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 University of Bristol 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 CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2010 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: 20121026 International Standard Book Number-13: 978-1-4441-1324-2 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com 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 t olerated our absences – both material and spiritual – while preparing this new edition. 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 Tumours 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 University of Bristol 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