Orthopaedic Trauma Protocols.

This book is written by the orthopedic and rehabilitation staff members of the Harborview Medical Center at the University of Washington, in Seattle, Wash. The purpose of the book is to "bring together" the knowledge and expertise of the clinicians at this institution and to formulate a manuscript on managing the patient with orthopedic trauma. It appears, from reading most of the chapters, that the primary audience of this text is orthopedic and trauma surgeons; however, there are two chapters that address rehabilitation strategies for the patient with orthopedic trauma.

The book is divided into two parts. The first part covers general considerations, including psychological and posttrauma analgesia, rehabilitation strategies, and nursing standards. The second section of the book addresses regional fracture management and reviews the most common types of fractures to the extremities and how they are clinically managed in the emergency department by the physician.

The book is a valiant attempt at reviewing the most common types of orthopedic trauma that occur to the extremities. I found, however, that many of the descriptions of these clinical entities are short and incomplete. Although it would be difficult to incorporate every type of orthopedic injury into one textbook, I think the coverage of mechanisms, anatomic considerations, and management is weak and unpolished. The chapters on rehabilitation are extremely short and incomplete. It would have been helpful to have a review of the physical therapist's role in evaluating the patient with orthopedic trauma and of how a rehabilitation program is developed. I would like to have seen more on the role of active exercise in these patients, including the various modes of exercise, how they should be implemented and in what time sequence, and more importantly, the role that exercise plays in facilitating the healing process. This text deals primarily with stabilization of the patient with orthopedic trauma and spends little time on orthopedic rehabilitation management. Obviously, the intent of this book was to describe the medical entities of orthopedic trauma and focus very little on the importance of rehabilitation.

On a positive note, there are excellent illustrations in the text, especially radiographs and diagrammatic descriptions of how fractures are reduced, both operatively and closed. Each chapter on regional management is referenced, but the lists of references are especially short, particularly when volumes have been written and are available about these special clinical entities.

The text is very expensive, and, although it does have very good information, I found nothing in it that is new or adds to the literature currently available on orthopedic trauma. I do not think that this text would be a welcome addition to the physical therapist's library, although it could serve as a reference to complement other literature on orthopedic trauma.