MRCS Part A_ Essential Revision Notes_ Book 1

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General Infirmary, Leeds Orthopaedic Surgery; Trauma Part 2:MusculoskeletalDavid Mansouri BSc(Med Sci) MBChB MRCSST3 General Surgery, Professorial Unit, Western Infirmary,GlasgowSurgical Technique and TechnologyTristan McMillan MBChBCore Surgical Trainee, Department of Plastic Surgery, Glasgow Royal Infirmary, Glasgow PerioperativeCareHayley M Moore MA MBBS MRCSClinical Research Fellow, Academic Section of Vascular Surgery, Imperial College, LondonPostoperative Management and Critical CareJuliette Murray MBChB, MD, FRCS (Gen Surg)Consultant Surgeon, Wishaw General Hospital, North LanarkshireStuart J O’Toole MD FRCS(Paeds) FEAPUConsultant Paediatric Surgeon and Urologist, Department of Surgical Paediatrics, Royal Hospital for SickChildren, Glasgow Paediatric SurgerySusan Picton BM BS FRCPCHConsultant Paediatric Oncologist, Leeds Teaching Hospitals Trust, Leeds Paediatric SurgeryGeorge Hondag Tse MSc MRCSEd MBChB BSc (Hons)Clinical Research Fellow, Centre for Inflammation Research, University of Edinburgh Trauma Part 1:Head, Abdomen and TrunkStuart W Waterston BScMedSci(Hons), MBChB, PGCertMedEd, FRCSEd(Plast)Fellow in Plastic Surgery/Hand Surgery, Department of Plastic Surgery, St Andrews Centre for PlasticSurgery & Burns, Broomfield Hospital, Chelmsford Plastic Surgery; Trauma Part 1: Head, Abdomenand Trunk – Burns
Contributors to previous editionsSam Andrews MA MS FRCS (Gen)Consultant General and Vascular Surgeon, Department of General and Vascular Surgery, MaidstoneHospital, Maidstone Amer Aldouri MBChB MRCSSpecialist Registrar in Hepatobiliary and Transplantation Surgery, Hepatobiliary and TransplantationSurgery Unit, St James University Hospital, Leeds David Crabbe MD FRCSConsultant Paediatric Surgeon, Clarendon Wing, Leeds General Infirmary, Leeds Nerys ForesterSpecialist Registrar in Clinical Radiology, Yorkshire DeanerySheila M Fraser MBChB MRCSClinical Research Fellow, Institute of Molecular Medicine, Epidemiology & Cancer Research, St.James’s University Hospital, Leeds Sunjay Jain MD FRCS (Urol)Clinical Lecturer in Urology, University of Leicester, Leicester Shireen N. McKenzie MB.ChBMRCS(Ed)Specialist Registrar in General Surgery, Airdale General Hospital, Keighley, West Yorkshire ProfessorKilian Mellon MD FRCS (Urol)Professor of Urology, University of Leicester, LeicesterSally Nicholson BSc MBChBSenior House Officer in Yorkshire School of Surgery, ENT Department, Leeds General Infirmary, LeedsSusan Picton BM BS FRCPCHConsultant Paediatric Oncologist, Leeds Teaching Hospitals Trust, Leeds Catherine Sargent BM BCh(Oxon) MRCPSpecialist Registrar in Infectious Diseases/General Medicine, The John Radcliffe Hospital, OxfordJames Brown MRCSSpecialist Registrar in Surgery, South East Thames Surgical Rotation NeoplasiaAlistair R K Challiner FRCA FIMC.RCSEd DCHConsultant Anaesthetist and Director Intensive Care Unit, Department of Anaesthetics, MaidstoneHospital, Maidstone, Kent Intensive Care and Peri-operative Management 1Nicholas D Maynard BA Hons (OXON) MS FRCS (Gen)Consultant Upper Gastrointestinal Surgeon, Department of Upper Gastrointestinal Surgery, John RadcliffeHospital, Headington, Oxford Peri-operative Management 2Gillian M Sadler MBBS MRCP FRCR
Page 4 and 5: © 2012 PASTEST LTDEgerton CourtPar
Page 6 and 7: Tristan E McMillanChapter 2 Surgica
Page 8 and 9: Claire Ritchie ChalmersChapter 5 Pr
Page 10 and 11: George Hondag Tse
Page 12 and 13: Nigel W GummersonChapter 7 Evidence
Page 14 and 15: Nigel W GummersonChapter 10 Paediat
Page 16 and 17: AcknowledgementsI would like to tha
Page 18 and 19: Picture PermissionsThe following fi
Page 20 and 21: copyright material. However, if any
Page 24 and 25: Consultant Clinical Oncologist, Ken
Page 26 and 27: A Tension pneumothoraxB Aortic rupt
Page 28 and 29: Emergency medicine 9Oncology 8Surgi
Page 30 and 31: The MRCS exam and syllabus is being
Page 32 and 33: 3.1 Local anaesthesia3.2 Regional a
Page 34 and 35: In 2011 NCEPOD published Knowing th
Page 36 and 37: history of problems under anaesthet
Page 38 and 39: cardiovascular system • All patie
Page 40 and 41: orthopaedics, spinal cord compressi
Page 42 and 43: General concerns of the surgical pa
Page 44 and 45: Documentation often starts with cle
Page 46 and 47: SECTION 2Preoperative management of
Page 48 and 49: Indications for perioperative corti
Page 50 and 51: Heparinucopolysaccharide purified f
Page 52 and 53: FBCorrection of anaemia is essentia
Page 54 and 55: Assessing myocardial ischaemiaECG:
Page 56 and 57: HypertensionCauses of hypertensionE
Page 58 and 59: Patients should have the pacemaker
Page 60 and 61: arbon monoxide reduces oxygen deliv
Page 62 and 63: advance - can predispose to lactic
Page 64 and 65: Preoperative management of epilepsy
Page 66 and 67: Preoperative management of cholesta
Page 68 and 69: C-spine: 15% of RA patients have at
Page 70 and 71: 20-27Malnourished
Page 72 and 73:
30-35Overweight
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Morbidly obese50-60 Super-obese }60
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Catabolic states40-45 1.5-2.5
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Increasingly catabolic stateDue to
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Aspirationncreased gastric volume a
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Technical problemsurgery takes long
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Metabolic complicationsyperglycaemi
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Upper GI surgeryOesophageal and gas
Page 88 and 89:
Dosage of local anaesthetic agents:
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3.2 Regional anaesthesiaField block
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The sciatic nerve block can be perf
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nguinal ligament T12High block may
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cause seizures) • All patients ha
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Inhalational anaesthetics may also
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Contraindications of depolarising m
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No IV access required
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Dose titratableUpper oesophageal to
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DisadvantagesRespiration maintained
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Loss of airway controlIrritantMay c
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Apnoea commonPatient monitoring dur
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cardiovascular collapse • Managem
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Treatment of malignant hyperpyrexia
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Risk factors for aspiration• Rais
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Muscle injuriesPressure-area injury
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CHAPTER 2Surgical Technique and Tec
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SECTION 1Surgical wounds1.1 Skin an
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Depth of woundSuperficial woundsSup
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1.4 Pathophysiology of wound healin
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Neutrophils1-2 days
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Fibroblasts2-4 days
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Endothelial cellsFigure 2.3 Wound h
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and growth factors that activate fi
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LiverThe liver has remarkable regen
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Nutritional factorsroteins are esse
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perpendicular to the skin, avoids a
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SECTION 2Surgical technique2.1 Prin
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Scalpel blades should be changed us
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Abdominal incisionsFigure 2.6 Commo
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reat vessels (especially ascending
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Thoracic closure is covered in the
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Bipolarower power unit (50 W)urrent
Page 154 and 155:
Choose your suture with regard to:S
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Polyglycolic acidynthetic homopolym
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Staples for skin closureThe teeth o
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infectionExamples of surgical drain
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packingxamples: Kaltostat, SorbsanF
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Uses of biopsyBiopsy is used specif
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Advantages of core biopsyimple, eas
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Advantages of endoscopic biopsyvoid
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Advantages and usesssessment of ope
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Figure 2.10 Incisions for benign le
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upuytren’s contracture surgeryngr
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Hollow organs: GI and genitourinary
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General factorsoor tissue perfusion
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each consultant’s preference, and
Page 182 and 183:
• Fundoplication• Gastric bypas
Page 184 and 185:
photographic images or video. A sec
Page 186 and 187:
Physiological changes include:or ch
Page 188 and 189:
variety of operations using multich
Page 190 and 191:
Disadvantagesecurity of access site
Page 192 and 193:
3.8 Managing the surgical listThere
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SECTION 4Diagnostic and interventio
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Occasionally patients can have true
Page 198 and 199:
levels on the screen as different l
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ExpenseClaustrophobiaContraindicate
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CHAPTER 3Postoperative Management a
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• Endoplasmic reticulum• Golgi
Page 206 and 207:
Transport across membranesGeneratio
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Energy from lipidsThe basic compone
Page 210 and 211:
channels open and sodium ions flood
Page 212 and 213:
muscle therefore travel in both dir
Page 214 and 215:
Figure 3.6 The structure of the myo
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Thrombocytes (platelets)The haemato
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ncrease in allergic states (eg hayf
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• Ileal resection• Crohn’s di
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aemoglobinopathyInappropriate incre
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Inflammationurnsrauma (eg postopera
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LymphocytosisLymphocytosis is used
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latelet count of >1000 × 10 9 /lli
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kidney, liver and penis (priapism)I
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Nitric oxideTissueplasminogenactiva
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It is often expressed as the intern
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Acquired bleeding disordersThromboc
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giving advice about minimising othe
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Clots usually start in the deep vei
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No risk factors other than age with
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Scores ≥3Moderate probability of
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Complications of pulmonary embolism
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INR of 0.8-1.2 Normal coagulationIN
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Blood compatibility testingDonor an
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significant haemorrhage) • Prophy
Page 254 and 255:
Early complications:Immunological c
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administration of donated blood (wh
Page 258 and 259:
Chronic Group characterised by an u
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Lymphoma is a cancer of the reticul
Page 262 and 263:
Multiple myeloma is a neoplastic pr
Page 264 and 265:
1.3 Fluid balance and fluid replace
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ATPase pump which was discussed ear
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Figure 3.14 The movement of fluids
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In general, fluid maintenance needs
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• Small risk of anaphylaxis• Li
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In a nutshell ...The products of me
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Respiratory acidosisRespiratory aci
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normal (ie if there was no respirat
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Metabolism = anabolism + catabolism
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Energy supplied by different food t
Page 284 and 285:
This is achieved by:utaneous vasoco
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SECTION 2Critical care2.1 The struc
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Admission to ITUor elective, emerge
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Medical staffTU director: should ha
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Improvement in survivalThis is poss
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Systemic vascular resistanceSystemi
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Regulation of stroke volumeStroke v
Page 298 and 299:
Arterial BP sensorsMean arterial pr
Page 300 and 301:
ChemoreceptorsChemoreceptors found
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Natriuretic peptidesBlood volume ch
Page 304 and 305:
wide QRS (>0.12) occurs when depola
Page 306 and 307:
Catheterisation and hourly urine me
Page 308 and 309:
Fluid challenge using CVP monitorin
Page 310 and 311:
Figure 3.22 Pressure waves as cathe
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SternumThis consists of three parts
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Costal cartilages-7 articulate dire
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Innermost intercostalsross more tha
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Lung rootsulmonary artery lies supe
Page 320 and 321:
The mechanics of breathingThe funct
Page 322 and 323:
The work of breathingThe work of br
Page 324 and 325:
Respiratory rateThe amount of air b
Page 326 and 327:
ChemoreceptorsChemoreceptors detect
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Binds four molecules of O 2 per mol
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Increased carboxyhaemoglobinIncreas
Page 332 and 333:
CvO 2 is measured by substituting m
Page 334 and 335:
urrent management depends on what i
Page 336 and 337:
Chest traumaHypovolaemia
Page 338 and 339:
Burns
Page 340 and 341:
Fat embolism
Page 342 and 343:
DIC
Page 344 and 345:
haemoglobin, and combined this beco
Page 346 and 347:
Early (see ‘Hazards’ above): da
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Mini-tracheostomyA small tracheosto
Page 350 and 351:
Continuous positive airway pressure
Page 352 and 353:
ExtubationThe patient must:e able t
Page 354 and 355:
fibres terminate in lamina 2 and la
Page 356 and 357:
Spinal mechanismsOpioids act direct
Page 358 and 359:
Referred painThis is when pain is p
Page 360 and 361:
Methods of assessing acute painSubj
Page 362 and 363:
reventing the development of pain i
Page 364 and 365:
Aetiology of chronic painNeural sys
Page 366 and 367:
Assessment of chronic painistory of
Page 368 and 369:
Pain in malignancyPain from maligna
Page 370 and 371:
OralSublingual
Page 372 and 373:
IntravenousInhalational
Page 374 and 375:
Transdermal SpinalParacetamolildly
Page 376 and 377:
Management of analgesiaRemember to
Page 378 and 379:
Disadvantages of PCAechnical error
Page 380 and 381:
Routes for sedationolus dosing: pre
Page 382 and 383:
Indications for peripheral venous a
Page 384 and 385:
Complications of peripheral venous
Page 386 and 387:
introduced into the vein:eedle intr
Page 388 and 389:
Ultrasonography for identification
Page 390 and 391:
Infuse and pumpIn a nutshell ...The
Page 392 and 393:
Blood pressureim for MAP >60 mmHg o
Page 394 and 395:
SECTION 3Postoperative complication
Page 396 and 397:
Postoperative pyrexiaPyrexia is a c
Page 398 and 399:
Prophylaxis for wound infectionsden
Page 400 and 401:
eriprosthetic fracturealunionon-uni
Page 402 and 403:
In a nutshell ...Respiratory proble
Page 404 and 405:
cascade).Factors influencing renal
Page 406 and 407:
There are two types of nephrons wit
Page 408 and 409:
Measurement of GFRThere are a numbe
Page 410 and 411:
Oliguria is defined as a urine outp
Page 412 and 413:
Measurement Prerenal RenalUrinary s
Page 414 and 415:
Indications for renal replacement t
Page 416 and 417:
SIRS is a disseminated inflammatory
Page 418 and 419:
3.5 Sepsis and septic shockDefiniti
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Management of sepsis-induced shock,
Page 422 and 423:
Neurological failureCS <6 in the ab
Page 424 and 425:
CHAPTER 4Infection and Inflammation
Page 426 and 427:
SECTION 1Inflammatory processesIn a
Page 428 and 429:
Due to three different responseshe
Page 430 and 431:
Mediators of the inflammatory respo
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Kinin systemLysosomal enzymes
Page 434 and 435:
Fibrinolytic system
Page 436 and 437:
Complement systemThe complement sys
Page 438 and 439:
Coagulation and fibrinolysisThe clo
Page 440 and 441:
Lysosomal enzymesLeucocytes degranu
Page 442 and 443:
pyrogen (see Section 2, The immune
Page 444 and 445:
Infiltration of tissue with mononuc
Page 446 and 447:
OrganismMycobacterium tuberculosis
Page 448 and 449:
Treatment of TBultiple drug therapy
Page 450 and 451:
Symptoms of syphilisThese are divid
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Treatment of syphilisntravenous (IV
Page 454 and 455:
Demographics of leprosyHO data show
Page 456 and 457:
Classification of leprosyaucibacill
Page 458 and 459:
Asbestosissbestosis results from pr
Page 460 and 461:
Immune reactions and granulomasGran
Page 462 and 463:
FibrinogenComponent of the clotting
Page 464 and 465:
(eg rofecoxib, celecoxib, valdecoxi
Page 466 and 467:
Commensal organismsNormal commensal
Page 468 and 469:
roliferation of T lymphocytesntibod
Page 470 and 471:
Figure 4.5 Activation of CD8 + T ly
Page 472 and 473:
proliferations: uncontrolled produc
Page 474 and 475:
Monozygotic twins of patients are a
Page 476 and 477:
Group of autosomal or X-linked rece
Page 478 and 479:
are some reports that the risk of i
Page 480 and 481:
Endotoxinsipopolysaccharide molecul
Page 482 and 483:
Gram-negative bacteriaStain pink/re
Page 484 and 485:
eath of the host cell by lysis to r
Page 486 and 487:
Figure 4.12 The virionaccine includ
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Human immunodeficiency viruses (HIV
Page 490 and 491:
ring-enhancing lesions on CT/MRI
Page 492 and 493:
immunodeficiency. Progressive deple
Page 494 and 495:
(systemic; often fatal in immunosup
Page 496 and 497:
lagellate parasitesesponsible for A
Page 498 and 499:
Examination for sepsisPossible foci
Page 500 and 501:
Acute phase proteinsCRP is commonly
Page 502 and 503:
Clotting screenThere may also be a
Page 504 and 505:
MicrobiologySee section 4.6, Specim
Page 506 and 507:
Organism related to wound typelean
Page 508 and 509:
4.3 Abscess managementIn a nutshell
Page 510 and 511:
ontaminated needlePathology of necr
Page 512 and 513:
If considering endocarditis, three
Page 514 and 515:
Growth in both bottlestaphylococci:
Page 516 and 517:
SECTION 5Prevention and control of
Page 518 and 519:
wound sepsis • Therefore shave im
Page 520 and 521:
SterilisationSterilisation methods
Page 522 and 523:
Dry heat sterilisationot-air ovenso
Page 524 and 525:
Irradiation sterilisationse of gamm
Page 526 and 527:
Hydrogen peroxidenly weak bacterici
Page 528 and 529:
Patient preparationSkin disinfectio
Page 530 and 531:
Dirty woundsross pus, perforated vi
Page 532 and 533:
tudents (medical and nursing)aborat
Page 534 and 535:
SECTION 6Antibiotic control of infe
Page 536 and 537:
Bacteriostatic antibioticsnclude te
Page 538 and 539:
ttachment of mRNA to ribosome (eg b
Page 540 and 541:
Alteration of cell membrane functio
Page 542 and 543:
Aminoglycosidesxamples: gentamicin,
Page 544 and 545:
Sulfonamidesxamples: co-trimoxazole
Page 546 and 547:
Quinolonesxamples: ciprofloxacin, n
Page 548 and 549:
CellulitisMost likely organisms are
Page 550 and 551:
Complicated UTIUTI involving urosep
Page 552 and 553:
Diarrhoea after food poisoningMay n
Page 554 and 555:
infection and antibiotic resistance
Page 556 and 557:
Systemic MRSA infectionsMay require
Page 558 and 559:
5.2 Radiotherapy5.3 Chemotherapy5.4
Page 560 and 561:
Information from death certificates
Page 562 and 563:
reast cancer: much less common in t
Page 564 and 565:
Environmental exposuresbestos: the
Page 566 and 567:
Screeningnitial increase in inciden
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differentiation:Labile cells: const
Page 570 and 571:
tem cell: a cell from an embryo, fe
Page 572 and 573:
HypertrophyIncrease in cell size bu
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Chemical carcinogensChemical carcin
Page 576 and 577:
are damaged or missing).Examples of
Page 578 and 579:
Familial cancers - congenital mutat
Page 580 and 581:
• Surgical prophylaxis (eg mastec
Page 582 and 583:
Homeostasis: eg loss of the uterine
Page 584 and 585:
Inhibitors of angiogenesisNaturally
Page 586 and 587:
in the filtering lymph nodes draini
Page 588 and 589:
components and the abnormal cells a
Page 590 and 591:
e simple and cheap/cost-effective
Page 592 and 593:
SECTION 4Clinical and pathological
Page 594 and 595:
in guiding treatment.4.3 Tumour mar
Page 596 and 597:
SECTION 5Principles of cancer treat
Page 598 and 599:
Sentinel nodes can then be identifi
Page 600 and 601:
Administration of radiotherapyocall
Page 602 and 603:
Alkylating agentsAntimetabolitesAnt
Page 604 and 605:
ChlorambucilCLLNon-Hodgkin’s lymp
Page 606 and 607:
Bladder cancerOvary cancerWilms’
Page 608 and 609:
Acute complicationsausea and vomiti
Page 610 and 611:
ncreasing use in primary treatment
Page 612 and 613:
Dry mouthAppetite loss, nausea, vom
Page 614 and 615:
Colic
Page 616 and 617:
Muscle spasmNerve pain-compression
Page 618 and 619:
Nerve irritationLiver pain (capsula
Page 620 and 621:
Dyspnoea
Page 622 and 623:
CoughGIAntacid, metoclopramide, chl
Page 624 and 625:
AnorexiaLactulose, co-danthrusate
Page 626 and 627:
Nausea and vomitingSkin/mucous memb
Page 628 and 629:
Dry mouthNeurological
Page 630 and 631:
HypoxiaConfusion/sedationConfusion/
Page 632 and 633:
Key features of using the LCPNon-es
Page 634 and 635:
Management of spinal cord compressi
Page 636 and 637:
leep disturbance and loss of diurna
Page 638 and 639:
Planning and follow-upPlanning for
Page 640 and 641:
CHAPTER 6TraumaPart 1: Head, Abdome
Page 642 and 643:
SECTION 1Overview of trauma1.1 Hist
Page 644 and 645:
servicesrimary care: general practi
Page 646 and 647:
LaryngoscopeRapid communication lin
Page 648 and 649:
Fully stocked anaesthetictrolleyDes
Page 650 and 651:
OxygenBlood sampling equipment1.4 T
Page 652 and 653:
SECTION 2Injury and shock2.1 The bi
Page 654 and 655:
HypothermiaHypothermia may be accid
Page 656 and 657:
Hypovolaemic shockPathophysiology o
Page 658 and 659:
sign of ongoing blood loss.Fluid re
Page 660 and 661:
Expect the following values for uri
Page 662 and 663:
Contraindicationsulmonary oedemausp
Page 664 and 665:
SECTION 3Resuscitation: the primary
Page 666 and 667:
Recognition of a compromised airway
Page 668 and 669:
Chest wall movementAdminister suppl
Page 670 and 671:
Surgical cricothyroidotomyThis tech
Page 672 and 673:
Spontaneous breathing may resume wh
Page 674 and 675:
Establish IV accessEstablish IV acc
Page 676 and 677:
HistoryIt is important to take a me
Page 678 and 679:
ThoraxAbdomenPelvisExtremitiesSpine
Page 680 and 681:
DocumentationDocument ABCDE status,
Page 682 and 683:
Moderate Coma lasting >24 hours No
Page 684 and 685:
Obstruction of CSF flow (rarely an
Page 686 and 687:
Burr holesA burr hole is a small ho
Page 688 and 689:
Best eye-opening response 4 Open sp
Page 690 and 691:
blood supply and nerve supply of th
Page 692 and 693:
This consists of:asal bones (right
Page 694 and 695:
The inferior alveolar nerve provide
Page 696 and 697:
Figure 6.17 Le Fort injuryZygomatic
Page 698 and 699:
Types of traumalunt chest trauma as
Page 700 and 701:
Figure 6.18 Tension pneumothoraxrai
Page 702 and 703:
If there are any signs of penetrati
Page 704 and 705:
Procedure box: PericardiocentesisIn
Page 706 and 707:
Confirmation of oesophageal trauma
Page 708 and 709:
Contraindications to DPLbsolute - d
Page 710 and 711:
Management includes simultaneous as
Page 712 and 713:
4Grade5A completely shattered kidne
Page 714 and 715:
bladder. If this is unsuccessful, p
Page 716 and 717:
If there is blood at the urethral m
Page 718 and 719:
RadiotherapyStructure of peripheral
Page 720 and 721:
In a nutshell ...The major trauma p
Page 722 and 723:
Figure 6.21 The peripheral and cent
Page 724 and 725:
system can manifest as priapism and
Page 726 and 727:
These usually result in wedge fract
Page 728 and 729:
aematomaseudo-aneurysm occurs when
Page 730 and 731:
SECTION 5Special cases in trauma5.1
Page 732 and 733:
Pathophysiology of burnsBurn injuri
Page 734 and 735:
Primary surveyAirway + C-spineEnsur
Page 736 and 737:
DeathCO poisoning must be excluded
Page 738 and 739:
Fluid resuscitationFluid resuscitat
Page 740 and 741:
Assessment of the burn woundIn addi
Page 742 and 743:
Management of special areasFaceSign
Page 744 and 745:
Figure 6.24 Causes of death (A) and
Page 746 and 747:
BreathingNote these differences whe
Page 748 and 749:
n children aged <6 years: intraosse
Page 750 and 751:
ExposureRemember that the relativel
Page 752 and 753:
Abdominal trauma in childrenecompre
Page 754 and 755:
lunt/penetrating uterine traumalace
Page 756 and 757:
The diagnosis of brainstem deathDef
Page 758 and 759:
neither revascularization nor amput
Page 760 and 761:
Nigel W GummersonPathophysiology of
Page 762 and 763:
SECTION 1Pathophysiology of fractur
Page 764 and 765:
Reparative phaseFibroblasts, recrui
Page 766 and 767:
Factors that delay bone healingSyst
Page 768 and 769:
A fall on the outstretched hand the
Page 770 and 771:
SECTION 3Principles of management o
Page 772 and 773:
Complications of internal fixationn
Page 774 and 775:
1-3 Limb ischaemia (double score if
Page 776 and 777:
Complications of fracturesComplicat
Page 778 and 779:
Fractures and fat embolism syndrome
Page 780 and 781:
Radial nerveRadial nerve (most comm
Page 782 and 783:
Distal radial fractureLumbar-sacral
Page 784 and 785:
Sciatic nervePopliteal artery and c
Page 786 and 787:
Open tibial fracturePriorities in m
Page 788 and 789:
Features of cellulitishere is infec
Page 790 and 791:
Risk factors for cellulitisymphoede
Page 792 and 793:
Features of gas gangrenehock and se
Page 794 and 795:
Risk factors for gas gangrenefter a
Page 796 and 797:
Features of tetanusSymptoms begin 3
Page 798 and 799:
Risk factors for tetanusounds that
Page 800 and 801:
Treatment of tetanususcle relaxants
Page 802 and 803:
increase the risk of AVN. Early and
Page 804 and 805:
Features of AVNainhondrolysis and c
Page 806 and 807:
Fractures and myositis ossificansMy
Page 808 and 809:
Treatment of myositis ossificansiff
Page 810 and 811:
Treatment of CRPS type IUsually thi
Page 812 and 813:
Mechanics of anterior shoulder disl
Page 814 and 815:
Radiographs of anterior shoulder di
Page 816 and 817:
Proximal humerus fracturesThese fra
Page 818 and 819:
GroupIISurgical neck fracture with
Page 820 and 821:
GroupIV
Page 822 and 823:
Group Fracture dislocationsVIGroups
Page 824 and 825:
Fractures around the elbowAdult sup
Page 826 and 827:
Complications of fractures around t
Page 828 and 829:
Complications of forearm shaft frac
Page 830 and 831:
Scaphoid fractureThe most commonly
Page 832 and 833:
Intracapsular fracture of the proxi
Page 834 and 835:
Management of intracapsular fractur
Page 836 and 837:
Postoperative complications of intr
Page 838 and 839:
Complications of proximal femur fra
Page 840 and 841:
Complications associated with tibia
Page 842 and 843:
The pelvic ring comprises the sacru
Page 844 and 845:
Investigating pelvic fracturesA pla
Page 846 and 847:
Acetabular fracturesAcetabular frac
Page 848 and 849:
Classification of spinal injuriesSp
Page 850 and 851:
Treatment of cervical spine injurie
Page 852 and 853:
Type Iistraction injury of growth p
Page 854 and 855:
Complete, greenstick and torus frac
Page 856 and 857:
SECTION 7Soft-tissue injuries and d
Page 858 and 859:
pathology at presentation or pathol
Page 860 and 861:
of patella (patella tendon rupture)
Page 862 and 863:
Forced dorsiflexionWhen the foot is
Page 864 and 865:
SECTION 8Compartment syndromeIn a n
Page 866 and 867:
Management of compartment syndromeI
Page 868 and 869:
Nerys ForesterSurgical research and
Page 870 and 871:
There are advantages and disadvanta
Page 872 and 873:
ControlsA control group is a group
Page 874 and 875:
Asking an answerable questionClinic
Page 876 and 877:
All studies suffer from loss to fol
Page 878 and 879:
Applying evidence to clinical pract
Page 880 and 881:
se and storage of human tissue (if
Page 882 and 883:
Paper contentThe paper should inclu
Page 884 and 885:
ReferencesCross-reference statement
Page 886 and 887:
Experimental studies are the RCTs.S
Page 888 and 889:
Observational studyAccurate and pre
Page 890 and 891:
CrosssectionalExample is Framingham
Page 892 and 893:
RandomisedcontrolledtrialInterventi
Page 894 and 895:
Measures of spreadMeasure of spread
Page 896 and 897:
The normal distributionIf you study
Page 898 and 899:
Types of biasbserver bias: may occu
Page 900 and 901:
Survival analysisSurvival analysis
Page 902 and 903:
5.2 Who can obtain consent?5.3 Who
Page 904 and 905:
interests of their patients.Non-mal
Page 906 and 907:
SECTION 2Clinical governance and ri
Page 908 and 909:
improvements in safety.A patient sa
Page 910 and 911:
This has replaced the Health Care C
Page 912 and 913:
rediction scores (eg ASA)emographic
Page 914 and 915:
Personal knowledgeThis may be subdi
Page 916 and 917:
Referral involves transferring some
Page 918 and 919:
even where there has probably been
Page 920 and 921:
egible handwritingclearly defined p
Page 922 and 923:
complication after surgery, and the
Page 924 and 925:
Permanent incapacityThis is a compl
Page 926 and 927:
atients whose conditions may be rel
Page 928 and 929:
ny financial interest must be openl
Page 930 and 931:
CHAPTER 9Orthopaedic SurgeryNigel W
Page 932 and 933:
Disorders of the hand10.1 Clinical
Page 934 and 935:
SECTION 1Bone, muscle and joint str
Page 936 and 937:
Parathyroid hormoneine regulator of
Page 938 and 939:
Oestrogens and androgensAnabolic ho
Page 940 and 941:
Bone cellsThe osteoblasts and osteo
Page 942 and 943:
load transfer from the articular su
Page 944 and 945:
Synovial jointsSynovial joints are
Page 946 and 947:
muscle occurs. This is called the s
Page 948 and 949:
Type II fibresew mitochondriaich in
Page 950 and 951:
SECTION 2Joint pathologyDifferentia
Page 952 and 953:
Pain in OA is due to:nflamed and th
Page 954 and 955:
flares, 5% per cent show relentless
Page 956 and 957:
chronic renal failurePathological f
Page 958 and 959:
SECTION 3Bone pathology3.1 Osteopor
Page 960 and 961:
skeletal loading.
Page 962 and 963:
supplements should be given first t
Page 964 and 965:
capital epiphysisMain radiological
Page 966 and 967:
aged >90. Most commonly seen in Bri
Page 968 and 969:
SECTION 4The hip and thigh4.1 Anato
Page 970 and 971:
Nerve supply and movement of the hi
Page 972 and 973:
ExtensionGluteus maximus and hamstr
Page 974 and 975:
AbductionPiriformis, obturators, qu
Page 976 and 977:
Medial rotation4.2 Anatomy of the g
Page 978 and 979:
nferior glutealedial femoral circum
Page 980 and 981:
Move:Thomas’ test for fixed flexi
Page 982 and 983:
Signs of osteoarthritis of the hipT
Page 984 and 985:
Rheumatoid arthritis of the hipRheu
Page 986 and 987:
Compartments of the thighFemoral tr
Page 988 and 989:
SECTION 5The knee5.1 Anatomy of the
Page 990 and 991:
Posterior cruciateligamentPosterior
Page 992 and 993:
• Femur• Posterior ligament of
Page 994 and 995:
Clinical examinationStanding, trous
Page 996 and 997:
Joint injectionsSecond-line treatme
Page 998 and 999:
SECTION 6Disorders of the foot and
Page 1000 and 1001:
Classic peroneal nerve injuryoss of
Page 1002 and 1003:
Classic tibial nerve injuryoss of a
Page 1004 and 1005:
The arches of the footMedial longit
Page 1006 and 1007:
Toenails: onchogryphosis, subungal
Page 1008 and 1009:
Pes cavus (claw foot)This is charac
Page 1010 and 1011:
Surgical optionsild to moderate def
Page 1012 and 1013:
SECTION 7The shoulder and humerus7.
Page 1014 and 1015:
the glenoid cavity to the anatomica
Page 1016 and 1017:
Infraspinatuseinforces the posterio
Page 1018 and 1019:
Anterior (deltopectoral) approachAp
Page 1020 and 1021:
translation: fixing humeral head in
Page 1022:
7.5 Anatomy of the upper armIn a nu
Page 1025 and 1026:
ensory braches: posterior cutaneous
Page 1027 and 1028:
ronation is performed by pronator t
Page 1029 and 1030:
8.3 Clinical assessment of the elbo
Page 1031 and 1032:
8.4 Elbow disordersTennis elbowTenn
Page 1033 and 1034:
SECTION 9The forearm and wrist9.1 A
Page 1036 and 1037:
9.2 Bones of the forearmAnatomy of
Page 1038:
Compartment 6 (ulnar)Extensor carpi
Page 1041 and 1042:
Zone5Area of carpal tunnelContains
Page 1043 and 1044:
Approachevelop plane between brachi
Page 1045 and 1046:
Approachevelop plane between extens
Page 1047 and 1048:
SECTION 10Disorders of the hand10.1
Page 1049 and 1050:
Remember to assess any sensory defi
Page 1051 and 1052:
ParonychiaApical infectionsPulp inf
Page 1053 and 1054:
Conservative management of the rheu
Page 1055 and 1056:
•Little
Page 1057 and 1058:
Index• Thumb (least commonly)Cond
Page 1059 and 1060:
skin (unlike sebaceous cysts) nor t
Page 1061 and 1062:
supracondylar fracturesExamination
Page 1063 and 1064:
Palpationalpate the nerve where it
Page 1065 and 1066:
Powerbductor pollicis brevis: this
Page 1067 and 1068:
Treatment of carpal tunnel syndrome
Page 1069 and 1070:
InspectionAsk patient to roll up th
Page 1071 and 1072:
Sensationlnar side of the palm over
Page 1073 and 1074:
InspectionAsk the patient to roll u
Page 1075 and 1076:
Sensationesions distal to the elbow
Page 1077 and 1078:
canals, causing thrombosis of blood
Page 1079 and 1080:
Spread of infectionOsteomyelitis ma
Page 1081 and 1082:
Common organisms. aureus is most co
Page 1083 and 1084:
Clinical features of septic arthrit
Page 1085 and 1086:
pollution is dilution’ashout may
Page 1087 and 1088:
In adultsecondary OAoint stiffnessi
Page 1089 and 1090:
Aetiology of acute osteomyelitisCau
Page 1091 and 1092:
Other causesalmonella spp. in patie
Page 1093 and 1094:
Investigating acute osteomyelitisad
Page 1095 and 1096:
Classification of chronic osteomyel
Page 1097 and 1098:
Management of chronic osteomyelitis
Page 1099 and 1100:
Microbiology of skeletal TBCausativ
Page 1101 and 1102:
Spinal TBSpinal TB typically involv
Page 1103 and 1104:
Management of skeletal TBAnti-TB ch
Page 1105 and 1106:
Microbiology of spinal infectionsCo
Page 1107 and 1108:
Management of spinal infectionsTrea
Page 1109 and 1110:
Pathogenesis of prosthetic joint in
Page 1111 and 1112:
Management of prosthetic joint infe
Page 1113 and 1114:
Swellingleeding into tumours may pr
Page 1115 and 1116:
pen incisional biopsypen excisional
Page 1117 and 1118:
• Second smaller peak in incidenc
Page 1119 and 1120:
definitive investigationresentation
Page 1121 and 1122:
maging: lytic lesion in epiphysis.
Page 1123 and 1124:
Fibrous dysplasiapidemiology: major
Page 1125 and 1126:
Imaging of skeletal metastasesPlain
Page 1127 and 1128:
SECTION 13Spine13.1 Development of
Page 1129 and 1130:
Figure 9.18 Formation of the neural
Page 1131 and 1132:
Role of the spineStructuralaintenan
Page 1133 and 1134:
attachment points for the muscles a
Page 1135 and 1136:
Cervical vertebraell have a hole in
Page 1137 and 1138:
Sacrumransmits the weight of the bo
Page 1139 and 1140:
Intervertebral discsThese are the j
Page 1141 and 1142:
Figure 9.24 Some of the extrinsic m
Page 1143:
Posterior longitudinal ligamentimil
Page 1146 and 1147:
Suboccipital triangleThis is a tria
Page 1148 and 1149:
Forces on the spineWhen comparing r
Page 1150 and 1151:
Spinal cord coveringsThe spinal cor
Page 1152 and 1153:
Composition of the spinal cordThe s
Page 1154 and 1155:
Spinal nerve roots and spinal nerve
Page 1156 and 1157:
Spinal nerve leaves the foramen↓D
Page 1158 and 1159:
Figure 9.28 The interrelationships
Page 1160 and 1161:
Sympathetic nervous systemIf you ca
Page 1162 and 1163:
Spinal nerve↓
Page 1164 and 1165:
Postganglionic fibres↓Grey ramus
Page 1166 and 1167:
Radicular arteriesThe radicular art
Page 1168 and 1169:
HistoryWhen taking a history for so
Page 1170 and 1171:
Summary of neurological examination
Page 1172 and 1173:
Elderly; on steroidsSpinal fracture
Page 1174 and 1175:
Night sweatsTumour, infection
Page 1176 and 1177:
Previous cancer historyMetastatic t
Page 1178 and 1179:
Recent bacterial infectionInfection
Page 1180 and 1181:
Saddle anaesthesiaCauda equina synd
Page 1182 and 1183:
Generalised ill health
Page 1184 and 1185:
Examination Bruising/haematomaTumou
Page 1186 and 1187:
Neurological loss with level
Page 1188 and 1189:
Severe pain on palpation
Page 1190 and 1191:
Lax anal sphincterPerianal/perineal
Page 1192 and 1193:
LymphadenopathyTumour
Page 1194 and 1195:
Abnormal chest examinationTumourInv
Page 1196 and 1197:
Disc prolapseProlapse of the interv
Page 1198 and 1199:
spastic paraparesis, and hyper-refl
Page 1200 and 1201:
Inflammation of ligamentous inserti
Page 1202 and 1203:
Replacement by fibrous tissue↓
Page 1204 and 1205:
Wall testIf a healthy person stands
Page 1206 and 1207:
Extraskeletal manifestationsritis (
Page 1208 and 1209:
Spinal infectionsSee also Section 1
Page 1210 and 1211:
Causes of back painAge 0-10Scoliosi
Page 1212 and 1213:
Management of nerve root painOnce s
Page 1214 and 1215:
Cauda equina syndromeIf the narrowi
Page 1216 and 1217:
Microdiscectomyim: to remove hernia
Page 1218 and 1219:
Intradiscal extracanalicular approa
Page 1220 and 1221:
Posterolateral or intertransverse f
Page 1222 and 1223:
Transforaminal lumbar interbody fus
Page 1224 and 1225:
Pathology of neck painAcute cervica
Page 1226 and 1227:
Management of cervical spondylosisO
Page 1228 and 1229:
ortality (5% for transoral odontoid
Page 1230 and 1231:
urgical treatment reserved for larg
Page 1232 and 1233:
Figure 9.33 Cobb’s method for mea
Page 1234 and 1235:
SpondylolisthesisSpondylolisthesis
Page 1236 and 1237:
The most common site is the lumbar
Page 1238 and 1239:
Spinal column reconstructionThe aim
Page 1240 and 1241:
DecompressionDecompression is a gen
Page 1242 and 1243:
spinal surgery). Upper limb procedu
Page 1244 and 1245:
InfectionImplanting prosthetic mate
Page 1246 and 1247:
Skeletal dysplasiaOsteogenesis impe
Page 1248 and 1249:
septic arthritis in cases where sus
Page 1250 and 1251:
Flex the knees.Place hands so that
Page 1252 and 1253:
Perthes’ diseasePerthes’ diseas
Page 1254 and 1255:
Acute-on-chronic presentation is co
Page 1256 and 1257:
15.2 Problems with the foot in chil
Page 1258 and 1259:
varus/valgus malalignment.Pathologi
Page 1260 and 1261:
Discoid lateral meniscusIncidence i
Page 1262 and 1263:
dominant form is often associated w
Page 1264 and 1265:
CHAPTER 10Paediatric surgeryStuart
Page 1266 and 1267:
SECTION 1Children as surgical patie
Page 1268 and 1269:
Abdominal organs in childrenThere a
Page 1270 and 1271:
Maintenance fluid and electrolyte r
Page 1272 and 1273:
Recognising shock in children is mo
Page 1274 and 1275:
9 months Crawls, babbles, eg ‘mam
Page 1276 and 1277:
Give initial bolus of 20 ml/kg flui
Page 1278 and 1279:
Embryology of the GI tractBy the th
Page 1280 and 1281:
The pharyngeal gutThis extends from
Page 1282 and 1283:
The spleen is a foregut derivative
Page 1284 and 1285:
reatment consists of closure of the
Page 1286 and 1287:
Low and intermediate anorectal anom
Page 1288 and 1289:
bowel lumen and its detergent effec
Page 1290 and 1291:
Embryology of the diaphragmFigure 1
Page 1292 and 1293:
week 6.Figure 10.10 Development of
Page 1294 and 1295:
Formation of the definitive kidneyT
Page 1296 and 1297:
Testesf the germ cells carry an XY
Page 1298 and 1299:
Descent of the testesThe testis is
Page 1300 and 1301:
Genital ducts in the malen the pres
Page 1302 and 1303:
External genitalia in the malehe ge
Page 1304 and 1305:
ay be solitary, multiple or bilater
Page 1306 and 1307:
Associationsystic change in other o
Page 1308 and 1309:
Medullary sponge kidneyystic dilata
Page 1310 and 1311:
Management of PUJ obstructionThe in
Page 1312 and 1313:
Surgery is performed between the ag
Page 1314 and 1315:
Figure 10.15 Ectopic positions for
Page 1316 and 1317:
ilms tumourntersex disorders (gonad
Page 1318 and 1319:
3.7 Urinary tract infections in chi
Page 1320 and 1321:
Idiopathic scrotal oedemaHenoch-Sch
Page 1322 and 1323:
SECTION 4Paediatric oncologyIn a nu
Page 1324 and 1325:
are patent and if blood flow is nor
Page 1326 and 1327:
of tumour volume • Given in fract
Page 1328 and 1329:
Rhabdomyosarcoma
Page 1330 and 1331:
Germ cell tumoursLiver tumours (hep
Page 1332 and 1333:
Treatment of liver tumoursurther ch
Page 1334 and 1335:
Investigating rhabdomyosarcomanitia
Page 1336 and 1337:
Investigating neuroblastomat presen
Page 1338 and 1339:
Treatment of Wilms tumourhemotherap
Page 1340 and 1341:
Staging of germ cell tumoursarious
Page 1342 and 1343:
SECTION 5Paediatric general surgery
Page 1344 and 1345:
can be identified by the prepyloric
Page 1346 and 1347:
ust preserve the umbilicus to avoid
Page 1348 and 1349:
engorged (with rectal bleeding) and
Page 1350 and 1351:
Investigating intussusceptionbdomin
Page 1352 and 1353:
Outcome of treatmentRecurrence rate
Page 1354 and 1355:
CHAPTER 11Plastic SurgeryStuart W W
Page 1356 and 1357:
giving ‘granular’ appearance 4.
Page 1358 and 1359:
complete surgical excision of the c
Page 1360 and 1361:
lesion, particularly on the limbs o
Page 1362 and 1363:
SCC commonly presents in older, fai
Page 1364 and 1365:
Aetiology of melanomaMalignant mela
Page 1366 and 1367:
1.01-2.0 1-22.01-4.0 2-3>4 3Managin
Page 1368 and 1369:
IIb T3bN0M0 T4aN0M0 63-67IIc T4bN0M
Page 1370 and 1371:
Avulsion involves tearing or forcib
Page 1372 and 1373:
Wound debridementDebridement is the
Page 1374 and 1375:
Tissue expansionTissue expansion is
Page 1376 and 1377:
FlapsA flap is a vascularised unit
Page 1378 and 1379:
Scapular and parascapular flapsFlap
Page 1380 and 1381:
Gracilis flapGracilis is a long thi
Page 1382 and 1383:
List of Abbreviations5-HIAA 5-hydro
Page 1384 and 1385:
CT computed tomographyCTEV congenit
Page 1386 and 1387:
ITUIVIVUJGAJIAJVPKUBLALDHLFTsLIFLMW
Page 1388 and 1389:
RARBCRIFRTARUQSBPSIMVSIRSSLESMASPEC
Page 1390 and 1391:
BibliographyBooks:nderson ID (1999)
Page 1392 and 1393:
lter RB, Harris WR (1963) ‘Injuri
Page 1394 and 1395:
management ref 1, ref 2specimen col
Page 1396 and 1397:
liver trauma ref 1pre-hospital resu
Page 1398 and 1399:
aplastic ref 1blood transfusion ref
Page 1400 and 1401:
terior white commissure ref 1terola
Page 1402 and 1403:
electrical injuries ref 1hypothermi
Page 1404 and 1405:
cille Calmette-Guérin (BCG) vaccin
Page 1406 and 1407:
opsy ref 1bone infections ref 1, re
Page 1408 and 1409:
infections ref 1island ref 1, ref 2
Page 1410 and 1411:
segmental ref 1traumatic injuries r
Page 1412 and 1413:
hydrostatic pressure ref 1membrane,
Page 1414 and 1415:
rriage, microbial ref 1rtilageartic
Page 1416 and 1417:
fibres ref 1ancre ref 1emical burns
Page 1418 and 1419:
indamycin ref 1inical decision-maki
Page 1420 and 1421:
postoperative see postoperative com
Page 1422 and 1423:
of surgery ref 1st-utility analysis
Page 1424 and 1425:
osteoclast development ref 1SIRS re
Page 1426 and 1427:
ad spacealveolar ref 1anatomical re
Page 1428 and 1429:
hiscenceanastomosis ref 1wound ref
Page 1430 and 1431:
aphragmcongenital herniation ref 1e
Page 1432 and 1433:
sabilityburns ref 1paediatric traum
Page 1434 and 1435:
odenumatresia ref 1development ref
Page 1436 and 1437:
ectrolytescytoplasmic ref 1daily re
Page 1438 and 1439:
dothelial cellsinflammatory respons
Page 1440 and 1441:
ergymetabolism, paediatric patients
Page 1442 and 1443:
aporation, heat loss via ref 1
Page 1444 and 1445:
posureburns ref 1paediatric trauma
Page 1446 and 1447:
ctor VIIIconcentrate ref 1deficienc
Page 1448 and 1449:
sciotomycompartment syndrome in cal
Page 1450 and 1451:
distaladults ref 1children ref 1fat
Page 1452 and 1453:
gersDupuytren’s contracture ref 1
Page 1454 and 1455:
latedeficiency ref 1red cell ref 1l
Page 1456 and 1457:
fracturesadults ref 1children ref 1
Page 1458 and 1459:
ngal infections ref 1ITUs ref 1, re
Page 1460 and 1461:
Duties of a Doctor ref 1Good Medica
Page 1462 and 1463:
nital tractdevelopmental abnormalit
Page 1464 and 1465:
ucoseenergy production from ref 1,
Page 1466 and 1467:
nadsdescent ref 1development ref 1o
Page 1468 and 1469:
emarthrosishaemophilia-related ref
Page 1470 and 1471:
emophiliaA ref 1B (Christmas diseas
Page 1472 and 1473:
alingfracture ref 1wound see wound
Page 1474 and 1475:
artconducting system ref 1trauma se
Page 1476 and 1477:
rpes simplex virus1 (HSV-1) ref 12
Page 1478 and 1479:
merusanatomy ref 1, ref 2fractures
Page 1480 and 1481:
perkalaemiamassive transfusion ref
Page 1482 and 1483:
povolaemiaburn injuries ref 1physio
Page 1484 and 1485:
capacitypermanent ref 1temporary re
Page 1486 and 1487:
formationconfidentiality see confid
Page 1488 and 1489:
sulin therapydiabetes mellitus ref
Page 1490 and 1491:
tracranial haemorrhageburr holes re
Page 1492 and 1493:
nsdistribution in body ref 1see als
Page 1494 and 1495:
aspirationdiagnostic ref 1, ref 2,
Page 1496 and 1497:
dneyaberrant vasculature ref 1bilat
Page 1498 and 1499:
parotomyabdominal trauma ref 1, ref
Page 1500 and 1501:
erdevelopment ref 1immaturity in ne
Page 1502 and 1503:
wer leganatomy ref 1see also ankle;
Page 1504 and 1505:
mbar spinebiomechanics ref 1disc re
Page 1506 and 1507:
acrophagesacute inflammation ref 1,
Page 1508 and 1509:
edian ref 1
Page 1510 and 1511:
embranecell ref 1transport ref 1emb
Page 1512 and 1513:
etastatic diseaseskeletal ref 1surg
Page 1514 and 1515:
otor endplate ref 1, ref 2
Page 1516 and 1517:
ucous membranesbarrier to infection
Page 1518 and 1519:
ckabscesses ref 1burns, management
Page 1520 and 1521:
urological assessmentback/spinal pr
Page 1522 and 1523:
servational studies ref 1server bia
Page 1524 and 1525:
sophagusatresia ref 1cancer ref 1tr
Page 1526 and 1527:
erating theatre staffminimising ris
Page 1528 and 1529:
tcomesresearch study ref 1, ref 2su
Page 1530 and 1531:
ygen contentarterial blood (CaO 2 )
Page 1532 and 1533:
3 protein ref 1, ref 2cemakers ref
Page 1534 and 1535:
in assessmentchronic pain ref 1paed
Page 1536 and 1537:
ncreasdevelopment ref 1secretions r
Page 1538 and 1539:
telladislocation ref 1fractures ref
Page 1540 and 1541:
lvispaediatric patients ref 1second
Page 1542 and 1543:
ysiologycellular ref 1general ref 1
Page 1544 and 1545:
gmented skin lesionsassessment of s
Page 1546 and 1547:
eumothoraxopen ref 1tension ref 1ly
Page 1548 and 1549:
anion gap ref 1daily requirements r
Page 1550 and 1551:
evalence ref 1, ref 2evalence bias
Page 1552 and 1553:
ostate cancerepidemiology ref 1, re
Page 1554 and 1555:
oteinscatabolism after surgery ref
Page 1556 and 1557:
eudoaneurysmsinjecting drug users r
Page 1558 and 1559:
blicationsurgical outcomes ref 1wri
Page 1560 and 1561:
estionsclinical ref 1patient ref 1,
Page 1562 and 1563:
dial neckfractures ref 1posterolate
Page 1564 and 1565:
diationheat loss via ref 1injuries
Page 1566 and 1567:
flexestendon ref 1testing ref 1flex
Page 1568 and 1569:
placement arthroplastyhip ref 1infe
Page 1570 and 1571:
spiratory distresspaediatric patien
Page 1572 and 1573:
suscitationacute renal failure ref
Page 1574 and 1575:
turday night palsy ref 1alds ref 1a
Page 1576 and 1577:
reeningcancer ref 1, ref 2programme
Page 1578 and 1579:
nsory functionperipheral nerve inju
Page 1580 and 1581:
dislocationsanterior ref 1posterior
Page 1582 and 1583:
dium/potassium pump (Na + /K + ATPa
Page 1584 and 1585:
curvatureabnormal ref 1measurement
Page 1586 and 1587:
ffcritical care ref 1theatre see op
Page 1588 and 1589:
pination, forearm ref 1, ref 2, ref
Page 1590 and 1591:
rgical teampreparation ref 1see als
Page 1592 and 1593:
amsconflict within ref 1working in
Page 1594 and 1595:
ighanatomy ref 1compartments ref 1i
Page 1596 and 1597:
oracotomyanterolateral ref 1, ref 2
Page 1598 and 1599:
umbmallet ref 1movement ref 1simian
Page 1600 and 1601:
esclaw ref 1hammer ref 1mallet ref
Page 1602 and 1603:
initial hospital care ref 1limping
Page 1604 and 1605:
atmentoptions, alternative ref 1ref
Page 1606 and 1607:
nar nerveanatomy ref 1, ref 2, ref
Page 1608 and 1609:
per limbarterial injuries ref 1comp
Page 1610 and 1611:
ethracongenital abnormalities ref 1
Page 1612 and 1613:
inary tractcongenital abnormalities
Page 1614 and 1615:
ine outputburns ref 1hypovolaemic s
Page 1616 and 1617:
scular accesschildren ref 1, ref 2c
Page 1618 and 1619:
insanastomoses ref 1injuries ref 1,
Page 1620 and 1621:
ntilatory supportcritical care ref
Page 1622 and 1623:
n Hippel-Lindau syndrome ref 1, ref
Page 1624 and 1625:
ound closureprimary ref 1principles
Page 1627 and 1628:
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