PART Ⅰ PRINCIPLES OF FRACTURE TREATMENT 1
CHAPTER Ⅰ REPAIR OF FRACTURES 3
Histological features 3
Clinical features 5
Biochemical features 6
Pathological features 6
Rate of repair of fractures 9
Vascularity and the repair of fractures 9
CHAPTER Ⅱ DELAYED UNION AND NON-UNION 13
Differentiation of slow union，delayed union and non-union 14
Slow union from poor blood supply 16
Slow union from excessive traction 19
Delayed union from inadequate immobilisation 22
Delayed union from infection 32
Non-union from interposition of soft parts 37
Established non-union of fractures 38
CHAPTER Ⅲ ADHESIONS AND JOINT STIFFNESS 39
Causes of adhesions and joint stiffness 44
Stiffness of joints and Sudeck＇s acute bone atrophy 53
CHAPTER Ⅳ MYOSITIS OSSIFICANS，TRAUMATIC OSSIFICATION 56
Types of pathological ossification 56
Traumatic subperiosteal ossification 58
CHAPTER Ⅴ AVASCULAR NECROSIS OF BONE 64
Avascular necrosis of the femoral head 68
summary 73
Fracture of the neck of the femur 73
Traumatic dislocation of the hip joint 80
Legg-Perthes＇ disease of the hip 83
Avascular necrosis of the head of the humerus 85
Avascular necrosis of the carpal scaphoid bone 86
Avascular necrosis of the lunate bone 90
Avascular necrosis of the lateral condyle of the humerus 92
Avascular necrosis of the talus 92
Avascular necrosis and osteochondritis dissecans 96
CHAPTER Ⅵ VASCULAR INJURIES 98
Types of arterial injury 98
Results of arterial injury 108
Volkmann＇s ischaemic contracture 111
Gangrene from fractures 116
Gangrene from tourniquets 121
Immersion foot，shelter foot，trench foot 122
Frost-bite 123
Crush syndrome and traumatic oedema 124
CHAPTER Ⅶ NERVE INJURIES 126
Types of nerve injury 126
Nerve injuries in wounds 128
Nerve injuries in closed fractures and dislocations 130
Fractures with primary nerve injuries 130
Fractures with secondary nerve injuries 134
Fractures with delayed nerve injuries 135
Median paralysis 136
Ulnar paralysis 137
Radial paralysis 138
Circumflex paralysis 140
Sciatic paralysis 140
Lateral popliteal paralysis 142
CHAPTER Ⅷ CLINICAL AND RADIOGRAPHIC DIAGNOSIS 143
Clinical diagnosis 143
Radiographic diagnosis 143
Diagnosis of union of a fracture 160
The danger of Ⅹ-rays to surgeons 163
CHAPTER Ⅸ MANIPULATIVE REDUCTION OF FRACTURES 165
Methods of reduction and immobilisation 165
Plaster-of-Paris technique 168
Complications of plaster immobilisation 175
General complications 179
Manipulative reduction and continuous traction 182
Mechanical reduction and skeletal transfixion 186
CHAPTER Ⅹ OPERATIVE REDUCTION OF FRACTURES 187
Indications for operative reduction 188
Aseptic technique 191
Methods of internal fixation 198
Intramedullary nailing 201
CHAPTER Ⅺ REACTIONS OF BONE TO METAL 205
Thermal destruction of bone 205
Electrolytic destruction of bone 210
Bacteriological destruction of bone 214
Physical destruction of bone 217
Fallacy of the＂compression factor＂in accelerating the union of fractures 223
CHAPTER Ⅻ SHOCK，STRESS ＆ THE ADAPTATION SYNDROME 227
Clinical features of shock 227
Biochemical features of shock 228
General circulatory changes in shock 228
Local circulatory changes in shock 229
Nervous and hormonal defences－alarm reaction－adaptation syndrome 230
Treatment of shock 232
CHAPTER ⅩⅢ OPEN FRACTURES AND JOINT WOUNDS 237
First-aid treatment 237
Treatment of wound shock 239
Emergency treatment of the wound 239
Excision of the wound 243
Excision of bullet wounds 247
Excision of wounds of joints 249
Excision of head wounds 253
Excision of chest wounds 253
Chemotherapeutic control of infection 253
Unusual infections of wounds 258
Gas-gangrene infection 258
Tetanus infection 260
Infection with actinomyces 260
After-treatment of wounds 261
Restoration of skin cover by delayed suture or free-skin grafting 269
Final control of infection by sequestrectomy 273
Replacement of unstable scars by whole-thickness skin grafts 277
Late reconstructive surgery－atlas of typical cases 280
Amputations for open and infected fractures 294
CHAPTER ⅩⅣ TRANSPLANTATION OF BONE 298
History of bone grafting 298
The fate of transplanted bone 305
Bone banks 306
Technique of cortical bone grafting 307
Technique of cancellous bone grafting 311
Atlas of un-united fractures treated by grafting 314
PART Ⅱ FATIGUE OR STRESS FRACTURES，BIRTH FRACTURES AND PATHOLOGICAL FRACTURES 341
CHAPTER ⅩⅤ FATIGUE OR STRESS FRACTURES 343
Concealed crack fractures 343
March fracture of the metatarsal 345
Fatigue fracture of the fibula 347
Fatigue fractures of the upper limbs 348
Other spontaneous fractures 348
CHAPTER ⅩⅥ BIRTH FRACTURES 351
Fracture shaft of humerus 351
Fracture shaft of clavicle 352
Fracture shaft of femur 352
Depressed fracture of skull 354
Epiphyseal displacements 355
Congenital pseudarthrosis of the tibia 355
CHAPTER ⅩⅦ PATHOLOGICAL FRACTURES 361
Development and growth of normal bone 361
Developmental disorders of bone causing pathological fracture 370
Nutritional and vitamin dificiencies causing pathological fracture 383
Hormonal imbalance causing pathological fracture 390
Disuse and senile osteoporosis of bone 398
Dystrophic cysts and fibrous dysplasias of bone 401
Paget＇s disease of bone－osteitis deformans 409
Primary and secondary tumours of bone causing pathological fracture 414
Diseases of the marrow constituents 431
Parasitic disease of bone causing pathological fracture 436
Neurotrophic dystrophies of bone causing fracture 439