Ao Principles of Fracture Management

882 Pages·2000·72.03 MB·English

by  T.P. Ruedi

AO Publishing
T. P. Rüedi
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C. L. Colton, A. Fernandez Dell‘Oca
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AO Publishing
Thomas P. Rüedi
William M. Murphy
AO Principles of
Fracture Management
with illustrations by Michael Renner and Kaspar Hiltbrand
Section Editors
Chris L. Colton
Alberto Fernandez Dell’Oca
Ulrich Holz
James F. Kellam
Peter E. Ochsner
Coordinating Editor
Gustave E. Fackelman
Illustration Editor
Yves Harder
Thieme
Stuttgart · New York 2000
Design & typesetting: DynaPub, CH-8645 Jona Library of Congress Cataloging-in-Publication Data
Concept: Egle Consulting, CH-8332 Russikon
Illustrations: Büro für Gestaltung, Michael Renner, Rüedi, Thomas P., 1935-
CH-4123 Allschwil, and AO Principles of Fracture Management/T.P. Rüedi, W.M. Murphy;
K. Hiltbrand, CH-4058 Basel with illustrations by M. Renner and K. Hiltbrand.
Illustration editing: Dr. med. Yves Harder, p.; cm.
Inselspital, CH-3010 Bern Includes bibliographical references and index.
Scans: ComArt, CH-6330 Cham, and ISBN 3131174412 — ISBN 0-86577-886-8
AO Media Services, CH-7270 Davos Platz 1. Fractures—Treatment. I. Title Principles of Fracture Management.
Video digitizing: AO Media Services, CH-7270 Davos Platz II. Title: Fracture management. III. Murphy, W.M. (William M.) IV.
Video editing: PD Dr. med. Dr. h.c. U. F. A. Heim, Title.
CH-3073 Gümligen [DNLM: 1. Fractures—therapy. WE 175 R918a 2000]
Coordinating editor: Prof. Dr. med. vet G. E. Fackelman, RD101, R84 2000
USA-Rockwood, ME 04478 617.1’5—dc21 00-032598
Indexing: Jill Halliday, GB-Diss, Norfolk IP21 4QT
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Copyright © 2000, by AO Publishing Acknowledgement:
Clavadelerstrasse, CH-7270 Davos Platz Photos in chapters 3.2.2 and 3.3.3 are reproduced by permission
Exclusive distribution right by Georg Thieme Verlag, of Mathys Medical Ltd. and Stratec Medical.
Rüdigerstrasse 14, D-70469 Stuttgart, Germany, and Figure 3.2.3-1 is reprinted from Pauwels F, Biomechanics of the
Thieme New York, 333 Seventh Avenue, New York, Locomotor Apparatus, (1980, Fig. 11a-f, page 157) with permission
NY 10001, USA from Springer-Verlag Berlin Heidelberg.
Figures 5.2-1 to 5.2-7 (all figures of chapter 5.2) are reprinted
Printed in Italy from Masquelet AC, Gilbert A, An Atlas of Flaps in Limb
Reconstruction, 2nd edition (Martin Dunitz: London 2000).
ISBN 3-13-117441-2 (GTV) Sequences of non-AO videos are reproduced by permission of
ISBN 0-86577-886-8 (TNY) the authors (see video index).
v
Contributors
Authors
Jorge E. Alonso, MD
University of Alabama
at Birmingham
1813 6th Avenue South MEB 509
USA-Birmingham, AL 35233
Editors/Authors Chris L. Colton, FRCS, FRCSEd George M. Babikian, MD
The Maltings, Tofts Farm Orthopaedic Association of
Thomas P. Rüedi GB-Bradmore NG11 6PE Portland Maine Medical Center
Prof. Dr. med., FACS University of Vermont
Kantonsspital Alberto Fernandez Dell’Oca, MD 33 Sewall Street, PO Box 1260
Chirurgisches Departement British Hospital, Orthopaedic USA-Portland, ME 04104
CH-7000 Chur Dept., Av. Italia 2420
U-11600 Montevideo Craig S. Bartlett, III, MD
William M. Murphy, FRCSI Department of Orthopaedics and
Corbie Wood, 52 Copsem Lane Ulrich Holz, Prof. Dr. med. Rehabilitation, University of
Oxshott, Leatherhead Katharinenhospital Vermont McClure Musculoskeletal
GB-Surrey KT22 ONT Klinik für Unfall- und Research Center
Wiederherstellungschirurgie R.T. Stafford Hall, Room 426
Kriegsbergstrasse 60 USA-Burlington, VT 05405
D-70174 Stuttgart
Fred Baumgaertel, PD Dr. med.
James F. Kellam, MD, FRCS, FACS Gesundheitszentrum Evang. Stift
Carolinas Medical Center Sankt Martin GmbH
Dept. of Orthopaedic Surgery Johannes Müller Str. 7
PO Box 32861 D-56068 Koblenz
USA-Charlotte, NC 28232
Flip P. Besselaar, MD
Peter E. Ochsner, Prof. Dr. med. Academisch Medisch Centrum
Orthopädische Klinik Universiteit van Amsterdam
Kantonsspital Liestal Meibergdreef 9
CH-4410 Liestal NL-1105 Amsterdam AZ
vi
Jochen Blum, PD Dr. med. Robert Frigg Dominik Heim, Dr. med.
Johannes Gutenberg Universität Mathys Medical Ltd. Spital Frutigen, Chirurgische Abt.
Klinik und Poliklinik für Güterstrasse 5, Postfach CH-3714 Frutigen
Unfallchirurgie CH-2544 Bettlach
Langenbeckstrasse 1 David L. Helfet, MD
D-55131 Mainz Emanuel Gautier, Dr. med. Orthopaedic Trauma Service
Department of Orthopaedic Surgery Hospital for Special Surgery
Lutz Claes, Prof. Dr. med. Kantonsspital 535 East 70th Street
Institut für Unfallchirurgische CH-1708 Fribourg USA-New York, NY 10021
Forschung und Biomechanik
Universität Ulm Christoph W. Geel, MD, FACS Reinhard Hoffmann, PD Dr. med.
Helmholtzstr. 14 Orthopedic Trauma Service Städtische Kliniken Offenbach/Main
D-89081 Ulm Upstate Medical University Klinik für Unfall- und Wiederher-
550 Harrison Center, Suite 100 stellungschirurgie
R. Paul Clifford, FRCS USA-Syracuse, NY 13202 Starkenburgring 66
Jersey General Hospital D-63069 Offenbach
Gloucester Street Rene J. A. Goris, Prof. Dr. med.
GB-St Helier, Jersey, JE2 3Qs University Hospital Nijmegen Brian J. Holdsworth
PO Box 98101 BSc, MB, LRCP, FRCS
Peter de Boer, FRCS NL-6500 Nijmegen HB Nottingham University Hospital
York District Hospital Orthopaedic Department
Wigginton Road Norbert P. Haas, Prof. Dr. med. The Queens Medical Centre
GB-York YO3 7HE Unfall- und Wiederherstellungs- GB-Nottingham NG7 2UH
chirurgie, Universitätsklinikum
Deborah M. Eastwood, FRCS Charité, Humboldt Universität Dankward Höntzsch, Prof. Dr. med.
Royal Free Hospital Campus Virchow-Klinikum BG-Unfallklinik Tübingen
Pond Street Augustenburger Platz 1 Schnarrenbergstr. 95
GB-London NW3 2QG D-13353 Berlin D-72076 Tübingen
Donald P. Endrizzi, Dr. med. David M. Hahn, FRCS James B. Hunter, BA, FRCSEd Orth
Orthopaedic Association of Portland University Hospital Queen’s Medical Centre
Maine Medical Center University The Queens Medical Centre GB-Nottingham NG7 2UH
of Vermont GB-Nottingham MG7 2UH
33 Sewall Street, PO Box 1260 Ann E. Hunter, FRCP, MRCPath
USA-Portland, ME 04104 Markus Hehli, Dipl. Ing. Department of Haematology
AO Development Institute Leicestershire Royal Infirmary
Diego L. Fernandez, PD Dr. med. Clavadelerstrasse GB-Leicester LE1 5WW
Lindenhofspital Bern CH-7270 Davos Platz
Bremgartenstrasse 119 Roland P. Jakob, Prof. Dr. med.
CH-3012 Bern Hôpital Cantonal Fribourg
CH-1708 Fribourg
vii
Eric E. Johnson, MD René K. Marti, Prof. Dr. med. Michael Nerlich, Prof. Dr. med.
University of California—Los Academisch Medisch Centrum Klinikum der Universität
Angeles, UCLA School of Medicine Universiteit van Amsterdam Abtl. Unfallchirurgie
Depart. of Orthopaedic Surgery Meibergdreef 9 Franz-Josef-Strauss-Allee 11
10833 Le Conte Ave, 76-134 CHS NL-1105 Amsterdam AZ D-93042 Regensburg
USA-Los Angeles, CA 90095
Alain C. Masquelet, MD John O’Dowd, FRCS Orth
Christoph Josten, Prof. Dr. med. Service de Chirugie Orthopédique Orthopaedic Department
Zentrum für Chirurgie, Unfall- Hôpital Avicenne, Université Paris XIII Guy’s and St Thomas’s Hospitals
und Wiederherstellungschirurgie 125, route de Stalingrad St Thomas Street
Liebigstrasse 20a F-93009 Bobigny Cedex GB-London SE1 9RT
D-04103 Leipzig
Robert Mathys, jr., Dipl. Ing. ETH Stephan M. Perren, Prof. Dr. med.
Jesse B. Jupiter, MD Dr. h.c. Robert Mathys Stiftung AO Zentrum
Harvard Medical School Bischmattstrasse 12, Postfach Clavadelerstrasse
Massachusetts General Hospital CH-2544 Bettlach CH-7270 Davos Platz
WAC 527, 15 Parkman Street
USA-Boston, MA 02114 Peter Matter, Prof. Dr. med. Tim Pohlemann, Prof. Dr. med.
AO Foundation Unfallchirurgische Klinik der
Lothar Kinzl, Prof. Dr. med. Clavadelerstrasse Medizinischen Hochschule
Abt. für Unfall-, Hand- und CH-7270 Davos Platz Hannover
Wiederherstellungschirurgie Carl-Neubergstrasse 1
Universitätsklinikum Ulm Michael D. McKee, MD D-30625 Hannover
Steinhövelstrasse 9 St. Michael’s Hospital
D-89075 Ulm 55 Queen Street East, Suite 800 Ortrun Pohler, Prof., PhD
CDN-Toronto, Ont. M5C 1R6 STRATEC Medical
Christian Krettek, MD, FRACS Eimattstrasse 3
Monash University Dept. of Gert Muhr, Prof. Dr. med. CH-4436 Oberdorf
Surgery Berufsgen. Krankenanstalt
The Alfred Hospital “Bergmannsheil Bochum” Jaime Quintero, MD
Commercial Road Gilsingstr. 14 Depto. de Ortopedia y
AUS-Melbourne, Victoria 3181 D-44789 Bochum Traumatologia
Hospital Clinica San Rafael
Dieter Leu, Dr. med. Urs Müller, Dr. med. Carrera 8a. No. 17-45 Sur
Im Wiesengrund 3 Orthopädische Klinik CO-Santafe de Bogota
CH-4613 Rickenbach Kantonsspital Liestal
CH-4410 Liestal Ernst L.F.B. Raaymakers, MD
Academisch Medisch Centrum
Universiteit van Amsterdam
Meibergdreef 9
NL-1105 Amsterdam AZ
viii
Pietro Regazzoni, Prof. Dr. med. Norbert P. Südkamp, Prof. Dr. med. Bernhard Weigel, Dr. med.
Kantonsspital Unfallchirurgie Klinikum der Universität
Chirurgische Abteilung Universitätsklinikum Charité der Abtl. Unfallchirurgie
Spitalstrasse 21 Humboldt Universität Franz-Josef-Strauss-Allee 11
CH-4031 Basel Campus Virchow-Klinikum D-93042 Regensburg
Augustenburger Platz 1
Pol M. Rommens, Prof. Dr. med. D-13353 Berlin Andy Weymann, Dr. med.
Johannes Gutenberg Universität AO International
Klinik und Poliklinik für Rudolf Szyszkowitz, Prof. Dr. med. Clavadelerstrasse
Unfallchirurgie Landeskrankenhaus— CH-7270 Davos Platz
Langenbeckstrasse 1 Universitätsklinikum Graz,
D-55131 Mainz Klinik für Unfallchirurgie Raymond R. White, MD
Auenbruggerplatz 7a Orthopaedic Association of Portland
Christian Ryf, Dr. med. A-8036 Graz Maine Medical Center University
Spital Davos of Vermont
Promenade 4 Slobodan Tepic, Dr. sci. 33 Sewall Street, PO Box 1260
CH-7270 Davos Platz Rigistrasse 27b USA-Portland, ME 04104
CH-8006 Zürich
Joseph Schatzker, MD, B.Sc., FRCS(c) Bernd Wittner, Dr. med.
Sunnybrook Health Otmar L. Trentz, Prof. Dr. med. Katharinenhospital
Science Centre Universitätsspital Klinik für Unfall- und
2075 Bayview Avenue, Suite A315 Departement Chirurgie Wiederherstellungschirurgie
CDN-Toronto, Ont. M4N 3M5 CH-8091 Zürich Kriegsbergstrasse 60
D-70174 Stuttgart
Christoph Sommer, Dr. med. Lijckle van der Laan, MD, PhD
Kantonsspital Department of Surgery Peter Worlock, DM FRCS
Chirurgisches Departement Saint Elisabeth Hospital Oxford Radcliffe Hospital
CH-7000 Chur PO Box 90151 Trauma Unit, Critical Care Centre
NL-5000 LC Tilburg Headley Way
Michael D. Stover, MD GB-Oxford OX3 9DU
Loyola University Medical Center J. Tracy Watson, MD
Department of Orthopaedic Surgery Division of Orthopaedic Werner Zimmerli, Prof. Dr. med.
2160 South 1st Avenue Traumatology, Wayne State Medizinische Universitätsklinik
USA-Maywood, IL 60153 University School of Medicine Kantonsspital
4201 St. Antoine Street Rheinstrasse 26
University Health Center 7-C CH-4410 Liestal
Detroit Medical Center
USA-Detroit, MI 48201
Foreword—D.L. Helfet ix
Foreword
Revolutions, and their leaders, that are suc- tures. This yeoman task has been spearheaded
cessful and survive are rare—especially in by Thomas P. Rüedi and William M. Murphy,
medicine. The five founders of the AO were who with their associate editors and AO “in-
such, and like true revolutionaries they had to house” Publication Department, under the
convince the proletariat that this revolution, direction of Rainer Egle, in collaboration with
though appealing to surgeons, was also based Thieme International, have produced this, the
on scientific principles. To do this required AO “Bible” for the new millennium—a truly
careful documentation of all cases, from which remarkable achievement.
evaluation and learning allowed them the full On behalf of all fracture surgeons, but espe-
development of a method which culminated in cially those of the AO family, our thanks and
the original AO Manual, the working treatise congratulations to all those involved and may
of this remarkable AO revolution. the revolution, started 40 years ago, continue
Fortunately, the revolution continues even to flourish and evolve.
today—the principles remain the same, but the
methods have evolved, as clearly they should.
This, the fifth major publication, is no longer a David L. Helfet, MD
manual, as its predecessors, but an interpre- New York, March 2000
tation of the AO philosophy and principles as
they apply to the management of fractures for
the new millennium. In addition, the baton has
been passed and the message herein has been
written by the many disciples of the founders—
all of whom have benefited, as have their many
patients worldwide, by their association with
the AO revolution.
As befits the AO at the turn of the new
century, the format is also revolutionary and
high tech, including a written tome and a CD-
ROM version with surgical techniques, videos
and annotated references—a first for such a text,
to my knowledge, in surgery, let alone for frac-
x