The central theme of this book is that there is a direct relationship between anatomical restoration of the fractured distal part of the radius and later function of the limb. The authors present their argument by leading the reader on a journey through the recognition, definition, and treatment of these common injuries.
The text begins with a historical review, a cornerstone for the chapters that follow. With great reverence, personality is given to the names that we attach to types of fractures, reduction maneuvers, and methods of treatment. These eponyms are not only quoted from their original sources but are placed in the context of their contemporaries and the settings in which our predecessors practiced. The multilingual skills of the authors provide further insight by allowing the inclusion of works that were not written in English and whose importance is infrequently appreciated in English-language texts. This introductory chapter is essential reading for the student of fractures of the distal part of the radius and ulna.
The text continues with a chapter on functional and radiographic anatomy that presents the various measurements that have been used to report injuries of the wrist and the results of treatment. The methods of measurement are succinctly explained, clearly illustrated, and reinforced with a thorough bibliography.
Epidemiology, classification, and mechanism of injury are covered in one chapter. The discussion of epidemiology is based on a compilation of Scandinavian studies that emphasize the socioeconomic magnitude of fractures of the wrist. Classification systems are viewed in both a chronological and a functional light. Each system's contribution to the identification of these fractures, the determination of treatment recommendations, and the classification of the results of treatment is discussed. The authors recommend a classification system consisting of five types, which has been presented previously by Fernandez. The system is explained in terms of mechanism of injury and is integrated with the AO/ASIF classification. Although the prospect of learning yet another classification may seem burdensome, this text demonstrates the facility of the Fernandez system. Five chapters addressing specific types of fractures follow a similar outline. The reader is guided through classification of the fracture, mechanism of injury, non-operative treatment, operative indications, preoperative planning, and operative strategy. The issues unique to each type of fracture are considered, and the solutions are well defined.
The final chapters deal with complications. Malunion receives the greatest attention and is presented as a synthesis of material previously described by the authors at international meetings, in various instructional courses, and in earlier publications. As in the preceding chapters, this topic is presented in a logical sequence of assessment, operative strategy, and postoperative management. The clarity with which these complex problems are addressed reflects the depth of understanding and the ability of the authors to teach the novice as well as the experienced surgeon.
As in any journey, not all of the stops are great and some of the tours can be confusing. A potential source of confusion in this book is the placement of the end-result rating scales at the end of a chapter on extra-articular bending fractures. Since rating scales are pertinent to all types of fractures, they would have been better presented and more easily remembered in the chapter on epidemiology, classification, and mechanism of injury. Similarly, including a chapter dedicated to fractures of the distal part of the ulna would have been more helpful than interspersing the subject throughout the text and would have encouraged the authors to discuss the operative treatment of these fractures in association with acute and chronic fractures of the distal part of the radius.
There are only a few technical problems with the text. An occasional illustration is mislabeled, and there are a few spelling errors.
I strongly recommend this book to anyone interested in fractures of the distal part of the radius and ulna. The reader seeking advice on the treatment of a wrist fracture will easily find examples of and solutions for most problems. Someone planning to write about fractures of the distal part of the radius will find that the bibliography is the most complete available. Anyone simply looking for a well written and informative text will also benefit from reading this book. The journey is most enjoyable and is easily accomplished in two or three evenings.
Douglas P. Hanel, M.D.