By Louis Solomon, David Warwick, Selvadurai Nayagam
A entire advent to the sphere of orthopaedics and trauma.
summary: A complete creation to the sphere of orthopaedics and trauma
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Extra resources for Apley's system of orthopaedics and fractures
Bone deformity may alter the arc of movement, such that it is limited in one direction (loss of abduction in coxa vara is an example) but movement in the opposite direction is full or even increased. These are all examples of ‘ﬁxed deformity’. 12 Bony lumps The lump above the left knee is hard, well-deﬁned and not increasing in size. The clinical diagnosis of cartilage-capped exostosis (osteochondroma) is conﬁrmed by the x-rays. Plain ﬁlm x-ray examination is over 100 years old. Notwithstanding the extraordinary technical advances of the last few decades, it remains the most useful method of diagnostic imaging.
By moving the tube and the x-ray ﬁlm in opposite directions around the patient during the exposure, images on either side of the pivotal plane are deliberately blurred out. When several ‘cuts’ are studied, lesions obscured in conventional x-rays may be revealed. g. of the vertebral body or the tibial plateau); these defects are often obscured in the plain x-ray by the surrounding intact mass of bone. Small radiolucent lesions, such as osteoid osteomas and bone abscesses, can also be revealed. A useful procedure in former years, conventional tomography has been largely supplanted by CT and MRI.
Acute or chronic synovitis), a fracture, a highly vascular tumour or regional sympathetic dystrophy. Decreased activity in the perfusion phase This is much less common and signiﬁes local vascular insufﬁciency. Increased activity in the delayed bone phase This could be due either to excessive isotope uptake in the osseous extracellular ﬂuid or to more avid incorporation into newly forming bone tissue; either would be likely in a fracture, implant loosening, infection, a local tumour or healing after necrosis, and nothing in the bone scan itself distinguishes between these conditions.