The editors of this marvelous pair of books have certainly fulfilled the
goals set out in the Preface: to present the pathological anatomy of all
fractures and dislocations in a historical context and to provide a
comprehensive discussion of the different management alternatives as well as
the authors' preferred methods of treatment.
The original 1975 edition reflected fracture care to that time and was
heavily weighted toward nonoperative care. Discussion of operative treatment
was, by and large, limited to operations commonly done at that time:
predominantly, stabilization of hip fractures, both-bone fractures in the
forearm and occasionally combined tibial and fibular fractures, and
intra-articular fractures. In the thirty years since the first edition was
published, an enormous change has taken place in the methods applied to
fracture care. Today, the emphasis is on functional restoration, shorter
hospital stays, and treatment of severe and/or multiple injuries, as many
patients now survive severe injuries thanks to the advent of paramedic teams
in the 1970s.
About 1975, we started to think of fracture care in severely injured
patients as a new orthopaedic subspecialty, defined as traumatology or the
science (or art and science) of caring for acutely and severely injured
patients. This book wonderfully reflects that evolution by including many
complete and extensive sections on the principles and basic science of
traumatology. The list of authors reveals an extremely well-selected group
from both North America and Europe, all of whom have provided extensive
references. The new edition has also kept the important feature of having
authors distill their often wide-ranging discussions to express their
preferred methods of treatment, when appropriate. They offer pearls and
pitfalls and, frequently, ideas about what might be accomplished in the future
in their fields. The historical awareness present in the previous editions has
been maintained to some degree, especially in Dr. Connolly's chapter on
nonoperative fracture treatment and, interestingly, in the considerable
discussion of nonoperative treatment of ankle fractures. Although the added
feature of including CD-ROMs to demonstrate surgical approaches on cadavers is
somewhat homespun and casual, it no doubt will be helpful to many younger
surgeons.
The size of the book (more than 3655 pages in two volumes, plus the index)
makes it an exhaustive study of the current state of fracture care and
orthopaedic traumatology. It is certainly a reference book and not a manual,
but it is complete enough that it should be in the library of every hospital
in which major fracture care is carried out. I certainly would recommend it to
any young trauma surgeon or orthopaedist who is often on trauma call duty. I
asked two of my young trauma surgeon colleagues to look at the book fairly
extensively, and they were enthusiastic and interested in adding it to their
libraries.
I would like to have seen some discussion with regard to the cost of care
in relation to the industrial fervor to supply ever more specific and costly
devices to deal with every fracture as well as the sometimes excessive use of
imaging, particularly magnetic resonance imaging; however, this book might not
be the best format for that discussion. Certainly, some of the authors made an
effort to define the need for the new and expensive, less invasive surgical
stabilization (LISS) plates and locking plates and did not recommend them for
every patient. The counter-argument for the use of expensive devices is that
the implants are a small part of the total cost of care. In my personal
opinion, the use of these devices should be considered along with all of the
other aspects of cost, including length of hospitalization, efficiency in the
operating room, and prevention of medical complications.
I extend my congratulations to the editors and the multiple authors in
producing an outstanding set of books.