By Louis Solomon, David Warwick, Selvadurai Nayagam
A complete advent to the sphere of orthopaedics and trauma.
summary: A accomplished creation to the sphere of orthopaedics and trauma
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Additional resources for Apley's system of orthopaedics and fractures
G. due to a burn or following surgery. Contracture of the subcutaneous fascia The classical example is Dupuytren’s contracture in the palm of the hand. Muscle contracture Fibrosis and contracture of muscles that cross a joint will cause a ﬁxed deformity of the joint. This may be due to deep infection or ﬁbrosis following ischaemic necrosis (Volkmann’s ischaemic contracture). Muscle imbalance Unbalanced muscle weakness or spasticity will result in joint deformity which, if not corrected, will eventually become ﬁxed.
Although x-ray examination is essential, the clinical features can be highly informative. A large lump attached to bone, or a lump that is getting bigger, is nearly always a tumour. Size Site A lump near a joint is most likely to be a tumour (benign or malignant); a lump in the shaft may be fracture callus, inﬂammatory new bone or a tumour. Margin A benign tumour has a well-deﬁned margin; malignant tumours, inﬂammatory lumps and callus have a vague edge. Consistency A benign tumour feels bony hard; malig- nant tumours often give the impression that they can be indented.
The medium (usually one of the ionic watersoluble compounds) is injected into an open sinus; the ﬁlm shows the track and whether or not it leads to the underlying bone or joint. 1 Orthopaedic diagnosis • Bone destruction + periosteal new bone formation = infection or malignancy until proven otherwise. • Remember: the next best investigation is either the previous radiograph or the subsequent follow-up radiograph. Sequential ﬁlms demonstrate either progression of changes in active pathology or status quo in longstanding conditions.
Apley's system of orthopaedics and fractures by Louis Solomon, David Warwick, Selvadurai Nayagam