CHAPTER 1: Introduction to Fractures and Dislocations 1
Fractures 1
Definition 1; Types of Fracture 1; Deforming Forces 4; Specific Types of Fracture 4;
Signs and Symptoms of a Fracture 5; Healing of a Fracture 5;
Factors Influencing Healing (Predisposing Factors for Delayed Union and Nonunion) 6;
Management of a Fracture 6; Basic Methods of Treating a Fracture 7; Complications 7;
Treatment of Delayed and Nonunions 9; Recent Concept of Fracture Healing 14
Dislocations 15
Definition of Dislocation and Subluxation 15; Types of Dislocation 15; Traumatic Dislocation 15;
Pathological Dislocation 17; Paralytic Dislocation 17
CHAPTER 2: Fractures in the Upper Limb 18
Fractures Around the Wrist 18
Bennett’s Fracture 18; Rolando’s Fracture 19; Scaphoid Fracture 20; Colles’ Fracture 25;
Smith’s Fracture 29; Barton’s Fracture 30; Essex-Lopresti Fracture 31; Chauffeur’s Fracture 32
Fractures in the Forearm 33
Fracture of the Radius and the Ulna 33; Monteggia Fracture 34; Galeazzi Fracture 36
Fractures Around the Elbow 37
Radial Head Fracture 38; Olecranon Fracture 39; Capitulum and Trochlea Fractures 40;
Medial and Lateral Epicondyle Fractures 40; Medial and Lateral Condyle Fractures 41;
Supracondylar Fracture of the Humerus 42; Intercondylar Fracture 50
Fractures in the Arm and Around the Shoulder 51
Fracture Shaft of the Humerus 51; Fractures of the Proximal Humerus 53; Fracture of the Clavicle 54;
Fractures of the Scapula 56
CHAPTER 3: Ligament Injuries and Fractures in the Lower Limb 60
Fractures of the Foot 60
Chopart’s Injury 61; Lisfranc’s Injury 61; Fracture of the Fifth Metatarsal Bone 63; Jones’ Fracture 63;
Pseudo-Jones’ Fracture 64; Fracture of the Talus 64; Calcaneus Fracture 67

xx Essentials of Orthopedics
Injuries Around the Ankle 71
Ligament Injuries 71; Bony Injuries of the Ankle (Pott’s Fracture) 71;
The Surgical Sequence of Reconstruction Followed in Vertical Compression Injury 77
Tibial Diaphyseal Fractures 77
Injuries Around the Knee Joint 79
Ligament Injuries 79; Meniscal Injuries 82; Fracture of the Patella 85;
Fractures of the Tibial Condyle (Tibial Plateau) 88; Fractures of the Femoral Condyles 89
Fracture of the Shaft of the Femur 91
Complications 92
Fractures Around the Hip 92
Fracture of the Neck of the Femur 92; Intertrochanteric Fracture 99; Subtrochanteric Fracture 102
CHAPTER 4: Dislocations 107
Dislocation of the Acromioclavicular Joint 107
Mechanism of Injury 107; Classification 107; Clinical Features 108; Diagnosis 108;
Management 108
Dislocation of the Shoulder 109
Types 109; Anterior Dislocation of the Shoulder 109; Recurrent Anterior Dislocation 110;
Posterior Dislocation of the Shoulder 111; Recurrent Posterior Dislocation 112
Dislocation of the Elbow 112
Types 112; Mechanism of Injury 112; Diagnosis 112; Management 113
Dislocation of the Hip Joint 114
Types 114; Mechanism of Injury 114; Classification of Posterior Dislocation 116;
Diagnosis 116; Management 116; Complications 118
Dislocation of the Knee 118
Diagnosis 119; Treatment 119
CHAPTER 5: Fractures of the Pelvis 120
Formation of Pelvis 120
Mechanisms of Injury 121; Classifications 122; Clinical Signs of Importance 123;
Investigations 124; Principles of Management 124; Complications of Fracture Pelvis 125
Malgaigne Fracture 125
CHAPTER 6: Spinal Injuries 127
Structure of the Spinal Column 127; Structures that Impart Stability to the Spinal Column 127;
Functions of the Spinal Column 128;
Spinal Injury 128
Denis’ Three Column Concept 129; Mechanisms of Spinal Injuries 129;
Specific Types of Spinal Column Injury 131; Spinal Cord Injury 133; Management of Spinal Injuries 134;
Management of Established Paralysis (Quadriplegia and Paraplegia) 136; Signs of Grave Prognosis 137;
Perianal Anesthesia 137; Bulbocavernous Reflex 137; Anal Wink 137; Rehabilitation 138;
A Ray of Hope for Paraplegics and Quadriplegics 138

Contents xxi
CHAPTER 7: Peripheral Nerve and Brachial Plexus Injuries 140
Peripheral Nerve Injury 140
Structure of a Peripheral Nerve 140
Response of a Neuron to Injury 140
Classification of Nerve Injury 142
Based on Seddon’s Classification (1943) 142; Based on Sunderland Classification (1951) 142
Diagnosis 142
Autonomic and Sensory Changes 142; Motor Changes 142; Special Tests 144;
Sensory Zones of a Peripheral Nerve 144; Diagnostic Tests 144
Management 145
Neuropraxia and Axonotmesis 145; Neurotmesis 145;
Reconstructive Procedures in Cases of Absent Recovery 147; Management 152;
Pathomechanics of Various Deformities and Signs 152
Brachial Plexus 159
Formation of Brachial Plexus 159
Injuries of Brachial Plexus 160
Upper Plexus Injury—Erb’s Paralysis 161; Lower Plexus Injury—Klumpke’s Paralysis 161;
Whole Plexus Injury 161; Management 162
CHAPTER 8: Bone and Joint Infections 165
Introduction 165
Osteomyelitis 165
Nonspecific Infection 166
Acute Hematogenous Osteomyelitis 166; Chronic Osteomyelitis 169; Subacute Osteomyelitis 171;
Brodie’s Abscess 171; Sclerosing Osteomyelitis of Garre 172; Acute Suppurative Arthritis 172;
Tom Smith’s Arthritis of Infancy 173
Specific Infections 174
Tuberculosis of Bones and Joints 174; Tuberculosis of the Spine 175; Types of Kyphus/Gibbus 176;
Cold Abscess 176; Pott’s Paraplegia 179; Tuberculosis of the Hip 181; Tuberculosis of the Knee 184;
Tuberculosis of the Ankle and Foot 186; Tuberculosis of the Shoulder and Elbow 186;
Tuberculosis of the Wrist 186; Spina Ventosa (Tuberculous Dactylitis) 187;
Mycotic Infections of the Bone 187; Maduromycosis 187; Syphilitic Infection of the Bone 188;
Parasitic Infestation of the Bone 188; Hydatid Cysts in the Bone 188
CHAPTER 9: Bone Tumors 190
Evaluation of a Bone Tumor 190
Clinical Evaluation 190; Radiological Evaluation 192; Role of Angiography 192; Bone Biopsy 193;
Laboratory Investigations 194; Management 194
Common Benign Bone Tumors 195
Osteoid Osteoma 195; Benign Osteoblastoma 195; Osteochondroma 196; Chondroblastoma 197;
Chondromyxoid Fibroma 198; Enchondroma 198; Aneurysmal Bone Cyst (ABC) 199;
Unicameral Bone Cyst (UBC) 200

xxii Essentials of Orthopedics
Common Malignant Bone Tumors 201
Giant Cell Tumor (GCT) 201; Osteosarcoma 203; Chondrosarcoma 206; Ewing’s Tumor 206;
Myeloma 207
Metastatic Bone Disease 209
CHAPTER 10: Slipped Capital Femoral Epiphysis,
Perthes’ Disease and Other Osteochondritis 211
Slipped Capital Femoral Epiphysis (SCFE) 211
Predisposing Factors 211; Pathology of the Slip 212; Clinical Features 212; Investigations 213;
Radiological Classification of the Slip 213; Treatment 213
Legg-Calve-Perthes’ Disease 216
Predisposing Factors 216; Pathology 217; Radiological Features 217;
Clinical Features 218; Head at Risk Signs 219; Investigations 220;
Treatment 220; Prognostic Factors 222
Idiopathic Avascular Necrosis/Osteochondritis 223
Kienbock’s Disease 223; Kohler’s Disease 224
CHAPTER 11: Intervertebral Disc Prolapse 227
Introduction 227
Pathomechanics of Intervertebral Disc Prolapse 227
Diagnosis 228
Investigations 231; Treatment 233
CHAPTER 12: Nutritional, Endocrine, Degenerative and
Autoimmune Disorders 235
Rickets and Osteomalacia 235
Rickets 236; Pathology 237; Clinical Features 237; Investigations 238;
Treatment 239
Osteoporosis 241
Types 241; Risk Factors 241; Pathology 241; Clinical Features 241; Investigations 241;
Treatment 242
Osteoarthritis 242
Types 242; Etiology and Pathogenesis 243; Pathology 243; Clinical Features 243;
Diagnosis 243; Management 244
Rheumatoid Arthritis 245
Definition 245; Etiology 245; Joints, Organs and Tissues Involved 245; Pathology 245;
Clinical Features 245; Investigations 245; Treatment 246
Hyperparathyroidism 247
Classification 247; Pathology 247; Laboratory Investigations 248; Treatment 248

Contents xxiii
CHAPTER 13: Congenital and Developmental Anomalies 250
Congenital Talipes Equinovarus 250
Etiology and Pathogenesis 250; Deformities in Clubfoot 250; Diagnosis 251; Treatment 252
Congenital Vertical Talus 256
Synonyms 256; Definition 256; Etiology 256; Pathological Anatomy 256; Diagnosis 256;
Differential Diagnosis 256
Developmental Dysplasia of the Hip (DDH) 258
Predisposing Factors 259; Clinical Features 259; Investigations 262; Treatment 263
Skeletal Dysplasia and Other Conditions 264
Skeletal Dysplasias 264
Important Skeletal Dysplasias 265
Spondyloepiphyseal Dysplasia 265; Multiple Epiphyseal Dysplasia 265; Achondroplasia 265;
Hypochondroplasia 266; Osteopetrosis 266; Paget’s Disease 267; Fibrous Dysplasia 268;
Osteogenesis Imperfecta 269
CHAPTER 14: Miscellaneous Conditions 272
Mallet Finger 272
Etiology 272; Clinical Features 272; Treatment 272
Boutonniere Deformity 272
Etiology 272; Clinical Features 273; Treatment 273
Trigger Finger/Thumb 273
Etiology 273; Clinical Features 274; Treatment 274
de Quervain’s Disease 274
Clinical Features 274; Treatment 274
Dupuytren’s Contracture 274
Etiology 275; Clinical Features 275; Treatment 275
Carpal Tunnel Syndrome 275
Etiology 275; Clinical Features 275; Treatment 275
Tennis Elbow 276
Pathology 276; Clinical Features 276; Test 277; Treatment 277
Golfer’s Elbow 277
Test 277; Treatment 277
Supraspinatus Tendinitis 278
Treatment 278; Calcific Tendinitis 278; Clinical Features 278; Treatment 278
Subacromial Bursitis 278
Etiology 278; Clinical Features 279; Treatment 279
Painful Arc Syndome 279
Etiology 279; Clinical Features 279; Treatment 279

xxiv Essentials of Orthopedics
Periarthritis Shoulder 279
Clinical Features 279; Treatment 280
Calcaneal Spur 280
Etiology 280; Clinical Features 280; Treatment 280
Ganglion 280
Treatment 281
Baker’s Cyst 281
Treatment 281
Neuropathic Joint 282
Etiology 282; Pathology 282; Clinical Features 282; Diagnosis 282; Treatment 283
Congenital Torticollis or Wry Neck 283
Natural Course of the Fibromatosis 283; Clinical Features 283; Diagnosis 283; Treatment 283;
Prognosis 283
Idiopathic Avascular Necrosis of the Head of the Femur 283
Other Names 283; Clinical Features 283; Staging: Ficat and Arlet (1980) 284;
Radiological Features of AVN 284; Treatment 284
Spondylolisthesis 284
Types: Based on Wiltse Classification 284; Etiopathogenesis 284; Clinical Features 285;
Diagnosis 285; Treatment 285
Bursa and Bursitis 286
Myositis Ossificans 286
Predisposing Factor 287; Pathophysiology 287; Treatment 287
CHAPTER 15: Fractures in Children 288
Types of Injuries 288
Physeal Injuries 288; Thurston Holland Sign (Shiny Corner Sign) 289; Plastic Deformation 291;
Buckle Fractures 291; Greenstick Fractures 292
Common Fractures in the Lower Limb: Diagnosis and Management 292
Fracture of Shaft of Femur in Children 292; Fracture of Neck of Femur in Children 293
CHAPTER 16: Poliomyelitis 295
General Information 295
Epidemiology 295
Pathogenesis 295
Stages of Poliomyelitis 296; Differential Diagnosis 296; Laboratory Diagnosis of Poliomyelitis 296;
Treatment of Poliomyelitis 296
Immunization and its Current Status 297

Contents xxv
Skeletal Deformities in Poliomyelitis 297
Pathogenesis of Deformities 297; Preoperative Considerations 298; Design of Surgical Procedures 298
Deformities Around the Hip 298
Role of Iliotibial Band in Contractures 299; Paralytic Dislocation of the Hip 299;
Surgical Procedures for Release of Contractures 299;
Surgical Procedures for Paralytic Dislocation of the Hip 299
Deformities of Foot and Ankle 300
Tendon Transfers and Corrective Procedures for Muscle Insufficiency 300;
Bony Procedures for Deformity Correction 301; Triple Arthrodesis 301;
Other Bony Procedures 301; Claw Toes 302; Correction of Claw Toes 302
CHAPTER 17: Cerebral Palsy 303
Etiology 303
Prenatal Causes 303; Natal Causes 303; Postnatal Causes 303
Terminologies Used in the Assessment of Limb Involvement 303
Monoplegia 303; Hemiplegia 304; Paraplegia 304; Triplegia 304; Quadriplegia 304;
Whole Body Involvement 304
Clinical Evaluation of a Child with Cerebral Palsy 304
Signs of Prognosis 304
Treatment 305
Role of Surgery 306; Procedures 306
CHAPTER 18: Gait 307
Definition 307
Phases 307
Gait Cycle 307
Common Terminologies Used in the Analysis of Gait 307
Abnormal Gaits 308
Due to Muscle Weakness, e.g. Poliomyelitis 308;
Due to Changes in the Bones and Joints 308;
Due to Abnormalities in the Nervous System 309
Trendelenburg Gait 309
Pathomechanics of Trendelenburg Gait 310
CHAPTER 19: Amputations 311
Definition 311
Indications 311

xxvi Essentials of Orthopedics
Types of Amputations 311
General Amputations 311; Specific Amputations 311
An Ideal Stump of Amputation 313
Recommended Ideal Length of the Stump 313
CHAPTER 20: Arthroscopy and Total Joint Arthroplasty 315
Arthroscopy 315
Evolution of Arthroscopes 315; Components of an Arthroscope 315; Technique 315;
Advantages of Arthroscopic Procedures 316; Limitations of the Arthroscopic Procedures 316;
Complications 316; Common Arthroscopic Procedures 316
Total Joint Replacement (Arthroplasty) 316
Evolution 317; Complications 317;
Postoperative Rehabilitation after Joint Replacement Surgery 317
CHAPTER 21: Implants and Instruments 318
Introduction 318
Materials Used for Orthopedic Implants 318; Desirable Properties of an Implant 318;
Types of Implants 318; Types of Prosthesis 319; Implant Selection 319; Implant Insertion 320;
Asepsis in the Operating Room 320
Surface Implants 320
Screws 320; Plates 321
Intramedullary Implants 323
Rigid Nails 323; Hollow Nails 324; Elastic Nails 324
Biodegradable Implants 325
Dynamic Hip Screw and a Barrel Plate 325; Jewett Nail 325;
Cannulated Cancellous Hip Screw 325
General Instruments Used in Orthopedics 326
Mallet 326; Chisel 327; Osteotome 327; Bone Gouge 327; William Arbuthnot Lane 328;
William Ferguson 328
Designs of Limb Lengthening Apparatus 328
Ilizarov Fixator 328; Orthofix Type 328; Wagner Type 328
Index 331