Practical Procedures in
Orthopaedic Trauma Surgery

A Trainee's Companion

This highly illustrated textbook provides an essential guide for surgeons in training. It follows a step-by-step approach to performing a surgical procedure. It includes details of positioning the patient, the approach and reduction technique, the implant to be inserted, proto- cols for post-operative mobilisation, complications to look for, when the patient should be seen in the outpati- ent clinic and whether the implant should be removed. Intraoperative pictures have been incorpoated to make the surgeon aware of all the important issues involved. It covers the most common trauma procedures that surgeons in training are expected to perform during their residency. Each procedure has been written by an expert. This will be an invaluble resource for the resident in training during the long on-call nights in the hospital while preparing for the operations necessary to help trauma patients.

Peter V. Giannoudis is Professor of Trauma and Orthopaedic Surgery at St James’ University Hospital, Leeds, UK.

Hans-Christoph Pape is Professor of Trauma and Orthopaedic Surgery at Pittsburgh School of Medicine.

Practical Procedures in
Orthopaedic Trauma Surgery

A Trainee's Companion

Edited by

Peter V. Giannoudis

and

Hans-Christoph Pape

CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo

Cambridge University Press
The Edinburgh Building, Cambridge CB2 2RU, UK

Published in the United States of America by Cambridge University Press, New York

www.cambridge.org
Information on this title: www.cambridge.org/9780521678599

© Cambridge university Press 2006

This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without
the written permission of Cambridge University Press.

First published 2006

Printed in the United Kingdom at the University Press, Cambridge

A catalogue record for this publication is available from the British Library

ISBN-13-978-0-521-67859-9 paperback
ISBN-10-0-521-67859-5 paperback

Cambridge University Press has no responsibility for the persistence or accuracy of URLs for
external or third-party internet websites referred to in this publication, and does not guarantee
that any content on such websites is, or will remain, accurate or appropriate.

To my wife Rania and my children Marilena and Vasilis,
whose love and support made this book a reality

PVG

To Claudia and Julia, who missed me while I was on call

HCP

   Contents

Contributors

Toby Branfoot, M.B. B.S., F.R.C.S., Ed. (Tr. & Orth.), M.Sc.
Consultant Trauma Surgeon
Department of Trauma and Orthopaedics
St James’s University Hospital
Leeds, L59 7TF, UK

Doug Campbell, F.R.C.S. (Orth.)
Consultant Orthopaedic Surgeon
Department of Hand Surgery
St James’s University Hospital
Leeds, LS9 7TF, UK

Charles M. Court-Brown, M.D., F.R.C.S., Ed. (Orth.)
Professor of Orthopaedic Trauma
Orthopaedic Trauma Unit
Royal Infirmary of Edinburgh
Edinburgh, EH3 9YW, UK

Roderick Dunn, M.B. B.S., D.M.C.C., F.R.C.S. (Plast.)
Senior Fellow in Hand and Microsurgery
Department of Plastic and Reconstructive Surgery
St James’s University Hospital
Leeds, LS9 7TF, UK

Peter V. Giannoudis, B.Sc., M.B. B.S., M.D., E.E.C.(Ortho.)
Professor Trauma and Orthopaedic Surgery
School of Medicine
University of Leeds
St James’s University Hospital
Leeds, LS9 7TF, UK

Thomas Gosling, M.D.
Orthopaedic Trauma Fellow
Department of Trauma Surgery
Hannover Medical School
Hannover, GERMANY, 30625

Stefan Hankemeier, M.D.
Orthopaedic Trauma Fellow
Department of Trauma Surgery
Hannover Medical School
Hannover, GERMANY, 30625

Gregoris Kambouroglou, M.D.
Consultant Trauma and Orthopaedic Surgeon
Oxford Trauma Unit
John Radcliffe Hospital
Oxford, OX3 9DU, UK

Simon Kay, F.R.C.S., F.R.C.S. (Plast.), F.R.C.S.E.
Professor of Hand Surgery
Consultant in Plastic Surgery and Surgery of the Hand
Department of Plastic and Reconstructive Surgery
St James’s University Hospital
Leeds, LS9 7TF, UK

John F. Keating, M.Phil., F.R.C.S., Ed. (Orth.)
Consultant Orthopaedic Surgeon
Orthopaedic Trauma Unit
Royal Infirmary of Edinburgh
Edinburgh, EH3 9YW, UK

Paige T. Kendrick, B.A.
Orthopaedic Trauma Fellow
Department of Orthopaedic Surgery
University of Louisville School of Medicine
Louisville, Kentucky, USA

Simon Knight, M.B. B.S., F.R.C.S.
Consultant Orthopaedic Surgeon
Department of Trauma and Orthopaedics
St James’s University Hospital
Leeds, LS9 7TF, UK

David Limb, B.Sc., F.R.C.S., Ed. (Orth.)
Senior Lecturer
School of Medicine
University of Leeds
St James’s University Hospital
Leeds, LS9 7TF, UK

David A. Macdonald, F.R.C.S. (Orth.)
Consultant Orthopaedic Surgeon
Department of Trauma and Orthopaedics
St James’s University Hospital
Leeds, LS9 7TF, UK

Caroline McGuiness F.R.S.C. (Plas. Surg.)
Consultant Plastic Surgeon
Department of Plastic Surgery
St James’ University Hospital
Leeds, LS9 7TF, UK

Reinhard Meier, M.D.
Orthopaedic Trauma Fellow
Department of Trauma Surgery
Hannover Medical School
Hannover, GERMANY, 30625

Peter Millner, F.R.C.S., (Orth.)
Consultant Spinal Surgeon
Department of Trauma and Orthopaedics
St James’s University Hospital
Leeds, LS9 7TF, UK

Hans-Christoph Pape, M.D.
Professor of Trauma and Orthopaedic Surgery
Division of Trauma
University of Pittsburgh School of Medicine
3471 Forbes Avenue
Kaufmann Building, Suite 911, 15215 Pittsburgh, USA

Raghu Raman, M.R.C.S.,
Trauma Fellow
Department of Trauma and Orthopaedics
St James’s University Hospital
Leeds, LS9 7TF, UK

Martinus Richter, M.D.
Head of the Orthopaedic Foot Service
Coburg Hospital
Coburg, GERMANY

Craig S. Roberts, M.D.
Associate Professor
Department of Orthopaedic Surgery
University of Louisville School of Medicine
Louisville, Kentucky, USA

Brian W. Scott, F.R.C.S. (Orth.)
Consultant Paediatric Orthopaedic Surgeon
Department of Trauma and Orthopaedics
Leeds Teaching Hospital
Leeds, LS9 7TF, UK

David Seligson, M.D.
Professor of Orthopaedic Surgery and Vice Chairman
Department of Orthopaedic Surgery
University of Louisville School of Medicine
Louisville, Kentucky, USA

Christopher C. Tzioupis, M.D.
Trauma Fellow
Department of Trauma and Orthopaedics
St James’s University Hospital
Leeds, LS9 7TF, UK

Preface

Over the years the evolution of orthopaedic surgical techniques led to the development of a plethora of orthopaedic textbooks aiming to present the principles of modern orthopaedic surgical practice in order to contribute to the continuing medical education of all the orthopaedic surgeons in training.

The notion of this book arose during the first years of our training. It was difficult to find a book to refer to as a quick yet thorough reference, prior to performing a surgical procedure.

Our aim was therefore to develop a book that would contain a step-wise approach to performing a surgical procedure. Details have been included such as positioning of the patient, the approach and reduction technique, the implant to be inserted, the protocol of post-operative mobilization, complications to look for, when the patient should be seen in the outpatient clinic and whether the implant should be removed. Intraoperative pictures have been incorporated to allow the surgeon to be aware of all the important issues involved.

The most common trauma procedures that a surgeon in training is expected to perform during his residency have been included. Each procedure has been written by an expert or under the supervision of an expert.

This book is expected to be the companion for the resident in training during the long on-call nights in the hospital while preparing for the operations necessary to help our trauma patients.

Acknowledgments

During the preparation of this book we had the pleasure of working together with people whose efforts and contribution made possible the birth of this edition. We particularly wish to acknowledge Cambridge University Press, and our publishingdirectors Geoffrey Nuttall and Peter Silver for their commitment to this project and the maintenance of this level of excellence.

Without the dedication and the hard work of our hospital staffs we would not have been able to accomplish this project.

We would also like to thank all the contributors who have shared with us their expertise.

We also appreciate the continuing support of our colleagues at our university hospitals and especially the daily stimulus of our registrars, whose quest for knowledge remains the major motivation and encouragement for our efforts.