Abstract
The preface of the Sixth Edition emphasises that, for the Fifth Edition, “the text was condensed to one volume and structured to be concise enough for the resident and medical student to obtain a broad presentation of the specialty in a limited amount of time.” It goes on to say that this was done by eliminating details of specific surgical treatment which were only appropriate for the advanced level resident. The scope and content of this book is appropriate for residents starting a career in orthopaedics and, in the UK, for doctors studying for MRCS. With other pressures on the undergraduate curriculum, I think that it would be too detailed for undergraduates, unless they were thinking of orthopaedics as a possible career and wanting to know more about it, in which case it would be an excellent introduction to the subject.
Some of the highlights are in the first section, “Orthopaedics and the musculo-skeletal system”, which is lavishly illustrated and includes a lot of data on the basic clinical sciences for orthopaedics, which is certainly at postgraduate trainee level. I especially liked the embryology section, which concluded with diagrams showing the dates of appearance of all of the centres of ossification of the skeleton and dates of epiphyseal closures.
The second section of the book is on “General disorders of the musculo-skeletal system”, with chapters on bone and joint infections in children, rheumatic diseases (which, curiously, includes infectious arthritis in adults), metabolic bone disease, neuromuscular diseases, idiopathic and heritable disorders and musculo-skeletal neoplasms and disorders which resemble neoplasms. These chapters were well written and appropriate for undergraduate and postgraduate level.
The third section is on regional disorders of the musculo-skeletal system and, reviewing for the Journal of Hand Surgery, I have naturally concentrated on the neck and upper limb sections. The layout of these chapters could be improved for a book aimed at undergraduates, or postgraduate trainees in their early years of training. The emphasis at the beginning of each chapter should be on basic clinical presentation, history taking and examination findings, with annotation of what disorders are to be expected in different age groups, before proceeding to consider specific conditions. As an example, the shoulder and arm chapter commences with obstetrical brachial plexus palsy, following by degenerative and painful conditions of the acromio-clavicular joint. It is only at the end of the chapter, when dealing with rotator cuff disease, that much of the basic examination is detailed. There is no mention of impingement syndrome, as separate from a rotator cuff tear, although the first sentence of this section reads “diseases of the rotator cuff involve a continuum of disorders ranging from subacromial bursitis and tendonosis to full thickness tears.” Under glenohumeral instability, there is mention of the need to test for ligamentous laxity, but there is no mention, either here or in the Index, of the Carter or Beighton scales, used worldwide to assess this.
In the chapter on forearm and elbow and the chapter on wrist and hand, the arrangements of headings is alphabetical which leads to some curious juxtapositions which would be better suited to a reference book, rather than a book to be read as a text by trainees. The forearm and elbow chapter starts with congenital conditions and, then, nerve entrapment conditions, before dealing with osteoarthritis, rheumatoid disease and tendonopathies. Although the text for osteoarthritis of the elbow states that only small series of elbow replacements have been reported, with a high rate of complications compared with rheumatoid disease, semi-constrained non-hinged replacements are, theoretically, better for the degenerate elbow. However, the radiograph shows a restrained hinged prosthesis!
The wrist and hand chapter starts with Boutonnière deformity and states that a closed rupture of the middle slip of the extensor mechanism is treated by splinting, but does not state what type of splint or give any indications of the causes of poor results. This chapter includes the only reference in the book to complex regional pain syndrome, which was not particularly well covered. Congenital anomalies did not have any classification system and rheumatoid arthritis of the hand and wrist only merited one page. This includes one picture showing “ulnar deviation deformity of the wrist and digits”, whereas, of course, the common deformity is radial deviation of the wrist and ulnar deviation of the digits, as the typical “zigzag” deformity.
Although I liked the book and found it much more easy to read than many American authored texts, I was worried that sections one and two were set, predominantly, at postgraduate level and section three more at undergraduate level, which might limit its usefulness for orthopaedic trainees and cause them to choose alternative books, if they had a limited budget. However, sections one and two alone merit the inclusion of this book in the libraries of all hospitals with orthopaedic trainees.