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El. knyga: Rationale of Operative Fracture Care

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  • Formatas: PDF+DRM
  • Išleidimo metai: 01-Aug-2005
  • Leidėjas: Springer-Verlag Berlin and Heidelberg GmbH & Co. K
  • Kalba: eng
  • ISBN-13: 9783540277088
Kitos knygos pagal šią temą:
Rationale of Operative Fracture CareDidesnis paveikslėlis
  • Formatas: PDF+DRM
  • Išleidimo metai: 01-Aug-2005
  • Leidėjas: Springer-Verlag Berlin and Heidelberg GmbH & Co. K
  • Kalba: eng
  • ISBN-13: 9783540277088
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Since its initial publication in 1987, The Rationale of Operative Fracture Care has enjoyed tremendous popularity. So much so, that the second edition was also published in Spanish, Portuguese, Japanese, and Greek. It is a book written by surgeons for surgeons. It explains in clear terms the logical progression of problem-solving in the evolution of a treatment rationale. First identify the problem and then logically outline its various potential solutions. This provides a basis for deciding which is best from a technical perspective and which will lead to the best outcome for the patient. Then choose from the available armamentarium the most suitable surgical technique and implant. All the chapters in the volume have been carefully revised to reflect the state of the art in biology, in biomechanics, in the understanding of the biology of injuries and surgical wounds, and in stabilization systems. The book should continue to serve the surgical community well, both in the most advanced teaching environments and at the forefront of care, in the community hospital practice of surgeons.

Recenzijos

From the reviews of the third edition:





"This is the third edition of a book that has become a standard textbook on trauma, since its first edition in 1990. Rare are books that reach that level of expectation. This attractive and superbly illustrated book gives a modern approach to fracture management and is a practical guide to decision-making in fracture treatment . This book is a major reference work in an orthopaedic library, a refreshing course for the mature surgeon or a basic investment for the younger colleague." (C. Delloye, Acta Orthopaedica Belgica, Vol. 72 (1), 2006)

Daugiau informacijos

3rd edition
Part I General Aspects of Internal Fixation
1 Principles of Internal Fixation
3(30)
J. Schatzker
1.1 Introduction
3(6)
1.1.1 Mechanical Properties of Bone
3(1)
1.1.2 Types of Load and Fracture Patterns
4(1)
1.1.3 Classification of Fractures
4(4)
1.1.4 Effects of Fracture
8(1)
1.1.5 Soft Tissue Component and Classification of Soft Tissue Injuries
8(1)
1.2 Aims of Treatment
9(1)
1.3 Previous Experience with Internal Fixation
10(1)
1.4 Rigidity and Stability
10(1)
1.5 Methods of Absolutely Stable Fixation
11(3)
1.5.1 Lag Screw
11(1)
1.5.2 Lag Screw, Neutralization, and Buttressing
12(1)
1.5.3 Tension Band Plate and Compression Plate
12(2)
1.6 Methods of Relative Stability or Splinting
14(4)
1.6.1 External Skeletal Fixation
14(1)
1.6.2 Intramedullary Nailing
15(1)
1.6.3 Bridge Plating
16(1)
1.6.4 Methods of Reduction
17(1)
1.7 Changes to the Early Concepts in Internal Fixation
18(9)
1.7.1 Articular Fractures
21(1)
1.7.2 Diaphyseal Fractures
22(1)
1.7.2.1 Locked Intramedullary Nailing
22(1)
1.7.2.2 Reaming
22(1)
1.7.2.3 Bridge Plating
23(1)
1.7.2.4 Blood Supply to Bone and Implants
23(1)
1.7.2.5 The Limited Contact-Dynamic Compression Plate (LC-DCP)
23(1)
1.7.2.6 The PC Fix or the Point Contact Plate (PCP) and Angularly Stable Fixation
24(1)
1.7.2.7 The Advantages of Locked Fixation and Its Angular Stability
25(2)
1.8 Biological Plating and Minimally Invasive Plate Osteosynthesis (MIPO)
27(2)
1.9 Implant Failure and Bone Grafting
29(1)
1.10 Implant Removal
30(3)
References
30(3)
2 Intra-articular Fractures
33(12)
J. Schatzker
2.1 Introduction
33(2)
2.2 Clinical Aspects
35(1)
2.2.1 Physical Examination
35(1)
2.2.2 Radiological Evaluation
35(1)
2.3 Surgery
36(3)
2.3.1 Timing
36(2)
2.3.2 Approach and Technique
38(1)
2.4 Postoperative Care
39(1)
2.5 Late Intra-articular Reconstructions
39(6)
References
43(2)
3 Open Fractures
45(12)
J. Schatzker
M. Tile
3.1 Introduction
45(1)
3.2 Assessment of the Soft Tissue Wound
45(1)
3.3 Classification
45(1)
3.4 Management
46(7)
3.4.1 Decision-Making
46(1)
3.4.2 Immediate Treatment
46(1)
3.4.3 Operative Treatment
47(1)
3.4.3.1 Limb Salvage
47(1)
3.4.3.2 Cleansing
47(1)
3.4.3.3 Debridement
47(1)
3.4.3.4 Choice of Fixation
48(1)
3.4.3.5 Implant Selection
48(2)
3.4.3.6 Care of the Soft Tissue Wound
50(1)
3.4.3.7 Secondary Fracture Care
51(1)
3.4.3.8 Open Joint Injuries
52(1)
3.5 Summary
53(4)
References
54(3)
Part II Fractures of the Upper Extremity
4 Fractures of the Proximal Humerus
57(34)
M. Tile
4.1 Introduction
57(2)
4.1.1 General Considerations
57(1)
4.1.2 Anatomy
57(1)
4.1.3 Vascular Anatomy
58(1)
4.1.4 Four-Segment Classification
58(1)
4.1.5 Stability
58(1)
4.1.6 Surgical Difficulties
59(1)
4.2 Classification
59(1)
4.3 Natural History and Surgical Indications
60(14)
4.3.1 Stable Fractures
60(1)
4.3.2 Unstable Fractures
60(1)
4.3.2.1 Minimal Displacement
60(2)
4.3.2.2 Major Displacement
62(6)
4.3.3 Articular Fractures
68(1)
4.3.3.1 Impacted (Hill-Sachs)
68(1)
4.3.3.2 Humeral Head
69(1)
4.3.3.3 Glenoid Labrum
69(5)
4.4 Management
74(17)
4.4.1 Assessment
74(1)
4.4.1.1 Clinical
74(1)
4.4.1.2 Radiological
75(1)
4.4.1.3 Examination Under Anesthesia
75(1)
4.4.2 Decision-Making
75(1)
4.4.2.1 Stable Fractures
75(1)
4.4.2.2 Unstable Fractures
75(5)
4.4.3 Surgical Technique
80(1)
4.4.3.1 Timing
80(1)
4.4.3.2 Approaches
81(1)
4.4.3.3 Reduction
82(1)
4.4.3.4 Methods of Internal Fixation
83(3)
4.4.3.5 Wound Closure
86(1)
4.4.3.6 Postoperative Care
87(1)
References
88(3)
5 Fractures of the Humerus (12-A, B, and C)
91(12)
J. Schatzker
5.1 Introduction
91(1)
5.2 Indications for Surgery
91(5)
5.2.1 Failure to Obtain a Satisfactory Reduction
91(2)
5.2.2 Failure to Maintain Reduction
93(1)
5.2.3 Injuries to the Chest Wall
93(1)
5.2.4 Bilateral Humeral Fractures
93(1)
5.2.5 Multiple Injuries
94(1)
5.2.6 Vascular Lesions
94(1)
5.2.7 Neurological Lesions
94(1)
5.2.8 Fractures of the Shaft Associated with Intra-articular Fractures or Articular Extensions of the Fracture
95(1)
5.2.9 Open Fractures of the Humerus
95(1)
5.2.10 Pathological Fractures of the Humerus
95(1)
5.3 Surgical Approaches
96(1)
5.4 Surgical Methods of Stable Fixation
96(6)
5.4.1 Biomechanical Considerations
96(6)
5.5 Postoperative Regimen
102(1)
5.6 Removal of Internal Fixation
102(1)
References
102(1)
6 Fractures of the Distal End of the Humerus (13-A, B, and C)
103(20)
J. Schatzker
6.1 Introduction
103(1)
6.2 Fractures with a Good Prognosis
103(3)
6.2.1 Fractures of the Epicondyles
103(1)
6.2.1.1 Fractures of the Lateral Epicondyle (13-A1.1)
103(1)
6.2.1.2 Fractures of the Medial Epicondyle (13-A1.2)
103(2)
6.2.1.3 Fractures of the Lateral Condyle (B1)
105(1)
6.2.1.4 Fractures of the Capitellum (13-B3.1)
105(1)
6.3 Fractures with a Poor Prognosis: The Extra-Articular Group A2 and A3 and Complete Articular Type C
106(17)
6.3.1 Supracondylar Fractures
106(1)
6.3.1.1 Natural History
106(2)
6.3.1.2 Factors Influencing Decisions in Treatment
108(2)
6.3.1.3 Indications for Surgery
110(1)
6.3.1.4 Surgical Treatment
110(10)
References
120(3)
7 Fractures of the Olecranon (12-B1)
123(8)
J. Schatzker
7.1 Introduction
123(1)
7.2 Methods of Evaluation and Guides to Treatment
124(1)
7.3 Classification
124(2)
7.3.1 Intra-articular Fractures
124(1)
7.3.1.1 Transverse (21-B1.1)
124(1)
7.3.1.2 Oblique (21-B1.1)
125(1)
7.3.1.3 Comminuted Fractures and Associated Injuries
125(1)
7.3.2 Extra-articular Fractures
126(1)
7.4 Surgical Treatment
126(3)
7.4.1 Positioning the Patient
126(1)
7.4.2 Draping
126(1)
7.4.3 Tourniquet
126(1)
7.4.4 Surgical Exposure
127(1)
7.4.5 Techniques of Reduction and Internal Fixation
127(1)
7.4.5.1 Transverse Fractures
127(1)
7.4.5.2 Transverse Fractures with Joint Depression
128(1)
7.4.5.3 Oblique Fractures
128(1)
7.4.5.4 Comminuted Fractures
129(1)
7.5 Postoperative Care
129(2)
References
129(2)
8 Fractures of the Radial Head (21-A2.2, 21-B2.1, 21-B2.2, and 21-B2.3)
131(6)
J. Schatzker
8.1 Introduction
131(1)
8.2 Mechanism of Injury
131(1)
8.3 Guides to Treatment
131(1)
8.4 Surgical Treatment
132(5)
8.4.1 Classification
132(1)
8.4.2 Positioning and Draping the Patient
133(1)
8.4.3 Surgical Exposure
133(1)
8.4.4 Techniques of Reduction and Internal Fixation
133(1)
8.4.4.1 Comminuted Fractures
133(1)
8.4.4.2 Split-Wedge Fractures
134(1)
8.4.4.3 Impaction Fractures
134(1)
8.4.5 Postoperative Care
135(1)
References
135(2)
9 Fractures of the Radius and Ulna
137(30)
M. Tile
9.1 Introduction
137(1)
9.2 Natural History
137(1)
9.2.1 Closed Treatment
137(1)
9.2.2 Open Treatment
137(1)
9.2.3 AO/ASIF Techniques
137(1)
9.3 Management
138(16)
9.3.1 Principles
138(1)
9.3.2 Indications for Surgery
138(1)
9.3.2.1 Fractures of Both Bones
138(1)
9.3.2.2 Fracture of One Bone
139(1)
9.3.2.3 Open Fracture of the Forearm
140(1)
9.3.3 Timing of Surgery
140(2)
9.3.4 Surgical Technique
142(1)
9.3.4.1 Preliminary Considerations
142(1)
9.3.4.2 Surgical Approaches
142(2)
9.3.4.3 Reduction Techniques
144(3)
9.3.4.4 Technique of Fracture Fixation
147(7)
9.4 Special Considerations
154(10)
9.4.1 Fractures of Both Bones of the Forearm
154(1)
9.4.2 Fractures of One Bone
155(1)
9.4.2.1 Fractures of the Radius with Distal Radioulnar Subluxation (Galeazzi)
155(1)
9.4.2.2 Fractures of the Ulna
156(3)
9.4.3 Fractures of the Forearm in Adolescents
159(3)
9.4.4 Open Fractures of the Forearm
162(2)
9.5 Complications
164(3)
9.5.1 Radioulnar Synostosis
164(1)
9.5.2 Stress Fracture
164(1)
9.5.3 Refracture and Plate Removal
165(1)
References
166(1)
10 Fractures of the Distal Radius
167(26)
T. S. Axelrod
10.1 Distal Radius Fractures
167(3)
10.1.1 Classification
168(1)
10.1.2 Imaging
168(2)
10.2 Overview of Treatment Options Based on Fracture Configuration
170(1)
10.3 Closed Treatment
171(1)
10.4 Operative Management of Distal Radius Fractures
171(2)
10.4.1 Percutaneous Pinning
171(1)
10.4.2 Pins and Plaster
171(1)
10.4.3 External Skeletal Fixation
172(1)
10.4.4 Limited Open Reduction
172(1)
10.4.5 Open Reduction and Internal Fixation
173(1)
10.5 Algorithm for Treatment
173(1)
10.6 Surgical Technique
174(9)
10.6.1 External Fixation Application
174(4)
10.6.2 Limited Open Reduction
178(1)
10.6.3 Open Reduction and Internal Fixation
178(1)
10.6.3.1 Open Reduction and Internal Fixation of Shear Fractures (Volar Barton's, Radial Styloid)
178(2)
10.6.3.2 Open Reduction and Internal Fixation of Joint Compression Fractures (Die-Punch Fractures)
180(1)
10.6.3.3 Shear Plus Compression
180(1)
10.6.3.4 Multifragmentary Combined Fractures
181(2)
10.7 The Distal Radioulnar Joint
183(4)
10.8 Postoperative Care
187(1)
10.9 Complications
187(1)
10.9.1 Pin Site Infection
187(1)
10.9.2 Median Nerve Compression
187(1)
10.9.3 Reflex Sympathetic Dystrophy
187(1)
10.9.4 Malunion of the Distal Radius
187(1)
10.9.5 Nonunion of the Distal Radius
187(1)
10.9.6 Posttraumatic Osteoarthritis of the Radiocarpal Joint
188(1)
10.10 Conclusions
188(5)
References
188(5)
Part III Fractures of the Spine, Pelvis, and Acetabulum
11 Fractures of the Spine
193(46)
R. Hu
11.1 Introduction
193(1)
11.2 History
193(2)
11.2.1 Internal Fixation and Fusion
193(1)
11.2.2 Distraction Rod Fixation
194(1)
11.2.3 Segmental Sublaminar Wires
194(1)
11.2.4 Short-Segment Fixation
194(1)
11.3 Initial Assessment and Management
195(8)
11.3.1 Physical Examination
195(1)
11.3.1.1 Neurological Examination
195(1)
11.3.1.2 Sacral Reflexes
196(1)
11.3.1.3 Corticosteroids
196(1)
11.3.2 Initial Radiological Assessment
197(1)
11.3.2.1 Plain Films and Tomography
197(3)
11.3.2.2 Computed Tomography Scan
200(1)
11.3.2.3 Myelography
200(1)
11.3.2.4 Magnetic Resonance Imaging
201(2)
11.4 Classification
203(2)
11.5 Operative Decision-Making with Neurological and Biomechanical Goals
205(2)
11.5.1 Indications
205(1)
11.5.1.1 Does the Patient Have a Neurological Deficit? If so, to What Degree?
205(1)
11.5.1.2 Are the Anterior Elements Intact?
206(1)
11.5.1.3 Are the Posterior Elements Intact?
206(1)
11.5.1.4 What Information to Assess with Imaging?
206(1)
11.5.1.5 Will the Patient Tolerate Operative or Nonoperative Treatment?
206(1)
11.6 Preparation for Surgery
207(1)
11.6.1 Timing of Surgery
207(1)
11.6.2 Patient Positioning
207(1)
11.6.3 Intraoperative Blood Loss
208(1)
11.7 Anatomy as Related to Surgical Approaches
208(6)
11.7.1 Posterior Approach
208(1)
11.7.1.1 Cervical Spine Posterior Approach
208(1)
11.7.1.2 Cervical Spine Decompression
209(1)
11.7.1.3 Thoracic Spine Posterior Approach
209(1)
11.7.1.4 Lumbosacral Junction Posterior Approach
209(1)
11.7.2 Thoracolumbar and Lumbar Spine Decompression
209(2)
11.7.3 Anterior Approach
211(1)
11.7.3.1 Cervical Spine
211(1)
11.7.3.2 Cervicothoracic Junction
212(1)
11.7.3.3 Thoracic Spine
212(1)
11.7.3.4 Thoracolumbar Junction
212(1)
11.7.3.5 Lumbar Spine
213(1)
11.7.3.6 Lumbosacral Junction
213(1)
11.7.4 Decompression Anterior Approach
213(1)
11.8 Fractures and Specific Management
214(18)
11.8.1 Upper Cervical
214(1)
11.8.1.1 Atlas Injury
215(1)
11.8.1.2 Atlas and Odontoid Injury
216(1)
11.8.1.3 Odontoid Injury
216(1)
11.8.1.4 C2 Injury
216(1)
11.8.2 Lower Cervical Spine
216(5)
11.8.3 Thoracic Spine
221(2)
11.8.4 Thoracolumbar Junction
223(1)
11.8.4.1 Internal Fixation
224(4)
11.8.5 Lumbar Spine
228(1)
11.8.6 Sacral Fractures
229(2)
11.8.6 Osteoporotic Fractures
231(1)
11.9 Postoperative Care
232(2)
11.9.1 Brace Wear
232(1)
11.9.2 Mobilization
233(1)
11.9.3 Complications and Their Prevention
233(1)
11.9.4 Pedicle Screw Insertion
233(1)
11.9.5 Thromboembolic Disease
233(1)
11.9.6 Urinary Care
234(1)
11.10 Outcomes of Treatment of Spinal Injury
234(1)
11.11 Conclusions
234(5)
References
235(4)
12 Fractures of the Pelvis
239(52)
M. Tile
12.1 Introduction
239(1)
12.2 Understanding the Injury
239(7)
12.2.1 Ring Structure of the Pelvis
239(2)
12.2.2 Anatomical Lesions
241(1)
12.2.3 Stability of the Pelvis
241(2)
12.2.3.1 Sacroiliac Complex
243(1)
12.2.3.2 Pelvic Floor
244(1)
12.2.4 Types of Injurious Forces Acting on the Pelvis
244(2)
12.2.5 Effect of Forces on Soft Tissue
246(1)
12.3 Classification
246(9)
12.3.1 Comprehensive Classification (from Tile 1988)
246(1)
12.3.1.1 General Concepts
246(1)
12.3.2 Type A Stable Fractures (Table 12.2)
247(1)
12.3.3 Type B - Partially Stable Fractures (Table 12.2)
247(1)
12.3.3.1 Open Book (Anteroposterior Compression) Fractures (B1, B3.1)
247(3)
12.3.4 Partially Stable Fractures (Type B2)
250(1)
12.3.4.1 Lateral Compression Fractures (Tables 12.1, 12.2, 12.4)
250(4)
12.3.5 Type C - Unstable Fractures - Complete Disruption of the Posterior Arch (see Tables 12.1, 12.2)
254(1)
12.3.6 Unusual Types of Fracture
255(1)
12.3.6.1 Complex Fractures
255(1)
12.3.6.2 Bilateral Sacroiliac Dislocation with an Intact Anterior Arch
255(1)
12.3.6.3 Pelvic Disruptions Associated with Acetabular Fractures
255(1)
12.4 Natural History
255(2)
12.5 Management of the Pelvic Disruption
257(31)
12.5.1 Assessment
257(1)
12.5.1.1 General Assessment
257(1)
12.5.1.2 Specific Musculoskeletal Assessment
258(2)
12.5.1.3 Diagnosis of Pelvic Instability
260(1)
12.5.2 Resuscitation
260(1)
12.5.3 Provisional Stabilization
261(1)
12.5.3.1 External Fixation or Pelvic Clamp
262(1)
12.5.3.2 Role of Skeletal Traction
263(1)
12.5.3.3 Early Internal Fixation
263(2)
12.5.4 Definitive Stabilization
265(1)
12.5.4.1 Stable Fractures (Type A)
265(1)
12.5.4.2 Unstable Fractures (Type C)
266(10)
12.5.4.3 Surgical Techniques
276(11)
12.5.4.4 Postoperative Care
287(1)
12.5.4.5 Complications
287(1)
12.6 Conclusions
288(3)
References
290(1)
13 Fractures of the Acetabulum
291(52)
M. Tile
13.1 Introduction
291(5)
13.1.1 Natural History
291(3)
13.1.2 Surgical Anatomy
294(1)
13.1.3 Mechanism of Injury
295(1)
13.2 Assessment
296(4)
13.2.1 Clinical Assessment
296(1)
13.2.2 Radiological Assessment
296(1)
13.2.2.1 Special Radiographs of the Pelvis
296(1)
13.2.2.2 Specific Acetabular Views
296(2)
13.2.2.3 Tomography
298(1)
13.2.2.4 Computed Tomography
298(2)
13.2.2.5 Magnetic Resonance Imaging
300(1)
13.3 Classification
300(3)
13.4 Treatment
303(32)
13.4.1 Decision-Making
303(1)
13.4.2 Fracture Factors
303(1)
13.4.2.1 Nonoperative Management
303(5)
13.4.3 Operative Management
308(26)
13.4.3 Postoperative Care
334(1)
13.5 Complications
335(1)
13.5.1 Nerve Injury
335(1)
13.5.2 Role of Total Hip Arthroplasty
335(1)
13.6 Conclusions
335(8)
References
339(4)
Part IV Fractures of the Lower Extremity
14 Subcapital and Intertrochanteric Fractures
343(24)
J. Schatzker
14.1 Anatomy and Blood Supply
343(1)
14.1.1 Cross-Sectional Anatomy of the Head
343(1)
14.1.1.1 Neck Shaft Angle
343(1)
14.1.1.2 Greater Trochanter
343(1)
14.1.2 Blood Supply
344(1)
14.2 Classification
344(1)
14.3 Subcapital Fractures
345(12)
14.3.1 Classification
345(2)
14.3.2 History and Physical Examination
347(1)
14.3.3 Imaging Techniques
347(1)
14.3.3.1 X-Rays
347(1)
14.3.3.2 Bone Scan
348(1)
14.3.3.3 Computerized Axial Tomography
348(1)
14.3.3.4 Magnetic Resonance Imaging
348(1)
14.3.4 Surgical Treatment
348(1)
14.3.4.1 Method of Reduction
348(2)
14.3.4.2 Methods of Internal Fixation
350(2)
14.3.4.3 Methods of Joint Replacement
352(1)
14.3.5 Decision-Making
353(1)
14.3.5.1 Undisplaced Fractures
353(1)
14.3.5.2 Displaced Fractures
353(2)
14.3.5.3 Special Fracture Situations
355(1)
14.3.6 Postoperative Management
355(1)
14.3.7 Complications
355(1)
14.3.7.1 Nonunion
355(1)
14.3.7.2 Avascular Necrosis and Loss of Fixation
356(1)
14.4 Intertrochanteric Fractures
357(10)
14.4.1 Surgical Anatomy and Classification
357(1)
14.4.2 History and Physical Examination
358(1)
14.4.3 Surgical Treatment
358(1)
14.4.3.1 Reduction
359(1)
14.4.3.2 Internal Fixation
359(2)
14.4.4 Postoperative Management
361(1)
14.4.5 Common Early and Late Postoperative Complications
362(3)
References
365(2)
15 Subtrochanteric Fractures of the Femur
367(18)
J. Schatzker
15.1 Biomechanical Considerations
367(1)
15.1.1 Mechanical Forces
367(1)
15.1.2 Degree of Comminution
367(1)
15.1.3 Level of the Fracture
368(1)
15.1.4 Pattern of the Fracture
368(1)
15.1.5 Deformity
368(1)
15.2 Natural History
368(1)
15.3 Indications for Open Reduction and Internal Fixation
369(1)
15.4 Surgical Techniques
370(15)
15.4.1 Diagnosis
370(1)
15.4.2 Classification
370(1)
15.4.3 Planning the Surgical Procedure
370(1)
15.4.3.1 Implants
370(6)
15.4.3.2 Preoperative Planning
376(3)
15.4.4 Surgery
379(1)
15.4.4.1 The Operating Table
379(1)
15.4.4.2 Positioning the Patient
379(1)
15.4.4.3 Surgical Approach for Plating
380(1)
15.4.4.4 Technique of Insertion of Guide Wires and Insertion of the Fixation Devices
381(2)
15.4.4.5 Bone Grafting
383(1)
15.4.5 Postoperative Care
383(1)
15.4.5.1 Signs of Instability
383(1)
15.4.5.2 Infection
383(1)
References
384(1)
16 Fractures of the Femur
385(24)
J. Schatzker
16.1 Introduction
385(1)
16.2 Factors Important in Evaluating the Mode of Treatment
385(1)
16.3 Surgical Treatment
386(19)
16.3.1 Timing of Surgery
386(1)
16.3.1.1 Multiple System Injuries
386(1)
16.3.1.2 Head Injury
387(1)
16.3.1.3 Open Fractures
388(1)
16.3.1.4 Vascular Injury
388(1)
16.3.1.5 Ipsilateral Neck Fracture or Dislocation of the Hip
388(1)
16.3.1.6 Ipsilateral Fracture of the Femoral Shaft and Ligamentous Disruption of the Knee
388(1)
16.3.1.7 Floating Knee Syndrome
389(1)
16.3.1.8 Isolated Fractures of the Femoral Shaft
389(1)
16.3.2 Surgical Technique
389(1)
16.3.2.1 Positioning the Patient, Skin Preparation, and Draping
389(1)
16.3.2.2 Surgical Approach
389(1)
16.3.2.3 Technique of Open Reduction
390(2)
16.3.2.4 Technique of Fracture Fixation
392(13)
16.3.2.5 Bone Grafting
405(1)
16.3.2.6 Wound Closure
405(1)
16.3.3 Postoperative Care
405(1)
16.4 Special Considerations: Open Fractures of the Femur
405(4)
References
406(3)
17 Supracondylar Fractures of the Femur (33-A, B, and C)
409(32)
J. Schatzker
17.1 Introduction
409(2)
17.2 Guides to Treatment and Indications for Surgery
411(3)
17.2.1 Absolute Indications
412(1)
17.2.1.1 Intra-articular Fractures in Which Adequate Joint Congruity Cannot Be Restored by Manipulation
412(1)
17.2.1.2 Open Intra-articular Fractures
413(1)
17.2.1.3 Associated Neurovascular Injuries
413(1)
17.2.1.4 Ipsilateral Fracture of the Tibial Plateau or Patellar Fracture
414(1)
17.2.1.5 Ipsilateral Fracture of the Tibia (the Floating Knee)
414(1)
17.2.1.6 Multiple Injuries
414(1)
17.2.1.7 Pathological Fractures
414(1)
17.2.2 Relative Indications
414(1)
17.3 Surgical Treatment
414(23)
17.3.1 Timing of Surgery
414(1)
17.3.2 History and Physical Examination
415(1)
17.3.3 Radiological Examination
415(1)
17.3.4 Classification
415(1)
17.3.5 Planning the Surgical Procedure
416(1)
17.3.6 Surgical Anatomy of the Distal Femur
417(2)
17.3.7 Positioning and Draping the Patient
419(1)
17.3.8 Surgical Exposure
419(1)
17.3.8.1 Lateral Exposure
419(1)
17.3.8.2 Anterior Exposure
420(1)
17.3.9 Techniques of Reduction and Internal Fixation
421(1)
17.3.9.1 Type A Fractures
421(5)
17.3.9.2 Type B Fractures
426(1)
17.3.9.3 Type C Fractures
427(2)
17.3.9.4 Minimally Invasive Plate Osteosynthesis, the Condylar LCP and LISS
429(5)
17.3.9.5 The Open Supracondylar Fracture
434(2)
17.3.10 Bone Grafting
436(1)
17.3.11 Methyl Methacrylate
436(1)
17.4 Postoperative Care
437(1)
17.5 Complications
437(1)
17.6 Conclusions
438(3)
References
439(2)
18 Fractures of the Patella
441(6)
J. Schatzker
18.1 Introduction
441(1)
18.2 Methods of Evaluation and Guides to Treatment
441(1)
18.3 Classification
441(1)
18.3.1 Osteochondral Fractures
441(1)
18.3.2 Stellate Fractures
441(1)
18.3.3 Transverse Fractures
442(1)
18.3.4 Multifragmentary Displaced Fractures
442(1)
18.4 Surgical Treatment
442(2)
18.4.1 Undisplaced Fractures
442(1)
18.4.2 Displaced Fractures
442(1)
18.4.2.1 Surgical Approaches
443(1)
18.4.2.2 Biomechanical Considerations
443(1)
18.4.2.3 Techniques of Internal Fixation
443(1)
18.5 Postoperative Care
444(3)
References
445(2)
19 Fractures of the Tibial Plateau
447(24)
J. Schatzker
19.1 Introduction
447(1)
19.2 Classification and Guides to Treatment
448(8)
19.2.1 Type I(41-B1)
448(1)
19.2.2 Type II (41-B3.1)
449(1)
19.2.3 Type III (41-B.2)
450(1)
19.2.4 Type IV (41-B1, 41-B2, and 41-B3)
451(2)
19.2.5 Type V (41-C1)
453(1)
19.2.6 Type VI
454(1)
19.2.7 Relationship of the Comprehensive Classification to the Six Fracture Types
455(1)
19.2.8 Absolute Indications for Surgery
455(1)
19.2.8.1 Open Fractures
455(1)
19.2.8.2 Acute Compartment Syndrome
455(1)
19.2.8.3 Associated Vascular or Neurological Injury
455(1)
19.3 Methods of Assessment
456(2)
19.3.1 History
456(1)
19.3.2 Physical Examination
457(1)
19.3.3 Radiological Examination
457(1)
19.4 Surgical Treatment
458(10)
19.4.1 Planning the Surgical Procedure
458(1)
19.4.2 Approaches
458(3)
19.4.3 Positioning the Patient
461(1)
19.4.4 Timing the Surgical Procedure
461(1)
19.4.5 Methods of Open Reduction and Internal Fixation
462(3)
19.4.6 Internal Fixation of Different Fracture Types
465(1)
19.4.6.1 Type I
465(1)
19.4.6.2 Type II
465(1)
19.4.6.3 Type III
465(1)
19.4.6.4 Type IV
465(1)
19.4.6.5 Type V
466(1)
19.4.6.6 Type VI
466(1)
19.4.7 Ligament and Meniscal Repair
467(1)
19.4.8 Postoperative Care
467(1)
19.5 Summary and Conclusions
468(3)
References
469(2)
20 Fractures of the Tibia
471(52)
M. Tile
20.1 Introduction
471(1)
20.2 Natural History
471(8)
20.2.1 Nonoperative School
472(1)
20.2.2 Operative School
473(1)
20.2.3 Plaster Disease
474(1)
20.2.3.1 Compartment Syndromes
474(1)
20.2.3.2 Reflex Sympathetic Dystrophy
475(1)
20.2.3.3 Thromboembolic Disease
475(1)
20.2.3.4 Severe Soft Tissue Injury
476(1)
20.2.4 Factors Influencing the Natural History
476(1)
20.2.4.1 Pathoanatomy of the Fracture
476(2)
20.2.4.2 Soft Tissue Injury
478(1)
20.2.4.3 Other Injuries to the Limb
478(1)
20.2.4.4 Patient Factors
478(1)
20.2.4.5 The Health Care Team
479(1)
20.2.5 Summary
479(1)
20.3 Assessment
479(3)
20.3.1 Clinical Assessment
479(1)
20.3.1.1 History
479(1)
20.3.1.2 Physical Assessment
479(2)
20.3.2 Radiological Assessment
481(1)
20.4 Management
482(36)
20.4.1 Decision-Making
482(1)
20.4.2 Nonoperative Treatment
482(1)
20.4.3 Indications for Surgery
483(1)
20.4.3.1 Primary Indications
484(8)
20.4.3.2 Delayed Primary Indications
492(1)
20.4.3.3 Secondary Indications
492(1)
20.4.4 Role of Amputation in Severe Tibial Fractures
492(1)
20.4.5 Timing of Surgery
492(2)
20.4.6 Surgical Methods
494(1)
20.4.6.1 Approaches
494(2)
20.4.6.2 Reduction Techniques
496(1)
20.4.6.3 Fixation
496(21)
20.4.6.4 Wound Closure
517(1)
20.4.6.5 Postoperative Course
518(1)
20.5 Conclusions
518(5)
References
520(3)
21 Fractures of the Distal Tibial Metaphysis Involving the Ankle Joint: The Pilon Fracture
523(28)
D. Stephen
21.1 Introduction
523(1)
21.2 Overview
523(6)
21.2.1 Nature of the Injury
523(1)
21.2.1.1 Axial Compression
523(1)
21.2.1.2 Shear (Tension)
524(1)
21.2.1.3 Combined
525(1)
21.2.2 State of the Bone
526(1)
21.2.3 State of the Soft Tissues
526(1)
21.2.4 Technical Difficulties
527(1)
21.2.5 The Dilemma
528(1)
21.2.6 Summary
528(1)
21.3 Classification
529(5)
21.3.1 Comprehensive Classification
529(1)
21.3.2 Use of Classification in Decision-Making
529(1)
21.3.2.1 Fibula
529(1)
21.3.2.2 Articular Surface of the Tibia
529(1)
21.3.2.3 Distal Tibial Metaphysis
529(2)
21.3.3 Personality of the Fracture
531(3)
21.4 Assessment
534(1)
21.4.1 Clinical
534(1)
21.4.2 Radiological
534(1)
21.5 Indications for Surgery
534(3)
21.5.1 Minimal Displacement
534(1)
21.5.2 Significant Displacement
535(1)
21.5.2.1 Operable
536(1)
21.6 Surgical Technique
537(10)
21.6.1 Timing
537(2)
21.6.2 Approach
539(1)
21.6.2.1 Soft Tissue
539(1)
21.6.2.2 Skeletal Tissue
539(1)
21.6.3 Technique of Internal Fixation
540(1)
21.6.3.1 Without Fibular Fracture
540(1)
21.6.3.2 With Fibular Fracture
540(5)
21.6.4 Wound Closure
545(1)
21.6.5 Postoperative Care
546(1)
21.6.5.1 Early
546(1)
21.6.5.2 Late
547(1)
21.7 Common Pitfalls of Treatment
547(1)
21.7.1 Poor Decision-Making
547(1)
21.7.2 Operating Through Poor Skin
547(1)
21.7.3 Technical Difficulties with the Fibula
547(1)
21.7.4 Technical Difficulties with the Tibial Fracture
547(1)
21.7.5 Poor Postoperative Care
547(1)
21.8 Late Reconstruction: Malunion
548(3)
References
550(1)
22 Fractures of the Ankle
551(40)
M. Tile
22.1 Introduction
551(8)
22.1.1 Basic Principles
551(1)
22.1.2 Anatomical Considerations
551(1)
22.1.2.1 Stability
551(1)
22.1.2.2 Congruity
551(1)
22.1.2.3 Physiology
552(1)
22.1.2.4 Pathoanatomy
552(2)
22.1.3 Natural History
554(3)
22.1.4 Mechanism of Injury
557(1)
22.1.4.1 Supination-Adduction
557(1)
22.1.4.2 Eversion-Abduction
558(1)
22.2 Classification
559(5)
22.2.1 Introduction
559(2)
22.2.2 Comprehensive Classification (Fig. 22.14)
561(1)
22.2.2.1 Type A
562(1)
22.2.2.2 Type B
562(1)
22.2.2.3 Type C
563(1)
22.2.2.4 Isolated Medial Malleolus Fracture
564(1)
22.3 Assessment of Stability
564(5)
22.3.1 Clinical Assessment
564(1)
22.3.1.1 History
564(1)
22.3.1.2 Physical Examination
565(1)
22.3.2 Radiological Assessment
565(1)
22.3.2.1 Lateral Complex: Fibula and Tibiofibular Syndesmosis
566(2)
22.3.2.2 Talus
568(1)
22.3.2.3 Posterior Tibial Process
568(1)
22.3.2.4 Medial Complex
568(1)
22.4 Management
569(15)
22.4.1 Decision-Making
569(1)
22.4.1.1 Type A
569(1)
22.4.1.2 Types B and C
570(1)
22.4.1.3 Isolated Medial Malleolar Fracture
571(1)
22.4.2 Surgical Technique
571(1)
22.4.2.1 Tourniquet
571(2)
22.4.2.2 Timing
573(1)
22.4.2.3 Incisions
573(1)
22.4.2.4 Open Reduction and Internal Fixation
574(10)
22.4.3 Wound Closure
584(1)
22.4.4 Postoperative Program
584(1)
22.4.4.1 Immediate Management
584(1)
22.4.4.2 Early Motion
584(1)
22.5 Special Problems in Ankle Fractures
584(7)
22.5.1 Open Ankle Fractures
584(1)
22.5.2 Ankle Fractures in the Elderly
585(1)
22.5.3 Primary Ankle Arthrodesis
586(1)
22.5.4 Fibular Lengthening for Malunion
586(1)
22.5.5 Supramalleolar Osteotomy
587(1)
22.5.6 Ankle Fractures in Adolescents
587(2)
References
589(2)
23 Fractures of the Talus
591(28)
M. Tile
23.1 Introduction
591(1)
23.2 Anatomical Considerations
591(6)
23.2.1 Vascular Anatomy
591(1)
23.2.1.1 Extraosseous Arterial Supply
592(1)
23.2.1.2 Intraosseous
593(1)
23.2.1.3 Summary
593(2)
23.2.2 Mechanism of Injury
595(1)
23.2.2.1 Common Pattern
595(1)
23.2.2.2 Atypical Patterns
596(1)
23.2.2.3 Total Dislocation of the Talus
596(1)
23.3 Classification and Natural History
597(7)
23.3.1 Fractures of the Body of the Talus
597(1)
23.3.2 Fractures of the Talar Neck
597(1)
23.3.2.1 Type A: Undisplaced Fractures of the Talar Neck
597(1)
23.3.2.2 Type B: Displaced Fractures of the Talar Neck with Subluxation of Subtalar Joint
597(2)
23.3.2.3 Type C: Displaced Fractures of the Talar Neck with Posterior Dislocation of the Body
599(1)
23.3.3 Subtalar Dislocation
599(2)
23.3.4 Total Dislocation of the Talus
601(3)
23.4 Management
604(15)
23.4.1 Assessment
604(1)
23.4.1.1 Clinical Assessment
604(1)
23.4.1.2 Radiological Assessment
604(1)
23.4.2 Decision-Making
605(1)
23.4.2.1 Fractures of the Body
605(1)
23.4.2.2 Fractures of the Talar Neck
606(2)
23.4.3 Surgical Technique
608(1)
23.4.3.1 Timing
608(1)
23.4.3.2 Antibiotics
608(1)
23.4.3.3 Tourniquet
609(1)
23.4.3.4 Skin Approaches
609(2)
23.4.3.5 Stable Internal Fixation
611(1)
23.4.3.6 Postoperative Care
611(5)
23.4.4 Special Problems
616(1)
23.4.4.1 Open Fractures and Fracture-Dislocations
616(1)
23.4.4.2 Comminuted Fractures of the Talar Body
617(1)
References
617(2)
24 Fractures of the Calcaneus
619(16)
M. Tile
24.1 Introduction
619(1)
24.2 Anatomy
620(1)
24.3 Pathoanatomy (Mechanism of Injury; Fig.24.3)
621(1)
24.4 Classification
621(2)
24.5 Assessment
623(3)
24.5.1 Clinical Assessment
623(1)
24.5.2 Radiographic Assessment
624(2)
24.6 Decision-Making
626(1)
24.6.1 Fracture Factors
626(1)
24.6.2 Patient Factors
626(1)
24.7 Treatment
626(5)
24.7.1 Nonoperative Treatment
626(1)
24.7.2 Operative Treatment
627(1)
24.7.2.1 General Aspects
627(1)
24.7.2.2 Specific Aspects
627(4)
24.8 Postoperative Care
631(1)
24.9 Prognosis and Results
632(1)
24.10 Conclusions
633(2)
References
633(2)
25 Injuries of the Midfoot and Forefoot
635(22)
D.J.G. Stephen
25.1 Fractures of the Navicular
635(3)
25.1.1 Anatomy
635(1)
25.1.2 Treatment
635(3)
25.2 Fractures of the Cuboid
638(1)
25.3 Fractures of the Metatarsals
638(7)
25.3.1 Anatomy
638(1)
25.3.2 Treatment
638(2)
25.3.3 Fractures of the Proximal Fifth Metatarsal
640(1)
25.3.3.1 Anatomy
640(3)
25.3.3.2 Clinical and Radiological Diagnosis
643(1)
25.3.3.3 Treatment
644(1)
25.4 Fractures of the Phalanges
645(1)
25.5 Tarsometatarsal (Lisfranc) Fracture-Dislocations
646(5)
25.5.1 Anatomy
646(1)
25.5.2 Mechanism and Classification
647(1)
25.5.3 Clinical and Radiological Diagnosis
647(1)
25.5.4 Treatment
648(3)
25.6 Dislocations of the Metatarsophalangeal Joints
651(2)
25.7 Compartment Syndromes of the Foot
653(4)
References
654(3)
Subject Index 657
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