Those who are familiar with earlier editions of Dr. Salter's textbook know it as the definitive work for students of the musculoskeletal system. Newcomers will discover a scholarly, thorough, highly organized text that may be used for specific references or read straight through for a complete introduction to musculoskeletal disorders.
The third edition, coming sixteen years after the second, has been extensively revised and the references updated. A notable change is an expanded table of contents, which enables the reader to perceive the pattern of organization and to determine at a glance the subtopics covered under each subject. It is not often that a book's table of contents exceeds its index in length, but it is a useful innovation.
Another elegant touch is the introductory quotation that keynotes each chapter; for example, Chapter 4, on terminology, begins with a statement by Voltaire: "If you wish to converse with me, define your terms."
The book is divided into four sections: "Basic Musculoskeletal Science and Its Application," "Musculoskeletal Disorders—General and Specific," "Musculoskeletal Injuries," and "Research." Although Dr. Salter is an orthopaedic surgeon, the scope of this book transcends traditional surgical texts by its emphasis on the whys of surgery—from which the whats, whens, and hows proceed almost naturally—and by embracing, in chapters on rheumatology, metabolic bone disease, and rehabilitation, the medical aspects of musculoskeletal disease. Woven into this blend of science, like warp and woof, are threads of emphasis on understanding, kindness, and compassion—so critical to the art of medical practice.
Singly authored texts, increasingly rare in this era of proliferating subspecialties, maintain a uniformity of style and structure that facilitates reading and organization of thought by the student. Such works may omit sufficiently detailed information to satisfy those whose interests lie in a particular field of orthopaedics; however, this book is not intended for subspecialists so much as for those beginning in the field, for whom a horizontal rather than a vertical emphasis is more appropriate.
The section on "Musculoskeletal Injuries," particularly the chapter on "Specific Fractures and Joint Injuries in Adults," has been expanded considerably. Recommendations for treatment in this section lean toward closed reduction and use of a cast, with open reduction and internal fixation usually and appropriately reserved for patients for whom closed methods have failed. However, there is mounting evidence for primary open reduction and internal fixation for certain of these injuries—for example, completely displaced fractures of the radial and ulnar shafts and widely displaced fractures of the greater tuberosity of the humerus. Conversely, one might take issue with the viewpoint that dislocations of the acromioclavicular joint are most satisfactorily treated with "open reduction, capsular repair, and the insertion of a threaded wire through the acromion, across the acromioclavicular joint …" since there is a place here for nonoperative treatment as well. A bit surprising, too, is the recommendation that a complete tear of "the lateral ligament" of the ankle be immobilized in a cast in eversion and valgus for at least eight weeks, which overlooks the benefits of early movement in the treatment of ligamentous injuries as suggested by Dr. Salter's landmark studies on the value of motion in the repair of damaged cartilage.
The classification of ankle fractures as first, second, or third-degree, depending on whether one, two, or three malleoli have been fractured, has the virtue of simplicity in addition to prognostic value, although some may believe that the omission of frequently associated ligamentous damage precludes a full understanding of these injuries.
But these are minor issues. This text, written by a highly acclaimed orthopaedic physician and scientist, enjoys a comfortable lead in terms of comprehensiveness, illustrations, uniformity of style, and editing compared with other basic orthopaedic treatises. In short, the work is a classic. It is difficult to improve on a classic, but Dr. Salter has done just that in this superbly integrated new edition. Where Dr. Salter is concerned, we have come to expect nothing less.
Frank C. Wilson, M.D.
Department of Orthopaedics
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina