Manual of Orthopaedic Surgery for Spasticity.

This book is intended primarily for orthopedic surgeons. The authors' purpose in writing this book is to provide orthopedists with a comprehensive guide to treating patients with complex neurologic problems. The entire content consists of detailed information on current soft tissue surgical techniques used to correct specific spastic limb deformities. The surgical procedures are organized to distinguish between procedures intended to improve limb function and those in which the goal is to release contractures in the nonfunctional extremity.

The book is divided into four parts. The first two parts describe 10 surgical procedures to improve upper-extremity function and to release contractures in the nonfunctional arm and hand. They include functional elbow release, elbow flexor release, fractional lengthening of the wrist and finger flexors, wrist flexor release, phenol block of the ulnar motor nerves, thumb-in-palm release, shoulder release, superficialis to profundus transfer, intrinsic release, and wrist arthrodesis.

Parts 3 and 4 describe 13 procedures to improve lower-extremity function and to release contractures in the nonfunctional lower extremity including iliopsoas muscle recession, hip flexor release, obturator muscle neurectomy, hip adductor release, hamstring muscle lengthening, proximal and distal hamstring releases, selective quadriceps femoris muscle releases, quadriceps lengthening, split anterior tibial tendon transfer, tendo achillis lengthening, peroneus longus muscle transfer, and release of the toe flexor tendons. Although there are several procedures currently being used for tendo achillis lengthenings, only one is described in this book. Rectus femoris muscle transfers and split posterior tibial tendon transfers, procedures that have gained popularity for use with children with cerebral palsy, are not included. Each procedure follows the same format. It begins with very brief statements of the clinical problem and the rationale for surgery, which are followed by the operative technique and postoperative care. Black-and-white line drawings illustrate each problem and the recommended surgical technique. References are listed at the end of the book and are grouped into general reading, upper-extremity, and lower-extremity categories.

The book's strengths lie in its simple, well-organized format and its illustrations. The book is very easy to read due to the minimum amount and concise nature of written text. The line drawings, which make up more than half of the book, are excellent.

From a clinican's perspective, however, the brevity of the written text could also be considered one of the book's primary weaknesses. I would consider the book to be relatively comprehensive in the number and descriptions of surgical techniques presented, but not in its coverage of clinical indicators for surgical intervention. In most instances, the authors make general statements recommending dynamic electromyography and clinical evaluation to determine whether a patient is a good candidate for a particular procedure. Expanding the recommendation for clinical evaluation to include more specific patient selection criteria such as a patient's overall functional status; patient age if the patient is a child; goniometric measurements; or the presence or absence of other orthopedic deformities, such as subluxated or dislocated hips, would have enhanced the text. Addressing possible postoperative complications, such as tendon overlengthening, and presentation of case studies would also have been beneficial.

Although this book is costly, therapists looking for simple "nuts-and-bolts" descriptions of surgical procedures for individuals with neurological impairments would find it to be a useful resource. I would, however, recommend that it be used as a companion text to other references that include more comprehensive coverage of rationale for surgery and patient selection.