Handbook of Orthopaedic Trauma Implantology

Foreword 1
Foreword 2
Preface
Background to Writing This Book on Orthopaedic Trauma Implantology
Contents
About the Editors
Section Editors
Contributors
Part I: General Introduction to Orthopaedic Trauma Implantology
1 The Science, Art, and Commerce of Orthopaedic Trauma Implantology: How to Use This Book
Introduction
What Has Changed in Orthopaedic Traumatology over the Years?
Why Are There So Many Different Kinds of Trauma Implants?
What Are Orthopaedic Trauma Implants?
Factors Which Influence Implantology and Choice and Evolutions of Implants
Rationale of Trauma Implants
Objective of a Trauma Implant and How It Works
Management of Fractures Without Implants
Management of Fractures with Implants
Reduce
Retain (with Implants)
Plates and Screws
Rigid Nails
TENs (Titanium Elastic Nails)
External Fixators
Cannulated Screws
Kirchner Wires
Stainless Steel Wires and Cables
Replacement of Fractured Bones with Prosthesis
Rehabilitation
Bone Augmentation Techniques
Conclusion
References
2 The Drivers of Change in Orthopaedic Trauma Implant Designs
Introduction
Patient-Driven Demands
Fracture-Driven Demands
Surgeon-Driven Demands
Infrastructure-Driven Demands
Medical and Ancillary Infrastructure (Non-exhaustive List)
Surgical and Ancillary Infrastructure (Non-exhaustive List)
Impact of Material Sciences and Progress in Other Non-medical Specialities
Industry-Driven Demands
War-Driven Demands
Conclusion
References
3 Defining the Clinical and Radiological Endpoint of a Successfully Fixed Fracture
Introduction
Clinical Features
Radiological Features
Callus and Consolidation on Radiographs
Computerized Tomography (CT)
Ultrasound
Conclusion
References
4 Trying to Predict Implant Failure in Orthopaedic Traumatology
Introduction
Predictors for Defect in Biology
Intrinsic
Patient Characteristics Associated Factors
Immune Response to Implants
Trauma Pattern Associated Factors
Condition Where Achieving Rigid Union Is Not the Aim
Effect of Lever Arm on Implant Failure
High-Energy Trauma Versus Low-Energy Trauma
Direct Versus Indirect Injury
Extrinsic
Surgeon Associated Factors
Relative Stability
Problems with Fixation
Plates and Screws
Conventional Plates
Locking Plates and Locking Screws
Intramedullary Nails and External Fixators
Predictors for Failure of IM Nails
External Fixator
Predictors for Defect in Metallurgy
Implant Associated Factors
Predictors
Improper Manufacture and Handing of Implants
Poor Certification/Testing of the Implants
Conclusion
References
5 Orthopaedic Nails Versus Orthopaedic Plates: An Evolutionary Tale for Dominance and Relevance
Introduction
Features of Modern Plates
Features of Modern Nails
Nailing
Improvements in Techniques
Improvements in Designs (General)
Improvements in Design (Special)
Improvements in Materials
Improvements in Infrastructure
Plating
Improvements in Techniques
Improvements in Designs (General)
Improvements in Design (Special)
Improvements in Materials
Improvements in Infrastructure
Changes in the Last Decade: Cooperation Rather than Rivalry
The Future: SWOT (Strength, Weakness, Opportunities, and Threats) Analysis for Nails and Plates in the Fixation of Limb Fractu...
How Do We Decide Whether to Nail or Plate?
Conclusion
Cross-References
References
6 Internal Fixation Versus External Fixation in Orthopaedic Trauma Implantology
Introduction
External Fixation
Definition
Components
Indications
Biomechanics
Complications
Internal Fixation
Definition
Hardware
Interfragmentary Compression
Position Screw
Interlocking Screw
Poller Screw
Tension Band
Intramedullary Nails
Indications
Complications
Comparison Between Both Fixation Methods
Conclusion
References
7 Predicting the Future of Orthopaedic Trauma Implantology
Introduction
Ideal Implant
Newer Materials
Tantalum
Polyether Ether Ketone (PEEK)
Modified Titanium Implants
Polylactic Acid (PLA)
Biomaterials
Biomaterials of the Future
Manufacturing Technology
Additive Manufacturing or 3D printing
Customized 3D-Printed Die Casts
Direct Metal Printing
Surface Modification
Coatings of Biomaterials
Inorganic Coatings
Organic Biomolecule Coatings
Physiochemical Adsorption
Covalent Binding
Peptide Inclusion
Ion Implantation
Patient-Specific Orthopaedics
Intraoperative Advantages
Future Directions in Implantology
In the Era of Digital Orthopaedic
Summary/Conclusion
Newer Manufacturing Process
Newer Materials
References
Part II: Principles of Orthopaedic Nailing
8 General Principles of Intramedullary Nailing for Long Bone Fractures
Hollow Nails Versus Solid Nails
Bibliography
9 Evolution of Intramedullary Nails for Long Bone Fractures in the Upper Limb
Introduction
Nailing for Humerus Shaft Fractures
Evolution of Nail Designs for Humeral Shaft
Nailing in Proximal Humerus Fractures
Nailing in Forearm Shaft Fractures
References
10 Evolution of Intramedullary Nails for Long Bone Fractures in the Lower Limb
History
Biomechanics: Evaluation and Challenges
Locking of Intramedullary Nails
Slotted Versus Non-slotted Nails
Dynamization
Titanium Alloy
Latest Developments
Proximal Femoral Nail (PFN) Anti-Rotation A2
Conclusion
References
11 Antegrade and Retrograde Femoral Nailing
Introduction
History
The Kuntscher Nail
Interlocking Intramedullary Nail
Antegrade Nailing
Position of the Patient
Entry Points
Piriformis Fossa Entry
Unreamed and Reamed Nailing
Interlocking of Nail
Dynamic Versus Static Interlocking Fixation
Retrograde Nailing
Nailing in Comminuted and Segmental Femur Fractures
Rotational Malalignment
Prognosis
Complications
Conclusion
References
Part III: Principles of Orthopaedic Plating
12 General Principles of Orthopaedic Plating and Overview
Introduction
History
Characteristics of Plates
Biomechanics
Indications of Plates
Disadvantages of Plates
Functions of Plates
Types of Plates
Conclusion
References
13 Conventional Orthopaedic Plating
Introduction
Interfragmentary Screw
Neutralization Plate
Compression Plate
Plate Benders
Conclusion
References
14 Orthopaedic Locking Plates
Introduction
History of Locking Plates [1]
Biomechanics of Locking Bone Plates
Effect of Different Forces on a Locked Screw-Plate Construct
Bending and Axial Load
Optimized Plate Anchorage with Divergent or Convergent Locked Screws
Working Length of a Screw (Fig. 4)
Unicortical Screws
Hazards of Unicortical Insertion
Indications of Bicortical Screw Fixation
Flexible Fixation
Far Cortex Locking
Load Distribution in FCL Screws [7]
Progressive Stiffness [8]
Parallel Interfragmentary Motion [8]
Plate Length and Plate Working Length
Screw Type and Placement
Choosing the Number of Screws
Choosing the Position of Screws
Plate-Screw Density
Choosing the Material of Implants: Stainless Steel or Titanium
Effect of Screw Position on Axial and Torsional Stiffness
Plate Clearance
Biomechanics of Locking Screws
Head
Recess
Countersink
Shaft
Runout
Screw Thread
Core Diameter (Fig. 15)
Minor Diameter/Root Diameter/Inner Diameter
Thread Diameter (Fig. 15)
Major Diameter/Outside Diameter
Pitch
Lead
Tip
Self-Tapping Tip
Self-Drilling Self-Tapping Tip
Biomechanics of Locking Holes
Locking Mechanism
Fixed-Angle Plates
Variable-Angle Plates
Undersurface of a Locking Plate
Indications of Locking Plating
Contraindications of Locked Plating
Disadvantages of Locked Internal Fixator Plate (LIFP)
Conclusion
References
15 Orthopaedic Anatomical Plates
Introduction
History
Initial Designs
Less Invasive Stabilization System (LISS): A True Anatomic Locking Plate; The Forerunner of Locking Plates
Present Usage
Variable Angle LCPs
Recent Advances
Conclusion
References
Part IV: Principles of External Fixation in Orthopaedics
16 Principles and Overview of External Fixators in Orthopaedic Traumatology
Historical Background
Working Principles of External Fixator
Components of External Fixators and Application Principles
Clinical Indications of External Fixator
Techniques of Application of External Fixator
Complications of External Fixator
Advantage of External Fixator over Internal Fixation
Conclusion
References
17 Use of External Fixation in Primary Management of Fractures
Introduction
External Fixator System in Management of Fractures
External Fixator System
History and Evolution of External Fixator System
Basic Principles of Healing with External Fixator System
Advantages of External Fixator System in the Primary Management of Fractures
Current Common Indications of External Fixator System in the Primary Management of Fractures
Implantology: Components of External Fixator System
Metallurgy of External Fixator System Construct Components
Basic Construct Designs of External Fixator Systems
Stability of External Fixator Systems
``Safe Corridors´´ During Application of External Fixator Systems
Complications Associated with External Fixator Systems
Strategies to Prevent and Treat Pin Site Complications
Future Advancements in External Fixator Systems
Conclusion
References
18 External Fixator as an Augment or Alternative to an Internal Fixator
Introduction
External Fixator as a Replacement of Internal Fixation
Non-spanning External Fixator
Compound Fracture with Contaminated Wound and Soft Tissue Involvement
Treatment of Infected Non-union (INU) with or without Implants
External Fixation as an Augment of Internal Fixation
Augmentation for Stabilization of Fracture
Augmentation During Surgical Procedure (Fixator-Assisted Internal Fixation)
Recent Advances in External Fixator and Its Implication
Summary
References
19 Principles and Usage of Ilizarov Techniques in the Management of Fractures
Introduction
Basic Principles
Description of Components and Assembly of Fixator
Rings and Arches
Rings
Arches
Ring Connections
Bolts and Nuts (Fig. 6)
Rods and Plates
Rods
Connection Plates (Fig. 8)
Posts and Hinges
Wire Fixation Bolts
Washers (Fig. 12)
Wire Types and Utilization (Fig. 13)
Principles of the Circular Fixator
Surgical Principles
Indications for Multi-Planar Fixation
Advantages
Complications of the Ilizarov Fixator [7]
Applications of the Ilizarov Frame in Acute Fractures
Conclusion
References
20 Computer-Aided External Fixation Systems in the Management of Fractures
Introduction
History
TSF Hardware [4]
Biomechanics and Application in Fracture Care
Basic Rules of TSF Fixator Application
Application in Trauma [9-14]
Femoral Application [15-18]
Tibial Application [9-18]
Proximal Ring
Creating a Hexapod Frame
Fracture Reduction
Terminology [4]
TSF Software [4, 10]
Complications
Conclusion
References
Part V: Bone Replacement in Orthopaedic Traumatology
21 Natural Sources of Bone Grafts
Introduction
Natural Bone Graft Sources
Iliac Crest
Distal Radius
Distal Tibia
Greater Trochanter
Proximal Tibia
Fibular Strut Graft
Ribs
Bone Marrow
References
22 Techniques of Bone Grafting and Bone Augmentation
Introduction
Properties of Bone Graft
Autologous Bone Grafts
Cancellous Bone Grafts
Types of Cancellous Bone Graft
Harvesting Sites
Iliac Crest
Proximal Tibia
Distal Radius
Distal Tibia
Greater Trochanter
Complications
Application and Limitations of Cancellous Bone Graft
Cortical Bone Grafts
Types of Cortical Bone Grafts
Special Techniques
Allograft
Common Types of Allograft
Fresh Allograft
Fresh Frozen
Freeze-Dried (Croutons) (Freeze Dried Bone Graft (FDBA))
Allograft Prosthetic Composite
Osteochondral or Osteoarticular Allograft
Demineralized Freeze-Dried Bone Allograft (DFDBA) or DBM (Demineralized Bone Matrix)
Recent Advances
Pros and Cons of Allograft
Summary
References
23 Advances in Bone Grafting Technology
Introduction
Properties of Bone Graft Materials
Biocompatibility
Porosity
Mechanical Strength
Flexibility
Biodegradability
Promoting Angiogenesis
Autografts and Allografts
Developing a Bone Graft Composite (BGC)
Natural Polymers
Synthetic Polymers
Bioactive Ceramics
Bioactive Glass
Hydrogels
Metals
Cell-Based Bone Grafts
Growth Factor-Based Bone Grafts
Parathyroid Hormone
Gene Therapy
Nanotechnology in Bone Grafting
Fabrication and Design of Bone Graft Composites
Summary
References
24 Principles of Bone Grafting
Bone Structure
Bone Healing or Regeneration
Properties of Bone Grafts
Bone Grafts in Clinical Practice
Types of Bone Graft and Substitutes
Autografts
Allograft and Bone Bank
Demineralized Bone Matrix
Bone Marrow Aspirate Concentrate (BMAC)
Cultured Autologous Osteoblasts
Growth Factors
Bone Morphogenetic Proteins
Transforming Growth Factor Beta (TGF-β)
Conclusion
References
25 Silicone Implants in Orthopaedic Traumatology
Introduction to Orthopedic Filler Materials
Advantages of Fillers
Disadvantages of Fillers
Factors Affecting Success of Filler Materials
History of Silicone Implants
Conclusion
References
26 Primary Arthroplasty for Fractures of the Acetabulum
Introduction
Indications
Goals of Primary Arthroplasty
Technical Considerations
Surgical Approaches
Fracture Reconstruction
Acetabular Reconstruction and Addressing the Bony Defect
Stability
Secondary Arthroplasty
Conclusion
References
27 Primary Arthroplasty for Fractures of the Proximal Femur
Introduction
Indications for Primary Arthroplasty
Technical Considerations
Implant Choice
Joint Preparation and Fracture Reconstruction
Conclusion
References
28 Primary Arthroplasty for Fractures Around the Knee
Introduction
Indications
Technical Considerations
Implant Choice and Constraint
Joint Preparation
Addressing the Bone Defects
Zones of Implant Fixation
Ancillary Internal Fixation
Conclusion
References
29 Primary Arthroplasty for Proximal Humeral Fractures and Fracture Sequelae Following Implant Failure
Introduction
Open Reduction and Internal Fixation
Arthroplasty
Proximal Humeral Fracture Sequelae Classification:
Conclusion
References
Part VI: Other Implants Used in Orthopaedic Implantology
30 Titanium Elastic Nails in the Management of Fractures
Introduction
History of Elastic Nails
Metallurgy of Elastic Nails
Principles of TENS
Appropriate Constructs for
Specific Bones
Femur
Ideal Indications
Extended Indications/Relative Contraindications
Tibia
Humerus
Forearm
Indications
Steps
Radial Neck
Clavicle
Indications
Relative Contraindications
Steps
Metacarpals
Indications
Steps
Ribs
Indications
Relative Contraindication
Principles of Fixation
Benefits and Limitations TENS
Benefits
Complications and Failures of TENS
Failure of the Surgical Principle
Prebend
Nail Diameter
Insertion Point
Corkscrew Phenomenon
Fracture-Specific Errors
Failures in Femoral Nailing
Failures of Forearm Nailing
Failures of Humeral Nailing
Failures of Tibia Nailing
Complications
Nail-End Related Complications
Malalignment and Loss of Reduction
Non-Union and Delayed Union
Limb Length Discrepancy
Nail Removal
Recent Advances and the Way Forward
Conclusion
References
31 Importance of Orthopaedic Screws
Introduction
Evolution of Orthopaedic Screws
Parts of a Screw
The Head
The Shaft
The Thread (Fig. 1)
Biomechanics of a Screw
Special Screws
Herbert Screws
Interference Screws
Bioabsorbable Screws
Conclusion
References
32 Role of K-wires in Orthopaedic Traumatology
Introduction
Evolution of K Wire
Biomechanical Property of K Wires
General Principles [2]
Indication of K-wire
Contraindication
K-wire in Osteosynthesis
Size of the K Wire to Be Used
Stability with K Wire
Steps of K Wire Insertion
Specific Use of K Wire [2]
Paediatric Age Group
Adult age Group
Unconventional Use of K Wires
Used as Retractors [4]
Used as Distractor [4]
Complications [5]
Prevention of Pin Track Infection
References
33 Tension Banding, Cerclage Wires and Cables in Management of Fractures
Introduction
Types of Compression
Static Compression
Dynamic Compression
Materials
Technique
Complications [6]
Specific Fractures
Olecranon Fracture
Specific Complications
Patella Fractures
Greater Tuberosity Fractures
Greater Trochanter of Femur
Medial Malleolus
Tips
Cerclage Wiring
Indications in Site of Fractures (Figs. 11 and 12)
Techniques
Complications
Special Conditions
Cables
Conclusion
References
34 Implants Used for Periprosthetic Fractures
Introduction
Risk Factors for Periprosthetic Fractures
Diagnostic Studies for Periprosthetic Fractures
Classifications for Periprosthetic Fractures
Evaluation of Periprosthetic Fractures
Periprosthetic Fractures Around the Hip
Acetabular Component
Femoral Component
Periprosthetic Fractures Around the Knee
Stable Femoral Component
Unstable/Loose Femoral Component
Tibial Component
Periprosthetic Fractures Around the Shoulder
Periprosthetic Fracture Around the Elbow
Conclusion
References
Part VII: Metallurgy and Biomechanics in Orthopaedic Trauma Implantology
35 Evolution and Principles of Metals and Alloys Used in Orthopaedic Trauma Implantology
Introduction
Characteristics of an Ideal Implant
The Commonly Used Metals/ Alloys in Orthopaedic Practice
In Order to Understand These Alloys Better, They Need to Be Analysed on Three Fronts
Physical Properties [1, 3]
Strength
Plasticity
Stiffness
Ductility
Elasticity (Stress, Strain, and Young´s Modulus)
Fatigue Failure
Chemical Properties
Corrosion
Types of Corrosion
Galvanic
Fretting
Crevice Corrosion
Pitting Corrosion
Corrosion Fatigue
Biocompatibility
After Having Understood the Properties of Metallic Alloys in General, Now Let Us Study the Commonly Used Alloys in Detail
AISI440B. Instrument Steel
Cobalt-Based Alloys
Ti-Based Alloys
Properties
Elements of Implants and Their Implication
Recent Advances
Conclusion
References
36 Biomechanics of Orthopaedic Implants Demystified
Introduction
Screws [1-3]
Structures of Screw
The Core and Thread Diameter (Fig. 2 and 3)
Different Uses of Screws
Basics of Screw Insertion Technique
The Heat Production Factor During Screw Insertion
The Wobbling Factor of Drilling for Preparation of Exact Shape of Pilot Hole
Precise Cutting of Threads by Tapping After Drilling
Benefits of Tapping
Screws Which Does Not Require Tapping
The Screw Insertion Torque
Purchase Strength or Holding Power of Screw
Lag Effect of Screw
Plates
The Absolute and Relative Stability
Functions of Plate
Role of Plate for Interfragmentary Compression of Fracture Fragments [6]
Biomechanics of Plate Fixation Construct Depends on Several Factors as Below
Technical Consideration of LCP
Screw Fixation Techniques in LCP
Biomechanics of Intramedullary Nails [1-3, 7, 8]
Biomechanics of Entry Hole of Intramedullary Nail
Biomechanics of Reaming
Biomechanics of Nail Design
Diameter of Nail
Shape of Nail
Nail Bone Contact (NBC) and Working Length of IMN
The Slot Inside the Nail
The Holes of Interlocking Nail
Static and Dynamic Locking
Dynamization
The External Fixators [1-3, 9]
Indications
Biomechanical Concern of External Fixations
Parts of External Fixations
Factors Responsible for the Stability and Stiffness of Frame
Frame Design (Flowchart 6)
Contribution of Pins Clamps and Rods for Stiffness of Fixation of Construct
Pattern of Behaviour of External Fixators Under Different Load Distribution
Healing Response of Fracture, Stabilised with External Fixator
Conclusion
References
37 Less Used Orthopaedic Implants
Introduction
Evolution of Fixations to the Present Plating Systems
Evolution of Fixation to the Present Nail System
Evolution of Present External Fixators
Nailing Versus Plating of Clavicle Fractures
IM Nailing of Forearm Fractures
Expandable Intramedullary Nails for Humeral Fractures
Just Unic Hemiarthroplasty (Fig. 8)
Da Vinci Cage for Proximal Humerus Fractures
Intramedullary Cage for Proximal Humerus Fractures
Dynamic Locking Blade Plate (DLBP)
Trochanteric Fixation Nail-Advanced (TFNA)
Hansson Twin Hook
Medoff Sliding Plate with Twin Hook
Gotfried´s Percutaneous Compression Plate (PCCP)
Conclusion
References
Part VIII: Strategies in Choosing Orthopaedic Trauma Implants in Complex Cases
38 Multidisciplinary Approach to Major Trauma: Changing Strategies and Priorities in Orthopaedic Implantology
Introduction
``Early Total Care´´ Versus ``Damage Control Orthopaedics´´
How to Assess Trauma Severity?
Damage Control Orthopaedics: Windows of Opportunity
Conclusion and Outlook
References
39 Orthopaedic Implant Fixation Strategies in Multiple Limb Injury Combinations
Introduction
Phases of Care in the Multiple Injured Patient
Early Total Care Vs Damage Control Surgery
Indications for DCO Concept
Thoracic Trauma
Traumatic Brain Injury
Timing of Definitive Osteosynthesis
External Fixation
Treatment Strategies
Treatment Strategies of Multiple Limb Fractures
Case Example: Combined Upper and Lower Limb Fractures
Treatment Strategies of Pelvic Fractures and Limb Fractures Combined
Pelvic Binders
Anterior Pelvic External Fixation
C-Clamp
Case Example: Pelvic Fracture with Multiple Lower Limb Soft Tissue Injuries
Conclusion
References
40 Orthopaedic Implant Fixation Strategies for Multiple Fractures in a Single Bone
Introduction
Femur
Epidemiology and Aetiology
Diagnosis
Surgical Treatment Options
Choice of Implants
Complications
Non-union
Avascular Necrosis
Reoperations
Postoperative Infection
Case Report from the Author´s Clinic
Tibia
Special Situations: Distal Tibial Triplane Fracture with Ipsilateral Tibial Shaft Fracture in Adolescent Patients
Humerus
Conclusion
References
41 Using Different Implant Combinations to Improve Fracture Fixation
Introduction
Cerclage Wiring and Osteosynthesis
Intramedullary Nailing and Poller Screws
Use of Kirschner Wires During Intramedullary Nailing
Intramedullary Nailing and Provisional Plating
AO Distractor
Suture Anchor Systems
Conclusion
References
Part IX: Infrastructure Necessary for Orthopaedic Implantology
42 Importance of Orthopaedic Infrastructure and Ancillary Tools
Introduction
Infrastructure, Implants, and Ancillary Tools
Surgeons and Industry
Conclusion
References
43 Orthopaedic Tables and Their Evolution
Introduction
History and Evolution
Modern Orthopaedic Tables
Orthopaedic Attachments and Accessories
Future Trends
Conclusion
References
44 Intraoperative Imaging Techniques in Orthopaedic Trauma Implantology
Introduction
Historical Perspective
Types of Intraoperative Imaging
The C-Arm
Intraoperative 3D Fluoroscopy
Intraoperative CT Scan
The O-Arm
Conclusion
References
45 How 3D CT Scans Are Revolutionizing Orthopaedic Trauma Implantology
Introduction
The 3D CT Technology in General, and in Simple Terms
Advantages
3D Imaging Examples in a Few Selected Areas
Carpus
Distal Radius
Proximal Ulna
Distal Humerus
Proximal Humerus
Acetabulum
Distal Femur, Proximal and Distal Tibia
Conclusion
References
46 Cutting Tools Used in Orthopaedic Trauma Implantology
Introduction
Sterilization Protocol for All Instruments
Osteotome (Fig. 2)
Bone Chisel (Fig. 3)
Bone Gouge (Fig. 4)
Corticotome (Fig. 5)
Gigli Saw (Fig. 6)
Amputation Saw (Fig. 7)
Kuntscher´s Diamond Pointed Awl (Fig. 8)
Brad-Awl (Cobbler´s Awl) (Fig. 9)
Pedicle Awl (Fig. 10)
Kirschner´s Wire (Fig. 11)
Orthopaedic Drill-Bit and Drilling Systems (Figs. 12 and 13)
Intramedullary Reamers
Orthopaedic Drill Machine (Fig. 15)
Modern Electric Bone-Saw and Saw Blades (Fig. 16)
Wire Cutter (Figs. 17 and 18)
Orthopaedic Pliers/Cutter Combined (Fig. 19)
Conclusion
References
47 Role of Vacuum Suction Therapy in Orthopaedic Wound Closure
Introduction
Basic Principles of Negative Pressure Therapy
Instruments and Materials
Complex Wound Management with NPWT
Wound Conditioning Process
NPWT in Open Fractures
Incisional Vacuum-Assisted Therapy
Contraindications
Conclusion
References
48 Computer Navigation and Robotics in Orthopaedic Trauma Implantology
Computer-Assisted Navigation
Background
Applications in Orthopaedics
Spine
Trauma
Limitations
Robotic Surgery
Background
Robotic Surgery in Trauma and General Orthopaedics
Conclusion
References
49 Components of Infrastructure Necessary for a Successful Implantation
Introduction
The Backstage
The Team and the Ecosystem
Documentation
Updates
Inventory Management
The Arena
The Orthopaedic Operation Theatre Complex (OTC)
Hybrid Operating Room
Power Supply PS and Uninterrupted PS (UPS) (Fig. 1)
Anaesthesia-Related Infrastructure (Fig. 2)
Postoperative Pain Control
Operation Table and Imaging System
ESU (Fig. 7)
Suction Apparatus (Fig. 9)
Power Tools (Fig. 10)
Instruments for Implant Surgery in Trauma
Conclusion
References
Part X: Bone Healing and Removal of Implants
50 Bone Healing in the Presence of Orthopaedic Implants
Introduction
Fracture and Its Healing
Bone Structure, Loading, and Fracture
Factors Influencing Bone Healing and the Choice of Treatment
Biomechanics of Healing
Histology and Bone Healing
Direct or Primary Bone Healing
Contact Healing
Gap Healing
Indirect or Secondary Healing
Inflammation
Reparative
Bone Remodelling
Speed of Direct and Indirect Fracture Healing
Why Bone Formation Has to Pass Through Different Stages of Differentiation?
Blood Supply: Fracture Healing and Surgery
Why Is Blood Supply Important for Osteogenesis?
Blood Supply of a Normal Bone and the Change After Fracture
Surgery and Blood Supply
Effects of Reaming on the Blood Supply and Fracture Healing
Effect of Plating on Vascularity
Causes of Re-fracture After Removal of Plates
Biomechanics of Fracture Healing
Biomechanics of Fracture Callus
Biomechanics and Fracture Fixation
Effects of Instability After Fracture Fixation
Absolute Stability
General Biomechanics
Implants Providing Absolute Stability
Lag Screw
Plate Fixation
Tension Band Principle and Tension Band Plate
Circular External Fixators
Relative Stability: Methods and Mechanics
General Biomechanics
Implants
External Fixator
Bridge Plating and Biological Fixation
Hybrid Fixation
Locking Plate: Internal Fixator Principle
Intramedullary Nailing
The Spectrum of Stability
Failure of Healing
Absolute Stability and Failure of Healing
Relative Stability and Failure of Healing
Conclusion
Cross-References
References
51 Removal of Orthopaedic Implants
Introduction
Troubleshooting Issues with Difficult Screws
Widened Screw Slot
Standard Hexagonal Slot
Square Slot
Stripped Screw Head
Cold-Welded Screw to Plate
Older Implants: Occasionally Seen in Practice
Troubleshooting Issues with Nailings
Jammed Nail in Cortex
Broken Non-locking Nail
Removal of Square Nail (Talwalkar Nail)
Interlocking Intramedullary Nail Extractors
Pre-bent K Wire Extractors
Broken Nails
Broken Nail and a Non-union
Ossification of Interlocking Screw Hole
Broken Interlocking Screw
Broken Long Fusion Nail
Removal of a Retained Screw
Conclusion
References
Part XI: Why Orthopaedic Trauma Implantology Is in a State of Flux
52 Impact of Changing Epidemiology on Orthopaedic Trauma Implantology
Introduction
Behavioral Changes
How Implantology Has Changed
More Conservative to More Surgical, e.g., Comminuted Clavicle Fractures
Shift from External Fixation to Internal Fixation for Open Fractures
Shift from Weaker Fixation to Stronger Fixation (Nailing vs Plating, LCP vs DCP)
The Development of Anatomical Plates
Shift from Stainless Steel Implants to Titanium and Magnesium-Based Implants
Shift from Nonabsorbable to Absorbable Fixation Methods (e.g., Anchors, K-Wires, Plates)
3D Printing Technology and Customized Implants
Conclusion
References
53 Impact of Increased Life Expectancy on Orthopaedic Trauma Implantology
Introduction
Osteoporosis: A Public Health Problem
Brief History of Modern Implantology
Problems of Fracture Fixation in Osteoporosis
Conclusions
References
54 Impact of Increased Body Mass Index on Orthopaedic Trauma Implantology
Introduction
BMI and Fracture-Related Risks
BMI and Its Effects on Fracture Treatment
Conservative Versus Surgical Treatment in Obesity
Considerations During Fracture Fixation
Plating of Fractures
Plating Versus Nailing
Obesity in Children
Implant-Related Complications
Conclusion
References
55 Changing Fracture Geometry and Its Impact on Orthopaedic Trauma Implantology
Introduction
Correlation Between Fractures and Energy Dissipation
Fracture Patterns in Low-Energy Trauma
Fractures x Trauma Energy
Fracture Patterns in High-Energy Trauma
Correlation Between Fractures and Activities
Sports
Motor Vehicle Traumas
High-Energy Firearm Fractures
Fractures on the Elderly
Principles of Treatment
Open Fractures
Principles of Internal Fixation
Principles of External Fixation
Summary
References
56 Understanding and Appreciating Fracture and Fixation Stability
Fracture and Bone Healing
Biomechanical Aspects of Bone Healing
Natural Bone Healing
Primary Bone Healing
Fracture Fixation Strategies
Load Transfer Through Fractures
Biomechanics of Fractures
Relation of Load with Fracture
Creating a Durable Fixation Construct
Minimizing Stress Concentrations
Load Distribution
MIPO (Minimally Invasive Plate Osteosynthesis) Technique
Locking Plate Principle
Concept of Working Length
Reduction of Stiffness Gradient
Prevention of Preloading During Fixation
Transverse Fractures
Oblique Fractures
Butterfly Fractures
Spiral Fractures
Comminuted Fractures
Osteoporosis
Fracture Risk
Fixation Failure in Osteoporotic Bone
Issues in Osteoporotic Fracture Fixation
Periprosthetic, Interprosthetic, and End Screw Fractures
Periprosthetic Fractures
Interprosthetic Fractures
End Screw Fractures
Bone Defect and Fracture Risk
Conclusion
References
57 Changing Fracture Classifications in the Age of Three-Dimensional Computed Tomography Imaging
Introduction
General Principles
Distal Femur Fractures
Seinsheimer Classification
AO Classification System: Müller and Associates
Proximal Tibia Fractures
Plain Radiographs
Computed Tomography
Schatzker Classification
AO/OTA (41: Proximal Section) (Fig. 4 and Table 4)
Newer Classifications
Posterolateral Tibial Plateau Fractures
Posteromedial Tibial Plateau Fractures
Calcaneum Fractures
Distal Humerus Fracture
AO/OTA Classification (Fig. 12)
Jupiter and Mehne Classification [27] (Fig. 13 and Table 8)
Riseborough and Radin Classification (Fig. 14)
Distal Radius Fractures
Melone Classification
Frykman Classification
Conclusion
References
58 Quest for Better Fracture Reduction in Orthopaedic Traumatology
Introduction
Why the Quest for Better Fracture Reduction?
Reduction Methods, Principles, and Techniques
Implants Helping in Reduction
Cerclage Wiring
Plate as a Reduction Device
Bibliography
Part XII: Changes in Attitudes to Soft Tissue and Their Effect on Implants
59 Indirect Reduction Techniques in Primary Fracture Management
Introduction
Distractors
External Fixators
Kirschner Wire
Fracture Table
Bridge Plating
Locking Plates
Intra-medullary Nailing
Hohmann Retractor: As a Reduction Tool
Conclusion
References
60 Evolution of Entry Points in Nailing of Long Bone Fractures
Introduction
Femur
Technique of Antegrade Femoral Nail Entry Point
Retrograde Femoral Nail
Tibia
Humerus
Entry Point for Antegrade Humeral Nail
Retrograde Humeral Nail
Radius and Ulna
References
61 MIPPO Techniques and Bridge Plates
MIPPO Techniques (Introduction)
What Is MIPPO?
MIPPO Techniques
Preoperative Planning and OT Setup
Timing of the Surgery
Reduction
Direct Reduction
Indirect Reduction
Intraoperative Assessment of Reduction
Length
Rotation
Axial Alignment
Anatomy and Approach
Neurovascular Issues Doing MIPPO
Humerus
Femur
Fixation
Bridge Plates
What Should Be the Ideal Length of the Plate?
Type of Screws
Conclusion
References
62 Role of Spanning Implants in Fracture Management
Introduction
History [2]
Surgical Choice
Periarticular Fracture
Open Fracture Management [2]
Damage Control Orthopaedics and Spanning Fixator [2, 4]
Indications of Spanning External Fixator [1, 2]
Spanning Fixator Use in Tibia (Fig. 1)
Spanning Fixator for Distal Femoral Fracture [1, 2]
Instruments Required
MRI and External Fixator [15]
Knee Dislocation [2]
Pilon Fracture [12-14]
How to Apply Spanning Fixator Around Ankle [10]
Spanning Fixator Around Wrist [5-7]
Spanning Fixator Around Elbow [11]
Spanning Plate Fixation in Fracture Management
Conclusion
Reference
63 Low-Contact Plates in Orthopaedic Trauma Implantology
Introduction
Biomechanical Advantages
Sizes
Features of Screw Hole
Application Technique
References
Part XIII: Upper Limb Orthopaedic Trauma Implantology
64 Implantology of Fractures of the Clavicle
Introduction
Intramedullary Fixation
Kirschner Wire Fixation
Hagie and Rockwood Pin Fixation
Knowles Pin Fixation
Elastic Stable Intramedullary Nailing [ESIN]
Intramedullary Screw Fixation
Second-Generation Intramedullary Implants
Summary of Intramedullary Implants
Plating
Dual Plating
Plate and Screws Versus Intramedullary Nails
Rehabilitation
Lateral Clavicle Injuries
Medial Clavicle Injuries
Conclusion
References
65 Acromioclavicular Dislocation: Current Perspective on Optimal Surgical Techniques and Implants
Introduction
Pins for AC Joint Fixation
Hook Plates
Bosworth Screw
Coracoacromial Ligament Transfer Technique
Suspensory Fixation Techniques and Implants
Artificial Ligament Implants
Allografts and Autografts
Conclusion
References
66 Implantology of Scapula and Glenoid Fractures
Introduction
Diagnosis
Imaging
Measurement of Displacement of the Scapula Fracture
Classification
Management
Surgical Indication
Surgical Approach
Osseous Anatomy of Scapula
Mapping of Scapular Fractures
Reduction
Fixation
Implants for Fixation
Scapular Neck and Body Fracture
Glenoid Fractures (Rim and Fossa)
Isolated Process Fracture
Recent Developments in Implants and Challenges
Key Points
Illustrative Cases
References
67 Implantology of Fractures of the Proximal Humerus
Introduction
Blood Supply to the Proximal HUMERUS
Fracture Morphology
Microarchitecture of the Proximal Humerus Bone
Use of K Wires in Proximal Humerus
Enders Nail/ Titanium Elastic Nails
Percutaneous Screw Fixation
External Fixator
T Plate or Clover Leaf Plate
Locking Proximal Humerus Plate
Proximal Humerus Plate (Contoured)
Proximal Humerus Plate with Polyaxial Screws
Future of Plates
Humerus Nail with Unidirectional/Multidirectional Locking
Humerus Nail with Spiral Blade
Multiple Locking Option Nail
Special Implants
Comparision of the Various Implant
Conclusion
References
68 Implantology of Fractures of the Shaft of Humerus
Introduction
History of Treatment of Humerus Fractures
Egyptian Era
Roman and Greek Era
Hippocrates (440-340 BC)
Celsius (25 BC-50 AD)
Galen (Second Century AD)
Ancient India (1000-500 BC)
Modern Era (Nineteenth-Twentieth Century AD)
History of Internal Fixation of Humerus Fractures
Diagnosis
Why Fix Humeral Fractures
Classification of Humeral Fractures
Timing of Surgery
Proximal Diaphyseal Fractures
Mid-Diaphyseal Fractures
Distal Diaphyseal Fractures
Conclusion
References
69 Implantology of Fractures of the Distal Humerus
Introduction
Classification
Evolution of Treatment
Evidence from Biomechanical Studies
Traditional Reconstruction Plate Versus Precontoured Locked Plate
Conventional Plate Versus Locked Plate
Double Tension Band Wiring Versus Dual Plate
Extra-articular Fractures
Parallel Dual Versus Perpendicular Dual Plating in 13-C Fracture
Coronal Shear Fractures
Evidence from Clinical Studies Comparing Parallel and Perpendicular Configurations
Guiding Principles and Crucial Concepts of Internal Fixation of Distal Humerus Fractures
Contraindications for Open Reduction and Internal Fixation
Differences in the Conventional Plating and Locking Compression Plate
Advantages of the Modern Anatomically Precontoured Locking Plates
General Rules for Dual Anatomically Contoured Locking Plates
Kirschner Wires
Indications
Design Features
4 mm Cannulated Cancellous Screws
Indications
Design Features
Cortical Screw
Indications
Design Features
Headless Compression Screw
Indications
Design Features
3.5 mm Reconstruction Plates
Indications
Design Features
One-Third Tubular Plate
Indications
Design Features
3.5 mm Limited Contact: Dynamic Compression Plate
Indications
Design Features
Y-Plate or Lambda Plate
Indications
Design Features
3.5 mm LCP Extra-articular Plate Distal Humerus Locking Plate
Indications
Design Features
2.7/3.5 LCP Dorsolateral Plate Without Shelf
Indications
Design Features
2.7/3.5 LCP Dorsolateral Plate with Support
Indications
Design Features
3.5 mm LCP: Distal Humerus Lateral Plate
Indications
Design Features
3.5 LCP Metaphyseal Plate for Distal Medial Humerus
Indications
Design Features
2.7/3.5 mm LCP Distal Humerus Medial Plate
Indications
Design Features
Total Elbow Replacement (TER)
Indications
Disadvantages
External Fixator
Indications
Design Features
References
70 Implantology of Fractures of the Radial Head and Neck
Introduction
Fractures
Non-operative Treatment
Surgical Management
Radial Head Excision
Radial Head Replacement
Metallic Implants
Open Reduction Internal Fixation
Screw Fixation
Locking Screws
Kirschner Wires
Bioabsorbable Materials
Plates
Modern Anatomic Plates
Intramedullary Fixation and Paediatric Radial Neck Fractures
References
71 Implantology of Olecranon and Coronoid Fractures
Introduction: Historical Considerations
Modern Olecranon Fracture Fixation
Kirschner and Tension Band Wire
Suture Fixation
Tubular Plates
Dynamic Compression Plates
LC-DCP Plates
LCP Plates
Olecranon-Specific Plates (Figs. 3 and 4)
Column Plates (Figs. 5 and 6)
Tension Band Plate (Fig. 7)
Carbon Fiber Plates
Intramedullary Nails (Fig. 8)
Olecranon Sled (Fig. 9)
Intramedullary Screws (Fig. 10)
Coronoid
Suture Fixation
K-Wires
Coronoid Lasso Plate
Screws (Fig. 11)
Plate Fixation (Figs. 12 and 13)
Conclusion
References
72 Implantology of Fractures of the Shaft of Radius and Ulna
Introduction
Anatomical Background
Evolution of Fixation Methods for the Forearm
Nailing for Diaphyseal Fractures of the Forearm Bones
Plating for Diaphyseal Fractures of the Forearm Bones
External Fixation
Conclusion and Take Home Points
References
73 Implantology of Distal Radius and Distal Ulna Fractures
Introduction
Evolution of Distal Radius Implants
Kirschner Wire Fixation (Including Intrafocal Pinning)
Conclusion
References
74 Implantology of Fractures of the Carpal Bones
Introduction
Evolution of Operative Treatment of Scaphoid Fractures
The Herbert Screw
Advances in Headless Compression Screw Design
Fully Threaded, Variable-Pitch Conical Screws
Dual-Component Modular Screws
Other Screw Designs
Performance of Second-Generation Headless Compression Screws
Scaphoid Staples
Plates and Screws for Scaphoid Fractures
Current Indications
Author´s Preferences and Technical Tips
Conclusion
References
75 Implantology of Metacarpal Fractures
Introduction
Implants in Orthopaedic Practice
Kirschner Wires (K-Wires)
Screws
Plates
External Fixators
Surgical Procedures
Wiring
Tension Band Wiring
Shaft Fractures
Avulsion Fractures
Lag Screws
Lag Screws with Neutralization Plate
Percutaneous Lag Screws
Plate Fixation
Interfragmentary Compression
Fixed Angle Locking Plates
Condylar Plates [8]
Intraosseous Compression Screws
Intramedullary K-Wires
External Fixators
Absorbable Pins
Conclusion
References
76 Implantology of Phalangeal Fractures
Introduction
Implants
Kirschner Wires
Plates and Screws
Plates
Screw
External Fixation
Examples of Use of Implants for Individual Fractures
Fracture at the Base of the Proximal Phalanx
Proximal and Middle Phalangeal Shaft Fracture
Intra-articular Fracture of the Proximal Interphalangeal Joint
Intra-articular Fracture of the Distal Interphalangeal Joint
Conclusion
References
77 Upper Limb Orthopaedic Trauma Implantology in a Nutshell
Introduction
Current Concepts in Upper Limb Implantology
Conclusion
References
Part XIV: Lower Limb Orthopaedic Trauma Implantology
78 Implantology of Fractures of the Head of Femur
Introduction
History of development of implants
Conclusion
References
79 Implantology of Fractures of the Neck of Femur
Introduction
History of Development of Implants
Use of Fixation Devices
Neck of Femur Fracture in Pediatric Age
Arthroplasty
Monopolar Prosthesis
Moore Prostheses
Thompson Prosthesis
Bipolar Hemiarthroplasty
Cemented Versus Uncemented Hemiarthroplasties
Comparison Between Two Different Uncemented Hemiarthroplasties
Total Hip Arthroplasty
Cementless Arthroplasty
Conclusion
References
80 Implantology of Intertrochanteric Fractures
Introduction
History
Nails Without Side Plates
Static Nails Including Side Plates
Condylar Blade Plate
Mode of Failure/Disadvantages
Dynamic Nails Including Side Plates
Plate Trochanteric Buttress
Gotfried Percutaneous Compression Plate
Intramedullary Nails for Intertrochanteric Fractures
Kuntscher Y Nail
Zickel Nail
Enders Nail
Third-Generation Intramedullary Nail
Proximal Femoral Nail
Proximal Femoral Nail Antirotation
Intertan Nail
Advanced Trochanteric Fixation (Trochanteric Femoral Nail or TFN)
Halifax Nail
Arthroplasty in the Treatment of Intertrochanteric Fractures
Conclusion
References
81 Implantology of Subtrochanteric Fractures
Introduction
Imaging and Classification
Evolution of Surgical Implants
Jewett Nail Plate
Condylar Blade Plate or Angled Blade Plate
Pugh Nail and Sliding Hip Screw Plate
Dynamic Condylar Hip Screw
Medoff Sliding Plate
Locking Plates
Intramedullary Implants
Kuntscher K Nail
Kuntscher Y Nail
Zickel Nail
Enders Nailing
Russel Taylor Nail
Third-Generation Reconstruction Nail: Gamma Nail and Halifax Nail
The Trochanteric Gamma Nail (TGN)
Proximal Femoral Nail
Proximal Femoral Nail Antirotation
Advanced Trochanteric Fixation (Trochanteric Femoral Nail or TFN)
Trigen Nail
Conclusion
References
82 Implantology of Fractures of the Shaft of Femur Including Segmental and Combination Fractures
Introduction
Historical Perspective
Operative Treatment of Femoral Shaft Fracture
External Fixation of Femoral Shaft Fracture
Plate Fixation
Intramedullary Nailing
Special Situations: Segmental Fractures and Combined Fractures of the Hip and the Shaft of Femur
Conclusion
References
83 Implantology of Fractures of the Distal Femur
Introduction
Open Reduction and Internal Fixation
Angle Blade Plate and Dynamic Condylar Screw
Distal Femur Locking Plate
Modern Locking Plates
Distal Femoral Locking Compression Plate (DFLCP)
Variable Angle Locked Compression Plate (VA-LCP)
Plate Length and Screw Density
Far Cortical Locking Screws
New Implant Materials
New Plate Designs
Dual Plating
Intramedullary Nailing
Nail + Plate Construct
Distal Femoral Replacement (DFR)
Conclusion
References
84 Implantology of Fractures of the Proximal Tibia
Introduction
Historical Aspects and Evolution of the Treatment of Tibial Plateau Fractures
Internal Fixation
Bone Grafts and Substitutes
External Fixation
Evidence from Biomechanical Studies
Extra-articular Comminuted Proximal Tibial Fracture
Schatzker I Fracture
Schatzker II Fracture
Schatzker III Fracture
Schatzker IV Fracture
Schatzker V Fracture
Schatzker VI Fracture
Fundamental Principles of Fixation of Tibial Plateau Fractures
Guiding Principles and Crucial Concepts
Skeletal Traction
Indication
Description
External Fixator
Indications
Advantages
Disadvantages
Modalities
Pin and Rod Fixator
Ring Fixator
Hybrid Fixator
Cannulated Cancellous Screws (6.5 mm CCS)
Indications
Description
L Buttress Plate
Indications
Description
T Buttress Plate
Types of T Buttress Plates (Fig. 5)
Indications
Description
One-Third Tubular Plate and Reconstruction Plate
Indications
Description
Lateral Tibial Head Buttress Plate 6.5
Indications
Description
LCP - Proximal Lateral Tibial Plate 5.0
Indications
Description
LCP - Lateral Proximal Tibial Plate 4.5 (Raft Plate 4.5)
Indications
Description
LCP - Lateral Proximal Tibial Plate 3.5 (Raft Plate 3.5)
Indications
Description
LCP - Medial Proximal Tibial Plate 4.5/5.0
Indications
Description
LCP - Medial Proximal Tibial Plate 3.5
Indications
Description
LCP Posteromedial Tibia Plate 3.5
Indications
Description
Variable Angle LCP Proximal Tibial Plate 3.5
Indications
Description
Rim Plate
Indications
Description
References
85 Implantology of Fractures of the Shaft of the Tibia Including Segmental Fractures
Introduction
Biomechanics
Open Fractures
External Fixation
Tibia Interlocking Nailing
Plating
Closed Fractures
Conservative Treatment
Interlocking Nailing of the Tibia
The Ideal Intramedullary Nail
History of Intramedullary Nailing
Future of the Interlocking Nailing
Principles of Nailing
Bone Response to Nailing
Nail Design
Cross-Section
Nail Diameter
Nail Curvatures
Hoop Stress
Herzog Bend (Fig. 4)
Length and Working Length
Ends of the Tibial Nail
End Cap
Interlocking Screw
Static and Dynamic Locking (Fig. 6)
Static Locking
Dynamic Locking
Primary Dynamization
Secondary Dynamization
Poller Screw (Fig. 8)
Exchange Nailing
Basic Instruments Needed for Tibial Interlocking Nailing
Multidirectional Locking Nails
Suprapatellar Nailing (Figs. 11 and 12)
Procedure Highlights
Closed and Open Nailing
Reaming
Tips for Nailing in Segmental Fractures of the Tibia
Removal of the Tibial Interlocking Nail
Flexible Intramedullary Nailing
Plating of the Tibia
Indications
Technical Considerations
Fulcrum Effect (Fig. 15)
Bridge Plating of the Tibia
Tibial Locked Internal Fixator Plate
Conclusion
References
86 Implantology of Distal Tibia Fractures with Pilon Fracture
Introduction
Initial Management
External Fixation
Extramedullary Implants
Conclusion
References
87 Implantology of Ankle Fractures
History
Implant Materials
Ankle Fractures
Lateral Malleolus
Plating
One-Third Tubular Plate as a Neutralization Plate with Lag Screw
Recon Plate
Locking Compression Plate (LCP)
Anatomically Contoured Plates
Interlocking Nails
Titanium Elastic Nails (TENs)
Kirschner Wire (k-wire) and Tension Band Wiring (TBW)
Intramedullary (IM) Screw Fixation
Rush Rods
Medial Malleolus
Malleolar Screw
K-wire and TBW
Cannulated Cancellous Screw
Anatomical Buttress Plates and Locking Peg Hook Plates
Posterior Malleolus
Syndesmotic Disruption
Conclusion
References
88 Implantology of Fractures of the Foot
Introduction
Calcaneum Fractures
Percutaneous K-Wire Fixation
Screws and Tension Band Wire
Locking vs Non-locking Plates
Calcaneum Nailing System
Talar Neck Fractures
Talar Body Fractures
Navicular Fracture
Metatarsal Fractures
Fifth Metatarsal
Lisfranc Injury
Central Metatarsals
First Metatarsal
Hallux and Lesser Toes
References
89 Lower Limb Orthopaedic Trauma Implantology in a Nutshell
Introduction
Synopsis of Femur Fractures
Synopsis of Patella Fractures
Synopsis of Tibia and Fibula Fractures
Synopsis of Foot Fractures
Conclusion
References
Part XV: Paediatric Orthopaedic Trauma Implantology
90 Principles and Overview of Paediatric Orthopaedic Trauma Implantology
Introduction
Characteristics of Children´s Bone
The Periosteum
The Physis
Specific Fracture Patterns in Children
Therapeutic Particularities
Remodeling Potential
Respecting Growth Potential
Faster Consolidation
Therapeutic Options
Non-operative Treatment
Surgical Treatment
Implants in Paediatric Orthopaedic Traumatology
Kirschner Wires
Traction
Tension Band Wiring
Cerclage Wiring
Screws
Plates
Elastic Stable Intramedullary Nailing (ESIN)
Rigid Intramedullary Nails (Locked Nails)
External Fixators
Staples
Should Implants Be Removed in Children?
Conclusion
References
91 Implantology of Paediatric Upper Limb Fractures
Introduction
Clavicle Fractures
Proximal Humerus and Diaphyseal Fractures
Supracondylar Fractures
Lateral Condyle Fracture, Medial Condyle Fracture, Epitrochlear Fracture, and Capitellum Fracture
Coronoid Fractures
T-Condylar Fractures
Olecranon Fractures
Proximal Radius Fractures
Forearm Fractures
Monteggia Fractures
Wrist Fractures
Hand Fractures
References
92 Implantology of Paediatric Lower Extremity Fractures
Introduction
Implant Choices
Kirschner Wire, Steinman Pins, and Schanz Screw
Screws
Plate and Screw Constructs: Non-locking and Locking
Flexible Nails
Rigid Nails
Telescoping Growing Rods
Bioabsorbable Fracture Implants
Anatomical Considerations
Hip
Distal Femur
Patella
Proximal Tibia
Ankle
Foot
Special Paediatric Considerations
Implant Removal
Physis Consideration
References
93 Extended Applications of Trauma Implants to Prevent or Treat Fractures in Pathological Bone
Introduction
Osteogenesis Imperfecta, Fibrous Dysplasia, and Pathological Fractures
Nail Selection Criteria
Congenital Pseudarthrosis of the Tibia
Femoral Neck Pseudarthrosis and Coxa Vara (Congenital or Acquired)
Tumors (e.g., Unicameral Bone Cyst Internal Support)
Malignant Bone Tumors
Conclusion
References
Part XVI: Orthopaedic Trauma Implantology in Pelvi-acetabular Fractures
94 General Instrumentation and Implantology for Pelvi-acetabular Reduction and Fixation
Introduction
History
Evolution of Implants
Instruments for Pelvi-Acetabular Fractures
Standard Pelvic Instrumentation
Pelvic Retractors
Instruments for Fracture Reduction and Preliminary Holding
Implants for Pelvi-Acetabular Fractures
Plates
Low-Profile Reconstruction Plate
Spring Plate
Tubular Plate
Pre-contoured Anatomic Buttress Plate
Screws
External Fixator
Recent Advances and Future Prospects
Conclusion
References
95 Screws in Pelvic-acetabular Fracture Fixation
Introduction
Hardware Options
Screw Biomechanics and Pull-out Strength
Application in Pelvic-Acetabular Surgery
Conclusion
References
96 Plate Designs and Their Applications in Acetabular and Pelvic Implantology
Introduction and History
Implant Material
Plate Designs and Function
Reconstruction Plates
Symphyseal Plates
Semitubular Plates
Dynamic Compression (DCP) Plates
Anterior Sacro-iliac Plates
Small Fragment Plates
Anatomical and Approach-Specific Plates
3D Printing
Summary
Conclusion
References
97 External Fixation in Pelvi-acetabular Implantology
Introduction
Fixator Frame Design and Evolution
Stability of the Fixator Construct
External Fixator Systems of Various Companies
Role of Pelvic Internal Fixator (INFIX)
Conclusion
References
98 New Ideas and Innovations in Pelvi-acetabular Implantology
Introduction
Designs of Plates for Quadrilateral Buttressing
An Anatomical Wing Plate [1]
Acetabular Fracture Reduction Internal Fixator (AFRIF) [2]
Omega Pelvic Plate [3]
Quadrilteral Butress Plate [4]
Quadrilateral Plate with Bicortical Fixation [5]
Plates for Posterior Column Buttressing
Anatomical Locking Plate for Posterior Column [6]
Plates for Fixation of Pubic Symphyseal Disruption
The Assiut Symphyseal Plate (ASP) [7]
Intramedullary Fixation in Pelvis
Curvafix´s Bendable Ortho Screw [8]
Memory Shape Alloys Made Implants
Continuous Compression Implant [10]
Three-Dimensional Printed Patient-Specific Implants Along with Drilling Guides [11]
References
Part XVII: The Implantology of Spinal Surgery
99 Introduction and History of Spinal Implantology
Introduction
History of Spinal Surgery
Pre-Greco-Roman Period
Greco-Roman Period
Medieval Period
Renaissance Period
Modern Period (Table 2)
Conclusion
References
100 Biomechanics of the Cervical Spine
Introduction
Cranio-vertebral Junction (CVJ) (C0-2)
Functional and Biomechanically Relevant Anatomy
Kinematics Under Physiological Conditions
Atlanto-occipital Joint (O-C1)
Atlanto-axial Joint (C1-C2)
Kinematics in Pathological Instability
Fractures Altering the Biomechanics
Basi-occiput Fractures
Atlanto-occipital Dislocations
Occipital Condylar Fractures
Fractures of the C1 (Axis)
Fractures of the C2 (Axis)
Ligamentous Injuries Altering the Biomechanics
Biomechanics of C0-C2 Fixation
Vertebro-axial Joint (C2-3)
Functional Anatomy
Biomechanics of Surgical Fixation or Fusion of C2-3
Lower Cervical Spine (C3-7)
Functional Anatomy and Biomechanics of C3-7
Kinematics Under Physiological Conditions
Cervical Instability
Cervical Kinematics After Motion Preserving Surgery
Laminoplasty
Cervical Disc Arthroplasty (CDA)
Biomechanics of Anterior Cervical Spinal Fusion (ACDF)
Biomechanical Comparisons Between Surgical Techniques
CDA Versus ACDF
Hybrid Surgery
MIS Fusion Versus ACDF
Summary
References
101 Biomechanics of the Thoracic Spine
Introduction
Thoracic Spine As an Integrated System (Vertebral and Costal)
Thoracic Spine As a Couple Between Cervical and Lumbar Spine: Thoracic Kyphosis
Anatomical Differences
Vertebromanubrial
Vertebrosternal
Vertebrochondral
Thoracolumbar
Thoracic Intervertebral (IV) Disc
Functional Thoracic Spine Unit
Physical Properties
Spinal Stability: Neutral Zone and Soft Tissues
Stiffness: Elastic Zone, Tensile, and Compressive Stiffness
Basic Mechanisms of Load Transfer
Influence of Ageing
Influence of Injury or Disease
Influence of Fusion
Influence of Implants on Thoracic Spine
Pedicle Instrumentation
Sublaminar Wiring
Intervertebral Cages
Expandable Corpectomy Cage with a Self-Adjusting, Multiaxial End Cap
Titanium Mesh Cage
Titanium Vertebral Body Replacement (VBR) - 3D
Other Implants
Rod-Hook Construct
Long vs Short Fixation Construct
Implant Failures
Pedicle Screws
Rods
Sublaminar Wire
Summary
References
102 Biomechanics of the Lumbar Spine
Introduction
Sagittal Alignment
Mechanical Stability
Anatomical Differences
Vertebral Body and Facets
Intervertebral Disc
Ligaments
Muscles
Physiology of Loading
Kinematics
Failure Modes of Motion Segment
Fracture Patterns
Disc Degeneration and Altered Biomechanics
Segmental Instability
Back Pain
The Effect of Fusion on Kinematics
Implants in Lumbar Spine
Posterior Instrumentation
Pedicle Screws
Other Screw Types
Spinous Process Fixation
Lamina Hooks and Wires
Interspinous Posterior Device
Facet Arthroplasty
Load-Sharing by Posteriorly Stabilized Spinal Segments
Anterior Instrumentation
Screw-Rod Systems
Intervertebral Cages
Intervertebral Disc Replacement
Hybrid Constructs
Anterior Vertebral Body Tethering
Conclusion
References
103 Bioengineering of Spinal Implants
Introduction
Bioengineering
Spinal Anatomy and Biomechanics
Current Concepts of Bioengineering in Spine
Biomaterials and Implant Designs
Pedicle Screws
Plates
New Developments
Conclusion
References
104 Allied Devices and Their Influence on Spinal Implants
Introduction
Image Guidance and Navigation Systems in Spine Surgery
C-Arm
Navigation Systems
Preoperative CT-Based Navigation
2D Fluoroscopy-Based Navigation
Cone-Beam CT-Based Navigation
Intraoperative CT-Based Navigation
Robotic-Assisted Surgery
Tubular Retraction Systems
Retraction Systems
Intraoperative Neurophysiological Monitoring
Operating Room
Surgical Environment
Surgical Table
Endoscopy in Spine Surgery
Microscope in Spine Surgery
Thoracoscopy in Spine Surgery
Conclusion
References
105 Complications of Spinal Implants
Introduction
Classification
Rationale
Early Complications
Intraoperative
Postoperative
Intermediate Complications
Late Complications
Techniques to Prevent Complication
Management of Complications
References
106 Recent Advances in Spinal Implants
Introduction
Enhancing Spinal Fusion
Biomaterials and Design Materials
Cage
Titanium Alloy Modifications
PEEK Modifications
Rods
Pedicle Screws
Plates
Biologics
Osteoconductive Materials
Osteoinductive Agents
Demineralized Bone Matrix (DBM)
Bone Morphogenetic Proteins
Other Growth Factors
Parathyroid Hormone
Motion Preservation Implants
Artificial Disc Replacement (ADR)
Cervical Spine Disc Arthroplasty (CDA)
Lumbar Spine Disc Arthorplasty (LDA)
Dynamic Stabilization Systems
Non-fusion Systems of Deformity Correction
Three-Dimensional Printing and Tissue Engineering
Tissue Engineering
Less Invasive Approaches
Improving Patient Safety: Techniques
Navigation
Robotics
Intraoperative Neurological Monitoring (IONM)
The Road Ahead
Stem Cells in Spine Surgery
Gene Therapy
Smart Implants
References
107 Craniovertebral Implants
Introduction
Biomechanics of Cranio-vertebral Junction (CVJ)
Anatomy
Movements of the CVJ and the Related Kinematics of the Joints Involved
Indications of CVJ Fixation
Various CVJ Implants in Common Usage (Fig. 3a, b)
Occipito-cervical Fusions
Wiring Technique
Hooks System
Loops and Rectangles (Fig. 3b)
Recently Available Systems
C1/C2 Fusions
Wiring Techniques
Trans-articular Screws
C1 Lateral Mass/C2 Pedicle Screw/Pars Screw Fixation
Use of Cages at C1/2 Joint
Salvage Techniques
Osteosynthesis
Complications of CVJ Surgery
References
108 Anterior Cervical Spinal Implants
Introduction
Cervical Plate System
Features
Upgraded Features
Vectra (Depuy Synthes)
Cervical Interbody Cage
Cage Structure Surface
Cage Materials
Titanium Mesh Cage (TMC)
Zero Profile Cervical Cage and Screw
Advantages of Zero Profile Cervical Cage and Screw over Conventional Anterior Cervical Plate and Cage
Expandable Corpectomy Cages (Devices)
Odontoid Screw
Indication
Contraindication
Surgical Techniques
Cervical Artificial Disc
Contraindication
Important Tricks and Tips
Conclusion
References
109 Posterior Cervical Spinal Implants
Introduction
Posterior Sub-Axial Cervical Instrumentation
Surgical Anatomy of the Occipito-Cervical and Sub-Axial Cervical Region
Surgical Approach
Posterior Cervical Instrumentation May Be Grouped As Follows
Posterior Sub-Axial Cervical Fixation Using Cables: Interspinous Wiring
Indications
Technique
Posterior Screw and Rod System in Sub-Axial Spine (Fig. 1)
Lateral Mass Screw Fixation in Cervical Spine
Indications
Technique
Pedicular Screw Fixation in Cervical Spine
Indications
Technique
Conclusion
References
110 Cervico-thoracic Spinal Implants
Introduction
Anatomy
Surgical Approach
Posterior Cervico-Thoracic Approach
Anterior Cervico-Thoracic Approach
Biomechanics of CTJ
Spinal Implants
Implants from a Posterior Approach
Wire Fixations
Cervical Lateral Mass Screws
Cervical Pedicle Screws
Translaminar Screws
Implants from an Anterior Approach
Conclusion
References
111 Posterior Thoracic Spinal Implants
Introduction
Relevant Anatomy
Spinal Instrumentation Systems
Hook-Based Systems
Harrington System
Distraction Rod
Hooks
Compression Device
Wire-Based Systems (Fig. 4)
Spinous Process Wiring of Resina
Drummond Wire
Luque Rod System
Hartshill Rectangle
Hybrid System
Cotrel-Dubousset System
Screw-Based Systems
Translaminar Screw
Pedicle Screws
Steffee Plate-Screw System
Rod-Screw System
Moss-Miami
Universal Spine System
Universal Spine System-II
CD Horizon
Expedium
Minimal Invasive (Percutaneous) Pedicle Screw
Fenestrated Pedicle Screw
Expandable Pedicle Screw
Cage
Titanium Mesh Cage
Expandable Cage
Vertebral Body Augmentation
Vertebroplasty
Balloon Kyphoplasty
Spine Jack
Conclusion
References
112 Anterior Thoracic Spinal Implants
Introduction
Relevant Surgical Anatomy
Approaches to Anterior Thoracic Spine
Anterior Approach to Cervicothoracic Spine
Transclavicular Transmanubrial Approach
Anterior Approach to Mid-Thoracic Spine
Transthoracic Approach
Anterior Approach to Lower Thoracic and Thoraco-Lumbar Spine
Thoraco-Abdominal Approach
Minimal Invasive Anterior Approach to Thoracic Spine
Video-Assisted Thoracoscopic Surgery (VATS)
Anterior Thoracic Implant Systems
Plate-Based Systems
Plates
Screw
Staples
Bolts
Rod-Based Systems
Screws
Staples
Nut
Cross Link
Cage
Titanium Mesh Cage
Expandable Cage
Allograft
Bone Graft Substitutes
Vertebral Body Stapling [VBS]
References
113 Lumbar and Lumbo-sacral Spinal Implants
Introduction
Posterior Implants
Pedicle Screw System
Biomechanics
Components
Screw Tip
Body
Thread
Screw Head
Monoaxial
Polyaxial
Uniplaner
Connecting Rods
Top Nut
Pedicle Screw Variants
Percutaneous Pedicle Screws
Fenestrated Screws
Hydroxyappetite (HA)-Coated Screws
Expandable Screws
Reduction Screws
Cross-connectors
Posterior Motion Sparing Systems
Posterior Pedicle Fixation-Based Dynamic Stabilization Systems
Interspinous Process Devices (ISP)
Interspinous Fusion Devices
Total Facet Replacement Devices
Principle of Pedicle Screw Insertion
Spine Hook Implant System
Principle of Surgical Technique
Complications of Spine Hook System
Sublaminar Wire
Interbody Devices
Fundamentals of Interbody Fusion
Cage Materials
Other Experimental Cage Materials
Bone Grafts and Substitutes
Sizes and Shapes of Cages
Mesh Cage
Few Specialized Varieties of Interbody Cages
Expandable Cage
Expandable Interbody Cage
Anterior Implants
Interbody Cage with Integral Fixation Device
Anterior Screw-Plate System
Screw Staple and Rod System
Lateral Implants
Sacrum and Sacroiliac Fixation Implants
Conclusion
References
114 Sacral and Sacro-pelvic Implants
Introduction
Biomechanics of the Sacro-pelvic Region
Anatomy
Movements of L5/S1 and SIJs and the Related Kinematics of the Joints Involved
Indications for Fixation of the Sacral and Sacro-pelvic Regions
Zones of the Sacro-pelvic Region and Its Fixation Techniques
Implants in Common Usage and Related Technical Notes (Fig. 1)
Sacral Fixations
S1 Pedicle Screws
Alar Screws
S2 and S3 Screws
Colorado System
L5/S1 Cages
Sacral Plates
Sacro-pelvic Fixations
Galveston Technique for Sacro-pelvic Fixation
Iliac Screws
S2-Alar Iliac Screws (S2AI Screws)
Complications of Sacral and Sacro-pelvic Fixation
Minimally Invasive Surgeries and Future Research in Sacral and Sacro-pelvic Implants
References
Index