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 Textbook of
ORTHOPEDICS AND TRAUMA
 4 VOLUMES
Textbook of
ORTHOPEDICS AND TRAUMA
Third Edition
Under the Aegis of
Indian Orthopedic Association

Editors
GS Kulkarni
MS MS (Ortho) FRCS FICS
Director, Professor and Head
Postgraduate Institute of
Swasthiyog Pratishthan
Miraj, Maharashtra, India
Director
Sandhata Medical Research Society
Miraj, Maharashtra, India

Sushrut Babhulkar
MS (Ortho) MCh (Orth) Liverpool, UK
Director
Sushrut Hospital
Research Centre and Postgraduate Institute of Orthopedics
Nagpur, Maharashtra, India
Secretary
Trauma Society of India
Chief
Centre for Joint Reconstruction and Trauma Surgery

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Textbook of Orthopedics and Trauma (4 Volumes)

First Edition: 1999

Second Edition: 2008
Third Edition: 2016
ISBN: 978-93-85891-05-2
Printed at
 Dedicated to
My wife Shashikala
and Children
Milind, Sunil, Rajiv, Vedavati, Ruta and Vidisha, Sujay and Madhura
for their untiring help

— GS Kulkarni

My father Professor Dr Sudhir Babhulkar,

who inculcated in me the art of Orthopedics,
My mother Aruna who created the passionate me,
my loving wife, Dr Nandini, and
lovely daughters Sanskriti and Siddhi
for sparing me for Orthopedic Academics

— Sushrut Babhulkar
 Contributors
AA Kulkarni Aditya Pawaskar Amit Chanduka
Dental Clinic Assistant Professor Associate Consultant
Bijapur, Karnataka, India Lokmanya Tilak Municipal Medical College Department of Neurosciences
Mumbai, Maharashtra, India Sakra World Hospital, Bengaluru, Karnataka, India
A Devendra
Associate Consultant Aditya Prasad Panda Amit Jhala
(Orthopedics and Trauma Surgery) Association of Spine Surgeons of Consultant Spine Surgeon
Ganga Hospital India (ASSI) Spine Fellow Director and Head
Coimbatore, Tamil Nadu, India Department of Orthopedics Department of Spine Surgery
Apollo Hospitals Chirayu Hospital and HCG Hospitals
Aashish Gulati Chennai, Tamil Nadu, India Ahmedabad, Gujarat, India
Specialist Registrar
Trauma and Orthopedics Ajay Chandanwale Amit Narayan
East Midlands South Rotation, UK Dean and Professor ASSI Spine Fellowship
Honorary Research Fellow BJ Medical College and Spine Fellow
Nuffield Department of Orthopaedics Sassoon General Hospital Indian Spinal Injuries Center, New Delhi, India
Rheumatology and Musculoskeletal Sciences Pune, Maharashtra, India
Amit Nath Mishra
(NDORMS), University of Oxford, UK
Chief of Orthopedic Surgery
Ajay Puri
Max Hospital
Abhay Nene Chief (Orthopedic Oncology)
Noida and Greater Noida, Uttar Pradesh, India
Consultant Spine Surgeon Professor and Head (Surgical Oncology)
Wockhardt Hospital Tata Memorial Center and Amit Singla
PD Hinduja Hospital and Homi Bhabha National Institute Senior Resident
Medical Research Center Mumbai, Maharashtra, India Department of Orthopedics
Mumbai, Maharashtra, India All India Institute of Medical Sciences (AIIMS)
Ajay Singh Thakur
New Delhi, India
Abhinav Agarwal Department of Orthopedics
Senior Resident Amol Patil
Department of Orthopedics Ajoy Prasad Shetty Sushrut Hospital
All India Institute of Medical Sciences (AIIMS) Senior Consultant Spine Surgeon Research Centre and Postgraduate Institute of
New Delhi, India Division of Orthopedics Orthopedics
Trauma and Spine Surgery Ramdaspeth, Nagpur, Maharashtra, India
Abhishek Kulkarni Ganga Hospital
Rainbow Superspecialty Hospital and Children’s Coimbatore, Tamil Nadu, India Amol Tambe
Orthopedic Centre Assistant Professor and
Pediatric Orthopedic Surgeon AK Jain Consultant Upper Limb Surgeon
Smt NHL Municipal Medical College Professor and Head Upper Limb Clinical Specialist Physiotherapist
Ahmedabad, Gujarat, India Department of Orthopedics The Derby Shoulder Unit
University College of Medical Sciences (UCMS) and Department of Trauma and Orthopaedic Surgery
Abhishek Srivastava Guru Teg Bahadur (GTB) Hospital Royal Derby Hospital
Senior Spine Fellowship (UK, Singapore) New Delhi, India Derby Teaching Hospitals NHS Foundation Trust, UK
Consultant Spine Surgeon Visiting Professor
Department of Spine Surgery The Tamil Nadu Dr MGR Medical University Anagha Vaze
Primus Superspecialty Hospital Chennai, Tamil Nadu, India Consultant Psychiatrist
New Delhi, India Institute for Psychological Health
Alaric Aroojis Thane, Maharashtra, India
Achut Rao Pediatric Orthopaedic Surgeon
Professor in Orthopedics Kokilaben Dhirubhai Ambani Hospital Anand J Thakur
Postgraduate Institute of Swasthiyog Pratishthan Mumbai, Maharashtra, India Consultant Orthopedic Surgeon
Fracture and Orthopedics Hospital PD Hinduja Hospital and Medical Research Center
Miraj, Maharashtra, India Alex Sonaru Mumbai, Maharashtra, India
Northwestern University
Anant Joshi
Aditya Kaushik Department of Orthopedic Surgery
E-52, Lokmanya Nagar
Honorary Consultant Chicago, Illinois, USA
Th Kataria Marg Mahim
Hand and Reconstructive Microsurgeon
Mumbai, Maharashtra, India
Nanavati Superspecialty Hospital Aman Dua
Mumbai, Maharashtra, India Orthopedic, Joint Replacement Sugeon Anil Agarwal
Consultant Joint Replacement Department of Orthopedics
Aditya Menon Surgeon and Orthopedic Surgeon School of Medical Sciences and Research
Bombay Orthopedic Research Fellow Primus Superspecialty Hospital Sharda University
Mumbai, Maharashtra, India New Delhi, India Greater Noida, Uttar Pradesh, India

Aditya N Aggarwal Amish Sanghvi Anil Arora

Department of Orthopedics Consultant and Head Department of Orthopedics
University College of Medical Sciences and Department of Spine Surgery School of Medical Sciences and Research
Guru Teg Bahadur (GTB) Hospital Sterling Hospitals Sharda University
New Delhi, India Rajkot, Gujarat, India Greater Noida, Uttar Pradesh, India
 viii Textbook of Orthopedics and Trauma

Anil Bhat Arjun Veigus Attique Vasdev

Professor and Head Inlaks and Budhrani Hospital Associate Director
Unit of Hand and Microsurgery Pune, Maharashtra, India Knee Division
Department of Orthopedics Medanta Bone and Joint Institute
Kasturba Medical College Arvind Bhave Medanta—The Medicity, Gurgaon, Haryana India
Manipal, Karnataka, India Professor of Orthopedics
Bharati Vidyapeeth Medical College Pune Atul Bhaskar
Anil Bhatia Spine Surgeon Fellowship Training in Pediatric
Academic Head Plastic Surgery Deenanath Mangeshkar Hospital Orthopedic (Sickkids—Toronto)
Bombay Hospital, Mumbai, India Pune, Maharashtra, India Pediatric Orthopedic Surgeon
Consultant Plastic Surgeon Bombay Hospital Institute of Medical Sciences
Bai Jerbai Wadia Hospital for Children Arvind Kulkarni RN Cooper Hospital
Mumbai, Maharashtra, India Consultant Spine Surgeon, Mumbai Mumbai, Maharashtra, India
Spine Scoliosis and Disc Replacement Centre
Bombay Hospital, Mumbai AV Gurava Reddy
Anirban Chatterji Consultant Joint Replacement Surgeon
Rainbow Superspecialty Hospital and Children’s Mumbai, Maharashtra, India
Hyderabad, Telangana, India
Orthopedic Centre
Pediatric Orthopedic Surgeon AS Rao
B Mohapatra
Smt NHL Municipal Medical College Pediatric Orthopedic Surgeon
Post Doctral Fellowship in Spine Surgery
Ahmedabad, Gujarat, India Sydney, Australia
Ashish Babhulkar
Consultant Spine Surgeon
Head
Ankit Varshneya Indian Spinal Injuries Center, New Delhi, India
Department of Shoulder and Sports Injuries
Postgraduate Institute of Swasthiyog Pratishthan
Deenanath Mangeshkar Hospital Baldev Dudani
Miraj, Maharashtra, India
Sancheti Institute of Orthopedics for Rehabilitation Head
Pune, Maharashtra, India Department of Orthopedics
Ankur Nanda
Fellowship in Deformity and Degenerative Ruby Hall Clinic
Ashish Gulati Pune, Maharashtra, India
Spine Surgery
Specialist Registrar
Spine Consultant
Trauma and Orthopedics Bassam A Masri
Indian Spinal Injuries Center
East Midlands South Rotation, UK Clinical Assistant Professor and Head
New Delhi, India
Honorary Research Fellow Division of Reconstructive Orthopedics
NDORMS, University of Oxford, UK University of British Columbia
Ankush Varshneya
Vancouver, BC, Canada
Postgraduate Institute of Swasthiyog Pratishthan Ashish Gulia
Fracture and Orthopedic Hospital Associate Professor BB Joshi
Miraj, Maharashtra, India Orthopedic Oncology Consultant in Hand Surgery and
Department of Surgical Oncology Reconstructive Surgery
Anoop Jhurani Secretary, BST-DMG JESS Research and Development Centre
Consultant Tata Memorial Hospital Mumbai, Maharashtra, India
Department of Orthopedics Mumbai, Maharashtra, India
Fortis Hospital BB Kanaji
Jaipur, Rajasthan, India Ashish Shah JESS Research and Development Centre
Assistant Professor Mumbai, Maharashtra, India
Aravind Kumar Orthopedic Foot and Ankle Surgery
Consultant Spine Surgeon University of Alabama BD Pujari
Khoo Teck Puat Hospital Shree Hospital, Extension Area
Birmingham, AL, USA
Singapore Miraj, Maharashtra, India
Ashok K Shyam Bharath R
Archi Agarwal Director Associate Consultant
Associate Professor The Arthritis Clinic, Mumbai Department of Neurosciences
Department of Nuclear Medicine and Sancheti Institute for Orthopedics and Sakra World Hospital
Molecular Imaging Rehabilitation, Pune Varthur, Hobli, Bengaluru, Karnataka, India
Tata Memorial Hospital Chief Researcher and Head
Mumbai, Maharashtra, India Indian Orthopedic Research Group Bharat R Dave
Thane, Maharashtra, India Spine Surgeon
Areena D’Souza Founding Trustee Stavya Spine Hospital and Research Institute
Spine Fellow Indian Orthopedics Research Society Ahmedabad, Gujarat, India
Indian Spinal Injuries Center Editor, Journal of Orthopaedic Case Reports
New Delhi, India Bhaskar Borgohain
Associate Professor
Ashok Rajgopal
Chairman, Medanta Bone and Joint Institute North Eastern Indira Regional Institute of Health
Arun Mullaji
and Medical Sciences
Joint Replacement Surgeon Medanta—The Medicity
Gurgaon, Haryana, India Neigrihms
Breach Candy Hospital and Lilavati Hospital
Shillong, Meghalaya, India
Mumbai, Maharashtra, India
Ashwath Acharya Bhaskarananda Kumar
Arun Pal Singh Associate Professor Former Professor
Professor of Orthopedics Unit of Hand and Microsurgery Unit of Hand and Microsurgery
Bharati Vidyapeeth Deemed University Medical Department of Orthopedics Department of Orthopedics
College and Hospital Kasturba Medical College Kasturba Medical College
Sangli, Maharashtra, India Manipal, Karnataka, India Manipal, Karnataka, India
 Contributors ix
Bhavin Jankharia CJ Thakkar Dinshaw Pardiwala
Consultant Radiologist 801, Shantanu Jiwan-Flat. 7a, Ii LD Ruparel Marg
Piramal Diagnostics—Jankharia Imaging St Martin Road, Mumbai, Maharashtra, India Malabar Hill
Mumbai, Maharashtra, India Mumbai, Maharashtra, India
Clement Joseph
Bhavuk Garg Orthopedic Surgeon DK Mukherjee
Assistant Professor (Orthopedics) Sports and Arthroscopy P 281, Narkal Danga
Editor-in-Chief, IJRI G Kuppuswamy Naidu Memorial Hospital Main Road, Kolkata, West Bengal, India
All India Institute of Medical Sciences Coimbatore, Tamil Nadu, India
New Delhi, India DK Taneja
Program Chair Clive Duncan 178, Anoop Nagar
Texilla American University, South America Professor and Chairman Indore, Madhya Pradesh, India
Former Consultant, Postgraduate Institute of Division of Reconstructive Orthopedics
Medical Education and Research (PGIMER) University of British Columbia Dominic K Puthoor
Chandigarh, India Vancouver, BC, Canada Department of Orthopedics
Fellow in Arthroplasty (J and J) Amala Institute of Medical Sciences
Conor JC Gouk Thrissur, Kerala, India
Fellow in Trauma and Orthopedic
Royal Devon and Exeter Hospital
Surgery (Germany)
Exeter EX2, SOW, UK Donald S Garbuz
Robert Roaf Fellow, ASSI Spine
Fellow, Dartmouth Spine Fellow (USA) Clinical Instructor
D Patil Division of Reconstructive Orthopedics
SRS Spine Clinical Fellow (USA)
Sushrut Hospital and Research Centre University of British Columbia
AADO Trauma Fellow (Hong Kong)
Ramdas Peth Vancouver, BC, Canada
Former Senior Research Associate (CSIR, ICMR)
Nagpur, Maharashtra, India
DP Bakshi
Bidre Upendra David Pedowitz DA-3, Sector 1
Consultant Spine Surgeon Associate Professor Salt Lake City
Jain Institute of Spine Care and Research (JISAR) Department of Orthopedic Surgery Kolkata, West Bengal, India
Bhagwan Mahaveer Jain Hospital Sidney Kimmel Medical College
Bengaluru, Karnataka, India Thomas Jefferson University Dror Paley
The Rothman Institute Professor of Orthopedic Surgery
Binu P Thomas Philadelphia, Pennsylvania, USA Maryland Centre for Limb
Professor and Head
Lengthening and Reconstruction
Paul Brand Centre for Hand Surgery David Stanley Baltimore, USA
Christian Medical College and Hospital Consultant Shoulder and Elbow Surgeon
Vellore, Tamil Nadu, India Department of Shoulder and Elbow Surgery Emmanuel Bhore
Sheffield Teaching Hospitals NHS Foundation Trust Postgraduate Institute of Swasthiyog Pratishthan
BM Diwanmal Sheffield, UK Fracture and Orthopedics Hospital
Postgraduate Institute of Swasthiyog Pratishthan
Miraj, Maharashtra, India
Miraj, Maharashtra, India David V Rajan
Professor and Head
BS Diwan Department of Arthroscopy and Sports Medicine Eric J Lew
Consultant Orthopedics Kovai Medical Center and Hospital Resident
Diwan Hospital Coimbatore, Tamil Nadu, India Mercy Health Foot and Ankle Residency
Sangli, Maharashtra, India Avon, Ohio, 44011 USA
Deepthi Nandan Adla
Chasnal Rathod Senior Consultant Orthopedic Surgeon Fares S Haddad
Pediatric Orthopedic Fellowship (Korea) Continental Hospital Clinical and Reserach Fellow
Pediatric Orthopedic Surgeon Hyderabad, Telangana, India Division of Reconstructive Orthopedics
Cerebral Palsy Clinic University of British Columbia
Jupiter Hospital Deepu Banerji Vancouver, BC, Canada
Mumbai, Maharashtra, India Director
Department of Neurosurgery Fouad Tariq Aziz
Cherry Kovoor Brain and Spine Center Postgraduate Institute of Swasthiyog Pratishthan
Pediatric Orthopedic and Fortis Hospitals Ltd, Mumbai, Maharashtra, India Fracture and Orthopedics Hospital
Limb Reconstruction Specialist Miraj, Maharashtra, India
Ernakulam Medical Center and Specialist Hospitals Devanand
Frank Luckino III
Kochi, Kerala, India Fellowship in Spine (SSHRI)
Resident
Minimally Invasive and Complex Spine Fellow
Mercy Health Foot and Ankle Residency
Chirag Thonse (UCSF, San Fransisco), USA
Avon, Ohio, 44011, USA
Orthopedic Consultant Clinical and Research Fellow in Scoliosis
St Martha’s Hospital (South Korea) G Omkarnath
Bengaluru, Karnataka, India Associate Consultant Spine Surgeon Associate Professor
Stavya Spine Hospital and Research Institute Department of Orthopedics
Chong Jin Yeo Ahmedabad, Gujarat, India Gandhi Medical College
Hand and Microsurgery Section Secunderabad, India
Department of Orthopedic Surgery Dhiren Ganjawala
Tan Tock Seng Hospital Consultant Orthopedic Surgeon GA Anderson
Singapore NHL Municipal Medical College Professor of Orthopedic Surgery
Ahmedabad Head Department of Hand Surgery and Leprosy
Christopher E Gross Ganjawala Orthopedic Hospital Reconstructive Surgery
Rush University Medical Center Pediatric Orthopedic Surgeon Christian Medical College and Hospital
Chicago, IL 60622 Ahmedabad, Gujarat, India Vellore, Tamil Nadu, India
 x Textbook of Orthopedics and Trauma

Gautam Zaveri Hiranya Kumar Seenappa J Maheshwari

Consultant Spine Surgeon Professor Delhi Institute of Trauma and Orthopedics
Jaslok Hospital and Research Center Department of Orthopedics Sant Parmanand Hospital
Mumbai, Maharashtra, India Vydehi Institute of Medical Sciences and New Delhi, India
Research Center
Girish Chinnaswamy Bengaluru, Karnataka, India Jaideep Dhamale
Tata Memorial Hospital Rainbow Superspeciality Hospital and Children’s
Mumbai, Maharashtra, India Hitesh Chauhan Orthopedic Centre
Pediatric Orthopedic Surgeon Pediatric Orthopedic Surgeon
Gregory Ian Bain Director Smt NHL Municipal Medical College
Associate Professor Rainbow Superspecialty Hospital and Ahmedabad, Gujarat, India
Department of Orthopedics and Trauma Children’s Orthopedic Center
Discipline of Anatomy and Pathology Ahmedabad, Gujarat, India Janardhana Aithala
University of Adelaide Associate Professor and In-charge (Spine Clinic)
Royal Adelaide Hospital and Hitesh Shah Department of Orthopedics
Modbury Public Hospital Associate Professor and Kasturba Medical College and Hospital
South Australia, Australia Pediatric Orthopedic Surgeon Mangaluru, Karnataka, India
Kasturba Medical College
GS Kulkarni Manipal, Karnataka, India Javahir A Pachore
Director, Professor and Head Plough Share, 4/A, 415 Sitladevi Temple Road
Postgraduate Institute of Swasthiyog Pratishthan HK Pande Mahim (W), Mumbai, Maharashtra, India
Miraj, Maharashtra, India Wanless Hospital
Jayanth Sampath
Director Miraj, Maharashtra, India
Consultant Pediatric Orthopedics Surgeon
Sandhata Medical Research Society
Bangalore Institute of Movement Research and
Miraj, Maharashtra, India HK Sugathan
Analysis (BIMRA)
Clinical Fellow (Foot and Ankle Surgery)
Guido Marra Bengaluru, Karnataka, India
Stockport NHS Foundation Trust
Northwestern University Poplar Grove Jayita Deodhar
Department of Orthopedics Surgery Stockport Psychiatric Unit and Department of Palliative Care
Chicago, Illinosis, USA SK2 7JE, UK Tata Memorial Hospital
Mumbai, Maharashtra, India
Gurunath S Wachche Hariram Jhunjhunwala
Associate Professor (Orthopedics) D/4, Sunita 62, Pedder Road JE Herzenberg
Lee-Shaw Fellowship - Singapore 2002 Mumbai, Maharashtra, India Associate Professor
UAB-IFAS Fellow - USA 2014 Division of Orthopedic Surgery
Wachche Hospital HS Chhabra University of Maryland
Solapur, Maharashtra, India Chief (Spine Service) Baltimore, USA
Medical Director
Gururaj M Sangondimath Indian Spinal Injuries Center Jean Destandau
Spine Consultant New Delhi, India Neurosurgeon
Indian Spinal Injuries Centre Endospine Surgery Center
New Delhi, India I Lorenz Maybelle Clinique Bel-Air
Former Chairman 138, avenue de la Republique,
Hari Ankem Department of Traumatology and 33200 Bourdeaux, Cedex, France
Consultant Orthopedic Surgeon Reconstructive Surgery
Apollo Health City Katharinen Hospital, Stuttgart, Germany Jennifer Gerres
Hyderabad, Telangana, India Resident
Ignacio Ponseti Mercy Health Foot and Ankle Residency
Harish Bhende Emeritus Professor 36711, American Way Blvd
5, Satjangad Co-Op. Housing Society University of Iowa, Iowa, USA Avon, Ohio, 44011 USA
166-D, Dr. Ambedkar Road, Dadar (E)
Mumbai, Maharashtra, India IK Dhammi Jeniffer Piezto
Consultant Orthopedic Surgeon
Harshit Gehlot Department of Orthopedics Jennifer Prezioso
Postgraduate Institute of Swasthiyog Pratishthan University College of Medical Sciences (UCMS) and Staff
Fracture and Orthopedics Hospital Guru Teg Bahadur (GTB) Hospital Department of Foot and Ankle Surgery
Miraj, Maharashtra, India New Delhi, India Mercy Health Clinical Faculty
Mercy Health Foot and Ankle Residency
HC Goyal Ishwara Keerthi 36711, American Way Blvd
Additional Director of General Health Services Consultant Spine Surgeon Avon, Ohio, 44011, USA
(DGHS), Nirman Bhavan Department of Spine Surgery
New Delhi, India KMC Hospital Jeremy Burnham
Mangaluru, Karnataka, India University of Kentucky
Hemant Wakankar Elbow Shoulder Research Centre
B-89, Tulshibagwale Colony J Aronson Department of Orthopedic and Sport Medicine
Devchhayaa, Sahakar Nagar Road Parvati USA
Pune, Maharashtra, India J Dheenadhayalan
Director and Head Jitendra Mangwani
Himani Kolhatkar Division of Orthopedics Consultant Trauma and Orthopaedic Surgeon
Physiotherapist Trauma and Spine Surgery University Hospitals of Leicester
AB Healthcare Ganga Hospital Infirmary Square
Pune, Maharashtra, India Coimbatore, Tamil Nadu, India Leicester, LE1 5WW, UK
 Contributors xi
JJ Patwa Karthik Kailash Kiran KV Acharya
Trauma, Ilizarov, Orthopedics, Orthoplastic Senior Consultant Assistant Professor
Reconstruction, Hand, Spine and Nova Specialty Hospitals Department of Orthopedics
Joint Replacement Surgeon Chennai, Tamil Nadu, India Kasturba Medical College
Manipal, Karnataka, India
JK Patil Kartik Hariharan
Apple Diagnostic Centre, Vyapari Peth Consultant Orthopaedic and Foot and Kiran Patnakar
Kolhapur, Maharashtra, India Ankle Surgeon, Royal Gwent Hospital Apple Diagnostic Centre
Newport, South Wales, UK Vyapari Peth
Joseph J Dias Kolhapur, Maharashtra, India
Professor of Hand and Orthopedic Surgery Kavita Iyenger
University Hospitals of Leicester Kiran Sasi P
Leicester, UK Kekre P Assistant Professor
Consultant Spine Surgeon Paul Brand Centre for Hand Surgery
John S Lewis Sundaram Medical Foundation Christian Medical College and Hospital
Orthopedic Surgery Specialist Chennai, Tamil Nadu, India Vellore, Tamil Nadu, India
Charlotte, North Carolina, USA
Kelly Bumpus Kirti Ramnani
JR Hanson Resident, Mercy Health Foot and Ankle Residency Rainbow Superspecialty Hospital and Children’s
36711 American Way Blvd Orthopedic Centre
Justin Gettings Avon, Ohio, 44011, USA Pediatric Orthopedic Surgeon
Northwestern University Smt NHL Municipal Medical College
Department of Orthopedic Surgery Kenny S David Ahmedabad, Gujarat, India
Chicago, Illinois, USA Professor and Head
Spinal Disorders Surgery Unit KN Shah
Jwalant Mehta Department of Orthopedic Surgery Fracture and Orthopedic Hospital
Consultant Spinal Deformity Surgeon Christian Medical College and Hospital Ahmedabad, Gujarat, India
Royal Orthopaedic Hospital Vellore, Tamil Nadu, india
Birmingham, UK KP Srivastava
Ketan Gandhi Emeritus Professor of Orthopedics
K Chakraborty Assistant Professor SN Medical College
DA-3, Sector 1 Department of Orthopedics Agra, Uttar Pradesh, India
Salt Lake City, Kolkata, West Bengal, India Bharati Vidyapeeth Medical College and
Bharati Hospitals and Research Centre Kumar Kaushik Dash
K Hardinge Pune, Maharashtra, India Assistant Professor
Writington General Hospital, UK Department of Orthopedics
Ketan Pande Grant Medical College
Krishnamurthy Sridhar Consultant Orthopedic and Spinal Surgeon Sir JJ Group of Hospitals
Director Division of Spinal Surgery Mumbai, Maharashtra, India
Institute of Neurosciences and Spinal Disorders Sushrut Hospital Research Centre and
Head Postgraduate Institute of Orthopedics KV Menon
Brain and Spine Surgery Ramdaspeth Senior Consultant (Orthopedics)
Global Health City, Chennai, Tamil Nadu, India Nagpur, Maharashtra, India Khoula Hospital
Muscat, Sultanate of Oman
K Venkatesan Ketan S Khurjekar
Professor Chief Lauren L Kishman
Spinal Disorders Surgery Unit Spine Surgery Services Resident
Christian Medical College (CMC) and Hospital Sancheti Hospital Mercy Health Foot and Ankle Residency
Vellore, Tamil Nadu, India Pune, Maharashtra, India 36711 American Way Blvd
Avon, Ohio, 44011 USA
KA Mansukhani Kevin Lim
Pediatric Orthopedic Fellowship (Sickkids - Toronto) Laxmi Vas
Kalpesh Shah Canada Consultant Pain Specialist
Director
Kanniraj Marimuthu Kevin Murr Ashirvad Institute of Pain Management and
Orthopedist University of Kentucky Research
Apollo Hospitals, Chennai, Tamil Nadu, India Elbow Shoulder Research Centre Mumbai, Maharashtra, India
Department of Orthopedic Surgery
Kanthan Theivendran UK Leena Jain
Shoulder Fellow
The Derby Shoulder Unit Leonid Solomin
Khalid Alquwayee
Department of Trauma and Orthopedic Surgery Clinical and Reserach Fellow
Royal Derby Hospital Madhura Kulkarni
Division of Reconstructive Orthopedics PGI of Swasthiyog Pratishthan
Derby Teaching Hospitals NHS Foundation University of British Columbia
Trust, UK Fracture and Orthopedics Hospital
Vancouver, BC, Canada Miraj, Maharahstra, India
Kapil Gangwal Khushboo Pilania Mahendra S Kudchadkar
Rainbow Superspeciality Hospital and Children’s
Healthway Hospital, Goa, India
Orthopedic Centre Kiran M Doshi
Pediatric Orthopedic Surgeon Kolhapur Institute of Orthopedics and Mahesh Kulkarni
Smt NHL Municipal Medical College Trauma (KIOT) Joint Replacement Clinic
Ahmedabad, Gujarat, India Kolhapur, Maharashtra, India Pune, Maharashtra, India
 xii Textbook of Orthopedics and Trauma

Mahesh Menon Manish Khanna Michael Aynardi

Consultant Former Consultant, SGPGI, Lucknow Assistant Professor
Department of Pain Medicine and Charter Secretary General, Indian Orthopaedic Department of Orthopedic Surgery and
Palliative Care Services Rheumatology Association Rehabilitation
Department of Integrated Oncology Associate Professor of Orthopedics, Government Penn State Hershey, School of Medicine
Kokilaben Dhirubhai Ambani Hospital and Medical Medical College, Ambedkarnagar, Uttar Pradesh Hershey, Pennsylvania, USA
Research Institute Convener Orthopedics, Stem Cell Society of India
Mumbai, Maharashtra, India Mumbai Milind Chaudhary
Former Secretary, Vice President, Indian Foot and Centre for Ilizarov Techniques
Malhar Dave Ankle Society, Mumbai Chaudhary Trust Hospital
Orthopedic and Foot and Ankle Surgeon Nominated Indian Member, International Clubfoot Akola, Maharashtra, India
Abhishek Hospital Study Group
Vadodara, Gujarat, India Chief Consultant, Apley Clinic Orthopedic Centre Milind G Kulkarni
Lucknow, Uttar Pradesh, India Professor in Orthopedics
Malini Lawande Postgraduate Institute of Swasthiyog Pratishthan
Consultant Manoj Kumar Goyal Fracture and Orthopedics Hospital
Department of MRI, Balabhai Nanavati Hospital A-6, Meera Bagh Miraj, Maharashtra, India
Mumbai, Maharashtra, India Pashchim Vihar, New Delhi
Mohammed Sadiq
Mallikarjun Balagaon Manoj Kumar Shukla Senior Resident
Postgraduate Institute of Swasthiyog Pratishthan Professor Department of Orthopedics
Fracture and Orthopedics Hospital Department of Orthopedics All India Institute of Medical Sciences (AIIMS)
Miraj, Maharashtra, India Vydehi Institute of Medical Sciences and New Delhi, India
Research Center, Bengaluru, Karnataka, India
Manan Gujarathi Mohinder Kaushal
Postgraduate Institute of Swasthiyog Pratishthan Manoj Padman Chief Consultant (Orthopedics)
Fracture and Orthopedics Hospital Rainbow Superspecialty Hospital and Children’s Endoscopic Spine, Knee and Sports Surgeon
Miraj, Maharashtra, India Orthopedic Centre Chairman, Department of Orthopedics and
Pediatric Orthopedic Surgeon Minimal Access Surgery, North India
Mandar Acharya Smt NHL Municipal Medical College
Rainbow Superspecialty Hospital and Children’s Ahmedabad, Gujarat, India Muhammod Tariq Sohail
Orthopedic Centre
Pediatric Orthopedic Surgeon Marcus Bateman Mukund R Thatte
Smt NHL Municipal Medical College Upper Limb Clinical Specialist Physiotherapist Academic Head Plastic Surgery
Ahmedabad, Gujarat, India The Derby Shoulder Unit Bombay Hospital, Mumbai
Department of Trauma and Orthopedic Surgery Consultant Plastic and Reconstructive Hand and
Mandar Agashe Royal Derby Hospital, Derby Teaching Hospitals Microvascular Surgeon
Pediatric Orthopedic Fellowship (Korea) NHS Foundation Trust, UK Bai Jerbai Wadia Hospital for Children
KJ Somaiya Hospital, Mumbai, Maharashtra, India Mumbai, Maharashtra, India
Mark A Hardy
Mandeep Dhillon Chief Nagesh Naik
Chairperson, AO Trauma India Foot and Ankle Surgery Professor of Orthopedics
President, Indian Association for Mercy Health Hospital Systems Bharati Vidyapeeth Deemed University Medical
Sports Medicine Clinical Faculty, Case Western Reserve University College and Hospital
Amritsar, Punjab, India School of Medicine Sangli, Maharashtra, India
Founder President Director, Mercy Health Foot and Ankle Residency
Indian Biological Orthopedics Society Director, NOFA Foundation Nandan Adla
Past President, Indian Arthroplasty Association Director, NOFA International Fellowship Consultant Shoulder Surgeon
Past President 36711 Amercian Way Blvd. Hyderabad, Telangana, India
Indian Foot and Ankle Society Avon, Ohio, USA
Nandan Rao
Past President, North Zone IOA
Mark Yuhas Consultant in Orthopedics
Professor and Head, Orthopedics
Elbow Shoulder Research Center Surat, Gujarat, India
Head
Department of Orthopedics and Sport Medicine
Department of Physical Medicine Narayana Prasad
University of Kentucky, Lexington, USA
PGIMER, Chandigarh, India Shoulder and Elbow Fellow
Mary Ann Muckaden Department of Shoulder and Elbow Surgery
Mandeep Shah Professor Sheffield Teaching Hospitals
Radiation Oncology and Pallative Care Services NHS foundation Trust Sheffield, UK
Mangal Parihar Tata Memorial Hospital
Mangal Anand Hospital Mumbai, Maharashtra, India Narendra Kumar Magu
Mumbai, Maharashtra, India Department of Orthopedics
Maulin M Shah Medical College, Rohtak, Haryana
Manik Menezes Consultant Pediatric Orthopedic Surgeon
Specialist, Plastic Surgeon OrthoKids Clinic Naresh Kumar
International Modern Hospital Ahmedabad, Gujarat, India Associate Professor
Dubai, UAE University of Singapore, Singapore
Mayilvahanan Natrajan
Manish Chadha Narsimha Ramni
Professor of Orthopedic MH Patwardhan Pediatric Orthopedic Surgery Fellow (USA)
Bharati Vidyapeeth Deemed University Endocrine Research Centre Senior Consultatnt
Medical College and Hospital Vantamure Corner, Sangli Road Pediatric Orthopedic Surgery
Sangli, Maharashtra, India Miraj, Maharashtra, India Indraprastha Apollo Hospitals, New Delhi, India
 Contributors xiii
Nayana Nayak P Suryanarayan Prakash Naik
Department of Plastic Surgery Plough Share, 4/A
Bombay Hospital and Institute of Medical Sciences 415 Sitladevi Temple Road Prakash P Kotwal
Mumbai, Maharashtra, India Mahim (W) Professor and Head
Mumbai, Maharashtra, India Department of Orthopedics
Nicolas Dedy All India Institute of Medical Sciences (AIIMS)
Upper Limb Fellow Pavan Desai New Delhi, India
Gold Coast University Hospital Consultant Upper Limb Surgeon Pramod Nagure
Southport, Australia Surat, Gujarat, India Consultant
Nikesh Shah Department of MRI, Balabhai Nanavati Hospital
Pankaj Patel Mumbai, Maharashtra, India
Foot and Ankle Surgeon Dean and Professor of Orthopedics Surgery
Indrapuri Hospital NHL Municipal Medical College Prasad Krishnan
Vadodara, Gujarat, India Ahmedabad, Gujarat, India Academic Director and Consultant Neurosurgeon
National Neurosciences Centre
Nikhil Sharma Pankush Arora Peerless Hospital Complex
Research Fellow Sancheti Institute of Orthopedics and Kolkata, West Bengal, India
Department of Orthopedics Rehabilitation, Pune
Apollo Hospitals Indian Orthopedic Research Group Prasanna C Rathi
Bengaluru, Karnataka, India Thane, Maharashtra, India Postgraduate Institute of Swasthiyog Pratishthan
Miraj, Maharashtra, India
Nilendu Purandare Parag Aland
Associate Professor Prashant Deshmane
Deparment of Nuclear Medicine and Molecular Parag Sancheti Plough Share, 4/A
Imaging Sancheti Institute for Orthopedics and 415 Sitladevi Temple Road
Tata Memorial Hospital Rehabilitation Mahim (W), Mumbai, Maharashtra, India
Mumbai, Maharashtra, India Pune, Maharashtra, India
Prashant Kamble
Assistant Professor
Niraj B Vasavada Parag Shah
Department of Orthopedics
Head of Department and Chief Surgeon Consultant Shoulder and Upper Limb Surgeon
Seth GS Medical College and
Department of Minimal Access and Endoscopic Fracture and Orthopedics Hospital
KEM Hospital, Mumbai, Maharashtra, India
Spine Surgery Ahmedabad, Gujarat, India
Consultant Spine Surgeon Praveen Bhardwaj
Shalby Hospitals and Krishna Shalby Hospital Parag Tamhankar Consultant, Hand and Wrist Surgery
Ahmedabad, Gujarat, India Rainbow Superspecialty Hospital and Division of Plastic Surgery
Children’s Orthopedic Centre Hand and Microsurgery and Burns
Nirmal C Mahapatra Pediatric Orthopedic Surgeon Ganga Hospital, Coimbatore, Tamil Nadu, India
Associate Professor in Orthopedics Smt NHL Municipal Medical College
SCB Medical College and Hospital Ahmedabad, Gujarat, India Pravin Kanabar
Cuttack, Odisha, India Love and Compassion Accident Free
Parmanand Gupta Ahmedabad
Nirmal Raj Gopinathan Associate Professor of Orthopedics Former President, Indian Orthopedic Association
Professor Government Medical College Hospital Indian Arthroscopy Society
Postgraduate Institute of Medical Education and Chandigarh, India Gujarat Orthopedic Association
Research (PGIMER), Chandigarh, India Professor and Head
PN Gupta Department of Orthopedics
Nishit Patel KM School of Postgraduate Medical and Research
Assistant Spine Consultant PN Jain NHL Municipal Medical College and VS Hospital
Indian Spinal Injuries Centre Professor Ahmedabad
New Delhi, India Anesthesiology Critical Care and Pain Consultant, Jaliyan Orthopedic Hospital
Head, Division of Pain Keshav Arthroscopy and Sport Medicine Clinic
Nitish Arora Department of Anesthesiology Ahmedabad, Gujarat, India
Postgraduate Institute of Swasthiyog Pratishthan Critical Care and Pain
Premal Naik
Fracture and Orthopedics Hospital Tata Memorial Hospital
Director
Miraj, Maharahstra, India Mumbai, Maharashtra, India
Rainbow Superspecialty Hospital and Children’s
Orthopedic Centre, Pediatric Orthopedic Surgeon
P Menon Pradeep Agarwal
Associate Professor of Orthopedics
Postgraduate Institute of Swasthiyog Pratishthan Director
Smt NHL Municipal Medical College
Fracture and Orthopedics Hospital Raffels Hospital
Ahmedabad, Gujarat, India
Miraj, Maharashtra, India Panchukla, Haryana, India
Priti Patil
P Ramesh Pradeep Kothadia Consultant
Director and Head, Division of Orthopedics Kothadia Nursing Home Department of MRI, Balabhai Nanavati Hospital
Trauma and Spine Surgery Solapur, Maharashtra, India Mumbai, Maharashtra, India
Ganga Hospital
Coimbatore, Tamil Nadu, India Pradeep Singh R Bhalla
President, Trauma Society of India
P Sripathi Rao Pradhyumn Rathi Past President, Indian Orthopedic Association
Professor of Orthopedics Postgraduate Institute of Swasthiyog Pratishthan Professor of Orthopedics
Kasturba Medical College Fracture and Orthopedics Hospital Institute of Medical Sciences
Manipal, Karnataka, India Miraj, Maharashtra, India Banaras Hindu Universtiy, Varanasi, India
 xiv Textbook of Orthopedics and Trauma

Rajesh Parasnis Rajiv Shah RL Thatte

Consultant Orthopedics and Spine Surgeon Orthopedic Foot and Ankle Surgeon Academic Head Plastic Surgery
Oyster and Pearl Hospital Past-President, Indian Foot and Ankle Society Bombay Hospital
Pune, Maharashtra, India Managing Director Consultant Plastic Surgeon Bai Jerbai Wadia
Sunshine Global Hospitals Hospital for Children
R Rachha Vadodara-Bharuch-Surat, Gujarat, India Parel, Mumbai, Maharashtra, India
Fellow in Foot and Ankle Surgery
Stockport NHS Foundation Trust Renuka Pai
Raju Gite
Slepping Hill Hospital Consultant Pain Specialist
Orthopedic Surgeon
Poplar Grove Stockport, Chestire, UK Ashirvad Institute of Pain Management and
Dombivali, Maharashtra, India
Research
R Raja Shanmugakrishnan Mumbai, Maharashtra, India
Ram Chaddha
Registrar, Division of Plastic Surgery
Spine Surgeon
Hand and Microsurgery and Burns Rujuta Mehta
Lilavati, Saifee, Wockhardt Hospitals
Ganga Hospital Head
Mumbai, Maharashtra, India
Coimbatore, Tamil Nadu, India Department of Pediatric Orthopedics
President, Association of Spine
Surgeons of India (2015-17) BJ Wadia Hospital for Children
R Siwach Professor and Head (Orthopedics) Consultant
Department of Orthopedics KJ Somaiya Medical College and Nanavati Superspecialty Hospital
Pt. BD Sharma Pgims General Hospital Jaslok Hospital
31/9J, Medical Enclaves Mumbai, Maharashtra, India Sushrusha Hospital
Rohtak, Haryana, India Mumbai, Maharashtra India
Ram Prabhoo
R Sreekanth W03, Carlton Court, Perry Cross Road Bandra (W) Ruta M Kulkarni
Assistant Professor Mumbai, Maharashtra, India Associate Professor
Paul Brand Centre for Hand Surgery Department of Orthopedics
Christian Medical College and Hospital Ramani Narasimhan Pediatric Orthopedic and Ilizarov Surgeon
Vellore, Tamil Nadu, India Pediatric Orthopedic Surgeon Postgraduate Institute of Swasthiyog Pratishthan
Indraprastha Apollo Hospitals Miraj, Maharashtra, India
Raghava Dutt Mulukutla New Delhi, India
S Karunakaran
Director and Chief of Spine Surgery Associate Professor of Spine Surgery
Ramesh Kumar Sen
Udai Omni Hospital and Apollo Health City Department of Orthopedics
Former Professor of Orthopedics
Hyderabad, Telangana, India Madras Medical College
Postgraduate Institute of Medical Education
Research (PGIMER), Chandigarh Chennai, Tamil Nadu, India
Rajesh Malhotra Director of Orthopedics
Fellow, Revision Joint Replacement and Fortis Hospital S Lahkar
Bone Banking, Princess Alexandra Hospital Mohali, Punjab, India
Brisbane, Australia S Raja Sabapathy
Fellow, Johnson and Johnson and Randy R Bindra Chairman
Roaf Fellowship (IOA) Professor Division of Plastic Surgery
Fellowship in Advance Trauma (AO/ASIF), Germany Department of Orthopedic Surgery Hand and Microsurgery and Burns
Fellowship Ranawat Orthopedic Centre (ROC) Griffith University and Gold Coast University Ganga Hospital
Senior Travelling Fellow (IOS UK) Hospital Coimbatore, Tamil Nadu, India
Editor, Orthopedics Today Southport, Australia
Convener Orthopedic Initiative, India Society of S Rajasekaran
Bone Mineral Research Rashmi Chopra Director and Head
Past President Delhi Orthopedic Association (2012) Consultant Orthopedic Hand and Wrist Surgeon Division of Orthopedics
Secretary, Regional Fragility Fracture Network, India Apollo Spectra Hospital, New Delhi, India Trauma and Spine Surgery
Professor of Orthopedics Ganga Hospital
All India Institute of Medical Sciences Rashmi Raut Coimbatore, Tamil Nadu, India
New Delhi, India Registrar
Department of Plastic and Reconstructive Surgery S Sane
Lilavati Hospital and Research Center Sane Nursing Home
Rajesh Rohira
Mumbai, Maharashtra, India Mumbai, Maharashtra, India
JESS Research and Development Centre
No.10-ONGC Colony, Bandra Reclamation
Mumbai, Maharashtra, India Ravijot Singh S Siddiqui
Senior Resident Orthopedics Spine Fellow
All India Institute of Medical Sciences (AIIMS) Jaslok Hospital and Research Centre
Rajiv Limaye Mumbai, Maharashtra, India
New Delhi, India
Consultant (Orthopedic Surgeon)
University Hospital of North Tees
Raviraj Patil SA Green
Stockton on Tees, UK
Postgraduate Institute of Swasthiyog Pratishthan Director
Fracture and Orthopedics Hospital The Problem Fracture Service
Rajiv Negandhi Miraj, Maharahstra, India Rancho Los Amigos Hospital
Pediatric Orthopedic Surgeon 7601 E Imperial Highway
Fellow, Pediatric Orthopedics RB Dalal Downey CA, USA
(Hong Kong UK Singapore USA) Consultant (Orthopedic Surgeon)
Postgraduate Institute of Swasthiyog Pratishthan Honorary Senior Lecturer SA Ranjalkar
Fracture and Orthopedic Hospital University of Manchester Postgraduate Institute of Swasthiyog Pratishthan
Miraj, Maharashtra, India Stockport NHS Foundation Trust, Stockport, UK Miraj, Maharashtra, India
 Contributors xv
Sachin Tapasvi Sanjeev Sabharwal Shaligram Purohit
8, Status Chambers Professor Assistant Professor
1221/A, Wrangler Paranjape Road, Off. FC Road Department of Orthopedics Department of Orthopedics
Pune, Maharashtra, India Chief Seth GS Medical College and
Pediatric Orthopedics KEM Hospital
Sagar Saxena Rutgers-New Jersey Medical School Mumbai, Maharashtra, India
Postgraduate Institute of Swasthiyog Pratishthan Newark, New Jersey, USA
Fracture and Orthopedics Hospital Rainbow Superspecialty Hospital and Children’s Shankar Acharya
Miraj, Maharashtra, India Orthopedic Centre Spine Surgeon
Pediatric Orthopedic Surgeon Sir Ganga Ram Hospital
Sahil Batra Smt NHL Municipal Medical College New Delhi, India
Spine Fellow Ahmedabad, Gujarat, India
Indian Spinal Injuries Centre Shashank Misra
Vasant Kunj, New Delhi, India Sanjit Singh Upper Limb Surgeon
Sir Ganga Ram Hospital
Sajan K Hegde Sarvdeep Dhatt Surya Hospital
Consultant Spine Surgeon Associate Professor New Delhi, India
Head Department of Orthopedic Surgery
Department of Orthopedics Postgraduate Institute of Shelton McKenzie
Apollo Hospitals Medical Education and Research Fellow in Foot and Ankle Surgery
Chennai, Tamil Nadu, India Chandigarh, India Department of Orthopedic Surgery
University of Texas Medical Branch
Samarth Mittal Satish Bhat Galveston, Texas, USA 77555
Senior Resident Consultant Plastic Surgeon
Department of Orthopedics Linea Cosmetic Clinic Shirish Pathak
All India Institute of Medical Sciences Balmatta, Mangaluru Consultant Orthoscopic Surgeon
New Delhi, India Karnataka, India Deena Nath Mangesh Hospital
Pune, Maharashtra, India
Samir Dalvie Satish Rudrappa
Spine Surgeon Fellow in Complex Spine and Shishir Rastogi
Hinduja and Breach Candy Hospitals Thoracoscopic Surgery (USA) Additional Professor of Orthopedics
Mumbai, Maharashtra, India Fellow in Microvascular Anastomosis (USA) All India Institute of Medical Sciences (AIIMS)
Senior Consultant-Neurosurgery and New Delhi, India
Samir Kumta Director
Consultant Plastic Surgeon and Skull Base Surgery Shiva Shankar Jha
Reconstructive Microsurgeon Head Jha Hospital
Lilavati Hospital and Research Centre Department of Spine Surgery Patna, Bihar, India
Mumbai, Maharashtra, India Sakra World Hospital
Bengaluru, Karnataka, India Shrikant Atreya
Sampat D Patil
Secretary Saumyajit Basu Shrinand V Vaidya
Indian Foot and Ankle Society Consultant Spine Surgeon and Plough Share, 4/A
Director and Head Program Director of Spine Fellowships 415 Sitladevi Temple Road
Noble Hospital, Pune, Maharashtra, India Neurosciences Division Mahim (W), Mumbai, Maharashtra, India
Park Clinic
Samuel B Adams Visiting Spine Surgeon Shrinivasan
Department of Orthopedic Surgery Department of Orthopedics
Duke University Medical Center Kothari Medical Centre
Durham, NC Shubhada Kher
Visiting Faculty for Pediatric Spine
Rehabilitation Consultant
Institute of Child Health
Sandeep Diwan Spine Clinic, Jupiter Hospital
Kolkata, West Bengal, India
Postgraduate Institute of Swasthiyog Pratishthan Mumbai, Maharashtra, India
Miraj, Maharashtra, India Saurabh Kapoor
Shumayou Dutta
Complex Spine Fellow
Sandeep Patwardhan Spine Fellow (ASSI)
Kings College Hospital, London, UK
Professor (Orthopedics) Mumbai Spine Scoliosis and Disc Replacement
Pediatric Orthopedic Specialist SC Goel Centre, Bombay Hospital
Sancheti Institute for Orthopedics and President, Trauma Society of India Mumbai, Maharashtra, India
Rehabilitation Past President, Indian Orthopedic Association
Pune, Maharashtra, India Professor of Orthopedics Shubhranshu S Mohanty
Institute of Medical Sciences Consultant Orthopedics and
Sandeep Vaidya Banaras Hindu Universtiy Joint Replacement Surgeon
Pediatric Orthopedic Surgeon Varanasi, Uttar Pradesh, India Jaslok, Sushrusha and Nanavati Hospitals Mumbai
Mumbai, Maharashtra, India Professor (Addl) and Unit Head in Orthopedics
Selene G Parekh King Edward Memorial Hospital
Sanjay B Kulkarni Duke Fuqua School of Business Mumbai, Maharashtra, India
Hospital Infection Control Consultant Durham, NC 27707, USA
Belagavi, Karnataka, India Siddhartha Sharma
Shailesh Hadgaonkar Professor
Sanjay Garude Spine Surgeon Postgraduate Institute of Medical Education and
36/A 1st Floor, Sai Nivas Sanheti Hospital Research (PGIMER)
Road No. 2, Sion (E), Mumbai, Maharashtra, India Pune, Maharashtra, India Chandigarh, India
 xvi Textbook of Orthopedics and Trauma

SKS Marya Sudhir K Kapoor Surya Bhan

Director Head Orthopedician, Joint Replacement Surgeon
Max Superspecialty Hospital Department of Orthopedics Consultant Joint Replacement
New Delhi, India Lady Hardinge Medical College Surgeon and Orthopedic Surgeon
New Delhi, India Primus Superspecialty Hospital
SM Tuli New Delhi, India
Senior Consultant Sudhir Kumar
Spinal Diseases and Orthopedics Professor and Head Suryaprakash Rao
Vidyasagar Institute of Mental Health Department of Orthopedics Consultant Spine Surgeon
and Neurosciences School of Medical Sciences and Research Max Cure Hospitals
New Delhi, India Sharda University Mediciti and Madhapur
Greater Noida, Uttar Pradesh, India Hyderabad, Telangana, India
Sneha Shah Sushrut Babhulkar
Associate Professor Sudhir Warrier
Consultant Hand Surgeon Centre for Joint Reconstruction and Trauma Surgery
Department of Nuclear Medicine and Director
Molecular Imaging Lilavati, Hinduja, Jaslok, Shushrusha
Sportsmed and Sunridges Hospitals Sushrut Hospital and Research Centre and
Tata Memorial Hospital Postgraduate Institute of Orthopedics
Mumbai, Maharashtra, India Laud Clinic
Mumbai, Maharashtra, India Secretary
Trauma Society of India
Sreeramalingam Rathinavelu Sujay M Kulkarni Chief
Spine Surgeon Postgraduate Institute (PGI) of Nagpur, Maharashtra, India
Ortho One-orthopedic Speciality Centre Swasthiyog Pratishthan Sushrut Hospital and Research Centre
Coimbatore, Tamil Nadu, India Fracture and Orthopedics Hospital Ramdaspeth, Nagpur, India
Miraj, Maharashtra, India
Srikanthnara Swaroop Gopal
Consultant Orthopedic Surgeon Sujit Joshi Senior Consultant Neurosurgery
Ozone Institute of Medical Sciences Director Neurosciences
Hyderabad, Telangana, India Sujit Kadrekar Department of Neurosciences
Clinical Associate Sakra World Hospital
Kokilaben Dhirubhai Ambani Hospital Varthur Hobli, Bengaluru, Karnataka, India
Srinath Kamineni
Elbow Shoulder Research Center Mumbai, Maharashtra, India
Taral Nagda
Department of Orthopedic Surgery Rainbow Superspecialty Hospital and Children’s
Sujit Kumar Tripathy
University of Kentucky, USA Orthopedic Centre
Assistant Professor
Department of Orthopedics Pediatric Orthopedic Surgeon
Srinivasa Moolya All India Institute of Medical Sciences Smt NHL Municipal Medical College
Spine Fellow Bhubaneswar, Odisha, India Ahmedabad, Gujarat, India
Indian Spinal Injuries Centre
Vasant Kunj, New Delhi, India Sunil G Kulkarni Tarun Suri
Professor FNB Fellow
SS Patil Department of Orthopedics Park Clinica
Spine Surgery Fellow ASSI Postgraduate Institute of Kolkata, West Bengal, India
Fellow Minimally Invasive Swasthiyog Pratishthan, Miraj, Maharashtra, India
Thomas J Kishen
Spine Surgery (USA, France) AO Trauma India Council Member
Spine Care Centre
Fellow Dynamic Fixation and Soft Stabilization of Vice President, Trauma Society of India
Manipal Hospital
Lumbar Spine (USA, France) Former President
Bengaluru, Karnataka, India
Fellow Spine-Oncosurgery (Italy) National Association of Interlocking Surgeons
Fellow Sacro Illiac Pathologies and (NAILS) India Thomas Palocaren
Minimally Invasive SI Fusion Surgery (USA) Associate Professor
Associate Spine Surgeon Sunny Gugale Pediatric Orthopedics
Wockhardt Hospital, Mumbai Central Christian Medical College and Hospital
Hinduja Healthcare Surgical, Khar (W) Suresh Pillai Vellore, Tamil Nadu, India
Sportsmed, Parel Spine Surgeon
Mumbai, Maharashtra, India Lakeshore Hospital and Research Centre Ltd Tushar Agrawal
Kochi, Kerala, India Consultant Pediatric Orthopedics Surgeon
SS Rajderkar Bombay Hospital
Sureshwar Pandey Mumbai, Maharashtra, India
Department of Anatomy
Consultant Orthopedics Surgeon
Government Medical College
Emeritus Professor, Ranchi University Tushar Rathod
Miraj, Maharashtra, India
Founder and Director GNH Handicapped Children Assistant Professor
Hospital and RJS Artificial Limb Center Department of Orthopedics
Subir N Jhaveri Founder and Emeritus President Seth GS Medical College and KEM Hospital
USA/Canada Fellowship Trained Spine Surgeon Indian Foot and Ankle Society (Affi-CIP-IFFAS) Mumbai, Maharashtra, India
Ahmedabad, Gujarat, India Founder and Emeritus Editor
The Journal of Foot and Ankle Surgery U Holz
Sudhir Babhulkar Ex-President, Asia-CIP (IFFAS) Former Chairman
Director Founder and Chairman Department of Traumatology and
Sushrut Hospital, Research Centre and Ramjanam Sulakshana Pandey Cancer Hospital Reconstructive Surgery
Postgraduate Institute of Orthopedics and Research and Rehabilitation Center Katharinen Hospital
Nagpur, Maharashtra, India Ranchi, Jharkhand, India Stuttgart, Germany
 Contributors xvii
Uday Phatak Vikram Shah VK Pande
Consultant Physician Plough Share, 4/A, Professor of Orthopedics (Hand Surgery)
Sharada Research Institute 415 Sitladevi Temple Road SMS Medical College and Hospital
Miraj, Sangli, Maharashtra, India Mahim (W), Mumbai, Maharashtra, India Jaipur, Rajasthan, India

V Paramshetti Viktor Vilensky VM Agashe

Paramshetti Hospital
Miraj, Maharashtra, India Vinod K Panchbhavi VM Iyer
Professor Iyer Orthopedic Centre and Physiotherapy Clinic
Vedant Vaksha Department of Orthopedic Surgery 103, Railway Line
Orthopedics, Fellow Spine Surgery Chief, Division of Foot and Ankle Surgery Solapur, Maharashtra, India
(Rochester, NY and Cleveland Clinic, OH) Assistant Director, Foot and Ankle Fellowship Program
Consultant Spine Services Department of Orthopedics
VT Ingalhalikar
Indian Spinal Injuries Centre University of Texas Medical Branch
Director
New Delhi, India Galveston Texas, USA
Spine Clinic
Vinod Mishra Professor Orthopedic Surgery
Venkatdass Jupiter Hospital
Pediatric Orthopedic Surgeon Thane, Maharashtra, India
Ganga Hospital Viraj Shingade
Coimbatore, Tamil Nadu, India Director
Children Orthopedic Care Institute Wilson Iype
Pravira Hospital, Nagpur, Maharashtra, India Department of Orthopedics
Venkatesh Rangarajan Amala Institute of Medical Sciences
Professor Thrissur, Kerala, India
Viren Mishra
Department of Nuclear Medicine and
Consultant
Molecular Imaging
Orthopedics and Trauma Yash Shah
Tata Memorial Hospital
Hull and East Yorkshire Hospitals, UK Bombay Hospital
Mumbai, Maharashtra, India
Senior Tutor, Hull York Medical School Mumbai, Maharashtra, India
Yorkshire, UK
Vidisha S Kulkarni
Yathiraj BR
Associate Professor Virendra Shandilya Clinical Associate
Department of Orthopedics EC member of OPAI Kokilaben Dhirubhai Ambani Hospital
Postgraduate of Swasthiyog Pratishthan Rehabs, Vadodara, Gujarat, India Mumbai, Maharashtra, Inida
Fracture and Orthopedics Hospital
Miraj, Maharashtra, India Vishal Kumar Yogesh Nathdwarawala
Assistant Professor Consultant
Vikas Agashe Department of Orthopedics Orthopedic Surgeon
Orthopedic Surgeon Postgraduate Institute of Medical Education and Nevill Hall Hospital
PD Hinduja Hospital Research (PGIMER) Monmouthshire, UK
Kohinoor Hospital Chandigarh, India
Dr Agashe’s Maternity and Surgical Nursing Home Yogesh Panchwagh
Mumbai, Maharashtra, India Vishal Kundnani Senior Registrar, Orthopedic Oncology
Consultant, Spine Surgeon Tata Memorial Hospital
Vikas Tandon Bombay Hospital and Research Centre Mumbai, Maharashtra, India
Spine Surgery Mumbai, Maharashtra, India
Deformity Correction Fellowship USA Yogesh Pithwa
Minimally Invasive Surgery (Germany) Vivek Pandey Fellow of National Board of Examinations
Consultant, Spine Surgeon Trauma, Arthroscopy and Joint Replacement Spine Surgery
Indian Spinal Injuries Centre Service, Orthopedics Surgery Consultant, Spine Surgeon
New Delhi, India KMC, Manipal, Karnataka, India Bengaluru, Karnataka, India

Vivek Shankar Yuvaraja

Vikram R Lele
Assistant Professor Assistant Professor
Chief of Nuclear Medicine
Sports Injury Centre Department of Orthopedics
Department of Radiology
Vardhman Mahavir Medical College and Pondicherry Institute of Medical Sciences
Jaslok Hospital and Research Centre
Safdarjung Hospital, New Delhi, India Puducherry, India
Mumbai, Maharashtra, India
 Foreword to the Third Edition
It is a privilege and honor to write a foreword for the third edition of the Textbook of Orthopedics and Trauma.
This textbook, which reflects the work and expertise of the Indian orthopedic surgeons, was made possible by the single effort of
Dr GS Kulkarni when he brought out the first edition in the year 1999. In the span of merely 16 years, the textbook has become a popular
and favored source of reference and learning for orthopedic surgeons and trainees alike around our country. The progress into third
edition in a short period reflects the popularity and also the intention of its editor to keep the textbook current and relevant with all
recent advances.
The textbook has great relevance as the burden of orthopedic diseases is increasing globally, especially in developing countries like
India. People suffering from joint disorders and low back pain include millions resulting in a major socioeconomic problem. Trauma,
especially due to road-traffic accidents is also on the rise, and there is one death on the Indian roads every four minutes causing more
than seven lakh people undergoing major injuries every year. Orthopedic surgery is also evolving rapidly. The tremendous advances
in allied sciences of molecular biology, genetics, biomechanics, and metallurgy that are taking place at a rapid pace have brought a
great change in the field. While all this has translated to better patient care and outcome, the trainees and the young surgeons face
a challenge to keep up with the current knowledge. The textbook captures the entire spectra of orthopedics in a concise and precise
fashion with contributions from many eminent surgeons. It thus fills the need adequately, and I am sure that the demand for the fourth
edition will not be far away.
I congratulate Dr Kulkarni for his enthusiasm and persistence towards making this book possible. He is a role model for all of us,
and his energy, passion and commitment to a cause is a source of inspiration for many of us.

S Rajasekaran MS MCh FRCS FACS PhD

Chairman
Department of Orthopedic Surgery
Ganga Hospital
Coimbatore, Tamil Nadu, India
President-Elect SICOT
Chair, International Research Commission, AOSpine
Past President, Indian Orthopedic Association
Past President, Association of Spine Surgeons of India
 Foreword to the Second Edition
The Herculean task of bringing out the second edition is taken up by the editor Prof Dr GS Kulkarni to update and edit the present
knowledge of orthopedics and traumatology. The textbook has an excellent collection of topics written by experienced and knowledgeable
orthopedic surgeons. The scholarly work done by the editor is being published by M/s Jaypee Brothers under the aegis of Indian
Orthopedic Association as its revised second edition.
All the contributors have taken tremendous efforts to incorporate the present-day knowledge and recent trends of the concerned
topics. Many orthopedic problems in developing countries are different from those in the Western country and most of the books,
journals and publications are published from the West. The problems associated with osteosynthesis and recent trends in nailing
interlocking have been elaborately written. The common problems of neglected fractures and their management which every surgeon
encounters in the practice are well covered. The conditions associated with traumatology and their complications are nicely covered
in this edition. The textbook has covered almost all the topics and conditions which we face day to day.
This book will be relevant and definitely helpful to orthopedic surgeons and students. Dr GS Kulkarni with his vast experience and
dedicated efforts has brought us the new edition of this book with a very high standard which will be helpful to the readers.

Prof (Dr) Sudhir Babhulkar

MS (Orth) D Ortho PhD Orth DSc Orth FAMS
Past President Indian Orthopedic Association
 Foreword to the First Edition
The Textbook of Orthopedics and Trauma being published by the Indian Orthopedic Association, edited by Dr GS Kulkarni, is the
most useful undertaking. This textbook provides the collective experiences in the field of orthopedics and trauma of all the senior and
experienced orthopedic surgeons of India.
India is perhaps the foremost amongst the developing countries. The CATCH 22 of the word “developing” fails to reveal that if the
whole population of countries like India is taken into account. A certain section may have reached a level of development almost near
to that developed by the so-called developed countries, and certain section is plagued by poverty and ignorance.
The orthopedic surgeons practicing in India are familiar and capable of dealing not only with diseases and disabilities that affect
the prosperous dominant elite, who expect the same kind of health care as is available in the most developed countries of the world
but also to be able to look after and treat adequately such conditions which have almost disappeared from those countries, e.g.
paralytic poliomyelitis, pyogenic infections of bones and joints, tuberculous disease of bone and joints, mycotic infections, the neural
and osteoarticular damage caused by Hansen’s infections especially among young children and infants, including the newborn. These
diseases usually affect the poorer section of the society.
The challenge of the orthopedic surgeons in developing countries, therefore, is more comprehensive and varied. They have to
handle all these serious conditions with severe financial and infrastructural constraints. Considering these challenges, Dr Kulkarni
has done an excellent job of selecting the topics and contributors for the book. Among all the developing countries, India happens to
have a fairly well-trained body of orthopedic surgeons, who have had experience in the management of these wide variety of diseases
and disabilities of the locomotor system. The contributors have taken great pains and have described in detail these subjects, which I
am sure, will be extremely useful to the orthopedists of the developing countries.
Lately, with the introduction of mechanization and high-speed transport facilities, there is increased incidence of high-velocity
trauma causing polytrauma, which requires a very well-planned system of casualty care, which does not exist in countries like India.
I am pleased to read the chapters on polytrauma written by eminent personalities.
Dr Kulkarni is known to me since long. He is a devoted orthopedic academician. I also know many of the section editors and
contributors. They are sincere hard-working group of orthopedic surgeons.
The book points out the wisdom of senior orthopedic surgeons of India and fills the gap that exists in this field. The enterprise that
the Indian Orthopedic Association is undertaking, is indeed most gratifying.
I hope that the book will act as a pathfinder and a guide to help orthopedic surgeons, who are practicing in developing countries.

B Mukhopadhyay
Emeritus Professor
Patna

Orthopedics and trauma is the largest specialty of surgery, and especially, with the subspecialties in orthopedics which are now more
than 15 in number, it obviously becomes difficult to encompass the total spectrum in its fullness in any textbook. However, I must give
credit to Dr GS Kulkarni, who has made tremen­dous efforts and that too successfully to cover most of the spectrum of this specialty
in an adequate manner.
Medical education and training with its threefold commitment to patient care, research and continuing education always presents
a difficult challenge. The term “core curriculum” is used widely but seldom defined; therefore, selection and integration of essential
information must form the basis for such publications.
A good medical textbook should provide not only information but also a philosophy and approach which makes the knowledge
relevant. The authors must have experience, ability and dedication to the mission of teaching. They should be scientifically accurate
and capable of projecting their personalized approach. This is amply seen in this textbook.
There are many reasons why prevention is still in its infantile stage. Grants for cancer and heart disease are largely available as this is
considered a real science. The life of a cell can be turned round more easily than the mind of a motorcyclist. Looking at the prevention
means stepping outside our familiar role as a curative orthopedic surgeon. Road trauma is a great challenge and fills the hospital beds
to a great extent.
Intoxication, designing of the roads, playground for children, police protection, bicycle tracks and maintenance of trucks and safe
driving are some of the few issues which should be considered very logically for prevention of trauma, and these are the legitimate
areas for research, even if they do not have the kudos of molecular biology or so much financial support. “Prevention is wholesale.
Treatment is retail”.
 xxii Textbook of Orthopedics and Trauma

I am sure that these remarks will be helpful to the future thinking, and the present textbook mainly contributed by the Indian
orthopedic surgeons will be a great boon for the orthopedic surgeons practicing not only in developing countries but also will be very
informative to all who are devoted to this science and art. I am sure that these volumes must find their place in academic libraries all
over the world.

KT Dholakia Hon FRCS (Eng)

Past President SICOT, Past President ASI
Past President IOA, Past President ASSI
Emeritus Professor of Orthopedics
University of Bombay
Sr Orthopedics Surgeon, Bombay Hospital
Breach Candy Hospital and
PD Hinduja National Hospital

The art and science of orthopedics has changed remarkably. There has been an explosion in the orthopedic knowledge in recent years.
The success of joint replacement, improvement in implant material with application of improved techniques and the new investigative
techniques have made orthopedics a very exciting and rewarding specialty.
Indian Orthopedic Association felt the necessity of a textbook, which can give more importance to commonly observed problems
in clinical practice in our specialty as our problems are not similar to those seen in Western countries. The aim of the book is to provide
authentic account of common conditions seen in our country more specifically for the young surgeons during and after their training.
The newer develop­ments like joint replacement, distraction osteogenesis (Ilizarov and Jess), interlocking intramedullary nail­ing, spinal
instrumentation and arthoscopy have been included. The operative details have been excluded as they are available in many books
on operative orthopedics. The commonly prevailing problems of cold orthopedics have also been properly dealt with. There can be
no better method of making the future of our specialty brighter than by ensuring that our trainee surgeons have the benefit of the
knowledge and experience of their seniors. The contributors deserve full appreciation for doing their best in this regard and for giving
their valuable time for this purpose.
Dr Kulkarni is an expert editor, with enormous experience of editing journals and books. It is his dedication and constructive efforts
that could provide us Textbook of Orthopedics and Trauma­of such a high standard and value. He has done a commendable job for the
Indian Orthopedic Association.
I am sure that this book will be of tremendous value and help to its readers.

KP Srivastava
MS (Surg) MS (Ortho) D (Ortho) FICS
FACS FAMS FAIS FIAMS
President
Indian Orthopedic Association
 Preface to the Third Edition

A welcome addition is Sushrut Babhulkar, who is enthusiastic, an outstanding orthopedic surgeon, educator,
and innovator. He has joined me as an associate editor.
—GS Kulkarni

The publication of third edition of the Textbook of Orthopedics and Trauma in 2016 includes a number of new features, and the
most important one is an addition in the list of contributors, many of whom are young, representing newer generation.
Orthopedic discipline is becoming a highly superspecialized branch. Almost every postgraduate resident wants to take up same
specialty. However, in India, orthopods at periphery have to be the general orthopedic surgeons. This book is designed for them as
well as for the resident who wish to become specialists. All the chapters are fully updated till 2015. Sections on poliomyelitis and
leprosy have been deleted and some new chapters like vacuum-assisted closure and Masquelet’s membrane techniques have been
added.
We are grateful to our contributing authors, whose high level of information; clinical experience and dedication have made this
book an excellent reference book for consultants and a must for postgraduate students. We sincerely thank the section editors who
have done excellent work to edit the chapters.
We plan to publish the fourth edition of this book in 2019 or 2020. Anybody who wishes to contribute is welcomed and is
requested to contact us.

GS Kulkarni
Sushrut Babhulkar
 Preface to the First Edition
Orthopedic knowledge is literally exploding at an astounding rate. No other surgical specialty has a greater number of procedures than
orthopedics has the orthopedic market is also flooded with bewildering number of implants and instrumentation sets. The practicing
orthopedic surgeons as well as the postgraduate students are at a loss to select the clinical material from the vast literature and the
implants and instrumentation. This book serves as a quick text refresher and an easy reference to orthopedic surgeons. For postgraduate
students, this book should be indispensible.
Orthopedic problems of the developing countries are different from those in the West, and most of the books and journals on the
subject emanate from the Western countries. Incidence of paralytic poliomyelitis, tuberculosis, chronic osteomyelitis, leprosy, etc. are
rampant and so are the road-side accidents which are common in the developing countries. Conditions associated with trauma, such
as nonunion (with or without infection), malunion, deformity stiff joints, etc. are day-to-day taxing problems. Even the sizes of Indian/
Asian bones are smaller than those in the West. This disparity creates problems in inserting implants for the replacement of joints
and for the treatment of fractures. Every orthopedic surgeon encounters a large number of cases of neglected trauma, deformities,
infections and even tumors of bones and joints. Neglect of orthopedic disease is a common scenario, as also are the poor conditions of
the operating rooms, and low quality of implants. Often, the surgical technique is not performed meticulously as described by different
methodology. All these add to the complications.
The textbook has been designed to adequately cover all such conditions which are missing from or inadequately described in
the Western textbooks. The main aim of the book is to give comprehensive information about diseases and problems peculiar to the
developing countries and to provide one source of orthopedic information. Each chapter is written by a surgeon who has a special interest
in the subject. I take particular pride in the list of outstanding contributors, many of whom are leading authorities in their fields. An
attempt is made to give a complete orthopedic knowledge, including basic and applied sciences and rehabilitation of musculoskeletal
system.
In a multiauthor book of this nature, some repetition is unavoidable but is useful. This is mainly addressed to the practicing orthopedic
surgeons and postgraduate students in the developing countries. I am very much thankful to the Indian Orthopedic Association for
asking me to edit this prestigious book.

GS Kulkarni
 Acknowledgments
We are very grateful to Dr MS Ghosh of Kolkata, who convinced the Indian Orthopedic Association to publish the book. We express
our gratitude to Milind, Sunil, Ruta, Vidisha, Rajiv Limaye, Sujay, Madhura and all the postgraduate students for their untiring help in
completing this book. They have helped us by proofreading, correcting articles and writing a few articles. Our thanks to the stenotypists
Arthur Shikhamani and Mr Pravind Sagare, who have tolerated us for the last 15 years. We sincerely thank all the orthopedic patients
who are the backbone of the textbook.
We are very much thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director-
Publishing), Mr KK Raman (Production Manager) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who have taken
great pains in publishing the book in time, maintaining the international standards. We also sincerely thank to Mr DC Gupta (Senior
Editor), Mr Gurnam Singh (Senior Proofreader), Mrs Yashu Kapoor (Senior Typesetter), Mr Manoj Pahuja (Senior Graphic Designer)
and the entire production staff of M/s Jaypee Brothers Medical Publishers, for their professional expertise and their active role and
cooperation in the production of the book.
 Contents
14. Evidence-based Medicine and Research 78
VOLUME ONE Ashok K Shyam

SECTION 1: Introduction and SECTION 3: Diagnostic Imaging in

Clinical Examination Orthopedics
Section Editor: Sureshwar Pandey Section Editor: JK Patil
1. Introduction and Clinical Examination 3
15. MRI and CT in Orthopedics 89
Sureshwar Pandey
JK Patil
2. Damage Control Orthopedics 12
16. Musculoskeletal Ultrasound 135
Anil Agarwal, Anil Arora, Sudhir Kumar
JK Patil, Kiran Patnakar
17. Advances in Orthopedic Imaging 144
SECTION 2: Basic Sciences
JK Patil, Priti Patil, Malini Lawande, Pramod Nagure
Section Editor: Anil Arora 18. Nuclear Medicine in Orthopedics 149
Vikram R Lele, Parag Aland
3. Functional and Anatomy of Joints 19
Nagesh P Naik, Manish Chadha, Arun Pal Singh
3.1 Joints: Structure and Function 19
SECTION 4: Metabolic Bone Diseases
Nagesh Naik, Manish Chadha, Arun Pal Singh Section Editor: Shishir Rastogi
3.2 Synovium Structure and Function 24
Nagesh Naik
19. Osteoporosis and Internal Fixation in 161
4. Growth Factors and Fracture Healing 26 Osteoporotic Bones
Anil Agarwal, Anil Arora Sushrut Babhulkar
5. Metallurgy in Orthopedics 34 20. Vertebroplasty for Osteoporotic Fractures 189
Aditya N Aggarwal, Manoj Kumar Goyal, Anil Arora Arvind Bhave
6. Pathophysiology of Spinal Cord Injury and 37 21. Ochronosis 196
Strategies for Repair GS Kulkarni, P Menon, Milind G Kulkarni, Sagar Saxena
Manish Chadha
22. Gout 199
7. The Stem Cells in Orthopedic Surgery 47 VM Iyer
Manish Chadha, Anil Agarwal, Anil Arora
23. Crystal Synovitis 207
8. Bone: Structure and Function 52
Vidisha S Kulkarni
Gurunath S Wachche
24. Rickets 208
9. Cartilage: Structure and Function 55
Gurunath S Wachche KN Shah, Prasanna C Rathi

10. Muscle: Structure and Function 59 25. Scurvy and Other Vitamin-related Disorders 217
Gurunath S Wachche KN Shah

11. Tendons and Ligaments: Structure and Function 62 26. Mucopolysaccharidosis 219
Gurunath S Wachche RM Kulkarni, Mandar Agashe
12. Synovial Fluid 64 27. Fluorosis 225
Surya Bhan, Aman Dua Gurunath S Wachche
13. Synovial Disorders 71 28. Osteopetrosis 227
Surya Bhan, Aman Dua Gurunath S Wachche
xxviii Textbook of Orthopedics and Trauma

SECTION 5: Endocrine Disorders 42. Evolution of Treatment of Skeletal Tuberculosis 316

SM Tuli
Section Editor: MH Patwardhan
43. Antitubercular Drugs 318
SM Tuli
29. Endocrine Disorders 231
Gurunath S Wachche 44. Principles of Management of Osteoarticular 321
Tuberculosis
30. Hyperparathyroidism and Bone 233 SM Tuli
MH Patwardhan, Parag Shah
45. Tuberculosis of the Hip Joint 330
SM Tuli
SECTION 6: Bone and Joint Infections
46. Tuberculosis of the Knee Joint 342
Section Editor: SC Goel SM Tuli

31. Pyogenic Hematogenous Osteomyelitis: 243 47. Tuberculosis of the Ankle and Foot 349
Acute and Chronic SM Tuli
SC Goel 48. Tuberculosis of the Shoulder 353
32. Septic Arthritis in Adults 262 SM Tuli
SC Goel, R Bhalla 49. Tuberculosis of the Elbow Joint 355
33. Fungal Infections 266 SM Tuli
Gurunath S Wachche 50. Tuberculosis of the Wrist 358
34. Miscellaneous Types of Infections 269 SM Tuli
Gurunath S Wachche 51. Tuberculosis of Short Tubular Bones 360
34.1 Gonococcal Arthritis 269 SM Tuli
Gurunath S Wachche
52. Tuberculosis of the Sacroiliac Joints 362
34.2 Bone and Joints in Brucellosis 270
SM Tuli
Gurunath S Wachche
34.3 Congenital Syphilis 271 53. Tuberculosis of Rare Sites, Girdle and Flat Bones 364
Gurunath S Wachche SM Tuli
34.4 Salmonella Osteomyelitis 272
54. Tuberculous Osteomyelitis 368
Gurunath S Wachche
SM Tuli
34.5 Hydatid Disease of the Bone 272
Gurunath S Wachche 55. Tuberculosis of Tendon Sheaths and Bursae 372
35. Postoperative Infection 276 SM Tuli
GS Kulkarni 56. Tuberculosis of Spine: Clinical Features 374
36. Prevention of Surgical Site Infection in India 282 SM Tuli
Sanjay B Kulkarni 57. Tuberculosis of Spine: Radiographic 379
Appearances and Findings on Modern Imaging
37. AIDS and the Orthopedic Surgeon 294
SM Tuli
SS Rajderkar, SA Ranjalkar
58. Tuberculosis of Spine: Differential Diagnosis 391
SECTION 7: Tuberculosis of Skeletal System SM Tuli
59. Tuberculosis of Spine: Neurological Deficit 397
Section Editor: SM Tuli AK Jain
38. Epidemiology and Prevalence 301 60. Management and Results 416
SM Tuli SM Tuli
39. Pathology and Pathogenesis 303 61. Surgery in Tuberculosis of Spine 430
SM Tuli SS Babhulkar, SM Tuli
40. The Organism and its Sensitivity 309 62. Operative Treatment 439
SM Tuli SM Tuli
41. Diagnosis and Investigations 310 63. Relevant Surgical Anatomy of Spine 453
SM Tuli SM Tuli
 Contents xxix

64. Atypical Spinal Tuberculosis 456 SECTION 10: Peripheral Nerve Injuries
Anil Jain
Section Editors: Mukund R Thatte, Anil Bhatia
65. The Problem of Deformity in Spinal Tuberculosis 460
S Rajsekharan 78. Injuries of Peripheral Nerve 547
Mukund R Thatte, RL Thatte
SECTION 8: Systemic Complications 79. Electrodiagnostic Assessment of 553
in Orthopedics Peripheral Nerve Injuries
KA Mansukhani, Mukund R Thatte
Section Editor: Sunil G Kulkarni
80. Painful Neurological Conditions of 560
66. Shock 469 Unknown Etiology
Uday Phatak Mandar Agashe, Mukund R Thatte
67. Crush Syndrome 472 81. Management of Adult Brachial Plexus Injuries 563
V Paramshetti Mukund R Thatte, Anil Bhatia, RL Thatte
68. Disseminated Intravascular Coagulation 476 82. Injection Neuritis 578
Uday Phatak Mandar Agashe, Mukund R Thatte
69. Thromboembolism 479 83. Median, Ulnar and Radial Nerve Injuries 580
Uday Phatak Vidisha S Kulkarni
70. Fat Embolism Syndrome: Adult Respiratory 481 84. Tendon Transfers 586
Distress Syndrome Mukund R Thatte, RL Thatte
Milind G Kulkarni, Fouad Tariq Aziz
85. Entrapment Neuropathy in the Upper Extremity 595
71. Orthopedic Manifestations of Sickle Cell 484 Mukund R Thatte
Hemoglobinopathy
86. Affections of Sciatic Nerve 601
SS Babhulkar
Sunil G Kulkarni
72. Gas Gangrene and Tetanus 490
87. Peroneal Nerve Entrapment 603
Uday Phatak
Sunil G Kulkarni
72.1 Gas Gangrene 490
72.2 Tetanus 491 88. Anterior Tarsal Tunnel Syndrome 606
Vidisha S Kulkarni
89. Lateral Femoral Cutaneous Nerve Entrapment 608
SECTION 9: Orthopedic Rheumatology
Mandar Agashe, Mukund R Thatte
Section Editor: Manish Khanna
Introduction VOLUME TWO
Manish Khanna
73. Rheumatoid Arthritis: Etiopathogenesis, 495 SECTION 11: Bone Tumors
Clinical Features and Management
Manish Khanna Section Editors: Ajay Puri, Prakash Naik
74. Ankylosing Spondylitis and Other Seronegative 502 90. Principles of Management of Bone Tumors 613
Spondyloarthropathies Ajay Puri
Bhaskar Borgohain, S Lahkar
91. Radiology of Bone Tumors 622
75. Surgical Management of Rheumatoid Arthritis 509 Khushboo Pilania, Bhavin Jankharia
Manish Khanna, Rashmi Chopra
92. Role of Nuclear Imaging 634
76. Crystal Deposition Disorders 515 Venkatesh Rangarajan, Nilendu Purandare,
G Omkarnath Sneha Shah, Archi Agrawal
77. Juvenile Rheumatoid Arthritis 535 93. Pathology of Bone Tumors 638
Pradeep Agarwal, Manish Khanna Sujit Joshi, Yogesh Panchwagh
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