There are many textbooks on fractures in adults, but few deal with those in children and young persons. Publications on fractures in children are usually written by orthope­ dic surgeons who are familiar with the problems presented by the growing skeleton. The principles taught in the best known works on fractures in children by BLOUNT (1954), RETTIG (1957), CHIGOT and ESTEVE (1957), EHALT (1960), POLLEN (1973), and RANG (1974), differ from each other only slightly. The controversy which has sur­ rounded the treatment of fractures in adults in recent years has never extended to chi1drens'' fractures. Skillful nonoperative treatment of the latter leads to uneventful healing in the majority of cases, which cannot always be said of similar injuries in adults. "Considerable skill" is required to induce nonunion in a child, and its occur­ rence always results from a serious error of management. In the adult, prolonged immobilization frequently leads to muscle atrophy, joint stiffness, and disturbances of the peripheral innervation and circulation. Fracture treatment by internal fixation in the manner originally described by LANE (1894), LAMBOTTE (1892, 1907, 1913), KONIG (1905, 1931), and DANIS (1932, 1949) has gained wide acceptance only in the last 15 years. Since 1958, MULLER, ALLGOWER, WIL­ LENEGGER, and the other members of the Swiss Association for the Study of Internal Fixation (ASIF) have been developing techniques and instruments for the operative treatment of fractures.

The publication of this Cast Manual is very timely. Technological advances made in the past two decades have resulted in increased popularization of open reduction and internal fixation in the treat­ ment of long bone fractures. Due primarily to incorrect application of those techniques, it has become increasingly apparent that its routine and casual use can result in complications - oftentimes of catastrophic nature. Students and practitioners of orthopedics must keep uppermost in their minds that osteogenesis takes place spontaneously through an orderly and physiological process. Surgical intervention and the intro­ duction of a foreign body at the fracture site alters that process. Though the fracture heals, it does so not because of the mechanical device but in spite of it. Therefore, internal fixation must be reserved only for those instances when its practical advantages heavily out­ weigh its biological disadvantages. The success of nonsurgical treatment of fractures is also predicated on the clear understanding of fracture healing and the proper application of stabilizing techniques. This cast manual emphasizes the importance of proper application of various casts and discusses very well those details which are important for the success of nonsurgical treatment of fractures. Dr. F. FREULER, Dr. U. WIEDMER, and D. BIANCHINI'S Cast Manual must be read carefully by students of orthopedics and used as a reference book for those who should keep abreast of new concepts and techniques of closed management of fractures. Summer 1979 AUGUSTO SARMIENTO, M. D.

There are many textbooks on fractures in adults, but few deal with those in children and young persons. Publications on fractures in children are usually written by orthope­ dic surgeons who are familiar with the problems presented by the growing skeleton. The principles taught in the best known works on fractures in children by BLOUNT (1954), RETTIG (1957), CHIGOT and ESTEVE (1957), EHALT (1960), POLLEN (1973), and RANG (1974), differ from each other only slightly. The controversy which has sur­ rounded the treatment of fractures in adults in recent years has never extended to chi1drens'' fractures. Skillful nonoperative treatment of the latter leads to uneventful healing in the majority of cases, which cannot always be said of similar injuries in adults. "Considerable skill" is required to induce nonunion in a child, and its occur­ rence always results from a serious error of management. In the adult, prolonged immobilization frequently leads to muscle atrophy, joint stiffness, and disturbances of the peripheral innervation and circulation. Fracture treatment by internal fixation in the manner originally described by LANE (1894), LAMBOTTE (1892, 1907, 1913), KONIG (1905, 1931), and DANIS (1932, 1949) has gained wide acceptance only in the last 15 years. Since 1958, MULLER, ALLGOWER, WIL­ LENEGGER, and the other members of the Swiss Association for the Study of Internal Fixation (ASIF) have been developing techniques and instruments for the operative treatment of fractures.

The publication of this Cast Manual is very timely. Technological advances made in the past two decades have resulted in increased popularization of open reduction and internal fixation in the treat­ ment of long bone fractures. Due primarily to incorrect application of those techniques, it has become increasingly apparent that its routine and casual use can result in complications - oftentimes of catastrophic nature. Students and practitioners of orthopedics must keep uppermost in their minds that osteogenesis takes place spontaneously through an orderly and physiological process. Surgical intervention and the intro­ duction of a foreign body at the fracture site alters that process. Though the fracture heals, it does so not because of the mechanical device but in spite of it. Therefore, internal fixation must be reserved only for those instances when its practical advantages heavily out­ weigh its biological disadvantages. The success of nonsurgical treatment of fractures is also predicated on the clear understanding of fracture healing and the proper application of stabilizing techniques. This cast manual emphasizes the importance of proper application of various casts and discusses very well those details which are important for the success of nonsurgical treatment of fractures. Dr. F. FREULER, Dr. U. WIEDMER, and D. BIANCHINI'S Cast Manual must be read carefully by students of orthopedics and used as a reference book for those who should keep abreast of new concepts and techniques of closed management of fractures. Summer 1979 AUGUSTO SARMIENTO, M. D.