By: 24 October 2011

This book is another addition to the ongoing problems in Trauma and orthopaedics where treatment is still evolving and advances are being made to best treat and manage these injuries. This book is broad-based and simple and is directed to junior orthopaedic residents and trainees embarking on their orthopaedic career. This may also be useful to medical students in their final stages of training in qualifying examinations. The author hopes to see this book in accident and emergency departmental shelves and medical libraries where it may prove to be a quick guide to the world of basic orthopaedics.

The preface mentions that this book was designed to help students practising at District and sub divisional hospital level where easy access to a fully stocked library may yet be utopian. By the authors own admission this book is not comprehensive nor does it aspire to be. Most subjects have been chosen by relevance to a developing country thus tuberculosis and other exotic conditions find mention. This book is conveniently divided into various broad sections namely tuberculosis, bone malignancies, low back pain, implant infection and preventive strategies followed by internal fixation of common fractures and problems in managing the omnipresent neck of femur fractures.

Authored by a single person namely Dr. R.C.Mohanti who was former Professor and head of Department of Orthopaedics in one of the premier medical institutes in India, this book has been published by JayPee Brothers Medical publishers with offices in India and the US. It has been typeset at JPBMP Typesetting Unit. It bears the ISBN 978-81-6448-540-0.

This book starts with the section on Tuberculosis of the bones and joints and deals in a concise fashion with various burning issues like current investigations and serological diagnosis, current drug recommendations, causes and treatment for resistant cases, surgical management of tuberculosis of the spine then going onto the salient treatment features associated with individual joints. The take home messages from a wide collection of recent literature emphasises the fact that there are presently only a few indications for surgical management for tuberculosis affecting the lumbar spine and surgery is reserved for cases where either diagnosis is in doubt or in face of progressive neurology or instability.

Current concepts in management of primary malignant tumours gives a snapshot of staging (revisited) and adjuvant and neoadjuvent chemotherapy, treatment for metastasis and a note on limb salvage. This section does seem inadequate since there is nothing new or advances really covered here. The author makes a very poignant observation that, “the role of the orthopaedic surgeon although pivotal in the management of bone malignancies is pivotal but not singular”. It also emphasises the role of multidisciplinary teams in the management of these difficult scenarios.

Low back pain discusses predisposing factors in great detail and prevention has been accorded great importance. Yet the treatment is limited to enumerating various options for surgical management and makes no reference to current or details about sophisticated techniques. “It is easy to enumerate with a classification of causes in low back pain but when it comes to diagnosis the causes in an individual case one is at a loss”. This effectively summarises the practical difficulties in treatment of backache especially when so many patients are left with lingering and often disabling symptoms. A flowchart approach to the various treatment options would have been useful. No mention is made of detailed red flag or yellow flag symptoms to emphasise diagnostic evaluation.

Disorders of the foot and ankle are refreshingly comprehensive and deals with common and resistant conditions seen in daily practice. Much emphasis has been laid on CTEV or clubfeet as arguably it is the most frequent birth anomaly with frequency of 1.24 per 100,000 of the population. Protocols and recurrent surgical options for resistant cases are elucidated. A section has been added on Achilles tendon disorders including ruptures. With increasing patients presenting with Achilles tendinopathy for which no effective treatment as yet exists this is invaluable.

The best chapter in the book is unarguably the one on measures to optimise fracture healing. This is an interesting section detailing growth factors and current manipulative strategies, various measures for enhancing fracture healing in various clinical situations. Stem cells treatments find mention here and future directions for healing technologies are outlined. Appropriately the author has quoted David Marsh, “the evolution has been first to use nature, then to ignore her, then to remember her and now to outdo her”.

The controversies in the current internal fixation of fractures are well listed though depth and dimension are sorely missing. A lot of space has been inappropriately devoted to classification systems and radiographic evaluation rather than evidence-based current management solutions. Newer treatments do not find a mention here and biomechanics of locking systems and minimally invasive surgery ought to have found an eminent place here. Unfortunately these have been given a wide berth. Some comments are out of context and some are nauseatingly patronising, “tibial plateau fractures are a challenge to the orthopaedic surgeon. Open reduction and internal fixation remains a safe technique in experienced hands”. Not what you want to hear in an update on current problems.

Implant infection is a refreshing chapter dealing with causes and evidence-based steps to be undertaken to reduce its incidence. This has been appropriately outlined in form of easy-to-read tables and references. Treatment of established infection finds takers here yet the treatment for periprosthetic fractures leaves you feeling short changed. The section on fractured neck of femurs is short and enumerates current problems. This area describes the McMurreys osteotomy in detail and though of little significance in the developed world is important to surgeons in rural or developing locations where patient lifestyle or affordability may not be able to dictate more sophisticated treatments.

In conclusion this book is a brief coverage on current problems in orthopaedics and trauma. Though detailed in few aspects it is quite shallow in most parts to be useful as a concise orthopaedic guide. The small size and easy read is ideal for occasional or light reading.