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.

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."

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.

External fixation is now being used widely to maintain fractures, osteo tomies, and arthrodeses in a desired position during consolidation. Whereas external fixation has been readily accepted in European countries, its use has weathered a rather stormy course in North America, especially in the treatment of fractures. Only recently has external fixation found its rightful place on this continent as well. Many different models are on the market today, and the practitioner is faced with a difficult decision in selecting a model. Should he buy a system where the fracture has to be reduced first, or should he work with a device permitting a reduction after insertion of the pins? To enable surgeons to study the different systems, to discuss their advantages and disadvantages, and to permit them to put their hands on these devices and inspect them personally, the Division of Orthopedic Surgery, University of Ottawa organized an applied basic science course in May 1981, External Fixation of Fractures. During this course, all major systems were pre sented to the participants. As happened during the course "Internal Fixation of Fractures" held two years ago, the rigidity of internal fixation was frequently and intensively debated. Whereas the rigidity of internal fixation cannot be altered during the course of healing, the rigidity of external fixation can be changed. In fact, with progression of union, rods of increasing elasticity can be used."

Volume 3 of this series is concerned with geriatric aspects of surgical specialties: gynecology, orthopedics, general surgery, otorhinolaryn gology, and ophthalmology. Closely associated with these specialties is anesthesiology. Dermatology has an intermediate position between surgical and nonsurgical fields. The peculiarities of physiological and pathological aging of otgans and the consequences for diagnosis and therapy - presented in the first two volumes - are of great significance, especially for surgical special ties. There are a large number of pre-, intra-, and postoperative problems in multimorbid geriatric patients, e. g., coronary insufficiency, brady arrhythmias, hypertonia, and hypotonia. While as recently as the tum of the century the age of 65 years was viewed as a contraindication for sur gery, today even older patients undergo operations on aortic aneurysms, bypass operations for coronary sclerosis, pulmonary resections, and abdominosacral resections of rectal carcinomas, for example. Pre requisite for successful surgery at an advanced age is good pre- and postoperative care of multimorbid patients. Physiological changes of the lungs with aging, the increased frequency in pneumonia and pulmonary just a few embolisms with age, and the decrease in receptors, to give examples, confront anesthetists with difficulties. The maxim "in old age a little less" is also applicable in this field. Only improved experimental gerontological research, possibly reaching even into anesthesia, will provide objective data for anesthesia in elderly patients. The skin is an organ that experiences characteristic qualitative and quantitative changes in old age."

Minimally Invasive Surgery in Orthopedics: Knee Handbook contains all of the valuable chapters from Section III (The Knee) and selections from Section IV (Computer Navigation) of Scuderi and Tria's 2010 hardcover reference. Newly available in an affordable softcover format, this book covers minimally invasive procedures and techniques for the knee as well as computer navigation and robotics. The book is fully illustrated with more than one hundred pictures and clearly written for ease of understanding. Surgeons, residents and fellows alike will find this thorough and focused handbook invaluable.

In few areas of medicine is progress more spectacular than in the field of prenatal diagnosis. New clinical techniques such as chorion villus sampling, detailed ultrasound scanning and cordocentesis are being evaluated by obstetricians, and refinement of biochemical testing is widening the scope of maternal serum screening. In the laboratory, dramatic advances in molecular biology are occurring: families at risk of genetic disease can be investigated with gene probes, and preimplantation diagnosis of the embryo is now becom ing a reality. These technical advances have important ethical and practical implications, among which will be a further increase in public expectations of the standards required of antenatal services. Clini cians will need a high degree of skill to inform healthy women about the options for screening normal pregnancies, and to counsel high-risk women about the benefits and limitations of prenatal diagnosis. Obstetricians, scientists and health service managers will face the difficult task of deciding how prenatal diagnosis can be made available to women in a caring and cost-effective way. Recognising the rapid progress in this field, the Royal College of Obstetricians and Gynaecologists made prenatal diagnosis the subject of its 23rd Study Group. An international panel of leading researchers, whose expertise ranged from molecular biology to philosophy, was invited to participate in a three day workshop, with time for in-depth discussion as well as the presentation of papers.

Recent years have witnessed major developments in diagnostic imaging methods. The facilities for these new methods are sometimes expensive. and not always accessible. yet they continue to improve and to change. It is essential that those concerned with orthopaedic imaging should appreciate not only recent developments but also the changes likely to occur during the next few years. It is also important that the indications. contraindications. uses and complications for each individual imaging technique should be understood. This book is an attempt to provide such information for orthopaedic surgeons. diagnostic radiologists. and other clinicians. par ticularly those in training or those who are involved in management of patients with disorders of the musculoskeletal system. In the first part of the book the different imaging techniques are discussed. with emphasis on advantages and disadvantages. indications and contraindica tions. In the second part. authors have been asked to discuss ways in which specific groups of disorders might be investigated. It is hoped that the reader will obtain from this section a balanced view of the different diagnostic imaging methods. the indications for their use. and the sequence in which they might be carried out. The Editors are grateful to aU authors for the time and work they have put into their individual chapters. They are also grateful to the publishers. in particular Michael Jackson. for help given in the preparation of this book. Manchester C. S. B. Galasko I.

Cervical Spine Research Society European Branch "The Cervical Spine Research Society is an organization of individuals interested in clinical and research problems of the cervical spine. Its purpose is for the exchange and development of ideas and philosophy regarding the diagnosis and treatment of cervical spine injury and disease. The com position of the membership should reflect the varying specialities and disciplines dealing with the cervical spine; biochemical, engineering, neurology, neurosurgery, radiology, orthopedic surgery and others," wrote J. William Fielding, New York City, one of the Society'S founding members. In 1984 the membership list contained 118 names. The overwhelming majority of members came from the United States, four from Canada and 9 Europeans, amongst them Mario Boni. He was the organizer, in con junction with the members of the Cervical Spine Research Society, of a splendid "International Meeting for the updating on pathology and surgery Preface VI of the cervical spine" held in Pavia (Italy) in May 1982. It was from this meeting that the idea of a European branch of the Society first originated, with the purpose of establishing multi-disciplinary meetings in Europe. The first meeting of the European branch was organized by A. Weidner in September 1984 in Osnabriick (Federal Republic of Germany). Mario Boni was elected president. He was not only the initiator but also the drivinglorce who tirelessly promoted the development of the European branch. Mario Boni's death in 1986 at the age of 64 was a great loss to us."

The AOjASIF* dynamic hip screw (DRS) has been designed primarily to stabilize trochanteric fractures of the hip. Selected fractures of the femoral neck and some subtrochanteric fractures are further indications for the DRS [40, 46]. The dynam ic condylar screw (DCS) has been developed for fractures of the distal femur and is now being tested clinically. The DRS and DCS are carefully coordinated with the preexisting ASIF standard sets of equipment for internal fixation of fractures. The concept of a sliding screw for trochanteric fractures is not new. The first author describing such an implant was Schumpelick [44]; he gives credit to Pohl [22], who was primarily a manufacturer working for Gerhardt Kiinscher. Re described the possibility of impaction at the fracture site with a sliding device. In the United States Clawson [7, 8] introduced the hip screw and found it to be extremely beneficial in trochanteric fractures. At approximately the same time, Massie [31, 32] and Pugh [39] designed the sliding-type flange nails, which offer similar intramedullary splinting with the possibility of fracture impaction. The following chapters describe the concept and design features of the DRS, as well as the details of the surgical technique. The application of the DRS for different types of fractures is illustrated with clinical examples. The results of 268 cases of trochanteric fractures treated with the DRS are presented and compared with results using the angled blade plate and Ender's nails. Finally, some laboratory tests are described.

The enormous importance of the diseases of the locomotor system in all populations and the large component of general clinical practice which they represent have not, in the past, been matched by an appropriate pathological effort. Increasing expectation of an active and long life has resulted in a great increase in specialisation in Rheumatology and rehabilitation of those with crippling diseases. This volume presents many of the pathological advances that have followed this clini cal interest, beginning with reviews of changes in biological materials obtained by in vasive investigation of joints, continuing with an account of therapy Goint replace ment) and also describing a "new" hazard - hyperbaric injury. Experimental models of joint disease are also described as are other entities such as crystal deposition dis ease. A detailed consideration of the electron microscopy of bone tumours is included since this data is not widely available in current texts. Finally, the role of the HLA system in rheumatic disease is included, indicating the value of close co-operation between clinician and pathologist in defining and link ing the various rheumatic syndromes. London Contents Examination of Synovial Fluid. With 9 Figures P.A. Revell ........................................... . The Synovial Biopsy. With 20 Figures F. Eulderink. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 25 Tissue Reactions to Joint Prostheses and the Products of Wear and Corrosion. With 20 Figures P.A. Revell. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 73 Bone and Joint Diseases in Workers Exposed to Hyperbaric Conditions."

Blood Supply of Bone: Scientific Aspects provides a comprehensive description of the development and physiology of blood supply to the skeleton. Investigative techniques for different types of bone in the body are discussed and the effects of disturbed circulation and the vascular control of osteogenesis is described. This highly illustrated and authoritative volume contains much revised material and many new illustrations reflecting 25 years of advances in this research field since the publication of its well-known precursor in 1971. The wealth of information will not only be invaluable to orthopaedic surgeons, rheumatologists, and radiologists but also pathologists, sports medicine specialists and bone metabolism research workers.

"The. phil..o.6opru.c.al -

Modern endoprosthetics requires the examination of basic principles such as metallurgy, tribology, gait analysis, model and system development, methods of implant fixation, design, surface problems, material characteristics, stability behaviour, and operating techniques. With a background of more than 30 years of experience, this work presents a summary of these fields, providing the reader with the current state of knowledge. It is dedicated to Dr. med. h.c. Otto Frey-Zund who, in conjunction with orthopaedic surgeons, scientists and engineers from all over Europe, developed artificial joints for hips, knees, elbows and wrists in over 30 years of pioneering work.

A half century ago, orthopedic surgeons needed to specialize in only the pathophysiology and treatment of the neuromuscular and skeletal systems in order to treat patients. However, since then, surprising progress has been made in medicine, and through the limitless avenues for research orthopedics is now divided into many subspecialities, with terms such as orthopedic pathology, orthopedic oncology, orthopedic rheumatology, and orthopedic traumatology becoming commonplace. Interdisciplinary studies in this and other related fields are now indispensible. As a result, the half-life of the information accumulating yearly has been estimated at five years. In times such as these, if one stubbornly adheres to treatment alone, progress comparable to that in other fields will not be made. If one opens an orthopedic textbook, it is easy to see that there are still many diseases of undetermined etiology; in the last quarter of a century, there has been no evidence of even one of these diseases' etiology having been resolved internationally. This is a direct result of the ineptitude of basic orthopedic research. Therefore, recently in the United States, Japan and Canada, orthopedic research institutes and associations have been established, and SIROT has been organized internationally. This book contains the manuscripts presented by international and Japanese speakers at the 5th Annual Meeting of the Orthopedic Research Society of the Japanese Orthopedic Association, and the Second Inter national Cherry Blossom Conference of Rheumatology.

The picture on the front cover of this book depicts a young man pulling a fishnet, a task of practical relevance for many centuries. It is a complex task, involving load transmission throughout the body, intricate balance, and eye head-hand coordination. The quest toward understanding how we perform such tasks with skill and grace, often in the presence of unpredictable pertur bations, has a long history. However, despite a history of magnificent sculptures and drawings of the human body which vividly depict muscle ac tivity and interaction, until more recent times our state of knowledge of human movement was rather primitive. During the past century this has changed; we now have developed a considerable database regarding the com position and basic properties of muscle and nerve tissue and the basic causal relations between neural function and biomechanical movement. Over the last few decades we have also seen an increased appreciation of the impor tance of musculoskeletal biomechanics: the neuromotor system must control movement within a world governed by mechanical laws. We have now col lected quantitative data for a wealth of human movements. Our capacity to understand the data we collect has been enhanced by our continually evolving modeling capabilities and by the availability of computational power. What have we learned? This book is designed to help synthesize our current knowledge regarding the role of muscles in human movement. The study of human movement is not a mature discipline."

The different chapters of the present book were published separately each as a complete entity in the Proceedings of the Royal Saxon Society for Sciences. Chapter 1 appeared in 1895 under the names of Wilhelm Braune and Otto Fischer although Braune died immediately after the initial experiments, before the recordings had been interpreted. Chapters 2-6 were signed by Fischer only and appeared in 1899, 1900, 1901, 1903 and 1904. Basic data needed for this investigation of the human gait had been provided previously. A research on the centre of gravity ofthe human body and its different segments by both authors was published in 1889, determination of the moments of inertia of the human body and its segments in 1892. So far only the fIrst of these two works has been published in English. The other has been translated and awaits publication. Springer-Verlag must be congratulated for the quality of this edition and for the care they took in reproducing the original fIgures. This was certainly no easy task. We thank them for the patience they displayed towards the translators. Publication of the present book was made possible fInancially by Prof. M. Muller, Bern. We are grateful to him for his generosity and so will be the scientifIc community.

The past 25 years have seen a progressive improvement in external fixation techniques in terms of patient acceptability, ease of appli- cation and apparatus stability. The recent awareness in Europe of the method, application and excellent results of the technique pio- neered by G. A. I1izarov has caused a rapid increase here in the number of surgeons who have become "banderilleros". In particu- lar, external fixators can be used in the treatment of difficult clini- cal conditions, such as severe fractures and their sequelae, as well as for the correction of congenital deformities of the peripheral skeleton. As one of the first in France to use the lIizarov method, I became increasingly aware that we needed an updating of anatomical knowledge oriented towards this technique, which uses multiple fixation pins. Without this anatomical infonnation, there is real danger of damaging neuro-vascular structures or entering ajoint in the course of assembling the fixator. Traditional anatomical cross- sections are often inadequate or too schematic to serve as a safe guide for the surgeon using this particular technique. This is the reason why my colleagues Claude Faure and Philippe Merloz have produced and analysed a series of anatomical cross-sections of the limbs to serve this particular need.

HRT and Osteoporosis is a response to the increasing awareness among both the medical profession and the general public that ovarian failure is an important cause of osteoporosis and that much of the bone loss after the menopause can be prevented by oestrogen treatment. There is now an urgent need on the part of women, their doctors and those responsible for public health policy for practical guidance on such questions as the safety and acceptability of long-term treatment with sex hormones, the economic costs and benefits of such treatment, and the role of specialists and GPs in promoting and monitoring hormone replacement therapy. All these issues and more are considered here. The book comprehensively reviews current knowledge of the subject and gives recommendations for clinical practice and future research.

J. SCHATZKER Friedrich Pauwels first postulated that excessive osteotomies and in particular on a group ofJ 09 joint pressure could cause the destruction of ar- osteotomies followed up for 13-15 years after ticular cartilage and lead to osteoarthritis, and surgery. that the reduction of this pressure would bring Erwin Morscher supports the long-term re- about regeneration of articular cartilage and re- sults of Bombelli and Schneider in his analysis gression of the disease. The first chapter of this of a study of over 2,000 osteotomies performed book is a synthesis of Pauwels' lifelong devotion in several Swiss centers. to the biomechanics of the hip. It presents the He also presents a careful analysis of his reader with a clear exposition of the intertro- own smaller series. Based on all these data, he chanteric osteotomy as a procedure based on defines for us the ideal parameters which clear biomechanical principles, and illustrates should be present in order to make the patient how biomechanical regeneration of the joint can an ideal candidate for an intertrochanteric os- be influenced by a reversal of the mechanical teotomy.

Avascular Necrosis (AVN) is a disease resulting from temporary or permanent loss of blood supply. It frequently affects the femoral head and in this area, if left untreated, routinely causes premature joint destruction.

In the USA, 5 to 10% of cases of hip osteoarthritis requiring total hip replacement are primarily caused by AVN. In 33 to 72% of patients, the disease is bilateral. The peak incidence is between 30 and 60 years of age, and the social costs of this pathology are remarkable. There is therefore increasing interest in hip joint preserving techniques such as conservative treatment through electromagnetic fields and shockwaves as well as joint preserving surgical techniques. This volume aims to present a complete overview of the current knowledge on AVN including therapeutic options.

This book is concerned with the effect that displacement, whether minimal or severe, may have on the hip joint. Although it is concerned with the changes which take place in childhood and during growth, when they are most common and most severe, it is also to a lesser extent concerned with the way they will continue or even start long after growth has ceased. It is based on a series of about 450 cases of congenital displacement of the hip treated when the deformity was established, together with unstable hips drawn from 82000 children whose hips were examined at the time of birth. This study was carried out at the Nuffield Orthopaedic Centre in Oxford. It was started in early 1949 by the author with Mr. J. C. Scott and continued until mid-1977, since when it has continued in the capable hands of Mr. J. W. Goodfellow and Mr. M. K. Benson. The study was started at a time when the generally accepted view was still that the displacement was part of the primary failure of development of the acetabulum, which could not adequately contain the femoral head. Conservative treatment with manipulative reduc tion followed by a prolonged period of plaster immobilisation was the method of choice. Few attempts had been made with surgery as a primary procedure and these had not met with continuing success."

The fourth volume of Progress in Orthopaedic Surgery is somewhat different from pre vious publications of the series. The editors have again tried to present two topics but the publications presented from the European literature are of very recent origin. In the age of total joint replacement it was felt to be imperative to counteract the pre sent tendency to treat every joint which does not seem to be healthy with an artificial re placement. Orthopaedic surgery seems to be influenced by trends. In 1963, E. A. Nichol discussing intracapsular hip fractures, quoted from Alice In Wonderland in an editorial written for volume 45B of the Journal of Bone and Joint Surgery "The Queen had only one way of settling all difficulties, great or small, "Off with his head" ." Today one could paraphrase his implied critizism by saying "Out with the joint." No one doubts that joint replacements have been of great value in treating degenerative joint changes, but it is already apparent that replacement operations are not the ultimate answer for treating every joint deformity. This volume represents the European experience of different types of surgery in treat ing arthrosis of the joints of the lower limb. A reader of the Anglo-American literature will find suggestions in it which reaffirm his uneasiness in considering only one solution for problems concerning lower limb joints. I feel strongly that there are other ways which allow a patient to function well with less extensive operations."

When 1 first developed an interest in the pathology of bone 1 found that there were relatively few books on the subject available. Much of my information had either to be obtained from searching the journals or from senior colleagues in the field, who, 1 should add, were always more than willing to teach me. With this memory in mind, 1 have endeavoured to produce a book which 1 hope is of a convenient size and yet will hold sufficient information to be of use mainly to the pathologist faced with a bone problem. This is not intended to be an all-embracing source of knowledge on the subject; indeed, such a task could not be undertaken by a single author in these days of the rapid increase in information even in small subspecialist areas within bone pathology. Although this book is written mainly for the pathologist, it is hoped that it may also be of interest and value to orthopaedic surgeons, rheumatolog ists and radiologists. Most of the illustrations are original and many of the drawings are my own. There has been a long tradition of interest in bone pathology at The London Hospital, which has resulted in a wealth of material being available to me from the archives of the Department of Morbid Anatomy. A few of the photo graphs are those of Prof. H. Turnbull; the observant reader will detect these, since the scales used are not metric."

Written by a team of world-leading experts in the field, who have published extensively

For primary care physicians, haematologists, surgeons and other healthcare professionals with an interest in thromboprophylaxis

Discusses both medical and surgical thromboprophylaxis and includes all relevant guidelines for thromboprophylaxis in pregnancy

Thoroughly revised and updated new edition

This second edition of the Handbook of Thromboprophylaxis expands upon the role of anticoagulants in clinical practice. In addition, it summarises key papers in the field and provides evidence-based guidelines for the use of anticoagulants in routine day-to-day practice.

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