Orthopaedics

Textbook of
Textbook of
has been written keeping in view the fast pace of changes in medical technology, the treatment and the
protocols that have evolved recently. The textbook aims to serve the requirements of undergraduate medical and
young postgraduate students in orthopaedics. It will also greatly benefit the students of courses in physiotherapy,
nursing and related disciplines.

Textbook of
All aspects of orthopaedic disorders are touched upon in a precise and clear way. Written in a simple and easy to
understand language, the text has been supplemented by relevant clearly drawn colour line diagrams and
radiographs. Clinical pictures have been added wherever necessary for better understanding of the subject. The
section on clinical examinations provides a systematic approach to case presentations.
Taking and engaging the easily understandable approach, this comprehensive textbook is designed to help the
students master essential concepts of orthopaedics and perform well in theory as well as practical examinations.

Orthopaedics

Orthopaedics
Key Features
• Clear, reader-friendly style of presentation
• A large number of easily reproducible line diagrams to make learning interesting
• Appropriate clinical photographs, X-rays and MRIs to supplement understanding of difficult topics
• A separate section on clinical examination describing systematic approach to various clinical cases
• Common cases included for practical examination, along with relevant X-rays and clinical
photographs
• A special section on radiology, Orthopaedic implants and orthotics covering important topics for
viva voce examination.

Binoti Sheth MS,DNB, MNAMS, FCPS, D Ortho

is currently Associate Professor and Unit Head, Department of Orthopaedics, Lokmanya Tilak Municipal Medical
College and Hospital, Sion, Mumbai. She has a brilliant academic career with more than 20 years of teaching
experience. She has published many papers in national and international journals of repute. She has received many
international awards like Japanese SICOT award, Pillar de Zamudio fellowship, AO fellowship, etc. for her excellent work
in orthopaedics. Her earlier book Practicals in Undergraduate Orthopaedics has been very popular among students. An
academician of repute, she possesses deep appreciation of orthopaedics as well as has a great passion for teaching.
Muqtadeer Ansari MS, DNB, MNAMS
is currently Associate Professor, Department of Orthopaedics, Goverment Medical College, Aurangabad. He has
worked at Lokmanya Tilak Medical College, Sion, Mumbai, with Dr CJ Thakkar, a renowned joint replacement surgeon,
and Dr AB Goregaonkar, a renowned spine surgeon). He is a skilled spine and joint replacement surgeon with many
research publications in international and national journals. He is a faculty for many spine and trauma workshops and
conferences. He is member of North American Spine Society, Association of Pelvi-Acetabular Surgeons of India and Indian
Society of Hip and Knee Surgeons.
Atul Kantilal Patil MS, DNB
is currently Associate Professor, Department of Orthopaedics, Terna Medical College, Navi Mumbai. He has an illustrious

Sheth | Ansari | Patil

career as an orthopaedic surgeon, an academician and a teacher spanning over a deacde. He is an expert in
advanced spine, major joint arthroplasty and complex trauma surgeries. He has to his credit many research
publications in international and national journals. He is faculty and organiser of many spine and trauma workshops and
courses with keen interest in conducting hands on and cadaver workshops for postgraduate training. He is a favourite teacher
amongst his undergraduate and postgraduate students.

Binoti Sheth
Dedicated to Education

ISBN: 978-93-86478-15-3
Muqtadeer Ansari
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 Textbook of
Orthopaedics
 Textbook of
Orthopaedics
Binoti Sheth
Associate Professor and Head of the Unit
Department of Orthopaedics
Lokmanya Tilak Municipal Medical College and Hospital
Sion, Mumbai

Muqtadeer Ansari
Associate Professor
Department of Orthopaedics
Government Medical College
Aurangabad

Atul Kantilal Patil

Associate Professor
Department of Orthopaedics
Terna Medical College, Navi Mumbai

CBS Publishers & Distributors Pvt Ltd

New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai
Hyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand
 Disclaimer
Science and technology are constantly changing fields. New
research and experience broaden the scope of information and
knowledge. The authors have tried their best in giving information
available to them while preparing the material for this book.
Although all efforts have been made to ensure optimum
accuracy of the material, yet it is quite possible some errors might
have been left uncorrected. The publisher, the printer and the
authors will not be held responsible for any inadvertent errors,
omissions or inaccuracies.

ISBN: 978-93-86478-15-3
Copyright © Authors and Publisher

First Edition 2018

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical,
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holder and the publisher.

Published by Satish Kumar Jain and Produced by Varun Jain for

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Printed at
 Foreword

I t gives me immense pleasure to comment on this basic yet extremely important textbook authored by
Dr Binoti Sheth, Dr Atul Patil and Dr Muqtadeer Ansari. This book has been written keeping in mind the fast
pace of changes in medical technology, the treatment and the protocols that have evolved in this new era. The
work has been painstakingly completed and documented into print format as a textbook and is targeted for the
benefit of the undergraduate medical and therapy students and junior postgraduate students.
I appreciate the efforts of the authors in undertaking this enormous work of compiling the orthopaedic work
for the benefit of academic community at large. All aspects of orthopaedic disorders are touched upon in a precise
and clear way, using artistic diagrams, X-rays and clinical pictures. I take great pride in writing the Foreword to
this book and wish the authors a great success. I am sure this textbook will go a long way in helping the students
master the subject of orthopaedics and help them pass with flying colours.

AB Goregaonkar
Professor and Head
Department of Orthopaedics
Lokmanya Tilak Municipal Medical College
Mumbai
 Preface

I t gives me immense pleasure to present the first edition of Textbook of Orthopaedics to medical students.
Orthopaedic surgery has progressed from an immature limited speciality to a vast field of various orthopaedic
subspecialities. Having worked in the field of medical education for the past 20 years, I felt the need for a concise
textbook that the students would enjoy reading and which would enable them to thoroughly grasp important
concepts required for exams and clinical practice. This book is prepared to serve as a textbook for undergraduate
and junior postgraduate medical students as well as physiotherapy, occupational therapy and nursing students.
We have endeavoured to make the text simple and easy to understand. The text has been supplemented by
relevant simple line diagrams, radiographs and clinical pictures, wherever necessary for better understanding of
the subject. The section on clinical examination provides a systematic approach to case presentations for practical
examination.
I am thankful to my seniors, colleagues and family members for their constant support and encouragement. I
also thank Dr Mohan Desai and Dr Dinshaw Pardiwala for their contribution to the section on clinical examination,
Dr Rahul Jagtap for excellent diagrams work, and Dr Aditya Pathak, Dr Chetan Anchan and Dr Kshitij Chaudhary
for their contribution to clinical photographs.
Finally, I am highly indebted to the dedicated team of Rajesh Bhalani of Bhalani Publishers and CBS Publisher
& Distributors Pvt Ltd for their constant guidance and advice in the preparation of this book. I wish the students
happy reading and great success in their examinations.

Binoti A Sheth
 Contents

Foreword by AB Goregaonkar v
Preface vii
Abbreviations xi

Section I: Introduction
1. Introduction to Orthopaedics 3

Section II: Trauma

2. Trauma: General Principles 7
3. General Principles of Fracture 10
4. Fracture: Management 22
5. Open Fractures 25
6. Complications of Fracture 28
7. Peripheral Nerve Injuries 38
8. Shoulder Injuries 48
9. Humeral Shaft Fractures 61
10. Elbow Injuries 63
11. Paediatric Elbow Injuries 68
12. Forearm Fractures 74
13. Wrist Fractures 78
14. Hand Injuries 86
15. Pelvic Injuries 90
16. Acetabulum Injuries 94
17. Injuries around the Hip 97
18. Femoral Shaft Fracture 106
19. Injuries around the Knee 109
20. Tibial Shaft Fractures 114
21. Ankle Fractures 119
22. Injuries around Foot 122

Section III: Infection

23. Infection of Bones and Joints 129
24. Tuberculosis of Bones and Joints 139
 x Textbook of Orthopaedics

Section IV: Spine

25. Anatomy of the Vertebral Column 147
26. Spinal Injuries 149
27. Degenerative Disorders of Spine 157
28. Spinal Deformities 164
29. Tuberculous Spondylodiscitis (Pott’s Spine) 168

Section V: Tumours
30. Bone Tumours: General Principles 175
31. Benign Bone Tumours 179
32. Malignant Bone Tumours 187

Section VI: Paediatric Orthopeadics

33. Congenital and Developmental Disorders 197
34. Common Paediatric Disorders 212

Section VII: Other Orthopaedic Disorders and Special Subjects

35. Neurological Disorders 221
36. Metabolic Disorders 227
37. Arthritis 233
38. Miscellaneous Disorders 239
39. Orthopaedic Appliances 251
40. Amputations 256
41. Special Orthopaedic Techniques 259

Section VIII: Orthopaedic Clinical Examinations

42. Shoulder 265
43. Elbow 269
44. Wrist, Forearm and Hand 274
45. Spine 280
46. Hip 290
47. Knee 296
48. Foot and Ankle 300

Section IX: Orthopaedic Implants, Radiology and Orthotics

49. Orthopaedic Implants 309
50. Orthopaedic Radiology 315
51. Orthopaedic Orthotics 322
Index 325
 Introduction to Orthopaedics xi

Abbreviations

ABC Aneurysmal bone cyst EDQ Extensor digiti quinti

ACL Anterior cruciate ligament EIP Extensor indicis proprius
AFO Ankle foot orthosis EMG Electromyography
AK Above knee EPB Extensor pollicis brevis
AKT Anti-Koch’s treatment EPL Extensor pollicis longus
ALL Anterior longitudinal ligament FCR Flexor carpi radialis
AMC Arthrogryposis multiplex congenita FDL Flexor digitorum longus
AMP Austin Moore prosthesis FDP Flexor digitorum profundus
AP Anteroposterior FDS Flexor digitorum superficialis
APB Abductor pollicis brevis FFD Fixed flexion deformity
APL Abductor pollicis longus FHL Flexor hallucis longus
AS Ankylosing spondylitis FPB Flexor pollicis brevis
ASH Anterior spinal hyperextension GCT Giant cell tumour
ASIS Anterior superior iliac spine HKAFO Hip knee ankle foot orthosis
AVN Avascular necrosis HNP Herniated nucleus pulposus
BB Bohler Braun HTO High tibial osteotomy
BK Below knee IP Interphalangeal
BMD Bone mineral density JESS Joshi’s external stabilisation system
CDK Congenital dislocation of knee KAFO Knee ankle foot orthosis
CNS Central nervous system LCL Lateral collateral ligament
CP Cerebral palsy LCPD Legg-Calvé-Perthes disease
CPK Creatine phosphokinase LCS Lumbar canal stenosis
CPPD Calcium pyrophosphate deposition MCC Multiple congenital contracture
CPT Congenital pseudoarthrosis of tibia MCL Medial collateral ligament
CRIF Closed reduction internal fixation MCP Metacarpophalangeal
CRP C-reative protein MCP Metacarpophalangeal
CRPS Complex regional pain syndrome MIPPO Minimally invasive percutaneous plate
CTEV Congenital talipes equinovarus osteosynthesis
DCP Dynamic compression plate MMC Meningomyelocele
DD Differential diagnosis MTP Metatarsophalangeal
DDH Developmental dysplasia of hip MUGA Manipulation under general anaesthesia
DIP Distal interphalangeal NCV Nerve conduction velocity
DMARD Disease modifying anti-rheumatic drugs NSAID Non-steroidal anti-inflammatory drugs
DMD Duchenne’s muscular dystrophy OA Osteoarthritis
DRUJ Distal radio-ulnar joint OGS Osteogenic sarcoma
DVT Deep vein thrombosis OI Osteogenesis imperfecta
ECRB Extensor carpi radialis brevis ORIF Open reduction internal fixation
ECRL Extensor carpi radialis longus PA Posterior anterior
ECU Extensor carpi ulnaris PBH Pelvis both hips
EDC Extensor digitorum communis PCL Posterior cruciate ligament
 xii Textbook of Orthopaedics

PID Prolapsed intervertebral disc SI Sacroiliac

PIP Proximal interphalangeal SLE Systemic lupus erthematosus
PL Palmaris longus SLR Straight leg raising
POP Plaster of Paris SWD Short vlave diathermy
TBW Tension band wiring
PPRP Post polio residual paralysis
TENS • Titanium elastic nailing system
PQ Pronator quadratus
• Trascutaneous electric nerve stimulation
PSIS Posterosuperior iliac spine
TFCC Triangular fibrocartilaginous complex
PT Pronator teres
THR Total hip replacement
PTB Patellar tendon bearing TKR Total knee replacement
RA Rheumatoid arthritis TNF Tumour necrosis factor
ROM Range of motion UBC Unicameral bone cyst
RSD Reflex sympathetic dystrophy USG Ultrasonography
SCFE Slipped capital femoral epiphysis VDRO Varus derotation osteotomy