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In the last 10 years, total prosthetic replacement has become the
hip oper ation for many but not all surgeons. In our clinic the
increasing frequency of TP has been paralleled by a reduction in
the frequency of 10 and HA. For the experienced orthopaedic surgeon
and hip surgeon, hip disease has so many facets that it could not
possibly be tackled with one operation alone. Thus, HA seems
recently to have won renewed recognition. It has once more become
the procedure of choice in specific cases, possibly because of
certain disadvantages and complications associated with TP which
have somewhat tempered the original optimism. Currently, the risk
of infection or loosening of the pros thesis is such that the
operation cannot justifiably be recommended for patients under
55-60 years of age. In contrast with HA, in the majority of cases
the results of TP or 10 are not fully predictable. The loss of
joint motion is offset by two important advantages: -complete
freedom from pain - full weight bearing is possible on the
arthrodesed hip. On following up our HA operations from 1961 to
1971, we examined the development of the operative procedures in
our clinic. We found that the range of indications had narrowed as
stricter criteria were applied in choosing patients for operation.
Adequate and precise operative tech niques were developed. We
studied the biomechanics of the hip joint exten sively (effect of
arthrodesis on the statics and dynamics of the hip joint and
neighbouring joints).
The publication of this Cast Manual is very timely. Technological
advances made in the past two decades have resulted in increased
popularization of open reduction and internal fixation in the treat
ment of long bone fractures. Due primarily to incorrect application
of those techniques, it has become increasingly apparent that its
routine and casual use can result in complications - oftentimes of
catastrophic nature. Students and practitioners of orthopedics must
keep uppermost in their minds that osteogenesis takes place
spontaneously through an orderly and physiological process.
Surgical intervention and the intro duction of a foreign body at
the fracture site alters that process. Though the fracture heals,
it does so not because of the mechanical device but in spite of it.
Therefore, internal fixation must be reserved only for those
instances when its practical advantages heavily out weigh its
biological disadvantages. The success of nonsurgical treatment of
fractures is also predicated on the clear understanding of fracture
healing and the proper application of stabilizing techniques. This
cast manual emphasizes the importance of proper application of
various casts and discusses very well those details which are
important for the success of nonsurgical treatment of fractures.
Dr. F. FREULER, Dr. U. WIEDMER, and D. BIANCHINI'S Cast Manual must
be read carefully by students of orthopedics and used as a
reference book for those who should keep abreast of new concepts
and techniques of closed management of fractures. Summer 1979
AUGUSTO SARMIENTO, M. D."
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