Orthopaedic Diagnosis

Transcription

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2 Hubert A. Sis sons. Ronald O. Murray H.B.S. Kemp Orthopaedic Diagnosis Clinical, Radiological and Pathological Coordinates With 534 Figures, Many in Colour Springer-Verlag Berlin Heidelberg New York Tokyo 1984

3 Hubert A. Sissons, MD, FRCPath, FRCP, FRCS, FCAP Director, Department of Pathology and Laboratory Medicine, Hospital for Joint Diseases Orthopaedic Institute, New York, and Professor of Pathology, Mount Sinai School of Medicine, New York; Formerly Professor of Morbid Anatomy, Institute of Orthopaedics, University of London, and Honorary Consultant in Morbid Anatomy, Royal National Orthopaedic Hospital, London and Stanmore, Middlesex RonaldO. Murray, MBE, MD(Cantab), FRCP (Edin), FRCR,FACR(Hon), FRACR(Hon), FFRRCSI(Hon) Honorary Consulting Radiologist, Royal National Orthopaedic Hospital and Institute of Orthopaedics, London and Stanmore, Middlesex, and Honorary Consulting Radiologist, Lord Mayor Treloar Orthopaedic Hospital, Alton, Hampshire H.B.S. Kemp, MB, MS, FRCS,FRCS(Ed) Consultant Orthopaedic Surgeon, Royal National Orthopaedic Hospital, London and Stanmore, Middlesex Library of Congress Cataloging in Publication Data Sissons, Hubert A. (Hubert Armand), Orthopaedic Diagnosis. Bibliography: p. Includes index. 1. Orthopedia-Diagnosis. I. Murray, Ronald O. II. Kemp, H.B.S. (Hubert Bond Stafford), III. Title. [DNLM: 1. Orthopedics-Problems. WE 18 S6230j RD734.S ' ISBN-13: e-isbn-13: DOl: / This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under 54 of the German Copyright Law, where copies are made for other than private use, a fee is payable to 'Verwertungsgesellschaft Wort', Munich. Springer-Verlag Berlin Heidelberg 1984 Softcover reprint of the hardcover 1 st edition 1984 The use of registered names, trademarks etc, in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Filmset by Wilmaset, Birkenhead, Merseyside, England 2128/

4 For Pat, Jane and Moyra

5 Preface This book was conceived with the object of presenting to doctors and medical students with a potential interest in the disciplines of orthopaedic surgery, diagnostic radiology and orthopaedic pathology, a volume which would contain basic and essential information concerning those disorders of the skeleton in which a common interest exists. Diagnosis in such conditions is dependent on close collaboration between specialists in these subjects. As medical knowledge has advanced, so the necessity for detailed specialisation has increased. As a result co-operation in a combined approach has become of great importance. The method of presentation, in the form of Exercises, is designed to permit readers to test their own diagnostic ability. The book consists of ninety-four problems of diagnosis which might be encountered in any orthopaedic unit. The case material has been chosen to emphasise those conditions in which appreciation and integration of the clinical, radiological and pathological features are required in order to establish the diagnosis. Each Exercise consists of a number of questions and answers. The questions (QI, Q2 etc.) all refer to individual patients. They describe the initial complaint of the patient, the clinical findings and, where relevant, significant laboratory data. The appropriate radiograph is illustrated, with attention drawn to the abnormalities which are present. The histological features of the lesion are reproduced without comment. The reader is encouraged to join in this learning experience by reaching personally a diagnostic conclusion before turning to the answers to the problems (AI, A2 etc.), which are to be found on the succeeding pages. The answers discuss first the pre-operative diagnosis, especially when the subsequent histological findings have shown it to be incorrect. Indeed, many of the cases illustrated have been chosen for this reason. In some instances suppleme.ntary operative photographs, radiographs and pathological material from the patient concerned are illustrated. The ultimate and definitive diagnosis is established by a co-ordinated approach involving all the disciplines concerned. In each Exercise a fuller description of the particular entity follows, headed by a short introductory paragraph referring to its incidence and its predilection for age and sex. Important clinical features then are described, indicating the natural history of the disorder and the complications which may develop. The radiological features are considered by reference to the skeletal sites most likely to be affected and by description of the appearances encountered most commonly. Supplementary radiographs illustrate the variety of abnormalities which may be recognised. In order to include a comprehensive selection of radiographs, a number of these have been reduced in size, illustrating only the essential features of the lesion, so that the reader can appreciate the diagnostic messages contained in their descriptive legends.

6 Vlll Preface The histological features, similarly, are described in sufficient detail to allow the reader to become familiar with the characteristic appearances of the various entities discussed. Treatment of each condition is summarised, with reference to recent advances in medical and surgical management. References are designed to include significant developments in recent years and to lead to the literature, rather than to be comprehensive. They are to be found mainly in journals of wide circulation and are therefore available in most medical libraries. Brief mention has been made of some related or rarer entities for which space has prevented detailed description, but for each of these a leading reference has been inserted. The book is concluded by a number of Exercises illustrating diagnostic problems of particular interest. To each of these conditions reference has been made in the preceding pages. Finally, the authors express the hope that study of this volume will emphasise again the necessity of a co-ordinated approach by all the disciplines concerned with the diagnosis and treatment of orthopaedic disorders.

7 Contents Preface.... Acknowledgements Exercises Index.... VII XI The omission of a conventional Table of Contents is deliberate. To identify each exercise by a diagnosis would detract from the specific purpose of presenting each exercise as an unknown case.

8 Acknowledgements The authors express their thanks to their colleagues at the Royal National Orthopaedic Hospital in London and the Hospital for Joint Diseases in New York for permission to use their case material and for access to the collected material in the Departments of Radiology and Pathology of these Institutions. Many of the radiological illustrations are from the Museum of Orthopaedic Radiology in the Institute of Orthopaedics in the University of London. This Museum contains radiographs from many parts of the world and grateful acknowledgement is made to those who have contributed this material. The authors are deeply indebted to Miss Frances Quinn, who typed the manuscript, to Mrs. Uta Boundy and Mr. John Collins, who prepared the clinical and radiographic illustrations, and to Mr. Daniel Benevento and the late Mr. Terry Davies, who were responsible for the histological illustrations. The authors also acknowledge with pleasure the unfailing co-operation of the publishers through Mr. Michael Jackson and Mr. Roger Dobbing.