Operation on fractures of shafts and joints is chiefly indicated in the upper arm, forearm, femur and tibia. Injuries in these areas can almost always be successfully treated by the techniques described in the "AS IF Manual of Internal Fixation," followed by early exercises. The fixation of small fragments which are of such biomechanical importance, has hitherto given indifferent results, especially when the distal parts of the hand and foot are involved. The implants and instruments developed by Dr. Heim and tried out by AS IF members during recent years have now been assembled into a "small fragment set," which is now available. These implants have significantly expanded the scope of AS IF instrumentation for internal fixation. Pannike first compared the application of the small fragment set with the conventional methods used in hand surgery. Heim and Pfeiffer in cooperation with Meuli, illustrate in this Volume the small fragment set, elucidating in a didactic manner the composition of the set, the indications for its use, and its method of application to all suitable fractures. Enough good results have been secured to establish the usefulness of this development. The following volume may therefore be regarded as an important supplement to the ASIF Manual. It makes it clear again that every internal fixation requires a high level of technical skill, a sense of responsibility, and very gentle handling of the soft tissues.
The second English-language edition of the Small Fragment Set Manual was enthusiastically received and quickly went into a second printing. In preparing a third edition, we found it necessary to revise the text extensively and partly restructure it. The reasons for this are numerous. Experience of recent years has brought technical refinements in the operative treatment of many types of small fracture. Many of these changes stem from the small-fragment-set training programs conducted in Switzerland since 1980, and also from courses and symposia that have been held in other European countries and the United States. These events were occasions for a fruitful ex change of experience with surgeons who were critical of our methods. As a result of this exchange, we perceived a need both to revise our indications and to give greater attention to alternative techniques. We also felt it necessary to respond to criticisms of the first two editions concerning the catalog-like instrument lists and illustrations, and the attention given to fundamental techniques. Many surgeons who work or would like to work with small implants, especially those practicing abroad, are inexperienced in operations on the larger bones. It is imperative that these colleagues be given a basic introduction to the "biomechanical thinking" of the Swiss Association for the Study of Internal Fixation (ASIF).
The Manual of INTERNAL FIXATION is well known internationally as a standard work for every specialist dealing with osteosynthesis. Due to the many changes that have taken place, an international faculty of orthopaedic surgeons and traumatologists completely revised and expanded the manual. In its third edition the manual reflects the state of the art and is the necessary reference for every AO specialist.
In the past, conservative (or nonoperative) treatment of fractures of the hand has been the rule and severe and multiple fractures usually did not receive surgical atten tion. There are probably several reasons why this is so. Rarely did these fractures threaten life; they usually healed rapidly; and after immobilization, hand pain usually subsided. At the same time, intraarticular fractures frequently were unstable and often displaced and attempts to correct deformity were considered difficult to achieve. As a result, the ultimate joint motion in many cases was limited. It can fairly be said that decisions and techniques regarding internal fixation of small joints and bones were not known to most surgeons. Although the history of internal fixation is not extensive, there have been some exciting events. In the 16th century gold plates were used to repair cleft palates. Later, the Chinese employed wire loop sutures to correct difficult fractures. In the 18th century silver cerclage wires were used to achieve fixation and promote early bone healing. Although these fracture treatments occasionally proved successful, more frequently they did not and they never enjoyed wide acceptance. Doctors Alan Free land, Michael Jabaley, and James Hughes have described this history of bone fixation in a manner that is both colorful and educational and they have managed to extract the essential features that lend continuity to the story of the development of internal fixation.
During their 20 years of activity members of the Associa tion for the Study of Internal Fixation (AO - ASIF) have made authoritative contributions to the development of internal and external fixation. The close collaboration of surgeons, basic researchers, metallurgists, engineers and the establishment of clinical documentation has made it possible to achieve a solid scientific basis for internal fixa tion. Clear definitions for the standardization of different types of osteosynthesis were possible: interfragmentary compression, splintage and buttressing as well as combina tions of these three techniques. At the same time a scienti fic and workmanlike instrumentation was developed. The idea was to keep diversification within limits but, however, to assemble a comprehensive collection of implants and in struments to answer all the problems presented by the com plexity of bone operations. Osteosynthesis is a difficult and demanding operative method. Its. claims on the surgeon and the theatre staff are high. Therefore plans have existed for a long time to supplement the "Manual of Internal Fixation" with a de tailed description of the AO Instrumentation, its use and maintenance. Our collaborator FRIDOLIN SEQUIN, graduate engineer, has accomplished this task with expert knowledge. He has organized over many years courses for theatre nurses and has been able from the resulting experience to provide helpful suggestions. When RIGMOR TEXHAMMAR R. N. joined AO-International four years ago, it was natural to include her as a co-author.
Written by more than 400 subject experts representing diverse academic and applied domains, this multidisciplinary resource surveys the vanguard of biomaterials and biomedical engineering technologies utilizing biomaterials that lead to quality-of-life improvements. Building on traditional engineering principles, it serves to bridge advances in mat
The first part of this manual deals with the experimental and scientific basis and the principles of the AOjASIF method of stable internal fixation. It deals with the function and main use of the different AO implants, the use of the different AO instruments, and with the essentials of the operative technique and of postoperative care. It also discusses the handling of the most important postoperative complications. The second part deals at length with the AO recommendations for the operative treatment of the most common closed fractures in the adult. This has been organized in anatomical sequence. The discussion of the closed fractures is followed by a discus sion of open fractures in the adult, then by fractures in children and finally by pathological fractures. The third part presents, in a condensed fashion, the application of stable internal fixation to reconstructive bone surgery. 1 GENERAL CONSIDERATIONS 1 Aims and Fundamental Principles of the AO Method The Chief Aim of Fracture Treatment is the Full Recovery of the Injured Limb In every fracture there is a combination of damage to both the soft tissues and to bone. Immediately after the fracture and during the phase of repair, we see certain local circulatory disturbances, certain manifestations of local inflammation, as well as pain and reflex splinting. These three factors, that is, circulatory disturbances, inflammation and pain, when combined with the defunctioning of bone, joints and muscle, result in the so-called jl'acture disease.
External fixation is now being used widely to maintain fractures, osteo tomies, and arthrodeses in a desired position during consolidation. Whereas external fixation has been readily accepted in European countries, its use has weathered a rather stormy course in North America, especially in the treatment of fractures. Only recently has external fixation found its rightful place on this continent as well. Many different models are on the market today, and the practitioner is faced with a difficult decision in selecting a model. Should he buy a system where the fracture has to be reduced first, or should he work with a device permitting a reduction after insertion of the pins? To enable surgeons to study the different systems, to discuss their advantages and disadvantages, and to permit them to put their hands on these devices and inspect them personally, the Division of Orthopedic Surgery, University of Ottawa organized an applied basic science course in May 1981, External Fixation of Fractures. During this course, all major systems were pre sented to the participants. As happened during the course "Internal Fixation of Fractures" held two years ago, the rigidity of internal fixation was frequently and intensively debated. Whereas the rigidity of internal fixation cannot be altered during the course of healing, the rigidity of external fixation can be changed. In fact, with progression of union, rods of increasing elasticity can be used.
The original AO/ASIF Instrumentation manual presented a concise and complete description of the AO instruments. Thoughtfully developed by Fridolin Sequin and Rigmor Tex hammar, the manual discussed in a clear fashion the purpose and care of the various AO instruments that are handled by the operating room staff. One important feature of the first edition was a detailed checklist of the instruments required for the more common operative procedures for treating fractures. Fridolin Sequin was well-suited to author the first edition: his 15 years of experience as a technical engineer for the AO gave him in-depth knowledge of AO instruments, and he drew on the clinical knowledge of Rigmor Texhammar, a consultant and di rector of the AO courses for nurses. Its original feature of com bining a column of text with a column of illustrations meant the manual quickly became accepted as a standard. By 1981, trans lations could be found in English, French, Spanish, and Italian. Not surprisingly, the manual was very popular.
This book – now a classic - was developed to facilitate the preparation of medicolegal reports following musculoskeletal injuries. It collates data from the world literature in one source, together with review articles on related topics such as Repetitive Strain Injury. As a result, it saves readers from the time-consuming task of researching multiple references. A comprehensive guide to the preparation of medicolegal reports in the field of personal injury litigation following musculoskeletal trauma.. It provides prognostic information following musculoskeletal injuries and assists the clinician acting as an expert medical witness prepare the report. Each of the chapters is devoted to different areas of injury and takes the reader through the full range of treatments, results and complications and how these impact on prognosis. Collates data on treatment, results, complications from the relevant medical literature and review articles and saves the orthopaedic surgeon acting as an expert witness a lot of hours of unnecessary research.
For many years, the operative manipulation of the most minute struc tures was frustrated by the limitations of the human eye. With the introduction of the operating microscope by Nylen (1921), fine detailed anatomy was made visible, so that structures could be prepared, pre sented and manipulated. Nylen used the microscope for treating dis eases of the middle ear. In 1946 Perrit in the U.S.A. introduced the operating microscope into the field of ophthalmic surgery. In 1964, Smith, Kunze and Mitchen published reports on their clinical experi ence using the operating microscope in nerve surgery. Using this tech nique, it was possible to divide a peripheral nerve into individual fascicle bundles and reapir each bundle precisely. Following on from these developments, the term" microsurgery" was introduced to cover that branch of surgery which was carried out using the" equiped" eye - either by using 10upe spectacle magnifica tion or, more commonly, the operating microscope. The term "micro vascular surgery" developed for the operative treatment of small ves sels below 2 mm in diameter. Experimental studies for the use of microsurgery in the clinical situation developed alongside its use on small research animals for transplantation models in immunological study. Microsurgical techniques were used in the transplantation of rat liver, kidneys, pancreas, heart and other organs. The clinical appli cation of these microsurgical techniques is nowadays called "recon structive microvascular surgery."
The theme of this work is the application of the engmeermg theory of frictional torque to total hip replacement. The author adhered tenaciously to this theory, involving the use of a small-diameter femoral head, throughout the epoch when the large-diame ter, metal-to-metal design dominated the field. During that considerable period general satisfaction with the early results rendered criticisms of the large-diameter head unwelcome. There was a formidable array of counter criticism: the small head would pierce a film of synovial fluid; the small head would wear the socket too rapidly; the small head would always have a high risk of dislocation; detachment of the trochanter, to achieve precise orientation for the small head, was unacceptable. But all these objections have now been largely overcome. Lubrication of high molecular weight polyethylene (HMWP) on metal is now accepted as being mainly by the boundary regime with thick fluid films playing no part. We now know that HMWP can indeed tolerate the very high stresses imposed by the small head and in tribological theory there may even be some advantage in high stress. Dislocation is now known not to be an automatic sequel to the small head.