Stanley Hoppenfeld, Piet deBoer, and Richard Buckley, editors. Philadelphia: Wolters Kluwer/Lippincott Williams and Wilkins; 2009. 741 pages. $229.00. ISBN: 978-0-7817-7623-3.
How much can surgical exposures change in six years? The third edition was published in 2003 and, while the classic surgical exposures have not changed, the fourth edition has new material and new exposures. It is twenty-six pages longer (741 pages), there are new references, some of the images from the third edition have been reoriented to make them easier to interpret, there are 100 new illustrations, and fourteen old ones have been removed.
Almost every chapter has been changed. While the majority of the new material is for "minimal access" approaches, a complete list of the new material includes an approach to the clavicle; minimal access approaches to the humerus, spine, femur, and tibia; a posterior approach to the distal part of the humerus; approaches for decompression of compartment syndromes of the forearm and leg; new exposures to the proximal part of the tibia; and detailed illustrations of pin placement for external fixation. The section on the acetabulum has been moved from the chapter on the hip to the chapter on the pelvis, improving both. Very little of the old text has been changed, but the new illustrations are accompanied by substantial new text.
The book continues to be organized by anatomic area with the chapter titles: The Shoulder, The Humerus, The Elbow, The Forearm, The Wrist and Hand, The Spine, Pelvis and Acetabulum, The Hip, The Femur, The Knee, The Tibia and Fibula, The Ankle and Foot, and finally Approaches for External Fixation. The book also continues to be rich in illustrations, with one or more on almost every page. The illustrations are large with easily seen details. Proper patient positioning for most approaches is included. The text is adequate but not excessive. The written text describes how the patient should be positioned, anatomic landmarks, the skin incision, the internervous plane, the superficial dissection, the deep dissection, and how to extend the exposure; it also points out dangers.
Hugh A. Thomas again illustrated the text, and his four-color art work is outstanding. Richard Buckley, an orthopaedic surgeon from Calgary, Canada, has been added as a third author for this edition, but the text continues to be called simply "Hoppenfeld's," after the first author.
Surgical Exposures in Orthopaedics: The Anatomic Approach belongs in every orthopaedic resident's library, every orthopaedic surgeon's library, and every hospital library. It should be referred to often, especially before using an exposure with which one is not familiar. It is a resource of substantial value. The fourth edition is probably not sufficiently better than the third to justify purchasing it if one owns the third edition, but if one owns a first or second edition I believe the fourth is worth purchasing.