BOOK
Skeletal Trauma E-Book
Bruce D. Browner | Jesse B. Jupiter | Christian Krettek | Paul A Anderson
(2014)
Additional Information
Book Details
Abstract
Obtain the best outcomes from the latest techniques with help from a "who's who" of orthopaedic trauma experts. The updated edition of Skeletal Trauma: Basic Science, Management, and Reconstruction is dedicated to conveying today's most comprehensive information on the basic science, diagnosis, and treatment of acute musculoskeletal injuries and post-traumatic reconstructive problems. You'll be equipped with all of the knowledge needed to manage any type of traumatic injury in adults.
- Confidently approach every form of traumatic injury with current coverage of relevant anatomy and biomechanics, mechanisms of injury, diagnostic approaches, treatment options, and associated complications.
- Access critical information concerning mass casualty incidents and war injuries. Sixteen active-duty military surgeons and physicians from various branches of the U.S. Military have collaborated with civilian authors to address injuries caused by road traffic, armed conflicts, civil wars, and insurgencies throughout the world.
- Learn from many brand-new chapters including Principles of Internal Fixation; Gunshot Wounds and Blast Injuries; New Concepts in Management of Thoracolumbar Fractures; Surgical Treatment of Acetabular Fractures; Diaphyseal Fractures of the Forearm; Fractures of the Distal Femur; Tibial Plateau Fractures; and Amputations in Trauma.
- Take advantage of guidance from expert editors, two brand new to this edition, and a host of new authors who provide fresh insights on current trends and approaches in the specialty.
- Know what to look for and how to proceed with a fully updated art program that features full-color intraoperative images and crisp, new figures.
- Handle the most challenging cases of latent or post-operative nonunions, malunions, and more with extensive coverage of post-traumatic reconstruction.
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| 9780323294980v1_WEB.pdf | 1 | ||
| Front Cover | 1 | ||
| Endsheet 2 | 2 | ||
| Skeletal Trauma | 5 | ||
| Copyright Page | 6 | ||
| Dedication | 7 | ||
| Contributors | 8 | ||
| Foreword | 23 | ||
| Preface | 24 | ||
| Acknowledgments | 26 | ||
| Table Of Contents | 27 | ||
| Video Contents | 31 | ||
| One General Principles | 35 | ||
| 1 The History of Fracture Treatment | 37 | ||
| Early Splinting Techniques | 37 | ||
| Precursors of the Plaster Bandage | 39 | ||
| The Plaster Bandage and Its Derivatives | 41 | ||
| Traction | 42 | ||
| Functional Bracing | 44 | ||
| Open Fractures | 44 | ||
| Early Fracture Surgery | 46 | ||
| Wire Fixation | 46 | ||
| Screw Fixation | 46 | ||
| Plate Fixation | 46 | ||
| External Fixation | 51 | ||
| Intramedullary Fixation | 53 | ||
| Robert Danis and the Development of the AO Group | 56 | ||
| Gavriil a. Ilizarov and the Discovery of Distraction Osteogenesis | 59 | ||
| Stuart A. Green | 59 | ||
| Emile Letournel and the Surgery of Pelvic and Acetabular Fractures | 59 | ||
| Joel M. Matta | 59 | ||
| Klaus Klemm and Interlocking Nailing and Local Antibiotic Bead Chain Therapy | 60 | ||
| David Seligson | 60 | ||
| Maurice Edmond Müller, Internal Fixation Techniques and Hip Prostheses | 61 | ||
| Joseph Schatzker | 61 | ||
| Martin Allgöwer, Internal Fixation and Fracture Management | 63 | ||
| Marvin Tile | 63 | ||
| Summary | 64 | ||
| Christopher L. Colton | 64 | ||
| References | 65 | ||
| 2 Global Burden of Musculoskeletal Injuries | 67 | ||
| Causes of Injury | 67 | ||
| Geographic and Demographic Distribution of Injury Burden | 67 | ||
| Estimating the Burden of Musculoskeletal Injury | 71 | ||
| Focus on Military Injuries | 72 | ||
| References | 73 | ||
| 3 The Challenges of Orthopaedic Trauma Care in the Developing World | 75 | ||
| Introduction | 75 | ||
| Improving Trauma Care Systemwide Globally: the World Health Organization’s Essential Trauma Care Project | 75 | ||
| Background | 75 | ||
| Case Studies of Individual Institutions | 76 | ||
| Global Efforts to Improve Trauma Care | 76 | ||
| The Role of the World Health Organization: the World Health Assembly Resolution on Trauma and Emergency Care Services and the Creation of the Global Alliance for Care of the Injured | 79 | ||
| Barriers to Access | 79 | ||
| Education | 82 | ||
| Pediatric Trauma (Management of Common Injuries) | 83 | ||
| Adult Trauma | 86 | ||
| Spinal Injuries | 87 | ||
| Cervical Spine | 88 | ||
| Thoracolumbar Spine (TLS) | 88 | ||
| Pelvic and Acetabular Fractures | 88 | ||
| Pelvic Ring Injuries | 88 | ||
| Acetabular Fractures | 89 | ||
| Lower Extremity Injuries | 89 | ||
| Hip Dislocations | 89 | ||
| Hip Fractures | 90 | ||
| Femoral Shaft Fractures | 90 | ||
| Knee Injuries | 90 | ||
| Tibia-Fibula Fractures | 91 | ||
| Foot and Ankle Injuries | 91 | ||
| Upper Extremity Injuries | 92 | ||
| Shoulder Injuries | 92 | ||
| Humeral Shaft Fractures | 93 | ||
| Elbow Injuries | 93 | ||
| Forearm Injuries | 93 | ||
| Hand and Wrist | 93 | ||
| Amputations | 93 | ||
| Avenues for Orthopaedic Volunteerism | 94 | ||
| The Surgical Implant Generation Network Intramedullary Nail System | 96 | ||
| Introduction | 96 | ||
| Background | 96 | ||
| Design Features | 97 | ||
| Innovation | 97 | ||
| Outcomes | 97 | ||
| Surgical Technique | 98 | ||
| Interlocking Screw Placement | 98 | ||
| Fin Nail | 98 | ||
| Tibial Nail Technique | 99 | ||
| Design Features. | 99 | ||
| Incision and Bone Entrance. | 99 | ||
| Reduction. | 99 | ||
| Reaming. | 100 | ||
| Nail Insertion. | 100 | ||
| Placement of Interlocking Screws. | 100 | ||
| Femoral Nail Technique | 100 | ||
| Introduction. | 100 | ||
| Reduction. | 100 | ||
| Antegrade Nail Technique. | 101 | ||
| Retrograde Nail Technique. | 102 | ||
| Hip Fractures | 102 | ||
| Background. | 102 | ||
| The Surgical Implant Generation Network Hip Construct Technique. | 103 | ||
| Key References | 103 | ||
| References | 105 | ||
| 4 Biology and Enhancement of Skeletal Repair | 108 | ||
| Introduction | 108 | ||
| Biology of Graft Substitutes | 108 | ||
| Stages of Bone Graft Incorporation | 109 | ||
| Autogenous Iliac Crest Bone Graft | 109 | ||
| Osteoconductive Graft Substitutes | 110 | ||
| Calcium Sulfate Substitutes | 111 | ||
| Calcium Phospate Substitutes | 112 | ||
| Hydroxyapatite | 112 | ||
| Tricalcium Phosphate | 113 | ||
| Demineralized Bone Matrix | 115 | ||
| Patient-Derived Cellular Therapies | 120 | ||
| Marrow Aspirate | 120 | ||
| Historic Perspective | 120 | ||
| Current Methodology | 120 | ||
| Preclinical Substantiation | 121 | ||
| Clinical Application of Marrow Elements | 122 | ||
| Platelet-Rich Plasma | 123 | ||
| Platelet-Derived Growth Factor | 123 | ||
| Transforming Growth Factor-β | 124 | ||
| Platelet-Rich Plasma Augmentation of Graft Materials | 124 | ||
| Preclinical Studies | 124 | ||
| Platelet-Rich Plasma Preparation | 124 | ||
| Clinical Evidence | 125 | ||
| Bone Applications. | 125 | ||
| Soft Tissue Applications. | 126 | ||
| Recombinant Human Platelet-Derived Growth Factor | 127 | ||
| Inductive Substrates (Bone Morphogenic Protein) | 127 | ||
| Off-Label Use and Complications | 130 | ||
| Bone Morphogenic Protein Interactions | 131 | ||
| Economic Impact | 131 | ||
| Summary | 132 | ||
| Conclusions | 132 | ||
| Key References | 132 | ||
| References | 133 | ||
| 5 Biomechanics of Fractures | 140 | ||
| Introduction | 140 | ||
| Basics of Mechanics | 140 | ||
| Movement and/or Displacement | 140 | ||
| Stress/Strain | 141 | ||
| Stress-Strain and Other Diagrams | 141 | ||
| Properties of Materials (Young’s or Elastic Modulus, Yield and Failure, Energy/Toughness) | 141 | ||
| Other Material Properties (Viscoelasticity, Anisotropy, Creep and Relaxation, Fatigue, S-N Curve) | 141 | ||
| Finite Element Analysis Primer | 145 | ||
| Bone Properties and Fracture Risk | 147 | ||
| Bone Mechanical Properties | 148 | ||
| Cortical Bone Properties and Microstructure | 149 | ||
| Trabecular Bone Properties and Microstructure | 150 | ||
| Age-Related Bone Property Changes | 150 | ||
| Osteoporosis | 151 | ||
| Structural Properties and Loading Modes | 152 | ||
| Definition (Area Moment of Inertia) | 152 | ||
| Cylinder (Long Bone, Intramedullary Nail, Screw) | 152 | ||
| Rectangle (Plate) and Optimization (I Beam, External Fixator) | 153 | ||
| Loading Modes | 153 | ||
| Tension/Compression and Shear | 154 | ||
| Bending | 154 | ||
| Torsion | 154 | ||
| Loading Experienced by the Skeleton | 154 | ||
| Clinical Examples of Combined Loading | 154 | ||
| Fracture Severity Quantification | 155 | ||
| Fractures Associated with Particular Diseases and Conditions | 155 | ||
| Osteoporosis and Age-Related Fractures | 155 | ||
| Defects in Bone Caused by Malignancy and Benign Conditions | 157 | ||
| Implant-Related Bone Fracture: Periprosthetic and Interprosthetic Fractures | 158 | ||
| Stress Shielding | 160 | ||
| Fracture Healing | 160 | ||
| Healing by Callus Formation— Biomechanical Considerations | 160 | ||
| Biomechanical Stages of Fracture Healing | 161 | ||
| Biomechanics of Fracture Fixation | 162 | ||
| Nonoperative Treatment, Casting and Splinting, Traction | 163 | ||
| Surgical Fixation—Biomechanical Considerations | 163 | ||
| Intramedullary Rods | 164 | ||
| Plate Fixation | 165 | ||
| External Fixation | 165 | ||
| Summary | 165 | ||
| Key References | 165 | ||
| References | 166 | ||
| 6 Closed Fracture Management | 168 | ||
| 6A Introduction | 168 | ||
| Introduction | 168 | ||
| References | 169 | ||
| 6B Basic Principles | 169 | ||
| Fracture Reduction and Maintenance of Reduction | 170 | ||
| Manipulative Reduction | 170 | ||
| Types of Anesthesia | 171 | ||
| Timing of Reduction | 172 | ||
| Radiographic Examination of Fractures | 172 | ||
| External Support of Fractures | 172 | ||
| Plaster of Paris | 172 | ||
| Management of Acute Fractures | 173 | ||
| Application of Three-Point Loading Techniques | 173 | ||
| Postreduction Management of Acute Fractures | 173 | ||
| Wedging of Casts | 175 | ||
| Walking Casts | 175 | ||
| Key References | 177 | ||
| References | 178 | ||
| 6C Scaphoid Fractures | 177 | ||
| Incidence and Demographics | 177 | ||
| Clinical Examination | 179 | ||
| Radiologic Examination | 179 | ||
| Classification and Fracture Incidence | 179 | ||
| Treatment Options | 180 | ||
| Operation versus Conservative Treatment | 180 | ||
| Minimally Displaced and Undisplaced | 180 | ||
| Cast Treatment | 180 | ||
| Conclusion | 181 | ||
| Key References | 181 | ||
| References | 182 | ||
| 6D Distal Radius Fractures | 181 | ||
| Demographics | 181 | ||
| Clinical Assessment | 183 | ||
| Radiologic Assessment | 183 | ||
| Normal Parameters | 183 | ||
| How Much Deformity is Acceptable in Adults | 183 | ||
| Treatment | 184 | ||
| Young Patients | 184 | ||
| Elderly Patients | 184 | ||
| Key References | 187 | ||
| References | 188 | ||
| 6E Humeral Shaft Fractures | 187 | ||
| Introduction | 187 | ||
| Treatment | 189 | ||
| Outcomes | 190 | ||
| Controversies | 191 | ||
| Conclusion | 192 | ||
| Key References | 192 | ||
| References | 193 | ||
| 6F Proximal Humerus Fractures | 192 | ||
| Diagnosis | 194 | ||
| Initial Immobilization | 195 | ||
| Rehabilitation | 195 | ||
| Nonoperative Treatment Outcomes | 196 | ||
| Conclusion | 197 | ||
| Key References | 197 | ||
| References | 198 | ||
| 6G Ankle Fracture | 200 | ||
| Epidemiology and Risk Factors | 200 | ||
| Clinical Evaluation | 200 | ||
| Assessment | 200 | ||
| Radiographic Evaluation | 201 | ||
| Classification Systems | 201 | ||
| Determining Stability | 201 | ||
| Smokers | 202 | ||
| Elderly Patients | 202 | ||
| Treatment | 202 | ||
| General | 202 | ||
| Special Techniques | 202 | ||
| Long Term | 203 | ||
| Conclusion | 203 | ||
| Key References | 204 | ||
| References | 205 | ||
| 6H Tibial Fractures | 206 | ||
| Pathophysiology of Fracture Healing | 206 | ||
| Vascularity and Fracture Healing | 206 | ||
| Callus Formation | 206 | ||
| Shortening | 207 | ||
| Angulation | 207 | ||
| Expected Outcomes | 209 | ||
| Representative Examples | 212 | ||
| Clinical Protocol | 212 | ||
| Acute Management | 212 | ||
| The Short Functional Cast | 212 | ||
| The Functional Brace | 212 | ||
| Brace Removal and Follow-up | 212 | ||
| Key References | 222 | ||
| References | 223 | ||
| 6I Fractures of the Femur | 222 | ||
| Manipulative Reduction and Continuous Traction | 222 | ||
| Principles of Traction | 222 | ||
| Methods of Applying Traction | 222 | ||
| Complications of Traction | 225 | ||
| Fracture Bracing | 225 | ||
| Biomechanics and Physiology of Fracture Bracing | 225 | ||
| Lower Limb Fracture Bracing | 225 | ||
| Application Procedure for Femoral Fracture Bracing | 228 | ||
| Key References | 231 | ||
| References | 232 | ||
| 7 Principles and Complications of External Skeletal Fixation | 233 | ||
| Historical Background | 233 | ||
| Early Fixators | 233 | ||
| Fixators for Limb Lengthening | 233 | ||
| Circular Fixators | 233 | ||
| Fixators for Severe Trauma | 235 | ||
| Computerized Correction | 235 | ||
| Combined Internal and External Fixation | 236 | ||
| Fixator-Assisted Nailing | 236 | ||
| External Skeletal Fixation in the Future | 236 | ||
| Fixator Terminology | 237 | ||
| Frame Configuration | 237 | ||
| Prefabricated Fixators | 238 | ||
| Improvised Fixators | 238 | ||
| Problems, Obstacles, and Complications | 238 | ||
| Nerve and Vessel Injury | 238 | ||
| Introduction | 238 | ||
| Vessel Injuries | 238 | ||
| Compartment Syndrome | 239 | ||
| Nerve Injuries | 240 | ||
| Implant Placement to Avoid Neurovascular Injury | 240 | ||
| Introduction | 240 | ||
| Technique of Identifying Landmarks | 241 | ||
| Pin Tract Infection | 241 | ||
| Introduction | 241 | ||
| Pathophysiology of Pin- or Wire-Site Sepsis | 260 | ||
| Fluid Secretion | 260 | ||
| Abscess Formation | 260 | ||
| Skin Necrosis | 260 | ||
| Heat Injury | 260 | ||
| Deep Soft Tissue Necrosis | 260 | ||
| Bone Necrosis | 261 | ||
| Motion | 261 | ||
| The Pin–Skin Interface | 261 | ||
| The Pin–Bone Interface | 262 | ||
| Strategies to Reduce Implant-Site Sepsis | 262 | ||
| Fixator Selection | 262 | ||
| Pin Selection | 263 | ||
| Pin and Wire Insertion Considerations | 263 | ||
| Fracture Alignment | 263 | ||
| Predrilling | 263 | ||
| Pin Insertion | 263 | ||
| Inserting Transfixion Wires | 263 | ||
| Implant–Skin Interface Management | 264 | ||
| Frame Assembly | 264 | ||
| Pin Care Routine | 264 | ||
| Ambulatory Aids | 265 | ||
| Dealing with Pinhole Problems | 265 | ||
| Fixator-Associated Problems | 265 | ||
| Introduction | 265 | ||
| Pressure Necrosis | 265 | ||
| Broken Components | 265 | ||
| Disruption of Lifestyle | 265 | ||
| Pain | 266 | ||
| Postoperative Pain | 266 | ||
| Pain While the Fixator Is in Place | 266 | ||
| Pain on Pin Removal | 266 | ||
| Persistent Pain after Fixator Removal | 266 | ||
| Bone Pain | 266 | ||
| Neurogenic Pain | 266 | ||
| Pain Associated with Fracture Healing | 266 | ||
| Psychological Problems | 266 | ||
| Principles Unique to the Ilizarov Method | 267 | ||
| Introduction | 267 | ||
| Treatment Principles for Nonunions and Malunions | 267 | ||
| Segmental Skeletal Defects | 268 | ||
| Joint Mobility | 269 | ||
| Stretching | 269 | ||
| Contractures | 269 | ||
| Limb Positioning | 269 | ||
| Functional Limb Use | 270 | ||
| Regenerate Healing and Maturation | 270 | ||
| Post-Ilizarov Management | 270 | ||
| External Fixators as Nonunion Machines | 270 | ||
| External Fixators for Damage Control Orthopaedics | 271 | ||
| Introduction | 271 | ||
| The Temporary Fixator | 272 | ||
| Military Applications | 272 | ||
| The Drill Sleeve | 272 | ||
| Conversion to Permanent External Fixation | 272 | ||
| Choice of Implants | 272 | ||
| Reducing Costs from Inventory Control | 272 | ||
| Implant Depth | 273 | ||
| Using the Atlas for Damage Control Orthopaedics | 273 | ||
| Danger Regions for Percutaneous Pins Inserted without Fluoroscopy | 273 | ||
| Femur | 273 | ||
| Tibia | 274 | ||
| Humerus | 275 | ||
| Forearm | 275 | ||
| Key References | 276 | ||
| References | 277 | ||
| 8 Principles of Internal Fixation | 279 | ||
| Introduction | 279 | ||
| Plan of Attack and How to Use This Chapter | 279 | ||
| Fracture Pattern | 280 | ||
| Fracture Pattern = Law of Conservation of Energy | 280 | ||
| Fracture Pattern Reveals the Intrinsic Stability of the Bone after Reduction | 281 | ||
| Fracture Pattern Characterizes the Unbalanced Forces That Create Displacement and Subsequent Deformity | 281 | ||
| Fracture Pattern Predicts Expected Soft Tissue Damage | 282 | ||
| Fracture Pattern Defines Expected Mode of Healing | 282 | ||
| Speaking of Fracture Patterns | 283 | ||
| Soft Tissue Pattern | 283 | ||
| Recognize the Severity of the Soft Tissue Injury Preoperatively | 283 | ||
| Modify Surgical Plans Based on Soft Tissue Injury Pattern | 284 | ||
| Familiarize Yourself with the Concept of Angiosomes | 285 | ||
| Empower Fracture Fixation Constructs | 286 | ||
| Speaking of the Soft Tissue Pattern | 286 | ||
| Area Involved | 286 | ||
| Articular Surface | 287 | ||
| Metaphysis and Diaphysis | 288 | ||
| Speaking of the Area Involved | 288 | ||
| Desired Stability | 289 | ||
| Spectrum of Stability | 289 | ||
| Absolute Stability | 290 | ||
| Summary of Absolute Stability | 296 | ||
| Speaking of Absolute Stability | 296 | ||
| Relative Stability | 296 | ||
| Strain Theory of Perren | 296 | ||
| Stress Distribution versus Stress Concentration | 298 | ||
| Summary of Relative Stability | 298 | ||
| Speaking of Relative Stability | 298 | ||
| Approach | 300 | ||
| Intraoperative Positioning and Patient Safety | 300 | ||
| Supine Position | 300 | ||
| Prone Position | 300 | ||
| Lateral Decubitus Position | 300 | ||
| Special Considerations: Hemilithotomy and Perineal Post | 301 | ||
| Surgical Exposure | 301 | ||
| Speaking of the Surgical Approach | 303 | ||
| Reduction: Direct Versus Indirect | 303 | ||
| Quality of Reduction | 303 | ||
| Method of Reduction | 303 | ||
| AO Philosophy and Inherent Conflict | 303 | ||
| Direct Reduction: Instruments and Techniques | 303 | ||
| Indirect Reduction: Instruments and Techniques | 306 | ||
| Direct and Indirect Reduction: Summary | 309 | ||
| Speaking of Direct and Indirect Reduction | 309 | ||
| Fixation | 309 | ||
| Wires and Pins | 310 | ||
| Speaking of Wires and Pins | 311 | ||
| Screws, Drill Bits, Taps, and Screwdrivers | 311 | ||
| Screw Functions | 311 | ||
| Screw Parts: Head | 312 | ||
| Screw Parts: Inner Diameter | 312 | ||
| Screw Parts: Outer Diameter | 313 | ||
| Screw Parts: Tip | 314 | ||
| Screw Types | 315 | ||
| Screw Function Revisited | 316 | ||
| Speaking of Screws | 316 | ||
| Drill Bits and Taps | 316 | ||
| Speaking of Drills and Taps | 318 | ||
| Screwdrivers | 318 | ||
| Speaking of Screwdrivers | 318 | ||
| Plate | 319 | ||
| Mechanical Function | 319 | ||
| Neutralization Plating | 319 | ||
| Compression Plating | 320 | ||
| Tension Band Plating | 320 | ||
| Buttress Plating | 323 | ||
| Bridge Plating | 324 | ||
| Locked Internal Fixator | 325 | ||
| Speaking of Plate Function | 327 | ||
| Specific Design Features: Shape, Holes, and So On | 327 | ||
| Speaking of Plate Design | 329 | ||
| Intramedullary Nail or Rod | 329 | ||
| Mechanical Form of Stability | 329 | ||
| Speaking of an Intramedullary Rod | 331 | ||
| General Design Features | 331 | ||
| Proximal End. | 331 | ||
| Central Portion. | 332 | ||
| Distal End. | 334 | ||
| Other Design Features. | 335 | ||
| Cross-Sectional Shape. | 335 | ||
| Diameter. | 335 | ||
| Cannulation. | 335 | ||
| Speaking of Intramedullary Rod Design | 335 | ||
| Steps of Intramedullary Rodding | 335 | ||
| Starting Point and Entrance Angle into the Proximal Segment | 336 | ||
| Reduction of the Fracture | 337 | ||
| Reaming (If Chosen) | 337 | ||
| Entrance Angle into and Ending Point in the Distal Segment | 339 | ||
| Interlocking Screw Insertion | 339 | ||
| Working Length Revisited | 339 | ||
| Speaking of Intramedullary Rod Technique | 340 | ||
| Construct Stability | 340 | ||
| Speaking of Construct Stability | 342 | ||
| Construct Failure | 342 | ||
| Injury Factors | 342 | ||
| Patient Factors | 343 | ||
| Surgeon Factors | 344 | ||
| Proactive Failure Analysis | 344 | ||
| Loosening of Screws in a Conventional Plating Construct | 344 | ||
| Screw Fracture in a Conventional Plating Construct | 344 | ||
| Plate Fracture in a Conventional or Locking Construct | 344 | ||
| Bone/Screw Interface Failure in a Locking Construct | 345 | ||
| Interlocking Screw Fracture in an Intramedullary Rod Construct | 345 | ||
| Interlocking Screw Backout and Bone/Screw Interface Failure in an Intramedullary Rod Construct | 345 | ||
| Speaking of Construct Failure | 345 | ||
| Preoperative Planning | 345 | ||
| The Elements of Preoperative Planning | 346 | ||
| The Desired End Result | 346 | ||
| The Surgical Tactic | 346 | ||
| The Operation Logistics | 346 | ||
| Speaking of Preoperative Planning | 347 | ||
| Summary | 347 | ||
| Key References | 347 | ||
| References | 348 | ||
| 9 Evaluation and Treatment of the Multi-injured Trauma Patient | 352 | ||
| Introduction | 352 | ||
| Trauma Systems | 352 | ||
| Prehospital Evaluation and Care | 353 | ||
| Prehospital Personnel | 353 | ||
| Prehospital and En Route Critical Care Providers | 353 | ||
| Airway Control | 353 | ||
| Hemorrhage Control | 354 | ||
| Resuscitation | 354 | ||
| Hospital Evaluation and Care | 355 | ||
| Trauma Team | 355 | ||
| Assessing the Severity of Injury | 355 | ||
| Hospital Resuscitation | 355 | ||
| Primary Survey | 356 | ||
| Airway | 356 | ||
| Breathing | 356 | ||
| Circulation | 358 | ||
| Disability | 358 | ||
| Exposure and Environmental Control | 359 | ||
| Secondary Survey | 359 | ||
| Damage Control Surgery | 359 | ||
| Trauma to the Cranium | 359 | ||
| Neck Injury | 360 | ||
| Thoracic Injury | 360 | ||
| Abdominal Injury | 360 | ||
| Retroperitoneal Injuries | 361 | ||
| Genitourinary Injuries | 362 | ||
| Musculoskeletal Injuries | 362 | ||
| Tertiary Survey | 362 | ||
| Summary | 362 | ||
| Key References | 362 | ||
| References | 364 | ||
| 10 Initial Evaluation of the Spine in Trauma Patients | 366 | ||
| Initial Evaluation and Stabilization | 366 | ||
| Advanced Trauma Life Support | 366 | ||
| Classification of Neurologic Injury | 368 | ||
| Radiographic Assessment | 369 | ||
| Cervical Spine Clearance | 372 | ||
| Patient Classification | 372 | ||
| Asymptomatic Patients | 373 | ||
| Temporarily Nonassessable Secondary to Distracting Injuries or Intoxication | 373 | ||
| Symptomatic Patients | 374 | ||
| Obtunded Patients | 374 | ||
| Conclusion: Cervical Spine Clearance | 374 | ||
| Thoracolumbar Spine Clearance | 375 | ||
| Conclusion | 376 | ||
| Key References | 376 | ||
| References | 378 | ||
| 11 Damage Control Orthopaedic Surgery: | 380 | ||
| Introduction to the Concept of Damage Control Orthopaedics | 380 | ||
| History of Damage Control Orthopaedics Versus Early Total Care | 382 | ||
| Diagnosis and Classification of the Basic Pathophysiology and Inflammatory Process in Critically Injured Patients | 383 | ||
| The Basic Characteristics of Shock | 383 | ||
| The Basic Principles of Resuscitation | 383 | ||
| Achieving Hemostasis | 383 | ||
| Volume Replacement | 384 | ||
| Optimizing Pulmonary Function | 384 | ||
| Early Fracture Care versus Damage Control Orthopaedics | 384 | ||
| Management of the Multiply Injured Patient | 384 | ||
| The Decision for Damage Control Orthopaedic Surgery | 384 | ||
| Assessment | 385 | ||
| Care for the Stable Patient (Grade I) | 385 | ||
| Care for the Borderline Patient (Grade II) | 385 | ||
| Care for Unstable Patients (Grade III) | 385 | ||
| Care for Patients in Extremis (Grade IV) | 385 | ||
| Damage Control Orthopaedic Treatment Principles | 385 | ||
| Management Goals | 385 | ||
| Surgical Timing and Titration of Care | 386 | ||
| External Fixation | 386 | ||
| Pelvic Stabilization and Hemodynamic Control | 386 | ||
| Managing Other Musculoskeletal Injuries | 387 | ||
| Avoiding Missed Opportunities: Value of the Team Approach for Care of Multiply Injured Patients | 387 | ||
| Conversion to Definitive Fixation | 387 | ||
| Treatment of Patients with Severe Thoracic and Musculoskeletal Injuries: Establishing the Model for Damage Control Orthopaedics | 388 | ||
| The Effect of Timing | 388 | ||
| The Effect of Reaming | 389 | ||
| The Effect of the Fracture | 390 | ||
| Current Treatment Recommendations in Cases of Severe Thoracic Injury and Musculoskeletal Injury | 390 | ||
| Damage Control Orthopaedic Guidelines for Other Unique Musculoskeletal Injuries: Clinical Evidence Based on Meta-Analysis and Systematic Reviews | 390 | ||
| Clinical Experience: Bilateral Femur Fractures | 390 | ||
| Clinical Experience: Femoral Fracture and Head Injury | 391 | ||
| Clinical Experience: Unstable Pelvic Ring Injury and Polytrauma | 392 | ||
| Clinical Experience: Military Combat Casualty Care Lessons Learned | 394 | ||
| Conclusion | 395 | ||
| Key References | 395 | ||
| References | 396 | ||
| 12 Disaster Management | 400 | ||
| Introduction | 400 | ||
| Disaster Planning | 400 | ||
| Disaster Classification | 401 | ||
| Disaster Management | 401 | ||
| Barriers to Effective Disaster Response | 402 | ||
| Disaster Response Organization—Incident Command System | 403 | ||
| Accidental and Human-Made Disasters | 404 | ||
| Nuclear and Radiologic Events | 405 | ||
| Biological Events | 405 | ||
| Chemical Events | 405 | ||
| Blast Events | 405 | ||
| Blast Injury Pathophysiology | 406 | ||
| Primary Blast Injury | 406 | ||
| Secondary Blast Injury | 408 | ||
| Tertiary and Quaternary Blast Injury | 408 | ||
| Medical Management of Disaster Casualties | 409 | ||
| Triage—Concept and Principles | 409 | ||
| The Challenge of Individual Triage | 409 | ||
| Global Triage Accuracy | 410 | ||
| Decontamination | 411 | ||
| Evacuation | 411 | ||
| Evacuation and Echelons | 412 | ||
| Echelon I | 413 | ||
| Echelon II | 413 | ||
| Echelon III | 414 | ||
| Echelon IV | 414 | ||
| Echelon V | 414 | ||
| Hospital Care | 415 | ||
| Blast Injury | 415 | ||
| Disaster Education Initiatives | 416 | ||
| Summary | 417 | ||
| Acknowledgement | 417 | ||
| Key References | 417 | ||
| References | 418 | ||
| 13 Occupational Hazards in the Treatment of Orthopaedic Trauma | 420 | ||
| 13A Optimal and Safe Use of C-Arm X-Ray Fluoroscopy Units | 420 | ||
| Introduction | 420 | ||
| Features | 420 | ||
| Reduction of Radiation Dose during C-Arm Operation | 425 | ||
| In Summary: to Operate a C-Arm and Reduce the Radiation Exposure | 428 | ||
| Protection From Radiation of C-Arm Equipment When in Operation | 429 | ||
| Annual Inspection of C-Arm Equipment | 430 | ||
| Bibliography | 430 | ||
| Bibliography | 431 | ||
| 13B Prevention of Occupationally Acquired Bloodborne Pathogens | 430 | ||
| Hepatitis B Virus | 432 | ||
| Acute Infection | 432 | ||
| Chronic Disease | 432 | ||
| Treatment | 432 | ||
| Prevention Before and After Occupational Exposure | 432 | ||
| Hepatitis C Virus | 433 | ||
| Screening | 433 | ||
| Human Immunodeficiency Virus | 433 | ||
| Management of Occupational Exposure to HIV | 434 | ||
| Strategies to Prevent Occupational Transmission of Bloodborne Pathogens | 434 | ||
| Screening for Bloodborne Pathogens | 434 | ||
| Human Immunodeficiency Virus | 435 | ||
| Hepatitis C Virus | 435 | ||
| Management of Bloodborne Pathogen Infected Healthcare Workers | 435 | ||
| Personal Protective Equipment | 435 | ||
| Gloves | 435 | ||
| Gowns | 435 | ||
| Masks, Eye Protection, and Face Shields | 436 | ||
| Other Personal Protective Equipment | 436 | ||
| Work Practices and Engineering Controls | 436 | ||
| Setting Expectations | 436 | ||
| Needles and Sharps | 436 | ||
| Hands-Free Technique | 436 | ||
| Blunted Surgical Needles | 436 | ||
| Regulated Medical Waste | 436 | ||
| Summary | 437 | ||
| Key References | 437 | ||
| References | 438 | ||
| 14 Medical Management of the Orthopaedic Trauma Patient | 440 | ||
| 14A Acute Pain Management, Regional Anesthesia Techniques, and Management of Complex Regional Pain Syndrome | 440 | ||
| Neurophysiology of Pain Processing | 440 | ||
| Nociceptors and Primary Afferents | 441 | ||
| Central Nervous System Relay and Processing | 441 | ||
| Treatment Options | 443 | ||
| Opioids | 443 | ||
| Patient-Controlled Analgesia | 443 | ||
| Assessment | 444 | ||
| Pharmacotherapy | 445 | ||
| Nonsteroidal Antiinflammatory Drugs | 445 | ||
| Acetaminophen | 445 | ||
| Opioids | 445 | ||
| Selection of Opioids | 447 | ||
| Appropriate and Inappropriate Use of Opioids | 449 | ||
| Diagnosis and Differential | 449 | ||
| Informed Consent | 449 | ||
| Abuse | 449 | ||
| Addiction | 449 | ||
| Physical Dependence | 449 | ||
| Tolerance | 450 | ||
| Withdrawal (Abstinence) | 450 | ||
| Opioid Agreements | 450 | ||
| Initiation and Assessment of Therapy | 450 | ||
| Analgesia | 451 | ||
| Activity | 451 | ||
| Adverse Effects | 451 | ||
| Aberrant Behavior | 451 | ||
| Neuraxial Delivery Systems: Subarachnoid Injections | 451 | ||
| Neuraxial Delivery Systems: Continuous Epidural Catheters | 452 | ||
| Peripheral Nerve Blocks | 453 | ||
| Upper Extremity Blocks | 454 | ||
| Interscalene Block | 454 | ||
| Supraclavicular | 456 | ||
| Infraclavicular | 456 | ||
| Axillary | 458 | ||
| Lower Extremity Blocks | 458 | ||
| Lumbar Plexus Blocks (Psoas Compartment Block) | 459 | ||
| Femoral | 459 | ||
| Adductor Canal Block | 460 | ||
| Parasacral Block | 461 | ||
| Sciatic Nerve Block | 462 | ||
| Popliteal Block | 463 | ||
| Complex Regional Pain Syndrome | 464 | ||
| Risk Factors | 464 | ||
| Pathophysiology | 465 | ||
| Symptomatology | 465 | ||
| Imaging and Testing | 465 | ||
| Treatment | 465 | ||
| Medical Therapies | 465 | ||
| Conclusion | 466 | ||
| References | 466 | ||
| 14B Perioperative Assessment | 470 | ||
| Introduction to Perioperative Medicine | 470 | ||
| Preoperative Cardiac Risk Assessment | 470 | ||
| Pulmonary Risk Assessment | 471 | ||
| Medications | 472 | ||
| β-Blockers | 472 | ||
| Hyperglycemic Medications | 472 | ||
| Glucocorticoids | 473 | ||
| Antihypertensive Medications | 473 | ||
| Anticoagulation Medications | 474 | ||
| Herbal Supplements | 474 | ||
| Other Medications | 475 | ||
| Ordering Tests | 475 | ||
| Diabetes Mellitus | 475 | ||
| Obstructive Sleep Apnea | 476 | ||
| Liver Disease | 476 | ||
| Preventing Complications | 477 | ||
| Delirium | 477 | ||
| Acute Renal Failure | 477 | ||
| Postoperative Fever | 477 | ||
| Other | 478 | ||
| Conclusion | 478 | ||
| Key References | 478 | ||
| References | 479 | ||
| 14C Management of the Pregnant Woman | 480 | ||
| Introduction | 480 | ||
| Assessment | 480 | ||
| Physiologic Changes in Pregnancy | 480 | ||
| Diagnostic Imaging in Pregnancy | 481 | ||
| X-Ray | 481 | ||
| Computed Tomography | 481 | ||
| Magnetic Resonance Imaging | 482 | ||
| Nuclear Imaging | 482 | ||
| Common Musculoskeletal Complaints in Pregnancy | 482 | ||
| Fetal Monitoring during Nonobstetric Surgery | 483 | ||
| Anesthesia during Pregnancy | 483 | ||
| Preterm Labor | 483 | ||
| Trauma in Pregnancy | 483 | ||
| Medications for Use in Musculoskeletal Injuries or Complaints in Pregnancy | 484 | ||
| Perimortem Cesarean Delivery | 484 | ||
| Key References | 485 | ||
| References | 486 | ||
| 14D Substance Abuse Syndromes: Recognition, Prevention, and Treatment | 485 | ||
| Introduction | 485 | ||
| Definitions | 487 | ||
| Recognition—Estimating Risk | 487 | ||
| Alcohol | 487 | ||
| Opiates | 488 | ||
| Cocaine | 488 | ||
| Benzodiazepines | 489 | ||
| Recognition—Early Identification of Signs and Symptoms | 489 | ||
| Alcohol | 489 | ||
| Opiates | 491 | ||
| Cocaine | 491 | ||
| Benzodiazepines | 491 | ||
| Management—Prophylaxis/Treatment | 491 | ||
| General Medical Considerations | 492 | ||
| Alcohol | 492 | ||
| Benzodiazepine Administration | 492 | ||
| Benzodiazepine Protocol | 492 | ||
| Alcohol Replacement | 493 | ||
| Ethanol Replacement Protocol | 494 | ||
| Additional Considerations for Implementation of Alcohol Replacement Therapy | 494 | ||
| Opiates | 495 | ||
| Cocaine | 495 | ||
| Benzodiazepines | 495 | ||
| Discharge Plans | 495 | ||
| Summary | 495 | ||
| Key References | 496 | ||
| References | 497 | ||
| 15 Evaluation and Treatment of Vascular Injuries | 500 | ||
| History | 500 | ||
| Etiology | 500 | ||
| Locations and Types of Vascular Injuries | 500 | ||
| Diagnosis | 501 | ||
| History and Physical Examination | 501 | ||
| Radiologic Studies | 502 | ||
| Management of Vascular Injuries | 503 | ||
| The Emergency Center | 503 | ||
| Nonoperative Treatment of Arterial Injuries | 504 | ||
| Therapeutic Embolization | 504 | ||
| Endovascular Stents and Stent Grafts | 504 | ||
| The Operating Room | 504 | ||
| Arterial Repair | 504 | ||
| Skin Preparation and Draping | 504 | ||
| Incisions | 505 | ||
| Standard Techniques of Arterial Repair | 505 | ||
| Completion Arteriography | 507 | ||
| Venous Injuries | 508 | ||
| Indications for Fasciotomy | 509 | ||
| Combined Orthopaedic–Vascular Injuries | 509 | ||
| Temporary Intraluminal Vascular Shunts | 509 | ||
| Mangled Extremities | 510 | ||
| Bleeding or Edema in Soft Tissues | 511 | ||
| Heroic Techniques to Save a Limb | 511 | ||
| Postoperative Care | 511 | ||
| Complications | 511 | ||
| Early Occlusion of Arterial Repair | 511 | ||
| Delay in Diagnosis of an Arterial Injury | 511 | ||
| Soft Tissue Infection over an Arterial Repair | 511 | ||
| Late Occlusion of Arterial Repair | 511 | ||
| Summary | 512 | ||
| Key References | 512 | ||
| References | 513 | ||
| 16 Compartment Syndromes | 516 | ||
| Introduction | 516 | ||
| History | 516 | ||
| Pathophysiology | 516 | ||
| Diagnosis: Clinical Assessment | 519 | ||
| Crush Syndrome | 521 | ||
| Compartment Syndrome in Combat | 521 | ||
| Measurement Techniques | 524 | ||
| Needle Manometer | 524 | ||
| Arterial Line Catheter | 524 | ||
| Stryker Stic Catheter System | 525 | ||
| Microporous Catheter | 525 | ||
| New Technologies | 526 | ||
| Fasciotomy Techniques | 528 | ||
| Compartment Syndrome of the Hand | 528 | ||
| Compartment Syndrome of the Forearm | 530 | ||
| Volar (Henry) Approach | 530 | ||
| Volar Ulnar Approach | 531 | ||
| Dorsal Approach | 531 | ||
| Compartment Syndrome of the Upper Arm | 531 | ||
| Compartment Syndrome of the Leg | 531 | ||
| Fibulectomy | 533 | ||
| One-Incision (Perifibular) Fasciotomy. | 533 | ||
| Double-Incision Technique. | 535 | ||
| Compartment Syndrome of the Thigh | 536 | ||
| Compartment Syndrome of the Foot | 537 | ||
| Closure and Aftercare of Fasciotomy Wounds | 538 | ||
| Chronic Exertional Compartment Syndrome | 541 | ||
| Future Direction | 541 | ||
| Acknowledgment | 542 | ||
| Key References | 542 | ||
| References | 543 | ||
| 17 Open Fractures | 547 | ||
| Introduction | 547 | ||
| Mechanism | 547 | ||
| Direct Blow | 547 | ||
| Crush Injury | 547 | ||
| Explosion and Blast Injury | 547 | ||
| Pathophysiology | 549 | ||
| Infection | 549 | ||
| Classification | 549 | ||
| Gustilo and Anderson | 549 | ||
| Other Open Fracture Classifications | 549 | ||
| Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association Open Fracture Classification | 550 | ||
| Basic Principles of Open Fracture Management in the Emergent Setting | 551 | ||
| Initial Trauma Assessment | 551 | ||
| Prompt Diagnosis | 551 | ||
| Control Bleeding | 551 | ||
| Injury Assessment | 551 | ||
| Integument | 551 | ||
| Contamination | 551 | ||
| Vascular | 551 | ||
| Muscle Integrity and Function | 556 | ||
| Bone Loss | 556 | ||
| Splinting | 556 | ||
| Wound Infections and Antibiotics | 557 | ||
| What and Type | 558 | ||
| How Long? | 559 | ||
| Basic Principles of Open Fracture Management in the Operating Suite | 559 | ||
| Débridement | 559 | ||
| Irrigation | 560 | ||
| Tips and Tricks | 562 | ||
| Future Studies | 562 | ||
| Open Fractures with Compartment Syndrome | 562 | ||
| Osseous Stabilization | 563 | ||
| Internal Fixation | 563 | ||
| Intramedullary Nailing | 563 | ||
| External Fixation | 564 | ||
| Wound Management | 565 | ||
| Primary Closure | 565 | ||
| Tips and Tricks | 565 | ||
| Ankle Fractures | 565 | ||
| Delayed Primary Closure | 565 | ||
| Vacuum-Assisted Closure and Negative-Pressure Wound Management | 565 | ||
| Local Antibiotics | 566 | ||
| Comparison of Different Options for Initial Wound Management | 567 | ||
| Immediate Shortening | 567 | ||
| Future Developments | 567 | ||
| Bacteria Identification Using Molecular Platform | 567 | ||
| Antimicrobial Implants | 568 | ||
| Local Antibiotic Delivery Devices | 568 | ||
| Antibiofilm Agents | 568 | ||
| Dual-Purpose Bone Grafts | 569 | ||
| Tissue Engineering and Regenerative Medicine Approaches | 569 | ||
| Conclusion | 569 | ||
| Key References | 569 | ||
| References | 570 | ||
| 18 Soft Tissue Reconstruction | 575 | ||
| Introduction and General Principles | 575 | ||
| Introduction | 575 | ||
| Initial Evaluation | 575 | ||
| Wound Preparation | 575 | ||
| Wound Coverage Types | 576 | ||
| Skin Grafts | 576 | ||
| Dermal Substitutes | 577 | ||
| Random Pattern Flaps | 577 | ||
| Axial Pattern Flaps | 577 | ||
| Island Pattern Flaps | 577 | ||
| Perforator Flap | 577 | ||
| Free Flap | 577 | ||
| Soft Tissue Reconstruction of the Upper Extremity | 577 | ||
| Surgical Planning | 577 | ||
| The Shoulder | 578 | ||
| Scapular and Parascapular Flap | 578 | ||
| The Brachium and Arm | 578 | ||
| Pedicled Latissimus Dorsi Muscle Flap | 578 | ||
| Pedicled Pectoralis Muscle Flap | 579 | ||
| The Elbow | 579 | ||
| Radial Forearm Flap | 579 | ||
| Anconeus Muscle Flap | 579 | ||
| Pedicled Latissimus Dorsi Muscle Flap | 579 | ||
| Forearm | 580 | ||
| Anterolateral Thigh Flap | 580 | ||
| Lateral Arm Flap | 580 | ||
| Scapular and Parascapular Flap | 581 | ||
| Omental Flap | 581 | ||
| Wrist and Hand | 581 | ||
| Reverse Radial Forearm Flap | 581 | ||
| Posterior Interosseous Artery Flap | 583 | ||
| Groin Flap | 583 | ||
| First Dorsal Metacarpal Artery Flap | 584 | ||
| Lower Extremity Soft Tissue Reconstruction | 585 | ||
| Introduction | 585 | ||
| Surgical Planning | 585 | ||
| Hip and Thigh | 585 | ||
| Lower Thigh, Knee, and Proximal Third of the Leg | 586 | ||
| Gastrocnemius Muscle Flap | 586 | ||
| Vastus Lateralis Muscle Flap | 586 | ||
| Saphenous Artery Fasciocutaneous Flap | 587 | ||
| Sural Artery Fasciocutaneous Flap | 587 | ||
| Popliteal-Based Posterior Thigh Fasciocutaneous Flap | 588 | ||
| Superior Lateral Genicular Artery Fasciocutaneous Flap | 588 | ||
| Middle Third of the Leg | 589 | ||
| Soleus Flap | 589 | ||
| Lower Third of the Leg and Ankle | 589 | ||
| Propeller Flaps | 589 | ||
| Reverse Sural Artery Flap | 589 | ||
| The Foot | 590 | ||
| Distally Based Sural Artery Flap | 590 | ||
| Dorsalis Pedis Flap | 590 | ||
| Medial Plantar Flap | 591 | ||
| Free Flap | 591 | ||
| Rehabilitation and Outcomes | 591 | ||
| Outcome Studies | 591 | ||
| Key References | 591 | ||
| References | 593 | ||
| 19 Gunshot Wounds and Blast Injuries | 595 | ||
| Introduction | 595 | ||
| Ballistics | 595 | ||
| Diagnosis | 595 | ||
| General Treatment Principles | 596 | ||
| Antibiotic Usage | 596 | ||
| Wound Assessment | 597 | ||
| Upper Extremity | 598 | ||
| Proximal Humerus and Shoulder Joint | 598 | ||
| Vessel and Nerve Injury | 598 | ||
| Fracture | 598 | ||
| Humeral Shaft and Arm | 599 | ||
| Vessel and Nerve Injury | 599 | ||
| Fracture | 601 | ||
| Elbow | 601 | ||
| Distal Humerus | 603 | ||
| Ulna | 603 | ||
| Forearm | 604 | ||
| Gunshot Fractures of the Hand and Wrist | 604 | ||
| Introduction | 604 | ||
| Initial Treatment | 605 | ||
| Surgical Treatment | 605 | ||
| Soft Tissue Management | 606 | ||
| Fracture Treatment | 606 | ||
| Lower Extremity | 607 | ||
| Pelvis | 607 | ||
| Imaging Studies | 607 | ||
| Intraarticular Bullets | 607 | ||
| Intestinal Contamination | 607 | ||
| Fracture Management | 608 | ||
| Femur | 609 | ||
| History and Physical Examination | 609 | ||
| Imaging | 609 | ||
| Initial Treatment | 609 | ||
| Definitive Treatment | 609 | ||
| Diaphyseal and Subtrochanteric Fractures | 609 | ||
| Distal Femoral Fractures | 611 | ||
| Tibia | 611 | ||
| Intraarticular Fractures | 612 | ||
| Foot | 614 | ||
| Orthopaedic Management in the Blast Trauma Patient | 614 | ||
| Blast Trauma Mechanisms of Injury | 615 | ||
| Lessons Learned | 618 | ||
| Conclusions | 620 | ||
| Key References | 620 | ||
| References | 621 | ||
| 20 Pathologic Fractures | 623 | ||
| Introduction | 623 | ||
| Metastatic Bone Lesions | 623 | ||
| Prognosis | 624 | ||
| Biology of Bone Metastases | 624 | ||
| Evaluation | 625 | ||
| Examination | 625 | ||
| Clinical Features and Presentation | 625 | ||
| Diagnosis | 625 | ||
| Diagnostic Evaluation | 625 | ||
| Imaging | 626 | ||
| Biopsy | 626 | ||
| Management | 627 | ||
| Impending Fractures | 627 | ||
| Pathologic Fractures | 627 | ||
| Goals | 627 | ||
| Nonoperative Treatment | 630 | ||
| Surgical Treatment | 632 | ||
| Upper Extremity. | 632 | ||
| Lower Extremity. | 636 | ||
| Pelvis and Acetabulum. | 639 | ||
| Spine. | 642 | ||
| Complications | 647 | ||
| Special Considerations | 648 | ||
| Renal Cell Carcinomas | 648 | ||
| Radiation-Induced Fractures | 649 | ||
| Bisphosphonate-Associated Fractures | 649 | ||
| Conclusion | 649 | ||
| Key References | 649 | ||
| References | 651 | ||
| 21 Osteoporotic Fragility Fractures | 655 | ||
| Demographics of Osteoporotic Fragility Fractures | 655 | ||
| Trends of Fragility Fractures | 655 | ||
| Results of Fragility Fractures | 657 | ||
| Socioeconomic Implications of Fragility Fractures | 658 | ||
| Is the Medical System Prepared for This Change? | 658 | ||
| Secondary Fracture Prevention: Dietary Supplementations and Medical Therapies | 660 | ||
| Vitamin D and Calcium | 660 | ||
| Bisphosphonate Therapy | 661 | ||
| Selective Estrogen Receptor Modulators | 661 | ||
| Calcitonin | 661 | ||
| Antiresorptive Monoclonal Antibodies | 661 | ||
| Denosumab | 661 | ||
| Anabolic Agents | 661 | ||
| Teriparatide | 661 | ||
| Prevention of Falls | 662 | ||
| Comprehensive Falls Assessment | 662 | ||
| Modification of the Home | 662 | ||
| Exercise Programs | 662 | ||
| Medical and Surgical Interventions | 662 | ||
| Unsuccessful Interventions | 662 | ||
| Implementing Secondary Fracture Prevention as a System: The Fracture Nurse Liaison Model | 662 | ||
| Obtaining Dual-Energy X-Ray Absorptiometry Scans | 663 | ||
| Intradisciplinary Team Communication | 663 | ||
| Initiation of Medical Management | 663 | ||
| Medical Therapy Compliance | 663 | ||
| The Role of a Metabolic Bone Clinic | 663 | ||
| Summary | 663 | ||
| Key References | 663 | ||
| References | 664 | ||
| 22 Surgical Site Infection Prevention | 667 | ||
| Defining Surgical Site Infections | 667 | ||
| Preoperative Interventions | 667 | ||
| Prophylactic Antibiotics | 671 | ||
| Timing of Administration | 671 | ||
| Antimicrobial Choices | 671 | ||
| Dosing | 672 | ||
| Duration | 672 | ||
| Intraoperative Means of Reducing Infection | 672 | ||
| The Operating Room Environment | 672 | ||
| The Surgical Team | 673 | ||
| The Surgical Site | 673 | ||
| Conclusion | 674 | ||
| Key References | 674 | ||
| References | 675 | ||
| 23 Diagnosis and Treatment of Complications | 680 | ||
| Systemic Complications | 680 | ||
| Fat Embolism Syndrome | 680 | ||
| Etiology | 682 | ||
| Prevention and Treatment | 683 | ||
| Thromboembolic Disorders | 684 | ||
| Pathogenesis | 684 | ||
| Diagnosis | 685 | ||
| Venous Thromboembolism Protection in Orthopaedic Trauma | 686 | ||
| Polytrauma Patient. | 686 | ||
| Hip Fracture Patient. | 686 | ||
| Isolated Lower Leg Injury Patient Distal to the Knee. | 687 | ||
| Spinal Cord Injury Patient. | 687 | ||
| Treatment of Existing Deep Venous Thrombosis and Pulmonary Embolism. | 687 | ||
| Summary | 687 | ||
| Multiple Organ System Dysfunction and Failure | 688 | ||
| Orthopaedic Management | 691 | ||
| Local Complications of Fractures | 692 | ||
| Soft Tissue and Vascular Problems | 693 | ||
| Posttraumatic Arthrosis | 693 | ||
| Joint Incongruity | 694 | ||
| Articular Cartilage Damage | 694 | ||
| Malalignment | 695 | ||
| Malorientation | 695 | ||
| Repetitive Loading Injury | 696 | ||
| Summary | 696 | ||
| Peripheral Nerve Injuries | 696 | ||
| History of the Treatment of Nerve Injury | 696 | ||
| Classification of Nerve Injury | 696 | ||
| Incidence of Nerve Injuries Associated with Fractures | 698 | ||
| Evaluation of Peripheral Nerve Injuries | 699 | ||
| Electromyography and Electrodiagnostics. | 699 | ||
| Basic Science of Electrodiagnostics. | 699 | ||
| Characteristic Electromyography Patterns. | 699 | ||
| Nerve Conduction Studies. | 699 | ||
| Somatosensory-Evoked Potentials. | 700 | ||
| Association of Peripheral Nerve Injury with Causalgia | 701 | ||
| Prognosis | 701 | ||
| Nerve Injuries Associated with Open and Closed Fractures and Dislocations. | 701 | ||
| Nerve Injuries Associated With Projectile Injuries. | 701 | ||
| Summary | 701 | ||
| Complex Regional Pain Syndrome | 701 | ||
| Modern Terminology | 701 | ||
| Etiology and Epidemiology | 701 | ||
| Pathophysiology | 702 | ||
| Clinical Presentation | 702 | ||
| Staging | 703 | ||
| Diagnostic Testing | 703 | ||
| Radiography. | 703 | ||
| Bone Scanning. | 703 | ||
| Thermography. | 703 | ||
| Psychologic or Psychiatric Assessment | 703 | ||
| Current Concepts in Treatment | 704 | ||
| Overview. | 704 | ||
| Nonsteroidal Antiinflammatory Drugs. | 704 | ||
| Antidepressants. | 704 | ||
| Narcotic Analgesics. | 704 | ||
| Anticonvulsants. | 704 | ||
| Calcium Channel Blockers (Nifedipine) and Adrenergic Blocking Agents (Phenoxybenzamine). | 704 | ||
| Corticosteroids. | 704 | ||
| Physical Therapy. | 705 | ||
| Electroacupuncture. | 705 | ||
| Regional Intravenous and Arterial Blockade. | 705 | ||
| Sympathetic Blocks. | 705 | ||
| Transcutaneous Electrical Stimulation. | 705 | ||
| Topical Capsaicin. | 705 | ||
| Chemical Sympathectomy. | 705 | ||
| Surgical Sympathectomy. | 705 | ||
| Electrical Spinal Cord and Motor Cortex Stimulation. | 705 | ||
| Nontraditional Therapies and Treatments. | 705 | ||
| Prevention | 705 | ||
| Prognosis | 706 | ||
| Summary | 706 | ||
| Management of Complications | 706 | ||
| Risk Management | 707 | ||
| Missed Injuries | 707 | ||
| Documentation of Complications | 708 | ||
| Summary | 709 | ||
| Key References | 709 | ||
| References | 710 | ||
| 24 Chronic Osteomyelitis | 717 | ||
| Background | 717 | ||
| Epidemiology | 718 | ||
| Pathogenesis | 719 | ||
| Microbiology | 720 | ||
| Classification | 722 | ||
| Diagnosis | 723 | ||
| History | 723 | ||
| Physical Examination | 724 | ||
| Cultures | 724 | ||
| Laboratory Values | 724 | ||
| Imaging | 725 | ||
| Management | 727 | ||
| Overview | 727 | ||
| Suppressive Therapy | 728 | ||
| Amputation | 728 | ||
| Technique | 729 | ||
| Postoperative Care | 730 | ||
| Limb Salvage | 730 | ||
| Débridement | 731 | ||
| Skeletal Stabilization | 732 | ||
| Skeletal Defect Management | 732 | ||
| Soft Tissue Coverage | 733 | ||
| Infection Control | 734 | ||
| Systemic Antibiotics | 735 | ||
| Illustrative Cases | 735 | ||
| Case 1: Antibiotic Cement Rod | 735 | ||
| Case 2: Acute Shortening and Relengthening | 737 | ||
| Conclusion and Future Directions | 743 | ||
| Key References | 743 | ||
| References | 744 | ||
| 25 Nonunions: | 749 | ||
| Introduction | 749 | ||
| Definitions | 749 | ||
| Fracture Repair | 749 | ||
| Healing via Callus | 749 | ||
| Direct Bone (Osteonal) Healing | 749 | ||
| Indirect Bone Healing | 750 | ||
| Etiology of Nonunions | 750 | ||
| Predisposing Factors—Instability, Inadequate Vascularity, Poor Contact | 750 | ||
| Instability | 750 | ||
| Inadequate Vascularity | 750 | ||
| Poor Bone Contact | 750 | ||
| Other Contributing Factors | 750 | ||
| Infection | 750 | ||
| Nicotine and Cigarette Smoking | 750 | ||
| Certain Medications | 753 | ||
| Other Contributing Factors | 753 | ||
| Evaluation of Nonunions | 753 | ||
| Patient History | 753 | ||
| Physical Examination | 754 | ||
| Radiologic Examination | 755 | ||
| Plain Radiographs | 755 | ||
| Anatomic Location. | 756 | ||
| Healing Effort and Bone Quality. | 756 | ||
| Surface Characteristics. | 758 | ||
| Status of Previously Implanted Hardware. | 758 | ||
| Deformities. | 758 | ||
| Computed Tomographic Scanning and Tomography | 761 | ||
| Nuclear Imaging | 761 | ||
| Other Radiologic Studies | 762 | ||
| Laboratory Studies | 762 | ||
| Consultations | 763 | ||
| Treatment | 765 | ||
| Objectives | 765 | ||
| Strategies | 767 | ||
| Nonunion Type | 767 | ||
| Hypertrophic Nonunions. | 767 | ||
| Oligotrophic Nonunions. | 769 | ||
| Atrophic Nonunions. | 769 | ||
| Infected Nonunions. | 771 | ||
| Active Purulent Drainage. | 772 | ||
| Active Nondraining. | 773 | ||
| Quiescent. | 773 | ||
| Synovial Pseudarthrosis. | 773 | ||
| Treatment Modifiers | 773 | ||
| Anatomic Location. | 773 | ||
| Epiphyseal Nonunions. | 773 | ||
| Metaphyseal Nonunions. | 773 | ||
| Diaphyseal Nonunions. | 775 | ||
| Nonunions Traversing More Than One Anatomic Region. | 775 | ||
| Segmental Bone Defects. | 775 | ||
| Static Treatment Methods. | 775 | ||
| Acute Compression Methods. | 776 | ||
| Gradual Compression Methods. | 779 | ||
| Prior Failed Treatments. | 780 | ||
| Deformities. | 780 | ||
| Surface Characteristics. | 785 | ||
| Pain and Function. | 785 | ||
| Osteopenia. | 785 | ||
| Mobility of the Nonunion. | 789 | ||
| Status of Hardware. | 790 | ||
| Motor and Sensory Dysfunction. | 790 | ||
| Patient Health and Age. | 790 | ||
| Problems at Adjacent Joints. | 791 | ||
| Soft Tissue Problems. | 791 | ||
| Metabolic and Endocrine Abnormalities. | 793 | ||
| Treatment Methods | 796 | ||
| Mechanical Methods | 796 | ||
| Weight-Bearing. | 796 | ||
| External Supportive Devices. | 796 | ||
| Dynamization. | 797 | ||
| Excision of Bone. | 798 | ||
| Screws. | 798 | ||
| Cables and Wires. | 798 | ||
| Plate-and-Screw Fixation. | 798 | ||
| Intramedullary Nail Fixation. | 801 | ||
| Osteotomy. | 806 | ||
| External Fixation. | 806 | ||
| Biological Methods | 807 | ||
| Nonstructural Bone Grafts | 807 | ||
| Autogenous Cancellous Graft. | 807 | ||
| Allogeneic Cancellous Graft. | 807 | ||
| Bone Marrow Injection. | 807 | ||
| Bone Graft Substitutes. | 808 | ||
| Growth Factors. | 808 | ||
| Decortication. | 808 | ||
| Electromagnetic, Ultrasound, and Shock-Wave Stimulation. | 809 | ||
| Methods That Are Both Mechanical and Biological | 809 | ||
| Structural Bone Grafts. | 809 | ||
| Mesh Cage Bone Graft Constructs. | 810 | ||
| Exchange Nailing. | 810 | ||
| Technique. | 810 | ||
| Modes of Healing. | 812 | ||
| Other Issues | 813 | ||
| Bone Contact. | 813 | ||
| Deformity. | 814 | ||
| Infection. | 814 | ||
| Literature Review for Exchange Nailing. | 815 | ||
| Summary. | 815 | ||
| Synostosis Techniques. | 816 | ||
| Ilizarov Method. | 816 | ||
| Arthroplasty. | 827 | ||
| Arthrodesis. | 828 | ||
| Amputation. | 828 | ||
| Summary | 829 | ||
| The 10 Commandments of Nonunion Treatment | 830 | ||
| Acknowledgments | 830 | ||
| Key References | 830 | ||
| References | 831 | ||
| 26 Physical Impairment Ratings for Fractures | 838 | ||
| Generic Issues of Disability and Impairment | 838 | ||
| Definitions | 838 | ||
| Role of the Physician | 838 | ||
| Third-Party Payers and the Workers’ Compensation System | 839 | ||
| Work Restrictions | 839 | ||
| Types of Disability | 839 | ||
| Temporary Total Disability | 839 | ||
| Temporary Partial Disability | 839 | ||
| Permanent Partial Disability | 840 | ||
| Epidemiology of Fractures in the United States | 840 | ||
| Guides for Impairment Determination | 841 | ||
| Historical Perspective | 841 | ||
| How to Perform an Impairment Evaluation | 842 | ||
| Example 1. | 842 | ||
| Impairment Rating. | 842 | ||
| Example 2. | 843 | ||
| 9780323294980v2_WEB | 1516 | ||
| Front Cover | 1516 | ||
| Skeletal Trauma | 1519 | ||
| Copyright Page | 1520 | ||
| Dedication | 1521 | ||
| Contributors | 1522 | ||
| Foreword | 1537 | ||
| Preface | 1538 | ||
| Acknowledgments | 1540 | ||
| Table Of Contents | 1541 | ||
| Video Contents | 1545 | ||
| Four Upper Extremity | 1549 | ||
| 44 Fractures of the Distal Radius | 1549 | ||
| Functional Anatomy | 1549 | ||
| Classification | 1549 | ||
| Extraarticular Fractures | 1552 | ||
| Intraarticular Fractures | 1552 | ||
| Radiographic Assessment | 1553 | ||
| Determination of Stability | 1553 | ||
| Relation of Anatomy to Function | 1558 | ||
| Treatment | 1558 | ||
| Patient Considerations | 1558 | ||
| Options | 1559 | ||
| Treatment of Extraarticular Fractures | 1559 | ||
| Stable Fractures | 1559 | ||
| Unstable Fractures | 1560 | ||
| Percutaneous Pins | 1560 | ||
| External Skeletal Fixation | 1560 | ||
| Open Reduction | 1561 | ||
| Comparison of Fixation Techniques | 1566 | ||
| Treatment of Intraarticular Fractures | 1567 | ||
| Stable Fractures | 1567 | ||
| Unstable Fractures | 1568 | ||
| Two-Part Radiocarpal Fractures | 1568 | ||
| Two-Part Impacted Fractures | 1574 | ||
| Two-Part Radial Styloid Fractures | 1575 | ||
| Three-Part Intraarticular Fractures | 1577 | ||
| Four-Part Intraarticular Fractures | 1577 | ||
| Intraarticular Fractures with Five or More Parts | 1577 | ||
| Associated Injuries | 1580 | ||
| Ulnar Styloid Fractures | 1580 | ||
| Carpal Injuries | 1584 | ||
| Complications | 1584 | ||
| Nerve Injuries | 1584 | ||
| Tendon Adhesions and Ruptures | 1588 | ||
| Malunion | 1588 | ||
| Nonunion | 1595 | ||
| Evaluation of Outcome | 1595 | ||
| Future Considerations | 1595 | ||
| Bone Replacement Materials | 1595 | ||
| Alternative Fixation Options | 1595 | ||
| Arthroscopically Guided Reduction | 1595 | ||
| Summary | 1597 | ||
| Key References | 1597 | ||
| References | 1598 | ||
| 45 Diaphyseal Fractures of the Forearm | 1604 | ||
| Functional Anatomy | 1604 | ||
| Proximal Radioulnar Joint | 1604 | ||
| Distal Radioulnar Joint | 1605 | ||
| Interosseous Membrane | 1605 | ||
| Muscles | 1605 | ||
| Supinators | 1605 | ||
| Pronators | 1605 | ||
| Nerves and Vessels | 1605 | ||
| Classification of Diaphyseal Forearm Fractures | 1605 | ||
| Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association Classification | 1605 | ||
| Monteggia Fracture | 1606 | ||
| Galeazzi Fracture | 1606 | ||
| Essex-Lopresti Lesion | 1606 | ||
| Classification of Associated Soft Tissue Trauma | 1607 | ||
| Diagnosis | 1609 | ||
| Anamnesis | 1609 | ||
| Clinical Examination | 1609 | ||
| Radiologic Examination | 1609 | ||
| Magnetic Resonance Imaging Examination | 1611 | ||
| Ultrasonography | 1611 | ||
| Treatment | 1611 | ||
| Simple Ulna Fracture, Radius Intact | 1611 | ||
| Simple Fracture of the Radius, Ulna Intact | 1614 | ||
| Simple Fracture of the Radius and the Ulna | 1617 | ||
| Wedge Fracture of the Ulna, Radius Intact | 1619 | ||
| Wedge Fracture of the Radius, Ulna Intact | 1621 | ||
| One Bone Wedge Fracture, the Other Simple or Wedge | 1622 | ||
| Complex Fracture of the Ulna, Radius Simple or Wedge | 1622 | ||
| Complex Fracture of the Radius, Ulna Simple or Wedge | 1624 | ||
| Complex Fracture of the Radius and the Ulna | 1625 | ||
| Essex-Lopresti Lesion | 1626 | ||
| Aggravating Cofactors | 1627 | ||
| Open Fracture | 1627 | ||
| Peri-implant Fractures | 1630 | ||
| Periprosthetic Fractures | 1631 | ||
| Osteoporosis and Osteomalacia | 1631 | ||
| Osteogenesis Imperfecta | 1631 | ||
| Spastic Palsy and Epilepsy | 1631 | ||
| Nicotine Abuse | 1633 | ||
| Immune Suppression and Diabetes | 1633 | ||
| Complications | 1633 | ||
| Compartment Syndrome of the Forearm | 1633 | ||
| Wound Infection and Osteomyelitis | 1633 | ||
| Delayed Bone Healing and Nonunion | 1634 | ||
| Malunion and Bridging Callus | 1634 | ||
| Concomitant Soft Tissue Injury | 1635 | ||
| Traumatic Forearm Amputation | 1636 | ||
| Implant Removal | 1636 | ||
| Outcome | 1637 | ||
| Conclusion | 1637 | ||
| Key References | 1637 | ||
| References | 1638 | ||
| 46 Trauma to the Adult Elbow and Fractures of the Distal Humerus | 1641 | ||
| 46A Trauma to the Adult Elbow | 1641 | ||
| Introduction: Scope and Purpose | 1641 | ||
| Mechanism of Injury and Biomechanics | 1641 | ||
| Evaluation | 1641 | ||
| Examination | 1641 | ||
| Imaging | 1641 | ||
| Diagnosis and Classification | 1641 | ||
| Management | 1642 | ||
| Disorder or Injury: Radial Head Fractures | 1642 | ||
| Emergent Treatment | 1642 | ||
| Indications for Definitive Care | 1642 | ||
| Nonoperative Treatment | 1642 | ||
| Surgical Treatment | 1643 | ||
| Surgical Anatomy. | 1644 | ||
| Positioning Techniques. | 1644 | ||
| Surgical Approach. | 1644 | ||
| Reduction and Fixation Techniques. | 1645 | ||
| Pitfalls and Avoidance of Complications | 1645 | ||
| Management of Intraoperative Problems. | 1645 | ||
| Postoperative Care and Rehabilitation. | 1646 | ||
| Complications | 1646 | ||
| Outcome | 1646 | ||
| Disorder or Injury: Olecranon Fractures | 1646 | ||
| Emergent Treatment | 1646 | ||
| Indications for Definitive Care | 1646 | ||
| Nonoperative Treatment | 1646 | ||
| Surgical Treatment | 1647 | ||
| Surgical Anatomy. | 1647 | ||
| Positioning Techniques. | 1647 | ||
| Surgical Approach. | 1647 | ||
| Reduction Techniques. | 1647 | ||
| Fixation Techniques. | 1647 | ||
| Pitfalls and Avoidance of Complications. | 1648 | ||
| Management of Intraoperative Problems. | 1648 | ||
| Postoperative Care and Rehabilitation. | 1648 | ||
| Complications | 1648 | ||
| Outcome | 1649 | ||
| Disorder or Injury: Coronoid Fractures | 1649 | ||
| Emergent Treatment | 1650 | ||
| Indications for Definitive Care | 1650 | ||
| Nonoperative Treatment | 1651 | ||
| Surgical Treatment | 1651 | ||
| Surgical Anatomy. | 1651 | ||
| Positioning Techniques. | 1651 | ||
| Surgical Approach and fracture Reduction and Fixation. | 1651 | ||
| Pitfalls and Avoidance of Complications. | 1652 | ||
| Management of Intraoperative Problems. | 1652 | ||
| Postoperative Care and Rehabilitation. | 1652 | ||
| Complications | 1653 | ||
| Outcome | 1653 | ||
| Disorder or Injury: Elbow Dislocations | 1653 | ||
| Emergent Treatment | 1653 | ||
| Indications for Definitive Care | 1653 | ||
| Nonoperative Treatment | 1653 | ||
| Surgical Treatment | 1653 | ||
| Surgical Anatomy. | 1653 | ||
| Positioning. | 1653 | ||
| Surgical Approach and Reduction and Fixation. | 1653 | ||
| Pitfalls and Avoidance of Complications. | 1654 | ||
| Management of Intraoperative Problems. | 1654 | ||
| Postoperative Care and Rehabilitation. | 1654 | ||
| Complications | 1654 | ||
| Outcomes | 1654 | ||
| Meta-Analyses and Systematic Reviews | 1654 | ||
| Conclusion | 1654 | ||
| Key References | 1654 | ||
| References | 1656 | ||
| 46B Fractures of the Distal Humerus | 1655 | ||
| Introduction: Scope and Purpose | 1655 | ||
| Epidemiology | 1655 | ||
| Anatomy | 1655 | ||
| Functional Anatomy | 1655 | ||
| Surgical Anatomy | 1659 | ||
| Blood Supply | 1661 | ||
| Evaluation | 1662 | ||
| Examination | 1662 | ||
| Imaging | 1663 | ||
| Classification | 1663 | ||
| Management | 1663 | ||
| A and C Type Fractures | 1663 | ||
| Emergent Treatment | 1663 | ||
| Nonoperative Treatment | 1663 | ||
| Surgical Treatment | 1664 | ||
| Surgical Approach. | 1664 | ||
| Paratricipital (Triceps-Sparing) Approach. | 1667 | ||
| Triceps-Splitting Approach. | 1668 | ||
| Olecranon Osteotomy. | 1668 | ||
| Reduction Techniques. | 1669 | ||
| Fixation Techniques. | 1670 | ||
| Postoperative Care and Rehabilitation. | 1671 | ||
| Coronal Shear Fractures (B Type) | 1671 | ||
| Emergent Treatment | 1671 | ||
| Nonoperative Treatment | 1672 | ||
| Surgical Treatment | 1672 | ||
| Positioning Techniques. | 1672 | ||
| Surgical Approach. | 1672 | ||
| Reduction Techniques. | 1672 | ||
| Fixation Techniques. | 1672 | ||
| Postoperative Care and Rehabilitation. | 1672 | ||
| Open Fractures of the Distal Humerus | 1672 | ||
| Total Elbow Arthroplasty | 1677 | ||
| Complications | 1677 | ||
| Ulnar Nerve | 1677 | ||
| Heterotopic Ossification | 1680 | ||
| Nonunion and Fixation Failure | 1682 | ||
| Elbow Stiffness | 1682 | ||
| Outcome | 1683 | ||
| Meta-Analyses and Systematic Reviews | 1683 | ||
| Conclusion | 1684 | ||
| Key References | 1684 | ||
| References | 1685 | ||
| 47 Fracture of the Humeral Shaft | 1688 | ||
| Introduction: Scope and Purpose | 1688 | ||
| Relevant Anatomy | 1688 | ||
| Mechanism of Injury and Biomechanics | 1688 | ||
| Evaluation | 1688 | ||
| Examination | 1688 | ||
| Imaging | 1689 | ||
| Diagnosis and Classification | 1689 | ||
| Management | 1689 | ||
| Disorder or Injury | 1689 | ||
| Emergent Treatment | 1689 | ||
| Indications for Definitive Care | 1689 | ||
| Pathologic Fractures. | 1690 | ||
| Nonoperative Treatment | 1690 | ||
| Surgical Treatment | 1690 | ||
| Surgical Anatomy. | 1690 | ||
| Positioning Techniques | 1690 | ||
| Surgical Approach | 1690 | ||
| Plate Osteosynthesis. | 1690 | ||
| Anterior Approach. | 1690 | ||
| Posterior Approach. | 1692 | ||
| Medial Approach. | 1692 | ||
| Anterolateral Minimally Invasive Approach. | 1692 | ||
| Intramedullary Nailing. | 1692 | ||
| Retrograde Humerus Nailing. | 1692 | ||
| Antegrade Humerus Nailing. | 1692 | ||
| External Fixator. | 1692 | ||
| Reduction Techniques | 1692 | ||
| Closed Reduction Techniques. | 1692 | ||
| Fixation Techniques | 1692 | ||
| Pitfalls and Avoidance of Complications | 1700 | ||
| Management of Intraoperative Problems | 1700 | ||
| Postoperative Care and Rehabilitation | 1700 | ||
| Complications | 1700 | ||
| Radial Nerve Palsy | 1700 | ||
| Delayed Union and Nonunion | 1701 | ||
| Outcome | 1701 | ||
| Meta-Analyses and Systematic Reviews | 1701 | ||
| Nonoperative versus Operative Therapy | 1701 | ||
| Plate Fixation versus Intramedullary Nailing | 1701 | ||
| Antegrade versus Retrograde Nailing | 1701 | ||
| Cost Effectiveness | 1701 | ||
| Conclusion | 1701 | ||
| Key References | 1704 | ||
| References | 1705 | ||
| 48 Proximal Humerus Fractures and Glenohumeral Dislocations | 1708 | ||
| 48A Essential Principles | 1708 | ||
| Relevant Anatomy and Biomechanics | 1708 | ||
| Joint Anatomy | 1708 | ||
| Neurovascular Anatomy | 1709 | ||
| Biomechanics | 1711 | ||
| Evaluation of an Acutely Injured Shoulder | 1712 | ||
| History | 1712 | ||
| Physical Examination | 1712 | ||
| Imaging | 1713 | ||
| Trauma Series (Three Views) | 1713 | ||
| Rotational Anteroposterior Views (Two Views) | 1716 | ||
| Computed Tomography | 1716 | ||
| Magnetic Resonance Imaging | 1717 | ||
| Ultrasonography | 1717 | ||
| X-Ray Image Intensifier | 1718 | ||
| Differential Diagnosis | 1718 | ||
| Surgical Treatment of Proximal Humeral and Glenohumeral Injuries | 1718 | ||
| Anesthetic Considerations | 1718 | ||
| Intraoperative Imaging | 1718 | ||
| Intraoperative Patient Positioning | 1718 | ||
| Surgical Approaches | 1719 | ||
| Deltopectoral Approach | 1719 | ||
| Superior Approach With or Without Anterior Acromioplasty | 1719 | ||
| Posterior Approach | 1721 | ||
| Outcome Evaluation | 1721 | ||
| Key References | 1723 | ||
| References | 1724 | ||
| 48B Proximal Humeral Fractures and Fracture-Dislocations | 1723 | ||
| Introduction | 1723 | ||
| Scope and Instruction for the Clinical Use of This Chapter | 1723 | ||
| Epidemiology | 1723 | ||
| Mechanism of Injury | 1723 | ||
| Associated Injuries | 1725 | ||
| Polytrauma Patient | 1725 | ||
| Ipsilateral Upper Extremity Fracture | 1726 | ||
| Rotator Cuff Tear | 1726 | ||
| Nerve Injuries | 1727 | ||
| Vascular Injuries | 1728 | ||
| Seizures | 1728 | ||
| Pathologic Fractures | 1728 | ||
| Evaluation | 1729 | ||
| Clinical Examination | 1729 | ||
| Imaging | 1729 | ||
| Classification | 1729 | ||
| The Neer Classification | 1729 | ||
| AO/ASIF Classification System | 1731 | ||
| Hertel’s Predictors of Humeral Head Ischemia | 1732 | ||
| Role and Reliability of Classifications | 1732 | ||
| Authors’ Preferences and Fractures with Special Interest | 1732 | ||
| Two-Part Greater Tuberosity Fracture | 1733 | ||
| The Valgus Impacted Three- and Four-Part Fractures | 1733 | ||
| Fracture-Dislocations | 1733 | ||
| Management | 1733 | ||
| Emergent Treatment | 1733 | ||
| Evaluation of Osteoporosis | 1734 | ||
| Nonoperative Treatment: Indications and Outcome | 1735 | ||
| Nonoperative Treatment in Young Patients | 1735 | ||
| Nonoperative Treatment Algorithm | 1735 | ||
| Complications After Nonoperative Treatment | 1736 | ||
| Surgical Treatment | 1736 | ||
| Surgical Approaches | 1737 | ||
| Open Reduction of Specific Fracture Types | 1737 | ||
| Two-Part Greater Tuberosity Fractures. | 1737 | ||
| Two-Part Lesser Tuberosity Fractures. | 1738 | ||
| Two-Part Fracture-Dislocations of the Tuberosities with Undisplaced Fractures of the Surgical or Anatomic Neck. | 1738 | ||
| Two-Part Surgical Neck Fractures. | 1738 | ||
| Three-Part and Four-Part Fractures. | 1738 | ||
| Intramedullary Rodding | 1738 | ||
| Closed Reduction and Percutaneous Fixation | 1738 | ||
| Positioning Techniques and Surgical Approach. | 1739 | ||
| Reduction and Fixation Techniques. | 1739 | ||
| Pitfalls and Avoidance of Complications. | 1739 | ||
| Management of Intraoperative Complications. | 1739 | ||
| Complications. | 1739 | ||
| Outcome. | 1740 | ||
| Open Reduction and internal Fixation: Conventional Plate | 1740 | ||
| Positioning Techniques and Surgical Approach. | 1740 | ||
| Reduction and Fixation Techniques. | 1740 | ||
| Pitfalls and Avoidance of Complications. | 1740 | ||
| Management of Intraoperative Complications. | 1740 | ||
| Complications. | 1741 | ||
| Outcome. | 1741 | ||
| Open Reduction and Internal Fixation: Locking Plate | 1742 | ||
| Positioning Techniques and Surgical Approach. | 1742 | ||
| Reduction and Fixation Techniques. | 1742 | ||
| Pitfalls and Avoidance of Complications. | 1742 | ||
| Management of Intraoperative Complications. | 1742 | ||
| Complications. | 1742 | ||
| Outcome. | 1743 | ||
| Primary Hemiarthroplasty | 1744 | ||
| Positioning Techniques and Surgical Approach. | 1745 | ||
| Reduction and Fixation Techniques. | 1745 | ||
| Pitfalls and Avoidance of Complications. | 1746 | ||
| Management of Intraoperative Complications. | 1747 | ||
| Complications. | 1747 | ||
| Outcome. | 1747 | ||
| Primary Reverse Total Shoulder Arthroplasty | 1747 | ||
| Positioning Techniques and Surgical Approach. | 1747 | ||
| Reduction and Fixation Techniques. | 1747 | ||
| Pitfalls and Avoidance of Complications. | 1748 | ||
| Management of Intraoperative Complications. | 1749 | ||
| Complications. | 1749 | ||
| Outcome. | 1749 | ||
| The Role of Arthroscopy for Fracture Treatment | 1749 | ||
| Complications and Outcome. | 1750 | ||
| Comparison of Surgical Treatments | 1750 | ||
| Conventional versus Locking Plate Open Reduction and Internal Fixation | 1750 | ||
| Primary Hemiarthroplasty versus Open Reduction and Internal Fixation | 1750 | ||
| Primary Reverse Total Shoulder Arthroplasty versus Primary Hemiarthroplasty | 1750 | ||
| Postoperative Rehabilitation Algorithm | 1750 | ||
| Authors’ Preferred Treatment | 1751 | ||
| Fractures in Young and Active Patients | 1752 | ||
| Fractures in Elderly Patients | 1753 | ||
| Implications for Future Research | 1755 | ||
| Conclusion | 1755 | ||
| Key References | 1755 | ||
| References | 1756 | ||
| 48C Glenohumeral Dislocations | 1760 | ||
| Introduction: Scope and Purpose | 1760 | ||
| Direction of Dislocation | 1760 | ||
| Anterior Dislocation | 1760 | ||
| Inferior Dislocation | 1761 | ||
| Posterior Dislocation | 1761 | ||
| Findings after the Glenohumeral Dislocations | 1762 | ||
| “The Essential Lesion” | 1762 | ||
| Glenohumeral Ligaments | 1762 | ||
| Hill-Sachs Lesions | 1763 | ||
| Associated Injuries and Complications | 1764 | ||
| Fractures | 1764 | ||
| Greater Tuberosity Fracture. | 1764 | ||
| Glenoid Fracture. | 1765 | ||
| Coracoid Process Fractures. | 1765 | ||
| Rotator Cuff Tears | 1767 | ||
| Nerve Injuries | 1767 | ||
| Vascular Injuries | 1768 | ||
| Evaluation | 1768 | ||
| Examination and Imaging | 1768 | ||
| Patient History | 1768 | ||
| Physical Examination | 1769 | ||
| Rotator Cuff Testing. | 1769 | ||
| Imaging Testing | 1769 | ||
| Diagnosis and Classification | 1770 | ||
| Classification | 1770 | ||
| Management and Treatment | 1771 | ||
| Closed Reduction | 1771 | ||
| Recurrence | 1774 | ||
| Age and Gender | 1774 | ||
| Postreduction Management | 1774 | ||
| Immobilization in Internal Rotation | 1774 | ||
| Immobilization in External Rotation | 1775 | ||
| Instability Repair | 1776 | ||
| Indication | 1776 | ||
| Capsulolabral Repair | 1777 | ||
| Bone Block Procedures | 1778 | ||
| Treatment of Glenoid Rim Fractures | 1780 | ||
| Surgical Treatment | 1780 | ||
| Rotator Cuff Repair | 1780 | ||
| Authors’ Preferred Treatment | 1780 | ||
| Posterior Dislocation | 1781 | ||
| Introduction | 1781 | ||
| Characteristics of Posterior Dislocation | 1781 | ||
| Etiology | 1781 | ||
| Directions of Posterior Dislocations | 1781 | ||
| Associated Fractures | 1781 | ||
| Diagnosis | 1781 | ||
| Associated Injuries | 1783 | ||
| Classification | 1783 | ||
| Recurrence | 1783 | ||
| Treatment | 1783 | ||
| Closed Reduction | 1784 | ||
| Open Reduction | 1784 | ||
| Outcome | 1787 | ||
| Authors’ Preferred Treatment | 1787 | ||
| Key References | 1788 | ||
| References | 1789 | ||
| 48D Treatment of Fracture Sequelae of the Proximal Humerus | 1788 | ||
| Biomechanics | 1788 | ||
| Evaluation | 1798 | ||
| Examination | 1798 | ||
| Imaging | 1798 | ||
| Diagnosis and Classification | 1798 | ||
| Management | 1800 | ||
| Nonunion Management | 1800 | ||
| Greater Tuberosity Nonunion | 1800 | ||
| Surgical Neck Nonunion | 1800 | ||
| Malunion Management | 1802 | ||
| Two-Part Fracture Malunion | 1802 | ||
| Tuberosity Malunion. | 1802 | ||
| Surgical Neck Malunion. | 1804 | ||
| Three- and Four-Part Fracture Malunions | 1810 | ||
| Technique of Arthroplasty | 1810 | ||
| Technique of Standard Shoulder Replacement | 1810 | ||
| Technique of Reverse Total Shoulder Replacement | 1812 | ||
| Summary | 1812 | ||
| Key References | 1813 | ||
| References | 1814 | ||
| 49 Fractures and Dislocations of the Clavicle | 1816 | ||
| Anatomy | 1816 | ||
| Sternoclavicular Joint Dislocation | 1818 | ||
| Shoulder Suspensory Complex | 1818 | ||
| Acromioclavicular Joint Dislocation | 1819 | ||
| Decision Making | 1820 | ||
| Operative Treatment | 1820 | ||
| Fractures of the Clavicle | 1820 | ||
| Classification | 1822 | ||
| Epidemiology | 1822 | ||
| Mechanism | 1823 | ||
| Evaluation | 1824 | ||
| Radiographic Evaluation | 1824 | ||
| Management of Specific Injuries | 1824 | ||
| Birth Fractures | 1824 | ||
| Midclavicular Fractures | 1824 | ||
| Nonoperative Treatment | 1824 | ||
| Operative Treatment | 1825 | ||
| Authors’ Preferred Technique | 1825 | ||
| Intramedullary Nailing | 1826 | ||
| Postoperative Care | 1827 | ||
| Results | 1827 | ||
| Pitfalls | 1828 | ||
| Plating | 1828 | ||
| Implantation through Minimally Invasive Approach | 1828 | ||
| Patient Positioning. | 1828 | ||
| Surgical Approach (Minimal Invasive). | 1829 | ||
| Fracture Reduction. | 1829 | ||
| Plate Insertion and Position. | 1829 | ||
| Confirmation of Reduction and Fixation. | 1830 | ||
| Open Plating. | 1830 | ||
| Patient Positioning. | 1830 | ||
| Surgical Approach. | 1830 | ||
| Fracture Reduction and Fixation. | 1831 | ||
| Postoperative Care. | 1831 | ||
| Distal Clavicular Fractures | 1831 | ||
| Floating Shoulder | 1832 | ||
| Medial Clavicular Fractures | 1832 | ||
| Complications | 1833 | ||
| Nonunion and Malunion. | 1833 | ||
| Neurovascular Complications | 1834 | ||
| Refracture | 1835 | ||
| Complications of Operative Treatment | 1835 | ||
| Key References | 1835 | ||
| References | 1836 | ||
| 50 Scapula and Rib Fractures | 1838 | ||
| 50A Scapula Fractures | 1838 | ||
| Introduction: Scope and Purpose | 1838 | ||
| Mechanism of Injury and Biomechanics | 1840 | ||
| Evaluation | 1840 | ||
| Examination | 1840 | ||
| Imaging | 1841 | ||
| Diagnosis and Classification | 1843 | ||
| Management | 1844 | ||
| Scapula Fracture | 1844 | ||
| Emergent Treatment | 1844 | ||
| Indications for Definitive Care | 1844 | ||
| Nonoperative Treatment | 1849 | ||
| Surgical Treatment | 1850 | ||
| Choosing the Surgical Approach. | 1850 | ||
| Surgical Anatomy | 1851 | ||
| Positioning Techniques | 1852 | ||
| Positioning for Anterior Approaches. | 1852 | ||
| Positioning for Posterior Approaches. | 1852 | ||
| Surgical Approach | 1852 | ||
| Posterior Approach Options. | 1852 | ||
| Exposure Options. | 1853 | ||
| Wound Closure. | 1854 | ||
| Minimally Invasive Approach. | 1854 | ||
| Anterior Approach. | 1855 | ||
| Reduction Techniques | 1856 | ||
| Fixation Techniques | 1857 | ||
| Pitfalls and Avoidance of Complications | 1858 | ||
| Neurovascular Complications. | 1858 | ||
| Management of Intraoperative Problems | 1859 | ||
| Mobilization of Fracture Fragments. | 1859 | ||
| Postsurgical Manipulation. | 1860 | ||
| Postoperative Care and Rehabilitation | 1860 | ||
| Complications | 1860 | ||
| Nonoperative Complications | 1860 | ||
| Missed or Delayed Diagnosis | 1860 | ||
| Deformity and Malunion | 1861 | ||
| Pain | 1861 |