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Clinical Assessment and Examination in Orthopedics

C. Rex. pp. 196 Jaypee Brothers, Medical Publishers Pvt. Ltd. 2012. Second revised edition. ISBN: 978-9350256428




This is the second edition of the book first published in 2002. Author Dr C Rex is a well known orthopedic surgeon in south India who did his higher orthopaedic training in India and the UK. This well-written book is mainly aimed at orthopaedic trainees and new consultants, and provides a wealth of information for both.

As the title suggests, the book covers the general clinical assessment and examination of an orthopaedic patient. The bulk of the book covers non-traumatic orthopedic conditions. The author has briefly covered general aspects of assessment of an injured patient including ATLS protocols and complications such as ARDS, fat embolism, deep vein thrombosis and pulmonary embolism.  250 illustrations include clinical photographs, line drawings and some radiographs, mostly in black and white.

With the exception of the initial few chapters, the material is presented in anatomical sections. Chapters start with a brief note on history, and then examination is presented in the logical sequence of: look; feel; move; and special tests. The author has done a good job including all the common special tests with their correct methodology and interpretation. All common eponyms have been mentioned and highlighted. Useful notes have been provided on common conditions affecting each anatomical area.

Another strong point of this book is that important ‘do-not-miss’ aspects of examination have been mentioned clearly in all chapters. This will certainly help trainees avoid pitfalls. Specific examination according to the presenting complaints has been covered well in the examination of hand and wrist, however this approach has not been followed in all the chapters.

One aspect which this book has covered only partially is the reliability of different tests. Some eponymous tests described in the literature are mentioned for the sake of awareness and have limited clinical value. The author could help by pointing out high yield tests. I also think that for the trainees it would help to have the differential diagnoses tabled according to the common presenting complaint.

The author could also include warning against some tests which can be harmful to the patient if done without adequate precautions. One such test is pelvic compression-distraction test (much safer to do the compression test at greater trochanter level) which should be avoided before radiographic examination of the pelvis if possible. The chapter on imaging modalities would benefit from more detail.

Despite these minor shortcomings, this remains an excellent book. Although author may not have succeeded in making this slightly grey topic multi-coloured, he certainly has succeeded it making it very clear and concise.

Dawar Abbas

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