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Arthroplasty of the Hand and Wrist

Ian A. Trail pp 136 Cleckheaton: Amadeus Press, 2010 ISBN: N/A

With the inexorable widening of the range of implants and materials facing the surgeon today, this book is a timely contribution in the field of hand surgery. It is a single-author monograph which not only encapsulates the experience of the author, but also draws upon the collective wisdom of the Upper Limb Unit at Wrightington Hospital. It covers the science and surgery of replacement of five joints: the DRUJ, the MCPJ, the PIPJ, the CMCJ of the thumb and the wrist. Ian Trail is an internationally recognised figure in the field of joint replacement of the upper limb in both design and evaluation. This book is a testament to his scholarship and meticulous research.

Each of the five chapters in this short book covers a single joint and adheres to the same format, namely Background, Surgical Anatomy, Biomechanics, Surgical Technique and Rehabilitation, Evaluation, Results, Complications, the author's personal view, and ending with one or two interesting cases. The format is therefore predictable and helpful to the reader who might wish to skip some sections and focus upon others. Each joint is covered in meticulous detail from inception to possible failure and rescue or salvage. Earlier designs are mentioned and the reasons for their failure are outlined with reference to relevant publications. The author refers to the gradual decline of the use of silastic and the rise of more rigid materials which are more anatomical and therefore technically more challenging to insert. In the chapter on the MCP joint he does pay tribute to the enormous role that silastic has played, and still does, in the armamentarium of the hand surgeon. This important chapter covers an extensive review of published literature and evaluation tools currently in use.

I found his personal view for each joint to be a fair and balanced summary of the current situation; the case reports at the end of each chapter are instructive as well as reassuring that things can go wrong even in such a centre of excellence. Every chapter is well referenced with an impressive bibliography, but curiously the book comes without an index. While the content of this book is uniformly informative, the writing style is repetitive, as though the proof-reading stage had been omitted. There are many spelling and typographical errors throughout, tending to distract the reader. Hopefully these will be addressed in the next edition. The black and white illustrations and colour photographs are of a generally good standard throughout, with the exception of those in the chapter on the thumb, which are insufficiently clear to add anything to the text.

The author has aimed this book at the experienced surgeon rather than the trainee and I would agree that this is the correct target readership; its modest price nevertheless makes it affordable for all grades of surgeon who will find valuable lessons within its pages.

D. S. Nairn

Click here to view this book on the author's website