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The Wrist: Master Techniques in Orthopaedic Surgery

Edited by Richard H. Gelberman pp. 554 Philadelphia: Lippincott, Williams & Wilkins, 2010 ISBN: 978-0-7817-8339-2

The flavour of a practical surgical textbook is determined by the angle from which the subject matter is approached - either problem-based (making each clinical condition the focus to which methods of treatment, surgical or otherwise, are attached) or technique-based, where the heading of each chapter states the procedure under discussion, and the indications are attached to it. This book, and indeed the whole series, falls very much into the latter category. As a result it feels very much like a cookery book, providing the trainee or fully fledged surgeon with a valuable source of technical information. If used in that way it has an important place, but it should not be used as a primary source of guidance in the management of clinical conditions presenting in the wrist.

There is a strong emphasis on surgery of the bones of the wrist, there being for example no less than eight chapters on various methods of internal fixation of fractures of the distal radius, with no real guidance to the reader on choice of procedure for an individual case. By contrast, scapholunate ligament injury has a chapter on acute repair (which is sadly only possible when early diagnosis is made, and that is rarely the case), and two brief chapters on tenodesis techniques, which many feel have been superseded by techniques of ligament reconstruction. The Brunelli operation for example and other tendon substitutes are not mentioned.

The format of the book is standardised throughout the series. It is logical and predictable, but it can also be irritating, particularly the endless repetition of detail that could and should be taken for granted, such as the need for a tourniquet, anaesthesia and a sterile field. The short-hand bullet-point system of technical description does make for easy reading. A little editorial culling would be welcome to simplify the language, avoiding expressions like "in contradistinction" and "sterilely prepare the arm".

Some chapters stand out, especially Marc Garcia-Elias' account of radio-scapho-lunate arthrodesis with distal scaphoid excision and Kleinman's chapter on capsular release of the distal radioulnar joint. Kirk Watson's ideas on scaphoid internal fixation avoiding compression screwing are interesting. The account of distal radioulnar joint reconstruction for instability is disappointing; Linscheid describes one technique only, and that is partly directed towards correcting carpal supination. True DRUJ instability is very disabling, and there are excellent methods of reconstruction that could have been mentioned, including those of Adams, and Scheker. Another surprising omission was the pisiform bone which does not get a mention and would have every reason to be aggrieved! Pisotriquetral arthritis is common, painful and readily cured - something that cannot be said for many of the conditions that are covered.

There is a great deal of technical information to be found in this book. It is well organised and readily accessible once a surgical course of action has been determined, but it will not provide the means to move from the clinical presentation through diagnostic methods to a decision that surgical treatment is needed, and the selection of the most suitable procedure.

D. Evans

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