208 BRITISH JOURNAL OF PLASTIC SURGERY

To read the contents through from start to finish would be to court indigestion. It reminds one of a meal entirely of tit-bits lacking real first-class protein--a continuing diet of hors d'oeuvre.

Doubtless with so many desirous of delivering their paper this result is inevitable, but the good is submerged in a sea of mediocrity.

It is a book to be consulted in a library rather than bought for perusal. Regrettably it brings to mind the cynic on such congresses " where papers are read that nobody listens to, published in proceedings which nobody reads ". One hopes that the Australian Congress will prove the cynic wrong.

I. A. M.

WORKSHOP ON ARTIFICIAL FINGER JOINTS. Supplement to Annals of the Rheumatoid Diseases, Vol. 28, Sept . 1969. Ed i t ed by J. S. CALNAN and P. J. L. HOLT. Pp. I IO, with 90 i l lustrat ions. ( L o n d o n : Bri t ish Medica l Associat ion, 1969.) 3os.

This supplement is devoted to the proceedings of the Workshop held at the Royal Postgraduate Medical School on I4th-I5th April 1969. It contains all papers presented, many having been pruned considerably, and much of the discussion. The papers are grouped intothe following six sections : anatomy and pathology, biomechanics, arthroplasties, assessments, surgery and research reports. Relevant dis- cussion follows on each sectiom

Joint anatomy and mechanics, both in normal and in rheumatoid hands, are fully discussed in the first section, together with the pathogenesis of the joint lesions. One presentation on the aetiology of rheumatoid arthritis with regard'to its chronicity would seem to have little relevance to the subject under discussion. Of the four contributions on biomechanics two are excellent, discussing the theoretical principles in finger joint design and the biomechanical problems associated with finger joint replacemem. The other two papers strangely enough are entirely concerned with large joint prostheses. As one would expect, both excisional and replacement arthroplasties are fully considered, considerable discussion being evoked with the very experienced Drs Flatt and Swanson prominent. What is rather disappointing is the reluctance of the protagonists of replacement and excision to give any objective assessment of their results. The important problem of assessment is adequately covered although those with large experience in this field would not necessarily agree with some of the conditions laid down for replacement.

The surgery section is disappointing ; experienced American and continental hand surgeons particu- larly will find several points at variance with their views. It is unfortunate that Dr Vainio discusses the complications of joint replacement, a subject of which he has only slight personal experience. It would surely have been considerably more rewarding to have heard his views and results of excision arthroplasty, since he is the world's leading authority on this procedure. Only in the research reports do we find a comparison of excisional and replacement arthroplasties performed by one individual. Great skill and judgement has been shown in the editing of the discussion ; the irrelevancies in heated exchanges and doubtful points of view have been eliminated without lessening the feeling of enthusiasm, honesty and desire to improve results which was so characteristic of this Workshop.

A useful and reasonably comprehensive list of references is given. Anyone working in rheumatology, from the physician who wants a guide as to what can be offered to

his crippled patients to the surgeon contemplating the use of artificial finger joints, will find this book of interest.

I. T. J.

FRACTURES DE L'ORBITE. INDICATIONS OPHTALMOLOGIQUES DANS LES TECHNIQUES OPERATORIES. By A. RENY and M. STRICKER. Pp. 174 wi th 156 i l lustrat ions. (Paris : M a s s o n et Cie, 1969.) 86 F.

This work, the result of long years of co-operation in the field of facial fractures between an ophthalmic and an oral surgeon, aims to guide those surgeons who are likely to be involved in the treatment of orbital fractures.

The first 12o pages and 129 figures deal with diagnosis, and analysis of visual function under normal and abnormal conditions receives a good deal of attention. Post-traumatic disturbances of oculo-motor equilibrium are fully discussed. The chapters on radiology and electromyography are brief but full of useful information. The clarity of presentation and a searching analysis of functional disabilities make this a valuable section.

The authors chose to present their material in a dissociated form describing first the individual fractures and pointing out the problems of each injury and, in a later section of the book, outlining their treatment.

The section dealing with treatment consists of 4o pages with 36 illustrations. It is not so good as the first part ; most of the information provided is relatively sketchy and is contained in two chapters--" The restoration of bony framework" a n d " The cure of complications ". Although the principles of treatment are presented and discussed, the book does not provide an adequate practical guide to a surgeon who may be called upon to treat such injuries. The lack of index too, and the separate presentation of individual fractures and their treatment, make it difficult to locate and correlate specific injury and its management.

In summary, this work provides an excellent text for diagnosis and ophthalmic assessment of orbital fractures but does not .present the treatment as fully as the reviewer would expect. There is a very full bibliography. M . F . S .