Cover
Operative Techniques: Orthopaedic Trauma Surgery
Copyright
Dedication
Preface
Foreword
Contributors
1 - Acromioclavicular Joint Injuries: Open Reduction and Internal Fixation
Indications
Physical Examination
Imaging Studies
Surgical Anatomy
Positioning
Portals/Exposures
Procedure: Hook Plate Fixation
Step 1: Skin Incision and Surgical Dissection
Step 2: Acromioclavicular Joint Exposure and Mobilization
Step 3: Hook Plate Insertion
Step 4: Optional Coraco-Acromial (CA) Ligament Transfer
Step 5: Optional Coracoclavicular Augmentation
Step 6: Deltotrapezial and Acromioclavicular Repair
Postoperative Care and Expected Outcomes
2 - Sternoclavicular Joint Open Reduction and Internal Fixation
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures (Video 2-1)
Procedure (Video 2.1)
Step 1: Open Reduction of the SC Joint
Step 1 Controversies
Step 2: Technique 1: Suture or Autograft/Allograft TendonStabilization of the SC Joint
Step 3: Technique 2: Plate and Screw Fixation across SC Joint(Transarticular Plating)
Step 4: Closure
Postoperative Care and Expected Outcomes
3 - Fractures of the Clavicle
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Exposures
Procedure
Step 1
Step 2
Step 3
Step 4
Postoperative Care and Expected Outcomes
4 - Intramedullary Fixation of Clavicle Shaft Fractures
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
STEP 1: Preparing the Medial Fragment
STEP 2: Preparing the Lateral Fragment
STEP 3: Reduction and Final Preparation of the Canal
STEP 4: Placement of the Intramedullary Device
STEP 5: Securing the Device
Step 6: Management of Comminuted Fragments
Postoperative Care and Expected Outcomes
EVIDENCE
5 - Glenoid Fracture
Indications
Examination/Imaging
Physical Examination
Plain Radiography
Computed Tomography and Magnetic Resonance Imaging
Classification of Glenoid Fractures
Surgical Anatomy
Positioning
Portals/Exposures
Procedure: Open Reduction and Internal Fixation
Step 1
Step 2
Step 3
Step 1
Step 2
Step 3
Postoperative Care and Expected Outcomes
6 - Open Reduction and Internal Fixation of Scapula Fractures
Indications
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Clear the Fracture Lines of Clot or Debris and Mobilize Fragments
Step 2: Reduce Fracture with Provisional Fixation
Step 3: Definitive Stabilization
Step 4: Wound Closure
Postoperative Care and Expected Outcomes
EVIDENCE
7 - Open Reduction and Internal Fixation of Proximal Humerus Fractures
Indications
Absolute Indications
Specific Indications
Work-up
Physical Examination
Imaging
Surgical Anatomy
Positioning
Surgical Approach
Procedure: ORIF of Isolated GT and LT Fractures
Step 1: Fracture Reduction
Step 2: Fixation
Isolated LT Fractures (Fig. 7.10)
Procedure: ORIF of Surgical Neck Fractures
Procedure: ORIF of Complex Proximal Humerus Fractures (Anatomic Neck Fractures, Three- and Four-Part Fractures, and Fracture-Dis...
Reduction
Fixation (Locking Plate)
Nonoperative Care of Proximal Humerus Fractures
Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures
8 - Proximal Humerus: IM Nailing
Introduction
Indications
Technique
Patient and Room Positioning
Fluoroscopy Positioning and Images
Surgical Approach
Reduction Techniques
Closure
Rehabilitation Protocol
Outcomes
Conclusion
EVIDENCE
9 - Hemiarthroplasty for Proximal Humerus Fractures
Indications
Examination and Imaging
History and Physical Examination
Imaging Studies
Surgical Anatomy
Proximal Humerus
Positioning
Exposures
Procedure
Step 1: Mobilize the Tuberosities and Size the Humeral Head
Step 2: Humeral Shaft Preparation
Determine the Retroversion
Determine the Height of the Prosthesis
Step 4: Trial Reduction
Step 5: Bone Grafting and Cementing of Final Implant
Step 6: Tuberosity Repair and Closure
Postoperative Care and Expected Outcomes
Postoperative Care
Expected Outcomes
Complications
10 - Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures
Indications
Indications Controversies
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
STEP 1: Glenoid Preparation and Baseplate Implantation
STEP 2: Humeral Canal Preparation and Stem Trial
STEP 3: Implantation of Final Humeral Components
STEP 4: Repair of the Tuberosities
STEP 5: Closure
Postoperative Care and Expected Outcomes
11 - Humeral Shaft Fractures: Open Reduction and Internal Fixation
INDICATIONS FOR OPEN REDUCTION AND INTERNALFIXATION (ORIF)
INDICATIONS FOR HUMERAL INTRAMEDULLARY (IM) NAILING
Examination/Imaging
Surgical Anatomy
Positioning
For Open Reduction and Internal Fixation
Portals/Exposures
Procedure: Open Reduction and Internal Fixation
Step 1
Step 2
Step 3
Postoperative Care and Expected Outcomes
EVIDENCE
12 - Intramedullary Nailing of Humeral Shaft Fractures
Indications
Examination/Imaging
Positioning
Portals/Exposures
Procedure (Antegrade IM nailing)
Step 1
Step 2
Step 3
Step 4
Step 5
Procedure (Retrograde IM Nailing)
Step 1
Step 2
Step 3
Step 4
Step 5
Postoperative Care and Expected Outcomes
EVIDENCE
13 - Open Reduction and Internal Fixation of Intraarticular Fractures of the Distal Humerus
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Postoperative Care and Expected Outcomes
EVIDENCE
14 - Arthroplasty in Supracondylar Humeral Fractures
Treatment Options in Distal Humerus Fracture
The Role of Arthroplasty
Evidence
Indications
Total Elbow Arthroplasty
Hemiarthroplasty
Examination
Imaging
Surgical Anatomy
Positioning
Controversies in Approach
Exposure for TEA
For Triceps-on Technique
Total Elbow Arthroplasty Procedure
Step 1: Humeral Preparation
Step 2: Ulnar Preparation
Step 3: Trial Reduction
Step 4: Insertion and Cementing of the Final Prosthesis
Step 5: Wound Closure
Postoperative Care and Expected Outcomes
Hemiarthroplasty Procedure
Exposure for Hemiarthroplasty
Step 1: Reconstruction of Condyles and Epicondyles
Step 2: Humeral Preparation
Step 3: Closure and Postoperative Management
EVIDENCE
15 - Terrible Triad Injuries of the Elbow: Open Reduction Internal Fixation
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Skin Incision
Deep Exposure
Procedure
Step 1: Treatment of the Coronoid Fracture
Step 2: Treatment of the Radial Head Fracture
Step 3: Repair of the Lateral Collateral Ligament
Step 4: Repair of the Medial Collateral Ligament
STEP 5: External Fixator Application
Additional Steps
Postoperative Care and Expected Outcomes
Rehabilitation
Outcomes
EVIDENCE
16 - Traumatic Elbow Dislocation
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Repair of LCL
Step 2: Repair of MCL
Step 3: Reconstruction of LCL/MCL
Step 4: External Fixator
Postoperative Care and Expected Outcomes
Rehabilitation
Outcomes
EVIDENCE
17 - Radial Head and Neck Fractures: Open Reduction and Internal Fixation
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Exposures
Procedure
Step 1
Step 2
Step 3
Postoperative Care and Expected Outcomes
EVIDENCE
18 - Open Reduction and Internal Fixation of Fractures of the Anteromedial Facet of the Coronoid
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Repair of Medial-Sided Injury: Anteromedial Coronoid Fracture
STEP 2: REPAIR OF LATERAL-SIDED INJURY: LATERALCOLLATERAL LIGAMENT INJURY
STEP 3: REPAIR OF BASILAR CORONOID FRACTURE WITH OLECRANON FRACTURE
POSTOPERATIVE CARE AND EXPECTED OUTCOMES
EVIDENCE
19 - Radial Head Arthroplasty
Introduction
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1:Preparation
Step 2:Radial Head Sizing
Step 3:Placement and Closure
Postoperative Care and Expected Outcomes
EVIDENCE
20 - Open Reduction and Internal Fixation of Olecranon Fractures
Indications
Examination/Imaging
Surgical Anatomy
Classification and Choice of Fixation Technique
Positioning
Portals/Exposures
Procedure: Tension Band Technique
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Alternative Modes of Fixation
Oblique Fracture
Comminuted Fracture with Joint Depression
Grossly Comminuted Fracture
Postoperative Care and Expected Outcomes
EVIDENCE
21 - Open Reduction and Internal Fixation of Forearm Fractures
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Approach to the Ulna
Procedure
Step 1: Preparation for Fixation
Step 2: Fixation
Step 3: Fluoroscopic Verification and Closure
Postoperative Care and Expected Outcomes
EVIDENCE
22 - Open Reduction and Internal Fixation of Monteggia and Galeazzi Fractures
Monteggia Fractures
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Step 1
Step 2: Open Reduction
Step 3: Internal Fixation
Step 4
Postoperative Care and Expected Outcomes
Galeazzi Fracture of the Forearm in Adult
Introduction
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Step 1: Skin Incision Planification
Step 2: Henry Volar Approach
Step 3: Fixation of the Radius
Step 4: Evaluation of the DRUJ Needs to be Done after Fixation of the Radius
Step 5: Open Reduction and Internal Fixation of the Ulna Styloid
Postoperative Care and Expected Outcomes
EVIDENCE
Monteggia Fractures
Galeazzi Fractures
23 - Distal Radius Fractures
External Fixation
Indications
Contraindications
Examination/Imaging
Physical Examination
Imaging Studies
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Closed Reduction to Correct Significant Deformity
Step 2: Placement of Proximal Fixator Pins
Step 3: Placement of Distal Fixator Pins
Step 4: Assembly of Fixator Frame
Postoperative Care and Expected Outcomes
Postoperative Care
Expected Outcomes
EVIDENCE
24 - Distal Radius Fracture: Open Reduction and Internal Fixation
Indications
Examination and Imaging
Surgical Anatomy
Osseous Anatomy
Volar Surgical Anatomy
Dorsal Surgical Anatomy
Positioning
Portals/Exposures
Volar Exposure
Dorsal Exposure
Procedure
Step 1: Initial Reduction
Step 2: Articular Reduction
Step 3: Provisional Fixation
Step 4: Volar Plate Application
Step 5: Dorsal Plate Application
Step 6: Fragment-Specific Fixation
Step 7: Spanning Plate Fixation
Step 8: Closure and Imaging
Postoperative Care and Expected Outcomes
Postoperative Care
Expected Outcomes
EVIDENCE
25 - Scaphoid Fracture Fixation
Indications
Examination and Imaging
Classification
Surgical Anatomy
Positioning
Portals/Exposures
Equipment
Procedure: Open Volar Approach
Step 1: Incision
Step 2: Superficial Dissection
Step 3: Deep Dissection
Step 4: Reduction
Step 5: Fixation
Step 6: Closure
Procedure: Open Dorsal Approach
Step 1: Incision
Step 2: Superficial Dissection
Step 3: Deep Dissection
Step 4: Reduction
Step 4 Controversies
Step 5: Fixation
Step 6: Closure
Procedure: Percutaneous Volar Approach
Step 1: Approach
Step 2: Insertion of Guidewire
Step 3: Fixation
Procedure: Percutaneous Dorsal Approach
Step 1: Approach
Step 2: Insertion of the Guidewire
Step 3: Fixation
Postoperative Care and Expected Outcomes
EVIDENCE
Procedure 26 - Dorsal Approach for Open Reduction Internal Fixation of Perilunate Fractures and Dislocations
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Postoperative Care And Expected Outcomes
27 - Open Reduction and Internal Fixation of Fractures and Dislocations of the Hand
GENERAL Indications
Examination
General Imaging
Imaging for Specific Injury Patterns
Surgical Anatomy
Positioning
Fixation of Extra-Articular Fractures of the Tubular Bones of the Hand
Illustrative Examples
Procedure: Closed Reduction and Percutaneous Pinning of Metacarpal Neck Fractures
Specific Indications
Portals/Exposures
Step 1: Closed Reduction of the Metacarpal Neck
Step 2: Fluoroscopic Assessment of Reduction
Step 3: Percutaneous K-wire Fixation
Step 4: Final Assessment
Additional Steps
Procedure: Lag Screw Fixation of Proximal Phalangeal Shaft Fractures
Specific Indications
Unstable fractures
Portals/Exposures
Step 1: Reduction and Provisional Fixation
Step 2: Clinical and Radiographic Assessment of Reduction
Step 3: Definitive Fixation
Step 4: Final Assessment
Step 5: Closure
Additional Steps
Procedure: Open Reduction Plate Fixation of Metacarpal Shaft Fractures
Specific Indications
Portals/Exposures
Step 1: Reduction and Initial Fixation
Step 2: Clinical and Fluoroscopic Assessment
Step 3: Definitive Fixation
Step 4: Final Assessment
Step 5: Closure
Additional Steps
ORIF of Periarticular Fractures and Dislocations of the CMC, MCP and IP Joints of the Hand
Illustrative Examples
Procedure: Open Reduction and Internal Fixation of First CMC Joint Fracture-Dislocations (Bennett Fracture)
Specific Indications
Portals/Exposures
Step 1: Closed Reduction and Provisional Fixation
Step 2: Clinical and Radiographic Assessment of Reduction
Step 3: Definitive Fixation
Step 4: Final Assessment
Step 5: Closure
Additional Steps
Procedure: Open Reduction and Internal Fixation of PIP Joint Fracture-Dislocations
Specific Indications
Portals/Exposures
Step 1: Reduction and Provisional Fixation
Step 2: Clinical and Radiographic Assessment of Reduction
Step 3: Definitive Fixation
Step 4: Final Assessment
Step 5: Closure
Additional Steps
Postoperative Care and Expected Outcomes
Postoperative Care
Expected Outcomes
Procedure 28 - Femoral Neck: Closed Reduction and Internal Fixation (CRIF)
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Closed Reduction
Step 2: Guidewire Insertion
Step 3: Screw Predrilling
Step 4: Screw Insertion
Step 5: SHS Plate Application
Additional Steps
Postoperative Care and Expected Outcomes
29 - Femoral Neck: Open Reduction and Internal Fixation
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure: Closed Reduction and Internal Fixation
Step 1: Closed Reduction
Procedure: Open Reduction and Internal Fixation
Step 1: Open Reduction
Step 2: Internal Fixation
Step 2: Sliding Hip Screw
Step 2: Internal Fixation with Multiple Cannulated Screws
Postoperative Care and Expected Outcomes
Complications
Procedure 30 - Treatment of Hip Dislocations and Femoral Head Fractures
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Gibson Approach
Step 2: Trochanteric Osteotomy and Surgical Dislocation
Step 3: Fracture Preparation and Fixation
Step 4: Osteotomy Repair and Closure
Postoperative Care and Expected Outcomes
Procedure 31 - Femoral Neck Fractures: Hemiarthroplasty
Indications
Examination/Imaging
Surgical Anatomy
Preoperative Planning
Positioning
Portals/Exposures
Procedure
Step 1: Femoral Neck Cut and Excision of Femoral Head
Step 2: Bone Preparation and Trialing
Step 3: Implantation and Reduction
Step 4: Closure
Postoperative Care and Expected Outcomes
Procedure 32 - Femoral Neck Fractures: Arthroplasty
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Femoral Neck Cut and Excision of Femoral Head
Step 2: Preparation of the Acetabulum
Step 3: Cup, screw and Liner Implantation
Step 4: Femoral Bone Preparation and Trialing
Step 5: Stem Implantation and Reduction
Step 6: Closure
Postoperative Care and Expected Outcomes
Procedure 33 - Unstable Intertrochanteric Hip Fractures Plate Fixation
Sliding Hip Screw
Introduction
Examination/Imaging
Surgical Anatomy
Positioning
Exposure
Procedure
Step 1: Reduction
Step 2
Step 3: Measure, Ream, Insert the Screw and the Plate
Step 4: Trochanteric Stabilizing Plate (TSP) Placement
Step 5: Closure
Postoperative Care and Expected Outcomes
34 - Intertrochanteric Hip Fractures: Intramedullary Nailing
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Obtaining Reduction
Step 2: Start Point/Canal Preparation
Step 3: Nail Insertion
Step 4A: Sliding Screw Placement
Step 4B: Blade Placement
Step 5: Locking Screw Placement
Postoperative Care and Expected Outcomes
Procedure 35 - Open Reduction and Internal Fixation of Subtrochanteric Fractures
Indications
Examination and Imaging
Positioning
Procedure
Step 1: Plan Device Size and Position
Step 2
Step 3
Step 4
Step 5
Procedure 36 - Subtrochanteric Femur Fractures: Intramedullary Nailing
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Step 4
Step 5
Postoperative Care and Expected Outcomes
Procedure 37 - Femoral Shaft Fractures: Intramedullary Nailing
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Step 4
Step 5
Postoperative Care and Expected Outcomes
38 - Femoral Shaft Uniplanar and Multiplanar Plating
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Fracture Reduction
Step 2: Lateral Plating of the Reduced Femoral Fracture
Step 3: Multiplanar Fixation (If Required)
Step 4: Wound Closure
Postoperative Care and Expected Outcomes
Procedure 39 - Supracondylar Femur Fractures
Open Reduction and Internal Fixation
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Exposure
Procedure
Step 1: Temporary Anatomic Reduction of the Joint
Step 2: Definitive Articular Stabilization
Step 3A: Control of the Condyles with the Plate (Distal Fixation)
Step 3B: Plating Technique
Step 3C: Alternative Devices for Distal Fixation
Postoperative Care and Expected Outcomes
Acknowledgments
40 - Supracondylar Femur Fractures: Retrograde Intramedullary Nailing
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Postoperative Care and Expected Outcomes
Procedure 41 - Knee Dislocations
Indications
Urgent—Within Hours
Semi-urgent/Emergent—Within Days
Elective—Within Weeks to Months
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Graft Harvest/Preparation
Step 2: Drilling Tunnels
Step 3: Graft Fixation
Postoperative Care and Expected Outcomes
42 - Operative Treatment of Fractures of the Patella
Indications
Examination/Imaging
Physical Examination
Imaging Studies
Surgical Anatomy
Positioning
Portals/Exposures
Step 1
Step 1
Step 2
Procedure: Anterior Tension Band Technique
Step 1
Step 1
Step 2
Step 3
Step 4
Variations
Procedure: Lag Screws
Step 1
Step 2
Step 3
Variations
Procedure: Cerclage Wiring
Multiple Fragment Fractures
Multiple Major Fracture Lines
Inferior Pole Fractures
Procedure: Plate Fixation (Locked plating)
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Procedure: Patellectomy (Partial and Total)
Partial Patellectomy: Superior and Inferior Poles
Postoperative Care and Expected Outcomes
Procedure 43 - Patella Fractures: Plating
Indications
Nonoperative Indications
Operative Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Lateral Parapatellar Approach and Temporary Reduction
Procedure
Step 1: Plate Preparation
Step 2: Plate Placement and Screw Fixation
Postoperative Care and Expected Outcomes
Procedure 44 - Proximal Tibia ORIF: Anterior Approaches
Indications
Examination/Imaging
Physical Examination
Imaging Studies
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Reduction of the Articular Surface
Step 2: Placement of Bone Graft or Bone Graft Substitute
Step 3: Fixation of Articular Surface
Step 4: Definitive Stabilization
Step 5: Closure
Postoperative Care and Expected Outcomes
Postoperative Care
Expected Outcomes
45 - Fractures of the Posterior Tibial Plateau
Posteromedial Approach
Indications
Examination/Imaging
Plain X-Rays (AP/LAT) (Fig. 45.1A–B)
Computed Tomography (CT) (Fig. 45.2)
CT Angiogram
Magnetic Resonance Imaging (MRI) (Fig. 45.3)
Surgical Anatomy
Positioning
Portals/Exposures
Procedure : Posteromedial approach to the posterior surface of the proximal tibia
Step 1
Step 2
Step 3
Step 4
Step 5
Postoperative Care and Expected Outcomes
Posterolateral Approach
Indications
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Step 4
Step 5
Postoperative Care and Expected Outcomes
Procedure 46 - Proximal Tibia Fractures: Infrapatellar Intramedullary Nailing
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Entry Point and Entry Reaming
Step 2: Fracture Reduction and Provisional Fixation
Step 3: Reaming and Nail Insertion
Postoperative Care and Expected Outcomes
Procedure 47 - Proximal Tibia Fractures: Suprapatellar
Introduction and Treatment Options
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1 Starting Point and Starting Trajectory
Step 2 Opening Reaming and Guidewire Insertion
Steps 3 and 4 Reduction Tricks and Reaming
Steps 5 and 6 Nail Insertion and Distal Interlocks
Step 7 Incision Closure
Postoperative Care and Expected Outcomes
Procedure 48 - Proximal Tibia Fractures: Spanning + Definitive External Fixation
Spanning External Fixation
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Postoperative Care and Expected Outcomes
Definitive External Fixation
Circular External Fixation
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Postoperative Care and Expected Outcomes
Procedure 49 - Tibial Shaft Fractures: Intramedullary Nailing
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
STEP 1: Reduction and Guidewire Insertion
STEP 2: Reaming and Measurement
STEP 3: Fixation
Postoperative Care and Expected Outcomes
Procedure 50 - Plate Fixation of Tibial Shaft Fractures
Indications
Examination/Imaging
Physical Examination
Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Open Reduction
Percutaneous Reduction
Procedure 1: Open Reduction and Plate Fixation
Preoperative Planning: Deciding Where to Apply the Plate
Preoperative Planning: Choice of Implant
Step 3: Surgical Exposure
Step 4: Fracture Reduction
Step 5: Implant Contouring
Step 6: Fracture Fixation
Step 7: Final Intraoperative Imaging
Procedure 2: Percutaneous Reduction and Plate Fixation for Proximal Tibial Metaphysis and Shaft Fractures
Step 1: Preoperative Planning: Deciding Where to Apply the Plate
Step 2: Preoperative Planning: Choice of Implant
Step 3: Surgical Exposure
Step 4: Fracture Reduction
Step 5: Implant Contouring
Step 6: Plate Insertion
Step 7: Fracture Fixation
Step 8: Final Intraoperative Imaging
Procedure 3: Percutaneous Reduction and Plate Fixation for Distal Tibial Metaphysis Fractures
Step 1: Reduction and Fixation of Fibular Fracture
Step 2: Plate Contouring
Step 3: Tibial Plate Insertion and Fracture Reduction
Step 4: Screw Placement in the Tibial Plate
Step 5: Final Intraoperative Imaging
Postoperative Care and Expected Outcomes
Postoperative Care
Expected Outcomes
Evidence
Procedure 51 - Tibial Pilon Fractures: ORIF Anterior Approaches
Indications
Examination/ Imaging
Surgical Anatomy (Fig. 51.3)
Positioning
Direct Anterior Approach
Anteromedial Approach
Anterolateral Approach
Procedure
Step 1: Bridging External Fixation
Step 2: Anatomic Reduction of Joint Surface
Step 3: Anterior/Anterolateral Plating
Step 4: Medial Plating
Step 5: Wound Closure
Postoperative Care and Expected Outcomes
52 - Tibial Pilon Fractures: ORIF Posterior Approaches
Examination/Imaging
Surgical Anatomy
Positioning
STEP 1: Skin Incision and Superficial Dissection
STEP 2: Deep dissection
STEP 3: Fracture Reduction and Provisional Fixation
STEP 4: Definitive Fracture Fixation and Wound Closure
Postoperative Care and Expected Outcomes
Procedure 53 - External Fixation of Distal Tibial Fractures
Indications
Examination/Imaging
Treatment Options
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Fibular Fracture: Reduction and Fixation
Step 2: Tibial Fracture: Reduction and Internal Fixation
Step 3A: Tibial Fracture: Spanning External Fixation
Step 3B: Tibial Fracture: Nonspanning External Fixation
Postoperative Care and Expected Outcomes
Procedure 54 - Operative Management of Ankle Fractures
Indications
Treatment Goal
Surgical Options
Initial Assessment
Physical Examination
Imaging Studies
Surgical Anatomy
Positioning
Surgical Approaches
Procedure
Repair of the Fibula
Medial Malleolus Repair
Posterior Malleolus and Syndesmosis
Posterior Malleolus Repair
Assessment and Stabilization of the Syndesmosis
Postoperative Care and Expected Outcomes
Postoperative Care
Expected Outcomes
Procedure 55 - Ankle Fractures: Syndesmosis and Posterior Approaches
Ankle Fractures—Syndesmosis
Background
Anatomy
Classification System
Indications
Examination/Imaging
Imaging
Positioning
Exposures and Approaches
Step 1: Malleolar Reduction and Fixation
Step 2: Intraoperative Syndesmosis Disruption and Stability Testing
Step 3: Open Anterior Syndesmotic Reduction
Step 4: Syndesmotic Stabilization
Syndesmotic Screw Stabilization
Evidence: Syndesmotic Screw Stabilization
Dynamic Syndesmotic Suture Button Fixation
Evidence: Suture-Button Fixation
Anterior Inferior Tibiofibular Ligament Repair
Posterior Inferior Tibiofibular Ligament Repair (as described by Little et al., 2015)
Evidence: Posterior Inferior Tibiofibular Ligament Repair
Intraoperative Syndesmosis Assessment: Following Fixation
Deltoid Ligament Repair
Postoperative Management
Evidence: Postoperative Management
Outcomes: Syndesmosis
Ankle Fractures—Posterior Approaches
Introduction
Surgical Anatomy
Indications
Positioning
Approach (Fig. 55.15)
Indications
Positioning
Approach
Procedure 56 - Fractures of the Talus: Screw Fixation
Introduction
Indications
Examination/Imaging
Surgical Anatomy
Procedure: Talar Neck Fracture
Step 1: Positioning
Step 2: Approach
Step 2.1: Anteromedial Approach
Step 2.2: Anterolateral Approach
Step 2.3: Posterolateral Approach
Step 3: Reduction
Step 4: Fixation
Step 4.1: Anterior-to-Posterior Fixation
Step 4: Closure and Splinting
Procedure: Talar Body Fractures
Step 1: Approach
Step 2: Reduction and Fixation
Step 3: Closure
Step 3: Closure
Step 4: Follow-up
Procedure: Lateral Process Fractures
Step 1: Approach
Step 2: Fracture Assessment and Screw Fixation
Procedure: Posterior Process Fractures
Step 1: Approach
Step 2: Screw Fixation
Postoperative Care
Evidence: Implant and Technique Specific
Expected Clinical Outcomes
Procedure 57 - Talus Fractures: Open Reduction and Internal Fixation (Plating)
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 4: Provisional Fixation
Step 5: Final Fixation
Additional Steps
Postoperative Care and Expected Outcomes
Procedure 58 - Calcaneus Fractures: Open Reduction and Internal Fixation
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Step 4
Step 5
Postoperative Care and Expected Outcomes
Procedure 59 - Repair of Tarsometatarsal Joint (Lisfranc) Fracture Dislocation
Indications
Examination/Imaging
Physical Examination
Imaging Studies
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Postoperative Care and Expected Outcomes
Procedure 60 - Compartment Syndrome
Indications
Pathophysiology of Acute Compartment Syndrome
Examination/Imaging
Clinical Diagnosis
Compartment Pressure Monitoring
Surgical Anatomy
Positioning
Exposures
Step 1
Step 2
Step 3
Procedure: Single-Incision Fasciotomy for the Leg
Step 1
Step 2
Step 3
Procedure: Two-Incision Fasciotomy for the Leg
Step 1
Step 2
Step 3
Step 4
Procedure: The Thigh
Step 1
Step 2
Procedure: The Hand
Step 1
Step 2
Step 3
Procedure: The Forearm
Step 1
Step 2
Step 3
Step 4
Procedure: The Upper Arm
Step 1
Step 2
Step 3
Postoperative Care and Expected Outcomes
Procedure 61 - Pelvic External Fixation
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposure
Supra-acetabular pins
Iliac crest pins
Procedure
Step 1: Determination of Hemipelvis Orientation
Step 2: Pin Placement
Step 3: Reduction and External Frame Application
Postoperative Care and Expected Outcomes
62 - Pelvic Supraacetabular External Fixation
Indications
Indications Controversies
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
STEP 1: Pin Insertion
STEP 2: Pelvic Reduction and Frame Assembly
Postoperative Care And Expected Outcomes
Procedure 63 - Anterior Pelvic Internal Fixation
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Reduction
Step 2: Fixation
Step 3: Closure
Postoperative Care and Expected Outcomes
64 - Acetabulum Fracture Fixation Through the Anterior Intrapelvic (Stoppa) Approach
Open Reduction and Internal Fixation Using the Anterior Intrapelvic (AIP) Approach
Introduction
Indications
Examination/Imaging
Physical Examination
Plain Radiography
Computed Tomography and Magnetic Resonance Imaging
Classification of Acetabulum Fractures
Surgical Anatomy
Positioning
Procedure: Anterior Intrapelvic Approach
Procedure: Reduction and Fixation
Approach
Reduction
Fixation
Indications
Positioning and Draping
Approach
Postoperative Care and Expected Outcomes
Classification and Epidemiology
AIP Approach
Clinical Studies
Iliac Window
ASIS Osteotomy
Procedure 65 - Sacroiliac Joint Injuries: Iliosacral Screws
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Step 4
Step 5
Postoperative Care and Expected Outcomes
Procedure 66 - Open Reduction and Internal Fixation of Intraarticular Iliac Fracture-Subluxation (Crescent Fracture)
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Step 3
Step 4
Postoperative Care and Expected Outcomes
Procedure 67 - Open Reduction and Internal Fixation of Sacral Fractures
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Exposures
Procedure
Step 1: Reduction
Step 2: Iliosacral Screw Insertion
Postoperative Care and Expected Outcomes
Procedure 68 - Anterior Approaches to the Acetabulum
Indications
Surgical Anatomy
Ilioinguinal approach
Anterior Intrapelvic Approach (Modified Stoppa Approach)
Positioning
Portals/Exposures
Step 1
Step 2
Step 3
Step 4
Step 5
Step 1
Step 2
Step 1
Step 2
Procedure
Case 1: Anterior Column
Reduction
Case 2: Anterior Column Plus Posterior Hemi-Transverse
Reduction
Case 3: Anterior Wall
Reduction
Case 4: Associated Both-Column Fracture
Reduction
Additional Steps
Postoperative Care and Expected Outcomes
Postop Evaluation
Surgeon Volume
Delay to Surgery
Procedure 69 - Posterior Approach to the Acetabulum
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Reduction and Fixation of Columns
Step 2: Reduction and Fixation of Posterior Wall
Step 3: Wound Closure
Postoperative Care and Expected Outcomes
Procedure 70 - Surgical Dislocation of the Hip for the Treatment of Fractures
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Reduction
Step 2: Anterior Fixation
Step 3
Step 4: Femoral Head Fractures
Step 5: Closure
Procedure 71 - Posterior Wall Acetabular Fracture
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Exposures
Procedure
Step 1
Step 2
Step 3
Step 4
Step 5
Postoperative Care and Expected Outcomes
Anchor 388
Anchor 389
Fig. 71. 18
Anchor 391
Anchor 392
Fig. 71. 19
Anchor 394
Anchor 395
Anchor 396
Fig. 71. 20
Anchor 398
Anchor 399
Anchor 400
Fig. 71. 22
Anchor 402
Anchor 403
Anchor 404
Fig. 71. 21
Anchor 406
Anchor 407
Anchor 408
Fig. 71. 23
Anchor 410
Anchor 411
Anchor 412
Fig. 71. 24
Anchor 414
Anchor 415
Anchor 416
Fig. 71. 25
Anchor 418
Fig. 71. 26
Procedure 72 - Cervical Spine: Anterior and Posterior Stabilization
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Anterior Approach (Fig. 72.6A)
Posterior Approach (Fig. 72.6B)
Anterior
Posterior
Anterior
Posterior
Direct Odontoid Screw Fixation for Odontoid Fractures
Posterior C1-C2 Fixation for Instability
Postoperative Care and Expected Outcomes
PROCEDURE 73 - Thoracolumbar Spine Injuries
Indications
Examination/Imaging
Surgical Anatomy
Posterior Approach
Anterolateral Approach
Positioning
Posterior Approach
Anterolateral Approach
Portals/Exposures
Posterior Approach
Anterolateral Approach
Procedure: Posterior Approach
Step 1
Step 2
Step 3
Procedure: Anterolateral Approach
Step 1: Staple/Screw Insertion and Diskectomies
Step 2: Decompression
Step 3: Vertebral Body Reconstruction and Fusion
Postoperative Care and Expected Outcomes
Procedure 74 - Treatment of Open Fractures
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Procedure
Step 1: Debridement
Step 2: Wound Irrigation
Step 3: Antibiotic Treatment
Step 4A: Wound Coverage
Step 4B: Surgical Stabilization
Step 5: Wound Closure
Postoperative Care and Expected Outcomes
Fixation of Periprosthetic Femoral Fractures Using Locked Plates Combined with Minimally Invasive Insertion
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Alternative Positioning
Portals/Exposures
Procedure: Retrograde Plate Insertion
Step 1: Plate Insertion and Positioning
Antegrade Plate Insertion
Step 2: Indirect Fracture Reduction
Step 3: Definitive Plate Fixation
Postoperative Care and Expected Outcomes
Procedure 76 - Cable Plating Combined with Cortical Strut Allograft (90-90 Fixation) for the Treatment of Vancouver B1 Periprosthetic Femur Fractures
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Assessment of Implant Stability and Fracture Reduction
Step 2: Plate Application
Step 3: Allograft Preparation
Step 4: Allograft Placement and Cable Passage
Step 5: Final Proximal and Distal Screw Placement
Step 6: Cancellous Allograft Placement and Closure
Postoperative Care and Expected Outcomes
Procedure 77 - Periprosthetic Distal Femur Fractures: IM Nailing/Plating
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Procedure
Step 1
Step 2
Step 3
Step 4
Positioning
Portals/Exposures
Procedure
Step 1
Step 2A
Step 2B
Postoperative Care and Expected Outcomes
Procedure 78 - Acetabular Fractures: Acute Total Hip Arthroplasty (THA)
Introduction and Indications
Acute THA Alone
ORIF and THA Through an Anterior Approach
ORIF and THA Through a Posterior Approach
Positioning, Exposures, and Surgical Anatomy
Acute THA Alone
ORIF and THA Through an Anterior Approach
ORIF and THA Through a Posterior Approach
Procedure
Acute THA Alone
ORIF and THA Through an Anterior Approach
ORIF and THA Through a Posterior Approach
ORIF With the Femoral Head in Place
ORIF With the Femoral Head Resected
Total Hip Arthroplasty
Postoperative Care and Expected Outcomes
Procedure 79 - Total Hip Replacement for Intertrochanteric Hip Fractures
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1
Step 2
Postoperative Care and Expected Outcomes
Procedure 80 - Fractures Around the Knee: Acute Total Knee Arthroplasty (TKA)
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Preparation of the Distal Femur
Step 2: Preparation of the Proximal Tibia
Step 4: Implanting Definitive Components
Step 5: Closure
Postoperative Care and Expected Outcomes
81 - Nonunion
Indications
Examination/Imaging
Surgical Anatomy
Positioning
Procedure
Step 1: Exchange Nailing of Tibial Nonunion
Step 2: Augmentation Plating of Femoral Shaft Nonunion
Step 3: Revision ORIF and Bonegrafting Subtrochanteric Nonunion
Postoperative Care And Expected Outcomes
Procedure 82 - Use of the Reamer Irrigator Aspirator (RIA) for Bone Graft Harvesting
Indications
Examination/Imaging
Treatment Options
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Bone Graft Recipient Site Preparation
Additional Steps: Retrograde Femoral RIA Bone Graft Harvest
Postoperative Care and Expected Outcomes
Procedure 83 - Malunion
Procedure
Step 1: Deformity Correction for Valgus Malunion of Distal Femoral Fracture
Examination/ Imaging
Surgical Anatomy
Positioning
Portals/Exposures
Procedure
Step 1: Distal Femoral Lateral “Swashbuckler” Approach
Step 2: Previous Implant Removal
Step 3: Location of the Osteotomy Site
Step 4: Correction of Valgus Deformity and Shortening
Step 5: Osteotomy Fixation
Postoperative Care and Expected Outcomes
Procedure 84 - Surgical Fixation of Chest Wall Injuries
Indications
Examination and Imaging
Surgical Anatomy
Positioning
Exposures
Procedure
Step 1
Step 2
Step 3
Postoperative Care
Expected Outcomes
Procedure 85 - Optimizing Perioperative Fracture Care
Advanced Trauma Life Support*
Indications
Examination/Imaging
Procedure
Step 1: Airway
Step 2: Breathing
Step 3: Circulation
Step 4: Disability (Neurologic Status)
Step 5: Exposure/Environment
Step 6: Secondary Survey and Transfer Decision
Logrolling Mobilization Technique
Indications
Positioning
Procedure
Step 1: Positioning
Step 2: Logrolling
Step 3: Posterior Examination
Step 4: Repositioning
Initial Care of The Injured Limb
Limb Immobilization
Step 1
Step 2
Step 3
Immobilization of Other Injuries
Pain Management
Walking Aids
Thromboprophylaxis and Fracture
Current Recommendations
Antibiotic Prophylaxis and Tetanus Prevention
Current Recommendations
Psychological Reaction to Injury
Posttraumatic Stress Disorder
Risk Factors for PTSD
The Orthopedic Surgeon’s Responsibility
Secondary Prevention
Prevention of Sport- and Accident-Related Injury
Risk Factors for Recidivism of Injury
Modalities That Can Decrease the Risk of Injury
Intimate Partner Violence (IPV)
Risk Factors for a Woman to be a Victim of IPV
Red Flags of IPV
Recommendations
Osteoporosis
Definitions and Assessment
Medications
Advanced Trauma Life Support
Limb Immobilization
Thromboprophylaxis and Fracture
Antibiotic Prophylaxis and Tetanus Prevention
Psychological Reaction to Injury
Secondary Prevention: Prevention of Injury
Secondary Prevention: Intimate Partner Violence
Secondary Prevention: Osteoporosis