Apley and Solomon's Concise System of Orthopaedics and Trauma, Fourth Edition

477 Pages·2014·47.74 MB·English

by  Nayagam

Apley and Solomon’s
Concise System of Orthopaedics and Trauma
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Apley and Solomon’s Concise
System of Orthopaedics
and Trauma
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Apley and Solomon’s Concise
System of Orthopaedics
and Trauma
FOURTH EDITION
Louis Solomon
MB ChB MD FRCS FRCSEd
Emeritus Professor of Orthopaedic Surgery, University of Bristol, Bristol, UK
David Warwick
MD FRCS FRCS(Orth) Eur Dip Hand Surg
Professor, University of Southampton and Consultant Hand Surgeon,
University Hospital Southampton, Southampton, UK
Selvadurai Nayagam
BSc MCh(Orth) FRCS(Orth)
Consultant Orthopaedic Surgeon, Royal Liverpool Children’s Hospital
and Royal Liverpool University Hospital, Liverpool, UK
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CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2014 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20140319
International Standard Book Number-13: 978-1-4441-7432-8 (eBook - PDF)
This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reli-
able data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that
may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors
are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is
intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s
own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines.
Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified.
The reader is strongly urge to consult the relevant national drug formulary and the drug companies’ printed instructions, and their websites, before
administering any of the drugs recommended in this book. This book does not indicate whether a particular treatment is appropriate or suitable
for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as
to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced
in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not
been acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any elec-
tronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information
storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.com/) or
contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization
that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate
system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation
without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
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CONTENTS
CRC Press
Taylor & Francis Group PREFACE vi
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742 PREFACE TO THE FIRST EDITION vii
CONTRIBUTORS viii
© 2014 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business ACKNOWLEDGEMENTS ix
ABBREVIATIONS xi
No claim to original U.S. Government works
Printed on acid-free paper PART 1 GENERAL ORTHOPAEDICS 1
Version Date: 20140319
1 Diagnosis in Orthopaedics 2
International Standard Book Number-13: 978-1-4441-7431-1 (Paperback)
International Standard Book Number-13: 978-1-4822-6039-7 (International Students’ Edition, restricted territorial availability) 2 Infection 17
3 Inflammatory Rheumatic Disorders 29
This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reli-
able data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that 4 Gout and Pseudogout 40
may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors 5 Osteoarthritis and Related Disorders 46
are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is
intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s 6 Osteonecrosis (Avascular Necrosis) 52
own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. 7 Metabolic and Endocrine Disorders 59
Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified.
The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ printed instructions, and their websites, before 8 Genetic Disorders, Dysplasias and Malformations 81
administering any of the drugs recommended in this book. This book does not indicate whether a particular treatment is appropriate or suitable 9 Tumours and Tumour-like Lesions 101
for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as
to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced 10 Neuromuscular Disorders 117
in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not 11 Peripheral Nerve Injuries 137
been acknowledged please write and let us know so we may rectify in any future reprint.
12 Principles of Operative Treatment 150
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any elec-
tronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information PART 2 REGIONAL ORTHOPAEDICS 167
storage or retrieval system, without written permission from the publishers.
13 The Shoulder 168
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.com/) or 14 The Elbow 185
contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization
that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate 15 The Wrist 190
system of payment has been arranged. 16 The Hand 199
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation 17 The Neck 210
without intent to infringe. 18 The Back 219
19 The Hip 242
Library of Congress Cataloging-in-Publication Data
20 The Knee 265
Solomon, Louis, author. 21 The Ankle and Foot 286
Apley’s concise system of orthopaedics and fractures / Louis Solomon, David Warwick, Selvadurai Nayagam. -- Fourth
edition.
p. ; cm. PART 3 FRACTURES AND JOINT INJURIES 307
Concise system of orthopaedics and fractures 22 The Management of Major Injuries 308
Based on (work): Apley’s system of orthopaedics and fractures / Louis Solomon, David Warwick, Selvadurai Nayagam.
Includes bibliographical references and index. 23 Fractures and Joint Injuries 325
ISBN 978-1-4441-7431-1 (pbk. : alk. paper) 24 Fractures – Principles of Treatment 340
I. Warwick, David, 1962- author. II. Nayagam, Selvadurai, author. III. Solomon, Louis. Apley’s system of orthopaedics and
fractures. Digest of (work): IV. Title. V. Title: Concise system of orthopaedics and fractures. 25 Complications of Fractures 352
[DNLM: 1. Orthopedics--methods. 2. Fracture Fixation--methods. WE 168] 26 Injuries of the Shoulder, Upper Arm and Elbow 363
RD731 27 Injuries of the Forearm and Wrist 383
617.5--dc23 2014004724 28 Injuries of the Hand 397
29 Injuries of the Spine and Thorax 408
Visit the Taylor & Francis Web site at 30 Fractures of the Pelvis 422
http://www.taylorandfrancis.com
31 Injuries of the Hip and Femur 431
and the CRC Press Web site at
32 Injuries of the Knee and Leg 443
http://www.crcpress.com
33 Injuries of the Ankle and Foot 453
INDEX 464
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PREFACE
Although the name of this new edition is slightly the principles of operative orthopaedics and other
changed, we are confi dent that the Apley spirit methods commonly used in treating patients with
has been kept alive. Yes, we are now able to musculoskeletal complaints.
perform tests and imaging studies that were The second part, Regional Orthopaedics,
unknown in years gone by, and true, there are examines the specifi c manifestations and treatment
now more shortcuts to diagnosis than before. of these conditions in each of the major bodily
Even so, the most useful and important tools to regions.
assist in an understanding of our patients and the The third part, Fractures and Joint Injuries,
management of their problems are our own hands covers the principles of trauma surgery. It begins
and our clinical acumen. That has always been with a chapter on the emergency management of
the focus of the book that arose out of Apley’s the severely injured patient – a comprehensive
teachings. review of the internationally accepted Advanced
Why do we call it a System of orthopaedics Trauma Life Support (ATLS) Program – followed
and not simply a textbook? What Alan Apley had by a chapter on the principles of fracture
in mind when he set up his famous courses in management, and then individual chapters on the
orthopaedics almost 60 years ago was to imbue his management of fractures and dislocations in each
listeners – the orthopaedic surgeons of the future anatomical region.
– with not only the theory of this subject but also A hallmark of the book has been the liberal
the clinical habits that would lead them to all the spread of ‘on the spot’ pictures and illustrations,
observations and connections from which they culled from our clinical encounters during the last
could construct a credible diagnosis and a reliable 50 years. The early authors were (and are) avid
plan of treatment. Look – Feel – Move became not collectors of these real-life images, which together
merely a mantra for those who had been at his with their captions provide an instant summary of
classes but a constant reminder that diagnosis is the accompanying text.
more than inspired guesswork; it is the result of a A question that crops up repeatedly is ‘Which
systematic consideration of all the appearances and group of readers are we aiming at?’ Most obviously
issues (the trivial as well as the obviously unusual) medical students, trainees in orthopaedic surgery,
from which the alert mind will choose what is and even their consultant teachers who want
truly relevant. It is that approach that we have a concise review of subjects with which they
tried to preserve, however many clever instruments are already familiar. Then many others as well:
come into play during this repeatedly exciting trainees in related surgical specialties; doctors and
enterprise. nurses working in accident and emergency units;
As in previous editions, the book is divided into experienced general practitioners; physiotherapists,
three parts: General Orthopaedics, comprises the occupational therapists and ‘paramedics’ who deal
main categories of clinical examination, special with physical abnormalities. Our hope is that they
investigations and individual chapters on the most will enjoy these pages as much as we have enjoyed
common groups of musculoskeletal disorders such their preparation.
as infection, arthritis, metabolic bone disease,
developmental abnormalities, tumours, central L.S.
neurological conditions and peripheral nerve D.W.
disorders. This section ends with a chapter on S.N.
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PREFACE TO THE FIRST EDITION
For many years a course in orthopaedics and has been accepted as a challenge to provide
fractures, designed primarily for F.R.C.S. unambiguous verbal descriptions instead.
candidates, has been held at Pyrford. As the course The combination of method and compactness
grew and developed, so did the desire to cover the will, it is hoped, help the busy house surgeon,
fi eld as comprehensively as possible. Eventually, casualty offi cer, or the doctor who only occasionally
as a prophylactic against writer’s cramp, lecture practises orthopaedics, to fi nd his way quickly in a
notes were issued. Re-written and amplifi ed, large and complex subject.
these form the basis of the present book. The In preparing this book I have leaned heavily
aim has been to prepare a text comprehensive on others. Many of their ideas have made such
enough for postgraduates, yet simple enough for instant appeal that I have absorbed them and
undergraduates. can no longer recall their source or adequately
Many students, whether postgraduate or acknowledge my indebtedness. An immeasurable
undergraduate, are not lacking in factual debt is, however, due to my teacher George
knowledge so much as in a methodical approach. Perkins, whose infl uence has, I hope, pervaded
The presentation used is designed to overcome this both my work and my teaching.
handicap and to inculcate method. Physical signs On many occasions I have sought the help of
are described in a constant sequence throughout my colleague Mr. F. A. Simmonds, who has never
and, as far as possible, a standard system of failed to give sound advice. I am greatly indebted
headings is used both for orthopaedic disorders to Dr. I. Churchill-Davidson for his ungrudging
and for fractures. and detailed help in writing the sections on
In practice the same doctor usually deals with radiotherapy. Mr. Gordon Hadfi eld read through
orthopaedics and with fractures; and rightly the entire text and his many valuable suggestions
so, for they share many principles in common. are deeply appreciated. It is a pleasure to pay
Consequently a book dealing with both subjects tribute to the diligence and skill of my secretary,
may be appropriate and convenient. To this Miss L. Freeland, and to acknowledge the
end brevity was important. I have tried to constructive suggestions and friendly co-operation
avoid wordiness and to present facts concisely. of the publishers.
Illustrations have not been included; their value
is not denied but, if the reader keeps the patient A. Graham Apley
constantly in mind, and punctiliously follows the January 1959
precept of ‘LOOK, FEEL, MOVE’, illustrations
should not be indispensable. Their absence
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CONTRIBUTORS
PRINCIPAL AUTHORS Gorav Datta MD FRCS(Tr + Orth)
Consultant Trauma and Orthopaedic Surgeon
Louis Solomon MB ChB MD FRCS FRCSEd
University Hospital Southampton
Emeritus Professor of Orthopaedic Surgery
Southampton, UK
University of Bristol
Bristol, UK
Nick Hancock MBChB FRCS(Tr + Orth)
Consultant Trauma and Orthopaedic Surgeon
David Warwick MD FRCS FRCS(Orth) Eur University Hospital Southampton
Dip Hand Surg Southampton, UK
Professor, University of Southampton
Southampton, UK Max Jonas MB BS FRCA
Consultant Hand Surgeon Consultant and Senior Lecturer in Critical Care
University Hospital Southampton University Hospital Southampton
Southampton, UK Southampton, UK
Amir Ali Qureshi FRCS(Tr + Orth) MRCS
Selvadurai Nayagam BSc MCh(Orth)
MBBCh
FRCS(Orth)
Consultant Trauma and Orthopaedic Surgeon
Consultant Orthopaedic Surgeon
University Hospital Southampton
Royal Liverpool Children’s Hospital and Royal
Southampton, UK
Liverpool University Hospital
Liverpool, UK
David Sutton BM DA FRCA
Consultant Anaesthetist
University Hospital Southampton Major Trauma
Centre
ADDITIONAL AUTHORS Southampton, UK
Gavin W. Bowyer MChir FRCS(Orth) Pre-Hospital Emergency Physician
Consultant Trauma and Orthopaedic Surgeon South Central Ambulance Service
University Hospital Southampton Clinical Governance Lead
Southampton, UK Hampshire and Isle of Wight Air Ambulance
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ACKNOWLEDGEMENTS
Advances in medical research and practice during (Taylor & Francis Group), and our eagle-eyed
the last two decades have led to ever greater Copy Editors Kate Nardoni and Ruth Maxwell at
specialization and the need for multi-authorship Cactus Design. We pay them our sincere thanks.
in modern textbooks. The Apley System was no Thanks also to Dr Allen Zimbler, passionate
exception: the 9th edition of the main textbook, collector of antiquarian books, for tracing a fi ne
published 2 years ago, sported three Principal copy of the 1st Edition.
Authors and 24 Contributing Authors. They were We never forget that writing a textbook is not a
duly acknowledged in that edition and we express single-handed job. Behind the persons pounding
our gratitude to them again with the appearance of the computer keys there are our partners and
this new 4th edition of the concise version which is families: some take part in organizing the work,
based on the more advanced publication. some offer helpful comments, others offer a ready
In addition we have enlisted six new Contributing ear to listen to the problems that beset every
Authors whose remit has been an up-dating of author, all of them endure the long periods of
specifi c chapters in the present Concise System; silence around us the writers. We can never thank
they are listed in the front pages and we extend them enough for the many ways in which they
to them our sincere thanks for fi lling the gaps in help us in our somewhat selfi sh endeavours.
our earlier presentations. Although they would Finally, we owe a huge debt of gratitude to the
not have known Alan Apley and his inimitable many patients who have allowed us to intrude
teaching style, they have fi tted into our authorial upon their suffering and use their stories to
team splendidly. populate our book.
No textbook would see the light of day without
the help of their Publishing Editors and Copy L.S.
Editors. We have had the good fortune to work D.W.
with Dr Joanna Koster, Publisher at CRC Press S.N.
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