During their 20 years of activity members of the Associa� tion for the Study of Internal Fixation (AO - ASIF) have made authoritative contributions to the development of internal and external fixation. The close collaboration of surgeons, basic researchers, metallurgists, engineers and the establishment of clinical documentation has made it possible to achieve a solid scientific basis for internal fixa� tion. Clear definitions for the standardization of different types of osteosynthesis were possible: interfragmentary compression, splintage and buttressing as well as combina� tions of these three techniques. At the same time a scienti� fic and workmanlike instrumentation was developed. The idea was to keep diversification within limits but, however, to assemble a comprehensive collection of implants and in� struments to answer all the problems presented by the com plexity of bone operations. Osteosynthesis is a difficult and demanding operative method. Its. claims on the surgeon and the theatre staff are high. Therefore plans have existed for a long time to supplement the "Manual of Internal Fixation" with a de� tailed description of the AO Instrumentation, its use and maintenance. Our collaborator FRIDOLIN SEQUIN, graduate engineer, has accomplished this task with expert knowledge. He has organized over many years courses for theatre nurses and has been able from the resulting experience to provide helpful suggestions. When RIGMOR TEXHAMMAR R. N. joined AO-International four years ago, it was natural to include her as a co-author.

Contenuti

I Medical and Scientific Directives.- 1 The Origin and the Goals of the AO.- 2 Bone Heahng.- 3 Successful Internal Fixation.- 4 Failures Following Internal Fixation.- 5 Indications and Goals of Internal Fixation.- 6 Documentation.- II Principles of the AO (ASIF)-Technique and Basic Mechanical Principles.- The Principles of the AO (ASIF) Technique.- 1 Interfragmental Compression.- 1.1 Static Interfragmental Compression.- 1.1.1 Static Compression with External Fixators.- 1.1.2 Static Compression with Lag Screw.- 1.1.3 Static Compression with Plates.- 1.2 Dynamic Compression with the Tension Band.- 2 Splinting.- 2.1 Splints with Load-Bearing Function.- 2.2 Splints without Load-Bearing Function.- 3 Combinations.- 3.1 Lag Screw and Neutralization Plate.- 3.2 Lag Screw and Buttress Plate.- 3.3 Lag Screw and Tension Band Plate.- 3.4 Kirschner Wires and Tension Band Wire.- III Practical Part.- A Instrumentation of the AO/ASIF.- 1 Classification of AO Instruments.- 1.1 Standard Instrument Sets.- 1.2 Additional Necessary Instruments.- 1.3 Special Supplementary Instruments.- 2 Materials Used in AO Instruments and Implants.- 2.1 Metal for Implants.- 2.2 Metal for Instruments.- 3 Instruments for the Screw and Plate Fixation of Large Bones.- 3.1 Basic Instrument Set.- 3.1.1 Standard Instruments.- 3.1.2 Additional Necessary Instruments.- 3.1.3 Special Supplementary Instruments.- 3.2 Screw Set.- 3.2.1 Large AO Screws.- 3.2.2 Use of Screws as Lag Screws (static interfragmental compression).- 3.2.3 Screws for Plate Fixation.- 3.3 The Plate Set.- 3.3.1 Classification of Plates.- 3.3.2 Design Principles of Various Plates.- 3.3.3 Applications of the Plates.- 3.3.4 Use of the Dynamic Compression Plate.- 3.3.5 Use of the Round-Hole Plates.- 3.3.6 Use of the Semitubular Plates.- 3.3.7 Use of the Special Plates (Contoured Plates).- 3.3.8 Bending Instruments.- 3.3.9 Bending and Twisting of Plates.- 4 Instrument Set for Angled Blade Plates.- 4.1 Instruments for Angled Blade Plates.- 4.1.1 Standard Instruments.- 4.1.2 Additional Necessary AO/ASIF Instruments.- 4.1.3 Special Supplementary Instruments.- 4.2 Angled Blade Plates.- 4.2.1 Design.- 4.2.2 Four Main Types of Angled Blade Plates.- 4.3 Use ofthe Angled Blade Plates.- 4.3.1 130� Angled Blade Plates on the Proximal Femur.- 4.3.2 Condylar Plates on the Proximal Femur.- 4.3.3 Condylar Plates on the Distal Femur.- 4.3.4 Osteotomy Plates.- 5 Small Fragment Set.- 5.1 Size Ranges of Small Fragment Instruments and Implants.- 5.2 Instruments for Small Screws and Plates (4.0–3.5–2.7 mm dia.).- 5.2.1 Standard Instruments for Small Screws and Corresponding Plates.- 5.2.2 General Instruments of the Small Fragment Set.- 5.2.3 Additional Necessary Instruments.- 5.2.4 Special Supplementary Instruments.- 5.3 Implants of the “3.5”-Group.- 5.3.1 Small AO/ASIF Screws.- 5.3.2 Small Plates.- 5.3.3 Use of 4.0- and 3.5-mm Screws as Lag Screws.- 5.3.4 Use of the Plates with 3.5-mm (and 4.0-mm) Screws.- 5.4 Implants of the “2.7”-Group.- 5.4.1 Screws.- 5.4.2 Plates for the 2.7-mm Cortex Screws.- 5.4.3 2.7-mm Cortex Screw as Lag Screw.- 5.4.4 Use of the Plates with 2.7-mm Screws.- 5.4.5 Screw-Drill Bit-Tap.- 5.5 Mini Instruments.- 5.5.1 Mini Instruments for 2.0- and 1.5-mm Cortex Screws and Corresponding Plates.- 5.5.2 Special Supplementary Instruments.- 5.6 Mini Implants.- 5.6.1 Mini Screws (2.0 and 1.5 mm dia.).- 5.6.2 Use of 2.0- and 1.5-mm Mini Cortex Screws as Lag Screws.- 5.6.3 Mini Plates for 2.0-mm Cortex Screws.- 5.7 Use of Mini Implants on Bones of the Hand and Foot.- 5.8 Number of Engaged Cortices in Small Bones (During Plating).- 6 Instrument Set for Removal of Broken Screws.- 6.1 Instruments.- 6.2 Use of the Instruments.- 6.2.1 Demaged Hexagonal Screw Socket.- 6.2.2 Broken Screw Head.- 6.2.3 Broken Cancellous Bone Screw or Malleolar Screw.- 7 Medullary Instrument Set.- 7.1 Medullary Instruments.- 7.1.1 Instruments for Medullary Reaming.- 7.1.2 Instruments for the Insertion and Extraction of Medullary Nails.- 7.1.3 Additional Necessary Instruments.- 7.1.4 Special Supplementary Instruments.- 7.2 AO/ASIF Medullary Nails.- 7.3 Medullary Nailing.- 7.3.1 Technique of Medullary Nailing of the Tibia.- 7.3.2 Technique of Medullary Nailing of the Femur.- 7.4 Removal of the Medullary Nail.- 7.4.1 Medullary Nail Removal in the Tibia and Femur.- 7.4.2 Useful Hints.- 7.5 Removal of Broken Medullary Nails.- 8 Wire Instrument Set.- 8.1 Instruments and Implants.- 8.1.1 Standard Instruments.- 8.1.2 Implants.- 8.1.3 Special Supplementary Instruments.- 8.2 Cerclage Wiring.- 8.3 Tension-Band Wiring.- 8.3.1 Tension-Band Wiring ofthe Patella.- 8.3.2 Tension Band Wiring ofthe Olecranon.- 9 External Fixators.- 9.1 External Fixators (Tubular System).- 9.1.1 Instruments and Implants.- 9.1.2 Use ofthe External Fixator (Tubular System).- 9.2 External Compressors with Threaded Rods.- 9.2.1 External Compressors.- 9.2.2 Instruments and Implants.- 9.2.3 Use of the External Compressors with Double Clamps (for corrective osteotomy of the head ofthe tibia).- 9.2.4 Further Examples of the Application of External Compressors with Double Clamps.- 9.3 Lengthening Apparatus.- 9.3.1 Instruments and Implants.- 9.3.2 Lengthening of the Femur.- 9.3.3 Further Examples of the Use of the Lengthening Apparatus.- 10 General Instruments of the AO.- 10.1 Bone Forceps.- 10.2 General Instruments.- 10.3 Wire Instrument Set.- 11 Special Instrument Sets.- 11.1 Aiming Devices.- 11.1.1 Simple Aiming Device for External Fixators.- 11.1.2 Aiming and Measuring Device for Knee, Femoral Neck, and External Fixators.- 11.2 Distractor.- 11.2.1 Use of the Distractor in Reducing a Transverse Fracture of the Femur.- 11.2.2 Use of the Distractor in Comminuted Fractures of the Femoral Shaft.- 11.3 Instrument Set with Interchangeable Gouges, Chisels, and Impactors.- 11.3.1 Cancellous Bone Grafting.- 11.3.2 Donor Sites for Bone Grafts.- 11.3.3 Correct Application of the Cancellous Graft.- B Compressed Air and Compressed-Air Machines.- 1 Compressed Air as a Power Source.- 1.1 Sterility of the Compressed Air.- 1.2 Turbulence.- 2 Air Supply.- 2.1 Compressed Air from Cyhnders in the Operating Room.- 2.2 Compressed Air from a Central Supply System.- 2.3 Operating ― Room Filters.- 2.3.1 Coarse Filters (Oil and Water Separators).- 2.3.2 Mechanical Sterile Filter (Fine Filter).- 2.4 Pressure-Reducing Valves.- 2.5 Supply Lines to the Machines.- 2.5.1 Single Hose System.- 2.5.2 Double Hose System.- 3 Compressed-Air Machines.- 3.1 Small Air Drill.- 3.2 Medullary Reaming Machine.- 3.3 Oscillating Bone Saw.- 3.4 Universal Drill.- 3.5 Mini Compressed-Air Machine and Its Attachments.- 4 Cleaning and Lubrication of the Machines.- 4.1 Maintenance of the Large Machines.- 4.1.1 Cleaning.- 4.1.2 Oiling the Machines.- 4.1.3 Lubrication (Greasing).- 4.2 Maintenance of the Mini Compressed-Air Machine.- 5 Sterilization.- 5.1 Sterilization of the Compressed-Air Machines.- 5.2 Care and Sterilization of Air Hoses.- 6 Hand Drill.- C Cleaning, Care, and Sterilization of Instruments and Implants.- 1 General Guidelines During Surgery.- 2 Postoperative Cleanup of Instruments.- 2.1 Disinfecting.- 2.2 Cleaning.- 2.2.1 Mechanical Cleaning by Hand.- 2.2.2 Cleaning by Machine.- 2.3 Rinsing the Cleaned Instruments.- 2.4 Drying the Instruments.- 2.5 Lubricating the Instruments.- 3 Care and Cleaning of Implants.- 3.1 Disinfection of Contaminated Implants.- 3.2 Cleaning.- 4 Packaging Items for Sterilization.- 4.1 Packaging Material.- 5 Methods of Sterihzation.- 5.1 Autoclaving.- 5.2 Hot-Air Sterilization.- 6 Storage of Sterile Items.- 7 Unpacking Sterile Items.- 8 Instrument Repair and Sharpening.- 9 Surgical Stockroom.- D Preoperative, Operative, and Postoperative Guidelines.- 1 Preoperative Care of the Patient on the Ward.- 1.1 Preparation of Skin on the Ward.- 2 Preparation of the Patient in the Preparation Room.- 2.1 Pneumatic Tourniquet.- 2.2 Positioning the Patient for Surgery.- 2.3 Shaving.- 2.4 Degreasing.- 2.5 Preoperative Scrubbing of the Operation Site.- 2.6 Preoperative Skin Preparation in Open Fractures.- 3 General Operative Guidelines.- 3.1 Planning the Operation.- 3.2 Final Disinfection of the Operative Field.- 3.3 Draping.- 3.4 Incise Drapes.- 3.5 Pneumatic Tourniquet.- 3.6 Fascial Towels.- 3.7 Irrigation.- 3.8 Suction Device with On/Off Switch.- 3.9 Intraoperative Roentgenograms.- 3.10 Suction Drainage.- 3.11 Wound Closure.- 3.12 Dressings.- 3.13 Release of the Tourniquet.- 4 Guidehnes for Postoperative Positioning.- 5 Removal of Implants.- 5.1 Timing of Implant Removal.- 5.2 Operative Procedure for Implant Removal.- 5.2.1 Removal of Plates.- 5.2.2 Removal of Angled Blade Plates.- 5.2.3 Removal of Cerclage Wires.- 5.2.4 Removal of Medullary Nails.- 5.2.5 Removal of Broken Screws.- 6 Postoperative Complications.- 6.1 Hematomas.- 6.2 Infections.- 6.2.1 Procedure for Early Postoperative Infection.- 6.2.2 Procedure for Chronic and Delayed Infection.- 6.3 Refractures.- 6.4 Implant Fractures.- 6.5 Loosening of Implants.- E Suggestions for the Management of Various Fractures.- 1 Fractures of the Scapula.- 2 Fractures of the Clavicle.- 3 Fractures of the Humerus.- 4 Fractures of the Forearm.- 5 Fractures of the Hand.- 6 Fractures of the Femur.- 7 Fractures of the Patella.- 8 Fractures of the Tibia.- 9 Fractures of the Foot.- 10 Fractures in Children.- F Preparation of the Instruments.- 1 Fractures of the Proximal Humerus.- 2 Fractures of the Humeral Shaft.- 3 Fractures of the Distal Humerus.- 4 Fractures of the Shaft of the Radius and Ulna, Fractures of the Olecranon.- 5 Fractures of the Distal Forearm.- 6 Fractures of the Hand.- 7 Fractures of the Proximal Femur and Intertrochanteric Osteotomies.- 8 Fractures of the Femoral Shaft.- 9 Fractures of the Distal Femur.- 10 Fractures of the Patella.- 11 Fractures of the Head ofthe Tibia.- 12 Fractures of the Tibial Shaft.- 13 Fractures of the Distal Tibia.- 14 Malleolar Fractures.- 15 Fractures of the Foot.- 16 Medullary Nailing of the Femur.- 17 Medullary Nailing of the Tibia.- 18 Suggestion for Tray with Surgical Bone Instruments (A), Necessary for Surgery on Large Bones.- 19 Suggestion for Tray with Surgical Bone Instruments (B), Necessary for Surgery on Small Bones.

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