Dr. David Orthopedic Traumatology-A Resident's Guide

548 12 Fall Prevention in the Elderly n This is because when the elderly (say, in their 80s) fall, they usually tend to fall backwards, landing on the hip/buttock region. When younger people (say, in their 60s) fall, there is a higher tendency to have more protective response like using the upper extremities to blunt the impact of the fall or reach out for supports 12.4.2 Local Protective Response n The therapist looking after a patient after hip fracture can help by teaching the patient better protective mechanisms in case of an im- pending fall n Home modification, training with the use of aids and upper and lower limb muscle strengthening are also important n Community Nursing Service (CNS) nurses can help to reinforce those techniques learned during the hospital stay after the patient has been discharged from the hospital 12.4.3 Local Protective Soft Tissue Structures n The adequacy of the soft tissue envelope around the hip, and the bulk and tone of the musculature around the hips of the elderly are impor- tant to damp down the energy of impact (e.g. gluteus maximus, glu- teus medius and minimus, vastus lateralis) n Thus, an emaciated and thin patient in their 80s with atrophied hip muscle is more likely to have a hip fracture after a fall n The CNS can help teach and supervise the elderly wearing, say, hip protectors (if the family had purchased one). Advice on nutrition can also be provided 12.4.4 Bone Mineral Density n Patients with osteoporosis (BMD ± 2.5 SD) are more prone to hip fractures n Prevention and management of osteoporosis is most important. This was discussed in detail in the companion volume of this book n CNS nurses can also see whether elderly patients have difficulty in taking medications and help ensure proper administration of medica- tion, e.g. of bisphosphonates. Dietary calcium and vitamin D as sup- plements are often needed, especially in the institutionalised elderly living in nursing homes. Previous studies by MGH reviewed that si- lent osteomalacia is not uncommon

a 12.7 Role of Community Nursing Service 549 12.5 What Is the First Step in a Fall Prevention Programme? n The first step in the right direction in preventing falls is the setting up of a ªpanel of fall preventionº consisting of trained persons from multiple disciplines n A multi-disciplinary approach is needed to tackle the complicated long-term rehabilitation of the elderly patient with a hip fracture 12.6 Panel for Fall Prevention n Rehabilitation specialist n Traumatologist n Physiotherapist n Occupational therapist n Medical social worker n Patient relation officer n Community nurses 12.7 Role of Community Nursing Service n Community Nursing Service (CNS) nurses, as the name implies, are nurses who actually go to the community and provide nursing care to the discharged patients n CNS nurses can help identify extrinsic factors (that predispose an el- derly person to fall) after a patient with a hip fracture has been dis- charged from hospital n Also, CNS nurses may be able to pick up intrinsic factors regarding falls in an elderly person that have not yet been picked up during hospitalisation

550 12 Fall Prevention in the Elderly 12.8 What About Long-Term Care? n Even CNS nursing service cannot provide indefinite long-term care, so who will be caring for our elderly in the long term and reinforcing the methods of fall prevention? n The answer probably lies in the use of non-government organisations (NGO) and other volunteer charitable organisations 12.8.1 Non-Government Organisation and Other Related Disciplines n NGO n Home helper n Carers at nursing homes n Volunteers n Home care teams 12.8.2 Role of Non-Government Organisations n The CNS nurses are important as they act as a continuation of the line of care for the elderly with hip fractures after hospital discharge, i.e. in the subacute period n After the initial period of stabilisation, non-government organisations can help take over this vital role in the chronic rehabilitation period n Before the patient is discharged from the fall prevention programme, the CNS plays a pivotal role in referring suitable patients to the care of an NGO 12.8.3 Role of NGO in Both Primary and Secondary Prevention n It is expected that the NGO can play an important role in identifying the elderly at risk of falling and/or teaching the elderly about the fall prevention programme (primary prevention) n In addition, they take over the continuous care of our elderly patients at risk of falling who had entered our fall prevention programme (sec- ondary prevention) 12.8.4 Conclusion n The expected exponential rise in the incidence of hip fractures in the coming decades underlines the importance of a long awaited fall pre- vention programme

a Selected Bibliography of Journal Articles 551 n Concomitant early detection and treatment of osteoporosis is impor- tant n Although the programme just described was used in the author's home country; it is expected that a similar programme tailored to the local resources will also be of benefit to any country with an aging population General Bibliography Ip D (2005) Orthopaedic principles ± a resident's guide. Springer, Berlin Heidelberg New York NHS Centre for Reviews and Dissemination, University of York (1996) Effective health care, preventing falls and subsequent injury in old people, vol 2, no. 4 Selected Bibliography of Journal Articles 1. Dolan P, Togerson DJ (1998) The cost of treating osteoporotic fractures in the Uni- ted Kingdom female population. Osteoporos Int 8:611±617 2. Sheehan J, Mohamed F et al. (2000) Secondary prevention following fractured neck of femur: a survey of orthopaedic surgeons practice. Ir Med J 93:105±107 3. Cummings SR, Nevitt MC et al. (1989) Factors implicated in the aetiology of a hip fracture. J Gerontol 44:107±111 4. Jarnlo GB, Ceder L et al. (1984) Early rehabilitation at home of elderly patients with hip fractures and consumption of resources in primary care. Scand J Prim Health Care 2:105±112 5. Seagger R, Howell J (2004) Prevention of secondary osteoporotic fractures ± why are we ignoring the evidence? Injury 35:986±988

Subject Index A Ankle 7 A/P disruption 352 ± arthroscopy 403 Abductor pollicis brevis see APB ± arthrosis 59 Abnormal electrolyte flux 468 ± -brachial index 36 Abnormal vascular perfusion 468 Ankylosing spondylitis 486 Acetabular fracture 302, 303, 445 Annulus fibrosis 481 Acetabulum 3, 5, 164, 445, 448, 450 Antegrade nail 221 Achilles tendon 413 Anterior cord syndrome 466 Acidosis 25 Anterior cruciate ligament see ACL ACJ injury 205 Anterior fusion cage 491, 506 ACL (anterior cruciate ligament) 354, Anterior interosseus nerve see AIN Anterior oblique ligament see AOL 356, 539 Anterior spinal fusion see ASF Acromioclavicular joint disloca- Anterior tibial artery 415 Antibiotics 378 tion 193, 194 ± prophylactic 67 Acute trauma patient 487 Anti-shock garment 26, 438 Adjunctive fibula fixation 176 AO 88, 97, 99, 110, 166, 172, 177, ADL 157, 245 Adult ADI (Atlas-Dens interval) 462 213, 214, 218, 252, 255, 310, 316, Adult respiratory distress see ARDS 318, 319, 338, 373, 387, 389, 390, Aging population 10 536 AIN (anterior interosseus nerve) 519, ± classification 208, 209, 223, 334 ± concept 5 521, 533 ± method 88 Alho classification 319 ± ORIF plating 361 Allen's (mechanistic) classifica- ± plating 367, 377 ± principles 88, 94 tion 481±483, 489 ± trochanteric fixation nail 327 Allis method 301 ± Ventrovix 491, 500, 505 Allograft 491 AO/OTA classification 368 ± posthesis composite 151 AOL (anterior oblique ligament) 278, Alonzo CT classification of HO 443 282 American Association of Neurological APB (abductor pollicis brevis) 282 Apoptosis 469 Surgeons 471 Arachidonic acid 469 American College of Surgeons 16 Arch pain 141 American Spinal Injury Association ARDS (adult respiratory distress) 17, 21, 32, 34, 116, 374 scale see ASIA scale Areflexia 465 Amputation 19, 35, 37 Arterial anastomosis 415 Anatomic reduction 524 Arterial bleeding 24 Anderson and d'Alonzo classifica- Arterial clamping 27 Arteriogram 353, 358, 539 tion 476 Angiogram 36, 520 Angiographic embolisation 27 Angiosomes 383 Angle blade plate 340, 342 Angular deformity 287, 513

554 Subject Index Bankart lesion 195, 196 ± reverse 199 Arthrocentesis 348 Bankart repair 131, 197, 198 Arthrodesis 386, 411, 418, 419 Bar excision 513 Arthrofibrosis 402 Bar reform 514 Arthrogram 522, 524, 527 Barrel chest 478 Arthroplasty 271 Bedside Doppler 36 ± DRUJ 271 Bennett fracture subluxation 282 ± excision 271 BG 141, 145, 149, 153, 251, 258, 285, ± hemi- 322 ± total 322 367, 390, 485 Arthroscopic debridement 265 Bibial medullary canal deformity 372 Arthroscopy 197, 199, 200, 248, 251, Bi-columnar plating 254 Bicondylar fracture 176, 359, 360 266, 269, 348, 356, 360 Bifocal injury 319 ± intraoperative 409 Bigelow method 301 Arthrosis 342, 363, 391 Bioabsorbable implant 130 ± degenerative 386 ± advantages 130 ± post-traumatic 385 ± disadvantages 130 ± progressive 406, 411 Biofeedback 199 Articular congruity 356 Biplanar fluoroscopy 494 Articular fracture 208 Bipolar prosthesis 311 Articular shearing fracture (Bar- Bladder 432, 438 Bleeding 25, 26, 178, 431, 437 ton's) 247 ± sources of 441 ASF (anterior spinal fusion) 491, 505 ± ways to stop 438 ASIA(American Spinal Injury Associa- Blind tunnelling 174 Blocking screw 366, 381 tion) scale 466 Blood flow 49 Atlas C1 fracture 475 Blood recollection 513 ATLS 35, 462, 487 Blood supply 307, 398 ± protocol 434 Blood vessel 465 ATPase 468 BMP (bone morphogenetic pro- Attritional flexor injury 263 Auto-destructive process 465 tein) 62±65 Autogenous marrow 83 Body mass index, high 408 Autograft 74, 491 Bohler angle restoration 407, 410 ± disadvantages 81 Bone architecture 492, 506 ± massive 74 Bone bridge formation 524 Autologous bone marrow 62 Bone cement 496 Avascular necrosis see AVN Bone defect 148 AVN (avascular necrosis) 178, 211, ± classification 74 ± management 142, 145 213, 216, 248, 272, 273, 275, 306, Bone graft 76 310, 314, 315, 398, 400, 402, 413, ± common types of substitutes 82 525, 528, 536, 538 ± free vascularised 76 ± post injury 403 ± materials 79, 80 ± risk 209 ± ± incorporation of synthetics 81 Avulsion 422 ± ± remodelling of synthetics 81 ± fracture 247, 435 Bone healing 48±50, 98, 173, 379 Axial instability 267 ± biological means 62 Axial loading injury 483 ± bophysical methods 62 Axial skeleton 96, 164 ± contact 53 Axillary vein thrombosis 210 ± direct 51, 53, 54 Axonal membrane 465 ± gap 53, 54 B Bacterial adherence 67 Ballgames 416

a Subject Index 555 ± after IM nails 55 Buttress principle 505 ± indirect 51, 53 Bypass stress riser 147, 148 ± mechanical means 62 ± natural 52 C ± stages 48 Cage stiffness 506 Bone hypertrophy 140 Calcaneus 411, 412 Bone loss 277, 376 ± fractured 404 Bone marrow injection 63, 64 Calcium 472 Bone mineral density 162, 547, 548 Callus formation 171 Bone morphogenetic protein Callus healing 56 Cancellous bone 50 see BMP Cantilever 100 Bone overgrowth, long-term 531 CAOS (computer-aided orthopaedic Bone plate 94 ± biological 100, 101 surgery) 180, 217 ± buttress 95, 96 Capitellum fracture 233 ± common types 95 ± types 233 ± compression 96 Capsular ligament damage 259 ± condylar 97 Capsular shift 197 ± conventional 97 Capsulodesis 263 ± DCP (dynamic compression Capsulotomy 287 Cardiopulmonary disorder 19 plate) 96, 98, 99, 103 Carpal instability 258, 259 ± locked compression plate see LCP Carpal malalignment 246 ± neutralisation 95 Carpal tunnel syndrome see CTS ± newer systems 102 Carpal-metacarpal joint see CMCJ Bone-rod distance 120 Cell death 468 Bone scan 137, 140 Cell necrosis 469 Bone-stimulating method 63 Cement implantation syndrome 313 Bone stock 161 Cementless cup 147 Bone tamp 494 Central nervous system 471 Bone tissue engineering 64 Centre of rotation of angulation see Bone transport 78 Bony anatomy 407 CORA Bony chance fracture 500 Cephalomedullary nailing 160, 182, Bony comminution 376 Bony deformity 197 323, 326 Bony healing 123 Cephalosporin 143 Bosworth fracture 394 Cerebral perfusion pressure see CPP Brachial artery 518 Cervical cord injury 465 Brachial plexus injury 201 Cervical orthosis 482, 483 Brachialis muscle 518 Cervical spine 504 Bracing 57 ± injury 4, 474 ± contraindications 58 ± instability 482 ± functional 57 Cervicothoracic junction see CTJ ± Sarmiento 58 Chapman's method 75 Bronchoscopy 31 Chest trauma 32 Brooks' classification 443 Child fracture 517 Brooks's fusion 477 ± healing 512 Brown Sequard syndrome 467 Chochrane database 325 Bulbous urethra 432 Chondrocyte allograft transplant Burgess classification 432 Burst fracture 488, 489, 492, 502 513 ± stable 497 Christian's method 75 ± unstable 498 Cierny-Mader classification 68 Circular frame 127 Civilian triage 16

556 Subject Index CT (computed tomography) 3, 137, 140, 141, 192, 217, 225, 272, 275, Clavicular fracture 202, 203, 206 348, 357, 386±388, 399, 480, 491, ± classification 201 497, 498, 507, 513, 514, 541 Clostridia myonecrosis 142 Clumsy proximal locking 221 ± assessment 447 CMCJ (carpal-metacarpal joint) 278, ± scanning 4, 178, 193, 248, 301, 281 474 CNS (Community Nursing Ser- CT-based navigation 179 CTJ (cervicothoracic junction) 462, vice) 548±550 Coagulopathy 21, 23±25 463 Coccygeal muscle 430 CTS (carpal tunnel syndrome) 253, Colostomy 439 Column fracture, double 446 263 Columnar classification 243 Cubitus valgus 525 Comminuted fracture 235, 531 Cubitus varus 521, 527 Common fixator configuration 121 Cx 197, 212, 217 Community Nursing Service see CNS ± of tendon injuries 255 Compartment syndrome 59, 176, 219, CXR 31 Cyclo-oxygenase 472 237, 357, 359, 360, 363, 368, 370, Cyclosporin 472 372±374, 376, 415, 520, 532, 539 Cytoskeletal calmodulin 65 Compressing haematoma 484 Cytosolic calcium 65 Compression fracture 488 Compression nail 381 D Compression/distraction system 117, Damage control see DC 118 Dancers 416 Compressive flexion 483 DBM (demineralised bone ma- Computer-aided orthopaedic surgery see CAOS trix) 80, 82 Computer-aided surgery 8, 9 DC (damage control) 22, 23, 28, 29, Condylar buttress plate 340, 344 Congress of Neurological Sur- 65 geons 471 ± concepts 21 Conservative Rn see Rn ± orthopaedics 337 Contrast allergy 495 DCP (see also bone plate) 22, 221, Contrast sensitivity 520 Conus medullaris syndrome 467 226, 236, 239, 280 CORA (Centre of rotation of angula- DCS (dynamic condylar screw) 332, tion) 72 Coraco-clavicular screw 194 333, 340, 342 Corona mortis 431 DCU (dynamic compression Coronoid fracture 233 Cortical avulsion fracture 420 unit) 98, 108 Cortical bone 50 DDx 403 Cortical comminution 244 Death from haemorrhage 193 Corticotomy 78, 128 Deep venous thrombosis see DVT Cosmesis 70 Deformity correction 128 CPP (cerebral perfusion pressure) Degeneration 449 33 Delayed union 288, 367, 373, 526 CR 211, 212, 276, 301, 305, 309, ± definition 60 529±532, 534, 540, 541 Delayed vascular problems 520 ± technique 245 Demineralised bone matrix see DBM CRIF 422, 423 Denis classification 487, 488 Crush injury 288 Devascularisation 171, 367 Crushing 414 DFN (distal femoral nail) 153, 154, 336, 343, 345, 346, 355 DHS 159, 317, 320, 322, 323, 326±328 Diaphyseal deformity 7 ± correction 7

a Subject Index 557 Diaphysis 96, 102, 109 ± problems 256, 257 DIC (disseminated intravascular coag- DVT (deep venous thrombosis) 326, ulation) 17 338, 498 DIPJ (distal interphalangeal Dynamic compression unit see DCU Dynamic condylar screw see DCS joint) 278 Dynamisation 116, 123 ± dorsal dislocation 285 ± active axial 124 Disc prolapse 484, 485 ± controlled axial 124 Disc widening 478 ± passive 124 Discectomy 484 DISI (dorsal intercalated segment in- E Early total care see ETC 21 stability) 255, 259, 261, 263, 264 ECU (extensor carpi ulnaris) 268 Displaced fracture 313 EF (external fixation) 26, 28, 34, 38, Disseminated intravascular coagula- 68, 94, 109, 117±119, 121±125, 127, tion see DIC 144, 165, 173, 178, 220, 237, 245, Distal femoral nail (see also DFN) 343 247±251, 257, 335, 337, 346, 353, Distal femural physeal fracture 538 360, 363, 366, 372, 374, 377±380, Distal femural fracture 159, 339 382, 389±392, 414, 535, 537, 540, ± supracondylar 341 541 Distal fibular fracture 393 ± non-bridging 246 Distal humeral metaphyseal ± stiffness 120 Effendi classification 478 bone 518 Ejaculation, loss of 467 Distal humeral physeal fracture 527 Elastic flexible fixation 6 Distal humerus fracture 223, 226, Elbow deformity 525, 526 Elbow dislocation 229, 230 227, 229 Elbow fracture 231 Distal interphalangeal joint see DIPJ ± dislocation 231, 232, 235 Distal juxta-articular limb 252 Elbow injury 241 Distal metaphyseal fracture 534 Elbow instability 230 Distal physeal fracture 534 ± posterolateral rotatory 230 Distal physeal injury 541 ± valgus 230 Distal radius fracture 249, 250, 252, Elbow joint 234 ± dislocation 528 253, 255, 533 Elbow stiffness 228 Distal radius injury 270 Electromagnetic stimulation 65 Distal radius intra-articular frac- Embolisation, role of 438 Emergency operation, case for 407 ture 242, 243 Endoprosthesis 161 Distal radius osteotomy 270 Endosteal blood flow 371 Distal realignment 349 Endothelial-capillary cells 49 Distal tibial fracture 379, 380±382 Epicondyle fracture 223 Distraction osteogenesis 125, 126, Epiphyseal injury 517 Epiphysiodesis 533 128 EPL (extensor pollicis longus) 262 Distractive flexion 483 Epstein type V injury 304 Dobyns classification 259 ER (external rotation) 300, 302 Dorsal arthrotomy 251 Erythrocyte sedimentation rate Dorsal base fracture of middle pha- see ESR Erythropoietin 472 lanx 283, 284 ESR (erythrocyte sedimentation Dorsal distal radius anatomy 252 rate) 67 Dorsal intercalated segment instability see DISI Dorsal plate 252, 253 Dorsal side ligament 261 Dorsiflexion 384, 388 DRUJ 239, 240, 241, 249, 255 ± injury 267 ± instability 244, 267±270

558 Subject Index FHL (flexor hallucis longus) 77 Fibrous cartilage 431 Essex-Lopresti lesion 233 Fibrous tissue 136 ETC (early total care) 21, 22 Fibula bone defect 378 EUA (examination under anaesthe- Fibula fracture 357 Fibula, free vascularised 77 sia) 351 Fibula plating 391 Examination under anaesthesia Finger fracture 277, 286 Finger joint reconstruction 278 see EUA Finger palpating 453 Excitotoxicity 468, 469 Fishtail deformity 525 Exsanguination 27 Fixation 453 Extension casting 501 ± percutaneous 455 Extensor carpi ulnaris see ECU Flaccid paralysis 465 Extensor pollicis longus see EPL Flap 39 Extensor tendon injury 257 ± Chinese 41 Extensor tendon rupture 253 ± classification 40 Extensor tendon synovitis 253 ± coverage 40 Extensor tenolysis 287 ± definition 40 External fixation see EF ± fasciocutaneous 41 External reduction 381 ± free 39 External rotation see ER ± gastrocnemius 41, 70 Extra-articular basal transverse frac- ± local 39 ± muscle 41, 70 ture of the middle phalanx 287 ± neurocutaneous 41 Extra-articular intracapsular frac- ± random pattern 40 ± rectus 70 ture 224 ± regional 39 Extra-articular phalangeal frac- ± reverse flow 41 ± surgery 40 ture 286 Fleck sign 416 Extra-osseous blood flow 370 Flexible elastic fixation 105 Flexion deformity 365, 366 F Flexion distraction injury 488, 500 Fall prevention 546, 550 Flexor carpi radialis see FCR ± primary 550 Flexor carpi ulnaris see FCU ± programme 549 Flexor hallucis longus see FHL ± secondary 550 Flexor pollicis brevis see FPB Falling accident 464 Floating knee 542 Fat embolism 374 ± injury 334, 354 FCR (flexor carpi radialis) 265 Floating shoulder 202, 206 FCU (flexor carpi ulnaris) 270 Fluoroscopic image 174 FDS 279 Fluoroscopic stress 449 Femoral distractor 346 Fluoroscopy 409 Femoral head fracture 302±305, 446 ± Bohler angle restoration 410 Femoral head impaction injury 444 Food and Drug Administration Femoral IM nailing 34 Femoral nailing procedure 181 (FDA) 60 Femoral neck fracture 307, 309±311, Foot ± drop 456 314, 321, 437, 443, 444 ± painless 417 ± concomitant 319, 320 ± pressure distribution 422 Femoral shaft fracture 319, 320, 333, ± traction 413 ± weight distribution 421 338, 354 ± bilateral 334 Femoro-acetabular impingement 315 Femur anterior notching 146 Femur shaft fracture 535, 536 Femur supracondylar fracture 538 FGF (fibroblast growth factor) 64, 82

a Subject Index 559 Foot compartment syndrome 421, Fractured pelvis 19 423 ± associated injuries 430 ± Cx in 442 Forearm fracture 237, 241, 529, 530 ± management of 430 ± dislocation 532 Fractured sacrum 3 Forearm longitudinal instability 240 Fractured talar neck 413 Forefoot abduction 418 Fracture-specific implant 217 Forefoot equines 418 Fracture-specific plating 254 Four-point bending 100, 381 Fragile bone, porosity 163, 164 FPB (flexor pollicis brevis) 282 Fragility fracture 162 Fracture 3 Frankel's grading 466 ± alignment 175 Frankel scale 463 ± callus 51 Free radical generation 468 ± in children see child fracture FTSG (full thickness skin graft- ± comminution 331 ± configuration 115, 116, 171 ing) 39 ± definition 48 Fulkerson procedure 349 ± devitalisation 176 Full thickness skin grafting see FTSG ± dislocation 208, 210, 485, 488 ± displacement 203, 448 G ± extension 379 Galeazzi fracture dislocation 237, 532 ± fixation 32, 117, 165, 450 Gamma nail 159, 322±324 ± forearm 5 Gangliosides 472 ± ragility 10 Ganz's surgical dislocation of the ± healing 8, 88, 89, 142, 161 ± ± after plating 55 hip 307 ± intra-articular 5±7 Garden's Alignment Index 329 ± location 115 Garden's classification 309, 317 ± low energy 58 GCS (Glasgow Coma Scale) 18, 20 ± manipulation 181 Gene therapy 62, 65, 83 ± meta-diaphyseal 6 Genu valgum 347 ± missed 3, 4 Girdlestone 315, 316 ± morphology 237 Glasgow Coma Scale see GCS ± neglected 71 Glenoid fracture ± patient 7 ± extra-articular 205 ± pelvic/acetabular 8 ± intra-articular 206 ± risk 526 Glutamate 469 ± rotation 175 Glutamate receptor antagonist 472 ± scaphoid 3 Glycocalyx formation 67 ± stress 3 Goldberg classification 155 ± surgery 36 Graft incorporation 505 ± tibial 8, 59, 61 Greenstick fracture 530 ± ± shaft 57 Gross obesity 478 ± treatment 57 Ground Zero recognition 23 ± vascularisation 177 Growth 512 Fracture reduction 4, 180, 181 ± asymmetrical 512 ± intra-articular 5 ± disturbance 512 ± intraoperative 4, 9 ± partial arrest 528 Fractured acetabulum, management ± remaining 515 ± retarded child 515 of 443 ± velocity 515 Fractured clavicle 200 Growth plate injury 538 Fractured distal radius 241 Gustillo's classification 142 Fractured lateral epicondyle 527 Gustilo's open fracture classifica- Fractured medial condyle 526 tion 74

560 Subject Index ± instability 450 ± relocation 435 H ± subluxation 446 Haematuria 434 Hip fracture 159, 162, 534, 535, 547± Haemodynamics, unstable 430, 455 Haemorrhage 415 549 Haemostasis 514 ± incidence 321 HAGL (humeral avulsion of gleno- ± inter-trochanteric 319 ± prevention 319, 546 humeral ligaments) 196 ± subtrochanteric 535 ± lesion 198, 199 Hit theory, 2nd 22 Halo immobilisation 482, 483 HO (heterotropic ossification) 306, Halo traction 474 Hand dislocation 275 528 Hand fracture 275, 276 Hoffa type fracture 344 ± peri-articular 277 Hohl's classification 358, 363 Hangman's fracture 478, 479 Holstein fracture 218, 220 Hard callus 50 Hong Kong study 66 Hardware failure 379 Hotchkiss classification 232 Haversian canal 136 Howard Kenny bracing 202 Haversian remodelling 54 Humeral avulsion of glenohumeral Hawkins classification 399, 400 Hawkins and Fielding classifica- ligaments see HAGL Humeral head blood supply 209 tion 481 Humeral head subluxation 206 Hawkins' sign 402 Humeral osteotomy 197 Hawkins 1 400 Humeral shaft fracture 217, 219 Hawkins 2 401 Humerus 159 Hawkins 3 401 Humour necrosis factor 469 Hawkins 4 401 Hybrid fixator 120 Head fractures 437 ± advantages 120 Head injury, severe 17 ± disadvantages 120 Healing, slow 423 Hydroxyapatite 82, 83 Hemi-arthroplasty 164, 214±217, 310, ± coating 163 Hyperdorsiflexion 398 312±314, 329 Hyper-extended elbow 518 ± bipolar 311 Hyperextension 481, 521 ± unipolar 311 ± injury 466, 539 Hemipelvis 435 Hyperflexion 481, 521 Heterotropic ossification see HO Hypoperfusion 469 High contact pressure 347 Hypotension 465 High-dose steroid 464 Hypothermia 21, 23, 25 High energy injury 178, 351, 390 Hypotonia 465 High energy plateau fracture 359 Hypovolaemia 17 High energy trauma 8, 16, 17, 35, 38, Hypoxia 17 217, 300, 303, 333, 334, 358, 399, I 430, 464, 486, 487 Iatrogenic neural injury 501 Hill-Sachs defect 216 Iatrogenic shoulder impingement Hill Sachs lesion 196±198 Hind-foot 406 223 ± broadened 411 ICP (intracerebral pressure) 33 Hip IDDM (immunosuppressed/insulin- ± anatomy 300 ± arthroplasty 316 dependent diabetes mellitus) 19 ± dislocation 300±302, 304, 443, Ideberg classification 205, 206 445, 446 IF (internal fixation) 26, 28, 149, ± ± central 446 ± dynamic 449 150, 172, 310, 311, 313, 314, 317

a Subject Index 561 IGHL (inferior glenohumeral liga- Intra-articular fracture 88, 97, 242, ment) 200 248, 249 ± anterior band 200 Intra-articular shearing fracture 224 ± posterior 200 Intracellular sodium concentra- IL-1 31 Iliac apophysis 516 tion 469 Iliac crest 441 Intracerebral pressure see ICP 33 Iliacus muscle 430 Intramedullary hip screw see IMHS Iliolumbar ligament 431, 432 Intramedullary nails see IM nail Iliosacral screw 442 Intramembranous ossification 127 Ilizarov fixator 73 Intrinsic muscles 414 Ilizarov method 73, 124±126 IOL (interosseus ligament) 241 Ilizarov procedure 68 IOM (interosseous membrane) 77, IM device 159, 323 IM fixation 531 241, 383, 384, 395, 396 IM (intramedullary) nail 52, 55, 57, ± damage 259 ± disruption 392 62, 115, 116, 158, 159, 163, 165, Isilateral upper limb 234 173, 181, 220, 222, 326, 331, 332, IR (internal rotation) 198, 300, 307, 334±337, 364, 369, 377, 379, 380, 536, 537 309 ± infected 375, 378 Ischaemia 8 ± reamed 370 Ischial spine 435 ± rod 153 Ischial tuberosity 431 ± unreamed 370, 371 ISS 22 IMHS (intramedullary hip screw) 164 J Immune response 468 Jefferson fracture 475 Immuno-inflammatory state 21 John Hopkin's experience 67 Immunosuppressed/insulin-dependent Joint arthrosis 203 diabetes mellitus see IDDM Joint levelling 270 Immunosuppression 29 Joint stability 7 Impaction injury 307 ± restoration 7 Implant breakage 108 Joint stiffness 229, 240, 369 Implant failure 369, 379 Jones fracture 421 Implanted device 66 Jumping athlete 140 Indian Hedgehog molecule 82 Jupiter and Fernandez classifica- Indirect reduction 89 Individual fractures, manage- tion 241 ment 452 Inferior glenohumeral ligament K see IGHL Kapandji intrafocal pinning 247 Inflammatory process 468 Knee dislocation 351±353 Initial intravenous therapy 67 Knee hyperextension 347 Injury mechanism 398 Knee joint 347, 372 Injury Severity Score see ISS Knee stiffness 61 ISS (Injury Severity Score) 20 Knee trauma series 357 Interlocking 115 Kocher-Langenbeck approach 453, 454 Interosseous ligament see IOM k-wire fixation 410 Inter-trochanteric hip fracture 321, Kyle's classification 321 324, 325 Kyphoplasty 164, 486, 493±496, 503 Intra-articular bi-column frac- Kyphosis 501 ture 224 L Langenskiold procedure 516 Lateral buttress plating 361 Lateral column injury 231

562 Subject Index LT (lunotriquetral) instability 265 ± articulation tender 269 Lateral compression injury 441 ± balottement test 266 Lateral condylar prominence 526 ± compression test 266 Lateral condyle fracture 522 ± shear test 266 Lateral elbow swelling 523 LTIL (lunotriquetral interosseus liga- Lateral femoral cortex 115 Lateral plantar aponeurosis 422 ment) 262 Lateral scapula dissociation 206 Lumbar spine 487 Lateral superior geniculate artery Lumbosacral ligament 431 Lunate dislocation 260, 262 350 Lung injury 31 Lateral third fracture 203 Lunotriquetral dissociation 259 ± classification 201 Lunotriquetral interosseus ligament Lateral tibial plateau fracture 361 Lauge-Hansen classification 392 see LTIL Laurin's view 348 LC-DCP 98, 99, 103, 104, 108, 238, 239 M LCL 236 Maisonneuve fracture 392, 395 LCP (locked compression plate) 6, Maleolar osteotomy 403 Malleolus 384 103, 104, 108, 164, 166, 173, 215 ± lateral 395 ± indications 109 ± medial 384 Leap study 37 ± ± fracture 393, 387, 388 Less invasive stabilisation system see ± posterior 384 ± ± fracture 395 LISS Malunion 219, 222, 228, 239, 240, Letournel classification 445 Levator ani muscle 430 245, 287, 315, 326, 363, 364, 375, Levine classification 476 378, 532 Ligamentotaxis 171, 177, 357, 360, ± gradual corrections 73 ± tackling 70, 71 500 Mangled extremity severity index Ligamentous chance fracture 500 see MESI Limb salvage 35, 37 Mangled extremity severity score Limb vascularity 209 see MESS Limb-threatening injuries 445 MAP (mean arterial pressure) 33 Linshield procedure 270 Marginal wound 38 Lipid peroxidation 468 Marrow injection 75 Lisfranc injury 420, 421 Mason classification 232 Lisfranc ligament 416, 417 Massachusetts General Hospital ± avulsion 416 (MGH) study 352, 353, 548 LISS (less invasive stabilisation sys- Mast method 72 Mayfield stages 261 tem) 89, 105, 153, 154, 166, 173, Mayo Clinic classification 234, 235 174, 176, 339, 342, 345, 346, 355, MC (metacarpal) fracture 279 360, 363 MC base fracture 281 ± complication 106 MC head fracture 280 ± plating 104, 106, 107 MC neck fracture 279 ± screw orientation 106 Mc Queen's study 246 LLD 78, 377, 516 MC shaft fracture 280, 281 Local protective response 547, 548 McAfee classification 489 Local protective soft tissue struc- MCL (medial collateral liga- ture 547 ment) 229, 230, 356, 358, 364 Locking compression plate see LCP MCPJ (metacarpal-phalangeal Long bone fracture 28, 29, 33, 95, 102 joint) 278±280 Long skin incision 413 Low energy injury 333 L-shaped incision 409 L-shaped plate 362

a Subject Index 563 MDI (multi-directional instability) Morel-Lavallee lesion 439 199, 200 Mortality 16, 17, 430, 439 ± prevention 18, 29 Mean arterial pressure see MAP ± causes 18 Mechanical stimulus 123 ± pre-hospital 18 Medial condylar fracture 359 ± reduction 20 Medial epicondyle fracture 527 MR arthrogramm 196 Medial tarsal, shortened forefoot 418 MRA 520 Medial tightening 349 MRI (magnetic resonance imag- Melone classification 242 Membrane stabilisation 470 ing) 3, 137, 140, 210, 266, 269, Membranous urethra in female 432 272, 274, 301, 315, 348, 356, 358, Merchant's view 348 376, 399, 484, 485, 513, 514, 522, Mesenchymal cells 64 524, 527 MESI (mangled extremity severity in- ± preoperative 500 MT 414- 416 dex) 37 Multi-directional instability see MDI MESS (mangled extremity severity Multi-fragmentary fracture 225 Multi-fragmentary intra-articular frac- score) 37 ture 343 Metacarpal base articulation 278 Multiple basal MT fractures 421 Metacarpal fracture see MC fracture Multiple organ dysfunction see MODS Metacarpal-phalangeal joint see MCPJ Muscle fatigue 136 Metal marker 515 Muscle imbalance 406 Metaphyseal bending fracture 245 Muscle stripping 171 Metaphyseal comminution 245 Metaphyseal deformity 7 N Metaphyseal fracture 517 Na/K-ATPase activity 470 Metaphysis 96, 109 Nail breakage 370 Metastatic lesion 158 Naloxone 471 Metatarsal fracture 420 NASCIS (National Acute Spinal Cord Methylmethacrylate 514 Methylprednisolone 470 Injury Study) 468, 470, 471 Micro-motion 123 Navicular fracture, types 419 Milch classification 523 Navicular stress fracture 420 Minimal fracture exposure 153 Navicular tuberosity 400 Minimally invasive plate osteosynth- Neck of femur see NOF Neer's classification 207, 208, 212 esis see MIPO Nerve exploration 220 Minimally invasive technique 8, 210 Nerve injury 521 MIPO (minimally invasive plate osteo- Nerve palsy 240, 526 Neural deficit 501 synthesis) 88, 104, 105, 171±177, Neural injury 363 339, 345, 346, 360, 361, 365, 389, Neuralgia 476 391 Neurological deficit 434, 498, 499 Mirel's score 157 Neuroma 204 Mobilisation, early 449 Neuromuscular weakness 149, 154 Modern society 16 Neurovascular bundle 340 MODS (multiple organ dysfunc- Neurovascular complication 392 tion) 17, 29, 30 Neurovascular deficit 234 ± patients at high risk 30 Neurovascular injury 8, 197, 202, ± prevention 30 ± significance 30 218, 368, 386, 421, 531, 533 ± supportive therapy 30 Neutralisation plate 442 Monteggia fracture dislocation 237± Neutralisation principle 504 240, 532 New binary classification 209 Montesano classification 474 Morbidity 430

564 Subject Index 355, 390, 401, 418, 422, 423, 441, 522, 524, 529, 537, 540, 541 NGO (non-government organisa- Orthopaedic emergency 36, 401 tion) 550 Orthopaedic implant 90 ± general stages of development 90 NMDA (N-methyl-D-aspartate) 469 ± new 91 NOF (neck of femur) 319 ± traditional 91 Non-government organisation see Orthopaedic Principles ± A Resident's Guide 37, 166 NGO Orthopaedic trauma 20 Non-union 60, 71, 115, 116, 129, 204, Orthopaedic Trauma Association (OTA) 74 219, 222, 228, 239, 240, 273, 274, 288, Orthosis 476 326, 363, 367, 375, 377, 476±478, Os calcis 407, 410, 414 522, 532 ± fractures 406, 411 ± atrophic 61 Os trigonum 398 ± causes 60, 62 Ossification, heterotopic 456 ± classification 61 Osteoarthritis 255 ± definition 60 Osteoarthritis see OA ± hypertrophic 61 Osteoblast 50 ± infection 63 Osteochondral flap replacement 350 ± mechnical 63 Osteochondral fractures 413 ± painful 256, 257 Osteochondral injury 349 ± septic see septic non-union Osteochondritis dissecans see OCD Normal saline (NS) irrigation 74 Osteoclast 50 NSAID 376 Osteoconduction 79 Nutrient artery 77, 128 Osteogenesis 51, 58 Osteogenicity 79 O Osteoinduction 79 OA 227, 263, 264, 271, 321, 456 Osteology 382, 397 Occipitocervical dislocation 474 Osteolysis 146, 149, 152, 154 Occipitocervical instability 474 Osteomalacia 502 OCD (osteochondritis dissecans) 412 Osteomyelitis 402 Odontoid C2 fracture 476, 477 Osteonecrosis 136, 302, 303 Odontoid fracture 479, 503 Osteopenia 146 Odontoid screw 477 ± plate-related 52 Oesophagus rupture 193 Osteoporosis 136, 149, 152, 154, 162, Old implant 147 166, 310, 339, 477, 478, 492, 502, Olecranon 110 548, 551 ± fracture 234±236 ± prophylaxis 10 ± injury 523 ± treatment 10 ± osteotomy 226, 228 Osteoporotic bone 6, 106, 107, 109, Open fracture 202, 359, 368, 408 147, 164, 213±215, 226, 251, 327, ± type III 144, 145 342, 365, 396, 499, 503 ± wound closure 145 Osteoporotic fracture 80, 161, 162, 343 Open pelvic fracture, aspects of treat- Osteoporotic pilon 397 Osteoporotic population, elderly 486 ment 439 Osteoporotic vertebral collapse 495 Open reduction and internal fixation Osteoporotic vertebral fracture 493, 494 see ORIF Osteoprogenitor cells 79 Open surgery 199, 391 Osteosynthesis 61, 103, 165 Operation timing 407 Operative approach, choice 409 ORIF (open reduction and internal fixation) 53, 55, 56, 149, 155, 175, 203, 206, 212, 214, 222, 228, 232, 233, 249, 256, 274, 277, 280, 283±285, 302, 303, 305, 306, 309, 319, 341, 351,

a Subject Index 565 Osteotomy 72, 73, 78, 98, 129, 400, Penicillin, synthetic 143 533 Penile erection, loss of 467 Percutaneous pinning 212 OTA 314 Peri-articular fracture 90 Oxygenation 462 Perilunate dislocation 258, 260, 261 Periosteal reaction 49 P Periosteal stripping 171 Paediatric fracture of the lower ex- Periosteum 216 Periostitis 137 tremity 534 Peripheral vascular disease see PVD Paediatric patient 238 Periprosthetic fracture 146, 147, 151, Paediatric spinal injury 542 Pain 152, 221, 223 ± chronic 440 Peroneal nerve injury 176, 352 ± level 158 Peroneus longus 414 Paley's method 72 ± tendon 417 Palmar side ligament 260 Persistent subluxation 239 Panjabi and White criteria 482 PFJ (patellofemoral joint) 106, 347 Papineau technique 74 PFN (proximal femoral nail) 164, Paraparesis 470 Patella 139 324±326 ± alta 347 Physeal bar excision 533 ± dislocation 347, 349, 351 Physeal injury 515 ± dysplasia 347, 348 ± multifocal 515 ± eversion 148 ± unifocal 515 ± fracture 155, 350, 539 PIIS (posterior inferior iliac ± implant 155 ± quadriceps 139 spine) 430 ± tendon 139, 156 Pilon fracture 385, 386, 389 Patellofemoral joint see PFJ PIN (posterior interosseus Pathologic bone 71, 310 Pathological fracture 156, 157, 159 nerve) 533 Pathomechanics 201 Pin-bone interface 124 Patterson method 529 Pinning man<fluvre 521 PC-Fix 102±104, 238 Pin-rod fixator 119 PCL (posterior cruciate liga- ± advantages 119 ± disadvantages 119 ment) 344, 354 Pin track Pedicle graft 75 ± Cx 130 ± muscle 75 ± infection 165 ± vascularised 75 PIPJ (proximal interphalangeal Pedicle screw 165, 499, 501 Pelvic brim 487 joint) 278±280 Pelvic C-clamp 26, 27 ± fracture dislocation 283±285 Pelvic floor 432 Pipkin type I 305, 306 Pelvic fracture 24, 25, 440 Pipkin type II 305, 306 ± acute phase 34 Pipkin type III 305, 306 ± mortality 24 Pipkin type IV 305, 306 Pelvic injury 441 Piriformis fossa 332, 536, 538 Pelvic packing 27, 28 Plantar ecchymosis 417 Pelvic sling and binder 26 Plantar fascia 414 Pelvis Plastic deformity 530 ± local examination 434 Plate-screw construct 94 ± screw insertion 450 Plate-style system 490 ± sources of bleeding 437 PLC (posterolateral complex) 354 ± X-ray 435 PLL (posterior longitudinal liga- ment) 486, 487 ± rupture 500

566 Subject Index Proximal interphalangeal joint see PIPJ PMMA (polymethyl methacry- late) 143 Proximal row carpectomy see PRC Proximal tibia fracture 175, 176, 364, Pneumothorax 193, 201 PMN (polymorphonucleocyte) 116 365, 367 Polydioxanone (PDS) 131 PRUJ 239±241, 256, 258 Polyglycolic acid (PGA) 130 ± dislocation 532 Polylactic acid (PLA) 130, 131 Pseudarthrosis 98, 129, 377 Polymethyl methacrylate see PMMA PSI (predictive salvage index) 37 Poly-trauma 32, 33, 368 PSIS (posterior superior iliac ± patient 4, 334, 337 ± in young patients 300 spine) 430 Popliteal artery 352 Ptosis of ipsilateral shoulder 204 Position of impact 547 Pulled elbow 528 Posterior annulus 486 Pulmonary injury 32, 34 Posterior column 454 Pulsatile lavage 143 Posterior cruciate ligament see PCL PuttiPlate 197 Posterior iliac crest 431 PVD (peripheral vascular disease) 63 Posterior interosseus nerve see PIN Posterior longitudinal ligament see Q Quadratus femoris 303 PLL Quadriparesis 476 Posterior lumbar fixation 490 Posterior tuberosity fracture 403 R Posterolateral complex see PLC RA 149, 152, 266 Posteromedial comminution 325 Radial head fracture 232 Postoperative radiograph 221, 236 Radial head subluxation 240 Post-traumatic complication 117 Radial neck fracture 529 Pott's fracture 392, 396, 397 Radial nerve injury 219 Power's ratio 474 Radial nerve palsy 8 PRC (proximal row carpectomy) 263, Radiation exposure 179 Radiocapitellar articulation 229 275 Radiocarpal joint see RCJ Predictive salvage index see PSI Radiolunate articulation 241 Pregnancy 19 Radioscaphoid articulation 241 Pressure necrosis 396 Radioscapholunate ligament see RSL Primary closure, contraindica- Radio-ulnar ligament see RUL Range of motion see ROM tions 38 RCJ (radiocarpal joint) 255 Primary fracture lines 405 ± dislocation 247 Pronation abduction 392 RCT (random clinical trials) 454 ± injury 394 RDS (respiratory distress syn- Pronation ER injury 394 Prophylactic fasciotomy 353 drome) 253 Prophylactic surgery 157 Reaming 115, 117 Prostaglandin 469 Rectum 430 Prostate 435 Reduction manoeuvre 192 Proximal bony deformity 336 Reflex sympathetic dystrophy see RSD Proximal carpal row 258 Regan Morrey classification 233 Proximal femoral nail see PFN Regan type 3 fracture 231 Proximal femur 445 Renal failure (RF) 69 ± fracture 164 Respiratory distress syndrome see Proximal fibula fracture 393 ± PE type 395 RDS ± SE type 395 Respiratory rate (RR) 18 Proximal humerus fracture 177, 207, Retrograde femoral nail 340 210, 212, 215, 216

a Subject Index 567 Retrograde nailing 159, 221 Scapholunate advanced collapse see Revascularisation 8 SLAC Revision arthroplasty, two-stage 315 Rheumatoid arthritis 146 Scapholunate dissociation 259 Rib, 1st 430 Scapholunate instability 258 Ring fixator 120 Scapholunate interosseus ligament see ± advantages 120 ± disadvantages 120 SLIL Rockwood classification 193 Scapula fracture 205, 430 Rod-style system 490 ± classification 204 Rolando fracture 282 Schanz pins 39 ROM (range of motion) 7, 222, 251, Schanz screw 117, 118, 120, 121, 122, 402 163 ± restoration 7 Schatzker classfification 358 Rorabeck classification 152 Schatzker-Schmeling classifica- Rotation alignment 391 Rototional deformity 287 tion 235 Rotational displacement 242 Sciatic nerve 431 Rotational malalignment 520 ± palsy 456 Rotatory subluxation 480 SCIWORA (spinal cord injury without Roux-Goldthwait procedure 349 Roy Sanders' classification 405 obvious radiological abnormal- ± usefulness 406 ity) 542 RSC 274 Scoliosis surgery 67 RSD (reflex sympathetic dystro- Screw 404 ± cancellous 92, 93 phy) 249, 257 ± cannulated 93 RSL (radioscapholunate liga- ± cortical 92 ± fixation 409 ment) 260 ± head 91 Ruedi and Allgower classifica- ± iliosacral 440 ± machine-type 93 tion 385 ± monocortical 109 RUL (radio-ulnar ligament) 268 ± percutaneous 440 Russell-Taylor classification 330, 332, ± Schanz 94 ± shaft 91 335 ± thread 92 ± wood-type 92, 93 S Screw position guide 329 Sacral reflex loss 467 Secondary brain injury 33 Sacroilial joint see SIF Self-tamponade 437 Sacrospinous ligament 432 Sepsis 75, 173, 178, 204, 211, 228, Sacrotuberous ligament 430, 432 273, 324, 336, 374, 375, 391, 411, Sacrum 435 423, 495, 501 Salter-Harris type 1 534 Septic non-union 68 Salter-Harris type 2 523, 534, 541 ± diagnosis 69 Salter-Harris type 3 541 ± local factors 69 Salter-Harris type 4 541 ± systemic factors 69 Salvage surgery 89, 90 ± treatment 69 Sarmiento brace 219 Severe chest injury 32 Sarmiento study 57, 369 Severe head injury 33, 34, 338 SBP (systolic blood pressure) 18, 20 Severe limb injury 35, 37 Scaphoid fracture 273 Severe pulmonary injury 338 ± acute 274 Severe trauma 21 Scaphoid injury 271 Shallow trochlea 350 Scaphoid non-union with advanced Sharp bony spike impinging 340 Shenton's line of the ankle 387 carpal collapse see SNAC

568 Subject Index ± function 462 ± injury 464, 468 Shock monitoring 438 ± ± without obvious radiological ab- Short neck 478 Shortening 536, 537 normality see SCIWORA Shoulder 194 ± syndrome 467 ± dislocation 195 ± ± incomplete 466 ± fracture 210 Spinal fixation 504 ± impingement 194 Spinal fusion cage 492 ± instability 195 Spinal shock 169, 463, 465 ± rehabilitation 197 Spine-injured patient 462 ± stability 198 Spine surgery 66 Shoulder girdle protraction 204, 206 Spinous process 463 SI ligament 431 Split skin grafting see SSG SIF (sacroilial joint) 27 Spondylolisthesis of axis, trau- Sigmoid notch 241 SIJ 430 matic 478 ± dislocation 435 Sports 195 ± subluxation 432, 435, 440 Spur sign 446 Siliski classification 352 SRS (skeletal repair system) 164 Singh Index 308 SSG (split skin grafting) 39, 68 SIRS (systemic inflammatory re- SSSC (superior suspensory shoulder sponse) 29, 30 complex) 206 Skeletal repair system see SRS ST 76, 414 Skeletal stabilisation 144 STARS study from Edinburgh 314 Skeletal traction 441 Stellate bruise 417 Skin coverage 76 Stellate fracture 351 Skin impingement 202 Sternoclavicular joint 192 Skin necrosis 391, 402 ± dislocation 192 SL instability 263, 264 Steroid 502 SLAC (scapholunate advanced col- Steroid infusion 470 Steroid therapy, high dose 471 lapse) 263, 265 Stimson method 301 SLIL (scapholunate interosseus liga- Strain theory 88 Stress 409 ment) 261, 262 ± reaction 137 Smoking 376, 408 ± riser 146 SNAC (scaphoid non-union with ad- Stress fracture 136, 141, 421, 423 ± categories 138 vanced carpal collapse) 272 ± chronic 139 ± wrist 275 ± high-risk 138 Snow-boarder's injury 399 ± hormonal factors 136 Sodium channel blocker 472 ± treatment 138 Soft callus 49 ± women 136 Soft tissue Sub-axial cervical spine injury 481 ± coverage 145 Subchondral articular fragment 254 ± Cx 130, 423 Subscapularis 213 ± defect 378 Subtrochanteric fracture 158, 330, 333 ± dissection 153, 179, 391 Successful resuscitation 31 ± injury 7, 356, 389, 396 Superior labral anterior posterior ± status 415, 446 ± structure 192 (SLAP) lesion 131, 196 ± swelling 397 Superior suspensory shoulder complex ± trauma 36, 173, 174 Spinal cage 505 see SSSC Spinal canal penetration 490 Superior vena cava laceration 193 Spinal column 462 Supination ER injury 392, 394 Spinal cord

a Subject Index 569 Supracondylar fracture, sequelae 525 TGF-˜ 64, 82 Supracondylar humerus fracture in THA (total hip arthroplasty) 312 Thermal necrosis 370, 372 children 517, 519 ± prevention 373 Supracondylar towel bumps 346 Thomas splint 334, 335 Supra-syndesmotic area 384 Thompson prosthesis 312 Surgery Thoracic outlet syndrome 193 ± benefactors 408 Thoracic spine 486, 490 ± goal of 407, 413 Thoracolumbar fracture 486, 489 Surgical navigation 440 Thoracolumbar spine fracture 503 Surgical principles 158 Thoracolumbosacral orthosis Surgical trauma 179 Sustentaculum area 404 see TLSO Swelling 386, 418 Thoracotomy 502 Syndesmosis 385, 394, 395 THR 116, 147, 149, 150, 159, 164, Synostosis 239, 240 Synovial stripping 200 301, 310, 311, 313±315, 324, 329 Systemic inflammatory response see ± implant 336 Three-part fracture 213, 214 SIRS Thumb base fracture 281 Systolic blood pressure see SBP ± extra-articular 282 Thumb injury 277 T Thumb loss 277 TAD (tip-apex distance) 329 Thumb MC shaft fracture 283 Tai Chi 162 Ti-Al-Niobium alloy 343 Talar head fractures 403 Tibia 7, 140, 141, 147 Talar neck fracture 397, 398 ± bone defect 378 Talar neck osteotomy 402 ± fracture 372, 373, 539, 540 Taleisnik classification 259 ± ± intra-articular 354 Talonavicular joint see TNJ ± ± type IIIB 39 Talus 405, 412 Tibial comminution 384 ± fracture 397 Tibial nerve injury 353 Tamponade 309 Tibial plafond fracture 382 TARPO (trans-articular approach with Tibial plateau fracture 94, 96, 356, percutaneous plating for intra- 357, 385, 390 articular fractures) 172 Tibial shaft fracture 367±369, 371, Taylor spatial frame 73 TBW (tension band wiring) 110, 212, 540 286 Tibial tubercle 155 T-condylar-like fracture 528 ± fracture 540 TDW (touch-down weight-bear- ± osteotomy 148 ing) 149 Tibialis anterior tendon 417 TEA (total elbow arthroplasty) 227, 228 Tibilas posterior artery 383 Tenodesis 265 Tibiocalcaneal fusion 403 Tension band principle 110, 504 Tibio-fibular synostosis 75 Tension band wiring see TBW Tiles' B1 fractures 440 Terry Thomas sign 264 Tiles' B2 fractures 440 Texas Scottish Rite Hospital see TSRH Tiles' C fractures 440 TFC 268 Tiles' classification 25, 432, 434 TFCC (triangular fibrocartilage com- Timing of operation 407 plex) injury 244, 248, 256, 257, Tirilazad mesylate 471 267, 271 Titanium 6, 505 ± injury 268, 269 TKR (total knee replacement) 107, TFN (trochanteric fixation nail) 325, 326 147, 148, 152±155, 339, 350, 355, 356, 363, 364 TLJ fracture 489

570 Subject Index U Ulna impingement 256, 257 TLSO (thoracolumbosacral ortho- Ulna nerve 226 sis) 493, 503 Ulna neuritis 228 Ulna styloid 256, 257 TMT 418 ± fracture 269, 270 TNJ (talonavicular joint) 398, 399 Ulna translocation 266 Tomogram 516 Ulnohumeral articulation 229 Total arthroplasty 310 Ulno-humeral axis injury 233 Total elbow arthroplasty see TEA Undisplaced fracture 313 Total hip arthroplasty see THA University of Pennsylvania 23 Total knee replacement see TKR University of Southern California Touch-down weigth-bearing 149 Tourniquet 373 (USC) 59 Trabeculae 308, 317, 404 Upper extremity injury 517 Trabecular bone 492 Upper limb bone 207 Tracheo-oesophagel fistula 193 Urbaniak's vascular fibula graft 77 Transarticular screw 477, 503 Urethra 438 Transchondral fracture 302 ± coccyx 430 Transcranial Doppler 34 ± injury 435 Translational injury 501 ± membranous 432 Transverse ligament rupture 475, Use of robotics 9 479 V Transverse tibio-fibular ligament 383 Vagina 430 Trapezial erosion 273 Valgus angulation 364, 380 Trauma Valgus deformity 365 ± protective mechanisms against 48 Valgus-impacted four-part frac- Trauma centre 16, 18±20 Trauma life support 18 ture 216 Trauma score 16, 18 Valgus osteotomy 322 ± revised 19 Vancouver classification 149 Trauma triage 16 Varus angulation 405 ± over-triage 17 Varus collapse 318, 344 ± under-triage 17 Varus/valgus alignment 346 Triangular fibrocartilage complex Varus/valgus malalignment 520 Vascular endothelial growth factor see see TFCC Trigonum 403 VEGF Triplane fracture 541 Vascular injury 201, 213, 352, 353, Triple arthrodesis 402 Trochanter 446 359, 539 ± fracture 151, 327 Vascular insult 519 Trochanteric fixation nail see TFN Vascular permeability 469 Trochanteric osteotomy 451 Vascularised bone graft see VBG Trochanteric stabilisation plate 322, Vascularity 61, 201, 375, 378, 422 ± altered 55 323, 328 ± impairment 101 Trochlea 525 ± insufficient 62 Trochlea dysplasia 347 Vastus lateralis muscle 345 True axial artery 40 VBG (vascularised bone graft) 69, TSRH (Texas Scottish Rite Hospital) 274 instrumentation treatment 66 VEGF (vascular endothelial growth Tuberosity 208, 214, 409, 410, 421 ± fracture 211 factor) 126 ± fragment 405 Venous anastomosis 38 Tumour deposits in bone 156 Venous plexus 24 Tumour necrosis factor 31 Venturi principle 142 Tumour recurrence 161

a Subject Index 571 Vertebra 462, 463, 494 Wedge compression fracture 492, Vertebral fracture 161, 162, 493 493 Vertebroplasty 164, 486, 492±496, Weight-bearing see WB 503 Winquist classification 334 Vertical compression 482 Wound 434 Vessel dilatation 472 ± necrosis 411 Virtual depth gauge 182 Wrist fracture 162 Virtual fluoroscopy 8, 9, 174, 175, X 179±182 X-ray 5, 36, 49, 137, 140, 141, 148, VISI (volar intercalated segment insta- 180, 192, 196, 199, 202, 206, 211, bility) 255, 259, 261, 265, 266 215, 244, 264, 266, 271, 272, 276, VMO fibres 349 280, 281, 317, 318, 337, 351, 353, Volar base fracture of middle pha- 376, 385±387, 396, 400, 416, 477, 480, 497, 499, 507, 513, 516, 522, lanx 283, 284 530 Volar intercalated segment instability ± iliac oblique 447 ± intraoperative 262 see VISI ± obturator oblique 447 Volar plating 251 ± postoperative 6, 7 ± screening 231, 234, 410 W ± standard-AP 447 Waddell/Fraser classification 354 ± traction 225 Ward triangle 308 Warner's method 200 Y WB (weight-bearing) 115, 119, 127, Young/Burgess classification 24, 25 Youngs' classification 432 161, 308, 381, 403, 449 ± stress 383 Weaver-Dunn procedure 204 Weber classification 392