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Title: The Nonsurgical Treatment of Fractures in Contemporary Orthopedics

Author: Augusto Sarmiento, MD, and Loren Latta, PhD
Publisher: Jaypee Brothers Medical Publishers LTD; Number of pages: 407
Reviewed by: Kate Muller, CPO, FAAOP

In their latest work, Sarmiento and Latta, pioneers in the development of functional fracture bracing systems, update previous publications with recent research findings. They have added numerous diagrams, full-color images, supporting study data, and representative examples. The textbook begins with a thorough review of the basic science and biomechanics of fracture healing before proceeding to fractures of the lower limb and then upper limb. It should be emphasized that this textbook relates to the treatment of the adult and geriatric fracture populations and does not address pediatrics.

The book's primary focuses are the functional non-surgical treatment of fractures of the tibia, humeral shaft, isolated fracture of the ulna, and Colles' fracture. Secondary focuses are the fractures of the femoral shaft, both bones of the forearm, and isolated radial shaft fracture. In each section, the authors explain the rationale for functional bracing of that body region; report indications and contraindications; discuss initial fracture management; use illustrations to demonstrate how to place and remove bracing; and offer advice on patient instruction, rehabilitation, follow-up, expected outcomes, and prevention and management of complications.

The authors try to balance surgical versus non-surgical approaches of care of the major fractures in a rational way. They acknowledge that although modern surgery has made wonderful advances in the treatment of open fractures (e.g., superior metallurgy, sophisticated imagery, better infection control), there is still a place for the nonsurgical treatment of closed fractures. They do explicitly state that there isn't one treatment modality applicable to all fractures under all circumstances. Every treatment has its indications and contraindications as well as potential complications.

In summary: This text is geared toward the orthopedist and the orthotist specializing in functional fracture management. It is unlikely to serve as a cover-to-cover read for most busy O&P practitioners. The strength of this text lies in the expanded number of clinical results and representative examples presented by the authors in each section. The O&P student or resident may be overwhelmed by the amount of detail provided in the many clinical representative samples and may not appreciate the nuances provided by the authors. For the general O&P clinician looking for specific explanations for trim line locations or fitting guidelines, they will instead only find a series of visual illustrations of the step-by-step processes. For the experienced clinician, unless they frequently treat adult or geriatric patients with these types of closed fractures, the provided data and charts supporting functional fracture treatment will go unappreciated.

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