Internal Fixators

This is the first compendium of principles of using locking compression plates in fracture management. With more than 100 cases from world-leading surgeons, including the inventors of the technique, this book will guide orthopedic trauma surgeons, general orthopedists, and residents through applications of the internal fixator technique. Intraoperative photos and illustrations and an interactive DVD containing additional cases, animations, and videos makes this AO Manual an indispensable reference.

and refinement that exists within the necessarily strict rules of the internal fixation method. In this way we seek to contribute to as weIl as to stimulate the search for rational solutions to surgical problems. It is assumed throughout that the reader is fa miliar with the technical fundamentals of internal fixation, and so these details are omitted. Instead, special indications and technical refinements are presented on the basis of case examples. Because an endless variety of situations can arise in orthopedic surgery (a circumstance that is attracting more and more surgeons to the field), we have taken ca re that our examples can readily be applied to novel situations. We now credit, in alphabetic order, those who contributed most to the techniques presented: R. BLATTER, A. BOITZY, C. BRUNNER, O. CECH, A. DEBRUNNER, F. MAGERL, G. SEGMÜLLER, G. STÜHMER, and B.G. WEBER. We thus express thanks to those colleagues in our clinic who agreed to having their ideas published. But we are also grateful to our illustrators, H. and K. SCHUMACHER, our photographer, M. SCHAFFNER, and our chief secretary, U. OETLIKER, who contributed so much to the preparation of the manuscript. Finally, we thank Springer-Verlag for their patience with us and especiaUy for their efficient work in bringing the book to press. St. GaU, Fall 1981 CH.F. BRUNNER B.G. WEBER Contents Lag Screws ............. .

Includes interactive CD-ROM! This is the first compendium of principles of using locking compression plates in fracture management. With more than 100 cases from world-leading surgeons, including the inventors of the technique, this book will guide orthopedic trauma surgeons, general orthopedists, and residents through applications of the internal fixator technique. Intraoperative photos and illustrations and an interactive DVD containing additional cases, animations, and videos make this AO Manual an indispensable reference.

The Manual of INTERNAL FIXATION is well known internationally as a standard work for every specialist dealing with osteosynthesis. Due to the many changes that have taken place, an international faculty of orthopaedic surgeons and traumatologists completely revised and expanded the manual. In its third edition the manual reflects the state of the art and is the necessary reference for every AO specialist.

Knochenbruch / Fixation.

The AO documentation was established at the beginning of 1959, only 3 months after the founding of the AO. We used from the very beginning our X-ray cards and code sheets. Progress was rapid. Towards the end of 1959, we had already over 1000 X-ray cards with miniaturized X-rays representing the initial X-ray, the one after surgery, and the one at the 4-month follow-up. From the very beginning, the documentation was one of our four main pillars and provided us with manifold services. The docu mentation helped us in teaching the use of our instruments and implants, made it possible for us to establish a quality control system, helped us establish the indications for treatment, made it possible for us to plan graphically the operative procedures, and was of enormous help for us when we were developing our operative techniques. As an added bonus, the documentation provided us also with many slides of X-rays of the cases which we had documented. These we used in our 1ectures on the AO method. The X-ray cards of the documentation became also the basis for the AO technical commission in its evaluation of the instruments. Furthermore, the chief of each participating clinic received duplicates of all miniaturized X-rays which the documentation received from his institution. This he1ped him to see immediately what his co-workers were able to achieve and whether his co-workers had grasped the essence of the AO method and its applications.

The second English-language edition of the Small Fragment Set Manual was enthusiastically received and quickly went into a second printing. In preparing a third edition, we found it necessary to revise the text extensively and partly restructure it. The reasons for this are numerous. Experience of recent years has brought technical refinements in the operative treatment of many types of small fracture. Many of these changes stem from the small-fragment-set training programs conducted in Switzerland since 1980, and also from courses and symposia that have been held in other European countries and the United States. These events were occasions for a fruitful ex change of experience with surgeons who were critical of our methods. As a result of this exchange, we perceived a need both to revise our indications and to give greater attention to alternative techniques. We also felt it necessary to respond to criticisms of the first two editions concerning the catalog-like instrument lists and illustrations, and the attention given to fundamental techniques. Many surgeons who work or would like to work with small implants, especially those practicing abroad, are inexperienced in operations on the larger bones. It is imperative that these colleagues be given a basic introduction to the "biomechanical thinking" of the Swiss Association for the Study of Internal Fixation (ASIF).

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.