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AO Surgery Reference

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  1. Proximal humerus

    Diagnosis
    Overview
    Preparations
    Overview
    Preparation/Positioning
    Approaches
    Overview
    Deltopectoral approach
    Anterolateral approach
    Transdeltoid lateral approach
    Safe zones
    Reduction & Fixations
    Overview
    A1.1 Extraarticular unifocal fracture of greater tuberosity, not displaced
    Nonoperative treatment
    Screw fixation
    A1.2 Extraarticular unifocal fracture of greater tuberosity, displaced
    Nonoperative treatment
    Closed reduction; screw fixation
    Open reduction; screw or suture fixation
    A1.3 Extraarticular unifocal fracture with glenohumeral dislocation
    Nonoperative treatment
    Closed reduction; screw fixation
    Open reduction; screw or suture fixation
    A2 Extraarticular unifocal fracture, impacted metaphyseal
    Nonoperative treatment
    Closed reduction; screw fixation
    Closed reduction; plate fixation
    Closed reduction; nail fixation
    Open reduction; screw fixation
    Open reduction; plate fixation
    A3 Extraarticular unifocal fracture, nonimpacted metaphyseal
    Nonoperative treatment
    Closed reduction; screw fixation
    Closed reduction; plate fixation
    Closed reduction; nail fixation
    Open reduction; plate fixation
    B1.1/3 Extraarticular bifocal fracture, with metaphyseal impaction, greater tuberosity is off
    Nonoperative treatment
    Limited open reduction; screw fixation
    Limited open reduction; nail fixation
    Limited open reduction; plate fixation
    Open reduction; plate fixation
    B1.2 Extraarticular bifocal fracture, with metaphyseal impaction, lesser tuberosity is off
    Nonoperative treatment
    Limited open reduction; nail fixation
    Limited open reduction; plate fixation
    Open reduction; plate fixation
    B2 Extraarticular bifocal fracture, without metaphyseal impaction
    Nonoperative treatment
    Limited open reduction; screw fixation
    Limited open reduction; nail fixation
    Limited open reduction; plate fixation
    Open reduction; plate fixation
    Hemiarthroplasty
    B3 Extraarticular bifocal fracture, with glenohumeral dislocation
    Nonoperative treatment
    Limited open reduction; screw fixation
    Limited open reduction; plate fixation
    Open reduction; plate fixation
    Hemiarthroplasty
    C1.1 Articular fracture with slight displacement, cephalotubercular, with valgus malalignment
    Nonoperative treatment
    Limited open reduction; screw fixation
    Limited open reduction; plate fixation
    Open reduction; plate fixation
    C1.2 Articular fracture with slight displacement, cephalotubercular, with varus malalignment
    Nonoperative treatment
    Limited open reduction; screw fixation
    Limited open reduction; plate fixation
    Open reduction; plate fixation
    C1.3 Articular fracture with slight displacement, anatomical neck (non-displaced / displaced)
    Nonoperative treatment
    Closed reduction; screw fixation
    Open reduction; screw fixation
    Open reduction; plate fixation
    Hemiarthroplasty
    C2.1 Articular fracture, impacted with marked displacement, cephalotubercular, with valgus malalignment
    Nonoperative treatment
    Open reduction; plate fixation
    Hemiarthroplasty
    C2.2 Articular fracture, impacted with marked displacement, cephalotubercular, with varus malalignment
    Nonoperative treatment
    Open reduction; plate fixation
    Hemiarthroplasty
    C2.3 Articular fracture, impacted with marked displacement, transcephalic (double profile image on X-ray) and tubercular, with varus malalignment
    Nonoperative treatment
    Open reduction; plate fixation
    Hemiarthroplasty
    C3.1 Articular fracture, dislocated, anatomical neck (anterior / posterior)
    Nonoperative treatment
    Open reduction; plate fixation
    Hemiarthroplasty
    C3.2 Articular fracture, dislocated , anatomical neck and tuberosities (head impacted / non-impacted)
    Nonoperative treatment
    Open reduction; plate fixation
    Hemiarthroplasty
    C3.3 Articular fracture, dislocated, cephalotubercular fragmentation (head intact / fragmented)
    Nonoperative treatment
    Open reduction; plate fixation
    Hemiarthroplasty
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  2. Humeral shaft

    Diagnosis
    Overview
    Preparations
    Overview
    Beach chair position
    Supine position
    Lateral position
    Prone position
    Approaches
    Overview
    Anterolateral approach
    Lateral approach
    Dorsal (posterior) approach
    MIPO approach
    Antegrade nailing approach
    Retrograde nailing approach
    Safe zones
    Reduction & Fixations
    Overview
    A1 Simple fractures, spiral
    Nonoperative treatment; brace
    External fixation
    Closed reduction; antegrade nailing
    Closed reduction; retrograde nailing
    Open reduction; lag screw(s) with neutralization plate
    A2 Simple fractures, oblique (>30°)
    Nonoperative treatment; brace
    External fixation
    Closed reduction; antegrade nailing
    Closed reduction; retrograde nailing
    Open reduction; lag screw(s) with neutralization plate
    Open reduction; compression plating
    A3 Simple fractures, transverse (<30°)
    Nonoperative treatment; brace
    External fixation
    Closed reduction; antegrade nailing
    Closed reduction; retrograde nailing
    Open reduction; compression plating
    B1 Spiral wedge fractures
    Nonoperative treatment; brace
    External fixation
    Closed reduction; antegrade nailing
    Closed reduction; retrograde nailing
    Closed reduction; bridge plating (MIO)
    Open reduction; bridge plating
    B2 Bending wedge fractures
    Nonoperative treatment; brace
    External fixation
    Closed reduction; antegrade nailing
    Closed reduction; retrograde nailing
    Closed reduction; bridge plating (MIO)
    Open reduction; bridge plating
    B3 Fragmented wedge fractures
    Nonoperative treatment; brace
    External fixation
    Closed reduction; antegrade nailing
    Closed reduction; retrograde nailing
    Closed reduction; bridge plating (MIO)
    Open reduction; bridge plating
    C1 Complex spiral fractures
    Nonoperative treatment; brace
    External fixation
    Closed reduction; antegrade nailing
    Closed reduction; retrograde nailing
    Closed reduction; bridge plating (MIO)
    Open reduction; bridge plating
    C2 Segmental complex fractures
    Nonoperative treatment; brace
    External fixation
    Closed reduction; antegrade nailing
    Closed reduction; retrograde nailing
    Closed reduction; bridge plating (MIO)
    Open reduction; bridge plating
    C3 Irregular complex fractures
    Nonoperative treatment; brace
    External fixation
    Closed reduction; antegrade nailing
    Closed reduction; retrograde nailing
    Closed reduction; bridge plating (MIO)
    Open reduction; bridge plating
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  3. Distal humerus

    Diagnosis
    Overview
    Preparations
    Overview
    Supine for lateral approach
    Supine for medial approach
    Prone position
    Lateral decubitus position
    Approaches
    Overview
    Lateral approach
    Medial approach
    Transolecranon approach
    Posterior triceps-on approach
    Triceps-elevating approach
    Safe zones
    Reduction & Fixations
    Overview
    A1.1 Extraarticular apophyseal avulsion fractures, lateral epicondyle
    Sling with or without splinting
    Open reduction; screw fixation
    A1.2 Extraarticular apophyseal avulsion fractures, medial epicondyle
    Sling with or without splinting
    Open reduction; screw fixation
    A1.3 Extraarticular apophyseal avulsion fractures, medial epicondyle, incarcerated
    Open reduction; screw fixation
    A2.1/2 Extraarticular fractures, metaphyseal simple, oblique downwards
    Sling with or without splinting
    External fixation
    Open reduction; plate fixation
    A2.3 Extraarticular fractures, metaphyseal simple, transverse
    Sling with or without splinting
    External fixation
    Open reduction; plate fixation
    A3.1/2 Extraarticular fractures, metaphyseal wedge, multifragmentary
    Sling with or without splinting
    External fixation
    Open reduction; plate fixation
    A3.3 Extraarticular fractures, metaphyseal multifragmentary, complex
    Sling with or without splinting
    External fixation
    Open reduction; plate and screw fixation
    B1 Partial articular fractures, lateral sagittal
    Open reduction; screw fixation
    Open reduction; lag screw and protection plate
    Open reduction; plate fixation
    Open reduction; plate and screw fixation (+/- headless screws)
    B2.1 Partial articular fractures, medial sagittal, medial transtrochlear simple
    Open reduction; screw fixation
    B2.2 Partial articular fractures, medial sagittal, transtrochlear simple, through the groove
    Open reduction; plate and screw fixation
    B2.3 Partial articular fractures, medial sagittal, transtrochlear multifragmentary
    Open reduction; plate and screw fixation
    B3.1 Partial articular fractures, frontal, capitellum
    Open reduction; headless screw fixation
    B3.2 Partial articular fractures, frontal, trochlea
    Open reduction; headless screw fixation
    B3.3 Partial articular fractures, frontal, capitellum and trochlea
    Open reduction; screw fixation +/- protection plate
    C1 Complete articular fractures, articular simple, metaphyseal simple
    Open reduction; perpendicular (biplanar) plating
    Open reduction; parallel (uniplanar) plating
    C2 Complete articular fractures, articular simple, metaphyseal multifragmentary
    Open reduction; perpendicular (biplanar) plating
    Open reduction; parallel (uniplanar) plating
    C3 Complete articular fractures, multifragmentary
    Open reduction; perpendicular (biplanar) plating
    Open reduction; parallel (uniplanar) plating
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  4. Scapula

    Diagnosis
    Overview
    Preparations
    Overview
    Lateral
    Prone
    Beach chair
    Supine
    Approaches
    Overview
    Posterior approach
    Arthroscopic entry points
    Deltapectorial Approach
    Delta split
    Superior approach
    Reduction & Fixations
    Overview
    14.1 A1 Extraarticular glenoid neck, simple
    Nonoperative treatment
    Plate fixation
    14.1 A2 Extraarticular glenoid neck, wedge
    Nonoperative treatment
    Plate fixation
    14.1 A3 Extraarticular glenoid neck, multifragmentary
    Nonoperative treatment
    Plate fixation
    14.1 B1.1 Partial articular, anterior simple
    Nonoperative treatment
    Lag screw fixation
    Lag screw fixation (MIO)
    Suture anchors
    14.1 B1.2 Partial articular, anterior multifragmentary
    Nonoperative treatment
    Lag screw fixation
    Suture anchors
    14.1 B2.1 Partial articular, posterior simple
    Nonoperative treatment
    Lag screw fixation
    Lag screw fixation (MIO)
    Suture anchors
    14.1 B2.2 Partial articular, posterior multifragmentary
    Nonoperative treatment
    Lag screw fixation
    Suture anchors
    14.1 B3.1 Partial articular, transverse simple
    Nonoperative treatment
    Lag screw fixation
    Lag screw fixation (MIO)
    14.1 B3.2 Partial articular, transverse multifragmentary
    Nonoperative treatment
    Lag screw fixation
    14.1 C1 Complete articular, simple articular, simple neck
    Nonoperative treatment
    Plate fixation
    14.1 C2 Complete articular, simple articular - wedge or multifragmentary neck
    Nonoperative treatment
    Plate fixation
    14.1 C3 Complete articular, multifragmentary articular
    Nonoperative treatment
    Plate fixation
    14.2 Body and processes, acromion
    Nonoperative treatment
    Lag screw fixation
    Tension band
    14.3 Body and processes, coracoid
    Nonoperative treatment
    Lag screw fixation
    14.4 Body and processes, body
    Nonoperative treatment
    Special considerations
    Complete LSSS Failure
    Floating shoulder - Sequence of repair
    Ligament reconstruction
  5. Clavicle

    Diagnosis
    Overview
    Preparations
    Overview
    Beach chair
    Supine
    Approaches
    Overview
    Anterior approach
    Nailing approach
    MIPO - anterior approach
    Superior approach
    Reduction & Fixations
    Overview
    15.1 A Medial clavicle, extra articular
    Nonoperative treatment
    Reduction of sternoclavicular dislocation
    15.1 B Medial clavicle, intra articular
    Nonoperative treatment
    Reduction of sternoclavicular dislocation
    15.1 C Medial clavicle, multifragmentary
    Nonoperative treatment
    Reduction of sternoclavicular dislocation
    15.2 A1 Simple shaft, spiral
    Nonoperative treatment
    15.2 A2 Simple shaft, oblique
    Nonoperative treatment
    Lag screw with neutralization plate
    Compression plate with lag screw
    Flexible intermedullary nail
    15.2 A3 Simple shaft, transverse
    Nonoperative treatment
    Compression plate
    Flexible intermedullary nail
    15.2 B1 Wedge shaft, spiral wedge
    Nonoperative treatment
    ORIF Bridge plate
    15.2 B2 Wedge shaft, bending wedge
    Nonoperative treatment
    Flexible intermedullary nail
    Lag screw with neutralization plate
    ORIF Bridge plate
    15.2 B3 Wedge shaft, fragmented wedge
    Nonoperative treatment
    ORIF Bridge plate
    15.2 C1 Complex shaft, complex spiral
    Nonoperative treatment
    ORIF Bridge plate
    15.2 C2 Complex shaft, segmental
    Nonoperative treatment
    Compression plate
    15.2 C3 Complex shaft, complex irregular
    Nonoperative treatment
    ORIF Bridge plate
    MIO Bridge plate
    15.3 A1 Undisplaced lateral, extra articular
    Nonoperative treatment
    15.3 A2 Undisplaced lateral, intra articular
    Nonoperative treatment
    15.3 B1 Displaced lateral, CC intact, extra articular
    Nonoperative treatment
    Precontoured distal plate
    15.3 B2 Displaced lateral, CC intact, comminuted
    Nonoperative treatment
    Hook plate
    Precontoured distal plate
    15.3 C1 Displaced lateral, CC ruptured, extra articular
    Nonoperative treatment
    Hook plate
    Precontoured distal plate
    15.3 C2 Displaced lateral, CC ruptured, intra articular
    Nonoperative treatment
    Hook plate
    Special considerations
    Floating shoulder - Sequence of repair
    Complete LSSS Failure
  6. Proximal forearm

    Diagnosis
    Overview
    Preparations
    Overview
    Supine for posterior access
    Prone position
    Lateral decubitus position
    Supine for lateral access
    Supine for anterior access
    Approaches
    Overview
    Posterior approach
    Safe zones for pin insertion
    Two incision approach
    Anterior approach
    Lateral approach
    Reduction & Fixations
    Overview
    A1.1 Extraarticular fracture of the ulna, avulsion of the triceps insertion
    Circular cast or splint
    Functional treatment
    Triceps reinsertion
    A1.2 Extraarticular fracture of the ulna, simple metaphyseal
    Circular cast or splint
    Temporary external fixation
    Compression plate
    Compression plate and lag screw
    Lag screw and protection plate
    A1.3 Extraarticular fracture of the ulna, multifragmentary metaphyseal
    Circular cast or splint
    Temporary external fixation
    Bridging plate
    A2.1 Extraarticular fracture of the radius, avulsion of bicipital tuberosity
    Functional treatment
    Biceps reinsertion
    A2.2 Extraarticular fracture of the radius, simple radial neck
    Circular cast or splint
    Functional treatment
    Lag screw fixation
    Compression with T-plate
    A2.3 Extraarticular fracture of the radius, multifragmentary radial neck fracture
    Circular cast or splint
    Temporary external fixation
    Bridging plate (multifragmentary fracture)
    Replacement arthroplasty
    A3.1 Extraarticular fracture of both bones, simple
    Temporary external fixation
    Compression plate for ulna
    Compression plate and lag screw for ulna
    Lag screw and protection plate for ulna
    Lag screw fixation for radius
    Compression with T-Plate for radius
    A3.2/3 Extraarticular fracture of both bones, one or both multifragmentary
    Temporary external fixation
    Compression plate for ulna
    Compression plate and lag screw for ulna
    Lag screw and protection plate for ulna
    Bridging plate for ulna
    Lag screw fixation for radius
    Compression with T-plate for radius
    Bridging plate for radius
    Replacement arthroplasty for radius
    B1 Articular fracture of the ulna
    Circular cast or splint
    Temporary external fixation
    Hinged external fixation following ORIF
    Tension band wiring
    Lag screw and protection plate
    Tension band plate
    Bridging plate
    Repair of coronoidal fracture
    B2 Articular fracture of the radius
    Circular cast or splint
    Functional treatment
    Temporary external fixation
    Lag screw fixation
    Lag screws through plate
    Excision of the radial head
    Replacement arthroplasty
    B3.1 Simple articular ulna, extraarticular radius
    Temporary external fixation
    Hinged external fixation following ORIF
    Tension band wiring for olecranon
    Lag screw and protection plate for olecranon
    Tension band plate for olecranon
    Lag screw fixation for radius
    Compression with T-plate for radius
    Bridging plate (simple, impacted fracture) for radius
    Bridging plate (multifragmentary fracture) for radius
    Replacement arthroplasty for radius
    B3.2 Simple articular radius, extraarticular ulna
    Temporary external fixation
    Lag screw fixation for radius
    Compression plate for ulna
    Compression plate and lag screw for ulna
    Lag screw and protection plate for ulna
    Bridging plate for ulna
    B3.3 Multifragmentary articular of one bone, extraarticular of the other
    Temporary external fixation
    Hinged external fixation following ORIF
    Bridging plate for olecranon
    Repair of coronoidal fracture
    Lag screws and plate for radius
    Replacement arthroplasty for radius
    Compression plate for ulna
    Compression plate and lag screw for ulna
    Lag screw and protection plate for ulna
    Bridging plate for ulna
    Lag screw fixation for radius
    Compression with T-plate for radius
    Bridging plate (simple, impacted fracture) for radius
    Bridging plate (multifragmentary fracture) for radius
    C1 Simple articular fractures of both bones
    Temporary external fixation
    Hinged external fixation following ORIF
    Lag screw and protection plate for olecranon
    Tension band plate for olecranon
    Repair of coronoidal fracture
    Lag screw fixation of radial head
    C2.1 Articular fracture of both bones, Olecranon multifragmentary, radial head simple
    Temporary external fixation
    Hinged external fixation following ORIF
    Bridging plate for olecranon
    Repair of coronoidal fracture
    Lag screw fixation of radial head
    C2.2/3 Articular fracture of both bones, olecranon or coronoid simple, radial head multifragmentary
    Temporary external fixation
    Hinged external fixation following ORIF
    Lag screw and protection plate for olecranon
    Tension band plate for olecranon
    Repair of coronoidal fracture
    Lag screws and plate for radius
    Replacement arthroplasty for radius
    C3 Multifragmentary articular fractures of both bones
    Temporary external fixation
    Hinged external fixation following ORIF
    Bridging plate for olecranon
    Repair of coronoidal fracture
    Lag screws and plate for radius
    Replacement arthroplasty for radius
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  7. Forearm shaft

    Diagnosis
    Overview
    Preparations
    Overview
    Preparation and positioning
    Approaches
    Overview
    Anterior approach (Henry)
    Posterolateral approach
    Approach to the ulna
    Combined posterior approach
    Speed and Boyd’s approach
    Approaches to the DRUJ
    Safe zones for pin placement
    Nailing approach for ulna
    Nailing approaches for radius
    Lateral approach to prox. radius
    Reduction & Fixations
    Overview
    A1.1 Simple fracture of the ulna, radius intact, oblique
    Nonoperative treatment
    External fixation
    Lag screw and plate fixation
    A1.2 Simple fracture of the ulna, radius intact, transverse
    Nonoperative treatment
    External fixation
    Compression plating
    A1.3 Simple fracture of the ulna, radius intact, with dislocation of radial head (Monteggia)
    Nonoperative treatment
    External fixation
    Plating with our without lag screw
    A2.1 Simple fracture of the radius, ulna intact, oblique
    Nonoperative treatment
    External fixation
    Lag screw and plate fixation
    A2.2 Simple fracture of the radius, ulna intact, transverse
    Nonoperative treatment
    External fixation
    Minimally invasive compression plating
    Compression plating
    A2.3 Simple fracture of the radius, ulna intact, with dislocation distal radioulnar joint (Galeazzi)
    Nonoperative treatment
    External fixation
    Plating with or without lag screw
    A3 Simple fracture of both bones
    Nonoperative treatment
    External fixation
    Compression plating with or without lag screw
    B1.1/2 Wedge fracture of the ulna, radius intact
    Nonoperative treatment
    External fixation
    Compression plating with or without lag screw
    B1.3 Wedge fracture of the ulna, radius intact, with dislocation of radial head (Monteggia)
    External fixation
    Compression plating with or without lag screw
    B2.1/2 Wedge fracture of the radius, ulna intact
    Nonoperative treatment
    External fixation
    Compression plating with or without lag screw
    B2.3 Wedge fracture of the radius, ulna intact, with dislocation of the distal radioulnar joint (Galeazzi)
    External fixation
    Compression plating
    B3 Wedge fracture of one bone, with a simple or wedge fracture of the other
    Nonoperative treatment
    External fixation
    Compression plating
    C1 Complex fracture of the ulna, simple fracture of the radius
    Nonoperative treatment
    External fixation
    Plating of one (C1.1) or both (C1.2/.3) bones
    Nailing (C1.3)
    C2 Complex fracture of the radius, simple fracture of the ulna
    Nonoperative treatment
    External fixation
    Plating of one (C2.1) or both (C2.2/.3) bones
    Nailing (C2.3)
    C3.1 Complex fracture of both bones, bifocal
    Nonoperative treatment
    External fixation
    Compression plating
    C3.2 Complex fracture of both bones, Bifocal of one bone, irregular of the other
    Nonoperative treatment
    External fixation
    Nailing
    Plating
    C3.3 Complex fracture of both bones, irregular
    Nonoperative treatment
    External fixation
    Nailing
    Bridge plating
    Special considerations
    Principles underlying forearm shaft fracture treatment
    Principles of management of open fractures
    Infection
    Compartment syndrome
  8. Distal forearm

    Diagnosis
    Overview
    Preparations
    Overview
    Supine positioning (distal ulna)
    Supine (dorsal approach)
    Supine (palmar approaches)
    Approaches
    Overview
    Anatomy of the distal forearm
    Direct to the radial styloid
    Ulnar palmar
    Dorsal approach
    Palmar approach
    Ulnar approach
    Dorsal approach
    Reduction & Fixations
    Overview
    A1.1 Ulna: styloid fracture
    Nonoperative treatment; casting
    Open reduction; tension band wiring
    Open reduction; lag screw fixation
    A1.2 Ulna: simple metaphyseal fracture
    Nonoperative treatment; casting
    Open reduction; lag screw and protection plate
    Open reduction; compression plate
    A1.3 Ulna: multifragmentary metaphyseal fractures
    Nonoperative treatment; casting
    Open reduction; bridge plating
    Open reduction; hook plating
    A2.1 Radius: extraarticular: undisplaced fracture
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Open reduction; palmar plating
    A2.2 Radius: extraarticular: dorsal tilt (Pouteau-Colles)
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Closed reduction; k-wires and cast/external fixation
    Open reduction; palmar plating
    A2.3 Radius: extraarticular: volar tilt (Goyrand-Smith)
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Closed reduction; k-wires and cast/external fixation
    Open reduction; palmar plating
    A3 Radius: extraarticular: multifragmentary
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Closed reduction; k-wires and cast/external fixation
    Open reduction; palmar bridge plating
    B1.1 Partial articular: sagittal: lateral: simple
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Closed reduction; k-wires and cast/external fixation
    Closed reduction; lag screws
    Open reduction; palmar plating
    Open reduction; radial column plating
    B1.2 Partial articular: sagittal: lateral: multifragmentary
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Open reduction; ORIF with lag screws/K-wires
    Open reduction; radial column plating
    B1.3 Partial articular: sagittal: medial
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Open reduction; dorsal plating
    B2.1 Partial articular: dorsal rim (Barton): simple
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Open reduction; dorsal plating
    B2.2 Partial articular: dorsal rim (Barton): with lateral sagittal fracture
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Open reduction; Dorsoradial double plating
    B2.3 Partial articular: dorsal rim (Barton): with dorsal dislocation of the carpus
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Open reduction; dorsoradial double plating
    Open reduction; dorsal double plating
    B3 Partial articular: volar rim
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary)
    Open reduction; palmar plating
    C1 Simple articular: with simple metaphyseal injury
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Closed reduction; k-wires and cast/external fixation
    Open reduction; palmar plating
    Open reduction; dorsoradial double plating
    C2 Simple articular: with comminuted metaphysis
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Closed reduction; k-wires and cast/external fixation
    Open reduction; palmar bridge plating
    Open reduction; dorsoradial double plating
    C3 Multifragmentary articular fractures
    Nonoperative treatment; casting
    Joint-spanning external fixation (temporary or definitive)
    Open reduction; palmar bridge plating
    Open reduction; joint-spanning distraction plating
    Open reduction; dorsoradial double plating
    Open reduction; dorsoradiopalmar triple plating
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  9. Proximal femur

    Diagnosis
    Overview
    Preparations
    Overview
    Supine position (fracture table)
    Supine on conventional table
    Supine position for nailing
    Lateral decubitus position
    Approaches
    Overview
    Lateral approach (CRIF)
    Nailing approach
    Posterolateral approach
    Anterolateral approach
    Iliofemoral approach
    Direct lateral approach
    Reduction & Fixations
    Overview
    A1 Pertrochanteric: simple fracture
    Closed reduction; sliding hip screw
    Closed reduction; short intramedullary nail (PFNA)
    Open reduction; sliding hip screw
    A2 Pertrochanteric: multifragmentary fracture
    Closed reduction; sliding hip screw
    Closed reduction; sliding hip screw with trochanteric stabilization plate (TSP)
    Closed reduction; short intramedullary nail (PFNA)
    A3 Intertrochanteric fracture
    Closed reduction; long intramedullary nail
    Open reduction; dynamic condylar screw (DCS)
    B1 Subcapital fracture with slight displacement
    Nonoperative treatment
    Internal fixation without reduction; cancellous screws
    B2 Transcervical fracture
    Closed reduction; cancellous screws
    Closed reduction; sliding hip screw
    Open reduction; cancellous screws
    Open reduction; sliding hip screw
    Operative treatment; arthroplasty
    B3 Displaced, subcapital fracture
    Closed reduction; cancellous screws
    Closed reduction; sliding hip screw
    Open reduction; cancellous screws
    Open reduction; sliding hip screw
    Operative treatment; arthroplasty
    C1 Split fracture of femoral head
    Open reduction; small fragment screws
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  10. Femur shaft

    Diagnosis
    Overview
    Preparations
    Overview
    Abducted contralateral leg
    Supine position without traction
    Bilateral traction
    Lateral decubitus position
    Knee flexed 30°
    Unilateral leg support
    Elevated fractured leg
    Approaches
    Overview
    Antegrade nailing (piriformis)
    Antegrade nailing (trochanteric)
    Lateral approach
    MIO approach
    Retrograde nailing
    Locations for pin placement
    Reduction & Fixations
    Overview
    A1 Simple spiral fractures
    Temporary Thomas splint
    External fixator (midshaft/distal shaft)
    External fixator (subtrochanteric)
    Antegrade nailing (subtrochanteric)
    Antegrade nailing (midshaft/distal shaft)
    Retrograde nailing (midshaft/distal shaft)
    Compression plating - DCS (subtrochanteric)
    Compression plating - locking plate (subtrochanteric)
    Compression plating - DCS (distal shaft)
    Lag screw with protection plate (midshaft)
    A2 Simple oblique fractures
    Temporary Thomas splint
    External fixator (midshaft/distal shaft)
    External fixator (subtrochanteric)
    Antegrade nailing (subtrochanteric)
    Antegrade nailing (midshaft/distal shaft)
    Retrograde nailing (midshaft/distal shaft)
    Compression plating - DCS (subtrochanteric)
    Compression plating - locking plate (subtrochanteric)
    Lag screw with protection plate (midshaft)
    Compression plating - DCS (distal shaft)
    A3 Simple transverse fractures
    Temporary Thomas splint
    External fixator (midshaft/distal shaft)
    External fixator (subtrochanteric)
    Antegrade nailing (subtrochanteric)
    Antegrade nailing (midshaft/distal shaft)
    Retrograde nailing (midshaft/distal shaft)
    Compression plating - DCS (subtrochanteric)
    Compression plating - locking plate (subtrochanteric)
    Compression plating - blade plate (subtrochanteric)
    Compression plating (midshaft)
    Compression plating - DCS (distal shaft)
    B1 Wedge fractures, spiral wedge
    Temporary Thomas splint
    External fixator (midshaft/distal shaft)
    External fixator (subtrochanteric)
    Antegrade nailing (subtrochanteric)
    Antegrade nailing (midshaft/distal shaft)
    Retrograde nailing (midshaft/distal shaft)
    Bridge plating (MIO) - locking plate (subtrochanteric)
    Bridge plating (MIO) - DCS (subtrochanteric)
    Bridge plating (MIO) - (midshaft)
    Bridge plating (MIO) - DCS (distal shaft)
    Bridge plating (MIO) - LISS (distal shaft)
    Bridge plating (ORIF) - DCS (subtrochanteric)
    Bridge plating (ORIF) - locking plate (subtrochanteric)
    Lag screw with protection plate (midshaft)
    Bridge plating (midshaft)
    Bridge plating - DCS (distal shaft)
    B2 Wedge fractures, bending wedge
    Temporary Thomas splint
    External fixator (midshaft/distal shaft)
    External fixator (subtrochanteric)
    Antegrade nailing (subtrochanteric)
    Antegrade nailing (midshaft/distal shaft)
    Retrograde nailing (midshaft/distal shaft)
    Bridge plating (MIO) - DCS (subtrochanteric)
    Bridge plating (MIO) - locking plate (subtrochanteric)
    Bridge plating (MIO) - (midshaft)
    Bridge plating (MIO) - DCS (distal shaft)
    Bridge plating (MIO) - LISS (distal shaft)
    Bridge plating - DCS (subtrochanteric)
    Bridge plating - locking plate (subtrochanteric)
    Lag screw with protection plate (midshaft)
    Bridge plating (midshaft)
    Bridge plating - DCS (distal shaft)
    B3 Wedge fractures, fragmented wedge
    Temporary Thomas splint
    External fixator (midshaft/distal shaft)
    External fixator (subtrochanteric)
    Antegrade nailing (subtrochanteric)
    Antegrade nailing (midshaft/distal shaft)
    Retrograde nailing (midshaft/distal shaft)
    Bridge plating (MIO) - DCS (subtrochanteric)
    Bridge plating (MIO) - locking plate (subtrochanteric)
    Bridge plating (MIO) - (midshaft)
    Bridge plating (MIO) - DCS (distal shaft)
    Bridge plating (MIO) - LISS (distal shaft)
    Bridge plating - DCS (subtrochanteric)
    Bridge plating - locking plate (subtrochanteric)
    Bridge plating (midshaft)
    Bridge plating - DCS (distal shaft)
    C1 Complex fractures, spiral
    Temporary Thomas splint
    External fixator (midshaft/distal shaft)
    External fixator (subtrochanteric)
    Antegrade nailing (subtrochanteric)
    Antegrade nailing (midshaft/distal shaft)
    Retrograde nailing (midshaft/distal shaft)
    Bridge plating (MIO) - DCS (subtrochanteric)
    Bridge plating (MIO) - locking plate (subtrochanteric)
    Bridge plating (MIO) - (midshaft)
    Bridge plating (MIO) - DCS (distal shaft)
    Bridge plating (MIO) - LISS (distal shaft)
    Bridge plating - DCS (subtrochanteric)
    Bridge plating - locking plate (subtrochanteric)
    Bridge plating (midshaft)
    Bridge plating - DCS (distal shaft)
    C2 Complex fractures, segmented
    Temporary Thomas splint
    External fixator (midshaft/distal shaft)
    External fixator (subtrochanteric)
    Antegrade nailing (subtrochanteric)
    Antegrade nailing (midshaft/distal shaft)
    Retrograde nailing (midshaft/distal shaft)
    Bridge plating (MIO) - DCS (subtrochanteric)
    Bridge plating (MIO) - locking plate (subtrochanteric)
    Bridge plating (MIO) - (midshaft)
    Bridge plating (MIO) - DCS (distal shaft)
    Bridge plating (MIO) - LISS (distal shaft)
    Bridge plating - DCS (subtrochanteric)
    Bridge plating - locking plate (subtrochanteric)
    Bridge plating (midshaft)
    Bridge plating - DCS (distal shaft)
    C3 Complex fractures, irregular
    Temporary Thomas splint
    External fixator (midshaft/distal shaft)
    External fixator (subtrochanteric)
    Antegrade nailing (subtrochanteric)
    Antegrade nailing (midshaft/distal shaft)
    Retrograde nailing (midshaft/distal shaft)
    Bridge plating (MIO) - DCS (subtrochanteric)
    Bridge plating (MIO) - locking plate (subtrochanteric)
    Bridge plating (MIO) - (midshaft)
    Bridge plating (MIO) - DCS (distal shaft)
    Bridge plating (MIO) - LISS (distal shaft)
    Bridge plating - DCS (subtrochanteric)
    Bridge plating - locking plate (subtrochanteric)
    Bridge plating (midshaft)
    Bridge plating - DCS (distal shaft)
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  11. Distal femur

    Diagnosis
    Overview
    Preparations
    Overview
    Supine position
    Supine position knee flexed 30°
    Supine position on a split table
    Supine - unilateral leg support
    Supine position knee flexed 90°
    Supine position for arthroscopy
    Prone position
    Approaches
    Overview
    Lateral/anterolateral approach
    Lateral parapatellar approach
    Arthroscopic approach
    MIPO approach
    Medial approach
    Retrograde nailing approach
    Posterior approach
    Medial parapatellar approach
    Safe zones
    Reduction & Fixations
    Overview
    A1.1 Extra-articular apophyseal fractures, simple
    Long leg cast then hinged knee brace
    Temporary long leg splint
    Temporary joint-spanning external fixator
    Open reduction; lag screw(s)
    A1.2/3 Extra-articular metaphyseal fractures, simple
    Long leg cast then hinged knee brace
    Temporary long leg splint
    Temporary joint-spanning external fixator
    Temporary skeletal traction
    Closed reduction; dynamic condylar screw - MIO (DCS)
    Closed reduction; condylar locking compression plate - MIO (LCP)
    Closed reduction; retrograde nailing
    Open reduction; dynamic condylar screw (DCS)
    Open reduction; condylar locking compression plate (LCP)
    Open reduction; angled blade plate
    A2 Extra-articular fractures, metaphyseal wedge
    Long leg cast then hinged knee brace
    Temporary long leg splint
    Temporary joint-spanning external fixator
    Temporary skeletal traction
    Closed reduction; dynamic condylar screw - MIO (DCS)
    Closed reduction; condylar locking compression plate - MIO (LCP)
    Closed reduction; less invasive stabilization system (LISS)
    Closed reduction; retrograde nailing
    Open reduction; dynamic condylar screw (DCS)
    Open reduction; condylar locking compression plate (LCP)
    Open reduction; angled blade plate
    A3 Extra-articular fractures, metaphyseal complex
    Long leg cast then hinged knee brace
    Temporary long leg splint
    Temporary joint-spanning external fixator
    Temporary skeletal traction
    Closed reduction; dynamic condylar screw - MIO (DCS)
    Closed reduction; condylar locking compression plate - MIO (LCP)
    Closed reduction; less invasive stabilization system (LISS)
    Closed reduction; retrograde nailing
    Open reduction; dynamic condylar screw (DCS)
    Open reduction; condylar locking compression plate (LCP)
    Open reduction; angled blade plate
    B1.1/2 Partial articular fractures, lateral condyle, sagittal; simple
    Long leg cast then hinged knee brace
    Temporary long leg splint
    Temporary joint-spanning external fixator
    Closed reduction; lag screws - MIO
    Closed reduction; cannulated lag screws - MIO
    Open reduction; lag screws
    Open reduction; lag screws with buttress plate
    Open reduction; cannulated lag screws
    Open reduction; cannulated lag screws with buttress plate
    B1.3 Partial articular fractures, lateral condyle, sagittal; multifragmentary
    Long leg cast then hinged knee brace
    Temporary long leg splint
    Temporary joint-spanning external fixator
    Open reduction; lag screws
    Open reduction; lag screws with buttress plate
    Open reduction; cannulated lag screws
    Open reduction; cannulated lag screws with buttress plate
    B2.1/2 Partial articular fractures, medial condyle, sagittal; simple
    Long leg cast then hinged knee brace
    Temporary long leg splint
    Temporary joint-spanning external fixator
    Closed reduction; lag screws - MIO
    Closed reduction; cannulated lag screws - MIO
    Open reduction; lag screws
    Open reduction; lag screws with buttress plate
    Open reduction; cannulated lag screws
    Open reduction; cannulated lag screws with buttress plate
    B2.3 Partial articular fractures, frontal; anterior and lateral flake fracture
    Long leg cast then hinged knee brace
    Temporary long leg splint
    Temporary joint-spanning external fixator
    Open reduction; lag screws
    Open reduction; lag screws with buttress plate
    Open reduction; lag screws (cannulated)
    Open reduction; lag screws (cannulated) with buttress plate
    B3.1 Partial articular fractures, frontal; anterior and lateral flake fracture
    Long leg cast then hinged knee brace
    Temporary long leg splint
    Temporary joint-spanning external fixator
    Open reduction; screws
    B3.2/3 Partial articular fractures, frontal; posterior
    Long leg cast then hinged knee brace
    Temporary long leg splint
    Temporary joint-spanning external fixator
    Open reduction; screws from anterior for large fragments
    Open reduction; screws from posterior for small fragments
    C1 Complete articular fractures, articular simple, metaphyseal simple
    Temporary joint-spanning external fixator
    Temporary skeletal traction
    Temporary long leg splint
    Open reduction; dynamic condylar screw (DCS)
    Open reduction; condylar locking compression plate (LCP)
    Open reduction; angled blade plate and lag screws
    Open reduction; retrograde nailing
    C2 Complete articular fractures, articular simple, metaphyseal multifragmentary
    Temporary joint-spanning external fixator
    Temporary skeletal traction
    Temporary long leg splint
    Open reduction; dynamic condylar screw (DCS)
    Open reduction; condylar locking compression plate (LCP)
    Open reduction; less invasive stabilization system (LISS)
    Open reduction; angled blade plate and lag screws
    Open reduction; retrograde nailing
    C3 Complete articular fractures, multifragmentary
    Temporary joint-spanning external fixator
    Temporary skeletal traction
    Temporary long leg splint
    Open reduction; condylar locking compression plate (LCP)
    Open reduction; less invasive stabilization system (LISS)
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  12. Patella

    Diagnosis
    Overview
    Preparations
    Overview
    Supine position
    Supine position on a split table
    Approaches
    Overview
    Midline longitudinal approach
    Reduction & Fixations
    Overview
    A1 Extraarticular avulsion fracture
    Open reduction; salvage techniques
    Open reduction; sleeve fracture fixation
    Open reduction; Krackow whip stitch - suture repair
    A2 Extraarticular isolated body fracture
    Long leg cast then hinged knee brace
    B1.1 Partial articular fractures, vertical, lateral; simple
    Long leg cast then hinged knee brace
    Open reduction; lag screws
    B1.2 Partial articular fractures, vertical, lateral; comminuted
    Long leg cast then hinged knee brace
    Open reduction; lag screws
    Open reduction; cerclage wire
    B2.1 Partial articular fractures, vertical, medial; noncomminuted
    Long leg cast then hinged knee brace
    Open reduction; lag screws
    B2.2 Partial articular fractures, vertical, medial; comminuted
    Long leg cast then hinged knee brace
    Open reduction; cerclage wire
    Open reduction; lag screws
    C1.1/2 Complete articular fractures, transverse; middle and proximal
    Open reduction; tension band wiring
    C1.3 Complete articular fractures, transverse; distal
    Open reduction; tension band wiring
    Open reduction; salvage techniques
    Open reduction; Krackow whip stitch - suture repair
    C2 Complete articular transverse fractures plus additional fragment
    Open reduction; cerclage wire
    Open reduction; salvage techniques
    C3.1 Complete articular fractures, complex; with 4 fragments
    Open reduction; cerclage wire
    Open reduction; salvage techniques
    C3.2 Complete articular fractures, complex; with more than 4 fragments
    Open reduction; cerclage wire
    Open reduction; salvage techniques
    Special considerations
    Principles of management of open fractures
    Infection
  13. Proximal tibia

    Diagnosis
    Overview
    Preparations
    Overview
    Supine position
    Supine position, no knee support
    Approaches
    Overview
    Safe zones in the tibia
    Anterolateral approach
    MIO approach
    Posteromedial approach
    Reduction & Fixations
    Overview
    A1.1 Extraarticular fracture, avulsion of fibular head
    Nonoperative treatment
    Tension band fixation
    Lag screws
    A1.2 Extraarticular fracture, avulsion of tibial tuberosity
    Nonoperative treatment
    Lag screws
    A1.3 Extraarticular fracture, avulsion of cruciate insertion
    Nonoperative treatment
    Lag screws
    Tension band fixation
    A2 Extra-articular fracture, metaphyseal simple
    Nonoperative treatment
    Bridging external fixator (temporary)
    Modular external fixation with large pins (definitive)
    Hybrid external fixation (definitive)
    Ring external fixation (definitive)
    Angular stable plate (LISS)
    Plates without angular stability
    A3 Extra-articular fracture, metaphyseal multifragmentary
    Nonoperative treatment
    Bridging external fixator (temporary)
    Modular external fixation with large pins (definitive)
    Hybrid external fixation (definitive)
    Ring external fixation (definitive)
    Angular stable plate (LISS)
    Plates without angular stability
    B1 Partial articular fracture, pure split
    Nonoperative treatment
    Bridging external fixation (temporary)
    Hybrid external fixation (definitive)
    Ring external fixator
    Percutaneous lag screws
    Lag screws
    Plates without angular stability
    B2 Partial articular fracture, pure depression
    Nonoperative treatment
    Bridging external fixation (temporary)
    Ring external fixation (definitive)
    Plates without angular stability
    B3 Partial articular fracture, split-depression
    Nonoperative treatment
    Bridging external fixation (temporary)
    Hybrid external fixation (definitive)
    Ring external fixation (definitive)
    Plates without angular stability
    C1 Complete articular fracture, articular simple, metaphyseal simple
    Nonoperative treatment
    Bridging external fixation (temporary)
    Hybrid external fixation (definitive)
    Ring external fixation (definitive)
    Angular stable plate (LISS)
    Plates without angular stability
    C2 Complete articular fracture, articular simple, metaphyseal multifragmentary
    Nonoperative treatment
    Bridging external fixator (temporary)
    Hybrid external fixator
    Ring external fixator
    Angular stable plate (LISS)
    Conventional plates
    C3 Complete articular fracture, articular multifragmentary
    Nonoperative treatment
    Bridging external fixator (temporary)
    Hybrid external fixator
    Ring external fixator
    Conventional plates
    Less invasive stabilization system
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  14. Tibial shaft

    Diagnosis
    Overview
    Preparations
    Overview
    Flexed knee
    Supine position
    Supine position for ring fixator
    Supine position for nailing
    Lateral position
    Prone position
    Approaches
    Overview
    Anteromedial approach
    Anterolateral approach
    Medial approach, MIO
    Lateral approach, MIO
    Intramedullary nailing approach
    Safe zones for pin insertion
    Posteromedial approach
    Posterolateral approach
    Reduction & Fixations
    Overview
    A1 Simple spiral fracture
    Nonoperative (casting)
    CREF - Modular external fixator
    CREF - Uniplanar external fixator
    CREF - Ring fixator (Ilizarov)
    CRIF - Intramedullary nailing
    ORIF - Lag screws through protection plate
    ORIF - Lag screws outside protection plate
    A2 Simple oblique fracture
    Nonoperative (casting)
    CREF - Modular external fixator
    CREF - Uniplanar external fixator
    CREF - Ring fixator (Ilizarov)
    CRIF - Intramedullary nailing
    MIO - Compression plating
    ORIF - Lag screws through plate
    ORIF - Lag screws outside protection plate
    ORIF - Compression plate with lag screw
    A3 Simple transverse fracture
    Nonoperative (casting)
    CREF - Modular external fixator
    CREF - Uniplanar external fixator
    CREF - Ring fixator (Ilizarov)
    CRIF - Intramedullary nailing
    MIO - Compression plating
    ORIF - Axial compression plating
    B1 Spiral wedge fracture
    Nonoperative (casting)
    CREF - Modular external fixator
    CREF - Uniplanar external fixator
    CREF - Ring fixator (Ilizarov)
    CRIF - Intramedullary nailing
    MIO - Bridge plating
    ORIF - Lag screws through protection plate
    ORIF - Lag screws outside protection plate
    B2 Bending wedge fracture
    Nonoperative (casting)
    CREF - Modular external fixator
    CREF - Uniplanar external fixator
    CREF - Ring fixator (Ilizarov)
    CRIF - Intramedullary nailing
    MIO - Bridge plating
    ORIF - Lag screws with protection plate
    ORIF - Compression plating
    B3 Fragmented wedge fracture
    Nonoperative (casting)
    CREF - Modular external fixator
    CREF - Uniplanar external fixator
    CREF - Ring fixator (Ilizarov)
    CRIF - Intramedullary nailing
    MIO - Bridge plating
    C1 Complex spiral fracture
    Nonoperative (casting)
    CREF - Modular external fixator
    CREF - Uniplanar external fixator
    CREF - Ring fixator (Ilizarov)
    CRIF - Intramedullary nailing
    MIO - Bridge plating
    Open bridge plating
    C2 Complex segmental fracture
    Nonoperative (casting)
    CREF - Modular external fixator
    CREF - Uniplanar external fixator
    CREF - Ring fixator (Ilizarov)
    CRIF - Intramedullary nailing
    MIO - Compression plating
    MIO - Bridge plating
    ORIF - Compression plating
    ORIF - Lag screws with protection plate
    C3 Complex irregular fractures
    CREF - Modular external fixator
    CREF - Uniplanar external fixator
    CREF - Ring fixator (Ilizarov)
    CRIF - Intramedullary nailing
    MIO - Bridge plating
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  15. Distal tibia

    Diagnosis
    Overview
    Preparations
    Overview
    Supine position
    Supine position (fracture table)
    Supine position with knee flexed
    Supine position for MIPO
    Supine position, figure-of-four
    Prone position
    Lateral position
    Approaches
    Overview
    Anteromedial approach
    Anterolateral approach
    Posteromedial approach
    Medial approach
    Minimally invasive approach
    Posterolateral approach
    Nailing approach
    Safe zones
    Reduction & Fixations
    Overview
    A1 Extraarticular fractures, metaphyseal simple
    Nonoperative treatment; casting for definitive treatment
    Nonoperative treatment; traction (initial provisional stabilization)
    Closed reduction; temporary joint-bridging modular external fixation
    Closed reduction; temporary joint-bridging triangular external fixation
    Closed reduction; hybrid external fixation
    Closed reduction; full ring fixation (Ilizarov)
    Closed reduction; intramedullary nailing (reamed) (MIPO)
    Closed reduction; compression plating (MIPO)
    Open reduction; compression plating with or without lag screw
    A2 Extraarticular wedge fractures
    Nonoperative treatment; casting as initial temporary treatment
    Nonoperative treatment; traction (initial provisional stabilization)
    Closed reduction; temporary joint-bridging modular external fixation
    Closed reduction; temporary joint-bridging triangular external fixation
    Closed reduction; hybrid external fixation
    Closed reduction; full ring fixation (Ilizarov)
    Closed reduction; intramedullary nailing (reamed) (MIPO)
    Closed reduction; bridge plating (MIPO)
    Open reduction; lag screw and protection plate fixation
    A3 Complex metaphyseal fractures
    Nonoperative treatment; casting as initial temporary treatment
    Nonoperative treatment; traction (initial provisional stabilization)
    Closed reduction; temporary joint-bridging modular external fixation
    Closed reduction; temporary joint-bridging triangular external fixation
    Closed reduction; hybrid external fixation
    Closed reduction; full ring fixation (Ilizarov)
    Closed reduction; intramedullary nailing (reamed) (MIPO)
    Closed reduction; bridge plating of 43-A3.1/3.2 fractures (MIPO)
    Closed reduction; bridge plating of 43-A3.3 fracture (MIPO)
    B1 Partial articular fractures – “pure split fractures"
    Nonoperative treatment; casting for definitive treatment
    Nonoperative treatment; traction (initial provisional stabilization)
    Closed reduction; temporary joint-bridging modular external fixation
    Closed reduction; temporary joint-bridging triangular external fixation
    Open reduction; buttress plating and lag screws
    B2 Partial articular fractures – “split-depression fractures”
    Nonoperative treatment; casting as initial temporary treatment
    Nonoperative treatment; traction (initial provisional stabilization)
    Closed reduction; temporary joint-bridging modular external fixation
    Closed reduction; temporary joint-bridging triangular external fixation
    Open reduction; buttress plating and lag screws
    B3 Partial articular fracture, multifragmentary depression
    Nonoperative treatment; casting as initial temporary treatment
    Nonoperative treatment; traction (initial provisional stabilization)
    Closed reduction; temporary joint-bridging modular external fixation
    Closed reduction; temporary joint-bridging triangular external fixation
    Open reduction; plating and screws
    C1 Complete articular fracture, articular simple, metaphyseal simple
    Nonoperative treatment; casting as definitive treatment
    Nonoperative treatment; traction (initial provisional stabilization)
    Closed reduction; temporary joint-bridging modular external fixation
    Closed reduction; temporary joint-bridging triangular external fixation
    Closed reduction; hybrid external fixation
    Closed reduction; full ring fixation (Ilizarov)
    Closed reduction; intramedullary nailing (reamed) (MIPO)
    Open reduction; plating and screws
    C2 Complete articular fracture, articular simple, metaphyseal multifragmentary
    Nonoperative treatment; traction (initial provisional stabilization)
    Closed reduction; temporary joint-bridging modular external fixation
    Closed reduction; temporary joint-bridging triangular external fixation
    Open reduction; plating and screws
    C3 Complete articular fractures, multifragmentary
    Nonoperative treatment; traction (initial provisional stabilization)
    Closed reduction; temporary joint-bridging modular external fixation
    Closed reduction; temporary joint-bridging triangular external fixation
    Open reduction; screws and plate fixation through anterolateral approach (complex)
    Open reduction; screw and plate fixation through anterolateral approach (3-part)
    Open reduction; screws and plate fixation through anteromedial approach
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  16. Malleoli

    Diagnosis
    Overview
    Preparations
    Overview
    Supine positioning
    Lateral positioning
    Supine, figure-of-four
    Prone positioning
    Approaches
    Overview
    Lateral approach
    Medial approach
    Safe zones
    Posteromedial approach
    Posterior approach to Volkmann
    Safe zones
    Lateral approach (C-fractures)
    Reduction & Fixations
    Overview
    A1.1/2 Infrasyndesmotic lesion, isolated; rupture of lateral collateral ligaments, or avulsion of the tip of the lateral malleolus
    Functional treatment
    Circular cast
    A1.3 Infrasyndesmotic lesion, isolated; Transverse fracture of the lateral malleolus
    Functional treatment
    Circular cast
    Tension band wiring
    Tension band plate
    A2.1 Infrasyndesmotic lateral lesion, with fracture of the medial malleolus; Rupture of the lateral collateral ligaments
    Circular cast
    Open reduction; lag screw (oblique or vertical fractures)
    Open reduction; lag screw (transverse fracture)
    Open reduction; lag screw and buttress plate (vertical fracture)
    Open reduction; lag screw through buttress plate (vertical fracture)
    A2.2/3 Infrasyndesmotic lateral lesion, avulsion of the tip of the lateral malleolus or transverse fracture of the lateral malleolus, with fracture of the medial malleolus
    Circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Open reduction internal fixation
    A3.1 Infrasyndesmotic lateral lesion, with posteromedial fracture; Rupture of the lateral collateral ligaments
    Circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Lag screw (Posteriomedial extension)
    A3.2/3 Infrasyndesmotic lateral lesion, with posteromedial fracture; Avulsion of the tip, or transverse fracture, of the lateral malleolus
    Circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Open reduction internal fixation
    B1.1/2 Isolated transsyndesmotic fibular fracture; Simple, without or with rupture of the anterior syndesmosis
    Circular cast
    Lag screw and neutralization plate
    Antiglide plate
    B1.3 Isolated transsyndesmotic fibular fracture; Multifragmentary
    Circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Bridging plate
    Antiglide plate
    B2.1 Transsyndesmotic fibular fracture: medial lesion; ruptured medial collateral ligament
    Circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    B2.2 Transsyndesmotic fibular fracture: medial lesion; simple fracture of the medial malleolus
    Circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Open reduction internal fixation
    B2.3 Transsyndesmotic multifragmentary fibular fracture, with medial lesion
    Circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Open reduction internal fixation
    B3.1 Transsyndesmotic fibular fracture, with medial lesion and fracture of the posterolateral rim (Volkmann); Simple, with ruptured medial collateral ligament
    Circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Open reduction internal fixation
    B3.2 Transsyndesmotic simple fibular fracture, fracture of the posterolateral rim (Volkmann); with fracture of the medial malleolus
    Circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Open reduction internal fixation
    B3.3 Transsyndesmotic multifragmentary fibular fracture, fracture of the posterolateral rim (Volkmann); medial malleolus fractured
    Circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Open reduction internal fixation
    C1 Suprasyndesmotic simple diaphyseal fibular fracture, with medial lesion, without or with Volkmann injury
    Long-leg circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Open reduction internal fixation
    C2 Suprasyndesmotic multifragmentary fracture of the fibula; with medial lesion: without or with Volkmann injury
    Long-leg circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Open reduction internal fixation
    C3 Suprasyndesmotic, proximal fibular fracture (Maisonneuve); without or with shortening, with medial lesion, without or with Volkmann injury
    Long-leg circular cast
    Joint-bridging modular external fixation
    Joint-bridging triangular external fixation
    Open reduction internal fixation
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  17. Occipitocervical trauma

    Diagnosis
    Overview
    Preparations
    Overview
    Prone position
    Supine position
    Approaches
    Overview
    Posterior access to C1-C2
    Anterior access to C1-T2
    Reduction & Fixations
    Overview
    ATLAS Type I
    Soft collar
    ATLAS Type II
    Soft collar
    ATLAS Type IIIa
    Hard collar
    ATLAS Type IIIb
    Halo vest
    C1 lateral masses osteosynthesis
    Posterior C1-C2 fusion
    ATLAS Type IV
    Hard collar
    Halo vest
    Occipitocervical fusion
    ATLAS Type V
    Collar
    C0, Atlanto occipital dissociation Atlanto occipital dissociation
    Temporary halo and traction
    Occipitocervical fusion (screw fixation)
    C0, C0 Fractures C0 fractures
    Hard collar
    Occipitocervical fusion (screw fixation)
    C1-C2, Dislocation C1-C2 Dislocation
    Anterior C1-C2 fusion
    Posterior C1-C2 fusion
    C1-C2, Rotatory subluxation C1-C2 Rotatory subluxation
    Hard collar
    Halo vest
    Anterior C1-C2 fusion
    Posterior C1-C2 fusion
    C2, Body fracture C2 Body fracture
    Hard collar
    Halo vest
    Posterior fixation
    Anderson d'Alonzo Type I
    Hard collar
    Anderson d'Alonzo Type II
    Hard collar
    Halo vest
    Odontoid screw fixation
    Anterior C1-C2 trans articular screws
    Posterior C1-C2 fixation
    Anderson d'Alonzo Type III
    Hard collar
    Halo vest
    Odontoid screw fixation
    Posterior C1-C2 fixation
    Effendi Type I
    Hard collar
    Effendi Type II
    Halo vest
    Anterior fixation
    Posterior fixation
    Effendi Type III
    Halo vest
    Posterior fixation
    Levine IIa
    Halo vest
    Direct osteosynthesis of the isthmus
    Posterior fixation
    Anterior fixation
  18. Subaxial cervical trauma

    Diagnosis
    Overview
    Preparations
    Overview
    Supine position
    Prone position
    Approaches
    Overview
    Anterior to cervical spine
    Anterior access to C7-T2
    Posterior to cervical spine
    Posterior to cervical spine
    Posterior access to C7-T2
    Reduction & Fixations
    Overview
    A0 Minor, nonstructural fractures
    Nonoperative (collars)
    A1 Compression fracture single endplate
    Nonoperative (collars)
    Nonoperative (halo vest)
    Anterior plating
    A2 Coronal split/pincer fracture
    Nonoperative (collars)
    Nonoperative (halo vest)
    Combined anterior and posterior (360)
    Anterior plating
    A3 Burst fracture of single endplate
    Nonoperative (collars)
    Nonoperative (halo vest)
    Combined anterior and posterior (360)
    Anterior plating
    A4 Burst fracture or sagittal split involving both endplates
    Nonoperative (collars)
    Nonoperative (halo vest)
    Combined anterior and posterior (360)
    Anterior plating
    B1 Posterior tension band injury (bony)
    Nonoperative (collars)
    Cervical spine - posterior fixation
    B2 Posterior tension band injury (bony capsuloligamentous, ligamentous)
    Cervicothoracic junction - posterior fixation
    Cervical spine - posterior fixation
    Combined anterior and posterior (360)
    Anterior plating
    B3 Antgerior tension band injury
    Cervicothoracic junction - posterior fixation
    Cervical spine - posterior fixation
    Anterior plating
    C Translational injury
    Cervicothoracic junction - posterior fixation
    Cervical spine - posterior fixation
    Combined anterior and posterior (360)
    Anterior plating
    Special considerations
    Pediatric fractures
    Ankylotic spine
    Postoperative deformities
  19. Thoracic and lumbar trauma

    Diagnosis
    Overview
    Preparations
    Overview
    Right sided thoracotomy (T3-T10)
    Left sided thoracotomy (T3-L1/2)
    Thoracolumbar junction (T10-L2)
    Lumbotomy (L1-L4)
    Mini open approach (L4-S1)
    Posterior midline (T1-S1)
    MIS right sided thoracic(T4-T10)
    MIS left sided thoracic (T10-L2)
    MIS lumbotomy (L2-L4)
    Percutaneous pedicle screws
    Approaches
    Overview
    Right sided thoracotomy (T3-10)
    Left sided thoracotomy (T3-L1/2)
    Thoracolumbar junction approach
    Lumbotomy (L1-4)
    Mini open approach (L4-S1)
    Posterior midline (T1-S1)
    MIS right side thoracic (T4-T10)
    MIS left side thoracic (T10-L2)
    MIS lumbotomy (L2-L4)
    Percutaneous pedicle screws
    Reduction & Fixations
    Overview
    A0 Minor, nonstructural fractures
    Nonoperative treatment/ bracing
    A1 Wedge-compression fractures
    Nonoperative treatment/ bracing
    A2 Split fractures
    Nonoperative treatment/ bracing
    Anterior stabilization
    Posterior short segment fixation with Schanz pins
    MIS Anterior stabilization
    MIS posterior short segment fixation with Schanz pins
    A3 Incomplete burst fractures
    Nonoperative treatment/ bracing
    Anterior stabilization
    Posterior short segment fixation with pedicle screws
    Posterior short segment fixation with Schanz pins
    Posterior short segment fixation with intermediate screws
    MIS Anterior Stabilization
    MIS posterior short segment fixation with pedicle screws
    MIS posterior short segment fixation with Schanz pins
    A4 Complete burst fractures
    Nonoperative treatment/ bracing
    Anterior stabilization
    Posterior short segment fixation with pedicle screws
    Posterior short segment fixation with Schanz pins
    Posterior short segment fixation with intermediate screws
    Posterior long segment fixation
    MIS Anterior Stabilization
    MIS posterior short segment fixation with pedicle screws
    MIS posterior short segment fixation with Schanz pins
    B1 Transosseous tension band disruption / Chance fracture
    Posterior short segment fixation with pedicle screws
    Posterior short segment fixation with Schanz pins
    MIS posterior short segment fixation with pedicle screws
    MIS posterior short segment fixation with Schanz pins
    B2 Posterior tension band disruption
    Anterior stabilization
    Posterior short segment fixation with pedicle screws
    Posterior short segment fixation with Schanz pins
    Posterior short segment fixation with intermediate screws
    Posterior long segment fixation
    MIS Anterior Stabilization
    MIS posterior short segment fixation with pedicle screws
    MIS posterior short segment fixation with Schanz pins
    B3 Hyperextension
    Anterior stabilization
    Posterior long segment fixation
    MIS Anterior Stabilization
    C Displacement or dislocation
    Posterior long segment fixation (C)
  20. Sacral trauma

    Diagnosis
    Overview
    Preparations
    Overview
    Prone
    Supine
    Approaches
    Overview
    Midline approach
    Paramedian approach
    Reduction & Fixations
    Overview
    A1 A1 Coccygeal/sacral compression or ligamentous avulsion fractures
    Nonoperative
    A2 A2 Non-displaced transverse fracture below S-I joint
    Nonoperative
    A3 A3 Displaced transverse fracture below the S-I join
    Nonoperative
    ORIF - Sacral alar plating
    Laminectomy
    B1 B1 Central fracture
    Nonoperative
    ISS fixation
    Spinopelvic fixation
    Fixation of associated pelvic ring injuries
    B2 B2 Transalar fracture
    Nonoperative
    Spinopelvic fixation
    ISS fixation
    Fixation of associated pelvic ring injuries
    B3 B3 Transforaminal fracture
    Nonoperative
    Spinopelvic fixation
    ISS fixation
    Fixation of associated pelvic ring injuries
    C0 C0 Nondisplaced U-fracture
    Nonoperative
    ISS fixation
    C1 C1 B fracture with ipsilateral superior S1 facet discontinuous with medial part of sacrum
    Spinopelvic fixation
    Fixation of associated pelvic ring injuries
    C2 C2 Bilateral type B injury
    Spinopelvic fixation
    Fixation of associated pelvic ring injuries
    C3 C3 Non-displaced transverse fracture below S-I joint
    Spinopelvic fixation
    Fixation of associated pelvic ring injuries
  21. Adolescent Idiopathic Scoliosis

    Diagnosis
    Overview
    Preparations
    Overview
    Preparation posterior procedures
    Preparation anterior procedures
    Approaches
    Overview
    Posterior approach
    Thoracoscopic approach
    Anterior to lumbar spine
    Anterior to thoracic spine
    Reduction & Fixations
    Overview
    Lenke 1
    Posterior Screws - No direct vertebral body derotation
    Posterior Screws - With direct vertebral body derotation
    Posterior Hybrid
    Thoracoscopic release, posterior instrumentation
    Anterior open
    Lenke 2
    Posterior Screws - No direct vertebral body derotation
    Posterior Screws - With direct vertebral body derotation
    Posterior Hybrid
    Lenke 3
    Posterior Screws - No direct vertebral body derotation
    Posterior Screws - With direct vertebral body derotation
    Posterior Hybrid
    Lenke 4
    Posterior Screws - No direct vertebral body derotation
    Posterior Screws - With direct vertebral body derotation
    Posterior Hybrid
    Lenke 5
    Posterior Screws - No direct vertebral body derotation
    Posterior Screws - With direct vertebral body derotation
    Posterior Hybrid
    Anterior open
    Lenke 6
    Posterior Screws - No direct vertebral body derotation
    Posterior Screws - With direct vertebral body derotation
    Posterior Hybrid
  22. Deformity - Scheuermann Kyphosis

    Diagnosis
    Overview
    Preparations
    Overview
    Preparation posterior procedures
    Combined posterior and left side
    Approaches
    Overview
    Posterior approach
    Anterior thoracoscopic release
    MIS left side thorax
    Reduction & Fixations
    Overview
    Scheuermann Kyphosis
    Nonoperative procedure
    Posterior instrumentation without release
    Posterior instrumentation with release
  23. Spondylolisthesis

    Diagnosis
    Overview
    Preparations
    Overview
    Prone
    Supine
    Approaches
    Overview
    Wiltze approach
    Retroperitoneal approach
    Reduction & Fixations
    Overview
    Spondylolisthesis - Type 1
    Nonoperative
    Primary repair with pars screw
    Primary repair with pedicle screw and rod
    Anterior fusion of L5-S1
    Posterior fusion L5-S1
    Spondylolisthesis - Type 2
    Nonoperative
    Anterior fusion of L5-S1
    Posterior fusion of L5-S1
    Spondylolisthesis - Type 3
    Nonoperative
    Posterior fusion of L5-S1
    Combined anterior and posterior fusion
    Spondylolisthesis - Type 4
    Nonoperative
    Posterior fusion of L5-S1
    Spondylolisthesis - Type 5
    Nonoperative
    Posterior fusion of L5-S1
    Spondylolisthesis - Type 6
    Nonoperative
    Posterior fusion of L4-S1 (with or without pelvic fixation or ala)
  24. Pelvic ring

    Diagnosis
    Overview
    Preparations
    Overview
    Supine position
    Prone
    Approaches
    Overview
    Anterior to illiac wing/SI joint
    Approach to the pubic symphysis
    Modified Stoppa
    Posterium to sacrum
    Posterior to the SI joint
    Reduction & Fixations
    Overview
    A1 A.1 Avulsion fractures of the innominate bone
    Nonoperative
    ORIF; apophyseal avulsion fracture
    A2.1 A2.1 Direct blow fracture of the iliac wing
    Nonoperative
    ORIF; iliac crest
    A2.2/3 A2.2/3 Uni- or bilateral blow fracture of the anterior pelvic arch
    Nonoperative
    Pubic symphysis plate
    Pubic ramus plate
    Pubic ramus screw
    A3.1 A3.1 Sacrococcygeal dislocation
    Nonoperative
    A3.2 A3.2 Undisplaced sacral fracture
    Nonoperative
    A3.3 A.3.3 Displaced sacral fracture
    Nonoperative
    ORIF Plate
    Primary survey
    Airway
    Breathing
    Circulation
    Disability
    Exposure and environmental control
    Acute pelvic treatment
    Extraperitoneal pelvic packing
    Angio embolization
    External fixation: Emergency stabilization with a C-clamp
    External fixation
    B1 B1 Unilateral partial injury of the posterior pelvic arch with external rotation (open book)
    Nonoperative
    External fixation and traction (resource-limited)
    Operative treatment
    B2 B2 Unilateral partial injury of the posterior pelvic arch with internal rotation
    Nonperative
    ExFix and traction in resource limited settings
    External fixation
    Operative treatment
    B3 B3 Bilateral partial injury of the posterior arch of the pelvic ring
    Nonoperative
    External fixation and traction (resource-limited)
    Operative treatment
    C1.1 C1.1 Unilateral complete fracture of the posterior ilium
    External fixation and traction (resource-limited)
    Operative treatment
    C1.2 C1.2 Unilateral complete injury though the SI joint
    External fixation and traction (resource-limited)
    Operative treatment
    C1.3 C1.3 Unilateral complete fracture though the sacrum
    External fixation and traction (resource-limited)
    Operative treatment
    C2 C2 Unilateral complete, ipsialteral partial injury of the posterior pelvic arch
    External fixation and traction (resource-limited)
    Operative treatment
    C3 C3 Bilateral completely unstable posterior pelvic ring injuries
    External fixation and traction (resource-limited)
    Operative treatment
    Iliac fractures
    External fixation and traction (resource limited)
    External fixation
    ORIF ilium
    Pubic ramus fractures
    Nonoperative
    External fixation
    Pubic ramus plate
    Pubic ramus screw
    Pubic symphysis fractures
    Pubic symphysis plate
    SI-joint fractures
    External fixation and traction (resource-limited)
    External fixation
    Anterior ORIF SI fracture
    Posterior ORIF SI fracture
    Iliosacral screw for sacrum
    Iliosacral screw navigation
    Anterior ORIF SI Joint
    Secondary survey
    Secondary survey
    Sacral fractures
    External fixation and traction (resource-limited)
    External fixation
    ORIF sacrum
    Iliosacral screw for sacrum
    Iliosacral screw navigation
    Triangular osteosynthesis
    Ilioiliac plate
    Spinopelvic fixation
    Stable ring fractures
    Nonoperative
    ORIF; apophyseal avulsion fracture
    ORIF; iliac crest
    ORIF sacrum
  25. Acetabulum

    Diagnosis
    Overview
    Preparations
    Overview
    Prone position
    Lateral position
    Supine position
    Approaches
    Overview
    Kocher-Langenbeck
    Trochanter flip extension
    Iliofemoral approach
    Extended iliofemoral
    Ilioinguinal approach
    Reduction & Fixations
    Overview
    Nonoperative
    Nonoperative treatment
    Kocher-Langenbeck
    Posterior wall fixation
    Posterior column
    Posterior column and wall fixation
    Transverse fracture fixation
    Transverse and posterior wall fracture fixation
    T-type fracture fixation
    Ilioinguinal
    Anterior wall fixation
    Anterior column fixation
    Anterior column / posterior hemitransverse
    Both column fixation
    Extended iliofemoral
    Transverse and posterior wall fracture fixation
    Both column fixation
    Posterior column and wall fixation
    Transverse fracture fixation
    T-type fracture fixation
    Trochanter flip extension
    Posterior wall fixation
  26. Hand Carpal bones

    Diagnosis
    Overview
    Approaches
    Overview
    Anatomical structures
    Palmar to the scaphoid
    Dorsal to the scaphoid
    Combined to perilunate
    Reduction & Fixations
    Overview
    Lunate, dislocation
    Open reduction, internal fixation (ORIF)
    Perilunate, dissociation
    ORIF of Lunotriquetral dissociation
    Ligament repair of scapholunate dissociations
    Perilunate, fracture
    Open reduction, internal fixation (ORIF)
    Scaphoid, proximal pole
    Prograde screw fixation
    Scaphoid, waist
    Nonoperative treatment
    Percutaneous screw fixation
    Screw and K-wires fixation
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  27. Hand Proximal phalanx

    Diagnosis
    Overview
    Approaches
    Overview
    Palmar to PIP joint
    Dorsal to the PIP joint
    Dorsal approach to the MCP joint
    Midaxial to the proximal phalanx
    Dorsal to phalangeal metaphysis
    Midaxial to the PIP joint
    Reduction & Fixations
    Overview
    Distal articular, bicondylar
    Lag screw fixation
    Distal articular, oblique
    Nonoperative treatment
    Lag screw fixation
    Distal articular, unicondylar fracture dislocation
    Lag screw fixation
    Distal metaphyseal (head), multifragmentary
    Nonoperative treatment
    Minicondylar bridge plate fixation
    Distal metaphyseal (head), oblique
    Nonoperative treatment
    Lag screw fixation
    Lag screw with protection plate
    Minicondylar plate with lag screw
    Distal metaphyseal (head), transverse
    Minicondylar compression plate fixation
    Proximal articular, avulsion
    Tension-band wiring
    Collateral ligament reattachment
    Lag screw fixation
    Proxmial articular, multifragmentary
    Minicondylar bridge plate fixation
    T-plate fixation
    Proximal articular, shearing
    Lag screw fixation
    Proximal metaphyseal, oblique
    Nonoperative treatment
    Lag screw fixation
    Minicondylar compression plate fixation
    T-compression plate fixation
    Proximal metaphyseal, transverse
    Nonoperative treatment
    Minicondylar plate fixation
    T-plate fixation
    Shaft, multifragmentary
    Nonoperative treatment
    Bridge plate fixation of oblique wedge fractures
    Bridge plate fixation of multifragmentary fractures
    Shaft, oblique
    Nonoperative treatment
    Compression plate fixation
    Shaft, transverse
    Nonoperative treatment
    Compression plate fixation
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  28. Hand Middle phalanx

    Diagnosis
    Overview
    Approaches
    Overview
    Dorsal to the middle phalanx
    Midaxial to the PIP joint
    Dorsal to the PIP joint
    Palmar to PIP joint
    Midaxial to the middle phalanx
    Reduction & Fixations
    Overview
    Distal, bicondylar
    Nonoperative treatment
    Lag screw fixation
    Distal, unicondylar
    Nonoperative treatment
    Lag screw fixation
    Proximal, collateral ligament avulsion
    Lag screw fixation
    Tension-band wiring
    Proximal, dislocation
    Collateral ligament repair
    Proximal, dorsal avulsion fracture
    Dorsal lag screw fixation
    Tension-band wiring
    Proximal, multifragmentary
    Hemi-hamate arthroplasty with bone graft
    Joint reconstruction with bone graft
    Minicondylar plate fixation of Pilon compression fracture
    Screw fixation of lateral plateau compression fracture
    Screw fixation with bone graft of central impaction fracture
    Proximal, volar plate avulsion
    Lag screw fixation of volar plate
    Suture fixation
    Volar plate arthroplasty
    Shaft, multifragmentary
    Nonoperative treatment
    Minicondylar bridge plate
    Shaft, oblique
    Nonoperative treatment
    Lag screw fixation
    Shaft, transverse
    Nonoperative treatment
    K-wire fixation
    Compression plate fixation
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  29. Hand Distal phalanx

    Diagnosis
    Overview
    Approaches
    Overview
    Percutaneous through finger tip
    Dorsal to the DIP joint
    Palmar to the DIP joint
    Reduction & Fixations
    Overview
    Distal and shaft, multifragmentary
    Nonoperative treatment
    K-wire fixation
    Distal and shaft, transverse
    Nonoperative treatment
    K-wire fixation
    Dislocation
    Nonoperative treatment
    K-wire fixation
    Dorsal avulsion
    Nonoperative treatment
    K-wire immobilization
    Lag screw fixation
    Tension-band wire
    K-wire fixation
    Palmar avulsion
    Nonoperative treatment
    K-wire fixation
    Suture fixation
    Lag screw fixation
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  30. Hand Thumb

    Diagnosis
    Overview
    Approaches
    Overview
    Palmar to PIP joint
    Dorsal to the PIP joint
    Approach to thumb metacarpal
    Approach to base of the thumb
    Dorsal to MCP joint
    Dorsoulnar to MCP joint
    Midaxial to the proximal phalanx
    Midaxial to the PIP joint
    Percutaneous through finger tip
    Dorsal to the DIP joint
    Palmar to the DIP joint
    Dorsal to IP joint of the thumb
    Reduction & Fixations
    Overview
    Distal phalanx: Base - Dislocation
    Nonoperative treatment
    K-wire fixation
    Distal phalanx: Base - dorsal avulsion
    Nonoperative treatment
    K-wire immobilization
    Lag screw fixation
    Tension-band wire
    K-wire fixation
    Distal phalanx: Base - palmar avulsion
    Nonoperative treatment
    K-wire fixation
    Suture fixation
    Lag screw fixation
    Distal phalanx: Distal and Shaft - multifragmentary
    Nonoperative treatment
    K-wire fixation
    Distal phalanx: Distal and Shaft - transverse
    Nonoperative treatment
    K-wire fixation
    Metacarpal: Base
    External fixation
    Locking compression plate (LCP) fixation
    Metacarpal: Bennett fracture
    Nonoperative treatment
    K-wire fixation
    Lag screw fixation
    Metacarpal: Rolando fracture
    Nonoperative treatment
    Plate fixation
    Proximal phalanx: Articular (head) - bicondylar
    Lag screw fixation
    Proximal phalanx: Articular (head) - Oblique
    Nonoperative treatment
    Lag screw fixation
    Proximal phalanx: Articular (head) - unicondylar fracture dislocation
    Lag screw fixation
    Proximal phalanx: Base and shaft - multifragmentary
    Bridge plate fixation
    Proximal phalanx: Base and shaft - pilon fractures
    Open reduction, internal fixation (ORIF)
    Proximal phalanx: Base and shaft - Skiers thumb
    Ligament reattachment with suture anchors
    Proximal phalanx: Metaphyseal (head) - multifragmentary
    Nonoperative treatment
    Minicondylar bridge plate fixation
    Proximal phalanx: Metaphyseal (head), oblique
    Nonoperative treatment
    Lag screw fixation
    Lag screw with protection plate
    Minicondylar plate with lag screw
    Proximal phalanx: Metaphyseal (head) - transverse
    Minicondylar compression plate fixation
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  31. Hand Metacarpals

    Diagnosis
    Overview
    Approaches
    Overview
    Dorsal approach to metacarpals
    Dorsal to 2nd metacarpal
    Dorsal to 5th metacarpal
    Dorsal to base of 5th metacarpal
    Dorso-ulnar to 5th metacarpal
    Dorsal to the MCP joint
    Reduction & Fixations
    Overview
    Base fracture
    Plate fixation
    Head, intraarticular
    Screw fixation
    Head, subcapital
    Intramedullary K-wire fixation
    Shaft, multifragmentary
    Nonoperative treatment
    Bridge plate fixation
    Shaft, oblique
    Nonoperative treatment
    Lag screw with protection plate
    Lag screw fixation
    Shaft, transverse
    Nonoperative treatment
    Compression plate fixation
    Special considerations
    Principles of management of open fractures
    Infection
    Compartment syndrome
  32. Foot Talus

    Diagnosis
    Overview
    Approaches
    Overview
    Anterolateral to the talus
    Anteromedial to the talus
    Direct lateral to the talus
    Posteromedial to the talus
    Posterolateral to the hindfoot
    Medial malleolar osteotomy
    Lateral malleolar osteotomy
    Reduction & Fixations
    Overview
    Body
    ORIF - screw and plate fixation
    Neck, displaced
    ORIF - screw fixation
    Lateral process
    ORIF - screw fixation
    Neck, multifragmentary
    ORIF - plate fixation
    Posterior process
    ORIF - screw fixation
    Neck, undisplaced
    Nonoperative treatment
    Special considerations
    Reinsertion of an extruded talus
    Combined hindfoot injuries
    Compartment syndrome
    Osteonecrosis
  33. Foot Calcaneus

    Diagnosis
    Overview
    Approaches
    Overview
    Extended lateral to calcaneus
    Medial approach to the calcaneus
    Sinus tarsi approach
    MIO lateral approach
    MIO posterior approach
    Reduction & Fixations
    Overview
    Displaced fracture of the calcaneus body
    ORIF - plate and screw fixation
    MIO - K-wire and screw fixation (joint-depression type)
    MIO - K-wire fixation (tongue type)
    Extreme tongue-type (beak) fracture of the calcaneus body
    ORIF - screw fixation
    Simple undisplaced fracture of the calcaneus body
    Nonoperative treatment
    Sustentacular fracture of the calcaneus body
    ORIF - screw fixation
    Special considerations
    Open fractures
    Combined hindfoot injuries
    Compartment syndrome
  34. Foot Midfoot

    Diagnosis
    Overview
    Approaches
    Overview
    Dorsomedial to the navicular
    Percutaneous to the navicular
    Dorsolateral to the cuboid
    Medial utility incision
    Reduction & Fixations
    Overview
    TMT (Lisfranc) injuries
    ORIF - screw fixation
    Cuboid, crush
    ORIF - plate fixation
    Intertarsal crush
    External fixation
    Intertarsal fractures
    ORIF - plate fixation
    Navicular, multifragmentary
    ORIF - plate fixation
    Navicular, split/stress
    Nonoperative treatment
    Screw fixation
    Cuboid, simple
    Nonoperative treatment
    Special considerations
    Compartment syndrome
  35. Foot Metatarsals

    Diagnosis
    Overview
    Preparations
    Overview
    Supine position
    Approaches
    Overview
    Medial approach to MT1
    Dorsal approach to MT1
    Dorsal approach to MT1 & MTPJ
    Dorsal intermetatarsal approach
    Lateral approach to MT5
    Dorsal approach to midfoot / MT
    Reduction & Fixations
    Overview
    1st, base, intraarticular
    ORIF: lag screw or plate fixation
    1st, head, intraarticular T-type
    ORIF or K-wire fixation
    1st, head, intraarticular comminuted
    ORIF or MTP joint fusion
    1st, head, intraarticular oblique
    ORIF or K-wire fixation
    1st, shaft, transverse or oblique
    ORIF: lag screw and plate fixation
    2nd-4th, diaphyseal fractures
    ORIF: screw and plate fixation
    2nd-4th, proximal metaphyseal fractures
    ORIF: screw and plate fixation
    2nd-4th, subcapital fractures
    ORIF: plate fixation
    5th, base, metaphyseal avulsion fractures
    Nonoperative treatment
    5th, base (Jones fracture)
    ORIF: screw fixation
    5th, long oblique diaphyseal fractures
    ORIF: screw fixation
    5th, multifragmentary diaphyseal fractures
    ORIF: plate fixation
    Crush injuries
    ORIF or K-wire fixation
    Special considerations
    Compartment syndrome
  36. Foot Phalanges

    Diagnosis
    Overview
    Preparations
    Overview
    Supine position
    Approaches
    Overview
    Medial approach to the hallux
    Dorsal approach to MT1 & MTPJ
    Dorsal approach to P1
    Plantar approach to DIP joint
    Dorsal approach to DIP joint
    Reduction & Fixations
    Overview
    2nd-5th row, MTP-joint dislocation
    CRIF: K-wire fixation
    2nd-5th row, distal phalanx, multifragmentary
    Reinsertion of the nail
    2nd-5th row, proximal phalanx, base, intraarticular, T-type
    K-wire fixation
    2nd-5th row, proximal phalanx, excessively displaced
    K-wire fixation
    2nd-5th row, proximal phalanx, head, intraarticular
    K-wire fixation
    2nd-5th row, proximal phalanx, head, small fragment
    Nonoperative treatment
    Hallux, distal phalanx, base, impression fractures
    Excision
    Hallux, proximal phalanx, base, intraarticular, T-type
    ORIF: screws or plate
    Hallux, proximal phalanx, base, intraarticular, comminuted
    ORIF or MTP joint fusion
    Hallux, proximal phalanx, base, shear fracture
    ORIF: screw fixation
    Hallux, proximal phalanx, diaphysis, simple
    ORIF: screw fixation
    Hallux, proximal phalanx, head, intraarticular
    ORIF or K-wire fixation
    Special considerations
    Compartment syndrome
  37. Mandible

    Diagnosis
    Overview
    Approaches
    Overview
    Use of existing lacerations
    Intraoral approach to symphysis
    Intraoral approach to the angle
    Submental approach
    Submandibular approach
    Retromandibular approaches
    Facelift (rhytidectomy) approach
    Preauricular approach
    Intraoral approach to the ramus
    Safe zones
    Reduction & Fixations
    Overview
    Angle and ramus, complex
    Closed treatment
    ORIF, two plates (basal triangle)
    ORIF, reconstruction plate (basal triangle)
    ORIF, reconstruction plate (comminuted fracture)
    External fixator
    Angle and ramus, simple
    Observation
    Closed treatment
    ORIF, wire
    ORIF, miniplate fixation to the oblique ridge
    ORIF, two miniplates
    ORIF, reconstruction plate
    Body, complex
    Closed treatment
    ORIF, two plates (basal triangle)
    ORIF, reconstruction plate
    External fixator
    Body, simple
    Observation
    Closed treatment
    ORIF, lag screws
    ORIF, one miniplate
    ORIF, two plates
    ORIF, one large plate
    Condylar process and head, simple and complex
    Observation
    Closed treatment
    ORIF, one/two plate(s) - extraoral approach
    ORIF, one/two plate(s) - intraoral approach
    ORIF, one/two plate(s) - endoscopically assisted
    Symphysis and parasymphysis, complex
    Closed treatment
    ORIF, two plates (basal triangle)
    ORIF, reconstruction plate (basal triangle)
    ORIF, reconstruction plate (comminuted fracture)
    External fixator
    Symphysis and parasymphysis, simple
    Closed treatment (MMF)
    ORIF, two lag screw fixation
    ORIF, lag screw and plate
    ORIF, one plate and arch bar
    ORIF, two plates
    Special considerations
    Multiple fractures
    Edentulous atrophic fractures
    Teeth in the line of fracture
    Involvement of alveolar area
    Infected fractures with or without bone loss
    Coronoid process fractures
    Complications
  38. Midface

    Diagnosis
    Overview
    Approaches
    Overview
    The use of existing lacerations
    Approaches to the maxilla
    Lower eyelid - transcutaneous
    Lower eyelid - transconjunctival
    Glabellar approach
    Coronal approach
    Not recommended
    Superolateral orbital rim
    Preauricular approach
    Endonasal approaches
    External rhinoplasty approach
    Extended glabellar approach
    Zygomatic arch (indirect)
    Reduction & Fixations
    Overview
    Le Fort I, bilateral comminution
    Open reduction internal fixation
    Le Fort I, edentulous patients
    Observation
    Open reduction internal fixation
    Le Fort I, linear fracture
    Observation
    Closed treatment
    Open reduction internal fixation
    Le Fort I, unilateral comminution
    Closed treatment
    Open reduction internal fixation
    Le Fort II
    Observation
    Closed treatment
    Open reduction internal fixation
    Le Fort III
    Observation
    Closed treatment
    Open reduction internal fixation
    NOE Type I
    Observation
    Open reduction internal fixation
    NOE, Type II
    Open reduction internal fixation
    NOE, Type III
    Open reduction internal fixation
    Nasal bone
    Observation
    Closed reduction
    Open reduction
    Septorhinoplasty
    Nasal septal hematoma drainage
    Orbit, combined fracture
    Observation
    Orbital reconstruction
    Orbit, medial orbital wall fracture
    Observation
    Orbital reconstruction
    Orbit, orbital floor fracture
    Observation
    Open reduction with or without internal fixation
    Orbital reconstruction
    Orbital reconstruction, CAS: Intraoperative imaging
    Orbital reconstruction, CAS: Virtual planning and intraoperative navigation
    Orbit, orbital roof fracture
    Observation
    Open treatment
    Palatoalveolar fracture, complex injury
    Observation
    Closed treatment
    Open reduction internal fixation
    Palatoalveolar fracture, simple injury
    Observation
    Closed treatment
    Open reduction internal fixation
    Zygoma, isolated zygomatic arch
    Closed treatment
    Open reduction without fixation
    Open reduction with fixation
    CAS: Intraoperative imaging in closed treatment
    Zygoma, zygomatic complex fracture
    Closed treatment
    ORIF, 1-point fixation (without orbital reconstruction)
    ORIF, 2-point fixation (without orbital reconstruction)
    ORIF, 3-point fixation (without orbital reconstruction)
    ORIF, 3-point fixation (with orbital reconstruction)
    ORIF, 4-point fixation (with orbital reconstruction)
    CAS: Intraoperative imaging (ORIF without orbital reconstruction)
    CAS: Virtual planning and intraoperative imaging (ORIF without orbital reconstruction)
    CAS: Virtual planning and intraoperative imaging (ORIF with orbital reconstruction)
    CAS: Virtual planning and intraoperative navigation (ORIF with orbital reconstruction)
    Special considerations
    Airway considerations
    Panfacial fractures (sequencing of repair)
    Intraoperative imaging (closed reduction)
    Intraoperative imaging
    Virtual planning and intraoperative imaging
    Intraoperative imaging
    Virtual planning and intraoperative navigation
    Virtual planning and intraoperative imaging
    Virtual planning and intraoperative navigation
    Virtual planning and intraoperative navigation
  39. Skull base & Cranial vault

    Diagnosis
    Overview
    Approaches
    Overview
    Lacerations
    Coronal approach
    Lateral skull base approach
    Posterior skull base approach
    Transmatoid approach
    Endoscopy: Transnasal
    Endoscopy: Central skull base
    Endoscopy: Anterior table
    Reduction & Fixations
    Overview
    Cranial vault fracture
    Observation
    Treatment of depressed cranial vault fractures
    Frontal sinus fracture, anterior table
    Observation
    Open reduction internal fixation
    Obliteration
    Delayed endoscopic repair
    Frontal sinus fracture, frontal recess
    Obliteration
    Observation (and when indicated frontal sinus endoscopy)
    Frontal sinus fracture, posterior table
    Observation
    Cranialization
    Obliteration
    Skull base fracture, anterior
    Observation
    Intradural repair
    Extradural repair
    Skull base fracture, central (anterior)
    Observation
    Endoscopic repair of CSF leak
    Skull base fracture, lateral
    Observation
    Extradural middle fossa repair using temporal fascia flap
    Skull base fracture, posterior
    Observation
    Treatment modalities
    Skull base fracture, temporal bone (lateral skull base)
    Observation
    Surgical management
    Delayed management of hearing loss
    Special considerations
    Traumatic brain injury/Vascular injury
    Infections
    Late sequelae
    Cranioplasty (bone versus alloplast)
  40. Congenital deformities

    Approaches
    Overview
    Reduction & Fixations
    Overview
  41. Orthognathic

    Approaches
    Overview
    Reduction & Fixations
    Overview
  42. Corrections of posttraumatic deformities

    Approaches
    Overview
    Reduction & Fixations
    Overview
  43. Postablative reconstruction

    Approaches
    Overview
    Reduction & Fixations
    Overview
  44. Nose Reconstruction

    Diagnosis
    Overview
    Reduction & Fixations
    Overview
    Full thickness defects
    Three stage forehead folded flap
    Four stage forehead flap with radial forearm flap for lining
    Large partial thickness defect
    Two stage forehead flap - Ala reconstruction
    Two stage forehead flap - Tip reconstruction
    Three stage forehead flap
    Small superficial defect
    Secondary healing
    Full thickness skin graft
    One stage nasolabial flap
  45. Dentoalveolar trauma

    Diagnosis
    Overview
    Reduction & Fixations
    Overview
    Alveolar fracture, segmental
    Closed treatment
    Open reduction internal fixation
    Tooth fracture, crown-root fracture
    Various treatment options
    Tooth fracture, enamel only/dentin exposure
    Enamel only - no immediate treatment
    Dentin exposure - sealing dentin
    Tooth fracture, pulp exposure
    Pulp capping / partial amputation / extirpation
    Tooth fracture, root fracture
    Splint
    Tooth luxation, avulsion (total luxation)
    Various treatment options
    Tooth luxation with displacement - Extrusion
    Repositioning and fixation
    Tooth luxation with displacement - Intrusion
    Repositioning and fixation
    Tooth luxation, with displacement - Lateral luxation
    Repositioning and fixation
    Tooth luxation, without displacement - Concussion
    No active treatment
    Tooth subluxation, without displacement - Subluxation
    No active treatment
    Special considerations
    Computer assisted dental implant surgery