitoring disease activity. A chapter reviewing possible future novel therapies is included.

This volume addresses the issues, complications and treatments that face hip specialists and general orthopaedic surgeons in both the surgical and non-surgical treatment of hip fractures. Over 500 photographs and drawings explain the various types of hip fractures. In addition, this book covers epidemiology and mechanisms of injury, diagnosis, treatment principles, rehabilitation, outcome assessment, and the economics of treatment and prevention. Hip Fractures provides complete coverage of the diagnostic and technical techniques making it the definitive source for decision making.

Focusing on the most current, cutting-edge, innovative, and advanced arthroscopic techniques for wrist and hand, elbow, shoulder, hip, knee, ankle, foot, and spine, this book presents orthopaedic surgeons with the detailed procedures needed to stay competitive in the age of managed care. With contributions from specialist leaders in orthopaedic and arthroscopic surgery, the text is supplemented by full-color arthroscopic views and custom illustrations, detailing complex procedures for rotator cuff tear, TFCC repair, meniscus repair, ACL reconstruction, intraarticular fractures and many others. Special sections on laser applications in arthroscopy and office arthroscopy make this volume a must for every practicing orthopaedic surgeon.

Lumbar spine or back pain is one of the most important problems in orthopedics and neurosurgery today. Two key ways of treating this malady, lumbar fusion and stabilization, are critically discussed in the forty-three papers in this volume. They represent the best of the contributions to the 5th ICLFS, carefully selected and edited to give a good overview of recent knowledge and the state of the art.

Congenital hip dysplasia and dislocation are common diseases of newborns and small infants, with frequently severe consequences if orthopaedic therapy is not initiated at an early stage. Therefore many clinicians have been looking for a simple method for the investigation of the hip joint in the early neonatal period. Up to 1980 the diagnosis of hip dysplasia could usually not be made before the 3rd month of life, by means of pelvic roentgenography. Only incomplete or complete unilateral dislocations were diagnosed in the neonatal age group. In 1980, however, Graf, an Austrian orthopaedic surgeon, began using ultrasound investigation ofthe hip joint in newborns and small infants in order to make an early diagnosis and to avoid radiation exposure. The intention of the present study was to compare ultrasound of the hip joint with other established diagnostic procedures and to establish whether it is suitable as a screening procedure in newborns. 2 Incidence of Congenital Hip Dysplasia and Dislocation In 1972 Barlow reported that 90 % of hips which are unstable at birth develop to normal joints spontaneously without any therapy. Visser (1984) thus suggested determining the percentage of hip dislocations after the 2nd - 3rd month of life so that children with spontaneous stabilisation would be excluded.

This book was conceived with the object of presenting to doctors and medical students with a potential interest in the disciplines of orthopaedic surgery, diagnostic radiology and orthopaedic pathology, a volume which would contain basic and essential information concerning those disorders of the skeleton in which a common interest exists. Diagnosis in such conditions is dependent on close collaboration between specialists in these subjects. As medical knowledge has advanced, so the necessity for detailed specialisation has increased. As a result co-operation in a combined approach has become of great importance. The method of presentation, in the form of Exercises, is designed to permit readers to test their own diagnostic ability. The book consists of ninety-four problems of diagnosis which might be encountered in any orthopaedic unit. The case material has been chosen to emphasise those conditions in which appreciation and integration of the clinical, radiological and pathological features are required in order to establish the diagnosis.

An international group ofresearchers has met every 2 years since 1981 to examine the progress made in limb salvage techniques and the perspectives of this field of surgery. In 1989 the Fifth International Symposium On Limb Salvage (ISOLS) was held in Saint Malo and was attended by more than 300 participants from 34 different countries. The 105 papers presented, grouped under eleven main headings, have been included in this book. Limb salvage has indeed progressed in the years since the first symposium. Initially it essentially concerned tumours and the main aim was to salvage the diseased limb through non-mutilating surgery without jeopardizing the patient's prospects of survival. Now, with a confirmed high rate of 5-year disease-free survival, new goals can be set: improvement of the functional results and of the survival of our reconstructions. How can this be achieved: - By favouring muscle reattachment on the prosthesis, for instance through the use of a bone allograft-sleeved composite prosthesis? - By improving the survival of the arthroplasty through the develop ment of a more biological fixation of its stems? - By limiting the side effects of the necessary adjuvant treatments on the function of the allograft as well as on the fixation of the prosthesis? In addition, limb salvage procedures now concern not only primary tumours (and metastases, which must be treated using the same osteosynthetic and prosthetic techniques), but also reconstructive orthopaedic surgery as a whole."