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- •Preface
- •Contents
- •Contributors
- •Bone Circulation
- •Embryology
- •Postnatal Development
- •Bone Tissue
- •Bone Organization
- •Bone Metabolism
- •Bone Growth Factors
- •Cartilage
- •Metabolic Bone Disease
- •Eucalcemic States: Osteoporosis
- •Hypercalcemic States: Hyperparathyroidism
- •Renal Osteodystrophy
- •Sick Cell Syndromes
- •Osteogenesis Imperfecta
- •Osteopetrosis
- •Paget’s Disease
- •Arthritis
- •Metabolic Arthritides: Crystalline Arthropathy
- •Gout
- •Pseudogout
- •Ochronosis
- •Vascular Disease
- •Circulatory Disease: Avascular Necrosis
- •Hematologic Syndromes
- •Neurodevelopmental Disorders
- •Neurologic Diseases
- •Developmental/Congenital Defects
- •Dysplasias
- •Chromosomal Defects
- •Congenital Deformity
- •Miscellaneous
- •Summary
- •Further Reading
- •References
- •3: Musculoskeletal Imaging
- •Introduction
- •Conventional Radiographs
- •Shoulder
- •Hand/Wrist
- •Pelvis/Hip
- •The Knee
- •Cervical Spine
- •Bone Scan
- •PET Scan
- •Further Reading
- •4: Skeletal Trauma
- •Introduction
- •Fractures
- •Initial Evaluation
- •Fracture Descriptors
- •Fracture Deformities
- •Fracture Patterns
- •Soft Tissues
- •Vascular Injury
- •Nerve Damage
- •Muscle Injury
- •Ligament Tears
- •Classic Fractures
- •Incomplete Fractures
- •Stress Fractures
- •Pathologic Fracture
- •Physeal Fractures
- •Intra-articular Fractures
- •Fracture Healing
- •Orthopedic Emergencies
- •Acromioclavicular Separation
- •Pelvic Fractures
- •Hip Fractures
- •Femoral Neck Fractures
- •Intertrochanteric Fractures
- •Subtrochanteric Fractures
- •Femoral Shaft Fractures
- •Distal Femoral Fractures
- •Conclusion
- •Further Reading
- •5: Orthopedic Infections
- •Introduction
- •Pediatric Infections
- •Acute Hematogenous Osteomyelitis
- •Pediatric Septic Arthritis
- •Adult Osteomyelitis
- •Adult Septic Arthritis
- •Open Fractures
- •Prosthetic Joint Infections (PJI)
- •Further Reading
- •Biopsy
- •Biopsy Techniques
- •Core-Needle Biopsy
- •Incisional Biopsy
- •Excisional Biopsy
- •Background
- •Clinical Evaluation
- •Radiographic Evaluation
- •X-Rays
- •Computed Tomography
- •Magnetic Resonance Imaging
- •Nuclear Medicine
- •Ultrasound
- •Angiography
- •Staging
- •Staging Systems
- •Amputation
- •Malignant Bone Tumors
- •Classic Intramedullary Osteosarcoma
- •Clinical Presentation
- •Radiographic Findings
- •Histologic Characteristics
- •Treatment Strategy
- •Outcomes
- •Chondrosarcoma
- •Clinical Presentation
- •Radiographic Findings
- •Histologic Characteristics
- •Treatment Strategy
- •Outcomes
- •Clear Cell Chondrosarcoma
- •Mesenchymal Chondrosarcoma
- •Ewing Sarcoma
- •Clinical Presentation
- •Radiographic Findings
- •Histologic Characteristics
- •Treatment Strategy
- •Outcomes
- •Benign Bone Tumors
- •Enchondroma
- •Osteochondroma (Exostosis)
- •Osteoid Osteoma
- •Aneurysmal Bone Cysts
- •Unicameral Bone Cysts
- •Eosinophilic Granuloma
- •Natural History
- •Radiographic Findings
- •Treatment Strategy
- •Soft Tissue Sarcomas
- •Clinical Presentation
- •Radiographic Findings
- •Treatment
- •Outcomes
- •Liposarcoma
- •Myxoid Liposarcoma
- •Leiomyosarcoma
- •Fibrosarcoma
- •Synovial Sarcoma
- •Epithelioid Sarcoma
- •Benign Soft Tissue Tumors
- •Lipomas
- •Schwannoma
- •Fibromatosis
- •Benign Vascular Lesions
- •Tenosynovial Giant Cell Tumor
- •Ganglia
- •References
- •7: Pediatric Orthopedics
- •Growth
- •Remodeling
- •Bone
- •Ligament
- •Periosteum
- •Cartilage
- •The Growth Plate
- •Torsional Variations
- •Infection
- •Osteomyelitis
- •Clinical Features
- •Diagnosis
- •Treatment
- •Septic Arthritis
- •Clinical Features
- •Diagnosis
- •Treatment
- •Septic Joint Destruction
- •Physeal Damage
- •Pathologic Fracture
- •Chronic Infection
- •Juvenile Rheumatoid Disease
- •Hemophilia
- •Lyme Disease
- •Metabolic Disease
- •Hematologic Disease
- •Sickle Cell Disease
- •Leukemia
- •Osteogenesis Imperfecta
- •Down Syndrome
- •Skeletal Dysplasias
- •Achondroplasia
- •Clinical Features
- •Neuromuscular Disease
- •Cerebral Palsy (CP)
- •Polio
- •Regional Orthopedic Problems
- •The Pediatric Hip
- •Treatment
- •Perthes’ Disease
- •Slipped Capital Femoral Epiphysis (SCFE)
- •The Pediatric Knee
- •Osgood–Schlatter’s Disease
- •Osteochondritis Dissecans (OCD)
- •The Discoid Meniscus
- •Popliteal Cysts
- •The Pediatric Foot
- •Flatfoot or Pes Planovalgus
- •Rigid Flatfoot
- •Congenital Clubfoot
- •Metatarsus Adductus
- •Sprengel’s Deformity
- •Congenital Muscular Torticollis
- •Radial Anomalies
- •Congenital Trigger Thumb
- •Pediatric Trauma
- •Non-accidental Trauma
- •Conclusions
- •Pediatric Spine
- •Scoliosis
- •Management
- •Congenital Scoliosis
- •Neuromuscular Deformity
- •Kyphosis
- •Spondylolisthesis
- •Conclusions
- •Further Reading
- •Introduction
- •Musculoskeletal Tissues
- •Articular Cartilage
- •Tendons
- •Ligaments
- •Muscle
- •Meniscus
- •History
- •Physical Examination
- •Special Tests
- •X-Rays
- •Magnetic Resonance Imaging
- •Arthroscopy
- •Acute Traumatic Injuries
- •Immediate
- •Early
- •Late
- •Chronic Overuse Injuries
- •Common Pathologies Treated by Sports Medicine Specialists
- •Hip: Femoroacetabular Impingement (FAI)
- •Knee: Anterior Cruciate Ligament (ACL) Injury
- •Shoulder
- •Further Reading
- •9: The Shoulder
- •Functional Anatomy
- •The Glenohumeral Joint
- •The Glenohumeral Ligaments
- •The Labrum
- •The Rotator Interval
- •The Subacromial Space
- •The Acromioclavicular Joint
- •The Sternoclavicular Joint
- •The Scapulothoracic Articulation
- •The Brachial Plexus
- •History
- •Functional Assessment
- •Inspection
- •Palpation
- •Strength Assessment
- •Neurologic Examination
- •Shoulder Instability
- •Radiographs
- •Magnetic Resonance Imaging
- •Computerized Tomography
- •Electrodiagnostic Testing
- •History
- •Examination
- •Imaging
- •Treatment
- •History
- •Examination
- •Imaging
- •Treatment
- •Osteoarthritis
- •History
- •Examination
- •Imaging
- •Treatment
- •Miscellaneous Arthropathy
- •Adhesive Capsulitis
- •History
- •Examination
- •Imaging
- •Treatment
- •History
- •Examination
- •Imaging
- •Treatment
- •History
- •Examination
- •Imaging
- •Treatment
- •History
- •Examination
- •Imaging
- •Treatment
- •Multidirectional Instability
- •History
- •Examination
- •Imaging
- •Treatment
- •Summary
- •Further Reading
- •10: The Spine
- •Introduction
- •Cervical Spine
- •History
- •Physical Examination
- •Diagnostic Studies
- •Plain Radiographs
- •Magnetic Resonance Imaging
- •Myelography
- •Computerized Tomography
- •Electromyography
- •Clinical Conditions
- •Myelopathy Versus Radiculopathy
- •Neck Sprain-Neck Ache
- •Acute Herniated Disc
- •Cervical Spondylosis
- •Rheumatoid Arthritis
- •Cervical Hyperextension Injuries
- •Cervical Spine Algorithm
- •Conservative Treatment
- •Neck Pain Predominant
- •Arm Pain Predominant (Radiculopathy)
- •Lumbar Spine
- •History
- •Physical Examination
- •Diagnostic Studies
- •Plain Radiographs
- •Magnetic Resonance Imaging
- •Computed Tomography
- •Electrodiagnostic Testing
- •Clinical Conditions
- •Back Strain-Lumbago
- •Herniated Disc
- •Spinal Stenosis
- •Spondylolisthesis
- •Lumbar Spine Algorithm
- •Conservative Treatment Modalities
- •Controlled Physical Activity
- •Drug Therapy
- •Trigger-Point Injection
- •Epidural Steroid Injection
- •Traction
- •Manipulation
- •Physical Therapy
- •Operative Management
- •Decompression
- •Fusion
- •Further Reading
- •11: The Elbow
- •Introduction
- •Anatomy
- •Skeletal
- •Muscles
- •Neurovascular
- •Brachial Artery
- •Musculocutaneous Nerve
- •Median Nerve
- •Radial Nerve
- •Ulnar Nerve
- •History
- •Physical Examination
- •Radiographic Evaluation
- •Stress X-Rays
- •Traction X-Rays
- •Computed Tomography
- •Magnetic Resonance Imaging
- •Electrodiagnostic Tests
- •Nonoperative Treatment
- •Injections
- •Operative Treatment
- •Lateral Epicondylitis: “Tennis Elbow”
- •Medial Epicondylitis: “Golfer’s Elbow”
- •Elbow Arthritis
- •Cubital Tunnel Syndrome (Ulnar Nerve Compression)
- •Olecranon Bursitis
- •Little Leaguer’s Elbow
- •Acute: Traumatic Common Tendon, Ligament, Fracture, Dislocation Injuries
- •Tendon Ruptures
- •Distal Biceps Rupture
- •Triceps Tendon Rupture
- •Dislocations
- •Simple Elbow Dislocation
- •Common Elbow Fractures
- •Olecranon Fractures
- •Distal Humerus Fractures
- •Coronoid Fractures
- •Monteggia Fracture
- •Ligamentous Injuries
- •Lateral Ulnar Collateral Ligament Injury
- •Medial Ulnar Collateral Ligament Injury
- •Further Reading
- •12: The Hand
- •Introduction
- •History
- •Physical Examination
- •Imaging
- •Arthroscopy
- •Pathophysiology
- •Duplication
- •Other Congenital Anomalies
- •Developmental or Acquired Disease
- •Arthritides
- •Nerve Compression Syndromes
- •Tendon Disorders
- •Dupuytren’s Contracture
- •Kienböck’s Disease
- •Infection
- •Trauma
- •Lacerations
- •Other Common Injuries
- •Metabolic Disease
- •Vascular
- •Neoplasms
- •Skin Cancer
- •Other Soft Tissue Masses
- •Management Protocols
- •Further Reading
- •Anatomy
- •Development
- •Biomechanics
- •Gait
- •Patient Evaluation
- •History
- •Physical Examination
- •Radiographic Evaluation
- •Hip Pathology
- •Hip Arthritis
- •Surgical Management
- •Arthroscopy
- •Arthrotomy
- •Osteotomy
- •Arthrodesis
- •Hip Replacement Surgery
- •Complications
- •Summary
- •Further Reading
- •Introduction
- •Anatomy
- •History
- •Physical Examination
- •Imaging
- •Knee Pathology
- •Meniscal Tears
- •Ligament Injuries
- •Patellofemoral Pathology
- •Arthritis
- •Further Reading
- •Anatomy
- •Ligaments
- •Muscles
- •Gait Cycle
- •Trauma
- •Ankle
- •Pilon Fractures
- •Ankle Fractures
- •Syndesmosis Injuries
- •Talus Fractures
- •Calcaneus Fractures
- •Ankle Sprains
- •Hallux Valgus
- •Hallux Varus
- •Hallux Rigidus
- •Lesser Toe Deformities
- •Peroneal Tendon Pathology
- •Cavovarus Foot Deformity
- •Anterior Tibial Tendon Pathology
- •Achilles Tendon Disorders
- •Posterior Tibial Tendon
- •Heel Pain
- •Osteoarthritis
- •Ankle
- •Rheumatoid Arthritis
- •Infections
- •Puncture Wounds
- •Paronychia
- •Diabetic Foot Infections
- •Charcot Arthropathy
- •Tumors
- •Soft Tissue Lesions
- •Bone Tumors
- •Complex Regional Pain Syndrome
- •Further Reading
- •Index

Essentials
ofOrthopedic
Surgery
WilliamF.Postma
JohnN.Delahay
SamW.Wiesel
Editors
FifthEdition
123

Essentials of Orthopedic Surgery

William F. Postma • John N. Delahay
Sam W. Wiesel
Editors
Essentials of Orthopedic
Surgery
Fifth Edition

Editors
William F. Postma
Orthopedic Surgery
MedStar Georgetown University
Hospital
Washington, DC, USA
Sam W. Wiesel
Orthopedic Surgery
MedStar Georgetown University
Hospital
Washington, DC, USA
John N. Delahay
Department of Orthopaedic Surgery
MedStar Georgetown Univeristy
Hospital
Washington, DC, USA
ISBN 978-3-031-66214-0 ISBN 978-3-031-66215-7 (eBook)
https://doi.org/10.1007/978-3-031-66215-7
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2007, 2011, 2024
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar 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 specic 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 publication. Neither the publisher nor
the authors or the editors give a warranty, expressed 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 afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.

I would like to dedicate this book to all my teachers and
mentors along the way, including my two co-editors. I
especially want to dedicate it to my father, Dr. Jan Postma Jr.,
who instilled in me the work ethic and determination necessary
in this profession. He has been an excellent clinician, surgeon,
and role model throughout this journey.
—William F. Postma, MD

Preface
The impetus for the 5th edition of this text came from medical students, who
requested an update to the 4th edition. They appreciated our approach with
Essentials, nding it particularly helpful for their education.
The goal of the 5th edition of Essentials of Orthopaedic Surgery continues
to focus on an up-to-date overview of orthopaedics written expressly for
medical students and others who are interested in beginning their study of the
musculoskeletal system (including residents in orthopaedic surgery, physiatry, rheumatology, family medicine, and emergency medicine). We have
added two new chapters to this book: One in biomechanics and the other in
imaging. The remaining chapters have been carefully revised to maintain a
standardized format as much as possible.
Every chapter has been authored by a subspecialist in the relevant topic. In
updating each section, the authors have tried to eliminate outdated content
and focus on providing practical information that is relevant to medical students. Each topic is covered in sufcient depth that when confronted with a
specic clinical problem, the student should be able to formulate an initial
diagnostic and treatment plan.
We would like to acknowledge several individuals who contributed to this
textbook. First, we would like to thank Dr. Bill Oppenheim for supporting the
use of gures and illustrations through his generous commitment to the Bill
and Patricia Oppenheim Lectureship in Pediatric Surgery at Georgetown.
Anna Beaufort produced a number of beautiful original illustrations. We
would also like to thank Kristopher Spring from Springer for the guidance in
bringing this text to publication. Finally, it has been a truly exciting and stimulating experience to once again work with all the members of the Orthopaedic
Department at MedStar Georgetown University Medical Center. Everyone
has been enthusiastic, and their contributions were excellent. The editors are
deeply appreciative and are very proud of the nal text.
Washington, DC, USA WilliamF.Postma
Washington, DC, USA JackN.Delahay
Washington, DC, USA SamW.Wiesel
January 5th, 2025
vii

Contents
1 Basic Science of Bone and Cartilage Metabolism . . . . . . . . . . . . 1
Michael J. Kelly and John N. Delahay
2 Biomechanics and Biomaterials . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Daniel Hampton and Patrick Burroughs
3 Musculoskeletal Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Akhil Jay Khanna and Bradley Gelfand
4 Skeletal Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
John L. Johnson and Robert Golden
5 Orthopedic Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
R Adams Cowley II, Kevin W. Park, and Kenneth M. Vaz
6 Tumors of the Musculoskeletal System . . . . . . . . . . . . . . . . . . . . . 103
Jonathan Day and Brock Adams
7 Pediatric Orthopedics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Denver B. Kraft, John N. Delahay, and Ryan S. Murray
8 Sports Medicine of the Hip and Knee . . . . . . . . . . . . . . . . . . . . . . 187
William F. Postma and Nicholas Apseloff
9 The Shoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Evan Michaelson and Brent Wiesel
10 The Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Joseph L. Ferguson and Douglass C. Johnson
11 The Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Kyle W. Zittel and Michael W. Kessler
12 The Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Edward Fakhre and Curtis M. Henn
13 Hip Osteoarthritis and Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . 323
Gregory Perraut, Brian G. Evans, and Kevin W. Park
ix

x
14 Knee Osteoarthritis and Arthroplasty . . . . . . . . . . . . . . . . . . . . . 351
Evan Jacquez, Brian G. Evans, and Kenneth M. Vaz
15 The Foot and Ankle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Paul S. Cooper, Nicholas D. Casscells, and Julia A. McCann
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Contents

Contributors
BrockAdams, MD Department of Orthopedics, MedStar Washington Hospital Center, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
Nicholas Apseloff, MD Department of Orthopedics, University of Pittsburgh, Pittsburgh, PA, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
PatrickBurroughs, MD Department of Orthopedics, MedStar Georgetown
University Hospital, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
NicholasD.Casscells, MD Department of Orthopedics, MedStar Georgetown University Hospital, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
Paul S. Cooper, MD Department of Orthopedics, MedStar Georgetown
University Hospital, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
R Adams Cowley II, MD Department of Orthopedics, MedStar Georgetown University Hospital, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
JonathanDay, MD Department of Orthopedics, MedStar Georgetown University Hospital, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
John N. Delahay, MD Department of Orthopaedic Surgery, MedStar
Georgetown Univeristy Hospital, Washington, DC, USA
xi

xii
Brian G. Evans, MD Department of Orthopaedics, MedStar Georgetown
Univeristy Hospital, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
Edward Fakhre, MD Department of Orthopedics, MedStar Georgetown
University Hospital, Washington, DC, USA
Georgetown University School of Medicine, Washington, DC, USA
Joseph L. Ferguson, MD Department of Orthopedics, MedStar Georgetown University Hospital, Washington, DC, USA
Bradley Gelfand, MD Department of Orthopedics, MedStar Georgetown
University Hospital, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
Robert Golden, MD Department of Orthopedics, MedStar Washington
Hospital Center, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
Daniel Hampton, MD Department of Orthopedics, MedStar Georgetown
University Hospital, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
Contributors
Curtis M. Henn, MD Department of Orthopedics, MedStar Georgetown
University Hospital, Washington, DC, USA
Georgetown University School of Medicine, Washington, DC, USA
EvanJacquez, MD Department of Orthopedics, MedStar Georgetown University Hospital, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
DouglassC.Johnson, MD Department of Orthopedics, MedStar Georgetown University Hospital, Washington, DC, USA
JohnL. Johnson, MD Department of Orthopedics, MedStar Georgetown
University Hospital, Washington, DC, USA
MedStar Georgetown Orthopedic Institute, Georgetown University School of
Medicine, Washington, DC, USA
Michael J. Kelly, MD Department of Orthopedics, MedStar Georgetown
University Hospital, Washington, DC, USA
Department of Orthopedic Surgery, Georgetown University Medical Center,
Washington, DC, USA
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