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The Bone Book an Orthopedic Pocket Manual Sumon Nandi Selvon F. St. Clair The Bone Book An Orthopedic Pocket Manual 123 The Bone Book Sumon Nandi • Selvon F. St. Clair The Bone Book An Orthopedic Pocket Manual Sumon Nandi, MD, MBA Chief of Adult Reconstruction Department of Orthopedic Surgery University of Maryland School of Medicine Baltimore, MD USA Selvon F. St. Clair, MD, PhD Orthopedic Institute of Ohio Lima, OH USA ISBN 978-1-4614-3090-2 ISBN 978-1-4614-3091-9 (eBook) https://doi.org/10.1007/978-1-4614-3091-9 © Springer Science+Business Media, LLC, part of Springer Nature 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of transla- tion, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimi- lar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, 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. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of pub- lication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Science+Business Media, LLC part of Springer Nature The registered company address is: 1 New York Plaza, New York, NY 10004, U.S.A To my residents and students, whom I have watched flourish and from whom I have learned, this book was written to ease the challenge of the steep early learning curve in orthopedics that you will surely overcome, but never forget. To my wife, who inspires and encourages me to do my very best, your love and support make everything possible. To my children, time with you is my life’s meaning and visions of your future are my hope. To my parents, this book is a monument to your sacrifice that began decades ago in a land far away and continues to this day. –Sumon Nandi This book is dedicated to my wonderful wife, Amy, and loving daughters Cyan, Kaya, and Eva: the absolute joys of my life. –Selvon F. St. Clair Foreword I have had the privilege of working with Dr. Sumon Nandi as a colleague and co-author. I enjoy watching, with great satis- faction, his rising star status in orthopedics. I ask you, the reader: Who better to author a book seeking to bridge the gap between senior and junior house staff and students than a rising star? A rising star retains the memory of his forma- tive years as a young surgeon supplemented by the experi- ence forged by time and effort. In my position as Chief of Adult Reconstruction at the Rothman Institute, I have a deep understanding of the educational challenges our students and house staff endure while caring for patients. As Deputy Editor of the Journal of the American Academy of Orthopedic Surgeons, I understand that while research is the foundation of the principles by which we care for patients, the data are often conflicted and not useful to house staff seeking an immediate and correct resolution for patients under their care. Practical information in medicine is often hard to come by quickly and concisely. The Bone Book by Sumon Nandi, MD, and Selvon St. Clair, MD, PhD, fills a glaring void in musculo- skeletal education for those students and junior house staff providing orthopedic care to patients. It is a compendium of pragmatic knowledge typically passed down from the senior to junior house staff but rarely addressed in standard text- books. Drs. Nandi and St. Clair cover essential anatomy, physical examination, and the diagnosis and treatment of vii viii Foreword emergencies in musculoskeletal care. Preparing the patient for the operating room and the proper performance of basic procedures are also comprehensively covered. I believe that The Bone Book will be the first source that junior house staff and students will reach for when seeking an accurate solution to the issue at hand. The Bone Book should be an essential part of the library of every budding orthopedist. It supplies pearls of wisdom we all wish we had when we were on-call and were long on ques- tions and short on answers. Drs. Nandi and St. Clair should be congratulated for providing those answers. I certainly wish I had The Bone Book when I was in that lonely position! Matthew S. Austin, MD Adult Reconstruction Division Chief Adult Reconstruction Fellowship Director Professor of Orthopedic Surgery Sidney Kimmel Medical College Rothman Institute Philadelphia, PA, USA Contents 1 Anatomy Essentials . 1 Upper Extremity ������������������������������������������������������������� 1 Shoulder ��������������������������������������������������������������������� 1 Arm . 6 Elbow ������������������������������������������������������������������������� 10 Forearm . 13 Wrist ��������������������������������������������������������������������������� 18 Hand ��������������������������������������������������������������������������� 22 Lower Extremity ������������������������������������������������������������� 28 Pelvis . 28 Hip . 33 Femur ������������������������������������������������������������������������� 37 Knee ��������������������������������������������������������������������������� 42 Lower Leg . 46 Ankle . 51 Foot. 56 Spine ��������������������������������������������������������������������������������� 60 Cervical Spine ����������������������������������������������������������� 60 Thoracic Spine ����������������������������������������������������������� 65 Lumbar Spine . 67 Sacrum ����������������������������������������������������������������������� 69 2 Physical Exam Fundamentals . 71 Principles . 71 Upper Extremity ������������������������������������������������������������� 73 Shoulder ��������������������������������������������������������������������� 73 ix x Contents Elbow ������������������������������������������������������������������������� 79 Hand and Wrist ��������������������������������������������������������� 81 Lower Extremity ������������������������������������������������������������� 86 Hip and Pelvis ����������������������������������������������������������� 86 Knee ��������������������������������������������������������������������������� 89 Foot and Ankle ��������������������������������������������������������� 92 Spine ��������������������������������������������������������������������������� 94 3 Managing the Floor . 99 Postoperative Check/Rounding ������������������������������������� 99 Lab Abnormalities . 101 4 Orthopedic Emergencies ������������������������������������������������� 119 Definition ������������������������������������������������������������������������� 119 Septic Joint ����������������������������������������������������������������������� 119 Suppurative Flexor Tenosynovitis ��������������������������������� 122 Necrotizing Fasciitis . 123 Compartment Syndrome . 125 Open Fracture . 127 Cauda Equina Syndrome ����������������������������������������������� 129 5 Emergency Room Consultations . .133 Emergency Room Consults ������������������������������������������� 133 High-Energy Trauma Patient and Fracture Management . 133 Pediatric Fractures . 139 Dislocations ��������������������������������������������������������������������� 155 Spinal Cord Injury (SCI) . 161 Tendon Rupture/Laceration . 163 Fingertip Amputation ����������������������������������������������������� 164 Postoperative Complications ����������������������������������������� 165 Other Common ER Consults: ��������������������������������������� 166 6 Sports Injuries ������������������������������������������������������������������� 167 Team Physician Responsibilities ����������������������������������� 167 Team Bag . 168 General ����������������������������������������������������������������������������� 169 Upper Extremity ������������������������������������������������������������� 170 Lower Extremity ������������������������������������������������������������� 173 Neurologic/Spine ������������������������������������������������������������� 179 Return to Play . 183 Contents xi 7 Operating Room Basics ��������������������������������������������������� 185 Getting the Patient Ready . 185 Getting the OR Ready ��������������������������������������������������� 188 Positioning, Prepping, Draping, and Sterile Technique ������������������������������������������������������������������������� 189 Principles . 192 Documentation . 193 Medical Student/Intern Tips & Tricks ��������������������������� 194 8 Techniques in Orthopedics . 195 Splinting ��������������������������������������������������������������������������� 195 Joint Aspiration/Injection . 212 Regional Blocks . 219 Index �����������������������������������������������������������������������������������������223 Chapter 1 Anatomy Essentials In this chapter we discuss essential orthopedic anatomy. Knowledge of anatomy is the foundation for diagnosis through physical examination and
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