Adams’s Outline of Orthopaedics For Elsevier: Commissioning Editor: Alison Taylor/Laurence Hunter Development Editor: Helen Leng Project Manager: Elouise Ball Designer/Design Direction: Kirsteen Wright Illustration Manager: Bruce Hogarth Adams’s Outline of Orthopaedics David L Hamblen PhD DSc FRCS (Edinburgh, England, Glasgow) Emeritus Professor of Orthopaedic Surgery, University of Glasgow Visiting Professor University of Strathclyde, Glasgow, UK A Hamish R W Simpson DM(Oxon) FRCS(Ed & England) Professor of Orthopaedics and Trauma, University of Edinburgh, UK Contributor Nigel Raby MRCP FRCR Consultant Musculoskeletal Radiologist, Western Infirmary, Glasgow Fourteenth Edition Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2010 © 2010, Elsevier Limited. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: healthpermissions@elsevier.
You may also complete your request online via the Elsevier website at http://www. First edition 1956 Eighth edition 1976 Second edition 1958 Ninth edition 1981 Third edition 1960 Tenth edition 1986 Fourth edition 1961 Eleventh edition 1990 Fifth edition 1964 Twelfth edition 1995 Sixth edition 1967 Thirteenth edition 2001 Seventh edition 1971 Fourteenth edition 2010 ISBN 9780702030611 International ISBN 9780702030604 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 Notice Neither the publisher nor the authors assume any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient. The Publisher Printed in China The publisher's policy is to use paper manufactured from sustainable forests Preface This new 14th edition of Outline of Orthopaedics is the first without the direct input of John Crawford Adams.
It appears just over 50 years from the pub- lication of his first edition of this book and its companion volume Outline of Fractures. To mark this remarkable achievement it was decided to add his name to both titles, which still contain evidence of his lucid writing style and clear illustrative line drawings. His original aim of providing a broader coverage of orthopaedic diseases and their diagnosis and treatment than that required for undergraduate examinations has been preserved. We make no apology for this, since musculoskeletal disorders now make up at least 20% of the clinical mate- rial presenting to primary care.
This book should provide a valuable reference tool for general practitioners, physiotherapists, orthopaedic nurses, and basic surgical trainees, as well as instructing the undergraduate medical student. The broad arrangement of material into three parts; clinical methods, a general survey of orthopaedic disorders, and regional orthopaedics, has been retained in the new edition. All the text has now been put into the same stan- dard font size which should ease the task of the reader. To make space for this change without enlarging the book to a cumbersome size, we decided to elimi- nate the literature references previously included.
It was felt that these are now more readily available in an up-to-date digital format using computer technol- ogy. We have also eliminated some of the duplication of material in the regional chapters where this has already been covered in the general survey of Part 2. Professor Hamish Simpson, the co-author for the latest edition of Outline of Fractures, has now joined the editorial team for this revision of Outline of Orthopaedics. His input has provided valuable material on the fast-changing nature of today’s orthopaedic practice.
We also welcome the collaboration of Dr Nigel Raby, who has contributed a new expanded chapter on the role of imaging in orthopaedic diagnosis and treatment. This development proba- bly represents the most important change to orthopaedic practice in the past ten years and has revolutionised clinical care. The danger is that these sophis- ticated investigations may also be used as a substitute for the clinical skills of history taking and physical examination of the patient. Without this, other co-morbid conditions may be missed and the opportunity to make a provisional diagnosis allowing more focused investigation may be lost.
With the assistance of Dr Raby and other clinical collaborators we have been able to include a large number of new illustrations to replace and enhance some of the older redundant images. We hope that the new edition, while retaining the strength of its prede- cessors, will provide today’s trainees, whether undergraduate or postgraduate, with a broad overview of the constantly expanding field of orthopaedic surgery. David L Hamblen Hamish Simpson 2010 Acknowledgements The authors must first pay tribute to the original author, John Crawford Adams, whose inspiration and enthusiasm produced the original volume and steered it through twelve further editions. The success the book has enjoyed for over 50 years is a tribute to his writing skills which have provided us with a sound base on which to develop this new edition.
A major contribution to the latest revision has come from Dr Nigel Raby, Radiologist at the Western Infirmary, Glasgow, who has written the new chapter on ‘Imaging in Orthopaedics’ and co-edited the material on bone and soft tissue tumours. In addition he has supplied a large number of new and replacement radiographs and scans in many of the other chapters to reflect the advances in this field of investigation. Because of the increasing specialisation within ortho- paedics we have had to seek help from other clinical colleagues to fill gaps in the illustrative material. For this we thank Dr Robin Reid, Dr Martin Sambrook, Mr Nick Geary, Mr Thanos Tsirikos, and Mr Graham Lawson.
Thanks also go to Dr Helen Frost for editing and updating the material on the role of physiotherapy in treatment. We acknowledge the assistance of Morag Macleod and the staff at the National Centre for Prosthetics and Orthotics, University of Strathclyde, for supplying the pictures of patient appliances and prostheses. Particular thanks are due to Helen Leng, our Development Editor, who has shown great patience and understanding in accommodating our frequent and confusing alterations to the text and figures. We are also grateful to all the staff at Elsevier for all their help and encouragement in the production of this new edition.
Our respective secretaries Catherine Davidson and Linda Digance have played a key role in the typing of the manuscript and their efforts are very much appreciated. Finally we record our appreciation for the support and forbearance of our wives and families during the time devoted to the writing of the book, which might otherwise have been spent in their company. David L Hamblen Hamish Simpson Note by John Crawford Adams Outline of Orthopaedics evolved from bedside teaching of medical students over many years. Despite inevitable flaws and omissions in the original version, the book proved popular and revised editions were called for every few years.
Indeed, so many changes have been made in successive editions that the present one is hardly recognisable as the same book. In the half century that has elapsed since the book was first published there has been spectacular progress in the practice of orthopaedic surgery – more so than in most other branches of surgery. One field in which developments have been particularly striking is that concerned with diagnostic procedures. Notable among the sophisticated refinements that now make diagnosis easier, more accurate, and substantially less traumatic for the patient include image intensification; computerised tomographic scanning; magnetic resonance imag- ing, contrast radiography; ultrasound scanning; radio-isotope scanning; and interventional radiology using intra-arterial cannulas.
These diagnostic meth- ods, together with techniques of direct inspection of the inside of joints or other cavities (arthroscopy, endoscopy) have nearly all been introduced or greatly refined since this book was first published. In the field of operative surgery the development of total replacement arthro- plasty – at first confined mainly to the hip – was the most spectacular land- mark. For several decades surgeons had striven to create a mobile artificial hip joint, but success generally eluded them and forced them to rely mainly upon arthrodesis for relief of arthritic pain. Only when a two-part (ball and socket) prosthesis of special metal, or metal and plastic, was developed was successful arthroplasty achieved.
The technique was refined very quickly and was soon extended to the knee and other joints. Today many thousands of replacement arthroplasties are undertaken every year in Britain alone. Another major surgical landmark in the last half century was the refinement of arthroscopic examination of major joints – at first mainly the knee – which led naturally to the development of arthroscopic surgery. This proved so suc- cessful – at first in the knee – that open operations for damaged semilunar car- tilages and ligaments of the knee were soon almost wholly superseded.
At the same time minimal access surgery was extended to other sites – notably the spine – as well as to the separate fields of abdominal and gynaecological sur- gery. These major developments are still relatively new: hardly mentioned in the earliest editions of this book half a century ago. One of the consequences of these developments has been a trend for surgeons to concentrate on a particular field of surgery – for instance hip sur- gery, knee surgery, spine surgery or hand surgery – while largely abandoning other fields to their colleagues. While this trend towards “super-specialisation” may be generally applauded, care must be taken to ensure that it does not go too far, to the point where a surgeon, initially trained in general orthopaedic techniques, becomes incapable of undertaking routine work.
viii Note by John Crawford Adams Adams’s outline of orthopaedics The stage has already been reached at which it is no longer practicable for a single author to undertake the production of a book covering the whole range of orthopaedic surgery. Some degree of collaboration is clearly desirable, and it is with much pleasure that I now hand over this work to the capable hands of Professor Davíd Hamblen, my long-term co-author, and Professor Hamish Simpson, his new collaborator. John Crawford Adams Note on terminology The anatomical nomenclature used in this book conforms to that recommended by the International Anatomical Nomenclature Committee and approved at the Eighth International Congress of Anatomists at Wiesbaden in 1965. This nomen- clature, which differs only in minor respects from the earlier Birmingham revi- sion of the Basle nomenclature, has been adopted at most schools of anatomy and it is to be hoped that it will become the standard terminology acceptable to anatomists and surgeons alike.
The recommended method of recording and expressing joint movement con- forms to that laid down by the American Academy of Orthopaedic Surgeons in the booklet Joint Motion published by the Academy in 1965 (reprinted 1966), and approved by most of the Orthopaedic Associations of the English-speaking world. (See also McRae, R. (2003): Clinical Orthopaedic Examination, 5th edn. Edinburgh: Churchill Livingstone.) The guiding principle of the method is that for any joint the extended ‘anatomical position’ is regarded as zero degrees (0°), and movement at the joint is measured from this starting position.
For example, in the knee the straight position is described as 0° and the fully flexed posi- tion is expressed as (say) 145 degrees (145°) of flexion; likewise at the elbow. At the ankle the anatomical position, with the foot at a right angle to the leg, is the zero position, from which plantarflexion and dorsiflexion (extension) are measured. The Academy booklet also gives figures for the normal range of movement at each joint.