Global Orthopedics: Caring for Musculoskeletal Conditions and Injuries in Austere Settings The recently published book, Global Orthopedics: Caring for Musculoskeletal Conditions and Injuries in Austere Settings, is a valuable reference for surgeons working in resource-limited environments. Co-edited and co-written by David A. Spiegel, MD, attending surgeon at The Children’s Hospital of Philadelphia, associate professor of Orthopedic Surgery at the Perelman School of Medicine at the University of Pennsylvania, and honorary consultant in Orthopedics for the Hospital and Rehabilitation Centre for Disabled Children in Benepa, Nepal, the book reviews the historical background of orthopedics in developing nations and the global burden of musculoskeletal conditions. It also tackles the cost-effectiveness of orthopedic surgery in austere environments, barriers to the delivery of orthopedic care in developing countries, and orthopedic needs in the face of conflicts and natural disasters.

Rife with illustrations in both black and white and color throughout its 500-plus pages, the book provides both case-based information and best practices. Detailed chapters highlight the best treatment methods for specific conditions—such as upper and lower extremity fractures, septic arthritis, chronic osteomyelitis, clubfoot, developmental dysplasia of the hip, cerebral palsy, bone and soft tissue tumors, polio, and amputations—given resource limitations.

A special section on noninfectious pediatric conditions is ideal for nonspecialists who encounter developmental and early childhood orthopedic problems commonly seen in low-resource settings.

Leaders from CHOP's Division of Orthopedics Leaders from CHOP’s Division of Orthopedics attended the National Orthopaedic Leadership Conference (NOLC) in Washington, D.C., last spring. “While the book was intended as a reference for surgeons from economically developed regions choosing to spend time in austere environments, volunteering or not, it really emphasizes the importance of redefining the field of orthopedics based on contextual variables,” notes Spiegel. “In austere environments, much of the pathology has been neglected due to a lack of access to health services, for a variety of reasons, and the technical solutions are more complex and less likely to achieve the desired outcomes. In addition, the technologies that we typically utilize in economically developed countries are often absent or more rudimentary.”

“Just as we adapt our knowledge and skills in such environments, we also have much to learn from practitioners working in austere environments,” he adds. “So global orthopedics is really a two-way street, and many cost-effective technologies developed in low-income countries may ultimately prove to be of value in higher income countries.”

Global Orthopedics: Caring for Musculoskeletal Conditions and Injuries in Austere Settings. 
Gosselin, Richard A., Spiegel, David A., and Foltz, Michelle (Eds.). Springer, 2014.
Print and eBook.