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Contemporary Surgical Management of Fractures & Complications (2 Volumes)
Asif Ilyas, Saqib Rehman
CHAPTER 1:
Phalangeal Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Closed Reduction Percutaneous Pinning
Open Reduction and Internal Fixation
External Fixation
Surgical Anatomy, Positioningand Approaches
Applied Anatomy
Positioning
Approaches
Dorsal Approach
Midaxial Approach
Volar Approach
Surgical Techniques
Technique 1: Proximal Phalangeal Base Fracture
Technique 2: Phalangeal Diaphyseal Fractures
Technique 3: Condylar Fracture
Technique 4: Middle Phalanx Base Fractures/PIP/Fracture-Dislocations
Dorsal Extension Block Pinning
Dynamic External Fixation
Open Reduction Internal Fixation
Hemi-hamate Reconstruction
Arthroplasty
Technique 5: Distal Phalanx Fractures
Jersey Finger Fracture Repair
Mallet Fracture Repair
Outcomes
Complications
Malunion
Stiffness
Authors’ Preferred Managementof Select Complications
Summary
CHAPTER 2:
Metacarpal Fractures and CarpometacarpalFracture-Dislocations
Introduction
Diagnosis
Classification
Surgical Indications
Metacarpal Fractures
Basal Thumb Metacarpal Fractures
Surgical Anatomy, Positioningand Approaches
Surgical Anatomy
Patient Positioning
Surgical Approaches
Surgical Techniques
Technique 1: Metacarpal Head Fractures: Screw Fixation
Technique 2: Metacarpal Neck, Shaft or Base Fractures: Closed Reduction and Pinning
Technique 3: Metacarpal Neck Fractures: Plate and Screw Fixation
Technique 4: Metacarpal Shaft and Base Fractures: Plate and Screw Fixation
Technique 5: Thumb Metacarpal Base Intra-articular “Bennett” Fractures: Closed Reduction and Pinning
Technique 6: Thumb Metacarpal Base Intra-articular “Bennett” Fractures: Plate andScrew Fixation
Outcomes
Complications
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 3:
Carpal Fractures and Perilunate Dislocations
Introduction
Diagnosis
Classification
Scaphoid Fractures
Triquetral Fractures
Trapezial Fractures
Lunate Fractures
Capitate Fractures
Hamate Fractures
Other Carpal Fractures
Carpal Dislocations
Surgical Indications
Scaphoid Fractures
Overview
Fractures of Other Carpal Bones
Carpal Dislocations
Radiocarpal Dislocations
Axial Dislocations
Transverse Dislocations
Surgical Anatomy, Positioningand Approaches
Relevant Surgical and Applied Anatomy
Surface Anatomy
Bones and Ligaments
Tendons
Nerves
Vessels
Positioning
Surgical Approaches
Surgical Techniques
Technique 1: Open Reduction and Internal Fixation (ORIF) of Scaphoid Fractures
Percutaneous Volar Scaphoid Fixation
Open Volar Scaphoid Fixation
Mini-Open Dorsal Scaphoid Fixation
Postoperative Management
Technique 2: ORIF of Other CarpalBone Fractures
Technique 3: ORIF of Perilunate Dislocations
Outcomes
Scaphoid Fractures
Perilunate Dislocations
Complications
Scaphoid Fractures
Delayed Union
Nonunion of the Scaphoid
Malunion
Osteoarthritis
Fractures of Other Carpal Bones
Carpal Dislocations—Carpal Instability
Authors’ Preferred Managementof Select Complications
Summary
Fractures
Dislocations
CHAPTER 4:
Scaphoid Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Nonoperative Treatment
Operative Treatment
Implants
Surgical Anatomy, Positioning and Approaches
Applied Anatomy
Positioning
Approaches
Surgical Techniques
Technique 1: Volar ORIF of Scaphoid Fractures
Surgical Technique
Technique 2: Dorsal ORIF of Scaphoid Fractures
Surgical Technique
Technique 3: Volar Percutaneous Fixation of Scaphoid Fractures
Surgical Technique
Technique 4: Dorsal Percutaneous Fixation of Scaphoid Fractures
Surgical Technique
Outcomes
Complications
Nonunions
Avascular Necrosis
Arthritis
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 5:
Distal Radius Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Closed Reduction and External Fixation
External Fixator
Closed Reduction and Internal Fixation
Kirschner Wire Fixation
Percutaneous Screw Fixation
Intramedullary Nailing
Open Reduction and Internal Fixation
Volar Plating
Dorsal Plating
Fragment Specific Fixation
Surgical Anatomy, Positioningand Approaches
Positioning
Approaches
Dorsal Approach
Radial Approach
Volar Approach
The Extensile Flexor Carpi Radialis Approach
Surgical Techniques
Technique 1: Kirschner Wire Fixation
Technique 2: External Fixation
Technique 3: Intramedullary Nailing
Technique 4: Volar Plating
Technique 5: Dorsal Plating
Outcomes
Complications
Complications of Kirschner Wire Fixation
Complications of External Fixation
Complications of Intramedullary Nailing
Complications of Volar Plating
Complications of Dorsal Plating
Authors’ Preferred Managementof Select Complications
Summary
CHAPTER 6:
Forearm Fractures
Introduction
Diagnosis
Classification
Ulnar Shaft Fracture
Monteggia Fracture
Radial Shaft Fracture
Galeazzi Fracture
Both Bones Fracture
Surgical Indications
Ulnar Shaft Fracture
Monteggia Fracture
Radial Shaft Fracture
Galeazzi Fracture
Both Bones Fracture
Surgical Anatomy, Positioning and Approaches
Applied Anatomy
Positioning
Approaches
Henry Approach
Thompson Approach
Direct Ulnar Approach
Surgical Techniques
Technique 1: Ulnar Shaft Fracture Fixation
Technique 2: Radial Shaft Fracture Fixation
Volar Fixation of the Radius
Dorsal Fixation of the Radius
Technique 3: Monteggia Fracture Fixation
Technique 4: Galeazzi Fracture Fixation
Technique 5: Both Bones Fracture Fixation
Technique 6: Intramedullary Fixation of Both Bones fracture
Outcomes
Complications
Infection
Nonunion and Malunion
Synostosis
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 7:
Olecranon Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Tension Band Fixation
Plate Fixation
Intramedullary Screw
Excision with Triceps Advancement
Surgical Anatomy, Positioningand Approaches
Surgical and Applied Anatomy
Positioning
Supine
Lateral Positioning
Prone
Surgical Approaches
Posterior Approach
Surgical Techniques
Technique 1: Tension Band Fixation
Surgical Technique
Technique 2: Plate Fixation
Surgical Technique
Technique 3: Intramedullary Nailing
Surgical Technique
Technique 4: Fragment Excision andTriceps Advancement
Outcomes
Biomechanical Studies
Clinical Studies
Complications
Symptomatic Hardware
Hardware Failure
Malunion/Nonunion
Stiffness
Heterotopic Ossification
Proximal Radioulnar Joint Injury
Ulnar Neuropathy
Infection
Authors’ Preferred Managementof Select Complications
Summary
CHAPTER 8:
Radial Head Fractures and Terrible Triad Injuries
Introduction
Diagnosis
Classification
Surgical Indications
Surgical Anatomy, Positioning and Approaches
Applied Anatomy
Positioning
Approaches
Kocher Approach
Kaplan Approach
Midaxial Approach
Medial Coronoid Approach
Surgical Techniques
Technique 1: Radial Head Fixation
Technique 2: Radial Head Arthroplasty
Technique 3: Terrible Triad Repair
Outcomes
Complications
Heterotopic Ossification
Elbow Stiffness
Radial Head Malunion/Nonunion
Essex-Lopresti Injury/LongitudinalInstability of the Forearm
Elbow Instability
Authors’ Preferred Managementof Select Complications
Summary
CHAPTER 9:
Distal Humerus Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Open Reduction and Internal Fixation
Elbow Arthroplasty
External Fixation
Surgical Anatomy, Positioningand Approaches
Applied Anatomy
Positioning
Approaches
Surgical Techniques
Technique 1: ORIF of Distal Humerus Fracture
Technique 2: Total Elbow Arthroplasty of Distal Humerus Fracture
Technique 3: ORIF of Capitellum Fracture
Technique 2: Total Elbow Arthroplasty of Distal Humerus Fracture
Outcomes
Complications
Post-traumatic Elbow Stiffness
Heterotopic Ossification
Nonunion
Ulnar Neuropathy
Authors’ Preferred Managementof Select Complications
Summary
CHAPTER 10:
Humeral Shaft Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Open Reduction and Internal Fixation
Intramedullary Nailing
Surgical Anatomy, Positioningand Approaches
Applied Anatomy
Positioning
Approaches
Surgical Techniques
Technique 1: Open Reduction and Internal Fixation
Technique
Technique 2: Intramedullary Nailing
Antegrade Technique
Retrograde Technique
Outcomes
Open Reduction and Internal Fixation
Intramedullary Nailing
Plates Versus Nails
Antegrade Versus Retrograde Nails
Complications
Radial Nerve Injury
Insertion Site Morbidity
Nonunion
Iatrogenic Fracture Extension
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 11:
Proximal Humerus Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Surgical Anatomy, Positioning and Approaches
Surgical Anatomy
Positioning
Approaches
The Deltopectoral Approach
The Anterolateral (Acromial) Approach
Surgical Techniques
Technique 1: Open Reduction Internal Fixation
Preoperative Planning
Technique
Technique 2: Intramedullary Nailing
Preoperative Planning
Technique
Technique 3: Hemiarthroplasty
Preoperative Planning
Technique
Outcomes
Complications
Malunion
Infection
Avascular Necrosis
Hemiarthroplasty—Specific Complications
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 12:
Glenoid and Scapula Fractures
Introduction
Diagnosis
Classification
Scapular Body Fractures
Scapular Neck Fractures
Glenoid Fractures
Coracoid Process Fractures
Acromion Process Fractures
Surgical Indications
Scapular Body Fractures
Scapular Neck Fractures
Glenoid Fractures
Coracoid Fractures
Acromial Fractures
Surgical Anatomy, Positioning and Approaches
Anterior Approach to the Scapula
Positioning
Approach
Subscapularis Split Technique
Subscapularis Tenotomy Technique
Posterior Approach to the Scapula
Positioning
Approach
Surgical Techniques
Technique 1: Scapular Body Fractures
Preoperative Planning
Technique
Technique 2: Scapular Neck Fractures
Preoperative Planning
Technique
Technique 3: Glenoid Fossa Fractures
Preoperative Planning
Technique: Type IA Glenoid Fractures
Technique: Type IB Glenoid Fractures
Technique 4: Coracoid Fractures
Preoperative Planning
Outcomes
Scapular Body Fractures
Scapular Neck Fractures
Glenoid Fractures
Acromion Process Fractures
Coracoid Process Fractures
Complications
Malunion
Iatrogenic Nerve Injury
Compartment Syndrome
Intrathoracic Scapular Impaction
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 13:
Clavicle Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Midshaft Clavicle Fixation
Distal Clavicle Fixation
Surgical Anatomy, Positioning and Approaches
Anatomy
Positioning
Approaches
Surgical Techniques
Technique 1: Plate Fixation of Midshaft Clavicle Fractures
Technique 2: Rockwood Pin Fixation of Midshaft Clavicle Fractures
Technique 3: Transarticular and Hook Plate Fixation of Lateral Clavicle Fractures
Technique 4: Coracoclavicular Screw Fixation of Lateral Clavicle Fractures
Outcomes
Midshaft Clavicle Fractures
Lateral Clavicle Fractures
Complications
Nonunion/Malunion
Hardware Complications
Thoracic Outlet Syndrome
Brachial Plexopathy
Wound Breakdown
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 14:
Cervical Spine Fractures and Dislocations
Introduction
Diagnosis
Clinical Evaluation in the Emergency Department
General Evaluation
Local Examination
Neurologic Examination
Neurological Examination of the Spinal Injured Patient
Classification and Scoring of the Spinal Injuries
Frankel Scale
American Spinal Injury Association Classification
ASIA Impairment Scale
Other Important Definitions
Clinical Syndromes of Incomplete Spinal Cord Injury (Table 14.4 and Figs 14.5A to D)
Brown-Sequard Syndrome
Posterior Cord Syndrome
Radiographic Evaluation of Spine Injured Patient
Clearing the Spine in Trauma Patients
Clinical Clearance
Conscious, Symptomatic Patients
Unconscious, Intubated Patients
Classification
Occipital Condyle Fractures
Occipitocervical Dislocation
Atlas Fractures
Odontoid Fractures
Traumatic Spondylolisthesis of C2 (Hangman's Fracture)
Subaxial Cervical Fractures
Management and Surgical Indications
Fractures of the Atlas
Nonsurgical Management
Fractures of the Odontoid Process
Traumatic Spondylolisthesis of C2 (Hangman's Fracture)
Subaxial Cervical Fractures
Vertical Compression Injuries
Compressive Flexion Injuries
Distractive Flexion Injuries
Compressive Extension Injuries
Distractive Extension Injuries
Lateral Flexion Injuries
Surgical Anatomy
Upper Cervical Spine
Lower Cervical Spine
Surgical Approaches
Anterior Approach to the Subaxial Cervical Spine
Position
Procedure
Posterior Approach to the Cervical Spine
Upper Cervical Spine
Lower Cervical Spine
Surgical Techniques
Technique 1: Direct C1 Posterior Fixation
Technique
Technique 2: C1–C2 Fusion
Magerl's Technique
Goel-Harm's Technique
Gallie's Wiring Technique
Brooks and Jenkins’ Wiring Technique
Technique 3: C2 Odontoid Fixation
Technique 4: C2 Pars Fixation
Technique 5: Subaxial Anterior Corpectomy and Fusion
Technique 6: Lateral Mass Screw Fixation
Technique
Outcomes
Complications
Complications related to the Injury
Complications due to Lateral Mass Fixation
Complications due to Anterior Fixation
Complication Cases
Case 1: Conservatively Treated Odontoid Fracture Resulting in Nonunion
Case 2: Neglected C2–C3 Fracture
Case 3: Prominent Lateral Mass Screws with Cervical Radiculopathy
CHAPTER 15:
Thoracic and Lumbar Spine Fractures and Dislocations
Introduction
Classification
Boehler's Classification
Column Concept
Denis Classification
Allen-Ferguson Classification
McAfee's Classification
AO Classification
Thoracolumbar Injury Classification System
Load Sharing Classification
Concept of Instability
Diagnosis
Compression Fractures
Burst Fractures
Unstable Thoracolumbar Injuries
Management and Surgical Indications
Compression Fractures
Burst Fractures
Unstable Thoracolumbar Injuries
Surgical Techniques
Technique 1: Percutaneous Stabilization
Vertebroplasty
Kyphoplasty
Percutaneous Pedicle Screw-assisted Spinal Stabilization
Technique 2: Anterior Decompression and Fixation
Anterior Surgical Approaches
Anterior Approach to the Thoracic and Lumbar Spine
Thoracolumbar Exposure from T11 to L1
Anterior Retroperitoneal Approach to the Lumbar Spine (L1–L5)
Surgical Technique of Anterior Decompression and Stabilization
Technique 3: Posterior Decompression and Fixation
Posterior Exposure of the Thoracic and Lumbar Spine
Surgical Technique (Figs 15.33 and 15.34)
Technique of Fracture Stabilization
Outcomes
Complications
Posterior Approach
Neurological Injury
Vascular Injury
Visceral Injury
Biomechanical Complications
Anterior Approach
Chronic Complications
Complication Cases
Case 1: Post-traumatic Kyphosis
Case 2: Implant Failure with Worsening Kyphosis
Case 3: Failure to Recognize Fracture Patterns
Case 4: Missed Systemic Injury in aPolytrauma Patient
Summary
CHAPTER 16:
Pelvic Ring and Sacral Injuries
Introduction
Diagnosis
Classification
Surgical Indications
Surgical Anatomy, Positioning and Approaches
Surgical Techniques
Technique 1: External Fixation of the Pelvis
Anterior Iliac Crest Pins
Supra-Acetabular Pins
Frame Application and Reduction
Technique 2: Anterior Pelvic Fixation
Symphyseal Plate Fixation
Medullary Ramus Screws
Technique 3: Iliosacral Screw Insertion
Supine Considerations: Preparation, Approach and Reduction
Prone Considerations: Preparation, Approach and Reduction
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 17:
Acetabulum Fractures
Introduction
Historical Perspective
Epidemiology and Outcome
Radiography and Classification
Classification and Identification by Judet Views
Surgical Indications
The Rationale for Operative and Nonoperative Treatment
Surgical Anatomy, Surgical Approaches and Techniques
Approaches to the Acetabulum
Posterior Approach
Anterior Approaches
Extensile Approaches (The Extended Iliofemoral, Texas T and Triradiate)
Posterior Wall and Column Injuries
Anterior Column and Anterior Wall Fractures
Transverse and Transverse PosteriorWall Fractures
Both Column Fractures
T-Type Fractures
Anterior Column Posterior Hemitransverse Fractures
Adjunct and Novel Methodologies
Complications
Heterotopic Ossification
Deep Vein Thrombosis and Pulmonary Embolism
Nerve Palsy
Malunion and Nonunion
Late Stage Arthritis
Late Instability after Open Reduction and Internal Fixation
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 18:
Femoral Head Fractures and Hip Dislocations
Introduction
Diagnosis
Classification
Surgical Indications
Surgical Anatomy, Positioning and Approaches
Applied Anatomy
Positioning
Approaches
Anterior and Anterolateral Approach
Posterior Approach
Transtrochanteric Approach
Arthroscopic Excision of Loose Bodies
Surgical Techniques
Technique 1: Anterior Dislocation of the Femoral Head with a Smith-Peterson Approach
Technique 2: ORIF of Femoral Head with a Kocher-Langenbeck Posterior Approach
Technique 3: Trochanteric Flip Osteotomy
Rehabilitation
Outcomes
Complications
Post-traumatic Arthritis
Osteonecrosis
Heterotopic Ossification
Sciatic Nerve Injury
Retained Loose Bodies
Residual Instability
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 19:
Femoral Neck Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Surgical Anatomy, Positioning and Approaches
Surgical Techniques
Technique 1: Closed Reduction and Cannulated Screw Fixation of Femoral Neck Fractures
Preoperative Planning and Anatomic Considerations
Instrumentation, Implant and Patient Positioning Considerations
Technique
Technique 2: ORIF of Displaced Femoral Neck Fracture
Preoperative Planning and Anatomic Considerations
Instrumentation, Implant and Patient Positioning Considerations
Technique
Technique 3: Hemiarthroplasty of Femoral Neck Fracture
Preoperative Planning
Instrumentation, Implants and Patient Positioning Considerations
Technique
Outcomes
Complications
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 20:
Intertrochanteric Femur Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Surgical Anatomy, Positioning and Approaches
Applied Anatomy
Positioning
Approaches
Surgical Techniques
Fracture Reduction
Technique 1: Open Reduction and Internal Fixation of Intertrochanteric Hip Fracture
Preoperative Planning
Technique
Technique 2: Intramedullary Nailing of Intertrochanteric Hip Fracture
Preoperative Planning
Technique
Outcomes
Complications
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 21:
Subtrochanteric Femur Fractures
Introduction
Diagnosis
Physical Examination
Diagnostic Imaging
Classification
Seinsheimer's Classification
Russell-Taylor Classification
AO/OTA Classification
Surgical Indications
Temporizing Measures
Definitive Fixation
Surgical Anatomy and Positioning
Anatomy
Positioning
Surgical Techniques: General Concepts
Intramedullary Nails
Reconstruction Nails
Trochanteric Nails
95° Angled Plates
Proximal Femoral Locking Plates
Preoperative Planning
Reduction
Length, Alignment and Rotation
Fluoroscopic Measurement of Anteversion
Lesser Trochanteric Profile
Computerized Tomography Scan
Computer Assisted Surgery
Clinical Assessment
Intraoperative Assessment
Surgical Techniques: Specific Procedures
Technique 1: Cephalomedullary Nailing
Technique 2: Proximal Femoral Locking Plate
Technique 3: Blade Plate
Postoperative Protocol
Outcomes
Complications and Management
Deep Vein Thrombosis
Loss of Fixation and Malunion
Nonunion
Malrotation
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 22:
Femoral Shaft Fractures
Introduction
Diagnosis
History and Physical Examination
Imaging
Classification
Surgical Indications
Plate Fixation
Intramedullary Nailing
Surgical Anatomy, Positioning and Approaches
Surgical Techniques
Technique 1: Antegrade Nailing
Positioning
Entry Point
Technique
Technique 2: Retrograde Intramedullary Nailing
Reaming
Postoperative Management for Antegrade and Retrograde Nailing
Technique 3: Traction Pin Placement
Technique 4: Placement of Antibiotic Cement-Coated Nails
Outcomes
Specific Situations
Open Fractures
Fractures from Gunshot Wounds
Damage Control Orthopedics
Floating Knee
Associated Femoral Neck Fractures
Vascular Injury
Complications
Nonunion
Malunion
Leg Length Discrepancy
Infection
Heterotopic Ossification
Traction Related
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 23:
Distal Femur Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Open Reduction and Internal Fixation
Intramedullary Fixation
External Fixation
Acute Knee Arthroplasty
Surgical Anatomy, Positioning and Approaches
Anatomy
Positioning
Approaches
Lateral
Lateral Parapatellar
Medial Parapatellar
Medial Subvastus
Surgical Techniques
Technique 1: Minimally Invasive Plate Osteosynthesis Plating of Type A(Extra-articular) Fracture
Technique 2: Retrograde Intramedullary Nail of Type A Fracture
Technique 3: ORIF of Type C Fracture
Technique 4: ORIF of Type B (Unicondylar) Fracture
Technique 5: ORIF of a Type B3 (Hoffa) Fracture
Outcomes
Complications
Knee Stiffness
Nonunion
Malunion
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 24:
Patellar Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Surgical Anatomy, Positioning and Approaches
Surgical Techniques
Tension Band Technique
Instrumentation and Implant Consideration
Surgical Approach
Fracture Reduction Techniques
Closure
Rehabilitation
Partial Patellectomy
Instrumentation and Implant Considerations
Surgical Approach
Fracture Reduction Techniques
Closure
Rehabilitation
Outcomes
Complications
Infection
Loss of Reduction
Hardware Irritation
Nonunion
Knee Stiffness
Arthritis
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 25:
Proximal Tibia Fractures
Introduction
Diagnosis
Patient Evaluation
Physical Examination
Imaging
Mechanism of Injury
Associated Injuries
Classification
The Schatzker Classification
The Lateral Unicondylar Fractures(Schatzker I–III)
The Medial Fractures (Schatzker IV)
The Bicondylar Fractures (Schatzker V and VI)
AO/OTA Classification
The Moore Classification ofFracture-Dislocations
Surgical Indications
Overview and Guiding Principles ofFracture Repair
Role of Locking Plates in Tibial Plateau Fractures
Surgical Anatomy, Positioning and Approaches
Relevant Anatomical Features
Approaches
Exposure of the Lateral Plateau
Additional Exposures: Posterolateral, Medial and Posteromedial
Surgical Techniques
Emergent Treatment
Technique of Spanning Frame
Compartment Syndrome in Tibial Plateau Fractures
Surgical Technique and Rationale by Classification
Split Fracture (Schatzker I)
Split Depression Fracture (Schatzker II)
Pure Depression Fracture (Schatzker III)
Lateral Fracture Dislocations
The Posterolateral Fracture
Medial Plateau Fractures (Schatzker IV) and Fracture Dislocations
The Posteromedial Fracture
Bicondylar Fractures (Schatzker V and VI, AO/OTA Type C and Moore 5)
Plating Options in Bicondylar fractures—Dual Plating
Plating Options in Bicondylar fractures—Locked Plating
Hybrid Circular External Fixation for Bicondylar Plateau Fractures
High-Energy Tibial Plateau Fracture—Approach to Treatment
Staged Management
Filling the Void—Bone Graft and Calcium Ceramics
The Use of Bone Morphogenic Proteins in Tibial Plateau Fractures
Postoperative Care
Complications and Author's Preferred Management of Select Cases
Loss of Fixation
Infection
Malunion and Nonunion
Post-traumatic Arthritis
Summary
CHAPTER 26:
Tibial Shaft Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Surgical Anatomy, Positioning and Approaches
Surgical Techniques
Technique 1: Reamed, Locked Intramedullary Nailing of Tibial Shaft Fracture
Preoperative Planning
Technique
Technique 2: Intramedullary Nailing of a Proximal Tibial Shaft or Metadiaphyseal Fracture
Technique 3: Intramedullary Nailing of a Distal Tibial Metadiaphyseal Fracture
Technique 4: ORIF of a Tibial Diaphyseal Fracture
Technique
Outcomes
Complications
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 27:
Distal Tibia Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Nonoperative Management
Surgical Evolution
Surgical Anatomy, Positioning, Approaches and Techniques
Applied Surgical Anatomy
Staged Approach
Stage 1
Stage 2
Postoperative Care
Special Considerations
Outcomes
Complications
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 28:
Ankle Fractures and Syndesmotic Injuries
Introduction
Diagnosis
Classification
Surgical Indications
Lateral Malleolar Fractures
Bimalleolar Fractures
Posterior Malleolar Fractures
Syndesmotic Injuries
Open Ankle Fractures
Role of External Fixation
Surgical Anatomy, Positioning and Approaches
Applied Anatomy
Positioning
Surgical Approach
Surgical Techniques
Technique 1: Open Reduction and Internal Fixation (ORIF) of Distal Fibula and Diaphyseal Fibula Fractures
Preoperative Planning
Technique
Technique 2: Operative Fixation of Medial Malleolus Fractures
Preoperative Planning
Technique
Technique 3: ORIF of Posterior Malleolar Fractures
Preoperative Planning
Technique
Technique 4: ORIF of Syndesmotic Injuries of the Ankle
Preoperative Planning
Technique
Outcomes
Complications
Infection and Wound Breakdown
Early Loss of Hardware Fixation
Malunion
Nonunion
Late Syndesmotic Widening and Neglected Syndesmotic Instability
Peroneal Tendonitis
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 29:
Hindfoot Fractures
Introduction
Diagnosis
Physical Examination
Classification
Surgical Indications
Surgical Procedure
Surgical Anatomy, Positioning and Approaches
Surgical Techniques
Technique 1: Essex-Lopresti Technique
Technique 2: Lateral Extensile Approach to the Calcaneus
Technique 3: Medial Approach to the Calcaneus
Outcomes
Complications
Tibiotalocalcaneal Fusion with an Intramedullary Nail
Diagnosis
Classification
Surgical Indications
Surgical Anatomy, Positioning and Approaches
Surgical Techniques
Anteromedial Approach to the Talar Neck
Anterolateral Approach to the Talar Neck
Complications
Avascular Necrosis
Malunion
Arthritis
Subtalar Fusion
Subtalar Fusion with Bone Block Arthrodesis
Tibiotalocalcaneal Fusion with an Intramedullary Nail
Authors’ Preferred Management of Select Complications
Summary
CHAPTER 30:
Midfoot and Forefoot Fractures
Introduction
Diagnosis
Classification
Surgical Indications
Open Reduction and Internal Fixation
Closed Reduction and Percutaneous Pinning
Midfoot Fusion or Arthrodesis
Surgical Anatomy, Positioning and Approaches
Applied Anatomy
Positioning
Approaches
Technique 1: Open Reduction and Internal Fixation of Lisfranc Fracture-dislocations
Preoperative Planning
Anatomical Considerations
Instrumentation and Implant Considerations
Patient Considerations
Technique
Closure
Rehabilitation
Technique 2: Midfoot Arthrodesis for Lisfranc Fracture-dislocations with Irreparable Joint Damage
Preoperative Planning
Patient Considerations
Anatomical Considerations
Instrumentation and Implant Considerations
Technique
Closure
Rehabilitation
Technique 3: Open Reduction and Internal Fixation of Extra-articular First-fourth Metatarsal Fractures
Preoperative Planning
Anatomical Considerations
Instrumentation and Implant Considerations
Patient Considerations
Technique
Closure
Rehabilitation
Technique 4: Open Reduction and Internal Fixation of Proximal Fifth Metatarsal Fractures
Preoperative Planning
Anatomical Considerations
Instrumentation and Implant Considerations
Patient Considerations
Technique
Closure and Rehabilitation
Technique 5: Open Reduction and Internal Fixation of Hallucal Fracture-dislocations
Preoperative Planning
Anatomical Considerations
Instrumentation and Implant Considerations
Patient Considerations
Technique
Closure
Rehabilitation
Technique 6: Open Reduction and Internal Fixation of Hallucal Sesamoid Fractures
Preoperative Planning
Anatomical Considerations
Instrumentation and Implant Considerations
Patient Considerations
Technique
Closure
Rehabilitation
Outcomes
Complications
Postoperative Infection
Wound Complications
Post-traumatic Arthritis
Nonunion
Compartment Syndrome
Author's Preferred Management of Select Complications
Case 2: Nonunion vs Refracture of a Proximal Zone Two Fifth Metatarsal Fracture
Case 3: Treatment of Compartment Syndrome of the Foot
Summary
INDEX
TOC
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