This book represents the work of many physicians who trained at the Hospital for Joint Diseases. Starting in the 1980s, the Department of Orthopaedic Surgery initiated a weekly, didactic topicrelated fracture case conference. This conference consisted of a short lecture presented by a senior resident on pertinent anatomy, fracture mechanism, radiographic and clinical evaluation, and classification and treatment options, followed by a series of cases that were used to further clarify the options for fracture care. The senior resident was also responsible for preparing a handout on the fracture topic, which was distributed prior to the lecture.
SECTION EDITORS PEDIATRIC FRACTURES AND DISLOCATIONS Norman Otsuka, MD Joseph E Milgram Professor of Orthopaedic Surgery Associate Chief of the Division of the Pediatric Orthopaedic Surgery Director of the Neuromuscular and Cerebral Palsy Center Director of the Center for Children Departments of Orthopaedic Surgery and Pediatrics Hospital for Joint Diseases NYU Langone Medical Center New York, New York AXIAL SKELETON FRACTURES Themi Protopsaltis, MD Assistant Professor Department of Orthopaedic Surgery Hospital for Joint Diseases NYU Langone Medical Center New York, New York Acquisitions Editor: Brian Brown Product Development Editor: Dave Murphy Production Project Manager: David Orzechowski Design Coordinator: Joan Wendt Manufacturing Coordinator: Beth Welsh Marketing Manager: Daniel Dressler Prepress Vendor: Absolute Service, Inc Fifth edition Copyright © 2015 Wolters Kluwer Health Copyright © 2002, 2006, and 2010 Lippincott Williams & Wilkins All rights reserved This book is protected by copyright No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright To request permission, please contact Wolters Kluwer Health at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at lww.com (products and services) Printed in China Library of Congress Cataloging-in-Publication Data Egol, Kenneth A., 1967- , author Handbook of fractures / Kenneth A Egol, Kenneth J Koval, Joseph D Zuckerman — Fifth edition p ; cm Includes bibliographical references and index ISBN 978-1-4511-9362-6 (alk paper) I Koval, Kenneth J., author II Zuckerman, Joseph D (Joseph David), 1952- , author III Title [DNLM: Fractures, Bone—Handbooks Dislocations—Handbooks WE 39] RD101 617.1'5—dc23 2014032433 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work This work is no substitute for individual patient assessment based on healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data, and other factors unique to the patient The publisher does not provide medical advice or guidance, and this work is merely a reference tool Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made, and healthcare professionals should consult a variety of sources When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings, and side effects and identify any changes in dosage schedule or contradictions, particularly if the medication to be administered is new, infrequently used, or has a narrow therapeutic range To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law, or otherwise, or from any reference to or use by any person of this work LWW.com To my family, Lori, Alexander, Jonathan, and Gabrielle, and to my mentors KJK, JDZ, and MJB – Kenneth A Egol To my wife and children who bring me joy in life And to my father who was my inspiration and role model in orthopaedics – Kenneth J Koval To the residents and faculty of the NYU Hospital for Joint Diseases Department of Orthopaedic Surgery for all of their support during the past 30 years – Joseph D Zuckerman CONTENTS Preface I GENERAL CONSIDERATIONS Closed Reduction, Casting, and Traction Multiple Trauma Open Fractures Gunshot Wounds Pathologic Fractures Periprosthetic Fractures Orthopaedic Analgesia II AXIAL SKELETON FRACTURES General Spine Cervical Spine 10 Thoracolumbar Spine III UPPER EXTREMITY FRACTURES AND DISLOCATIONS 11 12 13 14 15 16 17 18 19 20 21 22 Clavicle Fractures Acromioclavicular and Sternoclavicular Joint Injuries Scapula Fractures Glenohumeral Dislocation Proximal Humerus Fractures Humeral Shaft Fractures Distal Humerus Elbow Dislocation Olecranon Radial Head Radius and Ulna Shaft Distal Radius 23 Wrist 24 Hand IV LOWER EXTREMITY FRACTURES AND DISLOCATIONS 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 Pelvis Acetabulum Hip Dislocations Femoral Head Femoral Neck Fractures Intertrochanteric Fractures Subtrochanteric Fractures Femoral Shaft Distal Femur Knee Dislocation (Femorotibial) Patella and Extensor Mechanism Injuries Tibial Plateau Tibia/Fibula Shaft Injuries about the Ankle Calcaneus Fractures Talus Fractures of the Midfoot and Forefoot V PEDIATRIC FRACTURES AND DISLOCATIONS 42 43 44 45 46 47 48 49 50 51 52 Pediatric Orthopaedic Surgery: General Principles Pediatric Shoulder Pediatric Elbow Pediatric Forearm Pediatric Wrist and Hand Pediatric Hip Pediatric Femoral Shaft Pediatric Knee Pediatric Tibia and Fibula Pediatric Ankle Pediatric Foot VI INTRAOPERATIVE IMAGING 53 Intraoperative Patient Positioning and Fluoroscopy for Fracture Surgery: A Suggested Guide to Obtaining the Quality Images William Rossy Index Retrograde inserted intramedullary nailing of distal femur fractures, 418 of femoral shaft fractures, 406–407 Retroperitoneal hemorrhage, 327–329, 328f Reverse Bennett fracture, 310 Reverse Bigelow maneuver, 362 Reverse Colles fracture See Smith fracture Reverse Galeazzi fractures, 262–263 Reverse Hill-Sachs lesions, 192 Reverse obliquity intertrochanteric fractures, 383–384, 385f, 389 Reverse shoulder arthroplasty, for proximal humerus fractures, 189–192 Revised trauma score (RTS), 17, 18t Revision surgery, periprosthetic fracture during, 47–48 Rigid cervical orthosis, 110 Riluzole, 88 Riseborough and Radin classification, of intercondylar fractures, 214, 215f Robert views, 293 Rockwood pin, 140 Rolando fracture, 310f, 311, 316 Roof arcs, in acetabular fractures, 347, 349 Ropivacaine, 60 Rotational ankle fractures anatomy, 465–469, 466f, 468f, 469f classification, 472–476, 473f, 474f, 476f clinical evaluation, 470 complications, 480, 481f epidemiology, 465 mechanism of, 469–470 radiographic evaluation, 470–472, 471f treatment, 477–480 variants, 477 Rotational deformities after pediatric fracture, 556 radius and ulna shaft fractures with, 632 after toddler’s fracture, 719 Rotational knee dislocation, 704 Rotator cuff tear, 167 Rotatory knee dislocation, 425, 425f RTS See Revised trauma score Rüedi and Allgöwer classification, of pilon fractures, 483–484, 483f Rush rods, 462 Russell-Taylor classification, of subtrochanteric fractures, 395, 395f S SA ankle fractures See Supination–adduction ankle fractures Sacral sparing, 120f Sacroiliac joint, 323, 324f, 336 Sacroiliac ligaments, 323, 325 Sacrospinous ligament, 325 Sacrotuberous ligament, 325 Sacrum, 323, 324f, 325, 329, 336–337 Salter-Harris classification, of physeal fractures, 553–554, 553f distal femoral, 680–681, 680f distal radius, 638, 639f lateral condyle, 593, 593f medial condyle, 596 proximal humerus, 559, 560f proximal tibia, 686–687, 687t radial head/neck fractures, 613, 613f Sanders classification, of calcaneus fractures, 501–502, 501f Sangeorzan classification, of navicular fractures, 523–524, 524f Scaphoid anatomy, 279–280, 280f, 283–284, 285f, 642, 643f fractures, 279, 286–290, 287f, 288f pediatric, 644–645, 645f perilunate dislocations/fracture-dislocations involving, 296–299, 297f, 298f Scaphoid shift test, 287 Scaphoid views, 644 Scapholunate angle, 280, 284, 300 Scapholunate joint, 298 Scapholunate (SL) ligament anatomy, 280–281, 282f, 284, 285f dissociation of, 300 perilunate dislocations involving, 296–299, 297f, 298f Scaphotrapezial ligament, 282f Scapula anatomy, 154, 156f, 570–571, 571f fractures classification, 156, 156f, 157f, 158f, 159 clinical evaluation, 155 complications of, 162–163, 163f epidemiology, 154 injuries associated with, 154–155 mechanism of injury, 154 pediatric, 570–576, 571f, 573f radiographic evaluation, 155 treatment, 159–161, 160f, 161f intrathoracic dislocation, 163 ossification of, 570–571 Scapular inclination, 164 Scapular manipulation technique, 175 Scapular neck dysplasia See Glenoid hypoplasia Scapular-Y radiographs, 169, 170f, 178, 181, 183 Scapulothoracic dissociation, 162–163, 163f Schatzker classification of olecranon fractures, 241–242, 242f of tibial plateau fractures, 448, 449f Schmidt and Weiner classification, of calcaneus fractures, 734–735, 736f Sciatic nerve, 356, 678 injuries to acetabulum fractures with, 339, 341, 351, 353 hip dislocations with, 355, 356f, 359–360, 365–366, 668–669 SC joint See Sternoclavicular joint Screw fixation of ankle fractures, 478–479, 728–729 of calcaneus fractures, 503–505, 506f of capitellar fractures, 221 of carpal bone fractures, 290 of cervical spine injury, 112–113 of clavicle fractures, 140 of condylar fractures, 217 of distal femoral physeal fractures, 683, 683f of distal femur fractures, 417 of femoral head fractures, 368–369 of femoral neck fractures, 377–379 of greater trochanteric fractures, 388f, 390, 391f of humeral shaft fractures, 201, 202f of intertrochanteric fractures, 385–387, 386f, 387f, 388f, 389–390 of Lisfranc injuries, 535 of metacarpal and phalangeal fractures, 306–314 of navicular fractures, 525–526 of olecranon fractures, 244 of pelvic fractures, 336 of proximal humerus fractures, 189–190 of radial head fractures, 250, 251f, 252 of radial shaft fractures, 264 of scapula fractures, 159 of subtrochanteric fractures, 397–398 of talus fractures, 513 of tibia/fibula shaft fractures, 463 of tibial plateau fractures, 451–452 Scuderi technique, 441 Seat belt–type injuries, 125, 125f, 129t, 130 Secondary injury, spine, 76–77 Second hit phenomena, 21, 21f Second metatarsal injuries, 537–538, 741–744 Sedation, moderate, 63, 70–71 Sedatives, 62–63 Segond sign, 447 Sensory examination, for spinal injury patients, 78, 79f–80f, 81t cervical spine, 92 thoracolumbar spine, 118, 118f, 119f Sentinel fracture, 109 Septic shock, 15 SER ankle fractures See Supination–external rotation ankle fractures Serendipity view, 149–150, 151f Sesamoids, 543–544 Shear fracture-dislocations, thoracolumbar spine, 126–127, 126f, 129t, 130 Shear test See Ballottement test Shock cardiogenic, 15 hemorrhagic, 16 hypovolemic, 81t, 337 management, 15–16 neurogenic, 15, 78, 81t, 82t septic, 15 spinal, 78, 80 Short arm cast, Short leg cast See Below knee cast Shotgun wounds, 35, 38 Shoulder See also Proximal humerus fractures AC joint injuries classification, 144, 145t, 146f clinical evaluation, 144, 145t complications, 147 epidemiology, 142 fractures and injuries associated with, 144 mechanism of, 143, 143f radiographic evaluation, 144, 145t treatment of, 144, 147 anatomy, 164–167, 165f, 166f AC joint, 142–143, 142f clavicle, 135 glenohumeral joint, 164–167, 165f, 166f scapula, 154, 156f clavicle fractures classification, 137–138, 137f, 138f, 139f clinical evaluation, 136 complications, 141 epidemiology, 135 injuries associated with, 136 mechanism of, 136 physeal, 148, 153 radiographic evaluation, 136 treatment, 139–141 glenohumeral joint dislocations active stability mechanisms, 165f, 166 anterior, 167–177, 168f, 169f, 170f, 171f, 172f, 173f, 174f, 175f epidemiology, 164 Hill-Sachs lesions, 166–167, 166f inferior, 180–182, 181f passive stability mechanisms, 164–166, 165f pathoanatomy, 166 posterior, 177–180 rotator cuff tear with, 167 superior, 182–183 intraoperative imaging, 749, 750f pediatric injuries AC joint, 567–570, 569f clavicle fractures, 563–567, 565f, 566f glenohumeral dislocations, 576–581 proximal humerus fractures, 557–563, 557f, 558f, 560f, 561f scapula fractures, 570–576, 571f, 573f scapula dislocations, 163 scapula fractures classification, 156, 156f, 157f, 158f, 159 clinical evaluation, 155 complications, 162–163, 163f epidemiology, 154 injuries associated with, 154–155 mechanism of, 154 radiographic evaluation, 155 treatment, 159–161, 160f, 161f stiffness of, 194, 562, 575, 581 Shoulder spica cast, 199 SHS See Sliding hip screw Shuck test See Ballottement test SI ankle fractures See Supination–inversion ankle fractures Simple elbow dislocations, 225, 229, 233–235, 234f Sinus tarsi, 495 Skeletal traction, 7–10, 8f, 9f for femoral shaft fractures, 405, 673, 676 for hip dislocations, 668 for pediatric fractures, 555 for T-condylar fractures, 610 Skin child abuse injuries to, 552 degloving injuries of, 334, 349 open fracture injuries to, 25–26 classification of, 27, 28t, 29–30, 29t treatment of, 30–34, 32t, 33f spine injury complications of, 89 Skin slough, after talus fracture, 516 Skin traction, 7, 555 Sleeve fracture, patella, 696–697, 696f Sliding hip screw (SHS) for intertrochanteric fractures, 386–387, 386f, 387f, 389–390 for subtrochanteric fractures, 397 Sling for clavicle fractures, 566–567 for glenohumeral dislocations, 580 for scapula fractures, 574–575 Sling and swathe, for proximal humerus fractures, 561, 561f SL ligament See Scapholunate ligament Smith fracture, 271f, 272 Smith–Peterson approach, 364 Soft cervical orthosis, 110 Soft tissue coverage, for open fractures, 33–34 Soft tissue injuries ankle fractures with, 470, 479–480 in closed fractures, 30, 460 gunshot wounds with, 35–38, 36f in open fractures, 25–26 classification of, 27, 28t, 29–30, 29t, 460 treatment of, 30–34, 32t, 33f pilon fractures with, 482, 484–486 tibia/fibula shaft fractures with, 456–457, 459–460, 464 Sonoma nail, 140 Space of Poirier, 282 Spanning external fixation, 10 SPF ankle fractures See Supination–plantar flexion ankle fractures Spilled tea cup sign, 298 Spinal cord injuries anatomy, 75–76, 82t classification, 83 complete, 83 epidemiology, 75 grading systems, 86–87 incomplete, 83 patterns of, 84–86, 85t medical management, 87–88 Spinal shock, 78, 80 Spinal stability, 127–130, 128t, 129f, 129t Spine See also Cervical spine; Thoracolumbar spine anatomy, 75–76 clearing of, 89 injuries cauda equina syndrome, 85t, 86 classification, 83 clinical evaluation, 77–80, 79f–80f, 81t, 82t complications, 88–89 epidemiology, 75 grading, 83–84, 86–87 mechanism of, 76–77 nerve root lesions, 85t, 86 patterns of incomplete cord injuries, 84–86, 85t radiographic evaluation, 83 treatment, 87–88 pathologic fractures, 46 Splinting, 3–6, 4f of Achilles tendon rupture, 492 of ankle fractures, 478 of capitellar fractures, 221 of condylar fractures, 217 of elbow dislocations, 234–235 of extra-articular supracondylar fractures, 210–211 of femoral shaft fractures, 673 of humeral shaft fractures, 198 of medial epicondyle apophyseal fractures, 603 of metacarpal and phalangeal fractures, 306–314, 653–655, 657–658, 660 of metatarsal fractures, 743 of olecranon fractures, 242–243 of pediatric fractures, 555 of PIP joint dislocations, 318 Sprain ankle lateral ligaments, 486–488 pediatric, 722 syndesmosis, 489–490 first MTP joint, 540–541 midfoot, 521 Springfield classification, 42–43 Spring ligament See Plantar calcaneonavicular ligament Spur formation, 224, 594 Spur sign, 347 Squeeze test, 470, 489 S-shaped angulation, at elbow, 589 SSSC See Superior suspensory shoulder complex Stabilization for multiple trauma patients, 20 for open fractures, 33 Steel maneuver, 580 Stellate fracture, patella, 696 Stener lesion, 317, 318f Sternoclavicular (SC) joint injuries anatomy, 147–148, 148f classification, 150–151 clinical evaluation, 149 complications, 153 epidemiology, 147 mechanism of, 148, 149f radiographic evaluation, 149–150, 150f, 151f treatment, 151–153, 152f Steroids, for spinal injury, 87–88, 110 Stimson technique, 174–175, 175f, 362, 364f, 580 Stoppa approach, 754 Stress fractures femoral neck, 372, 377 femoral shaft, 402 fifth metatarsal, 539 metatarsal, 742–743 navicular, 523, 525 pediatric hip, 664 pediatric tibia and fibula, 719–720 tibia/fibula shaft, 457, 458f, 459, 461 Stress radiographs of ankle fractures, 472 of distal femoral physeal fractures, 679–680, 679t flexion/extension, 93, 95 of pelvic fractures, 331 of syndesmosis sprain, 490 of tibial plateau fractures, 447, 448f Stress tests of ankle sprains, 487, 489 of Lisfranc injuries, 531 Stretch, spinal injury due to, 76 Stryker notch view, 155, 170, 173f, 572, 579 Stubbed toe, 542 Subarachnoid hemorrhage, 23 Subdural hemorrhage, 22 Subscapularis, 184, 185f, 558 Subtalar dislocation, 516–517 Subtrochanteric fractures anatomy, 392, 393f, 394f classification, 395, 395f clinical evaluation, 393–394 complications, 397–399, 398f epidemiology, 392 mechanism, 392–393 pathologic, 393 radiographic evaluation, 394 treatment, 396–397, 397f Subungual hematomas, 652 Sugar-tong splint, 3, 4f Sulcus sign, 578 Sunrise view See Axial radiographs Superficial deltoid ligament, 467, 469f Superficialis tendon, 313f Superior glenohumeral joint dislocation, 182–183, 578 Superior glenohumeral ligament, 165, 165f Superior gluteal artery, 328, 339 Superior gluteal nerve, 353 Superior patella dislocation, 436 Superior posterior compartment, lower leg, 454, 456f Superior suspensory shoulder complex (SSSC), 160–161, 160f, 571, 571f Supination–adduction (SA) ankle fractures, 472, 473f Supination–external rotation (SER) ankle fractures, 472, 473f, 723 Supination–inversion (SI) ankle fractures, 724 Supination–plantar flexion (SPF) ankle fractures, 724 Supinator, 628, 629f Supinator fat pad, 587f, 588 Supracondylar fractures femur periprosthetic, 51–53, 52f above total knee replacement, 418 humerus extra-articular, 210–213 pediatric, 588–591 process, 207, 223–224 radius and ulna shaft fractures with, 634 Suprascapular nerve, 162, 571, 576 Supraspinatus, 184, 185f, 558 Sural nerve, 506 Surgical approach See also specific approaches for acetabular fractures, 351–353 for cervical spine injury, 112–114 for distal radius fracture reduction, 274–275 for extra-articular supracondylar fractures, 211–212 for hip dislocation reduction, 364 for humeral shaft fractures, 200 for proximal humerus fractures, 191f, 192–193 for radial and ulna shaft fracture fixation, 257 for radial head fractures, 250, 251f for talus fractures, 511, 513 for thoracolumbar spinal injury, 124–125, 127 Surgical wound infection, 351, 353 Sustentacular fractures, 499 Sustentaculum tali, 495 Swanson, Szabo, and Anderson classification, of hand fractures, 305–306 Symphyseal ligaments, 325 Syndesmotic ligament complex, 467, 468f injuries to, 468–470, 472, 474f, 475, 476f, 479, 487 sprains of, 489–490 Systemic skeletal disease, pathologic fractures caused by, 39–46, 41t, 42t, 46t T TAD See Tip–apex distance Talar dome, 465 Talar head, 507, 515 Talar neck, 507–514, 509f, 510f, 512f, 513f Talar tilt, 470 Talar tilt test, 467 Talocrural angle, 471f, 472 Talotibial ligament, 467, 469f Talus dislocations subtalar, 516–517 total, 517, 517f fractures anatomy, 465–469, 466f, 468f, 469f, 507–508, 508f, 730, 731f body, 511–515, 512f, 513f, 514f classification, 509–511, 510f clinical evaluation, 508–509 complications, 515–516 epidemiology, 507 head, 515 mechanism, 508 pediatric, 730–733, 731f radiographic evaluation, 509, 509f treatment, 511–514, 512f, 513f Taping, of phalanges fractures, 745, 746f Tarsal bones See also Calcaneus; Talus cuboid, 518, 519f, 520f, 527–528 cuneiform, 518, 519f, 520f, 528–529 navicular, 518, 519f, 520f, 522–526, 524f Tarsometatarsal joint injuries anatomy, 529, 530f, 737–738, 738f classification, 533, 533f, 534f clinical evaluation, 531 complications, 535 epidemiology, 529 injuries associated with, 531 mechanism, 530 pediatric, 737–741, 738f, 739f radiographic evaluation, 531, 532f treatment, 534–535 T-condylar fractures, 608–611 Team, trauma, 12 Teardrop, 584, 586f Teardrop fractures, 105–106, 106f of cervical spine, 105–106, 106f Tension band fixation of ankle fractures, 478–479 of olecranon fractures, 243, 244f of patella fractures, 432, 433f–434f Tension pneumothorax, 12, 14 Terrible triad injuries, 230–231, 235–236, 237f Terry Thomas sign, 300 Tetanus prophylaxis for gunshot wounds, 37–38 for open fractures, 31 TFCC See Triangular fibrocartilage complex Third metatarsal injuries, 537–538, 741–744 Thompson and Epstein classification, of posterior hip dislocations, 360–361, 361f Thompson approach, 257 Thompson test, 491, 492f Thoracic injuries, multiple trauma with, 23 Thoracic Spine Stability Scale, 128t Thoracobrachial immobilization, 199 Thoracolumbar Injury Classification System (TICS), 121–122 Thoracolumbar spinal orthosis, 122 Thoracolumbar spine injuries anatomy, 115–116, 117f classification, 121–127, 123f, 124f, 125f, 126f, 127f clearing of, 89 clinical evaluation, 116, 118, 118f, 119f, 120f complications, 132 epidemiology, 115 gunshot wounds to, 130 mechanism of, 116 prognosis and neurologic recovery of, 131–132 radiographic evaluation, 118–119 stability of, 127–130, 128t, 129f, 129t Thoracolumbar Spine Stability Scale, 128t Three-column spine cervical, 91, 91f thoracolumbar, 127–130, 129f, 129t Thromboembolism acetabular fractures with, 353 hip dislocations with, 366 pelvic fractures with, 337–338 Thrombophlebitis, closed reduction causing, Thumb IP joint dislocations of, 319–320 MCP joint dislocations of, 317, 318f metacarpal fractures of, 310–311, 310f, 311f pediatric, 654–656, 655f Thyrotropin-releasing hormone, for acute spinal cord injury, 88 Tibia fractures anatomy, 454–456, 455f, 456f, 465–469, 466f, 468f, 469f pediatric, 677, 685, 689–690, 689f, 692, 706, 708, 710, 714, 716, 721–722 distal, 463, 472, 473f, 474f, 475, 476f, 479, 728 distal metaphyseal, 714–716, 717f intraoperative imaging, 756, 758, 758f, 759f ossification centers and, 677, 706 pediatric anatomy, 677, 685, 689–690, 689f, 692, 706, 708, 710, 714, 716, 721–722 clinical evaluation, 707 diaphyseal fractures, 709–714, 712f distal tibial metaphyseal, 714–716, 717f epidemiology, 706 mechanism of, 707 proximal tibial metaphyseal, 707–709 radiographic evaluation, 707 stress, 719–720 toddler’s, 716, 718–719 periprosthetic, 53–54, 54f pilon, 481–486, 483f plateau anatomy, 445–446 classification, 448–450, 449f, 450f clinical evaluation, 446 complications, 452–453 epidemiology, 445 injuries associated with, 446–447 intraoperative imaging, 756, 758f mechanism of, 446 radiographic evaluation, 447, 448f treatment, 450–452, 451f proximal, 463, 685–689, 687t, 688f, 707–709 rotational ankle, 470–480, 471f, 473f, 474f, 475–477, 476f shaft anatomy, 454–456, 455f, 456f classification, 459–460 clinical evaluation, 457 complications, 463–464 epidemiology, 454 intraoperative imaging, 758, 759f mechanism, 456–457, 457f radiographic evaluation, 458–459 treatment, 460–463 shortening after, 486 Tibial artery, 454, 457, 464, 707, 710 Tibial nerve, 457 Tibial skeletal traction, 7, 8f Tibial spine, 692–694, 694f Tibial tubercle, 445 anatomy, 689–690, 689f fractures, 689–692, 689f, 691f ossification of, 677 Tibial tuberosity, 470 Tibiocalcaneal ligament, 467, 469f Tibiofibular clear space, 471f, 490 Tibiofibular synostosis, 480 Tibionavicular ligament, 467, 469f TICS See Thoracolumbar Injury Classification System Tillaux–Chaput fracture, 477 Tillaux fragment, 722, 724, 725f, 726f, 728 Tip–apex distance (TAD), 386, 387f Toddler’s fracture, 716, 718–719 Tongue-type fracture, of calcaneus, 500, 500f, 505, 506f Torus fractures, 551, 638 Total elbow arthroplasty for extra-articular supracondylar fractures, 213 for intercondylar fractures, 216 periprosthetic fractures, 57–58, 58f for transcondylar fractures, 214 Total hip arthroplasty for femoral neck fractures, 378–380 periprosthetic fractures, 47–51, 48f, 49f Total knee arthroplasty periprosthetic fractures, 51–55, 52f, 54f supracondylar fractures above, 418 Total shoulder arthroplasty periprosthetic fractures, 55–57, 56f for proximal humerus fractures, 189–192 Toxicity, local anesthetic, 59–60 Traction, for cervical spine injury, 110–111, 111f skeletal, 7–10, 8f, 9f for femoral shaft fractures, 405, 673, 676 for hip dislocations, 668 for pediatric fractures, 555 for T-condylar fractures, 610 skin, for pediatric fractures, 555 Traction–countertraction reduction for closed shoulder reduction, 174, 174f for glenohumeral dislocations, 579–580 Transcondylar fractures, 213–214 Transolecranon fracture-dislocations, 233 Transphyseal fractures, elbow, 598–601 Transtectal acetabular fractures, 346 Transverse fractures acetabular, 345f, 346–347 patella, 696, 696f Transverse ligament of atlas, 90–91 Transverse ligament rupture, 100, 100f Transverse tibiofibular ligament, 467, 468f TRAP approach See Triceps reflecting anconeus pedicle approach Trapezium anatomy, 279, 280f, 642, 643f fractures, 279, 293–294, 647 Trapezoid anatomy, 279, 280f, 642, 643f fractures, 279, 294, 647–648 Trapezoid ligament anatomy, 135, 142f, 143 in clavicle fractures, 137–138, 137f, 138f, 139f injuries to, 145t, 146f pediatric, 568 Trauma See Multiple trauma Trauma series, for glenohumeral dislocations, 169, 170f, 171f, 178, 181, 183, 578 Traumatic C1–C2 instability See Transverse ligament rupture Traumatic spondylolisthesis, of C2, 103–104, 104f Triage, multiple trauma, 11 Triangular fibrocartilage complex (TFCC), 266, 279, 282–283, 628 Triceps reflecting anconeus pedicle (TRAP) approach, 212 Triceps splitting surgical approach, 211 Triceps tendon, 239 Triplane fractures, 725–726, 727f, 728–729 Triquetrocapitate ligament, 281f Triquetrum anatomy, 279–280, 280f, 284, 642, 643f fractures, 279, 292, 646 perilunate dislocations involving, 296–299, 297f, 298f Trochanters See Greater trochanter; Lesser trochanter Trochlea, 207, 208f, 225, 226f, 582 fractures, 221–222 ossification of, 583, 583f osteonecrosis of, 611 Trough sign, 178 True pelvis, 323, 324f Tscherne classification, of soft tissue injury in closed fractures, 29–30, 460 T-shaped fracture, acetabular, 345f, 346 Tuberosity fractures calcaneus, 499, 504 navicular, 525 Tumors, pathologic fractures caused by, 39–46, 41t, 42t, 46t Turf toe, 540–541 U Ulna fractures anatomy, 254, 255f, 279, 627–629, 629f biomechanics, 628 intraoperative imaging, 752, 752f Monteggia, 258–262, 259f, 635–636, 636f, 637f physeal, 636–638, 637f proximal, 752, 752f shaft anatomy, 254, 255f classification, 259f, 260 clinical evaluation, 259–260 complications, 261–262 epidemiology, 254 mechanism of, 259, 259f pediatric, 631–635, 631f, 633f radial shaft fractures with, 255–258 radiographic evaluation, 260 treatment, 261 Ulnar artery, 283, 283f Ulnar collateral ligament, 317, 318f Ulnar compression test, 301 Ulnar nerve block, 65–67, 66f, 67f Ulnar nerve injuries elbow dislocations with, 236, 620, 622–623 hamate fractures with, 296, 649 medial condyle physeal fractures with, 595, 598 medial epicondyle apophyseal fractures with, 602, 604 olecranon fractures with, 240, 626 supracondylar humerus fractures with, 591 ulnocarpal dissociation with, 302 Ulna styloid fractures, 277 Ulnocarpal ligament, 301–302 Ulnolunate ligament, 281f Ulnotriquetral ligament, 281f Ultrasound of multiple trauma patients, 20, 23 of proximal humerus fractures, 559 University of Texas San Antonio classification, of periprosthetic shoulder fractures, 56, 56f Unreamed nails, for tibia/fibula shaft fractures, 462 Urethra injuries, pelvic fractures with, 329, 336 Urinary tract infections, spine injury with, 88 V Vacant glenoid sign, 178 Vacuum-assisted closure (VAC) system, 32, 33f Valgus angulation, after tibia and fibula fracture, 709 Valgus stress radiographs, 229 Vancouver classification, periprosthetic femoral shaft fractures, 49–50, 49f Van Gorder approach, 212 Varus posteromedial rotational instability, elbow, 231 Vascular injuries See Neurovascular injuries Vasoconstrictors, 60 Velpeau axillary radiograph of glenohumeral dislocations, 169, 171f, 178, 578 of proximal humerus fractures, 187, 187f Velpeau dressing, 199 Vertebral artery, 90–91 Vertebral fractures common locations of, 77–78 epidemiology, 75 Vertical compression injuries See Burst fractures Vertical shear pelvic fractures, 327, 332f, 332t, 333, 338 Volar intercalated segmental instability (VISI), 280, 284, 285f Volar tilt See Palmar tilt Volkmann ischemic contracture, 209 elbow dislocations with, 236, 623 after extra-articular supracondylar fracture, 213 after radial and ulna shaft fractures, 258 W Waddell triad, 672 Wagner approach, 294 Walsh classification, of Galeazzi fractures, 637, 637f Watson–Jones approach, 364 Watson–Jones classification, of tibial tubercle fractures, 690–691 Watson shift test, 287 West Point axillary radiograph, 169–170, 172f, 578 White and Punjabi spine stability scales, 127, 128t Wilkins classification, of radial head/neck fractures, 613, 613f Winquist and Hansen classification, of femoral shaft fractures, 404, 404f Wounds See also Gunshot wounds bite, 306, 652 dehiscence of, 505 in open fractures, 25–26 classification of, 27, 28t, 29–30, 29t treatment of, 30–34, 32t, 33f Wrinkle test, 651 Wrist See also Carpal fractures; Distal radius fractures anatomy, 279–284, 280f, 281f, 282f, 283f, 285f pediatric, 642, 643f injuries classification, 286 clinical evaluation, 285 epidemiology, 279 lunotriquetral dissociation, 300–301 mechanism of, 284 perilunate dislocations and fracture-dislocations, 296–299, 297f, 298f radiographic evaluation, 286 scapholunate dissociation, 300 ulnocarpal dissociation, 301–302 instability, 280, 284, 285f, 286 after perilunate dislocations/fracture-dislocations, 296–299, 297f, 298f after scapholunate dissociation, 300 after ulnocarpal dissociation, 302 intraoperative imaging, 752, 753f kinematics, 284 pain, 253 pathomechanics, 284, 285f pediatric anatomy, 642, 643f carpal fractures, 644–645, 645–646, 645f, 646–647, 647–648, 649 clinical evaluation, 643 epidemiology, 642 mechanism of injury, 642–643 radiographic evaluation, 644 stiffness in, 278 Wrist block, 64–65, 66f X X-rays See Radiographic evaluation Y Y-ligament of Bigelow, 371 Young and Burgess classification, of pelvic fractures, 331–333, 332f, 332t Z Zanca view, 144 Zdravkovic and Damholt classification, of scapula fractures, 156, 156f Z-effect, 390