3820027_fm.qxp:ps 12/24/09 3:11 PM Page i FOURTH EDITION Handbook of Fractures 3820027_fm.qxp:ps 12/24/09 3:11 PM Page ii 3820027_fm.qxp:ps 12/24/09 3:11 PM Page iii FOURTH EDITION Handbook of Fractures Kenneth A Egol, MD Professor and Vice Chairman Department of Orthopaedic Surgery NYU Hospital for Joint Diseases New York University Medical Center New York, New York Kenneth J Koval, MD Professor Department of Orthopaedics Dartmouth Hitchcock Medical Center Lebanon, New Hampshire Joseph D Zuckerman, MD Professor and Chairman Department of Orthopaedic Surgery NYU Hospital for Joint Diseases New York University Medical Center New York, New York 3820027_fm.qxp:ps 12/24/09 3:11 PM Page iv Acquisitions Editor: Robert Hurley Product Manager: Elise M Paxson Production Manager: Bridgett Dougherty Senior Manufacturing Manager: Benjamin Rivera Marketing Manager: Lisa Lawrence Design Coordinator: Doug Smock © 2010 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business 530 Walnut Street Philadelphia, PA 19106 USA LWW.com All rights reserved This book is protected by copyright No part of this book may be reproduced in any form by any means, including photocopying, 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 Printed in China Library of Congress Cataloging-in-Publication Data Egol, Kenneth A., 1967Handbook of fractures/Kenneth A Egol, Kenneth J Koval, Joseph D Zuckerman — 4th ed p ; cm Rev ed of: Handbook of fractures/Kenneth J Koval, Joseph D Zuckerman Abridgement of Rockwood and Green's fractures in adults 7th ed c2010 Includes bibliographical references and index ISBN 978-1-60547-760-2 (alk paper) Fractures Handbooks, manuals, etc Dislocations Handbooks, manuals, etc I Koval, Kenneth J II Zuckerman, Joseph D (Joseph David), 1952III Koval, Kenneth J Handbook of fractures IV Rockwood & Green's fractures in adults V Title [DNLM: Fractures, Bone—Handbooks Dislocations—Handbooks WE 39 E31h 2010] RD101.K685 2010 617.1'5—dc22 2009051161 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of the information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to pm, EST 10 3820027_fm.qxp:ps 12/24/09 3:11 PM Page v To my family, Lori, Alexander, Jonathan, and Gabrielle, and to my mentors KJK, JDZ, and MJB – Kenneth A Egol To all those people who have believed in me and stood by me during adversity – Kenneth J Koval To the residents and faculty of the NYU Hospital for Joint Diseases for all their support in the past 25 years – Joseph D Zuckerman 3820027_fm.qxp:ps 12/24/09 3:11 PM Page vi 3820027_fm.qxp:ps 12/24/09 3:11 PM Page vii CONTENTS Preface Acknowledgments I GENERAL CONSIDERATIONS Closed Reduction, Casting, and Traction xi xii Multiple Trauma 11 Open Fractures 25 Gunshot Wounds 36 Pathologic Fractures 41 Periprosthetic Fractures 50 Orthopaedic Analgesia 63 II AXIAL SKELETON FRACTURES 77 General Spine 79 Cervical Spine 97 10 Thoracolumbar Spine 123 III UPPER EXTREMITY FRACTURES AND DISLOCATIONS 141 11 Clavicle Fractures 143 12 Acromioclavicular and Sternoclavicular Joint Injuries 150 13 Scapula Fractures 162 14 Glenohumeral Dislocation 172 15 Proximal Humerus Fractures 193 vii 3820027_fm.qxp:ps viii 12/24/09 3:11 PM Page viii Contents 16 Humeral Shaft Fractures 203 17 Distal Humerus 214 18 Elbow Dislocation 230 19 Olecranon 243 20 Radial Head 249 21 Radius and Ulna Shaft 257 22 Distal Radius 269 23 Wrist 281 24 Hand 305 IV LOWER EXTREMITY FRACTURES AND DISLOCATIONS 325 25 Pelvis 327 26 Acetabulum 344 27 Hip Dislocations 360 28 Femoral Head 372 29 Femoral Neck Fractures 378 30 Intertrochanteric Fractures 388 31 Subtrochanteric Fractures 399 32 Femoral Shaft 408 33 Distal Femur 420 34 Knee Dislocation (Femorotibial) 429 35 Patella and Extensor Mechanism Injuries 439 36 Tibial Plateau 455 37 Tibia/Fibula Shaft 464 38 Injuries about the Ankle 476 39 Calcaneus Fractures 507 3820027_fm.qxp:ps 12/24/09 3:11 PM Page ix Contents ix 40 Talus 520 41 Fractures of the Midfoot and Forefoot 530 V PEDIATRIC FRACTURES AND DISLOCATIONS 561 42 Pediatric Orthopaedic Surgery: General Principles 563 43 Pediatric Shoulder 572 44 Pediatric Elbow 598 45 Pediatric Forearm 645 46 Pediatric Wrist and Hand 660 47 Pediatric Hip 681 48 Pediatric Femoral Shaft 690 49 Pediatric Knee 698 50 Pediatric Tibia and Fibula 727 51 Pediatric Ankle 743 52 Pediatric Foot 752 Index 769 3820027_fm.qxp:ps 12/24/09 3:11 PM Page x Index.qxp:ps 786 12/30/09 5:47 PM Page 786 Index Olecranon fractures (cont.) mechanism of injury, 243–244 mechanism of injury for, 642 radiographic evaluation, 244 radiographic evaluation of, 642–643 Schatzker classification of, 246f treatment of, 246–248, 643–644 nonoperative, 247 operative, 247–248 postoperative management and, 248 surgery, indications for, 247 Olecranon osteotomy, 628 Olecranon traction, Open fractures, 25–35 antibiotic coverage for, 31 classification of, 27–30, 28t, 29t Tscherne, 29 clinical evaluation of, 26 compartment syndrome and, 26 complications of, 35 debridement for, 31–33, 32t defined, 25 emergency room management, 30–31 foreign bodies in, 33 irrigation for, 31–33, 32t mechanism of injury for, 25–26, 25t operative treatment of, 31–34 in tarsal fractures, 528 tetanus prophylaxis, requirements for, 31 treatment of, 30–34 vascular injury, 26–27 Open lesion in acromioclavicular joint injuries, 586 Open reduction, indications for, 570 Open reduction and internal fixation (ORIF), 50, 197, 198, 199 ORIF See Open reduction and internal fixation (ORIF) Orthopaedic analgesia anasthetics, local, 63–76 basic function of, 63 bupivacaine as, 64 lidocaine, 63–64 local effects of, 63–64 maximal dose of, 64 pharmacology, 63 toxicity of, 63 moderate sedation, 73–76 nitrous oxide, 67 opioids, 64–66 regional blocks, 67–73 sedatives, 66–67 vasoconstrictors, 64 Orthopaedic Trauma Association (OTA) cervical spine injury classification by, 102 classification of clavicle fractures, 146 scapula fractures, 166 thoracolumbar spine injuries classification by, 129 Osseous lesions, 185 Osseous segments, 193 deforming muscular forces on, 193 Ossification centers appearance of, 698 Osteoarthritis distal head fractures, 427 hand fractures, 323 patella and extensor mechanism injuries, 445 tibia/fibula shaft, 469 tibial plateau, 463 Osteochondral fractures, 641, 719–720 anatomy related to, 719 clinical evaluation of, 720 epidemiology of, 719 mechanism of injury for, 719 radiographic evaluation of, 720 treatment of, 720 Osteology, 645–646 Osteonecrosis, 201 of capitellar fragment, 625 in cuboid fractures, 541 femoral head fractures, 376–377 femoral neck fractures, 387 of fracture fragment, 714 intertrochanteric fracture, 398 in medial in condylar physeal fracture, 614 in navicular fractures, 539 patella and extensor mechanism injuries, 445 proximal femoral, 696–697 of radial head, 634 in skeletally immature patients, 571 Index.qxp:ps 12/30/09 5:47 PM Page 787 Index in tarsal fractures, 527 in traumatic dislocation of hip, 688 of trochlea, 629 Osteopenia, 50 Osteopenia, disorders producing, 43t OTA See Orthopaedic Trauma Association (OTA) P Padding, Papaver somniferum, 64 Parvin’s method of closed reduction of an elbow dislocation, 239f Patella, soft tissue anatomy of, 439f Patella alta, 714, 719 Patella and extensor mechanism injuries, 439–454 patella dislocation, 445–450 patellar fractures, 439–445 patella tendon rupture, 451–453 quadriceps tendon rupture, 450–451 Patella dislocation, 445–450, 720–724 anatomy, 443f, 444f, 445 anatomy related to, 720–721, 721f classification, 447 classification of, 722, 723 clinical evaluation, 446 clinical evaluation of, 722, 723f complications, 449–450 complications of, 724 epidemiology, 445 epidemiology of, 720 intra-articular, 446 lateral, 446 mechanism of injury, 446 mechanism of injury for, 721–722 medial, 446 radiographic evaluation, 446–447, 447f, 448f radiographic evaluation of, 722 superior, 446 surgical interventions, 449 treatment, 447–449 nonoperative, 447–448 operative, 449 treatment of nonoperative, 723 operative, 724 787 Patella fractures, 58–59, 716–719 anatomy related to, 716–717 classification of, 58, 718, 718f clinical evaluation of, 717 complications of, 719 epidemiology, 58 epidemiology of, 716 fragment excision, 59 mechanism of injury for, 717 nonoperative treatment of, 58–59 operative treatment of, 59 radiographic evaluation of, 717–718, 718f risk factors, 58 treatment of nonoperative, 718 operative, 719 Patellar fractures, 439–445 anatomy, 439–440, 439f classification, 441–442 descriptive, 441, 441f OTA, 442 clinical evaluation, 440 complications, 444–445 epidemiology, 439 mechanism of injury, 440 radiographic evaluation, 441 treatment, 442–444 nonoperative, 442 open reduction and internal fixation, 442, 443f, 444f operative, 442–444, 443f, 444f patellectomy, 442–444 Patella tendon rupture, 451–453 anatomy of, 452 biomechanics, 453 blood supply, 452 classification, 453 complications, 454 delayed repair, 454 early repair, 453–454 history, 453 nonoperative, 453 physical examination, 453 postoperative management, 454 radiographic examination, 453 risk factors, 452 treatment, 453 Patellectomy, 442–444 in patella fractures, 59 Index.qxp:ps 788 12/30/09 5:47 PM Page 788 Index Patellofemoral pain, 724 Pathologic fractures, 41–49 adjuvant therapy for, 47 benign local disease, 45 causes of, 41 classification of, 44–45 Springfield, 44 clinical evaluation, 42 defined, 41 initial treatment of, 45 laboratory evaluation of, 42, 43t localized, 44 management of specific, 47–49 mechanism of injury, 42 metastases of unknown origin and, 47 nonoperative treatment of, 45 operative treatment of, 45–47 physical examination of, 42 radiographic evaluation for, 42–43, 42–44 Springfield classification of, 44 systemic, 44 systemic skeletal disease, 44–45 treatment of, 45–49 tumors and, 41 Patterson’s manipulative technique, 632f Pectoralis major, 194f Pediatric bone, 563–564 Pediatric forearm fractures See Forearm fractures, pediatric Pediatric fractures, 563–571 anatomy related to, 563–565, 564f classification of Ogden types VI to IX, 568–569 Salter–Harris types I to V, 567–568, 568f clinical evaluation of, 565–566 complications of, 570–571 epidemiology of, 563 mechanism of injury for, 565 radiographic evaluation of, 566–567 treatment of, 569–570 Pelvic brim, 327 Pelvic fractures, 327–343 anatomy, 327–329, 328f, 329f iliolumbar ligaments, 329 innominate bone, 327 ligamentous structures, 327 lumbosacral ligaments, 329 pelvic brim, 327 pelvic ring, 327 sacrospinous ligament, 329 sacrotuberous ligament, 327 symphyseal ligaments, 329 associated Morel–Lavallé Lesion, 339 bladder injury, 333 bowel injury, 333 classification, 335–338 OTA, 338 Tile, 338 Young and Burgess, 335–338, 336t, 337f clinical evaluation, 331 crush injuries, 330 epidemiology, 327 genitourinary and gastrointestinal injury, 333 bladder, 333 bowel, 333 urethral, 333 hemodynamic status, 331-333 impact injuries, 330 injury patterns, 330–331, 336t instability, radiographic signs of, 335 mechanism of injury, 329-331 mortality, factors increasing, 338–339 neurologic, special consideration, 333, 340–341 open, special consideration, 340 pelvic stability, 329 radiographic evaluation, 333–335, 334f, 335f inlet, 334, 334f outlet, 334–335, 335f skin degloving injury, 339 stability, 327, 329 treatment, 339–342 nonoperative, 339 operative, 339–340 urethral injury, 333 urologic, special consideration, 340 Pelvic ring, 327 Pelvic stability, 329 Pendulum exercises, 197 Percutaneous pinning, 627–628 Perilunate dislocations/fracture dislocations, 297–301 classification of, 299–300 Index.qxp:ps 12/30/09 5:47 PM Page 789 Index clinical evaluation of, 298 complications for, 300–301 greater arc injury, 297, 298f lesser arc injury, 297 mechanism of injury, 298 radiographic evaluation of, 298–299 treatment of, 300 Periprosthetic fractures, 50–62 total elbow arthroplasty, 61–62 total hip arthroplasty, 50–54 total knee arthroplasty, 54–59 total shoulder arthroplasty, 59–61 Peritoneal lavage, abdominal injury, 23–24 Peroneal nerve palsy, 705, 709 Peroneal tendon subluxation, 505–506 clinical evaluation, 506 radiographic evaluation, 506 treatment, 506 Phalangeal fractures, 314–315, 557–559, 676–678 anatomy related to, 676f classification of, 558 complications of, 559 distal, 678–679, 678f epidemiology of, 557 mechanism of injury for, 558 pediatric, 767–769 anatomy related to, 767 classification of, 768 clinical evaluation of, 767 complications of, 769 epidemiology of, 767 mechanism of injury for, 767 radiographic evaluation of, 768 treatment of, 768–769, 768f proximal and middle, 675–678, 676f, 677f radiographic evaluation of, 558 treatment of, 558–559, 559f Phenylephrine, 64 Physeal closure of knee, 698 Pilon fracture See Plafond fracture Pipkin type, femoral head fractures, 374–376, 375f Pisiform fractures, 294 clinical evaluation of, 294 mechanism of injury, 294 pediatric, 665 789 radiographic evaluation of, 294 treatment of, 294 Plafond fracture, 314, 492–498 arthrodesis and, 497 classification, 493–495 OTA, 494 Rüedi And Allgöwer, 493–494, 495f clinical evaluation, 493 epidemiology, 492 mechanism of injury, 492–493 postoperative management, 497 radiographic evaluation, 493 treatment, 495–497 nonoperative, 495 operative, 496 surgical tactic, 496–497 timing of surgery, 496 Plantar stress injury of midfoot, 533 Plaster, Plastic deformation, 650–651 Plate fixation of fracture, 652 PLRI See Posterolateral rotatory instability (PLRI) Pneumatic antishock garment ( for hemorrhage), 17 Pneumothorax, 14 Popliteal artery injury, 705, 709, 710f Popliteal block, 72–73 Posterior cord syndrome, 92 Posterior process fractures, treatment of, 527 Posterior slab splint, Posterolateral rotatory instability (PLRI), 237f Postoperative rehabilitation, 211 Posttraumatic arthritis in tarsal fractures, 527 Posttraumatic osteoarthritis, 625, 719 in cuboid fractures, 541 distal femoral fractures, 427 femoral head fractures, 377 hand fractures, 323 hip dislocations, 371 patella and extensor mechanism injuries, 445 in scapula fractures, 591 tibial plateau fractures, 463 Posttraumatic radio-capitellar osteoarthritis, 256 Index.qxp:ps 790 12/30/09 5:47 PM Page 790 Index Posttraumatic radioulnar synostosis, 261 Progressive valgus angulation, 731 Propofol, 67 Prosthesis, 197 Proximal and middle phalanges hand fractures, 314–315 Condylar, 314 extra-articular, 315, 315f intra-articular, 314 proximal interphalangeal fracturedislocations, 314 Proximal humerus fractures anatomy, 193–195 classification, 195–197 clinical evaluation, 195 complications, 201–202 epidemiology, 193 mechanism of injury, 195 neer classification of, 196f treatment, 197–201 Proximal interphalangeal (PIP) joint dislocations, 321–322 Proximal patellar realignment, 724 Proximal radius fracture treatment for, 266–267 Proximal radius/ulna fractures OTA classification of, 252 Proximal tibial physeal closure, premature, 731, 735 Pseudodislocation, 592 Pulmonary embolus, Pulmonary injuries in clavicle fractures, 583 stabilization of, 20–21 Q Quadriceps tendon rupture, 450–451 complications, 451 history, 450 nonoperative management, 451 operative management, 451, 452f physical examination, 450 postoperative management, 451 radiographic examination, 450–451 tendinitis, 450 treatment, 451 Quadriceps weakness, 719 R Radial head fractures anatomy of, 249 classification of, 250–252 clinical evaluation of, 250 complications for, 256 entire head of radius, operative treatment for, 253–254, 254f epidemiology of, 249 Essex-Lopresti lesions as, treatment of, 255 excision of radial head and, 255 isolated partial, operative treatment of, 253 mechanism of injury, 249 partial as part of a complex injury, 253 prosthetic replacement, 255 radiographic evaluation of, 250 treatment goals for, 252 treatment of, 252–256 nonoperative, 252–253 operative, 253–254 postoperative care, 256 Radial head instability, 265 Radial nerve injury, 211, 213, 640 Radial shaft fractures, 265–268 classification of, 266 clinical evaluation of, 266 complications for, 267–268 mechanism of injury, 265–266 radiographic evaluation of, 266 treatment for Galeazzi fractures, 267 proximal radius fracture, 266–267 Radial styloid fracture eponyms classification of, 274f, 275 Radioulnar synostosis, 268, 634, 641 Radius fractures, 257–261 anatomy related to, 257 classification of, 259 clinical evaluation of, 258–259 complications of, 260–261 epidemiology of, 257 mechanism of injury for, 257–258, 258f radiographic evaluation of, 259 Index.qxp:ps 12/30/09 5:47 PM Page 791 Index treatment of, 259–260 nonoperative, 259 operative, 260 Range of motion (ROM) ankle decreased, 498 Recurrent anterior dislocation, 185 Recurrent dislocation, 268 Reflex arc, 80 Regan and Morrey classification of coronoid fractures, 235f Regional blocks, 68–69 Repetitive stress injuries, 629 Revised Trauma Score (RTS), 17, 19t Riseborough and Radin, classification of intercondylar fractures, 219–220, 220f Riseborough and Radin classification, 220f Rolando fracture, 312 ROM See Range of motion (ROM) Ropivicaine, 64 Rotational ankle fractures, 476–492 anatomy, 476–480, 477f, 479f, 480f biomechanics, 479–480 classification, 483–488 collicular, 488 curbstone, 488 Danis–Weber, 486–487, 487f Lauge-Hansen, 483–487, 484f, 485f, 487f LeForte–Wagstaffe, 488 maisonneuve, 488 OTA, 488 pronation–abduction, 485f, 486 pronation–dorsiflexion, 488 pronation–external rotation, 485f, 486 supination–adduction, 483f 484f supination–external rotation, 483, 484f, 486 Tillaux–Chaput, 488 clinical evaluation, 481 collicular, 488 complications, 491–492, 494f curbstone, 488 Danis–Weber, 486–487, 487f epidemiology, 476 fibula, treatment, 490–491 791 lateral malleolar, treatment, 490 LeForte–Wagstaffe, 488 maisonneuve, 488 mechanism of injury, 481 medial malleolar, treatment, 490 open, treatment, 491 posterior malleolus, treatment, 490 pronation–abduction, 485f, 486 pronation–dorsiflexion, 488 pronation–external rotation, 485f, 486 radiographic evaluation, 481–483, 482f supination–adduction, 483f 484f supination–external rotation, 483, 484f, 486 Tillaux–Chaput, 488 treatment, 488–491 emergency room, 488–489 fibula, 490–491 lateral malleolar, 490 medial malleolar, 490 nonoperative, 489 open, 491 operative, 489–491 posterior malleolus, 490 variants, 488 Rotator cuff tear shoulder dislocations with, 175 RTS See Revised Trauma Score (RTS) Russell-Taylor subtrochanteric fractures, 403–404, 404f S Salter–Harris classification, 567–568, 568f Sanders calcaneus fractures, 513, 514f Scaphoid fractures, 288–291 anatomy related to, 288, 289f classification of displacement-based, 290 fracture pattern-based, 290 location-based, 290 differential diagnoses of, 290 mechanism of injury, 288 radiographic evaluation of, 290 treatment of, 291–292 complications, 292 Index.qxp:ps 792 12/30/09 5:47 PM Page 792 Index Scaphoid fractures (cont.) treatment of (cont.) nonoperative, 291 operative, 291 surgical techniques for, 291–292 suspected fractures, 291 Scaphoid fractures, pediatric, 662–664 classification, 662, 663f clinical evaluation, 662 complications, 663–664 radiographic evaluation, 662 treatment of, 662–663 Scaphoid shift test, 290 Scapula fractures, 162–171, 586–591 anatomy related to, 162, 586, 587f classification of, 164–166 acromial fractures, 589–590 acromial fractures classification and, 164, 166f anatomic, 164, 164f body and neck fractures, 588 coracoid fractures, 589 coracoid fractures classification and, 164, 166f glenoid fractures, 588, 589f ideberg classification of intraarticular glenoid fractures, 164, 165f OTA, 166 clinical evaluation of, 163, 587 complications of, 169–171, 591 scapulothoracic dissociation, 170–171, 170f epidemiology of, 162, 586 injuries associated with, 162 mechanism of injury for, 162, 586–587 radiographic evaluation of, 163, 588 treatment of, 167–169, 590–591 nonoperative, 167 operative, 167–169 specific options for, 167–169 surgical indications for operative, 167 Scapular body fractures treatment of, 168 Scapular inclination, 172–173 Scapular neck dysplasia, 163 Schatzker classification of olecranon fractures, 245–246, 246f Schatzker tibial plateau fractures, 457–459, 458f Sciatic nerve injury, 689 SC joint injuries See Sternoclavicular (SC) joint injuries Seinsheimer subtrochanteric fractures, 402, 403f Sesamoids, fractures of, 556–557 anatomy related to, 556 classification of, 557 clinical evaluation of, 556–557 complications of, 557 epidemiology of, 556 mechanism of injury for, 556 radiographic evaluation of, 557 treatment of, 557 Shear injuries, 642–643 Shock cardiogenic, 15 hemorrhagic, 16 hypovolemic, 88t neurogenic, 15, 82–84, 88t bulbocavernosus reflex and, 84, 87 defined, 82 patient in, initial management of, 15 septic, 16 spinal, 82 Shoulder dislocations pathoanatomy of, 174 with rotator cuff tear, 175 Shoulder hemiarthroplasty, 197 Shoulder spica cast, 207 Shoulder stiffness, 201, 596 in glenohumeral dislocations, 596 Skeletal olecranon traction, 627 Skeletal traction, 7–10 calcaneal, 8–9 femoral, 8, 9f Gardner Wells tongs for, 9–10 olecranon, sites, 7f spanning external fixation, 10 Steinmann pin for, tibial, Skeletal trauma, 563 Skin degloving injury, 339, 355 Skin traction, 6–7 Sleeve fracture, 719 Sliding-screw sideplate devices, 386 Index.qxp:ps 12/30/09 5:47 PM Page 793 Index Smith fracture eponyms classification of, 274–275, 274f mechanism of injury, 275 Soft tissue injuries, 185 coverage of, 34 Spanning external fixation, 10 Spinal cord injury acute, medical management of, 94 ASIA impairment scale, 93 neurologic assessment, 93 complete, 88, 90 definitions of terms describing, 87t Frankel classification, 92–93 grading systems for, 92–93 incomplete, 90 patterns of, 90, 91t, 92 Spinal shock, 82 Spinal stability instability degrees and, 137 lumbar, 136t thoracolumbar, 135–138 Denis scoring system for, 135–138, 137f, 138t McAfee scoring system for, 138 White and Punjabi scoring system for, 135, 136t Spine, general injuries, 79–96 anatomy related to, 79–80 Cauda Equina syndrome as, 79, 92 classification of, 88 clearing the spine and, 95–96 clinical evaluation of, 81–87 injury evaluation and, 81–82 reflex evaluation and, 82, 83f–84f, 85t–86t complications of, 94–95 conus medullaris syndrome as, 79 epidemiology, 79 mechanism of injury for, 80–81 primary, 80 secondary, 80–81 nerve root lesions as, 92 neurogenic shock and, 82–84, 88t bulbocavernosus reflex and, 84, 87 defined, 82 neurologic injury grading and, 88, 90 radiographic evaluation of, 87–88 793 reflex arc, 80 resuscitation and, 81 spinal shock and, 82 treatment of, 93–94 Splints “Bulky” Jones, coaptation, complications of, 5–6 lower extremity, posterior slab, sugar-tong, 3, 4f techniques, 3–4, 4f thumb spica, ulnar gutter, upper extremity, volar/dorsal hand, Sprains, treatment of, 533–534 Springfield classification of pathologic fractures, 44 SSSC See Superior suspensory shoulder complex (SSSC) Stabilization fracture, 34 of lower cervical spine, 121–122 of upper cervical spine, 120–121 Steel maneuver, 596 Steinmann pin for Skeletal traction, Sternoclavicular (SC) joint injuries, 155–161 anatomy related to, 155, 156f classification of, 158–159 anatomic, 158 etiologic, 158–159 clinical evaluation of, 157 complications of, 161 epidemiology of, 155 mechanism of injury for, 156, 157f presentation of, 157 radiographic evaluation of, 157–158, 158f severe, treatment of, 159–161, 160f treatment of, 159–161 Stimson technique, 595–596 Stress fractures, 537, 741–743 classification of, 742 clinical evaluation of, 742 complications of, 743 epidemiology of, 741 mechanism of injury for, 741–742 Index.qxp:ps 794 12/30/09 5:47 PM Page 794 Index Stress fractures (cont.) radiographic evaluation of, 742 treatment of, 743 Stress maneuvers, 531 Subchondral osteopenia, 525 Subtalar dislocation, 528–529 Subtrochanteric fractures, 399–407 anatomy, 399, 400f–401f classification, 401–404 Fielding, 401–402, 402f OTA, 404 Russell-Taylor, 403–404, 404f Seinsheimer, 402, 403f clinical evaluation, 399–400 complications, 406–407, 407f epidemiology, 399 gunshot injuries, 399 mechanism of injury, 399 open, treatment of, 406 radiographic evaluation, 401 treatment, 404–406 bone grafting, 405 implants, 405 interlocking nail, 405 ninety-five-degree fixed angle device, 405, 406f nonoperative, 404 operative, 405 sliding hip screw, 405 Sugar-tong splint, 3, 4f Superior suspensory shoulder complex (SSSC) anatomy of, 167, 168f Supracondylar humerus fractures, 604–607 anatomy related to, 604–605 classification of, 605–606 clinical evaluation of, 605 complications of, 607 epidemiology of, 604 mechanism of injury for, 605 treatment of, 606–607 Suprascapular nerve injury in scapula fractures, 591 Surgical approaches, 208 Surgical neck fractures, 197–198 Surgical techniques, 208–211 Syndesmosis sprains, 500–502 classification, 501 clinical evaluation, 501 radiographic evaluation, 501–502 treatment, 502 Systemic skeletal disease, 44–45 T Talar body fractures, 526-527 classification, 526 treatment, 526 lateral process fractures, 526 posterior process fractures, 527 talar head fractures, 527 Talar head fractures, treatment of, 527 Talar neck fractures epidemiology of, 520 Hawkins classification of, 523–524, 523f, 524f mechanism of injury for, 521 Talus arterial supply to, 753 ossification center of, 753, 754f superior and inferior views of, 520f total dislocation of, 529, 529f vascular supply to, 521 Tarsal bones, 530 Tarsal fractures, 520–529 anatomy related to, 520–521, 521f classification of anatomic, 522 Hawkins, 523–524, 523f, 526f clinical evaluation of, 521 complications of, 527–529 subtalar dislocation, 528–529 total dislocation, 529, 529f epidemiology of, 520 mechanism of injury for, 521 pediatric anatomy related to, 753, 754f classification of, 755 clinical evaluation of, 754 complications of, 756 epidemiology of, 753 mechanism of injury for, 753 radiographic evaluation of, 755 treatment of, 755–756 radiographic evaluation of, 522, 522f treatment of displaced fractures, 524–525, 524f internal fixation, 525 nondisplaced fractures, 524–525 surgical approaches, 525 Index.qxp:ps 12/30/09 5:47 PM Page 795 Index Tarsometatarsal (lisfranc) joint, injuries of, 541–548 anatomy related to, 541–542, 542f, 545f associated injuries, 544 classification of Myerson, 545, 546, 546f Ouenu and Kuss, 545, 546f clinical evaluation of, 543 complications of, 548 epidemiology of, 541 mechanism of injury for, 543 pediatric, 761–763 anatomy related to, 761, 761f classification of, 763 clinical evaluation of, 762 complications of, 764 epidemiology of, 761 mechanism of injury for, 762 radiographic evaluation of, 762–763 treatment of, 763–764 radiographic evaluation of, 543–544, 544f treatment of nonoperative, 547 operative, 547 postoperative management, 547–548 T-condylar fractures, 625–629 anatomy related to, 626 classification of, 627 clinical evaluation of, 626 complications of, 628–629 epidemiology of, 625 mechanism of injury for, 626 radiographic evaluation of, 627 treatment of nonoperative, 627 operative, 627–628 Tetanus prophylaxis, open fractures and, 31 TFCC See Triangular fibrocartilage complex Thoracic injuries, trauma and, 23 Thoracobrachial immobilization (Velpeau dressing), 207 Thoracolumbar spine injuries, 123–140 anatomy related to, 123–124, 125f bulbocavernosus reflex and, 126, 128f 795 classification of, 129–135 Denis, 129–135, 132f, 133f, 134f, 135f McAfee et al., 129 McCormack et al., 129 OTA, 129 clinical evaluation of, 124, 126 neurologic assessment and, 126, 126f, 127f, 128f physical, 126 complications, 140 compression fractures, Denis classification of, 130–131, 130f epidemiology of, 123 flexion-distraction, Denis classification of, 132–133, 133f fracture-dislocations, Denis classification of, 133–135, 134f, 135f gunshot wounds, 138–139 major, Denis classification of, 129–135, 130f, 132f, 133f, 134f, 135f mechanism of, 124, 126 minor, Denis classification of, 129 neurologic recovery after Bradford and McBride and, 139 Camissa et al and, 140 Dall and Stauffer and, 139–140 Keenen et al and, 140 neurologic recovery and, 139–140 prognosis, neurologic recovery after, 139–140 radiographic evaluation of, 126–128 spinal stability See Spinal stability Three-point molding, 659f Thromboembolism and hip dislocations, 371 Thrombophlebitis, Thumb, traction and counteraction of, 649f Thumb fractures, 312, 313f Bennett, 312 Rolando, 312 Thumb spica splint, Tibia/fibula shaft fractures, 464–475 anatomy, 464–466, 465f, 466f classification, 469–470 descriptive, 469–470 Gustilo and Anderson, 470 Index.qxp:ps 796 12/30/09 5:47 PM Page 796 Index OTA, 470 Tscherne, 470 claw toe deformity, 475 clinical evaluation, 467–469 Tibia/fibula shaft fractures (cont.) closed, Tscherne classification, 470 compartment syndrome, 475 complications, 474–475 distal tibia fractures, treatment, 473 epidemiology, 464 fasciotomy, treatment, 474 fibula shaft fracture, treatment, 472 flexible nails, treatment, 472–473 intramedullary nailing, treatment, 472 mechanism of injury, 466–467, 468f neurovascular injury, 475 open, Gustilo and Anderson classification, 470 proximal tibia fractures, treatment, 473 radiographic evaluation, 469 reflex sympathetic dystrophy, 474 soft tissue injuries, 474 stress fractures, 467, 468f tibia fracture with intact fibula, treatment, 473–474 Tibia stress fracture, treatment, 471–472 treatment, 471–474 distal tibia fractures, 473 external fixation, 473 fasciotomy, 474 fibula shaft fracture, 472 flexible nails, 472–473 intramedullary nailing, 472 nonoperative, 471–472 operative, 472–474 proximal tibia fractures, 473 tibia fracture with intact fibula, 473–474 tibia stress fracture, 471–472 Tibia fractures, pediatric, 728–729 anatomy related to, 728 clinical evaluation of, 729 diaphyseal anatomy related to, 731–732 classification of, 732–733 clinical evaluation of, 732 complications of, 735–736 epidemiology of, 731 mechanism of injury for, 732 radiographic evaluation of, 732 treatment of, 733–735, 734f of distal third of tibia, 736–738 epidemiology of, 728 mechanism of injury for, 728–729 proximal tibial metaphyseal fractures anatomy related to, 729–730 classification of, 730 clinical evaluation of, 730 complications of, 731 epidemiology of, 729 mechanism of injury for, 730 radiographic evaluation of, 730 treatment of, 730–731 radiographic evaluation of, 729 Tibia fracture with intact fibula, treatment of, 473–474 Tibial fractures, 57–58 classification of, 57 nonoperative treatment of, 58 operative treatment of, 58 risk factors, 57 Tibial fractures, proximal, 706–710 anatomy related to, 706–707 classification of, 708, 708t clinical evaluation of, 707 complications of angular deformity, 709, 710 leg length discrepancy, 710 peroneal nerve palsy, 709 popliteal artery injury, 709, 710f recurrent displacement, 709 epidemiology of, 706 mechanism of injury for, 707 radiographic evaluation of, 707–708 treatment of nonoperative, 708–709 operative, 709 Tibial plateau fractures, 455–463 anatomy, 455 arterial injuries, 457 classification, 457–459 Moore, 459, 459f OTA, 459 Schatzker, 457–459, 458f clinical evaluation, 456 compartment syndrome, 456 complications, 463 epidemiology, 455 hemarthrosis, 456 Index.qxp:ps 12/30/09 5:47 PM Page 797 Index injuries associated with, 456–457 mechanism of injury, 455–456 meniscal tears, 456 neurovascular examination, 456 peroneal nerve injuries, 457 radiographic evaluation, 457 soft tissue injury, 456 treatment, 459–462 arthroscopy, 461, 462f nonoperative, 459–460 operative, 460–462, 460f, 461f, 462f operative treatment principles, 460–461 surgical indications for, 460, 460f Tibial skeletal traction, Tibial spine, 698 Tibial spine (intercondylar eminence) fractures anatomy related to, 714 classification of, 715, 715f clinical evaluation of, 714–715 complications of, 716 epidemiology of, 714 mechanism of injury for, 714 radiographic evaluation of, 715 treatment of, 716 Tibial tubercle fractures, 710–714 anatomy related to, 711, 711f classification of Ogden, 713f Watson–Jones, 712 clinical evaluation of, 712 complications of, 714 epidemiology of, 710–711 mechanism of injury for, 711 radiographic evaluation of, 712 treatment of nonoperative, 712, 713 operative, 713 Tibia stress fracture, treatment of, 471–472 Tibiofibular syndesmotic ligamentous injuries, treatment, 502 Tillaux–Chaput ankle fractures, 488 Toddler’s fracture, 738–741 anatomy related to, 740 clinical evaluation of, 740 complications of, 741 epidemiology of, 738, 740 mechanism of injury for, 740 radiographic evaluation of, 740–741 797 treatment of, 741 Torus fractures treatment of, 657–658 Total elbow arthroplasty, 61–62 classification of, 61 epidemiology, 61 nonoperative treatment, 61 operative treatment, 61–62 risk factors, 61 Total hip arthroplasty, 50–54 acetabular fractures, 54 femural shaft fractures, 50–54 Total knee arthroplasty, 54–59 patella fractures, 58–59 supracondylar femur fractures, 54–57 tibial fractures, 57–58 Total shoulder arthroplasty, 59–61 classification of, 59–60 controversial treatment of, 60 epidemiology, 59 nonoperative treatment of, 60 operative treatment of, 60–61 risk factors, 59 Traction, 3–10 bucks, skeletal, 7–10 calcaneal, 8–9 femoral, 8, 9f Gardner Wells tongs for, 9–10 olecranon, sites, 7f spanning external fixation, 10 Steinmann pin for, tibial, skin, 6–7 Traction–countertraction, 595 Traction radiographs, 205 Transcondylar fractures, 219 Transphyseal fractures, pediatric, 615–618 anatomy related to, 615 classification of, 617 clinical evaluation of, 616 complications of, 618 epidemiology of, 615 mechanism of injury for, 615 radiographic evaluation of, 616–617 treatment of, 617–618 Transverse ligament rupture (traumatic C1-C2 instability), 107 C1–C2 fusion, 107, 108f Index.qxp:ps 798 12/30/09 5:47 PM Page 798 Index Transverse ligament rupture (cont.) determining, 107 treatment of, 107 Trapezium fractures, 294–295 clinical evaluation of, 294 complications of, 295 epidemiology of, 294 mechanism of injury, 294 pediatric, 665–666 radiographic evaluation, 294–295 treatment of, 295 Trapezoid fractures, 295–296 clinical evaluation of, 295 complications of, 296 pediatric, 666 radiographic evaluation of, 296 treatment of, 295–296 Trauma abdominal injuries and, 23–24 airway control after, 12 blunt, 11 breathing after, 14 circulation after, 14–15 concomitant injuries, 22–24 deaths from, 11–12 disability (neurologic assessment) for, 17 Glasgow coma scale and, 17, 18t RTS and, 17, 19t exposure, 20 field triage for, management priorities of, 11 genitourinary injuries and, 24 golden hour and, 12 head injuries and, 22–23 hemorrhage and See Hemorrhage high-velocity, 11 hypotension in, differential diagnosis of cardiogenic shock, 15 hemorrhagic shock, 16 neurogenic shock, 15 septic shock, 16 ISS for, 17–19, 19t multiple, 11–24 operating after, decision to, 21–22 radiographic evaluation of, 20 resuscitation after, 12 shock, patient in initial management of, 15 stabilization of, 20–21 statistics about, 11 thoracic injuries and, 23 Traumatic C1-C2 instability See Transverse ligament rupture Traumatic dislocation of hip, 686–689 classification of, 687 clinical evaluation of, 687 complications of, 688–689 epidemiology of, 686 mechanism of injury for, 686–687 radiographic evaluation of, 687 treatment of, 688 Traumatic spondylolisthesis of C2 (Hangman’s fracture), 110–112 classification of, 110–112, 111f treatment of, 112 Triangular fibrocartilage complex (TFCC), 646 Triplane fractures classification of, 748, 749 treatment of, 752 Triquetrum fractures, 293–294 clinical evaluation of, 293 mechanism of injury, 293 pediatric, 664–665 radiographic evaluation of, 293 treatment of, 293–294 Trochlear notch, 231f Trough sign, 186 Tscherne classification of closed fractures, 30 open fractures, 29 Tscherne tibia/fibula shaft fractures, 470 Tuberosity (avulsion) fractures, treatment, 515–516 Tuberosity fractures, 537 Tumors pathologic fractures and, 41 U Ulnar gutter splint, Ulnar nerve injuries, 640 Ulnar neuropathy in medial in condylar physeal fracture, 614 Ulna shaft fractures, 261–265 classification of, 263 Index.qxp:ps 12/30/09 5:47 PM Page 799 Index clinical evaluation of, 262–263 complications for, 264–265 mechanism of injury for, 262 pediatric, 649–653 classification of, 649 complications of, 653 nonoperative treatment, 649–652, 649f, 651f operative indications, 652 operative treatment, 652 radiographic evaluation of, 263 treatment for Monteggia fractures, 264 nightstick fractures, 264 Ulnocarpal dissociation, 303–304 UPEP See Urine protein electrophoresis (UPEP) Upper extremity fractures and dislocations acromioclavicular (AC) joint injury, 150–155 clavicle fractures as, 143–149 scapula fractures as, 162–171 sternoclavicular (SC) joint injuries as, 155–161 Upper extremity splint, Urine protein electrophoresis (UPEP), 42 V Vacant glenoid sign, 186 VAC system See Vacuum-assisted closure (VAC) system Vacuum-assisted closure (VAC) system, 32, 33f Valgus, 215f Valgus deformity, pediatric ankle fractures and, 752 Valgus injuries, 631 Varus deformity, pediatric ankle fractures and, 752 Vascular compromise, knee dislocations and, 438 pediatric, 726–727 Vascular injury, 185, 201, 213, 641 in glenohumeral dislocations, 597 knee dislocations, 431–432 open fractures and, 26–27 in supracondylar humerus fracture, 607 799 Vascular status, knee dislocations and, 431–432 Vascular supply to medial epicondyle and metaphysis, 611 to talus, 521 wrist, 284–285, 285f Velcro straps, 207 Venous thromboembolic disease (VTE), 389 Venous thrombosis, deep and trauma, 20 Volar/dorsal hand splint, Volar lip fracture, 314 Volar locked/nonlocked plating, distal radius fracture treatment with, 278–279 Volkmann contracture, 641 Volkmann ischemia, 214, 261 W Watson–Jones classification of tibial tuberosity fractures, 712 Watson test, 290 Winquist and Hansen, classification of femoral shaft fractures, 412–413, 412f Wrist block, 68–69 median nerve, 68–69 radial nerve, 69 surgical anatomy for, 70f ulnar nerve, 69 Wrist fractures anatomy related to, 281–287 carpal bones in, 281 kinematics of, 285–286 ligaments, 282–284, 283f, 284f pathomechanics, 286–287, 286f TFCC, 284 vascular supply to, 284–285, 285f carpal dislocations, 301 classification, OTA of, 288 clinical evaluation, 287 lunotriquetral dissociation and, 302–303 mechanism of, 287 perilunate dislocations and, 297–301 perilunate fracture dislocations and, 297–301 Wrist fractures (cont.) Index.qxp:ps 800 12/30/09 5:47 PM Page 800 Index radiographic evaluation, 287–288 scapholunate dissociation and, 302 specific capitate fractures as, 296 hamate fractures as, 296–297 lunate fractures as, 292–293 pisiform fractures as, 294 scaphoid fractures as, 288–291 trapezium fractures as, 294–295 trapezoid fractures as, 295–296 triquetrum fractures, 293–294 ulnocarpal dissociation and, 303–304 Y Young and Burgess, classification of pelvic fractures, 335–338, 337f Younger patients, 195, 197 ... Kenneth A., 196 7Handbook of fractures/Kenneth A Egol, Kenneth J Koval, Joseph D Zuckerman — 4th ed p ; cm Rev ed of: Handbook of fractures/Kenneth J Koval, Joseph D Zuckerman Abridgement of Rockwood... well with the probability of survival Score (NISS) This is defined as the sum of squares of the AIS scores of each of a patient’s three most severe injuries regardless of the body region in which... It consists of Restoration of stable hemodynamics Restoration of adequate oxygenation and organ perfusion Restoration of adequate kidney function Treatment of bleeding disorders Risk of deep venous