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After the publication of the AO book Technique of Internal Fixation of Fractures (Miiller, Allgower and Willenegger, Springer-Verlag, 1965), the authors decided after considerable discussion amongst themselves and other members of the Swiss AO that the next edition would appear in three volumes. In 1969, the first volume was published (the English edition, Manual of Internal Fixation, appeared in 1970). This was a manual of surgical technique which discussed implants and instruments and in which the problems of internal fixation were presented schematically without radio logical illustrations. The second volume was to be a treatise on the biomechanical basis of internal fixation as elucidated by the work done in the laboratory for experi mental surgery in Davos. The third volume was planned as the culminating effort based upon the first two volumes, treating the problems of specific fractures and richly illustrated with clinical and radiological examples. It was also to discuss results of treatment, comparing the results obtained with the AO method with other methods. The second and third volumes were never published. The second edition of the AO Manual appeared in 1977. It dealt in greater detail with the problems discussed in the first edition, although it still lacked clinical exam ples and any discussion of indications for surgery. Like the first edition, it was trans lated into many languages and was well received. Finally, after 22 years, the much discussed and much needed third volume has appeared.
During the past 30 years, the Study Group for the Problems of Osteosyn thesis (AO) has made decisive contributions to the development of osteo synthesis as a surgical method. Through close cooperation among special ists in the fields of orthopedic and general surgery, basis research, metallurgy, and technical engineering, with consistently thorough follow up, it was possible to establish a solid scientific background for osteosyn thesis and to standardize this operative method, not only for the more ob vious applications in fracture treatment, but also in selective orthopedics where hardly any problems relating to bone, such as those with osteoto mies can be solved without surgical stabilization. Besides the objective aim, the AO was additionally stimulated by a spirit of open-minded friendship; each member of the group was recruited according to his pro fessional background and position, his skills, and his talent for improvisa tion. Against this backdrop without even mentioning the schooling program well known throughout the world I should like to add some personal and general comments. This book is written for clinicians, instructing them how to perform osteo synthesis with special reference to plating in all its varieties and in strict accordance with the biomechanical and biological aspects and facts. From this point of view, the chapter on preoperative planning merits par ticular emphasis. Not only is it conductive to optimal surgery, it will also contribute to self-education and may found a school.
It is to the great and lasting credit of LORENZ BOHLER and his school that they have in the last decade developed and demonstrated so thoroughly the techniques for the conservative management of fractures. Nevertheless there have always been many, including some from BOHLER'S school, who have found considerable place for surgical management, and with the significant progress in general surgery seen in postwar years, a new stimulus has been given to this part of traumatic surgery, especially since bone injuries have become more complex and frequent. The concept of internal fixation is not new. The serious criticisms that have been levelled at it retain today their basic significance. Progress in the fields of asepsis, corrosion-free metal implants, operative experience and postoperative care has diminished the dangers but has not relieved the surgeon of responsibility. The Association for the Study of the Problems of Internal Fixation (AO) has devoted itself over a number of years to the basic principles and best methods of open treatment of fractures by means of extended clinical and scientific studies in order to determine in each individual case the most promising line of treatment. At the same time a well designed and tested instrument set has been developed with precise instructions for the appropriate techniques. As a result, the new observations about primary bone healing which have emerged from the practice of rigid internal fixation are as interesting as the uses to which they can be put in allowing early mobilization.
Reoperative Hand Surgery is a major contribution to the literature, offering a wide range of reoperative options for challenging problems that face the reconstructive hand surgeon after failed primary surgery. Concise and discussing all of the more common issues that hand surgeons often face in performing revision surgery, this invaluable title is unique in that it looks specifically at the problem of what to do when the original index procedure did not go as planned. Topics covered include the hand, wrist, forearm and elbow, and several sections of the book discuss some of the psychological and social factors that also go into the decision process to reoperate or not. The chapters are tightly focused so that the important aspects to consider for reoperation can be quickly reviewed. There is also a component that discusses how to avoid other pitfalls and to minimize as well as manage any complications that may occur with reoperative procedures. Importantly, the book is replete with original art work to help describe and demonstrate how to perform many reoperative procedures. The artwork is simple and straightforward but yet detailed enough to convey the important steps and aspects for the surgical intervention it is outlining. Developed by renowned experts in the hand surgery field, Reoperative Hand Surgery is an indispensable, state-of-the-art reference, offering the busy hand and upper extremity surgeon easily accessible information relating to the evaluation, diagnosis, and possible surgical interventions for the diagnoses discussed.
The AOjASIF* dynamic hip screw (DRS) has been designed primarily to stabilize trochanteric fractures of the hip. Selected fractures of the femoral neck and some subtrochanteric fractures are further indications for the DRS [40, 46]. The dynam ic condylar screw (DCS) has been developed for fractures of the distal femur and is now being tested clinically. The DRS and DCS are carefully coordinated with the preexisting ASIF standard sets of equipment for internal fixation of fractures. The concept of a sliding screw for trochanteric fractures is not new. The first author describing such an implant was Schumpelick [44]; he gives credit to Pohl [22], who was primarily a manufacturer working for Gerhardt Kiinscher. Re described the possibility of impaction at the fracture site with a sliding device. In the United States Clawson [7, 8] introduced the hip screw and found it to be extremely beneficial in trochanteric fractures. At approximately the same time, Massie [31, 32] and Pugh [39] designed the sliding-type flange nails, which offer similar intramedullary splinting with the possibility of fracture impaction. The following chapters describe the concept and design features of the DRS, as well as the details of the surgical technique. The application of the DRS for different types of fractures is illustrated with clinical examples. The results of 268 cases of trochanteric fractures treated with the DRS are presented and compared with results using the angled blade plate and Ender's nails. Finally, some laboratory tests are described.
During their 20 years of activity members of the Associa tion for the Study of Internal Fixation (AO - ASIF) have made authoritative contributions to the development of internal and external fixation. The close collaboration of surgeons, basic researchers, metallurgists, engineers and the establishment of clinical documentation has made it possible to achieve a solid scientific basis for internal fixa tion. Clear definitions for the standardization of different types of osteosynthesis were possible: interfragmentary compression, splintage and buttressing as well as combina tions of these three techniques. At the same time a scienti fic and workmanlike instrumentation was developed. The idea was to keep diversification within limits but, however, to assemble a comprehensive collection of implants and in struments to answer all the problems presented by the com plexity of bone operations. Osteosynthesis is a difficult and demanding operative method. Its. claims on the surgeon and the theatre staff are high. Therefore plans have existed for a long time to supplement the "Manual of Internal Fixation" with a de tailed description of the AO Instrumentation, its use and maintenance. Our collaborator FRIDOLIN SEQUIN, graduate engineer, has accomplished this task with expert knowledge. He has organized over many years courses for theatre nurses and has been able from the resulting experience to provide helpful suggestions. When RIGMOR TEXHAMMAR R. N. joined AO-International four years ago, it was natural to include her as a co-author.
Our decision to dedicate several years to the writing of this Atlas was based on the professional acknowledgement of negative surgical results due to incorrect or incomplete approaches to the bones or joints requiring treatment. We are convinced that in order to obtain the best possible anatomic and functional results in surgery of the locomotor apparatus, it is necessary to obey several rules of behaviour con stituting the basis for correct surgical execution: a) to respect the anatomy of the muscular and neural formations; b) to safeguard the vascularization of these anatomical elements and consequently of the osteoarticular apparatus; c) to use the most appropriate surgical approaches fully respecting the regional anatomy and the least traumatic exposure of the skeleton; d) to correctly perform surgery, thus creating the best conditions for the excel lent recovery of the function of the limb. The anatomic findings and surgical approaches to the extremities described here are not complete: we have based our selection of the former on their frequency in the normal surgical activity of any specialised ward, and the latter on the surgi cal approaches most commonly used by the 3rd Division of the Rizzoli Orthopaedic Institute. Wide surgical approaches for the surgical treatment of bone tumors have been excluded as they deal with specific «compartmental» methods which do not involve the anatomic rules to be followed in the normal treatment of orthopaedic and trau matologic affections of the extremities.
Con?rming the British genetic trait for writing and publishing (as well as acting), two English (Oxford and London) and a Scottish orthopaedic surgeon (Edinburgh) have produced a third edition of their comprehensive text, joined, as in the second edition by an editor from Germany, recognizing its part in the European community. The 62 physician contributors are drawn from pink-colored countries in our childhood geography books—the old British Empire from Australia to Zambia and two from the former colony, the USA. The original purpose of the book was to give residents or registrars an easily accessible and concise description of diseases and conditions encountered in the practice of paediatric orthopaedic surgery and to prepare for their examinations. But the practicing orthopaedic s- geon will ?nd an update of current practice that can be read for clarity and constraint—enough but not too much. A foreword might be a preview of things to come, but a “back word” of what was thought to be the ?nal say on the subject is needed for a perspective in progress. A “back word” look reveals the tremendous progress in medical diagnosis and treatment of which paediatric orthopaedics and fracture care is a component. Clubfoot treatment based on the dictums of Hiram Kite has had a revolutionary change by Ponseti. The chapter by Eastwood has the details on cast application and orthotics follow-up to obtain the 95% correction without the extensive surgery many of us thought was needed.
Pathological conditions affecting the hip and knee joints occupy a particular place amongst the important orthopaedic entities affect ing the extremities. On the one hand they are relatively frequent and on the other they mean for the patient limitation of his ability to walk, because of their considerable detrimental effects. A purposeful basic treatment of these joint diseases (and here osteoarthritis takes pride of place) is only possible if it stems from a reliable biomechanical analysis of the normal and pathological stressing of the joint in question. Whilst the situation in the hip can be considered to be fundamentally clarified, a comprehensive representation of the knee is still lacking, particularly when taking into account the latest knowledge of biomechanics. Recently our concepts of the kinematics of the knee have been completely changed, but the clinically important question of articular stressing remains unanswered. Dr. Maquet has carried out pioneer work in this field for some years in adapting, by analogy, to the knee joint principles already accepted for the hip joint. Since the knee is not a ball and socket joint, a complicated problem arises for which new thoughts are necessary. The results of the numerous operations carried out by Dr. Maquet according to the biomechanical considerations demon strate that his thinking is fundamentally correct. Above all, it is here again proven (as earlier in the case of the hip) that healing of osteoarthritis depends decisively on reducing and evenly dis tributing joint pressure.
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