Atlas of Internal Fixation: Fractures of Long Bones. Classification, Statistical Analysis, Technique, Radiology

350 Pages·2000·70.11 MB·English

by  Rafael Orozco, J. Miquel Sales, Miquel Videla (auth.)

Orozco • Sales • Videla: Atlas of Interna! Fixation - Fractures of Long Bones
Springer-Verlag Berlin Heidelberg GmbH
R. Orozco · J. M. Sales · M. Videla
Maurice E. Müller Foundation - Spain
ATLAS OF
INTERNAL FIXATION
Fractures of Long Bones
Classification, Statistical Analysis, Technique, Radiology
Foreword by
Maurice E. Müller
54,280 Fractures Reviewed
1304 Radiographie Images
273 Cases
360 Color Illustrations
Springer
ISBN 978-3-662-05895-4
Cataloging - in Publication Data applied for
Die Deutsche Bibliothek-CIP-Einheitsaufnahme
Orozco, Rafael:
Atlas of internal fixation : fractures of long bones ; classification, statistical analysis, technique, radiology IR. Orozco ; J. M. Sales ;
M. Videla. Foreword by Maurice E. Müller. [Trans!. Enric Boada].
Einheitssacht: Atlas de osteosfntesis <eng!.>
ISBN 978-3-662-05895-4 ISBN 978-3-662-05893-0 (eBook)
DOI 10.1007/978-3-662-05893-0
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© Springer-Verlag Berlin Heidelberg 2000
Originally published by Springer-Verlag Berlin Heidelberg New Yo rk in 2000
Softcover reprint of the hardcover 1st edition 2000
The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific
Statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
Product liability: The publishers cannot guarantee the accuracy of any information about the application of operative techniques and medi
cations contained in this book. In every individual case the user must check such information by consulting the relevant literature.
Cover design: e STUDIO CALAMAR, Pau/Girona
Typesetting and graphic composition: J. M. Sales, J. Ceamanos, A. Munar, R. Orozco (Jr.)
Data conversion by Fotosatz-Service Köhler GmbH, Würzburg
Printedon acid-free paper SPIN: 10703838 24/3135PF 543210
People almost always follow the same
paths which have been trodden by
others before them. Nor are they
original; they imitate others. As not all
of us can follow the same path nor
achieve the same as those we have
chosen as models, a wise man should
only follow the paths trodden by
superior beings and imitate those who
have shown excellence, so that even if
we cannot achieve the same, at least we
might get near in certain aspects.
MAQUIAVELO
Dedicated to Maurice E. Müller
on the occasion
of his 80th birthday
Authors Rafael Orozco (RO)
J. Miquel Sales (MS)
Miquel Videla (MV)
Fundacion M. E. Müller - Espafia
Calle Horacio 14-16
08022 Barcelona
Spain
Director Rafael Orozco
Foreword Maurice E. Müller
Preface to the English Edition Christopher Colton
Preface to the Spanish Edition Antonio Navarro
lntroduction
to the Classification Serge Nazarian
Clinical cases: C. Barcons (CB) J.L. Imizcos (JI)
J. Bertnin (JB) P. Koch (PK)
J. Cafiadell (JC) M. Llobet (MLI)
J. Cervello (JCe) J. Muriano (JM)
D. Femandez (DF) E. Norberto (EN)
J. Galf (JG) L. Orozco (LO)
X. Gallart (XG) C. Puig (CP)
R. Ganz (RG) E. Queipo (EQ)
J. Giros (JG) C. Solano (CS)
A. Gonzalez (AG) (xxx = surgeon unknown)
U. Heim (UH)
Translator Enric Boada
Contributors A. Albos M. Nufiez
M.J. Barrenechea A. Orozco
V. Corbaton M. Pesudo
M. Mafia M. Velasco
A. Munar A. Vilamajo
AnaNavarro
Data Base Maurice E. Müller Foundation (Bem and Barcelona)
AO Documentation Center (Davos)
Drawings of the Classification Maurice E. Müller Foundation (Bem), Springer Verlag
Collaborating Hospitals: Centro Medico Teknon Hospital de Barcelona
(Barcelona) Hospital Clfnic Universitari
Clinica Universitaria (Barcelona)
(Navarra) Inselspital (Bem)
Creu Roja (L'H. Barcelona) Lindenhofspital (Bem)
Creu Roja (Tarragona) Union de Mutuas (Castellon)
Cruz Roja (Madrid)
Funding Sources Maurice E. Müller Foundation, Union de Mutuas,
Fundacion M. E. Müller - Espafia
Index
Segment 11
Humerus, Proximal 1
Segment 12
Humerus, Diaphysis 9
Segment 13
Humerus, Distal 29
Segment 21
Radius/Ulna, Proximal 49
Segment 22
Radius/Ulna, Diaphysis 57
Segment 23
Radius/Ulna, Distal 79
Segment 31
Femur, Proximal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Segment 32
Femur, Diaphysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Segment 33
Femur, Distal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Segment 41
Tibia!Fibula, Proximal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Segment 42
Tibia!Fibula, Diaphysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Segment 43
Tibia!Fibula, Distal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Segment 44
Tibia!Fibula, Malleolar Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Bone 91.2
Clavicle 333
VII
M.E. Müller Foreword
The AO documentation was established at the beginning of 1959, only 3 months after the founding
of the AO. We used from the very beginning our X-ray cards and code sheets. Progress was rapid. Towards
the end of 1959, we had already over 1000 X-ray cards with miniaturized X-rays representing the initial
X-ray, the one after surgery, and the one at the 4-month follow-up. From the very beginning, the
documentation was one of our four main pillars and provided us with manifold services. The docu
mentation helped us in teaching the use of our instruments and implants, made it possible for us to
establish a quality control system, helped us establish the indications for treatment, made it possible for
us to plan graphically the operative procedures, and was of enormous help for us when we were
developing our operative techniques. As an added bonus, the documentation provided us also with many
slides of X-rays of the cases which we had documented. These we used in our 1ectures on the AO method.
The X-ray cards of the documentation became also the basis for the AO technical commission in
its evaluation of the instruments. Furthermore, the chief of each participating clinic received duplicates
of all miniaturized X-rays which the documentation received from his institution. This he1ped him to
see immediately what his co-workers were able to achieve and whether his co-workers had grasped the
essence of the AO method and its applications.
The X-ray cards became also very important for us in our teaching and as illustrations for our
pub1ications. Thus we used them as illustrations for our first publication "The technique of internal
fixation of fractures" which appeared in 1963 and for the publication of the three editions of the AO
Manual, w hich appeared in 1969, 1979 and 1991.
In 1977, at the U niversity Hospital of Bern, we tested for the first time the methodology of
organizing fractures of bone segments into triads, which became subsequently the basis of the Müller
comprehensive fracture classification. Between the years 1979 and 1987, the AO documented about
60,000 fractures. 52,280 X-ray cards were of sufficiently good quality to allow for subsequent
classification of the fractures. The fractures of the long bones were divided into those of the 4 long
bones, which yielded 13 segments, 39 Types, 117 Groups, and 351 Subgroups. We used most of these
X-ray cards as reference material when we wrote the two books about our fracture classification, "The
AO Classification of Fractures" by Müller, N azarian, and Koch, which appeared in 1987, and "The
Comprehensive Classification of Fractures" by Müller, Nazarian, Koch and Schatzker, which appeared
in 1990.
A very talented Spanish group working in Barcelona under the leadership of Raphael Orozco and
consisting of J. Miquel Sales and Miquel Videla studied the 54,280 fractures which the AO document
ed between the years 1980 and 1988. This task took them 5 years. They found 99% of the 351
Subgroups. Less than 0.5% of the fractures could not be classified with our alphanumeric coding
system.
Their work resulted in the creation of our databank which was compiled using to the same criteria,
the same methodology, the same nomenclature and the same hierarchical principles of organization.
The fractures were ordered in an ascending order of severity which corresponded to their morphologic
complexity, the difficulties of treatment, and their prognosis.
This databank is probably unique not only in traumatology and surgery, but probably also in
all of medicine. All terminology is carefully defined in the "glossary". This has made it possible to
compare data. The statistical evaluation of the databank of the 54,280 fractures by Orozco and his co
workers has given us very important statistical information on the incidence of the different fractures.
IX
The first 1500 copies of the first Spanish edition of the "Atlas" soldout in 3 months. The second
and slightly improved edition of 5000 copies went quickly to press. This English edition will open for
the English-speaking world the treasures of the contribution of our Spanish colleagues.
In 1994, we concluded that the method which we had recommended in our first publications for
classifying a fracture which consisted of comparing an X-ray to the three schematic drawings which
represented the Types, Groups, and Subgroups of a particular segment, resulted in too many intra- and
interpersonal errors. This motivated us to design a new method which consists of a binary system of
questions which are used in the classification of the triads of Types, and Groups. Thus, with a set of
2-4 specific questions which one must always be able to answer with either a "yes" or "no" we can
always arrive at a very accurate classification. If a clear answer to one of the questions is not possible,
it means that the necessary information is not available from the X-rays and that further imaging is
necessary either in the form of further plain X-rays or CT scans.
If we consider the great and rapid technological progress of today, and the steadily rising life
expectancy, as well as the rising cost of health care deli very, and the greater and greater expectations
of our patients, we come to understand and appreciate the great need for quality assurance. Quality
assurance and documentation are inseparably linked. The costs of healthcare, patient satisfaction, the
motivation of one's assistants, and the demands of the competition authorities are all issues which are
very closely intertwined and issues which must be built into every documentation. The demands today
are for data which can be subjected to analysis and comparison, for full transparency of organization of
our institutions, and for an easily and universally accepted and used documentation methodology.
Subjective residual disability, disability payments, and the length of recovery are essential issues to be
dealt with.
The databank of Orozco has made it possible to demonstrate the many of the newer and much
more expensive implants are not at all necessary. In this way the Classification can be used to provide
support for the new current philosophy which maintains that we should concentrate all our efforts in
providing for the needs of the patients.
In conclusion, in the name of the whole orthopaedic community I would like to thank the
Barcelona team, Rafael Orozco, J. Miquel Sales, and Miquel Videla for their Atlas, an immense and
invaluable contribution to the orthopaedic literature.
To Learn, and then understand,
one must Teach.
To Learn and Teach,
it is necessary without exception
to Evaluate the choices, the concepts and the results.
X