TREATMENT OF COMPLEX FRACTURES

INDEX

Note: Page numbers of article titles are in boldface type.

Acetabular fractures, associated injuries complicatingmanagement of, 73–95acetabular fracture with associated hip dislocation,

75, 77femoral head fracture with associated acetabular

fracture, 77–80, 82femoral head injury with associated acetabular

fracture, 82, 86–87femoral neck fracture with associated acetabular

fracture, 87–88femoral shaft fracture with associated acetabular

fracture, 91, 94proximal femoral fracture with associated acetabular

fracture, 88–89, 91Arthrodesis, primary, for talar neck fractures, 254Arthrosis, as complication of talar neck fractures, 260Avascular necrosis, as complication of femoral neck

fractures, 106–107

Calcaneus, fractures of, 263–285anatomy, 263, 265classification, 268–270complications, 280, 282fracture anatomy, 265, 268imaging, 270–272results, 280treatment, closed treatment, 272–277postoperative management, 279reduction, 277–279

Cast immobilization, for high-energy tibial shaftfractures, 212–213

for wrist fractures, 43Cerclage fixation, for periprosthetic fractures of femur,

146Children, femoral neck fractures in, 107–108Closed reduction, of femoral neck fractures, 101vs. open reduction, for wrist fractures, 41–42and splint or cast alone, for wrist fractures, 43for wrist fractures, 42–43

Compartment syndrome, femoral shaft fracturesassociated with, 133

Complex fractures, treatment of, associated injuriescomplicating management of acetabular fractures,73–95complicated femoral shaft fractures, 127–142distal femur fractures with complex articular

involvement, 153–175femoral neck fractures, 97–112fractures of calcaneus, 263–285

fractures of the talar neck, 247–262high-energy pelvic ring disruptions, 59–72high-energy tibial shaft fractures, 211–230hybrid external fixation for tibial plateau fractures,

199–209management of the smashed distal humerus, 19–33open reduction and internal fixation of high-energy

tibial plateau fractures, 177–198periprosthetic fractures of femur, 143–152pilon fractures, 231–245scapula fractures, 1–18subtrochanteric femoral fractures, 113–125wrist fractures, 35–57

Cortical strut grafts, for periprosthetic fractures of femur,147

Degloving injury, closed, associated with high-energypelvic ring disruptions, 66

Diaphyseal fractures, associated with total hiparthroplasty, 149

Distal radioulnar joint, treatment of, 53–56Distal radius, operative approaches to, 46–48, 50–52

External fixation, for high-energy tibial shaft fractures,213–216

hybrid, for tibial plateau fractures. See Tibial plateaufractures, hybrid external fixation for.

vs. open reduction internal fixation, results of, for pilonfractures, 242–244

for wrist fractures, 43–45

Femoral fractures, proximal, with associated acetabularfracture, 88–89, 91

subtrochanteric, 113–125anatomy and biomechanics, 113–114classification, 114–115incidence and mechanism of injury, 114patient assessment, 115–116treatment, intramedullary fixation, 116–11895◦ fixed angle devices, 120options, 116principles of, 116sliding hip screws, 118–120

Femoral head fracture, with associated acetabularfracture, 77–80, 82

287

288 INDEX

Femoral head injury, with associated acetabular fracture,82, 86–87

Femoral neck fractures, 97–112with associated acetabular fracture, 87–88biological and mechanical considerations, 98–99in children, 107–108classification, 99closed reduction of, 101combined fractures of femoral neck and shaft, 108complications, avascular necrosis, 106–107loss of fixation, 104–105nonunion, 105–106

epidemiology, 97–98future treatment of, 108–109internal fixation of femoral neck, 101–102ipsilateral, femoral shaft fractures in combination with,

130–131prosthetic replacement, 102–103sliding hip screws, 102treatment, 99–101

Femoral shaft fractures, with associated acetabularfracture, 91, 94

complicated, 127–142femoral shaft fracture associated with implant

failure, 133, 135, 137femoral shaft fractures associated with compartment

syndrome, 133femoral shaft fractures associated with vascular

injury, 132–133femoral shaft fractures in combination with

ipsilateral femoral neck fractures, 130–131femoral shaft fractures resulting from gunshot

wounds, 137–139infected femoral shaft fractures, 139–140open fractures, 127–128segmental femoral shaft fractures, 128–130

Femoral stems, fractures distal to, associated with totalhip arthroplasty, 149

Femur, periprosthetic fractures of, 143–152femoral fractures above total knee arthroplasty,

classification, 149methods of treatment, 150

fractures around the femoral component of total hiparthroplasty, biologic and mechanicalconsiderations, 143–144

classification, 144–145epidemiology, 143

fractures between implants, 150, 152methods of treatment, 145–146cerclage fixation, 146cortical strut grafts, 147intramedullary nails, 148nonoperative treatment, 146plating, 146–147revision arthroplasty, 147–148

prevention of, 152types of femur fractures associated with total hip

arthroplasty, diaphyseal fractures, 149fractures distal to femoral stems, 149intraoperative fractures, 148–149trochanteric fractures, 149

Femur fractures, distal, anatomy, 157–158clinical results in treatment of, 153–157with complex articular involvement, 153–175implant options, 166injury pathoanatomy, 158–159LISS as “internal fixator,” 166, 168preoperative assessment and planning, 159, 162TARPO technique, 162–163, 166

Fixation, loss of, as complication of femoral neckfractures, 104–105

Fractures. See specific fractures.

Genitourinary injury, associated with high-energy pelvicring disruptions, 66–67

Gunshot wounds, femoral shaft fractures resulting from,137–139

Hip dislocation, acetabular fracture with, 75, 77Hip screws, sliding, for femoral neck fractures, 102

for subtrochanteric femoral fractures, 118–120Humerus, smashed distal, management of, 19–33

potential complications, 30–33principles and technical objectives, 20–21results to be expected, 30surgical technique, bony reconstruction, 22exposure, 21–22fixation of articular segment to shaft, 22–24,

26, 28postoperative treatment, 29–30supracondylar shortening, 28–29

Implant failure, femoral shaft fractures associated with,133, 135, 137

Infection, associated with femoral shaft fractures,139–140

Internal fixation, of femoral neck fractures, 101–102open reduction and, vs. external fixation, results of, for

pilon fractures, 242–244for femoral fractures above total knee arthroplasty,

150of high-energy tibial plateau fractures. See Tibial

plateau fractures, high-energy, open reduction andinternal fixation of.

rationale for, in talar neck fractures, 252surgical approach for, in talar neck fractures,

252–254Intramedullary fixation, for subtrochanteric femoral

fractures, 116–118Intramedullary nailing, for femoral fractures above total

knee arthroplasty, 150for high-energy tibial shaft fractures, 216–217for periprosthetic fractures of femur, 148potential iatrogenic complications of, disturbance of

cortical bone circulation, 220elevation of compartment pressures, 217–220thermal injury to cortical bone, 220–221

reamed, for high-energy tibial shaft fractures,224

unreamed, for high-energy tibial shaft fractures,222–224

Intraoperative fractures, associated with total hiparthroplasty, 148–149

Less invasive stabilization system (LISS), for distal femurfractures, 166, 168

LISS, for distal femur fractures, 166, 168

INDEX 289

Malunion, as complication of talar neck fractures,260–261

Neurologic injury, associated with high-energy pelvicring disruptions, 67

95◦ fixed angle devices, for subtrochanteric femoralfractures, 120

Nonunion, as complication of femoral neck fractures,105–106

Open reduction, closed reduction vs., for wrist fractures,41–42

and internal fixation, vs. external fixation, results of,for pilon fractures, 242–244

for femoral fractures above total knee arthroplasty,150

of high-energy tibial plateau fractures. See Tibialplateau fractures, high-energy, open reduction andinternal fixation of.

rationale for, in talar neck fractures, 252surgical approach for, in talar neck fractures,

252–254Orthopedic injuries, occult, associated with high-energy

pelvic ring disruptions, 67Osteonecrosis, as complication of talar neck fractures,

259from talar neck fractures, prognosis and, 251

Pelvic ring disruptions, high-energy, 59–72associated injuries, closed degloving injury, 66genitourinary injury, 66–67neurologic injury, 67occult orthopedic injuries, 67open wounds, 64, 66

definitive treatment, 68–69early treatment, 62–64evaluation and resuscitation, 59–61injury and mechanism, 59outcomes and complications, 69–71radiology and common zones of injury, 61

Percutaneous pin fixation, with or without limited dorsalapproach, for wrist fractures, 45–46

Pilon fractures, 231–245anatomy, 232assessment, 232–234complications, 241–242fracture classification, 234–235operative indications, 235–236postoperative course, 241results, 242of external fixation vs. open reduction internal

fixation, 242–244treatment options, 236–238preferred treatment method, 238–241

Plate fixation, for high-energy tibial shaft fractures,213

Plating, for periprosthetic fractures of femur,146–147

Prosthetic replacement, of displaced femoral neckfractures, 102–103

Radius, distal, operative approaches to, 46–48,50–52

Revision arthroplasty, for periprosthetic fracturesof femur, 147–148

Scapula fractures, 1–18anatomy and biomechanics, 1–2classification, 2–3evaluation, associated injuries, 3, 6history, 3physical examination, 6radiographic imaging, 6

rehabilitation, 12, 16–17treatment, operative approaches and techniques,

12surgical indications, 6–7, 12

Soft tissue coverage, for high-energy tibial shaft fractures,221–222

Supracondylar shortening, for smashed distal humerus,28–29

Talar neck, fractures of, 247–262anatomy, bony anatomy, 247–248vascular anatomy, 248

classification, 250–251complications, arthrosis, 260malunion, 260–261osteonecrosis, 259

examination, 249mechanism of injury, 248–249open injuries, 258–259outcomes, historical results, 256–257modern results, 257–258

radiographic evaluation, 249treatment, fracture-specific, 254–256historical perspective, 251–252primary arthrodesis, 254rationale for open reduction and internal fixation,

252surgical approach for open reduction and internal

fixation, 252–254TARPO technique, for distal femur fractures, 162–163,

166Tibial plateau fractures, high-energy, open reduction and

internal fixation of, 177–198classification, 179–180nonoperative treatment, 179radiographic assessment, 180rehabilitation, 194treatment, combined anterolateral and

posteromedial plate application, 187, 194dual plating, 186–187open bicondylar high-energy fractures of tibial

plateau, 183, 186type I through III fractures, 180–181type IV fractures, 181type V and VI fractures, 181, 183

hybrid external fixation for, 199–209fracture model, 200–201clinical applications, 204–205frame configuration, 203–204mechanical testing, 201, 203

indications, 199–200surgical technique for, 205–206, 208

290 INDEX

Tibial shaft fractures, high-energy, 211–230comparison studies of tibial fracture fixation,

225–226energy absorption and soft tissue injury,

211–212potential iatrogenic complications of intramedullary

nailing, disturbance of cortical bone circulation,220

elevation of compartment pressures,217–220

thermal injury to cortical bone, 220–221reamed tibial nailing, 224soft tissue coverage, 221–222treatment options, cast, 212–213external fixation, 213–216intramedullary nailing, 216–217plate fixation, 213

unreamed tibial nailing, 222–224Total hip arthroplasty, fractures around femoral

component of, biologic and mechanicalconsiderations, 143–144classification, 144–145epidemiology, 143

types of fractures associated with, 148–149Total knee arthroplasty, femoral fractures above,

149–150Transarticular percutaneous osteosynthesis (TARPO)

technique, for distal femur fractures, 162–63,166

Trochanteric fractures, associated with total hiparthroplasty, 149

Ulnar styloid fractures, associated with distal radioulnarjoint, treatment of, 53–56

Vascular injury, femoral shaft fractures associated with,132–133

Wounds, open, associated with high-energy pelvic ringdisruptions, 64, 66

Wrist fractures, 35–57anatomy, 36–37classification, 37history and physical examination, 37–39radiographic evaluation, 39–40treatment, background, 40–41closed reduction, 42–43vs. open reduction, 41–42and splint or cast alone, 43

distal radioulnar joint and associated ulnar styloidfractures, 53–54

bone graft, 54–56postoperative care, 56

external fixation, 43–45high-energy injuries, 52–53operative approaches to distal radius, 46–47dorsal approach, 51–52radial and ulnar volar approaches, 47–48, 50–51

percutaneous pin fixation with or without limiteddorsal approach, 45–46