FOURTH EDITION
J. Maheshwari MS Ortho (AIIMS)
Formerly Additional Professor of Orthopaedics All India Institute of Medical Sciences
New Delhi, India
Presently Director Knee and Shoulder Clinic,
New Delhi, India
Consultant Orthopaedic Surgeon Sitaram Bhartia Institute of Science and Research,
New Delhi, India
exclusively distributed worldwide by
Published by
J. Maheshwari
MS Ortho (AIIMS)
Flat No. 541, Type-IIIA Category SFS-III
Seventh Floor, East of Kailash
New Delhi, India
Essential Orthopaedics
© 2011, J. Maheshwari
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author.
First Edition | : 5 Reprints |
Second Edition | : 5 Reprints |
Third Edition | : Aug. 2001 (6 Reprints) |
Third Edition (Revised) | : May 2005 (7 Reprints) |
Fourth Edition | : 2011 |
9788184655421
Printed in India
4Dedicated to
My patients
for giving me an opportunity to make a difference in their lives
and
My family & friends
for continuous support at all times
5FOREWORD TO THE FIRST EDITION
This book written by Dr Maheshwari, is designed to introduce the trainee doctor and the young surgeon to orthopaedic surgery as he will meet it in the developing countries. There have been many good books on orthopaedic surgery and trauma written by experienced authors from Britain and America but their exposure to the real orthopaedic problems experienced in developing countries has often been limited, and today the difference in presentation of orthopaedic surgery in these countries and the presentation of conditions in developing countries like India and Africa is so different that this book, written by a surgeon with a good grounding of clinical experience in India, is most appropriate for the trainee from the developing countries.
I have read a number of chapters and have been impressed with the simple text and clarity with which the different conditions are explained.
Dr Maheshwari has visited my centre in Nottingham for a period of two months. I was impressed with his clarity of thought and his depth of understanding of orthopaedic conditions. I anticipate that this book will be one of many that he writes in future years and is likely to be a major contribution to orthopaedic training in developing countries.
WA Wallace
Professor of Orthopaedic and Accident Surgery
University Hospital, Queen's Medical Centre
Nottingham NG7 2UH
United Kingdom
6PREFACE TO THE FOURTH EDITION
Medical science is an ever evolving science. Human body remains the same, but our understanding of it changes, and hence our methods of treating patients. Technology has played a vital role in development of orthopaedics in particular.
What is most important is, that over the years these new technologies and methods have percolated down to the remotest areas of the developing world. It is with this perspective that updating even a basic book such as this has become necessary.
I have updated all chapters and added a new column “What have we learnt?” at the end of each chapter. A few more flow charts have also been added.
As this book is meant for undergraduate students, I have resisted the temptation to ‘teach too much’. Of course, it now comes in multicolour with a new look. I hope the readers would like its current format.
Feedback is welcome.
Knee and Shoulder Clinic
F-7, East of Kailash
New Delhi, India
e-mail: drjmaheshwari@hotmail.com
J. Maheshwari
May 2011
7PREFACE TO THE FIRST EDITION
What was the thought behind this book in 1993
As an undergraduate, though exposed to orthopaedics only for a short period, I was impressed by the ease with which I could understand the wonderful texts I studied. The problems were that their contents did not exactly meet the requirements of an undergraduate, and most of these books, written by authors from developed countries, did not provide adequate information about diseases peculiar to tropical and underdeveloped countries. Above all, I thought that the concepts could be presented with still more clarity, and improved by way of presentation.
This feeling continued to haunt me everytime I was called upon to teach undergraduates. A couple of years later, an experience at home helped me give a practical shape to this feeling. My wife, who was preparing for PG entrance examination, expected me to teach her orthopaedics. I tried out my ideas on her, and the result was extremely gratifying. Soon after, many more such occasions of teaching undergraduates gave me further opportunities for refining the material. It was on the request of the students that I decided to give it the shape of a book.
The book is primarily addressed to undergraduates and those preparing for the postgraduate entrance tests. General practitioners, particularly in the early stage of their practice would find it useful reference. It would enable nurses and physiotherapists to understand the basic concepts in orthopaedics. Junior postgraduates would find it an enjoyable reading.
Following are the salient features of the book:
- Most chapters begin with a brief review of the relevant anatomy. This is because by the time a student comes to clinical departments, he has forgotten most of the anatomy he had learnt in the dissection hall.
- While discussing treatment of a condition, a brief mention of principles is made first, followed by various methods and their indications. This is followed by treatment plan; a practical plan of treatment which is either being followed or can be developed in an average hospital. A brief mention of recent developments is also made.
- The book has three additional chapters. These are “Approach to a Patient with Limb Injury”, “Approach to a Patient with Back Pain”, and “Recent Advances in Treatment of Fractures”. The first two present a practical approach to handling these frequently encountered emergencies, and the third chapter updates the reader with the latest in this rapidly developing field. Due emphasis has been given to aspects of rehabilitation, considering the recent recommendations of Medical Council of India for including ‘rehabilitation’ in undergraduate curriculum.
- Simple line diagrams have been used to supplement the text. Most of them have been developed by myself while teaching the undergraduates. Simplified line diagrams, rather than photographs, enable students understand the basic concepts better.
- Self-explanatory flow charts are made use of wherever they would help to develop a concept in decision-making.
- Tables have been used liberally. These serve two purposes: Firstly, they present the text matter in a concentrated form and allow review at a glance. Secondly, they permit quick and easily understandable comparison between related conditions.
- Necessary information on instruments and implants commonly used in orthopaedics has been provided as an appendix, purely considering the requirement of such knowledge for final professional examination.
New Delhi
September 1993
J. Maheshwari