The explosive growth in the field of molecular biology over the last two decades has started to make a great impact on clinical medicine. Genes have been cloned for diseases that were poorly understood only a decade ago. Additionally, investigators are increasingly aware that there are strong genetic components to complex disorders, such as osteoporosis, that are not classically thought of as genetic disorders. New insights into the pathogenesis of metabolic bone diseases have been obtained from investigations into the molecular biology of these diseases and new therapies will become available based on these new insights. In The Genefies of Osteoporosis and Metabolie Bane Disease, I have assembled an internationally renowned group of experts to write the various chapters. Each of the authors is an expert in his/her field who is currently performing research on the content of their chapter and have made important contributions to the understanding of the clinical fea tures and pathophysiology of metabolic bone disease and genetics. The first part of The Genefies of Osteoporosis and Metabolie Bane Disease addresses issues related to genetic contributions to the development of osteoporosis and the many factors that must be considered when searching for genesthat predispose to osteoporosis. The second sec tion addresses recent advances in the clinical and molecular biological aspects of inherited metabolic bone disorders. The last section reviews the latest techniques for finding genes that predispose to metabolic bone diseases.

Osteoarthritis (OA), the most common form of arthritis, is generally characterized by a slowly progressive degeneration of articular cartilage, particularly in the weight-bearing joints. It has a stronger prevalence in women, and its incidence increases with age. OA is a major and growing health concern in developed countries, owing to steadily increasing life expectancy and the demand for better quality of life. Because of its chronic nature and nonfatal outcome, OA affects the growing population of the elderly over an increasing time span. Moreover, despite its relatively benign character, OA is one of the most disabling diseases; it is responsible for increasing financial and social burdens in terms of medical treatments, forced inactivity, loss of mobility, and dependence. Despite a growing awareness of OA as a medical problem that has yet to reach its maximum impact on society, there is a surprising absence of effective medical treatments beyond pain control and surgery. So far, only symptom-modifying drugs are available, while there remains a major demand for disease-modifying treatments of proven clinical efficacy. This demand will hopefully be met in the future by some of the drugs that have been pressed into development and are now at different stages of clinical investigation. Nevertheless, the current lack of effective treatments reflects a still insufficient knowledge of cartilage with respect to its metabolism, interactions with other joint tissues, and causes and mechanisms (possibly of very different nature) leading to failure of its turnover.

A cutting-edge review of the biochemical, physiological, pharmacological, genetic, and molecular interactions involved in the development and homeostasis of the skeleton. Topics range from chondrogenesis, chondrocytes, and cartilage to skeletal dysmorphology, and include the control of skeletal development, osteoblastic cell differentiation, and bone induction, growth, remodeling, and mineralization. The authors' understanding of bone physiology-and how it is modified throughout all the stages of life-offers novel approaches for improving the endurance of load-bearing implants, achieving life-long optimal bone strength, overcoming microgravity situations (space flight), and hastening the healing of fractures, osteotomies, and antrodeses.

The last decade has seen a tremendous advance in our understanding of bone biology. The genes responsible for the majority of rare inherited bone disorders have been identified and much progress has been made in the identification of genes in polygenic disorders such as Paget's disease and complex multigene diseases such as osteoporosis. Transgenic technology has identified further genes, sometimes unexpectedly, with profound effects on bone. This wealth of new genetic information will undoubtedly lead to extensive cell biological studies to understand the mechanisms by which these gene products affect bone mass and bone strength. In Bone Research Protocols a catalogue of protocols has been assembled to perform such mechanistic studies. In the tradition of the Methods in Molecular Medicine series, the chapters are practical laboratory protocols that should enable the reader to carry out the techniques from scratch. To our knowledge this is the first time such a truly practical manual on well-established bone methods has been assembled, and this volume aims to be complementary to and follow on from the more theoretical Methods in Bone Biology, edited by Arnett and Henderson (1).

The varus knee has a group of bone and ligament abnormalities that must be addressed to correct the deformity. The mechanical axis of the femur is tilted medially relative to the long axis of the tibia. The distal femoral surface usually remains in valgus alignment to the long axis of the femur. Most of the varus deformity is caused by deficiency in the medial tibial plateau. The deep and superficial medial collateral ligaments are contracted and deformed by osteophytes.

Hip replacement surgery is a radical and traumatic procedure that has enormous disadvantages to the patient in terms of postoperative mobility and morbidity. Hip resurfacing is a more conservative approach resulting in less of the patient 's hip and femur being lost, which has great advantages to a younger patient group. The author of Hip Resurfacing is the world 's leading authority on this surgery, making this the definitive resource in hip resurfacing

Biomedical devices that contact with blood or tissue represent a wide range of products. Depending on their potential harm to a body, medical devices are categorized according to the degree, so their safety can be assured. All biomaterials are by definition designed to contact with a body for a certain period of time. The nature of the body contact, as well as the duration a material contacts with the body may initiate unwanted biological In comparison with invasive devices Oike catheters and medical responses. implants contact directly with tissue or with the circulating blood) non invasive devices (like wound-dressings and contact lenses contact with the skin, the sclera, and the mucosa or with open wounds) have a lesser risk of hurting a patient. When blood contacts with a foreign material, plasma proteins become absorpted to the surface within a few seconds. The reactions that follow, the so-called intrinsic pathway lead to the formation of fibrin and activation of platelets and white blood cells, result in blood clot formation."

Bone research in recent years has generated much new knowledge, in large measure because of the broad public health implications of osteoporosis and related bone disorders. Bone Formation, the first in a series entitled Topics in Bone Biology, evaluates this new information and formulates novel insights and hypotheses within the broad framework of current knowledge. An easy-to handle and to read work, with concise reviews that are extensively referenced, the chapters in this book are written by internationally known authorities. Particular emphasis is on osteoporosis and related disorders of diminished bone formation. Among the general topics treated is a chapter on biomechanical aspects of bone formation, not often considered in relation to diseases of bone formation. The book constitutes essential reading for those entering the field of bone biology and those who wish to become familiar with up-to-date information in a particular area of bone research.

There is currently no single book with up to date information on osteoclast function and bone resorption.

A useful collection of information, not readily available in a concentrated and convenient form on the market.

Provides a comprehensive overview of the field.

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

This volume discusses the background and various clinical applications of radiation therapy in the treatment of non-malignant diseases. It documents the radiobiological and physical principles of treatment and the rationale underlying the use of radiotherapy for various disorders of the CNS, head and neck, eye, skin and soft tissues, bone and joints, and vascular system. In so doing, it draws attention to and elucidates the scope for application of radiotherapy beyond the treatment of malignancies. Both the risks and the benefits of such treatment are fully considered, the former ranging from minor clinical problems to life-threatening diseases.

Because of the relatively low incidence of involvement efforts to enhance the diagnosis and management of elbow pathology are not common. Nonetheless, because of a rapidly expanding knowledge base,both with regard to a more - fined understanding of elbow pathology, coupled with exciting and emerging approaches and options for management, it is appropriate and timely to - dress this deficiency in the orthopedic literature. This volume, therefore, was produced in order to provide current and relevant information with content that is drawn from a very well received symposium of the same name as this book and convened in Modena, Italy recently. As with the symposium, the s- cific goals of this text are to provide the most updated concepts in the m- agement of a full spectrum of elbow pathology. The content, therefore, is c- prehensive in nature,but with a focus on emerging options in the management of traumatic conditions as well as reconstructive options for the sequelae of trauma. These topics are covered in detail in the 31 chapters which comprise this text. The focus of each chapter was specifically designed to address the topic in the most timely fashion and with less of an emphasis on the historical context and more focus on current thinking. The references documenting c- tent are intended to be efficient and focused. In addition, the popular and - propriate expectation of the orthopedic community of enhanced explanation of technique are featured in the appropriate chapters.

Edited by two leading orthopedic surgeons who are specialists in the treatment of hemophilia, Orthopedic Surgery in Patients with Hemophilia shows all the surgical techniques needed for surgical treatment of musculoskeletal complications of hemophilia. A practical guide, designed for use on the ward or in the office, this book draws on the experience of numerous specialists worldwide, from developed and developing countries. As well as orthopedic surgery, it also covers research, hematology, and rehabilitation. Although of primary interest to the orthopedic surgeon, rheumatologist, and physiotherapist, this book will also be relevant to the hematologist responsible for the care of the hemophiliac patient.

For more than 30 years, the highly regarded Secrets Series (R) has provided students and practitioners in all areas of health care with concise, focused, and engaging resources for quick reference and exam review. Spine Secrets Plus, 3rd Edition, by Dr. Vincent J. Devlin, features the Secrets' popular question-and-answer format that also includes lists, tables, pearls, memory aids, and an easy-to-read style - making inquiry, reference, and review quick, easy, and enjoyable. The proven Secrets Series (R) format gives you the most return for your time - succinct, easy to read, engaging, and highly effective. Fully revised and updated throughout, including protocols and guidelines that are continuously evolving and that increasingly dictate best practices. Expanded PLUS format includes extended coverage, a larger format, colorful visual elements, and larger, detailed images and illustrations to provide an overall enhanced learning experience. Remain at the forefront of the nuances of spine surgery and related specialties with updates on new techniques and technologies, as well as changing treatment options and drug information. Top 100 Secrets and Key Points boxes provide a fast overview of the secrets you must know for success in practice and on exams. Zero in on key information with bulleted lists, mnemonics, and practical tips from prominent specialists - all providing a concise overview of important, board-relevant content. Portable size makes it easy to carry with you for quick reference or review anywhere, anytime. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

This is a compendium of data pertinent to the methods and protocols that have contributed to recent advances in molecular medicine in general, but to the molecular basis of rheumatic disease in particular. These volumes details novel technologies, some of which are still evolving and whose impacts are yet to be determined. Leaders in the field contribute to cover exciting and cutting edge topics. This compendium will be a valuable tool.

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.

"Knee replacement is bound to fail-providing the patient lives long enough." There is some truth in this hoary cliche, so why write books on the subject? I think the answer is that knee replacement has at last become established and even respectable. The more absurd surgical extravaganzas have been recognised and discarded; today a patient can expect to rely on his new knee to serve him with comfort for a fair number of years. Of course even the early knee replacements often made the patient comfortable; the trouble was they just did not last. All too often the innovator's enthusiasm was overtaken by the patient's disillusionment. Indeed, the operation might well have been abandoned had it not been for the hope that one day the dazzling results at the hip might be matched at the knee. These pioneer prostheses were designed as though the knee were biomechanically as straightforward as the hip. Alas, numerous complexities soon became apparent; in response the models multiplied-and multiplied-until the ordinary orthopaedic practitioner became hopelessly bewildered. He found himself subjected to high pressure propaganda; from the surgeon offering a miracle cure, from the engineer seeking fame and from the manufacturer expecting fortune. Visiting his unit as a team, this trio was well-nigh irresistible.

The most frequently requested investigation in any nuclear medicine department remains the technetium-99m (99mTc)-labelled diphosphonate bone scan. Despite rapid advances in all imaging modalities. there has been no serious challenge to the role of bone scanning in the evaluation of the skeleton. The main reason for this is the exquisite sensitivity of the bone scan for lesion detection. combined with clear visualisation of the whole skeleton. In recent years several new diphosphonate agents have become available with claims for superior imaging of the skeleton. Essentially. they all have higher affinity for bone. thus allowing the normal skeleton to be visualised all the more clearly. However. as will be dis cussed. this may occur at some cost to the principal role of bone scanning. lesion detection. The major strength of nuclear medicine is its ability to provide functional and physiological information. With bone scanning this leads to high sensitivity for focal disease if there has been any disturbance of skeletal metabolism. However. in many other clinical situations. and particularly in metabolic bone disease. more generalised alteration in skeletal turnover may occur. and quantitation of diphosphonate uptake by the skeleton can provide valuable clinical information."

Disorders of the Achilles tendon are universal, affecting people in a wide range of age groups. Because the Achilles tendon is one of the most pow- ful musculotendinous structures in the body, the impact of an injury to the Achilles tendon becomes magnified. There is a wide range of disorders or problems that can involve the insertional region, where pathology may rest with bone, tendon, or bursae. A completely different set of pathologic entities resides in the noninsertional region, one of which may include the frustrating degenerative tendinopathy. As our growing population ages but remains phy- cally active longer into life, the incidence of these disorders will continue to increase. I am proud to be given the opportunity to write the foreword to this text, which is intended for foot and ankle surgeons worldwide. Seldom does a book on a single entity become a current concepts review, as this work has. Too often, textbooks are not published for several years after the chapters have been written, making them obsolete upon publication. Not so with this book, which deals with timely topics on the Achilles tendon. Dr. James Nunley has compiled this work in slightly over a year, thus providing the reader with sta- of-the-art material. Dr. Nunley had the foresight to create a much needed techniques-oriented book dealing with the complexities of the Achilles tendon. His approach was to develop a comprehensive guide to managing Achilles tendon problems.

Plain radiography is still alive. In many institutions, including ours, conventional radiography has been replaced by digital systems including imaging-plate-based computed radiography and fat-panel detector-based digital radiography. Even for the education of radiation technologists, conventional flm-screen radiography has been de-- phasized, and their education is concentrated on digital systems. Spatial resolution of a conventional system is still far better than the current digital systems, although the dynamic range is wider in the latter system. Industrial flm radiography with small grain size and direct exposure has an even higher resolution, and such hi- resolution systems are something we lost in the transition from the conventional system to the current PACS-friendly system. I am pleased to know that Giuseppe Guglielmi and Wilfred Peh have published this textbook of high-resolution hand radiographs that cannot be obtained with any other techniques. Radiography has always been the most important modality in the evaluation of the hand, and, moreover, high-resolution industrial flms are extremely efective in the evaluation of the hand, particularly for assessing subtle erosions. Hands are not just one of the peripheries of the human body. Tey refect conditions of the whole human body. Not only the metabolic status, but also many congenital disorders are manifested in the hand. Radiographic fndings of the hand are ofen specifc, and contribute to the diagnoses a great deal. Tere have been several publications concerning the radiology of the hand, and they have been well accepted.

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

It is indeed a pleasure to prepare the foreword for vidual surgeons. In addition, it can be read from this text, mainly because I am now a senior ortho- front to back as a history of orthopedics. We are pedist who has known so many of the great ortho- all indebted to S. B. Mosto? for this fascinating pedists who are described in such great detail in book. It is truly a text for everyone who has an this book. Some of the named physicians have interest in orthopedics, and surely should be read been my very close personal friends, many have by orthopedic trainees, faculty members, and been my teachers, professors and colleagues. practicing orthopedists. I suggest it be placed in Indeed, these physicians through their contribu- every library in medical institutions and hospitals. tions have made the ?eld of orthopedic surgery what it is today worldwide. Charles A. Rockwood, Jr. , MD This is a wonderful source of information on University of Texas Health Science Center the interesting lives and contributions of the indi- San Antonio, TX, USA vii PREFACE My obsession with history goes back a long way. To keep the book readable and reasonable in Some years ago I began to focus my curiosity on size, I sadly had to cut down the number of individuals whose names are attached to orthope- entries.

This is the first book to cover minimal-invasive treatment of osteoporotic, tumorous and traumatic vertebral fractures in the English language. In addition to detailed descriptions of the techniques, including tips and tricks from experts, the book contains a chapter about the medical treatment of osteoporosis, which is indispensable in the interdisciplinary approach to osteoporosis. This acclaimed innovative concept unites several treatment aspects. More conservative treatment methods are also presented in this work.

All chapters reflect new developments and clinical findings in the field of orthopaedics, surgery, traumatology and neurosurgery.

th This book contains most of the papers presented at the Iy Inter- national Symposium on Bone Circulation which was held in Tou- louse, France, in September of1987. The symposium was attended by over 200 specialists from 17 different countries. Some of them were in Toulouse for the fourth time to discuss their favourite topic of study and research: bone circulation, its exploration, its pathol- ogy. Many, including a group of Japanese orthopaedic surgeons, were present for the first time, delighted to meet the authors of papers they had read. There were more than 100 oral presentations and posters, but many meaningful informal discussions took place both in and outside of the auditorium, in the hall and during meals. The organizers wished to maintain a balance between funda- mental themes and subjects of clinical and practical interest. This balance was accomplished: recent developments including scintig- raphy, magnetic resonance imaging and bone grafts played just as important a part as more sophisticated topics such as the evalua- tion of the blood flow rate in animal bone tissue. Thus, as did the previous symposia, this book aims to present a progress report on developments during the last 5 years in the study of bone circulation. We wish to thank all those who helped and encouraged us throughout the organization of the congress, especially C. Ar- noldi, M. Brookes, R. Burkhardt, L. Coutelier, S.P.F. Hughes, P. Kehr, J.P. Jones, A. Trias, K.Ono, T. Yizkelety and G.J.

Our common interest in surgery of the vertebral artery was born in 1976, when as residents in the same hospital, we attended an attempt by two senior surgeons to treat an aneurysm of the vertebral artery at the C 3 level. Long discussions had preceded this unsuccessful trial, to decide if surgery was indicated and to choose the surgical route. Finally a direct lateral approach was performed, but access was difficult and correct treatment was impossible, resulting in only partial reduction of the aneurysmal pouch. Following this experience, we decided to seek a regular and well defined approach for exposition of the vertebral artery. Review of the literature indicated some surgical attempts, but the descriptions did not give the impression of safety and reproducibility. No landmark on the described surgical route appeared sufficiently reliable. Henry's anatomical work (1917) gave the only accurate description on vertebral artery anatomy, and it became the basis for our work. When the same patient was referred again one year later, after a new stroke in the vertebro-basilar system, we had behind us repetitive experience on cadavers of an original approach to the distal vertebral artery.