Essentials of Orthopedic Surgery

Voorwerk

Chapter 1. Basic Science of Bone and Cartilage Metabolism

Abstract

Bone is a biphasic connective tissue consisting of an inorganic mineral phase and an organic matrix phase. The hardness of bone allows it to provide several specialized mechanical functions: the protection of internal organs, the scaffold providing points of attachment for other structural elements, and the levers needed to improve the efficiency of muscle action. In addition, bone serves two biologic functions: a site for hematopoietic activity and a reservoir of minerals needed for metabolic interchange.

John N. Delahay

Chapter 2. Skeletal Trauma

Abstract

Skeletal trauma can be divided into three major groups of injuries to the musculoskeletal system: fractures, dislocations, and fracture/dislocations. A fracture is a disruption in the continuity of cortical and/or cancellous bone. A dislocation is a disruption of the normal articulating anatomy of a joint. Dislocations can be either a complete disruption of the normal anatomy or a partial dislocation, termed a subluxation. A fracture/dislocation is a fracture occurring in or near a joint that results in a subluxation or dislocation of the joint.

Francis X. McGuigan

Chapter 3. Orthopedic Infections

Abstract

Musculoskeletal infections can prove to be extremely difficult to diagnose and treat due to the wide variation in clinical presentation, which often mimics other diagnoses such as trauma, and due to the potential for serious complications that can have lifelong implications for the patient. Unrecognized infections can destroy normal joint anatomy and function, threaten limb viability, and potentially be fatal if not recognized and treated appropriately. The most important aspect of caring for patients with a musculoskeletal infection is to come to an early and accurate diagnosis. When proper treatment is administered in a timely manner, most musculoskeletal infections can be effectively treated and the morbidity minimized with an excellent outcome for the patient. A missed infection can lead to irreversible impairment and loss of mobility for the individual, along with significant costs for society due to loss of productivity and requirements for medical care.

Mark W. Zawadsky, Steven C. Scherping Jr

Chapter 4. Tumors of the Musculoskeletal System

Abstract

Both benign and malignant tumors (neoplasms) may arise from any mesenchymal soft tissue or bony tissue of the extremities, pelvis, shoulder girdle, or the axial skeleton. All tumors arise from one of the different histological types of tissue that comprise the musculoskeletal system: bone (osteoid forming tumors), cartilage (chondroid forming tumors), muscle, and the fibrous connective tissue (soft-tissue tumors). Only rarely do tumors arise from the arteries or nerves.

Martin M. Malawer, Kristen L. Kellar-Graney

Chapter 5. Children’s Orthopedics

Abstract

Children are different! This statement has been presented in many different ways; but it is critically important that this central fact be recognized, if one is to successfully diagnose and treat disease in this age group. Even within this rather broad range of ages there are dramatic differences among specific subsets: neonate, child, and adolescent.

John N. Delahay, William C. Lauerman

Chapter 6. Sports Medicine

Abstract

The emphasis presently placed on physical fitness in society in terms of overall health is at an all-time high. Participation in both organized as well as recreational sports has escalated over the past several decades as a result. This increase in participation has led to an emphasis on treating injuries associated with sporting activities. The advances within medicine regarding the diagnosis of these injuries, such as magnetic resonance imaging (MRI), as well as arthroscopy for their treatment, have improved results only to focus more attention within this field. A number of skilled physicians and other health professionals have developed interests regarding the specific care of athletes. The goal of sports medicine as a subspecialty is the prevention of injury, diagnosis and treatment of athletic injury, and returning athletes to pre-injury activity with no acute or long-term sequelae.

John J. Klimkiewicz

Chapter 7. The Spine

Abstract

The majority of adults, at some point in their lives, are affected by disorders of the spine. Every physician should have a basic knowledge of the potential pathology and be able to distinguish a serious problem from a minor condition. Disastrous sequelae such as paralysis can occur if this differentiation is not appreciated. This chapter will first address the cervical spine and then present the lumbar spine. In each area, the history, physical, and appropriate diagnostic studies will be reviewed. Next, a standardized protocol or algorithm for the diagnosis and management of these patients will be described. Finally, several of the most common conservative treatment modalities will be presented with special attention given to their efficacy.

William C. Lauerman, Steven C. Scherping Jr, Sam W. Wiesel

Chapter 8. The Shoulder

Abstract

The shoulder joint, as it is commonly called, is not a single joint but a complex arrangement of bones, ligaments, and musculotendinous units that is more aptly called the shoulder girdle. The primary role of the shoulder girdle is to provide a tremendous range of motion for positioning the upper extremity in space. The shoulder girdle also provides power and support for the upper extremity throughout and at the extremes of the range of motion. Many shoulder girdle problems stem from overuse injuries such as pitching a baseball or serving a tennis ball that exploit both the power and range of motion of the shoulder girdle. This chapter will review the anatomy of the shoulder girdle and provide an approach to evaluating and treating common shoulder problems.

Brent B. Wiesel, Raymond M. Carroll

Chapter 9. The Elbow

Abstract

In looking at the arm as a whole, the tremendous range of motion of the shoulder can be thought of as positioning the hand on the outer surface of a sphere. It is the flexion, extension, pronation, and supination of the elbow and forearm that allow positioning of the hand within that sphere, thus creating the ability to function throughout a huge volume of space surrounding a person. When elbow and forearm function are compromised by pain, injury, or loss of motion, significant disability can result. The goals of this chapter are to present the elbow’s functional anatomy, describe how to evaluate this region, and present an approach to diagnosis and treatment of common elbow problems.

Scott G. Edwards, Brent B. Wiesel

Chapter 10. The Hand

Abstract

The human hand is one of the most important interfaces of a person’s body with the outside world. It allows us to touch, feel, manipulate, and modify our environment. Its cortical representation in the brain is nearly as large as the rest of the musculoskeletal system combined. Loss of hand function can have devastating effects on a person’s ability to work or perform activities of daily living. Unfortunately, because of its constant use and its position at the forefront of human activity, it is frequently affected by trauma and other disease processes. Nearly all physicians will see patients with hand problems, so some familiarity with these processes and the basic hand evaluation is very important.

Scott G. Edwards

Chapter 11. The Hip and Femur

Abstract

The primary function of the lower extremities is locomotion. Any alteration of the function of the lower extremities will result in an alteration in the ability to walk and run. The hip is the most proximal joint in the lower extremity. Alteration in the hip due to disease will significantly affect the biomechanics of gait and place abnormal stress on the joints above and below the hip, which can lead to pain in areas such as the lumbar spine and the knee.

Brian G. Evans, Mark W. Zawadsky

Chapter 12. The Knee

Abstract

This chapter will discuss the anatomy, biomechanics, and pathology of the knee. The function of the knee is provided primarily by the soft tissue. Therefore, injury to these soft tissue structures will have significant impact upon the stability of the knee.

Brian G. Evans, Mark W. Zawadsky

Chapter 13. The Foot and Ankle

Abstract

An overview of orthopedics would not be complete without an understanding of the foot and ankle. This area of the body is often forgotten in the scheme of things and yet is one of the most common sources of complaints in any physician’s office. Painful feet are seen in emergency rooms and family practitioner’s offices. Ankle discomfort is seen in medical clinics and on the sidelines of recreational sporting activities. This chapter is meant to familiarize the student of medicine, be it an actual medical student, resident, or practitioner, with the anatomy, diagnostic tools, and some common conditions that affect the foot and ankle.

Paul S. Cooper

Nawerk