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A dam s s
O utline of F r
actures
Includin oi
g J
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F or E lsetTier
C oJJz)nissionin E ditor F iona C onn
g
D euelo
pm ent E ditor : H elen L eng
P ro ect M ana er : N anc A rnott
j g y
S enior D esi ner S arah R ussell
g
Illustrator O xford Illustrators
/[lustration M ana er G illian M urra
g y
C H U R C H IL L
U V lN G sT O N E
E L SE V I E R
A n im print of E lsevier L im ited
© L ongm an G roup U K L inrited 1 9 9 2
© 2C0h0u7r, cEhlislel vL iievri nL gimstoitne de .1 9A9l8l rights reser v e d.
T he right of D avid L H am blen and A H am ish R W S im pson to D e lu " ' " ' " _ _ " _ _ ' " " _ _ " " " _ _ ' " ' " ° W n
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S eventh edition 1 9 7 8
First edition 1 9 5 7
Second edition 1 9 5 8 E ighth edition 1 9 8 3
T hird edition 1 9 6 0 N inth edition 1 9 8 7
Fourth edition 1 9 6 4 T enth edition 1 9 9 2
F ifth edition 1 9 6 8 E leventh edition 1 9 9 9
S ixth edition 1 9 7 2 T w elfth edition 2 0 0 7
IS B N 9 7 8 0 4 4 3 1 0 29 74
R eprinted 2 0 0 8
International edition IS B N 9 7 8 0 4 4 3 1 0 2 9 8 1
R eprinted 2 0 0 8 , 2 0 1 1 (tw ice)
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A catalogue record for this book is available from the B ritish L ibrar
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A catalog record for this book is available from the L ibrar
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N ote
K now ledge and besE
practice in this field are constantly chan
ging. A s new research and experience broaden our
know led
ge, c h a n g e s in p ra c tic e , tre a tm e n t a n d d r u
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P reface
T he invitation to produce a new edition of such a w ell- e stablished textbook as
O utline of F ractures presented a considerable challen
ge. T he attractions to
accept w ere that the new 1 2 th edition w ould a
ppear 5 0 years after John
C raw ford A dam s published the first edition of his book and that his w ise
guidance 1« as still available to us in its prepara tion . T he science and technology
of the m anagem ent of injuries of the m usculoske]eta] s
ystem has changed
dram atically over this tim e period . E ven in the 8
years since the last edition
there has been a m ajor shift to a m ore aggressive su rgical ap proach for the
treatm ent of som e com m on fractures p ]'" viously m anaged by conservative
m ethods. T his change has been driven as m u ch by health econom ics an d
patient dem and , a s by im proved long- term outcom es, a n d w e continue to
describe both radical and conservative solutions, w here appropriate.
T he changes to the content and for m at also reflect changes in the potential
readership since the book, that w as once aim ed prim arily at the m edical
student, is now used by a broad ran ge of health professionals, including basic
surgical trainees. W e have not attem pted to produce a volum e aim eci at the
specialist orthopaedic surgeon, a lthough m uch of the content goes beyond the
needs of the student or basic practitioner. S om e of this additional infom iation
w as previously presented in a sm aller size of print, bu t in th is ed ition all text
has been changed to a standard font form at. It is hoped that this w ill allow the
reader the opportunity to study selected topics in greater depth if their interests
dem and it. T he detailed references to other literature have also been rem oved
since these are inevitably becom ing out of date by the tim e of p ublica tion .
Tnie easy availability of this inform ation on the In ternet through links to
orthopaedic and scientific literature w ebsites provides a far m ore satisfactory
alternative. W e have added one new chapter to address the im portant topic of
osteoporosis and its association w ith fragility fractures in the elderly,. T his is
now recognised as a m ajor health problem w ith a w orld - w ide im pact, re s u lting
from the increased longevity in ageing popula tions.
M any of the illustrations h ave been u p dated to reflect current treatm ent
trends, but the anatom ical classification of injuries has been retained and
enhanced . W e feel that this provides a m ore readily understandable basis for
ftihcea tgioennse ruasl erde abdye rt hien sppreecfeiarleinstc es utrog ethoen .m T ohree fcuotmurpe ledxir etrcetaiotmn eonf tf-rbaacsteudre c tlraesasti-
m ent is difficult to predict, but som e of the new er techniques resulting from
develop m ents in cell biology and m olecular genetics that allow local
stim ulation of bone healing have been included .
It is ho ed that the book w ill continue to provide a sound basis for the
p
m ana em ent of m usculoskeletal injuries, based on an am algam of established
g
traditional conservative m ethods anel safe surgical techniques w ith proven
results.
D avid L H a
m ble
n
A H am ish R W S i
m
pson
N
J ohn C raw ford A=dam s
Fifty years ago, a s a young orthopaedic and traum a sur
geon at S t. M ary' s
H ospital in L ondon, I developed a keen interest in teachin
g. F inding that
students show ed in terest in w hat I tau ght, I resolved to set dow n, in an easily
read form , the elem ents of orthopaedic surgery and of fracture m anagem ent.
T he m aterial w as to be in tw o slim volum es, a n d there w ould be a heavy
em phasis on the provision of num erous illustrations of high quality. A lthough
the books w ould be prim arily for the benefit of undergraduate students, they
m ight also be u seful for general practitioners an d p hysiotherapists, a n d even
for law yers. M r C harles M acm illan of E dinburgh , a n e n te rprising publisher
w ith a prestigious bookshop in T eviot P lace, u n dertook to publish the books.
Tnie first of the tw o books, O utline of O rthopaedics, w a s published in 1 9 5 6 , a n d
w as follow ed in 1 9 5 7 by the com panion volum e, O utline of F ractures. T he books
proved popular w ith m edical students and physiotherapists, both in the U K
and abroad , a n d updated editions w ere called for every few years. B y 19 9 0 the
task of keeping the texts up to date w as proving difficult for m e, a n a geing
author and I w as fortunate that P rofessor D avid H am blen, then P rofessor of
O rthopaedic S urgery in the U niversity of G lasgow , w a s w illing to com e to m y
assistance to help transform the books for the needs of the m odern w orld . B ut
still events m ove on, a n d the tim e has com e for m e to bow out and to w elcom e
P rofessor H am ish S im pson, o f the U niversity of E diLrburgh , to a s sist P rofessor
H am blen w ith the task of once again bringing the books - starting w ith O utline
of F ractures - r ight up to date. In doing so, I thank all those students - m a n y
now m ature doctors - for their interest in using the books to gain an insight
into the fascinating subject of orthopaedic surgery.
John C raw ford A dam s
A cknow led em ents
g
T he authors \nrish to ack n ow led g e th e assistan ce of a n u m b er of collea
gu es in
the preparation of the new edition of this w ell established text. In particular
, w e
w ish to thank the original author, John C raw ford A dam s, w hose ins
piration
and enthusiasm produced the original volum e an d steered it throu
gh eleven
fuF ther edi tions, T he success it has enjoyed is a tribute to his w ritin
g skills and
w e w ere fortunate to have been able to seek his adyice, w hen required .
A large num ber of additional illustrations have been added to reflect tle
changes in the diagnosis and treatm ent of injuries. W e thank D r N igel R ab
y of
the W estern Infirm ary, G lasgow , for providing us w ith the new im a
ges of
radiographs, C T and M R scans in cluded in m any of the chapters.
M r D avid A llan, the D irector of the S cottish S pinal Injury C en tre, a n d his
staff and patients are thanked for providing u 5 w ith advice and the illustrations
used in the chapters on spinal injury and paraplegia.
W e are grateful to D r R abin R eid, W estern Infirm ary, G lasgow , for providing
the im ages of pathological fractures resulting from p rim ary an d secondary
bone tum ours.
T hanks are also due to H elen L en g, S arah R ussell, N ancy A rnott, a n d the
staff at E lsevier for all their help and encouragem ent in the production of this
new edition .
O ur respective secretaries C atherine D avidson an d L inda D igance have
played a key role in the typing of the m anuscript and their efforts are very
m uch appreciated .
F inally, w e re c o rd our appreciation of the support and forbearance of our
w ives and fam ilies during the tim e devoted to the w riting of the book.
contents
Introduction
1 . P athology of fractures and fracture healing 3
2 . C linical and radiological features of fractures 2 o
3 . P rinciples of fracture treatm ent 2 9
4 . C om plications of fractures 5 2
5 . S pecial features of fractures in children 7 4
6 . 0 steoporosis and fragility fractures 7 9
7 . J oint injuries 8 6
8 . C ervical spine 9 2
9 . S pine and thorax 1 0 8
1 0 . paraplegia from spinal injuries 1 2 2
1 1 . S houlder and upper arm 1 3 1
1 2 . E lbow and forearm 1 6 2
1 3 . W rist and hand 1 9 0
1 4 . P elvis and hip 2 1 1
1 5 . T high and knee 2 3 8
1 6 . L eg and ankle 2 6 8
1 7 . T he foot 2 9 8
F urther reading 3 1 3
Index 3 1 5
