Manual of Internal Fixation (2^nd Ed., Softcover reprint of the original 2nd ed. 1979)
Techniques Recommended by the AO Group

The first part of this manual deals with the experimental and scientific basis and the principles of the AOjASIF method of stable internal fixation. It deals with the function and main use of the different AO implants, the use of the different AO instruments, and with the essentials of the operative technique and of postoperative care. It also discusses the handling of the most important postoperative complications. The second part deals at length with the AO recommendations for the operative treatment of the most common closed fractures in the adult. This has been organized in anatomical sequence. The discussion of the closed fractures is followed by a discus­ sion of open fractures in the adult, then by fractures in children and finally by pathological fractures. The third part presents, in a condensed fashion, the application of stable internal fixation to reconstructive bone surgery. 1 GENERAL CONSIDERATIONS 1 Aims and Fundamental Principles of the AO Method The Chief Aim of Fracture Treatment is the Full Recovery of the Injured Limb In every fracture there is a combination of damage to both the soft tissues and to bone. Immediately after the fracture and during the phase of repair, we see certain local circulatory disturbances, certain manifestations of local inflammation, as well as pain and reflex splinting. These three factors, that is, circulatory disturbances, inflammation and pain, when combined with the defunctioning of bone, joints and muscle, result in the so-called jl'acture disease.

General Considerations.- 1 Aims and Fundamental Principles of the AO Method.- 1.1 Aims of the AO Method.- 1.2 Basic Principles of the AO Method.- 1.2.1 Histology of Bone Healing in the Presence of Stable Internal Fixation.- 1.2.2 Bone Reaction to Compression.- 1.2.3 Bone Reaction to Movement.- 1.2.4 Reaction of Bone to Metallic Implants.- 1.2.5 Documentation.- 1.2.6 Surgical Bone Instruments.- 1.3 Principles of the AO Method.- 1.3.1 Inter-fragmental Compression.- 1.3.2 Splinting.- 1.3.3 Combination of Inter-fragmental Compression and Splinting.- 2 Means by Which Stable Internal Fixation is Achieved.- 2.1 Lag Screws.- 2.1.1 Cancellous Lag Screws.- 2.1.2 Cortical Screws.- 2.1.3 Technique of Screw Fixation.- 2.1.4 Orientation of Cortical Screws.- 2.2 Dynamic Compression with the Tension Band.- 2.2.1 Tension Band Wires.- 2.2.2 AO Wire Tightener.- 2.2.3 Combination of Tension Band Wire and Kirschner Wires.- 2.3 Standard AO Plates Grouped According to Shape.- 2.3.1 Straight Plates.- 2.3.1.1 Round Hole Plates.- 2.3.1.2 Tubular Plates.- 2.3.1.3 Dynamic Compression Plates (DCP).- 2.3.2 Special Plates.- 2.3.3 Angled Plates.- 2.3.4 Mini-Implants and Mini-Instruments.- 2.4 Intra-medullary Nailing.- 2.4.1 AO Intra-medullary Nails.- 2.4.2 AO Intra-medullary Reamers.- 2.4.3 Technical Complications of Intra-medullary Reaming.- 2.4.4 AO Insertion Assembly for the Tibial and Femoral Nails.- 2.4.5 Complications of Nail Insertion.- 2.4.6 Technique of Open Intra-medullary Nailing of the Tibia.- 2.4.7 Technique of Open Intra-medullary Nailing of the Femur.- 2.4.8 Femoral Distractor.- 2.4.9 Closed Intra-medullary Nailing of the Tibia and Femur.- 2.5 External Fixators.- 2.5.1 Instrumentation.- 2.5.2 Correction of Rotational Alignment with the External Fixator.- 2.5.3 External Fixator and Compression.- 2.6 Composite Internal Fixation.- 3 Preoperative, Operative and Postoperative Guidelines.- 3.1 Organizational Prerequisites.- 3.2 Priorities in the Assessment and Treatment of Injuries.- 3.3 Timing of Surgery.- 3.4 General Guidelines for Operative Procedures.- 3.4.1 Planning.- 3.4.2 Preparation of the Operative Field.- 3.4.3 The Operation.- 3.4.4 Autologous Cancellous Bone Grafts.- 3.4.5 Wound Closure.- 3.4.6 Release of the Tourniquet.- 3.5 Postoperative Positioning and Treatment.- 3.5.1 Guidelines for Weight Bearing.- 3.5.2 Secondary Plaster Fixation.- 3.5.3 Education of the Patient.- 3.5.4 Prophylactic Antibiotics.- 3.5.5 Prophylaxis of Thromboembolism.- 3.5.6 Radiological Follow-Up of Bone Healing.- 3.6 Removal of Implants.- 3.6.1 Timing of Implant Removal.- 3.6.2 Technique of Metal Removal.- 3.6.3 Safeguards After Metal Removal.- 3.7 Postoperative Complications.- 3.7.1 Haematomas.- 3.7.2 Postoperative Pain.- 3.7.3 Infections.- 3.7.4 Refractures.- 3.8 Plate Fractures.- 3.8.1 Removal of Broken Screws.- 3.8.2 Removal of Broken Intra-medullary Nails.- Special Part.- Internal Fixation of Fresh Fractures.- 1 Closed Fractures in the Adult.- 1.1 Fractures of the Scapula.- 1.2 Fractures of the Clavicle.- 1.3 Fractures of the Humerus.- 1.3.1 Proximal Humerus.- 1.3.2 Fractures of the Shaft of the Humerus.- 1.3.3 Distal Extra-articular Metaphyseal Fractures (Type A).- 1.3.4 Distal Intra-articular Fractures of the Humerus.- 1.4 Fractures of the Forearm.- 1.4.1 Fractures of the Olecranon.- 1.4.2 Fractures of the Radial Head.- 1.4.3 Fractures of the Shaft of the Radius and Ulna.- 1.4.4 Fractures of the Distal Radius.- 1.5 Hand Fractures.- 1.6 Acetabular Fractures.- 1.6.1 Surgical Approaches.- 1.6.2 Diagnosis of Acetabular Fractures.- 1.6.3 Classifications of Acetabular Fractures.- 1.6.4 Surgical Technique.- 1.6.5 Postoperative Care.- 1.7 Fractures of the Femur.- 1.7.1 Fractures of the Proximal Femur.- 1.7.2 Fractures of the Femoral Shaft.- Comminuted and Badly Comminuted Subtrochanteric Fractures.- 1.7.3 Fractures of the Distal Femur (Metaphyseal and Transcondylar Fractures).- 1.8 Fractures of the Patella.- 1.8.1 Tension Band Fixation of Patellar Fractures.- 1.8.2 Fixation of Patellar Fractures Using Two Kirschner Wires and a Tension Band.- 1.8.3 Postoperative Care.- 1.9 Fractures of the Tibia.- 1.9.1 Fractures of the Tibial Plateaus.- 1.9.2 Fractures of the Tibial Shaft.- 1.10 Malleolar Fractures.- 1.10.1 Malleolar Fractures Type A.- 1.10.2 Malleolar Fractures Type B.- 1.10.3 Malleolar Fractures Type C.- 1.11 Fractures of the Foot.- 1.12 Fractures of the Spine.- 2 Open Fractures in the Adult.- 3 Fractures in Children.- 3.1 Epiphyseal Plate Fracture Separations.- 3.2 Fractures of the Humerus.- 3.3 Fractures of the Radius and Ulna.- 3.4 Fractures of the Femur.- 3.5 Fractures of the Tibia.- 3.6 Malleolar Fractures.- Supplement.- Reconstructive Bone Surgery.- 1 Delayed Union.- 2 Pseudarthroses.- 2.1 Non-infected Pseudarthroses.- 2.1.1 Pseudarthroses of the Arm.- 2.1.2 Pseudarthroses of the Leg.- 2.2 Previously Infected Pseudarthroses, Closed Pseudarthroses and Pseudarthroses with Bone Loss.- 2.3 Infected Pseudarthroses.- 3 Osteotomies.- 3.1 Osteotomies of the Arm.- 3.2 Osteotomies of the Leg.- 3.2.1 Intertrochanteric Osteotomies.- 3.2.2 Osteotomies of the Femoral Shaft.- 3.2.3 Supracondylar Osteotomies.- 3.2.4 High Tibial Osteotomies.- 3.2.5 Osteotomies of the Tibial Shaft.- 3.2.6 Supramalleolar Osteotomies.- 4 Arthrodeses.- 4.1 Arthrodesis of the Shoulder.- 4.2 Arthrodesis of the Elbow and Wrist.- 4.3 Arthrodesis of the Hip with the Cobra Plate (R. Schneider).- 4.4 Arthrodesis of the Knee.- 4.5 Arthrodesis of the Ankle.