The eighth edition of the Manual of Orthopaedics further expands the conversion of the manual from one focused on medical students and orthopaedic surgery junior residents to adding the audience of emergency room providers, urgent care providers, primary care providers, and now physician assistants and nurse practitioners (PAs/ NPs) practicing in musculoskeletal care centers. This is the fourth edition to use this title, which was changed from the original title of Manual of Acute Orthopaedic Therapeutics. The title change started the evolution toward the broader audience, which is now complete. This introduction will conclude with a list of new features in the eighth edition. It remains a worthwhile task to review the history of this useful �spiral notebook� to place the continuing changes within the context of the evolution of musculoskeletal care. The Manual of Acute Orthopaedic Therapeutics was the creation of Dr. Larry Iversen, who worked out its basic framework and conceptualization with his orthopaedic mentor, Dr. D. Kay Clawson. Dr. Iversen was at the time a senior resident working closely with Dr. Clawson, who was the first professor and chairman of the Department of Orthopaedic Surgery at the University of Washington. The orthopaedic services at the University Hospital and King County Hospital (later renamed Harborview Medical Center) were active and focused mainly around the management of injured patients. Drs. Clawson and Iversen saw the need for a manual that would improve education and patient care in these institutions. Those were days when the management of long bone fractures was in transition from traction and casting to surgical techniques, and the University of Washington Orthopaedic department was at the forefront with wonderful, dedicated, and creative clinicians like Drs. Robert Smith and Sigvard Hansen. In those times, care was primarily delivered by junior house staff, interns, and medical students, and they needed information readily at hand. Therefore, the manual provided the �how-to�s� for traction, casting, and preand postoperative care while explaining the rationale for treatment decisions and providing an excellent reference list for later review and in-depth study. This manual was a labor of love for Drs. Iversen and Clawson; the two would often work on the manuscripts for three straight weeks seated around the dining room table in Dr. Clawson�s home. Little Brown publishers liked the concept of the book and added it to its growing list of subspecialty spiral manuals; the book enjoyed broad acceptance . Each of the first three editions brought a review of the contents and reference list for each chapter as the field continued to evolve. In 1987, I returned to the University of Washington, where I had done my training (and used the second edition), to assume a position at Harborview Medical Center. In 1991, I was a new professor in the department and chief of the orthopaedic service, and Dr. Clawson asked me to assume his place with the manual. It was then Dr. Iversen and I who labored for 2 weeks in the medical school library revising the chapters, updating the reference lists, adding sections of historical references, changing several illustrations, and adding fresh chapters on infection and rheumatologic conditions. As such we began to broaden the scope of the manual to include conditions that were nonacute and nontrauma related in order to make the manual more useful for students and interns as well as to provide a more comprehensive tool for primary care physicians.