Apley’s System of Orthopaedics and Fractures Alan Graham Apley 1914–1996 Inspired teacher, wise mentor and joyful friend Louis Solomon MD FRCS Emeritus Professor of Orthopaedics Bristol UK David Warwick MD FRCS FRCSOrth Eur Dip Hand Surg Consultant Hand Surgeon Reader in Orthopaedic Surgery University of Southampton Southampton UK Selvadurai Nayagam BSc MChOrth FRCSOrth Consultant Orthopaedic Surgeon Royal Liverpool Children’s Hospital and The Royal Liverpool University Hospital Liverpool UK Apley’s System of Orthopaedics and Fractures Ninth Edition First published in Great Britain in 1959by Butterworths Medical Publications Second edition 1963 Third edition 1968 Fourth edition 1973 Fifth edition 1977 Sixth edition 1982 Seventh edition published in 1993 by Butterworth Heineman. Eight edition published in 2001 by Arnold. This ninth edition published in 2010by Hodder Arnold, an imprint of Hodder Education,an Hachette UK Company, 338 Euston Road, London NW1 3BH http://www.hodderarnold.com © 2010 Solomon, Warwick, Nayagam All rights reserved. Apart from any use permitted under UK copyright law, this publica- tion may only be reproduced, stored or transmitted, in any form, or by any means, with prior permission in writing of the publishers or in the case of reprographic production, in accordance with the terms of licences issued by the Copyright Licensing Agency. In the United Kingdom such licences are issued by the Copyright Licensing Agency: 90 Tottenham Court Road, London W1T 4LP Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN-13 978 0 340 942 055 ISBN-13 [ISE] 978 0 340 942 086(International Students’ Edition, restricted territorial availability) 1 2 3 4 5 6 7 8 9 10 Commissioning Editor: Gavin Jamieson Project Editor: Francesca Naish Production Controller: Joanna Walker Cover Designer: Helen Townson Indexer: Laurence Errington Additional editorial services provided by Naughton Project Management. Cover image ©Linda Bucklin/stockphoto.com Typeset in 10 on 12pt Galliardby Phoenix Photosetting, Chatham, Kent Printed and bound in Indiaby Replika Press What do you think about this book? Or any other Hodder Arnold title? Please visit our website: www.hodderarnold.com iv Dedication To our students, trainees and patients, all of whom have helped to make our lives interesting, stimulating and worthwhile; and also to our wives and children (and grand-children) who have tolerated our absences – both material and spiritual – while preparing this new edition. This page intentionally left blank Contents Contributors ix Preface xi Acknowledgements xiii List of abbreviations used xv PART 1: GENERAL ORTHOPAEDICS 1 Diagnosis in orthopaedics 3 Louis Solomon, Charles Wakeley 2 Infection 29 Louis Solomon, H. Srinivasan, Surendar Tuli, Shunmugam Govender 3 Inflammatory rheumatic disorders 59 Christopher Edwards, Louis Solomon 4 Crystal deposition disorders 77 Louis Solomon 5 Osteoarthritis 85 Louis Solomon 6 Osteonecrosis and related disorders 103 Louis Solomon 7 Metabolic and endocrine disorders 117 Louis Solomon 8 Genetic disorders, skeletal dysplasias and malformations 151 Deborah Eastwood, Louis Solomon 9 Tumour s 187 Will Aston, Timothy Briggs, Louis Solomon 10 Neuromuscular disorders 225 Deborah Eastwood, Thomas Staunton, Louis Solomon 11 Peripheral nerve injuries 269 David Warwick, H. Srinivasan, Louis Solomon 12 Orthopaedic operations 303 Selvadurai Nyagam, David Warwick PART 2: REGIONAL ORTHOPAEDICS 13 The shoulder and pectoral girdle 337 Andrew Cole, Paul Pavlou 14 The elbow and forearm 369 David Warwick 15 The wrist 383 David Warwick, Roderick Dunn 16 The hand 413 David Warwick, Roderick Dunn 17 The neck 439 Stephen Eisenstein, Louis Solomon 18 The back 453 Stephen Eisenstein, Surendar Tuli, Shunmugam Govender 19 The hip 493 Louis Solomon, Reinhold Ganz, Michael Leunig, Fergal Monsell, Ian Learmonth 20 The knee 547 Louis Solomon, Theo Karachalios 21 The ankle and foot 587 Gavin Bowyer PART 3: FRACTURES AND JOINT INJURIES 22 The management of major injuries 627 David Sutton, Max Jonas 23 Principles of fractures 687 Selvadurai Nayagam 24 Injuries of the shoulder, upper arm and elbow 733 Andrew Cole, Paul Pavlou, David Warwick 25 Injuries of the forearm and wrist 767 David Warwick 26 Hand injuries 787 David Warwick 27 Injuries of the spine 805 Stephen Eistenstein, Wagih El Masry 28 Injuries of the pelvis 829 Louis Solomon 29 Injuries of the hip and femur 843 Selvadurai Nayagam 30 Injuries of the knee and leg 875 Selvadurai Nayagam 31 Injuries of the ankle and foot 907 Gavin Bowyer Epilogue: Global Orthopaedics 935 Christopher Lavy, Felicity Briggs Index 939 S T N E T N O C viii Contributors Principal Authors Timothy William Roy Briggs MD(Res) MCh(Orth) FRCS FRCS Ed Professor and Consultant Orthopaedic Surgeon Louis Solomon MD FRCS Eng FRCS Ed Joint Medical Director Emeritus Professor of Orthopaedic Surgery Joint Training Programme Director Royal National Orthopaedic Hospital Honorary Consultant Orthopaedic Surgeon Stanmore, UK Bristol Royal Infirmary, Bristol, UK Tumours Selvadurai NayagamBSc, MChOrth FRCSOrth Consultant Orthopaedic Surgeon Andrew Spencer ColeBSc MBBS Royal Liverpool Children’s Hospital and FRCS(TR&Orth) The Royal Liverpool University Hospital Consultant Orthopaedic Surgeon Liverpool, UK Southampton University Hospitals Southampton, UK David Warwick MD BM FRCS FRCS (Orth) The Shoulder and Pectoral Girdle Eur Dip Hand Surg Injuries of the Shoulder and Upper Arm and elbow Consultant Hand Surgeon Reader in Orthopaedic Surgery Roderick Dunn MBBS DMCC FRCS(Plast) University of Southampton, Southampton, UK Consultant Plastic, Reconstructive and Hand Surgeon, Odstock Centre for Burns, Plastic and Maxillofacial Surgery, Salisbury District Hospital Salisbury, UK The Wrist and The Hand: Congenital Variations Contributing Authors Deborah Eastwood FRCS Will Aston BSc,MBBS,FRCSEd(TR&Orth) Consultant Orthopaedic Surgeon and Consultant Orthopaedic Surgeon Hon Senior Lecturer Royal National Orthopaedic Hospital University College London; Stanmore, UK Great Ormond Street Hospital for Children Tumours London, UK Genetic Disorders, Dysplasias and Malformations Gavin William Bowyer MA MChir FRCS(Orth) Neuromuscular Disorders Consultant Trauma and Orthopaedic Surgeon and Honorary Senior Lecturer Southampton University Hospitals Christopher J Edwards BSc MBBS FRCP MD Southampton, UK Consultant Rheumatologist & Honorary Senior The Ankle and Foot Lecturer Injuries of the ankle and foot Associate Director Wellcome Trust Clinical Research Facility Felicity Briggs MA(Oxon) UK Southampton University Hospitals NHS Trust Research Assistant and Graduate Medical Student Southampton General Hospital, UK Epilogue: Global Orthopaedics Inflammatory Rheumatic Disorders