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Operative Techniques in Pediatric Orthopaedics

John. M. Flynn and Sam. W. Wiesel pp. 664 Philadelphia: Lippincott, Williams and Wilkins, 2011 ISBN: 978-1-4511-0263-5

This comprehensive textbook of operative techniques in children's orthopaedics is one in a series on operative techniques in orthopaedic subspecialities e.g. Foot and Ankle, Trauma, Shoulder and Elbow etc. edited by Sam W. Wiesel and published by Wolters Kluwer/ Lippincott Williams & Wilkins. John M. Flynn from the Children's Hospital of Philadelphia is the editor of this volume which has 92 chapters and 97 contributors; a truly formidable task. The authors are almost all based in the United States with two from Canada and only three from outside North America.

The book is profusely illustrated with excellent colour photographs (anatomical, clinical and operative), black and white images (radiographs, CT scans and MRI) and illustrative diagrams.

In the preface Sam Wiesel, editor-in-chief, states that there are three questions for any surgeon contemplating an operative procedure; why, when and how?; and that the purpose of the text is to answer the how, i.e. the step-by-step details of how to perform a particular procedure. The indications for the procedure, i.e. the why and when, are only sketched in, as it is assumed that the surgeon already has that all important basic knowledge, without which no procedure, however well performed, will be a success either for the patient or the surgeon.

Each chapter is presented in a standard format under a set of sub-headings starting with Definition, Anatomy, Pathogenesis etc. and finishing after the step-by-step technical details with Post-operative care, Outcomes, Complications and References. Each section is written in the form of "bullet-point" sentences which convey a great deal of information in a concise, if rather staccato fashion. The book comes with access to the complete contents online through their website using an access code supplied with the book.

Inevitably with so many authors and requiring a great deal of editing there are one or two inconsistencies. There is a very useful 'Pearls and Pitfalls' section at the end of the step-by-step technical section in each chapter, although this is missing from chapter 42. Chapter 46 suffers from its many references not being cited in the text itself. While on the subject of references it would be helpful for readers to have references for the measurement of the Reimers index at the hip, the Metaphysial/Diaphysial angle at the knee and the Hueter-Volkmann principle.

It is nice to see an excellent chapter on the largely non-operative Ponseti technique for the treatment of clubfoot, but there is no chapter on surgery for congenital vertical talus or the modification of the Ponseti technique, reported in 2006 for the treatment of this rare and difficult congenital foot deformity. The last nine pages on some basic techniques of orthopaedic clinical examination in children are also helpful and instructive.

There is an enormous amount of useful information in this book and I would thoroughly recommend it to anyone studying or undertaking children's orthopaedic surgery either as a trainee or trainer in the developed world. I hope it will become available to all orthopaedic trainees in the United Kingdom during their six months period of children's orthopaedic training. For surgeons in the developing world treating vast numbers of children without access to the latest technology who still have to deal with the ravages of neglected trauma, acute and chronic bone infection, tuberculosis and poliomyelitis it may be less useful as some techniques are either not described or would at present be inappropriate.

J. A. Fixsen

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