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Children's Fractures.
  1. Thomas F Beattie
  1. Consultant in Accident and Emergency, Edinburgh

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    By Anna Thornton and Catherine Gyll. (Pp 208; £39.95.) W B Saunders, 1999. ISBN 0-7020-2164-4.

    Reading radiographs is one of the many skills senior house officers (SHOs) learn in accident and emergency (A&E). One of the more difficult aspects of radiological interpretation is that of children's radiographs. As the authors state the young doctor in the A&E department has only a sketchy idea of how very different children's fractures are from adults. The growing skeleton and the different nature of the bones make the nature of the injuries different and their interpretation very difficult. This book goes a long way to solving this conundrum.

    The general idea behind the book is superb and its execution is in the main adequate. Minor criticisms revolve around the size of the illustrations but one understands the dilemma having pictures big enough to be seen and yet cramming enough pictures in to make the book achieve its ideas.

    I would, however, take issue with some of the recommendations for radiology. For instance, I would find it unacceptable not to have the joint above and below a forearm fracture radiographed. It is not unusual for pain to be referred from the elbow to the wrist and vice versa. Failure to radiograph the full arm would mean that as a consequence injuries will be missed on occasion. I would also take issue for the need of only one view in children under 2 years of age, even if a fracture is positive.

    With regard to pulled elbow, our orthopaedic surgeons would be very cross if we referred every pulled elbow to them as is suggested.

    Finally, while a number of people have been consulted, it is a pity that there is no consultant in A&E medicine in the list of those who helped. This is all the more so as this book will be of most use to those in A&E.

    These are minor criticisms however, as the overall conception and design of the book is excellent. In particular I think the epidemiology of paediatric fractures and the list of references at the end are a tremendous addition, which are frequently missing from books of this nature.

    It is difficult to know who would benefit most from this book as there is something in it for everyone. I can see myself showing it to my nurse practitioners as both a learning and re-education tool. Definitely the SHOs will benefit from having it available. The references at the back will make it easier for the specialist registrars to do their research and I am sure that I will still continue to refer to it from time to time.

    I would recommend this book thoroughly, and perhaps for future editions (and I am sure there will be several editions) I would recommend that the authors take the minor criticisms on board.

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