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."

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.

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."

Recent experience of the treatment of segmental idiopathic necrosis of the femoral head are discussed in this book by several experts. The discussed methods oftreatment are practically unknown in the US orthopaedic literature. It describes alternate methods of treatment with regard to total joint replacement In Chapter 1 Dr. Wagenhauser expresses his thoughts on posture and its affects on the human body. The following 7 chapters focus on diagnosis and treatment of idio pathic necrosis of the femoral head - an especially timely subject since the incidence of this disease, which primarily affects males during the most active period of their lives, seems to be increasing. New Haven, Connecticut, August 1981 Ulrich H. Well The Question of Posture F. J. Wagenhliuser Every expert would agree with Taillard (1964) that. posture is the most unsettled of all orthopaedic problems. Its onus of ambiguity no longer concerns orthopaedists alone, nor is it limited only to the fields of medical practice and research. It is, rather, a fundamental question spanning a wide range of sciences and occupations that deal with human exist ence and actions. Therefore fascination with this problem has steadily increased. Ques tions on human posture, its concepts and terminology, its normal forms and variations, the diagnosis of pathologic disorders, and their response to treatment concern many of today's anatomists, pathologists, physiologists, orthopaedists, rheumatologists, pediatri cians, gerontologists, psychiatrists, psychosomatic therapists, physiologists, behavioral therapists, and epidemiologists."

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.

The introduction of the operating microscope as a surgical tool revolutionized the treatment of peripheral nerve lesions. A new era thus began in the early 1960s, which led to a substantial improvement in the management of nerve lesions. The results of nerve grafting techniques have demonstrated that, independent of the length of the defect, lesions can be successfully bridged. The free tissue transplants with microvascular anastomosis have also opened new, rewarding possibilities for peripheral nerve reconstruction procedures, facilitating the achievement not only of satisfactory anatomical but also of satisfactory fUhctional results. In order to evaluate the state of the art and reflect retrospectively on 25 years of microneurosurgical treatment of peripheral nerves, numerous outstanding scientists and clinicosurgical physicians were invited to Hanover in order to exchange their viewpoints and experiences. An active und fruitful discussion resulted which dealt with the many aspects of anatomy, pathology, clinical and neuro physiology, diagnosis, and with the surgery and physiotherapy which constitute modern-day peripheral nerve lesion treatment. The excit ing ongoing experimental and clinical activities have led us to support the wish and idea to publish the scientific exchange which took place during the Hanover symposium. I truly believe that the articles presented in this book cover so many interesting subjects concerned with peripheral nerve lesions that the book will serve the interested and dedicated physician involved with such cases as a reference work for the basics and also provide him with the therapeutic guidelines to assist him in his daily work."

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.

As one of the leading specialists in hip arthroscopies, Dr. Joseph McCarthy's proposed text Early Hip Disorders promises to become a definitive addition to the field. Featuring full color, arthroscopic views and contributions from such prestigious figures in the orthopaedic community as John McGinty, Richard Villar and James Bono, this text will cover all the essentials of hip arthroscopy including: examiniations, arthroscopic procedures for loose bodies, labral injuries, defects of the femoral head and acetabulum, treatment for infections, tumors, differential diagnosis and, most uniquely, a section on pediatric hip injuries. In addition, this text will provide the surgeon with detailed analysis of cost considerations and comparison with open hip procedures as well as outcome analysis. This text is a must- have for any orthopaedic surgeon interested in learning the newest procedures in the treatment of hip injuries and providing their patients with the safest, most effective treatment available.

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.

Sonography is a noninvasive diagnostic method that has gained an established place in many branches of medicine. Although the inability of ultrasound to penetrate bone delayed its application in the orthopedic field, the successful work of R. Graf in the early detection of pediatric hip disorders with ultra sound has served as an impetus for the increasing use of sonogra phy to detect and evaluate abnormalities of the musculoskeletal system. It is certain that further advances in this modality will be forth coming, and that sonography will be applied to new lines of inves tigation in orthopedic diagnosis. In Arthrosonography the authors use concise text and copious illustrations to demonstrate the potential applications of articular ultrasound, its diagnostic capabilities, and technical aspects of the ultrasound examination. Potential pitfalls are also explained. This book is the logical outcome of the application of diagnos tic ultrasound in orthopedics and rheumatology. It covers all basic practical aspects of arthrosonography and will be a valued re source for those concerned with the evaluation of the musculo skeletal system. HANS RETTIG Contents Introduction . . . . . . . . . . . . . 1 The Piezoelectric Effect - The Basis of Modem Sonography . . . . . . 1 Ultrasound Techniques. . . . . . . . . . . 1 General Principles of Diagnostic Ultrasound 2 Landmarks for Arthrosonography 6 Artifacts ........ . 6 Reverberations . . . . . 7 Hyperbolic Artifacts . . 7 Acoustic Mirror Image . 8 Special Phenomena in Arthrosonography 8 "Wandering Echo" Phenomenon . ."

Since 1958 the Association for the Study of Internal Fixation (ASIF) has worked to establish the experimental and biomechanical prin ciples of the operative treatment of fractures. It has been proven that immediate, pain-free mobilization, made possible by stable internal fixation, is the key to restoring function in a fractured extremity. The same principles were applied in 1972173 by Roland Schmoker, who developed a universal plate and sophisticated instrument set designed initially for the treatment of comminuted fractures of the mandible. To extend the applications of his plate to reconstructions after ex tensive tumor resections, he supplemented the device with tem poromandibular joint prostheses and anchoring elements for the at tachment of dentures. He first tested the functional stability of these implants experimentally in sheep. Later he found that the minipig had a more human-like jaw shape and masticatory action, and so he tested the implants in 37 mini pigs that underwent extensive mandibular re sections without bone grafting, using sequential dye injections and postoperative weight gain to chart the progress of osseous regener ation. Seven other animals were not operated and served as controls."

The number of studies on chronic and recurrent pain bears no relation to the frequency of these complaints in gynecologic practice, nor to the clinical and scientific problems that still need solving in this area. Several factors stand in the way of progress in this field, such as the strongly subjective nature of the complaints, the frequent lack of correlation between them and objective findings, and the complexity of the psychosomatic interac tions involved. Although progress in our knowledge has been much slower than we would have wished, and although we are well aware of these many gaps, it was considered useful to gather in a book what we think we have learned during 3 decades of active interest in pain patients and pain problems in gynecologic practice and 12 years of supervision of a pain clinic in the Department of Obstetrics and Gynecology of Leuven University. As there are many differences between acute pain - clinical as well as experi mental - on the one hand and chronic pain symptoms on the other, it was felt preferable to limit the scope of this book essentially to chronic and recurrent pain in gynecologic practice. When presented with a complaint of lower abdominal and/or low back pain, the gynecologist should constantly be on the lookout for nongynecologic causes, of which the most frequent will be either gastroenterologic or orthopedic and sometimes urologic. I have been fortunate in obtaining the collaboration of Dr."

Inherited skeletal disorders have a fascination for many medical and surgical disciplines. For the geneticist there is interest in the study of families and their inheritance of lesions. The paediatrician is concerned because most of the disorders present in childhood as a problem in clinical differential diagnosis. The radiologist is interested because of the manifest, multiple and curious bone changes that provide a challenge in diagnosis and classification. The orthopaedic surgeon is involved because they present a challenge in the management of the many and various lesions of the limbs and trunk. Most of the text books are slanted towards one or other aspect of the subject, depending upon the specialist interests of their author. Though informative to colleagues in their own discipline, the information which they contain is liable to be overwhelming in its complexity or unhelpful in its content for the orthopaedic surgeon or trainee. Frank Horan and Peter Beighton have aimed their admirable and concise monograph to help the orthopaedic surgeon-the one individual who is likely to be able to ameliorate the musculo-skeletal problems from which so many of the children and adults with these diseases suffer. In recent years, much more orthopaedic help has become available for dysplastics.

The reconstructive surgery of posttraumatic deformities has made significant advances in recent years. Reports on technical progress and clinical results are encouraging, even though they have often raised patient expectations to an unrealistic level. The operative methods available to us today enable corrective osteotomies to be performed with a high degree of accuracy and success. Precisely because the sequelae of trauma are so difficult to schematize, every case must be evaluated individually based on a critical assessment of subjective complaints, diagnosis and prognosis before a decision can be made. The planning and execution of corrective procedures are carried out with the same meticulous care as for idiopathic limb deformities. However, the occurrence of a traumatizing event with its immediate and long-term complications calls for special insight in the setting of therapeutic goals. It is essential that the patient be appraised of the results that can reasonably be expected and of the risks that are involved. Success in therapeutic procedures requires detailed theoretical knowledge, thorough operative training, and a strong commitment on the part of the surgeon. It is these aspects of the corrective surgery of posttraumatic deformities with which the editors are principally concerned.

The first edition of Surgery of the Hip loint has had certain measures of success. Its cover won the Outstanding Award for art at a publishers trade show. A year later it was translated into Spanish for exposure to the vast world of the Spanish speaking peoples. As I traveled through Europe, it was repeatedly a pleasant surprise to have the book recognized as an authorita tive reference. This was a great tribute to the experts whose diligent efforts made it all possible. Apparently the book has stood the test of time to judge from the many inquiries and constructive comments made toward urging us on to write a second edition. It was not an easy task to gather another cadre of authorities to update our knowledge of the hip joint. People who have earned respected positions in their field are unavoidably burdened with a busy schedule, so a chapter in this text must be appreciated as coming from someone devoted to giving up some of his precious time for the sake of sharing his knowledge with peers and students."

The current interest in developing novel materials has motivated an increasing need for biological and medical studies in a variety of dinical applications. Indeed, it is dear that to achieve the requisite mechanical, chemical and biomedical properties, especially for new bioactive materials, it is necessary to develop novel synthesis routes. The tremendous success of materials science in developing new biomaterials and fostering technological innovation arises from its focus on interdisciplinary research and collaboration between materials and medical sciences. Materials scientists seek to relate one natural phenomenon to the basic structures of the materials and to recognize the causes and effects of the phenomena. In this way, they have developed explanations for the changing of the properties, the reactions of the materials to the environment, the interface behaviors between the artificial materials and human tissue, the time effects on the materials, and many other natural occurrences. By the same means, medical scientists have also studied the biological and medical effects of these materials, and generated the knowledge needed to produce useful medical devices. The concept of biomaterials is one of the most important ideas ever generated by the application of materials science to the medical field. In traditional materials research, interest focuses primarilyon the synthesis , structure, and mechanical properties of materials commonly used for structural purposes in industry, for instance in mechanical parts of machinery.

The subtitle of this book - A Holistic Approach to Rehabilitatio- underscores our fundamental point of view regarding spinal ailments. The patient with his ailments should be at the focus of attention, yet the subtitle combines two important elements, namely, "rehabilitation" and "holistic approach. " It is only by combining both concepts to show that they do belong together that the door to successful treatment of persons with vertebral problems can be opened. Holistic medicine does not require an ideological classification of its own, but should be under stood as a unified, optimal form of medicine which encompasses the whole person: his health and his illnesses in all their aspects. Too often, there is an automatic, senseless separation of the two concepts. Purists in one or the other camp need to recognize the common ground and to eliminate the barriers that have been erected by extreme positions and attacks. When we look back into history, we can see that there have always been schools of medical thought that have promulgated one or another direction. Evaluations and interpretations change in accordance with our knowledge and the times themselves, but that which is most valu able remains in end effect, forming the starting point for following gen erations. It should be noted that the entire body of medical knowledge had its beginnings in empiricism, whose ideas could not be confirmed and supported until much later, parallel with the developments in research technology."

Arthroscopic Laser Surgery: Clinical Applications is designed to introduce the use of lasers to the orthopaedic surgeon who performs arthroscopic surgery and is the first text of its kind entirely devoted to the unification of these two exciting technologies.
This groundbreaking work examines the following subjects: - the basic sciences of laser arthroscopy as well as the history of its development - techniques for arthroscopic laser applications in the knee, for carpal tunnel release, ankle, shoulder, and much more - practical, clinical guidelines on its advantages, disadvantages, and complications - technical overview of the laser systems currently in use in the United States and worldwide - important safety measures and administrative issues - glossary of terms and reference sources.
Each chapter is written by an arthroscopic laser surgeon distinguished in both his knowledge of the topic addressed as well as by his expertise with that specific laser arthroscopic system. Over 120 full-color illustrations enhance the presentation. The definitive text of arthroscopic laser surgery applications and technique, this volume is a must-have information source for all orthopaedic surgeons.

Interest in bone densitometry methods has recently experienced a resurgence within the medical community. Physicians have become more interested than ever before in the diagnosis and treatment of degenerative diseases of bone such as osteoporosis. The public perception of osteoporosis and its prevention has been recently heightened. Because osteoporosis is widespread, especially in women, and leads to an increase in fractures in our population, many re searchers and clinicians are strongly motivated in their search for more sensi tive and accurate methods of diagnosis. This book was written for physicians, scientists, engineers, medical phy sicists, and others desiring an introduction or further understanding of this exciting field. Beginning with the early development of x-ray film methods for assessing bone status, the field has steadily grown throughout the years. Novel and interesting devices have been designed for the measurement of bone mass, bone density, cortical thickness, and other parameters of bone changes. Both qualitative and quantitative bone methods are described. The techniques include imaging devices such as CT and radiography as well as fixed point methods in which bone characteristics of a region of interest are analyzed."

Since the first edition of this book, sonography of the peripheral nervous system has evolved further. This second, revised edition includes many state-of-the-art high-resolution images, the text has been adapted to reflect the current state of the literature, and information is presented using a more modern layout. This book provides a practical, clinically oriented overview of all aspects of sonographic diagnosis and interventional therapy of the peripheral nervous system.

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.

Why anDther series .on infectiDus disease? The questiDn is a fair .one in view .of the proliferatiDn .of mDnDgraphs, texts, and periDdicals .on the vast subject .of infectiDus disease. The gDal .of this series is tD provide an additiDnal service tD the clinician in the fDrm .of clinical infDrmatiDn nDt usually assembled in .one convenient vDlume. One type .of mDnDgraph presented in this series will CDver a specific infecti.on, detailing microbi.ol.ogic research and clinical aspects. It is h.oped that such a cDmpilati.on will be helpful in bDth its thDroughness and breadth tD the clinician interested in this particular problem. The .other type .of mDnDgraph that this series will pr.ovide will discuss a clinical presentati.on that c.omprises many pDssible specific etiDI.ogies. V.olumes in the series will be multiauthDred, giving us the DppDrtunity tD invite auth.orities in each specific area t.o cDntribute their expertise and experience. Regular revisions are planned SD that each v.olume will remain as current as it is thorDugh. We hDpe that .our gDals are met and that the present series .of mDn.o graphs establishes its .own identifiable and valuable niche in the growing cDmpendium .of resDurce material available tD the clinician. Contents Series Preface ....................................................... VB Contributors .......................................................... Xl Introduction ......................................................... xv 1. Acute Osteomyelitis FRANCIS A. WALDVOGEL ...................................... ."