Table Of ContentEighth Edition
A Manual of
Orthopaedic
Terminology
Fred R.T. Nelson, MD, FAAOS
Emeritus, Orthopaedics
Henry Ford Hospital
Detroit, Michigan
Carolyn Taliaferro Blauvelt
Formerly Writer-Editor, Medical-Dental Publications
Department of Orthopaedic Surgery
National Naval Medical Center and
Department of Surgery, Uniformed Services University
of the Health Sciences
Bethesda, Maryland
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
A MANUAL OF ORTHOPAEDIC TERMINOLOGY,
EIGHTH EDITION ISBN: 978-0-323-22158-0
Copyright © 2015 by Saunders, an imprint of Elsevier Inc.
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
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Library of Congress Cataloging-in-Publication Data
Nelson, Fred R. T., 1941- author.
A manual of orthopaedic terminology / Fred R.T. Nelson, Carolyn Taliaferro Blauvelt. -- Eighth edition.
p. ; cm.
Includes index.
ISBN 978-0-323-22158-0 (paperback : alk. paper)
I. Blauvelt, Carolyn Taliaferro, 1933- author. II. Title.
[DNLM: 1. Orthopedics--Terminology--English. WE 15]
RD723
616.7001ʹ4--dc23
2014014681
Content Strategist: Delores Meloni
Content Development Specialist: Margaret Nelson
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Mary Pohlman
Design Direction: Teresa McBryan
Printed in the United States
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Foreword
Medical terminology is by necessity complex. Under- consumers of orthopaedic information. They have peri-
standing the “jargon” of medicine takes extensive years odically refined the manual to keep it up to date and
of education and enculturation. Orthopaedic terminol- comprehensive within the evolving universe of muscu-
ogy is perhaps the most difficult of all because of the loskeletal medicine. This resource can guide individuals
breadth of disease and injury that affects the musculo- as they perform literature reviews, systematic reviews
skeletal system. Terms related to anatomy, pathology, of that literature, meta-analyses, and other clinical
physiology, genetic injury descriptors, and syndromes investigations in the field of orthopaedics. This tool is
require an intimate knowledge of the broad field of or- straight-forward, easy to read, and comprehensive. It
thopaedics. Individuals other than those well versed in will continue to serve as the go-to reference for indi-
the terminology need resources to answer their inqui- viduals needing to access orthopaedic information to
ries and investigations. Practitioners in need of a lexi- serve their individual audiences.
con include researchers, physicians in fields other than
orthopaedics, the legal profession, and the universe of Marc F. Swiontkowski, MD
patients. Professor, Department of Orthopaedic Surgery
For 35 years, Nelson and Blauvelt have provided University of Minnesota
a wonderful resource to assist this population of CEO, TRIA Orthopaedic Center
v
Preface
This manual was first published more than 35 years ago New procedures and devices have been developed
to encompass the vast terminology unique to orthopae- that are rapidly replacing those found in former edi-
dic surgery and its related allied health fields, (i.e., radi- tions. However, some devices named have been retained
ology, prosthetics, orthotics, and physical and occupa- because they may still be in use. Also, “ jargon” not offi-
tional therapy). Scientific discoveries and technological cially recognized by certifying organizations may con-
advances led to new and updated editions and, during tinue to be found in legal reports and is retained here.
that time, the publishing industry merged and moved ICD codes have been deleted from this edition because
to the paperless electronic age of publishing. they can be found on the internet and other sources.
The manual has continued to provide a reference The human genome project, DNA breakthroughs in
source for medical students, interns, residents, ortho- cellular mechanisms, and changes in therapies have
paedic nurses and technicians, and transcriptionists occurred at a rapid rate. This eighth edition reflects
and office managers in hospital and doctors offices. these new changes, and lots of new information has
Newcomers to orthopaedics, such as sales representa- been updated.
tives for pharmaceutical and surgical devices, medical From its inception, the authors have invited con-
publishers, insurance adjustors, and attorneys, have also tributors with expertise in specific areas to review and
appreciated this reference source for better clarification update chapters to be current and accurate. The man-
of orthopaedic terminology. The format of this manual ual has continued to serve a need, and that is the goal
enables the layperson without a strong musculoskeletal of this eighth edition.
background to understand why terms are not in A-Z Fred R.T. Nelson
order, but rather are placed in their proper context to Carolyn Taliaferro Blauvelt
facilitate understanding of both the words and their
associations.
vii
Contributors
No one can write a book on all areas of orthopaedics Musculoskeletal Diseases and Related Terms
and keep it current without the help of many competent Sheila Ann Conway, MD
people. This manual is no exception. We have chosen Associate Professor, Department of Orthopaedic
contributors whose background and experience make Surgery
them well qualified to assist in updating material for Program Director, Orthopaedic Surgery Residency
each edition and who work directly or indirectly in this Program
specialty. These people have generously given their time, University of Miami/Jackson Memorial Medical
in view of other professional commitments, to improve Center
the correctness and accuracy of information, provide an Miami, Florida
update, and give constructive criticism. We can share in
the success of this manual with them, and we wish to Robert J. Esther, MD
express our appreciation and thanks to our past contrib- University of North Carolina
utors, and to the following persons and organizations Department of Orthopaedics
who participated in the revisions of the eighth edition. Chapel Hill, North Carolina
Shawn R. Gilbert, MD
Classifications of Fractures, Dislocations,
Associate Professor of Surgery
and Sports-Related Injuries
University of Alabama at Birmingham
Steven M. Kane, MD Birmingham, Alabama
Chairman and Program Director
Orthopaedic Surgery Residency Craig S. Roberts, MD, MBA
Atlanta Medical Center K. Armand Fischer Professor and Chair
Orthopaedic Residency Program University of Louisville School of Medicine
Atlanta, Georgia Department of Orthopaedic Surgery
Louisville, Kentucky
Bruce H. Ziran, MD, FACS
Director of Orthopaedic Trauma Montri Daniel Wongworawat, MD
Gwinnett Orthopaedic Trauma Department of Orthopaedic Surgery
The Hughston Clinic at Gwinnett Medical Center Loma Linda University
Lawrenceville, Georgia Loma Linda, California
ix
x Contributors
Imaging Techniques Robert J. Esther, MD
Jean Jose, MD University of North Carolina
Associate Professor of Radiology Department of Orthopaedics
Associate Chief, Musculoskeletal Radiology Chapel Hill, North Carolina
Director, Imaging Sports Medicine
University of Miami Radiology Department Shawn R. Gilbert, MD
Miami, Florida Associate Professor of Surgery
University of Alabama at Birmingham
Orthopaedic Tests, Signs, and Maneuvers Birmingham, Alabama
J. Milo Sewards, MD
Director, Orthopaedic Surgery Residency The Spine
Temple University Hospital Young Lu, BA
Philadelphia, Pennsylvania Icahn School of Medicine at Mount Sinai
Department of Orthopaedic Surgery
Laboratory Evaluations Mount Sinai Medical Center
Sudhaker D. Rao, MD, MB, BS, FACP, FACE New York, New York
Section Head, Bone and Mineral Metabolism
Director, Bone and Mineral Research Laboratory Sheeraz Qureshi, MD, MBA
Henry Ford Hospital Associate Professor, Orthopaedic Surgery
Detroit, Michigan Minimally Invasive Spinal Surgery
Mount Sinai Hospital
Casts, Splints, Dressings, and Traction Icahn School of Medicine at Mount Sinai
Meagan Clark, CPO Co-Director, Spinal Surgery Fellowship
Assistant Director of Clinical Education New York, New York
Loma Linda University, el-MSOP Program
Loma Linda, California The Hand and Wrist
Montri Daniel Wongworawat, MD
Prosthetic and Orthotics Department of Orthopaedic Surgery
Meagan Clark, CPO Loma Linda University
Assistant Director of Clinical Education Loma Linda, California
Loma Linda University, el-MSOP Program
Loma Linda, California The Foot and Ankle
Anthony D. Watson, MD
Anatomy and Orthopaedic Surgery Greater Pittsburgh Ortho Associates
Sheila Ann Conway, MD Pittsburgh, Pennsylvania
Associate Professor, Department of Orthopaedic
Surgery Physical Medicine and Rehabilitation:
Program Director, Orthopaedic Surgery Residency Physical Therapy and Occupational Therapy
Program Eugene Bulkin, MD
University of Miami/Jackson Memorial Medical Assistant Professor
Center Department of Orthopaedics
Miami, Florida Mount Sinai School of Medicine
Port Washington, New York
Contributors xi
Stacy Oster, MS, OTR/L, CHT The Research Enterprise
Senior Occupational Therapist William Wu, PhD
Certified Hand Therapist Adjunct Associate Professor of Pharmacology
Beth Israel Medical Center Wayne State Medical School
Phillips Ambulatory Care Center Detroit, Michigan
Department of Rehabilitation Medicine
New York, New York
Paul Zucker, MS, PT, LAc
Director of Ambulatory Services
PACC Administration
Department of Physical Medicine and Rehabilitation
Beth Israel Medical Center
New York, New York
Introduction to the
Orthopaedic Speciality
Orthopaedic (ortho-pae’dic) means correction or pre- disabilities through conservative management. In the
vention of bony deformities (formerly, especially in operating room, the orthopaedist is skilled in the repair
children). The word comes from the Greek orthos, and reconstruction of major skeletal defects, which
meaning “straight, upright, right, or true”—hence, include replacing diseased joints with plastic implants;
also “correct” or “regular”—and from the Greek pais, inserting metallic rods and other devices for stability;
meaning “child.” or performing fusions, revisions, or amputations. Of
The scope of orthopaedic surgery includes the treat- a more delicate nature, he or she applies arthroscopic
ment, management, and rehabilitation of patients with and microvascular techniques that include skin grafts,
musculoskeletal conditions affecting bones, muscles, finger transplantations, nerve repairs, and similar dif-
joints, tendons, ligaments, cartilage, blood vessels, ficult procedures.
nerves, and related tissues through surgical, nonsurgi- The rheumatologist is an internist who specializes in
cal, and other medical measures. The nature of these rheumatic diseases that affect joints, muscles, and soft
conditions may involve congenital abnormalities, meta- tissue. Often they work in collaboration with orthopae-
bolic disease processes, metastatic (tumor) pathologic dic surgeons. The osteopathic physician specializes in
findings, or traumatic injuries (fractures) requiring the orthopaedics with emphasis on body mechanics, or may
expertise of the orthopaedic specialty. When surgery is specialize in rheumatology.
indicated, postoperative rehabilitation is equally impor- From a team approach, the orthopaedic specialty
tant in the continued care and treatment plan. depends on many other disciplines in the treatment of
The orthopaedic surgeon develops many skills and patients. The immediate team members are the pro-
must possess a working knowledge of neurology, car- fessional nurses who provide primary care of patients
diopulmonary physiology, and bioengineering in the and who are assisted by orthopaedic technicians, both
care of the orthopaedic patient. This expertise also in the clinic and hospital setting. The second group
includes electrical and magnetic bone stimulation, of team members include the physical medicine and
microsurgery, and knowledge of internal and external rehabilitation specialists called physiatrists. Physiat-
fixation devices. Orthopaedic medicine is continually rists, physical therapists, and occupational therapists
changing, and the orthopaedic surgeon is challenged are directly involved in, and may be consulted for the
with the responsibility of keeping informed of new development of a treatment plan in a patient’s rehabili-
techniques through continued education in the field. tation. The next group of team members include the
Nonoperative measures include everything from the prosthetists (artificial limbs) and orthotists (braces),
application of casts for immobilization and management who measure, fit, design, and fabricate expertly applied
of fractures or scoliosis to the treatment of diseases and devices for the orthopaedic patient. The developers
xiii
xiv Introduction to the Orthopaedic Specialty
and manufacturers of internal orthopaedic appliances and development of the form and function of the
play an important role, as does the researcher who tests extremities, spine, and associated structures by medical,
the biocompatibility of materials used in the musculo- surgical, and physical methods.
skeletal system.
All of these specialties are an integral part of the ORTHOPAEDIC ORGANIZATIONS
orthopaedic team and provide a combination of skills OF NORTH AMERICA
that benefit thousands of patients with musculoskeletal American Academy for Cerebral Palsy and Develop-
problems. Other disciplines that interface with ortho- mental Medicine
paedics include bioengineering, electrobiology, trans- American Association for Hand Surgery
plantation, diagnostic imaging, oncology, biochemistry, American Association of Hip and Knee Surgeons
and similar areas. American Board of Orthopaedic Surgery, Inc.
Orthopaedic surgery has become so diverse that American Orthopaedic Association
there is specialization within the specialty. In addition American Orthopaedic Foot and Ankle Society
to general orthopaedics, a physician may specialize in American Orthopaedic Society for Sports Medicine
diseases and surgery of the spine, soft tissues, the hand, American Shoulder and Elbow Surgeons
the foot, major joints, trauma, sports medicine, or American Society of Orthopaedic Physician’s
the ever-changing area of orthopaedic research. Many Assistants
physicians are exposed to orthopaedic surgery during American Society of Plastic Surgeons
their training years, but only a select group actually American Society for Reconstructive Microsurgery
pursue this difficult and diverse field to the point of American Society for Surgery of the Hand
certification. American Spinal Injury Association
The qualification for certification by the Ameri- Arthroscopy Association of North America
can Board of Orthopaedic Surgery is 5 or 6 years of Association of Bone and Joint Surgeons
postgraduate education after medical school. After Association of Children’s Prosthetic-Orthotic Clinics
graduation from an Accreditation Council for Gradu- Bones Society, Inc.
ate Medical Education–approved 5-year program, a Cervical Spine Research Society
candidate sits for Part 1, which is a written examina- Clinical Orthopaedic Society
tion. After 22 months of practice in the same location, Clinical Orthopaedics and Related Research (journal)
he or she may sit for Part 2, which is a practice-based Council of Musculoskeletal Specialty Societies
examination reviewing cases and outcomes. The physi- Eastern Orthopaedic Association
cian must complete all requirements to become board Federation of Spine Associations
certified and a Diplomate of the Board. After comple- Hip Society
tion of the certification requirements, an orthopaedic International Cartilage Repair Society
surgeon becomes eligible for Fellowship in the Ameri- International Society of Arthroscopy, Knee Surgery
can Academy of Orthopaedic Surgeons, the national and Orthopaedic Sports Medicine
organization of the specialty. The admission to fel- Irish American Orthopaedic Society
lowship in the Academy requires board certification J. Robert Gladden Society
and recommendations from the community. This is Knee Society
typically 18 months following board certification. The Limb Lengthening and Reconstruction Society
Academy fellowship at present represents approxi- Mid-America Orthopaedic Association
mately 81% of the practicing orthopaedic surgeons in Mid-Central States Orthopaedic Society, Inc.
the United States. The national organization of the Musculoskeletal Tumor Society
specialty developed the accepted definition of ortho- North American Spine Society
paedics in 1952: Orthopaedic Rehabilitation Association
Orthopaedic Surgery is the medical specialty that Orthopaedic Research and Education Foundation
includes the investigation, preservation, restoration, Orthopaedic Research Society
Introduction to the Orthopaedic Specialty xv
Orthopaedic Trauma Association SICOT Société Internationale de Chirurgie
Osteoarthritis Research Society International Orthopédique et de Traumatologie
Pediatric Orthopaedic Society of North America Society of Military Orthopaedic Surgeons
Ruth Jackson Orthopaedic Society Southern Orthopaedic Association
Scoliosis Research Society Western Orthopaedic Association
