Churchill’s Pocketbook of Orthopaedics, Trauma and Rheumatology

323 Pages·2016·11.807 MB·English

by  Andrew Duckworth, Daniel Porter, Stuart Ralston

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2015v1.0
CHURCHILL’S POCKETBOOKS
ORTHOPAEDICS, TRAUMA AND
RHEUMATOLOGY
This page intentionally left blank
SECOND EDITION
CHURCHILL’S POCKETBOOKS
ORTHOPAEDICS, TRAUMA
AND RHEUMATOLOGY
Andrew D. Duckworth MB ChB BSc MRCSEd MSc PhD
Specialty Registrar (StR) and Clinical Research Fellow, Edinburgh
Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
Daniel E. Porter MD FRCSEd(Orth)
Director of Department of Orthopaedic Surgery, First Affiliated Hospital of
Tsinghua University, Professor of Orthopaedic Surgery, Tsinghua
University Medical Centre, Beijing, China
Stuart H. Ralston MD FRCP FMedSci FRSE
Arthritis Research UK Professor of Rheumatology, Centre for Genomic
and Experimental Medicine, Institute of Genetics and Molecular Medicine,
Western General Hospital, Edinburgh, UK
Edinburgh  London  New York  Oxford  Philadelphia  
St Louis  Sydney  Toronto
© 2017 Elsevier Ltd. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means,
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can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
First edition 2009
Second edition 2017
ISBN 978-0-7020-6318-3
International ISBN 978-0-7020-6317-6
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 methods they should be mindful of their own safety and
the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to
check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each individual
patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of
products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.
Content Strategist: Laurence Hunter
Content Development Specialist: Helen Leng
Project Manager: Anne Collett
Designer: Miles Hitchen
Illustration Manager: Nichole Beard
The
publisher’s
policy is to use
paper manufactured
from sustainable forests
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contents
Preface  vii Seronegative 
Spondyloarthropathies  111
Acknowledgements  viii
Polymyalgia Rheumatica  118
Acronyms  ix Giant Cell Arteritis  119
Systemic Vasculitis  120
1  Anatomy  1 Adult-Onset Still Disease  128
Shoulder  1 Familial Fever Syndromes  129
Elbow  6 Systemic Lupus  
Wrist and Hand  12 Erythematosus  129
Hip and Knee  22 Scleroderma  132
Ankle and Foot  33 Polymyositis and 
Spine  40 Dermatomyositis  134
Sjögren Syndrome  135
2  History and Examination  43 Fibromyalgia  136
History  45 Complex Regional Pain 
Wrist and Hand  49 Syndrome  137
Elbow and Forearm  52 Crystal-Induced Arthritis  138
Shoulder  54 Osteoarthritis  141
Hip  58 Osteoporosis  145
Knee  61 Osteomalacia and Rickets  148
Ankle and Foot  63 Paget Disease  150
Spine  67 Fibrous Dysplasia  154
3  Investigations  73
6  Regional Orthopaedics and 
Routine Haematology and 
Trauma  156
Biochemistry  73
Shoulder and Arm  156
Immunology  76
Elbow and Forearm  165
Joint Aspiration and Synovial Fluid 
Wrist and Hand  171
Analysis  77
Pelvis, Hip and Knee  187
Imaging  80
Ankle and Foot  204
Tissue Biopsy  84
Head, Neck and Spine  211
Arthroscopy  85
Bone and Joint Infections  224
4  Trauma, Injury Classification  Musculoskeletal Tumours  231
and Perioperative Care  87 Nerve Injuries  239
Trauma Assessment  87
7  Paediatric Orthopaedics and 
Injury Assessment, Classification and 
Rheumatology  242
Management  88
Bone Structure and Injury  242
Preoperative Management  96
Injuries in Children  246
Postoperative Management  97
Disorders of the Hip  252
Fracture Complications  99
Disorders of the Knee  262
5  Rheumatology and Bone  Disorders of the Foot  263
Disease  105 Juvenile Idiopathic  
Rheumatoid Arthritis  105 Arthritis  265
v
vi    Contents
8  Therapeutics  269 Hyperuricaemia and Gout  289
Pain Management  269 Anticoagulants  291
Corticosteroids  275
Bibliography, Further Reading and 
Disease-Modifying Antirheumatic 
Useful Websites  295
Drugs  276
Biological Antirheumatic Drugs  281 Index  297
Drugs for Bone Diseases  284
Preface
There continues to be a range of excellent undergraduate orthopaedic,
rheumatology and trauma textbooks available to medical students and junior
doctors alike. However, the authors have endeavoured to provide a fresh and
concise pocket-sized single publication that covers all three topics at a level
suitable for both trainees and junior doctors. In this second edition we have
updated the content to reflect changes in surgical practice and advances in
therapeutics, as well as the molecular understanding of genetic and
inflammatory disorders.
The purpose of this text is not to replace the current recommended
undergraduate texts within this specialty. It continues to have the ambition of
providing an affordable pocket-sized adjunct to these texts, whilst also
imparting much of the core knowledge needed as an undergraduate. As before,
the text is aimed primarily at medical undergraduates for use during their
placements in orthopaedics, A&E, rheumatology and general practice, as well
as during their musculoskeletal anatomy course. However, with the new
additions we hope it will also be a useful adjunct for junior doctors during any
time spent in these specialties.
The handbook is designed to provide the essential points for each region
with regards to anatomy, examination, investigations and management, whilst
also providing succinct illustrations and figures where appropriate. In this
second edition we hope that the reader will appreciate the updated layout and
additions. The new ‘overview’ and ‘hints and tips’ boxes, as well as the addition
of details on common procedures, aim to provide concise and important
information not only to medical students revising for their exams, but also to
junior doctors in their first years following graduation.
A.D.D.
D.E.P.
S.H.R.
vii
Acknowledgements
The authors would again like to acknowledge those who provided invaluable
advice with the first edition of the book. We would also like to thank Mr Tim
White and Mr Paul Jenkins for their invaluable assistance with the procedure
sections of the book, and Mr Sam Molyneux for his expertise with the trauma
topics. We would also like to acknowledge Dr Catherine Collinson for her
expert advice regarding the perioperative care section, and Mr Mark Hughes
for his assistance with the head, neck and spine section.
We would like to thank our colleagues for their assistance with acquiring the
new figures seen throughout the text, in particular Sam Mackenzie, as well as
Mr Mark Gaston for his help with acquiring the figures for the paediatric
section of the book.
As acknowledged in the first edition, we are forever indebted to Dr Mike
Ford for allowing us to use the pictures from his text: Introduction to Clinical
Examination.
viii