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The rapid development in the surgical treatment of fractures during the past 9 years has necessitated considerable modifications to the first edition of this book. Numerous new implants and instruments are presented in this, the second edition. In 4.0-, 3.5- and 2.7-mm screws the hexagonal socket has definitively superseded the Phillips head, while mini-implants have been modified and a 1.5-mm screw introduced. A number of new plates and implants have been introduced and have long since proved their value. At the same time new techniques, described here, have been developed and applied. The tension-band wire is included, despite the fact that it does not consist of specific AO implants, and use of the Kirschner wire is also illustrated and emphasized whenever the authors consider that this simple method is still the best available. Alterations in the organization of the book have been necessary: the shoulder, the forearm and the knee are treated in separate chapters, and other sections have been extended. With regard to clinical-radiological examples, new typical situations are described and documented. The case studies from the first edition have been recontrolled in all instances in which it was feasible to do so. In this way many valuable late results, 9-12 years after internal fixation, were obtained. We found that almost all joints had remained stable after healing of an articular fracture; so-called late arthrosis is rare in the peripheral skeleton.
and refinement that exists within the necessarily strict rules of the internal fixation method. In this way we seek to contribute to as weIl as to stimulate the search for rational solutions to surgical problems. It is assumed throughout that the reader is fa miliar with the technical fundamentals of internal fixation, and so these details are omitted. Instead, special indications and technical refinements are presented on the basis of case examples. Because an endless variety of situations can arise in orthopedic surgery (a circumstance that is attracting more and more surgeons to the field), we have taken ca re that our examples can readily be applied to novel situations. We now credit, in alphabetic order, those who contributed most to the techniques presented: R. BLATTER, A. BOITZY, C. BRUNNER, O. CECH, A. DEBRUNNER, F. MAGERL, G. SEGMÜLLER, G. STÜHMER, and B.G. WEBER. We thus express thanks to those colleagues in our clinic who agreed to having their ideas published. But we are also grateful to our illustrators, H. and K. SCHUMACHER, our photographer, M. SCHAFFNER, and our chief secretary, U. OETLIKER, who contributed so much to the preparation of the manuscript. Finally, we thank Springer-Verlag for their patience with us and especiaUy for their efficient work in bringing the book to press. St. GaU, Fall 1981 CH.F. BRUNNER B.G. WEBER Contents Lag Screws ............. .
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.
First multi-year cumulation covers six years: 1965-70.
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).
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.
A chronicle written only by someone for whom the present important. Goethe, Maximen und Reflexionen The second volume of our company's history differs from the first in several ways. With a great appreciation of history, Heinz Sarkowski has impressively reconstructed the company cor- spondence, which is fortunately almost completely preserved, and made it speak. * There is an inexhaustible amount of c- respondence pertaining to the period I have taken it upon myself to cover, and working through it properly not only would have required many years, but also would have detracted from the immediacy of the account. Thus, I decided to proceed from personal experience, to describe what has happened and to provide details gleaned from the correspondence. I have - counted here by no means only my own, but rather the personal experiences of the many company members and employees who are mentioned below. With the founding of the New York firm, developments branch out, becoming parallel but separate, and the change from one scene to another repeatedly interrupts the continuing course of events and the chronological flow of the report. In this connection, the occasional repetition of certain facts was - avoidable. In some places, however, it seemed more appropriate not to interrupt particular lines of development, but to describe them in continuity without regard to specific periods of time.
A chronicle written only by someone for whom the present important. Goethe, Maximen und Reflexionen The second volume of our company's history differs from the first in several ways. With a great appreciation of history, Heinz Sarkowski has impressively reconstructed the company cor- spondence, which is fortunately almost completely preserved, and made it speak. * There is an inexhaustible amount of c- respondence pertaining to the period I have taken it upon myself to cover, and working through it properly not only would have required many years, but also would have detracted from the immediacy of the account. Thus, I decided to proceed from personal experience, to describe what has happened and to provide details gleaned from the correspondence. I have - counted here by no means only my own, but rather the personal experiences of the many company members and employees who are mentioned below. With the founding of the New York firm, developments branch out, becoming parallel but separate, and the change from one scene to another repeatedly interrupts the continuing course of events and the chronological flow of the report. In this connection, the occasional repetition of certain facts was - avoidable. In some places, however, it seemed more appropriate not to interrupt particular lines of development, but to describe them in continuity without regard to specific periods of time.