This text is a compilation of twenty-five cases of trauma involving the upper extremity and thirty-nine involving the lower extremity. Each case is described in an orthopaedic-rounds format, with the history, results of physical examination, and radiographs presented. The operative and postoperative treatments are described, followed by a discussion section and a summary of possible alternative methods of treatment. Especially innovative is the succinct table for each case, depicting the advantages and disadvantages of the different treatment modalities. Interspersed in the margins are notes entitled "Pearls and Pitfalls," which provide gems of wisdom concerning diagnosis and treatment. The text covers a wide spectrum of fractures, including common fractures (such as those of the distal part of the radius and the hip) and rare injuries (such as displaced ipsilateral fractures of the glenoid neck and the clavicle).
As in most case-presentation conferences, the reader often will agree with some but not all of the decisions that were made and the methods that were used in these cases. In fact, it is this constant questioning by the reader that constitutes the educational strength of this text. Although the alternative treatments are presented in a nonbiased manner, the reader already knows which one was chosen by the authors, who make no claim to have treated all cases optimally. The controversy regarding the relative merits of the different forms of treatment creates fertile ground for thought.
I do not consider this text to be a superior educational tool for beginning orthopaedists. Many confounding factors, such as the mechanism of injury, the deforming muscle forces after fracture, the timing of the operation, and the operative approaches, are beyond the scope of this text. The authors state that "this book assumes a degree of orthopaedic knowledge." The references for suggested additional reading, supplied after each case, include classic articles as well as selected recent investigations. These lists are brief and are not intended to be exhaustive. Therefore, this book should not be mistaken for a treatise on the methods of fracture care. Rather, it depicts a wide scope of anatomical injuries and their treatments in a clear, readable package that encourages the reader to ponder and to critique his or her past and future decisions. As an orthopaedic surgeon with an interest in trauma, I found the book to be unique, informative, and stimulating.
Robert J. Brumback, M.D.
Department of Orthopaedic Surgery
The Union Memorial Hospital
and Division of Orthopaedic Traumatology
The R Adams Cowley Shock Trauma Center
The University of Maryland Medical System
Baltimore, Maryland