Pediatric Fractures and Dislocations.

Pediatric Fractures and Dislocations von Laer L. New York, NY 10001, Thieme, 2004, hardcover, 528 pp, illus, ISBN: 1-58890-260-9, $129.

This is an English translation of the fourth German edition of this comprehensive text. The author emphasizes that children are capable of making decisions for themselves and that they must be treated with dignity and respect. This theme, in the author's opinion, is equally as important as the technical content related to diagnosis and treatment of pediatric skeletal injuries.

In the preface to the book, the author explains that his stridency regarding doctor-patient communication is related to the way medicine is practiced in Europe and that readers in the United States may take his attitude about doctor-patient communication for granted. It is certainly consistent with the patient/client management model presented in the Guide to Physical Therapist Practice. His position is best summarized in the following statements: "Children are not miniature adults," and that "Physicians who u-eat children for fractures and dislocations must minimize iatrogenic traumatization by listening to the patient while using the most efficient treatment strategy."

The author has applied extensive knowledge acquired in clinical research to clinical practice. His stated purpose in writing this text is to provide a practical book about routine clinical concerns. It is meant to be a clinical guide to pediatric fractures and dislocations for use in everyday practice. This book is not targeted at rehabilitation professionals or physical therapists in particular. Physical therapy is referred to in general for particular injuries, and it is not mentioned frequently. The intended audience is pediatric medical practitioners, primarily physicians who do not specialize in pediatrics.

The book is organized into three sections on general considerations, upper-extremity injuries, and lower-extremity injuries. The first section covers basic science applied specifically to pediatric conditions, including growth and growth disturbances, corrective mechanisms in the growing skeleton, consolidation and consolidation disturbances, patterns of injury and prognosis of childhood fractures, and classification of pediatric fractures. Diagnostic studies, measurements, follow-up, after care, and medicine and sports are discussed in general terms. General observations are presented on the nature and correction of post-traumatic deformities; prevention of injuries in growing patients; anesthesia; hospital, parents, and the child; information; and lastly, in a section entitled "Don't Make Such a Fuss--You're Only a Child." This last section specifically addresses social and economic considerations and current health care in Switzerland.

Specific injuries of the upper and lower extremities are covered systematically in the second and third sections of the book. Common injuries are covered in detail from mechanism of injury through rehabilitation and long-term results. Overviews are provided, which include: (1) common causes of functional limitations, (2) indications, time and techniques of correction, and (3) after care. The text is liberally supplemented with photographic and radiographic examples and line drawings. Exclamatory boxes emphasize the author's primary concerns, ranging from discussion of after care with the patient and parents to goals of treatment for specific injuries.

Appendixes include: (1) "Battered Child Syndrome," (2)"Birth Trauma," (3)"Pelvic Fractures," (4) "Spinal Disorders and Injuries," (5) "Toddler's Fractures," and (6) "Pathological Fractures." A comprehensive bibliography and thoroughly cross-referenced index are included.

This book considers the child as a patient with an injury. The author consistently reminds the reader that a person is being treated, not an extremity, joint, or bone. Clearly, the patient comes first. It is refreshing to read a book by a physician who writes in a manner consistent with the "person first" language advocated in Physical Therapy.

The text is current and comprehensive in its coverage of common pediatric fractures and dislocations, including recent advances in diagnostic imaging and surgical techniques. Efficacious use of both is discussed frequently and is supported with citations of current literature. The author does not advocate over-treatment, but strongly emphasizes economy and efficacy in his approach to diagnostic studies and treatment options. He clearly discusses which diagnostic tests, in his opinion, are most useful, and he debates the overuse of plain film radiographs in favor of increased use of ultrasound, magnetic resonance imaging, and computed tomograph scans. Repeatedly, he emphasizes that the patient can tell you what is wrong without the need for imaging studies that may or may not confirm the diagnosis based on the interview and clinical examination.

This comprehensive text on pediatric skeletal injuries was written for physicians in general practice. Physical therapists seeking a thorough discussion of current diagnosis and medical treatment of pediatric fractures and dislocations will find this book comprehensive and useful. The high regard for the child/patient is the feature of the book that most impressed me.

Mary Jean Gelsomino, PT

Utica College 

Utica, NY

Ms Gelsomino is Assistant Professor in the Physical Therapy Program. She primarily teaches pediatric and neurological rehabilitation content in a problem-based learning curriculum. Her research emphasis is on children's health, especially on obesity and cardiovascular disease risk.