PRACTICAL ORTHOPEDICS Biological Options and Simpler Techniques for Common Disorders: (With an Atlas of Rare Conditions)
PRACTICAL ORTHOPEDICS Biological Options and Simpler Techniques for Common Disorders: (With an Atlas of Rare Conditions)
Second Edition
SM Tuli MBBS MS PhD FAMS
Senior Consultant, Spinal Diseases and Orthopedics Vidyasagar Institute of Mental Health and Neurosciences Nayati Medical Institutes
New Delhi, India
Formerly
Chairman, Department of Orthopedics Banaras Hindu University
Varanasi, Uttar Pradesh, India
Professor and Head Department of Orthopedics University College of Medical Sciences
New Delhi, India
Forewords
Mathew Varghese
Hardas Singh Sandhu
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Practical Orthopedics—Biological Options and Simpler Techniques for Common Disorders
First Edition: 2015
Second Edition: 2020
9789389188547
Printed at
My teachers Prof KS Grewal, Prof PK Duraiswami and Prof Balu Sankaran, the great orthopedic educators of their time,
My enquiring students who induced me to continue as “student of orthopedics”
and
My ungrudging patients who could understand and accept a balance between their expectations and constraints or limitations of clinical medicine.
There are some people in this world you respect so much that it is difficult to turn down a request from them. You actually feel honored when such a person asks you for something. When that person is a teacher you feel your responsibility is much more. And then, if he happens to be Professor SM Tuli, your dilemma and confusion becomes complete. These were the emotions I went through when Professor Tuli asked me to write a foreword for this book. I was really flattered and embarrassed by the request. He was a giant in the field of orthopedics and a teacher of teachers asking someone as junior as me to write a foreword for the second edition of this book. I felt I was unworthy of this honor but he was persistent and would hear none of my excuses to avoid writing a foreword. He would not let go, he would call from his land line and ask ‘Dr Mathew I am waiting for your mail’. I gave in finally and agreed.
Writing a concise book on general orthopedics is difficult. The field of orthopedics has grown to be a vast field with so many subspecialties as the parts of the musculoskeletal system and more. How much do you need to know and how much do you need to tell? That is a constant dilemma of the student and the teacher. With modern imaging teachniques and the success of the genome project there has been a explosion of knowledge in the field of orthopedic surgery. This combined with advances in technology have made orthopedic surgery a very complex subject. So any attempt to write a short book for practitioners is a daunting task. But if the task is taken up by a master you can expect only distilled wisdom.
Professor Tuli had given me a copy of the first edition of the book to read and review, so when I met him after reading the book he said “Mathew we must sit and discuss”. I was amazed by the humility of this giant when he would patiently sit and listen to me, gently prodding me on and asking probing (nay, thought provoking) questions as we moved page by page till the end of the book. With Professor Tuli as the mind behind the revised edition of the book I am certain this book will have many a pearl of wisdom not only for the general practicing orthopedic surgeon but also for many an academic.
I am sure the general practicing orthopedic surgeon, especially those in resource constrained settings, would find this a useful guide for their daily practice.
Mathew Varghese MBBS MS
Chairman
Department of Orthopedics
and Rehabilitation
St. Stephen's Hospital
Former Director
St. Stephen's Hospital
Delhi, India
Foreword
The author of Tuberculosis of the Skeletal System, Prof SM Tuli has come out with another very useful book Practical Orthopedics—Biological Options and Simpler Techniques for Common Disorders. Scientific papers on various aspects of orthopedics published in national and international journals of repute have earned him global recognition and popularity.
The strength of this book is that it is a reflection of his vast experience of nearly six decades as a teacher, and of ethical practice in orthopedics.
This book appropriately covers the fundamental principles of orthopedics and its practical applications. It would be a very useful book for new entrants and young orthopedic surgeons before they get exposed to the market-driven orthopedics. It will serve as a good guide to all medical practitioners who are engaged in the care of musculoskeletal disorders. One can appreciate the advantages of simple but effective available technology. I congratulate Prof Tuli, for his effort to put his long experience in the shape of a book.
Hardas Singh Sandhu MBBS MS FRCS FAMS
Chairman
Department of Orthopedics
Government Medical College
Amritsar, Punjab, India
Preface to the Second Edition
There are many books on orthopedics but most of these are written by authors working in resource-rich countries. One must, however, realize that nearly 70 percent of people worldwide are living in resource-compromised environment far away from the modern facilities of metropolitan cities. The world is not made of New York, Paris, or Tokyo, and similarly Indian subcontinent is not made of Delhi, Mumbai or Chennai. Seventy percent of orthopedic problems are being managed in areas, which barely have moderate infrastructure facilities available. One should appreciate the skill, and ingenuity of these specialists, who show responsiveness to the needs of people who do not have access to the metropolitan facilities. Despite intentions of upgradation of infrastructure facilities worldwide, at all times there would be differences of economic inequalities and such differences are not likely to disappear in future as well. Due to perpetual man-made conflicts and natural disasters, there would always be pockets of deprivation, crowding, malnutrition and inaccessibilities.
The experience and observations of orthopedic surgeons in resource-limited environments, related published material in national and international literature, and personal observations of over 60 years in the management of common orthopedic disorders in moderate facilities form the basis of this book. The readers of this book are requested and encouraged to communicate their thoughts for corrections, deletions and additions. I seek their cooperation for help to continually improve orthopedic education and related health care. Based upon the suggestions of inquisitive readers, text has been added in many sections of the book. A new chapter has been added in the second edition as an Atlas of Rare Conditions one many encounter while taking care of disorders and diseases of skeletal system. This may help a general orthopedic specialist to make the diagnosis and seek the help for specialized care of the patients.
The guidelines suggested here are based upon the observations of the natural course of common conditions and the observed efficacy of biological options and simpler techniques. The suggestions made here are not limited to geographic boundries, but are generally applicable to the patients who would prefer modalities in environments where they reside, options, which do not require major changes in their lifestyle or entail frequent medical or operative intervention, and are cost effective.
I hope this write-up would provide credibility to the efforts and techniques for development of accessible, affordable and effective options for many orthopedic disorders. Sound advice would be available for the family physicians, physical therapists, nursing care personnel and concerned orthopedic specialists. Some problems, like complex spine operations, repeat surgeries for joint replacement and the care of the malignant disease, would, however, need to be referred to dedicated specialized hospitals.
SM Tuli
Preface to the First Edition
There are many books on orthopedics but most of these are written by authors working in resource-rich countries. One must, however, realize that nearly 70 percent of people worldwide are living in resource-compromised environment far away from the modern facilities of metropolitan cities. The world is not made of New York, Paris, or Tokyo, and similarly Indian subcontinent is not made of Delhi, Mumbai or Chennai. Seventy percent of orthopedic problems are being managed in areas, which barely have moderate infrastructure facilities available. One should appreciate the skill, and ingenuity of these specialists, who show responsiveness to the needs of people who do not have access to the metropolitan facilities. Despite intentions of upgradation of infrastructure facilities worldwide, at all times there would be differences of economic inequalities and such differences are not likely to disappear in future as well. Due to perpetual man-made conflicts and natural disasters, there would always be pockets of deprivation, crowding, malnutrition and inaccessibilities.
The experience and observations of orthopedic surgeons in resource-limited environments, related published material in national and international literature, and personal observations of over 60 years in the management of common orthopedic disorders in moderate facilities form the basis of this book. The readers of this book are requested and encouraged to communicate their thoughts for corrections, deletions and additions. I seek their cooperation for help to continually improve orthopedic education and related health care.
The guidelines suggested here are based upon the observations of the natural course of common conditions and the observed efficacy of biological options and simpler techniques. The suggestions made here are not limited to geographic boundries, but are generally applicable to the patients who would prefer modalities in environments where they reside, options, which do not require major changes in their lifestyle or entail frequent medical or operative intervention, and are cost effective.
I hope this write-up would provide credibility to the efforts and techniques for development of accessible, affordable and effective options for many orthopedic disorders. Sound advice would be available for the family physicians, physical therapists, nursing care personnel and concerned orthopedic specialists. Some problems, like complex spine operations, repeat surgeries for joint replacement and the care of the malignant disease, would, however, need to be referred to dedicated specialized hospitals.
SM Tuli
Acknowledgments
No purposeful writing can be done without peace at home and this was provided by my wife Swarn (literally meaning gold) through different phases of life. All the photographs were taken by me (immature photographer), which were ultimately formatted for presentations by Mr Yogesh Himdan and Mr Amit Kumar, the manuscript was typed-revised-retyped by Mr Kundan Thakur, all from VIMHANS Hospital, New Delhi. Minu Nayar curetted material from a collection of illustrations and collated these for making the chapter Atlas of Rare Conditions. The whole raw material reached the publishing house where many special people contributed in diverse ways: coordination by Ms Samina Khan (Executive Assistant to Publishing Head–Education).
I am very grateful to the whole team of M/s Jaypee Brothers Medical Publishers (P) Ltd, who helped and guided me, Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), for all their support to work in this project and make it a success. Dr Madhu Choudhary (Publishing Head–Education), Ms Pooja Bhandari (Production Head), Ms Sunita Katla (Executive Assistant to Group Chairman and Publishing Manager), Mr Rajesh Sharma (Production Coordinator), Ms Seema Dogra (Cover Visualizer), Ms Geeta Shrivastava, Mr Vakil Khan (Proofreader), Mr Ajeet Rathor (Typesetter) and Mr Nitin Bhardwaj (Graphic Designer), for their painstaking effort to make this book attractive and lucid. Without their cooperation, I could not have completed this project.