2 Volumes
Editor
Manish Kumar
Varshney
MS (Orth) DNB (Orth) MNAMS MRCS (Glasgow)
Senior Consultant Orthopedic Surgeon Tata Motors Hospital
Jamshedpur,
Jharkhand,
India
9PREFACE
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Essential Orthopedics (Principles and Practice) (2 Volumes)
First Edition: 2016
9789352501755
Printed at
5Dedicated to
My loving children Siddhant and Mrigank
and my life partner giving strength
to my devotion, Neeta Verma.
The blessings of my parents and my sister have always helped
7CONTRIBUTORS
- Abheek Kar MBBS MS (Orth) MRCS (Edinburgh)
- Shoulder Unit
- Department of Orthopedics
- Apollo Gleneagles Hospital
- Kolkata, West Bengal, India
- E-mail: abheekkar@gmail.com
- Aditya Soral MS Orth (AIIMS)
- Fellow
- Bone and Cartilage Transplantation and Joint Revision Surgery Brisbane, Australia
- Senior Consultant, Department of Orthopedics
- Eternal Hospital
- Jaipur, Rajasthan, India
- E-mail: aditya.soral@gmail.com
- Alok Sud MS
- Commonwealth Fellow
- Pediatric Orthopedic and Spinal Deformities
- Royal Hospital for Sick Children
- Edinburgh, Scotland
- Professor, Department of Orthopedics
- Lady Hardinge Medical College and Associated Hospitals
- New Delhi, India
- E-mail: avimukta2@gmail.com
- Amit Singh MBBS D Orth
- Senior Resident
- Maharishi Valmiki Hospital
- New Delhi, India
- E-mail: drnamitanmch@gmail.com
- Ankit Data MBBS DNB
- General Medicine
- 2nd Year Resident
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- E-mail: adata12@gmail.com
- Ashok Jadon MD DNB MNAMS FIPP (USA)
- Chief Consultant and Head Department of Anesthesia
- In-Charge, Pain Relief Service
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- E-mail: ashok.jadon@tatamotors.com
- Ayush Kumar MBBS DNB Trainee
- Senior Medical Officer
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- E-mail: akk324802@tatamotors.com
- Jaydip Patel MBBS DNB
- Orthopedic Surgery
- 3rd Year Resident
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- E-mail: jaydip_shyani_88@yahoo.co.in
- Manish Kumar Varshney
- MS (Orth) DNB (Orth) MNAMS MRCS (Glasgow)
- Senior Consultant Orthopedic Surgeon
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- E-mail: drmkvarshney@gmail.com
- Palak Mehta MD FIPP
- Director
- Pain Care Clinic
- Ahmedabad, Gujarat, India
- E-mail: pbm_111@yahoo.co.in
- S Pavan MS
- Senior Consultant and Head
- Department of Orthopedics
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- E-mail: pavan.sudarshan@tatamotors.com
- Sachin Bharti MBBS DNB
- General Medicine
- 3rd Year Resident
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- E-mail: bharti_sachin@rediffmail.com
- Sanjay L Srivastava MD (Medicine)
- Chief Consultant and Head Department of Medicine
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- E-mail: sanjay.srivastava@tatamotors.com
- Senior Consultant and Head
- Department of Pathology
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- E-mail: somdattad@tatamotors.com
- Swapnil Sharma MBBS DNB Orthopedic Surgery
- 3rd Year Resident
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- E-mail: swapnil917@yahoo.com
Orthopedics like other medical faculties is a growing branch. The growth is, however, much faster than other fields. Till the beginning of last century, the orthopedics as a discrete was nonexistent to this world but the efforts of pioneers in the field gave birth to the baby that boomed possibly the fastest to become one of the most favored surgical branches to new entrants in the postgraduation. Orthopedics is the most glamorous and preferred surgical faculty for all youngsters aspiring to quickly gain sort of “superspecialization” as not much is available or required after one does his postgraduation in orthopedics, the region-wise faculty development into knee, shoulder, hip, pediatric orthopedics, orthopedic oncology and spine surgery are mostly fellowship dependent.
The scenario in orthopedics was not similar when the faculty started and in the beginning most of the evidences were mere “possibilities” as propounded in the replete literature of the older times written by the eminent persons in the field. Soon it came to be realized that opinions do not count and are often deleterious to general practice that may be true only for certain circumstances, so the era of “evidence-based practice” gradually evolved. With a few hitches then dawned the time where evidence was sought for most of the prevailing practices that were repeatedly questioned by surgeons around the world. This was pioneered by efforts of Association for Osteosynthesis (AO) foundation and others and did help to some extent. In the beginning, however, the evidence was more of confusion rather than leading and the laid down facts had to be constantly changed and adjusted more due to poverty in exactness of the previously laid principles and less also to the emerging evidence as is evident from changing AO philosophy and the glaring failure of metal-on-metal hips. As a postgraduate, it became difficult for me to comprehend the historical errors and practice, changing philosophy and emerging new evidence and importantly remember them all. It was even more difficult to be accurate in orthopedic examinations to rationalize my understanding and teachings to that of the senior examiners who had started the practice even in a more bleak and confused environment prevailing at their time. However, I did realize during the course that some fundamentals were constantly getting lost in these times of evolution that could not be passed on to the youngsters and clinical examination has by now become a mere formality due to higher dependence/pervasiveness on advanced imaging and some illicit activities. The beginning of this century was marked by two major developments I feel—the development of improved implants and instrumentation (particularly the locked plate screw constructs) and higher importance laid down for minimally invasive surgery. It became quickly evident to me that we need a text that encompasses all these facts so that the student gets a “One Stop” text where he can refer to most of his queries. This encouraged me to write down the current text and incorporate the most significant of previous practices and the current developments, some attempts have been made to incorporate the futuristic techniques but it is limited by unavailability of “evidence-based practice”, so I have personally restricted that.
I feel that the future of orthopedics lies in correct and prudent diagnosis (aided solidly by sound knowledge and clinical examination) and ethical practice (not just money making as is considered an important practice nowadays); the basis of which should be correct and true literature and not polluted one. I found some youngsters in the race of just publishing even resort to unethical practice and publish skewed and incorrect findings that pollute the sacred literature which has access to all and even amateur people who may not be able to rationalize and fall prey to wrong practice. This, I feel, also is the reason that newer meta-analysis and even systematic reviews are unable to yield evidence in favor of one or the other method rather often end in saying “no statistically significant different in practice”.
The current text will help a practicing surgeon to acquaint himself with the alternatives available for a particular condition. I have tried to integrate most of the methods that are in practice or known currently for different orthopedic conditions and also organize the text in the form of answers to common theory questions for use to a postgraduate student. I tried to make a sincere effort in producing a text that can give an orthopedic surgeon insight into the orthopedic practice importantly the basic sciences and how diseases are based on faults in them. The textbook has been organized in the form of regional disposition to capture the region-specific conditions. There is vast emerging evidence and will keep emerging even at the time of this writing in the form of modern and new molecular markers that aim to diagnose 10disorders correctly and fast. The future for treatment of some of these disorders might also lie in the molecular level by using microinstruments like nanotechnology and gene therapy, so I tried to cover that topic also comprehensively.
I would like to thank from my heart to all those who have contributed to the text. Particularly Prof Alok Sud from Lady Hardinge Medical College and Associated Hospitals, New Delhi, India, who stood by the commitment once made and put constant efforts in providing me the text in pediatric orthopedics and helped till end in organizing some photographs despite ourselves being only formally introduced and worked for a short duration together. The other person who has helped in preparing the text is Dr S Pavan, who stood always by my side whenever required and also relieved me of my duties often at even hectic times to prepare the text. My juniors Dr Jaydip Patel, Dr Amit Singh and Dr Swapnil Sharma have provided help at difficult times when I needed them for text correction and improvement despite some of them being engaged in their own academic work. Especially, I would thank Dr Jaydip, who even woke-up untiringly at nights despite his duties to correct the text and add to the base work done by others and Dr Swapnil, who provided support regardless of his examinations going on. The contribution of others is not nevertheless small and Dr Ashok Jadon, Dr Sanjay L Srivastav, Dr Ankit Data and Dr Sachin Bharti have contributed thoroughly to the nonorthopedic topics and Dr Aditya Soral, Dr Ram Kinkar Jha and Dr S Dutta, without their help the text could never be completed. My family had been very supportive in displaying immense courage to face social restrictions and my untimely absence from home due to writing work, sometimes when my kids needed me most to play, read, learn and enjoy and my wife missing me sometimes altogether in important festivals and ceremonies. There are, however, some sour memories also and it is also important to mention that the writing had not been easy at all, with minimal help coming from persons I thought would contribute the most. The most respected and dear ones from my earlier relations in the field got too busy or otherwise to provide any help but this was to my best use and possibly advantage that it made me write all the topics by myself, which gave me further knowledge and confidence in areas where I was lacking in my training.
Lastly, I am highly thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing), Ms Samina Khan (Executive Assistant to Director–Publishing), the artists and all the team members who untiringly worked to bring out this wonderful text despite various delays and hitches from my end. It is only with the help of the publishing team at M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, that I could produce the text with confidence. Especially Shri Jitendar P Vij has grown in respect and stature in my thoughts who gave me the opportunity and initiated me for writing giving timely broad outlines, similarly Mr Tarun Duneja has constantly assisted me in sorting out nitty-gritty problems that an author would usually encounter.
Providing an updated and correct text is always a challenge and some concepts would keep changing over time—is a fact. To this end, I reiterate all the readers of this text to kindly keep posting me in case they find fundamental errors in the text or some critical updates that should be incorporated so that we can help all others in their future reading. I am open to all the criticism as they are bound to arise by difference of opinion that should be freely communicated to me at my e-mail—drmkvarshney@gmail.com. One may also reach me at the so-called in fashion social sites like Facebook® or WhatsApp. In the name of Almighty I present the text as an endeavor to promote the proficiency of both the neophyte and experienced orthopedic surgeon, bearing in mind to the truest of an attempt to present contradictory accumulation of discernment into logical concepts and the fact that condensing the mountain of knowledge may not be possible in the lifetime with ever-evolving concepts.
Manish Kumar Varshney
11ACKNOWLEDGMENTS
I heartily acknowledge the contribution of my teachers Dr PP Kotwal and Dr S Rastogi (Professors, Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India) for providing clinical photographs and radiographs representative of typical disorders as a learning resource used at various places in the chapters on pediatric upper and lower limb disorders, rheumatoid arthritis, etc. and various clinical and operative learning representative photographs and radiographs for chapter on bone neoplasia respectively.