Book Review


Master Cases: Orthpaedic Trauma.Clayton R. Perry and Charles M. Court-Brown, Thieme, New York, NY, U.S.A., 1999

The purpose of this book was to present a case-based approach to orthopaedic traumatology. The authors employ a collection of case presentations to provide an interactive format to examine critical issues surrounding trauma in both the upper and lower extremities. The use of a clinical case-based teaching format to illustrate basic principles and controversies in orthopaedic traumatology stands in marked contrast to conventional orthopaedic trauma textbooks. The authors carefully detail a representative cross-section of orthopaedic trauma experience. The material examined ranges from simple to complex, but is not all-inclusive.

The book is organized in two principle sections. Section I examines upper extremity fractures (25 cases) and section II lower extremity injuries (39 cases). Each chapter is organized as if a patient were presenting to an emergency room: history and physical examination, radiographic findings, diagnosis, surgical management, and postoperative management. Three sections follow each case presentation: discussion, alternative methods of management, and complications. Each alternative management of a given fracture is displayed in a table format highlighting its advantages and disadvantages and a brief comment about each technique. Last, the authors provide suggested readings for each clinical scenario.

This format challenges the reader to think critically about each patient's case and problem in a sequential fashion. The reader is presented with the history and clinical findings and has the opportunity to interpret the radiographs. The reader can formulate a potential treatment plan, and as the discussion unfolds, the reader will learn if it is one of the methods proposed by the authors. The authors often provide clinical pearls and pitfalls based on their voluminous experience as internationally known traumatologists. The authors do not emphasize particular instrumentation choices but examine the key anatomic, technical, and fundamental patient management issues. Decision points are emphasized. Is the distal humerus fracture intra-articular? Does one need to use an olecranon osteotomy or two-incision approach? What features shape these decisions? These are representative issues that are addressed. Throughout the text, the authors emphasize the need to look not only at the osseous injuries, but to consider the complete management of the patient's injury patterns. The author's stress the importance of the soft tissue injury, need for debridements, timing of interventions, and consideration of ultimate patient function.

Naturally, criticism of case-based textbooks will stem from the author's lack of coverage of particular injury patterns or those not covered in enough detail. The lack of coverage of acetabular fractures and sole case of a pelvic injury represent a shortcoming of this text. Acetabular fracture management seems uniquely suited to this type of format. These fractures often confuse orthopaedic surgery residents and the general orthopaedist. Other injury patterns that merit more attention are knee dislocations or fracture/dislocations.

In summary, this text is a valuable addition to the libraries of most orthopaedic residents and general orthopaedists. It will provide a useful starting ground to stimulate further discussion of the numerous controversies that surround orthopaedic trauma management. However, the more experienced reader will want to supplement this text with more recent, comprehensive and in depth studies and reviews of the respective injury types. This book, however, represents a refreshing case based format to examine the complex field of orthopaedic traumatology.