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Textbook of Textbook of Orthopaedics has been written keeping in view the fast pace of changes in medical technology, the treatment and the protocols that have evolved recently. The textbook aims to serve the requirements of undergraduate medical and young postgraduate students in orthopaedics. It w...
Orthopaedics
has been written keeping in view the fast pace of changes in medical technology, the treatment and the protocols that have evolved recently. The textbook aims to serve the requirements of undergraduate medical and young postgraduate students in orthopaedics. It will also greatly benefit the students of courses in physiotherapy, nursing and related disciplines. All aspects of orthopaedic disorders are touched upon in a precise and clear way. Written in a simple and easy to understand language, the text has been supplemented by relevant clearly drawn colour line diagrams and radiographs. Clinical pictures have been added wherever necessary for better understanding of the subject. The section on clinical examinations provides a systematic approach to case presentations. Taking and engaging the easily understandable approach, this comprehensive textbook is designed to help the students master essential concepts of orthopaedics and perform well in theory as well as practical examinations.
• • • • •
Clear, reader-friendly style of presentation A large number of easily reproducible line diagrams to make learning interesting Appropriate clinical photographs, X-rays and MRIs to supplement understanding of difficult topics A separate section on clinical examination describing systematic approach to various clinical cases Common cases included for practical examination, along with relevant X-rays and clinical photographs • A special section on radiology, Orthopaedic implants and orthotics covering important topics for viva voce examination.
Binoti Sheth
MS,DNB, MNAMS, FCPS, D Ortho
is currently Associate Professor and Unit Head, Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and Hospital, Sion, Mumbai. She has a brilliant academic career with more than 20 years of teaching experience. She has published many papers in national and international journals of repute. She has received many international awards like Japanese SICOT award, Pillar de Zamudio fellowship, AO fellowship, etc. for her excellent work in orthopaedics. Her earlier book Practicals in Undergraduate Orthopaedics has been very popular among students. An academician of repute, she possesses deep appreciation of orthopaedics as well as has a great passion for teaching.
Muqtadeer Ansari
MS, DNB, MNAMS
is currently Associate Professor, Department of Orthopaedics, Goverment Medical College, Aurangabad. He has worked at Lokmanya Tilak Medical College, Sion, Mumbai, with Dr CJ Thakkar, a renowned joint replacement surgeon, and Dr AB Goregaonkar, a renowned spine surgeon). He is a skilled spine and joint replacement surgeon with many research publications in international and national journals. He is a faculty for many spine and trauma workshops and conferences. He is member of North American Spine Society, Association of Pelvi-Acetabular Surgeons of India and Indian Society of Hip and Knee Surgeons.
Atul Kantilal Patil
Textbook of
Orthopaedics
MS, DNB
ISBN: 978-93-86478-15-3
Sheth | Ansari | Patil
is currently Associate Professor, Department of Orthopaedics, Terna Medical College, Navi Mumbai. He has an illustrious career as an orthopaedic surgeon, an academician and a teacher spanning over a deacde. He is an expert in advanced spine, major joint arthroplasty and complex trauma surgeries. He has to his credit many research publications in international and national journals. He is faculty and organiser of many spine and trauma workshops and courses with keen interest in conducting hands on and cadaver workshops for postgraduate training. He is a favourite teacher amongst his undergraduate and postgraduate students.
Dedicated to Education
Orthopaedics
Key Features
Textbook of
Textbook of
Binoti Sheth Muqtadeer Ansari Atul Kantilal Patil
CBS Publishers & Distributors Pvt Ltd 4819/XI, Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, India E-mail: delhi@ cbspd.com, cbspubs@ airtelmail.in; Website: www.cbspd.com
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Textbook of
Orthopaedics
Textbook of
Orthopaedics Binoti Sheth Associate Professor and Head of the Unit Department of Orthopaedics Lokmanya Tilak Municipal Medical College and Hospital Sion, Mumbai
Muqtadeer Ansari Associate Professor Department of Orthopaedics Government Medical College Aurangabad
Atul Kantilal Patil Associate Professor Department of Orthopaedics Terna Medical College, Navi Mumbai
CBS Publishers & Distributors Pvt Ltd New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai Hyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand
Disclaimer Science and technology are constantly changing fields. New research and experience broaden the scope of information and knowledge. The authors have tried their best in giving information available to them while preparing the material for this book. Although all efforts have been made to ensure optimum accuracy of the material, yet it is quite possible some errors might have been left uncorrected. The publisher, the printer and the authors will not be held responsible for any inadvertent errors, omissions or inaccuracies.
ISBN: 978-93-86478-15-3 Copyright © Authors and Publisher First Edition 2018 All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the copyright holder and the publisher. Published by Satish Kumar Jain and Produced by Varun Jain for CBS Publishers & Distributors Pvt Ltd 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, India. Ph: 23289259, 23266861, 23266867
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Foreword
I
t gives me immense pleasure to comment on this basic yet extremely important textbook authored by Dr Binoti Sheth, Dr Atul Patil and Dr Muqtadeer Ansari. This book has been written keeping in mind the fast pace of changes in medical technology, the treatment and the protocols that have evolved in this new era. The work has been painstakingly completed and documented into print format as a textbook and is targeted for the benefit of the undergraduate medical and therapy students and junior postgraduate students. I appreciate the efforts of the authors in undertaking this enormous work of compiling the orthopaedic work for the benefit of academic community at large. All aspects of orthopaedic disorders are touched upon in a precise and clear way, using artistic diagrams, X-rays and clinical pictures. I take great pride in writing the Foreword to this book and wish the authors a great success. I am sure this textbook will go a long way in helping the students master the subject of orthopaedics and help them pass with flying colours.
AB Goregaonkar Professor and Head Department of Orthopaedics Lokmanya Tilak Municipal Medical College Mumbai
Preface
I
t gives me immense pleasure to present the first edition of Textbook of Orthopaedics to medical students. Orthopaedic surgery has progressed from an immature limited speciality to a vast field of various orthopaedic subspecialities. Having worked in the field of medical education for the past 20 years, I felt the need for a concise textbook that the students would enjoy reading and which would enable them to thoroughly grasp important concepts required for exams and clinical practice. This book is prepared to serve as a textbook for undergraduate and junior postgraduate medical students as well as physiotherapy, occupational therapy and nursing students. We have endeavoured to make the text simple and easy to understand. The text has been supplemented by relevant simple line diagrams, radiographs and clinical pictures, wherever necessary for better understanding of the subject. The section on clinical examination provides a systematic approach to case presentations for practical examination. I am thankful to my seniors, colleagues and family members for their constant support and encouragement. I also thank Dr Mohan Desai and Dr Dinshaw Pardiwala for their contribution to the section on clinical examination, Dr Rahul Jagtap for excellent diagrams work, and Dr Aditya Pathak, Dr Chetan Anchan and Dr Kshitij Chaudhary for their contribution to clinical photographs. Finally, I am highly indebted to the dedicated team of Rajesh Bhalani of Bhalani Publishers and CBS Publisher & Distributors Pvt Ltd for their constant guidance and advice in the preparation of this book. I wish the students happy reading and great success in their examinations.
Binoti A Sheth
Contents Foreword by AB Goregaonkar Preface Abbreviations
v vii xi
Section I: Introduction 1. Introduction to Orthopaedics
3
Section II: Trauma 2. Trauma: General Principles
7
3. General Principles of Fracture
10
4. Fracture: Management
22
5. Open Fractures
25
6. Complications of Fracture
28
7. Peripheral Nerve Injuries
38
8. Shoulder Injuries
48
9. Humeral Shaft Fractures
61
10. Elbow Injuries
63
11. Paediatric Elbow Injuries
68
12. Forearm Fractures
74
13. Wrist Fractures
78
14. Hand Injuries
86
15. Pelvic Injuries
90
16. Acetabulum Injuries
94
17. Injuries around the Hip
97
18. Femoral Shaft Fracture
106
19. Injuries around the Knee
109
20. Tibial Shaft Fractures
114
21. Ankle Fractures
119
22. Injuries around Foot
122
Section III: Infection 23. Infection of Bones and Joints 24. Tuberculosis of Bones and Joints
129 139
Textbook of Orthopaedics
x
Section IV: Spine 25. Anatomy of the Vertebral Column 26. Spinal Injuries 27. Degenerative Disorders of Spine 28. Spinal Deformities 29. Tuberculous Spondylodiscitis (Pott’s Spine)
147 149 157 164 168
Section V: Tumours 30. Bone Tumours: General Principles 31. Benign Bone Tumours 32. Malignant Bone Tumours
175 179 187
Section VI: Paediatric Orthopeadics 33. Congenital and Developmental Disorders 34. Common Paediatric Disorders
197 212
Section VII: Other Orthopaedic Disorders and Special Subjects 35. Neurological Disorders 36. Metabolic Disorders 37. Arthritis 38. Miscellaneous Disorders 39. Orthopaedic Appliances 40. Amputations 41. Special Orthopaedic Techniques
221 227 233 239 251 256 259
Section VIII: Orthopaedic Clinical Examinations 42. Shoulder 43. Elbow 44. Wrist, Forearm and Hand 45. Spine 46. Hip 47. Knee 48. Foot and Ankle
265 269 274 280 290 296 300
Section IX: Orthopaedic Implants, Radiology and Orthotics 49. Orthopaedic Implants 50. Orthopaedic Radiology 51. Orthopaedic Orthotics
309 315 322
Index
325
Introduction to Orthopaedics
xi
Abbreviations ABC ACL AFO AK AKT ALL AMC AMP AP APB APL AS ASH ASIS AVN BB BK BMD CDK CNS CP CPK CPPD CPT CRIF CRP CRPS CTEV DCP DD DDH DIP DMARD DMD DRUJ DVT ECRB ECRL ECU EDC
Aneurysmal bone cyst Anterior cruciate ligament Ankle foot orthosis Above knee Anti-Koch’s treatment Anterior longitudinal ligament Arthrogryposis multiplex congenita Austin Moore prosthesis Anteroposterior Abductor pollicis brevis Abductor pollicis longus Ankylosing spondylitis Anterior spinal hyperextension Anterior superior iliac spine Avascular necrosis Bohler Braun Below knee Bone mineral density Congenital dislocation of knee Central nervous system Cerebral palsy Creatine phosphokinase Calcium pyrophosphate deposition Congenital pseudoarthrosis of tibia Closed reduction internal fixation C-reative protein Complex regional pain syndrome Congenital talipes equinovarus Dynamic compression plate Differential diagnosis Developmental dysplasia of hip Distal interphalangeal Disease modifying anti-rheumatic drugs Duchenne’s muscular dystrophy Distal radio-ulnar joint Deep vein thrombosis Extensor carpi radialis brevis Extensor carpi radialis longus Extensor carpi ulnaris Extensor digitorum communis
EDQ EIP EMG EPB EPL FCR FDL FDP FDS
Extensor digiti quinti Extensor indicis proprius Electromyography Extensor pollicis brevis Extensor pollicis longus Flexor carpi radialis Flexor digitorum longus Flexor digitorum profundus Flexor digitorum superficialis
FFD FHL FPB GCT HKAFO HNP
Fixed flexion deformity Flexor hallucis longus Flexor pollicis brevis Giant cell tumour Hip knee ankle foot orthosis Herniated nucleus pulposus
HTO IP JESS KAFO LCL LCPD LCS
High tibial osteotomy Interphalangeal Joshi’s external stabilisation system Knee ankle foot orthosis Lateral collateral ligament Legg-Calvé-Perthes disease Lumbar canal stenosis
MCC MCL MCP MCP MIPPO MMC MTP MUGA NCV NSAID
Multiple congenital contracture Medial collateral ligament Metacarpophalangeal Metacarpophalangeal Minimally invasive percutaneous plate osteosynthesis Meningomyelocele Metatarsophalangeal Manipulation under general anaesthesia Nerve conduction velocity Non-steroidal anti-inflammatory drugs
OA OGS OI ORIF PA PBH
Osteoarthritis Osteogenic sarcoma Osteogenesis imperfecta Open reduction internal fixation Posterior anterior Pelvis both hips
PCL
Posterior cruciate ligament
Textbook of Orthopaedics
xii
PID
Prolapsed intervertebral disc
PIP
Proximal interphalangeal
PL
Palmaris longus
POP
Plaster of Paris
PPRP
Post polio residual paralysis
PQ
Pronator quadratus
PSIS
Posterosuperior iliac spine
PT
Pronator teres
PTB
Patellar tendon bearing
RA
Rheumatoid arthritis
ROM
Range of motion
RSD
Reflex sympathetic dystrophy
SCFE
Slipped capital femoral epiphysis
SI SLE SLR SWD TBW TENS TFCC THR TKR TNF UBC USG VDRO
Sacroiliac Systemic lupus erthematosus Straight leg raising Short vlave diathermy Tension band wiring • Titanium elastic nailing system • Trascutaneous electric nerve stimulation Triangular fibrocartilaginous complex Total hip replacement Total knee replacement Tumour necrosis factor Unicameral bone cyst Ultrasonography Varus derotation osteotomy...