Orthopedic Principles ± A Resident's Guide

David Ip

Orthopedic Principles ± A Resident's Guide

David Ip

Orthopedic Principles

± A Resident's Guide

1 2

David Ip

MBBS (HKU), FRCS (Ed) Orth, FHKCOS, FHKAM (Orthopaedic Surgery), LFIBA (UK)

Director of Division of Rehabilitation, Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong

Deputy Governor, American Biographical Institute Research Association, Deputy Director General, International Biographical Centre, Cambridge

ISBN 3-540-23259-1 Springer Berlin Heidelberg New York Library of Congress Control Number: 2004113413

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This book is dedicated to:

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My loving wife Esther without whose support this book would not have been a reality

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All my mentors, including Professor John Leong, Professor Luk, and Drs F.K. Ip and S.H. Yeung

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All my teachers in different fields of orthopaedics, including Professors Jesse Jupiter, Charles Court-Brown, John Wedge, Rorabeck and William Harris

Dedication

Dr. Ip is a graduate of Hong Kong University Medical School. Since his graduation (1985), he developed an interest in the field of orthopaedics and traumatology. He is the fellow of multiple professional organisations, including the Royal College of Surgeons of Edinburgh and the Hong Kong College of Orthopaedic Surgeons. He has published multiple jour- nal articles in peer-reviewed journals in the fields of total joint surgery, paediatric orthopaedics and traumatology. He is the winner of the Inter- national Health Professional of the Year 2004 Award and received the Universal Award of Accomplishment for Year 2004. He was also awarded the International Peace Prize by United Cultural Conventions of USA, among other awards that include the Man of the Year Award 2004, the Key Award (leader in science), Lifetime Achievement Award and 21st Century Award for Achievement, etc.

His biography has been included in famous biographical works, such as Marquis Who's Who in Science and Engineering, Marquis Who's Who in the World, Great Minds of the 21st Century, Leading Intellectuals of the 21st Century, 2000 Outstanding Scientists of the 21st Century and the Cambridge Blue Book.

His main interests include total joint replacement, osteoporosis and fragility fractures of the hip in elderly.

About the Author

The scope of orthopaedic knowledge has expanded to such a degree that it has become increasingly difficult to maintain a fundamental grasp of the required knowledge base. Add to this the time constraints of adult learning, with the student or practitioner facing ever-increasing demands on their time.

Dr. David Ip has laboured intensively to produce a much-needed re- source of orthopaedic knowledge that will prove useful not only to those in training but also in the ever-increasing demand of certification and re-certification examinations.

Organized into eight chapters extending from basic science to every speciality of orthopaedic surgery ± including hand, foot and ankle, sports medicine and spine, just to name a few with information provided in outline form ± the reader will find it quite easy to locate information on a specific subject for direct patient care, conferences or rounds, or examination review. Alternatively, the organisation of each chapter facili- tates on overall review of the subject matter. The chapters are well illus- trated with 120 figures throughout the text.

By virtue of its succinct style of presentation of information, I am confident that this text will prove to be most useful to students and prac- titioners throughout the world.

Jesse B. Jupiter, M.D.

Director, Orthopaedic Hand Service Massachusetts General Hospital Hansjærg Wyss/AO Professor Harvard Medical School

Foreword

The aim of writing this book on orthopaedic principles was manifold.

This book helps to arouse interest in the field of orthopaedics and high- light important points or concepts the reader might have overlooked during his reading of the subject matter in other large, thick standard textbooks. It is not meant to be a shortcut. The author feels that it is most useful to read this book after studying the standard texts and also useful to review the subject before professional examinations, grand rounds and vivas, even the long case of clinical examinations, since most examiners nowadays stress on asking clinical principles rather than dig- ging into details of how to perform a difficult operation. The second ma- jor aim of this book was that it aims at a wide readership, including sur- geons-in-training, practitioners, surgeons requiring re-certification and, in particular, surgeons in developing and under-developed countries where division into speciality or sub-speciality subjects is the exception rather than the rule. It may also prove useful for the orthopaedic sur- geon who had specialised in a field for many years, but wishes to know the latest concepts of orthopaedic management in other fields of ortho- paedics.

Lastly, the author wishes to express his gratitude to the world-re- nowned Professor Jupiter of Harvard University for writing a Foreword to this book. Happy reading!

Hong Kong, November 2004 David Ip

Preface

This section highlights the pearls to make reading of this book more fruitful for the reader. Please be reminded that the author expects the reader to know the classifications used for most of the common ortho- paedic conditions mentioned in this book, the detailed description of which is outside the scope of this book.

Chapter 1 deals with orthopaedic basic science, with clinical examples taken from many of the common sports injuries. Other common sports in- juries not mentioned, such as shoulder dislocation, etc., will be covered in a forthcoming textbook written by the same author on the field of Trauma- tology. Discussion of biomaterial science can be found in Chapter 6.

Chapter 2 deals with paediatric orthopaedics. The author recommends the reader to read textbooks written by Mercer Rang from the famous Hospital for Sick Children in Toronto before beginning clinical rotation to a paediatric orthopaedic service for training. Also, since this field of orthopaedics is sometimes more difficult to understand, this chapter has many illustrations.

Chapter 3 deals with hand surgery. The author strongly recommends the reader to read the books and articles published by Lister and Jupiter as a general reference. Quite lengthy description on management of the rheumatoid hand was given together with more illustrations, since this topic is more difficult to understand.

Chapter 4 deals with foot and ankle surgery. The author notices that many trainee surgeons consider gait analysis to be very difficult. This is not the view of the author. Gait analysis is an interesting yet important walk of orthopaedics, and a thorough understanding of pathological gait in different orthopaedic conditions is important. The books listed in the reference section for Chap. 4 provide a good basis for understanding this topic. Many an examiner expects the candidate to diagnose the patient just by looking at their gait.

Chapter 5 deals with spine surgery. There are many good articles on the degenerate spine, especially in the Japanese literature on the topic of

How to Use this Book

cervical myelopathy, which the reader should know. There are also many good articles on scoliosis published by eminent professors such as Pro- fessor John Leong and Professor Luk and Cheung of Hong Kong Univer- sity. Also the famous works of McMaster, Robert Winter and the Scolio- sis Research Society should be noted.

Chapter 6 deals with total joint surgery. Owing to the size constraints of the book, it is impossible for the author to include a lengthy discus- sion on revision of total knee and total hip surgeries. I strongly advise the reader to read the works of Professor Rorabeck when it comes to re- vision of total knee surgery and the works of Rosenberg, Harris, Calla- ghan and Jasty ± as well as Paprosky ± when it comes to revision of total hip surgery.

Chapter 7 deals with orthopaedic infections. Infections in the pres- ence of an orthopaedic implant is a common clinical problem as well as examination question. I strongly advise the reader to read the articles written by Gristina, Parry, Oga and also refer to the important animal studies coming from great works done in Case Western University.

Chapter 8 deals with tumour surgery. I advise the reader to read the books and articles published by Enneking. Limb salvage is quite a hot topic nowadays, but detailed discussions are outside the scope of this book. Many articles published in Clinical Orthopaedics and Related Re- search are worth reading, as are the great advances made in this field thanks to the marvellous works from the Mayo Clinic.

XII How to Use this Book

1 Orthopaedic Basic Science and Common Sports Injuries 1 2 General Paediatric Orthopaedics 91

3 Principles of Hand Surgery 193

4 Principles of Foot and Ankle Surgery 293 5 Spine Surgery Principles 343

6 Total Joint Surgery 425 7 Orthopaedic Infections 537

8 Musculoskeletal Tumour Principles 575 Subject Index 617

Contents

AAI atlanoaxial impaction ABC aneurysmal bone cyst ABI ankle brachial index ACL anterior cruciate ligament

AD autosomal dominant

ADI Atlas-Dens Interval ADL activities of daily living AFO ankle foot orthosis AKA above knee amputation ALL anterior longitudinal ligament ALP alkaline phosphatase

AMA Austin Moore hemiarthroplasty

AP anteroposterior

APL abductor pollicis longus AS ankylosing spondylitis ASD atrial septal defect ASF anterior spinal fusion ASIS anterior superior iliac spine ATR angle of trunk rotation AV atrioventricular

AVM arteriovenous malformation AVN avascular necrosis

BCC body-centred cubic

BG bone graft

BKA below knee amputation

BP blood pressure

BR brachioradialis

Bx biopsy

List of Abbreviations

C.G centre of gravity C/F clinical features C/I contraindication

CA carcinoma

CCJ calcaneo-cuboid joint

CE centre-edge

CES cauda equina syndrome CIA carpal instability adaptive CIC carpal instability complex CID carpal instability dissociative CIND carpal instability non-dissociative CMC carpal-metacarpal

CMCJ carpal-metacarpal joint CN calcaneal-navicular COM centre of motion

CP cerebral palsy

CPM continuous passive motion

CR close reduction

CRF chronic renal failure CRP C-reactive protein

CSM cervical spondylotic myelopathy CVS cardiovascular system

Cx complication

D/P distal phalanx

DDH developmental dysplasia of the hip DDx differential diagnoses

DF dorsiflexion

DIPJ distal interphalangeal joint

DISH diffuse idiopathic skeletal hyperostosis DISI dorsal intercalated segment instability DJD degenerative joint disease

DM diabetes mellitus

DRUJ distal radioulna joint

DVT deep vein thrombosis

ECRL extensor carpi radialis longus

ECU extensor carpi ulnaris

EDC extensor digitorum communis EDL extensor digitorum longus EF external fixation

EHL extensor hallucis longus

EMG electromyography

EOT emergency operation EPB extensor pollicis brevis EPL extensor pollicis longus ER external rotation

ESR erythrocyte sedimentation rate F/E flexion and extension

FB foreign body

FCC face-centred cubic FCR flexor carpi radialis FCU flexor pollicis ulnaris FDL flexor digitorum longus FDP flexor digitorum profundus FDS flexor digitorum superficialis

FF forward flexion

FFC fixed flexion contracture FHL flexor hallucis longus FPB flexor pollicis brevis FPL flexor pollicis longus FTSG full-thickness skin graft

Fu follow-up

G/C general condition GCT giant cell tumour

GCTTS giant cell tumour of tendon sheath GI gastrointestinal

GN gram negative

GT greater trochanter

GU genitourinary

HA hydroxyapatite

HCP hexagonal close packed HK operationHong Kong Operation

a List of Abbreviations XVII

HKAFO hip-knee-ankle-foot orthosis HO heterotopic ossification HTO high tibial osteotomy

HV hallux valgus

Hx history

I/F index finger

IB Insall-Burstein

IFSSH International Federation of Societies for Surgery of the Hand

IM intramedullary

IPJ inter-phalangeal joint IR internal rotation

IT iliotibial

IVU intravenous urogram

Ix investigation

JOA Japanese Orthopaedic Association JRA juvenile rheumatoid arthritis L/F little finger

LA local anaesthesia

LBP low back pain

LCL lateral collateral ligament LCS low contact stress LFT liver function test

LL lower limb

LLD leg length discrepancy LMN lower motor neurone

LN lymph node

LSJ lumbosacral junction LT lesser trochanter

M/F middle finger

M/L medial and lateral

M/P middle phalanx

MBKA mobile-bearing knee arthroplasty

MC metacarpal

XVIII List of Abbreviations

MCL medial collateral ligament MCPJ metacarpal-phalangeal joint MEP motor evoked potentials MFH malignant fibrous histiocytoma MIC minimum inhibitory concentration MMA methyl methacrylate

MPNST malignant peripheral nerve sheath tumour MPS medical protection society

MRC medical research council MTPJ metatarsal-phalangeal joint MUA manipulation under anaesthesia

MW molecular weight

NCT nerve conduction testing NCV nerve conduction velocity

NF neurofibromatosis

NM neuromuscular

NSAIDs non-steroidal anti-inflammatory drugs

NV neurovascular

NWB non-weight bearing OI osteogenesis imperfecta

ON osteonecrosis

OPD outpatient

OPLL ossification of posterior longitudinal ligament

OR open reduction

ORIF open reduction and internal fixation

OT operation

P/E physical examination P/P proximal phalanx

PA posteroanterior

PADI posterior atlantodens interval PCA porous coated anatomic PCL posterior cruciate ligament PCR polymerase chain reaction

PF patello-femoral

PF plantarflexion

a List of Abbreviations XIX

PFJ patello-femoral joint

PFMR proximal femoral modular reconstruction PID prolapsed inter-vertebral disc

PIPJ proximal interphalangeal joint

PL palmaris longus

PLC posterolateral complex

PLIF posterior lumbar inter-vertebral fusion PMMA polymethyl methacrylate

PMN polymorphonucleocyte

PMN polymorphonuclear neutrophils POP plaster casting

PS posterior stabilised PSA phosphate-specific antigen PSF posterior spinal fusion PSIS posterior superior iliac spine

PT pronator teres

PTFE tetrafluoroethylene polymer PTT tibialis posterior tendon

PVNS pigmented villonodular synovitis PWB partial weight bearing

R/F ring finger

RD radial deviation

Rn treatment

ROM range of motion RPS regional pain syndrome RSL radioscapholunate ligament

RT radiotherapy

S/E side effect

SAC `space available for the cord' SCFE slipped capital femoral epiphysis SCJ stenoclavicular joint

SED spondylo-epiphyseal dysplasia SIJ sacroiliac joint

SL scapholunate

SLJ scapholunate joint or articulation

SNAC scaphoid non-union with advanced carpal collapse

SNAP sensory nerve action potential SOL space-occupying lesion

SPECT single photon emission computed tomography SSEP somatosensory evoked potentials

SSG split thickness skin graft

TA tendo-achilles

TAL tendo-achilles lengthening

TB tuberculosis

TC talocalcaneal

TF tibio-fibular

TFC triangular fibrocartilage

TFCC triangular fibrocartilage complex TFL tensor fascia lata

THR total hip replacement TKR total knee replacement

TL thoracolumbar

TNJ talo-navicular joint TP tibialis posterior

UD ulnar deviation

UHMWPE ultra high molecular weight polyethylene

UL upper limb

UMN upper motor neurone

USS ultrasound

VBG vascularised bone graft VDRO varus derotational osteotomy VISI volar intercalated segment instability VSD ventricular septal defect

WBCs white blood cells

a List of Abbreviations XXI