Skeletal Trauma: Basic Science, Management, and Reconstruction, 2-Volume Set, 5th Edition

Cover
The History of Fracture T r eatment
	EARLY SPLINTING TECHNIQUES
	PRECURSORS OF THE PLASTER BANDAGE
	THE PLASTER BANDAGE AND ITS DERIVATIVES
	TRACTION
	FUNCTIONAL BRACING
	OPEN FRACTURES
		Screw Fixation
		Plate Fixation
	EARLY FRACTURE SURGERY
		W ire Fixation
	EXTERNAL FIXATION
	INTRAMEDULLARY FIXATION
	ROBERT DANIS AND THE DEVELOPMENT OF THE AO GROUP
	GAVRIIL A. ILIZAROV AND THE DISCOVERY OF DISTRACTION OSTEOGENESIS
		Stuart A. Green
	EMILE LETOURNEL AND THE SURGERY OF PELVIC AND ACETABULAR FRACTURES
		Joel M. Matta
	KLAUS KLEMM AND INTERLOCKING NAILING AND LOCAL ANTIBIOTIC BEAD CH
		David Seligson
	MAURICE EDMOND MÜLLER, INTERNAL FIXATION TECHNIQUES AND
	HIP PROSTHESES
		Joseph Schatzker
	MARTIN ALLGÖWER, INTERNAL FIXATION AND FRACTURE MANAGEMENT
		Marvin T ile
	SUMMARY
		Christopher L. Colton
Global Burden of Musculoskeletal Injuries
	CAUSES OF INJURY
	GEOGRAPHIC AND DEMOGRAPHIC DISTRIBUTION OF INJURY BURDEN
		BOX 2-1 W h a t I s t h e G lobal B u r den o f D isease S t
	ESTIMATING THE BURDEN OF MUSCULOSKELETAL INJURY
		BOX 2-2 H o w D id t h e G lobal B u r den o f D isease, I n
	FOCUS ON MILITARY INJURIES
		REFERENCES
The Challenges of Orthopaedic T rauma Care in the Developing W orld
	IMPROVING TRAUMA CARE SYSTEMWIDE GLOBALLY: THE WORLD HEALTH ORGANIZA
		Background
		Case Studies of Individual Institutions
		Global Efforts to Improve T rauma Care
	THE ROLE OF THE WORLD HEALTH ORGANIZATION: THE WORLD HEALTH ASSEMB
	BARRIERS TO ACCESS
	EDUCATION
	PEDIATRIC TRAUMA (MANAGEMENT OF COMMON INJURIES)
	ADULT TRAUMA
		Spinal Injuries
			Cervical Spine
			Thoracolumbar Spine (TLS)
		Pelvic and Acetabular Fractures
		Pelvic Ring Injuries
		Acetabular Fractures
		Lower Extremity Injuries
			Hip Dislocations
			Hip Fractures
			Femoral Shaft Fractures
			Knee Injuries
			T ibia-Fibula Fractures
			Foot and Ankle Injuries
		Upper Extremity Injuries
			Shoulder Injuries
			Humeral Shaft Fractures
			Elbow Injuries
			Forearm Injuries
			Hand and W rist
	AMPUTATIONS
	A VENUES FOR ORTHOPAEDIC VOLUNTEERISM
	THE SURGICAL IMPLANT GENERATION NETWORK INTRAMEDULLARY NAIL SYSTEM
		Introduction Background
			Design Features
			Innovation
			Outcomes
			Surgical T echnique Interlocking Screw Placement
			Fin Nail
			T ibial Nail T echnique
			Femoral Nail T echnique
			Hip Fractures
		KEY REFERENCES
Biology and Enhancement of Skeletal Repair
	BIOLOGY OF GRAFT SUBSTITUTES
	STAGES OF BONE GRAFT INCORPORATION
	AUTOGENOUS ILIAC CREST BONE GRAFT
	OSTEOCONDUCTIVE GRAFT SUBSTITUTES
		Calcium Sulfate Substitutes
			Hydroxyapatite
		Calcium Phospate Substitutes
			T ricalcium Phosphate
	DEMINERALIZED BONE MATRIX
		Historic Perspective
		Current Methodology
	P A TIENT-DERIVED CELLULAR THERAPIES
		Marrow Aspirate
			Preclinical Substantiation
		Clinical Application of Marrow Elements
		Platelet-Rich Plasma
			Platelet-Derived Growth Factor
			Preclinical Studies
			Platelet-Rich Plasma Preparation
			T ransforming Growth Factor- β
			Platelet-Rich Plasma Augmentation of Graft Materials
			Clinical Evidence
		Recombinant Human Platelet-Derived Growth Factor
	INDUCTIVE SUBSTRATES (BONE MORPHOGENIC PROTEIN)
		Off-Label Use and Complications
		Bone Morphogenic Protein Interactions
		Economic Impact
		KEY REFERENCES
			Summary
	CONCLUSIONS
Biomechanics of Fractures
	BASICS OF MECHANICS
		Movement and/or Displacement
		Properties of Materials (Young’s or Elastic Modulus, Y ield and Fail
		Other Material Properties (Viscoelasticity, Anisotropy, Creep and Rela
		Stress/Strain
		Stress-Strain and Other Diagrams
		Finite Element Analysis Primer
	BONE PROPERTIES AND FRACTURE RISK
		Bone Mechanical Properties
		Cortical Bone Properties and Microstructure
		T rabecular Bone Properties and Microstructure
		Age-Related Bone Property Changes
		Osteoporosis
		Definition (Area Moment of Inertia)
		Cylinder (Long Bone, Intramedullary Nail, Screw)
	STRUCTURAL PROPERTIES AND LOADING MODES
		Rectangle (Plate) and Optimization (I Beam, External Fixator)
		Loading Modes
		T ension/Compression and Shear
		Bending
		T orsion
		Loading Experienced by the Skeleton
		Clinical Examples of Combined Loading
		Fractures Associated with Particular Diseases and Conditions
		Osteoporosis and Age-Related Fractures
		Fracture Severity Quantification
		Defects in Bone Caused by Malignancy and Benign Conditions
		Implant-Related Bone Fracture: Periprosthetic and Interprosthetic Fract
		Stress Shielding
	FRACTURE HEALING
		Healing by Callus Formation— Biomechanical Considerations
		Biomechanical Stages of Fracture Healing
		Biomechanics of Fracture Fixation
		Surgical Fixation—Biomechanical Considerations
		Nonoperative T reatment, Casting and Splinting, T raction
		Intramedullary Rods
		External Fixation
	SUMMARY
		KEY REFERENCES
		Plate Fixation
Closed Fracture Management
	6A Introduction
		REFERENCES
	6B Basic Principles
		MANIPULATIVE REDUCTION
		FRACTURE REDUCTION AND MAINTENANCE OF REDUCTION
		X X
			TYPES OF ANESTHESIA
			RADIOGRAPHIC EXAMINATION OF FRACTURES
			EXTERNAL SUPPORT OF FRACTURES
				Plaster of Paris
			TIMING OF REDUCTION
				Application of Three-Point Loading T echniques
				Postreduction Management of Acute Fractures
				Management of Acute Fractures
				W edging of Casts
				W alking Casts
	6C Scaphoid Fractures
		The following video is included with this chapter and may be vi
		INCIDENCE AND DEMOGRAPHICS
		CLASSIFICATION AND FRACTURE INCIDENCE
		CLINICAL EXAMINATION
		RADIOLOGIC EXAMINATION
		TREATMENT OPTIONS
			Operation versus Conservative T reatment
			Minimally Displaced and Undisplaced
		CAST TREATMENT
		CONCLUSION
	6D Distal Radius Fractures
		The following video is included with this chapter and may be vi
		DEMOGRAPHICS
		NORMAL P ARAMETERS
		HOW MUCH DEFORMITY IS ACCEPTABLE IN ADULTS
		CLINICAL ASSESSMENT
		RADIOLOGIC ASSESSMENT
			Y oung Patients
			Elderly Patients
		TREATMENT
	6E Humeral Shaft Fractures
		The following videos are included with this chapter and may be viewed
		INTRODUCTION
		TREATMENT
			Outcomes
			Controversies
		CONCLUSION
	6F Proximal Humerus Fractures
		DIAGNOSIS
		INITIAL IMMOBILIZATION
		REHABILITATION
		NONOPERATIVE TREATMENT OUTCOMES
	6G Ankle Fracture
		EPIDEMIOLOGY AND RISK F ACTORS
		CLINICAL EVALUATION
		ASSESSMENT
		RADIOGRAPHIC EVALUATION
			Classification Systems
			Determining Stability
		SMOKERS
		ELDERLY P A TIENTS
		TREATMENT
			General
			Special T echniques
			Long T erm
			KEY REFERENCES
	6H T ibial Fractures
		The following video is included with this chapter and may be vi
		P A THOPHYSIOLOGY OF FRACTURE HEALING
			V ascularity and Fracture Healing
			Callus Formation
		SHORTENING
		ANGULATION
		EXPECTED OUTCOMES
		REPRESENTATIVE EXAMPLES
		CLINICAL PROTOCOL
			Acute Management
			The Short Functional Cast
			The Functional Brace
			Brace Removal and Follow-up
	6I Fractures of the Femur
		MANIPULATIVE REDUCTION AND CONTINUOUS TRACTION
			Principles of T raction
			Methods of Applying T raction
			Complications of T raction
		FRACTURE BRACING
			Biomechanics and Physiology of Fracture Bracing
			Lower Limb Fracture Bracing
			Application Procedure for Femoral Fracture Bracing
Principles and Complications of External Skeletal Fixation
	Additional videos related to the subject of this chapter are a
	HISTORICAL BACKGROUND
		Early Fixators
		Fixators for Limb Lengthening
		Circular Fixators
		Fixators for Severe T rauma
		Computerized Correction
			Fixator-Assisted Nailing
			External Skeletal Fixation in the Future
		Combined Internal and External Fixation
	FIXATOR TERMINOLOGY
		Frame Configuration
		Improvised Fixators
	PROBLEMS, OBSTACLES, AND COMPLICATIONS
	NERVE AND VESSEL INJURY
		Introduction
		V essel Injuries
		Prefabricated Fixators
		Compartment Syndrome
		Nerve Injuries
	IMPLANT PLACEMENT TO A VOID NEUROVASCULAR INJURY
		Introduction
		T echnique of Identifying Landmarks
	PIN TRACT INFECTION
		Introduction
		Pathophysiology of Pin- or W ire-Site Sepsis Fluid Secretion
			Abscess Formation
			Skin Necrosis
			Heat Injury
			Deep Soft T issue Necrosis
			Bone Necrosis
			Motion
			The Pin–Skin Interface
	STRATEGIES TO REDUCE IMPLANT-SITE SEPSIS
		Fixator Selection
			The Pin–Bone Interface
		Pin Selection
		Pin and W ire Insertion Considerations Fracture Alignment
			Predrilling
		Pin Insertion
			Inserting T ransfixion W ires
		Frame Assembly
		Pin Care Routine
			Implant–Skin Interface Management
	FIXATOR-ASSOCIATED PROBLEMS
		Ambulatory Aids
		Dealing with Pinhole Problems
		Introduction
		Pressure Necrosis
		Broken Components
		Disruption of Lifestyle
		Pain on Pin Removal
		Persistent Pain after Fixator Removal
		Bone Pain
		Neurogenic Pain
		Pain Associated with Fracture Healing
		Psychological Problems
	P AIN
		Postoperative Pain
		Pain While the Fixator Is in Place
	PRINCIPLES UNIQUE TO THE ILIZAROV METHOD
		Introduction
		T reatment Principles for Nonunions and Malunions
		Segmental Skeletal Defects
		Joint Mobility
		Stretching
		Contractures
		Limb Positioning
		Post-Ilizarov Management
	EXTERNAL FIXATORS AS NONUNION MACHINES
		Functional Limb Use
		Regenerate Healing and Maturation
	EXTERNAL FIXATORS FOR DAMAGE CONTROL ORTHOPAEDICS
		Introduction
		The Drill Sleeve
		Conversion to Permanent External Fixation
		Choice of Implants
		Reducing Costs from Inventory Control
		The T emporary Fixator
		Military Applications
		Danger Regions for Percutaneous Pins Inserted without Fluoroscopy
		Implant Depth
		Using the Atlas for Damage Control Orthopaedics
			Femur
			T ibia
			Humerus
			Forearm
Principles of Internal Fixation
	Additional videos related to the subject of this chapter are a
	at https://expertconsult.inkling.com :
	INTRODUCTION
	PLAN OF A TTACK AND HOW TO USE THIS CHAPTER
	FRACTURE P A TTERN
		Fracture Pattern = Law of Conservation of Energy
		Fracture Pattern Characterizes the Unbalanced Forces That Create Disp
		Fracture Pattern Reveals the Intrinsic Stability of the Bone after
		Fracture Pattern Defines Expected Mode of Healing
		Fracture Pattern Predicts Expected Soft T issue Damage
		Speaking of Fracture Patterns
	SOFT TISSUE P A TTERN
		Recognize the Severity of the Soft T issue Injury Preoperatively
		Modify Surgical Plans Based on Soft T issue Injury Pattern
		Familiarize Y ourself with the Concept of Angiosomes
	AREA INVOLVED
		Empower Fracture Fixation Constructs
		Speaking of the Soft T issue Pattern
		Articular Surface
		Metaphysis and Diaphysis
		Speaking of the Area Involved
		Spectrum of Stability
	DESIRED STABILITY
		Absolute Stability
			Strain Theory of Perren
			Summary of Absolute Stability
			Speaking of Absolute Stability
		Relative Stability
			Stress Distribution versus Stress Concentration
			Summary of Relative Stability
			Speaking of Relative Stability
			Prone Position
			Lateral Decubitus Position
	APPROACH
		Intraoperative Positioning and Patient Safety
			Supine Position
		Special Considerations: Hemilithotomy and Perineal Post
		Surgical Exposure
		Method of Reduction
		AO Philosophy and Inherent Conflict
		Direct Reduction: Instruments and T echniques
		Speaking of the Surgical Approach
	REDUCTION: DIRECT VERSUS INDIRECT
		Quality of Reduction
		Indirect Reduction: Instruments and T echniques
	FIXATION
		Direct and Indirect Reduction: Summary
		Speaking of Direct and Indirect Reduction
		W ires and Pins
			Speaking of W ires and Pins
		Screws, Drill Bits, T aps, and Screwdrivers Screw Functions
			Screw Parts: Inner Diameter
			Screw Parts: Head
			Screw Parts: Outer Diameter
			Screw Parts: T ip
			Screw T ypes
		Drill Bits and T aps
			Screw Function Revisited
			Speaking of Screws
			Speaking of Screwdrivers
			Speaking of Drills and T aps
		Screwdrivers
		Plate
			Mechanical Function
			Neutralization Plating
			Compression Plating
			T ension Band Plating
			Buttress Plating
			Bridge Plating
			Locked Internal Fixator
			Specific Design Features: Shape, Holes, and So On
			Speaking of Plate Function
			Speaking of Plate Design
		Intramedullary Nail or Rod
			Mechanical Form of Stability
			Speaking of an Intramedullary Rod
			General Design Features
			Speaking of Intramedullary Rod Design
	STEPS OF INTRAMEDULLARY RODDING
		Starting Point and Entrance Angle into the Proximal Segment
		Reaming (If Chosen)
		Reduction of the Fracture
		W orking Length Revisited
		Entrance Angle into and Ending Point in the Distal Segment
		Interlocking Screw Insertion
		Speaking of Intramedullary Rod T echnique
	CONSTRUCT STABILITY
		Speaking of Construct Stability
		Construct Failure
		Injury Factors
		Patient Factors
		Loosening of Screws in a Conventional Plating Construct
		Screw Fracture in a Conventional Plating Construct
		Plate Fracture in a Conventional or Locking Construct
		Surgeon Factors
		Proactive Failure Analysis
		Interlocking Screw Backout and Bone/Screw Interface Failure in an In
		Rod Construct
		Speaking of Construct Failure
	PREOPERATIVE PLANNING
		Bone/Screw Interface Failure in a Locking Construct
		Interlocking Screw Fracture in an Intramedullary Rod Construct
		The Surgical T actic
		The Operation Logistics
		The Elements of Preoperative Planning
		The Desired End Result
		Speaking of Preoperative Planning
Evaluation and T r eatment of the Multi-injured T rauma Patient
	TRAUMA SYSTEMS
		Prehospital and En Route Critical Care Providers
		Airway Control
	PREHOSPITAL EVALUATION AND CARE
		Prehospital Personnel
		Hemorrhage Control
		Resuscitation
		Assessing the Severity of Injury
	HOSPITAL RESUSCITATION
	HOSPITAL EVALUATION AND CARE
		T rauma T eam
	PRIMARY SURVEY
		Airway
		Breathing
		Circulation
		Disability
	SECONDARY SURVEY
		Damage Control Surgery
		T rauma to the Cranium
		Exposure and Environmental Control
		Neck Injury
		Thoracic Injury
		Abdominal Injury
		Retroperitoneal Injuries
		Musculoskeletal Injuries
	TERTIARY SURVEY
	SUMMARY
		Genitourinary Injuries
Initial Evaluation of the Spine in T rauma Patients
	INITIAL EVALUATION AND STABILIZATION
	ADVANCED TRAUMA LIFE SUPPORT
	CLASSIFICATION OF NEUROLOGIC INJURY
		STANDARD NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY
	RADIOGRAPHIC ASSESSMENT
	CERVICAL SPINE CLEARANCE
		Patient Classification
			Asymptomatic Patients
			T emporarily Nonassessable Secondary to Distracting Injuries or Into
			Symptomatic Patients
			Obtunded Patients
			Conclusion: Cervical Spine Clearance
	THORACOLUMBAR SPINE CLEARANCE
		KEY REFERENCES
	CONCLUSION
Damage Control Orthopaedic Surgery: A Strategy for the Orthopaedic C
	INTRODUCTION TO THE CONCEPT OF DAMAGE CONTROL ORTHOPAEDICS
	HISTORY OF DAMAGE CONTROL ORTHOPAEDICS VERSUS EARLY TOTAL CARE
		The Basic Principles of Resuscitation
			Achieving Hemostasis
	DIAGNOSIS AND CLASSIFICATION OF THE BASIC P A THOPHYSIOLOGY AND IN
		The Basic Characteristics of Shock
	MANAGEMENT OF THE MULTIPLY INJURED P A TIENT
		The Decision for Damage Control Orthopaedic Surgery
			V olume Replacement
			Optimizing Pulmonary Function
		Early Fracture Care versus Damage Control Orthopaedics
			Care for the Borderline Patient (Grade II)
			Care for Unstable Patients (Grade III)
			Care for Patients in Extremis (Grade IV)
		Damage Control Orthopaedic T reatment Principles Management Goals
			Assessment
			Care for the Stable Patient (Grade I)
			External Fixation
			Pelvic Stabilization and Hemodynamic Control
			Surgical T iming and T itration of Care
		A voiding Missed Opportunities: V alue of the T eam Approach for C
		Conversion to Definitive Fixation
			Managing Other Musculoskeletal Injuries
		The Effect of T iming
	TREATMENT OF P A TIENTS WITH SEVERE THORACIC AND MUSCULOSKELETAL INJ
		The Effect of Reaming
	DAMAGE CONTROL ORTHOPAEDIC GUIDELINES FOR OTHER UNIQUE MUSCULOSKELETA
		Clinical Experience: Bilateral Femur Fractures
		The Effect of the Fracture
		Current T reatment Recommendations in Cases of Severe Thoracic Inju
		Clinical Experience: Femoral Fracture and Head Injury
		Clinical Experience: Unstable Pelvic Ring Injury and Polytrauma
		Clinical Experience: Military Combat Casualty Care Lessons Learned
	CONCLUSION
Disaster Management
	DISASTER PLANNING
	DISASTER MANAGEMENT
	DISASTER CLASSIFICATION
		Barriers to Effective Disaster Response
		Disaster Response Organization—Incident Command System
	ACCIDENTAL AND HUMAN-MADE DISASTERS
		Nuclear and Radiologic Events
		Biological Events
		Chemical Events
		Blast Events
	BLAST INJURY P A THOPHYSIOLOGY
		Primary Blast Injury
		Secondary Blast Injury
		T ertiary and Quaternary Blast Injury
		The Challenge of Individual T riage
	MEDICAL MANAGEMENT OF DISASTER CASUALTIES
		T riage—Concept and Principles
		Global T riage Accuracy
		Evacuation
		Decontamination
		Evacuation and Echelons
			Echelon I
			Echelon II
			Echelon III
			Echelon IV
			Echelon V
		Hospital Care
			Blast Injury
	DISASTER EDUCATION INITIATIVES
	ACKNOWLEDGEMENT
	SUMMARY
	C h a p t e r 1 3
Occupational Hazards in the T r eatment of Orthopaedic T rauma
	13A Optimal and Safe Use of C-Arm X-Ray Fluoroscopy Units
		FEATURES
		REDUCTION OF RADIATION DOSE DURING C-ARM OPERATION
		IN SUMMARY: TO OPERATE A C-ARM AND REDUCE THE RADIATION EXPOSURE
		PROTECTION FROM RADIATION OF C-ARM EQUIPMENT WHEN IN OPERATION
			BIBLIOGRAPHY
		ANNUAL INSPECTION OF C-ARM EQUIPMENT
	13B Prevention of Occupationally Acquired Bloodborne Pathogens
		BIBLIOGRAPHY
		HEPATITIS B VIRUS
			Acute Infection
			Chronic Disease
			T reatment
			Prevention Before and After Occupational Exposure
		HEPATITIS C VIRUS
			Screening
		HUMAN IMMUNODEFICIENCY VIRUS
			Management of Occupational Exposure to HIV
		STRATEGIES TO PREVENT OCCUPATIONAL TRANSMISSION OF BLOODBORNE P A T
			Screening for Bloodborne Pathogens
				Human Immunodeficiency V irus
				Hepatitis C V irus
				Management of Bloodborne Pathogen Infected Healthcare W orkers
			Personal Protective Equipment
				Gloves
				Gowns
				Masks, Eye Protection, and Face Shields
				Other Personal Protective Equipment
		WORK PRACTICES AND ENGINEERING CONTROLS
			Setting Expectations
			Needles and Sharps
			Hands-Free T echnique
			Blunted Surgical Needles
		REGULATED MEDICAL W ASTE
			BOX 13B-1 L isting o f M e d ical W astes
Medical Management of the Orthopaedic T rauma Patient
	14A Acute Pain Management, Regional Anesthesia T echniques, and
		NEUROPHYSIOLOGY OF P AIN PROCESSING
			Central Nervous System Relay and Processing
			Nociceptors and Primary Afferents
		TREATMENT OPTIONS
			Opioids
			Patient-Controlled Analgesia
		ASSESSMENT
			Opioids
		PHARMACOTHERAPY
			Nonsteroidal Antiinflammatory Drugs
			Acetaminophen
			Selection of Opioids
			Appropriate and Inappropriate Use of Opioids
		DIAGNOSIS AND DIFFERENTIAL
			Informed Consent
				Abuse
				Addiction
				Physical Dependence
				T olerance
				W ithdrawal (Abstinence)
			Opioid Agreements
		INITIATION AND ASSESSMENT OF THERAPY
			Analgesia
			Activity
			Adverse Effects
			Aberrant Behavior
			Neuraxial Delivery Systems: Subarachnoid Injections
			Neuraxial Delivery Systems: Continuous Epidural Catheters
			Peripheral Nerve Blocks
			Upper Extremity Blocks
			Interscalene Block
			Supraclavicular
			Infraclavicular
			Axillary
			Lower Extremity Blocks
			Femoral
			Lumbar Plexus Blocks (Psoas Compartment Block)
			Adductor Canal Block
			Parasacral Block
			Sciatic Nerve Block
			Popliteal Block
		COMPLEX REGIONAL P AIN SYNDROME
			Risk Factors
			Imaging and T esting 175
			T reatment
			Medical Therapies 177
			Pathophysiology
			Symptomatology
		CONCLUSION
			REFERENCES
	14B Perioperative Assessment
		INTRODUCTION TO PERIOPERATIVE MEDICINE
		PREOPERATIVE CARDIAC RISK ASSESSMENT
		PULMONARY RISK ASSESSMENT
		MEDICATIONS
			β -Blockers
			Hyperglycemic Medications
			Antihypertensive Medications
			Glucocorticoids
			Anticoagulation Medications 23
			Herbal Supplements
		DIABETES MELLITUS
			Other Medications
		ORDERING TESTS
		OBSTRUCTIVE SLEEP APNEA
		LIVER DISEASE
			Acute Renal Failure
			Postoperative Fever
		PREVENTING COMPLICATIONS
			Delirium
				T i m e F r a m e
			Other
		CONCLUSION
			KEY REFERENCES
	14C Management of the Pregnant W oman
		INTRODUCTION
		ASSESSMENT
		PHYSIOLOGIC CHANGES IN PREGNANCY
		DIAGNOSTIC IMAGING IN PREGNANCY
		X-RAY
		COMPUTED TOMOGRAPHY
		COMMON MUSCULOSKELETAL COMPLAINTS IN PREGNANCY
		MAGNETIC RESONANCE IMAGING
		NUCLEAR IMAGING
		ANESTHESIA DURING PREGNANCY
		PRETERM LABOR
		TRAUMA IN PREGNANCY
		FETAL MONITORING DURING NONOBSTETRIC SURGERY
		MEDICATIONS FOR USE IN MUSCULOSKELETAL INJURIES OR COMPLAINTS IN PR
		PERIMORTEM CESAREAN DELIVERY
	14D Substance Abuse Syndromes: Recognition, Prevention, and T r
		“Whiskey claims to itself alone the exclusive office of sot-m
		INTRODUCTION
		DEFINITIONS
			BOX 14D-1 CAGE Scoring S ystem
		RECOGNITION—ESTIMATING RISK
			Alcohol
			Cocaine
			Opiates
			Benzodiazepines
		RECOGNITION—EARLY IDENTIFICATION OF SIGNS AND SYMPTOMS
			Alcohol
			Opiates
			Cocaine
			Benzodiazepines
		MANAGEMENT—PROPHYLAXIS/TREATMENT
			BOX 14D-2 Ch i ld-Pugh Classification o f Operative M o rtality A s so
			General Medical Considerations
			Alcohol
				Benzodiazepine Administration
				Benzodiazepine Protocol
					BOX 14D-3 Observer A lertness A wakeness/Sedation Score
				Alcohol Replacement
				Ethanol Replacement Protocol
				Additional Considerations for Implementation of Alcohol Replacement
			Cocaine
			Benzodiazepines
		DISCHARGE PLANS
		SUMMARY
			Opiates
Evaluation and T r eatment of V ascular Injuries
	HISTORY
	ETIOLOGY
	LOCATIONS AND TYPES OF V ASCULAR INJURIES
	DIAGNOSIS 31 - 33
		History and Physical Examination
		Radiologic Studies
	MANAGEMENT OF V ASCULAR INJURIES 31 - 33,53
		The Emergency Center
		Endovascular Stents and Stent Grafts
		The Operating Room Arterial Repair
			Skin Preparation and Draping
		Nonoperative T reatment of Arterial Injuries
		Therapeutic Embolization
			Incisions
			Standard T echniques of Arterial Repair
			Completion Arteriography
			V enous Injuries
			Indications for Fasciotomy
			Combined Orthopaedic–Vascular Injuries
			T emporary Intraluminal V ascular Shunts
			Mangled Extremities
			Delay in Diagnosis of an Arterial Injury
			Soft T issue Infection over an Arterial Repair
			Late Occlusion of Arterial Repair
			Bleeding or Edema in Soft T issues
			Heroic T echniques to Save a Limb
		Postoperative Care
		Complications
			Early Occlusion of Arterial Repair
	SUMMARY
		KEY REFERENCES
Compartment Syndromes
	INTRODUCTION
	HISTORY
	P A THOPHYSIOLOGY
	DIAGNOSIS: CLINICAL ASSESSMENT
	COMPARTMENT SYNDROME IN COMBAT
	CRUSH SYNDROME
	MEASUREMENT TECHNIQUES
		Needle Manometer
		Arterial Line Catheter
		Stryker Stic Catheter System
		Microporous Catheter
	NEW TECHNOLOGIES
	F ASCIOTOMY TECHNIQUES
		Compartment Syndrome of the Hand
		Compartment Syndrome of the Forearm
			V olar (Henry) Approach
			V olar Ulnar Approach
			Dorsal Approach
			Compartment Syndrome of the Upper Arm
		Compartment Syndrome of the Leg
			Fibulectomy
		Compartment Syndrome of the Thigh
		Compartment Syndrome of the Foot
		Closure and Aftercare of Fasciotomy W ounds
	FUTURE DIRECTION
	CHRONIC EXERTIONAL COMPARTMENT SYNDROME
	ACKNOWLEDGMENT
Open Fractures
	MECHANISM
		Direct Blow
		Crush Injury
		Explosion and Blast Injury
	P A THOPHYSIOLOGY
		Infection
	CLASSIFICATION
		Gustilo and Anderson
		Other Open Fracture Classifications
		Arbeitsgemeinschaft für Osteosynthesefragen/ Orthopaedic T rauma Associat
	BASIC PRINCIPLES OF OPEN FRACTURE MANAGEMENT IN THE EMERGENT SETTING
		Initial T rauma Assessment
		Prompt Diagnosis
		Control Bleeding
		Injury Assessment Integument
			Contamination
			V ascular
			Muscle Integrity and Function
			Bone Loss
		Splinting
	WOUND INFECTIONS AND ANTIBIOTICS
		What and T ype
		How Long?
	BASIC PRINCIPLES OF OPEN FRACTURE MANAGEMENT IN THE OPERATING SUITE
		Irrigation
		T ips and T ricks
		Future Studies
		Open Fractures with Compartment Syndrome
		Osseous Stabilization
			Internal Fixation
		Intramedullary Nailing
		External Fixation
	WOUND MANAGEMENT
		Primary Closure
		T ips and T ricks Ankle Fractures
		Delayed Primary Closure
			V acuum-Assisted Closure and Negative-Pressure W ound Management
			Local Antibiotics
		Comparison of Different Options for Initial W ound Management
		Immediate Shortening
	FUTURE DEVELOPMENTS
		Bacteria Identification Using Molecular Platform
		Antimicrobial Implants
		Local Antibiotic Delivery Devices
		Antibiofilm Agents
		Dual-Purpose Bone Grafts
		T issue Engineering and Regenerative Medicine Approaches
	CONCLUSION
		KEY REFERENCES
Soft T issue Reconstruction
	INTRODUCTION AND GENERAL PRINCIPLES
		Introduction
		Initial Evaluation
	WOUND PREPARATION
	WOUND COVERAGE TYPES
		Skin Grafts
		Dermal Substitutes
		Random Pattern Flaps
		Axial Pattern Flaps
		Island Pattern Flaps
		Perforator Flap
		Free Flap
	SOFT TISSUE RECONSTRUCTION OF THE UPPER EXTREMITY
		Surgical Planning
		The Shoulder
			Scapular and Parascapular Flap
		The Brachium and Arm
			Pedicled Latissimus Dorsi Muscle Flap
			Pedicled Pectoralis Muscle Flap
		The Elbow
			Radial Forearm Flap
			Anconeus Muscle Flap
			Pedicled Latissimus Dorsi Muscle Flap
			Lateral Arm Flap
		Forearm
			Anterolateral Thigh Flap
			Scapular and Parascapular Flap
			Omental Flap
		W rist and Hand
			Reverse Radial Forearm Flap
			Posterior Interosseous Artery Flap
			Groin Flap
			First Dorsal Metacarpal Artery Flap
	LOWER EXTREMITY SOFT TISSUE RECONSTRUCTION
		Introduction
		Surgical Planning
		Hip and Thigh
		Lower Thigh, Knee, and Proximal Third of the Leg
			Gastrocnemius Muscle Flap
			V astus Lateralis Muscle Flap
			Sural Artery Fasciocutaneous Flap
			Saphenous Artery Fasciocutaneous Flap
			Superior Lateral Genicular Artery Fasciocutaneous Flap
			Popliteal-Based Posterior Thigh Fasciocutaneous Flap
		Middle Third of the Leg Soleus Flap
		Lower Third of the Leg and Ankle
			Propeller Flaps
			Reverse Sural Artery Flap
		The Foot
			Distally Based Sural Artery Flap
			Dorsalis Pedis Flap
	REHABILITATION AND OUTCOMES
		Outcome Studies
			Medial Plantar Flap
			Free Flap
Gunshot W ounds and Blast Injuries
	BALLISTICS
	DIAGNOSIS
	GENERAL TREATMENT PRINCIPLES
		Antibiotic Usage
		W ound Assessment
			Fracture
	UPPER EXTREMITY
		Proximal Humerus and Shoulder Joint V essel and Nerve Injury
			Humeral Shaft and Arm V essel and Nerve Injury
			Fracture
		Elbow
		Distal Humerus
		Ulna
	GUNSHOT FRACTURES OF THE HAND AND WRIST
		Introduction
		Forearm
		Initial T reatment
		Surgical T reatment
		Soft T issue Management
		Fracture T reatment
	LOWER EXTREMITY
		Pelvis
			Imaging Studies
			Intraarticular Bullets
			Intestinal Contamination
			Fracture Management
			Initial T r eatment
			Definitive T r eatment
			Diaphyseal and Subtrochanteric Fractures
		Femur
			History and Physical Examination
			Imaging
			Distal Femoral Fractures
		T ibia
			Intraarticular Fractures
		Foot
	ORTHOPAEDIC MANAGEMENT IN THE BLAST TRAUMA P A TIENT
		Blast T rauma Mechanisms of Injury
		Lessons Learned
		KEY REFERENCES
Pathologic Fractures
	METASTATIC BONE LESIONS
		Biology of Bone Metastases
		Prognosis
	EVALUATION
		Examination
			Clinical Features and Presentation
	DIAGNOSIS
		Diagnostic Evaluation
		Biopsy
	MANAGEMENT
		Impending Fractures
		Pathologic Fractures Goals
	COMPLICATIONS
	SPECIAL CONSIDERATIONS
		Renal Cell Carcinomas
		Radiation-Induced Fractures
		Bisphosphonate-Associated Fractures
	CONCLUSION
Osteoporotic Fragility Fractures
	DEMOGRAPHICS OF OSTEOPOROTIC FRAGILITY FRACTURES
	TRENDS OF FRAGILITY FRACTURES
	RESULTS OF FRAGILITY FRACTURES
	IS THE MEDICAL SYSTEM PREPARED FOR THIS CHANGE?
	SOCIOECONOMIC IMPLICATIONS OF FRAGILITY FRACTURES
	SECONDARY FRACTURE PREVENTION: DIETARY SUPPLEMENTATIONS AND MEDICAL T
		V itamin D and Calcium
		Selective Estrogen Receptor Modulators
		Calcitonin
		Antiresorptive Monoclonal Antibodies Denosumab
		Anabolic Agents T eriparatide
		Bisphosphonate Therapy
	PREVENTION OF F ALLS
		Comprehensive Falls Assessment
			Modification of the Home
		Exercise Programs
	MEDICAL AND SURGICAL INTERVENTIONS
		Unsuccessful Interventions
		Implementing Secondary Fracture Prevention as a System: The Fracture
	SUMMARY
		Obtaining Dual-Energy X-Ray Absorptiometry Scans
		Intradisciplinary T eam Communication
		Initiation of Medical Management
		Medical Therapy Compliance
		The Role of a Metabolic Bone Clinic
Surgical Site Infection Prevention
	DEFINING SURGICAL SITE INFECTIONS
	PREOPERATIVE INTERVENTIONS
		T iming of Administration
		Antimicrobial Choices
	PROPHYLACTIC ANTIBIOTICS
		Duration
	INTRAOPERATIVE MEANS OF REDUCING INFECTION
		The Operating Room Environment
		Dosing
		The Surgical Site
		The Surgical T eam
Diagnosis and T r eatment of Complications
	SYSTEMIC COMPLICATIONS
		Fat Embolism Syndrome
			Etiology
			Prevention and T r eatment
		Thromboembolic Disorders Pathogenesis
			Diagnosis
			V enous Thromboembolism Protection in Orthopaedic T rauma
			Summary
		Multiple Organ System Dysfunction and Failure
			Orthopaedic Management
	LOCAL COMPLICATIONS OF FRACTURES
		Posttraumatic Arthrosis
		Soft T issue and V ascular Problems
			Joint Incongruity
			Articular Cartilage Damage
			Malalignment
			Malorientation
		Peripheral Nerve Injuries
			History of the T r eatment of Nerve Injury
			Classification of Nerve Injury
			Repetitive Loading Injury
			Summary
			Incidence of Nerve Injuries Associated with Fractures
			Evaluation of Peripheral Nerve Injuries
			Association of Peripheral Nerve Injury with Causalgia
			Prognosis
			Summary
		Complex Regional Pain Syndrome
			Modern T erminology
			Etiology and Epidemiology
			Pathophysiology
			Clinical Presentation
			Psychologic or Psychiatric Assessment
			Staging
			Diagnostic T esting
			Current Concepts in T r eatment
			Prevention
			Prognosis
			Summary
	MANAGEMENT OF COMPLICATIONS
		Missed Injuries
		Risk Management
			Documentation of Complications
			Summary
		KEY REFERENCES
Chronic Osteomyelitis
	BACKGROUND
	EPIDEMIOLOGY
	P A THOGENESIS
	MICROBIOLOGY
	CLASSIFICATION
	DIAGNOSIS
		History
		Physical Examination
		Cultures
		Laboratory V alues
		Imaging
	MANAGEMENT
		Overview
		Suppressive Therapy
		Amputation
			T echnique
			Postoperative Care
		Limb Salvage
		Débridement
		Skeletal Stabilization
		Skeletal Defect Management
		Soft T issue Coverage
		Infection Control
			Systemic Antibiotics
	ILLUSTRATIVE CASES
		Case 1: Antibiotic Cement Rod
		Case 2: Acute Shortening and Relengthening
	CONCLUSION AND FUTURE DIRECTIONS
Nonunions: Evaluation and T r eatment
	DEFINITIONS
	FRACTURE REPAIR
		Healing via Callus
		Direct Bone (Osteonal) Healing
			Inadequate V ascularity
			Poor Bone Contact
		Other Contributing Factors
			Infection
			Nicotine and Cigarette Smoking
		Indirect Bone Healing
	ETIOLOGY OF NONUNIONS
		Predisposing Factors—Instability, Inadequate V ascularity, Poor Contact
			Instability
	EVALUATION OF NONUNIONS
		Patient History
			Certain Medications
			Other Contributing Factors
		Physical Examination
		Radiologic Examination Plain Radiographs
			Computed T omographic Scanning and T omography
			Nuclear Imaging
			Other Radiologic Studies
		Laboratory Studies
		Consultations
	TREATMENT
		Objectives
		Strategies
			Nonunion T ype
			T r eatment Modifiers
		T reatment Methods
			Mechanical Methods
			Biological Methods
			Methods That Are Both Mechanical and Biological
	SUMMARY
		Th e 10 Commandments o f N o n u n ion T r e a tment
	ACKNOWLEDGMENTS
		KEY REFERENCES
Physical Impairment Ratings for Fractures
	GENERIC ISSUES OF DISABILITY AND IMPAIRMENT
		Definitions
		Role of the Physician
	TYPES OF DISABILITY
		T emporary T otal Disability
			T emporary Partial Disability
		Third-Party Payers and the W orkers’ Compensation System
			W ork Restrictions
	EPIDEMIOLOGY OF FRACTURES IN THE UNITED STATES
		Permanent Partial Disability
	GUIDES FOR IMPAIRMENT DETERMINATION
		Historical Perspective
		How to Perform an Impairment Evaluation
	PREEXISTING CONDITIONS AND APPORTIONMENT
		Neurologic Injuries
		Impairment and Fractures
	SUMMARY
		KEY REFERENCES
		Spine Fractures
Outcome Assessment in Orthopaedic T raumatology
	OUTCOMES RESEARCH—ASSESSMENT OF CLINICAL OUTCOMES
		Region-Specific Outcome Measures
		Patient-Reported Outcome Measures
		Patient Reported Outcome Measurement Information System
		Choosing an Outcome Measurement T ool
	QUALITY IMPROVEMENT IN HEALTHCARE
		Economic Outcome Measures
		An Example of Change in Healthcare: V enous Thromboembolism Reporting
		Moving T oward High Reliability in Healthcare Delivery
		Providing V alue in the Delivery of Healthcare
	CONCLUSION
		KEY REFERENCES
		Surgeon Leadership
Professionalism and the Economics of Orthopaedic T rauma Care
	THE “ON-CALL” CONTROVERSY
	EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT
	ECONOMICS OF ORTHOPAEDIC TRAUMA CARE
		KEY REFERENCES
Psychological, Social, and Functional Manifestations of Orthopaedic T
	BIOMEDICAL VERSUS BIOPSYCHOSOCIAL MODEL OF MEDICINE
	ANXIETY DISORDERS AND POSTTRAUMATIC STRESS
		Generalized Anxiety Disorder and Panic Disorder
		Posttraumatic Stress Disorder (PTSD)
	PTSD Checklist—Civilian V ersion (PCL-C)
		TRAUMATIC BRAIN INJURY AND POSTTRAUMATIC STRESS DISORDER
			T raumatic Brain Injury and Suicide
		DEPRESSION
		IMPACT OF PSYCHOLOGICAL COMORBIDITIES ON DISABILITY AND F AMILY FU
			Effect on Family Members and Relationships
		PREVENTION AND MANAGEMENT OF PSYCHOLOGICAL COMORBIDITIES
			T reatment of Posttraumatic Stress Disorder
			T reatment of Depression
		COMMUNICATION, EDUCATION, AND RESOURCES
			Role of the Orthopaedic Surgeon
				W eek 1: T aking Stock
				W eek 2: Moving Forward
				W eek 3: Managing Emotions I
				W eek 4: Managing Emotions II
				W eek 5: Family and Friends
			Peer Support
			Self-Management
		CONCLUSIONS AND FUTURE DIRECTIONS
			W eek 6: Moving Forward
			Family Involvement
Imaging of Spinal T rauma
	IMAGING SELECTION AND INDICATIONS
		The Pediatric Patient
		Geriatric Patient
		Obtunded Patient
		Magnetic Resonance Imaging Protocols
		Role of Magnetic Resonance Imaging
		Role of Flexion and Extension V iews and Dynamic Fluoroscopy
	IMAGING EVALUATION
		Cervical Spine
			Lateral V iew and Sagittal Computed T omography Reconstruction
			Anterior-Posterior and Open-Mouth V iews and Coronal Computed T omogra
		Thoracic and Lumbar Spine
			Injury Patterns Cervical Spine Injuries
		Spine Fractures in Patients with Preexisting Ankylosing Spinal Disord
		Blunt Cerebrovascular Injuries
	SUMMARY
		KEY REFERENCES
Pathophysiology and Emergent T r eatment of Spinal Cord Injury
	SPINAL CORD INJURY EPIDEMIOLOGY: DEMOGRAPHICS AND BASELINE FEATURES
	THE P A THOPHYSIOLOGY OF SPINAL CORD INJURY: PRIMARY AND SECONDARY I
		Initial Closed Reduction
		Early Decompression Surgery
		Therapeutic Hypothermia
	IMMEDIATE THERAPEUTIC APPROACHES
		Pharmacological Management: Methylprednisolone Sodium Succinate
	NEUROPROTECTIVE AND NEUROREGENERATIVE APPROACHES TO TREATING THE INJU
		Monosialotetrahexosylganglioside
		Autologous Macrophage
		Riluzole
		Improving Axonal Conduction in the Injured Spinal Cord Fampridine
		Minocycline
		Cethrin
	CELL-BASED THERAPIES FOR SPINAL CORD INJURY
		Schwann Cells
		Olfactory Ensheathing Cells
		Neural Stem and Progenitor Cells
		Bone Marrow Stromal Cells and Mesenchymal Stem Cells
	COMBINATORIAL PRECLINICAL INVESTIGATIONS
	CONCLUSIONS
The T iming of Management of Spinal Cord Injuries
	EPIDEMIOLOGY
		Incidence
		Prevalence
	SPINAL CORD INJURY P A THOMECHANICS: CURRENT OPINION
		Preclinical and Clinical Evidence
	TREATMENT STRATEGIES AND TIMING
		Early Management (Less Than 1 Hour): Maintaining and Optimizing P
		Surgical and Nonsurgical Management (Less Than 24 Hours): Spinal Cor
		Surgical and Nonsurgical Management (More Than 24 Hours)
		Evidence from STASCIS
		Thoracic Spinal Cord Injury 8,30
	FOCUSED CONSIDERATIONS
		T raumatic Central Cord Syndrome 3-4,22-24
	OUTCOMES RELATED TO SPINAL CORD TRAUMA
		Multitrauma Patients with Spinal Cord Injury
		Functional Recovery
		Neurological Recovery
		Survival
	EVOLVING AND FUTURE TREATMENT STRATEGIES
		Neuroprotective Agents
		Neuroregenerative Agents
Craniocervical Injuries
	33A Occipital-Cervical Spine Injuries
		ANATOMY
			Occiput
			Atlas
			Axis
			Ligamentous Anatomy
			Kinematics
		PHYSICAL EXAMINATION
		IMAGING OVERVIEW
			Plain Radiographs
			Computed T omography
			Magnetic Resonance Imaging
			T raction T est
		OCCIPITAL CONDYLE FRACTURES
			Mechanism of Injury
				Classification and Management
			Imaging
				Management
			Outcomes and Associated Injuries
		CRANIOCERVICAL DISSOCIATIONS
			Historical Perspective
			Classification
			Imaging
			Neurologic Issues
			V ascular Injuries
			Associated Injuries
			Nonoperative Management
			Operative Management
			Anesthetic Principles
			Monitoring
			Positioning
			Approach and T echnique
			Occipital Plating
			C1 Screw Options
			C2 Screw Options
			Cable Options
			Bone Graft Options
			Reduction and Postoperative Care
			Outcomes and Complications
		CONCLUSIONS
			KEY REFERENCES
	33B Atlas Fractures and Atlantoaxial Injuries
		INTRODUCTION: SCOPE AND PURPOSE
		MECHANISM OF INJURY AND BIOMECHANICS
		EVALUATION
			Examination
			Imaging
		DIAGNOSIS AND CLASSIFICATION
		MANAGEMENT
			Atlas Fractures Emergent T r eatment
			Indications for Definitive Care
			Nonoperative T r eatment
			Atlantoaxial Injuries and T ransverse Atlantal Ligament Injuries
				Emergent T r eatment
				Indications for Definitive Care
				Nonoperative T r eatment
			Atlantoaxial Rotatory Subluxations and Dislocations
				Emergent T r eatment
				Indications for Definitive Care
				Nonoperative T r eatment
				Surgical T r eatment
		COMPLICATIONS
		OUTCOME
		META-ANALYSES AND SYSTEMATIC REVIEWS
		GUIDELINES
		COST-EFFECTIVENESS
	33C C2 Fractures
		INTRODUCTION: SCOPE AND PURPOSE
		MECHANISM OF INJURY, BIOMECHANICS, AND ANATOMY
			Introduction
			Bony Anatomy
			Ligamentous Anatomy
			V ertebral Artery
		EVALUATION
			Clinical Assessment
			Imaging
		DIAGNOSIS AND CLASSIFICATION
			Odontoid Fracture
			T raumatic Spondylolisthesis (Hangman’s Fracture)
			Atypical C2 Fractures (Corpus Fractures)
		MANAGEMENT
			Odontoid Fractures Introduction
				T r eatment Options
				T r eatment of T ype I Injuries
				T r eatment of T ype II and T ype IIA
			T raumatic Spondylolisthesis/ Hangman’s Fracture Introduction
				T r eatment of T ype III
				T r eatment of C2 Corpus Fractures
				Outcomes
			Atypical C2 Fractures: Corpus Fractures
				Surgical T reatment Positioning T echniques
				Surgical Approach
				Reduction and Fixation T echniques
		META-ANALYSES AND SYSTEMATIC REVIEWS
		GUIDELINES
		COST-EFFECTIVENESS
		CONCLUSIONS
			KEY REFERENCES
Subaxial Cervical Spine T rauma
	ANATOMY
		Osseous Structures
		Nonosseous Structures
	BIOMECHANICS
		The Concept of Biomechanical Stability of the Cervical Spine
		Quantifying Instability
	EVALUATION
		Examination
		Imaging
	DIAGNOSIS AND CLASSIFICATION
	MANAGEMENT
		General Management Considerations
		Principles of Nonoperative Management
		Principles of Operative Management
	MANAGEMENT OF SPECIFIC INJURIES
		Flexion T eardrop Fracture
			Definitive T r eatment of T eardrop Fractures
		Compression Fracture
			Definitive T r eatment
		Burst Fractures
			T r eatment Recommendations of Burst Fractures
		Facet Subluxation, Unilateral Facet Dislocation, Bilateral Facet Dis
			Unilateral Facet Dislocations
			Bilateral Facet Dislocations
			T r eatment Recommendations
			Disc Herniations and the Reduction of Facet Dislocations
			T echnique of Closed Reduction of a Cervical Facet Dislocation
		Definitive T reatment of Unilateral and Bilateral Facet Fractures and
			Unilateral Facet Dislocations
			Bilateral Facet Dislocations
		Lateral Mass Fractures
			T r eatment Recommendations
		Anterior Distraction Injury
			T r eatment Recommendations for the Nonankylosed Spine
			T r eatment Recommendations for the Ankylosed Spine
		Isolated Lamina Fracture
			T r eatment
		Spinous Process Fracture
			Surgical T echniques
			T r eatment
		T ransverse Process Fracture
			Definitive T r eatment
		Surgical Stabilization
			Anterior Cervical Discectomy or Corpectomy and Fusion
			Posterior Stabilization and Decompression
	SUMMARY
		KEY REFERENCES
Thoracolumbar Fractures
	35A Classification
		HISTORICAL REVIEW
		UPDATED AO CLASSIFICATION
		RELIABILITY OF CLASSIFICATION SYSTEMS
		MORPHOLOGY AND CLASSIFICATION SYSTEM
		THORACOLUMBAR INJURY CLASSIFICATION SYSTEM
			Compression Fractures
			Burst Fractures
			Flexion-Distraction Injuries
			Hyperextension Injuries
			Fracture-Dislocation
	35B T reatment of Thoracolumbar Burst Fractures
		ANATOMY, CLASSIFICATIONS, AND RADIOLOGIC FINDINGS RELATED TO BURST
			Anatomy of the Thoracolumbar Junction, Spinal Cord, and Cauda Equina
			Burst Fractures in Thoracolumbar Fracture Classifications
			Radiologic Findings of the Burst Fractures
			The Posterior Ligamentous Complex
				Activity
		TREATMENT
			Nonoperative T reatment Indication
				Bracing
				Geriatric Considerations
			Surgical T reatment of Burst Fractures Surgical Indication
				The Anterior Thoracolumbar Approach with Corpectomy and Instrumentatio
		SURGICAL TECHNIQUE: POSTERIOR
		OUTCOME
			Nonoperative T reatment versus Operative T reatment for Thoracolumbar
			Comparison of Anterior and Posterior Approach
			Comparison of Posterior Instrumentation with and without Fusion
			KEY REFERENCES
	35C Identification, Classification, Mechanism, and T reatment of
	Fracture-Dislocations
		CLASSIFICATION
			Fracture-Dislocations
			Flexion-Distraction Injuries
		ASSESSMENT OF SEVERITY OF INJURY
		MECHANISMS OF INJURY
			Flexion Injuries
			Flexion-Rotation Injuries
		PREOPERATIVE PHYSICAL EXAMINATION AND RADIOGRAPHIC EVALUATION
			General Assessment
			Physical Examination
			Flexion-Distraction (Chance and Seat Belt Injuries)
			Lateral Shear Injuries
			Extension Injuries
		GENERAL APPROACH
			Nonoperative Care
			Radiographic Examination
		TREATMENT CONSIDERATIONS
			Spinal Cord Injuries
			Distraction Injuries
			Lateral Shear or Slice Injuries
			Hyperextension Injuries
		TREATMENT OF SPECIFIC INJURY TYPES
			Fracture-Dislocations
			Chance and Flexion-Distraction Injuries
		SURGICAL TECHNIQUE
			Anesthetic Considerations
			Positioning
			Instrumentation
			Exposure
			Fracture Reduction
			Fusion
			Dural T ears
			Neurologic Complications
			W ound Closure
			Postoperative Care
		COMPLICATIONS
			Intraabdominal Injuries
			Other Complications
			Postoperative Infections
		CONCLUSION
	35D Fractures of the Low Lumbar Spine
		UNIQUE BIOMECHANICAL FEATURES
		CLASSIFICATION SYSTEMS
		LOW LUMBAR INJURY P A TTERNS
			Compression Fractures
			Burst Fractures
			Flexion-Distraction (Chance) Fractures
			Fracture-Dislocations
			Shear Injuries
		ASSESSMENT
			Full T rauma Assessment
				American Spinal Injury Association Scale
		IMAGING
			Radiographs
				Examination Neurologic Status
			Computed T omography
			Goals of Management
			Nonoperative T reatment
			Magnetic Resonance Imaging
		MANAGEMENT
			Immediate
			Surgical T reatment
				Decompression
				Restoration of Alignment
				Posterior Instrumentation
				T reatment of Specific Injury Patterns T ransverse Process, Spinous Pro
				Anterior Column Reconstruction
			Maintenance of Alignment
			Outcomes
				Compression Fractures
				Burst Fractures
				Flexion-Distraction Injuries
				Nonunion
				Loss of Correction
				Infection
			KEY REFERENCES
	35E New Concepts in the Management of Thoracolumbar Fractures
		FUSIONLESS SPINE TRAUMA CARE
		MINIMALLY INVASIVE STABILIZATION WITH PERCUTANEOUS INSTRUMENTATION
			Screw Insertion
			Rod Insertion
		SURGICAL TECHNIQUE: PERCUTANEOUS INSTRUMENTATION
			Positioning
			Screw Starting Point
			Pedicle Cannulation
			Reduction T echnique
			W ound Closure
		CONCLUSION
			Facet Joint Fusion
		DAMAGE CONTROL SPINE SURGERY
Fractures in the Ankylosed Spine
	DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS
		Clinical Characteristics
		Epidemiology
		Etiology and Pathophysiology
		Spinal Fractures in Diffuse Idiopathic Skeletal Hyperostosis
	ANKYLOSING SPONDYLITIS
		Clinical Characteristics
		Prognosis of Fractures in Ankylosed Spines
		Epidemiology
		Etiology and Pathophysiology
		Spinal Fractures in Ankylosing Spondylitis
	TREATMENT OF DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS AND ANKYLOSIN
		Nonoperative T reatments
		Outcomes of Nonoperative T reatment
		Surgical T reatment
		Anesthetic and Positioning Considerations
		Principles of Surgical T reatment
		Complications of Surgical T reatment
		Surgical Outcomes
		Special Considerations
	CONCLUSION
Osteoporotic Spinal Fractures
	INTRODUCTION: SCOPE AND PURPOSE
	EVALUATION
	DIAGNOSIS AND CLASSIFICATION
	MECHANISM OF INJURY AND BIOMECHANICS
		Patient Selection
		V ertebroplasty T echnique
	MANAGEMENT
		Cement Augmentation: V ertebroplasty and Kyphoplasty
			Indications
			Kyphoplasty
			Cement Augmentation in Spinal Metastasis
		Surgical Intervention
	COMPLICATIONS
		Embolization
		Surgical Intervention
		New Fractures
		Complications of Surgical Intervention
	CLINICAL OUTCOMES
		V ertebroplasty and Kyphoplasty
	COST EFFECTIVENESS
	CONCLUSION
	META-ANALYSIS AND SYSTEMATIC REVIEWS
	GUIDELINES
		KEY REFERENCES
A voiding Complications in Spine T rauma Patients
	PREOPERATIVE
		Preoperative Evaluation and Decision Making
		Complications with Preoperative Cervical Collar Management
		Preoperative Nutritional Status
		Obesity
		Prognostic Implications of Diagnosis
	INTRAOPERATIVE MANAGEMENT
		Neurophysiologic Monitoring
		Preoperative T iming
		Steroids in Spinal Cord Injury: Indications and Potential Complicat
		Preoperative and Intraoperative Imaging
		Incidental Durotomy
		Recombinant Human Bone Morphogenetic Protein-2
		Pulmonary Complications
		Intraoperative Blood Loss
		Acute Deep V enous Thrombosis
		Inferior V ena Cava Filter
		Pseudarthrosis
	POSTOPERATIVE MANAGEMENT
		Surgical Site Infection
		Catheter-Associated Urinary T ract Infections
	CONCLUSION
		Neurologic Deterioration
		Decubitus Ulcer
		Controversy in Characterizing Spinal Cord Complications
		KEY REFERENCES
Principles of Orthotic Management
	CERVICAL ORTHOSIS
		Cervical Collar
		Cervicothoracic Orthosis and Poster Braces
		Recommended Orthoses for the Nonoperative T reatment of Selected Cerv
			C1 Ring Fracture
			T ransverse Ligament Injuries
		Halo-Vest Device
			Facet Fractures of the Subaxial Spine
	THORACOLUMBAR ORTHOSIS
		Recommended Orthoses for the Nonoperative T reatment of Thoracolumbar
			T ype II Odontoid Fractures
			T ype III Odontoid Fractures
			C2 Pars Fractures (Hangman’s Fractures)
			Spinous Process Fractures, Laminar Fractures, and Compression Fracture
	CLINICAL USE OF SPINAL ORTHOSIS IN TRAUMA
	ADVERSE EVENTS
		Adverse Events of Cervical Orthoses
		Adverse Events of the Halo-Vest Device
		Adverse Events of Thoracolumbar Orthoses
	SURGICAL TECHNIQUE: PLACEMENT OF THE HALO VEST
		Sizing of the Halo
		Localization of the Halo Ring
			Pin Placement
			Skin Preparation
			Pin Insertion
		V est Attachment
		Halo-Vest Care
	CONCLUSION
		KEY REFERENCES
Pelvic Ring Injuries
	ANATOMY
	PELVIC STABILITY AND BIOMECHANICS
	TRAUMA MECHANISM AND P A THOMECHANICS OF PELVIC INJURIES
	TRAUMA MECHANISM
		Motor V ehicle Accident
		Fall from a Height
		Osteoporotic Pelvic Fractures of the Elderly
	P A THOMECHANICS AND MECHANISM OF PELVIC INJURIES
		Anterior-Posterior Force Pattern
		Lateral Compressions Force Pattern
		External Rotation-Abduction Force Pattern
		Shear Force Pattern
	RADIOLOGY OF THE PELVIS
		Plain Radiographs
			Anterior-Posterior Radiograph
			Inlet Radiograph (Pennal I)
		Outlet Radiograph (Pennal II)
		Computed T omography
		Magnetic Resonance Imaging
		Scintigraphy
		Special Imaging of the Symphysis
	CLASSIFICATION AND ITS IMPACT ON TREATMENT
		Anatomic Classifications
		Mechanism of Injury Classification
		Fractures with Proper Names
			Open Book Fracture
			Malgaigne Fracture
			Hemipelvectomy
			Duverney Fracture
		Osteoporotic Pelvic Ring Fractures
		Sacral Fracture Classification
	ACUTE MANAGEMENT
		Marcel W inkelmann, Sebastian Decker
	EARLY (PREHOSPITAL) MANAGEMENT
		Acute Management
		Associated Injuries
		Damage Control Orthopaedics
	DEFINITIVE MANAGEMENT AND DECISION MAKING
		Sebastian Decker, Marcel W inkelmann, Christian Krettek, Carlo Bellaba
	HISTORY
	PHYSICAL EXAMINATION
	DECISION MAKING
	SURGICAL APPROACH
		Anterior Approaches Pfannenstiel Approach ( Fig. 40-39 )
		Stoppa Approach
		Anterolateral Approach ( Fig. 40-41 )
		Lateral Approach
		Posterior Approaches
			Paramedian Approach ( Fig. 40-43 )
	DEFINITIVE TREATMENT
		Subcutaneous Anterior Internal Fixation Device ( Fig. 40-32 )
		Anterior Pelvic Ring Fixation: Symphyseal Reduction and Stabilization
			Symphyseal Plating
		Superior Ramus Screw Fixation
		Anterior Pelvic Ring Fixation: Pubic Ramus
		Posterior Pelvic Ring Fixation: Iliac W ing Fractures and Sacroiliac
			Sacroiliac (Fracture) Dislocations: Anterior Approach
			Sacroiliac (Fracture) Dislocations: Posterior Approach ( Fig. 40-50 )
		Percutaneous Posterior Pelvic Fixation
			T ransiliac-Transsacral Screw Fixation
		Isolated Iliac W ing Fractures
		Sacral Fractures with Spinopelvic Instability
	NEURAL DECOMPRESSION
	SURGICAL STABILIZATION TECHNIQUES
		Direct Osteosynthesis of the Sacrum ( Fig. 40-64 )
		Percutaneous Posterior Pelvic Fixation
		Spinopelvic Fixation
		Conservative T reatment of Pelvic Ring Fractures
		Postoperative Plan
	COMPLICATIONS
		Early Complications
			Infection
			Loss of Fixation
			Neurologic Injury
			Thromboembolism
		Late Complications Pain
			Malunion
			Nonunion
		Genitourinary Injuries
			Assessment
			Management
		Management
			Results
	OPEN PELVIC FRACTURES
		Assessment
		Follow-Up Care
		Results
		KEY REFERENCES
Surgical T r eatment of Acetabular Fractures
	EPIDEMIOLOGY
	OSTEOLOGY
	RADIOLOGY
	CLASSIFICATION
		Posterior W all
		Posterior Column
		Anterior W all
		T ransverse
		Anterior Column
		T ransverse Fractures with Associated Posterior W all Involvement
		Anterior Column Fracture with Associated Posterior Hemitransverse Inju
		T -Type
		Posterior Column Fracture with Associated Posterior W all Involvement
		Associated Both-Column Fracture
		V ariant Patterns
			Decision Making
		Initial Management
		Operative T iming
	SURGICAL EXPOSURES
		Kocher-Langenbeck
		Ilioinguinal
		Extended Iliofemoral
		Other Exposures
		Combined Anterior and Posterior Exposures
	MANIPULATIVE REDUCTION AND PERCUTANEOUS FIXATION
	EXPOSURE, REDUCTION, AND FIXATION BY FRACTURE P A TTERN
		Posterior W all
		Posterior Column
		Anterior W all
		Anterior Column
		T ransverse
		T ransverse Fracture with Associated Posterior W all Involvement
		Posterior Column Fracture with Associated Posterior W all Involvement
		Associated Both-Column Fracture
		Anterior Column Fracture with Associated Posterior Hemitransverse Invo
		T -Type
			T echnical Note: Operative Management of a T ransverse Fracture with
			T echnical Note: Application of an Intrapelvic Plate to Support th
			T echnical Note: Acetabular Osseous Pathways for Screw Fixation
	AFTERCARE
	COMPLICATIONS
		Malreduction
		Nerve Injury
		Ectopic Bone Formation
		Deep V enous Thrombosis
		Infection
		Aseptic Necrosis of the Femoral Head
		Arthritis
		Fixation Error
	SUMMARY
		KEY REFERENCES
Fractures and Dislocations of the Hand
	at https://expertconsult.inkling.com :
	THE THUMB RAY
	INTRAARTICULAR CARPOMETACARPAL FRACTURES OF THE THUMB METACARPAL
		Regional Anatomy
		Examination
		Indications
		Surgical Exposures and Fixation T echniques
		Outcomes
		Sequelae
			Indications
			Surgical Exposures and T echnique
		Future Directions
	EXTRAARTICULAR FRACTURES OF THE THUMB METACARPAL
	LIGAMENTOUS INJURIES
		Carpometacarpal Joint Examination
			Examination
			Outcomes
			Sequelae
			Future Directions
		Thumb Metacarpophalangeal Collateral Ligament Injuries
			Regional Anatomy
			Indications
			Surgical Exposures and Repair T echniques
			Future Directions
		Thumb Metacarpal-Phalangeal Joint Dislocations
	METACARPAL FRACTURES (EXCLUDING THE THUMB)
		Regional Anatomy
		Examination
		Metacarpal Base and Carpometacarpal Fractures of the Digits
			Surgical Exposures and Fixation T echniques
			Indications
			Outcomes
			Sequelae
			Nonoperative T r eatment
			Surgical Exposures and Fixation T echniques
			Future Directions
		Metacarpal Shaft Fractures Indications
			Sequelae
			Future Directions
		Metacarpal Neck Fractures
			Nonoperative T r eatment and Outcomes
			Surgical Exposures and Fixation T echniques
			Open Reduction and Internal Fixation in Special Circumstances
		Metacarpal Head Fractures
			Future Directions
			Fixed-Angle Implants
			Indications
			Nonoperative T r eatment
			Surgical Exposures and Fixation T echniques
			Outcomes
		Complications of Metacarpal Fractures
		Dislocations
		Collateral Ligament Injuries
	METACARPOPHALANGEAL JOINT LIGAMENTOUS INJURIES
		Regional Anatomy
	PHALANGEAL FRACTURES AND INTERPHALANGEAL JOINT INJURIES
		Phalangeal Fractures Fractures of the Distal Phalanx
		Metacarpophalangeal Collateral Ligament A vulsion Fractures
			Fractures of the Middle and Proximal Phalanges
			Articular Phalangeal Fractures
			Phalangeal Base Fractures
		Plateau Fractures
		V olar Central Fracture-Dislocations
			Extension Block Splinting
			Extension Block Pinning
			Closed Reduction and Percutaneous Fixation
			Open Reduction and Internal Fixation
			External Fixation
			V olar Plate Arthroplasty
			Hemi-Hamate Arthroplasty
		Nonarticular Fractures of the Phalanges Phalangeal Neck Fractures
			Phalangeal Shaft Fractures
			Closed Reduction and Immobilization
			Open Reduction and Internal Fixation
			Closed Reduction and Percutaneous Pinning
			Open Reduction and W ire Fixation
			Screw Fixation
			Plate Fixation
			External Fixation
		KEY REFERENCES
Fractures and Dislocations of the Carpus
	FRACTURES OF THE SCAPHOID
		Introduction: Scope and Purpose
		Mechanism of Injury and Biomechanics
			Evaluation Examination
			Imaging
		Diagnosis and Classification
			Duration
			Location
			Orientation
			Displacement
			Comminution
			Emergent T r eatment
			Indications for Definitive Care
			Nonoperative T r eatment
			Associated Injuries
			Patient Factors
			Management Disorder or Injury
			Surgical T r eatment
			Displaced or Unstable Fractures
			Nonunion
			Operative T r eatment
		Meta-analysis and Systematic Reviews
		Guidelines
			Authors’ Preferred Approach
	OTHER CARPAL FRACTURES
		Lunate Fractures
			Mechanism of Injury and Biomechanics
			Evaluation
			Management
			Diagnosis and Classification
			Meta-analysis and Systematic Reviews
		Fractures of the Capitate
		Fractures of the Hamate
			Complications
			Outcome
			T echnique
		Fractures of the T riquetrum
		Fractures of the T rapezium
		Fractures of the Pisiform
		Fractures of the T rapezoid
	DISLOCATION OF THE CARPUS
		Introduction: Scope and Purpose W rist Motion Theories
			W rist Ligament Anatomy
			W rist Kinematics
		Mechanism of Injury and Biomechanics
		Evaluation
			E xamination
			I maging
			Perilunate Dislocations and Fracture-Dislocations
			T ransscaphoid Perilunate Dislocation
			T ranstriquetral Perilunate Fracture-Dislocation
			Capitate–Hamate Diastasis
			Scapholunate Dissociation
				Reduction Association of the Scapholunate Joint (RASL) 335
			Lunotriquetral Dissociation
			Midcarpal Instability
			Secondary (Adaptive) Midcarpal Instability
		KEY REFERENCES
Fractures of the Distal Radius
	FUNCTIONAL ANATOMY
	CLASSIFICATION
		Extraarticular Fractures
		Intraarticular Fractures
	RADIOGRAPHIC ASSESSMENT
	DETERMINATION OF STABILITY
	TREATMENT
		Patient Considerations
	RELATION OF ANATOMY TO FUNCTION
	TREATMENT OF EXTRAARTICULAR FRACTURES
		Stable Fractures
		Options
		Unstable Fractures
			Percutaneous Pins
			External Skeletal Fixation
			Open Reduction
			Comparison of Fixation T echniques
	TREATMENT OF INTRAARTICULAR FRACTURES
		Stable Fractures
		Unstable Fractures
			T wo-Part Radiocarpal Fractures
			T wo-Part Impacted Fractures
			T wo-Part Radial Styloid Fractures
			Three-Part Intraarticular Fractures
			Four-Part Intraarticular Fractures
			Intraarticular Fractures with Five or More Parts
	ASSOCIATED INJURIES
		Ulnar Styloid Fractures
		Nerve Injuries
		Carpal Injuries
		T endon Adhesions and Ruptures
		Malunion
	FUTURE CONSIDERATIONS
		Bone Replacement Materials
		Alternative Fixation Options
		Arthroscopically Guided Reduction
		Nonunion
	EVALUATION OF OUTCOME
	SUMMARY
		KEY REFERENCES
Diaphyseal Fractures of the Forearm
	FUNCTIONAL ANATOMY
		Proximal Radioulnar Joint
			Muscles Supinators
			Pronators
		Nerves and V essels
	CLASSIFICATION OF DIAPHYSEAL FOREARM FRACTURES
		Arbeitsgemeinschaft für Osteosynthesefragen/ Orthopaedic T rauma Associat
		Distal Radioulnar Joint
		Interosseous Membrane
		Monteggia Fracture
			Galeazzi Fracture
			Essex-Lopresti Lesion
		Classification of Associated Soft T issue T rauma
		Clinical Examination
		Radiologic Examination
	DIAGNOSIS
		Anamnesis
		Magnetic Resonance Imaging Examination
		Ultrasonography
	TREATMENT
		Simple Ulna Fracture, Radius Intact
		Simple Fracture of the Radius, Ulna Intact
		Simple Fracture of the Radius and the Ulna
		W edge Fracture of the Ulna, Radius Intact
		W edge Fracture of the Radius, Ulna Intact
		Complex Fracture of the Ulna, Radius Simple or W edge
		One Bone W edge Fracture, the Other Simple or W edge
		Complex Fracture of the Radius, Ulna Simple or W edge
		Complex Fracture of the Radius and the Ulna
		Essex-Lopresti Lesion
	AGGRAVATING COFACTORS
		Open Fracture
		Peri-implant Fractures
		Periprosthetic Fractures
		Osteoporosis and Osteomalacia
		Osteogenesis Imperfecta
		Spastic Palsy and Epilepsy
		W ound Infection and Osteomyelitis
		Nicotine Abuse
		Immune Suppression and Diabetes
	COMPLICATIONS
		Compartment Syndrome of the Forearm
		Malunion and Bridging Callus
		Delayed Bone Healing and Nonunion
		Concomitant Soft T issue Injury
	IMPLANT REMOVAL
		T raumatic Forearm Amputation
		KEY REFERENCES
	OUTCOME
	CONCLUSION
T rauma to the Adult Elbow and Fractures of the Distal Humerus
	46A T rauma to the Adult Elbow
		INTRODUCTION: SCOPE AND PURPOSE
		MECHANISM OF INJURY AND BIOMECHANICS
		EVALUATION
			Examination
			Imaging
		DIAGNOSIS AND CLASSIFICATION
		MANAGEMENT
			Disorder or Injury: Radial Head Fractures
				Emergent T r eatment
				Indications for Definitive Care
				Nonoperative T r eatment
				Surgical T r eatment
				Complications
				Outcome
			Disorder or Injury: Olecranon Fractures
				Emergent T r eatment
				Indications for Definitive Care
				Nonoperative T r eatment
				Surgical T r eatment
				Complications
				Outcome
			Disorder or Injury: Coronoid Fractures
				Emergent T r eatment
				Indications for Definitive Care
				Nonoperative T r eatment
				Surgical T r eatment
				Complications
				Outcome
			Disorder or Injury: Elbow Dislocations
				Emergent T r eatment
				Indications for Definitive Care
				Nonoperative T r eatment
				Surgical T r eatment
		COMPLICATIONS
		OUTCOMES
		META-ANALYSES AND SYSTEMATIC REVIEWS
		CONCLUSION
			KEY REFERENCES
	46B Fractures of the Distal Humerus
		INTRODUCTION: SCOPE AND PURPOSE
			Epidemiology
		ANATOMY
			Functional Anatomy
			Surgical Anatomy
			Blood Supply
		EVALUATION
			Examination
			Imaging
		CLASSIFICATION
		MANAGEMENT
			A and C T ype Fractures Emergent T r eatment
				Nonoperative T r eatment
				Surgical T r eatment
			Coronal Shear Fractures (B T ype) Emergent T r eatment
				Nonoperative T r eatment
				Surgical T r eatment
			Open Fractures of the Distal Humerus
			T otal Elbow Arthroplasty
		COMPLICATIONS
			Ulnar Nerve
			Heterotopic Ossification
			Nonunion and Fixation Failure
			Elbow Stiffness
		OUTCOME
		META-ANALYSES AND SYSTEMATIC REVIEWS
		CONCLUSION
Fracture of the Humeral Shaft
	INTRODUCTION: SCOPE AND PURPOSE
	RELEVANT ANATOMY
	MECHANISM OF INJURY AND BIOMECHANICS
	EVALUATION
		Examination
	DIAGNOSIS AND CLASSIFICATION
	MANAGEMENT
		Disorder or Injury Emergent T r eatment
			Indications for Definitive Care
			Nonoperative T r eatment
			Positioning T echniques
			Surgical Approach
			Reduction T echniques
			Fixation T echniques
			Pitfalls and A voidance of Complications
			Management of Intraoperative Problems
			Postoperative Care and Rehabilitation
	COMPLICATIONS
		Radial Nerve Palsy
		Plate Fixation versus Intramedullary Nailing
		Antegrade versus Retrograde Nailing
	COST EFFECTIVENESS
	CONCLUSION
		Delayed Union and Nonunion
	OUTCOME
	META-ANALYSES AND SYSTEMATIC REVIEWS
		Nonoperative versus Operative Therapy
		KEY REFERENCES
Proximal Humerus Fractures and Glenohumeral Dislocations
	48A Essential Principles
		RELEVANT ANATOMY AND BIOMECHANICS
			Joint Anatomy
			Neurovascular Anatomy
			Biomechanics
		EVALUATION OF AN ACUTELY INJURED SHOULDER
			History
			Physical Examination
			Imaging
			T rauma Series (Three V iews)
			Rotational Anteroposterior V iews (Two V iews)
			Computed T omography
			Magnetic Resonance Imaging
			Ultrasonography
			X-Ray Image Intensifier
		DIFFERENTIAL DIAGNOSIS
		SURGICAL TREATMENT OF PROXIMAL HUMERAL AND GLENOHUMERAL INJURIES
			Anesthetic Considerations
			Intraoperative Imaging
			Intraoperative Patient Positioning
				Deltopectoral Approach
				Superior Approach W ith or W ithout Anterior Acromioplasty
			Surgical Approaches
			Posterior Approach
		OUTCOME EVALUATION
	48B Proximal Humeral Fractures and Fracture-Dislocations
		INTRODUCTION
			Scope and Instruction for the Clinical Use of This Chapter
			Epidemiology
		MECHANISM OF INJURY
			Associated Injuries Polytrauma Patient
				Ipsilateral Upper Extremity Fracture
				Rotator Cuff T ear
				Nerve Injuries
				V ascular Injuries
				Seizures
				Pathologic Fractures
		EVALUATION
			Clinical Examination
			Imaging
		CLASSIFICATION
			The Neer Classification
			AO/ASIF Classification System
			Hertel’s Predictors of Humeral Head Ischemia
			Role and Reliability of Classifications
			Authors’ Preferences and Fractures with Special Interest
				T wo-Part Greater T uberosity Fracture
				The V algus Impacted Three- and Four-Part Fractures
				Fracture-Dislocations
		MANAGEMENT
			Emergent T reatment
			Evaluation of Osteoporosis
			Nonoperative T reatment: Indications and Outcome
				Nonoperative T r eatment in Y oung Patients
				Nonoperative T r eatment Algorithm
				Complications After Nonoperative T r eatment
			Surgical T reatment
				Surgical Approaches
				Open Reduction of Specific Fracture T ypes
				Intramedullary Rodding
				Closed Reduction and Percutaneous Fixation
				Open Reduction and internal Fixation: Conventional Plate
				Open Reduction and Internal Fixation: Locking Plate
				Primary Hemiarthroplasty
				Primary Reverse T otal Shoulder Arthroplasty
				The Role of Arthroscopy for Fracture T r eatment
			Comparison of Surgical T reatments
				Conventional versus Locking Plate Open Reduction and Internal Fixatio
				Primary Hemiarthroplasty versus Open Reduction and Internal Fixation
				Primary Reverse T otal Shoulder Arthroplasty versus Primary Hemiarthro
			Postoperative Rehabilitation Algorithm
		AUTHORS’ PREFERRED TREATMENT
			Fractures in Y oung and Active Patients
			Fractures in Elderly Patients
		IMPLICATIONS FOR FUTURE RESEARCH
		CONCLUSION
			KEY REFERENCES
	48C Glenohumeral Dislocations
		INTRODUCTION: SCOPE AND PURPOSE
		DIRECTION OF DISLOCATION
			Anterior Dislocation
			Inferior Dislocation
			Posterior Dislocation
		FINDINGS AFTER THE GLENOHUMERAL DISLOCATIONS
			“The Essential Lesion”
			Glenohumeral Ligaments
			Hill-Sachs Lesions
			Associated Injuries and Complications Fractures
				Rotator Cuff T ears
				Nerve Injuries
				V ascular Injuries
		EVALUATION
			Examination and Imaging Patient History
				Physical Examination
				Imaging T esting
		DIAGNOSIS AND CLASSIFICATION
			Classification
		MANAGEMENT AND TREATMENT
			Closed Reduction
				Recurrence Age and Gender
				Postreduction Management Immobilization in Internal Rotation
				Immobilization in External Rotation
			Instability Repair Indication
				Capsulolabral Repair
				Bone Block Procedures
			T reatment of Glenoid Rim Fractures Surgical T r eatment
			Rotator Cuff Repair
				Authors’ Preferred T r eatment
		POSTERIOR DISLOCATION
			Introduction
			Characteristics of Posterior Dislocation Etiology
				Directions of Posterior Dislocations
				Associated Fractures
			Diagnosis
				Classification
				Recurrence
			T reatment
				Associated Injuries
				Closed Reduction
				Open Reduction
			Outcome
				Authors’ Preferred T r eatment
			KEY REFERENCES
	48D T reatment of Fracture Sequelae of the Proximal Humerus
		Biomechanics
		EVALUATION
			Examination
			Imaging
		DIAGNOSIS AND CLASSIFICATION
		MANAGEMENT
			Nonunion Management
				Greater T uberosity Nonunion
				Surgical Neck Nonunion
			Malunion Management
				T wo-Part Fracture Malunion
				Three- and Four-Part Fracture Malunions
		TECHNIQUE OF ARTHROPLASTY
			T echnique of Standard Shoulder Replacement
			T echnique of Reverse T otal Shoulder Replacement
		SUMMARY
Fractures and Dislocations of the Clavicle
	The following videos are included with this chapter and may be viewed
	ANATOMY
	SHOULDER SUSPENSORY COMPLEX
	STERNOCLAVICULAR JOINT DISLOCATION
	ACROMIOCLAVICULAR JOINT DISLOCATION
		Decision Making
	OPERATIVE TREATMENT
	FRACTURES OF THE CLAVICLE
		Classification
		Epidemiology
		Mechanism
	MANAGEMENT OF SPECIFIC INJURIES
		Birth Fractures
		Midclavicular Fractures Nonoperative T r eatment
		Evaluation
			Radiographic Evaluation
			Operative T r eatment
			Authors’ Preferred T echnique 66
			Intramedullary Nailing
			Postoperative Care
			Results
			Plating
			Pitfalls
		Distal Clavicular Fractures
			Floating Shoulder
		Medial Clavicular Fractures
			Complications
	NEUROVASCULAR COMPLICATIONS
		KEY REFERENCES
	REFRACTURE
	COMPLICATIONS OF OPERATIVE TREATMENT
Scapula and Rib Fractures
	50A Scapula Fractures
		INTRODUCTION: SCOPE AND PURPOSE
			History of T r eatment -- Scapula Fractur es
		MECHANISM OF INJURY AND BIOMECHANICS
		EVALUATION
			Examination
			Imaging
		DIAGNOSIS AND CLASSIFICATION
		MANAGEMENT
			Scapula Fracture Emergent T r eatment
			Indications for Definitive Care
			Surgical T r eatment
			Surgical Anatomy
			Positioning T echniques
			Surgical Approach
			Reduction T echniques
			Fixation T echniques
			Pitfalls and A voidance of Complications
			Management of Intraoperative Problems
		COMPLICATIONS
			Nonoperative Complications Missed or Delayed Diagnosis
			Postoperative Care and Rehabilitation
			Hematoma
			Hardware-Related Complications
			Malunion
			Nonunion
			Shoulder Stiffness
		OUTCOMES
			Isolated Extraarticular Fracture
				Deformity and Malunion
				Pain
				Nonunion
			Operative Complications Infection
				Neurovascular Injury
			Double Lesions of the Superior Shoulder Suspensory Complex
			Isolated Process Fractures
		CONCLUSION
			Intraarticular Glenoid Fractures
		META-ANALYSES AND SYSTEMATIC REVIEWS
			KEY REFERENCES
	50B Rib Fractures
		INTRODUCTION: SCOPE AND PURPOSE
		MECHANISM OF INJURY AND BIOMECHANICS
		EVALUATION
			Examination
			Imaging and Diagnosis
		CLASSIFICATION
			Nonoperative T r eatment
		MANAGEMENT
			Disorder and Injury Emergent T r eatment
				Indications for Definitive Care
				Surgical T r eatment
		COMPLICATIONS
		OUTCOME S
		META-ANALYSES AND SYSTEMATIC REVIEWS
Replantation
	INDICATIONS AND CONTRAINDICATIONS
		Indications
		Contraindications
	PREOPERATIVE EVALUATION AND TRANSPORT
		Preoperative Considerations
	MANAGEMENT
		T echnique of Replantation
			Bone Fixation
			T endon Repair
			Arterial Repair
	EXPECTATIONS AFTER REPLANTATION
		Nerve Repair
		V ein Repair
		Skin Closur e
		Postoperative Management
	SPECIAL CIRCUMSTANCES
Hip Dislocations
	INTRODUCTION: SCOPE AND PURPOSE
	MECHANISM OF INJURY AND BIOMECHANICS
		Biomechanics and Osseous Anatomy of the Uninjured Hip
		Mechanisms of Injury
	EVALUATION
		History and Examination History
			Physical Examination
			Commonly Associated Injuries
		Imaging
		Plain Film Analysis
			Computed T omography
			Magnetic Resonance Imaging
			Isotope Imaging
	DIAGNOSIS AND CLASSIFICATION
		Posterior Hip Dislocations
		Anterior Hip Dislocations
	MANAGEMENT OF HIP DISLOCATIONS
		Emergent T reatment—Initial Management
		Special Considerations in the Multiply Injured Patient
		Algorithm for Initial Management
		Management after Reduction
		Algorithm for Postreduction Management
			Levin T ype I (Closed Reduction Successful)
			Levin T ype II (Closed Reduction Unsuccessful)
		Management of Specific T ypes of Hip Dislocations
			Levin T ype III (Closed Reduction Unsuccessful or Not Concentric)
			Levin T ype IV (Significant Associated Acetabular Fractures Requiring
			Levin T ype V (Associated Femoral Head or Neck Injury)
		Surgical T reatment Surgical Anatomy
		Positioning T echniques Posterior Approach
			Direct Lateral and Anterolateral Approach
	COMPLICATIONS
		Surgical Complications Infection
			Extension of Posterior Approach, with Digastric T r ochanteric Osteoto
			Anterior Approach
			Sciatic Nerve Injury
			Late Sciatic Nerve Palsy
			Heterotopic Ossification
			Thromboembolism
	OUTCOMES
		Assessment of Results
		Posttraumatic Arthritis
		A vascular Necrosis
		Recurrent Dislocation
		Missed and Delayed Diagnoses
		Sciatic Nerve Injury
		Effects on Outcome of Other Associated Injuries
		Meta-Analyses and Systematic Reviews
	CONCLUSION
		KEY REFERENCES
Medical Management of the Patient with Hip Fracture
	OUTCOME V ARIABLES
		Mortality
		Functional Outcome
		Medical Complications
	PREOPERATIVE ASSESSMENT
		Cardiovascular Assessment
			V alvular Disease
			Hypertension
			Antiplatelet Therapy and Coronary Artery Stents
			Congestive Heart Failure
		Hepatic Disease
		Pulmonary Assessment
		Renal Assessment
		Glucocorticoid Replacement Therapy
		Laboratory Assessment
	PERIOPERATIVE MANAGEMENT
		Diabetic Management
		Mental and Functional Status Assessment
		W ound Infection Prophylaxis
		Deep V ein Thrombosis Prophylaxis
		Postoperative Fever
		Osteoporosis: Diagnosis and Management Options
	POSTOPERATIVE MANAGEMENT
		Bladder Management in the Postoperative Period
		Perioperative Blood Loss and T ransfusion
		Use of Hip Protectors
	SUMMARY
Intracapsular Hip Fractures
	FEMORAL HEAD FRACTURES
		Relevant Anatomy
		Articular Cartilage
		Osseous Anatomy
		Mechanism of Injury
			Consequences of Injury Degenerative Joint Disease
		Diagnosis and Evaluation History
			Physical Examination
			Radiographic Imaging
			A vascular Necrosis
			Limited Motion (Heterotopic Ossification)
		Associated Injuries
			Other Studies
		Classification
		Management
			Femoral Head Fracture and Dislocation
			Complications Chronic Instability
			W ound Infection
			Heterotopic Ossification
			Sciatic Nerve Palsy
			A vascular Necrosis
			Degenerative Arthritis
			Outcome Assessment of Results
		Meta-Analyses and Systematic Reviews
		Relevant Anatomy Osseous Anatomy
		Conclusion
	FEMORAL NECK FRACTURES
		V ascular Anatomy and Physiology
		Effect of Femoral Neck Fracture on V ascular Supply
		Mechanism of Injury and Prevention
		Incidence
			Bone Density
			Consequences of Injury
			Commonly Associated Injuries
			Imaging
			Diagnosis Clinical Suspicion
			Differential Diagnosis
		Evolution of Classification Systems
			Current Classification
			Management Evolution of T r eatment
			Individual T r eatment Procedures
			Protocols for Associated Injuries
			Fixation Failure
		Complications: Identification and T reatment A vascular Necrosis
			Failed Arthroplasty
			Nonunion
			Pressure Sores
		Outcome
			Open Reduction and Internal Fixation versus Arthroplasty (Hemi or T
			Subtrochanteric Fracture below Screws
		Meta-Analyses and Systematic Reviews
		Cost-Effectiveness
		Conclusion
		KEY REFERENCES
Intertrochanteric Hip Fractures
	P A THOLOGY
		Incidence and Epidemiology
	ANATOMY OF THE INTERTROCHANTERIC REGION
		Bony Anatomy
		Muscular and Neurovascular Anatomy
		Computed T omography or Magnetic Resonance Imaging for Negative
	CLASSIFICATION OF INTERTROCHANTERIC FEMUR FRACTURES
	DIAGNOSIS
		Radiographic Assessment
		Evans Classification
		AO/OTA Classification
	ASSESSMENT OF THE P A TIENT
	OPERATIVE MANAGEMENT
		High-Energy Fractures
	MANAGEMENT
		Nonoperative Management
			Surgical Intervention
			Patient Positioning
		Fragility Intertrochanteric Fractures
			T iming of Surgery
			Fluoroscopic Imaging
			Fracture Reduction
			Surgical Stabilization
			Axial Dynamic Compression Plating
			Intramedullary Sliding Hip Screws
			Hip Arthroplasty
	SPECIAL FRACTURE SITUATIONS
		Reverse Obliquity Fractures
		High-Energy and Combined Intertrochanteric–Diaphyseal Fractures
		Pathologic and Impending Fractures
		Fracture of the Greater T rochanter
	SUMMARY OF FIXATION OF INTERTROCHANTERIC FEMUR FRACTURE
	POSTOPERATIVE MANAGEMENT AND DISCHARGE PLANNING
	COMPLICATIONS
		Loss of Fixation
		Nonunion
	P A TIENT OUTCOME
		Secondary Fracture Displacement
	SUMMARY
Posttraumatic Reconstruction of the Hip Joint
	PREOPERATIVE EVALUATION
	SALVAGE OF THE YOUNG HIP
		Failed Femoral Neck Fixation
			V algus-Producing Osteotomy: Overview and Historic Results
			V algus-Producing Osteotomy: Author’s Preferred T echnique
		Intertrochanteric Fixation Failure: Revision Fixation
	SALVAGE OF THE OLDER HIP
		Failed Femoral Neck Fixation
			Decision Making: Hemiarthroplasty versus T otal Hip Arthroplasty
			T echnical Considerations for Conversion Arthroplasty in the Setting
		Failed Intertrochanteric Fixation
			T echnical Considerations for Conversion Arthroplasty in the Setting
		Failed Acetabular Fixation
			Preoperative Evaluation
			T echnical Considerations for Failed Acetabular Fixation
	CONCLUSIONS
Subtrochanteric Fractures of the Femur
	P A THOLOGY
		Anatomy
		Biomechanics
		Incidence and Mechanism of Injury
	DIAGNOSIS
		History
		Physical Examination
		Radiographic Studies
		Classification
	MANAGEMENT
		Evolution of T reatment and Implants
		T emporary Stabilization Before Definitive Fixation
		Current Algorithm
	DESCRIPTION OF INDIVIDUAL PROCEDURES
		T raction and Nonoperative T reatment
			Indications
			T echnique
		Plate Fixation, Including Minimally Invasive Plating of Subtrochanteri
			Results
			95-Degree Angled Blade Plate
			Dynamic Condylar Screw
			Sliding Hip Screw
			Proximal Femoral Locking Plate
		Intramedullary Nailing of Subtrochanteric Fractures
			Background and First-Generation Interlocked Nailing T echniques
			First-Generation Nails
		Piriformis Entry (Reconstruction) Interlocked Nailing T echniques
		T rochanteric Entry Interlocked Nailing T echniques
			Clinical Results
		Clinical Results after Intramedullary Nailing for Subtrochanteric Fr
	SPECIAL CONSIDERATIONS
		Polytrauma and Multiply Injured Patients: T iming of Provisional and
		Open Subtrochanteric Fractures
		Rehabilitation, W eight Bearing, and Follow-up Care
		Entry Site Comminution and Intramedullary Nailing
		Indications for Bone Grafting
		Comminution, Associated Fracture Patterns, Significant Osteopenia, and
		Obese Patients
		Nonunion
	COMPLICATIONS
		Loss of Fixation and Implant Failure
		Malunion
		Infection
	ACKNOWLEDGMENTS
		KEY REFERENCES
Femoral Shaft Fractures
	ANATOMY
	P A THOPHYSIOLOGIC ASPECTS
	FRACTURE CLASSIFICATION
	FEMORAL FRACTURES IN THE PRESENCE OF POLYTRAUMA
	ASSESSMENT AND INITIAL MANAGEMENT
		Femoral T raction Systems
	PRINCIPLES OF MANAGEMENT OF DIAPHYSEAL FEMORAL FRACTURES
		Nonoperative T reatment
			Open Reduction and Internal Fixation
		Operative T reatment
			External Fixation
			Intramedullary Nailing
			Role of Reaming
			Role of Locking
			Antegrade Nailing
		Entry Point
		T echnique of Antegrade Nailing
		Retrograde Nailing
		T echnique of Retrograde Nailing
		Antegrade or Retrograde Nailing
			Poller Screws
		Secondary Nailing
		Complications of Nailing Nerve Injury
			V ascular Injury
			Implant Removal
			Special Fracture Constellations Concomitant Ipsilateral Injuries
			Ipsilateral Neck of Femur Fracture and Intertrochanteric Fracture
			Iatrogenic Fracture
			Malalignment
			Aftercare
	BILATERAL FEMUR FRACTURE
	FEMORAL SHAFT FRACTURES WITH ACETABULAR FRACTURES
	FLOATING KNEE INJURIES
	P A THOLOGIC FEMORAL FRACTURES
	BONE LOSS IN FEMORAL FRACTURES
	NONUNION
		Management Options Aseptic Nonunion
	F A TIGUE (STRESS) FRACTURES
		Hardware Failure
		Septic Nonunion
	SUMMARY
		KEY REFERENCES
Fractures of the Distal Femur
	Additional videos related to the subject of this chapter are a
	P A THOLOGY
		Relevant Anatomy
			Bone, Muscles, T endons
			Alignment
			Incidence of Fractures
		Anatomic and Functional Consequences of the Injury
			Commonly Associated Injuries
			Soft T issue Injuries
			V ascular Injuries
	DIAGNOSIS
		Classification
			Complex T rauma of the Knee
			Patient History and Physical Examination
	TREATMENT
		History
			T raction and Cast
			Early Attempts of Open Reduction and Internal Fixation
		Decision Making
			Assessment for Surgery: Patient, Fracture, and Surgeon Factors
			Indications for Surgery
		Management
			Principles of Surgical T r eatment
			Preoperative Planning
			T iming of Surgery
				BOX 59-1 T e c h n ical T rick i n Damage Control
			Nonoperative T r eatment
			Operative T r eatment ( Fig. 59-20 )
	COMPLICATIONS
		T r eatment
		Malunion and Malalignment
		Nonunion
			Risk Factors
		Loss of Fixation
		Contractures and Decreased Knee Motion
		KEY REFERENCES
Patella Fractures and Extensor Mechanism Injuries
	ANATOMY
	DIAGNOSIS
		Patient’s History and Physical Examination
	P A TELLA FRACTURES
		Biomechanics of Patellar Fracture Fixation
		Partial Patellectomy
		T otal Patellectomy
		Postoperative Management
		Quadriceps T endon Ruptures
		Complications
	EXTENSOR MECHANISM INJURIES
		Patellar Dislocation
		Patellar T endon Ruptures
		Indications for Operative T reatment
			Medial Patellofemoral Ligament Suture or Reconstruction
			T ransfer of the T ibial T uberosity
		Results and Complications
	P A TELLA FRACTURES AND EXTENSOR MECHANISM INJURIES ASSOCIATED WITH
	TENDON–BONE AUTOGRAFT
	P A TELLA FRACTURES AND EXTENSOR MECHANISM INJURIES AFTER TOTAL KN
	MALUNION AND NONUNION OF P A TELLAR FRACTURES
		KEY REFERENCES
Knee Dislocations and Soft T issue Injuries
	P A THOLOGY
		Relevant Anatomy
		Bone, Muscles, T endons
		Functional Anatomy
			Anterior Cruciate Ligament
			Posterior Cruciate Ligament
			Lateral and Posterolateral Stabilizers
			Medial Stabilizing Structures
	ANATOMIC AND FUNCTIONAL CONSEQUENCES OF THE INJURY
		Incidence of Knee Dislocations
		Commonly Associated Injuries
		V ascular Damage
		Incidence of Nerve and Meniscus Lesions
		Fractures, Soft T issue Injury, and Complex Knee Injury
		Compartment Syndrome
		Prognostic Factors
		Outcome
		Suggested Classification System
		Soft T issue
		Associated Injuries
		Patient History and Physical Examination
	DIAGNOSIS
	CLASSIFICATION
		Arbeitsgemeinschaft für Osteosynthesefragen
		Schatzker
		Moore
		Schenck
		Radiographic Evaluation
	TREATMENT
		Principles
			Arterial Injuries and First Line of T r eatment
			Ligament Repair
			Ligament Reconstruction
		Decision Making
			Assessment for Surgery: Patient, Injury, Comorbidity
		Management
			Principles of Surgical T r eatment
			Indications for Surgery
			Nonoperative T r eatment
			Operative T r eatment
	COMPLICATIONS
		Infection
		Chronic Instability
		Joint Degeneration
		Contractures and Decreased Knee Motion
T ibial Plateau Fractures
	INTRODUCTION: SCOPE AND PURPOSE
	MECHANISM OF INJURY AND BIOMECHANICS
		Biomechanics
		Mechanism of Injury
	EVALUATION
		Examination History
		Consequences of Injury
			Physical Examination
			Associated Injuries
			Imaging Radiographs
			Computed T omography Scanning
			Magnetic Resonance Imaging
			Duplex Ultrasonography and Arteriography
		Schatzker Classification
	CLASSIFICATION
		General Concepts
		AO/OTA Comprehensive Long Bone Classification
			Schatzker T ype IV
			Schatzker T ype I
			Schatzker T ype II
			Schatzker T ype III
			Schatzker T ype VI
		Moore Classification 12,54
			Schatzker T ype V
			T ype I: Coronal Split
			T ype II: Entire Condyle
			T ype III: Rim A vulsion
			T ype IV: Rim Compression
			T ype V : Four Part
		Chertsey Classification
		Posterior Shear Fracture
	FRACTURE MANAGEMENT
		History
			Emergent and Urgent Stabilization
			Indications for Operative Management
			Nonoperative T r eatment
		Nonunion
		Contractures
	COMPLICATIONS
		Infection
		Posttraumatic Osteoarthritis
	OUTCOMES
		Randomized Prospective Studies
		Short-Term Results
		Long-Term Results
		Staged Management
		T ibial Plateau Fractures in Elderly Adults
		Return to Sports
	META-ANALYSES AND SYSTEMATIC REVIEWS
	GUIDELINES
		Cost Effectiveness
	CONCLUSION
		KEY REFERENCES
Malunions and Nonunions about the Knee
	GENERAL PRINCIPLES
		Basic Biomechanics
		Frontal Alignment and Knee Joint Line Angulation
		Sagittal Alignment and Soft T issue Contractures
		Patella-Femoral T racking and Rotational Deformities
	NONUNION CLASSIFICATION
	INTRAARTICULAR VERSUS EXTRAARTICULAR OSTEOTOMIES
	CHARCOT NEUROARTHROPATHY
	SURGICAL CONSIDERATIONS
	DISTRACTION OSTEOGENESIS
	LIMB LENGTH DISCREPANCY
	INTERNAL VERSUS EXTERNAL FIXATION
	ARTHROSCOPY-ASSISTED SURGERY
	MONOLATERAL VERSUS CIRCULAR EXTERNAL FIXATION
	FIXATOR-ASSISTED SURGERY
	TOTAL KNEE REPLACEMENT FOLLOWING TRAUMA
	AUTHORS’ PREFERRED TREATMENT METHOD
		Distal Femur Nonunion and Malunion
			Diagnosis
			Surgical T iming
			Surgical T echnique: Mobile Knee Joint
			Postoperative Care
			Surgical Alternatives
		Nonunions and Malunions of the Proximal T ibia
			Diagnosis
			Surgical T r eatment
			Postoperative Care
			Surgical Alternatives
T ibial Shaft Fractures
	INTRODUCTION: SCOPE AND PURPOSE
	RELEVANT SURGICAL ANATOMY
		Compartmental Anatomy
	MECHANISM OF INJURY AND BIOMECHANICS
		Examination
	EVALUATION
		History
		Imaging
	CLASSIFICATION
	MANAGEMENT
		Evolution of T reatment
		Emergent T reatment
			Initial Care: Immobilization
			Acute Compartment Syndrome of the Leg
			T ibial Shaft Fractures with Associated Arterial Injury
			The Polytrauma Patient and Damage Control Orthopaedics
			Mangled Extremity
			Closed T ibial Shaft Fractures Indications for Definitive Care (Surgica
			Nonoperative T r eatment
			Surgical T r eatment
		Closed Proximal Third T ibial Fractures
			Emergent T r eatment
			Indications for Definitive Care (Surgical versus Nonoperative Care)
			Nonoperative T r eatment
			Surgical T r eatment
			Indications for Definitive Care (Surgical versus Nonoperative Care)
			Nonoperative T r eatment
			Surgical T r eatment
		Closed Distal Third T ibial Fractures
			Emergent T r eatment
		Open T ibia Fractures
			Emergent T r eatment
			Indications for Definitive Care
			Reduction and Provisional Fixation T echniques
			Fixation T echniques
			Management of Intraoperative Problems
			Postoperative Care and Rehabilitation
		Fibula Fractures
			Pitfalls and A voidance of Complications in Open T ibia Fractures
		Injuries to the Proximal T ibiofibular Joint
		Fatigue Fractures of the T ibia
			Infection Acute Infection
			Infection after Intramedullary Nailing
			Chronic Infection (Osteomyelitis)
		Fixation Failure
		Delayed Union
		Nonunion
			Occult Infection at the Nonunion Site
			Intramedullary Nailing for T ibial Fracture Nonunion
			Plate Fixation for T ibial Shaft Nonunion
			Bone Grafting for T ibial Shaft Nonunion
			Evaluation and Planning
		Malunion (Residual Deformity) Indications for Surgery
		Refracture
		Complications Related to Intramedullary Nailing T echnical Problems
			Knee Pain
		Stiffness
		Arthritis
			Broken Nails
	OUTCOMES
		T ibial Fracture Outcome Scores
		Outcomes of T ibial Fractures
		Outcomes after Brace (Nonoperative) T reatment of T ibial Shaft Fract
		Outcomes after Nailing of T ibial Fractures
		Outcomes after Plating of T ibial Fractures
		Outcomes after External Fixation of T ibial Fractures
	META-ANALYSES AND SYSTEMATIC REVIEWS
	COST-EFFECTIVENESS
	CONCLUSION
	ACKNOWLEDGMENT
		KEY REFERENCES
Fractures of the T ibial Pilon
	MECHANISM OF INJURY
	RADIOGRAPHIC EVALUATION
	CLASSIFICATION
	EVOLUTION OF CARE
	TREATMENT OPTIONS
	INITIAL TREATMENT
		Closed T reatment
		T raction
		Surgical Management
			T iming of Surgery and Staged T r eatment
			Surgical Approaches
	TECHNIQUE OF OPEN REDUCTION AND INTERNAL FIXATION
		Restoration of Length (Step 1) Fibular Fixation
			Use of the Arbeitsgemeinschaft für Osteosynthesefragen Distractor
			Reconstruction of the Metaphyseal Shell (Step 2)
			Bone Grafting of Metaphyseal Defects (Step 3)
			Reattachment of the Metaphysis to the Diaphysis (Step 4)
	PLATE FIXATION
	EXTERNAL FIXATION
		Joint-Spanning Frames
		T ensioned-Wire External Fixation
	TENSIONED-WIRE TECHNIQUE
	OPEN FRACTURES
	WOUND CLOSURE
	FLAP COVERAGE
	OBESITY AND DIABETES
	POSTOPERATIVE CARE
	UNRECONSTRUCTIBLE PILON FRACTURES
	COMPLICATIONS
		Early Complications
		Late Complications
		Nonunion and Malunion
		Posttraumatic Arthrosis
		Chronic Osteomyelitis
		Other Complications
	CLINICAL OUTCOMES
	PROGNOSIS
		KEY REFERENCES
	SUMMARY
Malleolar Fractures and Soft T issue Injuries of the Ankle
	ANATOMY AND BIOMECHANICS
		Anatomy
		Biomechanics
			Ankle Joint Mechanics
			Ankle Ligament Mechanics
	EVALUATION OF THE INJURED ANKLE
		History
		Physical Examination
		Radiographic Imaging
		Other Studies
		Essential Studies to Exclude Other Injuries
		Differential Diagnosis
	MANAGEMENT OF ANKLE FRACTURES
		General Principles
		Special Considerations for Polytrauma Patients
	CLASSIFICATION
		Lauge-Hansen
			Supination-Adduction
			Supination-External Rotation
			Pronation-External Rotation
		Danis-Weber
			Pronation-Abduction
		Arbeitsgemeinschaft für Osteosynthesefragen- Orthopaedic T rauma Associat
		Significance of Classification
		Atypical Malleolar Fracture
	DEFINITIVE TREATMENT
		Malleolar Fracture
		T reatment Principles T ype A Injuries
			T ype B Injuries
			T ype C Injuries
		Nonoperative T reatment of Malleolar Fractures
			Choice and Planning of Fixation
			Operative Adjuncts
			Lateral Malleolus Fracture
		Operative T reatment of Malleolar Fractures Initial Care and T iming
			Syndesmosis T ransfixation
			T echniques
			Posterior T ibial Lip Fracture Reduction and Fixation
			Anterior Lip Fracture
			Medial Malleolar and Ligamentous Injuries
			Intraoperative Radiographs
			W ound Closure and Postoperative Care
		Special T reatment Groups Osteopenia
			Diabetic Patients
		Outcome for Malleolar Fracture
	SOFT TISSUE INJURIES OF THE ANKLE
		Lateral Collateral Ligament Injuries
			Diagnosis
			T r eatment
		Late Inversion Instability
		Persistent Pain after Ankle Sprain
		Ankle Dislocations
			Ankle Dislocation without Fracture
			Sprain of the Syndesmosis—The “High Ankle Sprain”
			T ibiofibular Diastasis
		Medial Collateral (Deltoid) Ligament Rupture
		Achilles T endon Rupture
		W ound Sloughs
		Infection
		Less Common T endon Injuries
			Peroneal T endon Dislocation
			Posterior T ibial T endon Rupture
		Malunion
		Posttraumatic Arthrosis
		Late Syndesmotic Instability
		T ibiofibular Synostosis
		Nonunion
	ACKNOWLEDGMENTS
Foot Injuries
	“Be sure you put your feet in the right place, then stand firm.”
	GENERAL PRINCIPLES OF CARE OF THE TRAUMATIZED FOOT
	INITIAL EVALUATION OF THE P A TIENT WITH A FOOT INJURY
	ANALYZING OUTCOMES OF FOOT INJURIES
	FRACTURES OF THE T ALUS
		Blood Supply
		Anatomy
		Injury Mechanism
		Imaging
		Classification
		Clinical Evaluation
	T ALAR NECK FRACTURES
		Percutaneous Fixation
		T reatment
			Closed T r eatment
			Open Reduction
		Postoperative Care and Rehabilitation
			Complications Posttraumatic Arthritis
		Outcomes
			A vascular Necrosis
			Nonunion and Malunion
		T reatment Overview
			Positioning
			Approaches
			Arthrofibrosis
			Salvage
	T ALAR BODY FRACTURES
		Internal Fixation
		T reatment Nonoperative
		Operative
		Postoperative Care and Rehabilitation
		Outcomes
	T ALAR HEAD FRACTURES
		Postoperative Care and Rehabilitation
		T reatment and Outcomes
		Outcomes
	POSTERIOR AND LATERAL T ALUS PROCESS FRACTURES
	POSTERIOR T ALAR PROCESS FRACTURES
	LATERAL T ALAR PROCESS FRACTURES
		Diagnosis
			T reatment Nonoperative
	OSTEOCHONDRAL FRACTURES OF THE T ALAR DOME
		Operative
		Outcomes
			T r eatment
	T ARSAL DISLOCATIONS
		Peritalar and Subtalar Dislocations
			Postoperative Care and Rehabilitation
			Complications
			Outcomes
		T otal T alar Dislocation
		Chopart or T ransverse T arsal Dislocation
			Injury Mechanism
			Classification
			Clinical Presentation
			Postoperative Care and Rehabilitation
			Outcomes
		Isolated T arsal Dislocations
			Calcaneus
			T r eatment
			Navicular and T alonavicular Joint
			Cuboid and Calcaneocuboid Joint
			Cuneiforms
		Hindfoot Sprain
			Calcaneal Fractures Intraarticular Calcaneus Fracture
			Outcomes
		Open Fractures of the Calcaneus
			Classification
			Management
		Extraarticular Calcaneus Fractures
		Anterior Calcaneal Process Fractures
		Posterior T uberosity Calcaneus Fractures
		Extraarticular Calcaneal Body Fractures
		Sustentacular Fractures
	NAVICULAR FRACTURES
		Anatomy
		Blood Supply
		Mechanism of Injury
		Initial Evaluation
		Classification
		A vulsion Fractures
		Body Fractures
		T uberosity and Accessory Navicular Fractures
		Surgical Approaches
		T reatment
			Dorsal A vulsion Fractures
			Body Fractures
			T uberosity and A vulsion Fractures
			Management of Severe Comminution
		Postoperative Care and Rehabilitation
		Outcomes
			A vascular Necrosis
			Nonunion
			Stiffness
			Hindfoot V arus
	T ARSOMETATARSAL (LISFRANC) INJURIES
		Mechanism of Injury
		Anatomy and Biomechanics
		Diagnosis
		Radiographs
		Classification
			T reatment Initial T r eatment
			Operative T r eatment
			Nonoperative T r eatment
			Associated Pathology
			Outcomes
			Postoperative Care and Rehabilitation
			Complications
	CUBOID FRACTURES
		T reatment
	CUNEIFORM FRACTURES
	METATARSAL FRACTURES
		Anatomy
		Mechanism of Injury
		Evaluation and Initial T reatment
		Classification
		Indications for T reatment
		Nonoperative T reatment
		Operative T reatment of Metatarsal Fractures First Metatarsal
			Second, Third, and Fourth Metatarsals
			Postoperative Care and Rehabilitation
			Complications
			Outcomes
	FIFTH METATARSAL FRACTURES
		Anatomy
		Mechanism of Injury
		Classification
			Outcomes
				III
		A vulsion Fractures
			T r eatment
		Metadiaphyseal (Jones) Fractures
			T r eatment
			Outcomes
		Fifth Metatarsal Shaft Fractures
		Proximal Diaphyseal Fractures (Stress Fractures)
			T r eatment
	INJURY TO THE METATARSOPHALANGEAL JOINTS
		First Metatarsophalangeal Joint Injuries
			Anatomy
			Mechanism of Injury
			Evaluation
			T urf T oe
			Metatarsophalangeal Dislocation
		Lesser Metatarsophalangeal Joints Anatomy
			T r eatment
			Injury to the Lesser Phalanges and Interphalangeal Joints
	DISTAL PHALANX AND NAIL BED INJURIES
		Fracture
		Nail Bed Injuries
	SESAMOID FRACTURES
		Anatomy
		Etiology and Evaluation
		Management
			Sesamoidectomy
			Open Reduction and Internal Fixation with Bone Grafting
	FOOT COMPARTMENT SYNDROME
		Anatomy and Diagnosis
		Pressure Measurement
		Outcomes
		Operative Decompression
	MUTILATING INJURIES: THE MANGLED FOOT
	CRUSH INJURIES
	THERMAL INJURY
		Burns
		Frostbite
	GUNSHOT WOUNDS
	TRAUMATIC TENDON INJURY
		Anterior T ibial T endon
	HEEL P AD INJURY
		Flexor Hallucis Longus T endon
		Flexor Digitorum Longus T endon
		Extensor Hallucis Longus T endon
		Peroneal T endons
		Extensor Digitorum Longus T endon
	PUNCTURE WOUNDS
	NEUROPATHIC FOOT FRACTURE
	ANIMAL BITES AND MARINE WOUNDS
	APPENDIX
		Intraoperative Three-Dimensional Imaging 753,754
		Discussion
		Intraoperative Pedography 6,7,12
			T echnical Equipment
			Study Results
		Matrix-Associated Stem Cell T ransplantation 13
			T echnique
			T echnical Equipment
			Study Results
			Discussion
Posttraumatic Reconstruction of the Foot and Ankle
	Additional videos related to the subject of this chapter are a
	at https://expertconsult.inkling.com :
	LOWER LIMB ALIGNMENT AND JOINT ORIENTATION
	PRINCIPLES
	PHYSICAL EXAMINATION
	IMAGING STUDIES
	MALUNION, NONUNION, AND DEGENERATIVE SPUR FORMATION ON THE T ALUS,
		Osteochondrotic Lesions on the Dome of the T alus
	CALCANEAL MALUNION AND NONUNION
	NAVICULAR NONUNION AND MALUNION AND T ALONAVICULAR ARTHROSIS
		T alonavicular Fusion for Arthrosis
	CUBOID MALUNIONS AND NONUNIONS WITH AND WITHOUT LATERAL COLUMN SH
		Cuboid–Metatarsal Fourth and Fifth Joint Arthrosis
	METATARSAL NONUNIONS AND MALUNIONS
	PHALANGEAL MALUNIONS AND NONUNIONS
	POSTTRAUMATIC ARTHROSIS
		Ankle Arthrosis
	EVALUATION AND NONOPERATIVE MANAGEMENT
	SURGICAL TREATMENT OF ANKLE ARTHROSIS
		Arthrodesis versus Ankle Arthroplasty Difficulties with Ankle Fusion
	ARTHRODESIS TECHNIQUES
		Subtalar Arthrosis
			Nonoperative T r eatment
			Surgical T r eatment
	TOTAL ANKLE ARTHROPLASTY TECHNIQUE
		Surgical T echniques
		Combination Fusion and Osteotomy
		Surgical T echnique
		T alonavicular and Calcaneocuboid (Chopart) Joint Arthrosis
			Surgical T echnique
		Lisfranc Joint Arthrosis
		Old, Deep Posterior Compartment Syndrome
	RESIDUALS OF COMPARTMENT SYNDROMES
		REFERENCES
Periprosthetic Fractures of the Lower Extremity
	INTRODUCTION
	RISK F ACTORS
		Periprosthetic Fractures around T otal Hip Arthroplasty
		Periprosthetic Fractures Around T otal Knee Arthroplasty
	EVALUATION
		Examination
		Investigations
	PERIPROSTHETIC FRACTURES AROUND TOTAL HIP ARTHROPLASTY
		Classification
			Periprosthetic Fractures of the Acetabulum
			Periprosthetic Fractures of the Femur
	MANAGEMENT
		Periprosthetic Fractures of the Acetabulum Intraoperative Fractures
		Periprosthetic Fractures of the Femur Intraoperative Fractures
			Postoperative Fractures
		Bone Grafting
	OUTCOMES AND COMPLICATIONS
	PERIPROSTHETIC FRACTURES AROUND TOTAL KNEE ARTHROPLASTY
		Classification Femoral Fractures
		T ibial Fractures
		Patellar Fractures
	MANAGEMENT
		Femoral Fractures
		Patellar Fractures
		T ibial Fractures
	OUTCOMES AND COMPLICATIONS
	PREVENTION OF PERIPROSTHETIC FRACTURES OF THE LOWER LIMB
Principles of Deformity Correction
	LOWER LIMB ALIGNMENT AND JOINT ORIENTATION
	CHARACTERISTICS OF DEFORMITY
		Level of Angulation
	OSTEOTOMY RULES
	FOCAL DOME OSTEOTOMY
		Plane of Angulation
		Multiapical Angulation
		T ranslation Deformity
		Angulation and T ranslation
		Rotational Deformity
		Length Deformity
	JOINT CONSIDERATIONS FOR CORRECTION OF DEFORMITY
	IMPROVEMENTS IN DEFORMITY CORRECTION: DEVELOPMENT AND APPLICATION
		REFERENCES
Limb Salvage and Reconstruction
	DO THE LIMBS MATTER?
	INITIAL MANAGEMENT: THINK PHYSIOLOGY, NOT ANATOMY
	COMMON F ACTORS ADDRESSED WITH INITIAL DECISION MAKING
		Scoring Systems
	WHY SO MANY EXTREMITY INJURIES?
		Nerve Injury and Plantar Sensation
		Limb Salvage
			Peripheral Nerve Injury
		V ascular Injury
	LIMB SALVAGE: SURGICAL RECONSTRUCTION
		Modern Intramedullary Interlocking Nails:
		External Fixation
		Special Considerations Bone Loss
			Soft T issue Loss
		Rehabilitation
		Costs
		Outcomes
		KEY REFERENCES
	SUMMARY
Amputations in T rauma
	GENERAL PRINCIPLES
		History
		Initial Management Principles
	UPPER EXTREMITY AMPUTATIONS
		Amputation versus Limb Salvage and Replantation in the Upper Extremi
		Length Selection and Preservation
		Partial Hand Amputation and Amputations through the Carpus
		Nerve and Muscle Management
		W rist Disarticulation
		T ransradial Amputation
		Proximal T ranshumeral Amputation and Shoulder Disarticulation Amputati
		Elbow Disarticulation and Distal T ranshumeral Amputations
		Pain Management in the Upper Extremity Amputation
		Outcomes of Upper Extremity Amputations
	LOWER EXTREMITY AMPUTATIONS
		T ranspelvic Amputation (Hemipelvectomy, Hip Disarticulation)
		T ransfemoral Amputation
		Knee Disarticulation
		T ranstibial Amputation
		Ankle Disarticulation
	SPECIAL CONSIDERATIONS
		Pediatric Amputations
		Extremity Replant
		Onsite Amputation
		Hindfoot Amputations
		Midfoot Amputations
		Forefoot Amputations
	GENERAL PROSTHETIC CONSIDERATIONS AND REHABILITATION
		Upper Extremity Prosthetic Considerations
		Prosthetic Advances
		Lower Extremity Prosthetic Considerations
		V ascularized Composite T issue Allotransplantation (Hand T ransplantati
		Rehabilitation Concerns
	FUTURE DIRECTIONS
		T argeted Muscle Reinnervation
		Infection
	COMPLICATIONS
		Bursitis
		Soft T issue Complications
		Neuromas and (Phantom) Pain
		Heterotopic Ossification
		Contractures
		Other Complications