AO Principles of Fracture Management.
This book represents the combined expertise of many of the world leaders in fracture management. Today, forty years after the founding of the Swiss AO group, we have, not the fourth edition of the AO Manual of Internal Fixation, but a new publication, AO Principles of Fracture Management, divided into six sections and forty-nine chapters. This textbook is designed not merely to be a handbook of osteosynthesis, but rather to offer comprehensive recommendations, supported by clinical guidance, on the principles of how to treat fractures in the new millennium. The editors handsomely achieve this goal.
The first section covers the philosophy of the AO group, first described in 1958, relating to anatomy, stability, biology, and mobilization. This section covers the biology and biomechanics of fracture management, the materials, and the AO fracture classification. The classification is logical but remains a little complex. The pathophysiology of soft tissue injury is discussed, with emphasis on the Hanover Fracture Scale and the new AO soft-tissue classification, instead of the widely used Gustillo and Anderson classification.
The second section deals with the basic principles of preoperative planning for diaphyseal and articular fractures.
In part three the reader will find reduction and fixation techniques. These techniques (such as nailing, tension bands, and so forth) offer absolute or relative stability. A new concept in this section is the "internal fixator with locked screws" that changes the original AO philosophy of internal fixation. Locked screws are used in newer implants like the PCFix (Point Contact-Fixator) and the LISS (Less Invasive Stabilization System). They are usually unicortical and work more like bolts than screws. They offer the advantage of very simple handling, allowing safe application by self-drilling and self-tapping.
There are 20 well-structured chapters (361 pages) in the fourth section, which cover specific fractures from the scapula to the foot and spine. This includes everything needed for surgical treatment of fractures in a comprehensive and clear way. The reader is presented with useful information related to specific clinical problems followed by options for surgical treatment, pre-operative planning, pitfalls, and complications in open reduction and internal fixation and post-operative management.
The fifth section is devoted to general topics such as the management of open fractures, care of fractures in children, general preoperative and postoperative considerations, and polytrauma management. This section also focuses on the most important component of high-energy trauma--injury to the soft tissues.
The last part contains five chapters that are concerned with the main complications seen in orthopaedic surgery, such as acute and chronic infection, mal-union, nonunion, and algodystrophy.
The text is well structured and this book has two additional major strengths. First, the number of quality illustrations, most of which are in color, distinguishes this text from the few others that exist. There are also very useful and interesting clinical photographs. The second strength of this text is the online bibliography and updates, which significantly enlarges the number of current references.
But the highlight of this publication, making it innovative in the paper-publishing field, is the CD-ROM version that accompanies this textbook. This electronic version contains the full text of the book, including all the illustrations in (encrypted) Adobe Portable Document format (PDF)--the screen version perfectly mirrors the bound one. The user will find dozens of video clips showing reduction maneuvers and technical tricks, and will also have access to the bibliography for easier study. An additional benefit is that the information on the CD is easy to access and read; there is no need for specialized computer skills nor is there a complex installation program. With the progress of computer technology, I am sure that we will be able to see longer and more detailed videos in future versions.
In summary, I believe that this publication is a remarkable achievement and I strongly recommend this textbook not only to orthopaedic residents but also to practicing orthopaedic surgeons. This book should reside in the libraries of all hospitals.
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|Publication:||Bulletin of the NYU Hospital for Joint Diseases|
|Article Type:||Book review|
|Date:||Sep 22, 2001|
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