Basic Biomechanics of the Musculoskeletal

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 COPYRIGHT © 2001

BY

THE JOURNAL

OF

BONE

AND JOINT

SURGERY, INCORPORATED

Book Reviews Basic Biomechanics of the Musculoskeletal System. 3rd ed. Margareta Nordin and Victor H. Frankel, editors. Illustrated by Kajsa Forssen. Philadelphia: Lippincott Williams and Wilkins; 2001. 450 pages. $49.95. The third edition of this by-now-familiar basic text relies more heavily on outside contributors than did past editions, providing more extensive coverage and including more specific topics. The chapters on basic biomechanics, by Nordin and Frankel, contain much the same material as did the previous editions as well as information on areas of new development. Thus, the reader has access to an historical development of basic biomechanical concepts as an introduction to more modern developments. The text treats all subjects in a nonmathematical manner, even to the point of presenting graphical solutions for joint-mechanics problems. Nordin and Frankel have drawn heavily from the faculty of their own hospital in selecting contributors. As with any multiauthored work, the quality of the contributions varies, but all of the chapters are good or excellent. The chapter on “Biomechanics of Gait” is exceptionally well written, providing a superb, compact introduction to gait analysis. The text covers a wide variety of topics, some of which are unusual for a basic text; for example, there is a chapter on “Biomechanics of Peripheral Nerves and Spinal Nerve Roots” and another on “Engineering Approaches to Standing, Sitting, and Lying.” Small proportions of the text are either out of date or removed from the mainstream of current biomechanical thought (for example, the chapter on “Biomechanics of Arthroplasty”). The chapter references, while not extensive, are generally well selected and diverse. Overall, this is both an excellent teaching text and a good reference source for basic applied biomechanics. It will be a useful tool for those teaching orthopaedic biomechanics to residents as well as for those engaging in independent study. Albert H. Burstein, PhD Deputy Editor for Research The Journal of Bone and Joint Surgery Needham, Massachusetts

Biomechanics in the Musculoskeletal System. Manohar M. Panjabi and Augustus A. White III. New York: Churchill Livingstone; 2001. 224 pages. $59.00. This basic text, presented in nine chapters, is directed toward anyone wishing to become familiar with the concepts underlying musculoskeletal biomechanics.

The book starts with “The Basics,” which includes simple vector analysis and an introduction to weights and measures. The chapters that follow describe basic concepts of motion, motion in response to load, and loads on rigid bodies. These topics, called statics and dynamics in common engineering terms, are discussed with a minimum of mathematics. Anatomic examples are used, and the material is easy to follow. Chapters 5 and 6 deal with the response of materials and structures to loads, and again, a minimum of mathematics and the use of anatomic examples ease the reading burden. Some of the diagrams and presentations have been simplified to the point of loss of accuracy, but this does not detract too much from the neophyte’s learning process. Chapter 7, on vibrations, presents material that is unusual and rarely included in a biomechanics text. That it is minimally relevant to orthopaedic biomechanics is consistent with the lack of biological examples. The chapter on material properties is somewhat superficial, even for a beginning text; it is little more than an extended list of numbers. The strength of this text is its simple and direct approach to the concepts underlying musculoskeletal biomechanics. The text does not, however, delve into biomechanics on an operational level, so the reader will not learn how to solve biomechanical problems either by example or by methodological instruction. Thus, this book is ideally suited as an introductory text for an orthopaedic resident who has no background in physics or engineering and wishes to learn the language of orthopaedic biomechanics. Albert H. Burstein, PhD Deputy Editor for Research The Journal of Bone and Joint Surgery Needham, Massachusetts

Principles and Practice of Orthopaedic Sports Medicine. William E. Garrett Jr., Kevin P. Speer, and Donald T. Kirkendall, editors. With medical illustrations by Marsha Dohrmann Kitkowski. Philadelphia: Lippincott Williams and Wilkins; 2000. 976 pages. $169.00. This book is part of a three-volume series dealing with the basic science and clinical practice of training and caring for athletes. As the title indicates, this volume emphasizes the causes, prevention, treatment, and rehabilitation of sports injuries. The editors have assembled a panel of experts in the field of orthopaedic sports medicine. Each chapter presents a

 THE JOUR NAL OF BONE & JOINT SURGER Y · JBJS.ORG VO L U M E 83-A · N U M B E R 9 · S E P T E M B E R 2001

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Book Reviews concise review of the mechanism of injury, the relevant basicscience and clinical issues, and an analysis of the treatment options. Pearls of wisdom regarding physical examination, diagnostic tests, and nonoperative and operative management are also provided. The sections on the hand, wrist, and elbow; the shoulder; the head, neck, and back; the knee; and the foot are so comprehensive that each could stand alone as a classic monograph on its subject. These chapters have been skillfully combined into a clear and unified text that is supported by both current and classic references. Illustrations, graphs, and photographs are accurately labeled and relevant. There are a few errors in the organization and presentation of the material. A chapter on ankle arthroscopy is misplaced in the section on the knee. There is no coverage of ligamentous ankle injuries. A few of the photographs of arthroscopic intra-articular anatomy and pathology would have been better rendered in color or high-gloss black and white. I also reviewed the two other volumes in this trilogy, and I consider the combination of these three volumes to be the most comprehensive effort, to date, on the art and science of sports medicine. Whether you are a resident, a surgeon, a primary-care physician, or a researcher, these volumes provide the most up-to-date descriptions of training techniques, research methods, clinical care, and rehabilitative techniques for maximizing athletes’ performance and returning them safely to competition. Jack B. Ryan, MD St. John Health System Orthopaedic-Sports Medicine Warren, Michigan

ing features of each abnormality. The material reflects the current dogma of those who routinely deal with, and are knowledgeable about, magnetic resonance imaging of the foot and ankle. Many books with multiple chapter authors suffer from the juxtaposition of significantly different writing styles and organization, but that was not the case for this book, in which the text flowed easily and consistently from chapter to chapter. Practical MRI of the Foot and Ankle would be best appreciated by radiologists familiar with or learning magnetic resonance imaging. It would be a good book for radiology residents and fellows as well as for radiologists who routinely deal with musculoskeletal magnetic resonance imaging. It also would be a useful resource to have in any radiology department or imaging center where magnetic resonance imaging is performed. I believe that this book would be of limited value to most orthopaedists who already know the clinical and anatomical information presented but have minimal interest in the technical details of imaging. My criticisms of this book are few, the major one being that the chapter on technique should conclude with specific recommendations for imaging the foot and ankle, which would indeed be more practical than the excellent discussion of the physics involved. In the chapter on normal anatomy, the abbreviations that appear in the diagrams are not explained until ten pages later in the text. These minor criticisms are not meant to detract from the fact that this is a very good review of magnetic resonance imaging of the foot and ankle. Phoebe Kaplan, MD Musculoskeletal Radiology Department Massachusetts General Hospital Boston, Massachusetts

Practical MRI of the Foot and Ankle Alison R. Spouge and Thomas L. Pope, editors. Boca Raton: CRC Press; 2001. 312 pages. $129.95. This book, which includes eleven chapters by nineteen different authors and coauthors, is a complete collection of what is currently known about magnetic resonance imaging of both the normal and abnormal foot and ankle. The obligatory chapters on magnetic resonance imaging technique and normal anatomy are followed by chapters covering such topics as trauma, tumors, internal derangements, inflammatory conditions, and pediatric diseases. The book was edited by two musculoskeletal radiologists: Spouge is an assistant professor at the University of Western Ontario, and Pope is a professor and the chair of radiology at the Medical University of South Carolina. Overall, I found this to be an excellent book, which can be easily and quickly read. The writing style of all of the contributors is clear and concise, the chapters are well organized, and the images are top-quality. The information is complete, and there is good clinical information to accompany the imag-

Guides to the Evaluation of Permanent Impairment. 5th ed. Linda Cocchiarella and Gunnar B.J. Andersson, editors. Chicago: American Medical Association; 2001. 350 pages. $139.00. The American Medical Association has assumed the nearly impossible mission of attempting to set standards for the quantification of loss of human body parts and their functions. The fifth edition of Guides to the Evaluation of Permanent Impairment is the latest attempt to refine that effort. Almost every body part is invaluable to the individual. Assigning a value to any body part is arbitrary, but assigning a value to a body part in relation to the whole body makes the process more reasonable. Even then, the assessment can be controversial. Quantification of loss is a necessary function in our society, in which individuals are compensated with cash payments for permanent impairments and disabilities. The fairness of the system depends on the ability to assign consis-

 THE JOUR NAL OF BONE & JOINT SURGER Y · JBJS.ORG VO L U M E 83-A · N U M B E R 9 · S E P T E M B E R 2001

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Book Reviews tent ratings for given losses. Consistency and fairness can come about only when every physician accepts and applies a universal standard for the evaluation of impairments. Many of the ratings derived from the Guides will be based on the subjective wisdom and experience of the authors. Nonetheless, this text provides the necessary single standard for all. It does not cover every possible loss, and individual examiners must still use their subjective wisdom when rating impairments. The application of each examiner’s unique experience and accumulated wisdom to the assessment of any given impairment produces impairment ratings as varied as the wisdom and experience of the many examiners. The authors recognize that they have not succeeded in their mission. In Chapter 1, section 1.5, the editors acknowledge that this edition does not provide impairment ratings for some conditions, and they recommend the application of clinical judgment and the assignment of ratings with use of the portions of the Guides that most closely approximate the patient’s condition. Compared with previous editions, the introductory chapters of the current edition provide clearer distinctions between the concepts of impairment and disability, but the definition of handicap has been reduced to a synonym for disability. The sections on the spine, the upper extremity, and the lower extremity (Chapters 15, 16, and 17), each written by a separate committee, are subdivisions of the third chapter of the fourth edition. (The recommended methods for calculating impairment of the lower extremity occasionally conflicted with those for calculating impairment of the upper extremity, and these conflicts were confusing within a single chapter.) The musculoskeletal system was covered in 113 pages of text in the fourth edition compared with 181 pages in the fifth edition. Both editions basically use the same tables and figures to define impairment. The expansion in the fifth edition comes from the inclusion of instructions for the use of those tables and figures. Table 16 of the fourth edition, which provided a greater impairment rating for mild residual sensory symptoms of carpal tunnel syndrome than for the complete loss of the ring finger, has been removed from the fifth edition. The current edition includes a separate section with clearer instructions for assigning a more appropriate rating to carpal tunnel syndrome. The index for this edition, like that for the last, is too brief to be useful. The improvements in the fifth edition are not based on the latest scientific advances as much as on an improved use of the age-old art of communication. Each new edition of the Guides has improved on the last by more clearly defining losses on the basis of objective criteria. This text continues to improve as it becomes more comprehensive and less reliant on the individual examiner’s subjective accumulated wisdom. Standardization of the impairment rating process began

nearly fifty years ago, and it will continue through many years and editions to come. The current edition of Guides to the Evaluation of Permanent Impairment is imperfect, but it is the best that is available in 2001. Joseph P. Zeppieri, MD Lawrence and Memorial Hospital Newfoundland, Connecticut

Skeletal Function and Form. Mechanobiology of Skeletal Development, Aging, and Regeneration. Dennis R. Carter and Gary S. Beaupré. Cambridge, United Kingdom: Cambridge University Press; 2001. 330 pages. $80.00. This splendid book has been thoughtfully and eloquently written by two renowned bioengineers from California (Carter is from Stanford and Beaupré, from Palo Alto), who have collaborated for many years in their research. The essence of the book is “about how function determines form” in the skeletal system. The authors’ objective is to present a consistent approach for understanding the regulatory role of mechanical factors in the biology of skeletal development, growth, aging, functional adaption, and regeneration. They merit our congratulations because they achieve their goal in keeping with the wisdom of Solomon, who said “Give me facts, but above all, give me understanding.” The broad audience for whom this book was written includes anatomists, anthropologists, bioengineers, biologists, biophysicists, molecular geneticists, paleontologists, physicians, surgeons, and students of the physical and life sciences. There is certainly something of interest in the text for all of these specialists. The book begins with a fascinating historical background of past theories of the relationship between function and form, from embryonic life to old age. It then goes on to describe the histomorphology and mechanics of skeletal tissue, including cartilage, bone, tendons, and ligaments. Stress is defined as “a measure of the local intensity of a force in a material and has units of force per area,” and strain is defined as “a normalized measure of local deformation.” From their investigations of the early development of the normal cartilage endoskeleton, the authors conclude that mechanical loading and hydrostatic pressure are important. They also cite their research on models of endochondral growth and ossification that shed light on the process of longitudinal bone growth through the epiphyseal plates (physes). With regard to bone-remodeling around surgical implants, the authors elucidate the phenomena of stressshielding under fracture plates and loosening of components of prosthetic joint replacements. The results of the healing of fractures under conditions of rigid immobilization (as exemplified by the AO system) are compared with those of functional treatment that encourages

 THE JOUR NAL OF BONE & JOINT SURGER Y · JBJS.ORG VO L U M E 83-A · N U M B E R 9 · S E P T E M B E R 2001

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Book Reviews controlled motion (as advocated by Sarmiento). The latter system is associated with much more abundant callus than is the former. The book includes many examples of the mechanobiological characteristics of various tissues. In chapter 7, “Skeletal Tissue Regeneration,” the authors refer to the biological concept of continuous passive motion as a stimulus for pluripotential mesenchymal cells to differentiate into hyaline articular cartilage (neochondrogenesis) and thereby to provide a biological resurfacing of a full-thickness defect of a joint surface. The pathogenesis of osteoarthritis is described in detail, with particular attention given to the gradual replacement of cartilage by bone in old age. This finely crafted book with its very clear illustrations provides an introduction to the role of physical factors in the development and evolution of the vertebrate skeleton. The authors emphasize that mechanobiological research in parallel with biomechanical research is essential in determining the role that mechanical factors play in regulating the form of skeletal tissues. Anyone who is interested in any aspect of skeletal disorders and injuries can feel deeply indebted to these two fine authors for providing us with complete coverage and facilitating a clear understanding of the complex, sophisticated field of bioengineering and its related field of mechanobiology. I am confident that this outstanding book will become a classic. Robert B. Salter, MD, FRSC, FRCS(C) Professor Emeritus of Orthopaedic Surgery University of Toronto The Hospital for Sick Children Toronto, Ontario, Canada

Chapman’s Orthopaedic Surgery. 3rd edition, volumes 1 through 4 and CD-ROM. Michael W. Chapman, editor. Philadelphia: Lippincott Williams and Wilkins; 2001. 5152 pages. $425.00. The second edition of this text has been a standard and heavily used reference in our residents’ library for years. This new edition is indeed welcome. Dr. Chapman has selected an out-

standing group of new section editors and chapter authors who represent the most active and influential contributors to the broad field of orthopaedics today. The book reflects an enormous organizational effort. The format of the sections and chapters is consistent. For each major area of orthopaedics, the relevant supporting basic science and pathophysiology are presented. Nonoperative treatment is appropriately discussed before surgical options. Classic operations as well as current operative treatments are described clearly and are supported by ample illustrations and photographs. Many chapters include refreshing sections entitled “Hints and Tricks” and “Author’s Perspective,” which greatly add to the readability of this comprehensive text. Many chapters include a section on “Pitfalls and Complications,” which clearly outlines the risks of the various procedures and presents appropriate management and salvage strategies. A CD-ROM is included as a special feature of this edition, which ensures portability and a comprehensive search capacity. I was particularly impressed with the chapter references, which, in almost every instance, include the classics of our literature as well as up-to-date reviews and scientific papers. Many of the books and articles that I have quoted repeatedly for years are cited, and I was pleased to see these references preserved for our younger generation of orthopaedists. This book is intended to serve not only as a reference but also as a primary source for an orthopaedic residency core curriculum. Supplemented by Orthopaedic Knowledge Update and Orthopaedic Basic Science, both published by the American Academy of Orthopaedic Surgeons, it should serve this function very well. This outstanding, up-to-date work will be a valuable addition to the libraries of orthopaedic residents, who can rely on it as a foundation for their study. It will also be an excellent reference for the general orthopaedic surgeon who wants a current, comprehensive source of orthopaedic knowledge. Larry S. Matthews, MD Section of Orthopaedic Surgery University of Michigan Hospitals Ann Arbor, Michigan
Basic Biomechanics of the Musculoskeletal

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