Essential Biomechanics for Orthopedic Trauma. A Case-Based Guide

✍ Scribed by Brett D. Crist, Joseph Borrelli Jr., Edward J. Harvey (eds.)

• Publisher: Springer
• Year: 2020
• Tongue: English
• Leaves: 328
• Category: Library

✦ Table of Contents

Preface
Contents
Editors
Contributors
Part I: Stress, Strain, and Young’s Modulus—How They Relate to Fracture Healing
1: Biomechanical Principles of Fracture Healing
Introduction
Material Strength
Stress-Strain
Anisotropy
Fatigue
Viscoelasticity
Structural Strength
Size
Material Distribution
Stress Concentrations
Clinical Implications
References
2: Perren’s Strain Theory and Fracture Healing
Introduction
Bone
Fracture
Mechanical and Biomechanical Effects
Biology of Fracture Healing
Biomechanics of Bone Healing
Methods of Fracture Stabilization
Conservative Fracture Treatment
Relative Stability
Indirect Fracture Healing: Perren’s Strain Theory
Absolute Stability
Direct Fracture Healing: Biomechanics
Summary
References
3: Case Studies in Fracture Healing and Nonunions
Introduction
Primary or Direct Fracture Healing
Case 1 (Fig. 3.1)
Failure of Fracture Healing
Case 2 (Fig. 3.3)
Secondary Fracture Healing
Case 3 (Fig. 3.4)
Secondary Fracture Healing
Case 4 (Fig. 3.5)
Case 5 (Fig. 3.6)
Hypertrophic Nonunion
Case 6: Failed Bone Healing (Fig. 3.8)
Conclusion
References
Part II: External Fixation Principles with Case Examples
4: Biomechanics of External Fixators for Fracture Fixation: Uniplanar, Multiplanar, and Circular Frames
Introduction
Indications for External Fixation
Biomechanics of External Fixator
The Importance of Pins and Wires in Biomechanics of External Fixators
Summary
References
5: Diaphyseal Fractures
Introduction
Implant and Anatomic Considerations
Pins
Clamps
Rods
Anatomic Considerations
Indications for Temporary External Fixation
Damage Control Orthopedics
Provisional Fixation
Construction of External Fixator Frames
Pin Insertion Technique
Management of Diaphyseal Fractures
Management of Intra-articular Fractures
Complications and Pin Care
Conclusion
References
6: Periarticular Fractures
Introduction
External Fixation for Temporary Stabilization
External Fixation for Definitive Treatment
Technical Issues with Periarticular External Fixation
Advantages of External Fixation in Periarticular Fractures
Current Indications
Biomechanics of Periarticular External Fixation—General Principles
Definitive Frames
Case 1: Temporary Joint-Spanning External Fixation
Case 2: Same-Side Definitive External Fixation
Case 3: Articulated External Fixation
Conclusions
References
7: External Fixators for Limb Lengthening
General Principles
Biology of Distraction
External Fixator Construction
Mechanical Modulation to Encourage Bone Formation
Biological Adjuvants
Complications
Integrated Techniques
Lengthening Over a Nail (LON)
Lengthening and Then Nailing (LATN) and Transport and Then Nailing (TATN)
References
8: External Fixators for Deformity Correction
Introduction
Why Circular Fixation?
Deformity Assessment and Strategy
Type of Circular Frame
Circular External Fixator Stability
Need for Neurolysis
When to Remove the Frame?
Complications
Summary
References
Part III: Tension Band Wire Principles with Case Examples
9: Biomechanics of Tension Band Constructs for Fracture Fixation
Introduction
Key Concepts for Tension Band Constructs
Determine the Tension and Compression Surfaces of the Fracture
Ensure the Fracture Can Withstand Stable Compression, with an Intact Opposite Cortex
Apply Fixation to Withstand Tension
Case 1
Why This Works
Case 2
Why This Works
Case 3
Why This Works
Conclusion
References
10: Olecranon Fractures
Introduction
Descriptive Olecranon Fracture Classification
Indications for Olecranon Fracture Tension Band
Surgical Tips and Tricks Based on Biomechanical Studies
K-Wires
Wire
Conclusion
References
11: Patella Fractures
Introduction
Anatomy
Biomechanics of the Extensor Mechanism and Its Relation to Injury
General Management Principles
Case 1
Physical Examination
Nonoperative Management
Case 2
Vertical Fractures
Case 3
Case 4
Modified Anterior Tension Band Wiring with Kirschner Wires
Surgical Technique: Modified Anterior Tension Band Wiring with Kirschner Wires
Case 5
Case 6
Tension Band Wiring Using Cannulated Screws
Surgical Technique
Adjunctive Techniques
Outcomes
References
Part IV: Plating Principles with Case Examples
12: Biomechanics of Plate and Screw Constructs for Fracture Fixation
Introduction
A Historical Perspective
Biomechanical Functions of a Plate
Biomechanical Properties of a Plate
Conclusions
References
13: Nonlocking Plate Functions
Compression Plating
Diaphyseal Compression Plating: Patient Example and Surgical Technique
Neutralization/Protection Plating
Neutralization Plating Patient Examples
Buttress/Antiglide Plating
Buttress/Antiglide Plate Function Patient Examples
Tension Band Plating
Tension Band Plating Patient Examples
References
14: Nonlocking Plate Functions 2
Bridge Plating
Length of the Plate
Working Length of the Plate
Screw Design and Density
Case 1: Bridge Plate
Why This Works
Wave Plate
Case 2: Wave Plate
Why This Works
Fixed Angle Devices
Case 3
Why This Works
Case 4: Dynamic Condylar Screw
Why This Works
Case 5: Sliding Hip Screw
Why This Works
Conclusion
References
15: Locked Plating
Introduction
Monoaxial/Unidirectional Locking Screws
Polyaxial/Multidirectional Locking Screws
Flexible Locking
Summary
References
Part V: Intramedullary Nailing Principles with Case Examples
16: Biomechanics of Intramedullary Nails Relative to Fracture Fixation and Deformity Correction
Introduction
Biomechanics
Fractures and Deformities
Case Examples
Case 1: Transverse Midshaft Femur Fracture (Fig. 16.1)
Why This Worked
Case 2: Comminuted Distal Femoral Shaft Fracture (Fig. 16.2)
Why This Worked
Case 3: Comminuted Femoral Shaft Fracture with Long Lateral Butterfly Fragment (Fig. 16.3)
Why This Worked
Case 4: Segmental Tibia Fracture, Including Proximal Metaphyseal Fracture Line (Fig. 16.4)
Why This Worked
Case 5: Humerus Fracture Nonunion After Nailing (Fig. 16.5)
Why This May Not Have Worked
References
17: Diaphyseal Fractures
Introduction
Case 1
Background
Treatment
Discussion
Case 2
Background
Treatment
Discussion
Case 3
Background
Treatment
Discussion
References
18: Periarticular and Intra-articular Fractures
Introduction
Key Concepts for Intramedullary Nailing in Peri- and Intra-articular Fracture
Advantages and Disadvantages
Reduction
Methods to Overcome Biomechanical Disadvantages
Advances in Interlocking Bolts
Cases
Case 1
Why This Did Not Work
Case 2
Why This Did Not Work
Case 3
Why This Did Not Work
Case 4
Why This Worked
Case 5
Why This Worked
Case 6
Why This Worked
Case 7
Why This Worked
Case 8
Why This Worked
Recent Biomechanical Studies Comparing IM Fixation and Plating
Conclusion
References
19: Use in Nonunions and Malunions
Introduction
Key Concepts for Intramedullary Malunion and Nonunion Repair
Manage Adjacent Joint Mobility
Determine the Etiology
Recognize the Deformity and Restore Axis
Preserve the Local Biologic Environment
Maximize Stability in the Short Segment
Case 1: Tibial Exchange Nailing
Why This Works
Case 2: Closed Femoral Shortening
Why This Works
Case 3: Tibial Diaphyseal Metaphyseal Clamshell Osteotomy
Why This Works
Case 4: Recalcitrant Distal Femur Plate Nonunion Exchanged to Nail
Why This Works
Conclusion
References
20: Use in Arthrodesis
Introduction
Key Concepts for Intramedullary Arthrodesis
Case 1
Why This Works
Case 2
Why This Works
Case 3
Why This Works
Case 4
Why This Works
Case 5
Why This Works
Case 6
Why This Works
Case 7
Why This Works
Conclusion
References
21: Intramedullary Lengthening and Compression Nails
Introduction
Preoperative Assessment
Intraoperative Execution
Postoperative Protocol
Case 1
Why This Worked
Case 2
Why This Worked
Case 3
Why This Worked
Complications
Failure to Distract
Crown Failure
Premature Consolidation
Regenerate Insufficiency
MRI Incompatibility
Corrosion and Late Failure
Compression Nail and Staged Lengthening
Conclusion
References
Index