cOntents

VolumE-1Section 1: Bone Anatomy, Physiology,

Pathology and Diseases

1 Structure and Function of Bones and Joints 3

Manish Kumar VarshneyBone Structure 3Classification of Bone By Appearance 4Gross Features of Bone 6Microscopic Anatomy 7Cellular Elements of Bone 7Composition and Structure of Bone Matrix 14Blood Supply of Bone 17Nerve Supply of Bone 19Bone Development 20Process of Bone Mineralization 25Bone Remodeling 26Regulation of Bone Metabolism 28Growth Factors in Regulation of Bone Metabolism 32Endocrinopathies and Bone Involvement 32

2 Fracture Repair, Bone Grafting and Bone Banking 35

Manish Kumar VarshneyDefinition and Classification 35Important Determinants of Fracture Repair 43Laws Associated with Fracture Repair and Bone

Remodeling 46Methods to Enhance Fracture Repair 51Bone Banking 64

3 Metabolic Diseases of Bone 68 Manish Kumar Varshney, Swapnil Sharma

Osteoporosis 68 Manish Kumar Varshney

Natural History of Bone Mass Changes in Human Body, Operational Definition of Osteoporosis and its Classification 68

Prevalence, Incidence and Problem Statement 70Genetics of Osteoporosis 71Risk Factors for Low Bone Mineral Density and

Fracture Risk Assessment 72Clinical Presentation and Evaluation of Osteoporosis 76Prevention and Treatment of Osteoporosis 82Pharmacotherapy for Osteoporosis 87Anabolic Agents 95Future Approaches 102Atypical Forms of Osteoporosis 103

Osteopetrosis 105 Manish Kumar Varshney

Etiology and Pathophysiology 105Epidemiology and Clinical Features 106Investigations 106Differential Diagnosis 107Treatment 107

Rickets 107 Swaphil Sharma

Pathophysiology 107Clinical Features 108Radiological Signs 108Nutritional Deficiency of Vitamin D 110Secondary Vitamin D Deficiency 111Vitamin D-dependent Rickets Type 1 111Vitamin D-dependent Rickets Type 2 111Rickets in Chronic Renal Failure 112Calcium Deficiency and Rickets 112Hypophosphatemic Rickets 113Fluorosis 115Gaucher’s Disease 117Mucopolysaccharidoses 118

4 Infections of Bone (Typical and Atypical and their Management), Actinomycosis, Mycetoma, Surgical Site Infection 123

Manish Kumar VarshneyOsteomyelitis 123History and Epidemiology 126Pathogenesis 127Modern Concept and Understanding of Osteomyelitis 129Bacteriological Factors 131

Essential Orthopedics: Principles and Practicexvi

Environmental Influence 134Diagnosis 136Functional Imaging 139Principles of Therapy 141Management of Chronic Osteomyelitis 142Tissue Debridement 143Bone Stabilization 145Local Antibiotic Therapy 145Biodegradable Systems 148Reconstruction of the Soft Tissue 155Amputation 155Adjuvant Therapies for Treatment of Osteomyelitis 156Prevention of Exogenous Bone Infection 156Some Special Forms of Osteomyelitis 157Actinomycosis 162Mycetoma (Maduramycosis) 163Surgical Site Infection 165

5 Bone Tumors, Common Soft Tissue Tumors and Heterotopic Ossification 168

Manish Kumar VarshneyIntroduction and General Principles 168Staging 168Clinical Evaluation 171Physical Examination 171Radiological Evaluation 172Grading of Bone Tumors 179Laboratory Evaluation 181Treatment 181Adjuvant Therapy 184Radiotherapy 187Benign and Malignant Bone Forming 191Neoplasms 191Cartilage Forming Lesions 213Fibrous Lesions 225Giant Cell Tumor (Osteoclastoma ICD-O 9250/1) 226Benign Fibrous Histiocytoma 231Malignant Fibrous Histiocytoma 231Plasma Cell Myeloma 232Malignant Lymphoma of Bone 235Ewing’s Sarcoma 235Fibrous Dysplasia 239Osteofibrous Dysplasia (Campanacci’s Disease) 242Adamantinoma 243Chordoma 245Vascular Lesions of Bone 246Metastatic Disease of Bone 251Musculoskeletal Soft Tissue Tumors 262Tumor and Tumor-Like Conditions of Fibroblasts/

Myofibroblasts 263Common Fibrous Tumors of Infancy and Childhood 266

Fibrohistiocytic Tumors 268Heterotopic Ossification 269

6 Osteonecrosis and Osteochondrosis 275

Manish Kumar VarshneyOsteonecrosis 275Femoral Head Osteonecrosis 279Osteonecrosis of the Distal Femur (Femoral Condyles) 301Osteonecrosis of Talus 306Kienbock’s Disease (Lunatomalacia) 315Preiser’s Disease 326Osteochondrosis 330Osteochondritis Dissecans of the Talus 336Caisson Disease 338

Section 2: Joint—Structure, Function and Related Disorders

7 Classification of Joints 343 Manish Kumar Varshney

Functions 343Joint Classification 343Kinematic Classification and Movements at

Different Types of Joints 345

8 Synovial Joint: Anatomy and Physiology 348

Manish Kumar VarshneySynovial Joint 348Detailed Anatomy and Physiology of Synovial Joint 348Traumatic Arthrotomy 349Synovial Membrane 350Synovial Fluid 350

9 Disorders of Synovium 355 Manish Kumar Varshney

Tenosynovial Giant Cell Tumors 355Pigmented Villonodular Synovitis (Synovial Xanthoma,

Villous Synovitis) 355Synovial Chondromatosis 359Synovial Sarcoma 361

10 Articular Cartilage: Structure, Function, Injury and Management 364

Manish Kumar VarshneyStructure and Composition 364Chondrocytes 365Intercellular Matrix 366

Contents xvii

Metabolism and Regulation 367Biomechanics of Articular Cartilage 368Lubrication and Wear (Synovial Joint Lubrication) 370Effects of Injury 370Osteochondritis Dissecans 372Methods to Repair or Reconstruct Focal Cartilage

Defects 374Scaffolds 383Biomolecules for Cartilage Defect Repair 384Gene Therapy in Cartilage Tissue Engineering 385Chondrocyte Culture and Co-culture Systems 385

11 Joint Disorders Including Inflammatory and Noninflammatory Arthritis and Infective Arthritides (Including Mycobacterial Infection and Prosthetic Joint Infection) 388

Manish Kumar VarshneyArthritis 388

Osteoarthritis (Osteoarthrosis, Arthrosis, Degenerative Joint Disease) 388Epidemiology 389Etiology 390Pathophysiology and Pathogenesis 392Microstructural Progression of 393Osteoarthritis 393Clinical Features and Diagnosis 393Clinical Staging of Osteoarthritis 395Investigations 396Differential Diagnosis 397Acute Complications of Osteoarthritis 397Variants of Primary Osteoarthritis 398Treatment of Osteoarthritis 400

Total Knee Arthroplasty 409History 409Contemporary Knee Designs 410Contemporary CR Design 410Contemporary PS Design 410Special Design Features 410Goals of Total Knee Replacement 411Principles of Total Knee Replacement 411Complications of TKR 413

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD Disease or Arthropathy, Pseudogout, Chondrocalcinosis, Pyrophosphate Arthropathy) 418

Hemophilic Arthropathy 422 Ochronosis (Alkaptonuria) 423

Clinical Features 423Treatment 423

Rheumatoid Arthritis 423Etiology 424

Pathogenesis 424Clinical Features and Diagnosis 426Differential Diagnosis 429Treatment 429Pharmacotherapy 429Newer Modalities and Advances in RA Management 432

Seronegative Spondyloarthropathies 437Ankylosing Spondylitis (Marie-Strumpell Disease, Morbus

Bechterew Disease) 437Psoriatic Arthritis (PSA) 442Enteropathic Arthritis (Ena), Reactive Arthritis

(REA), and Undifferentiated and Juvenile-Onset Spondyloarthropathy 444

Neuropathic Arthropathy [Charcot’s Joints, Charcot’s Arthropathy (CA), Charcot’s Neuroarthropathy] 445

Septic Arthritis 448Pathophysiology 448Clinical Features 449Septic Arthritis of Hip in Children and Its Sequel 451Late Sequel of the Septic Arthritis Hip in Infants 453

Prosthetic Joint Infection (PJI) 457Microbiology and Pathophysiology 457Diagnosis 458Treatment 461

Mycobacterial Arthritis 463Microbiology 463Pathology and Pathogenesis 464Clinical Types of Tubercular Arthritis 464Clinical Features 464Radiologic Findings 465Diagnosis 465Treatment 468Essential First-Line Drugs 470TB of Hip Joint 473

HIv Associated Musculoskeletal Conditions 478

Gout (“Podagra”) (Big Toe Involvement), Rich Man’s Disease, Disease of the Kings 479Pathophysiology 480Clinical Features 481Differential Diagnosis 483Treatment 483

Section 3: Basic Sciences

12 Biostatistics, Ethics and Research Methods 489

Manish Kumar VarshneyThe Measurement Scales 489Derived Data 490Censored Data 491

Essential Orthopedics: Principles and Practicexviii

Bias 491Biostatistics 493Sampling 500Randomization 501Blinding/Masking 502Data Collection 503Descriptive Statistics 503Type of Distributions 506Defining Statistics and Describing the Parametric and Non-

Parametric Tests 508Analysis of Continuous Variable 509Nonparametric Analysis (Analysis of Categorical

Variable) 512Hypothesis Testing (The P-value Approach) 514Levels of Evidence 515Some Essentials for Young Investigators and

Researchers 516Informed Consent 517

13 Biomechanics in Orthopedics: General Principles 519

Manish Kumar Varshney, Jaydip PatelStatics 519Dynamics 522

14 Gait 524 S Pavan

Phases of Gait 524Factors Affecting Gait 526Types of Pathological Gait 526

Section 4: Surgical and Medical Complications of Fractures

15 Nonunion of Long Bones 535 Manish Kumar Varshney

Epidemiology 536Classification 536Pathogenesis 538Diagnosis 539Investigations 540Treatment 540The Principle of Distraction Osteogenesis and Its

Application to Nonunion of Long Bones 542Scaphoid Fracture and Nonunion 548Femoral Neck Nonunion 561

16 Compartment Syndrome 570 Manish Kumar Varshney

Etiopathogenesis 570Natural History and Diagnosis 575

Measurement of Intra compartmental Pressure 576History and Physical Examination 578Differential Diagnosis 580Management 580Surgical Technique 580Chronic Compartment Syndrome 582Compartment Syndrome in Children 585

17 Complex Regional Pain Syndrome 587 Ashok Jadon, Amit Singh

History and Nomenclature 587Epidemiology 588Types of Complex Regional Pain Syndrome 588Pathophysiology 588Symptoms/Clinical Presentation 589Diagnosis 590Differential Diagnosis of Complex Regional Pain

Syndrome 592Treatment 592Prognosis 595Complex Regional Pain Syndrome in Children 597

18 Deep vein Thrombosis 598 Manish Kumar Varshney, Jaydip Patel

History 598Epidemiology 598Anatomy and Pathophysiology 599Development of Thrombosis and Balancing

Mechanisms 599Pathogenesis of Deep Venous Thrombosis: The Tilt of

Balance of Thrombosis 600Etiology of Deep Venous Thrombosis 602Clinical Features 602Diagnosis 603Differential Diagnosis 606Treatment of Deep Vein Thrombosis 606Prophylaxis of Deep Venous Thrombosis 610Choice of Anticoagulant 614

Upper Extremity Deep vein Thrombosis 617Pathogenesis and Risk Factors 618Clinical Presentation 619Diagnosis 619Complications 620Treatment 620Prophylaxis 621

19 Fat Embolism Syndrome 623 Sanjay L Srivastav, Ankit Data

Pathophysiology 623Presentation 624Diagnosis 624Laboratory Studies 625Imaging Studies 625

Contents xix

Treatment 625Medication 626Prognosis 626

20 Neurogenic Bladder 627 Jaydip Patel, Manish Kumar Varshney

Epidemiology 627Anatomy of the Bladder 627Neuroanatomy of the Bladder 627Pathophysiology and Etiology 628Classification 629Investigations 629Treatment and Management 630

21 Acute Respiratory Distress Syndrome 632

Sanjay L Srivastav, Ankit DataBackground and Definition 632Pathophysiology 632Etiology 632Presentation 633Physical Findings 633Workup 633Diagnostic Criteria 633Treatment 633

22 Systemic Inflammatory Response Syndrome 635

Jaydip Patel, Ankit DataEtiology 635Pathophysiology 635Multi-Hit Theory 636Clinical Examination 636Laboratory Evaluation 636Treatment 636Complications 637

23 Multiple Organ Dysfunction Syndrome [Multiple Organ Failure (MOF) and Multisystem Organ Failure (MSOF)] 638

Ankit Data, Ayush KumarEtiology 638Pathophysiology 638Clinical Features 639Other Systems 639Diagnosis 639Prevention 640Prognosis 640Treatment 640

24 Transfusion Medicine 641 Sanjay L Srivastav, Ankit Data, Sachin Bharti

Blood Group Systems 641Detection of Blood Group Antibodies 642Blood and Blood Products 643Clinical Use of Blood and Blood Components 643Adverse Reactions to Blood Transfusion 645Nonimmunologic Reactions 647Alternatives to Blood Component Therapy 647

25 Shock 651 Ankit Data, Sachin Bharti, Sanjay L Srivastav

Classification and Causes 651Pathophysiology 652Shock Manifestations 653Management 656

Section 5: Pediatric Orthopedics

26 Congenital, Genetic, Syndromic and Miscellaneous Disorders 663

Manish Kumar VarshneyTorticollis 664Ehlers-Danlos Syndrome 669Osteogenesis Imperfecta 672Marfan Syndrome 678Trisomy 21 (Down Syndrome) 682Turner Syndrome 683Disorders Caused by Abnormalities in Tumor-related

Genes 683Achondroplasia and Related Disorders 685Disorders Related to Type II Collagen Abnormalities 688Disorders Caused by Abnormalities in Genes Important in

Normal Skeletal Development 689Disorders Caused by Abnormalities in Genes that Play a

Role in the Processing of Proteins 690Other Skeletal Dysplasias 691

Some Miscellaneous Syndromes 693Arthrogryposis 693Fetal Alcohol Syndrome 700Prader-Willi Syndrome 700Angelman Syndrome (Happy Puppet Syndrome) 701Beckwith-Wiedemann Syndrome 701Trichorhinophalangeal Syndrome 701Progeria (Hutchinson-Gilford Syndrome) 702Rubinstein-Taybi Syndrome 702Congenital Constriction Band Syndrome 703Melorheostosis 705Osteopoikilosis (Osteopathia Condensans

Disseminata) 706Osteopathia Striata 706Dysplasia Epiphysealis Hemimelica 707

Essential Orthopedics: Principles and Practicexx

27 Poliomyelitis 709 Alok Sud, Manish Kumar Varshney

Pathology 709Clinical Features of an Acute Attack of Polio 711Management 712General Rules for Tendon Transfer in Foot 715Paralysis of Specific Muscle and Muscle Groups and Functio

Laesa (Modified From Peabody) 715Paralysis of Inversion 715Paralysis of Dorsiflexion and Inversion (Tibialis Anterior,

Tibialis Posterior and Toe Extensors) 716Paralysis of Dorsiflexion, Inversion and Eversion 717Paralysis of Eversion 717Paralysis of Plantar Flexion (Triceps Surae) 717Stabilization of Joints of Foot and Ankle 718Claw Toes 719Dorsal Bunion 721Cavus Deformity and Claw Toes 722Talipes Equinus 725Talipes Equinovarus 729Talipes Cavovarus 730Talipes Equinovalgus 730Talipes Calcaneus 731

28 Cerebral Palsy 733 Alok Sud, Manish Kumar Varshney

Classification of Activity Limitation and Assessment 734Clinical Assessment of a Cerebral

Palsy Child 737Principles of Management of Child

with Cerebral Palsy 741Treatment for Spasticity in Cerebral Palsy 741Management of Hip Deformities in Cerebral Palsy 742Management of the Knee in Spastic Diplegia 745Management of Foot and Ankle in Cerebral Palsy 746Management of the Upper

Extremity in Cerebral Palsy 749Management of Spinal

Deformity in Cerebral Palsy 752

29 Anomalies of Pediatric Lower Limb 753 Manish Kumar Varshney

Development of Lower Limb 753Congenital Femoral Deficiency 753Rotational and Angular Alignment of Lower Limb,

Common Pathologies and Principles of Correction of Deformity in Children 759

Genu Varum 771Tibia Vara 775Genu Valgum (Knock-Knees) 778Congenital Angular Deformities of Tibia and Fibula 782Congenital Deficiencies of the Tibia 785

Fibular Hemimelia 786Congenital Dislocation of the Knee 787Leg-length Discrepancy 790Patellar Instability 805Congenital Vertical Talus (Convex Pes Valgus, Rigid Rocker

Bottom Flatfoot) 814Polydactyly 815Macrodactyly (Banana Toes) 815Lesser Toe Abnormalities 816Cleft Foot (Ectrodactyly, Lobster Foot,

Partial Adactyly) 816Congenital Metatarsus Adductus (Metatarsus Varus,

Metatarsus Adductovarus) 818Tarsal Coalition 820Skewfoot (Z-Foot, Serpentine Foot, Metatarsus

Adductovarus, Congenital Metatarsus Varus) 823Flexible Flatfoot 823Accessory Navicular (Os Tibiale Externum, Navicular

Secundum and Prehallux) 825Slipped Capital Femoral Epiphysis (Slipped Upper Femoral

Epiphysis) 826

30 Anomalies of Pediatric Upper Limb 831 Manish Kumar Varshney

Development of Upper Limb 831Birth-Related Brachial Plexus Palsy 831Sprengel’s Deformity (Congenital Elevation of

Scapula) 840Glenoid Hypoplasia 842Congenital Pseudarthrosis of the Clavicle 842Congenital Radial Head Dislocation 843Congenital Proximal Radioulnar Synostosis 845Radial Longitudinal Deficiency 846Madelung’s Deformity 851Central Deficiency 854Syndactyly 855Polydactyly 858Camptodactyly (Bent Finger) 859Clinodactyly 860Thumb Hypoplasia or Aplasia 861Congenital Trigger Thumb or Digits 862

31 Clubfoot—Congenital Talipes Equinovarus 864

Manish Kumar VarshneyDefinition and Problem Statement 864Historical Perspective 865Etiology of Clubfoot 865Biology of Developing Clubfoot 866Clinical Examination and Characteristic Findings 867Characteristic Bony Changes and Radiological

Examination 868

Contents xxi

Radiology 869Types of Congenital Talipes Equinovarus 871Classification of Congenital Talipes Equinovarus 871Treatment 873Evaluation of Deformity Correction in Congenital Talipes

Equinovarus 885Treatment of Resistant Deformity and Relapsed Congenital

Talipes Equinovarus 885

32 Dysplastic Development of Hip [Developmental Dysplasia of Hip (DDH), Congenital Dysplasia of Hip, Congenital Dislocation of Hip (CDH)] 887

Alok Sud, Manish Kumar VarshneyClinical Presentation 890Imaging Studies 893Differential Diagnosis (Clinical and Radiological) 895Treatment 896Some Procedural Descriptions 902

33 Perthes Disease 907 Manish Kumar Varshney, Alok Sud

Etiology and Pathogenesis of Disease 907Pathophysiology and Pathoanatomy of the Disease 908Clinical Features 909Differential Diagnosis 910Radiological Workup 910Staging and Classification of Disease 912Prognostic Factors 914Treatment Principles and Methods 914Some Notes on Surgical Containment Procedure 917

Section 6: Sports Medicine

34 Sports Medicine: Knee 921 Manish Kumar Varshney

Tibiofemoral Articulation 921Cruciate Ligaments 932Patellofemoral Articulation 934Biomechanics of Knee Joint 942Knee Instability 945Tibial Collateral Ligament Injury 952Lateral Collateral Ligament Injury 956Anterior Cruciate Ligament Injury 956Posterior Cruciate Ligament Injury 963Posterolateral Corner Injuries 966Combined Ligament Injuries and Knee Dislocation 969

Meniscal Lesions 970Pathophysiology and Pathoanatomy 970Sports Related Peroneal Nerve Injury 974Bursitis 976Baker’s Cyst 977Infrapatellar Fat Pad Syndrome (Hoffa’s Disease,

Hoffa’s Fat Pad Syndrome, and Liposynovitis Prepatellaris) 979

Patellofemoral Pain Syndrome and Anterior Knee Pain 980

Patellar Tendinitis (Jumper’s Knee) 983Runner’s Knee (Iliotibial Band Friction Syndrome

and Pes Anserinus Tendinitis or Bursitis) 984Sinding-Larsen-Johansson Disease (Larsen-Johansson

Syndrome and Sinding-Larsen Disease) 985Osgood-Schlatter Disease 985

35 Sports Medicine: Foot, Ankle and Leg 988

Manish Kumar VarshneyAchilles Tendon 988Tibialis Posterior Tendon Disease/Insufficiency 990Peroneal Tendon Disease 991Stress Fractures 992Plantar Fasciitis (Plantar Fasciosis, Calcaneal Plantar

Enthesopathy) 997Posterior Ankle Impingement Syndrome 1001

36 Sports Medicine: Hip and Thigh 1004 Manish Kumar Varshney

Hip Arthroscopy Indications and Principles 1004Acetabular Labral Tears 1008Femoroacetabular Impingement (Acetabular Rim

Syndrome, Cervicoacetabular Impingement) 1016Snapping Hip (Coxa Saltans) 1026Piriformis Syndrome (Deep Gluteal Syndrome, Pelvic Outlet

Syndrome, Infrapiriform Foramen Syndrome) 1029Meralgia Paresthetica (Bernhardt-Roth Syndrome, Lateral

Cutaneous Nerve Neuralgia) 1034Trochanteric Bursitis (Greater Trochanteric Pain

Syndrome) 1037Osteitis Pubis 1039Hip Stress Fractures 1042Groin Pain (Athletic Pubalgia and Sports Hernia) 1043

37 Sports Medicine: Elbow 1048 Manish Kumar Varshney

Elbow Arthroscopy 1048Terrible Triad Injury of Elbow

(Hotchkiss Triad, 1996) 1050

Essential Orthopedics: Principles and Practicexxii

38 Sports Medicine: Hand Injuries 1054 Manish Kumar Varshney

Jersey Finger 1054Mallet Finger 1055Boxer’s Knuckle (Boxer’s Fracture) 1056Jammed Finger 1057

39 Head Injuries in Sports 1059 Manish Kumar Varshney

Pathophysiology 1059Spectrum of Head Injuries 1059Concussion (Commotio Cerebri) 1061

40 Doping (Drugs and Legal Aspects) 1065

Manish Kumar VarshneyTesting 1066Consequences of Anti-doping Rule Violations 1066

41 Skeletal Muscle: Structure and Function 1067

Manish Kumar VarshneyCytology 1067Motor Unit 1069Sarcoplasmic Reticulum 1069Structural Proteins of Muscle 1070Sliding Filament Model of Contraction 1070Muscle Twitch and Tetanus 1070Fiber Types and Muscle Adaptability 1072Length-Tension Relationship 1072Force-Velocity Relationship 1073

Section 7: Regional Orthopedics—Shoulder

42 Shoulder—Functional Anatomy 1077 Manish Kumar Varshney, Abheek Kar

The Rotator Cuff Anatomy and Pathoanatomy 1080

43 Biomechanics of Shoulder Joint 1084 Manish Kumar Varshney

The Glenoid Labrum 1084Scapulohumeral Rhythm 1086Force Couple Mechanism on Humeral Head 1087

44 History and Clinical Examination 1089 Abheek Kar, Manish Kumar Varshney

Age 1089Gender 1089

Pain 1090Instability 1090Physical Examination 1091Special Tests 1091

45 Investigations 1100 Manish Kumar Varshney

Ultrasonography 1101Magnetic Resonance Imaging and Magnetic Resonance

Arthrography 1101

46 Rotator Cuff Disease 1102 Manish Kumar Varshney

Subacromial Impingement Syndrome 1102Rotator Cuff Tears 1105Treatment of Subacromial Impingement Syndrome and

Rotator Cuff Lesions 1108

47 Shoulder Instability 1113 Abheek Kar, Manish Kumar Varshney

Anterior Instability 1114Superior Labrum Anterior and Posterior

Lesion and Internal Impingement 1124

48 Calcific Tendinopathy 1126 Manish Kumar Varshney

Etiopathogenesis 1126Radiologic Appearance and Classification 1127Clinical Course of Disease 1127Treatment 1127

49 Lesions of Biceps Tendon 1129 Manish Kumar Varshney

Introduction 1129Bicipital Tendinosis 1129Subluxating Biceps Tendon 1129Rupture of the Long Head of Biceps 1130

50 Atraumatic Osteolysis of the Distal Clavicle (Idiopathic Clavicle Osteolysis, Wrestlers Syndrome, Weightlifters Shoulder) 1132

Manish Kumar VarshneyPathogenesis 1132Pathoanatomy 1132Clinical Features 1132Differential Diagnoses 1133Radiological Findings 1133Treatment 1133Complications of Surgical Procedures 1133

Contents xxiii

51 The Stiff Shoulder 1135 Manish Kumar Varshney

Adhesive Capsulitis 1135

52 Hemorrhagic Shoulder (Milwaukee Shoulder, L’epaule Senile Hemorragique) 1139

Manish Kumar VarshneyPathogenesis 1139Pathoanatomy 1139Epidemiology 1139Clinical Features and Radiology 1140Diagnosis 1140Differential Diagnosis 1140Treatment 1140

53 Osteoarthritis of Shoulder Joint 1141 Manish Kumar Varshney

Clinical Features 1141Differential Diagnosis 1142Radiology 1142Treatment 1142

54 Scapular Instability 1148 Manish Kumar Varshney

Etiology 1148Clinical Feature 1148Treatment 1149

55 Suprascapular Nerve Syndrome 1150 Manish Kumar Varshney

Anatomy 1150Etiology 1150Clinical Presentation 1150Investigations 1151Differential Diagnosis 1151Treatment 1151

56 Tuberculosis of Shoulder Joint 1152 Manish Kumar Varshney

Pathoanatomy and Clinical Forms 1152Clinical Features 1152Radiology 1152Differential Diagnosis 1153Treatment 1153

VolumE-2Section 8: Regional Orthopedics—Hip

57 Surgical and Functional Anatomy 1157 Manish Kumar Varshney

Anatomy of the Hip 1157

58 Surgical Approaches to Hip Joint 1170 Manish Kumar Varshney

Classification of Approaches to Hip Joint 1170Techniques of Various Surgical Approaches to the Hip

Joint 1171

59 Biomechanics of Hip Joint 1183 Manish Kumar Varshney

Functional Anatomy 1183Forces Transmitted Across Hip Joint 1184Clinical Applications 1188

60 Tribology and Bearing Surfaces for Hip (Including Ceramics) 1191

Manish Kumar VarshneyHistorical Perspective 1191Problem Statement 1192Tribology of Articulating Surfaces 1192Bearing Surfaces for

Total Hip Arthroplasty 1205Materials Bearing Used As Against Polyethylene 1206Polyethylenes 1207Metal-on-metal Bearings 1210Ceramic Bearings 1213New Horizons in Bearing Surfaces 1218

61 Polymethyl-methacrylate (PMMA, Plexigas, Bone Cement, Acrylic Bone Cement) 1220

Manish Kumar VarshneyHistory of Development of Bone Cement 1220Effect of Various Factors on Cement Polymerization 1222Mixing Techniques 1222Physical Properties of Cement 1224

Essential Orthopedics: Principles and Practicexxiv

Adverse Effects/Complications of Bone Cement 1225Removal of Bone Cement 1228

62 Osteoarthritis of Hip Joint 1229 Manish Kumar Varshney

Risk Factors 1230Classification of Hip Osteoarthritis 1232Clinical Features and Evaluation 1232

63 Protrusio Acetabuli [Otto-Chrobak Pelvis, Otto Pelvis, Arthrokatadysis (Greek—Subsidence of Joint), Osteoarthritis Deformans, Osteoarthritic Protrusion of the Acetabulum] 1236

Manish Kumar VarshneyHistorical Considerations 1236Classification 1236Biomechanics of Protrusio 1237Clinical Features 1237Radiographs 1237Laboratory Workup 1239Management of Protrusio 1239

64 Transient Synovitis of Hip (Transitory Coxitis, Acute Transient Epiphysitis, Coxitis Fugax, Coxitis Serosa Seu Simplex, Phantom Hip Disease, Toxic Synovitis, and Observation Hip) 1242

Manish Kumar VarshneyEpidemiology 1242Etiology 1242Diagnosis 1242Differential Diagnosis 1243Treatment 1244Natural History and Prognosis 1244

65 Osteotomies Around the Hip Joint 1245

Manish Kumar VarshneyClassification and Types of Proximal Femoral

Osteotomies 1246General Work-up for Osteotomy 1247Clinical Examination 1247Radiological Evaluation of the Involved Hip 1248

Intertrochanteric Osteotomy 1248The Various Commonly Performed Osteotomies 1249Curved Varus Osteotomy for Osteonecrosis 1253Pelvic Support Osteotomy (Resection Angulation

Osteotomy) 1254Milch-Bachelor Osteotomy 1257McMurray’s Osteotomy 1258Lorenz Bifurcation Osteotomy 1259Schanz Osteotomy (Low Subtrochanteric

Osteotomy) 1259Trochanteric Osteotomies 1259Subtrochanteric Osteotomies 1265Derotational Osteotomy 1265

66 Total Hip Replacement Arthroplasty (Rationale, Design, Complications and Revision) 1267

Manish Kumar Varshney, Aditya SoralPrinciple of Total Hip Arthroplasty 1267History of Total Hip Arthroplasty 1267Components of a Modular Hip Prosthesis 1269Fixation Methods of Prosthesis: Cemented Versus

Uncemented 1277Goals of Total Hip Arthroplasty 1279Indications for Total Hip Arthroplasty 1279Contraindications for Hip Arthroplasty 1279Clinical Results and Possible Complications 1281Complications of Arthroplasty 1281Revision Hip Arthroplasty 1288Cement-In-Cement Revision 1294

67 Intertrochanteric Resection Osteotomy/Arthroplasty of Girdlestone (and its Modifications) 1295

Manish Kumar Varshney

68 Hip Arthrodesis 1297 Manish Kumar Varshney

History of the Procedure 1297Biomechanics and Natural History of the

Procedure 1299Classification of Hip Arthrodesis Procedures 1300Contraindications for Hip Arthrodesis 1300Surgical Technique of Cobra-Head Plate

Arthrodesis 1301Postoperative Course 1302Total Hip Replacement in An Arthrodesed

Hip 1303

Contents xxv

69 Surgical Dislocation of the Hip (Ganz Surgical Dislocation of Hip, Open Dislocation of Hip) 1304

Manish Kumar VarshneyPrinciples 1304Technique 1305Complications 1307

Section 9: Foot and Ankle Disorders

70 Anatomy of Ankle and Foot 1311 Manish Kumar Varshney

Tibia 1312Fibula 1312Talus 1312Ligaments of Ankle Joint 1312Foot 1314Tendons and Neurovascular Structures Around Ankle 1316

71 Biomechanics of the Foot and Ankle Joint and Related Examination 1317

Manish Kumar VarshneyBiomechanics of Ankle Joint Movements 1317Neurological Examination 1321Measurements 1323

72 Arches of the Foot 1324 Manish Kumar Varshney

Bones of the Arches 1324Mechanisms of the Arch Support (Masonry Concept) 1325Maintenance of the Medial Longitudinal Arch 1326Maintenance of the Lateral Longitudinal Arch 1327Maintenance of the Transverse Arch 1327Propulsive Action of the Foot 1327Forefoot 1327Sole of the Foot 1328Tripod Action of the Foot 1329Movements at Foot 1330

73 Examination of the Foot and Ankle 1332

Manish Kumar VarshneyInspection 1332Posture 1333Medial Arch 1333Heels 1333Shoes 1333

Club Foot Deformity 1334Palpation 1334

74 Tarsal Tunnel Syndrome 1338 Manish Kumar Varshney

Anatomy 1338Etiology 1339Clinical Features and Examination 1339Investigations 1340Differential Diagnosis 1340Treatment 1341

75 Ligament Injuries Around Ankle 1342 Manish Kumar Varshney

Classification 1344Chronic Instability After Injury 1347

76 Rheumatoid Affection of Foot, Diabetic Foot Disease, and Neuropathic (Charcot’s) Foot 1351

Manish Kumar VarshneyRheumatoid Affection of Foot 1351Diabetic Foot Disease and Neuropathic Foot 1356Charcot Neuroarthropathy 1360

77 Deformities of the Hallux 1364 Manish Kumar Varshney

Bunion or Hallux Valgus 1364Crossover Second Toe 1373Hallux Rigidus 1375Hallux Flexus 1376Deformities of the Lesser Toe 1377Claw Toe 1378Mallet Toe 1378Tailor’s Bunion or Bunionette 1379Ingrowing Toenail

(IGTN, Onychocryptosis) 1379

78 Acquired Flatfoot (Pes Planus) and Posterior Tibial Tendon Dysfunction 1381

Manish Kumar Varshney Acquired Flatfoot (PES Planus) 1381

Pathomechanism 1382Pathoanatomy 1382Symptoms 1382Physical Examination 1382Radiology of Flatfoot 1382Ancillary Studies 1384

Essential Orthopedics: Principles and Practicexxvi

Stages of Development of Flatfoot 1384Flexible Pes Planus 1384Treatment 1385Rigid Pes Planus 1386Posterior Tibialis Tendon Dysfunction 1386Peroneal Spastic Pes Planus 1388

79 Pes Cavus and Accompanying Deformities 1391

Manish Kumar VarshneyEtiology 1391Pathogenesis of Deformity 1392Types of Deformity 1394Natural History of Pes Cavus and Clinical Relevance 1395Principles of Treatment 1395

80 Hindfoot Deformities and Plantar Heel Pain 1400

Manish Kumar VarshneyHindfoot Valgus Deformity 1400Hindfoot Varus Deformity 1400Plantar Heel Pain 1401

81 Foot Drop 1405 Manish Kumar Varshney

Pathophysiology 1406Clinical Presentation 1406Diagnosis 1406Treatment 1406Complications 1407

82 Avascular Necrosis of the Metatarsal Head (Freiberg’s Disease) 1408

Manish Kumar VarshneyEtiology 1408Clinical Features 1408Investigations 1409Differential Diagnosis 1409Staging By Smillie 1409Treatment 1409

83 Tendo-Achilles Rupture 1411 Manish Kumar Varshney

Site and Mechanism of Tear 1411Pathoanatomy and Pathophysiology 1412Clinical Features 1412Investigations 1413Management 1413

84 Morton’s Metatarsalgia (Morton Toe, Interdigital Neuroma) 1417

Manish Kumar VarshneyPathogenesis 1417Pathoanatomy 1418Clinical Features 1418Investigations 1418Treatment 1418Complications 1419

Section 10: Regional Orthopedics—Spine

85 Anatomy of the Spine and Spinal Cord 1423

Manish Kumar Varshney, S PavanVertebral Column 1423Curvatures of Vertebral Column 1424Vertebral Joints 1425The Intervertebral Disc 1426Molecular Composition of the Intervertebral Disk 1426Functions of Intervertebral Disk 1428Changes in the Intervertebral Disk with Age 1429Biomechanics of Intervertebral Disk 1429Blood Supply of Intervertebral Disk 1429Innervation of Vertebral Disk 1430Blood Supply of Spine 1430The Spinal Cord 1431Structure of the Spinal Cord 1433White Matter and Spinal Cord Tracts 1436Blood Supply of the Spinal Cord 1437

86 Low Back Pain and Intervertebral Disk Degeneration 1439

Manish Kumar Varshney, S PavanInvestigations 1439The Concept of Pain Generator and Common Recognized

Pain Generators in Lumbar Spine 1440Management 1443

Intervertebral Disk Degeneration 1445Pathoanatomy 1445Pathobiomechanics 1446Degenerative Processes 1447Production of Pain and Radicular Symptoms in

Degenerative Disk Disease 1449Etiology of Disk Degeneration 1450Pathophysiology of Disk Degeneration 1453

Contents xxvii

Classification of Pathology of Disk Degeneration 1455

Diagnosis of Internal Disk Disruption 1455Treatment of Discogenic Pain 1456Chemonucleolysis 1457Radiofrequency Annuloplasty 1457Percutaneous Disk Decompression 1458Gene Therapy/Cell-Based Therapies 1459Augmentation of Nucleus Pulposus/Nucleus

Replacement 1461Regeneration of the Cartilage Endplate 1462

Lumbar Spondylosis and Lumbar Degenerative Disk Disease 1462Introduction 1462Epidemiology 1462Clinical Features 1462Diagnostic Imaging 1462Diagnosis 1463Treatment 1464Facet Replacement 1468

87 Interventional Techniques for Diagnosis and Treatment of Back Pain 1470

Ashok Jadon, Palak MehtaRole of Interventional Pain Management in the

Management of Low Back Pain 1471Red Flags and Yellow Flags—

A Caution Before Intervention 1471Facet Joint Injection and Medial

Branch Block 1473Myofascial Pain and Trigger Point Injection 1474Epidural Steroid Injection 1475Approaches for Epidural Steroid Injection in Back

Pain 1476Lumbar Interlaminar Approach 1476Caudal Epidural 1477Epidurography and Epiduroscopy 1478Epidurolysis/Epidural Adhesiolysis/Neuroplasty 1478Provocative Discography 1479Percutaneous Disk Decompression/Discectomy 1479Ozone Nucleolysis 1479Sacroiliac Joint Steroid Injection/Radiofrequency

Neurotomy 1480Percutaneous Vertebroplasty and Kyphoplasty 1481New Techniques 1481Annuloplasty 1482Gray Ramus Block 1482Spinal Cord Stimulator 1482Indication of Surgery 1483

88 Lumbar Disk Herniation and Spinal Stenosis 1485

Manish Kumar Varshney Lumbar Disk Herniation 1485

Terminology of Disk Pathology 1485Pathophysiology 1486Epidemiology 1486Pathoanatomy 1487Natural History of Lumbar

Disk Herniation 1487Clinical Features 1487Diagnostic Imaging 1489Treatment 1490Comparing Nonoperative And

Operative Management 1491Failure of Discectomy (Failed Back) 1491Indications for Fusion After Discectomy 1492Management of Cauda Equina Syndrome 1492Recurrent Herniation and Revision 1492Disk Herniation in Pediatric Patients 1492

Lumbar Spinal Stenosis 1493Pathoanatomy 1493Pathophysiology 1493Clinical Features 1494Diagnostic Imaging 1494Treatment 1495

89 Failed Back Surgery Syndrome 1498 Manish Kumar Varshney

Incidence 1498Etiology of Failed Back Surgery Syndrome 1498Classification of Patients with FBS 1499Patient Evaluation 1500Prevention and Management 1501Conservative Management 1502Surgical Management 1504

90 Deformities of Spine 1506 Manish Kumar Varshney Scoliosis 1506

Historical Perspective 1508Idiopathic Scoliosis 1510Adolescent Idiopathic Scoliosis 1511Clinical Features 1513Physical Examination and Diagnosis 1514Curve Classification 1521Nonoperative Treatment 1526Operative Treatment 1528Early Onset Scoliosis (Age < 8 Years) 1535Congenital Scoliosis 1538Adult Scoliosis and Deformity 1544

Essential Orthopedics: Principles and Practicexxviii

Neuromuscular Scoliosis 1553 Sagittal Plane Deformity of Spine 1556

Cervical Kyphosis 1561Thoracic Kyphosis 1563

91 Lumbar Spondylolysis and Spondylolisthesis 1569

Manish Kumar Varshney Spondylolysis 1569

Pathophysiology 1570Symptoms 1570Natural History 1570Clinical Features 1570Imaging 1570Differential Diagnosis 1571

Spondylolisthesis 1571Congenital or Dysplastic Spondylolisthesis 1572Isthmic Spondylolisthesis 1573Degenerative Spondylolisthesis 1577Traumatic Spondylolisthesis 1581Pathologic Spondylolisthesis 1581Iatrogenic Spondylolisthesis 1581

92 Diffuse Idiopathic Skeletal Hyperostosis (DISH, Forestier Disease, Ankylosing Hyperostosis, Generalized Juxta-articular Ossification of vertebral Ligaments, and Spondylosis Hyperostotica) 1582

Manish Kumar VarshneyEtiology 1583Prevalence 1583Clinical Presentation 1583Spinal Manifestations 1583Extraspinal Manifestations 1584Radiology 1585Differential Diagnosis 1586Treatment 1587

93 Rheumatoid Affection of Spine 1588 Manish Kumar Varshney

Epidemiology and Natural History 1592Clinical Presentation 1592Diagnostic Evaluation 1593Diagnostic Strategy 1596Management of Rheumatoid Spine 1596

94 vertebral Discitis and Osteomyelitis and Other Spinal Infections 1600

Manish Kumar VarshneyTuberculosis of Spine (Pott’s Spine, Pott’s Disease) 1600Vertebral Pyogenic Osteomyelitis 1621Pyogenic Epidural Abscess 1627

95 Spinal Cord Injury 1629 Manish Kumar Varshney

Etiology 1629Epidemiology 1629Classification 1629Mechanisms of Injury 1635Clinical Manifestations 1639Therapeutic Intervention 1639Assessment and Evaluation 1645Definitive Management 1645Rehabilitation Support 1646Complications of Spinal Cord Injury 1647Prognosis of Spinal Cord Injury 1647

96 Spinal Dysraphism (Spina Bifida, Myelocele, Meningomyelocele, Diastematomyelia, Tethered Cord Syndrome) 1648

Manish Kumar VarshneyEpidemiology 1650CLinical Features (In General for

Spinal Dysraphism) 1650Embryological and Developmental Aspects 1650Anomalies of Development 1653Malformations of Neurulation 1654Malformation During the Second Phase (Canalization,

Stages Xlll-Xx) and the Third Phase (Retrogressive Differentiation, Stages Xx Thereafter) 1656

Tethered Cord Syndrome 1660

97 vertebra Plana, Balloon Kyphoplasty and Ct-Guided Biopsy 1662

Manish Kumar VarshneyFeatures and Diagnosis 1662Radiological Features 1662Management 1663Computed Tomography-Guided Biopsy 1665

Contents xxix

HiStorical Perspective 1665Causes of False Negative Biopsies 1667Complications of Spinal Biopsy 1667Intervertebral Disk Calcification 1667

Section 11: Regional Orthopedics—Hand and Upper Extremity (Except Shoulder)

98 Elbow Anatomy and Biomechanics 1671

Manish Kumar VarshneyBony Anatomy 1671Ligaments 1671Functions of Elbow 1673Movements at Elbow Joint 1674Constraints of Elbow Joint 1674Biomechanics of Throw 1674

99 Tendon Disorders of Elbow 1676 Manish Kumar Varshney Lateral Epicondylitis 1676

History 1676Etiology 1676Associations 1677Pathogenesis 1677Clinical Features 1678Provocative Tests 1679Differential Diagnosis 1679Investigation 1679Treatment 1680

Medial Epicondylitis 1683History 1683Biomechanics 1683Anatomy and Pathomechanics 1683Pathophysiology 1684Clinical Features 1684Differential Diagnosis 1684Investigations 1684Treatment 1685

Distal Biceps Tendon Rupture 1686Anatomy 1686Pathophysiology 1686Epidemiology 1686Clinical Presentation 1687Investigations 1687Treatment 1687

Triceps Tendon Rupture 1689Anatomy 1689Pathophysiology 1689Clinical Presentation 1690Investigation 1690Treatment 1690Complications 1691

100 Elbow Instability 1692 Manish Kumar Varshney

Classification of Elbow Instability 1692Etiology 1692Pathomechanics 1693Evaluation of the Patient with Chronic Instability 1694Differential Diagnosis 1695Management of Elbow Instability 1695Chronic Valgus Elbow Instability 1698Erosive Arthropathies 1701Terrible Triad Injuries 1701Recurrent Dislocation of Elbow 1701Valgus-Extension Overload Syndrome 1701Radiocapitellar Overload Syndrome 1703Posterolateral Rotatory Instability 1703Recurrent Isolated Radial Head Instability 1705

101 Stiff Elbow 1707 Manish Kumar Varshney

Etiology 1707Classification 1707Clinical Features 1709Investigations 1709Management 1709Operative Management 1710Ectopic Ossification Around Elbow 1713Management 1714

102 Hand Anatomy and Function 1720 Manish Kumar Varshney

Positions of the Hand 1722Anatomy 1723Anatomy of Tendons 1731

103 Carpal Instability 1736 Manish Kumar Varshney

Pathomechanics 1737Classification of Carpal Instability 1738Management of Carpal Instability 1739Dissociative Carpal Instability 1740Dissociative Distal Carpal Instability (Distal CID) 1746Nondissociative Radiocarpal Instability 1746Carpal Instability Complex (CIC) 1748

104 Common Miscellaneous Conditions of Hand 1752

Manish Kumar VarshneyDe Quervain’s Stenosing Tenosynovitis (De Quervain’s

Tenovaginitis, De Quervain’s Disease, Washerwoman’s Sprain, Stenosing Peritendinitis) 1752

Essential Orthopedics: Principles and Practicexxx

Intersection Syndrome (Abductor Pollicis Longus Bursitis, Crossover Tendinitis, Squeaker’s Wrist, and Peritendinitis Crepitans) 1755

Trigger Finger 1755Congenital Trigger Thumb 1758Dupuytren’s Contracture 1758First Metacarpophalangeal Joint Ulnar Collateral

Ligament Injury (Gamekeeper’s Thumb and Skier’s Thumb) 1765

Thumb CMC Joint Arthritis (Basal Joint Arthritis) 1767

105 Distal Radioulnar Joint Disorders and Ulnar Wrist Pain 1772

Manish Kumar VarshneyAnatomy 1772Pathology at DRUJ and Pathogenesis 1774Diagnosis 1775Classification of DRUJ Instability 1777Treatment 1777ECU Tendon Problems

And ECU Tendinitis 1782Vaughan-Jackaon Syndrome 1785Ulnocarpal Impaction/Abutment Syndrome and Ulna

Impingement Syndrome 1786Ulnocarpal Impaction Syndrome Secondary to Ulnar

Styloid Nonunion 1788Ulnar Impingement Syndrome 1788

106 volkmann Ischemic Contracture 1790 Manish Kumar Varshney

Pathogenesis 1790Classification of Volkmann Ischemic Contracture 1791Assessment of Patient 1793Differential Diagnosis 1794Timing of Intervention 1794Treatment Options 1794

107 Compressive and Entrapment Neuropathies of Upper Limb 1797

Manish Kumar VarshneyCarpal Tunnel Syndrome 1797Anterior Interosseous Nerve Compressive Neuropathy

(Anterior Interosseous Nerve Syndrome) 1807Pronator Syndrome 1809Cubital Tunnel Syndrome 1810Ulnar Tunnel Syndrome 1815Radial Tunnel Syndrome

(RTS, Supinator Syndrome) 1817Wartenberg Syndrome 1821Posterior Interosseous Nerve Compression

Syndrome 1822

108 Peripheral Nerve Injuries 1824 Manish Kumar Varshney

Anatomical Considerations 1824Neuron 1825Structure and Function of

A Peripheral Nerve 1826Axonal Transport 1829Myoneural Junction 1830Blood-nerve Interface 1831Biomechanical Properties of

Peripheral Nerve 1831Peripheral Nerve Injury 1832Clinical Features of Peripheral Nerve Injury 1836Classification of Nerve Injury 1837Diagnosis of Nerve Injury 1838Nerve Conduction Velocity 1839Strength-Duration Curve 1840Management of Nerve Injury 1841Nerve Repair (Neurorrhaphy) 1841Special Scenarios 1846Injection Nerve Palsy 1848Management of Old and

Late Presenting Cases 1848Individual Upper Limb Nerve Palsies

of Upper Limb 1850Combined Nerve Palsies of Upper Limb 1855

109 Rheumatoid Hand 1857 Manish Kumar Varshney

General Perspective of Hand Deformities 1857Finger Deformity in Rheumatoid Arthritis 1858Boutonnière Deformity 1861Metacarpophalangeal Joint Involvement in Rheumatoid

Arthritis 1862Rheumatoid Affection

of the Wrist Joint 1864Thumb Deformities in Rheumatoid Arthritis 1865

110 Infections of the Hand 1868 Manish Kumar Varshney

General Principles of Treatment of Hand Infections 1868Complications of Hand Infections 1868Nail Bed Infections 1868Bite Wounds of Hand 1873Deep Space Infections 1874Webspace Infection (Collar-Button Abscess/Hourglass

Abscess 1874Midpalmar Space Infection 1875Thenar Space Infections 1875Hypothenar Space 1876Flexor Tenosynovitis (Pyogenic Flexor Teno-synovitis or

Suppurative Flexor Tenosynovitis) 1876

Contents xxxi

111 Tendon Injuries of Hand and Management 1878

Manish Kumar VarshneyHistorical Perspective 1878Anatomical and Biomechanical Considerations 1879Causes of Tendon Injuries 1881Clinical Features 1882Management of Flexor Tendon Injuries 1883Postoperative Protocol 1887Treatment of Tendon Ruptures 1888

Section 12: General Topics

112 Amputations and Rehabilitation 1891 S Pavan Amputations 1891

Indications and Principles 1891Surgical Technique 1892Dressing Technique 1895Immediate Postoperative Prosthesis and

Physiotheraphy 1895Pain Management 1896Rehabilitation 1897Complications of Amputation Surgery 1897Lower Limb Amputations 1897Amputations Around Ankle 1898Knee Disarticulation 1901Hip Disarticulation 1903Upper Limb Amputations 1907Hand Amputations 1907Thumb Reconstruction 1914

Prostheses 1924Lower Limb Prosthesis 1924Joints 1927Components for Interposing Joints 1933Externally Powered Prostheses 1934Orthotics 1935

113 Biomaterials in Orthopedics 1942 S Pavan

Biological 1942Mechanical 1942Metals and Their Alloys 1944Polymers 1945Ceramics 1946Composits 1946Osteointegration of Biomaterials 1946

114 Pain Management in Orthopedic Patient 1948

Ashok JadonPain Threshold, Perceptual Dominance and Pain

Tolerance 1948Types of Pain 1948Pathways of Pain 1949Gate Control Theory (Pain Production and

Modulation Theory) 1950Postoperative Pain and Its Management 1950Assessment of Pain 1951Systemic Effects of Poor Pain Control 1952Barriers to Effective Pain Management 1953Strategies for Adequate Postoperative

Pain Control 1954Methods for Postoperative Pain Control 1954Drugs Used for Postoperative Pain Control 1958

115 Necrotizing Fasciitis 1963 S Pavan

Etiology 1963Pathophysiology 1963Clinical Features 1963Treatment 1964

116 Robotics and Computers in Orthopedics 1966

Jayadip PatelHaptic Robotic Systems 1966Autonomous Robotic Systems 1967Robotic Surgery: Pitfalls and Limitations 1967Role of Computers in Orthopedics 1967

117 Gene Therapy in Orthopedics 1971 Jaydip Patel, Manish Kumar Varshney

The Use of Different Vectors and Strategies for Gene Transfer in Orthopedics 1972

Newer Approach: Nanoparticles and Nanotechnology 1976

Gene Therapy Using RNAI 1977New Vectors or Strategies for Stable and Safe Gene

Modification 1977Targeted Gene Delivery 1979Gene Therapy Applications for the Musculoskeletal

System 1980

118 Thoracic Outlet Syndrome 1986 Swapnil Sharma, Jaydip Patel, Amit Singh

History 1986Anatomy 1986

Essential Orthopedics: Principles and Practicexxxii

Epidemiology 1987Etiology 1987Clinical Presentation 1987Physical Examination 1988Differential Diagnoses for Thoracic

Outlet Syndrome 1989Diagnostic Studies 1989Treatment 1989Complications 1991

119 Wound Ballistics 1992 Manish Kumar Varshney, Swapnil Sharma

Classification 1993Soft-tissue Wound Management 1995Wound Infection 1996Pathophysiology of Lead Toxicity 1996Principles of Management 1996International Humanitarian Law 1996Blast Injuries 1997

120 Polytrauma, Mass Casualties and Disaster 2000

Manish Kumar VarshneyPrinciples of Management of Polytrauma 2000Damage Control Orthopedics (DCO) Versus

Early Total Care (ETC) 2005Principles of Managing Disasters 2007

121 Tourniquet in Orthopedics 2010 Manish Kumar Varshney

Tourniquet Safety 2010Size of Tourniquets and Application Technique 2011Tourniquet Pressure (Occlusion Pressure) and Size Pressure

Relationship 2012Duration of Tourniquet Use

(Ischemic Time) 2012The Use of Esmarch Tourniquet

and Martin Rubber Sheet 2013Complications 2013Contraindications for Use

of Tourniquets 2014Systemic and Local Effects of Tourniquet Usage 2014Systemic Adverse Effects 2014Tourniquet Pain and Tourniquet- induced

Hypertension 2016Alteration in Drug Kinetics due to Tourniquet

Application 2016

122 Replantation 2017 S Pavan

Level of Amputation 2017Mechanism of Injury 2017

Condition of the Vessels 2017Transport of Amputated Part 2018Preoperative Preparation 2018Order of Replantation 2018Postoperative Care and Outcomes 2019

123 Role of Isotope Bone Scan and PET Scan in Orthopedics 2020

Geetanjali Gupta, S PavanPositron Emission Tomography and its Role in

Orthopedics 2021

124 Lasers in Orthopedics 2023 S Pavan

Therapeutic Lasers 2023Surgical Lasers 2023Pitfalls 2024

125 Role of Magnetic Resonance Imaging in Orthopedics 2026

S PavanFast Spin-echo Technique 2026Gradient-echo Technique 2026Short Tau Inversion Recovery Enhanced Images 2027Fluid-attenuated Inversion Recovery 2027Functional MRI (FMRI) 2027Multinuclear Imaging 2028Contrast Magnetic Resonance Imaging 2028Contraindications of Magnetic Resonance Imaging 2029Knee 2029Shoulder 2030Spine 2032Foot and Ankle 2034Hip 2035Wrist 2036Tumor Imaging 2036

126 Role of Ultrasonography in Orthopedics 2037

Jaydip Patel, Manish Kumar VarshneyAdvantages of Ultrasonography 2038Uses of Ultrasonography in Orthopedics 2038

127 Instruments and Implants 2043 S Pavan

Awls 2043Chisels/Osteotomes/Gouges 2043Bone-Holding Clamps 2044Bone Cutters/Nibblers 2044Periosteal Elevators 2044Curettes 2047

Contents xxxiii

Retractor/Levers 2047Cartilage/Tendon Instruments 2048General Instruments 2049General Trauma Instruments 2051Nails 2054Plates 2056Screw 2059

128 History of Orthopedics 2065 Swapnil Sharma, Manish Kumar Varshney

Ambroise Paré (1510–1590) 2065Nicolas Andry (1658–1742) 2066Percivall Pott (1714–1788) 2066John Hunter (1728–1793) 2067Abraham Colles (1773–1843) 2067Antonius Mathijsen (1805–1878) 2068Hugh Owen Thomas (1834–1891) 2068Sir Robert Jones (1857–1933) 2068Thomas Porter McMurray (1888–1949) 2069Willis C Campbell (1880–1941) 2069Gerhard Küntscher (1900–1972) 2069Martin Kirschner (1879–1942) 2070Sir Reginald Watson-Jones (1902–1972) 2070Austin T Moore (1899–1963) 2071Gavriil A Ilizarov (1921–1992) 2071Sir John Charnley (1911–1982) 2072

129 Wound Healing and Principles of Wound Care 2073

Manish Kumar VarshneyEpithelialization 2073Wound Contraction 2074Choice of Suture Material 2078Factors Affecting Wound Healing 2078Soft Tissue Coverage in Orthopedics 2081Reconstruction of Proximal Third Leg 2088Reconstruction of Soft Tissue Defects in Middle Third

Region of Leg 2090Reconstruction of Distal Third Region of the Leg 2092Microvascular Free Flaps 2092Pressure Sores (Bed Sores, Pressure Ulcers) 2094

130 Regenerative Medicine and Stem Cell Research in Orthopedics 2096

Manish Kumar VarshneyStem Cells 2096Performing Regenerative Medicine 2099

Specific Orthopedic Applications 2100Stem Cell Banking 2102

131 Three-dimensional Printing and its Application in Orthopedics 2106

Manish Kumar VarshneyGeneral Perspective of 3D Bioprinting 2106Current Applications of 3D Printing

In Orthopedics 2108

132 Emerging Terms and Concepts in Orthopedics 2111

Manish Kumar VarshneyRestorative Medicine and Orthobiologics 2111Metabolomics 2113

133 Impact of Obesity and the Role of Bariatric Surgery in Lower Limb Joint Arthroplasty 2115

Manish Kumar VarshneyAlteration in Lower Limb Biomechanics due to

Obesity 2115Joint Arthroplasty Outcome in Obese Patients 2116Impact of Arthroplasty on Obesity 2116Bariatric Surgery and its Relevant Effects 2116Considerations for Faculty Surgery in Bariatric

Patients 2118Impact of Bariatric Surgery on Osteoarthritic Joints 2118Biomechanics After Bariatric Surgery 2118Arthroplasty Outcome in Patients Treated with Bariatric

Surgery 2118

Trauma Annexures 2121 Annexure 1: Upper Limb Trauma 2121 Manish Kumar Varshney

Annexure 2: Lower Limb Trauma 2177 Shafiq Hackla, Manish Kumar Varshney

Annexure 3: Fractures of Axial Skeleton 2232 Manish Kumar Varshney, Shafiq Hackla

Index 2249