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Fractures: Master Techniques in Orthopaedic Surgery

Donald A. Wiss. pp. 382 Lippincott Williams & Wilkins, 2005. ISBN: 978-0781752909

Master Techniques in Orthopaedic Surgery: Fractures, Third Edition was published in 2013, seven years after the successful second edition in 2006. Seventy nine orthopaedic surgeons who are truly masters in their field share their successful techniques in treating 46 common but often problematic fractures. All except two of the contributors come from the North America. The book is divided into four parts: Upper extremity; Lower extremity; Pelvis & Acetabulum; and Miscellaneous.

Two new chapters cover reverse shoulder arthroplasty for acute proximal humerus fracture and total elbow arthroplasty for intra-articular fractures of the distal humerus. Second edition chapters on intramedullary nailing of forearm fractures, and open reduction and internal fixation of tibial shaft fractures, are not present in this edition. Seventeen chapters have been rewritten.

The keys to the success of this book are the consistent format and quality throughout the volume, the high quality illustrations, and the tips and tricks shared by experts with years of experience.

Each chapter starts with a concise yet comprehensive Introduction on the epidemiology, region-specific biology & biomechanics, standard treatment methods and implant selection for the fracture concerned. Combining traditional teaching with modern concepts of fracture care, it sets the scene for the rest of the chapter. It is followed by a description of the Indications & Contraindications for surgery, an appropriately short section on non-operative treatment, and one or two of the most commonly used, operation-guiding classifications. The Pre-operative Evaluation & Planning section is, in my opinion, the most valuable part for operating surgeons. It explicitly points out the salient features of patient assessment and X-ray examination that affect surgical management. Advanced imaging, specific reduction tools, distractors, implants, bone grafts and adjuncts that have to be arranged before the operation are anticipated. This is the information that separates the good trauma surgeon from the average.

The core Surgical Technique is detailed in an easy-to-follow format that begins with theatre setup, anaesthesia, patient positioning, draping, fluoroscopy positioning, step-by-step description of the surgical approach, and concludes with tips and tricks on fracture reduction and implant fixation. It is extensively illustrated with surgeon’s view intra-operative photographs and high quality fluoroscopic and X-ray images. Compared with other technical manuals with ‘see-through’ drawings, this book gives readers an at-the-table experience. In addition to the key step that each photograph is intended to illustrate, readers can also see which retractors are used and how they are placed to obtain the exposure, what kind of reduction instruments are used and how they are applied to maintain an unobstructed reduction. Attentive readers will probably find the whole procedure is reproducible in their own hands. With master surgeons explaining their preferred technique in a stepwise fashion, together with tips and tricks from established literature in some chapters, reader’s technique and armamentarium are certainly enriched.

The chapter finishes with a short and precise description of

Post-operative Management, Outcomes, Complications, and Illustrative CasesReferences cited are up-to-date and offer good suggestions for further reading. However, a summary box or table would be helpful.

This book is not intended to cover the management of every single fracture. Common fractures faced by general orthopaedic surgeons, and peri-articular & pelvic fractures frequently encountered by trauma surgeons are well-covered. Less commonly performed Taylor Spatial Frame fixation and tensioned wire circular fixators are also described.

I would enjoy reading future editions with chapters on management of elbow fracture-dislocation including radial head replacement, fixation of acromioclavicular joint dislocation, locking nails for proximal humerus fractures, percutaneous fixation of calcaneal fracture, and total knee replacement for peri-articular fractures. It is advantageous that this book keeps its focus on operative techniques and keeps other sections, for example basic science and non-operative treatment, appropriately short.

This technique-focused reference serves not only as a operation manual, it gives readers a concise update of fracture care. I recommend this book to all trainees, evolving sub-specialists and established consultants.

Reviewed by Dr Terence Pun, Orthopaedic Trainee