Bone Plates

PRACTICAL
ORTHOPEDICS

PRACTICAL
ORTHOPEDICS
SECOND EDITION

Subhash Kakkad
MS (Orth)

Medical Lecturer
Health and Family Welfare Training Center
City Center
Gwalior, Madhya Pradesh, India

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Practical Orthopedics
2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any
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This book has been published in good faith that the material provided by author is original. Every effort is made to ensure
accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any
dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition:
Second Edition:

2005
2011

ISBN 978-93-80704-85-2

Typeset at JPBMP typesetting unit

Printed at Ajanta Offset

To
my beloved father
Late Shri Bholaram Kakkad
and uncles (Late)
Shri Dhannaram
Shri Jethanand
Shri Deewanchand

Preface to the Second Edition

This second edition of Practical Orthopedics includes Posture, Gait and
Exercises a separate chapter, which is necessary to orthopedicians.
Some modification has been done in chapter 34 Guidelines for Evaluation
of Permanent Physical Impairment.

Subhash Kakkad

Preface to the First Edition

As I passed my postgraduation in 1982 since then I had attended so many orthopedic conferences,
workshops and courses with Bombay Orthopaedic Society and others, and came in contact with so
many orthopedic doctors of rural and urban areas, private practitioners and those working in
government sectors, as I am also working as a Medical Lecturer in Health and Family Welfare
Training Center, City Center, Gwalior, Madhya Pradesh (India) since last 20 years.
Many doctors had some problems in rural and urban vicinity. They all inspired me to write this
book which solves their day-to-day problems and after taking feedback I have chosen the name
Practical Orthopedics.
I started writing since last 6 years. My first book was on School Health Programme in Hindi which
was a book-cum-flip chart. The book was written on behalf of training center and was published by
Government of MP in ten lakhs copies, and distributed to the rural school teachers and children.
My second book was on Practical Approach of Ilizarovs Techniques (Basics and Advances) for the
orthopedic surgeons and budding orthopedicians in the year 2002 which had been published by
CBS Publication, Daryaganj, New Delhi, which has been also shown in movie, David Dhawans Ek
aur Ek Gyaraha thrice.
Now, my third book on Practical Orthopedics which includes: Heart-Lung Resuscitation, Shock
and Its Management, Therapies in Orthopaedics and Their Indications, Different Types of Suture
Materials, Plaster of Paris Casts Applications and Their Cutting Wedging etc., Orthotics and Prosthetics,
External Fixator for Long Bones and for Hand Bones, Management of Patients in Traction, Classification
of Bone and Soft Tissue Injuries, DHS/DCS and Angle Blade Plate Fixation for Upper and Lower
Ends of Femur, Intramedullary Interlocking, Nailing for Femur and Tibia, Fractures of Pelvis and
AcetabulumTheir Classifications and Primary Management. It also includes the Assessment of
Permanent Disabilities in Cases of Claim Settlement by accepted Kesselers method.
This book is very useful to orthopedicians, undergraduate medical students, private practitioners
and orthopedic surgeons posted in rural areas. The theme of this book is:
Learn New Techniques
Do not Forget Old
These are Silver
Those are Gold
(In Indian scenario)

Practical Orthopedics

x
This book includes theory and practical aspects in precised way to serve as a complete handbook.
If detailed aspect has to be covered, I refer the reader to read their regular course books.
I would like to avail this opportunity to express my gratitude to my respected Prof B Das, Retd
Prof and Head of the Department of Orthopedics, GR Medical College, Gwalior (MP) and Dr GC
Patani, Principal of HFWTC, Gwalior. Both are constant source of inspiration to me, to express my
views in this book.
My wife Smt Jyoti Kakkad who in spite of heavy teaching load and family burden, has not only
contributed but also helped in editing of this book. My 17-year-old son Ankur has also helped me
a lot, in computerizing this book.
My sincere thanks to Mr Thamban of SIHMC, Gwalior and Mr Akeel Ahmad who have taken
pains in editing and computerizing this book systematically.
I greatly appreciate the constant support and encourgement given to me by the faculty members
and staff of HFWTC City Center, Gwalior and members of Gwalior Orthopaedic Society, Gwalior.
In the last I would like to thank readers and hope they give me feedback for improvement by
their valuable suggestions which would guide me in future.
Subhash Kakkad

Contents
1. Heart-Lung Resuscitation ...........................................................................................................

2. Shock ...............................................................................................................................................

3. Classification of Fractures of Long Bones ............................................................................... 12

4. Classification of Soft Tissue Injuries ....................................................................................... 17
5. Plaster of Paris Casts .................................................................................................................... 19
6. Management of Patients in Traction ......................................................................................... 25
7. Limbs Tractions ............................................................................................................................ 32
8. Spinal Tractions and Tractions in Fracture Dislocations ..................................................... 51
9. Functional Bracing ........................................................................................................................ 58
10. Orthoses .......................................................................................................................................... 68
11. Spinal Orthoses ............................................................................................................................. 76
12. Lower Limb Orthosis ................................................................................................................... 87
13. Footwear .......................................................................................................................................... 98
14. Short Lower Limb Compensation ............................................................................................. 105
15. Walking Aids ................................................................................................................................. 108
16. Tourniquets .................................................................................................................................... 117
17. Suture Materials ............................................................................................................................ 124
18. Basic Orthopedic Techniques ..................................................................................................... 127
19. Tendon Suturing ........................................................................................................................... 134
20. Suture of Divided Nerve ............................................................................................................. 138

Practical Orthopedics

xii
21. Minor Procedures ......................................................................................................................... 141
22. Bone Screws ................................................................................................................................... 157
23. Bone Plates ..................................................................................................................................... 168
24. Medullary Nailing ........................................................................................................................ 176
25. The DHS/DCS System ................................................................................................................. 201
26. The Angled Blade Plate System ................................................................................................ 210
27. Fracture of Lower Humerus ........................................................................................................ 214
28. Fracture of Pelvis .......................................................................................................................... 220
29. Fracture of Acetabulum ............................................................................................................... 227
30. External Fixation ........................................................................................................................... 240
31. Hand Bones Fracture Frame ....................................................................................................... 248
32. Therapies ........................................................................................................................................ 261
33. Posture, Gait and Exercises ......................................................................................................... 272
34. Guidelines for Evaluation of Permanent Physical Impairment ......................................... 323
Index ................................................................................................................................................. 359