THE WRIST. DIAGNOSIS AND OPERATIVE TREATMENT. Volume l and Volume 2. Edited by William P. Cooney, Ronald L. Linscheid and James H. Dobyns. 708 pp. (vol. 1) and 604 pp. (vol. 2). Illust. Mosby–Year Book Inc., St. Louis; Harcourt Brace & Co. Canada, Ltd., Toronto. 1997. Can$404 (set). ISBN 0-8016-6644-9 (set)
This 2-volume textbook is the most recent publication to appear on disorders related to the wrist. It follows by approximately 10 years, single-volume texts, written by others, that represented the most authoritative treatises on this subject. This new text provides an extremly comprehensive overview of the diagnosis and operative treatment for a very broad spectrum of problems affecting the wrist, including fractures, instability and arthritis.
The work is multiauthored and edited by 3 eminent wrist surgeons. Interestingly, almost all the contributors are former trainees at the Mayo Clinic so, despite variations in style through the chapters, the book essentially represents a synthesis of ideas that have developed at one centre over 25 to 30 years.
The comprehensiveness of the text is underlined by the first 2 chapters, which describe how our present concepts of the wrist joint have developed by reviewing the contributions of earlier surgeons extending to the preroentgen era. The second chapter describes the anthropologic features and anatomy of the wrist. This has long been an interest of Dr. Linscheid, and although the chapter does not necessarily add to the practical value of the text, it certainly makes for very interesting reading and is consistent with the desire of the editors to cover all aspects of the wrist.
At the opposite end of the spectrum, the final chapter entitled “Anticipations and needs” examines, philosophically, what might be anticipated in the future for clinicians concerned with the care of the wrist, such as the development of new diagnostic modalities and treatments (including arthroplasties) and the use of growth factors in hand surgery generally.
The intervening text is a compendium of surgical treatments for the care of wrist problems. There are extensive discussions of wrist anatomy and joint pathomechanics, 2 areas in which members of the Mayo Clinic have been very influential through their many publications. These sections are beautifully illustrated and clearly convey some of the difficult anatomic and mechanical points concerning the radiocarpal joint and the individual carpal elements. Throughout the 2 volumes the quality of the illustrations is uniformly superlative. The sheer number of illustrations is amazing — there are over 2600, an average of almost 2 per page.
Although the discussion of operative procedures is quite comprehensive, many areas of the text do not highlight the decision-making process in choosing a particular treatment. For instance, in the section on the treatment of fractures to the distal radius there is a description of a wide assortment of operative procedures, but the discussion of how to choose the right one for a given patient is limited and there are no tips on the technical aspects of some of these very difficult procedures. Also, in the section on malunion of distal radial fractures, little mention is made of the problem of ulnocarpal impingement, which is one of the most common complications of this injury. There is an entire chapter on ulnocarpal abutment, which is one of the most common causes of malunion of the distal radius, but it is not really described in the context of such malunion.
There is an excellent chapter on instability in the wrist, and in this regard the text excels by highlighting the important, basic work done by the authors. There are also several good chapters related to the care of rheumatoid arthritis. In this section a whole chapter is devoted to wrist arthroplasty, which is still considered by most surgeons to be experimental.
My principal criticism of this text is that it contains very little information on nonoperative management. Although it might be argued that nonsurgical care of wrist problems is better left to nonsurgeons, I feel that a more balanced approach to the care of these problems would have been provided had there been a more extensive discussion of nonoperative treatment. It was clearly the goal of the editors to provide a text that shows how operations on the wrist are performed; however, they appear to assume that the reader will recognize that many of these procedures should only be recommended after a course of appropriate nonoperative treatment. Overall, this is an excellent addition to the basic literature on the clinical care of upper extremity problems. It is appropriate reading for senior orthopedic residents and certainly for surgeons taking postgraduate training in upper extremity surgery. It is required reading for all practising surgeons who are involved in the care of wrist problems because it represents the most up-to-date and comprehensive information available on the care of a challenging aspect of orthopedic surgery.