Campbell’s Operative Orthopaedics 4-Volume Set (S. Terry Canale, James H. Beaty) (z-lib.org)

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Campbell’s Operative Orthopaedics 4-Volume Set (S. Terry Canale, James H. Beaty) (z-lib.org) copy Front Matter Copyright In Memory Contributors Preface Video Contents Campbell's Operative Orthopaedics, 12 th ed. List of Techniques Volume I Surgical Techniques and Approaches Arthroplasty of the Hip Arthrodesis of the Hip Hip Pain in the Young Adult and Hip Preservation Surgery Arthroplasty of the Knee Arthrodesis of the Knee Soft Tissue Procedures and Corrective Osteotomies About the Knee Total Ankle Arthroplasty Ankle Arthrodesis Shoulder and Elbow Arthroplasty Arthrodesis of the Shoulder and Elbow Amputations of the Foot Amputations of the Lower Extremity Amputations of the Hip and Pelvis Amputations of the Upper Extremity Amputations of the Hand Osteomyelitis Infectious Arthritis Tuberculosis and Other Unusual Infections General Principles of Tumors Volume II Congenital Anomalies of the Lower Extremity Congenital and Developmental Anomalies of the Hip and Pelvis Congenital Anomalies of the Trunk and Upper Extremity Osteochondrosis Cerebral Palsy Paralytic Disorders Neuromuscular Disorders Fractures and Dislocations in Children Spinal Anatomy and Surgical Approaches Fractures, Dislocations, and Fracture-Dislocations of the Spine Arthrodesis of the Spine Pediatric Cervical Spine Scoliosis and Kyphosis Lower Back Pain and Disorders of Intervertebral Discs Infections of the Spine Other Disorders of the Spine Volume III Knee Injuries Shoulder and Elbow Injuries Recurrent Dislocations Traumatic Disorders Arthroscopy of the Foot and Ankle Arthroscopy of the Lower Extremity Arthroscopy of the Upper Extremity General Principles of Fracture Treatment Fractures of the Lower Extremity Fractures and Dislocations of the Hip Fractures of Acetabulum and Pelvis Fractures of the Shoulder, Arm, and Forearm Malunited Fractures Delayed Union and Nonunion of Fractures Acute Dislocations Old Unreduced Dislocations Volume IV@ Peripheral Nerve Injuries Microsurgery The Hand: Basic Surgical Techniques and Aftercare Acute Hand Injuries Flexor and Extensor Tendon Injuries Fractures, Dislocations, and Ligamentous Injuries Nerve Injuries Wrist Disorders Special Hand Disorders Paralytic Hand Cerebral Palsy of the Hand Arthritic Hand Compartment Syndromes and Volkman Contracture Dupuytren Contracture Carpal Tunnel, Ulnar Tunnel, and Stenosing Tenosynovitis Tumors and Tumorous Conditions of the Hand Hand Infections Congenital Anomalies of the Hand The Foot: Surgical Techniques Disorders of the Hallux Disorders of Tendons and Fascia and Adolescent and Adult Pes Planus Lesser Toe Abnormalities Arthritis of the Foot Neurogenic Disorders Disorders of Nails and Skin Fractures and Dislocations of the Foot Sports Injuries of the Foot and Ankle COO1 PART I. GENERAL PRINCIPLES 1 Surgical Techniques and Approaches Surgical Techniques Tourniquets Radiographs in the Operating Room Positioning of the Patient Local Preparation of the Patient  Wound Irrigating Solutions Draping  Draping the Edges of the Incision Prevention of Human Immunodeficiency Virus Transmission Preventing Mistakes Special Operative Techniques Methods of tendon-to-Bone Fixation Fixation of Tendon to Bone Tendon Fixation into the Intramedullary Canal Tendon to Bone Fixation Using Locking Loop Suture Fixation of Tendon to Bone Using Wire Suture Fixation of Osseous Attachment of Tendon to Bone Bone Grafting  Structure of Bone Grafts  Sources of Bone Grafts Autogenous Grafts Allogenic Grafts Heterogeneous Grafts  Bone Bank  Cancellous Bone Graft Substitutes  Indications for Various Bone Graft Techniques Onlay Cortical Grafts Inlay Grafts Multiple Cancellous Chip Grafts Hemicylindrical Grafts Whole-Bone Transplant  Conditions Favorable for Bone Grafting  Preparation of Bone Grafts Removal of a Tibial Graft Removal of Fibular Grafts  Cancellous Iliac Crest Bone Grafts Removal of an Iliac Bone Graft Surgical Approaches Toes Approach to the Interphalangeal Joints  Approaches to the Metatarsophalangeal Joint of the Great Toe Medial Approach to the Great Toe Metatarsophalangeal Joint Dorsomedial Approach to Great Toe Metatarsophalangeal Joint Approach to the Lesser Toe Metatarsophalangeal Joints Calcaneus Medial Approach to the calcaneus Lateral Approach to the calcaneus U-Shaped Approach to the calcaneus Kocher Approach (Curved L) to the calcaneus Tarsus and Ankle  ANTERIOR APPROACHES Anterolateral Approach to the calcaneus Anterior Approach to Expose the Ankle Joint and Both Malleoli  LATERAL APPROACHES TO THE TARSUS AND ANKLE KOCHER Lateral Approach to the Tarsus and Ankle Ollier Approach to the Tarsus Posterolateral Approach to the Ankle Anterolateral Approach to the Lateral Dome of the Talus Posterior Approach to the Ankle  medial approaches to the ankle Medial Approach to the Ankle Medial Approach to the Posterior Lip of the Tibia Tibia Anterior Approach to the Tibia Medial Approach to the Tibia Posterolateral Approach to the Tibia Posterior Approach to the Superomedial Region of the Tibia Fibula Posterolateral Approach to the Fibula Knee  Anteromedial and Anterolateral Approaches Anteromedial Parapatellar Approach Subvastus (Southern) Anteromedial Approach to the knee Anterolateral Approach to the Knee  Posterolateral and Posteromedial Approaches Posterolateral Approach to the Knee Posteromedial Approach to the Knee  Medial Approaches to the Knee and Supporting Structures Medial Approach to the Knee Medial Approach to the Knee Transverse Approach to the Meniscus  Lateral Approaches to the Knee and Supporting Structures Lateral Approach to the Knee Lateral Approach to the Knee Lateral Approach to the Knee Extensile Approach to the Knee  Direct Posterior, Posteromedial, and Posterolateral Approaches to the knee Direct Posterior Approach to the Knee Direct Posteromedial Approach to the Knee for Tibial Plateau Fracture Direct Posterolateral Approach to the Knee Femur Anterolateral Approach to the femur Lateral Approach to the femoral shaft Posterolateral Approach to the Femoral Shaft Posterior Approach to the Femur Medial Approach to the Posterior Surface of the Femur in the Popliteal Space Lateral Approach to the Posterior Surface of the Femur in the Popliteal Space Lateral Approach to the Proximal Shaft and the Trochanteric Region Hip  Anterior Approaches Anterior Iliofemoral Approach to the hip Anterior Approach to the Hip Using a Transverse Incision Modified Anterolateral Iliofemoral Approach to the Hip  Lateral Approaches Lateral Approach to the Hip Lateral Approach for Extensive Exposure of the Hip Lateral Approach to the Hip Preserving the Gluteus Medius Lateral Transgluteal Approach to the Hip Lateral Transgluteal Approach to the Hip Posterolateral Approach  Posterior Approaches Posterior Approach to the Hip Posterior Approach to the Hip  Medial Approach Medial Approach to the Hip Acetabulum and Pelvis  Anterior Approaches Ilioinguinal Approach to the Acetabulum Iliofemoral Approach to the acetabulum Posterior Approach to the Acetabulum  Extensile Acetabular Approaches Extensile Iliofemoral Approach Extensile Iliofemoral Approach Triradiate Extensile Approach to the Acetabulum Extensile Approach to the Acetabulum Ilium Approach to the Ilium Symphysis Pubis Approach to the Symphysis Pubis Sacroiliac Joint Posterior Approach to the Sacroiliac Joint Anterior Approach to the Sacroiliac Joint Approach to Both Sacroiliac Joints or Sacrum Spine Sternoclavicular Joint Approach to the Sternoclavicular Joint Acromioclavicular Joint and Coracoid Process Approach to the Acromioclavicular Joint and Coracoid Process Shoulder  Anteromedial Approaches Anteromedial Approach to the Shoulder Anteromedial Approach to the Shoulder  Anterior Axillary Approach  Anterolateral Approaches Anterolateral Limited Deltoid-Splitting Approach to the shoulder Extensile Anterolateral Approach to the shoulder Transacromial Approach to the shoulder  Posterior Approaches Posterior deltoid-splitting Approach to the Shoulder Posterior Approach to the Shoulder simplified Posterior Approach to the Shoulder Posterior Inverted-U Approach to the shoulder Humerus Anterolateral Approach to the humerus Posterior Approach to the Proximal Humerus  Approaches to the Distal Humeral Shaft Posterolateral Approach to the Distal Humeral Shaft Posterolateral Extensile (Cold) Approach to the Distal Humerus Elbow  Posterior approaches Posterolateral Approach to the Elbow Extensile Posterolateral Approach to the Elbow Posterior Approach to the Elbow by Olecranon Osteotomy Extensile Posterior Approach to the Elbow  LATERAL APPROACHES Lateral Approach to the Elbow Lateral J-Shaped Approach to the Elbow Medial Approach with Osteotomy of the Medial Epicondyle Medial and Lateral Approach to the Elbow Global Approach to the Elbow Radius Posterolateral Approach to the Radial Head and Neck Approach to the Proximal and Middle Thirds of the Posterior Surface of the Radius Anterolateral Approach to the Proximal Shaft and Elbow Joint Anterior Approach to the Distal Half of the Radius Ulna Approach to the Proximal Third of the Ulna and Proximal Fourth of the Radius Wrist  Dorsal Approaches Dorsal Approach to the Wrist Dorsal Approach to the Wrist Volar Approach to the Wrist Lateral Approach to the Wrist Medial Approach to the Wrist Hand References Surgical Techniques Tarsus and Ankle Knee Hip Acetabulum and Pelvis Shoulder Elbow Supplemental References Surgical Approaches: General Calcaneus Tarsus and Ankle Tibia and Fibula Knee Femur Hip Symphysis Pubis Sacroiliac Joint Acromioclavicular Joint Humerus Radius Ulna Wrist 02. Magnetic Resonance Imaging in Orthopaedics 2 Magnetic Resonance Imaging in Orthopaedics Technology and Technique Contraindications Foot and Ankle Tendon Injuries Ligament Injuries Osseous Injuries Other Disorders of Foot and Ankle Knee Pathological Conditions of Menisci Cruciate Ligament Injury Other Knee Problems Hip Osteonecrosis Transient Osteoporosis Trauma Spine Intervertebral Disc Disease Postoperative Back Pain Spinal Tumors Spinal Trauma Shoulder Pathological Conditions of the Rotator Cuff Impingement Syndromes Pathological Conditions of Labrum Other Causes of Shoulder Pain Wrist and Elbow Carpal Ligament Disruptions Other Pathological Conditions of Hand and Wrist Elbow Tumor Imaging Conclusion References General Foot and Ankle Knee Hip Spine Shoulder Elbow, Wrist, and Hand Tumors Supplemental References General Foot and Ankle Knee Hip Spine Shoulder Elbow, Wrist, and Hand Tumors PART II. RECONSTRUCTIVE PROCEDURES OF THE HIP IN ADULTS 3 Arthroplasty of the Hip Applied Biomechanics Forces Acting on the Hip Stress Transfer to Bone Design and Selection of Total Hip Components Femoral Components  Cemented Femoral Components  Cementless Femoral Components  Specialized and Custom-Made Femoral Components Acetabular Components  Cemented Acetabular Components  Cementless Acetabular Components  Alternative Bearings Highly Crosslinked Polyethylene Metal-on-Metal Bearings Ceramic-on-Ceramic Bearings Indications for Total Hip Arthroplasty Contraindications to Total Hip Arthroplasty Preoperative Evaluation Preoperative Radiographs Preoperative Templating for Total Hip Arthroplasty Preparation and Draping Surgical Approaches and Techniques Total Hip Arthroplasty through the Posterolateral Approach with Posterior Dislocation of the Hip Implantation of Cementless Acetabular Components Implantation of Cementless Acetabular Component Implantation of Cemented Acetabular Components Implantation of Cemented Acetabular Component Implantation of Cementless Femoral Components Implantation of Cementless Femoral Component Implantation of Cemented Femoral Components Implantation of Cemented Femoral Component Minimally Invasive Techniques Computer-Assisted Surgery Trochanteric Osteotomy Surgical Problems Relative to Specific Hip Disorders Arthritic Disorders  Osteoarthritis (Primary or Secondary Hypertrophic Arthritis or Degenerative Arthritis)  Rheumatoid Arthritis Osteonecrosis Protrusio Acetabuli Developmental Dysplasia Dwarfism Posttraumatic Disorders  Acute Femoral Neck Fractures  Failed Hip Fracture Surgery  Acetabular Fractures Failed Reconstructive Procedures  Proximal Femoral Osteotomy and Deformity  Acetabular Osteotomy  Arthrodesis and Ankylosis Metabolic Disorders  Paget Disease  Gaucher Disease  Sickle Cell Anemia  Chronic Renal Failure  Hemophilia Infectious Disorders  Pyogenic Arthritis  Tuberculosis Tumors Neuromuscular Disorders Complications Mortality Hematoma Formation Heterotopic Ossification Thromboembolism Nerve Injuries Vascular Injuries Limb-Length Discrepancy Dislocation Fractures Trochanteric Nonunion Infection  Antibiotic Prophylaxis Recommendation 1 Recommendation 2 Recommendation 3  Classification  Diagnosis  Management Early Postoperative Infection Late Chronic Infection Acute Hematogenous Infection  Reconstruction after Infection Loosening  Femoral Loosening Cemented Femoral Components Cementless Femoral Components  Acetabular Loosening Cemented Acetabular Components Cementless Acetabular Components  Diagnosis Osteolysis Revision of Total Hip Arthroplasty Indications and Contraindications Preoperative Planning Surgical Approach Transtrochanteric Approach for Revision Total Hip Arthroplasty Removal of Cemented Femoral Component Removal of a Cementless Femoral Component Removal of Implants with Extensive Distal Bone Ingrowth Extended Trochanteric Osteotomy Removal of a Broken Femoral Component Removal of a Broken Stem Removal of a Broken Stem  Removal of Femoral Cement Removal of Femoral Cement Removal of Distal Cement with a High-Speed Burr Removal of Distal Cement with a High-Speed Burr (MALLORY)  Removal of a Cemented Acetabular Component Removal of a Loose All-Polyethylene Cup Removal of a Metal-Backed Cemented Acetabular Component  Removal of a Cementless Acetabular Component Removal of a Cementless Acetabular Component Reconstruction of Acetabular Deficiencies  Classification  Management Management of Acetabular Cavitary Deficits  Segmental Deficits Management of Segmental Acetabular Deficit Management of Segmental Acetabular Deficit  Combined Deficits Management of Combined Deficits with Structural Grafting  Pelvic Discontinuity Management of Pelvic Discontinuity with Antiprotrusio Cage Management of Pelvic Discontinuity with Allografting and Custom Component Reconstruction of Femoral Deficiencies  Classification  Management  Segmental Deficits  Cavitary Deficits Management of Femoral Deficit with Modular Femoral Component Revision with Extensively Porous-Coated Femoral Stem Management of Proximal Femoral Bone Loss with Distally Fixed Stem Management of Proximal Femoral Deficiencies with Impaction Bone Grafting and Cemented Revision Stem  Massive Deficits Management of Massive Deficits with Proximal Femoral Allograft-Prosthesis Composite Management of Massive Deficits with Modular Megaprosthesis  Femoral Deformity Postoperative Management of Total Hip Arthroplasty References General Biomechanics and Materials Surgical Technique and Preoperative Evaluation Specific Disorders Complications Heterotopic Ossification Thromboembolism Hematoma Infection Neurovascular Injuries Leg-Length Discrepancy Dislocation Fracture Trochanteric Nonunion Loosening/Osteolysis Revision Postoperative Management Supplemental References General Biomechanics and Materials Surgical Technique and Preoperative Evaluation Specific Disorders Complications Heterotopic Ossification Thromboembolism Hematoma Infection Neurovascular Injuries Leg-Length Discrepancy Dislocation Fracture Trochanteric Nonunion Osteolysis Loosening Revision Postoperative Management 4 Hip Resurfacing Patient Selection Results Postoperative Management Preoperative Radiographic Evaluation and Templating Technique Hip Resurfacing Posterolateral Position References Supplemental References 5 Arthrodesis of the Hip Indications and Results Techniques Arthrodesis with Cancellous Screw Fixation Arthrodesis with Cobra Plate Fixation Arthrodesis with Hip Compression Screw Fixation Arthrodesis in the Absence of the Femoral Head Arthrodesis of the Proximal Femur to the Ischium Arthrodesis with Cobra-Head Plate Fixation after Failed Total Hip Arthroplasty Total Hip Arthroplasty after Hip Arthrodesis References Supplemental References 6 Hip Pain in the Young Adult and Hip Preservation Surgery Evaluation and History Patient History Physical Examination Radiographic Assessment Femoroacetabular Impingement Surgical Indications Surgical Dislocation of the Hip  Results Combined Hip Arthroscopy and Limited Open Osteochondroplasty  Results Periacetabular Osteotomy  Surgical Technique  Results Hip Arthroscopy Hip Dysplasia Periacetabular Osteotomy  Surgical Indications  Surgical Technique Bernese Periacetabular Osteotomy  Results Extraarticular Sources of Hip Pain Greater Trochanteric Pain Syndrome Internal Snapping Hip Osteitis Pubis Sports Hernia Osteonecrosis of the Femoral Head Diagnosis Treatment  Core Decompression Core Decompression Core Decompression—Percutaneous Technique  Bone Grafting Vascularized Fibular Grafting Vascularized Fibular Grafting  Proximal Femoral Osteotomy  Resurfacing Hemiarthroplasty  Total Hip Arthroplasty and Bipolar Hemiarthroplasty Idiopathic Transient Osteoporosis Protrusio Acetabuli Adult-Onset Rheumatoid Arthritis Juvenile Idiopathic Arthritis Osteoarthritis Neuropathic Arthropathy (Charcot Joint) References Intraarticular Causes of Hip Pain Extraarticular Causes of Hip Pain Osteonecrosis of the Femoral Head Idiopathic Transient Osteoporosis Protrusio Acetabuli Adult-Onset Rheumatoid Arthritis Juvenile Idiopathic Arthritis Osteoarthritis Neuropathic Arthropathy (Charcot Joint) Supplemental References Intraarticular Causes of Hip Pain Extraarticular Causes of Hip Pain Osteonecrosis of the Femoral Head Idiopathic Transient Osteoporosis Protusio Acetabuli Adult-Onset Rheumatoid Arthritis Juvenile Idiopathic Arthritis Osteoarthritis Neuropathic Arthropathy (Charcot Joint) PART III. RECONSTRUCTIVE PROCEDURES OF THE KNEE IN ADULTS 7 Arthroplasty of the Knee Modern Prosthesis Evolution and Design Varus-Valgus Constrained Prostheses Mobile-Bearing Prostheses Unicompartmental Prostheses Hinged Implants Prosthesis Systems Biomechanics Functional Anatomy and Kinematics  Role of the Posterior Cruciate Ligament in Total Knee Arthroplasty  Axial and Rotational Alignment of the Knee  Patellofemoral Joint Biomechanics and Functional Anatomy Polyethylene Issues Component Fixation Indications and Contraindications Total Knee Replacement Unicondylar Knee Arthroplasty Patellofemoral Arthroplasty Indications for Patellar Resurfacing Indications for Simultaneous Bilateral Total Knee Arthroplasty Results of Primary Total Knee Arthroplasty Functional and Radiographic Outcome Measures Prosthesis Survival Preoperative Evaluation Anesthetic Options Surgical Technique for Primary Tricompartmental Knee Replacement Surgical Approach for Primary TKA Bone Preparation for Primary TKA  Intramedullary and Extramedullary Alignment Instrumentation  Computer-Assisted Alignment Technique Custom Cutting Blocks Ligamentous Balancing  Correction of Varus Deformity PCL-Stabilized TKA of the Varus Knee PCL-Retaining TKA of the Varus Knee  Correction of Valgus Deformity Valgus Deformity Correction Pie-Crusting Technique  Correction of Flexion Contracture Flexion Contracture Correction  Correction of Recurvatum Recurvatum Correction  Balancing of the Posterior Cruciate Ligament PCL Balancing Management of Bone Deficiency Bone Grafting of Peripheral Tibial Defects Patellofemoral Tracking Component Implantation Wound Closure Unicondylar Knee Arthroplasty Patellofemoral Arthroplasty Postoperative Management Surgical Problems Relative to Specific Disorders Previous High Tibial Osteotomy Previous Patellectomy Neuropathic Arthropathy Other Medical Conditions Complications Thromboembolism Infection Arthrodesis with an Intramedullary Nail for an Infected Total Knee Arthroplasty Patellofemoral Complications Neurovascular Complications Periprosthetic Fractures Revision Total Knee Arthroplasty Aseptic Failure of Primary Total Knee Arthroplasty Surgical Exposures Component Removal Reconstruction Principles Results References Component Design and Selection and Biomechanics Indications and Contraindications PATELLOFEMORAL ARTHROPLASTY Results of Total Knee Arthroplasty Surgical Technique Unicompartmental Knee Arthroplasty Surgical Problems in Specific Disorders Complications Revision Total Knee Arthroplasty Supplemental References Component Design and Selection and Biomechanics Results of Total Knee Arthroplasty Surgical Technique Unicompartmental Knee Arthroplasty Postoperative Care Surgical Problems in Specific Disorders Complications Revision Total Knee Arthroplasty 8 Arthrodesis of the Knee Indications and Results Techniques Compression Arthrodesis with External Fixation Compression Arthrodesis Using External Fixation Arthrodesis with Intramedullary Rod Fixation Arthrodesis Using Intramedullary Nail Fixation Knee Arthrodesis with Locked Intramedullary Nail after Failed Total Knee Arthroplasty Arthrodesis with Plate Fixation Arthrodesis Using Plate Fixation References Supplemental References 9 Soft Tissue Procedures and Corrective Osteotomies about the Knee Muscle Contractures Quadriceps Contracture of Infancy and Childhood Proximal Release of Quadriceps Snapping Syndromes Painful Paraarticular Calcifications Tendinitis and Bursitis Prepatellar Bursitis Drainage of Bursa Excision of Bursa Tibial Collateral Ligament Fibrositis and Bursitis Fibular Collateral Ligament Bursitis Infrapatellar Bursitis Popliteal Cyst (baker Cyst) Popliteal Cyst Excision Medial Gastrocnemius Bursitis Medial Gastrocnemius Bursa Excision Semimembranosus Bursitis Semimembranosus Bursa Excision Semimembranosus Tendinitis Semitendinosus Tendon Transfer Chronic Synovitis Synovectomy of the Knee Rheumatoid Arthritis OF THE KNEE Adult-Onset Rheumatoid Arthritis Juvenile Rheumatoid Arthritis Surgical Procedures  Arthroscopic Synovectomy  Proximal Tibial Osteotomy  Arthrodesis  Arthroplasty or Reconstruction Osteoarthritis of the Knee Surgical Procedures  Débridement  Osteochondral and Autologous Chondrocyte Transplantation  Proximal Tibial Osteotomy Lateral Closing Wedge Osteotomy Lateral Closing Wedge Osteotomy Medial Opening Wedge Osteotomy Opening Wedge Hemicallotasis Opening Wedge Hemicallotasis General Complications of High Tibial Osteotomy Total Knee Arthroplasty After Proximal Tibial Osteotomy  Distal Femoral Osteotomy Closing Wedge Distal Femoral Varus Osteotomy References General Snapping Syndromes Painful Paraarticular Calcifications, Bursitis, and Tendinitis Rheumatoid Arthritis Osteoarthritis Supplemental References General Snapping Syndromes Painful Paraarticular Calcifications, Bursitis, and Tendinitis Rheumatoid Arthritis Osteoarthritis PART IV. RECONSTRUCTIVE PROCEDURES OF THE ANKLE IN ADULTS 10 Total Ankle Arthroplasty Development of Total Ankle Arthroplasty Systems Design Rationale Fixed-Bearing Versus Mobile-Bearing Design Alignment Ingrowth Versus Cement Fixation Metaphyseal Fixation Talar Component Design Preoperative Evaluation Indications Total Ankle Arthroplasty or Ankle Arthrodesis for Ankle Arthritis Total Ankle Arthroplasty Considerations for Adjunctive Procedures Deformity Correction Ligament Considerations Reconstruction of Lateral Ankle Ligaments for Chronic Instability as an Adjunct to Total Ankle Arthroplasty Periarticular Deformities Special Circumstances  Osteonecrosis of the Talus  Pantalar Disease; Concomitant Hindfoot Arthrodesis  Takedown of Ankle Arthrodesis  Gout  Bilateral Total Ankle Arthroplasty Outcomes Sports Participation Role of Experience and Numbers of Cases Range of Motion By Diagnosis Complications Wound Healing Complications Osteolysis, Loosening, and Subsidence Malalignment Fracture Syndesmosis Nonunion Infection Deep Venous Thrombosis Heterotopic Ossification Progression of Arthritis IN Adjacent Joints Osteophyte Formation/Impingement References 11 Ankle Arthrodesis Alternatives to Ankle Arthrodesis Nonoperative Treatment Operative Treatment  Arthroscopic Débridement  Periarticular Osteotomies Opening Wedge Osteotomy of the Tibia for Varus Deformity and Medial Joint Arthrosis  Distraction Arthroplasty Distraction Arthroplasty of the Ankle  Total Ankle Arthroplasty Indications for Ankle Arthrodesis Patient Evaluation Clinical Evaluation Radiographic Evaluation Techniques of Ankle Arthrodesis Arthroscopic Arthrodesis Mini-Incision Technique Transfibular (Transmalleolar) Arthrodesis with Fibular Strut Graft Tibiotalocalcaneal Arthrodesis Technique Modifications Anterior Approach with Plate Fixation Posterior Approach for Arthrodesis of Ankle and Subtalar Joints Arthrodesis with External Fixation Tibiocalcaneal Arthrodesis with Calandruccio II External Fixation Device Tibiocalcaneal Arthrodesis with a Thin-Wire External Fixation Special Considerations Osteonecrosis of the Talus Tibiotalar Arthrodesis with a Sliding Bone Graft Failed Total Ankle Arthroplasty Tibiotalar or Tibiotalocalcaneal Fusion with Structural Allograft and Internal Fixation for Salvage of Failed Total Ankle Arthroplasty Infection/Osteomyelitis Charcot Neuroarthropathy Bone Graft/Supplementation Bone Graft Harvest From the Proximal Tibia Complications Nonunion  Treatment Adjacent Joint Pain and Arthritis References Supplemental References PART V. RECONSTRUCTIVE PROCEDURES OF THE SHOULDER AND ELBOW IN ADULTS 12 Shoulder and Elbow Arthroplasty Reconstructive Procedures of the Shoulder History Anatomy and Biomechanics Prosthesis Design Clinical Presentation and Radiographic Evaluation Preoperative Planning Hemiarthroplasty  Indications  Surgical Technique HEMIARTHROPLASTY  Outcomes  Modified Hemiarthroplasty—interposition Arthroplasty and Glenoidplasty (Ream and Run)  Resurfacing Hemiarthroplasty Total Shoulder Arthroplasty  Indications  Surgical Technique Total shoulder arthroplasty  Outcomes Osteoarthritis Inflammatory Arthritis Posttraumatic Arthritis Osteonecrosis Capsulorrhaphy Arthropathy and Arthropathy of Recurrent Instability Reverse Shoulder Arthroplasty  Indications  Surgical Technique REVERSE SHOULDER ARTHROPLASTY  Outcomes Cuff Tear Arthropathy Rotator Cuff Dysfunction without Arthritis Proximal Humeral Fractures Rheumatoid Arthritis with Rotator Cuff Tear Salvage Procedures Bone Grafting of the Glenoid Complications of Shoulder Arthroplasty  Intraoperative Complications  Postoperative Complications Glenoid Loosening Humeral Loosening Instability Periprosthetic Fracture Rotator Cuff Tear Infection Deltoid Muscle Dysfunction Heterotopic Ossification Stiffness  Complications of Reverse Total Shoulder Arthroplasty Revision Shoulder Arthroplasty  Indications  Outcomes Other Surgical Options for Failed Total Shoulder Arthroplasty  Hemiarthroplasty  Resection Arthroplasty  Glenohumeral Arthrodesis Rehabilitation after Shoulder Arthroplasty Reconstructive Procedures of the Elbow Anatomy and Biomechanics Types of Arthroplasty  Débridement Arthroplasty DEBRIDEMENT ARTHROPLASTY  Interposition (Fascial) Arthroplasty INTERPOSITION ARTHROPLAStY  Resection and Implant Arthroplasty of the Radial Head Resection Arthroplasty of the Radial Head Radial Head Implant Arthroplasty RADIAL HEAD IMPLANT ARTHROPLASTY Total Elbow Arthroplasty  Indications  Surgical Technique Coonrad-Morrey Total Elbow Arthroplasty  Outcomes Unconstrained Total Elbow Arthroplasty Semi-Constrained Total Elbow Arthroplasty  Complications Salvage  Revision Elbow Arthroplasty  Resection Arthroplasty ELBOW RESECTION ARTHROPLASTY References Reconstructive Procedures of the Shoulder Hemiarthroplasty Total Shoulder Arthroplasty Reverse Shoulder Arthroplasty Complications and Revision Reconstructive Procedures of the Elbow Resection Arthroplasty Supplemental References Reconstructive Procedures of the Shoulder Hemiarthroplasty Total Shoulder Arthroplasty Complications and Revision Reconstructive Procedures of the Elbow Anatomy and Biomechanics Implant Arthroplasty Resection Arthroplasty 13 Arthrodesis of the Shoulder and Elbow Shoulder Arthrodesis Indications Position Surgical Techniques External Fixation Screw Fixation Plate Fixation Pelvic Reconstruction Plate Shoulder Arthrodesis after Failed Prosthetic Shoulder Arthroplasty Complications Outcomes Elbow Arthrodesis Indications Surgical Techniques elbow arthrodesis (staples) elbow arthrodesis (MÜLLER ET AL.) elbow arthrodesis (SPIER) Complications Outcomes References Arthrodesis of the Shoulder Arthrodesis of the Elbow Supplemental References Arthrodesis of the Shoulder Arthrodesis of the Elbow PART VI. AMPUTATIONS 14 General Principles of Amputations Incidence and Indications Peripheral Vascular Disease Trauma Burns Frostbite Infection Tumors Surgical Principles of Amputations Determination of Amputation Level Technical Aspects  Skin and Muscle Flaps  Hemostasis  Nerves  Bone Open Amputations Postoperative Care Complications Hematoma Infection Wound Necrosis Contractures Pain Dermatological Problems Amputations in Children References Supplemental References 15 Amputations of the Foot Toe Amputations Terminal Syme AmputatioN Amputation at the Base of the Proximal Phalanx Metatarsophalangeal Joint Disarticulation First or Fifth Ray Amputation (Border Ray Amputation) Multiple Ray Amputation Central Ray Amputation Transmetatarsal Amputation Midfoot Amputations Chopart Amputation Hindfoot and Ankle Amputations Syme Amputation Two-Stage Syme Amputation Boyd Amputation References Supplemental References 16 Amputations of the Lower Extremity Foot and Ankle Amputations Transtibial (Below-Knee) Amputations Nonischemic Limbs Transtibial Amputation  Amputation Osteoplasty Ischemic Limbs Transtibial Amputation Using Long Posterior Skin Flap Disarticulation of the Knee Knee Disarticulation Knee Disarticulation Knee Disarticulation Transfemoral (Above-Knee) Amputations Transfemoral (Above-Knee) Amputation of Nonischemic Limbs Transfemoral (Above-Knee) Amputation of Nonischemic Limbs Transfemoral (Above-Knee) Amputation for Ischemic Limbs References Supplemental References 17 Amputations of the Hip and Pelvis Disarticulation of the Hip Anatomical Hip Disarticulation Posterior Flap Hemipelvectomy Standard Hemipelvectomy Anterior Flap Hemipelvectomy Conservative Hemipelvectomy References Supplemental References 18 Amputations of the Upper Extremity Hand Amputations Wrist Amputations Amputation at the Wrist Disarticulation of the Wrist Forearm Amputations (Transradial) Distal Forearm (Distal Transradial) Amputation Proximal Third of Forearm (Proximal Transradial) Amputation Elbow Disarticulation Disarticulation of the Elbow Arm Amputations (Transhumeral) Supracondylar Area Amputation Proximal to the Supracondylar Area Shoulder Amputations Amputation through the Surgical Neck of the Humerus Disarticulation of the Shoulder Forequarter Amputation Anterior Approach Posterior Approach References Supplemental References 19 Amputations of the Hand Considerations for Amputation Principles of Finger Amputations Fingertip Amputations Free Skin Graft Flaps for Fingertip Coverage Kutler V-Y or Atasoy Triangular Advancement Flaps Bipedicle Dorsal Flaps Adipofascial Turnover Flap Cross Finger Flaps Thenar Flap Local Neurovascular Island Flap Island Pedicle Flap Retrograde Island Pedicle Flap Ulnar Hypothenar Flap Amputations of Single Fingers Index Finger Index Ray Amputation Middle or Ring Finger Ray Amputations Transposing the Index Ray  Ring Finger Avulsion Injuries Little Finger Amputations Thumb Amputations Advancement Pedicle Flap for Thumb Injuries Amputations of Multiple Digits Phalangization of Fifth Metacarpal Painful Amputation Stump Reconstructions after Amputation Reconstruction after Amputation of the Hand Krukenberg Reconstruction Reconstruction after Amputation of Multiple Digits Reconstruction of the Thumb Lengthening of Metacarpal and Transfer of Local Flap Osteoplastic Reconstruction and Transfer of Neurovascular Island Graft  Pollicization Riordan Pollicization Buck-Gramcko Pollicization Foucher Pollicization References Supplemental References PART VII. INFECTIONS 20 General Principles of Infection Etiology Patient-Dependent Factors  Nutritional Status  Immunological Status Surgeon-Dependent Factors  Skin Preparation  Operating Room Environment  Prophylactic Antibiotic Therapy Methicillin-Resistant Staphylococcus Aureus Diagnosis Laboratory Studies Imaging Studies Culture Studies Treatment Human Immunodeficiency Virus Diagnostic Tests Confirmatory Tests Musculoskeletal Syndromes in Human Immunodeficiency Virus–Infected Patients Risks and Prevention References Etiology and Prophylaxis Diagnosis Treatment Human Immunodeficiency Virus Supplemental References Etiology and Prophylaxis Diagnosis Treatment Human Immunodeficiency Virus 21 Osteomyelitis Classification Acute Hematogenous Osteomyelitis Diagnosis Treatment Drainage of Acute Hematogenous Osteomyelitis Subacute Hematogenous Osteomyelitis Brodie Abscess Chronic Osteomyelitis Classification Diagnosis Treatment Sequestrectomy and Curettage for Chronic Osteomyelitis Open Bone Grafting  Polymethylmethacrylate Antibiotic Bead Chains ANTIBIOTIC BEAD POUCH Intramedullary Antibiotic Cement Nail  Biodegradable Antibiotic Delivery Systems  Closed Suction Drains  Soft Tissue Transfer  Ilizarov Technique  Adjunctive Therapies Sclerosing Osteomyelitis of Garré Residual Stage of Osteomyelitis Pathological Fracture in Osteomyelitis Chronic Recurrent Multifocal Osteomyelitis Osteomyelitis after Puncture Wound of the Foot Anaerobic Osteomyelitis Osteomyelitis of Specific Regions Calcaneus Split-Heel Incision Distal Third of the Femur Ilium  Treatment During the Acute Phase Drainage  Treatment During the Chronic Phase Ischium and Pubis Spine Resection or Excision for Osteomyelitis Resection of the Metatarsals Resection of the Tarsals Partial Calcanectomy Resection of the Fibula Resection of the Iliac Wing Amputation for Osteomyelitis References Supplemental References General Acute Hematogenous Osteomyelitis Subacute Hematogenous Osteomyelitis Chronic Osteomyelitis Chronic Recurrent Multifocal Osteomyelitis Osteomyelitis after Puncture Wounds Anaerobic Infections Osteomyelitis of Specific Regions Amputation for Osteomyelitis 22 Infectious Arthritis Clinical Presentation Imaging Studies Pathogenesis Microbiology Treatment Tarsal Joints Surgical Drainage of the Tarsal Joint Ankle Aspiration Drainage Anterolateral Drainage of the Ankle Posterolateral Drainage of the Ankle Anteromedial Drainage of the Ankle Posteromedial Drainage of the Ankle Knee Aspiration Drainage Arthroscopic Drainage Arthroscopic Drainage of the Knee Anterior Drainage of the Knee Posterolateral and Posteromedial Drainage of the Knee Posteromedial Drainage of the Knee Posteromedial and Posterolateral Drainage of the Knee Hip Aspiration Lateral Aspiration of the Hip Anterior Aspiration of the Hip Medial Aspiration of the Hip Drainage Posterior Drainage of the Hip Anterior Drainage of the Hip Lateral Drainage of the Hip Medial Drainage of the Hip  Arthroscopic Drainage Complications of Acute Septic Arthritis of the Hip  Pathological Dislocation  Osteomyelitis  Pelvic Abscess  Persistent Infection Resection of the Hip Sacroiliac Joint Spine Sternoclavicular and Acromioclavicular Joints Shoulder Aspiration Drainage Anterior Drainage of the Shoulder Posterior Drainage of the Shoulder  Arthroscopic Drainage Elbow Aspiration Drainage Medial Drainage of the Elbow Lateral Drainage of the Elbow Posterior Drainage of the Elbow Wrist Aspiration Drainage Lateral Drainage of the Wrist Medial Drainage of the Wrist Dorsal Drainage of the Wrist Operations to Correct Deformities after Septic Arthritis Ankle Osteotomy of the Ankle Knee Transverse Supracondylar Osteotomy of the Femur V-Osteotomy of the Femur Supracondylar Cuneiform Osteotomy of the Femur Supracondylar Controlled Rotational Osteotomy of the Femur Intraarticular Osteotomy Intraarticular Osteotomy Hip  Arthroplasty  Operations to Stabilize the Hip Reconstruction after Hip Sepsis  Operations to Correct Deformity Transverse Opening Wedge Osteotomy of the Hip Transverse Closing Wedge Osteotomy of the Hip Brackett Osteotomy of the Hip  Operations to Equalize Leg Lengths References Supplemental References 23 Tuberculosis and Other Unusual Infections Tuberculosis North American Demographics Musculoskeletal Involvement Laboratory Findings Imaging Nonoperative Treatment of Appendicular Tuberculous Infections Operative Treatment  Foot Curettage for Tuberculous Lesions in the Foot Excision of Bones Excision of Metatarsal Excision of Cuneiform Bones Excision of Navicular Excision of Cuboid Excision of Calcaneus Excision of Talus  Ankle  Knee  Hip Partial Synovectomy and Curettage Lesions Above Acetabulum Lesions of the Femoral Neck Lesions of the Trochanteric Area Arthrodesis Evacuation of Abscesses Excision of the Hip Joint  Sacroiliac Joint  Pubis  Clavicle  Shoulder  Elbow Excision of Elbow Joint Arthrodesis  Wrist and Hand Excision of Wrist Joint Tuberculosis of Long Bones  Amputation Other Unusual Infections Nontuberculous Mycobacterial Infections Brucellosis Typhoid Fever Syphilis Anaerobic Infections Viral Osteitis and Arthritis Actinomycosis Lyme Disease Fungal Infection Coccidioidomycosis Blastomycosis Histoplasmosis Cryptococcosis Sporotrichosis Echinococcosis References Supplemental References Tuberculosis Other Unusual Infections PART VIII. TUMORS 24 General Principles of Tumors Diagnostic Evaluation General Approach to Musculoskeletal Neoplasms  Physical Examination  Radiographic Examination  Other Imaging Examinations  Laboratory Tests Metastases of Unknown Origin Staging Biopsy Adjuvant Treatment Radiation Therapy Chemotherapy Principles of Surgery Amputation Versus Limb Salvage Margins Curettage Resection and Reconstruction Considerations for Pediatric Patients Surgical Techniques Upper Extremity  Resection of the Shoulder Girdle resection of shoulder girdle  Resection of the Clavicle  Resection of the Scapula Resection of the Proximal Humerus Intercalary Resection of the Humeral Shaft Resection of the Distal Humerus Resection of the Proximal Radius Resection of the Proximal Ulna Resection of the Distal Radius  Resection of the Distal Ulna  Resection of the Hand Pelvis Resection of the Pubis and Ischium Resection of the Acetabulum Resection of the Innominate Bone (Internal Hemipelvectomy) Resection of the Sacroiliac Joint Resection of the Sacrum Resection of sacrum Through Posterior Approach Resection of Vertebrae Lower Extremity Resection of the Proximal Femur Resection of Entire Femur  Resection of the Distal Femur Intraarticular Resection of the Distal Femur with Endoprosthetic Reconstruction Resection of the Proximal Tibia Resection of the Distal Femur or Proximal Tibia and Arthrodesis of the Knee  Resection of the Distal Femur or Proximal Tibia with Allograft Arthrodesis Resection of the Proximal Fibula Resection of the Distal Third of the Fibula  Resection-Arthrodesis of the Ankle  Resection of the Talus Rotationplasty Rotationplasty for A Lesion in the Distal Femur Rotationplasty for A Lesion of the Proximal Femur Without Involvement of the Hip Joint Rotationplasty for A Lesion of the Proximal Femur Involving the Hip Joint References Supplemental References 25 Benign Bone Tumors and Nonneoplastic Conditions Simulating Bone Tumors Bone-Forming Tumors Osteoid Osteoma Bone Island Cartilage Lesions Chondroma Osteochondroma Fibrous Lesions Nonossifying Fibroma Cortical Desmoid Benign Fibrous Histiocytoma Fibrous Dysplasia Osteofibrous Dysplasia Desmoplastic Fibroma Cystic Lesions Unicameral Bone Cyst Aneurysmal Bone Cyst Intraosseous Ganglion Cyst Epidermoid Cyst Fatty Tumors Lipoma Vascular Tumors Hemangioma Other Nonneoplastic Lesions Paget Disease “Brown Tumor” of Hyperparathyroidism Bone Infarct Osteomyelitis Stress Fracture Posttraumatic Osteolysis References Supplemental References 26 Benign/Aggressive Tumors of Bone Giant Cell Tumor Chondroblastoma Chondromyxoid Fibroma Osteoblastoma Langerhans Cell Histiocytosis References Giant Cell Tumor Chondroblastoma Chondromyxoid Fibroma Osteoblastoma Langerhans Cell Histiocytosis Supplemental References Giant Cell Tumor Chondroblastoma Chondromyxoid Fibroma Osteoblastoma Langerhans Cell Histiocytosis 27 Malignant Tumors of Bone Osteosarcoma Chondrosarcoma Ewing Sarcoma Chordoma Adamantinoma Malignant Vascular Tumors Malignant Fibrous Histiocytoma and Fibrosarcoma Multiple Myeloma and Plasmacytoma Lymphoma Metastatic Carcinoma References Osteosarcoma Chondrosarcoma Ewing Sarcoma Chordoma Adamantinoma Malignant Vascular Tumors Malignant Fibrous Histiocytoma and Fibrosarcoma Multiple Myeloma Lymphoma Metastatic Carcinoma Supplemental References Osteosarcoma Chondrosarcoma Ewing Sarcoma Chordoma Adamantinoma Malignant Vascular Tumors Malignant Fibrous Histiocytoma and Fibrosarcoma Multiple Myeloma Lymphoma Metastatic Carcinoma 28 Soft Tissue Tumors Benign Tumors and Tumor-Like Lesions (Table 28-1) Fatty Tumors Nerve Sheath Tumors Synovial Lesions Vascular Lesions Fibrous Lesions Malignant Tumors (Table 28-2) Malignant Fibrous Histiocytoma Liposarcoma Synovial Sarcoma (Malignant Synovioma) Fibrosarcoma Epithelioid Sarcoma Dermatofibrosarcoma Protuberans Rhabdomyosarcoma Malignant Peripheral Nerve Sheath Tumor Extraskeletal Osteosarcoma Extraskeletal Ewing Sarcoma Extraskeletal Chondrosarcoma References Supplemental References COO2 Part IX – Congenital and Developmental Disorders 29 Congenital Anomalies of the Lower Extremity Polydactyly Amputation of an Extra Toe Syndactyly Macrodactyly Ray Reduction Ray Amputation Cleft Foot (Partial Adactyly) CLEFT CLOSURE Contracture or Angulation of the Toes CORRECTION OF ANGULATED TOE Arthroplasty of the Fifth Metatarsophalangeal Joint Congenital Hallux Varus Creation of Syndactyly of the Great Toe and Second Toe for Hallux Varus Congenital Metatarsus Adductus Treatment Dome-Shaped Osteotomies of Metatarsal Bases Cuneiform and Cuboid Osteotomies Congenital Clubfoot (Talipes Equinovarus) Radiographic Evaluation Classification Nonoperative Treatment  Ponseti Casting Technique for Correction of Clubfoot Deformity Application of Ponseti Casts Maintenance Phase Management of Recurrence Operative Treatment Transverse Circumferential (Cincinnati) Incision Extensile Posteromedial and Posterolateral Release Achilles Tendon Lengthening and Posterior Capsulotomy Resistant Clubfoot Osteotomy of the Calcaneus for Persistent Varus Deformity of the Heel Medial Release with Osteotomy of the Distal Calcaneus Selective Joint-Sparing Osteotomies for Residual Cavovarus Deformity  Triple Arthrodesis and Talectomy for Uncorrected Clubfoot Triple Arthrodesis Talectomy  Dorsal Bunion First Metatarsal Osteotomy and Tendon Transfer for Dorsal Bunion Congenital Vertical Talus Clinical and Radiographic Findings Treatment Open Reduction and Realignment of Talonavicular and Subtalar Joints Open Reduction and Extraarticular Subtalar Fusion  Triple Arthrodesis Congenital Angular Deformities of the Leg Congenital Pseudarthrosis of the Fibula and Tibia Fibula Tibiofibular Synostosis Tibia  Classification  Treatment Insertion of Williams Intramedullary Rod and Bone Grafting Bone Morphogenetic Protein in the Treatment of Congenital Pseudarthrosis of the Tibia  Complications Stiffness of the Ankle and Hindfoot Refracture Valgus Ankle Deformity Tibial Shortening Constrictions of the Leg One-Stage Release of Circumferential Constricting Band Congenital Hyperextension and Dislocation of the Knee Capsular Release and Quadriceps Lengthening for Correction of Congenital Knee Dislocation Congenital Dislocation of the Patella Lateral Release and Medial Plication References Anomalies of the Toes Anomalies of the Foot Clubfoot Congenital Vertical Talus Tarsal Coalition Congenital Angular Deformities of the Leg and Congenital Pseudarthrosis Constrictions of the Leg Congenital Hyperextension and Dislocation of the Knee, Congenital Dislocation of the Patella Congenital Long Bone Deficiencies Limb-Length Discrepancy Supplemental References Anomalies of the Toes Anomalies of the Foot Clubfoot Congenital Vertical Talus Tarsal Coalition Congenital Angular Deformities of the Leg and Congenital Pseudarthrosis Constrictions of the Leg Congenital Hyperextension and Dislocation of the Knee Congenital Dislocation of the Patella Congenital Long Bone Deficiencies Tibial Hemimelia Fibular Hemimelia Proximal Femoral Focal Deficiency Limb-Length Discrepancy Chapter30 Congenital and Developmental Anomalies of the Hip and Pelvis Congenital and Developmental Dysplasia of the Hip Diagnosis and Clinical Presentation Imaging Treatment  Newborn (Birth to 6 Months)  Infant (6 to 18 Months) Preoperative Traction Adductor Tenotomy Arthrography and Closed Reduction Arthrography of the Hip in DDH Application of a Hip Spica Cast Open Reduction Anterior Approach Anteromedial Approach Concomitant Osteotomy Teratological Dislocations Osteonecrosis Trochanteric Advancement  Toddler (18 to 36 Months) Femoral Osteotomy in Dysplasia of the Hip Varus Derotational Osteotomy of the Femur in Hip Dysplasia, with Pediatric Hip Screw Fixation  Child (3 to 8 Years) Primary Femoral Shortening PRIMARY FEMORAL SHORTENING Pelvic Osteotomy Salter Innominate Osteotomy INNOMINATE OSTEOTOMY INCLUDING OPEN REDUCTION Pemberton Acetabuloplasty PERICAPSULAR OSTEOTOMY OF THE ILIUM Steel Osteotomy TRIPLE INNOMINATE OSTEOTOMY Dega Osteotomy Transiliac (dega) osteotomy Ganz (Bernese) Periacetabular Osteotomy Shelf Operations slotted acetabular augmentation Chiari Osteotomy chiari osteotomy  Adolescent and Young Adult (>8 Years) Congenital and Developmental coxa vara Valgus Osteotomy for Developmental Coxa Vara Exstrophy of the Bladder Anterior Iliac Osteotomies and Approximation of the Symphysis Pubis Bilateral Anterior Iliac Osteotomies References Congenital and Developmental Dysplasia of the Hip Congenital and Developmental Coxa Vara Exstrophy of the Bladder Supplemental References Congenital and Developmental Dysplasia of the Hip Congenital and Developmental Coxa Vara Exstrophy of the Bladder 31 Congenital Anomalies of the Trunk and Upper Extremity Congenital Elevation of the Scapula (sprengel Deformity) Woodward Operation Morcellization of the Clavicle Congenital Muscular Torticollis Unipolar Release Bipolar Release Congenital Pseudarthrosis of the Clavicle Open Reduction and Iliac Bone Grafting for Congenital Pseudarthrosis of the Clavicle Congenital Dislocation of the Radial Head Congenital Pseudarthrosis of the Radius Congenital Pseudarthrosis of the Ulna Congenital Radioulnar Synostosis Radial and Ulnar Osteotomies for Correction of Congenital Radioulnar Synostosis References Congenital Elevation of the Scapula Congenital Muscular Torticollis Congenital Pseudarthroses of the Clavicle, Radius, and Ulna Congenital Dislocation of the Radial Head Congenital Radioulnar Synostosis Supplemental References Congenital Elevation of the Scapula Congenital Muscular Torticollis Congenital Pseudarthroses of the Clavicle, Radius, and Ulna Congenital Dislocation of the Radial Head Congenital Radioulnar Synostosis 32 Osteochondrosis or Epiphysitis and Other Miscellaneous Affections Traction Epiphysitis of the Fifth Metatarsal Base (Iselin Disease) Osteochondrosis of the Metatarsal Head (Freiberg Infraction) Osteochondrosis of the Navicular (Köhler Disease) Osteochondritis of the Ankle Epiphysitis of the Tibial Tuberosity (Osgood-Schlatter Disease) Insertion of Bone Pegs into the Tibial Tuberosity for Osgood Schlatter Disease Excision of Ununited Tibial Tuberosity for Osgood-Schlatter Disease Arthroscopic Ossicle and Tibial Tuberosity Débridement for Osgood-Schlatter Disease Osteochondritis Dissecans of the Knee Extraarticular Drilling for Stable Osteochondritis Dissecans of the Knee Osteochondritis Dissecans of the Patella Osteochondrosis of the Capitellum (Osteochondritis Dissecans) Reconstruction of the Articular Surface with Osteochondral Plug Grafts for Osteochondrosis of the Capitellum Legg-Calvé-Perthes Disease Diagnosis  Classification  Bilateral Involvement  Imaging Evaluation Treatment  Innominate Osteotomy Innominate Osteotomy for Legg-Calvé-Perthes Disease  Lateral Shelf Procedure Lateral Shelf Procedure for Legg-Calvé-Perthes Disease  Varus Derotational Osteotomy Varus Derotational Osteotomy of the Proximal Femur for Legg-Calvé-Perthes Disease  Lateral Opening Wedge Osteotomy Lateral Opening Wedge Osteotomy for Legg- Calvé-Perthes Disease  Arthrodiastasis Arthrodiastasis for Legg-Calvé-Perthes Disease Reconstructive Surgery  Valgus Extension Osteotomy  Valgus Flexion Internal Rotation Osteotomy  Cheilectomy Cheilectomy for Legg-Calvé-Perthes Disease  Shelf Procedure  Chiari Osteotomy  Trochanteric Overgrowth Trochanteric Advancement for Trochanteric Overgrowth Trochanteric Advancement for Trochanteric Overgrowth Greater Trochanteric Epiphysiodesis for Trochanteric Overgrowth Osteochondritis Dissecans of the Hip Hemophilia Total Joint Arthroplasty Synovectomy Synovectomy of the Knee in Hemophilia  Arthroscopic Synovectomy Synoviorthesis for Treatment of Hemophilic Arthropathy  Open Ankle Synovectomy Open Ankle Synovectomy in Hemophilia Arthrodesis Osteotomy Complications of Hemophilia Rickets, Osteomalacia, and Renal Osteodystrophy Tibia Vara (Blount Disease) Osteotomies Metaphyseal Osteotomy for Tibia Vara Chevron Osteotomy for Tibia Vara Epiphyseal and Metaphyseal Osteotomy for Tibia Vara Intraepiphyseal Osteotomy for Tibia Vara Hemielevation of the Epiphysis Osteotomy with Leg Lengthening Using an Ilizarov Frame for Tibia Vara Neurovascular Complications of High Tibial Osteotomy Congenital Affections Osteogenesis Imperfecta  Multiple Osteotomies, Realignment, and Medullary Nail Fixation Osteotomy and Medullary Nailing in Osteogenesis Imperfecta Modified Sofield-Millar Operation in the Femur and Tibia in Osteogenesis Imperfecta Osteotomy and Medullary Nailing with A Telescoping Rod in the Femur for Osteogenesis Imperfecta Modified Rod with Interlocking Obturator for Osteogenesis Imperfecta  Osteotomy and Medullary Nailing with Trigen Nail Dwarfism (Short Stature) Tibial Lengthening Over An Intramedullary Nail with External Fixation in Dwarfism Traumatic Physeal Arrest from Bridge of Bone Bony Bridge Resection for Physeal Arrest Bony Bridge Resection and Angulation Osteotomy for Physeal Arrest Peripheral and Linear Physeal Bar Resection for Physeal Arrest Central Physeal Bar Resection for Physeal Arrest References Freiberg Disease; Osteochondrosis of the Ankle, Knee, and Elbow; and Osgood-Schlatter Disease Legg-Calvé-Perthes Disease Hemophilia Rickets, Osteomalacia, and Renal Osteodystrophy Tibia Vara Osteogenesis Imperfecta Dwarfism Traumatic Epiphyseal Arrest from Bridge of Bone Supplemental References Osteochondrosis and Epiphysitis Freiberg Disease; Osteochondrosis of the Ankle, Knee, and Elbow; and Osgood-Schlatter Disease Legg-Calvé-Perthes Disease Hemophilia Rickets, Osteomalacia, and Renal Osteodystrophy Tibia Vara Osteogenesis Imperfecta Dwarfism Traumatic Epiphyseal Arrest from Bridge of Bone Part X – Nervous System Disorders in Children 33 Cerebral Palsy Etiology Classification Geographical Classification  Monoplegia  Hemiplegia  Diplegia  Quadriplegia  Total Body  Other Types Physiological Classification  Spastic  Athetoid  Choreiform  Rigid  Ataxic  Hypotonic  Mixed Diagnosis Prognostic Factors Gait Analysis Associated Conditions Treatment Nonoperative Treatment Operative Treatment Neurosurgical Intervention Selective Posterior Rhizotomy Hip Flexion Deformities Adduction Deformities Adductor Tenotomy and Release Iliopsoas Recession Iliopsoas Release at the Lesser Trochanter Subluxation and Dislocation  Varus Derotational Osteotomy Combined One-Stage Correction of Spastic Dislocated Hip (San Diego Procedure) Proximal Femoral Resection Hip Arthrodesis Knee Hip and Knee Relationships Flexion Deformity Fractional Lengthening of Hamstring Tendons Combined Hamstring Lengthening, Posterior Capsular Release Distal Femoral Extension Osteotomy and Patellar Tendon Advancement Distal Transfer of Rectus Femoris RECTUS FEMORIS TRANSFER Recurvatum of the Knee Knee Valgus Patella Alta Rotational Abnormalities Foot Equinus Deformity  Surgical Correction of Equinus Deformity Open Lengthening of the Achilles Tendon Z-Plasty Lengthening of the Achilles Tendon Percutaneous Lengthening of the Achilles Tendon  Lengthening of the Gastrocnemius-Soleus Muscle Gastrocnemius-soleus lengthening Varus or Valgus Deformity  Equinovarus Deformity Lengthening of the Posterior Tibial Tendon Z-Plasty Lengthening of the Posterior Tibial Tendon Step-Cut Lengthening of the Posterior Tibial Tendon Musculotendinous Recession of the Posterior Tibial Tendon  Split Tendon Transfers Split Posterior Tibial Tendon Transfer Split Anterior Tibial Tendon Transfer  Osteotomy of the Calcaneus CALCANEAL OSTEOTOMY  Equinovalgus Deformity Medial Displacement Calcaneal Osteotomy Subtalar Arthrodesis  Calcaneus Deformity Crescentic Osteotomy of the Calcaneus  Cavus Deformity  Forefoot Adduction Deformity Correction of Flexible Forefoot Adductus  Hallux Valgus Deformity  Claw Toes Spine-Pelvic Obliquity and Scoliosis Upper Extremity Shoulder Elbow Release of Elbow Flexion Contracture Forearm, Wrist, and Hand Adults with Cerebral Palsy Adult Stroke Patients Lower Extremity Hip Knee Foot  Talipes Equinus  Talipes Equinovarus Correction of Talipes Equinovarus  Varus Foot  Planovalgus  Toe Flexion Upper Extremity  Shoulder Release of Internal Rotation Contracture of the Shoulder  Elbow Phenol Nerve Block Functional Electrical Nerve Stimulation References General Neurosurgical Treatment Hip Knee Foot and Ankle Spine Upper Extremity Adults with Cerebral Palsy Supplemental References General Neurosurgical Treatment Hip Knee Foot and Ankle Spine Upper Extremity Postnatal Cerebral Palsy Adult Stroke Patient 34 Paralytic Disorders Poliomyelitis Pathological Findings Clinical Course and Treatment  Acute Stage  Convalescent Stage  Chronic Stage Tendon Transfers Arthrodesis Foot and Ankle  Tendon Transfers Paralysis of Specific Muscles Anterior Tibial Muscle. Anterior and Posterior Tibial Muscles. Posterior Tibial Muscle. Anterior Tibial, Toe Extensor, and Peroneal Muscles. Peroneal Muscles. Peroneal and Long Toe Extensor Muscles. Gastrocnemius-Soleus Muscles. Posterior Transfer of anterior Tibial Tendon Flail Foot Dorsal Bunion flexor hallucis longus transfer for Treatment of Dorsal Bunion  Bony Procedures (Osteotomy and Arthrodesis) Calcaneal Osteotomy Dillwyn-Evans Osteotomy Subtalar Arthrodesis Subtalar Arthrodesis—grice and GREEN Subtalar Arthrodesis—Dennyson and Fulford Triple Arthrodesis Triple Arthrodesis Correction of Cavus Deformity Complications of Triple Arthrodesis. Talectomy Lambrinudi Arthrodesis Ankle Arthrodesis Pantalar Arthrodesis  Tendon Transfer Techniques Talipes Equinovarus Anterior Transfer of Posterior Tibial Tendon Split Transfer of Anterior Tibial Tendon Split Transfer of the Posterior Tibial Tendon Talipes Cavovarus Talipes Equinovalgus Peroneal Tendon Transfer Peroneus Longus, Flexor Digitorum Longus, or Flexor or Extensor Hallucis Longus Tendon Transfer Talipes Calcaneus Tenodesis of the Achilles Tendon Posterior Transfer of Peroneus Longus, Peroneus Brevis, and Posterior Tibial Tendons Posterior Transfer of Posterior Tibial, Peroneus Longus, and Flexor Hallucis Longus Tendons Knee  Flexion Contracture of the Knee  Quadriceps Paralysis Transfer of Biceps Femoris and Semitendinosus Tendons  Genu Recurvatum Osteotomy of the Tibia for Genu Recurvatum Soft Tissue Operations for Genu Recurvatum Triple Tenodesis for Genu Recurvatum  Flail Knee Tibia and Femur Hip  Flexion and Abduction Contractures of the Hip Complete Release of Hip Flexion, Abduction, and External Rotation Contracture Complete Release of Muscles From Iliac Wing and Transfer of Crest of Ilium  Paralysis of the Gluteus Maximus and Medius Muscles Posterior Transfer of the Iliopsoas for Paralysis of the Gluteus Medius and Maximus Muscles  Paralytic Dislocation of the Hip Leg-Length Discrepancy Total Joint Arthroplasty Trunk  Pelvic Obliquity Treatment Serratus Anterior Paralysis. Trapezius and Levator Scapulae Paralysis. Paralytic Scoliosis. Shoulder  Tendon and Muscle Transfers for Paralysis of the Deltoid Trapezius Transfer for Paralysis of Deltoid Transfer of Deltoid Origin for Partial Paralysis  Tendon and Muscle Transfers for Paralysis of the Subscapularis, Suprascapularis, Supraspinatus, or Infraspinatus Transfer of Latissimus Dorsi or Teres Major or Both for Paralysis of Subscapularis or Infraspinatus  Arthrodesis Elbow  Muscle and Tendon Transfers to Restore Elbow Flexion Flexorplasty Anterior Transfer of the Triceps Transfer of the Pectoralis Major Tendon Transfer of the Latissimus Dorsi Muscle  Muscle Transfers for Paralysis of the Triceps Posterior Deltoid Transfer (Moberg Procedure) Forearm  Pronation Contracture Rerouting of Biceps Tendon for Supination Deformities of Forearm Wrist and Hand Myelomeningocele Epidemiology Associated Conditions  Hydrocephalus  Hydrosyringomyelia  Arnold-Chiari Malformation  Tethered Spinal Cord  Other Spinal Abnormalities  Urological Dysfunction  Latex Hypersensitivity  Miscellaneous Medical Issues Classification Orthopaedic Evaluation Gait Evaluation Principles of Orthopaedic Management  Nonoperative Management  Operative Management Foot  Equinus Deformity  Clubfoot V-O Procedure  Varus Deformity  Cavovarus Deformity  Supination Deformity  Calcaneus Deformity Anterolateral Release Transfer of the Anterior Tibial Tendon to the Calcaneus  Hindfoot Valgus  Vertical Talus  Pes Cavus Deformity  Toe Deformities Ankle  Hemiepiphysiodesis of the Distal Tibial Epiphysis Screw Epiphysiodesis Supramalleolar Varus Derotation Osteotomy Knee  Flexion Contracture Radical Flexor Release  Extension Contracture  Varus or Valgus Deformity Hip  Flexion Contracture Anterior Hip Release  Flexion-Abduction–External Rotation Contracture  External Rotation Contracture  Abduction Contracture Fascial Release  Adduction Contracture Adductor Release  Hip Subluxation and Dislocation Transfer of Adductors, External Oblique, and Tensor Fasciae Latae Proximal Femoral Resection and Interposition Arthroplasty  Pelvic Obliquity Pelvic Osteotomy Spine  Scoliosis  Kyphosis Kyphectomy Arthrogryposis Multiplex Congenita Treatment  Lower Extremity  Upper Extremity Posterior Release of Elbow Extension Contracture (Tachdjian) Scoliosis Brachial Plexus Palsy Clinical Features Treatment Anterior Shoulder Release Rotational Osteotomy of the Humerus Release of the Internal Rotation Contracture and Transfer of the Latissimus Dorsi and Teres Major Arthroscopic Release and Transfer of the Latissimus Dorsi References Poliomyelitis Myelomeningocele Arthrogryposis Multiplex Congenita Brachial Plexus Supplemental References Poliomyelitis Foot and Ankle Knee Hip Trunk Shoulder Elbow and Forearm Myelomeningocele Arthrogryposis Multiplex Congenita Brachial Plexus 35 Neuromuscular Disorders Treatment Considerations Fractures Orthoses Seating Systems Differentiation of Muscle Disease From Nerve Disease Hematological Studies Electromyographic Studies Muscle Tissue Biopsy Open Muscle Biopsy Percutaneous Muscle Biopsy Muscular Dystrophy Duchenne Muscular Dystrophy  Physical Examination  Medical Treatment  Orthopaedic Treatment Percutaneous Release of Hip Flexion and Abduction Contractures and Achilles Tendon Contracture Rideau Technique Transfer of the Posterior Tibial Tendon to the Dorsum of the Foot Transfer of the Posterior Tibial Tendon to the Dorsum of the Base of the Second Metatarsal Other Variants of Muscular Dystrophy  Becker Muscular Dystrophy  Emery-Dreifuss Muscular Dystrophy  Limb-Girdle Dystrophy  Facioscapulohumeral Muscular Dystrophy Scapulothoracic Fusion  Infantile Facioscapulohumeral Muscular Dystrophy Congenital Dystrophies Myotonic Dystrophy Hereditary Motor and Sensory Neuropathies Charcot-Marie-Tooth Disease (Peroneal Muscular Atrophy)  Cavovarus Foot Deformity Clinical and Radiographic Evaluation Orthopaedic Treatment Radical Plantar-Medial Release and Dorsal Closing Wedge Osteotomy Transfer of the Extensor Hallucis Longus Tendon for Claw Toe Deformity Transfer of the Extensor Tendons to the Middle Cuneiform Stepwise Joint-Sparing Foot Osteotomies  Hip Dysplasia  Spinal Deformities Charcot-Marie-Tooth Disease Variants Friedreich Ataxia Spinal Muscular Atrophy References General Muscular Dystrophy—General Duchenne Muscular Dystrophy Limb-Girdle Dystrophy Facioscapulohumeral Dystrophy Congenital Dystrophy Myotonic Dystrophy Charcot-Marie-Tooth Disease Friedreich Ataxia Spinal Muscular Atrophy Supplemental References General Muscular Dystrophy—General Duchenne Muscular Dystrophy Becker Muscular Dystrophy Limb-Girdle Dystrophy Emery-Dreifuss Muscular Dystrophy Facioscapulohumeral Dystrophy Congenital Dystrophy Myotonic Dystrophy Charcot-Marie-Tooth Disease Friedreich Ataxia Spinal Muscular Atrophy Part XI – Fractures and Dislocations in Children 36 Fractures and Dislocations in Children Physeal Injuries Open Fractures Pathological Fractures Fractures at Birth and Fractures Caused by Child Abuse General Principles of Operative Fracture Treatment in Children Hand and Wrist Fractures, Dislocations, and Fracture-Dislocations Phalangeal Fractures Metacarpal Fractures  Thumb Metacarpal Fractures Open Reduction and Internal Fixation of Physeal Fractures of Phalanges and Metacarpals Dislocations Other Fractures and Fracture-Dislocations Forearm Fractures Fractures of the Distal Third of the Forearm Fractures of the Middle Third of the Forearm Closed Intramedullary Nailing Fractures of the Proximal Third of the Forearm  Synostosis (Cross Union)  Plastic Deformation  Monteggia and Galeazzi Fractures Monteggia Fracture Open Reduction of Old Monteggia Fracture in Children Galeazzi Fracture-Dislocation Isolated Dislocations of the Radial Head Osteotomy of the Ulna and Overcorrection of Angular Deformity Elbow Joint Fractures and Dislocations Radial Head and Neck Fractures Closed and Open Reduction of Radial Neck Fractures Closed Intramedullary Pinning Percutaneous Reduction and Pinning Olecranon Fractures Fractures of the Coronoid Process Elbow Dislocations  Acute Dislocations  Chronic Recurrent Elbow Dislocations  Old Unreduced Elbow Dislocations Open Reduction of Untreated (Chronic) Posterior Dislocation of the Elbow in Children Distal Humeral Fractures Capitellar Fractures Lateral Condylar Fractures Open Reduction and Internal Fixation Open Reduction and Internal Fixation with Bone Grafting for Nonunion or Delayed Union of Minimally Displaced Fractures Established Nonunion with Cubitus Valgus Osteotomy for Established Cubitus Valgus Secondary to Nonunion or Growth Arrest Medial Epicondylar Fractures Displaced or Entrapped Medial Epicondyle Medial Condylar Fractures Open Reduction and Internal Fixation Supracondylar Fractures  Closed Reduction and Percutaneous Pinning Ulnar Nerve Injury Closed Reduction and Percutaneous Pinning of Supracondylar Fracture (Crossed Medial and Lateral Pins) Closed Reduction and Percutaneous Pinning of Supracondylar Fracture (Two Lateral Pins)  Open Reduction and Internal Fixation Anterior Approach  Early Complications Nerve Injury Brachial Artery Injury Compartment Syndrome  Late Complications Lateral Closing Wedge Osteotomy Oblique Osteotomy with Derotation Step-Cut Osteotomy Step-Cut Translation Osteotomy with A y-Shaped Humeral Plate Separation of the Entire Distal Humeral Epiphysis Fractures of the Shaft and Proximal End of the Humerus Closed Reduction and Casting or Percutaneous Pinning Acromioclavicular Dislocations Fractures and Dislocations of the Clavicle Spine Fractures and Dislocations Cervical Spine  Atlantoaxial Fracture-Dislocations  Fractures of the Odontoid  C3-7 Fractures and Dislocations Thoracic and Lumbar Spine Fractures Pelvic Fractures Avulsion Fractures Pelvic Fractures Acetabular Fractures Hip Fractures in Children Type I, Transepiphyseal Separations Type II, Transcervical Fractures Type III, Cervicotrochanteric Fractures Type IV, Intertrochanteric Fractures Treatment Recommendations Closed Reduction and Internal Fixation Open Reduction and Internal Fixation Valgus Subtrochanteric Osteotomy for Acquired Coxa Vara or Nonunion Modified Pauwels Intertrochanteric Osteotomy for Acquired Coxa Vara or Nonunion Traumatic Hip Dislocations in Children Slipped Capital Femoral Epiphysis Treatment  In Situ Pin or Screw Fixation Determining the Entry Point for Cannulated Screw Fixation of A Slipped Epiphysis  Contralateral Slips  Closed Reduction  Open Reduction Positional Reduction and Fixation  Osteotomy Cuneiform Osteotomy of the Femoral Neck (Fish) Cuneiform Osteotomy of the Femoral Neck (Dunn) Subcapital Realignment of the Epiphysis Compensatory Basilar Osteotomy of the Femoral Neck Extracapsular Base-of-Neck Osteotomy Intertrochanteric Osteotomy Intertrochanteric Osteotomy (Imhäuser)  Cheilectomy Complications  Osteonecrosis  Chondrolysis  Femoral Neck Fracture  Continued Slipping Femoroacetabular Impingement Femoral Fractures Femoral Shaft Fractures (or Diaphyseal Femoral Fractures) Spica Cast Application Flexible Intramedullary Nail Fixation  Complications Fractures of the Distal Femoral Physis Closed or Open Reduction  Complications Knee Fractures and Dislocations Patellar Dislocations Reconstruction of the Patellofemoral and Patellotibial Ligaments with A Semitendinosus Tendon Graft Release of the Iliotibial Tract and Lateral Retinaculum for Patellar Dislocation 3-in-1 Procedure for Recurrent Dislocation of the Patella: Lateral Release, Vastus Medialis Obliquus Muscle Advancement, and Transfer of the Medial Third of the Patellar Tendon to the Medial Collateral Ligament Patellar Fractures Open Reduction and Internal Fixation of Sleeve Fracture Fractures of the Intercondylar Eminence of the Tibia Open Reduction and Internal Fixation of Tibial Eminence Fracture Arthroscopic Reduction of Tibial Eminence Fracture and Internal Fixation with Bioabsorbable Nails Tibial Tuberosity Fractures Open Reduction and Internal Fixation Osteochondral Fractures Floating Knee Injuries Tibial and Fibular Fractures Proximal Tibial Physeal Fractures Open Reduction and Internal Fixation of Tibial Tuberosity Fracture Proximal Tibial Metaphyseal Fractures Open Reduction and Removal of Interposed Tissue Middle and Distal Tibial Shaft Fractures Elastic Stable Intramedullary Nailing of Tibial Fracture Distal Tibial and Fibular Epiphyseal Fractures Open Reduction and Internal Fixation Triplane Fractures Open Reduction and Internal Fixation Tillaux Fractures Open Reduction and Internal Fixation Percutaneous Reduction and Internal Fixation Foot and Ankle Fractures Talar Fractures  Talar Neck Fractures  Fractures of the Dome and Lateral Process of the Talus  Osteochondral Fractures of the Talus Excision of Osteochondral Fragment of the Talus Calcaneal Fractures Tarsal Fractures Open Reduction and Internal Fixation of Cuboid Compression (Nutcracker) Fracture Metatarsal and Phalangeal Fractures References Physeal Injuries, Child Abuse Open and Pathological Fractures Hand and Wrist Fractures, Dislocations, and Fracture-Dislocations Forearm Fractures/Monteggia Fractures Elbow Joint Fractures and Dislocations Lateral Condylar Fractures Medial Epicondylar and Medial Humeral Condylar Fractures Supracondylar Fractures Fractures of the Shaft and Proximal End of the Humerus, Acromioclavicular Dislocations, and Fractures and Dislocations of the Shaft and Epiphysis of the Clavicle Spine Fractures and Dislocations Pelvic and Hip Fractures and Disorders Slipped Capital Femoral Epiphysis Femoral Fractures Knee Fractures Tibial and Fibular Fractures Foot Fractures Supplemental References Physeal Injuries, Child Abuse Open and Pathological Fractures Hand and Wrist Fractures, Dislocations, and Fracture-Dislocations Forearm Fractures/Monteggia Fractures Elbow Joint Fractures and Dislocations Lateral Condylar Fractures Medial Epicondylar and Medial Humeral Condylar Fractures Supracondylar Fractures Fractures of the Shaft and Proximal End of the Humerus, Acromioclavicular Dislocations, and Fractures and Dislocations of the Shaft and Epiphysis of the Clavicle Spine Fractures and Dislocations Pelvic and Hip Fractures and Disorders Slipped Capital Femoral Epiphysis Femoral Fractures Fractures About the Knee (Distal Femur, Proximal Tibia, Patella) Tibial Shaft Fractures Distal Tibial and Fibular Fractures and Foot Fractures Part XII – The Spine 37 Spinal Anatomy and Surgical Approaches Anatomy of Vertebral Column Anatomy of Spinal Joints Anatomy of Spinal Cord and Nerves Anatomy of Cervical, Thoracic, and Lumbar Pedicles Circulation of Spinal Cord Surgical Approaches Anterior Approaches  Anterior Approach, Occiput to C3 Anterior Transoral Approach Anterior Retropharyngeal Approach  Extended Maxillotomy and Subtotal Maxillectomy Subtotal Maxillectomy Extended Maxillotomy  Anterior Approach, C3 to C7 aNTERIOR APPROACH, C3 TO C7  Anterolateral Approach, C2 to C7 ANTEROLATERAL APPROACH, C2 TO C7  Anterior Approach to Cervicothoracic Junction, C7 to T1 Low Anterior Cervical Approach High Transthoracic Approach Transsternal Approach Modified Anterior Approach to Cervicothoracic Junction Anterior Approach to the Cervicothoracic Junction without Sternotomy  Anterior Approach to the Thoracic Spine ANTERIOR APPROACH TO THE THORACIC SPINE  Video-Assisted Thoracic Surgery VIDEO-ASSISTED THORACIC SURGERY  Anterior Approach to the Thoracolumbar Junction ANTERIOR APPROACH TO THE THORACOLUMBAR JUNCTION  Anterior Retroperitoneal Approach, L1 to L5 ANTERIOR RETROPERITONEAL APPROACH, L1 TO L5  Percutaneous Lateral Approach to Lumbar Spine, L1 to L4-5 (Dlif or Xlif) PERCUTANEOUS LATERAL APPROACH, L1 TO L4-5  Anterior Transperitoneal Approach to the Lumbosacral Junction, L5 to S1 ANTERIOR TRANSPERITONEAL APPROACH, L5 TO S1  Video-Assisted Lumbar Surgery VIDEO-ASSISTED LUMBAR SURGERY Posterior Approaches Posterior Approach to the Cervical Spine, Occiput to C2 Posterior Approach to the Cervical Spine, C3 to C7 Posterior Approach to the Thoracic Spine, T1 to T12 Costotransversectomy Posterior Approach to the Lumbar Spine, L1 to L5 Paraspinal Approach to Lumbar Spine Posterior Approach to the Lumbosacral Spine, L1 to Sacrum Posterior Approach to the Sacrum and Sacroiliac Joint References Supplemental References Anatomy and Biomechanics Surgical Approaches 38 Fractures, Dislocations, and Fracture-Dislocations of the Spine Initial Management of Spinal Injury Initial Spine Assessment Spine Precautions Diagnostic Imaging Additional Imaging Application of Gardner-Wells Tongs Stretch Test Neurological Assessment Spinal Cord Injury Neurogenic and Spinal Shock Immediate Spinal Reduction  Closed Reduction Technique Spinal Cord Injury Treatment Spinal Cord Syndromes Cervical Spine Injuries Halo Vest Immobilization and Cervical Orthoses Halo Vest Application Radiographic Evaluation Protocol Occipitocervical Dissociation Injury Patterns Occipitocervical Fusion Using Modular Plate and Rod Construct, Segmental Fixation with Occipital Plating, C1 Lateral Mass Screw, C2 Isthmic (Pars) Screws, and Lateral Mass Fixation Occipitocervical Fusion Using Wires and Bone Graft Occipital Condyle Fractures Transverse Atlantal Ligament Rupture  Posterior C1-C2 Fusion Techniques Posterior C1-C2 Fusion Using Rod and Screw Construct with C1 Lateral Mass Screws Posterior C1-C2 Fusion Using the Modified Gallie Posterior Wiring Technique Atlas Fractures  Treatment Axis Fractures  Odontoid Fractures Treatment Anterior Odontoid Screw Fixation Posterior Stabilization. Posterior Fusion of C1-C2. Posterior C1-C2 Transarticular Screws Posterior C1-C2 Fusion with C2 Translaminar Screws Posterior C1-C2 Wiring  Traumatic Spondylolisthesis of the Axis (Hangman Fracture) Treatment Subaxial Cervical Spine Injury (C3-T1)  Classification  Treatment  Extension Injuries  Burst Fractures  Facet Dislocations  Facet Fracture with Subluxation  Fracture-Dislocations Anterior Cervical Discectomy and Fusion with Locking Plate Anterior Cervical Corpectomy and Fusion, with Anterior Locking Plate Posterior Subaxial Fixation and Fusion Ankylosing Spondylitis Vertebral Artery Injuries Thoracic and Lumbar Injuries Classification Treatment Compression Fractures Burst Fractures Distraction Injuries Extension Injuries Fracture-Dislocations Decompression  Posterior Stabilization Thoracic and Lumbar Segmental Fixation with Pedicle Screws  Anterior Stabilization Anterior Plating Sacral Fractures and Spinopelvic Dissociation Injuries Classification Treatment Lumbopelvic Fixation (Triangular Osteosynthesis) References General Cervical Spine Thoracic and Lumbar Spine and Sacrum Supplemental References General Cervical Spine Thoracic and Lumbar Spine and Sacrum 39 Arthrodesis of the Spine Bone Grafts and Arthrodesis Healing Autografts Bone Graft Products for Spinal Fusion Cervical Spine Anterior Arthrodesis  General Complications  Postoperative Complications  Types Smith-Robinson Anterior Cervical Fusion Anterior Occipitocervical Arthrodesis by Extrapharyngeal Exposure Fibular Strut Graft in Cervical Spine Arthrodesis with Corpectomy Posterior Arthrodesis Thoracic and Lumbar Spine Anterior Arthrodesis  Transthoracic Approach to the Thoracic Spine  Anterior Disc Excision and Interbody Fusion of the Lumbar Spine Anterior Interbody Fusion of the Lumbar Spine  Minimally Invasive Anterior Fusion of the Lumbar Spine Percutaneous Anterior Lumbar Arthrodesis—lateral Approach to L1 to L4-5 Posterior Arthrodesis  Hibbs Fusion  Posterolateral or Intertransverse Fusions Posterolateral Lumbar Fusion Intertransverse Lumbar Fusion  Minimally Invasive Posterior Lumbar Fusion Internal Fixation in Lumbar Spinal Fusion Treatment after Posterior Arthrodesis Pseudarthrosis after Spinal Fusion Pseudarthrosis Repair References Supplemental References 40 Pediatric Cervical Spine Normal Embryology and Growth and Development Anomalies of the Odontoid Diagnosis Radiographic Findings Treatment  Posterior Cervical Approaches Atlantoaxial Fusion Posterior Atlantoaxial Fusion Posterior Atlantoaxial Fusion Using Laminar Wiring C1-2 Transarticular Screw Fixation Translaminar Screw Fixation of C2 Occipitocervical Fusion Occipitocervical Fusion Occipitocervical Fusion Passing Wires Through Table of Skull Occipitocervical Fusion Without Internal Fixation Occipitocervical Fusion Using Crossed Wiring Occipitocervical Fusion Using Contoured Rod AND Segmental Rod Fixation Occipitocervical Fusion Using A Contoured Occipital Plate AND Screw Fixation  Anterior Cervical Approaches Transoral Approach Transoral Mandible-Splitting AND Tongue-Splitting Approach Subtotal Maxillectomy Lateral Retropharyngeal Approach Anterior Retropharyngeal Approach Sternal-Splitting Approach  Halo Vest Immobilization Application of Halo Device Complications Basilar Impression Radiographic Findings Treatment Atlantooccipital Fusion Radiographic Findings Treatment Idiopathic Atlantooccipital Instability Klippel-Feil Syndrome Associated Conditions  Scoliosis  Renal Anomalies  Cardiovascular Anomalies  Deafness  Synkinesis  Respiratory Anomalies  Sprengel Deformity  Cervical Ribs Clinical Findings Radiographic Findings Treatment Posterior Fusion of C3-7 Posterior Fusion of C3 to C7 Using 16-Gauge Wire AND Threaded Kirschner Wires Posterior Fusion with Lateral Mass Screw Fixation Rib Resection Atlantoaxial Rotatory Subluxation Radiographic Findings Treatment Cervical Instability in Down Syndrome Neurological Findings Radiographic Findings Treatment Familial Cervical Dysplasia Congenital Anomalies of the Atlas Larsen Syndrome Posterior Spinal Fusion for Cervical Kyphosis Through A Lateral Approach Intervertebral Disc Calcification References Embryology and Growth and Development Surgical Approaches Anomalies of the Odontoid Basilar Impression Atlantoaxial Rotatory Subluxation Cervical Instability in Down Syndrome Intervertebral Disc Calcification Supplemental References Embryology and Growth and Development Surgical Approaches Anomalies of the Odontoid Basilar Impression Atlantooccipital Fusion Klippel-Feil Syndrome Atlantoaxial Rotatory Subluxation Cervical Instability in Down Syndrome Familial Cervical Dysplasia Congenital Anomalies of Atlas Larsen Syndrome Intervertebral Disc Calcification 41 Scoliosis and Kyphosis Scoliosis Infantile Idiopathic Scoliosis Treatment  Casting Casting  Operative Treatment Juvenile Idiopathic Scoliosis Treatment  Growing Rod Instrumentation Dual Growing Rod Instrumentation Without Fusion Growing Rod Attachment Using Rib Anchors Guided Growth and Physeal Stapling Intervertebral Stapling  Instrumentation with Fusion Adolescent Idiopathic Scoliosis Etiology Natural History Patient Evaluation Radiographic Evaluation  Measurement of Curves  Vertebral Rotation  Sagittal Balance  Curve Patterns Ponseti and Friedman Classification King Classification Lenke Classification Nonoperative Treatment  Observation  Orthotic Treatment  Casting Underarm Casts Operative Treatment  Preoperative Preparation  Intraoperative Considerations  Surgical Goals Posterior Surgeries for Idiopathic Scoliosis Posterior Approach Posterior Fusion Facet Fusion Facet Fusion Bone Grafting Autogenous Iliac Crest Bone Graft  Complications of Bone Grafting Posterior Spinal Instrumentation  Correction Maneuvers Multiple-Hook Segmental Instrumentation  Surgical Plan  Fusion Levels and Hook Site Placement  Hook Site Preparation and Placement Pedicle Hook Implantation Transverse Process Hook Implantation Lamina Hook Implantation Instrumentation Sequence in Typical Lenke 1a Curve Sublaminar Wires Sublaminar Cables  Complications and Pitfalls in Multiple-Hook Segmental Instrumentation Systems Pedicle Fixation  Insertion of Lumbar Pedicle Screws  Insertion of Thoracic Pedicle Screws Thoracic Pedicle Screw Insertion Techniques Rigid Curves Halo-Gravity Traction Temporary Distraction Rod Anterior Release Osteotomy in Complex Spinal Deformity Posterior Thoracic Vertebral Column Resection Complications of Posterior Scoliosis Surgery  Early Complications Neurological Injury Infection ILEUS Atelectasis Pneumothorax Dural Tear Wrong Levels Urinary Complications Vision Loss  Late Complications Pseudarthrosis Loss of Lumbar Lordosis Crankshaft Phenomenon Superior Mesenteric Artery Syndrome Trunk Decompensation Late Infection Posterior Thoracoplasty Thoracoplasty Complications and Pitfalls Concave Rib Osteotomies Osteotomy of the Ribs Anterior Instrumentation for Idiopathic Scoliosis Thoracoabdominal Approach Lumbar Extraperitoneal Approach Disc Excision Anterior Instrumentation of a Thoracolumbar Curve with CD Horizon Legacy Dual-Rod Instrumentation Complications and Pitfalls of Anterior Instrumentation Anterior Thoracoplasty Anterior Thoracoplasty Video-Assisted Thoracoscopy Video-Assisted Thoracoscopic Discectomy Pitfalls and Complications Endoscopic Anterior Instrumentation of Idiopathic Scoliosis CD Horizon Eclipse Spinal Instrumentation Neuromuscular Scoliosis Nonoperative Treatment  Observation  Orthotic Treatment Operative Treatment  Preoperative Considerations  Operative Considerations  Postoperative Considerations  Luque Rod Instrumentation with Sublaminar Wiring Luque Rod Instrumentation and Sublaminar Wires Without Pelvic Fixation  Sacropelvic Fixation Sacropelvic Fixation Galveston Sacropelvic Fixation Unit Rod Instrumentation with Pelvic Fixation Iliac Fixation with Iliac Screws S2 Iliac Lumbopelvic Screw Placement Cerebral Palsy  Classification  Nonoperative Treatment  Operative Treatment  Complications Friedreich Ataxia Charcot-Marie-Tooth Disease Syringomyelia Spinal Cord Injury  Orthotic Treatment  Operative Treatment Poliomyelitis Spinal Muscle Atrophy  Orthotic Treatment  Operative Treatment Familial Dysautonomia Arthrogryposis Multiplex Congenita Duchenne Muscular Dystrophy Variants of Muscular Dystrophy Other Than Duchenne Type Congenital Scoliosis Classification Patient Evaluation Natural History Nonoperative Treatment Operative Treatment  Posterior Fusion Without Instrumentation  Posterior Fusion with Instrumentation  Combined Anterior and Posterior Fusions Transpedicular Convex Anterior Hemiepiphysiodesis and Posterior Arthrodesis  Combined Anterior and Posterior Convex Hemiepiphysiodesis (Growth Arrest) Convex Anterior and Posterior Hemiepiphysiodeses and Fusion  Hemivertebra Excision Hemivertebra Excision Transpedicular Eggshell Osteotomies with Frameless Stereotactic Guidance Thoracic Insufficiency Syndrome Expansion Thoracoplasty Kyphosis Scheuermann Disease Classification Etiology Clinical Findings Radiographic Findings Natural History Associated Conditions Differential Diagnosis Treatment  Nonoperative Treatment Observation Orthotic Treatment  Operative Treatment Anterior Release and Fusion Posterior Multiple-Hook and Screw Segmental Instrumentation Posterior Column Shortening Procedure for Scheuermann Kyphosis Congenital Kyphosis Clinical and Radiographic Evaluation Operative Treatment  Treatment of Type I Deformity  Treatment of Type II Deformity Anterior Osteotomy and Fusion Anterior Cord Decompression and Fusion Anterior Vascular Rib Bone Grafting  Complications of Operative Treatment Progressive Anterior Vertebral Fusion Infantile Lumbar Hypoplasia Spondylolysis and Spondylolisthesis Classification Etiology and Natural History Clinical Findings Radiographic Findings Treatment of Acquired Spondylolysis  Repair of Spondylolytic Defect Spondylolysis Repair Modified Scott Repair Technique  Posterolateral Fusion Treatment of Developmental Spondylolisthesis  Nonoperative Treatment  Operative Treatment Treatment of Severe (High Dysplastic) Spondylolisthesis Posterolateral Fusion and Pedicle Screw Fixation Instrumented Reduction Partial Reduction and Interbody Fusion One-Stage Decompression and Posterolateral Interbody Fusion Uninstrumented Circumferential in Situ Fusion Treatment of Spondyloptosis L5 Vertebrectomy Kyphoscoliosis Myelomeningocele  Incidence and Natural History  Clinical Evaluation  Radiographic Findings  Scoliosis and Lordosis Orthotic Treatment Operative Treatment Selection of Fusion Levels Anterior-Only Fusion Posterior Instrumentation and Fusion Combined Anterior and Posterior Fusion  Kyphosis Incidence and Natural History Operative Treatment Vertebral Excision and Reduction of Kyphosis Sacral Agenesis  Treatment Unusual Causes of Scoliosis Neurofibromatosis  Management of Nondystrophic Curves  Management of Dystrophic Scoliosis  Scoliosis Without Kyphosis  Kyphoscoliosis  Kyphoscoliosis with Spinal Cord Compression  Postoperative Management  Complications of Surgery Marfan Syndrome  Diagnosis  Nonoperative Treatment Observation Orthotic Treatment  Operative Treatment Vertebral Column Tumors  Clinical Findings  Radiographic Evaluation and Treatment  Biopsy Open Biopsy of Thoracic Vertebra  Benign Tumors of Vertebral Column Osteoid Osteoma Osteoblastoma Aneurysmal Bone Cysts Eosinophilic Granuloma Hemangioma  Primary Malignant Tumors of the Vertebral Column Ewing Sarcoma Osteogenic Sarcoma Postirradiation Spinal Deformity  Incidence  Radiographic Findings  Treatment  Complications and Pitfalls Osteochondrodystrophy  Diastrophic Dwarfism  Spondyloepiphyseal Dysplasia Osteogenesis Imperfecta  Anesthesia Problems  Orthotic Treatment  Operative Treatment Unusual Causes of Kyphosis Postlaminectomy Spinal Deformity  Treatment Skeletal Dysplasias  Achondroplasia Mucopolysaccharidoses References Infantile and Juvenile Idiopathic Scoliosis Natural History of Adolescent Idiopathic Scoliosis Patient Evaluation in Adolescent Idiopathic Scoliosis Nonoperative Management of Idiopathic Scoliosis Operative Treatment of Idiopathic Scoliosis Neuromuscular Scoliosis (General) Cerebral Palsy Inheritable Neurological Disorders Syringomyelia Arthrogryposis Multiplex Congenita Duchenne Muscular Dystrophy Congenital Scoliosis Scheuermann Disease Congenital Kyphosis Progressive Anterior Vertebral Fusion Spondylolysis and Spondylolisthesis Kyphoscoliosis in Myelomeningocele Marfan Syndrome Vertebral Column Tumors Osteochondrodystrophy Postlaminectomy Spinal Deformity Skeletal Dysplasias Supplemental References Infantile and Juvenile Idiopathic Scoliosis Natural History of Adolescent Idiopathic Scoliosis Patient Evaluation in Adolescent Idiopathic Scoliosis Nonoperative Management of Idiopathic Scoliosis Operative Treatment of Idiopathic Scoliosis Neuromuscular Scoliosis (General) Cerebral Palsy Inheritable Neurological Disorders Syringomyelia Spinal Cord Injuries Poliomyelitis Arthrogryposis Multiplex Congenita Duchenne Muscular Dystrophy Congenital Scoliosis Scheuermann Disease Congenital Kyphosis Progressive Anterior Vertebral Fusion Spondylolysis and Spondylolisthesis Kyphoscoliosis in Myelomeningocele Sacral Agenesis Neurofibromatosis Marfan Syndrome Vertebral Column Tumors Postirradiation Spinal Deformity Osteochondrodystrophy Osteogenesis Imperfecta Postlaminectomy Spinal Deformity Skeletal Dysplasias 42 Lower Back Pain and Disorders of Intervertebral Discs Overview of Disc Degeneration and Herniation Disc and Spine Anatomy Neural Elements Natural History of Disc Disease Axial Lumbar Pain Diagnostic Studies Radiography Myelography Myelography Computed Tomography Magnetic Resonance Imaging Other Diagnostic Tests Injection Studies Epidural Cortisone Injections  Cervical Epidural Injection Interlaminar cervical epidural injection  Thoracic Epidural Injection Interlaminar thoracic epidural injection  Lumbar Epidural Injection Interlaminar lumbar epidural injection Transforaminal lumbar and sacral epidural injection Caudal sacral epidural injection Zygapophyseal (Facet) Joint Injections  Cervical Facet Joint cervical Medial Branch Block Injection  Lumbar Facet Joint lumbar Intraarticular Injection lumbar Medial Branch Block Injection  Sacroiliac Joint sacroiliac joint injection Discography Lumbar Discography Thoracic Discography Cervical Discography Cervical Disc Disease Signs and Symptoms Differential Diagnosis Confirmatory Imaging Nonoperative Treatment Operative Treatment Removal of Posterolateral Herniations by Posterior Approach (Posterior Cervical Foraminotomy)  Minimally Invasive Posterior Approaches to the Cervical Spine Minimally Invasive Posterior Cervical Foraminotomy with Tubular Distractors Full-Endoscopic Posterior Cervical Foraminotomy Results  Anterior Approach to the Cervical Discs Anterior Foraminotomy Microsurgical Anterior Cervical Foraminotomy  Cervical Disc Arthroplasty Thoracic Disc Disease Signs and Symptoms Confirmatory Imaging Treatment Results Operative Treatment  Costotransversectomy Thoracic costotransversectomy  Thoracic Disc Excision thoracic discectomy—anterior approach  Thoracic Endoscopic Disc Excision endoscopic thoracic discectomy Minimally Invasive Thoracic Discectomy Lumbar Disc Disease Signs and Symptoms Differential Diagnosis Confirmatory Imaging Nonoperative Treatment Operative Treatment  Microdiscectomy Micro Lumbar Disc Excision Ruptured Lumbar Disc Excision  Endoscopic Techniques  Additional Exposure Techniques Lumbar Root Anomalies Results of Surgery for Disc Herniation  Complications of Disc Excision Dural Repair Augmented with Fibrin Glue  Free Fat Grafting Repeat Lumbar Disc Surgery repeat lumbar disc excision Disc Excision and Fusion Degenerative Disc Disease and Internal Disc Derangement Patient Selection Process Differential Spinal Anesthetic Psychogenic Pain Sympathetic Pain Somatic Pain Central Pain  Modified Technique Interpretation Failed Spine Surgery Coccygeal Pain Coccygeal Injection References Overview of Disc Degeneration and Herniation Disc and Spine Anatomy Natural History of Disc Disease Diagnostic Studies Injection Studies Cervical Disc Disease Thoracic Disc Disease Lumbar Disc Disease Operative Treatment Degenerative Disc Disease and Internal Disc Derangement Failed Spine Surgery Coccygeal Pain Supplemental References Overview of Disc Degeneration and Herniation Disc and Spine Anatomy Natural History of Disc Disease Diagnostic Studies Injection Studies Cervical Disc Disease Thoracic Disc Disease Lumbar Disc Disease Operative Treatment Degenerative Disc Disease and Internal Disc Derangement Failed Spine Surgery Coccygeal Pain 43 Infections of the Spine Biology of Spinal Infection Natural History Epidemiology Diagnosis Physical Examination Diagnostic Techniques  Radiography  Computed Tomography  Magnetic Resonance Imaging  Radionuclide Scanning  Laboratory Studies  Diagnostic Biopsy Differential Diagnosis Nonoperative Treatment Prognosis Specific Infections Pyogenic Infections  Infections in Children  Disc Space Infection in Adults  Epidural Space Infection Postoperative Infections Brucellosis Fungal Infections Tuberculosis  Treatment of Tubercular Spinal Infection  Pott Paraplegia  Atypical Tubercular Infections Abscess Drainage by Anatomical Level Cervical Spine Drainage of A Retropharyngeal Abscess Drainage of An Abscess of the Posterior Triangle of the Neck Alternative Approach for Drainage of A Retropharyngeal Abscess Dorsal Spine Costotransversectomy Lumbar Spine and Pelvic Drainage Drainage of Paravertebral Abscess  Drainage of Psoas Abscess Drainage Through the Petit Triangle Drainage by Lateral Incision Drainage by Anterior Incision  Drainage by Ludloff Incision Coccygectomy for Drainage of A Pelvic Abscess Surgical Treatment for Tuberculosis of the Spine Radical Débridement and Arthrodesis Dorsolateral Approach to the Dorsal Spine Costotransversectomy Anterolateral Decompression (Lateral Rhachotomy) References Biology, Diagnosis, and Treatment of Spinal Infection Pyogenic Infections Infections in Children Epidural Space Infection Brucellosis Fungal Infections Tuberculosis Supplemental References Biology, Diagnosis, and Treatment of Spinal Infection Pyogenic Infections Infections in Children Epidural Space Infection Brucellosis Fungal Infections Tuberculosis 44 Other Disorders of the Spine Spinal Stenosis Anatomy Natural History  Clinical Evaluation Diagnostic Imaging  Radiography  Magnetic Resonance Imaging  Computed Tomographic Myelography  Other Diagnostic Studies Nonoperative Treatment  Epidural Steroid Injection Operative Treatment  Principles of Spinal Stenosis Surgery  Adjacent Segment Degeneration  Decompression Midline Decompression (Neural Arch Resection) Less-Invasive Decompression Spinous Process Osteotomy (Decompression) Microdecompression  Decompression with Fusion  Interspinous Distraction Degenerative Spondylolisthesis Incidence Anatomy and Biomechanics Natural History Clinical Evaluation Diagnostic Imaging  Radiography  Computed Tomographic Myelography and Magnetic Resonance Imaging  Discography  Other Studies Nonoperative Treatment  Epidural Steroid Injection Operative Treatment  Decompression  Decompression and Fusion for Degenerative Spondylolisthesis  Posterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion  Anterior Spinal Fusion  Decompression and Combined Fusion (360-Degree Fusion) Adult Isthmic Spondylolisthesis Incidence Anatomy Biomechanics Natural History Clinical Evaluation Diagnostic Imaging  Radiography  Magnetic Resonance Imaging  Bone Scanning  Computed Tomographic Myelography  Discography Nonoperative Treatment  Epidural Steroid Injections Operative Treatment  Decompression Laminectomy  Posterior and Posterolateral Fusion Posterolateral in Situ Fusion Modified Bilateral Posterolateral Fusion  Posterior Lumbar Interbody Fusion  Anterior Fusion Anterior Lumbar Interbody Fusion Spondylolisthesis Reduction Paramedian Retroperitoneal Approach  Direct Lateral or Far Lateral Interbody Fusion Adult Idiopathic and Degenerative Scoliosis Sagittal Balance Incidence Clinical Evaluation Anatomy and Biomechanics Diagnostic Imaging  Radiography  Computed Tomographic Myelography and Magnetic Resonance Imaging  Discography Nonoperative Treatment Operative Treatment  Decompression in Degenerative Scoliosis  Posterior Instrumentation and Fusion Idiopathic Scoliosis Degenerative Scoliosis  Anterior Spinal Instrumentation and Fusion  Postoperative Management  Combined Anterior and Posterior Fusions Combined Anterior and Posterior Fusion  Other Techniques Rheumatoid Arthritis of the Spine Clinical Evaluation Diagnostic Imaging  Radiography  Computed Tomographic Myelography and Magnetic Resonance Imaging  Cervical Instability  Nonoperative Treatment  Operative Treatment Ankylosing Spondylitis Osteotomy of the Lumbar Spine  Smith-Petersen Osteotomy  Pedicle Subtraction Osteotomy  Eggshell Osteotomy Osteotomy of the Cervical Spine Tumors of the Spine Benign Tumors  Stability  Classification  Posterior Element Tumors Osteoid Osteoma Osteoblastoma Osteochondroma Aneurysmal Bone Cyst  Vertebral Body Tumors Hemangioma Eosinophilic Granuloma Giant Cell Tumor Primary Malignant Tumors  Classification  Osteosarcoma  Ewing Sarcoma  Chordoma  Multiple Myeloma Metastatic Tumors  Pathoanatomy  Classification  Irradiation  Operative Treatment Anterior Decompression Costotransversectomy Posterolateral Decompression References Spinal Stenosis Spondylolisthesis Adult Scoliosis Rheumatoid Arthritis Ankylosing Spondylitis Tumors Supplemental References Spinal Stenosis Spondylolisthesis Adult Scoliosis Rheumatoid Arthritis Ankylosing Spondylitis Tumors Rheumatoid Arthritis Ankylosing Spondylitis Tumors COO3 Part XIII – Sports Medicine 45 Knee Injuries Anatomy Osseous Structures Extraarticular Tendinous Structures Extraarticular Ligamentous Structures Intraarticular Structures Mechanics Menisci Function and Anatomy Meniscal Healing and Repair Tears of Menisci  Mechanism of Tear  Classification  Diagnosis  Diagnostic Tests  Imaging Studies Radiography Arthrography Other Diagnostic Studies  Arthroscopy  Nonoperative Management  Operative Management Late Changes after Meniscectomy Surgical Repair of Torn Menisci Open Meniscal Repair Meniscal Autografts and Allografts Other Conditions of Menisci  Cysts of Menisci Arthroscopic Partial Meniscectomy and Decompression of Meniscal Cyst Excision of Meniscal Cyst  Discoid Meniscus Treatment Acute Traumatic Lesions of Ligaments General Considerations Etiology Mechanism Ligament Healing Classification Diagnosis  History and Physical Examination Standard Stress Tests Abduction (Valgus) Stress Test. Adduction (Varus) Stress Test. Anterior Drawer Test. Lachman Test. Posterior Drawer Test. Quadriceps Active Test. Rotary Tests Slocum Anterior Rotary Drawer Test. Jerk Test of Hughston and Losee. Lateral Pivot Shift Test of Macintosh. Flexion-Rotation Drawer Test. External Rotation-Recurvatum Test. Reverse Pivot Shift Sign of Jakob, Hassler, and Stäubli. Tibial External Rotation (Dial) Test. Posterolateral Drawer Test.  Radiographic Examination Classification of Knee Instability  One-Plane Instability  Rotary Instability  Combined Instabilities Treatment Considerations  Nonoperative Treatment  Operative Treatment Medial Compartment (Collateral) Disruptions  Repair Repair of Medial Compartment Disruptions  Reconstruction Reconstruction of Medial Compartment Repair of Posteromedial Corner Reconstruction of Posteromedial Corner  Reconstruction with Allograft Tendons Lateral Compartment (Collateral) Disruptions Repair of Lateral Compartment Disruptions  Reconstruction of Lateral Compartment  Posterolateral Rotary Instability Reconstruction of the Posterolateral Structures for Mild-to-Moderate Posterolateral Instability Reconstruction of the Popliteal Tendon Using the Iliotibial Band for Posterolateral Instability Rerouting of the Biceps Tendon to the Femoral Epicondyle for Posterolateral Instability Anatomical Posterolateral Knee Reconstruction for Grade III Posterolateral Injury  Posterolateral Instability with Varus Knee Valgus Tibial Osteotomy and Posterolateral Reconstruction Allograft Reconstruction of the Lateral Collateral Ligament Reconstruction of Posterolateral Structures with Semitendinosus Tendon  Anterolateral Rotary Instability Anterior Cruciate Ligament Injuries Incidence Anatomy Biomechanics History and Physical Examination Natural History Treatment Repair of Bony Tibial Avulsions of Anterior Cruciate Ligament  Reconstruction for Anterior Cruciate Ligament Insufficiency Extraarticular Procedures (Iliotibial Band Tenodesis) Extraarticular Procedures (Iliotibial Band Tenodesis) Extraarticular Procedures (Iliotibial Band Tenodesis) Intraarticular Reconstruction Graft Selection. Graft Placement. Graft Tension. Graft Fixation. Anterior Cruciate Ligament Reconstruction with Bone–patellar Tendon–bone Graft Reconstruction with Hamstring Tendons Anterior Cruciate Ligament Reconstruction with Hamstrings (with Proximal Release of Hamstrings) Combined Anterior Cruciate Ligament Instabilities Synthetic Materials for Ligament Reconstruction Allograft Ligament Replacement  Rehabilitation after Anterior Cruciate Ligament Reconstruction  Results of Anterior Cruciate Ligament Reconstruction  Complications of Anterior Cruciate Ligament Surgery Revision Anterior Cruciate Ligament Surgery  Graft Selection  Technical Considerations Posterior Cruciate Ligament Anatomy Biomechanics Physical Examination Natural History Treatment  Nonoperative Treatment  Operative Treatment Repair of Bony Avulsion Postoperative Care Reconstruction of Posterior Cruciate Ligament Reconstruction of Posterior Cruciate Ligament with Patellar Tendon Graft Reconstruction of Posterior Cruciate Ligament with Patellar Tendon Graft Reconstruction of Posterior Cruciate Ligament with Bone–patellar Tendon–bone or Achilles Tendon–bone Grafts Reconstruction of Posterior Cruciate Ligament with Bone–patellar Tendon–bone or Achilles Tendon–bone Grafts Reconstruction of Posterior Cruciate Ligament with Bone–patellar Tendon–bone or Achilles Tendon–bone Grafts  Arthroscopically Aided Posterior Cruciate Ligament Reconstruction  Complications of Posterior Cruciate Ligament Reconstruction Traumatic Dislocations Classification Examination and Radiographic Evaluation Vascular and Nerve Injuries  Vascular Injuries  Nerve Damage Other Associated Injuries Treatment  Outcome of Operative Treatment of Knee Dislocations Synovial Plicae Articular Cartilage Injuries Treatment Osteochondritis Dissecans Etiology Clinical and Radiographic Findings Treatment  Excision of Loose Bodies  Outcomes of Treatment of Osteochondritis Dissecans of the Knee Complications Disorders of the Patella Osteochondritis Dissecans of the Patella Dorsal Defect of the Patella Bipartite Patella Subperiosteal Release of the Lateral Quadriceps Mechanism Chondromalacia of the Patella  Classification and Etiology  Clinical Findings  Treatment Advancement of the Tibial Tuberosity Patellectomy Extraarticular Ankylosis of the Knee Extraarticular Ankylosis in Extension THOMPSON Quadricepsplasty Mini-Invasive Quadricepsplasty Extraarticular Ankylosis in Flexion Posterior Capsulotomy Posterior Capsulotomy Open Wounds of the Knee Joint References General Meniscus Knee Ligaments Anterior Cruciate Ligament Posterior Cruciate Ligament Dislocations of the Knee Joint Synovial Plica Articular Cartilage Injuries, Osteochondritis Dissecans Disorders of the Patella Extraarticular Ankylosis of the Knee Open Wounds of the Knee Joint Supplemental References General Meniscus Knee Ligaments Collateral Ligaments Anterior Cruciate Ligament Posterior Cruciate Ligament Dislocations of the Knee Joint Synovial Plica Articular Cartilage Injuries, Osteochondritis Dissecans Disorders of the Patella Extraarticular Ankylosis of the Knee Open Wounds of the Knee Joint 46 Shoulder and Elbow Injuries Shoulder Injuries Anatomy and Biomechanics Clinical Presentation and Physical Examination  Neer Impingement Sign and Impingement Test  Hawkins-Kennedy Test  Jobe Test  Internal Rotation Resistance Stress Test  Gerber Subcoracoid Impingement Test  Jobe Apprehension-Relocation Test  Speed Test  Yergason Sign  Lift-Off Test  Belly Press Test  External Rotation Stress Test  External Rotation Lag Sign  Drop Sign  Internal Rotation Lag Sign Imaging Impingement Syndrome  Subcoracoid Impingement  Internal Impingement Open Anterior Acromioplasty  Complications Rotator Cuff Tear  Partial-Thickness and Full-Thickness Tears Open Repair of Rotator Cuff Tears  Massive and Irreparable Tears Latissimus Dorsi Transfer Decompression and Débridement of Massive Rotator Cuff Tears  Complications Cuff Tear Arthropathy Adhesive Capsulitis  Primary Frozen Shoulder Treatment Closed Manipulation Complications Calcific Tendinitis  Chronological Progression  Surgical Treatment Quadrilateral Space Syndrome Posterior Surgical Approach for quadrilateral space syndrome Suprascapular Nerve Entrapment Posterior Surgical Approach for subscapular nerve entrapment Removal of a Ganglion from the Inferior Branch of the Suprascapular Nerve Elbow Injuries Elbow Tenopathies  Lateral Epicondylitis Treatment CORRECTION OF TENNIS ELBOW  Medial Epicondylitis CORRECTION OF MEDIAL EPICONDYLITIS Elbow Contractures Anterior and Posterior Release of Elbow Contracture Heterotopic Ossification Excision of Heterotopic Ossification References Shoulder Injuries Elbow Injuries Supplemental References Shoulder Injuries Elbow Injuries 47 Recurrent Dislocations Patella Clinical Features Radiographic Features (Table 47-1) Conservative Treatment  Acute Patellar Dislocation or Subluxation  Patellofemoral Malalignment and Recurrent Patellar Subluxation Surgical Treatment  Acute Patellar Dislocation Open Repair of the Medial Patellofemoral Ligament and Vastus Medialis Obliquus Muscle  Patellofemoral Malalignment and Recurrent Patellar Subluxation Lateral Release Open Lateral Release Proximal Soft Tissue Procedures Mini Open Medial Reefing and Arthroscopic Lateral Release Reconstruction of the Medial Patellofemoral Ligament. Medial Patellofemoral Ligament Reconstruction Distal Realignment Elmslie-Trillat Operation. elmslie-trillat operation Oblique Osteotomy of the Tuberosity FULKERSON OSTEOTOMY Derotational High Tibial Osteotomy Iatrogenic Medial Patellar Instability Hip Sternoclavicular Joint Shoulder Normal Functional Anatomy Pathological Anatomy Classification History Physical Examination Radiographic Evaluation Examination Using Anesthetic and Arthroscopy Anterior Instability of the Shoulder  Surgical Treatment Bankart Operation Modified Bankart Repair Anterior Stabilization with Associated Glenoid Deficiency (Laterjet Procedure) Reconstruction of Anterior Glenoid Using Iliac Crest Bone Autograft  Unsuccessful Surgical Repairs for Anterior Instability Multidirectional Instability of the Shoulder Capsular Shift  Capsular Shift with Incision Adjacent to the Glenoid Posterior Instability of the Shoulder  Conservative Treatment  Surgical Treatment Neer Inferior Capsular Shift Procedure Through A Posterior Approach Tibone and Bradley Technique Capsular Shift Reconstruction with Posterior Glenoid Osteotomy Mclaughlin Procedure Surgical Failures Arthroscopic Surgery Elbow Anatomy Pathophysiology Physical Examination Nonoperative Treatment Arthroscopy Surgical Treatment  Ulnar Collateral Ligament Reconstruction Jobe Technique UCL RECONSTRUCTION— Andrews et al. Technique UCL RECONSTRUCTION— Altchek et al. Technique Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability References Patella Hip Sternoclavicular/Acromioclavicular Joint Shoulder Elbow Supplemental References Patella Hip Sternoclavicular/Acromioclavicular Joint Shoulder Elbow 48 Traumatic Disorders Compartment Syndrome Anatomy and Pathophysiology Acute Compartment Syndrome  Clinical Evaluation  Treatment  Acute Compartment Syndrome of Thigh Fasciotomy for Acute Compartment Syndrome of the Thigh  Acute Compartment Syndrome of Lower Leg Single-Incision Fasciotomy Double-Incision Fasciotomy Chronic Exertional Compartment Syndrome  Clinical Evaluation  Treatment Nonoperative Treatment Operative Treatment Double Mini-Incision Fasciotomy for Chronic Anterior Compartment Syndrome Single-Incision Fasciotomy for Chronic Anterior and Lateral Compartment Syndrome Double-Incision Fasciotomy for Chronic Posterior Compartment Syndrome Rupture of Muscles and Tendons Rupture of Achilles Tendon  Anatomy and Pathophysiology  Clinical Evaluation  Treatment  Acute Rupture Open Repair of Achilles Tendon Rupture Open Repair of Achilles Tendon Rupture—Krackow et al. Open Repair of Achilles Tendon Rupture—Lindholm Open Repair of Achilles Tendon Rupture—Lynn Open Repair of Achilles Tendon Rupture—Teuffer Minimally Invasive and Percutaneous Repair of Acute Rupture of the Achilles Tendon  Chronic Rupture Transfer of the Peroneus Brevis Tendon for Neglected Ruptures of the Achilles Tendon Direct Repair of Neglected Ruptures Direct Repair of Neglected Ruptures—white and Kraynick; Teuffer, Modified Direct Repair of Neglected Ruptures—bosworth Direct Repair of Neglected Ruptures—Abraham and Pankovich Direct Repair of Neglected Ruptures—Wapner et al.  Complications Rupture of Gastrocnemius Muscle Tendinosis of Extensor Mechanism of Knee (Jumper’s Knee)  Chronic Patellar Tendinosis Repair of Chronic Patellar Tendinosis  Stress Fracture Through the Patella Rupture of Extensor Mechanism of Knee  Anatomy and Pathophysiology  Clinical Evaluation  Treatment of Acute Rupture of Patellar Tendon Repair with Suture Through Patellar Drill Holes Repair with Suture Anchors  Treatment of Chronic Rupture of Patellar Tendon Achilles Tendon Allograft Hamstring (Semitendinosus and Gracilis) Autograft Augmentation Hamstring Autograft Augmentation—mandelbaum, Bartolozzi, and Carney Rupture of Tendon of Quadriceps Femoris Muscle  Acute Rupture Repair of Acute Rupture of the Tendon of the Quadriceps Femoris Muscle  Chronic Rupture  Complications Rupture of Adductor Longus Muscle Rupture of Gluteus Medius and Minimus Tendons Rupture of Biceps Brachii Tendons  Proximal Biceps Tendon Rupture Repair of Proximal Biceps Tendon Rupture Subpectoral Biceps Tenodesis  Distal Biceps Tendon Rupture Two-Incision Technique for Repair of the Distal Biceps Tendon Single-Incision Technique for Repair of the Distal Biceps Tendon Rupture of Pectoralis Major Muscle Rupture or Avulsion of Triceps Tendon Displacement of Tendons Peroneal Tendons  Classification  Clinical and Radiographic Evaluation  Treatment Repair of the Superior Peroneal Retinaculum Fibular Groove Deepening with Tissue Transfer (Periosteal Flap) Indirect (Impaction) Fibular Groove Deepening Achilles Tendon Augmentation of Superior Peroneal Retinaculum Repair  Complications Biceps Brachii Tendon  Clinical Evaluation  Treatment Treatment of Biceps Brachii Tendon Displacement References Compartment Syndrome Rupture of Muscles and Tendons Rupture of Patellar Tendon Rupture of Tendon of Quadriceps Femoris Muscle/Extensor Mechanism of Knee Rupture of Gluteus Medius/Minimus Tendons Rupture of Biceps Brachii and Triceps Tendons Rupture of Pectoralis Major Muscle Displacement of Tendons Supplemental References Compartment Syndrome Rupture of Muscles and Tendons Rupture of Patellar Tendon Rupture of Tendon of Quadriceps Femoris Muscle/Extensor Mechanism of Knee Rupture of Biceps Brachii and Triceps Tendons Rupture of the Pectoralis Major Muscle Displacement of Tendons Part XIV – Arthroscopy 49 General Principles of Arthroscopy Instruments and Equipment Arthroscope Television Cameras Accessory Instruments  Probe  Scissors  Basket Forceps  Grasping Forceps  Knife Blades  Motorized Shaving Systems  Electrosurgical, Laser, and Radiofrequency Instruments  Implants  Miscellaneous Equipment Care and Sterilization of Instruments Irrigation Systems Tourniquet Leg Holders Anesthesia Documentation Advantages Disadvantages Indications and Contraindications Basic Arthroscopic Techniques Triangulation Technique Complications Damage to Intraarticular Structures Damage to Menisci and Fat Pad Damage to Cruciate Ligaments Damage to Extraarticular Structures  Blood Vessels  Compartment Syndromes  Nerves  Ligaments and Tendons Hemarthrosis Thrombophlebitis Infection Tourniquet Paresis Synovial Herniation and Fistulas Instrument Breakage References Supplemental References 50 Arthroscopy of the Foot and Ankle Ankle Arthroscopy Arthroscopic Examination and Débridement of the Ankle Joint Complications Ankle Impingement Syndromes  Anterior Ankle Impingement  Posterior Ankle Impingement Posterior Débridement for Ankle Impingement  Anterior and Posterior Impingement Osteochondral Lesions of the Talus Ankle Fractures Ankle Arthrodesis Ankle Instability Other Indications  Septic Arthritis  Arthrofibrosis Subtalar Arthroscopy First Metatarsophalangeal Joint Arthroscopy First Metatarsophalangeal Joint Arthroscopy Tendoscopy References Ankle Arthroscopy Subtalar Arthroscopy First Metatarsophalangeal Joint Arthroscopy Endoscopy Supplemental References Ankle Arthroscopy Subtalar Arthroscopy First Metatarsophalangeal Joint Arthroscopy Endoscopy 51 Arthroscopy of the Lower Extremity Knee Basic Diagnostic Techniques  General Principles  Patient Positioning  Portal Placement Standard Portals Anterolateral Portal. Anteromedial Portal. Posteromedial Portal. Superolateral Portal. Optional Portals Posterolateral Portal. Proximal Midpatellar Medial and Lateral Portals. Accessory Far Medial and Lateral Portals. Central Transpatellar Tendon (Gillquist) Portal.  Insertion of Scope Arthroscopic Examination of the Knee Arthroscopic Surgery of the Meniscus  Classification of Meniscal Tears  Types of Meniscal Excisions Partial Meniscectomy Subtotal Meniscectomy Total Meniscectomy  General Principles  Surgery for Specific Meniscal Tears Vertical Longitudinal (Bucket-Handle) Tears Resection of Bucket-Handle Tear Longitudinal Incomplete Intrameniscal Tears Removal of Posterior Horn Tear Horizontal, Oblique, Radial, and Complex Tears Treatment of Partial Depth Meniscal Tears  Discoid Lateral Meniscus Partial Excision of the Discoid Meniscus  Meniscal Cyst  Arthroscopic Repair of Torn Menisci Inside-to-Outside Technique Outside-to-Inside Technique Lateral Meniscal Suturing  Radial Tears and Meniscal Root Tears Repair of Radial or Meniscal Root Tear All-Inside Technique Preparation of Fibrin Clot  Meniscal Replacement Meniscal Replacement Arthroscopic Surgery for Other Disorders  Loose Bodies in the Knee Joint Removal of Loose Bodies  Synovial Plicae of the Knee Resection of Plica  Osteochondritis Dissecans of the Femoral Condyles and Patella Arthroscopic Drilling of an Intact Lesion of the Femoral Condyle Arthroscopic Screw Fixation for Osteochondritis Dissecans Lesions in the Medial Femoral Condyle Osteochondritic Loose Bodies Osteochondral Autografts Osteochondral Autograft Transfer Bone Grafting  Cruciate Ligament Reconstruction Anterior Cruciate Ligament Reconstruction Anatomical Single-Bundle Endoscopic Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft Two-Incision Technique for Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft Endoscopic Quadruple Hamstring Graft Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction Quadriceps Tendon Graft. Anterior Cruciate Ligament Injuries in Skeletally Immature Individuals. Transepiphyseal Replacement of Anterior Cruciate Ligament Using Quadruple Hamstring Grafts Physeal-Sparing Reconstruction of the Anterior Cruciate Ligament Complications of Anterior Cruciate Ligament Reconstruction. Posterior Cruciate Ligament Reconstruction Single-Tunnel Posterior Cruciate Ligament Reconstruction Double-Tunnel Posterior Cruciate Ligament Reconstruction Inlay Technique.  Chondromalacia of the Patella Syndrome Lateral Retinacular Release Arthroscopic Medial Parapatellar Plication. Synovectomy Drainage and Débridement in Pyarthrosis Other Applications of Arthroscopy of the Knee  Arthroscopy in Fractures Around the Knee Arthroscopically Assisted Fracture Reduction and Percutaneous Fixation  Arthrofibrosis Arthroscopic Lysis and Excision of Adhesions  Débridement of Osteoarthrosis and Abrasion Arthroplasty Complications Associated with Knee Arthroscopy Hip Indications General Setup Portals Supine Position Arthroscopy Lateral Position Arthroscopy Arthroscopic Management of Labral Tears  Classification of Labral Tears Arthroscopic Repair of Labral Tears Femoroacetabular Impingement Arthroscopic Treatment of Pincer Impingement Arthroscopic Treatment of Cam Impingement Complications of Hip Arthroscopy References Knee Hip Supplemental References Knee 52 Arthroscopy of the Upper Extremity Shoulder Indications Patient Positioning and Anesthesia  Lateral Decubitus Position  “Beach Chair” Position Control of Bleeding during Arthroscopy Fluid Extravasation Portal Placement  Posterior Portal Establishing a Posterior Portal  Posteroinferior 7-O’clock Portal  Anterior Portal Antegrade Method Retrograde Method  Anteroinferior 5-O’clock Portal  Superior Portal Establishing the Superior Portal  Suprascapular Nerve Portal as Described by LAFOSSE  Lateral, Posterolateral, and Anterolateral Portals  Portal of Wilmington Diagnostic Arthroscopy and Arthroscopic Anatomy Loose Bodies Arthroscopic Removal of Loose Body Synovectomy Drainage and Débridement Labral Tears Arthroscopic Fixation of Type II SLAP Lesions Biceps Tendon Lesions Biceps Tendon Release Arthroscopic Biceps Tenodesis with A Percutaneous Intraarticular Tendon Biceps Tenodesis: Arthroscopic or Mini-Open Technique Subpectoral Biceps Tenodesis with an Interference Screw Anterior Instability Arthroscopic Bankart Repair Technique Posterior Instability Posterior Shoulder Stabilization Multidirectional Instability Capsular Shift Humeral And/or Glenoid Avulsion of the Inferior Glenohumeral Ligament (See Fig. 52-19) Arthroscopic Repair of Posterior Humeral Avulsion of the Glenohumeral Ligament Hill-Sachs Lesion Remplissage  Latarjet Technique Impingement Syndrome Impingement and Os Acromiale Arthroscopic Acromioplasty Chockblock Method for Acromioplasty Partial-Thickness Rotator Cuff Tears Débridement of Partial-Thickness Rotator Cuff Tears Repair of Delamination and Localized, Articular-Side Partial-Thickness Cuff Tears Transtendinous Repair of A Partial Articular-Side Supraspinatus Tendon Avulsion Lesion Full-Thickness Rotator Cuff Tears Rotator Cuff Repair Massive Contracted Rotator Cuff Tears Repair of Large or Massive Contracted Tears Using the Interval Slide Technique Subscapularis Tendon Tears Subscapularis Tendon Repair Acromioclavicular Joint Arthroscopic Resection of the Distal End of the Clavicle (Mumford Procedure) Superior Approach Calcific Tendinitis of the Rotator Cuff Release of Calcific Tendinitis Osteoarthritis Posterior Ossification of the Shoulder (Bennett Lesion) Spinoglenoid Cyst Shoulder Contractures Capsular Release Suprascapular Nerve Entrapment Suprascapular Nerve Release Complications Elbow Indications Patient Positioning and Anesthesia  Supine Position  Prone Position  Lateral Decubitus Position Portal Placement Evaluation of the Elbow Arthroscopic Elbow Examination Loose Bodies Panner Disease and Osteochondritis Dissecans Arthroscopic Treatment of Osteochondritis Dissecans Osteochondral Autograft Transfer Throwing Injuries Evaluation of Ulnar Collateral Ligament Function Posterior Elbow Impingement Removal of Olecranon Tip and Osteophytes Posterolateral Synovial Plica Syndrome Resection of Thickened Pathological Synovial Plica Radial Head Resection Arthrofibrosis Arthroscopy for Arthrofibrosis Osteoarthritis Synovectomy Tennis Elbow Arthroscopic Tennis Elbow Release Olecranon Bursitis Arthroscopic Bursectomy Arthroscopic-Assisted Intraarticular Fracture Care Pyarthrosis Complications Wrist References Shoulder Elbow Supplemental References Shoulder Elbow Part XV – Fractures and Dislocations in Adults 53 General Principles of Fracture Treatment Classification of Fractures Classification of Soft Tissue Injuries Trauma Principles Open Fractures  Open Fractures Caused by Firearms  Amputation Versus Limb Salvage  Antibiotic Treatment Treatment of Soft Tissue Injuries Percutaneous Drainage of A Morel-Lavallée Lesion Débridement Irrigation and Débridement of Open Wounds Treatment of Bone Injuries  Fracture Stabilization Fracture Healing (Bone Regeneration) Stimulation of Fracture Healing  Bone Grafting Autologous Bone Grafts Harvest of Femoral or Tibial Bone Graft with the RIA Instrumentation  Bone Graft Substitutes Allograft-Based Bone Graft Substitutes Growth Factor–based Bone Graft Substitutes Cell-Based Bone Graft Substitutes Ceramic-Based Bone Graft Substitutes Polymer-Based Bone Graft Substitutes Miscellaneous Bone Graft Substitutes  Electrical and Ultrasound Stimulation  Factors That Negatively Affect Bone Healing Principles of Surgical Treatment General Indications for Surgical Reduction and Stabilization Contraindications to Surgical Reduction and Stabilization Disadvantages of Surgical Reduction and Stabilization Timing of surgical Treatment Lambotte’s Principles of Surgical Treatment of Fractures Biomaterials of Fracture Fixation Metals Bioabsorbable Materials  Complications Biomechanics of Implant Design and Fracture Fixation Pin and Wire Fixation Screw Fixation  Machine Screws  ASIF Screws Cortical Screws Cancellous Screws Self-Tapping, Self-Drilling Screws Locking Screws  Screw Fixation Techniques Screw Fixation ASIF Cancellous Screw Technique Plate and Screw Fixation  Locking Plates Intramedullary Nail Fixation  Types of Intramedullary Nails  Reamed Versus Unreamed Intramedullary Nailing External Fixation  Advantages  Disadvantages  Complications Pin Track Infection Neurovascular Impalement Muscle or Tendon Impalement Delayed Union Compartment Syndrome Refracture Limitation of Future Alternatives  Indications Accepted Indications Possible Indications Fixation of Multiple Closed Fractures Severely Comminuted Fractures Ligamentotaxis Fixation of Fractures in Patients with Head Injuries Fixation of Fractures in Patients Who Require Frequent Transportation for Diagnostic Testing, Therapy, or Other Surgical Procedures Fixation of Floating Knee Fractures Assessment of Knee Ligament Stability with Fractures of the Upper Tibia or Lower Femur in Patients in Whom Integrity of Knee Ligaments Is Difficult to Assess Occasional Indications  Design and Application of External Fixators General Method for Half-Pin Fixators General Method for Circular Wire Fixators Pin Insertion Ilizarov External Fixator Rehabilitation Treatment of Complications From Surgical Treatment of Fractures Infection Gas Gangrene Tetanus Soft Tissue Complications Thromboembolic Complications Biomechanical Construct Complications References General Polytrauma Soft Tissue Injury Open Fractures Stimulation of Fracture Healing Internal Fixation External Fixation Supplemental References General Polytrauma Soft Tissue Injury Open Fractures Stimulation of Fracture Healing Internal Fixation External Fixation 54 Fractures of the Lower Extremity Ankle Classification Isolated Fractures of the Medial and Lateral Malleoli  Medial Malleolus Stress Fracture of the Medial Malleolus  Lateral Malleolus Bimalleolar Fracture Syndesmotic Injury Fixation of the Lateral Malleolus Fixation of the Medial Malleolus Deltoid Ligament Tear and Lateral Malleolar Fracture Repair of the Deltoid Ligament and Internal Fixation of the Lateral Malleolus Irreducible Fracture or Fracture-Dislocation Trimalleolar Fracture Posterior Tibial Lip Fracture Reduction and Fixation of Posterior Lip Fracture Fracture of the Anterior Tibial Margin at the Ankle Joint Reduction and Fixation of Anterior Tibial Margin Fractures Ankle Fractures in Patients with Diabetes Open Ankle Fractures Unstable Ankle Fracture-Dislocation Stabilization of Unstable Ankle Fracture-Dislocation Tibial Pilon Fracture  Open Reduction and Plate Fixation  Two-Stage Delayed Open Reduction and Internal Fixation AO Plating Technique Minimally Invasive Plating Technique Minimally Invasive Plating of Tibial Pilon Fracture  Posterolateral Approach to Pilon Fractures Posterolateral Approach to Pilon Fractures  Combined External and Limited Internal Fixation  External Fixation and Fibular Plating Spanning External Fixation Spanning External Fixation of Tibial Pilon Fracture Hybrid External Fixation Hybrid External Fixation of Tibial Pilon Fractures  Primary Arthrodesis Tibial Shaft Treatment  Cast Bracing  Plate and Screw Fixation Locking Compression Plate with Bicortical Screw Fixation  Transfixation by Screws (ASIF)  Intramedullary Fixation Reamed Versus Unreamed Nailing Intramedullary Nailing of Fractures of the Proximal Third of the Tibial Shaft Intramedullary Nailing of Fractures of the Distal Tibial Shaft Anterior Knee Pain after Intramedullary Nailing Intramedullary Interlocking Nails Preoperative Planning. Intramedullary Nailing of Tibial Shaft Fractures  External Fixation Pin Fixators Preoperative Planning. External Fixation for Tibial Shaft Fractures Complications. Ilizarov External Fixation Device Ilizarov Method in Open Fractures. Reconstructive Procedures. Preoperative Planning. Ilizarov External Fixation for Tibial Shaft Fractures Complications.  Treatment of Delayed Union  Fixation of the Fibula for Tibial Fracture Deformities of the Foot and Toes after Tibial Fracture Tibial Plateau Fracture Fracture Classification (Schatzker) Fracture-Dislocation Classification (Hohl and Moore) Evaluation Treatment  Fracture of the Lateral Condyle Open Reduction and Fixation of a Tibial Plateau Fracture  Ligament Injury with Condylar Fracture  Arthroscopically Assisted Reduction and Fixation of Tibial Plateau Fractures  Fracture of the Medial Condyle Medial Exposure  Comminuted Proximal Fractures Open Reduction and Internal Fixation of Bicondylar Injuries Circular External Fixation  Osteochondral Autografts for Comminuted Lateral Tibial Condylar Fractures Patella Treatment Common Approach and Technique for Patellar Fractures Circumferential Wire Loop Fixation Tension Band Wiring Fixation Comminuted Patellar Fractures Partial Patellectomy Partial Patellectomy Using Figure-of-Eight Load-Sharing Wire or Cable Total Patellectomy Osteochondral Knee Fracture Distal Femur Plate and Screw Fixation Dynamic Condylar Screw Fixation Intramedullary Nailing External Fixation Condylar Fractures of the Femur  Unicondylar Fractures of the Femur Fracture Fixation of the Medial Condyle Fracture Fixation of the Posterior Part of the Medial Condyle Fracture of the Lateral Condyle  Intercondylar Fractures of the Femur Swashbuckler Approach to the Distal Femur Locking Condylar Plate Fixation Submuscular Minimally Invasive Locking Condylar Plate Application Less Invasive Stabilization System (LISS) Double Plate Fixation  Supracondylar Fractures of the Femur Shaft of the Femur Traction and Cast Immobilization External Fixation Fixation with Plates and Screws Plate and Screw Fixation of Femoral Shaft Fractures Intramedullary Fixation  Open Intramedullary Nailing Preoperative Planning  Closed Intramedullary Nailing  Antegrade Femoral Nailing (TRIGEN) Antegrade Femoral Nailing  Retrograde Nailing of the Femur Retrograde Femoral Nailing  Errors and Complications of Intramedullary Fixation Patient Positioning and Traction Errors in Nail Insertion Bent or Broken Nails Extraction of an Unbroken Antegrade Femoral Nail Extraction of a Broken Femoral Antegrade Nail Infections Intramedullary Fixation in Pathological Fractures Subtrochanteric Fracture of the Femoral Shaft Fracture of the Femoral Shaft with Dislocation of the Hip Fracture of the Femoral Shaft with a Femoral Head Prosthesis References General Ankle (Pilon Fractures) Tibial Shaft Tibial Condyle and Tibial Plateau Patella Femur Supplemental References General Ankle (Pilon Fractures) Tibial Shaft Tibial Condyle and Tibial Plateau Patella Femur 55 Fractures and Dislocations of the Hip Femoral Neck Fractures Classification Diagnosis Treatment  Operative Treatment Implant Choice Fixation of Femoral Neck Fracture with Cannulated Screws Open Reduction and Internal Fixation Outcomes and Complications  Failure of Fixation  Osteonecrosis and Nonunion Fluoroscopically Guided Capsulotomy of the Hip Arthroplasty Intertrochanteric Femoral Fractures Classification Treatment  Treatment with Screw-Side Plate Devices Compression Hip Screw Fixation of Intertrochanteric Femoral Fractures  Treatment with Intramedullary Nails Intramedullary Nailing of Intertrochanteric Femoral Fractures  Plate Fixation Compared with Intramedullary Nail Fixation Intramedullary Nailing of Intertrochanteric Femoral Fractures with Integrated Proximal Interlocking Screws (Intertan) Subtrochanteric Femoral Fractures Classification Treatment  Intramedullary Nailing Intramedullary Nailing in Reconstruction Mode  Plate Fixation Fixation of Subtrochanteric Femoral Fracture with a Proximal Femoral Locking Plate Fixation of Subtrochanteric Femoral Fracture with a Blade Plate Hip Dislocations and Femoral Head Fractures Reduction Maneuvers for Posterior Hip Dislocation Reduction Maneuver for Anterior Hip Dislocation Open Reduction of Posterior Hip Dislocation Through a Posterior Approach Fractures of the Ipsilateral Femoral Neck and Shaft References General Fractures of the Femoral Neck Intertrochanteric Fractures Subtrochanteric Fractures Fracture, Dislocation, and Fracture-Dislocation of the Hip Supplemental References General Fractures of the Femoral Neck Intertrochanteric Fractures Subtrochanteric Fractures Fracture, Dislocation, and Fracture-Dislocation of the Hip 56 Fractures of Acetabulum and Pelvis Acetabular Fractures Initial Treatment Anatomy Radiographic Evaluation Classification Treatment  Indications for Nonoperative Treatment Nondisplaced and Minimally Displaced Fractures Fractures with Significant Displacement But in Which the Region of the Joint Involved Is Judged to be Unimportant Prognostically Secondary Congruence in Displaced Both-Column Fractures Medical Contraindications to Surgery Local Soft Tissue Problems, Such as Infection, Wounds, and Soft Tissue Lesions From Blunt Trauma Elderly Patients with Osteoporotic Bone in Whom Open Reduction May Not be Feasible  Indications for Operative Treatment Fracture Characteristics Incarcerated Fragments in the Acetabulum After Closed Reduction of a Hip Dislocation Prevention of Nonunion and Retention of Sufficient Bone Stock for Later Reconstructive Surgery  Timing of Surgery  Choice of Surgical Approach  Specific Fracture Patterns Posterior Wall Fractures Posterior Column Fractures Anterior Wall and Anterior Column Fractures Transverse Fractures Posterior Column Fracture With Associated Posterior Wall Fracture Transverse Fracture with Associated Posterior Wall Fracture T-Type Fractures Anterior Column–Posterior Hemitransverse Fractures Both-Column Fractures Postoperative Care Outcome and Complications Total Hip Arthroplasty as Treatment of Acetabular Fracture Pelvic Fractures Initial Management Anatomy Classification Radiographic Evaluation Treatment  Initial Treatment (Box 56-2) External Fixation External Fixation Supraacetabular External Fixation Pelvic Clamps Pelvic Clamps  Reconstructive Phase Open Reduction and Internal Fixation of the Pubic Symphysis Internal Fixation: Posterior Screw Fixation of Sacral Fractures and Sacroiliac Dislocations (Prone) Percutaneous Iliosacral Screw Fixation Of Sacroiliac Disruptions And Sacral Fractures (Supine) Percutaneous Iliosacral Screw Fixation of Sacroiliac Disruptions and Sacral Fractures (Supine) Anterior Approach and Stabilization of the Sacroiliac Joint References Acetabular Fractures Pelvic Fractures Supplemental References Acetabular Fractures Pelvic Fractures 57 Fractures of the Shoulder, Arm, and Forearm Clavicle Treatment Options  Plate and Screw Fixation Open Reduction and Internal Fixation of Clavicular Fractures  Intramedullary Fixation Intramedullary Fixation with a Headed, Distally Threaded Pin (Rockwood Clavicle Pin) Lateral Clavicular Fractures Fractures Around the Shoulder Fractures of the Scapula  Treatment Options Glenoid Fractures Scapular Body or Neck Fractures Proximal Humeral Fractures  Classification  Radiographic Evaluation  Nonoperative Treatment  Operative Treatment Fixation of Specific Fracture Types Intramedullary Nailing of a Proximal Humeral Fracture Open Reduction and Internal Fixation of Proximal Humeral Fractures Anterolateral Acromial Approach for Internal Fixation of Proximal Humeral Fracture  Complications Fractures of the Humeral Shaft Operative Treatment Plate Osteosynthesis  Implant Choice  Approach  Postoperative Care  Complications Open Reduction and Internal Fixation of the Humeral Shaft Through a Modified Posterior Approach (Triceps-Reflecting) Intramedullary Fixation Antegrade Intramedullary Nailing of Humeral Shaft Fractures Fractures of the Humeral Shaft with Radial Nerve Palsy Periprosthetic Humeral Shaft Fractures Distal Humeral Fractures Open Reduction and Internal Fixation of the Distal Humerus with Olecranon Osteotomy Fractures, Dislocations, and Fracture-Dislocations of the Elbow Fractures of the Radial Head  Operative Treatment Treatment of Mason Type II Fractures Treatment of Mason Type III Fractures Open Reduction and Internal Fixation of Radial Head Fracture Fractures of the Coronoid Simple Elbow Dislocations Fracture-Dislocations of the Elbow  Treatment “Terrible Triad” Injuries of the Elbow  Treatment Stabilization of “Terrible Triad” Elbow Fracture-Dislocation  Complications Radial Head and Neck Fractures Associated with Elbow Dislocation Fractures and Fracture-Dislocations of the Olecranon  Fractures Treatment Excision. Tension Band Wiring. Plate-and-Screw Fixation.  Fracture-Dislocations Intramedullary Nailing Open Reduction and Internal Fixation of Olecranon Fracture Fractures of the Radial Head or Neck with Dislocation of the Distal Radioulnar Joint (Essex-Lopresti Fracture-Dislocation) Fractures of the Proximal Third of the Ulna with Dislocation of the Radial Head (Monteggia Fracture-Dislocation) Fractures of the Shafts of the Radius and Ulna Intramedullary Nailing of Forearm Fractures Open Reduction and Internal Fixation of Both-Bone Forearm Fractures Fractures of the Distal Third of the Radius with Dislocation of the Distal Radioulnar Joint (Galeazzi Fracture-Dislocation) Fractures of the Distal Radius Classification Assessment of Stability Treatment Options  Closed Treatment Percutaneous Pinning Closed Reduction and Percutaneous Pinning of Distal Radial Fracture External Fixation External Fixation of Fracture of the Distal Radius  Open Reduction and Plate Fixation Dorsal Plating Volar Plating Volar Plate Fixation of Fracture of the Distal Radius Distraction Plate Fixation Fragment-Specific Open Reduction and Internal Fixation of Comminuted Distal Radial Fractures Complications References Clavicle and Scapula Proximal Humerus Humeral Shaft Distal Humerus Elbow Dislocation; Forearm Fracture; Coronoid, Olecranon Fracture Distal Radial Fracture Supplemental References Clavicle and Scapula Proximal Humerus Humeral Shaft Distal Humerus Elbow Dislocation; Forearm Fracture; Coronoid, Olecranon Fracture Distal Radial Fracture 58 Malunited Fractures Foot Phalanges of the Toes Metatarsals Correction of Metatarsal Angulation Tarsals Correction of Tarsal Malunion Talus  Malunion of the Talar Neck  Malunion of the Talar Body Calcaneus Posterior Subtalar Arthrodesis Distraction Arthrodesis Resection of Lateral Prominence of Calcaneus Correction of Calcaneal Malunion Through Extensile Lateral Approach Correction of Valgus Malunion of Extraarticular Calcaneal Fracture Ankle Osteotomy for Bimalleolar Fracture Correction of Diastasis of the Tibia and Fibula Supramalleolar Osteotomy Arthrodesis for Malunited Fractures of the Ankle Leg Shafts of the Tibia and Fibula Oblique Tibial Osteotomy Clamshell Osteotomy Condyles of the Tibia Subcondylar Osteotomy and Wedge Graft for Malunion of Lateral Condyle Osteotomy and Internal Fixation of the Lateral Condyle  Inverted-Y Fractures of the Tibial Condyles  Fracture of the Intercondylar Eminence of the Tibia Patella Femur and Hip Condyles of the Femur  Lateral Femoral Condyle Open Reduction and Internal Fixation  Medial Femoral Condyle  Both Femoral Condyles Supracondylar Femur Femoral Shaft Osteotomy for Femoral Malunion  Femoral Malunion in Children Osteotomy for Femoral Malunion in Children Trochanteric Region of the Femur  Subtrochanteric Osteotomy for Coxa Vara and Rotational Deformities Cervicotrochanteric Region of the Femur Correction of Cervicotrochanteric Malunion Pelvis Three-Stage Reconstruction for Pelvic Malunions Clavicle Midshaft Malunions of the Clavicle Osteotomy and Plate Fixation Osteotomy and Elastic Intramedullary Nailing of Midshaft Clavicular Fracture Humerus Evaluation Treatment Closing Wedge Valgus Osteotomy for Varus Malunion of Proximal Humerus Anatomical Neck Surgical Neck Proximal Third Correction of Proximal Third Humeral Malunion Middle Third Distal Humerus Forearm Proximal Third of the Radius and Ulna  Radial Head  Radial Neck Correction of Radial Neck Malunion  Olecranon  Proximal Third of the Ulna with Anterior Dislocation of the Radial Head (Monteggia Fracture) Monteggia Fracture  Synostosis Between the Radius and the Ulna Resection of Proximal Part of Radial Shaft Shafts of the Radius and Ulna in Adults Osteotomy and Plating for Forearm Malunion  Forearm Malunions with Distal Radioulnar Joint Instability Correction of Forearm Malunion with Distal Radioulnar Joint Instability Drill Osteoclasis  Shaft of the Ulna Distal Radius Clinical Evaluation Radiographic Evaluation Operative Treatment Extraarticular Malunion with Dorsal Angulation  Osteotomy and Grafting of the Radius Opening Wedge Metaphyseal Osteotomy with Bone Grafting and Internal Fixation with Plate and Screws Extraarticular Malunion with Volar Angulation Volar Osteotomy Intramedullary Fixation External Fixation Intraarticular Malunions Osteotomy for Intraarticular Malunion  Salvage Procedures Radiolunate Arthrodesis Distal Radioulnar Joint Incongruity and Arthrosis Ulnar Shortening Osteotomy Resection of the Distal Ulna Carpus Hand References Foot Ankle Tibia Femur, Hip, and Pelvis Clavicle Humerus Forearm, Elbow, and Wrist Supplemental References Foot Ankle Tibia Femur, Hip, and Pelvis Clavicle Humerus Forearm, Elbow, and Wrist 59 Delayed Union and Nonunion of Fractures Delayed Union Nonunion Considerations before Surgery  Status of Soft Tissues and Neurovascular Structures  Status of Bones General Treatment of Nonunions  Reduction of Fragments  Bone Grafting Onlay Bone Graft Dual Onlay Graft Cancellous Insert Grafts Massive Sliding Graft Whole Fibular Transplants Free Vascularized Fibular Graft Intramedullary Fibular Allografts  Stabilization of Fragments Internal Fixation External Fixation  Low-Intensity Ultrasound  Electrical and Electromagnetic Stimulation Factors Complicating Nonunion  Infection Conventional Treatment Active Treatment Polymethyl Methacrylate Antibiotic Beads  Deformity, Shortening, and Segmental Bone Loss Ilizarov Method Spatial Frame Method Corticotomy Nonunion of Specific Bones Metatarsals Tibia  Medial Malleolus Resection of the Distal Fragment of the Medial Malleolus Sliding Graft Bone Graft of medial malleolar Nonunion  Tibial Shaft Partial Fibulectomy and Weight Bearing Posterolateral Bone Grafting Anterior Central Bone Grafting Percutaneous Bone Marrow Injection Internal Fixation Internal Fixation Using Russell-Taylor Interlocking Nail Open Tibial Nailing External Fixation Fibula  Lateral Malleolus  Fibular Shaft Patella Femur  Supracondylar Area  Femoral Shaft  Trochanteric and Subtrochanteric Region  Femoral Neck Osteosynthesis Osteotomy Prosthetic Replacement Arthrodesis Pelvis and Acetabulum Clavicle Plate Fixation and Bone Grafting of the Clavicle Humerus  Proximal Third Open Reduction and Insertion of A Prosthesis  Humeral Shaft  Condyles Open Reduction Internal Fixation with Bone Grafting of the Humeral Condyle  Distal Humerus Nonunion of the Proximal Third of the Ulna with Dislocation of the Radial Head (Monteggia Fracture) Forearm Bones  Both Radius and Ulna  Radius or Ulna Alone Defect in One Bone without Deformity of the Other Defect in One Bone with Overriding Fragments in the Other Defect in One Bone with Malunion of the Other Nonunited Colles Fracture  Proximal End of Ulna  Distal End of Ulna Amputations References Nonunion Bone Grafting Electrical Stimulation Ultrasound Factors Complicating Nonunion (Infection) Factors Complicating Nonunion (Deformity, Shortening, and Bone Loss) Nonunion of Specific Bones Lateral Malleolus Supracondylar Area of Femur Femoral Shaft Patella Trochanteric and Subtrochanteric Region Femoral Neck Pelvis and Acetabulum Clavicle Humerus and Forearm Bones Supplemental References Nonunion Bone Grafting Electrical Stimulation Ultrasound Factors Complicating Nonunion (Infection) Factors Complicating Nonunion (Deformity, Shortening, and Bone Loss) Nonunion of Specific Bones Tibial Shaft Lateral Malleolus Fibular Shaft Supracondylar Area of Femur Femoral Shaft Trochanteric and Subtrochanteric Region Femoral Neck Pelvis and Acetabulum Clavicle Humerus and Forearm Bones Amputation Supplemental References 60 Acute Dislocations Indications for Open Reduction Ankle Patella Acute Dislocations of the Patella Open Reduction and Repair of Patellar Dislocation Grafting of the Medial Patellar Retinaculum Intraarticular Dislocations of the Patella Open Reduction and Repair of the Extensor Mechanism Knee Proximal Tibiofibular Joint Hip Open Reduction of Hip Dislocation  Complications Pubic Symphysis and Sacroiliac Joints Sternoclavicular Joint Acromioclavicular Joint Etiology and Classification Clinical Findings Treatment Anatomic Reconstruction of the Conoid and Trapezoid Ligaments Coracoclavicular Suture Fixation Distal Clavicular Excision Shoulder Elbow Dislocation of the Radial Head Open Reduction of Radial Head Dislocation  Dislocation of Radial Head and Fracture of Proximal Third of Ulna (monteggia Fracture)  Fracture-Dislocation of Elbow with Severe Damage of Soft Structures Distal Radioulnar Joint References General Ankle Patella Knee and Proximal Tibiofibular Joint Hip and Pelvis Clavicular Joints Shoulder Elbow Distal Radioulnar Joint Supplemental References General Ankle Patella Knee and Proximal Tibiofibular Joint Hip and Pelvis Clavicular Joints Shoulder Elbow Distal Radioulnar Joint 61 Old Unreduced Dislocations Foot Ankle Proximal Tibiofibular Joint Ligamentous Reconstruction for Old Unreduced Dislocation of the Proximal Tibiofibular Joint Knee Open Reduction for Old Unreduced Dislocation of the Knee Patella Open Reduction for Old Unreduced Dislocation of the Patella Hip Chronic Unreduced (Old) Anterior Dislocations Intertrochanteric Osteotomy for Chronic Anterior Dislocation of the Hip Chronic Unreduced (Old) Posterior Dislocations Traction and Abduction for Chronic Posterior Hip Dislocation Sternoclavicular Joint Resection of the Medial End of the Clavicle for Old Sternoclavicular Joint Dislocation Posterior Dislocations Acromioclavicular Joint Resection of the Lateral End of the Clavicle for Old Unreduced Acromioclavicular Joint Dislocations Reconstruction of the Superior Acromioclavicular Ligament for Old Unreduced Acromioclavicular Joint Dislocation Transfer of the Coracoacromial Ligament for Old Unreduced Acromioclavicular Joint Dislocation Arthroscopic Transfer of the Coracoacromial Ligament for Old Unreduced Acromioclavicular Joint Dislocation Shoulder Treatment  Closed Reduction  Open Reduction Anterior Dislocations Open Reduction of Anterior Shoulder Dislocations Posterior Dislocations Open Reduction of Posterior Shoulder Dislocation from a Superior Approach Open Reduction of Posterior Shoulder Dislocation through an Anteromedial Approach Deltopectoral Approach for Posterior Shoulder Dislocation Hemiarthroplasty Total Shoulder Arthroplasty Elbow Closed Reduction Open Reduction Open Reduction and V-Y Lengthening of Triceps Muscles for Old Unreduced Elbow Dislocation Elbow Arthroplasty Anterior Dislocation of the Radial Head References Ankle Proximal Tibiofibular Joint and Knee Patella Clavicular Joints Shoulder Elbow Supplemental References Ankle Patella Hip Clavicular Joints Shoulder Elbow COO4 Part XVI – Peripheral Nerve Injuries 62 Peripheral Nerve Injuries Anatomy of the Spinal Nerves Components of Mixed Spinal Nerves  Motor  Sensory  Sympathetic Gross Anatomy Microscopic Anatomy Internal Topography of Peripheral Nerves Neuronal Degeneration and Regeneration Classification of Nerve Injuries Effects of Peripheral Nerve Injuries Motor Sensory Reflex  Autonomic Reflex Sympathetic Dystrophy  Clinical Presentation  Treatment Etiology of Peripheral Nerve Injuries Clinical Diagnosis of Nerve Injuries Diagnostic Tests  Electrodiagnostic Studies Nerve Conduction Velocity Electromyography  Tinel Sign  Sweat Test  Skin Resistance Test  Electrical Stimulation General Considerations of Treatment of Nerve Injuries Factors That Influence Regeneration after Neurorrhaphy Age Gap Between Nerve Ends Delay Between Time of Injury and Repair Level of Injury Condition of Nerve Ends General Considerations for Surgery Indications Time of Surgery Instruments and Equipment Anesthesia Preparation and Draping Technique of Nerve Repair Endoneurolysis (Internal Neurolysis) Partial Neurorrhaphy Neurorrhaphy and Nerve Grafting  Methods of Closing Gaps Between Nerve Ends Mobilization Positioning of Extremity Transposition Bone Resection Nerve Stretching and Bulb Suture Nerve Grafting Nerve Crossing (Pedicle Grafting) Source of Nerve for Interfascicular Nerve Grafting Nerve Allografts Synthetic Nerve Conduits Techniques of Neurorrhaphy Epineurial Neurorrhaphy Perineurial (Fascicular) Neurorrhaphy Interfascicular Nerve Grafting Results of Operation Cervical Plexus Spinal Accessory Nerve  Treatment  Results of Suture of the Spinal Accessory Nerve Brachial Plexus Etiology and Classification of Brachial Plexus Injuries Diagnosis of Brachial Plexus Injuries Treatment of Brachial Plexus Injuries  Indications for Surgery  Surgical Goals  Comprehensive Approach to the Brachial Plexus Approach to the Brachial Plexus  Methods of Closing Gaps  Results of Treatment Transfer of the Ulnar Nerve Fascicles to Nerve of the Biceps Muscle Double Fascicular Transfer From Ulnar and Median Nerves to Nerve of the Brachialis Branches Neurotization of the Suprascapular Nerve with the Spinal Accessory Nerve Neurotization of the Axillary Nerve with Radial Nerve Brachial Plexus Compression Syndrome Suprascapular Nerve  Examination  Treatment Posterior Approach for Division of the Transverse Scapular Ligament Long Thoracic Nerve Axillary Nerve  Examination  Treatment Approach to the Axillary Nerve  Methods of Closing Gaps  Results after Axillary Nerve Injury  Tendon and Muscle Transfers for Paralysis of the Deltoid Musculocutaneous Nerve  Examination  Treatment Approach to the Musculocutaneous Nerve  Methods of Closing Gaps  Results after Injury to the Musculocutaneous Nerve Radial Nerve  Examination  Treatment Approach to the Radial Nerve  Methods of Closing Gaps  Results of Suture of the Radial Nerve  Critical Limit of Delay of Suture Ulnar Nerve  Examination  Treatment Approach to the Ulnar Nerve  Methods of Closing Gaps  Results of Suture of the Ulnar Nerve  Critical Limit of Delay of Suture  Nerve Reconstruction Nerve Transfer for Ulnar Nerve Reconstruction  Tardy Ulnar Nerve Palsy and Cubital Tunnel Syndrome In Situ Decompression of the Ulnar Nerve Endoscopic Decompression of the Ulnar Nerve Endoscopic Cubital Tunnel Release Medial Epicondylectomy Transposition of the Ulnar Nerve Median Nerve  Examination  Treatment Approach to the Median Nerve  Methods of Closing Gaps  Results of Suture of the Median Nerve  Critical Limit of Delay of Suture Lumbar Plexus Femoral Nerve  Examination  Treatment Approach to the Femoral Nerve  Methods of Closing Gaps  Results of Suture of the Femoral Nerve Sacral Plexus Sciatic Nerve  Examination  Treatment Approach to the Sciatic Nerve  Methods of Closing Gaps  Results of Suture of the Sciatic Nerve  Critical Limit of Delay of Suture Common, Superficial, and Deep Peroneal Nerves  Examination  Treatment Approach to the Common, Superficial, and Deep Peroneal Nerves  Methods of Closing Gaps  Results of Suture of the Peroneal Nerve  Critical Limit of Delay of Suture  Tendon Transfer for Peroneal Nerve Paralysis Tibial Nerve  Examination  Approach to the Tibial Nerve in the Popliteal Fossa Approach to the Tibial Nerve Deep to the Soleus Muscle  Methods of Closing Gaps  Results of Suture of the Tibial Nerve References General Anatomy and Physiology Reflex Sympathetic Dystrophy Clinical Diagnosis of Nerve Injuries Surgical Technique Brachial Plexus Long Thoracic Nerve Axillary Nerve Radial Nerve Ulnar Nerve Sciatic Nerve Supplemental References General Anatomy and Physiology Reflex Sympathetic Dystrophy Clinical Diagnosis of Nerve Injuries Surgical Technique Cervical Plexus Spinal Accessory Nerve Brachial Plexus Suprascapular Nerve Long Thoracic Nerve Axillary Nerve Radial Nerve Ulnar Nerve Median Nerve Femoral Nerve Sciatic Nerve Peroneal Nerve Posterior Tibial Nerve Part XVII – Microsurgery 63 Microsurgery Microvascular Techniques Microvascular Anastomosis (End-to-End) Microvascular End-to-Side Anastomosis Microvascular Vein Grafting Microsurgical Treatment of Nerve Injuries Primary Neurorrhaphy Epineurial Neurorrhaphy Perineurial (Fascicular) Neurorrhaphy Epiperineurial Neurorrhaphy Interfascicular Grafting Interfascicular Grafting Replantation Results Replantation Team General Considerations Indications and Contraindications  Age  Severity of Injury  Level of Injury and Part Amputated  Warm Ischemia (Anoxic) Time  Preexisting Deformity or Disability  Conditions that Might Preclude Replantation Management and Transportation of Patient and Part Preoperative Preparation Preparation for Replantation Order of Repair Management of Bones and Joints Transposition of Digits Tendon Repair  Flexor Tendons  Extensor Tendons Vessel Repair  Order of Vessel Repair Vessel Repair in Replantation Nerve Repair for Replantation Management of Circulatory Compromise after Replantation Reoperation Complications Rehabilitation Monitoring Techniques after Microvascular Surgery Revascularization Special Techniques Pocket Technique for Microvascular Anastomosis Single-Stage Tissue Transfer (Free Flaps) Indications and Advantages Contraindications and Disadvantages Selection of Free Flaps  Upper Extremity  Lower Extremity Preoperative Requirements General Plan of Procedure General Postoperative Care Monitoring Free Groin Flap Vascular Anatomy Dissection for Free Groin Flap Anterolateral Thigh Flap Vascular Anatomy Dissection for Anterolateral Thigh Flap Scapular and Parascapular Flap Vascular Anatomy Dissection for Scapular and Parascapular Flap Lateral Arm Flap Vascular Anatomy Dissection for Lateral Arm Flap Muscle and Musculocutaneous Free Flaps Latissimus Dorsi Transfer Vascular Anatomy Dissection for Latissimus Dorsi Transfer Serratus Anterior Flap Vascular Anatomy Dissection for Serratus Anterior Flap Pectoralis Major Transfer Vascular Anatomy Dissection for Pectoralis Major Transfer Tensor Fasciae Latae Muscle Flap Vascular Anatomy Dissection for Tensor Fasciae Latae Muscle Flap Gracilis Muscle Transfer Vascular Anatomy Dissection for Gracilis Muscle Transfer Rectus Abdominis Transfer Vascular Anatomy Dissection for Rectus Abdominis Transfer Functioning Neuromuscular Transfers Free Transfer of Functioning Muscle Transfer of Functioning Muscle Free Vascularized Bone Transplant Indications Preoperative Planning Free Vascularized Fibular Transfer Posterior Approach for Harvesting Fibular Graft Lateral Approach for Harvesting Fibular Graft Distal Tibiofibular Fusion to Prevent Progressive Valgus Deformity Free Iliac Crest Bone Graft Free Vascularized Medial Femoral Condyle Flap Harvesting of Medial Femoral Condyle Corticoperiosteal Free Flap Harvesting Composite Rib Grafts Composite Rib Graft Harvest Composite Free Tissue Transfers from the Foot Neurovascular Anatomy Dorsalis Pedis Flap Dorsalis Pedis Free Tissue Transfer First Web Space, Pulp, and Hemipulp Neurovascular Free Flaps Neurovascular Free Flap Transfer First Web Space Great Toe Wraparound Flap Great Toe Wraparound Flap Transfer Thumb and Finger Reconstruction Single-Stage Transfer of the Great Toe  Indications  Preoperative Planning Single-Stage Great Toe Transfer Second and Third Toe Transplantation  Preoperative Preparation Second or Third Toe Transplantation Vascularized Free Flaps Containing Joints and Epiphyses Vascularized Nerve Grafts References General Microsurgery Nerves Replantation Free Soft Tissue Transfer Free Osseous Tissue Transfer Toe Transplantation Supplemental References General Microsurgery Nerves Replantation Revascularization Free Soft Tissue Transfer Free Osseous Tissue Transfer Toe Transplantation Part XVIII – The Hand 64 Basic Surgical Technique and Postoperative Care Preoperative Planning and Preparation Perioperative Antibiotics Arrangement and Routine in the Operating Room Choice of Anesthesia Brachial Plexus Blocks Intravenous Regional Anesthesia Peripheral Nerve Blocks Digital Nerve Blocks Local Infiltration Preparation and Draping for Elective Surgery Tourniquet Instruments Basic Skin Technique Incisions  Finger Incisions Midlateral Finger Incision  Thumb Incisions  Palmar Incisions Basic Skin Closure Techniques  Z-Plasty Care after Surgery Splinting References General/Anatomy Anesthesia Incisions Skin Closure Postoperative Management Tourniquet Splinting Supplemental References General/Anatomy Anesthesia Incisions Skin Closure Postoperative Management Tourniquet Splinting 65 Acute Hand Injuries History Examination Anesthesia Tourniquet Cleansing and Draping of Hand Considerations for Amputation Order of Tissue Repair Arterial Injuries Considerations for Skin Closure Methods and Indications for Skin Closure Direct Suture Skin Grafts Skin Flaps Coverage of Specific Areas with Flaps Management of Donor Area Grafts and Flaps Free Grafts Split-Thickness Skin Grafts  Obtaining Skin Grafts With a Dermatome Applying Split-Thickness Grafts Free Full-Thickness Grafts Applying Full-Thickness Grafts Skin Flaps Local Flaps  Local Flaps in Fingers  Local Flaps from the Dorsum of the Hand  Cross Finger Flaps Applying Cross Finger Flaps Forearm Flaps for Hand Coverage  Radial Forearm Flap Applying a Radial Forearm Graft  Posterior Interosseous Flap Applying a Posterior Interosseous Flap Abdominal Flaps  Random Pattern Abdominal Pedicle Flaps Applying a Random Pattern Abdominal Pedicle Flap  Axial Pattern Flaps Groin Pedicle Flap Hypogastric (Superficial Epigastric) Flap Filleted Grafts Applying a Filleted Graft Skin Coverage Granulating Areas Scars  Methods of Correcting Linear Scars  Methods of Correcting Area Scars References Supplemental References 66 Flexor and Extensor Tendon Injuries Flexor Tendons Examination Basic Tendon Techniques  Suture Material  Suture Configurations End-to-End Sutures Kessler Grasping Suture Modified Kessler Suture Tajima Suture Modified Kessler-Tajima Suture Modified Kessler-Tajima Suture Double Right-Angled Suture Fish-Mouth End-to-End Suture (Pulvertaft) End-to-Side Repair Roll Stitch Tendon-to-Bone Attachment Pull-Out Technique for Tendon Attachment Suture Anchor Tendon Attachment Timing of Flexor Tendon Repair  Partial Flexor Tendon Lacerations Primary Flexor Tendon Repair  Zone I  Zone II  Zone III  Zone IV  Zone V  Delayed Repair of Acute Injuries  Primary Suture of Flexor Tendons Repair in Zones I and II Repair in Zones III, IV, and V Flexor Tendon Injuries in Children Flexor Tendon Ruptures  Treatment  Postrepair Rupture Repair of Flexor Tendon of Thumb  Zone I  Zone II  Zone III  Zone IV  Zone V Secondary Repair and Reconstruction of Flexor Tendons  Flexor Tendons of Fingers Zone I (Distal Half of Finger) Zone II (Critical Area of Pulleys) Zones III, IV, and V (Forearm and Palm) Profundus Advancement Reconstruction of Finger Flexors: Single-Stage Tendon Graft  Donor Tendons for Grafting Palmaris Longus Plantaris Tendon Long Extensors of Toes Extensor Indicis Proprius, Extensor Digitorum Communis of Index Flexor Digitorum Sublimis  Complications “Lumbrical Plus” Finger “Quadriga” Effect  Reconstruction of Flexor Tendon Pulleys Reconstruction of Flexor Tendon Pulleys  Reconstruction of Finger Flexors by Two-Stage Tendon Graft Stage 1: Excision of Tendon and Scar and Reconstruction of Flexor Pulley Stage 2: Rod Removal and Tendon Graft Insertion  Long Flexor of Thumb Flexor Tendon Graft Two-Stage Flexor Tendon Graft for Flexor Pollicis Longus Transfer of Ring Finger Flexor Sublimis to Flexor Pollicis Longus  Flexor Tenolysis after Repair and Grafting Flexor Tenolysis after Repair and Grafting  Adherence of Tendons Adherence of A Tendon to A Fracture Site Freeing of Adherent Tendon Tenodesis Extensor Tendons Anatomy Examination Extensor Tendon Repair  Zone I Extensor Tendon Rupture Acute Transection of Extensor Tendon Chronic Mallet Finger (Secondary Repair) Chronic Mallet Finger (Secondary Repair) Correction of an Old Mallet Finger Deformity by Tendon Transfer or Tendon Graft Tendon Transfer for Correction of Old Mallet Finger Deformity Tendon Graft for Correction of Old Mallet Finger Deformity  Zone II  Zone III Rupture or Acute Transection of the Central Slip of the Extensor Expansion (Buttonhole Deformity) Repair of Central Slip of the Extensor Expansion Causing Buttonhole Deformity Chronic Buttonhole Deformity (Secondary Repair and Reconstruction) Reconstruction of the Extensor Mechanism for Chronic Buttonhole Deformity  Zone IV  Zone V Traumatic Dislocation of the Extensor Tendon at the Metacarpophalangeal Joint Repair of Traumatic Dislocation of the Extensor Tendon  Zone VI  Zone VII  Zone VIII  Zone IX Secondary Repair of Extensor Tendons Extensors of the Thumb  Zones TI and TII  Zones TIII and TIV  Zone TV References Anatomy Tendon Healing Postoperative Care Tendon Repair Secondary Repair, Reconstruction, and Tendon Grafts Flexor Tendon Injuries in Children Flexor Tendons Extensor Tendons Supplemental References General Anatomy Tendon Healing Postoperative Care Tendon Repair Secondary Repair, Reconstruction, and Tendon Grafts FlEXOR TENDON INJURIES IN CHILDREN Extensor Tendons 67 Fractures, Dislocations, and Ligamentous Injuries Principles of Treatment Open Fractures and Dislocations Basic Fracture Techniques Thumb Bennett Fracture Closed Pinning Open Reduction Corrective Osteotomy Rolando Fracture (Comminuted First Metacarpal Base) and Other Fractures Involving the First Carpometacarpal Joint Open Reduction and Internal Fixation Open Reduction and Internal Fixation Thumb Carpometacarpal Joint Dislocation Ligament Reconstruction for Recurrent Dislocation Thumb Metacarpophalangeal Fractures and Dislocations Open Reduction—Volar Approach Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Rupture Repair by Suture  Chronic Ulnar Collateral Ligament Reconstruction Anatomical Graft Reconstructions Jobe Four-Limb Reconstruction Radial Collateral Ligament Injuries Finger Metacarpals Carpometacarpal Fracture-Dislocations Intraarticular Fracture of the Fifth Metacarpal Base Finger Metacarpophalangeal Dislocations Open Reduction Open Reduction—Dorsal Approach Metacarpal Shaft or Neck Fractures Open Reduction and Fixation of Metacarpal Shaft Fracture Percutaneous Pinning of Metacarpal Shaft Fracture Intramedullary Pinning of a Metacarpal Shaft Fracture Metacarpal Head Fractures Open Reduction and Plate Fixation Open Reduction and Screw Fixation Minicondylar Plate Fixation Wiring Techniques Applicable to Long Bone Fractures Phalanges Fracture of the Middle or Proximal Phalanx Open Reduction Proximal Interphalangeal Joint Fracture-Dislocation Hemi-Hamate Autograft  Closed Reduction and Extension Block Splinting Open Reduction Open Reduction— Noncomminuted Dynamic External Splint Reduction Dynamic Distraction External Fixation Dynamic Intradigital External Fixation Interphalangeal Dislocations  Unstable Proximal Interphalangeal Joint Secondary to Chronic Collateral Ligament Rupture Tendon Graft to Replace Ruptured Collateral Ligament Repair of a Ruptured Interphalangeal Joint Collateral Ligament  Undiagnosed Interphalangeal Dislocations Open Reduction and Fixation with a Kirschner Wire  Distal Phalangeal Fractures  Mallet Finger Open Reduction and Fixation with a Pull-Out Wire and Transarticular Kirschner Wire Intraarticular Fractures Complications of Hand Fractures Malunion Correction of Metacarpal Neck Malunion Nonunion Correction of Nonunion of the Metacarpals Contracture Metacarpophalangeal Joint Capsulotomy Proximal Interphalangeal Joint Capsulotomy Proximal Interphalangeal Joint Capsulotomy References General Thumb Metacarpals and Phalanges (Excluding Thumb) Mallet Finger Supplemental References General Thumb Metacarpals and Phalanges (Excluding Thumb) Mallet Finger 68 Nerve Injuries Evaluation Preoperative Assessment  Type of Injury  Sensibility Evaluation  Motor Function  Sudomotor Function Postoperative Assessment  Sensibility Evaluation Two-Point and Moving Two- Point Discrimination Testing  Motor Function  Subjective Evaluation  Sudomotor Function Nerve Regeneration Primary and Delayed Primary Nerve Repair Timing of Repair Indications Secondary Nerve Repair Indications Suturing of Nerves Nerve Grafts Indications Sources of Nerve Grafts Alternative Nerve Graft Material Polyglycolic Acid and Digital Nerve Repair Tension-Free Nerve Graft Management of Specific Nerve Injuries Digital Nerves Suture of Digital Nerves Ulnar Nerve at the Wrist Repair of The Ulnar Nerve Deep Branch of the Ulnar Nerve Repair of the Deep Branch of the Ulnar Nerve Dorsal Branch of the Ulnar Nerve Median Nerve at the Wrist Repair of the Median Nerve Median Nerve in the Palm Superficial Radial Nerve Repair of the Superficial Radial Nerve Traumatic Neuromas Neurovascular Island Grafts Neurovascular Island Graft Transfer References Diagnostic Aids, Management Plan, and Results Techniques of Repair Nerve Grafts Neurolysis, Neuromas, and Pain Control Supplemental References Anatomy, Physiology, and Basic Research Diagnostic Aids, Management Plan, and Results Techniques of Repair Nerve Grafts Flaps to Restore Sensation Rehabilitation Neurolysis, Neuromas, and Pain Control 69 Wrist Disorders Anatomy Circulation Biomechanics and Kinematics Diagnosis of Wrist Conditions History Physical Examination Radiographic Techniques Other Diagnostic Techniques Arthroscopy of the Wrist Indications Equipment Positioning and Preparation of the Patient Patient Positioning for Wrist Arthroscopy General Principles Radiocarpal Examination Midcarpal Examination Distal Radioulnar Examination Fractures and Dislocations of the Carpal Bones, Including Kienböck Disease Fractures of the Scaphoid  Etiology  Anatomy and Blood Supply of the Scaphoid Bone  Diagnosis and Treatment Nondisplaced, Stable Scaphoid Fractures Displaced, Unstable Scaphoid Fractures Open Reduction and Internal Fixation of Acute Displaced Fractures of the Scaphoid—volar Approach Open Reduction and Internal Fixation of Acute Displaced Fractures of the Scaphoid—dorsal Approach Percutaneous Fixation of Scaphoid Fractures Nonunion of Scaphoid Fractures Styloidectomy Excision of the Proximal Fragment Excision of the Distal Scaphoid. Proximal Row Carpectomy Proximal Row Carpectomy Proximal Row Carpectomy Arthroscopic Proximal Row Carpectomy Grafting Operations Malpositioned Nonunion of Scaphoid Fractures (“Humpback” Deformity). Grafting Operations Grafting Operations Grafting Operations Vascularized Bone Grafts Vascularized Bone Grafts Arthrodesis of the Wrist. Naviculocapitate Fracture Syndrome and Capitate Fractures Fractures of Other Carpal Bones Fracture of the Hamate Excision or Reduction and Fixation of the Hook of the Hamate Trapezium and Trapezoid Fractures Fractures of the Lunate and Kienböck Disease  Joint Leveling Procedures  Osteotomies of the Distal Radius  Core Decompression Radial Decompression for Treatment of Kienböck Disease  Lunate Revascularization Procedures  Prosthetic Lunate Replacement Radial Shortening Distal Radioulnar and Ulnocarpal Joint Injuries Anatomy Diagnosis and Treatment  Lesions of the Triangular Fibrocartilage Complex, Including Traumatic Distal Radioulnar Joint Instability Physical Examination Radiographic Evaluation Arthroscopic Evaluation Classification Treatment of Traumatic Lesions of the Triangular Fibrocartilage Complex (PALMER Class 1) Arthroscopic Débridement of Triangular Fibrocartilage Tears Arthroscopic Repair of Class 1B Triangular Fibrocartilage Complex Tears From the Ulna Arthroscopic Transosseous Repair of Foveal Detachment of the TFCC Open Repair of Class 1B Injury Open Repair of Class 1C Injury Arthroscopic Repair of Class 1D Injury Open Repair of Class 1D Injuries  Chronic Instability of the Distal Radioulnar Joint Procedures to Stabilize the Distal Radioulnar Joint Anatomical Reconstruction of the Distal Radioulnar Ligaments Reconstruction of the Dorsal Ligament of the Triangular Fibrocartilage Complex  Ulnar Impaction-Abutment and Distal Radioulnar Joint Arthritis Ulnar Shortening Osteotomy Limited Ulnar Head Excision: Hemiresection Interposition Arthroplasty Ulnar Shortening Procedures “Matched” Distal Ulnar Resection “Wafer” Distal Ulnar Resection Combined Arthroscopic “Wafer” Distal Ulnar Resection and Triangular Fibrocartilage Complex Débridement Distal Radioulnar Arthrodesis with Distal Ulnar Pseudarthrosis (Baldwin; Sauvé-Kapandji; Lauenstein)  Procedures to Stabilize the Unstable Proximal Ulnar Segment after Distal Ulnar Excision Tenodesis of the Extensor Carpi Ulnaris and Transfer of the Pronator Quadratus Combination Tenodesis of the Flexor Carpi Ulnaris and the Extensor Carpi Ulnaris Arthrodesis of the Wrist Arthrodesis of the Wrist Compression Plate Technique Arthrodesis of the Wrist Carpal Ligament Injuries and Instability Patterns Instability Classification Progressive Perilunar Instability Rotary Subluxation of the Scaphoid Anterior Dislocation of the Lunate Palmar Transscaphoid Perilunar Dislocations Dorsal Transscaphoid Perilunar Dislocations Triquetrolunate and Midcarpal Instabilities Other Instability Patterns Treatment Options for Wrist Ligament Injuries and Instability Ligament Repair Ligament Reconstruction Ligament Reconstruction Ligament Reconstruction  Capsulodesis Dorsal Capsulodesis  Limited Wrist Arthrodesis Indications for Triscaphe Arthrodesis Contraindications for Triscaphe Arthrodesis Scaphotrapezial-Trapezoid Fusion  Other Limited Wrist Arthrodeses Scaphocapitate Arthrodesis Scaphocapitolunate Arthrodesis Lunotriquetral Arthrodesis Triquetrohamate Arthrodesis Osteoarthritis of the Wrist References Anatomy and Biomechanics Diagnosis and Evaluation Radiographic Techniques Arthroscopy of the Wrist Trauma (Fractures and Dislocations) Proximal Row Carpectomy Kienböck Disease Radioulnar Joint Arthrodesis Instability Wrist Arthritis Supplemental References General Anatomy and Biomechanics Diagnosis and Evaluation Radiographic Techniques Arthroscopy of the Wrist Trauma (Fractures and Dislocations) Proximal Row Carpectomy Kienböck Disease Radioulnar Joint Arthrodesis Instability Wrist Arthritis 70 Special Hand Disorders Aneurysm, Thrombosis, and Embolism in Radial, Ulnar, and Digital Arteries Thermal Burns Escharotomy Tangential Excision Full-Thickness Excision Electrical Burns Radiation Burns Chemical Burns Frostbite Injection Injuries Shotgun Injuries Wringer Injuries Extravasation Injuries Focal Dystonia of the Hand Psychoflexed and Psychoextended Hands (Dysfunctional Postures) Factitious Hand Syndromes References Aneurysm, Thrombosis, and Embolism Thermal Burns Electrical Burns Chemical Burns Frostbite Injection Injuries Shotgun Injuries and Gunshot Wringer Injuries Extravasation Injuries Psychological Conditions Supplemental References Aneurysm, Thrombosis, and Embolism Thermal Burns Electrical Burns Radiation Burns Chemical Burns Frostbite Injection Injuries Shotgun Injuries and Gunshot Wringer Injuries Extravasation Injuries Psychological Conditions 71 Paralytic Hand Principles of Tendon Transfer Planning Tendon Transfer  Evaluating Muscles for Tendon Transfer  Time of Tendon Transfer Technical Considerations for Tendon Transfer Restoration of Pinch Restoration of Thumb Opposition  Correction of Thumb Deformity  Tendon Transfers to Restore Opposition Transfer of the Sublimis Tendon Transfer of the Sublimis Tendon Transfer of the Extensor Indicis Proprius Transfer of the Flexor Carpi Ulnaris Combined with the Sublimis Tendon Transfer of the Palmaris Longus Tendon to Enhance Opposition of the Thumb Muscle Transfer (Abductor Digiti Quinti) to Restore Opposition Restoration of Adduction of the Thumb Transfer of the Brachioradialis or Radial Wrist Extensor to Restore Thumb Adduction Transfer of the Extensor Carpi Radialis Brevis Tendon to Restore Thumb Adduction Royle-Thompson Transfer (MODIFIED) Restoration of Abduction of the Index Finger Transfer of the Extensor Indicis Proprius Tendon Transfer of A Slip of the Abductor Pollicis Longus Tendon Restoration of Intrinsic Function of the Fingers Transfer of the Flexor Digitorum Sublimis of the Ring Finger Transfer of the Extensor Carpi Radialis Longus or Brevis Tendon Transfer of the Extensor Indicis Proprius and Extensor Digiti Quinti Proprius Capsulodesis Tenodesis Peripheral Nerve Palsies Radial Nerve Palsy Transfer of the Pronator Teres to the Extensor Carpi Radialis Brevis, the Flexor Carpi Radialis to the Extensor Digitorum Communis, and the Palmaris Longus to the Extensor Pollicis Longus Transfer of the Pronator Teres to the Extensor Carpi Radialis Longus and Extensor Carpi Radialis Brevis, the Flexor Carpi Radialis to the Extensor Pollicis Brevis and Abductor Pollicis Longus, the Flexor Digitorum Sublimis Middle to the Extensor Digitorum Communis, and the Flexor Digitorum Sublimis Ring to the Extensor Pollicis Longus and Extensor Indicis Proprius Low Ulnar Nerve Palsy High Ulnar Nerve Palsy Low Median Nerve Palsy High Median Nerve Palsy Combined Low Median and Ulnar Nerve Palsy (at the Wrist) Combined High Median and Ulnar Nerve Palsy (Above the Elbow) Severe Paralysis from Damage to the Cervical Spinal Cord or Other Causes Tetraplegia  Classification  Principles of Management  Elbow Extension Posterior Deltoid-to-Triceps Transfer  Forearm Pronation  Wrist Extension Transfer of the Brachioradialis to the Extensor Carpi Radialis Brevis  Key Pinch MOBERG Key Grip Tenodesis House Reconstruction TWO-STAGE RECONSTRUCTION TO RESTORE DIGITAL FLEXION AND KEY PINCH Zancolli Reconstruction References Supplemental References 72 Cerebral Palsy of the Hand Patient Evaluation Nonoperative Management Operative Management Goals Principles Pronation Contracture of the Forearm Transfer of the Pronator Teres Brachioradialis Rerouting Flexion Deformities of the Wrist and Fingers Fractional Lengthening of the Flexor Carpi Radialis Muscle and Finger Flexors Release of the Flexor-Pronator Origin Extensive Release of the Flexor Pronator Origin Transfer of the Flexor Carpi Ulnaris Wrist Arthrodesis Carpectomy Thumb-in-Palm Deformity  Treatment Myotomy Release of Contractures, Augmentation of Weak Muscles, and Skeletal Stabilization Flexor Pollicis Longus Abductorplasty Redirection of Extensor Pollicis Longus Swan-Neck Deformity Sublimis Tenodesis of the Proximal Interphalangeal Joint Lateral Band Translocation References Supplemental References 73 Arthritic Hand Rheumatoid Arthritis Osteoarthritis Systemic Lupus Erythematosus Psoriatic Arthritis Reiter Syndrome Gout Scleroderma (Progressive Systemic Sclerosis) Nonoperative Treatment of Synovitis and Tenosynovitis Rheumatoid Nodules Staging of Operations Use of Kirschner Wires in the Rheumatoid Hand Finger Deformities Caused by Rheumatoid Arthritis Intrinsic Plus Deformity Swan-Neck Deformity  Intrinsic Release Correction of Proximal Interphalangeal Joint Hyperextension Deformity Lateral Band Mobilization and Skin Release Buttonhole, or Boutonnière, Deformity Correction of Mild Buttonhole Deformity by Extensor Tenotomy Correction of Moderate Buttonhole Deformity Correction of Severe Buttonhole Deformity  Interphalangeal Joint Arthroplasty Proximal Interphalangeal Joint Volar Plate Interposition Arthroplasty Proximal Interphalangeal Joint Implant Arthroplasty Proximal Interphalangeal Joint Arthroplasty Through A Dorsal Approach Proximal Interphalangeal Joint Arthroplasty Through An Anterior (Palmar) Approach Distal Interphalangeal Joint Deformities  Ulnar Drift or Deviation of the Fingers Mild-to-Moderate Ulnar Drift Extensor Tendon Realignment and Intrinsic Rebalancing Severe Ulnar Drift and Metacarpophalangeal Dislocation Metacarpophalangeal Joint Arthroplasty Metacarpal Joint Surface Arthroplasty Extensor Tenosynovitis Extensor Tendon Rupture Flexor Tendon Rupture Persistent Proximal Interphalangeal Joint Synovitis Synovectomy Flexor Tenosynovitis Flexor Tendon Sheath Synovectomy  Finger Joint Arthrodesis Metacarpophalangeal Joint Arthrodesis Proximal Interphalangeal Joint Arthrodesis  Distal Interphalangeal Joint Arthrodesis Deformities of the Thumb Classification  Type I  Type II  Type III  Type IV Osteoarthritis  Correction of Arthritic Thumb Deformities Synovectomy Thumb Interphalangeal Joint Synovectomy Thumb Metacarpophalangeal Joint Synovectomy Thumb Trapeziometacarpal Joint Synovectomy Soft Tissue Reconstruction Interphalangeal Soft Tissue Reconstruction Metacarpophalangeal Synovectomy with Extensor Tendon Reconstruction Thumb Metacarpophalangeal Joint Reconstruction for Rheumatoid Arthritis Arthroplasty Metacarpophalangeal Arthroplasty Trapeziometacarpal Ligament Reconstruction Trapeziometacarpal Ligament Reconstruction  Trapeziometacarpal Arthroplasty Distraction Arthroplasty Tendon Interposition Arthroplasty with Ligament Reconstruction Implant Arthroplasty  Arthrodesis of Thumb Joints Interphalangeal Arthrodesis of the Thumb Metacarpophalangeal Arthrodesis of the Thumb Tension Band Arthrodesis of the Thumb Metacarpophalangeal Joint Thumb Metacarpophalangeal Joint Arthrodesis with Intramedullary Screw Fixation  Trapeziometacarpal Arthrodesis trapeziometacarpal arthrodesis Trapeziometacarpal Arthrodesis Thumb Carpometacarpal Arthrodesis with Kirschner Wire or Blade-Plate Fixation Rheumatoid Deformities of the Wrist Synovitis of the Wrist Dorsal Synovectomy Volar Synovectomy Wrist Arthrodesis and Arthroplasty Arthrodesis of the Wrist  Arthroplasty Silicone Wrist Arthroplasty References General Arthritis Arthritis Soft Tissue Procedures Metacarpophalangeal Joint Arthroplasty Trapeziometacarpal Arthroplasty Distal Radioulnar Joint Wrist Arthrodesis Wrist Arthroplasty Distal Interphalangeal Arthroplasty/Arthrodesis Proximal Interphalangeal Arthroplasty and Arthrodesis Supplemental References Arthritis Soft Tissue Procedures Metacarpophalangeal Joint Arthroplasty Finger Arthrodesis Trapeziometacarpal Arthroplasty Distal Radioulnar Joint Wrist Arthrodesis Wrist Arthroplasty Proximal Interphalangeal Arthroplasty and Arthrodesis 74 Compartment Syndromes and Volkmann Contracture Definition and History Anatomy Etiology Diagnosis Measuring Compartment Pressures in the Forearm and Hand Using a Hand-Held Monitoring Device Management Acute Compartment Syndrome of the Forearm Forearm Fasciotomy and Arterial Exploration Hand Fasciotomies Established Volkmann Contracture of the Forearm  Muscle Sliding Operation of Flexors for Established Volkmann Contracture Excision of Necrotic Muscles Combined with Neurolysis of Median and Ulnar Nerves for Severe Contracture Two-Staged Free Gracilis Transfer Established Intrinsic Muscle Contractures of the Hand Release of Established Intrinsic Muscle Contractures of the Hand Release of Severe Intrinsic Contractures with Muscle Fibrosis Adducted Thumb References Compartment Syndrome and Volkmann Contracture Supplemental References Compartment Syndrome and Volkmann Contracture Adducted Thumb 75 Dupuytren Contracture Pathogenesis Prognosis Treatment Subcutaneous Fasciotomy Partial (Selective) Fasciectomy References Supplemental References 76 Carpal Tunnel Syndrome, Ulnar Tunnel Syndrome, and Stenosing Tenosynovitis Carpal Tunnel Syndrome Diagnosis Treatment  Surgical Release “mini-Palm” Open Carpal Tunnel Release Open Carpal Tunnel Release  Endoscopic Release Endoscopic Carpal Tunnel Release Through A Single Incision Endoscopic Carpal Tunnel Release Through Two Incisions Unrelieved or Recurrent Carpal Tunnel Syndrome Ulnar Tunnel Syndrome Stenosing Tenosynovitis De Quervain Disease Surgical Treatment of De Quervain Disease Trigger Finger and Thumb Surgical Release of Trigger Finger Percutaneous Release of Trigger Finger Bowler’s Thumb References Carpal Tunnel Syndrome Ulnar Tunnel Syndrome de Quervain Disease Trigger Thumb and Trigger Finger Miscellaneous Tenosynovitis Supplemental References Carpal Tunnel Syndrome Ulnar Tunnel Syndrome de Quervain Disease Trigger Thumb and Trigger Finger Miscellaneous Tenosynovitis 77 Tumors and Tumorous Conditions of the Hand Classification Diagnosis Treatment Benign Tumors (Table 77-4) Lipoma  Infiltrating Lipomas  Lipoblastomas  Intraneural Lipofibromas Giant Cell Tumor of the Tendon Sheath (xanthoma) Benign Tumors of Fibrous Origin  Recurring Digital Fibrous Tumor of Childhood or Infantile Digital Fibromatosis  Juvenile Aponeurotic Fibroma or Calcifying Aponeurotic Fibroma  Fibroma  Neurofibroma Glomus Tumor Hemangioma Lymphangioma Neurilemoma (schwannoma) Osteoid Osteoma Enchondroma Benign Osteoblastoma Aneurysmal Bone Cyst Giant Cell Tumors of Bone Osteochondroma Synovial Chondromatosis Malignant Tumors Osteogenic Sarcoma Chondrosarcoma Epithelioid Sarcoma Squamous Cell Carcinoma Basal Cell Carcinoma Malignant Melanoma Fibrosarcoma Metastatic Tumors Rhabdomyosarcoma Ewing Sarcoma Tumorous Conditions Ganglion Excision of a Dorsal Wrist Ganglion Excision of a Volar Wrist Ganglion Arthroscopic Resection of a Dorsal Wrist Ganglion Epidermoid Cyst (inclusion Cyst) Sebaceous Cyst Mucous Cyst Congenital Arteriovenous Fistula Pyogenic Granuloma Foreign Body Granuloma Gout Traumatic Neuroma Déjérine-Sottas Disease Calcinosis  Calcinosis Circumscripta Turret Exostosis Carpometacarpal Boss Epidermolysis Bullosa Paget Disease References General Benign Tumors Malignant Tumors Tumorous Conditions Supplemental References General Benign Tumors Malignant Tumors Tumorous Conditions 78 Hand Infections Factors Influencing Hand Infections General Approach to Hand Infections Incision and Drainage of Hand Infection Paronychia Chronic Paronychia Eponychial Marsupialization Felon Incision and Drainage of Felons Subfascial Space Infections Web Space Infection (Collar Button Abscess) Deep Fascial Space Infections Incision and Drainage of Deep Fascial Space Infection Subaponeurotic Space Infections Tenosynovitis Postoperative Closed Irrigation Open Drainage Infections of Radial and Ulnar Bursae Incision and Drainage of Radial and Ulnar Bursae Finger Joint Infections (Septic Arthritis) Open Drainage of Septic Finger Joints Osteomyelitis Human Bite Injuries Miscellaneous and Unusual Infections Herpetic Infections Infections in Drug Addicts Infections in Patients with Acquired Immunodeficiency Syndrome Necrotizing Fasciitis Gas Gangrene (Clostridial Myonecrosis) Mycobacterial Infections  Tuberculosis  Nontuberculous Mycobacterial Infections Fungal Infections Pyoderma Gangrenosum References Supplemental References 79 Congenital Anomalies of the Hand Principles of Management Incidence and Classification Embryology Failure of Formation (Arrest of Development) Transverse Deficiencies  Prosthetic Management  Surgical Treatment KRUKENBERG Reconstruction Nathan and Trung Modification of Krukenberg Reconstruction Metacarpal Lengthening Longitudinal Deficiencies  Phocomelia Treatment  Radial Clubhand—radial Deficiencies Nonoperative Management Operative Treatment Centralization of the Hand Centralization of the Hand Using Transverse Ulnar Incisions Centralization of the Hand with Removal of the Distal Radial Anlage Centralization of the Hand and Tendon Transfers Centralization with Transfer of the Flexor Carpi Ulnaris Centralization of the Hand Pollicization for Reconstruction of the Thumb with Radial Clubhand Opponensplasty Triceps Transfer to Restore Elbow Flexion  Cleft Hand—central Deficiencies Treatment Cleft Closure Combined Cleft Closure and Release of Thumb Adduction Contracture Cleft Closure and Release of Thumb Adduction Contracture Palmar Cleft Closure Deepening of Web and Metacarpal Osteotomy Tendon Transfer for Type II Deformities  Ulnar Clubhand—ulnar Deficiencies Nonoperative Management Operative Treatment Rotational Osteotomy of the First Metacarpal Excision of an Ulnar Anlage Creation of A One-Bone Forearm Failure of Differentiation Syndactyly  Treatment Open Finger Syndactyly Release Syndactyly Release with Dorsal Flap Syndactyly Release with Matching Volar and Dorsal Proximally Based V-Shaped Flaps Apert Syndrome  Treatment Reconstruction of the Hand in Apert Syndrome Duplication (Polydactyly) Preaxial Polydactyly (Bifid Thumb)  Treatment Correction of Types I and II Bifid Thumbs Correction of Types III Through VI Bifid Thumbs Triphalangeal Thumb  Treatment Reduction Osteotomy Postaxial Polydactyly  Treatment Excision of Extra Digit Central Polydactyly  Treatment Ulnar Dimelia  Treatment Excision of the Proximal Ulna Reconstruction of the Hand and Wrist Overgrowth (Macrodactyly) Treatment Debulking Epiphysiodesis Digital Shortening Thumb Shortening Undergrowth Hypoplastic Thumb  Short Thumb Treatment  Adducted Thumb Treatment Simple Z-Plasty of the Thumb Web Four-Flap Z-Plasty Web Deepening with A Sliding Flap Ring Sublimis Opponensplasty Ring Sublimis Opponensplasty with Ulnar Collateral Ligament Reconstruction Abductor Digiti Quinti Opponensplasty  Abducted Thumb Treatment Rerouting of the Flexor Pollicis Longus  Floating Thumb (Pouce Flottant) Treatment  Absent Thumb Treatment Recession of the Index Finger  Congenital Clasped Thumb Nonoperative Management Operative Treatment Group 2 Clasped Thumb Deformity Group 3 Clasped Thumb Deformity Hypoplastic Hands and Digits  Nonoperative Management  Operative Treatment Metacarpal Lengthening Lengthening with Distraction Stage I Lengthening with Distraction Stage II Callotasis Metacarpal Lengthening Toe-Phalanx Transplantation Toe-Phalanx Transplantation Congenital Ring Syndrome Treatment Multiple Z-Plasty Release of A Congenital Ring Miscellaneous Anomalies Congenital Trigger Digits  Treatment Release of A Congenital Trigger Thumb Release of A Trigger Finger Camptodactyly  Treatment Tendon Release Transfer of the Flexor Superficialis Tendon to the Extensor Apparatus Kirner Deformity  Treatment Opening Wedge Osteotomy of the Terminal Phalanx Delta Phalanx  Treatment Reverse Wedge Osteotomy Madelung Deformity  Treatment Resection of A Dyschondrosteosis Lesion Closing Wedge Osteotomy Combined with Darrach Excision of the Distal Ulnar Head Dome Osteotomy and Excision of Vickers Ligament References General Phocomelia Radial Deficiencies Central Deficiencies Ulnar Deficiencies Syndactyly Apert Syndrome Preaxial Polydactyly Triphalangeal Thumb Postaxial Polydactyly Ulnar Dimelia Macrodactyly Hypoplastic Thumb Hypoplastic Hands and Digits Congenital Ring Syndrome Congenital Trigger Digits Camptodactyly Delta Phalanx Madelung Deformity Supplemental References General Transverse Deficiencies Phocomelia Radial Deficiencies Central Deficiencies Ulnar Deficiencies Syndactyly Apert Syndrome Preaxial Polydactyly Triphalangeal Thumb Postaxial Polydactyly Central Polydactyly Ulnar Dimelia Macrodactyly Hypoplastic Thumb Hypoplastic Hands and Digits Congenital Ring Syndrome Congenital Trigger Digits Camptodactyly Kirner Deformity Delta Phalanx Madelung Deformity Part XIX – The Foot and Ankle 80 Surgical Techniques Surgical Techniques Preoperative Preparation Tourniquet Application of a Tourniquet Prophylactic Anticoagulation Instruments Anesthesia  Forefoot Block Forefoot Block  Ankle Block Ankle Block  Popliteal Sciatic Nerve Block (Prone) Popliteal Sciatic Nerve Block (Prone)  Lateral Popliteal Nerve Block Lateral Popliteal Nerve Block References Supplemental References 81 Disorders of the Hallux Hallux Valgus (Bunion) Preoperative Management Soft Tissue Procedures Modified Mcbride Bunionectomy Combined Soft Tissue and Bony Procedures Keller Resection Arthroplasty Osteotomy of the Distal First Metatarsal Distal Metatarsal Osteotomy Distal Chevron Metatarsal Osteotomy Modified Chevron Distal Metatarsal Osteotomy Johnson Modified Chevron Osteotomy Increased Displacement Distal Chevron Osteotomy Chevron-Akin Double Osteotomy Percutaneous Distal Metatarsal Osteotomy Osteotomy of the Proximal First Metatarsal Proximal Crescentic Osteotomy with A Distal Soft Tissue Procedure Proximal Chevron First Metatarsal Osteotomy Scarf Osteotomy Ludloff Osteotomy Medial Cuneiform Osteotomy Proximal Phalangeal Osteotomy AKIN Procedure Arthrodesis of the First Metatarsophalangeal Joint Arthrodesis of the First Metatarsophalangeal Joint with Small Plate Fixation Arthrodesis of the First Metatarsophalangeal Joint with Low-Profile Contoured Dorsal Plate AND Compression Screw Fixation Truncated Cone Arthrodesis of the First Metatarsophalangeal Joint Arthrodesis of the First Metatarsocuneiform Articulation (Lapidus Procedure) Arthrodesis of the First Metatarsocuneiform Articulation (Lapidus Procedure) with Plate Fixation Molded (Ball-and-Socket) Arthrodesis of the First Metatarsophalangeal Joint Juvenile and Adolescent Hallux Valgus (10 to 19 Years Old) Double First Metatarsal Osteotomies Modified Peterson Procedure First Cuneiform Osteotomy Hallux Valgus IN Cerebral Palsy Complications after Surgery for Hallux Valgus  Preventing Complications  Recurrent Deformity after Simple Bunionectomy Recurrent Hallux Valgus with Normal Distal Metatarsal Angle after Bunionectomy First Web Space Dissection, Lateral Release, AND Repeat Capsular Imbrication (Hallux Valgus Angle < 30 Degrees AND First-Second Intermetatarsal Angle < 15 Degrees) Recurrent Valgus Deformity with Abnormal Distal Metatarsal Articular Angle Correcting distal metatarsal osteotomy Recurrent Deformity after Basilar Metatarsal Osteotomy and First Web Space Dissection or Release Recurrent Deformity IN Elderly Patients with Osteoarthritis Resection and Arthrodesis or Replacement Arthroplasty of the First Metatarsophalangeal Joint.  Complications after Chevron Osteotomy Correction of malunion Metatarsal Shortening Distraction Osteogenesis for Metatarsal Shortening  Acquired Hallux Varus and Intrinsic Minus Hallux Anatomy and Pathogenesis Correction of Uniplanar (Static) Hallux Varus Deformity Transfer of Extensor Hallucis Longus with Arthrodesis of the Interphalangeal Joint of the Hallux Extensor Hallucis Brevis Tenodesis Correction of Dynamic (Multiplanar) Hallux Varus Plantar Plate Release Claw Toe (Intrinsic Imbalanced Hallux) Limitation of Metatarsophalangeal Joint Motion Hallux Extensus Neuroma and Hematoma Stress Fractures of the Lesser Metatarsal  Complications of Resection Arthroplasty of the First Metatarsophalangeal Joint (Keller) Cock-Up Hallux Metatarsalgia  Complications after Arthrodesis of the First Metatarsophalangeal Joint Hallux Rigidus Nonoperative Treatment Operative Treatment Cheilectomy cheilectomy  Arthrodesis of the First Metatarsophalangeal Joint  Resection Arthroplasty (Keller Procedure) Extension Osteotomy of the Proximal Phalanx extension osteotomy of proximal phalanx Sesamoid Injuries of the Hallux Treatment Excision of the Sesamoid References Hallux Valgus Hallux Rigidus Sesamoid Injury Supplemental References Hallux Valgus Hallux Rigidus Sesamoid Injury 82 Disorders of Tendons and Fascia and Adolescent and Adult Pes Planus Disorders of Tendons Disorders of the Posterior Tibial Tendon  Classification  Diagnosis  Treatment Stage I Disease (Tenosynovitis) Synovectomy with Repair of Incomplete Tears Stage II Disease Transfer of Flexor Digitorum Longus or Flexor Hallucis Longus to Tarsal Navicular Repair of Spring Ligament Reconstruction of the Spring Ligament Using the Peroneus Longus Anterior Calcaneal Osteotomy (Lateral Column Lengthening) Medial Calcaneal Displacement Osteotomy Stage III Disease Medial Column Stabilization. Isolated Medial Column Arthrodesis Opening Wedge Medial Cuneiform (Cotton) Osteotomy Stage IV Minimally Invasive Deltoid Ligament Reconstruction Insufficiency of Posterior Tibial Tendon Secondary to Accessory Navicular Kidner Procedure. Lateral Column Lengthening and Excision of Accessory Navicular Disorders of the Anterior Tibial Tendon  Diagnosis  Treatment Tenosynovitis Synovectomy of the Anterior Tibial Tendon Insertional Tendinosis of the Anterior Tibial Tendon Débridement and Repair of the Distal Anterior Tibial Tendon Complete Rupture of the Anterior Tibial Tendon Repair of Complete Rupture of the Anterior Tibial Tendon Disorders of the Peroneal Tendons  Diagnosis  Treatment Peroneal Tendinitis Synovectomy of the Peroneal Tendons Subluxation of the Peroneal Tendons Fibular Groove Deepening and Repair of the Superior Retinaculum (RAIKIN) Distal Peroneal Longus Tendinitis Associated with Os Peroneum: The Painful Os Peroneum Syndrome Débridement of the Peroneus Longus Tendon, Removal of Os Peroneum, and Tenodesis of Peroneus Longus Tendon to Peroneus Brevis Tendon Intrasheath Peroneal Tendon Subluxation Rupture of the Peroneal Tendons Repair of Rupture of the Peroneal Tendons Peroneal Tendon Repair-Reconstruction Injuries of the Flexor Tendons  Flexor Hallucis Longus Tendinitis and Impingement Diagnosis Treatment Release of the Fibroosseous Tunnel  Flexor Hallucis Longus Tear Repair of Flexor Hallucis Tear  Flexor Digitorum Longus Tendon Injury Painful Heel Etiology Clinical and Radiographic Findings Treatment Plantar Fascia and Nerve Release Two-Portal Endoscopic Plantar Fascia Release Single-Portal Endoscopic Plantar Fascia Release Disorders of the Achilles Tendon  Differential Diagnosis  Insertional Achilles Tendinitis Diagnosis Treatment Débridement of the Tendon for Insertional Achilles Tendon Disease  Chronic Noninsertional Achilles Tendinosis Flexor Hallucis Longus Transfer for Chronic Noninsertional Achilles Tendinosis Haglund Deformity (Pump Bump) and Retrocalcaneal Bursitis Calcaneal Osteotomy for Haglund Deformity Pes Planus and Tarsal Coalition Calcaneonavicular Coalition  Treatment Calcaneonavicular Bar Resection Subtalar Arthrodesis Triple Arthrodesis for Calcaneonavicular Coalition Talocalcaneal Coalition  Clinical Findings  Radiographic Findings  Treatment Resection of a Middle Facet Tarsal Coalition Subtalar Arthroereisis References Adolescent and Adult Pes Planus Disorders of Tendons Posterior and Anterior Tibial Tendons Flexor Tendons Painful Heel, Chronic Achilles Tendinosis, Insertional Tendinitis, and Haglund Deformity Rigid Flatfoot and Tarsal Coalition Subtalar Arthroereisis Supplemental References Pes Planus Tarsal Coalition/Spastic Flatfoot Disorders of Tendons Posterior and Anterior Tibial Tendons Flexor Tendons Painful Heel, Chronic Achilles Tendinosis, Insertional Tendinitis, and Haglund Deformity Rigid Flatfoot and Tarsal Coalition Subtalar Arthroereisis 83 Lesser Toe Abnormalities Metatarsophalangeal Joint Instability Etiology Anatomy and Biomechanics Diagnosis Treatment Flexor-to-Extensor Transfer Primary Plantar Plate Repair Through A Dorsal Approach Axial Plane Deformity of the Metatarsophalangeal Joint Extensor Digitorum Brevis Transfer for Crossover Toe Deformity Closing Wedge Osteotomy of the Proximal Phalanx for Correction of Axial Deformity Hammer Toe and Claw Toe Etiology Clinical Findings Treatment  Soft Tissue Procedures (Girdlestone; Taylor; Parrish; Mann And Coughlin)  Bone and Joint Procedures Mild Deformity Moderate Deformity Severe Deformity Plantar Plate Tenodesis for Correction of Flexible Hammer Toe or Claw Toe Deformity Correction of Moderate Hammer Toe or Claw Toe Deformity Correction of Severe Deformity Correction of Severe Deformity with Dislocation of the Metatarsophalangeal Joint Metatarsophalangeal Joint Arthroplasty Correction of A Dislocated Second Metatarsophalangeal Joint with Shortening Metatarsal Osteotomy Shortening Metatarsal (Weil) Osteotomy Amputation for Severe Deformity Mallet Toe Etiology Treatment Resection Dermodesis Terminal Syme Procedure Combined Hammer Toe and Mallet Toe Deformity with Associated Double Corns Complications and Revision Surgery of Hammer Toe Deformities Proximal Interphalangeal Joint Arthrodesis with an Absorbable Intramedullary Pin Corns (Helomata and Clavi) Etiology and Clinical Findings Treatment  Hard Corn Hard Corn Treatment  Soft Corn (Interdigital Corn) Partial Syndactylization for Intractable Interdigital Corn  Plantar Corn (Intractable Plantar Keratosis) Arthroplasty of the Metatarsophalangeal Joint Metatarsal Osteotomy for Excessive Metatarsal Length and Diffuse Plantar Keratosis and Metatarsalgia Shortening Oblique Metatarsal Osteotomy Shortening Oblique Metatarsal Osteotomy for Intractable Plantar Keratosis Dorsal Closing Wedge Osteotomy of the Metatarsals for Intractable Plantar Keratosis Bunionette (Tailor’s Bunion) Partial Resection of the Lateral Condyle of the Fifth Metatarsal Head Osteotomy of the Metatarsal Transverse Medial Slide Osteotomy for Bunionette Deformity Oblique Diaphyseal Osteotomy of the Fifth Metatarsal for Severe Splay Foot or Metatarsus Quintus Valgus Chevron Osteotomy of the Fifth Metatarsal for Bunionette Deformity Resection of the Fifth Metatarsal Head for Bunionette Deformity Freiberg Infraction Dorsal Closing Wedge Osteotomy for Freiberg Disease Joint Débridement and Metatarsal Head Remodeling for Freiberg Disease Brachymetatarsia Distraction Osteogenesis for Lengthening of the Metatarsal in Brachymetatarsia References Metatarsophalangeal Joint Instability Hammer Toes Mallet Toe Corns and Calluses Bunionette Freiberg Disease Brachymetatarsia Supplemental References Metatarsophalangeal Joint Instability Hammer Toes Mallet Toe Corns and Calluses Bunionette Freiberg Disease 84 Arthritis of the Foot Inflammatory and Degenerative Arthritis Signs and Symptoms Nonoperative Treatment Forefoot Etiology of Joint Destruction Treatment  Avoiding Complications in Rheumatoid Foot Surgery  Forefoot Arthroplasty  Arthrodesis of the First Metatarsophalangeal Joint Arthrodesis of the First Metatarsophalangeal Joint with Resection of the Lesser Metatarsophalangeal Joints Cone Arthrodesis of the First Metatarsophalangeal Joint Resection of the Metatarsal Heads Through A Plantar Approach with Arthrodesis of the First Metatarsophalangeal Joint and Resection of the Head and Neck of the Metatarsals of the Lesser Toes Correction of Flexion Deformities of the Proximal Interphalangeal Joints Midfoot Treatment  First Metatarsal–medial Cuneiform Arthrodesis  Midfoot Arthrodesis Midfoot Arthrodesis Tarsometatarsal Interpositional Arthroplasty Hindfoot Treatment Subtalar Arthrodesis Arthroscopic Subtalar Arthrodesis Talonavicular Joint Arthrodesis Calcaneocuboid Joint Arthrodesis Triple Arthrodesis Isolated Medial Incision for Triple Arthrodesis Tibiocalcaneal and Ankle Arthrodeses References Supplemental References 85 Diabetic Foot Risk Factors for Foot Problems in Diabetic Patients Peripheral Neuropathy Peripheral Vascular Disease Delayed Bone Healing Altered Immune Function Diabetic Ulcers and Infections Pathophysiology Classification Treatment  Nonoperative Treatment  Operative Treatment Charcot Arthropathy Pathophysiology Evaluation Classification Treatment  Nonoperative Treatment  Operative Treatment Acute Fractures Conclusion References Supplemental References 86 Neurogenic Disorders Tarsal Tunnel Syndrome Anatomy and Etiology Clinical Findings and Diagnosis Treatment Tarsal Tunnel Release Anterior Tarsal Tunnel Syndrome (Deep Peroneal Nerve Entrapment) Anterior Tarsal Tunnel Release Interdigital Neuroma Historical Background Pathological Findings Signs and Symptoms Treatment Interdigital Neuroma Excision (Dorsal) INTERDIGITAL NEUrOMA EXCISION USING Longitudinal Plantar Incision Cavus Foot Etiology Clinical Findings Radiographic Findings Treatment  Claw Toes Plantar Fascia Release Correction of Clawing of The Great and Second Toes Tendon Suspension of The First Metatarsal and Interphalangeal Joint Arthrodesis  Charcot-Marie-Tooth Cavovarus Driven By Plantarflexed First Ray Forefoot Equinovarus Proximal First Metatarsal Osteotomy and Plantar Fasciotomy. combined proximal first metatarsal osteotomy, plantar fasciotomy, and transfer of the tibialis anterior plantar fasciotomies and closing wedge osteotomy EXTENSOR TENDON TRANSFER Tarsometatarsal Truncated-Wedge Arthrodesis  Midfoot Cavus Anterior Tarsal Wedge Osteotomy V-Osteotomy of The Tarsus  Combined Cavus (Calcaneocavus Deformity) Osteotomy of The Calcaneus Crescentic Calcaneal Osteotomy  Calcaneocavovarus and Cavovarus Deformity Triplanar Osteotomy and Lateral Ligament Reconstruction Z-Shaped Calcaneal Osteotomy Peroneus Brevis Tenodesis  Calcaneocavovarus and Cavovarus Deformity Associated With Arthritic Changes of The Subtalar and Midtarsal Joints Triple Arthrodesis Triple Arthrodesis Summary of Cavus Foot Evaluation and Treatment References Tarsal Tunnel Syndrome Interdigital Neuroma Cavus Foot Supplemental References Tarsal Tunnel Syndrome Morton Neuroma Cavus Foot 87 Disorders of Nails and Skin Anatomy Ingrown Toenail (Onychocryptosis, Unguis Incarnatus) Etiology Nonoperative Management  Stage I (Inflammatory Stage)  Stage II (Abscess Stage)  Stage III (Granulation Stage) Operative Management Total Nail Plate Removal Partial Nail Plate Removal Removal of the Nail Edge and Ablation of the Nail Matrix Partial Nail Plate and Matrix Removal Nail Plate and Germinal Matrix Removal Partial Nail Fold and Nail Matrix Removal Terminal Syme Procedure Dystrophic Nails (Onychogryposis, Onychomycosis) Other Lesions of the Nails Subungual Exostosis Subungual and Periungual Fibromas Glomus Tumor Malignant Melanoma References Supplemental References 88 Fractures and Dislocations of the Foot Fractures of the Calcaneus Intraarticular Fractures  Mechanism  Radiographic Evaluation  Classification  Treatment Decision Making in Calcaneal Fractures Age of the Patient. Health Status. Fracture Pattern. Soft Tissue Injury (Open Calcaneal Fractures) Open Reduction Techniques. Open Reduction of Calcaneal Fracture Subtalar Arthrodesis Open Reduction of Calcaneal Fracture: Medial and Lateral Approaches Tongue Fracture of the Calcaneus. Axial Fixation of Calcaneal Fracture Percutaneous Techniques. Percutaneous Reduction and Fixation of Calcaneal Fracture  Complications and Prevention Wound Necrosis, Dehiscence, and Infection Loss of Reduction of Major Fragments Malreduction Sural Nerve and Peroneal Tendon Injuries  Results  Late Complications Calcaneal Fracture Malunion Lateral Decompression of A Malunited Calcaneal Fracture Subtalar Arthrodesis Subtalar Distraction Bone Block Arthrodesis Extraarticular Fractures  Fractures of the Calcaneal Tuberosity  Fractures of the Sustentaculum Tali  Fractures of the Anterior Process of the Calcaneus Talar Fractures Anatomy Talar Head Fractures  Treatment Talar Neck Fractures  Treatment Type I Fractures Types II, III, and IV Fractures Open Reduction of the Talar Neck  Malunion of the Talar Neck  Osteonecrosis of the Talar Body after Talar Neck Fracture Onlay Graft Technique Through A Posterior Approach Talar Body Fractures Calcaneotibial Fusion Tibiotalar Arthrodesis Fractures of the Lateral or Posterior Process of the Talus  Lateral Process Fractures Open Reduction and Internal Fixation of Fractures of the Lateral Process of the Talus  Posterior Process Fractures Transchondral Fractures of the Talus Talar Body Extrusion Subtalar Dislocations Open Reduction of Subtalar Dislocation Midfoot Fractures and Dislocations Fracture-Dislocations of the Tarsometatarsal Articulation (Lisfranc Joint)  Classification  Evaluation and Treatment Open Reduction and Internal Fixation of Tarsometatarsal (Lisfranc) Fractures Metatarsals Fracture of the Proximal Portion of the Fifth Metatarsal Internal Fixation with A Malleolar Screw  Inlay Bone Graft Distal Fifth Metatarsal Fracture Stress Fractures of the Metatarsals Open Reduction and Plating of Lesser Metatarsal Stress Fracture  Complications Acute Fractures of the Metatarsals Phalangeal Dislocations Interphalangeal Joint of the Hallux Open Reduction of Dislocation of the Interphalangeal Joints of the Hallux First Metatarsophalangeal Joint Open Reduction of First Metatarsophalangeal Joint Dislocation Using A Midline Medial Approach Phalangeal Fractures Sesamoid Fractures Treatment Sesamoidectomy Bone Grafting of Sesamoid Nonunion Osteochondritis of the Sesamoid Other Conditions of the Sesamoid References Calcaneus Talus Midfoot Metatarsals Phalanges Sesamoids Supplemental References Calcaneus Talus Midfoot Metatarsals Phalanges Sesamoids 89 Sports Injuries of the Ankle Acute Ligamentous Injuries Anatomy Diagnosis  Inversion and Eversion Stress Tests  Anteroposterior Stress Test (Anterior Drawer Sign)  Magnetic Resonance Imaging Treatment  Repair of Acute Rupture of the Deltoid Ligament  Repair of Acute Rupture of the Ligaments of the Distal Tibiofibular Joint Repair of Acute Rupture of Ligaments of Distal Tibiofibular Joint  Repair of Acute Rupture of the Lateral Ligaments Repair of Acute Rupture of Lateral Ligaments Chronic Instability after Injury  Lateral Repair of Chronic Instability Lateral Repair of Chronic Instability (Watson-Jones, Modified) Lateral Repair of Chronic Instability (Evans) Lateral Repair of Chronic Instability (Chrisman-Snook) Lateral Repair of Chronic Instability (Karlsson et al.) Lateral Repair of Chronic Instability: modified Broström (Hamilton, Thompson, and Snow; Gould et al.) Lateral Repair of Chronic Instability (Eyring and Guthrie)  Medial Repair of Chronic Instability Deltoid Ligament Reconstruction with Peroneus Longus Autograft Peroneal Tendon Subluxation and Dislocation Internal Derangements Occult Lesions of the Talus and Calcaneus Sinus Tarsi Syndrome Osteochondral Ridges of the Talus and Tibia (Anterior and Posterior Impingement Syndromes) Osteochondral Lesions of the Talus (Osteochondral Fracture, Transchondral Fracture, Dome Fracture of the Talus) Medial Malleolar Osteotomy Posteromedial Arthrotomy Through Anteromedial Approach Approach to Posteromedial Ankle Through Posterior Tibial Tendon Sheath Osteochondral Autograft/Allograft Transplantation  Arthroscopic Treatment References Acute Ankle Ligament Injuries, Chronic Ankle Instability Osteochondral Lesions, Impingement Syndromes Supplemental References Acute Ankle Ligament Injuries, Chronic Ankle Instability Osteochondral Lesions, Impingement Syndromes Foot Injuries David Icke - Perceptions of a Renegade Mind-David Icke Books (2021) copy Copyright Title Page Dedication Contents Chapter 1: ‘I’m thinking’ – Oh, but are you? Chapter 2: Renegade perception Chapter 3: The Pushbacker sting Chapter 4: ‘Covid’: The calculated catastrophe Chapter 5: There is no ‘virus’ Chapter 6: Sequence of deceit Chapter 7: War on your mind Chapter 8: ‘Reframing’ insanity Chapter 9: We must have it? So what is it? Chapter 10: Human 2.0 Chapter 11: Who controls the Cult? Chapter 12: Escaping Wetiko Postscript Appendix: Cowan-Kaufman-Morell Statement on Virus Isolation Bibliography Index David Icke - Perceptions of a Renegade Mind-David Icke Books (2021)_compressed copy Copyright Title Page Dedication Contents Chapter 1: ‘I’m thinking’ – Oh, but are you? Chapter 2: Renegade perception Chapter 3: The Pushbacker sting Chapter 4: ‘Covid’: The calculated catastrophe Chapter 5: There is no ‘virus’ Chapter 6: Sequence of deceit Chapter 7: War on your mind Chapter 8: ‘Reframing’ insanity Chapter 9: We must have it? So what is it? Chapter 10: Human 2.0 Chapter 11: Who controls the Cult? Chapter 12: Escaping Wetiko Postscript Appendix: Cowan-Kaufman-Morell Statement on Virus Isolation Bibliography Index