Manual of Internal Fixation

General Considerations.- 1 Aims and Fundamental Principles of the AO Method.- 1.1 Aims of the AO Method.- 1.2 Basic Principles of the AO Method.- 1.2.1 Histology of Bone Healing in the Presence of Stable Internal Fixation.- 1.2.2 Bone Reaction to Compression.- 1.2.3 Bone Reaction to Movement.- 1.2.4 Reaction of Bone to Metallic Implants.- 1.2.5 Documentation.- 1.2.6 Surgical Bone Instruments.- 1.3 Principles of the AO Method.- 1.3.1 Inter-fragmental Compression.- 1.3.2 Splinting.- 1.3.3 Combination of Inter-fragmental Compression and Splinting.- 2 Means by Which Stable Internal Fixation is Achieved.- 2.1 Lag Screws.- 2.1.1 Cancellous Lag Screws.- 2.1.2 Cortical Screws.- 2.1.3 Technique of Screw Fixation.- 2.1.4 Orientation of Cortical Screws.- 2.2 Dynamic Compression with the Tension Band.- 2.2.1 Tension Band Wires.- 2.2.2 AO Wire Tightener.- 2.2.3 Combination of Tension Band Wire and Kirschner Wires.- 2.3 Standard AO Plates Grouped According to Shape.- 2.3.1 Straight Plates.- 2.3.1.1 Round Hole Plates.- 2.3.1.2 Tubular Plates.- 2.3.1.3 Dynamic Compression Plates (DCP).- 2.3.2 Special Plates.- 2.3.3 Angled Plates.- 2.3.4 Mini-Implants and Mini-Instruments.- 2.4 Intra-medullary Nailing.- 2.4.1 AO Intra-medullary Nails.- 2.4.2 AO Intra-medullary Reamers.- 2.4.3 Technical Complications of Intra-medullary Reaming.- 2.4.4 AO Insertion Assembly for the Tibial and Femoral Nails.- 2.4.5 Complications of Nail Insertion.- 2.4.6 Technique of Open Intra-medullary Nailing of the Tibia.- 2.4.7 Technique of Open Intra-medullary Nailing of the Femur.- 2.4.8 Femoral Distractor.- 2.4.9 Closed Intra-medullary Nailing of the Tibia and Femur.- 2.5 External Fixators.- 2.5.1 Instrumentation.- 2.5.2 Correction of Rotational Alignment with the External Fixator.- 2.5.3 External Fixator and Compression.- 2.6 Composite Internal Fixation.- 3 Preoperative, Operative and Postoperative Guidelines.- 3.1 Organizational Prerequisites.- 3.2 Priorities in the Assessment and Treatment of Injuries.- 3.3 Timing of Surgery.- 3.4 General Guidelines for Operative Procedures.- 3.4.1 Planning.- 3.4.2 Preparation of the Operative Field.- 3.4.3 The Operation.- 3.4.4 Autologous Cancellous Bone Grafts.- 3.4.5 Wound Closure.- 3.4.6 Release of the Tourniquet.- 3.5 Postoperative Positioning and Treatment.- 3.5.1 Guidelines for Weight Bearing.- 3.5.2 Secondary Plaster Fixation.- 3.5.3 Education of the Patient.- 3.5.4 Prophylactic Antibiotics.- 3.5.5 Prophylaxis of Thromboembolism.- 3.5.6 Radiological Follow-Up of Bone Healing.- 3.6 Removal of Implants.- 3.6.1 Timing of Implant Removal.- 3.6.2 Technique of Metal Removal.- 3.6.3 Safeguards After Metal Removal.- 3.7 Postoperative Complications.- 3.7.1 Haematomas.- 3.7.2 Postoperative Pain.- 3.7.3 Infections.- 3.7.4 Refractures.- 3.8 Plate Fractures.- 3.8.1 Removal of Broken Screws.- 3.8.2 Removal of Broken Intra-medullary Nails.- Special Part.- Internal Fixation of Fresh Fractures.- 1 Closed Fractures in the Adult.- 1.1 Fractures of the Scapula.- 1.2 Fractures of the Clavicle.- 1.3 Fractures of the Humerus.- 1.3.1 Proximal Humerus.- 1.3.2 Fractures of the Shaft of the Humerus.- 1.3.3 Distal Extra-articular Metaphyseal Fractures (Type A).- 1.3.4 Distal Intra-articular Fractures of the Humerus.- 1.4 Fractures of the Forearm.- 1.4.1 Fractures of the Olecranon.- 1.4.2 Fractures of the Radial Head.- 1.4.3 Fractures of the Shaft of the Radius and Ulna.- 1.4.4 Fractures of the Distal Radius.- 1.5 Hand Fractures.- 1.6 Acetabular Fractures.- 1.6.1 Surgical Approaches.- 1.6.2 Diagnosis of Acetabular Fractures.- 1.6.3 Classifications of Acetabular Fractures.- 1.6.4 Surgical Technique.- 1.6.5 Postoperative Care.- 1.7 Fractures of the Femur.- 1.7.1 Fractures of the Proximal Femur.- 1.7.2 Fractures of the Femoral Shaft.- Comminuted and Badly Comminuted Subtrochanteric Fractures.- 1.7.3 Fractures of the Distal Femur (Metaphyseal and Transcondylar Fractures).- 1.8 Fractures of the Patella.- 1.8.1 Tension Band Fixation of Patellar Fractures.- 1.8.2 Fixation of Patellar Fractures Using Two Kirschner Wires and a Tension Band.- 1.8.3 Postoperative Care.- 1.9 Fractures of the Tibia.- 1.9.1 Fractures of the Tibial Plateaus.- 1.9.2 Fractures of the Tibial Shaft.- 1.10 Malleolar Fractures.- 1.10.1 Malleolar Fractures Type A.- 1.10.2 Malleolar Fractures Type B.- 1.10.3 Malleolar Fractures Type C.- 1.11 Fractures of the Foot.- 1.12 Fractures of the Spine.- 2 Open Fractures in the Adult.- 3 Fractures in Children.- 3.1 Epiphyseal Plate Fracture Separations.- 3.2 Fractures of the Humerus.- 3.3 Fractures of the Radius and Ulna.- 3.4 Fractures of the Femur.- 3.5 Fractures of the Tibia.- 3.6 Malleolar Fractures.- Supplement.- Reconstructive Bone Surgery.- 1 Delayed Union.- 2 Pseudarthroses.- 2.1 Non-infected Pseudarthroses.- 2.1.1 Pseudarthroses of the Arm.- 2.1.2 Pseudarthroses of the Leg.- 2.2 Previously Infected Pseudarthroses, Closed Pseudarthroses and Pseudarthroses with Bone Loss.- 2.3 Infected Pseudarthroses.- 3 Osteotomies.- 3.1 Osteotomies of the Arm.- 3.2 Osteotomies of the Leg.- 3.2.1 Intertrochanteric Osteotomies.- 3.2.2 Osteotomies of the Femoral Shaft.- 3.2.3 Supracondylar Osteotomies.- 3.2.4 High Tibial Osteotomies.- 3.2.5 Osteotomies of the Tibial Shaft.- 3.2.6 Supramalleolar Osteotomies.- 4 Arthrodeses.- 4.1 Arthrodesis of the Shoulder.- 4.2 Arthrodesis of the Elbow and Wrist.- 4.3 Arthrodesis of the Hip with the Cobra Plate (R. Schneider).- 4.4 Arthrodesis of the Knee.- 4.5 Arthrodesis of the Ankle.