Given the strong current attention of orthopaedic, biomechanical, and biomedical engineering research on translational capabilities for the diagnosis, prevention, and treatment of clinical disease states, the need for reviews of the state-of-art and current needs in orthopaedics is very timely. Orthopaedic Biomechanics provides an in-depth review of the current knowledge of orthopaedic biomechanics across all tissues in the musculoskeletal system, at all size scales, and with direct relevance to engineering and clinical applications.

Discussing the relationship between mechanical loading, function, and biological performance, it first reviews basic structure-function relationships for most major orthopedic tissue types followed by the most-relevant structures of the body. It then addresses multiscale modeling and biologic considerations. It concludes with a look at applications of biomechanics, focusing on recent advances in theory, technology and applied engineering approaches.

With contributions from leaders in the field, the book presents state-of-the-art findings, techniques, and perspectives. Much of orthopaedic, biomechanical, and biomedical engineering research is directed at the translational capabilities for the "real world." Addressing this from the perspective of diagnostics, prevention, and treatment in orthopaedic biomechanics, the book supplies novel perspectives for the interdisciplinary approaches required to translate orthopaedic biomechanics to today s real world.

This book brings together the congenital, acquired and traumatic conditions which may affect the child's cervical and thoraco-lumbar spine. The immature spine poses considerable diagnostic dilemmas and radiographs are often difficult to interpret. The aetiology of deformity, its assessment, monitoring and treatment are comprehensively described. Back pain in children receives special attention. Care has been taken to identify symptoms and signs which should raise our level of anxiety and those which are likely to resolve. Where surgery is necessary the principles and risks are defined.

Children's upper and lower limb orthopaedic disorders has been written to give orthopaedic practitioners an easily accessible and concise description of regional disease and conditions encountered in the practice of pediatric orthopaedic surgery. The upper limb chapters describe fetal development and how this may go wrong. As always, function dominates our management plans although cosmetic considerations must be borne in mind. Perinatal brachial plexus injury is analyzed and a plea made for early recognition and reconstruction of both plexus lesions and peripheral nerve injuries. The lower limb chapters consider limb deficiency and deformity and how best we should manage them. Those prominent afflictions of the child's hip - dysplasia, Perthes' disease and epiphyseal slipping - are fully discussed. Chapters on the common conditions affecting the knee, foot and ankle complete the book.

Recent radiologic procedures in bone and joints, some of which eliminate the need for surgery are exposed, including: trephine biopsies of the thoracic and lumbar spine, sacro-iliac joints, peripheral bones synovial membrane and soft tissues, using either fluoroscopic echographic or CT guidance - chemonucleolysis - vascular embolization of skeletal tumors and management of vertebral hemangiomas - selective steroid injection in a broad spectrum of diseases including vertebral facet syndrom, cervicobrachial nerve root pain, rotator cuff calcium deposits, bone cysts. This unique volume supplies the reader with complete information regarding the performance of all these techniques.

Foot and ankle surgery has grown rapidly within the last 20 years, due to international collaboration between podiatric, orthopaedic, and trauma surgeons from around the globe. This book aims to provide trainees with a general overview of topics encountered in foot and ankle surgery, by presenting the general surgery section published originally within International Advances in Foot and Ankle Surgery. While this book does not exclude scientific background, it emphasizes a practical, hands-on approach. To meet the demand of all foot and ankle surgeons, the book encompasses forefoot and rearfoot deformities as well as reconstructive surgery of the diabetic foot. This book will appeal to trainees who have yet to specialise, but need access to an easy reference companion within general foot and ankle surgery.

Sharmila Majumdar In the area of osteoporosis and skeletal changes, it is currently accepted that bone mineral density (BMD), widely used for screening, monitoring and assessing therapeutic efficacy, does not adequately explain the pathogenesis of osteoporosis, the process of aging, or the therapeutic efficacy of various treatments. In this context, trabecular micro- architecture has enormous potential to contribute to understanding the pathophysiology of osteopor.osis and therapy assessment. The use and value of noninvasive imaging and quantitative image analysis and processing of trabecular bone micro-architecture have increased dramatically due to recent advances in instrumentation and software. This emerging field is diverse, interdisciplinary, and encompasses many different imaging modalities. Interested researchers include those involved in technique development, basic science and animal studies, as well as clinical researchers and practicing physicians. With the growth of this area of research, a group of investigators at the 11th Interna- tional Workshop of Bone Densitometry, 1 concluded that a forum dedicated to this matter was urgently needed. With this agenda, Dr. Peter Ruegsegger organized the first sympo- 2 sium on conjunction with the 10th Conference of the European Society of Biomechanics. The symposium on Bone Architecture and Competence was a two-hourlong event which resulted in five chapters in Bone Research and Biomechanics, edited by G. Lowet, P. Ruegsegger, H. Weinans, and A. Meunier, published by lOS Press, 1997. The second symposium was held as a pre-symposium to the 12th Workshop on Bone Denistometry,3 and flourished as a daylong event.

This book is the result of an international symposium on bone transplantation, the first of its kind, held in Berne, Switzerland, on May 14-16, 1987. This symposium brought together some of the most outstanding experts - from all over the world, principally from North America and Europe -in the clinical bone transplantation and in basic research. It was an unique opportunity to summarize in a few days the state of the art in this field and to bring clinicians who carry out some research related to their work together with basic scientists. The clinician can on the one hand profit from the basis researcher's knowledge and on the other stimulate the researcher to share the orthopedic surgeon's interest in osteo articular allografts. The book, like the symposium, contains two types of contributions: 1. Papers from invited experts who have often dedicated a significant part of their professional life to the subject of bone transplantation. Knowledge which would otherwise be scattered among original papers from many different sources, some of it less firmly established and therefore less well known, is thus collected together in one volume, so that the reader does not have to weed out a mass ofless important material. These chapters may for a certain time act as a textbook on bone transplantation, but inevitably will eventually be superseded by new findings. 2. Descriptions of current research in all the main subjects covered in the state of-the-art papers."

This book starts appropriately in considering the principles which should govern our care of the injured child and the background factors which influence fracture epidemiology. Knowing how to manage the multiply injured child and recognizing the one who has been non-accidentally injured are essential skills in our specialty. Injuries to the growth plate are not always easy to recognize and manage but, if we fail to do so, the long-term consequences may be serious. Succeeding chapters describe childhood injuries and fractures regionally. Conservative fracture management has not been forgotten amidst the plethora of newer methods of surgical fixation.

The first part of this manual deals with the experimental and scientific basis and the principles of the AOjASIF method of stable internal fixation. It deals with the function and main use of the different AO implants, the use of the different AO instruments, and with the essentials of the operative technique and of postoperative care. It also discusses the handling of the most important postoperative complications. The second part deals at length with the AO recommendations for the operative treatment of the most common closed fractures in the adult. This has been organized in anatomical sequence. The discussion of the closed fractures is followed by a discus sion of open fractures in the adult, then by fractures in children and finally by pathological fractures. The third part presents, in a condensed fashion, the application of stable internal fixation to reconstructive bone surgery. 1 GENERAL CONSIDERATIONS 1 Aims and Fundamental Principles of the AO Method The Chief Aim of Fracture Treatment is the Full Recovery of the Injured Limb In every fracture there is a combination of damage to both the soft tissues and to bone. Immediately after the fracture and during the phase of repair, we see certain local circulatory disturbances, certain manifestations of local inflammation, as well as pain and reflex splinting. These three factors, that is, circulatory disturbances, inflammation and pain, when combined with the defunctioning of bone, joints and muscle, result in the so-called jl'acture disease.

It is a great pleasure to introduce this book and its writer to the reader. Dr. Thijn has been interested in double contrast studies since he wrote his thesis on the double contrast examina tion of the colon. It would sound facetious to state that after he exhausted this field, he was in need of some other area where the same technique could be used. However, in the same exact and thorough way as in his colon studies, he has examined the knee joint. Considering that the knee is one of the most heavily taxed joints in man, with a multitude of afflictions, many of them closely connected with the age of the individual, radiological investiga tion has shown very few innovations over the decades. The true anteroposterior and lateral projections were ~ and still are ~ the mainstay of the investigation. Projections of the intercondylar fossa, and true patellar projections were used incidentally. Just prior to World War II the advent of arthrography as a double contrast investigation, as promoted by Oberholzer, was a real breakthrough.

The danger of infection remains the most serious drawback to internal fixation. Prevention, using all available prophylactic measures should be the central feature in every surgical department. Though the infection rate may remain below the acceptable level of 2 %, the infected patient derives little comfort from the large number of excellent results in other people. We must discover the best way to offer these patients a favourable prognosis. This should not be based on intuition but on clear proven guiding principles. Planning the treatment for a patient whose internal fixation has become septic must decide between steps which may have advantages or disadvan tages. The disadvantage of the presence of a foreign body must be weighed against the advantage of rigidity. The authors have taken up this challenge by planned animal experiments to study the healing of internally fixed fractures which have been infected with staphylococci. They have shown that under stable conditions, even massive infection did not destroy the healing process in cortical bone. Even under these circumstances fracture union, in the form of primary bone healing, can occur even if with less regularity than in unin fected internal fixation.

It is with great pleasure and, much interest that I accepted to write the foreword to this book by Paul Doury, Yves Dirheimer, and Serge Pattin on the subject of "algodystrophy." First, because I know the extent of their personal experience, from which they have selected the best for this book. Second, because it seemed to me that their detailed analysis of the numerous works on the subject, works which have been published all over the world and which provide diverse physiopathologic interpretations, would provide a comprehensive study meeting a real need. Algodystrophy, to adopt the term used by the authors, merits rheumatolog ists' careful attention. It is indeed a frequent condition and, as is now well known, occurs in the most varied etiologic circumstances; it is not solely posttraumatic, a notion on which diagnosis had long been based. This variable etiology suggests the complexity of algodystrophy's pathogenic mechanism."

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."

Abundantly illustrated with more than 1,850 figures, this comprehensive monograph describes the experience gained through the treatment of patients with spinal tumors over a 25-year period. It covers clinical presentations and neuroradiological features of intramedullary, extramedullary, and extradural spinal tumors. Coverage provides step-by-step intraoperative photographs to describe surgical strategies. In addition, the book offers techniques and gives detailed statistical analyses on postoperative outcomes by focusing on postoperative complications as well as short-term and long-term results.

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).

A rapid reference guide to the approach and management of orthopaedic emergencies, this book provides quick differential diagnosis and treatment guidance for the emergency physician and orthopaedic resident and trainee. Chapters detail the initial management of musculoskeletal injuries, including reduction, splinting, and casting techniques for specific fractures and soft tissue injuries. A stepwise, how-to approach ensures easy learning, and an abundance of images provide clarity in instruction. This book also helps the reader identify those patients who can be appropriately treated as outpatients and patients who require urgent and emergent orthopaedic consultation.

After 20 years of intense and gradual improvements in the practice of craniofacial surgery, the International Society was born in Montreal (June 1983) and I. Munro was selected as general secretary. Its first meeting was held in La Napoule (Sep tember 1985) under the chairmanship of D. Marchac. In the meantime, the Euro pean group of the Society had held a session in Stockholm (June 1985) with B. Jo hanson acting as chairman. This now belongs to the history of our specialty, as does the course organized by E. Caronni in Rome (March 1982). These four landmarks in such a short time show the lively interest in craniofacial malformations and all their correction involves: - Syndrome delineation - Evaluation of the components of the malformations - Anatomy of the malformations - Imaging and measurement - Strategies and tactics in very different syndromes - Follow-up with reference to growth patterns in patients subjected to surgery or merely kept under observation - Implications of orbitocranial procedures for routine maxillofacial surgery - The interdisciplinary approach involving pediatricians, anesthesiologists, n- rosurgeons, ophthalmologists, orthodontists and speech specialists - The theories in vogue and those revised for some of the abnormalities All this could not be resolved in a 2-day meeting and probably will not be solved in the next generation."

Dr. MAQUET, the foremost disciple of Professor PAUWELS' and the orthopae dic heir to the PAUWELS' concepts of osteotomy of the hip for arthritis, has assembled in this one book the strongest and most lucid contemporary statement of the principles and practice of this very important school of hip surgery. Professor PAUWELS' contributions to the understanding of the biomechanics of the hip and to the concepts and execution of osteotomy of the hip for arthritis are outstanding and timeless. With clarity, Dr. MAQUET articulates this position and refines it further in the light of his own investiga tion. While other investigators, of course, differ on individual concepts or princi ples in this book or disagree with specific positions, assumptions, or conclu sions, it is clear to all that this book is a benchmark work. Dr. MAQUET, as Professor PAUWELS always did, illustrates his text lavishly with beautiful examples of individual cases illuminating the principles ad vanced. But in addition, he has gone further and presents long-term follow-up data, quantifying the results of these surgical precepts as experienced in his own practice. It is a work that has been long sought and is richly received. Boston, Massachusetts, 1984 WILLIAM H. HARRIS, M.D.

In recent years wrist problems have increasingly attracted the attention of orthopaedic and hand surgeons. Numerous advances have been achieved in functional anatomy, biomechanics, diagnosis, and treatment. There are, however, many controversial aspects to these problems. Many clinical and associated investigators from around the world have attempted to increase our knowledge of the wrist with enthusiastic and devoted studies. An international symposium was held at the Nagoya Castle Hotel, Nagoya, Japan from March 6th through March 8th, 1991 to further understanding and promote discussion of wrist problems among a representive international group. Approximately 300 participants from 16 different countries assembled for these discussions. This monograph consists of 40 selected papers based on presentations given at the international symposium. The topics are divided into six chapters: Functional Anatomy, Diagnosis and Basic Studies; Kienbock's Disease; Scaphoid Fracture, Distal Radius Fracture; Carpal Instability and Wrist Pain; and Wrist Arthroplasty. A number of unique observations as well as detailed surgical techniques were presented. These include topics such as the vascularity of the triangular fibrocartilage, radial wedge osteotomy and vascular bundle implantation into the lunate for Kienbock's disease, Herbert screw insertion though a minimal exposure for acute scaphoid fracture, and closing wedge oseotomy of the radial styloid for the early stage of the SLAC wrist. It is hoped that this monograph will be of benefit to surgeons interested in not only achieving more satisfactory clinical outcomes, but also in stimulating further contemplation and research about these difficult wrist problems.

Fundamentals of Revision Hip Arthroplasty: Diagnosis, Evaluation, and Treatment is a unique and very timely book designed for surgeons who are beginning to more commonly encounter hip revisions in their practice. Unlike many traditional books on revision, Fundamentals of Revision Hip Arthroplasty does not focus on the most difficult and challenging of cases. Rather, Fundamentals of Revision Hip Arthroplasty is intended to guide the surgeon in the evaluation of the failed or painful total joint replacement, review basic tenants and surgical principles of revision arthroplasty, and guide the surgeon in determining whether a given case is one that should be managed or is best referred to a tertiary orthopedic center. Along with their 32 contributors, Dr. David J. Jacofsky and Dr. Anthony K. Hedley provide detailed information inside Fundamentals of Revision Hip Arthroplasty, including appropriate preoperative evaluation, equipment requirements, surgical planning, need for augments and allograft, and surgical techniques. Surgeons will be tackling hip revision surgery more frequently as the number of these cases is exponentially increasing. Fundamentals of Revision Hip Arthroplasty provides a "go-to" resource to turn to for guidance by community arthroplasty surgeons, arthroplasty fellows, and residents.

The Clubfoot: The Present and a View of the Future is a monumental source book of far greater magnitude and scope than has previously been written on this subject. It disseminates recent advances in basic and clinical research on the clubfoot. The introduction places the progress of the last 20 years in perspective. Papers present and evaluate the latest surgical techniques and the management of newly understood complications. The editorial comment section at the end of each chapter offers comparative analysis of the topics discussed in that chapter. This volume is a superb tool for pediatric orthopedists and orthopedists specializing in foot and ankle surgery who want to advance their knowledge of research, clinical management, and operative techniques in patients with clubfeet.

The idea for this treatise on the radiological anatomy of superficial and deep spinal cord vasculature evolved from daily routine neuroradiological work. This was also the reason for subdividing the monograph into a postmortem anatomical and a clinical part. The actual importance of a clear conception of radio anatomic fundamentals was made clear by many clinical conferences with neurologists, neurosurgeons and orthopedists, where a lack of knowledge about medullary syndromes of suspected vascular origin became evident. Also among neuroradiologists there is still widespread uncertainty in the interpretation of myelograms and angiographies in such cases. A study of the spinal cord's angioarchitecture is all the more justified and necessary considering the vast number of descriptions of cerebro vascular anatomy and pathology. The clinical challenge posed by patients suffering from partial or complete transverse spinal lesions has grown due to new diagnostic and therapeutic approaches. Myelography using water-soluble contrast media, X-ray computed tomography, magnetic resonance imaging and spinal angiography today allow and require both earlier and topographically and pathogenetically more exact classification of diseases of the spinal cord and its surrounding structures. Due to progress in microneurosurgery and interventional neuroradiology, even intramedullary lesions have become more and more accessible and treatable. Therefore this monograph mainly addresses those concerned with invasive therapeutic techniques and who are familiar with the interpretation of radio anatomic findings. A comprehensive description of medullary vascular syndromes would be beyond the scope of this treatise."

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"

For a long time I have felt that the present gynaecological training for registrars lacked familiarisation and understanding of the basic principles of surgery. This is due to several factors. Firstly, the historical separation of gynaecology from general surgery which led to our development as an independent speciality (and which Victor Bonney foretold to our detriment when he opposed the formation of the College of Obstetricians and Gynaecologists as a separate body from the College of Surgeons). Secondly, a vast improvement in medical management of many gynaecological conditions has made surgical practice dull and an unquestioning daily routine with little or no surgical instruction for many junior staff. Thirdly, the arrival of subspecialisation has exacerbated this, as complicated surgery may be referred out by the general gynaecologist. Finally, the trend in further education towards writing an MD rather than taking an FRCS degree. The arguments for and against were set out in an editorial in the British Journal of Obstetrics and Gynaecology (1983), later taken to task in the ensuing correspondence. That editorial. together with the difficulty in finding up-to-date articles on surgical principles in one volume, were the catalysts for this book. With the help of colleagues from other disciplines, I have attempted to present recent advances side-by-side with modern-day gynaecological practice.

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.