Apley's system of orthopaedics and fractures by Louis Solomon, David Warwick, Selvadurai Nayagam

By Louis Solomon, David Warwick, Selvadurai Nayagam

A entire creation to the sector of orthopaedics and trauma.

summary: A finished advent to the sphere of orthopaedics and trauma

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CT sagittal and axial views (b,c) give a much clearer idea of the seriousness of this fracture. New multi-slice CT scanners provide images of high quality from which multi-planar reconstructions in all three orthogonal planes can be produced. Three-dimensional surface rendered reconstructions and volume rendered reconstructions may help in demonstrating anatomical contours, but fine detail is lost in this process. Clinical applications Because CT achieves excellent contrast resolution and spatial localization, it is able to display the size, shape and position of bone and soft-tissue masses in transverse planes.

Furthermore, activity levels at known sites of disease can be used to assess treatment and distinguish ‘active’ residual tumour or tumour recurrence from ‘inactive’ post-surgical scarring and necrotic tumour. 23 Measurement of bone mass (a) X-ray of the lumbar spine shows a compression fracture of L2. The general loss of bone density accentuates the cortical outlines of the vertebral body end-plates. These features are characteristic of diminished bone mass, which can be measured accurately by dual energy x-ray absorptiometry.

The erythrocyte sedimentation rate (ESR) is usually increased in acute and chronic inflammatory disorders and after tissue injury. However, patients with lowgrade infection may have a normal ESR and this should not be taken as a reassuring sign. The ESR is strongly affected by the presence of monoclonal immunoglobulins; a high ESR is almost mandatory in the diagnosis of myelomatosis. C-reactive protein (and other acute phase proteins) may be abnormally increased in chronic inflammatory arthritis and (temporarily) after injury or operation.

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