Pathophysiology of Orthopaedic Disease

This book is a tribute to Dr. Mankin’s past chief and mentor Dr. Henry L. Jaffe. As Dr. Herndon notes in his preface, Dr. Mankin cites Dr. Jaffe`s publication in 13 of the 24 disease-specific chapters. An icon for the orthopaedic practitioner, Dr. Mankin has authored numerous publications on the various pathologies discussed and was to students a natural teacher and to clinicians a wonderful orator. He has been honoured with an Instructional Course Lecture at every AAOS annual meet and has lectured all over the world on most topics included in this publication. In his preface, he has professed the highest respect towards his mentor and teacher, Henry Jaffe who has been his guiding star in medical education.

The chapter on Henry Jaffe is a story in academic excellence and dedication, a genius dedicated to his work and author of the two best publications ever in the field of orthopaedic pathology. It will be interesting for the reader to note that many of the term almost in household use in clinical medicine were coined by Jaffe and associates. The Jaffe collection is a virtual treasure trove of the history of pathology itself and is the forerunner of modern pathology as we know it.

Interesting facts and anecdotes are revealed about the bygone relentless charge of the twin demons namely syphilis and tuberculosis describing the crescendo reached in the erstwhile urban population. Almost theatrical, Williams Osier’s remarks echoed in his words that, “Everyone in the end has a touch of tuberculosis”. Sadly these words ring true even now since after a low ebb this disease is back in fashion fuelled by overcrowding and migration. Poliomyelitis is described in interesting details and is now of historical rather than clinical interest in view of the fact that the disease has been successfully slowed down by worldwide immunizations and cases are too rare to be seen routinely and thus liable to be missed!

Various conditions like osteomyelitis and osteoarthritis make interesting reading. Remarkable historical facts and developments trace the history from its ancient roots to the modern-day treatments of these conditions. Indeed better preventive care has almost erased this malady from clinical presentations and as Dr. Mankin observes, “Traumatic or surgically induced osteomyelitis has now in large measure replaced the haematogenous disorder as principal cause for bone infection”. A subtle message no doubt to the surgeons! A birdseye view is given for current treatments for osteoarthritis and no bones is made of the fact that most treatments give temporary or fleeting relief and are bound to fail eventually necessitating joint replacements. As is rightly pointed out there is no cure yet for this marauding pathology.

Slightly unusual but not rare, pigmented villonodular synovitis has its history traced back to its first description by Jaffe, Lichtenstein and Sutro in 1941. A brief but succinct summary of histology and treatment makes this the ideal companion in the surgeons coffee rooms for quick reference. Similarly Paget’s disease of bone and the enigmatic fibrous dysplasia is well-treated and comprehensively described almost making the pathology come alive. I was glad to find the genetic theories of Pagets disease discussed and discarded! The histologic photographs accompanying the treatise could have been better visualised in colour, but, nonetheless conveys the accurate meaning of ‘hot’ and ‘cold’ disease.

Fracture healing has been tackled to make it interesting and appealing and is truly historic in content. Indeed following Homer and Hippocrates, considered the fathers of fracture treatment as we know it now, is the length of time their innovative and often brutal treatments were in vogue, used virtually unchanged in the late 19th and early 20th centuries. A small overview is given of the stages of fracture healing and one wishes that more detailed descriptions of the histological features would have added depth and dimension to this area of common interest. A small section explaining the nuances of the various bone substitutes and their use in fracture treatment makes helpful reading. Various terms like osteoinduction, osteoconduction, demineralised bone matrix (DBM) , bone morphogenetic protein (BMP) and its various components makes this the dummy`s guide to bone healing.

Neurofibromatosis is described in depth and makes excellent work of the histological features. The air is cleared of the many confusing terminologies and presentations and as Mankin puts it, “it is important to recognise the differences among them”. Not surprisingly that even though the authors of two different texts on the subject have gone to great lengths to distinguish the lesions of Neurofibromatosis Type I from schwannomas, the two disorders are still confused in the literature and by pathologists.

As is already known, Mankin has written tomes on metabolic disorders including scurvy, rickets and renal osteodystrophy, the fascinating description of its history and the detailed pathological features so described are legendary. At this point it would be wise to make the reader aware of another of Mankins excellent treatise on growth plate physiology and students and clinicians alike will benefit from a preliminary reading of the above before delving into the pathological conditions affecting the growth plate.

The world’s impending epidemic namely Osteoporosis surprisingly and refreshingly focuses more on treatment than pathology. Relevant laboratory studies are enumerated and a snapshot of currently used therapeutic range of products is provided.

It would do well to have future edition of the book having photomicrographs in colour to make it more pleasing to the eye. Interesting undoubtedly the book is a delight for the medical historian, the pathologist, the surgeon and the student in that order. An ideal addition to the operating suite library I believe it will serve as a ready reference manual for snapshot view of pathological conditions commonly seen and often missed.

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