Apley and Solomon's Concise System of Orthopaedics and by Nayagam, Selvadurai; Solomon, Louis; Warwick, David J

By Nayagam, Selvadurai; Solomon, Louis; Warwick, David J

Apley and Solomon's Concise process of Orthopaedics and Trauma is firmly tested because the best introductory textbook of orthopaedic perform and the rules of fracture administration. Praised in earlier variants for its systematic process, balanced content material and easy-to-read kind, the fourth version has been introduced absolutely modern with greater than 800 illustrations, many new to this variation, supplying an Read more...

summary: Apley and Solomon's Concise method of Orthopaedics and Trauma is firmly proven because the major introductory textbook of orthopaedic perform and the rules of fracture administration. Praised in past versions for its systematic process, balanced content material and easy-to-read variety, the fourth variation has been introduced absolutely modern with greater than 800 illustrations, many new to this version, delivering a useful pictorial account of this hugely visible subject.Key beneficial properties of the Fourth variation: displays the altering trend of musculoskeletal ailment worldwide makes a speciality of real

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Extra info for Apley and Solomon's Concise System of Orthopaedics and Trauma, Fourth Edition

Example text

Too little too late’ may result in chronic osteomyelitis. Subacute haematogenous osteomyelitis Once the infection has subsided, movements are encouraged; however, the patient may have to use crutches for another few weeks. Outpatient follow-up is important, to ensure that there is no recurrence of infection. Osteomyelitis may present in a relatively mild form, presumably because the organism is less virulent or the patient more resistant. The distal femur and the proximal and distal tibia are the favourite sites.

This involves radical excision of all avascular and infected tissue followed by closed irrigation and suction drainage of the bed using double-lumen tubes and an appropriate antibiotic solution in high concentration. The ‘dead space’ is gradually filled by vascular granulation tissue; the tubes are removed when cultures remain negative in three consecutive fluid samples and the cavity is obliterated. In refractory cases it may be possible to excise the infected and/or devitalized segment of bone completely and then close the gap by the Ilizarov method of ‘transporting’ a viable segment from the remaining diaphysis.

Supportive treatment Continuous bed rest is important. Osteomyelitis is extremely painful; the affected limb is splinted and adequate analgesics must be given. Drainage If antibiotics are given within the first 48 hours after the onset of symptoms, drainage may not be necessary. indd 20 11/04/2014 10:06 Subacute haematogenous osteomyelitis Subacute haematogenous osteomyelitis aspirated, the abscess should be drained by open operation under general anaesthesia. If pus is found – and released – there is little to be gained by drilling into the medullary cavity.

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