Hamlet A. Peterson. Heidelberg: Springer; 2007. 914 pages. $449.00. ISBN: 978-3-540-33801-7.
In 1898, Poland published his book Traumatic Separation of the Epiphysis, which was the most complete discussion of the knowledge of these fractures at that time. It is unfortunate that the orthopaedic community has had to wait 109 years for another all-encompassing work on physeal fractures to be published. However, the wait has been worth it. Dr. Peterson's book is superb in all aspects. He has made the study of these fractures his life's work. The orthopaedic community is indeed fortunate that he created an all-encompassing book to share the knowledge that he accumulated over the many years of his illustrious career. The book is truly a masterpiece on this subject.
Most modern orthopaedic textbooks are composed of a compilation of the works of multiple authors. These contributions are then edited and combined by an individual editor or a group of editors to produce a textbook that is supposedly the last word on the subject being covered. The remarkable aspect of this textbook is that it represents the efforts of a single author, Dr. Peterson, and that all of the cases presented are his own. In addition, each reference was reviewed by Dr. Peterson. Thus, in this book, we have the accumulated knowledge of one of the true icons of pediatric orthopaedics.
The book is divided into three sections: Physeal Fractures: General Considerations; Physeal Fractures: Anatomic Sites; and Partial Physeal Arrest. Each section is so complete that it alone could comprise a separate book.
Part I (Physeal Fractures: General Considerations) includes a historical review and covers a myriad of subtopics, including anatomy, evaluation, prognosis, and complications. The most useful chapter in Part I is Chapter 3, which describes the various classification systems. Dr. Peterson discusses all of the major classification systems that have been proposed since Poland's textbook was published. The most valuable aspect of this section is Dr. Peterson's full explanation of the classification system that he proposed in his article published in the Journal of Pediatric Orthopedics in 1994. This classification arose from his population-based study of 951 physeal fractures that occurred in the ten years from 1979 through 1988 in Olmsted County, Minnesota. When he first described his classification, it was not widely accepted because it did not follow the popular classification originally proposed by Dr. Salter and Dr. Harris. In Epiphyseal Growth Plate Fractures, Dr. Peterson describes in detail the reasoning behind his classification. The Peterson classification of six types depicts a continuum of physeal tissue injury from minor involvement to complete loss of some of the physeal cartilage. After reviewing this section, the reader will realize that this classification is based on a thorough study of the data. Instead of being primarily based on the structural aspect of the fracture pattern, it is based on five factors: anatomy, epidemiology, age of injury, prognosis, and complications. As a result, the Peterson classification has much more prognostic value than other classification systems. I would predict that after reading this very thorough and well-analyzed explanation of his classification, it will become more widely accepted. However, it will probably take years for the present generation of orthopaedic surgeons to become accustomed to it.
In Chapter 4, which deals with the epidemiology of the various types of physeal fractures, Dr. Peterson has organized the tremendous amount of data from both his Olmsted County study and many other articles in the literature to present meaningful statistics. These are very clearly summarized at the end of this chapter. The remaining chapters in this section are fairly straightforward regarding the imaging techniques, initial treatment, prognosis, and complication rate.
Part II (Physeal Fractures: Anatomic Sites) describes in intricate detail the specific anatomic structures, injury patterns, and complication rates associated with the specific anatomic physeal fracture sites. The unique properties of some of the more complex physeal structures are outlined in a very organized manner. The two largest chapters contain discussions of the complex physeal structures of the distal aspects of the tibia and humerus, and site-specific complications are reported for some of these structures. Part II is very complete in that it discusses some aspects of the other rare physeal fractures, such as those involving the triradiate cartilage of the pelvis, the proximal and distal aspects of the clavicle, and the ribs.
Part III (Partial Physeal Arrest), although the shortest section of the book at approximately 100 pages, contains what is probably the most complete discussion of the management of physeal growth arrest in the orthopaedic literature today. It covers in great detail all of the information needed by the orthopaedic surgeon to treat partial physeal arrest. The chapters in this section cover subjects such as etiology, assessment, general management, and most importantly, the specific techniques of physeal bar resection. There are also two good chapters that cover alternatives to resection, such as physeal distraction and physeal cartilage transplantation. A review of the information in this chapter is imperative for the orthopaedic surgeon who is contemplating physeal resection, even if he or she has performed the procedure many times in the past.
In addition to the outstanding qualities of the aforementioned individual sections, there are some general aspects that contribute to making this textbook outstanding. First, because the book contains the lifetime experience of one individual who worked in one location for his entire career, there are many examples of long-term follow-up of patients who were managed by Dr. Peterson. Long-term follow-up is especially important in evaluating the effectiveness of the management of physeal arrest. The literature contains literally hundreds of articles about all aspects of injuries to the epiphyseal growth plate. Dr. Peterson has painstakingly reviewed the data from these articles and combined them with the data from his own studies to produce ninety-five tables that provide an organized picture of the various aspects of the management of injuries to the physis in the skeletally immature patient. Finally, especially valuable is Dr. Peterson's "Author's Perspective" at the end of each chapter, in which he summarizes the important points of the chapter.
This textbook is destined to be considered one of the classic works in pediatric orthopaedics. It will become the standard reference source when questions arise regarding the management of these fractures.