Apleys

System of Orthopaedics
and Fractures

Alan Graham Apley 19141996

Inspired teacher, wise mentor and joyful friend

Louis Solomon MD FRCS

Emeritus Professor of Orthopaedics
Bristol
UK
David Warwick MD FRCS FRCSOrth Eur Dip Hand Surg
Consultant Hand Surgeon
Reader in Orthopaedic Surgery
University of Southampton
Southampton
UK
Selvadurai Nayagam BSc MChOrth
FRCSOrth
Consultant Orthopaedic Surgeon
Royal Liverpool Childrens Hospital
and
The Royal Liverpool University
Hospital
Liverpool
UK

Apleys
System of Orthopaedics
and Fractures
Ninth Edition

First published in Great Britain in 1959 by Butterworths Medical Publications

Second edition 1963
Third edition 1968
Fourth edition 1973
Fifth edition 1977
Sixth edition 1982
Seventh edition published in 1993 by Butterworth Heineman.
Eight edition published in 2001 by Arnold.
This ninth edition published in 2010 by
Hodder Arnold, an imprint of Hodder Education, an Hachette UK Company,
338 Euston Road, London NW1 3BH
http://www.hodderarnold.com
2010 Solomon, Warwick, Nayagam
All rights reserved. Apart from any use permitted under UK copyright law, this publication may only be reproduced, stored or transmitted, in any form, or by any means, with
prior permission in writing of the publishers or in the case of reprographic production, in
accordance with the terms of licences issued by the Copyright Licensing Agency. In the
United Kingdom such licences are issued by the Copyright Licensing Agency:
90 Tottenham Court Road, London W1T 4LP
Whilst the advice and information in this book are believed to be true and accurate at the
date of going to press, neither the author[s] nor the publisher can accept any legal
responsibility or liability for any errors or omissions that may be made. In particular (but
without limiting the generality of the preceding disclaimer) every effort has been made to
check drug dosages; however it is still possible that errors have been missed. Furthermore,
dosage schedules are constantly being revised and new side-effects recognized. For these
reasons the reader is strongly urged to consult the drug companies printed instructions
before administering any of the drugs recommended in this book.

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress
ISBN-13
ISBN-13 [ISE]

978 0 340 942 055

978 0 340 942 086 (International Students Edition, restricted
territorial availability)

1 2 3 4 5 6 7 8 9 10
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iv

Dedication

To our students, trainees and patients, all of whom have helped to make our lives
interesting, stimulating and worthwhile; and also to our wives and children (and
grand-children) who have tolerated our absences both material and spiritual while
preparing this new edition.

This page intentionally left blank

Contents

Contributors
Preface
Acknowledgements
List of abbreviations used
PART 1:

GENERAL ORTHOPAEDICS
1 Diagnosis in orthopaedics
Louis Solomon, Charles Wakeley
2 Infection
Louis Solomon, H. Srinivasan, Surendar Tuli, Shunmugam Govender
3 Inflammatory rheumatic disorders
Christopher Edwards, Louis Solomon
4 Crystal deposition disorders
Louis Solomon
5 Osteoarthritis
Louis Solomon
6 Osteonecrosis and related disorders
Louis Solomon
7 Metabolic and endocrine disorders
Louis Solomon
8 Genetic disorders, skeletal dysplasias and malformations
Deborah Eastwood, Louis Solomon
9 Tumours
Will Aston, Timothy Briggs, Louis Solomon
10 Neuromuscular disorders
Deborah Eastwood, Thomas Staunton, Louis Solomon
11 Peripheral nerve injuries
David Warwick, H. Srinivasan, Louis Solomon
12 Orthopaedic operations
Selvadurai Nyagam, David Warwick

PART 2:

ix
xi
xiii
xv

3
29
59
77
85
103
117
151
187
225
269
303

REGIONAL ORTHOPAEDICS
13 The shoulder and pectoral girdle
Andrew Cole, Paul Pavlou
14 The elbow and forearm
David Warwick
15 The wrist
David Warwick, Roderick Dunn
16 The hand
David Warwick, Roderick Dunn
17 The neck
Stephen Eisenstein, Louis Solomon
18 The back
Stephen Eisenstein, Surendar Tuli, Shunmugam Govender

337
369
383
413
439
453

19 The hip
Louis Solomon, Reinhold Ganz, Michael Leunig, Fergal Monsell,
Ian Learmonth
20 The knee
Louis Solomon, Theo Karachalios
21 The ankle and foot
Gavin Bowyer
PART 3:

Epilogue: Global Orthopaedics

Christopher Lavy, Felicity Briggs
Index

CONTENTS

547
587

FRACTURES AND JOINT INJURIES

22 The management of major injuries
David Sutton, Max Jonas
23 Principles of fractures
Selvadurai Nayagam
24 Injuries of the shoulder, upper arm and elbow
Andrew Cole, Paul Pavlou, David Warwick
25 Injuries of the forearm and wrist
David Warwick
26 Hand injuries
David Warwick
27 Injuries of the spine
Stephen Eistenstein, Wagih El Masry
28 Injuries of the pelvis
Louis Solomon
29 Injuries of the hip and femur
Selvadurai Nayagam
30 Injuries of the knee and leg
Selvadurai Nayagam
31 Injuries of the ankle and foot
Gavin Bowyer

viii

493

627
687
733
767
787
805
829
843
875
907

935
939

Contributors

Principal Authors
Louis Solomon MD FRCS Eng FRCS Ed
Emeritus Professor of Orthopaedic Surgery
Honorary Consultant Orthopaedic Surgeon
Bristol Royal Inrmary, Bristol, UK
Selvadurai Nayagam BSc, MChOrth FRCSOrth
Consultant Orthopaedic Surgeon
Royal Liverpool Childrens Hospital and
The Royal Liverpool University Hospital
Liverpool, UK
David Warwick MD BM FRCS FRCS (Orth)
Eur Dip Hand Surg
Consultant Hand Surgeon
Reader in Orthopaedic Surgery
University of Southampton, Southampton, UK

Timothy William Roy Briggs MD(Res)

MCh(Orth) FRCS FRCS Ed
Professor and Consultant Orthopaedic Surgeon
Joint Medical Director
Joint Training Programme Director
Royal National Orthopaedic Hospital
Stanmore, UK
Tumours
Andrew Spencer Cole BSc MBBS
FRCS(TR&Orth)
Consultant Orthopaedic Surgeon
Southampton University Hospitals
Southampton, UK
The Shoulder and Pectoral Girdle
Injuries of the Shoulder and Upper Arm and elbow
Roderick Dunn MBBS DMCC FRCS(Plast)
Consultant Plastic, Reconstructive and Hand
Surgeon, Odstock Centre for Burns, Plastic and
Maxillofacial Surgery, Salisbury District Hospital
Salisbury, UK
The Wrist and The Hand: Congenital Variations

Contributing Authors
Will Aston BSc, MBBS, FRCS Ed(TR&Orth)
Consultant Orthopaedic Surgeon
Royal National Orthopaedic Hospital
Stanmore, UK
Tumours
Gavin William Bowyer MA MChir FRCS(Orth)
Consultant Trauma and Orthopaedic Surgeon
and Honorary Senior Lecturer
Southampton University Hospitals
Southampton, UK
The Ankle and Foot
Injuries of the ankle and foot
Felicity Briggs MA(Oxon) UK
Research Assistant and Graduate Medical Student
Epilogue: Global Orthopaedics

Deborah Eastwood FRCS

Consultant Orthopaedic Surgeon and
Hon Senior Lecturer
University College London;
Great Ormond Street Hospital for Children
London, UK
Genetic Disorders, Dysplasias and Malformations
Neuromuscular Disorders
Christopher J Edwards BSc MBBS FRCP MD
Consultant Rheumatologist & Honorary Senior
Lecturer
Associate Director
Wellcome Trust Clinical Research Facility
Southampton University Hospitals NHS Trust
Southampton General Hospital, UK
Inammatory Rheumatic Disorders

Stephen Eisenstein PhD FRCS(Ed)

Hon Professor, Keele University; Emeritus Director
Centre for Spinal Studies;
The Robert Jones and Agnes Hunt Orthopaedic
Hospital, Shropshire, UK
The Neck
The Back
Injuries of the Spine
Reinhold Ganz MD
Professor and Chairman Emeritus
Orthopaedic Department Inselspital
University of Bern, Switzerland
The Hip: Femoro-acetabular Impingement
Shunmugam Govender MBBS MD FRCS
FC(Orth) (SA)
Professor and Head of Department of Orthopaedics;
Director of Spinal Services King George V Hospital;
Nelson R Mandela School of Medicine
Durban, South Africa
Infection
The Back: Infections of the Spine
Max Jonas MBBS FRCA
Consultant and Senior Lecturer in Critical Care
Southampton University Hospitals NHS Trust
Southampton, UK
The Management of Major Injuries
Theo Karachalios MD DSc
Associate Professor in Orthopaedics,
School of Health Sciences, University of Thessalia
University General Hospital of Larissa
Hellenic Republic
The Knee

CONTRIBUTORS

Christopher Lavy OBE MD MCh FRCS

Hon Professor and Consultant,
Nufeld Department of Orthopaedic Surgery,
University of Oxford, UK
Epilogue: Global Orthopaedics

Ian Douglas Learmonth MB ChB FRCS Ed FRCS

FCS(SA)Orth
Emeritus Professor, ;
Honorary Consultant, University Hospitals, Bristol;
Honorary Consultant, North Bristol Trust, UK
Total Hip Replacement
Michael Leunig MD
Head of Orthopaedics, Lower Extremities
Schulthess Klinik, Zurich, Switzerland
The Hip: Femoro-Acetabular Impingement

Wagih S El Masry FRCS FRCP

Consultant Surgeon in Spinal Injuries;
Director, Midlands Centre for Spinal Injuries
President International Spinal Cord Society (ISCOS)
RJ & AH Orthopaedic Hospital, Oswestry, UK
Injuries of the Spine
Fergal P Monsell MSc FRCS FRCS(Orth)
Consultant Paediatric Orthopaedic Surgeon
Bristol Royal Hospital for Children
Bristol, UK
The Hip: Disorders in Children
Paul Pavlou BSc (Hons) MB BS MRCS
Orthopaedic Registrar, Wessex training scheme
The Shoulder and Pectoral Girdle
Injuries of the Shoulder
H. Srinivasan MB BS FRCS FRCS Ed
DSc (Hon)
Formerly Senior Orthopaedic Surgeon
Central Leprosy Teaching & Research Institute
Chengalpattu (Tamil Nadu), India;
Director Central JALMA Institute for Leprosy
(ICMR), Agra (UP), India; and Editor Indian
Journal of Leprosy
Infection and Peripheral Nerve Disorders: Leprosy
Thomas G Staunton MB FRCP(C) FRCP
Consultant Neurologist
Norfolk and Norwich University Hospital;
Consultant Clinical Neurophysiologist
Robert Jones and Agnes Hunt Orthopaedic
Hospital, Shropshire, UK
Neuromuscular Disorders: Neurophysiological Studies
David Sutton BM DA FRCA
Department of Anaesthetics
Southampton General Hospital
Southampton, UK
Management of Major Injuries
Surendar Mohan Tuli MBBS MS PhD
Senior Consultant in Spinal Diseases and
Orthopaedics, Vimhans Hospital, New Delhi, India
Infection: Tuberculosis of Bones and Joints
The Back
Charles J Wakeley BSc MBBS FRCS FRCS Ed
FRCR
Consultant Radiologist, Department of Radiology
University Hospital Bristol NHS Foundation Trust
Bristol, UK
Diagnosis in Orthopaedics: Imaging

Preface

When Alan Apley produced the rst edition of his System of Orthopaedics and Fractures 50 years ago he
saw it as an aid to accompany the courses that he conducted for aspiring surgeons who were preparing for
the FRCS exams. With characteristic humour, he
called the book a prophylactic against writers
cramp. Pictures were unnecessary: if you had any
sense (and were quick enough to get on the heavily
oversubscribed Apley Course) you would be treated
to an unforgettable display of clinical signs by one of
the most gifted of teachers.
You also learnt how to elicit those signs by using a
methodical clinical approach the Apley System. The
Fellowship exam was heavily weighted towards clinical
skills. Miss an important sign or stumble over how to
examine a knee or a nger and you could fail outright.
What Apley taught you was how to order the steps in
physical examination in a way that could be applied to
every part of the musculoskeletal system. Look, Feel,
Move was the mantra. He liked to say that he had a
preference for four-letter words. And always in that
order! Deviate from the System by grasping a
patients leg before you look at it minutely, or by testing the movements in a joint before you feel its contours and establish the exact site of tenderness and
you risked becoming an unwilling participant in a theatrical comedy.
Much has changed since then. With each new edition the System has been expanded to accommodate
new tests and physical manoeuvres developed in the
tide of super-specialisation. Laboratory investigations
have become more important and imaging techniques
have advanced out of all recognition. Clinical classications have sprung up and attempts are now made to
nd a numerical slot for every imaginable fracture. No
medical textbook is complete without its basic science component, and advances are so rapid that
changes become necessary within the period of writing a single edition. The present volume is no exception: new bits were still being added right up to the
time of proof-reading.
For all that, we have retained the familiar structure
of the Apley System. As in earlier editions, the book is
divided into three sections: General Orthopaedics,

covering the main types of musculoskeletal disorder;

Regional Orthopaedics, where we engage with these
disorders in specic parts of the body; and thirdly
Fractures and Joint Injuries. In a major departure
from previous editions, we have enlisted the help of
colleagues who have particular experience of conditions with which we as principal authors are less familiar. Their contributions are gratefully acknowledged.
Even here, though, we have sought their permission
to edit their material into the Apley mould so that
the book still has the sound and feel of a single
authorial voice.
For the second edition of the book, in 1963, Apley
added a new chapter: The Management of Major
Accidents. Typically frank, he described the current
arrangements for dealing with serious accidents as
woefully inadequate and offered suggestions based
on the governments Interim Report on Accident
Services in Great Britain and Ireland (1961). There
has been a vast improvement since then and the number of road accident deaths today is half of what it was
in the 1960s (Department of Transport statistics). So
important is this subject that the relevant section has
now been re-written by two highly experienced Emergency and Intensive Care Physicians and is by far the
longest chapter in the present edition.
Elsewhere the text has been brought completely up
to date and new pictures have been added. In most
cases the illustrations appear as composites a series
of images that tell a story rather than a single typical
picture at one moment in the development of some
disorder. At the beginning of each Regional chapter,
in a run of pictures we show the method of examining that region: where to stand, how to confront the
patient and where to place our hands. For the experienced reader this may seem like old hat; but then we
have designed this book for orthopaedic surgeons of
all ages and all levels of experience. We all have something to learn from each other.
As before, operations are described only in outline,
emphasising the principles that govern the choice of
treatment, the indications for surgery, the design of the
operation, its known complications and the likely outcome. Technical procedures are learnt in simulation

PREFACE

courses and, ultimately, in the operating theatre. Written instructions can only ever be a guide. Drawings are
usually too idealised and in theatre photographs are
usually intelligible only to someone who has already
performed that operation. Textbooks that grapple with
these impediments tend to run to several volumes.
The emphasis throughout is on clinical
orthopaedics. We acknowledge the value of a more
academic approach that starts with embryology,
anatomy, biomechanics, molecular biology, physiology and pathology before introducing any patient to
the reader. Instead we have chosen to present these
basic subjects in small portions where they are relevant to the clinical disorder under discussion: bone
growth and metabolism in the chapter on metabolic
bone disease, genetics in the chapter on osteodystrophies, and so forth.
In the preface to the last edition we admitted our
doubts about the value of exhaustive lists of references
at the end of each chapter. We are even more divided

xii

about this now, what with the plethora of search

engines that have come to dominate the internet. We
can merely bow our heads and say we still have those
doubts and have given references only where it seems
appropriate to acknowledge where an old idea started
or where something new is being said that might at
rst sight be questioned.
More than ever we are aware that there is a dwindling number of orthopaedic surgeons who grew up
in the Apley era, even fewer who experienced his
thrilling teaching displays, and fewer still who worked
with him. Wherever they are, we trust that they will
recognise the Apley avour in this new edition. Our
chief concern, however, is for the new readers who
we hope will glean something that helps them
become the next generation of teachers and mentors.
LS
SN
DJW

Acknowledgements

Fifty years ago Apleys System of Orthopaedics and

Fractures was written by one person the eponymous
Apley. As the years passed and new editions became
ever larger, a second author appeared and then a
third. Throughout those years we have always been
able to get help (and sometimes useful criticism) from
willing colleagues who have lled the gaps in our
knowledge. Their words and hints are scattered
among the pages of this book and we are forever
grateful to them.
For the present edition we have gone a step further
and enlisted a number of those colleagues as nominated Contributing Authors. In some cases they have
brought up to date existing chapters; in others they
have added entirely new sections to a book that has
now grown beyond the scope of two or three specialists. Their names are appropriately listed elsewhere
but here we wish to thank them again for joining us.
They have allowed us to mould their words into the
style of the Apley System so that the text continues to
carry the avour of a unied authorial voice.
We are also grateful to those colleagues who have
supplied new pictures where our own collections have
fallen short. In particular we want to thank Dr
Santosh Rath and Dr G.N. Malaviya for pictures of
peripheral deformities in leprosy, Mr Evert Smith for
pictures (and helpful descriptions) of modern
implants in hip replacement operations, Dr Peter Bullough who allowed us to reprint two of the excellent
illustrations in his book on Orthopaedic Pathology,
and Dr Asif Saifuddin for permission to use some
images from his book on Musculoskeletal MRI.
Others who gave us generous assistance with pictures

are Fiona Daglish, Colin Duncan, Neeraj Garg,

Nikolaos Giotakis, Jagdeep Nanchahal and Badri
Narayan.
We have been fortunate in having friends and family
around us who have given us helpful criticism on the
presentation of this work. Caryn Solomon, a tireless
internet traveller, found the picture for the cover and
Joan Solomon gave expert advice on layout and
design. James Crabtree stepped in as a model for
some clinical pictures. We are grateful to all of them.
Throughout the long march to completion of this
work we have enjoyed the constant help and collaboration of Francesca Naish, Gavin Jamieson, Joanna
Walker and Helen Townson (our Editorial Manager,
Commissioning Editor, Production Manager and
Design Manager respectively) at Hodder Arnold. No
problem was too complex and no obstacle too great
to withstand their tireless efforts in driving this work
forward.
Nora Naughton and Aileen Castell (Naughton
Project Management) were in the background setting
up the page copies, patiently enduring the many
amendments that came in over the internet. Their
attention to detail has been outstanding.
Finally, we want to express our deepest thanks to
those nearest to us who added not a word to the text
but through their support and patience made it possible for us to take so much time beyond the everyday
occupations of family life to produce a single book.
L. S.
D.W.
S. N.

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List of abbreviations used

ACA
ACE
ACL
ACTH
AFP
AIDP
AIDS
AL
ALI
AM
AMC
ANA
anti-CCP
AP
APC
APC
ARCO
ARDS
ARDS
ARM
AS
ATLS
AVN
BASICS
BCP
BMD
BMP
BSA
BVM
CDH
CFD
CMAP
CMC
CMI
CNS
COMP
CORA
CPM
CPPD

angulation correction axis

angiotensin-converting enzyme
anterior cruciate ligament
adrenocorticotropic hormone
alpha-fetoprotein
acute inammatory demyelinating
polyneuropathy
acquired immune deciency
syndrome
anterolateral
acute lung injury
anteromedial
arthrogryposis multiplex congenita
antinuclear antibodies
anti-cyclic citrullinated peptide
antibodies
anteroposterior
antigen-presenting cell
anteroposterior compression (injuries)
Association Research Circulation
Osseous
adult respiratory distress syndrome
acute respiratory distress syndrome
awareness, recognition, management
ankylosing spondylitis
advanced trauma life support
avascular necrosis
British Association for Immediate
Care
basic calcium phosphate
bone mineral density
bone morphogenetic protein
body surface area
bag-valve-mask
congenital dislocation of the hip
congenital femoral deciency
compound muscle action potential
carpo-metacarpal
cell-mediated immunity
central nervous system
cartilage oligometric matrix protein
centre of rotation of angulation
continuous passive motion
calcium pyrophosphate dihydrate

CRP
CRPS
CSF
CT
CVP
DDH
dGEMRIC
DIC
DIP
DISH
DISI
DMARDs
DRUJ
DTH
DVT
DXA
ECRB
ECRL
EDF
EDG
EEG
EMG
EMS
ENL
ESR
ETA
FAI
FAST
FDP
FDS
FFOs
FPB
FPE
FPL
GABA
GAGs
GCS
GMFCS
GPI
HA

C-reactive protein
complex regional pain syndrome
cerebrospinal uid
computed tomography
central venous pressure
developmental dysplasia of the hip
delayed gadolinium-enhanced MRI of
cartilage
disseminated intravascular coagulation
distal interphalangeal (joint )
diffuse idiopathic skeletal hyperostosis
dorsal intercalated segment instability
disease-modifying antirheumatic
drugs
distal radio-ulnar joint
delayed type hypersensitivity
deep vein thrombosis
dual-energy x-ray absorptiometry
extensor carpi radialis brevis
extensor carpi radialis longus
elongation-derotation-exion
extensor diversion graft
electroencephalography
electromyography
emergency medical service
erythema nodosum leprosum
erythrocyte sedimentation rate
estimated time of arrival
femoro-acetabular impingement
focussed assessment sonography in
trauma
exor digitorum profundus
exor digitorum supercialis
functional foot orthoses
exor pollicis brevis
fatal pulmonary embolism
exor pollicis longus
gamma-aminobutryic acid
glycosaminoglycans
Glasgow Coma Scale
gross motor function classication
system
general paralysis of the insane
hydroxyapatite

HEMS
HGPRT
HHR
HIV
HLA
HMSN
HRT
ICP
ICU
IL
INR
IP
IRMER
ITAP
IVF
JIA
LCL
LMA
LMN
LMWH
MCL
MCP
M-CSF
MED
MHC
MIC
MIPO
MIS
MODS

ABBREVIATIONS

MPM
MPS
MRI
MRSA

xvi

MTP
NCV
NP
NSAIDs
OA
OI
OP
OPG
OPLL
PA
PACS
PAFC
PAOP
PCL

helicopter emergency medical service

hypoxanthine-guanine
phosphoribosyltransferase
humeral head replacement
human immunodeciency virus
human leucocyte antigen
hereditary motor and sensory
neuropathy
hormone replacement therapy
intracerebral pressure
intensive care unit
interleukin
international normalized ratio
interphalangeal
Ionising Radiation Medical Exposure
Regulations
intra-osseous transcutaneous
amputation prosthesis
in vitro fertilization
juvenile idiopathic arthritis
lateral collateral ligament
laryngeal mask airway
lower motor neuron
low molecular weight heparin
medial collateral ligament
metacarpo-phalangeal (joint)
macrophage colony-stimulating factor
multiple epiphyseal dysplasia
major histocompatibility complex
minimal inhibitory concentration
minimally invasive percutaneous
osteosynthesis
minimally invasive surgery
multiple organ failure or dysfunction
syndrome
mortality prediction model
mucopolysaccharidoses
magnetic resonance imaging
methicillin-resistant Staphylococcus
aureus
metatarsophalangeal (joint)
nerve conduction velocity
nasopharyngeal
non-steroidal anti-inammatory drugs
osteoarthritis
osteogenesis imperfecta
oropharyngeal
osteoprotegerin
ossication of the posterior
longitudinal ligament
posteroanterior
Picture Archiving and Communication
System
pulmonary artery otation
catherization
pulmonary artery occlusion pressure
posterior cruciate ligament

PCR
PD
PE
PEA
PEEP
PET
PFFD
PIP
PL
PM
PMMA
PNS
PPE
PPS
PTH
PTS
PVNS
QCT
QUS
RA
RANKL
RF
RR
RSD
RSI
SACE
SAMU
SAPHO
SCFE
SCIWORA
SDD
SE
SED
SEMLS
SIRS
SLAP
SLE
SMR
SMUR
SNAP
SNPs
SONK
SOPs
SPECT
SSEP
STIR
STT
SCIWORA

polymerase chain reaction

proton density
pulmonary embolism
pulseless electrical activity
positive end-expiratory pressure
positron emission tomography
proximal focal femoral deciency
proximal interphalangeal (joint)
posterolateral
posteromedial
polymethylmethacrylate
peripheral nervous system
personal protective equipment
post-polio syndrome
parathyroid hormone
post-thrombotic syndrome
pigmented villonodular synovitis
quantitative computed tomography
quantitative ultrasonometry
radiographic absorptiometry and
rheumatoid arthritis
receptor activator of nuclear factorligand
rheumatoid factor
reversal reaction
reex sympathetic dystrophy
rapid sequence induction
serum angiotensin converting enzyme
Services de lAide Medical Urgente
for synovitis, acne, pustulosis,
hyperostosis and osteitis
slipped capital femoral epiphysis
spinal cord injury without obvious
radiographic abnormality
digestive tract
spin echo
spondyloepiphyseal dysplasia
single event multi-level surgery
systemic inammatory response
superior labrum, anterior and posterior
(tear)
systemic lupus erythematosus
standardized mortality ratio
Services Mobile dUrgence et de
Reamination
sensory nerve action potential
single nucleotide polymorphisms
spontaneous osteonecrosis of the
knee
standard operating procedure
single photon emission computed
tomography
somatosensory evoked responses
short-tau inversion recovery
scaphoid-trapezium-trapezoid arthritis
spinal cord injury without radiographic
abnormality

TAR

TB
99m
Tc-MDP
TE
TFCC
TIP
TNF
TR
TSR
UHMWPE
UMN

prompts one to remember

thrombocytopaenia with absent radius
syndrome
tuberculosis
99m
Tc-methyl diphosphonate
time to echo
triangular brocartilage complex
terminal interphalangeal (joint)
tumour necrosis factor
repetition time
total shoulder replacement
ultra-high molecular weight
polyethylene
upper motor neuron

US
ultrasound
VACTERLS refers to the systems involved and the
defects identied: vertebral, anal,
cardiac, tracheal, esophageal, renal,
limb and single umbilical artery.
VCT
voluntary counselling and testing
VISI
volar intercalated segment
instability
VP
ventriculo-peritoneal
VS
vertical shear
VTE
venous thromboembolism
VQC
ventilation-perfusion
WBC
white blood cell
XLPE
highly cross-linked polyethylene

ABBREVIATIONS
xvii

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