Motor Vehicle Collision Injuries: Mechanisms, Diagnosis, and Management.

Nordhoff LS, ed. Gaithersburg, MD 20878, Aspen Publishers Inc, 1996, hardback, 373 pp, illus, $65.

This text explores collision-injury mechanisms, diagnosis, and management, in the effort to improve insight into current treatment protocols. With the knowledge that collision injuries are complex and frequently cause loss of life and productivity along with economic costs, a view is presented of insurance, medicolegal reports, litigation, and the various influences of injury, its tolerance and other factors.

When considering the mechanisms and diagnosis of injury in a car crash, two principles are operative: There is no typical crash, and there is no typical patient. The implication is that there is always some degree of the unknown.

Overall, neck and back injuries and their management are detailed in this text, with less coverage given to shoulder and other musculoligamentous involvement. Treatment is not emphasized and is, in fact, weak, whereas collision dynamics and various factors related to motor vehicle collision are the focus of various contributors to this publication. No physical therapists authored any of the chapters. Numerous chiropractors offered their viewpoints and philosophy.

The authors highlighted the belief that management costs associated with claims for back injuries showed work days lost were ten times higher when the patients were under the care of a physician than when patients were receiving chiropractic care. This book supports considering chiropractors as primary care providers, generalists, and gatekeepers when a patient enters the health care system.

On the whole, this text is unique in handling this topic and offers some problem-solving methods in exploring mechanisms of injury caused by motor vehicle collision. One of its strongest areas of coverage is radiographic evaluation, with many illustrations given. Relatively clearly written, the authors are adept at concentrating on their areas of expertise.

The true value of the material is questionable for rehabilitation personnel. This text could be used as a resource for an orthopedic physical therapy department.

Harvey Litofsky, PT Litofsky, Brager, & O'Brien LLC Owings Mill, Md

Mr Litofsky is President of Litofsky, Brager & O'Brien, a group private practice, and has a continued interest in orthopedics and the mechanics of injury.