Operative Techniques: Orthopaedic Trauma Surgery

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