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Views And Reviews

The Soft Tissues: Trauma and Sports Injuries

BMJ 1994; 308 doi: (Published 05 February 1994) Cite this as: BMJ 1994;308:422
  1. W N Dodds

    Ed G R McLarchie, C M E Lennox Butterworth Heinemann, (Pounda Sterling)45, pp 485 ISBN 0-7506-0170-1

    Soft tissue trauma is often neglected, yet many of us spend our time in out-patient clinics dealing with conditions affecting these tissues. As long ago as 1940 Reginald Watson-Jones was quoted as saying, “It is worse to sprain an ankle than to break it,” because soft tissue injuries are often ignored, with consequent morbidity.

    Damage to soft tissue may be the same whether incurred during sporting activities or from non-sporting trauma, and The Soft Tissues usefully groups the pathology and management together. The first few chapters are heavy going, and it is not until the sixth chapter that excellence appears, with a precise and concise chapter on tendon injury. From then on the uphill struggle eases and the regional accounts of injuries in the middle section are in general excellent. The final chapter in this middle section, on rehabilitation, is particularly good and to some extent removes the need to mention the general management of soft tissue trauma in other chapters.

    An excellent chapter on pains in growing children is unfortunately spoilt by use of the American classification for juvenile chronic arthritis; this differs from that used in Britain and the rest of the world, which follows the work of the world authority on the disease, who happens to be British (Barbara Ansell). I think it would have been enough to say that one should always remember juvenile chronic arthritis as a cause of pain in children and leave it at that.

    The third section covers specific groups of sporting injuries. Where the text relates the injuries to particular aspects of the sport, such as in the chapter on dance and gymnastics, this is very helpful. I learnt that the “efficiency” (whatever that means in the shoe world) of running shoes is reduced by 23% after 150 miles and by 45% after 500 miles. This perhaps adds further support to a recent suggestion that there may not be a lot to be gained by buying the more expensive running shoe. I am surprised that in a British text soccer is not covered as this sport probably results in more attendances at casualty departments and general practice surgeries than all other sports put together because of the large numbers playing each weekend.

    The book's strength is that it is comprehensive, bringing together material from a wide variety of sources into a single volume. Weaknesses are that there is much repetition with respect to certain injuries, particularly of the ankle and the knee, which could be avoided by suitable cross referencing. There are varying styles of references and many printing errors, which should be eradicated in future editions.


    * Stapling of a mesh patch during laparoscopic herniorrhaphy illustrated in Laparoscopic Urologic Surgery (Raven, $151.50, ISBN 0 7817 00442). There seems no limit to the advances taking place in all aspects of minimal surgery.

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