Air Instrument Surgery: Vol. 2: Orthopedics PDF
Preview Air Instrument Surgery: Vol. 2: Orthopedics
AIR INSTRUMENT SURGERY ORT HOPEDICS Compiled and edited by Robert M. Hall Santa Barbara, California With contributors and 356 illustrations by Ted Bloodhart, Medical Illustrator Springer-Verlag Berlin . Heidelberg . New York 1972 Additional information concerning these instruments and techniques is available from Hall International, Inc., P. O. Box 4307, Santa Barbara, California 931031 USA. Telephone (805) 969-4777, Cable: HINTL, and from Hall, SA, P.O. Box 172, 6301 Zug, Switzerland, telephone 042121 3421, Cable: HALLZug. ISBN -13:978-3-642-65383-4 e-ISBN -13: 978-3-642-65381-0 DOl: 10.1007/978-3-642-65381-0 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, re production by photocopying machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to the publisher, the amount of the fee to be determined by agreement with the publisher. © by Springer-Verlag Berlin' Heidelberg 1972. Softcover reprint of the hardcover 1st edition 1972 Library of Congress Catalog Card Number 70-132149. This Atlas is dedicated to my late father Dr. De Witt Hall who gave me the opportunity to pursue air instrument design and development. Acknowledgements We wish to thank many people who helped this book evolve, particularly the mem bers of the orthopedic profession who have contributed their creative ideas and criti cism. Thanks also go to Judith Bahr, R. N., research and editing, Dirck Cruser and Shirley Schainblatt, art and design, Jimmy Chen, photography, and the secretaries who typed and corrected the manuscript. v Preface Air Instrument Surgery, Volume 2: Orthopedics has been compiled to aid in the se lection and use of air instruments in orthopedic surgical techniques. In each instance it attempts to demonstrate the classic approach, leaving it to the individual surgeon to develop further his expertise and ingenuity with air-driven instruments. Possible applications and adaptations are as unlimited as the surgeon's skill and imagination. Detailed illustrations and text treat the use of each air instrument in various proce dures, but the surgical application is given only for that portion of each procedure in which manual operation can be advantageously replaced by the use of air instru ments. This book, therefore, does not depict complete surgical procedures, nor does it include all the procedures in orthopedic surgery for which air instruments are now employed. Use of air-driven instruments does not imply any change in basic surgical techniques. It does enhance the surgeon's dexterity, increase his speed and, in some situations, makes a surgical approach possible for the first time. A technical guide has been needed since air instruments were introduced. Air In strument Surgery, Volume 2: Orthopedics is the second publication to fill that need. Its function is to clarify problems and difficulties and to suggest solutions by means of air instrument surgery. It is also intended to remove any apprehension about the use of air instruments. To ensure this, the technical procedures are supplemented with detailed instructions for assembling, using and maintaining the instruments. The procedures, techniques and statements in this book were compiled from pub lished and unpublished communications by internationally renowned professors of orthopedic surgery, as well as from detailed commentaries by medical, surgical and engineering consultants. They are intended to suggest and illustrate proposed pro cedures, techniques and concepts. They do not necessarily apply to every particular situation or case. As ever, the surgeon alone must be the judge of proper technique, of the suitability of air instruments in general and of their appropriate uses in parti cular orthopedic procedures. The expanding scope of surgical techniques today demands an ever-greater use of advanced surgical systems. It is my hope that this book will be of some assistance in attaining this goal. Santa Barbara California/USA Robert M. Hall VII Contributors John E. Blakley, M. D. Attending Orthopedic Surgeon, Allegheny Gen eral Hospital, Pittsburgh, Pennsylvania/USA Heinz W. Buchholz, M. D. Professor of Orthopedic Surgery, St. George Hospital, Hamburg/Germany Ralph B. Cloward, M. D., Associate Professor of Neurosurgery, University F. A. C. S. of Hawaii, School of Medicine, Hawaii/USA Roger Gariepy, M. D., Professor of Orthopedic Surgery, University of F. R. C. S. (C) Montreal. Head of Orthopedics, Hotel-Dieu Hospital, Montreal! Canada. Benjamin Greenberg, M. D. Director of Orthopedic Surgery, Montefiore Hospital and Medical Center. Acting Chairman, Department of Orthopedic Surgery, Albert Ein stein College of Medicine, Bronx, New York/ USA Edward T. Habermann, M. D. Attending Orthopedic Surgeon, Montefiore Hospital and Medical Center. Assistant Profes sor of Orthopedic Surgery, Albert Einstein Col lege of Medicine, Bronx, New York/USA William H. Harris, M. D. Professor of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts/USA Donald A. Mahrle, D. P. M., Topeka, Kansas/USA A.A.C.F.S. Leonard Marmor, M. D., Associate Professor of Surgery, Orthopedic De F.A.C.S. partment, University of California School of Medicine, Los Angeles, California/USA Maurice E. MUller, M. D. Professor of Orthopedic Surgery, University of Berne, and Director of The Orthopedic Clinic, Berne/Switzerland Phanor L. Perot, Jr., M. D., Professor and Chairman, Division of Neurologi Ph.D., F.A.C.S. cal Surgery, Medical University of South Caro lina, South Carolina/USA Aidan A. Raney, M. D. Associate Clinical Professor of Neurological Surgery, University of Southern California, Sen ior Attending Physician, Los Angeles County USC Medical Center, California/USA J. Francis Silva, F. R. C.S., Professor and Head, Department of Orthopedic F.R.A.C.S., F.A.C.S. Surgery and Rehabilitation, University of Ma laya, Kuala Lumpur, Malaysia. Hunterian Pro fessor, Royal College of Surgeons. Formerly IX Contributors Surgeon-inCharge, Department of Orthopedic Surgery, General Hospital, Colombo, Ceylon. Senior Visiting Lecturer in Orthopedic-Surgery, Faculty of Medicine, University of Ceylon, Co lombo, Ceylon. Consultant Orthopedic Surgeon, Children's Hospital, Colombo, Ceylon. Regis trar, Nuffield Orthopedic Centre, Oxford/Eng land E. Shannon Stanffer, M. D., Chief, Spinal Injuries Service, Rancho Los Ami F.A.C.S. gos Hospital, Downey, California. Assistant Clinical Professor, Department of Orthopedic Surgery, University of Southern California School of Medicine, California/USA Alfred B. Swanson, M. D., Chief, Orthopedic Surgery and Training Pro F.A.C.S. gram, Chief, Orthopedic Research, Blodgett Memorial Hospital, Grand Rapids, Michigan/ USA John C. Wilson, Jr., M.D. Clinical Professor of Orthopedic Surgery, Uni versity of Southern California School of Medi cine. Head, Division of Orthopedic Surgery, Children's Hospital of Los Angeles. Head, Sec tion on Orthopedic Surgery, Hospital of the Good Samaritan, Los Angeles, California/USA x Contents SECTION I. UPPER EXTREMITY SURGERY Bankart Repair of Recurrent Shoulder Dislocation 4 Fixation of Fractured Clavicle . . . . . . . 9 Arthrodesis of the Shoulder ....... . 12 Excision of a Bone Cyst from the Humerus 16 Prosthetic Replacement of the Lower End of Humerus 18 Fixation of Supracondylar Fracture of the Humerus 26 Treatment for Ankylosed Destruction of the Elbow. 30 Total Prosthetic Replacement of the Elbow 34 Elbow Arthrodesis ............ . 41 Resection of the Radial Head ....... . 48 Intramedullary Fixation of a Radial Fracture 50 Intramedullary Nailing of the Ulna 54 Forearm Amputation 58 Technique Suggestions 60 Bibliography 61 SECTION II. WRIST AND HAND SURGERY Wrist Surgery Osteotomy for Colles' Fracture Malunion, Utilizing a Bone Wedge from the Distal Ulna ................... 66 Wedge Osteotomy for Malunion of a Colles' Fracture 69 Sliding Osteotomy for Malunion of a Colles' Fracture 72 Wrist Arthrodesis .................. 74 Wrist Arthrodesis when Ankylosis Involves the Radioulnar Joint 77 Insertion of a Silastic® Carpal Scaphoid Implant ....... 82 Insertion of a Silastic Trapezium Implant in Trapeziometacarpal Arthroplasty 88 Insertion of a Silastic Carpal Lunate Implant ............... 94 Hand Surgery Silastic Implant for Replacement of Arthritic Destroyed Joints of the Hand C)~ Small Joint Arthrodesis 107 Mallet Finger Fixation .............. 112 Fixation of Bennett's Fracture .......... 115 Peg Graft to Fractured Navicular (Scaphoid Bone) 117 Carpal Metacarpal Arthrodesis . . 120 Greater Multangular Subluxation. 124 Technique suggestions 126 Bibliography . . . . . . . . . . . 127 SECTION III. HIP SURGERY A Reinforced Bone Shelf Technique for Congenital Dysplasia of the Hip in Adolescence 132 Mold Arthroplasty 140 XI Contents Insertion of an Austin Moore Femoral Stem Prosthesis. 147 Extraction of an Austin Moore Prosthesis 151 Ring Total Hip Prosthesis ...... . 152 McKee-Farrar Total Hip Prosthesis 160 Total Hip Prosthesis: Miiller Technique 170 Total Hip Prosthesis: Model "S1. George" 180 Technique Suggestions 192 Bibliography ............. . 193 SEcrION IV. FEMORAL NECK AND FEMORAL SHAFT SURGERY Femoral Neck Surgery Insertion of a Jewett Nail and Plate in a Parat rochanteric Fracture 198 Multiple Peripheral Pin Fixation for Femoral Neck Fractures 204 Insertion of a Sliding Nail-Variable Angle Plate for Internal Fixation of a Femoral Neck Fracture ............... 208 Intertrochanteric Varus Osteotomy and Internal Fixation ......... 214 Femoral Shaft Surgery Internal Fixation: Compression - A. O. Method 222 Kiintscher Technique of Intramedullary Fixation 234 Retrograde Technique of Intramedullary Fixation 240 Technique Suggestions 242 Bibliography ................. . 243 SECTION V. KNEE SURGERY High Tibial Osteotomy: A Lateral Approach for Correction of Genu Varum 248 Osteotomy of the Upper Portion of the Tibia for Degenerative Arthritis of the Knee ................ 256 Repair of Freshly Torn Cruciate Ligaments 262 Reposition of Patellar Ligament 268 Hemiarthroplasty: MacIntosh Technique 272 Hemiarthroplasty: Marmor Technique 276 Total Knee Arthroplasty ........ 280 Knee Arthrodesis and Insertion of Charnley Compression Clamp 288 Technique Suggestions 294 Bibliography .......................... 295 SECTION VI. ANKLE AND FOOT SURGERY Ankle Surgery Posterior Arthrodesis of the Ankle 300 Anterior Arthrodesis of the Ankle 302 Triple Arthrodesis of the Ankle . 306 Removal of the Malleolus and Ankle Fusion 312 XII Contents Foot Surgery Bunionectomy .................. . 318 Bunionectomy and Osteotomy .......... . 322 Metatarsal Head Recession and Resection Procedure 326 Excision of Metatarsal Heads ....... . 330 Plantar Condylectomy .............. . 334 Metatarsal Head Repair with a Metal Implant ' . . . 336 Swanson Technique for Insertion of a Silastic® Great Toe Implant 338 Technique Suggestions 344 Bibliography .......................... . 345 SECTION VII. VERTEBRAL SURGERY Posterior Cervical Laminectomy ..... 350 Cervical Wiring ........ ..... 352 Anterior Cervical Fusion for Odontoid Fracture 354 Anterior Fusion of the Cervical Spine 362 Anterior Cervical Fusion with Fibula Graft 368 Anterior Cervical Fusion with Iliac Graft . 374 Decompression of Cervical Nerve Roots 378 Surgical Treatment of Vertebral Artery Insufficiency 384 Transoral Fusion of Odontoid Fracture 388 Posterior Lumbar Hemilaminectomy ........ 392 Posterior Lumbar Laminectomy .......... 392 Transthoracic Removal of Midline Thoracic Disc Protrusions 395 Facetectomy ......... 398 Foraminotomy . . . . . . . . 402 A Technique of Spinal Fusion 405 Anterior Lumbar Fusion 408 Posterior Approach to a Recurring Hyperostosing Pulposus Through an Existing Lumbar Fusion ...... . . . . . . 412 Removal of a Portion of the Sacrum for Decubitus 414 Technique Suggestions 416 Bibliography . . . . . . . . . . . . . . . . . . . . 417 SECTION VIII. ADDENDUM: THORACIC SURGERY Median Sternotomy ..... 422 Sectioning of Rib for Exposure 427 A Technique of Rib Grafting 430 Technique Suggestions 434 SECTION IX. EQUIPMENT GUIDE· Air Pressure Regulator Connecting the Regulator to the Nitrogen Tank 438 Attaching Air Instruments to the Regulator 440 Disconnecting Air Instruments from the Regulator 442 XIII
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