Musculoskeletal Trauma Simplified: A Casebook to Aid Diagnosis and Management

Musculoskeletal Trauma Simplified is another addition of the vast armamentarium that exists and aims to educate junior doctors in ordering and interpretation of radiographs and making a management plan. Although it is sufficiently broad-based, aimed towards the junior doctors and junior doctors alike, it deals with any broad speciality and the book claims to be especially useful to emergency room physicians and the orthopaedic trainees. The authors hope to see this book on accident and emergency shelves thus aiding as a handy and easy guide to the world of radiography.

The preface mentions that this book was designed to approach each radiograph on a case-by-case basis to different types of orthopaedic (predominantly) injuries. This book focuses on the plain film finding of skeletal trauma for practitioners of musculoskeletal injuries.

This book is conveniently divided into anatomic locations. Cases have been presented containing clinical information, summary of radiological findings and accompanying clinical management. The authors hope this will enable readers to test themselves on broad based fracture management, integrating this with other vital medical management.

The book starts with a section on spinal injuries – the most feared and yet the most exciting area of medicine. The radiographs reproduced here are of extremely good quality and combined with the clinical scenario they are presented almost as mini case studies which is very useful and infinitly important. All common conditions likely to be seen routinely in a busy emergency department are elucidated and the outcome is interesting, informative and rewarding. I was impressed with all the clinical situations described in the section on proximal humerus and shoulder girdle where succinct descriptions on the radiographs were presented and clear clinical treatment was outlined. Of particular note are the quick classifications and the line diagrams which made understanding easy and retention and recall even easier.

A few key CT scan images with their interpretation would have helped in this section though, since CT is so commonly ordered for these injuries from the emergency department itself.

The section on hand injuries has been dealt with in detail. There was a time when residents could only diagnose or would only look for injuries whih had been pigeon holed into simple types. With advances in diagnostic imaging and more importantly understanding of the mechanisms of injury, residents presently are expected to look for, diagnose and treat complex wrist conditions like the Volar and Dorsal intercalated segmental instability of the wrist (VISI/DISI). Gilula lines for the carpal alignment are very appropriately and yet simply described. The short section on management which follows the radiographs makes going back to heavier texts unnecessary. None of the simple injuries have been trivialised and have been given appropriate management status. It is rare to see a text offer so much vital information in so few words and so succinctly.

Pelvic and acetabular fractures have been outlined particularly well, especially in view of the fact that most physicians including radiologists and orthopaedic surgeons find their interpretation daunting. The various Judet views are clearly outlined and would be of great help in emergency room interpretation for juniors and seniors alike.

It is heartening to see a section on paediatric fractures which covered most emergency room situations. The clinical scenarios played out are classical and most junior emergency room personnel would have no trouble identifying the bulk of these injuries.

In conclusion this book deals with more than just radiology. It will actually encourage juniors to interpret X-rays and make a logical treatment plan. In future editions I hope to see basic emergency room CT images if only for the spine and pelvis. I thoroughly enjoyed this book review and I am convinced that this is a winner.

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