Rockwood and Green's Fractures in Adults

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Copyright Dedication Contributors Preface 1: Biomechanics of Fractures and Fracture Fixation Introduction Basic Mechanical Concepts Material Properties Structural Properties Load Transfer Through Joints and Fractures Biomechanics of Fractures Traumatic Loads Resulting in Fracture Transverse Fractures Oblique Fractures Butterfly Fractures Spiral Fractures Comminuted Fractures Physiologic Loads During Normal Activities Upper Extremity Lower Extremity Crutch Ambulation Osteoporosis Fracture Risk Fixation Failure in Osteoporotic Bone Periprosthetic, Interprosthetic, and End Screw Fractures Periprosthetic Fractures Interprosthetic Fractures End Screw Fractures Bone Defect and Fracture Risk Biomechanical Aspects of Bone Healing Interplay Between Biology and Mechanics Natural Bone Healing Primary Bone Healing Delayed Union and Nonunion Fracture Fixation Strategies Targeting a Fracture-Healing Mode Fixation Strategies for Natural Bone Healing Fixation Strategies for Primary Bone Healing Creating a Durable Fixation Construct Minimizing Stress Concentrations Maximizing Working Length Fixation Constructs Biomechanical Characterization of Fixation Constructs Stiffness of Intramedullary Nail Constructs Stiffness of External Fixator Constructs Stiffness of Plate Constructs Construct Stiffness and Fracture Healing Improvement of Fracture Fixation Biomechanical Evaluation of Fixation Constructs Benefits and Limitations of Biomechanical Studies Specimen Selection Loading Considerations Loading Modes Specimen Constraints Loading Patterns Outcome Parameters Numerical Simulation Summary Annotated References References RELATED CONTENT Textbook Video 2: Bone, Cartilage, and Tendon Healing Introduction Bone Healing Cellular Components Tissues and Cells Inflammatory Cellular Components Progenitor Cell Populations Chondrocytes Osteoblasts Osteoclasts Myocytes Extracellular Matrix Vascular Neural Signaling Pathways Bone Morphogenetic Proteins Transforming Growth Factor a Notch Signaling Fibroblast Growth Factors Wnt Signaling Hedgehog Signaling Types of Bone Healing Endochondral Ossification Intramembranous Ossification Response to Load Modifying Factors How Clinical Treatments Alter Healing Nonoperative Management Operative Management Challenges and Emerging Therapeutics Nonunion Atrophic Nonunion Hypertrophic Nonunion Progenitor Cell Enhancement Cartilage Cartilage Healing Response to Isolated Chondral Injury Response to Osteochondral Injury Factors Influencing Cartilage Healing Gap Step-Off Loading and Motion Patient Age Response of Cartilage to Mechanical Injury Consequences of Cartilage Injury Modifiers of Cartilage Damage Tendon Structure, Function, and Cell Biology Tendon Diseases and Injuries Emerging Therapies for the Treatment of Tendon Disorders Platelet-Rich Plasma Autologous Stem Cells Conclusion Annotated References References RELATED CONTENT Video 3: Biologic and Biophysical Technologies for the Enhancement of Fracture Repair Introduction Bone Graft and Bone Graft Substitutes Autograft Allograft Bone Graft Substitutes Calcium Phosphate Calcium Sulfate Enhancement of Fracture Healing Using Cell-Based Therapies Mesenchymal Stem Cells Platelet Concentrates Bone Marrow Aspirates Systemic Enhancement of Fracture Healing Bone Morphogenetic Proteins Transforming Growth Factor β Wnt Fibroblast Growth Factor Vascular Endothelial Growth Factor Platelet-Derived Growth Factor Arachidonic Acid Metabolites Parathyroid Hormone Growth Hormone, Insulin-Like Growth Factors Other Pathways Statins Physical Enhancement of Skeletal Repair Electrical Stimulation Low-Intensity Pulsed Ultrasound Extracorporeal Shock Wave Therapy Conclusion Annotated References References RELATED CONTENT Video 4: Osteoporosis and Metabolic Bone Disease Introduction Anatomy and Physiology Bone Anatomy Bone Modeling and Remodeling Molecular Regulators of Bone Remodeling Bone Resorption Bone Formation Coupling Factors Osteoporosis Epidemiology Pathophysiology Genetics Diet Mechanical Loading Smoking Cannabis Alcohol Social Deprivation Comorbid Diseases Glucocorticoids Thyroxine Other Drugs Clinical Features Investigations Fracture Risk Assessment Radiography Biochemistry and Hematology Management Diet Exercise Smoking and Alcohol Other Interventions Drug Treatments Bisphosphonates Alendronic Acid Risedronate Zoledronic Acid Ibandronate Denosumab Teriparatide Abaloparatide Romosozumab Calcium and Vitamin D Hormone Replacement Therapy Raloxifene Tibolone Testosterone Combination Therapy Monitoring Response to Treatment Treatment Failure Paget's Disease of Bone Epidemiology Pathophysiology Genetics Environmental Factors Clinical Features Investigations and Diagnosis Management Bisphosphonates Other Antiresorptive Treatments Supportive Treatments Nonpharmacologic Treatments Orthopedic Surgery Duration of Treatment Osteomalacia and Rickets Epidemiology Pathophysiology Clinical Features Investigations Management Primary Hyperparathyroidism Epidemiology Pathophysiology Clinical Features Investigations Management Fibrous Dysplasia Osteogenesis Imperfecta Osteopetrosis Annotated References References RELATED CONTENT Video 5: Classification of Fractures Introduction History of Fracture Classification Purposes of Fracture Classification Systems Why Do We Classify Fractures? Descriptive Terminology Common Language Treatment and Prognosis Research Education Limitations of Fracture Classification Systems Reliability, Measurement, and Validity Reliability Validity Measurement Categorizing Continuous Variables: Injury Severity Current Classification of Fractures OTA/AO or AO/OTA Classification System History Fracture Location Fracture Morphology Fracture-Specific Classifications Proximal Humerus Calcaneus Classifications of Soft Tissue Injury Associated with Fractures Open Fractures Orthopaedic Trauma Association Open Fracture Classification Classification of Soft Tissue Injury Associated with Closed Fractures Summary Annotated References References RELATED CONTENT Textbook Video 6: The Epidemiology of Musculoskeletal Injury Introduction History Fracture Incidence The Incidence of Fractures in Adults Gender and Age Social Deprivation Fracture Distribution Curves Changing Epidemiology Variation in Epidemiology The Future Open Fractures Multiple Fractures Fragility Fractures Mortality Mode of Injury Falls From a Standing Height Falls From a Low Height Falls From a Height Direct Blows, Assaults, or Crush Injuries Sports Motor Vehicle Accidents Cyclists Motorcyclists Pedestrians Vehicle Drivers Vehicle Passengers Pathologic Fractures Stress and Spontaneous Fractures Other Modes of Injury Gunshot Injuries Specific Fracture Types Clavicle Scapula Proximal Humerus Humeral Diaphysis Distal Humerus Proximal Forearm Forearm Diaphyses Distal Radius and Ulna Carpus Metacarpus Finger Phalanges Proximal Femur Femoral Diaphysis Distal Femur Patella Proximal Tibia Tibial Diaphysis Fibula Distal Tibia Ankle Talus Calcaneus Midfoot Metatarsus Toes Pelvis and Acetabulum Spine Epidemiology of Adolescent Fractures The Epidemiology of Dislocations Shoulder Dislocations Sternoclavicular and Acromioclavicular Dislocations Elbow Dislocations Wrist and Hand Dislocations Hip Dislocations Knee Dislocations Ankle and Foot Dislocations The Epidemiology of Tendinous and Ligament Injuries Hand and Forearm Injuries Knee Injuries Achilles Tendon Rupture Other Injuries Annotated References References RELATED CONTENT Textbook Video 7: Imaging Considerations in Orthopedic Trauma General Considerations Availability Image Resolution Invasiveness Cost-Effectiveness Patient Risk Surgeon Risk Specific Imaging Modalities Radiography Technical Considerations Conventional Radiography Portable Radiography Digital Radiography Applications Fluoroscopy Technical Considerations Conventional Fluoroscopy Digital Fluoroscopy Two- and Three-Dimensional Fluoroscopy Applications Intraoperative Imaging Surgical Navigation Computed Tomography Technical Considerations Dual-Energy/Spectral CT Applications Complex Fractures Postoperative Evaluation of Fracture Reduction Healing of Fractures Evaluation of Combat Injuries Magnetic Resonance Imaging Technical Considerations Applications Osseous Injury Soft Tissue Injury Orthopedic Hardware Arthrography Technical Considerations Conventional Arthrography CT and MR Arthrography Applications Upper Extremity Lower Extremity Pediatric Injuries Dynamic Imaging Ultrasonography Technical Considerations Conventional Ultrasonography Doppler US Applications Fractures Fracture Healing Soft Tissue Trauma Venous Thromboembolism Nuclear Medicine Imaging Technical Considerations Skeletal Scintigraphy Marrow Imaging Gallium Imaging White Blood Cell Imaging Applications Fractures Infection Osteonecrosis Angiography Technical Considerations Conventional Angiography Computed Tomography Angiography Applications Vascular Trauma Management of Imaging Data Distribution of Imaging Information Picture Archive and Communications Systems Digital Imaging and Communications in Medicine Standards Digital Imaging and Teleradiology in Orthopedics Digital Imaging Teleradiology Annotated References References RELATED CONTENT Textbook Video 8: Outcome Studies in Trauma Introduction Evidence-Based Orthopedics The Hierarchy of Evidence The Impact of High-Quality Studies in Trauma Case Study: TRUST Trial Clinical Study Designs in Trauma Research Randomized Trial Expertise-Based Randomized Trial Observational Study Prospective Cohort Study Case-Control Study Retrospective Case Series Case Study: The FAITH Trial of Hip Fractures Synthesizing Evidence in Trauma Systematic Review and Meta-Analysis Network Meta-Analysis Summarizing Evidence (the GRADE Approach) Case Study: Open Fracture Network Meta-Analysis Measuring Value in Trauma Fundamentals of Statistics in Trauma Outcome Studies Hypothesis Testing, the p-Value, and Statistical Significance Descriptive Statistics: Measures of Central Tendency and Spread Reporting a Treatment Effect Common Statistical Approaches Comparing Continuous Data: Two Groups Comparing Continuous Data: Three or More Groups Comparing Dichotomous Data Determining Association Between Two Variables Issues in the Design and Interpretation of Orthopedic Studies Type I (α) Error and Type II (β) Error Case Study: The SPRINT Trial (Reamed Versus Unreamed Tibial Nails) When to Believe a Subgroup Analysis The Minimal Clinically Important Difference Study Power and Sample Size Calculation Fragility: A New Concept to Assess Validity of Results Case Study: FAITH Subgroup Analyses When is a Study Truly Negative or Truly Positive? Guide to Interpretation of Results Measuring Patient Health and Function Health-Related Quality of Life Floor and Ceiling Effects Common Outcome Instruments Used in Trauma The Road Ahead Gaps and Opportunities Conclusion Annotated References References RELATED CONTENT Textbook Video 9: Principles of Nonoperative Management of Fractures Introduction History of Nonoperative Fracture Treatment Epidemiology of Nonoperative Fracture Treatment The Effect of Age Fractures in the Elderly Fracture Severity Mode of Injury Techniques of Nonoperative Management Traction Spinal Traction Cervical Spine Cranial Tongs Halo Rings Halo-Body Fixation Complications Thoracolumbar Spine Casts Cast Application Types of Cast Upper Limb Casts Long Arm Cast Hanging Cast or U-Slab Colles Cast (Forearm Cast) Scaphoid Cast Bruner Cast Burkhalter Cast James Cast Other Upper Limb Casts Lower Limb Casts Below-Knee Cast Long-Leg Cast Patellar Tendon-Bearing Cast Spinal Casts Braces Limb Braces Upper Limb Humeral Brace Distal Forearm Brace Metacarpal Brace Lower Limb Below-Knee Brace Patellar Tendon-Bearing Brace Knee Brace Spinal Braces Cervical Braces Thoracic and Lumbar Braces Casts or Braces? Tibial Diaphyseal Fractures Distal Radial Fractures Ankle Fractures Slings, Bandages, and Support Strapping Splints Specific Fractures Upper Limb Fractures Clavicle Fractures Scapular Fractures Floating Shoulder Proximal Humeral Fractures Humeral Diaphyseal Fractures Distal Humeral Fractures Proximal Forearm Fractures Proximal Radial Fractures Olecranon Fractures Other Proximal Forearm Fractures Forearm Fractures Distal Radial Fractures Carpal Fractures Metacarpal Fractures Finger Phalangeal Fractures Lower Limb Fractures Proximal Femoral Fractures Femoral Diaphyseal Fractures Distal Femoral Fractures Patella Fractures Proximal Tibial Fractures Tibial Diaphyseal Fractures Fibular Fractures Distal Tibial Fractures Ankle Fractures Talar Fractures Calcaneal Fractures Midfoot Fractures Metatarsal Fractures Toe Fractures Pelvic and Acetabular Fractures Spinal Fractures Specific Fracture Types Periprosthetic Fractures Stress Fractures Pathologic Fractures The Future of Nonoperative Fracture Treatment Annotated References References RELATED CONTENT Textbook Video 10: Principles of External Fixation Introduction Historical Perspective Origins of Monolateral External Fixation World War II Use of External Fixation Contemporary Monolateral External Fixation Evolution Circular External Fixation Frame Types, Biomechanics, and Components Large Pin Fixation Pin Design Pin Biomaterials and Biocompatibility Pin Insertion Technique and Pin–Bone Interface Mechanics Simple Monolateral Frames Monotube Fixators Monolateral Pin Orientation and Frame Stability Small Wire Circular Frame Fixation Wires Wire Tension Ring Diameter Wire Orientation Limb Position in the Ring Wire Connecting Bolts Hybrid Fixators Biology of External Fixation and Distraction Histogenesis Basic Biology Dynamization Fracture Healing with Limited ORIF Combined with External Fixation Biology of Distraction Osteogenesis Contemporary External Fixator Applications Damage Control External Fixation Small Wire External Fixation Bone Transport Hexapod Fixators External Fixator Frame Management Pin Insertion Technique Pin Care Frame Removal Frame Reuse Fixator-Related Complications Infection Premature Consolidation and Refracture Contractures Conclusion Annotated References References RELATED CONTENT Video 11: Principles and Biomechanics of Internal Fixation Principles of Internal Fixation Principles of Intramedullary Nailing Reamed Versus Unreamed Intramedullary Nailing Interlocking: Static Interlocking Versus Dynamic Interlocking Versus No Interlocking Compression Nailing Exchange Nailing Principles of Plate and Screw Constructs Screw Function and Design Cortical Versus Cancellous Screws Lag Screws Cannulation Locking Plate Function Neutralization Plating Compression Plating Buttress and Antiglide Plating Tension Band Constructs Bridge Plating Locked Plating Biomechanics of Internal Fixation General Biomechanical Principles Mechanobiology of Fracture Healing Working Length Stress Risers Biomechanics of IM Nails Torsion and Bending Mechanics Effects of Interlocking Biomechanics of Plate–Screw Constructs Nonlocked Constructs Locked Constructs Modulation of Implant Stiffness and Fatigue Implant Fatigue Material Properties Biomechanics of Multiple Implants Fixation Around Hip and Knee Arthroplasty Modes of Mechanical Failure of Fixation Devices Screw Breakage During Insertion Screw–Bone Interface Failure Stripping During Insertion Driver Interface Late Screw Loosening Failure by Cyclic Loading Screw Failure Plate Failure Locking Constructs Plate Failure Through a Screw Hole Annotated References References RELATED CONTENT Textbook Video 12: Templating and Technical Tricks in Internal Fixation Introduction Templating in Preoperative Planning Reduction Techniques Fracture Compression Techniques Fracture Distraction and Lengthening Techniques Direct Fracture Manipulation Techniques Implant-Aided Reduction and Stabilization Techniques Screws Plates Nails Future Directions: Patient-Specific Implants Annotated References References RELATED CONTENT Textbook Video 13: Management of the Multiply Injured Patient Philosophy Initial Assessment of the Trauma Patient Primary Survey Airway Breathing Circulation Disability Exposure Secondary Survey Tertiary Survey Role of the Orthopedic Surgeon Clinical Presentation Shock Hypovolemic Cardiogenic Neurogenic Septic Causes of Mortality Injury Scoring Initial Management Resuscitation Open Fractures Traumatic Arthrotomy Gunshot Wounds Fractures and Dislocations Long Bone Fractures Dislocations Management of Injuries to Other Systems Head Injury Chest Injury Chest Wall Pulmonary Cardiac Abdominal Injury Hepatic Splenic Intestinal Renal Pelvic Injury Rectal Injury Bladder Rupture Urethral Injury Timing of Management of Orthopedic Injury Benefits of Early Care Risks of Early Care Indications for Damage Control Techniques of Damage Control Principles of Early Definitive Management Management of Spinal Injury Cervical Spine Thoracolumbar Spine Controversies in Care Timing of Definitive Management Indications for Pelvis Angiography Fractures Associated with Severe Head Injury Fractures Associated with Vascular Injury Limb Salvage versus Amputation Patient Challenges in Care Obesity Diabetes Cardiovascular Disease Immunocompromise Elderly Patients Mental Illness Social Factors Recreational Substance Abuse Alcohol Abuse Tobacco Abuse System Challenges to Care Optimizing Recovery Nutrition Patient Engagement Acknowledgments Annotated References References 14: Gunshot and Wartime Injuries Wartime Injuries Introduction to Wartime Injuries Physics of Explosion Effect of Blast on the Musculoskeletal System Primary Orthopedic Blast Injury Secondary Orthopedic Blast Injury Combined Primary and Secondary Orthopedic Injuries Tertiary Orthopedic Injuries Quaternary Orthopedic Blast Injury Special Effects of Explosion Closed Explosion Versus Free Field Explosion Suicide Bombings Management of Blast Injury Prehospital Care Hospital Care Hemostatic Resuscitation Damage Control Surgery Acute Management of the Injured Extremity Antibiotic Prophylaxis Immunization Debridement Other Soft Tissue Structures Management of Small Fragment Injuries Compartment Syndrome Management of Skeletal Injury Amputations Ongoing Care and Reconstruction Definitive Fracture Stabilization Soft Tissue Reconstruction Gunshot Wounds Introduction Types of Guns Shotguns Handguns and Rifles Ammunition Wound Ballistics Bullet–Tissue Interface Evaluation and Management of Gunshot Wounds Initial Evaluation Management of Low-Velocity Gunshot Wounds Management of High-Velocity Gunshot Wounds Antibiotics Regimen Wound Debridement Retained Fragments Intra-articular Injuries Transabdominal Gunshot Injuries Vascular Injuries Nerve Injuries Initial Skeletal Fixation Summary Annotated References References 15: Initial Management of Open Fractures Introduction Pathophysiology Assessment Initial Evaluation Examination Role of Cultures in the Emergency Department Antibiotics Radiographic Imaging and Other Diagnostic Studies Role of Biochemical Markers CRP Interleukins Serum Lactate Classifications and Scores for Open Fractures Mangled Extremity Severity Score Ganga Hospital Open Injury Score Salvage or Amputation? Treatment Options Debridement and Lavage Lavage Use of Tourniquets Superficial Debridement Deep Debridement Bone Skeletal Stabilization Plaster Casts and Traction External Skeletal Fixation Primary Internal Fixation Plate Fixation Intramedullary Nails Acute Management of Bone Loss Wound Cover Primary Closure of Wounds Timing of Wound Cover Zone of Injury Source of Infection in Open Injuries The Timing of Soft Tissue Cover Type of Cover Negative-Pressure Wound Therapy Application of NPWT Device Clinical Effects Complications Author's Preferred Treatment Annotated References References RELATED CONTENT Video 16: Acute Compartment Syndrome Introduction to Acute Compartment Syndrome History Epidemiology Pathogenesis Effects of Raised Tissue Pressure on Muscle Effects of Raised Tissue Pressure on Nerve Effects of Raised Tissue Pressure on Bone Reperfusion Injury Diagnosis of Acute Compartment Syndrome Clinical Diagnosis Pain Paresthesia Paralysis Swelling Diagnostic Performance Characteristics Compartment Pressure Monitoring Noninvasive Techniques Invasive Techniques Catheter Placement Threshold for Decompression in Acute Compartment Syndrome Timing Clinical Signs Versus ICP Monitoring Diagnostic Performance Characteristics Surgical and Applied Anatomy Thigh Leg Foot Arm Forearm Hand Treatment of Acute Compartment Syndrome Fasciotomy Technique Leg Double-Incision Four-Compartment Fasciotomy of the Leg: Key Surgical Steps Thigh Foot Arm Forearm Hand Management of Fasciotomy Wounds Management of Associated Fractures Authors' Preferred Treatment for Acute Compartment Syndrome (Algorithm 16-1) Complications of Acute Compartment Syndrome Late Diagnosis Future Directions for Research Annotated References References RELATED CONTENT Textbook Video 17: Principles of Mangled Extremity Management Introduction Historical Background Principles of Management Initial Evaluation Vascular Assessment Salvage Versus Amputation Decision Making Survivability Plantar Sensation Decision-Making Protocols and Limb Salvage Scores Additional Important Factors Concomitant Foot and Ankle Injuries Mangled Foot Smoking Patient Characteristics Management Operative Debridement and Stabilization Skeletal Stabilization Hyperbaric Oxygen Soft Tissue Coverage Rehabilitation of the Mangled Extremity Outcomes: Amputation Versus Limb Salvage Clinical Practice Considerations Psychological Considerations Military Trauma Care Bone-Anchored Implant Systems for Prosthetic Attachment Upper Extremity Summary Annotated References References RELATED CONTENT Video 18: Soft Tissue Coverage for Injuries and Fractures Introduction to Soft Tissue Coverage for Injuries and Fractures The Effect of Traumatic Injury on Decision-Making Wound Assessment Anatomic Considerations in Wound Healing and Flap Design for the LOWER Limb Segment Vascular Anatomy Use of Exploratory Incisions in Fasciocutaneous Flaps Musculoskeletal Anatomy Posterior Muscles Lateral Muscles Anterior Muscles Muscles of the Thigh Operative Treatment of Soft Tissue Defects Pedicled Perforator Flaps, Advancement Flaps, Propeller Flaps, and Keystone Flaps Medial Gastrocnemius Muscle Axial Rotation Flap Indications/Contraindications Preoperative Planning Medial Gastrocnemius Muscle Axial Rotation Flap: Preoperative Planning Checklist Technique Medial Gastrocnemius Muscle Axial Rotation Flap: Key Surgical Steps Postoperative Care Lateral Gastrocnemius Muscle Axial Rotation Flap Indications/Contraindications Preoperative Planning Lateral Gastrocnemius Muscle Axial Rotation Flap: Preoperative Planning Checklist Technique Lateral Gastrocnemius Muscle Axial Rotation Flap: Key Surgical Steps Postoperative Care Medial Hemisoleus Muscle Flap Indications/Contraindications Preoperative Planning Medial Hemisoleus Muscle Flap: Preoperative Planning Checklist Technique Medial Hemisoleus Muscle Flap: Key Surgical Steps Postoperative Care Peroneus Brevis Muscle Flap Indications/Contraindications Preoperative Planning Peroneus Brevis Muscle Flap: Preoperative Planning Checklist Technique Peroneus Brevis Muscle Flap: Key Surgical Steps Postoperative Care Reverse Sural Artery Adipofascial Cutaneous Flap Indications/Contraindications Preoperative Planning Reverse Sural Artery Adipofascial Cutaneous Flap: Preoperative Planning Checklist Technique Reverse Sural Artery Adipofascial Cutaneous Flap: Key Surgical Steps Postoperative Care Keystone Fasciocutaneous Flap Indications/Contraindications Preoperative Planning Keystone Fasciocutaneous Flap: Preoperative Planning Checklist Technique Keystone Fasciocutaneous Flap: Key Surgical Steps Postoperative Care Authors' Preferred Treatment for Tibial Soft Tissue Defects (Algorithm 18-1) Potential Pitfalls and Preventive Measures Pedicled Perforator Flaps, Advancement Flaps, Propeller Flaps, and Keystone Flaps: Surgical Pitfalls and Preventions Outcomes Medial Gastrocnemius Muscle Axial Rotation Flap Lateral Gastrocnemius Muscle Axial Rotation Flap Medial Hemisoleus Muscle Flap Peroneus Brevis Muscle Flap Reverse Sural Artery Adipofascial Cutaneous Flap Keystone Fasciocutaneous Flap Annotated References References RELATED CONTENT Textbook Video 19: Principles of Nerve Injuries and Their Management Introduction Structure of Peripheral Nerves Relevant Physiology and Microanatomy Relevant Surgical Anatomy Nerve Reaction to Injury, Degeneration, and Regeneration Compression Neuropathy Traumatic Injury Conduction Block Axonal Degeneration Axonal Regeneration Summary Mechanism of Nerve Injury Classification of Nerve Injuries Neurapraxia Axonotmesis Neurotmesis Sunderland's Classification Summary Clinical Assessment of Nerve Injuries Motor Function Sensory Function Autonomic Function Record Keeping Investigations Clinical Neurophysiology Magnetic Resonance Imaging Ultrasound Angiography Principles of Management of Nerve Injuries Open Injuries Closed Injuries Acute Nerve Compression Nerve Injuries Associated with Treatment Nontraumatic Causes of Peripheral Nerve Dysfunction Nerve Exploration and Repair Surgical Exposure Intraoperative Neurophysiology Direct Nerve Suture Nerve Tubes Non-Neural Grafts Nerve Grafting Surgical Technique Harvesting Nerve Grafts Nerve Transfers Secondary Exploration and Repair of Nerves Neurolysis Secondary Repair with Nerve Grafts Postoperative Management Monitoring Recovery and Assessment of Outcome General Factors Influencing Recovery After Nerve Injury Delay Distance of Injury From End Organs Type of Nerve Secondary Reconstruction for Nerve Injury Tendon Transfer Other Reconstructive Procedures Nerve Injuries Associated with Specific Fractures and Dislocations Supraclavicular Brachial Plexus Infraclavicular Brachial Plexus, Shoulder Dislocation, and Proximal Humeral Fracture Radial Nerve Injury and Humeral Fractures Fractures and Dislocations of the Elbow Fractures of the Forearm and Wrist Open Injuries to the Hand and Wrist Pelvic Fractures Hip Dislocation and Acetabular Fractures Fractures and Dislocations of the Knee Acknowledgments Annotated References References RELATED CONTENT Video 20: Limb Amputation After Trauma Introduction to Limb Amputation Principles of Limb Amputation Residual Limb Length Weight Bearing Muscle Balancing Amputation as Part of Damage Control Orthopedics Decision Making in Amputation Limb Amputation or Reconstruction Determining the Appropriate Amputation Level Outcomes After Limb Amputation Outcome Measures for Amputation Technical Considerations of Limb Amputation Myoplasty and Myodesis Neurovascular Transection Dressings and Drains Transtibial Amputation Preoperative Planning Transtibial Amputation: Preoperative Planning Checklist Positioning Surgical Approach Technique Transtibial Amputation: Key Surgical Steps Knee Disarticulation Preoperative Planning Knee Disarticulation: Preoperative Planning Checklist Positioning Surgical Approach Technique Knee Disarticulation: Key Surgical Steps Transfemoral Amputation Preoperative Planning Transfemoral Amputation: Preoperative Planning Checklist Positioning Surgical Approach Technique Transfemoral Amputation: Key Surgical Steps Authors' Preferred Method for Amputation Decision Making (Algorithms 20-1 and 20-2) Postoperative Care Potential Pitfalls and Preventive Measures Amputation: Surgical Pitfalls and Preventions Management of Expected Adverse Outcomes and Unexpected Complications Related to Amputation Amputation: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Amputation Osseointegration The Ertl Procedure Annotated References References RELATED CONTENT Textbook Video 21: Psychosocial Aspects of Recovery After Trauma Introduction A Therapeutic Relationship Psychosocial Aspects of Recovery Specific Psychological Issues Psychological Distress (Depression and Anxiety) Isolation and Loneliness Opioid Misuse Stressful Life Alterations with Injury Assessing the Experience of Injury How Surgeons Can Ameliorate the Psychosocial Aspects of Recovery from Injury The Effect of Trauma on the Surgeon Treatment Options Limitations Summary, Controversies, and Future Directions Annotated References References RELATED CONTENT Textbook Video 22: Obesity and Diabetes in Orthopedic Trauma Obesity Scope and Burden Financial Implications Basic Science of Obesity Initial Evaluation and Management Injury Patterns Initial Bony Stabilization Resuscitation Anesthesia Considerations Preoperative Imaging Intraoperative Considerations Positioning Fracture-Specific Care Proximal Humerus Humeral Diaphysis Distal Humerus Elbow Forearm Wrist Pelvic Ring and Acetabulum Peritrochanteric/Subtrochanteric Femur Fractures Femoral Diaphysis Supracondylar Femur Periarticular Tibia Fractures Tibial Diaphysis Rotational Ankle Fractures/Syndesmotic Injuries Postoperative Care and Complication Prevention Respiratory Failure Pharmacokinetics/Analgesia Renal Failure/Multiorgan Failure Thromboembolic Disease Medical Co-Management Mortality Delayed Recovery Diabetes Mellitus Introduction Epidemiology of Diabetes Mellitus Diagnosis Orthopedic Pathophysiology Bone Metabolism/Fracture Healing Vasculopathy/Angiopathy Infection Fall Risk Peripheral Neuropathy Charcot Arthropathy Glucose Management Evaluating Diabetic Control Perioperative Glucose Management Annotated References References RELATED CONTENT Textbook Video 23: Stress Fractures Historical Perspective Pathophysiology Risk Factors Neuromuscular Hypothesis Caloric Insufficiency and the Female Triad Male Endurance Athlete Tetrad Vitamin D Insufficiency Stress Fracture Versus Insufficiency Fracture Diagnosis Clinical Presentation Imaging Classification/Grading High-Risk Stress Fractures Versus Low-Risk Stress Fractures Management of High-Risk Stress Fractures Return to Sports Participation Management of Low-Risk Stress Fractures Return to Sports Participation Upper Extremity Stress Fractures Authors' Preferred Treatment for Stress Injuries of Bone (Algorithms 23-1) Vertebral Stress Fractures Pelvic and Sacral Stress Fractures Lower Extremity Stress Fractures Femur Femoral Neck Femoral Shaft Knee and Lower Leg Stress Fractures Patella Tibial Shaft Medial Malleolus Fibula Stress Fractures of the Foot Calcaneus Tarsal Navicular Metatarsal Stress Fractures First Through Fourth Metatarsals Fifth Metatarsal Sesamoids Prevention of Stress Injuries Biologic Modalities and Future Treatment Options Summary Annotated References References 24: Pathologic Fractures Introduction Demographics Evaluation of the Patient with an Impending or Actual Pathologic Fracture Clinical Evaluation History Physical Examination Laboratory Studies Associated Medical Problems Imaging Studies Plain Radiographs Nuclear Medicine Studies Additional Staging and Three-Dimensional Studies Biopsy Impending Pathologic Fractures Classification Systems Authors' Preferred Treatment for Pathologic Fractures Treatment Options for Patients with Metastatic or Systemic Disease General Considerations Nonoperative Treatment Operative Treatment Upper Extremity Fractures Scapula/Clavicle Proximal Humerus Humeral Diaphysis Distal Humerus Forearm/Hand Pelvic/Acetabular Fractures Lower-Extremity Fractures Femoral Neck Intertrochanteric Region Subtrochanteric Region Femoral Diaphysis Supracondylar Femur Tibia Spinal Fractures Kyphoplasty/Vertebroplasty Complications Adjuvant Radiation and Medical Treatment External Beam Radiation Systemic Radionucleotides Bisphosphonates Controversies and Future Directions Treatment Options for Patients with Pathologic Fractures Through Primary Bone Tumors Benign Bone Tumors Unicameral Bone Cyst Aneurysmal Bone Cyst Eosinophilic Granuloma Nonossifying Fibroma Enchondroma Fibrous Dysplasia Giant Cell Tumor Malignant Bone Tumors Osteosarcoma and Ewing Sarcoma Chondrosarcoma Summary and Key Points Annotated References References RELATED CONTENT Textbook 25: Venous Thromboembolic Disease in Patients with Skeletal Trauma Introduction Pathophysiology Thromboembolic Risk Factors Trauma-Related Risk Factors Injury Severity Score Spinal Cord Injury Fracture-Related Risk Factors Nontraumatic Risk Factors Risk Assessment Venous Thromboembolism Prophylaxis in Orthopedic Trauma Options Chemical Prophylaxis (Table 25-3) Aspirin Unfractionated Heparin Low–Molecular-Weight Heparin Fondaparinux Novel Oral Anticoagulants Timing of Chemical Prophylaxis Administration Mechanical Prophylaxis Graduated Compressive Stockings Intermittent Pneumatic Compression Inferior Vena Cava Filters Prophylaxis Based on Orthopedic Trauma Isolated Foot/Ankle Trauma Upper Extremity Trauma Isolated Fractures of Pelvis, Femur, or Tibia Author's Preferred Prophylaxis for Deep Vein Thrombosis (Algorithms 25-1) Geriatric Hip Fractures Polytrauma (Injury Severity Score >10) Diagnosis of Venous Thromboembolism Treatment of Venous Thromboembolism Conclusion Annotated References References RELATED CONTENT Textbook Video 26: Complex Regional Pain Syndrome Introduction Some Important Definitions Late Phase of CRPS Bone Changes Incidence Etiology Psychological Abnormalities Abnormal (Neuropathic) Pain Sympathetic Nervous System Abnormalities Abnormal Inflammation and Immune Dysfunction Immobilization and Failure to Use the Affected Limb Making a Diagnosis Clinical Diagnosis in an Orthopedic Setting Pain Vasomotor Instability Abnormal Sweating Edema and Swelling Loss of Joint Mobility and Atrophy Bone Changes Other Clinical Examinations Investigations Differential Diagnosis Management Conclusion Annotated References References 27: Perioperative Pain Management of Fractures Introduction Assessment of Pain Pain Medication Preoperative Implications Perioperative Management Peripheral Nerve Blockade Intravenous Pain Medications Oral Pain Medications Authors' Preferred Method of Pain Management Pain Management During Recovery Mental Health and Pain Management Future Directions Annotated References References RELATED CONTENT Textbook Video 28: Osteomyelitis and Other Orthopedic Infections Historical Perspective Definitions Orthopedic-Related Infections Cellulitis Surgical Site Infections Septic Arthritis Periprosthetic Joint Infections Fracture-Related Infections Osteomyelitis Classification of Osteomyelitis Epidemiology of Osteomyelitis Predisposing Factors Pathogenesis of Osteomyelitis Initiation of Infection Role of Biofilm Propagation of Infection Common Pathogens Culture-Negative Infection Clinical Presentation of Osteomyelitis Diagnosis of Orthopedic Infection Choice of Radiologic Investigations Plain Radiography Computed Tomography Magnetic Resonance Imaging Ultrasonography Nuclear Medicine Imaging Bone Scintigraphy Leucocyte Scintigraphy Positron Emission Tomography Laboratory Diagnostic Tests Serum Tests Microbiologic Testing Polymerase Chain Reaction Sonication Dithiothreitol Histopathology Differential Diagnosis Principles of Treatment of Osteomyelitis Systemic Antibiotic Treatment Nonbiodegradable Antibiotic-Delivery Devices Biodegradable Antibiotic-Delivery Devices Natural Polymers Bone Graft Substitutes Synthetic Polymers Surgical Treatment of Osteomyelitis Surgical Debridement Management of Critical Size Bone Defects Management of Dead Space Amputation Hyperbaric Oxygen Therapy Complications of Osteomyelitis Summary, Controversies, and Future Directions Related to Osteomyelitis Annotated References References RELATED CONTENT Video 29: Principles of Nonunion and Bone Defect Treatment Introduction to Nonunions Pathophysiology, Etiology, and Risk Factors for Nonunion Fracture-Specific Factors Related to Nonunion Host Factors Related to Nonunion Diabetes Smoking Nonsteroidal Anti-Inflammatory Drugs Hypovitaminosis D Other Medications and Systemic Conditions Treatment Factors Related to Nonunion Infection as a Factor Related to Development of Nonunion Classification of Nonunion Atrophic Nonunion Hypertrophic Nonunion Oligotrophic Nonunion Pseudoarthrosis Bone Defects Evaluation and Diagnosis of Nonunion History and Physical Examination Related to Nonunion Radiographic Assessment of Nonunion Plain Radiographs Computed Tomography Nuclear Imaging Laboratory Studies for the Diagnosis of Nonunion Prediction of Nonunion Nonunion Treatment Objectives and General Principles of Nonunion Treatment Soft Tissue Management Associated with Nonunion Indications and Contraindications for Nonoperative and Operative Treatment Nonoperative Treatment of Nonunion Indirect Nonoperative Treatment Interventions Weight Bearing and External Stabilization Electrical Stimulation Ultrasound Stimulation Extracorporal Shock Wave Therapy Parathyroid Hormone Gene Therapy Operative Treatment of Nonunion Timing of Operative Intervention Plate and Screw Fixation for Nonunion Repair IM Nailing of Nonunions Primary and Exchange Nailing Dynamization Combined Plate and Nail Treatment of Nonunions External Fixation for Nonunion Treatment Arthroplasty for Nonunion Treatment Amputation for Nonunion Treatment Arthrodesis for Nonunion Treatment Fragment Excision and Resection Arthroplasty for Nonunion Treatment Osteotomy for Nonunion Treatment Synostosis for Nonunion Treatment Percutaneous Management of Nonunions Long-Term Outcomes and Risk Factors for Nonunion Repair Failure Bone Grafts and Other Adjuncts to Operative Nonunion Repair Autogenous Bone Graft Iliac Crest Bone Graft Alternative Sites for Autologous Bone Graft Harvest Reamer-Irrigator-Aspirator Vascularized Grafts Bone Graft Substitutes and Other Modifiers of Bone Healing Recombinant Proteins Demineralized Bone Matrix Bone Marrow Aspirate Allograft and Ceramics Graft Site Preparation Special Circumstances in the Treatment of Nonunions and Bone Defects Managing Articular Nonunion Managing Bone Defects and Segmental Bone Loss Autogenous Bone Grafting Using the Masquelet Technique Ilizarov Techniques for Bone Defects Management of Infected Nonunions Management of Soft Tissue Compromise Associated with Nonunion Author's Preferred Treatment for Nonunions (Algorithm 29-1) Annotated References References RELATED CONTENT Textbook Video 30: Principles of Malunion Treatment Evaluation Clinical Radiographic Limb Alignment Long Bone Anatomic Axes Mechanical Axes Joint Orientation Lines Joint Orientation Angles Center of Rotation of Angulation Evaluation of the Various Deformity Types Length Angulation Rotation Translation Treatment Osteotomies Wedge Osteotomy Dome Osteotomy Treatment by Deformity Type Length Angulation Rotation Translation Combined Deformities Treatment by Deformity Location Shaft (Diaphyseal Malunions) Periarticular (Metaphyseal and Epiphyseal Malunions) Treatment by Method Plate and Screw Fixation Intramedullary Nail Intramedullary Lengthening Nail Ilizarov Techniques Distraction Lengthening Complex Combined Deformities Annotated References References RELATED CONTENT Textbook Video 31: Acromioclavicular and Sternoclavicular Joint Injuries Introduction to Acromioclavicular and Sternoclavicular Joint Injuries Assessment of Acromioclavicular and Sternoclavicular Joint Injuries Mechanisms of Injury for Acromioclavicular and Sternoclavicular Joint Injuries Injuries Associated with Acromioclavicular and Sternoclavicular Joint Injuries Glenohumeral Intra-Articular Pathology Fractures Brachial Plexus Abnormalities Coracoclavicular Ossification Osteolysis of the Distal Clavicle Other Conditions Scapulothoracic Dissociation Signs and Symptoms of Sternoclavicular and Acromioclavicular Joint Injuries Clinical Presentation and History Physical Examination Examination Findings Based on Grade of Acromioclavicular Joint Injury Type I Injury Type II Injury Type III Injury Type IV Injury Type V Injury Type VI Injury Imaging and Other Diagnostic Studies for Acromioclavicular and Sternoclavicular Joint Injuries Imaging for Acromioclavicular Joint Injuries Imaging of Sternoclavicular Joint Injuries Radiography Computed Tomography Magnetic Resonance Imaging Ultrasonography CT Angiography Classification of Acromioclavicular and Sternoclavicular Joint Injuries Classification of Acromioclavicular Joint Injuries Tossy–Rockwood Classification of Acromioclavicular Joint Injuries Normal Joints Type I Injury Type II Injury Type III Injury Type IV Injury Type V Injury Type VI Injury Classification of Sternoclavicular Joint Injuries Anatomic Classification Atraumatic Problems Traumatic Injuries Joint Injury Physeal Injury Outcome Measures for Acromioclavicular and Sternoclavicular Joint Injuries Pathoanatomy and Applied Anatomy Relating to Acromioclavicular and Sternoclavicular Joint Injuries Anatomy of the Acromioclavicular Joint Acromioclavicular Ligaments Coracoclavicular Ligament Biomechanics Motion Anatomy of the Sternoclavicular Joint Intra-Articular Disc Ligament Costoclavicular Ligament Interclavicular Ligament Capsular Ligament Range of Motion Treatment Options for Acromioclavicular and Sternoclavicular Joint Injuries Nonoperative Treatment of Acromioclavicular Joint Injuries Indications Nonoperative Treatment of Acromioclavicular Joint Injuries: Indications and Contraindications Technique Outcomes Nonoperative Treatment of Sternoclavicular Joint Injuries Closed Reduction of Sternoclavicular Joint Dislocation Techniques Abduction Traction Technique Adduction Traction Technique (Buckerfield–Castle Technique) Direct Reduction with Towel Clip Acute Posterior Physeal Injuries of the Medial Clavicle Chronic Posterior Physeal Injuries of the Medial Clavicle Operative Treatment of Acromioclavicular Joint Injuries Indications/Contraindications Type III/V Variants Historical and Classic Techniques Chronic Acromioclavicular Injuries Anatomic Coracoclavicular Ligament Reconstruction Preoperative Planning Anatomic Coracoclavicular Ligament Reconstruction: Preoperative Planning Checklist Positioning and Surgical Approach Technique Anatomic Coracoclavicular Ligament Reconstruction: Key Surgical Steps Postoperative Care Arthroscopic Treatment Outcomes Potential Pitfalls and Preventive Measures Acromioclavicular Joint Injuries: Surgical Pitfalls and Preventions Operative Treatment of Sternoclavicular Joint Injuries Resection of the Medial End of the Clavicle Surgical Repair of the Scapuloclavicular Joint Preoperative Planning Surgical Repair of the Scapuloclavicular Joint: Preoperative Planning Checklist Technique Acute Repair of Posterior Dislocation Acute Repair of Posterior Dislocation: Key Surgical Steps Acute Repair with Medial Clavicle Resection (Technique of Rockwood and Wirth) Acute Repair with Medial Clavicle Resection: Key Surgical Steps Reconstruction with Figure-of-Eight Tendon Graft Reconstruction with Figure-of-Eight Tendon Graft: Key Surgical Steps Postoperative Care Pitfalls and Preventions Sternoclavicular Joint Injuries: Surgical Pitfalls and Preventions Author's Preferred Treatment for Acromioclavicular and Sternoclavicular Joint Injuries (Algorithms 31-1and 31-2) Management of Expected Adverse Outcomes and Unexpected Complications Related to Acromioclavicular and Sternoclavicular Joint Injuries Acromioclavicular and Sternoclavicular Joint Injuries: Common Adverse Outcomes and Complications Complications Related to Acromioclavicular Joint Injuries Migration of Pins Failure of Soft Tissue Repairs Graft Erosion and Foreign Body Reactions and Infections Acromioclavicular Arthritis Complications Related to Sternoclavicular Joint Injuries References 32: Scapular Fractures Introduction to Scapular Fractures Applied Anatomy Related to Scapular Fractures Scapular Architecture Superior Shoulder Suspensory Complex Muscles of the Scapula Blood Vessels and Nerves of the Scapula Assessment of Scapular Fractures Mechanisms of Injury for Scapular Fractures Basic Mechanisms Direct Blow to the Scapula Impact of the Humeral Head on a Part of the Scapula Dislocation of the Humeral Head Muscle Contracture Other Injury Mechanisms Intensity of Trauma Energy Injuries Associated with Scapular Fractures Signs and Symptoms of Scapular Fractures Patient's Medical History Visual Assessment Palpation Range of Motion Periphery Imaging and Other Diagnostic Studies for Scapular Fractures Radiology Computed Tomography (CT) Measurements of Angulation, Translation, Medialization, and Glenopolar Angle Classification of Scapular Fractures Overview of the Most Frequently Used Classifications Controversies of Current Classifications Scapular Neck Fractures Glenoid Fractures Importance of Internal Architecture of Scapula for Fracture Classification Anatomic 3D CT Classification Process Fractures and Fractures of the Borders of the Scapular Body Body Fractures Neck Fractures Glenoid Fractures Combined Fractures Outcome Measurements for Scapular Fractures Treatment Options for Scapular Fractures Nonoperative Treatment of Scapular Fractures Indications/Contraindications Nonoperative Treatment of Scapula Fractures: Indications Outcomes Operative Treatment of Scapular Fractures Indications/Contraindications Preoperative Planning Preoperative Planning Checklist Surgical Approach Judet Posterior Approach Patient Positioning Incision and Dissection Limited Approaches Reattachment of Muscles and Wound Closure Posterosuperior Approaches Dupont–Evrard Posterolateral Approach Deltopectoral Approach Limited Approaches Technique Implants Reduction and Fixation Arthroscopically Assisted Operations Postoperative Care Authors' Preferred Treatment for Scapular Fractures (Algorithm 32-1) Outcomes Injury Patterns Associated with Scapular Fracture Floating Shoulder History of the Floating Shoulder Concept Diagnosis of Floating Shoulder Anatomical Basis of Floating Shoulder Epidemiology of Floating Shoulder Treatment Options for Floating Shoulder Authors' Concept of Floating Shoulder and SSSC Injuries Scapulothoracic Dissociation Management of Expected Adverse Outcomes and Unexpected Complications Related to Scapular Fractures Scapular Fractures: Common Adverse Outcomes and Complications Nonoperative Complications Operative Complications Summary, Controversies, and Future Directions in Scapular Fractures Annotated References References RELATED CONTENT Textbook Video 33: Clavicle Fractures Introduction to Clavicle Fractures Assessment of Clavicle Fractures Mechanisms of Injury for Clavicle Fractures Injuries Associated with Clavicle Fractures Signs and Symptoms of Clavicle Fractures History Physical Examination Open Fractures Imaging and Other Diagnostic Studies for Clavicle Fractures Midshaft Fractures Polytrauma Patient Lateral Fractures Classification of Clavicle Fractures Outcome Measures for Clavicle Fractures Pathoanatomy and Applied Anatomy Relating to Clavicle Fractures Bony Anatomy of the Clavicle Ligamentous Anatomy of the Clavicle Medial Ligaments Lateral Ligaments Muscular Anatomy of the Clavicle Neurovascular Anatomy of the Clavicle Treatment Options for Midshaft Clavicle Fracture Nonoperative Treatment of Clavicle Fractures Outcomes Operative Treatment of Clavicle Fractures Indications/Contraindications Operative Treatment of Midshaft Clavicle Fractures: Indications External Fixation Intramedullary Pinning Preoperative Planning Open Reduction and Plate Fixation of Clavicle Fractures: Preoperative Planning Checklist Positioning Technique Intramedullary Fixation of Clavicle Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Intramedullary Fixation of Clavicle Fractures: Surgical Pitfalls and Preventions Open Reduction and Plate Fixation Timing of Surgery Preoperative Planning Open Reduction and Plate Fixation of Clavicle Fractures: Preoperative Planning Checklist Positioning Surgical Approach Anteroinferior Approach Anterosuperior Approach Technique Open Reduction and Plate Fixation of Clavicle Fractures: Key Surgical Steps Postoperative Care Outcomes Potential Pitfalls and Preventive Measures Open Reduction and Plate Fixation of Clavicle Fractures: Surgical Pitfalls and Preventions Treatment of Other Clavicle Injuries Treatment of Lateral Clavicle Fractures Plate or Hook Plate Fixation of Displaced Fractures of the Lateral Clavicle Preoperative Planning Plate or Hook Plate Fixation of Displaced Fractures of the Lateral Clavicle: Preoperative Planning Checklist Patient Positioning Surgical Approach Technique Plate or Hook Plate Fixation of Displaced Fractures of the Lateral Clavicle: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Plate or Hook Plate Fixation of Displaced Fractures of the Lateral Clavicle: Surgical Pitfalls and Preventions Outcomes Author's Preferred Treatment for Other Clavicle Fractures (Algorithm 33-1) Treatment of Medial Clavicle Fracture “Floating Shoulder” Associated Rib Fractures Management of Expected Adverse Outcomes and Unexpected Complications in Clavicle Fractures Clavicle Fractures: Management of Expected Adverse Outcomes and Unexpected Complications Infection Nonunion Malunion Glenohumeral Arthritis Neurovascular Injury Acute Injuries Delayed Injuries Iatrogenic Injury Hardware Failure Hardware Prominence Refracture Scapular Winging Summary, Controversies, and Future Directions Related to Clavicle Fractures Patient Selection for Operative Intervention Method of Fixation Timing of Surgical Intervention Summary Annotated References References RELATED CONTENT Video 34: Glenohumeral Instability Introduction to Glenohumeral Instability Assessment of Glenohumeral Instability Mechanisms of Injury for Glenohumeral Instability Injuries Associated with Glenohumeral Instability Signs and Symptoms of Glenohumeral Instability Physical Examination for Glenohumeral Instability Imaging and Other Diagnostic Studies for Glenohumeral Instability Radiography Magnetic Resonance Imaging and Arthrography Computerized Tomography Scan Evaluation of Glenoid Bone Loss Critical Glenoid Defect Size Classification of Glenohumeral Instability Glenohumeral Instability: FEDS System Classification Glenohumeral Instability: OTA Classification Glenohumeral Instability: Matsen and Thomas Classification Glenohumeral Instability: Stanmore Classification Glenohumeral Instability: Posterior Instability ABC Classification Outcome Measures for Glenohumeral Instability Western Ontario Shoulder Instability Index (WOSI) Oxford Instability Shoulder Score (OISS) or Oxford Shoulder Instability Questionnaire (OSIQ) Melbourne Instability Shoulder Scale (MISS) Pathoanatomy and Applied Anatomy Related to Glenohumeral Instability Static Stabilizers Articular Geometry and Concavity Glenoid Labrum Capsule and Glenohumeral Ligaments Rotator Interval and Superior Glenohumeral Ligament Middle Glenohumeral Ligament Inferior Glenohumeral Ligament Complex Dynamic Stabilizers Rotator Cuff Musculature and Biceps Tendon Deltoid Musculature Proprioception Treatment Options for Glenohumeral Instability Nonoperative Treatment of Glenohumeral Instability Indications/Contraindications Nonoperative Treatment of Glenohumeral Instability: Indications and Contraindications Outcomes Operative Treatment of Glenohumeral Instability Anterior Glenohumeral Instability Indications/Contraindications Operative Treatment of Anterior Glenohumeral Instability: Indications and Contraindications Arthroscopic Anterior Labral (Bankart) Repair Preoperative Planning Arthroscopic Anterior Labral (Bankart) Repair: Preoperative Planning Checklist Positioning Surgical Approach Technique Arthroscopic Anterior Labral (Bankart) Repair: Key Surgical Steps Open Anterior Labral (Bankart) Repair Preoperative Planning Open Anterior Labral (Bankart) Repair: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Anterior Labral (Bankart) Repair: Key Surgical Steps Open Latarjet Procedure Preoperative Planning Open Latarjet Procedure: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Latarjet Procedure: Key Surgical Steps Authors' Preferred Treatment for Anterior Glenohumeral Instability (Algorithms 34-1 and 34-2) Postoperative Care Potential Pitfalls and Preventive Measures Anterior Glenohumeral Instability: Surgical Pitfalls and Preventions Outcomes Open and Arthroscopic Bankart Repair Bony Glenoid Augmentation (Latarjet Coracoid Transfers and Bone Block Procedures) Management of Expected Adverse Outcomes and Unexpected Complications Related to Anterior Glenohumeral Instability Anterior Glenohumeral Instability: Common Adverse Outcomes and Complications Posterior Glenohumeral Instability Indications/Contraindications Arthroscopic Posterior Labral (Bankart) Repair Preoperative Planning Arthroscopic Posterior Labral (Bankart) Repair: Preoperative Planning Checklist Positioning Technique Arthroscopic Posterior Labral (Bankart) Repair: Key Surgical Steps Open Posterior Labral (Bankart) Repair or Capsular Shift Preoperative Planning Open Posterior Labral (Bankart) Repair or Capsular Shift: Preoperative Planning Checklist Positioning Technique Open Posterior Labral (Bankart) Repair: Key Surgical Steps Authors' Preferred Treatment for Posterior Glenohumeral Instability (Algorithm 34-3) Postoperative Care Potential Pitfalls and Preventive Measures Posterior Glenohumeral Instability: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Posterior Glenohumeral Instability Posterior Glenohumeral Instability: Common Adverse Outcomes and Complications Multidirectional Glenohumeral Instability Indications/Contraindications Arthroscopic Capsular Plication Preoperative Planning Arthroscopic Capsular Plication: Preoperative Planning Checklist Positioning Surgical Approach Technique Arthroscopic Capsular Plication: Key Surgical Steps Open Anterior-Inferior Capsular Shift Preoperative Planning Open Anterior-Inferior Capsular Shift: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Anterior-Inferior Capsular Shift: Key Surgical Steps Authors' Preferred Treatment for Multidirectional Glenohumeral Instability (Algorithm 34-4) Postoperative Care Potential Pitfalls and Preventive Measures Multidirectional Glenohumeral Instability: Surgical Pitfalls and Preventions Outcomes Arthroscopic Procedures Open Procedures Management of Expected Adverse Outcomes and Unexpected Complications Related to Multidirectional Glenohumeral Instability Multidirectional Glenohumeral Instability: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Glenohumeral Instability Anterior Glenohumeral Instability Posterior Glenohumeral Instability Multidirectional Instability Annotated References References 35: Proximal Humeral Fractures Introduction to Proximal Humeral Fractures Epidemiology of Proximal Humeral Fractures Assessment of Proximal Humeral Fractures Mechanisms of Injury for Proximal Humeral Fractures Injuries Associated with Proximal Humeral Fractures Signs and Symptoms of Proximal Humeral Fractures Imaging and Other Diagnostic Studies for Proximal Humeral Fractures Radiographs Computed Tomography Magnetic Resonance Imaging Other Imaging Techniques Classification of Proximal Humeral Fractures Brief Historical Perspective Codman and Neer Classifications AO/OTA Classification Additional Contributions from Other Classification Systems The Mayo/Fundacion Jimenez Diaz (Mayo/FJD) Classification Fracture Planes Surgical Neck Fracture Plane Greater Tuberosity Fracture Plane Lesser Tuberosity Fracture Plane Anatomic Neck Fracture Plane Fracture Categories Surgical Neck Fractures (SN) Isolated Tuberosity Fractures (GT or LT) Varus Posteromedial Impaction Fractures (VPM) Valgus Impacted Fractures (Vl) Fracture-Dislocations, Head-Splitting, and Head Impaction Fractures Outcome Measures for Proximal Humeral Fractures Pathoanatomy and Applied Anatomy Relating to Proximal Humeral Fractures Proximal Humerus Vascularity Muscles Nerves Treatment Options for Proximal Humeral Fractures Nonoperative Treatment of Proximal Humeral Fractures Indications/Contraindications Nonoperative Treatment of Proximal Humeral Fractures: Indications and Contraindications Fracture Pattern Fracture Displacement and Stability Surgical Neck Fractures Greater Tuberosity Fractures Lesser Tuberosity Fractures Varus Posteromedial Fractures Valgus Fractures Patient Factors Nonoperative Treatment Protocol Outcomes Outcomes According to the Neer Classification Outcomes According to the Mayo/FJD Classification Relationship Between Fracture Pattern and Outcome Segment Displacement and Outcome Patient-Related Factors Influencing Outcome Operative Treatment of Proximal Humeral Fractures Indications/Contraindications Surgical Approaches Deltopectoral Approach Superior Deltoid-Splitting Approach Internal Fixation Using Locking Plates Preoperative Planning Locking Plating: Preoperative Planning Checklist Positioning Surgical Approach Technique Locking Plating: Key Surgical Steps Tuberosity Identification and Control with Traction Sutures Head Reduction with/without Graft Augmentation and Provisional Wire Fixation Tuberosity Reduction and Fixation Initial Plate Positioning and Plate Fixation to the Shaft Head Fixation Elective Cement Augmentation Suture Augmentation Through the Plate Potential Pitfalls and Preventive Measures Locking Plating: Potential Pitfalls and Preventive Measures Internal Fixation: Intramedullary Nailing Intramedullary Nailing: Preoperative Planning Checklist Preoperative Planning Positioning Surgical Approach Technique Intramedullary Nailing: Key Surgical Steps Postoperative Care Potential Pitfall and Preventive Measures Intramedullary Nailing: Potential Pitfall and Preventions Closed Reduction and Internal Fixation with Percutaneous Pins and Screws Preoperative Planning Closed Reduction and Percutaneous Fixation: Preoperative Planning Checklist Positioning Surgical Approach Technique Closed Reduction and Percutaneous Fixation: Key Surgical Steps Surgical Neck Fractures Surgical Neck Fractures with Greater Tuberosity Involvement Valgus Impacted Fractures Postoperative Care Potential Pitfalls and Preventive Measures Closed Reduction and Percutaneous Pinning: surgical pitfalls and prevention Tension Band Fixation (Osteosuture) Preoperative Planning Tension Band Fixation: Preoperative Planning Checklist Positioning Surgical Approach Technique Postoperative Care Potential Pitfalls and Preventive Measures Tension band fixation: potential pitfalls and prevention Reverse Shoulder Arthroplasty Preoperative Planning Reverse Shoulder Arthroplasty for Fracture: Preoperative Planning Checklist Positioning Surgical Approach Technique Reverse Shoulder Arthroplasty for Fracture: Key Surgical Steps Head Removal and Tuberosity Control Glenoid Preparation and Implantation Humeral Component Preparation and Implantation Tuberosity Reconstruction Closure Potential Pitfalls and Preventive Measures Reverse Shoulder Arthroplasty for Fracture: Surgical Pitfalls and Preventions Hemiarthroplasty Preoperative Planning Hemiarthroplasty (Humeral Head Replacement) for Fracture: Preoperative Planning Checklist Positioning Surgical Approach Technique Hemiarthroplasty (Humeral Head Replacement) for Fracture: Key Surgical Steps Head Removal and Tuberosity Control Humeral Component Preparation and Implantation Tuberosity Reconstruction Closure Potential Pitfalls and Preventive Measures Hemiarthroplasty: Surgical Pitfalls and Prevention Authors' Preferred Treatment for Proximal Humeral Fractures (Alg. 35-1) Outcomes of Surgical Treatment Internal Fixation Using Plates Internal Fixation Using Nails Closed Reduction and Percutaneous Pinning Internal Fixation Using Tension Band Reverse Shoulder Arthroplasty Hemiarthroplasty Management of Expected Adverse Outcomes and Unexpected Complications Related to Proximal Humeral Fractures Proximal Humeral Fractures: Common Adverse Outcomes and Complications Osteonecrosis Humeral Head Osteonecrosis Tuberosity Osteonecrosis Nonunion Open Reduction and Internal Fixation Reverse Shoulder Arthroplasty and Hemiarthroplasty Malunion Greater Tuberosity Malunion or Displaced Nonunion Lesser Tuberosity Malunion or Displaced Nonunion Head–Shaft Malunion Combined Malunion of the Head, Shaft, and Tuberosities Other Complications Posttraumatic Shoulder Stiffness Infection Summary, Controversies, and Future Directions Related to Proximal Humeral Fractures Annotated References General references RELATED CONTENT Video 36: Humeral Shaft Fractures Introduction to Humeral Shaft Fractures Epidemiology of Humeral Shaft Fractures Assessment of Humeral Shaft Fractures Mechanisms of Injury for Humeral Shaft Fractures Injuries Associated with Humeral Shaft Fractures Nerve Injury Concomitant Fracture of the Ipsilateral Humeral Head Concomitant Dislocation of the Ipsilateral Shoulder Other Soft Tissue Injuries of the Ipsilateral Shoulder Floating Elbow Signs and Symptoms of Humeral Shaft Fractures Imaging and Other Diagnostic Studies for Humeral Shaft Fractures Classification of Humeral Shaft Fractures Bone Injury Soft Tissue Injury Outcome Measures for Humeral Shaft Fractures The Constant–Murley Score The DASH Score American Shoulder and Elbow Surgeons Self-Report Form for the Shoulder (ASES-s) Mayo Elbow Performance Index (MEPI) American Shoulder and Elbow Surgeons Self-Report Form for the Elbow (ASES-e) Pathoanatomy and Applied Anatomy Related to Humeral Shaft Fractures Treatment Options for Humeral Shaft Fracture Nonoperative Treatment of Humeral Shaft Fractures Indications/Contraindications Nonoperative Treatment of Diaphyseal Humeral Fractures: Indications and Contraindications Techniques Sling/Swathe and Velpeau Bandage U-Slab/Coaptation Splint Hanging Cast Functional Bracing Outcomes Operative Treatment of Humeral Shaft Fractures Indications/Contraindications Operative Treatment of Diaphyseal Humeral Fractures: Indications and Contraindications Plate Osteosynthesis Open Reduction and Internal Fixation (ORIF) Preoperative Planning Open Reduction and Internal Fixation of Diaphyseal Humeral Fractures: Preoperative Planning Checklist Positioning Surgical Approaches for Open Reduction and Internal Fixation Technique ORIF of Diaphyseal Humeral Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Open Reduction and Internal Fixation of Diaphyseal Humeral Fractures: Surgical Pitfalls and Preventions Outcomes Minimally Invasive Plate Osteosynthesis (MIPO) Preoperative Planning Minimally Invasive Plate Osteosynthesis of Diaphyseal Humeral Fractures: Preoperative Planning Checklist Positioning Surgical Approaches for Minimally Invasive Plate Osteosynthesis (MIPO) Technique Minimally Invasive Plate Osteosynthesis of Diaphyseal Humeral Fracture: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Minimally Invasive Plate Osteosynthesis Outcomes Intramedullary Nailing Antegrade Nailing Preoperative Planning Antegrade IMN of Diaphyseal Humeral Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Antegrade IMN of Diaphyseal Humeral Fracture: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Antegrade IMN of Diaphyseal Humeral Fractures: Surgical Pitfalls and Preventions Outcomes Retrograde Nailing Preoperative Planning Retrograde IMN of Diaphyseal Humeral Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Retrograde IMN of Diaphyseal Humeral Fracture: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Retrograde IMN of Diaphyseal Humeral Fractures: Surgical Pitfalls and Preventions Outcomes External Fixation Preoperative Planning External Fixation of Diaphyseal Humeral Fractures: Preoperative Planning Checklist Technique and Postoperative Care Outcomes Comparison Studies Plating or Nailing Antegrade or Retrograde Humeral Nailing? ORIF or MIPO? Author's Preferred Treatment for Humeral Shaft Fractures Management of Expected Adverse Outcomes and Unexpected Complications in Humeral Shaft Fractures Humeral Shaft Fractures: Common Adverse Outcomes and Complications General Adverse Outcomes and Complications Nonunion Incidence Treatment Options Infection Secondary Neurologic Injury Implant-Specific Adverse Outcomes and Complications Special Considerations for Humeral Shaft Fractures Open Fractures Osteoporotic Fractures Pathologic Lesions and Fractures Periprosthetic Fractures Summary, Controversies, and Future Directions Related to Humeral Shaft Fractures Acknowledgments Annotated References References RELATED CONTENT Video 37: Periprosthetic Fractures of the Upper Extremity Periprosthetic Humeral Fractures About Shoulder Arthroplasty Introduction to Periprosthetic Humeral Fractures About Shoulder Arthroplasty Assessment of Periprosthetic Humeral Fractures About Shoulder Arthroplasty Mechanisms of Injury for Periprosthetic Humeral Fractures About Shoulder Arthroplasty Injuries Associated with Periprosthetic Humeral Fractures About Shoulder Arthroplasty Signs and Symptoms of Periprosthetic Humeral Fractures About Shoulder Arthroplasty Imaging and Other Diagnostic Studies for Periprosthetic Humeral Fractures About Shoulder Arthroplasty Classification of Periprosthetic Humeral Fractures About Shoulder Arthroplasty Periprosthetic Humeral Fractures About Shoulder Arthroplasty: Wright and Cofield Classification235 Outcome Measures for Periprosthetic Humeral Fractures About Shoulder Arthroplasty Pathoanatomy and Applied Anatomy Related to Periprosthetic Humeral Fractures About Shoulder Arthroplasty Treatment Options for Periprosthetic Humeral Fractures About Shoulder Arthroplasty Nonoperative Treatment of Periprosthetic Humeral Fractures About Shoulder Arthroplasty Indications/Contraindications Nonoperative Treatment of Periprosthetic Humeral Fractures About Shoulder Arthroplasty: Indications and Contraindications Sling Management Fracture Brace Management Outcomes Operative Treatment of Periprosthetic Humeral Fractures About Shoulder Arthroplasty Indications/Contraindications Open Reduction and Internal Fixation Preoperative Planning Open Reduction and Internal Fixation: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Periprosthetic Humeral Fractures About Shoulder Arthroplasty: Key Surgical Steps Revision Shoulder Arthroplasty Preoperative Planning Revision Shoulder Arthroplasty: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Periprosthetic Humeral Fractures About Shoulder Arthroplasty: Key Surgical Steps Authors' Preferred Treatment for Periprosthetic Humeral Fractures About Shoulder Arthroplasty Postoperative Care Potential Pitfalls and Preventive Measures Periprosthetic Humeral Fractures About Shoulder Arthroplasty: Surgical Pitfalls and Prevention Outcomes ORIF for Periprosthetic Humeral Fracture About Shoulder Arthroplasty Outcomes Revision for Periprosthetic Humeral Fracture About Shoulder Arthroplasty Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Periprosthetic Humeral Fractures About Shoulder Arthroplasty Periprosthetic Humeral Fractures About Shoulder Arthroplasty: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Periprosthetic Humeral Fractures About Shoulder Arthroplasty Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Introduction to Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Assessment of Periprosthetic Scapular Fractures Mechanisms of Injury for Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Injuries Associated with Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Signs and Symptoms of Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Imaging and Other Diagnostic Studies on Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Classification of Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Periprosthetic Scapular Fractures About RSA: Crosby Classification43 Outcome Measures for Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Pathoanatomy and Applied Anatomy Related to Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Treatment Options for Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Nonoperative Treatment of Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Indications/Contraindications Nonoperative Treatment of Periprosthetic Scapular Fractures About RSA: Indications and Contraindications Nonoperative Treatment Protocol Outcomes Operative Treatment of Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Indications/Contraindications ORIF of Periprosthetic Scapular Fractures About RSA Preoperative Planning ORIF of Periprosthetic Scapular Fractures About RSA: Preoperative Planning Checklist Positioning Surgical Approaches Technique ORIF of Periprosthetic Scapular Fractures About RSA: Key Surgical Steps Authors' Preferred Treatment for Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty (Algorithm 37-2) Postoperative Care Potential Pitfalls and Preventive Measures Periprosthetic Scapular Fractures About RSA: Surgical Pitfalls and Prevention Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Periprosthetic Scapular Fractures About RSA: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions of Periprosthetic Scapular Fractures About Reverse Shoulder Arthroplasty Periprosthetic Fractures About Total Elbow Arthroplasty Introduction to Periprosthetic Fractures About Total Elbow Arthroplasty Assessment of Periprosthetic Fractures About Total Elbow Arthroplasty Mechanisms of Injury for Periprosthetic Fractures About Total Elbow Arthroplasty Injuries Associated with Periprosthetic Fractures About Total Elbow Arthroplasty Signs and Symptoms of Periprosthetic Fractures About Total Elbow Arthroplasty Imaging and Other Diagnostic Studies for Periprosthetic Fractures About Total Elbow Arthroplasty Classification of Periprosthetic Fractures About Total Elbow Arthroplasty Periprosthetic Fractures About Total Elbow Arthroplasty: O'Driscoll Classification157 Outcome Measures for Periprosthetic Fractures about Total Elbow Arthroplasty Pathoanatomy and Applied Anatomy Related to Periprosthetic Fractures About Total Elbow Arthroplasty Treatment Options for Periprosthetic Fractures About Total Elbow Arthroplasty Nonoperative Treatment of Periprosthetic Fractures About Total Elbow Arthroplasty Indications/Contraindications Nonoperative Treatment of Periprosthetic Fractures About Total Elbow Arthroplasty: Indications and Contraindications Nonoperative Treatment Protocol Periprosthetic Humeral Fractures About Total Elbow Arthroplasty Periprosthetic Ulnar Fractures About Total Elbow Arthroplasty Outcomes Operative Treatment of Periprosthetic Fractures About Total Elbow Arthroplasty Indications/Contraindications Revision Arthroplasty for Periprosthetic Fractures About Total Elbow Arthroplasty Preoperative Planning Revision Arthroplasty for Periprosthetic Fractures About Total Elbow Arthroplasty: Preoperative Planning Checklist Positioning Surgical Approaches ORIF Revision Total Elbow Arthroplasty Revision Arthroplasty for Periprosthetic Fractures About Total Elbow Arthroplasty: Key Surgical Steps Authors' Preferred Treatment for Periprosthetic Fractures About Total Elbow Arthroplasty (Algorithm 37-3) Postoperative Care Potential Pitfalls and Preventive Measures Periprosthetic Fractures About Total Elbow Arthroplasty: Surgical Pitfalls and Prevention Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Tibial Plateau Fractures Periprosthetic Fractures About Total Elbow Arthroplasty: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Periprosthetic Fractures About Total Elbow Arthroplasty Annotated References References RELATED CONTENT Textbook Video 38: Distal Humerus Fractures Introduction to Distal Humerus Fractures Epidemiology of Distal Humerus Fractures Extra-Articular and Complete-Articular Fractures Partial-Articular Fractures Assessment of Distal Humerus Fractures Mechanisms of Injury and Injuries Associated with Distal Humerus Fractures Extra-Articular and Complete-Articular Fractures Partial-Articular Fractures Signs and Symptoms of Distal Humerus Fractures Imaging and Other Diagnostic Studies for Distal Humerus Fractures Classification of Distal Humerus Fractures Extra-Articular and Complete-Articular Fractures Partial-Articular [Type B3] Fractures Outcome Measures for Distal Humerus Fractures Pathoanatomy and Applied Anatomy Related to Distal Humerus Fractures Treatment Options for Distal Humerus Fractures Nonoperative Treatment of Extra-Articular and Complete-Articular Distal Humerus Fractures Indications and Contraindications for Nonoperative Treatment Techniques for Closed Management Outcomes of Nonoperative Treatment Nonoperative Treatment of Partial-Articular Distal Humerus (Type B3) Fractures Operative Treatment of Distal Humerus Fractures Timing of Surgery Open Reduction and Internal Fixation of Distal Humerus Fractures Indications and Contraindications ORIF of Distal Humerus Fractures: Indications and Contraindications Preoperative Planning ORIF of Distal Humerus Fractures: Preoperative Planning Positioning Surgical Approaches to the Distal Humerus Posterior Approaches to the Distal Humerus Lateral Approaches to the Distal Humerus Medial Approaches to the Distal Humerus Surgical Technique ORIF of Extra-Articular and Complete-Articular Fractures (AO/OTA Types A and C Fractures) ORIF of Extra-Articular and Complete-Articular Distal Humerus Fractures (AO/OTA Types A and C Fractures): Key Surgical Steps Surgical Technique for AO/OTA Types B1 and B2 Fractures Surgical Technique of Partial-Articular Fractures Implant Biomechanics for ORIF Postoperative Care Potential Pitfalls and Preventive Measures Distal Humerus Fracture: Potential Pitfalls and Preventions Outcomes Outcomes of ORIF of Extra-Articular and Complete-Articular Fractures Outcomes of ORIF of Partial-Articular Fractures TEA for Distal Humerus Fractures Indications and Contraindications TEA for Distal Humerus Fractures: Indications and Contraindications Preoperative Planning TEA for Distal Humerus Fractures: Preoperative Planning Positioning Surgical Approaches Surgical Technique Linked TEA for Distal Humerus Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures TEA for Distal Humerus Fracture: Potential Pitfalls and Preventions Outcomes of Total Elbow Arthroplasty Hemiarthroplasty for Distal Humerus Fractures Indications and Contraindications Preoperative Planning for Hemiarthroplasty Positioning and Surgical Approaches Surgical Technique Potential Pitfalls of Hemiarthroplasty Outcomes of Hemiarthroplasty Authors' Preferred Treatment for Distal Humerus Fractures (Algorithm 38-1) Management of Special Situations, Expected Adverse Outcomes, and Unexpected Complications Related to Distal Humerus Fractures Common Adverse Outcomes and Complications Open Distal Humerus Fractures Nonunion of Distal Humerus Fractures Postoperative Elbow Stiffness and Heterotopic Ossification Wound Complications and Infection Ulnar Neuropathy Olecranon Osteotomy Complications Complications of Total Elbow Arthroplasty Controversies/Future Directions Related to Distal Humerus Fractures Acknowledgments Annotated References References RELATED CONTENT Textbook Video 39: Elbow Dislocations and Terrible Triad Injuries Simple Elbow Dislocation Introduction to Simple Elbow Dislocation Assessment of Simple Elbow Dislocation Mechanisms of Injury for Simple Elbow Dislocation Injuries Associated with Simple Elbow Dislocation Signs and Symptoms of Simple Elbow Dislocation Imaging and Other Diagnostic Studies for Simple Elbow Dislocation Classification of Simple Elbow Dislocation Outcome Measures for Simple Elbow Dislocation Pathoanatomy and Applied Anatomy Related to Simple Elbow Dislocation Treatment Options for Simple Elbow Dislocation Nonoperative Treatment of Simple Elbow Dislocation Indications/Contraindications Nonoperative Treatment of Simple Elbow Dislocation: Indications and Contraindications Techniques Outcomes Operative Treatment of Simple Elbow Dislocations Indications/Contraindications Open Reduction and Internal Fixation Preoperative Planning Open Reduction and Internal Fixation (ORIF) of Simple Elbow Dislocation: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Simple Elbow Dislocation: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Simple Elbow Dislocation: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications in Simple Elbow Dislocations Simple Elbow Dislocation: Common Adverse Outcomes and Complications Author's Preferred Treatment for Simple Elbow Dislocation (Algorithm 39-1) Summary, Controversies, and Future Directions Related to Simple Elbow Dislocations Radial Head Fractures Introduction to Radial Head Fractures Assessment of Radial Head Fractures Mechanisms of Injury for Radial Head Fractures Injuries Associated with Radial Head Fractures Signs and Symptoms of Radial Head Fractures Imaging and Other Diagnostic Studies for Radial Head Fractures Classification of Radial Head Fractures Outcome Measures for Radial Head Fractures Pathoanatomy and Applied Anatomy Related to Radial Head Fractures Treatment Options for Radial Head Fracture Nonoperative Treatment of Radial Head Fractures Indications/Contraindications Nonoperative Treatment of Radial Head Fractures: Indications and Contraindications Techniques Outcomes Operative Treatment of Radial Head Fractures Indications/Contraindications Arthroscopic Excision of Radial Head Fragments Preoperative Planning Arthroscopic Excision of Radial Head Fragments: Preoperative Planning Checklist Positioning Surgical Approach Technique Arthroscopic Excision of Radial Head Fragments: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Arthroscopic Excision of Radial Head Fragments: Surgical Pitfalls and Preventions Outcomes Open Radial Head Excision Preoperative Planning Open Radial Head Excision: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Radial Head Excision: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Open Radial Head Excision: Surgical Pitfalls and Preventions Outcomes Open Reduction and Internal Fixation Preoperative Planning ORIF of Radial Head and Neck Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Postoperative Care Potential Pitfalls and Preventive Measures Radial Head and Neck Fractures: Surgical Pitfalls and Preventions Outcomes Radial Head Arthroplasty Preoperative Planning Radial Head Arthroplasty: Preoperative Planning Checklist Positioning Surgical Approach Technique Radial Head Arthroplasty: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Radial Head Arthroplasty: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications in Radial Head Fractures Radial Head Fractures: Common Adverse Outcomes and Complications Author's Preferred Treatment for Radial Head Fractures (Algorithm 39-2) Summary, Controversies, and Future Directions Related to Radial Head Fractures Coronoid Fractures Introduction to Coronoid Fractures Classification of Coronoid Fractures Terrible Triad Injuries of the Elbow Introduction to Terrible Triad Injuries of the Elbow Assessment of Terrible Triad Injuries Mechanisms of Injury for Terrible Triad Injuries Injuries Associated with Terrible Triad Injuries Signs and Symptoms of Terrible Triad Injuries Imaging and Other Diagnostic Studies of Terrible Triad Injuries Classification of Terrible Triad Injuries Outcome Measures for Terrible Triad Injuries Pathoanatomy and Applied Anatomy Related to Terrible Triad Injuries Treatment Options for Terrible Triad Injuries Nonoperative Treatment of Terrible Triad Injuries Indications/Contraindications Nonoperative Treatment of Terrible Triad Injuries: Indications and Contraindications Techniques Outcomes Operative Treatment of Terrible Triad Injuries Indications/Contraindications Open Reduction and Internal Fixation Preoperative Planning ORIF of Terrible Triad Injuries: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Terrible Triad Injuries: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Terrible Triad Injuries: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications in Terrible Triad Injuries Terrible Triad Injuries: Common Adverse Outcomes and Complications Author's Preferred Treatment for Terrible Triad Injuries (Algorithm 39-3) Summary, Controversies, and Future Directions Related to Terrible Triad Injuries Posteromedial Rotatory Instability of the Elbow Introduction to POSTEROMEDIAL Rotatory Instability of the Elbow Assessment of POSTEROMEDIAL Rotatory Instability of the Elbow Mechanisms of Injury for Posteromedial Rotatory Instability of the Elbow Injuries Associated with Posteromedial Rotatory Instability of the Elbow Signs and Symptoms of Posteromedial Rotatory Instability of the Elbow Imaging and Other Diagnostic Studies of Posteromedial Rotatory Instability of the Elbow Classification of Anteromedial Coronoid Fractures Outcome Measures for Posteromedial Rotatory Instability of the Elbow Pathoanatomy and Applied Anatomy Related to POSTEROMEDIAL Rotatory Instability of the Elbow Treatment Options for Posteromedial Rotatory Instability Nonoperative Treatment of Posteromedial Rotatory Instability of the Elbow Indications/Contraindications Nonoperative Treatment of PMRI Treatment: Indications and Contraindications Techniques Outcomes Operative Treatment of Posteromedial Rotatory Instability of the Elbow Indications/Contraindications Open Reduction and Internal Fixation Preoperative Planning ORIF of PMRI of the Elbow: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of PMRI of the Elbow: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures PMRI of the Elbow: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications in Posteromedial Rotatory Instability PMRI of the Elbow: Common Adverse Outcomes and Complications Author's Preferred Treatment for Posteromedial Rotatory Instability (Algorithm 39-4) Summary, Controversies, and Future Directions Related to Posteromedial Rotatory Instability Proximal Ulna Fractures Introduction to Proximal Ulna Fractures Assessment of Proximal Ulna Fractures Mechanisms of Injury for Posterior Ulna Fractures Injuries Associated with Proximal Ulna Fractures Signs and Symptoms of Proximal Ulna Fractures Imaging and Other Diagnostic Studies for Proximal Ulna Fractures Classification of Proximal Ulna Fractures Olecranon Fractures Olecranon Fracture-Dislocations Outcome Measures for Proximal Ulna Fractures Pathoanatomy and Applied Anatomy Related to Proximal Ulna Fractures Treatment Options for Proximal Ulna Fracture Nonoperative Treatment of Proximal Ulna Fractures Indications/Contraindications Nonoperative Treatment of Proximal Ulna Fractures: Indications and Contraindications Techniques Outcomes Operative Treatment of Proximal Ulna Fractures Indications/Contraindications Olecranon Excision and Triceps Advancement Preoperative Planning Olecranon Excision and ORIF for Proximal Ulna Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Olecranon Excision and Triceps Advancement for Proximal Ulna Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Olecranon Excision in Proximal Ulna Fractures: Surgical Pitfalls and Preventions Outcomes Olecranon Tension Band Wiring Preoperative Planning ORIF and Tension Band Wiring of Olecranon Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF and Tension Band Wiring of Olecranon Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures ORIF and Tension Band Wiring of Olecranon Fractures: Surgical Pitfalls and Prevention Outcomes Olecranon Plating Preoperative Planning Plating of Proximal Ulna Fractures: Preoperative Planning Checklist Positioning and Surgical Approach Technique Plating of Proximal Ulna Fracture: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Plating of Proximal Ulna Fractures: Surgical Pitfalls and Preventions Outcomes Open Reduction and Internal Fixation of Posterior Monteggia Fractures Preoperative Planning ORIF of Posterior Monteggia Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Posterior Monteggia Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Posterior Monteggia Fractures: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications in Proximal Ulna Fractures Proximal Ulna Fracture: Common Adverse Outcomes and Complications Author's Preferred Treatment for Proximal Ulna Fractures (Algorithm 39-5) Summary, Controversies, and Future Directions Related to Proximal Ulna Fractures Annotated References References RELATED CONTENT Video 40: Fractures of the Proximal Forearm: Olecranon, Proximal Radius, and Radial Head Radial Head and Neck Fractures Introduction to Radial Head and Neck Fractures Assessment of Radial Head and Neck Fractures Mechanisms of Injury for Radial Head and Neck Fractures Injuries Associated with Radial Head and Neck Fractures Signs and Symptoms of Radial Head and Neck Fractures Imaging and Other Diagnostic Studies for Radial Head and Neck Fractures Classification of Radial Head and Neck Fractures Mason Classification of Radial Head Fractures Broberg and Morrey Classification of Radial Head Fractures Outcome Measures for Radial Head and Neck Fractures Pathoanatomy and Applied Anatomy Related to Radial Head and Neck Fractures Treatment Options for Radial Head and Neck Fractures Nonoperative Treatment of Radial Head and Neck Fractures Indications/Contraindications Nonoperative Treatment of Radial Head and Neck Fractures:Indications and Contraindications Technique Outcomes Operative Treatment of Radial Head and Neck Fractures Indications/Contraindications Open Surgical Excision of Radial Head Fragment or Radial Head Excision Preoperative Planning Open Surgical Excision of Radial Head Fragment or Radial Head Excision: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Surgical Excision of Radial Head Fragment or Radial Head Excision: Key Surgical Steps Open Reduction and Internal Fixation Preoperative Planning Open Reduction and Internal Fixation: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Reduction and Internal Fixation: Key Surgical Steps Radial Head Arthroplasty Preoperative Planning Radial Head Arthroplasty: Preoperative Planning Checklist Positioning Surgical Approach Technique Radial Head Arthroplasty: Key Surgical Steps Authors' Preferred Treatment for Radial Head and Neck Fractures (Algorithm 40-1) Postoperative Care Potential Pitfalls and Preventive Measures Radial Head and Neck Fractures: Surgical Pitfalls and Preventions Outcomes Fragment Removal or Radial Head Excision Open Reduction and Internal Fixation Radial Head Arthroplasty Management of Expected Adverse Outcomes and Unexpected Complications Related to Radial Head and Neck Fractures Radial Head and Neck Fractures: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Radial Head and Neck Fractures Proximal Ulna Fractures: Olecranon Fractures Introduction to Olecranon Fractures Assessment of Olecranon Fractures Mechanisms of Injury for Olecranon Fractures Injuries Associated with Olecranon Fractures Signs and Symptoms of Olecranon Fractures Imaging and Other Diagnostic Studies for Olecranon Fractures Classification of Olecranon Fractures Mayo Classification of Olecranon Fractures Outcome Measures for Olecranon Fractures Pathoanatomy and Applied Anatomy Relating to Olecranon Fractures Treatment Options for Olecranon Fractures Nonoperative Treatment of Olecranon Fractures Indications/Contraindications Nonoperative Treatment of Olecranon Fractures: Indications and Contraindications Technique Outcomes Operative Treatment of Olecranon Fractures Indications/Contraindications Positioning Surgical Approach Tension Band Wiring of Olecranon Fractures Preoperative Planning Tension Band Wiring of Olecranon Fractures: Preoperative Planning Checklist Technique Tension Band Wiring of Olecranon Fractures: Key Surgical Steps ORIF of Olecranon Fractures Preoperative Planning ORIF of Olecranon Fractures: Preoperative Planning Checklist Technique ORIF of Olecranon Fractures: Key Surgical Steps Intramedullary Fixation of Olecranon Fractures Preoperative Planning Intramedullary Fixation of Olecranon Fractures: Preoperative Planning Checklist Technique Intramedullary Fixation of Olecranon Fractures: Key Surgical Steps Fragment Excision and Triceps Advancement Preoperative Planning Fragment Excision and Triceps Advancement: Preoperative Planning Checklist Technique Fragment Excision and Triceps Advancement: Key Surgical Steps Authors' Preferred Treatment for Olecranon Fractures (Algorithm 40-2) Postoperative Care Potential Pitfalls and Preventive Measures Olecranon Fractures: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Olecranon Fractures Olecranon Fractures: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Olecranon Fractures Proximal Ulna Fractures: Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Introduction to Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Assessment of Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Mechanisms of Injury for Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Injuries Associated with Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Signs and Symptoms of Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Imaging and Other Diagnostic Studies for Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Classification of Monteggia Fractures Bado Classification Jupiter Modification of Bado Type II Outcome Measures for Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Pathoanatomy and Applied Anatomy Relating to Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Treatment Options for Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Nonoperative Treatment of Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Indications/Contraindications Nonoperative Treatment of Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations: Indications and Contraindications Operative Treatment of Monteggia Fracture–Dislocations ORIF for Monteggia Fracture–Dislocation Preoperative Planning ORIF for Monteggia Fracture–Dislocation: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF for Monteggia Fracture–Dislocation: Key Surgical Steps ORIF for Transolecranon Fracture–Dislocations Preoperative Planning ORIF for Transolecranon Fracture–Dislocations: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF for Transolecranon Fracture–Dislocation: Key Surgical Steps Authors' Preferred Treatment for Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations (Algorithm 40-3) Postoperative Care Potential Pitfalls and Preventive Measures Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Monteggia Fracture–Dislocations and Transolecranon Fracture–Dislocations Annotated References References RELATED CONTENT Textbook Video 41: Diaphyseal Fractures of the Radius and Ulna Introduction to Diaphyseal Fractures of the Radius and Ulna Epidemiology of Diaphyseal Fractures of the Radius and Ulna Assessment of Diaphyseal Fractures of the Radius and Ulna Mechanism of Injury of Diaphyseal Fractures of the Radius and Ulna Signs and Symptoms of Diaphyseal Fractures of the Radius and Ulna Associated Injuries with Diaphyseal Fractures of the Radius and Ulna Associated Musculoskeletal Injuries Open Diaphyseal Fractures Compartment Syndrome Associated Nonmusculoskeletal Injuries Imaging and Other Diagnostic Studies for Diaphyseal Fractures of the Radius and Ulna Classification of Diaphyseal Fractures of the Radius and Ulna Monteggia Fracture-Dislocation Galeazzi Fractures Open Fractures Outcome Measures for Diaphyseal Fractures of the Radius and Ulna Pathoanatomy and Applied Anatomy Related to Diaphyseal Fractures of the Radius and Ulna Osseous Plane Radius Ulna Interosseous Space Triangular Fibrocartilage Complex Proximal Radioulnar Joint Muscles Anterior Muscles Posterior Muscles Deforming Forces Nerves Median Nerve Ulnar Nerve Radial Nerve Arteries Treatment Options for Diaphyseal Fractures of the Radius and Ulna Nonoperative Treatment of Diaphyseal Fractures of the Radius and Ulna Indications/Contraindications Nonoperative Treatment of Forearm Fractures: Indications and Contraindications Techniques Outcomes Operative Treatment of Diaphyseal Fractures of the Radius and Ulna Indications/Contraindications Open Reduction with Plate and Screw Fixation Preoperative Planning Open Reduction with Plate and Screw Fixation of Forearm Fractures: Preoperative Planning Checklist Positioning Surgical Approach Ulna Radius Technique Open Reduction with Plate and Screw Fixation of Forearm Fractures: Key Surgical Steps Transverse Fractures Oblique Fractures Comminuted Fractures Segmental Fractures Postoperative Care Potential Pitfalls and Preventive Measures Open Reduction with Plate and Screw Fixation of Forearm Fractures: Surgical Pitfalls and Preventions Outcomes Intramedullary Nailing Indications/Contraindications Preoperative Planning IM Nailing of Forearm Shaft Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique IM Nailing of Forearm Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures IM Nailing of Forearm Fractures: Surgical Pitfalls and Prevention Outcomes Repair of Monteggia Fracture-Dislocations Repair of Galeazzi Fracture-Dislocations Repair of Open Fractures Authors' Preferred Treatment for Diaphyseal Fractures of the Radius and Ulna (Algorithm 41-1) Management of Expected Adverse Outcomes and Unexpected Complications of Diaphyseal Fractures of the Radius and Ulna Forearm Fractures: Common Adverse Outcomes and Complications Infection Malunion Nonunion Radioulnar Synostosis Nerve Palsy Implant Removal and Refracture Summary, Controversies, and Future Directions Related to Diaphyseal Fractures of the Radius and Ulna Annotated References References 42: Fractures of the Distal Radius and Ulna Introduction to Fractures of the Distal Radius and Ulna Epidemiology of Fractures of the Distal Radius and Ulna Risk Factors of Fractures of the Distal Radius and Ulna Costs of Fractures of the Distal Radius and Ulna Controversies in Management of Fractures of the Distal Radius and Ulna Assessment of Fractures of the Distal Radius and Ulna Mechanisms of Injury for Fractures of the Distal Radius and Ulna Injuries Associated with Fractures of the Distal Radius and Ulna Interosseous Ligament Injury Triangular Fibrocartilage Complex Injury Other Injuries Signs and Symptoms of Fractures of the Distal Radius and Ulna Imaging and Other Diagnostic Studies for Fractures of the Distal Radius and Ulna Radiography Computed Tomography Magnetic Resonance Imaging Classification of Fractures of the Distal Radius and Ulna Common Eponyms Historical Classification Systems Current Classification Systems Classification of Associated Ulnar Injury Reliability of Classification Systems Outcome Measures for Fractures of the Distal Radius and Ulna Physician-Based Outcome Measures Patient-Reported Outcome Measures Pathoanatomy and Applied Anatomy Related to Fractures of the Distal Radius and Ulna Outcomes Operative Treatment of Fractures of the Distal Radius and Ulna Fractures of the Distal Radius Indications/Contraindications Closed Reduction and Percutaneous Pinning Preoperative Planning Closed Reduction and Percutaneous Pinning: Preoperative Checklist Positioning Technique Closed Reduction and Percutaneous Pinning: Key Surgical Steps Complications Open Reduction and Internal Fixation Through a Volar Approach Preoperative Planning ORIF Through a Volar Approach: Preoperative Checklist Positioning Technique ORIF Through a Volar Approach: Key Surgical Steps Complications Open Reduction and Internal Fixation Through a Dorsal Approach Preoperative Planning ORIF Through a Dorsal Approach: Preoperative Checklist Positioning Technique ORIF Through a Dorsal Approach: Key Surgical Steps Complications Fragment-Specific Fixation of the Distal Radius Preoperative Planning Fragment-Specific Fixation of the Distal Radius: Preoperative Checklist Positioning Technique Fragment-Specific Fixation of the Distal Radius: Key Surgical Steps Complications External Fixation of the Distal Radius Preoperative Planning External Fixation of the Distal Radius: Preoperative Checklist Positioning Technique Bridging External Fixation of the Distal Radius: Key Surgical Steps Complications Dorsal Spanning Fixation of the Distal Radius Preoperative Planning Dorsal Spanning Fixation of the Distal Radius: Preoperative Checklist Positioning Technique Dorsal Spanning Fixation of the Distal Radius: Key Surgical Steps Complications Comparison of Outcomes and Complications for Different Fixation Methods of Fractures of the Distal Radius Percutaneous Pinning vs. External Fixation Percutaneous Pinning vs. Volar Locked Plating Bridging vs. Nonbridging External Fixation External Fixation vs. Volar Locked Plating External Fixation vs. ORIF Volar Locked Plating vs. Fragment Specific Fixation Other Comparisons Choosing a Fixation Method Authors' Preferred Treatment for Fractures of the Distal Radius (Algorithm 42-1) Fractures of the Distal Ulna Fixation of the Distal Ulna Technique Management of Expected Adverse Outcomes and Unexpected Complications Related to Fractures of the Distal Radius and Ulna Fractures of the Distal Radius and Ulna: Common Adverse Outcomes and Complications Nerve injury Tendon Injuries Malunion Controversies and Future Directions Related to Fractures of the Distal Radius and Ulna Open Fractures Role of Arthroscopy in Operative Management Bone Grafting Rehabilitation in Distal Radius Fractures Complex Regional Pain Syndrome Osteoporosis Assessment and Fracture Prevention Annotated References References RELATED CONTENT Textbook Video 43: Carpal Fractures and Dislocations Carpal Fractures and Dislocations Introduction to Carpal Fractures and Dislocations Pathoanatomy and Applied Anatomy Relating to Carpal Fractures and Dislocations Bony Anatomy of Carpal Fractures and Dislocations Ligamentous Anatomy of Carpal Fractures and Dislocations Extrinsic Ligaments Intrinsic Ligaments Neurovascular Anatomy of Carpal Fractures and Dislocations Kinematics of Carpal Fractures and Dislocations Pathoanatomy of Carpal Fractures and Dislocations Carpal Fractures Fracture of the Scaphoid Fracture of the Capitate Fracture of the Lunate Fracture of the Hamate Fracture of the Pisiform Fracture of the Trapezoid Fracture of the Trapezium Fracture of the Triquetrum Carpal Ligament Injuries Perilunate Dislocation and Fracture–Dislocation Assessment of Carpal Fractures and Dislocations Epidemiology of Carpal Fractures and Dislocations Injuries Associated with Carpal Fractures and Dislocations Mechanisms of Injury for Carpal Fractures and Dislocations Signs and Symptoms of Carpal Fractures and Dislocations Imaging and Other Diagnostic Studies for Carpal Fractures and Dislocations Radiographs Secondary Imaging Methods Carpal Injuries: Pearls and Pitfalls Scaphoid Fractures Introduction to Scaphoid Fractures Pathoanatomy and Applied Anatomy Related to Scaphoid Fractures Assessment of Scaphoid Fractures Mechanisms of Injury of Scaphoid Fractures Injuries Associated with Scaphoid Fractures Signs and Symptoms of Scaphoid Fractures Imaging and Other Diagnostic Studies for Scaphoid Fractures Imaging Radiography Magnetic Resonance Imaging Current Practice Assessing Diagnostic Tests Clinical Prediction Rules Classification of Scaphoid Fractures Diagnosis of Displacement and Instability Treatment Options for Scaphoid Fractures Nonoperative Treatment of Scaphoid Fractures Indications/Contraindications Nonoperative Treatment of Scaphoid Fractures: Indications and Contraindications Techniques Suspected Scaphoid Fractures Scaphoid Tubercle Fractures Nondisplaced or Minimally Displaced Scaphoid Fractures Operative Treatment of Scaphoid Fractures Indications Nondisplaced or Minimally Displaced Scaphoid Fractures Unstable or Displaced Scaphoid Fractures Percutaneous Fixation of Nondisplaced or Minimally Displaced Scaphoid Fractures Surgical Approach Technique Percutaneous Fixation of Nondisplaced or Minimally Displaced Scaphoid Fractures: Key Surgical Steps Open Reduction and Internal Fixation of Unstable or Displaced Scaphoid Fractures Open Reduction and Internal Fixation of Unstable or Displaced Scaphoid Fractures: Key Surgical Steps Arthroscopy-Assisted Reduction and Fixation of Unstable and/or Displaced Scaphoid Fractures Open Reduction and Internal Fixation of Proximal Pole Scaphoid Fractures Authors' Preferred Treatment for Scaphoid Fractures (Algorithm 43-1) Management of Expected Adverse Outcomes and Unexpected Complications Related to Scaphoid Fractures Malunion Nonunion Management Bone Grafting Operative Technique Stable Nonunion Unstable Nonunion Outcomes Avascular Necrosis Future Directions Related to Scaphoid Fractures Scaphoid Fractures: Pearls and Pitfalls Other Carpal Fractures Triquetral Fractures Introduction to Triquetral Fractures Assessment of Triquetral Fractures Treatment of Triquetral Fractures Lunate Fractures Introduction to Lunate Fractures Clinical Anatomy Kienböck's Disease Assessment of Lunate Fractures Imaging Classification Treatment of Lunate Fractures Uncommon Carpal Fractures Other Carpal Fractures: Pearls and Pitfalls Carpal Ligament Injuries Scapholunate Dissociation Introduction to Scapholunate Dissociation Assessment of Scapholunate Dissociation Signs and Symptoms Imaging Classification Treatment of Scapholunate Dissociation Acute Scapholunate Dissociation Subacute Scapholunate Dissociation Chronic Scapholunate Dissociation Wrist Fusion Authors' Preferred Treatment for Scapholunate Dissociation Lunotriquetral Dissociation Introduction to Lunotriquetral Dissociation Assessment of Lunotriquetral Dissociation Signs and Symptoms Imaging Treatment of Lunotriquetral Dissociation Perilunate Dislocation and Fracture–Dislocation Introduction to Perilunate Dislocation and Fracture–Dislocation Perilunate Dislocations Perilunate Fracture–Dislocations Assessment of Perilunate Dislocation and Fracture–Dislocation Signs and Symptoms Imaging Classification Treatment of Perilunate Dislocation and Fracture–Dislocation Lesser-Arc Injuries Greater-Arc Injuries Chronic Perilunate Dislocations Authors' Preferred Treatment for Perilunate Dislocation and Fracture–Dislocations (Algorithm 43-2) Radiocarpal Instability Introduction to Radiocarpal Instability Assessment of Radiocarpal Instability Signs and Symptoms Imaging Classification Treatment of Radiocarpal Instability Future Directions Related to Carpal Ligament Injuries Carpal Ligament Injuries: Pearls and Pitfalls Annotated References References RELATED CONTENT Textbook Video 44: Hand Fractures and Dislocations Introduction to Hand Fractures and Dislocations Distal Phalanx Fractures Introduction to Distal Phalanx Fractures Assessment of Distal Phalanx Fractures Mechanisms of Injury for Distal Phalanx Fractures Injuries Associated with Distal Phalanx Fractures Signs and Symptoms of Distal Phalanx Fractures Imaging and Other Diagnostic Studies for Distal Phalanx Fractures Classification of Distal Phalanx Fractures Classification of Distal Phalanx Fractures (Fig. 44-1)167 Outcome Measures for Distal Phalanx Fractures Pathoanatomy and Applied Anatomy Relating to Distal Phalanx Fractures Treatment Options for Distal Phalanx Fractures Nonoperative Treatment of Distal Phalanx Fractures Indications/Contraindications Nonoperative Treatment of Distal Phalanx Fractures Splinting Outcomes Operative Treatment of Distal Phalanx Fractures Indications/Contraindications Operative Treatment of Distal Phalanx Fractures: Indications Operative Treatment of Distal Phalanx Fractures Preoperative Planning Operative Treatment of Distal Phalanx Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Closed Reduction and Pinning of Tuft and Shaft Fractures: Key Surgical Steps Surgical Repair of Epiphyseal Fractures: Key Surgical Steps Open Reduction and Internal Fixation of Volar Base Fractures: Key Surgical Steps Surgical Fixation of Dorsal Bony Mallet Fractures: Key Surgical Steps Authors' Preferred Treatment for Distal Phalanx Fractures (Algorithm 44-1) Postoperative Care Potential Pitfalls and Preventive Measures Distal Phalanx Fractures: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Distal Phalanx Fractures Distal Phalanx Fractures: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Distal Phalanx Fractures Distal Interphalangeal Joint Dislocations Introduction to Distal Interphalangeal Joint Dislocation Assessment of Distal Interphalangeal Joint Dislocation Mechanisms of Injury for Distal Interphalangeal Joint Dislocation Injuries Associated with Distal Interphalangeal Joint Dislocation Signs and Symptoms of Distal Interphalangeal Joint Dislocation Imaging and Other Diagnostic Studies for Distal Interphalangeal Joint Dislocation Classification of Distal Interphalangeal Joint Dislocation Distal Interphalangeal Joint Dislocations: Classification Schemes Outcome Measures for Distal Interphalangeal Joint Dislocation Pathoanatomy and Applied Anatomy Relating to Distal Interphalangeal Joint Dislocation Treatment Options for Distal Interphalangeal Joint Dislocation Nonoperative Treatment of Distal Interphalangeal Joint Dislocation Indications/Contraindications Nonoperative Treatment of Distal Interphalangeal Joint Dislocations: Indications and Contraindications Closed Reduction Outcomes Operative Treatment of Distal Interphalangeal Joint Dislocation Indications/Contraindications Preoperative Planning Surgical Treatment: Preoperative Planning Checklist Positioning Surgical Approach Authors' Preferred Treatment for Distal Interphalangeal Joint Dislocation (Algorithm 44-2) Postoperative Care Potential Pitfalls and Preventive Measures Distal Interphalangeal Joint Dislocation: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Distal Interphalangeal Joint Dislocations Distal Interphalangeal Joint Dislocation: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Distal Interphalangeal Joint Dislocation Middle Phalanx Fractures Introduction to Middle Phalanx Fractures Assessment of Middle Phalanx Fractures Mechanisms of Injury for Middle Phalanx Fractures Injuries Associated with Middle Phalanx Fractures Signs and Symptoms of Middle Phalanx Fractures Imaging and Other Diagnostic Studies for Middle Phalanx Fractures Classification of Middle Phalanx Fractures Middle Phalanx Fractures: Classification Outcome Measures for Middle Phalanx Fractures Pathoanatomy and Applied Anatomy Relating to Middle Phalanx Fractures Treatment Options for Middle Phalanx Fractures Condylar, Neck, and Shaft Fractures of the Middle Phalanx Nonoperative Treatment of Condylar, Neck, and Shaft Fractures of the Middle Phalanx Indications/Contraindications Nonoperative Treatment of Condylar, Neck, and Shaft Fractures of the Middle Phalanx: Indications and Contraindications Nonoperative Technique Outcomes Operative Treatment of Condylar, Neck, and Shaft Fractures of the Middle Phalanx Indications/Contraindications Operative Fixation Condylar Fractures Neck Fractures Shaft Fractures Preoperative Planning Surgical Treatment of Condylar, Neck, and Shaft Fractures of the Middle Phalanx: Preoperative Planning Checklist Positioning Closed Reduction and Percutaneous Fixation Closed Reduction and Percutaneous Fixation: Key Surgical Steps Open Reduction and Internal Fixation Open Reduction and Internal Fixation: Key Surgical Steps Middle Phalanx Base Fractures Nonoperative Treatment of Middle Phalanx Base Fractures Indications/Contraindications Nonoperative Treatment of Middle Phalanx Base Fractures: Indications and Contraindications Volar Lip (Dorsal Fracture–Dislocation) Pilon Fractures Splinting Dorsal Base Fractures Volar Base Fractures Outcomes Operative Treatment of Middle Phalanx Base Fractures Indications/Contraindications Techniques Dorsal Base Fractures Volar Base Fractures Force Couple: Key Surgical Steps Dynamic Traction and External Fixation: Key Surgical Steps Open Reduction and Internal Fixation: Key Surgical Steps Volar Plate Arthroplasty: Key Surgical Steps Hemi-Hamate Arthroplasty: Key Surgical Steps Pilon Fractures Surgical Treatment of Pilon Fractures: Preoperative Planning Checklist Authors' Preferred Treatment for Middle Phalanx Fractures (Algorithm 44-3) Potential Pitfalls and Preventive Measures Middle Phalanx Fractures: Surgical Pitfalls and Preventions Outcomes Shaft and Neck Fractures Dorsal Base Fractures Volar Base Fractures Pilon Fractures Management of Expected Adverse Outcomes and Unexpected Complications Related to Middle Phalanx Fractures Middle Phalanx Fractures: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Middle Phalanx Fractures Proximal Interphalangeal Joint Dislocations Introduction to Proximal Interphalangeal Joint Dislocations Assessment of Proximal Interphalangeal Joint Dislocations Mechanisms of Injury for Proximal Interphalangeal Joint Dislocations Injuries Associated with Proximal Interphalangeal Joint Dislocations Signs and Symptoms of Proximal Interphalangeal Joint Dislocations Imaging and Other Diagnostic Studies for Proximal Interphalangeal Joint Dislocations Classification of Proximal Interphalangeal Joint Dislocations Proximal Interphalangeal Joint Dislocations: Classification Outcome Measures for Proximal Interphalangeal Joint Dislocations Pathoanatomy and Applied Anatomy Relating to Proximal Interphalangeal Joint Dislocations Treatment Options for Proximal Interphalangeal Joint Dislocations Nonoperative Treatment of Proximal Interphalangeal Joint Dislocations Indications/Contraindications Nonoperative Treatment of Proximal Interphalangeal Joint Dislocations: Indication and Contraindication Closed Reduction Dorsal Dislocations Volar Dislocations Rotatory Dislocation Outcomes Operative Treatment of Proximal Interphalangeal Joint Dislocations Indications/Contraindications Open Reduction Preoperative Planning Open Reduction of PIP Dislocations: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Reduction of PIP Dislocations: Key Surgical Steps Authors' Preferred Treatment for Proximal Interphalangeal Joint Dislocations (Algorithm 44-4) Postoperative Care Potential Pitfalls and Preventive Measures Proximal Interphalangeal Joint Dislocations: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Proximal Interphalangeal Joint Dislocations Proximal Interphalangeal Joint Dislocations: Common Adverse Outcomes and Complications Proximal Phalanx Fractures Introduction to Proximal Phalanx Fractures Assessment of Proximal Phalanx Fractures Mechanisms of Injury for Proximal Phalanx Fractures Injuries Associated with Proximal Phalanx Fractures Signs and Symptoms of Proximal Phalanx Fractures Imaging and Other Diagnostic Studies for Proximal Phalanx Fractures Classification of Proximal Phalanx Fractures Proximal Phalanx Fractures: Classification Outcome Measures for Proximal Phalanx Fractures Pathoanatomy and Applied Anatomy Relating to Proximal Phalanx Fractures Treatment Options for Proximal Phalanx Fractures Nonoperative Treatment of Proximal Phalanx Fractures Indications/Contraindications Nonoperative Treatment of Proximal Phalanx Fractures: Indications and Contraindications Closed Reduction and Splinting Followed by Buddy Taping Outcomes Operative Treatment of Proximal Phalanx Fractures Proximal Phalanx Condylar Fractures Indications/Contraindications Surgical Approach K-Wire Fixation of Condylar Fractures Technique Surgical Fixation of Proximal Phalanx Condylar Fractures with K-Wires: Key Surgical Steps Open Reduction and Internal Fixation of Condylar Fractures Technique ORIF of Proximal Phalanx Condylar Fractures: Key Surgical Steps Proximal Phalangeal Shaft Fractures Indications/Contraindications Preoperative Planning Surgical Fixation of Proximal Phalanx Fractures: Preoperative Planning Checklist Positioning Closed Reduction and Percutaneous Pinning of Proximal Phalanx Fractures Surgical Approach Technique Closed Reduction and Percutaneous Pin/Screw Fixation: Key Surgical Steps Open Reduction and Internal Fixation Surgical Approach Technique ORIF of Proximal Phalanx Fractures Through a Dorsal Approach: Key Surgical Steps ORIF of Proximal Phalanx Fractures Through a Midaxial Approach: Key Surgical Steps Authors' Preferred Treatment for Proximal Phalanx Fractures (Algorithm 44-5) Postoperative Care Potential Pitfalls and Preventive Measures Proximal Phalanx Fractures: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Proximal Phalanx Fractures Proximal Phalanx Fractures: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Proximal Phalanx Fractures Metacarpophalangeal Joint Dislocations and Ligamentous Disruption Introduction to Metacarpophalangeal Joint Dislocations and Ligamentous Disruption Assessment of Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Mechanisms of Injury for Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Injuries Associated with Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Signs and Symptoms of Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Imaging and Other Diagnostic Studies for Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Classification of Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Ligamentous Disruption: Classification MCP Joint Dislocations: Classification Outcome Measures for Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Pathoanatomy and Applied Anatomy Relating to Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Treatment Options for Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Nonoperative Treatment of Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Indications/Contraindications Nonoperative Treatment of Metacarpophalangeal Joint Dislocation or Ligamentous Disruption: Indications and Contraindications Closed Reduction Outcomes Dislocation Ligamentous Disruption Operative Treatment of Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Indications/Contraindications Open Reduction of the MCP Joint Preoperative Planning Open Reduction of the MCP Joint: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Reduction via Volar Approach: Key Surgical Steps Open Reduction via Dorsal Approach: Key Surgical Steps Open Repair of the Ulnar or Radial Collateral Ligament of the MCP Joint of the Thumb Preoperative Planning Open Repair of the Ulnar or Radial Collateral Ligament of the MCP Joint of the Thumb: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Repair of the Ulnar or Radial Collateral Ligament of the MCP Joint of the Thumb: Key Surgical Steps Authors' Preferred Treatment for Metacarpophalangeal Joint Dislocation and Ligamentous Disruption (Algorithm 44-6) Postoperative Care Potential Pitfalls and Preventive Measures Metacarpophalangeal Joint Dislocation or Ligamentous Disruption: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Metacarpophalangeal Joint Dislocation and Ligamentous Disruption MCP Joint Dislocations or Ligamentous Disruption: Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Metacarpophalangeal Joint Dislocation and Ligamentous Disruption Metacarpal Fractures Introduction to Metacarpal Fractures Assessment of Metacarpal Fractures Mechanisms of Injury for Metacarpal Fractures Injuries Associated with Metacarpal Fractures Signs and Symptoms of Metacarpal Fractures Imaging and Other Diagnostic Studies for Metacarpal Fractures Classification of Metacarpal Fractures Metacarpal Fractures: Classification Outcome Measures for Metacarpal Fractures Pathoanatomy and Applied Anatomy Relating to Metacarpal Fractures Treatment Options for Metacarpal Fractures Nonoperative Treatment of Metacarpal Fractures Indications/Contraindications Nonoperative Treatment of Metacarpal Fractures: Indications and Contraindications Closed Reduction and Splinting with or without Buddy Taping Outcomes Operative Treatment of Metacarpal Fractures Indications/Contraindications Closed Reduction and Surgical Fixation Surgical Approach Technique Closed Reduction and Surgical Fixation: Key Surgical Steps Open Reduction and Internal Fixation Surgical Approach Technique Open Reduction and Internal Fixation: Key Surgical Steps Preoperative Planning Open or Closed Reduction and Surgical Fixation: Preoperative Planning Checklist Positioning Authors' Preferred Treatment for Metacarpal Fractures (Algorithm 44-7) Postoperative Care Potential Pitfalls and Preventive Measures Metacarpal Fractures: Surgical Pitfalls and Preventions Outcomes Management of expected Adverse Outcomes and Unexpected Complications Related to Metacarpal Fractures Metacarpal Fractures: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Metacarpal Fractures Carpometacarpal Joint Dislocations Introduction to Carpometacarpal Joint Dislocations Assessment of Carpometacarpal Joint Dislocations Mechanisms of Injury for Carpometacarpal Joint Dislocations Injuries Associated with Carpometacarpal Joint Dislocations Signs and Symptoms of Carpometacarpal Joint Dislocations Imaging and Other Diagnostic Studies for Carpometacarpal Joint Dislocations Classification of Carpometacarpal Joint Dislocations Carpometacarpal Joint Dislocations: Classification Outcome Measures for Carpometacarpal Joint Dislocations Pathoanatomy and Applied Anatomy Relating to Carpometacarpal Joint Dislocations Treatment Options for Carpometacarpal Joint Dislocations Nonoperative Treatment of Carpometacarpal Joint Dislocations Indications/Contraindications Nonoperative Treatment of Carpometacarpal Joint Dislocations: Indications and Contraindications Closed Reduction and Splinting Outcomes Operative Treatment of Carpometacarpal Joint Dislocations Indications/Contraindications Closed Reduction and Percutaneous Pinning Preoperative Planning Closed Reduction and Percutaneous Pinning of Carpometacarpal Joint Dislocations: Preoperative Planning Checklist Positioning Technique CRPP of Carpometacarpal Dislocation or Fracture–Dislocation: Key Surgical Steps Open Reduction and Surgical Fixation Preoperative Planning Open Reduction and Surgical Fixation: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Reduction Surgical Fixation of CMC Joint of the Fingers: Key Surgical Steps Open Reduction Surgical Fixation of CMC Joint of the Thumb: Key Surgical Steps Authors' Preferred Treatment for Carpometacarpal Joint Dislocations (Algorithm 44-8) Postoperative Care Potential Pitfalls and Preventive Measures Carpometacarpal Joint Dislocations: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Carpometacarpal Joint Dislocations CMC Joint Dislocations: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Carpometacarpal Joint Dislocations Annotated References References RELATED CONTENT Textbook Video 45: Chest Wall Injuries Muscles Pulmonary Anatomy Pathoanatomy of Rib Fractures Flail Chest and Unstable Chest Wall Flail Chest Unstable Chest Wall Assessment of Chest Wall Injuries Mechanisms of Injury for Chest Wall Injuries Injuries Associated with Chest Wall Injuries Intrathoracic Injuries Pulmonary Contusion Extrathoracic Injuries Signs and Symptoms of Chest Wall Injuries Symptoms Signs Imaging and Other Diagnostic Studies for Chest Wall Injuries Radiographs CT Scanning Classification of Chest Wall Injuries Outcomes of Chest Wall Injuries Effect on Pulmonary Function Need for Mechanical Ventilation Mortality Outcomes for Patients with Concurrent Head Injury Outcomes for Patients with Concurrent Pulmonary Contusion Treatment Options for Chest Wall Injuries Nonoperative Treatment of Chest Wall Injuries Historical Treatment Practices Current Nonoperative Treatment Practices Mechanical Ventilation Pain Management Chest Tube Insertion Chest Tube Management Chest Physiotherapy Indications/Contraindications Nonoperative Treatment of Chest Wall Injuries Operative Treatment of Chest Wall Injuries Indications/Contraindications Indications Contraindications Surgical Fixation of Rib Fractures Preoperative Planning Surgical Fixation of Rib Fractures: Preoperative Planning Checklist Positioning Surgical Approaches Thoracotomy Approach Posterior Approach Technique Surgical Fixation of Rib Fractures: Key Surgical Steps Author's Preferred Treatment for Chest Wall Injuries (Algorithm 45-1) Postoperative Care Potential Pitfalls and Preventive Measures Flail Chest Injuries: Surgical Pitfalls and Preventions Current evidence for surgical fixation of rib fractures Management of Expected Adverse Outcomes and Unexpected Complications Related to Flail Chest Injuries Common Adverse Outcomes and Complications Infection Hardware Failure Nonunion Malunion Summary, Controversies, and Future Directions Related to Unstable Chest Wall Injuries Controversies Lack of High-Quality Studies Inclusion/Exclusion Criteria for Surgical Fixation Who Should Perform Surgical Fixation of Chest Wall Injuries Annotated References References 46: Principles of Spine Trauma Care Introduction to Spine Trauma Epidemiology of Spine Trauma United States and Worldwide Burden Functional Burden of Spine Trauma Financial Burden of Spine Trauma Assessment of Spine Trauma Field Assessment and Stabilization First Responders Immobilization Emergency Room Evaluation and Care Resuscitation Advanced Trauma Life Support Hemodynamics of Neurogenic Shock Secondary Survey Spine-Focused Physical Examination Determination of Spinal Shock Imaging and Other Diagnostic Studies for Spine Trauma Plain Film Radiography in the Acute Setting Computed Tomography Magnetic Resonance Imaging Treatment Options for Spine Trauma Nonoperative Treatment of Spinal Cord Injury Methylprednisolone Emerging and Experimental Therapies Cervical Spine Clearance Authors' Preferred Treatment for Cervical Spine Clearance (Algorithm 46-1) Multisystem Trauma Injuries Associated with Spine Trauma Thoracoabdominal and Noncontiguous Spine Injuries Blunt Cerebrovascular Injury Mechanics of Spinal Cord Injury Pathophysiology of Spinal Cord Injury Spine Trauma in the Geriatric Population Summary and Controversies in Spine Trauma Care Controversies in Spine Trauma Summary Authors' Preferred Treatment for Spine Trauma in the Elderly (Algorithm 46-2) Annotated References References 47: Cervical Spine Fractures and Dislocations Introduction to Cervical Spine Fractures and Dislocations Epidemiology of Cervical Spine Fractures and Dislocations Assessment of Cervical Spine Fractures and Dislocations Mechanisms of Injury for Cervical Spine Fractures and Dislocations Initial Care of Cervical Spine Fractures and Dislocations Prehospital Care Hospital Care History and Physical Examination Imaging and Other Diagnostic Studies for Cervical Spine Fractures and Dislocations Initial Imaging Protocol Injury Detection Imaging of Cervical Spine Fractures and Dislocations Plain Radiographs Computed Tomography Magnetic Resonance Imaging Outcome Measures for Cervical Spine Fractures and Dislocations Pathoanatomy and Applied Anatomy of Cervical Spine Fractures and Dislocations Upper Cervical Spine (Occiput to C2) Occipitocervical Region Atlantoaxial Region Lower Cervical Spine (C3–C7) Anterior Elements Posterior Elements Spinal Canal and Canal Compromise Cervical Spinal Cord Anatomy Treatment Options for Cervical Spine Fractures and Dislocations Nonoperative Treatment of Cervical Spine Fractures and Dislocations Nonoperative Treatment of Cervical Spine Fractures and Dislocations: Indications and Contraindications Cervical Orthoses Cervicothoracic Orthoses Halothoracic Vest Application Technique Outcomes Skull-Based Traction and Closed Reduction Application Technique Reduction Technique For Odontoid Fractures For Bilateral Facet Dislocations For Unilateral Facet Dislocations Role of Prereduction MRI Operative Treatment of Cervical Spine Fractures and Dislocations Timing Preoperative Planning Anterior Cervical Approach: Preoperative Planning Checklist Anterior Surgical Approaches Transoral Approach High Anterior Retropharyngeal Approach Anterior Approach to the Subaxial Cervical Spine Anterior Decompression and Instrumentation Technique Anterior Decompression and Instrumentation of the Cervical Spine: Key Surgical Steps Outcomes Posterior Approach and Techniques Preoperative Planning Posterior Cervical Approach: Preoperative Planning Checklist Posterior Approach Posterior Decompression Technique Authors' Preferred Treatment for Cervical Spine Fractures and Dislocations Postoperative Care Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Cervical Spine Fractures and Dislocations Cervical Spine Fractures and Dislocations: Adverse Outcomes and Complications Complications Associated with the Anterior Approach Complications Associated with the Posterior Approach Perioperative Neurologic Deficit Early Postoperative Complications Late Postoperative Complications Specific Injuries for Cervical Spine fractures and Dislocations Occipitocervical Dislocation (C0–C1) Assessment of Occipitocervical Dislocation (C0–C1) Mechanisms of Injury Diagnosis and Classification Nonoperative Treatment of Occipitocervical Dislocation (C0–C1) Indications/Contraindications Outcomes Operative Treatment of Occipitocervical Dislocation (C0–C1) Indications Occipital Plate and Screw–Rod Construct and Fusion Preoperative Planning Positioning Postoperative Care Pearls and Pitfalls Occipital Condyle Fractures Assessment of Occipital Condyle Fractures Mechanisms of Injury Associated Injuries Diagnosis and Classification Nonoperative Treatment of Occipital Condyle Fractures Indications/Contraindications Outcomes Operative Treatment of Occipital Condyle Fractures Indications Authors' Preferred Treatment for Occipital Condyle Fractures (Algorithm 47-1) Outcomes Complications of Occipital Condyle Fractures Atlas Fractures (C1) Assessment of Atlas Fractures (C1) Mechanisms of Injury Diagnosis and Classification Nonoperative Treatment of Atlas Fractures (C1) Indications/Contraindications Authors' Preferred Treatment for Atlas Fractures (C1) (Algorithm 47-2) Outcomes Operative Treatment of Atlas Fractures (C1) Posterior Atlantoaxial Stabilization and Fusion Indications Outcomes Osteosynthesis of the C1 Ring Indications Outcomes Complications of Atlas Fractures (C1) Sagittal Atlantoaxial Instability without Fracture (C1–C2) Assessment of Sagittal Atlantoaxial Instability without Fracture (C1–C2) Mechanisms of Injury Diagnosis and Classification Nonoperative Treatment of Sagittal Atlantoaxial Instability without Fracture (C1–C2) Indications/Contraindications Outcomes Operative Treatment of Sagittal Atlantoaxial Instability without Fracture (C1–C2) Indications Posterior Stabilization of Sagittal Atlantoaxial Instability without Fracture (C1–C2) Preoperative Planning Positioning Surgical Approach Technique Posterior Atlantoaxial Stabilization and Fusion: Key Surgical Steps Postoperative Care Pearls and Pitfalls Outcomes Atlantoaxial Rotatory Dislocation (C1–C2) Assessment of Atlantoaxial Rotatory Dislocation (C1–C2) Mechanisms of Injury Associated Injuries Diagnosis and Classification Nonoperative Treatment of Atlantoaxial Rotatory Dislocation (C1–C2) Indications/Contraindications Outcomes Operative Treatment of Atlantoaxial Rotatory Dislocation (C1–C2) Indications Closed Reduction and Instrumented Fusion Outcomes Odontoid Fractures (C2) Assessment of Odontoid Fractures (C2) Mechanisms of Injury Associated Injuries Diagnosis and Classification Nonoperative Treatment of Odontoid Fractures (C2) Indications/Contraindications Techniques Traction and Reduction Halo Vest Immobilization Outcomes Operative Treatment of Odontoid Fractures (C2) Indications Techniques Anterior Odontoid Screw Fixation Posterior C1–C2 Fusion Hangman'S Fractures (TRAUMATIC SPONDYLOLISTHESIS, C2–C3) Assessment of Hangman's Fractures (Traumatic Spondylolisthesis, C2–C3) Mechanisms of Injury Diagnosis and Classification Nonoperative Treatment of Hangman's Fractures (Traumatic Spondylolisthesis, C2–C3) Indications/Contraindications Outcomes Operative Treatment of Hangman's Fractures (Traumatic Spondylolisthesis, C2–C3) Posterior Surgery Anterior Discectomy and Fusion Authors' Preferred Treatment for Hangman's Fractures (TRAUMATIC SPONDYLOLISTHESIS, C2–C3) (Algorithm 47-4) Subaxial Cervical Fractures and Dislocations (C3–C7) Assessment of Subaxial Cervical Fractures and Dislocations (C3–C7) Classification Mechanistic Classification of Subaxial Cervical Injuries Subaxial Cervical Injury Scoring Systems AOSpine Subaxial Cervical Spine Injury Classification System Descriptive Classification of Subaxial Cervical Injuries Mechanisms of Injury Normal Mechanics Structural Injury and Cervical Pathomechanics Failure of Spinal Structures Treatment Options for Subaxial Cervical Fractures and Dislocations (C3–C7) Compression Fractures Nonoperative Treatment of Compression Fractures Operative Treatment of Compression Fractures Authors' Preferred Treatment for Compression Fractures (Algorithm 47-5) Burst Fractures Nonoperative Treatment of Burst Fractures Operative Treatment of Burst Fractures Burst Fractures: Pearls and Pitfalls Authors' Preferred Treatment for Burst Fractures (Algorithm 47-6) Flexion-Type Teardrop Fractures Nonoperative Treatment of Flexion-Type Teardrop Fractures Operative Treatment of Flexion-Type Teardrop Fractures Flexion-Type Teardrop Fractures: Pearls and Pitfalls Authors' Preferred Treatment for Flexion-Type Teardrop Fractures (Algorithm 47-7) Facet Fractures without Dislocation Nonoperative Treatment of Facet Fractures without Dislocation Operative Treatment of Facet Fractures without Dislocation Facet Fractures without Dislocation: Pearls and Pitfalls Authors' Preferred Treatment for Facet Fractures without Dislocation (Algorithm 47-8) Outcomes Complications Facet Dislocations Nonoperative Treatment of Facet Dislocations Operative Treatment of Facet Dislocations Authors' Preferred Treatment for Facet Dislocations (Algorithm 47-9) Facet Dislocations: Pearls and Pitfalls Outcomes Complications Miscellaneous Injuries Pedicle and Lamina Fractures Anterior Tension Band Injuries Cervical Injuries of the Ankylosed and Spondylotic Spine Spinal Cord Injury without Instability in the Spondylotic Spine Gunshot Wounds to the Cervical Spine Vertebral Artery Injury in Association with Cervical Trauma C7 Spinous Process (Clay-Shoveler's Fractures) Annotated References References Thoracic Region (T2–T10) Thoracolumbar Region (T11–L2) Lumbosacral Region (L3–S1) Assessment of Thoracolumbar Spine Fractures and Dislocations Mechanisms of Injury for Thoracolumbar Spine Fractures and Dislocations Injuries Associated with Thoracolumbar Spine Fractures and Dislocations Patient Evaluation for Thoracolumbar Spine Fractures and Dislocations Imaging and Other Diagnostic Studies for Thoracolumbar Spine Fractures and Dislocations Plain Radiographs Computed Tomography Magnetic Resonance Imaging Classification of Thoracolumbar Spine Fractures and Dislocations Historical Classification Systems Thoracolumbar Injury Classification and Severity Score Revised AOSpine Thoracolumbar Fracture Classification Revised AOSpine Thoracolumbar Classification System Treatment Options for Thoracolumbar Spine Fractures and Dislocations Hemodynamic Support High-Dose Corticosteroid Treatment Surgical Decision-Making Nonoperative Treatment of Thoracolumbar Spine Fractures and Dislocations Indications/Contraindications Nonoperative Treatment of Thoracolumbar Spine Fractures and Dislocations: Indications and Contraindications Bracing Outcomes Operative Treatment of Thoracolumbar Spine Fractures and Dislocations Timing of Surgery Indications/Contraindications Posterior Approach Anterior Approach Combined Anterior and Posterior Approach Minimally Invasive Surgery Posterior Thoracolumbar Stabilization Preoperative Planning Posterior Thoracolumbar Stabilization: Preoperative Planning Checklist Surgical Approaches Technique Exposure: Key Surgical Steps Discectomy and Corpectomy From a Lateral Approach: Key Surgical Steps Costotransversectomy: Key Surgical Steps Laminectomy: Key Surgical Steps Authors' Preferred Treatment of Thoracolumbar Spine Fractures and Dislocations (Algorithms 48-1, 48-2, and 48-3) Postoperative Care Special Considerations in Thoracolumbar Spine Fractures and Dislocations Osteoporotic Vertebral Fractures Treatment Options for Osteoporotic Vertebral Fractures Nonoperative Treatment of Osteoporotic Vertebral Fractures Bracing Medication Operative Treatment of Osteoporotic Vertebral Fractures Cement Augmentation Spinal Instrumented Fusion Penetrating Spinal Injuries Mechanisms of Injury for Penetrating Spinal Injuries Assessment of Penetrating Spinal Injuries Imaging of Penetrating Spinal Injuries Treatment of Penetrating Spinal Injuries Surgical Decision-Making Spinal Stability Neurologic Injury CSF Leakage Retained Bullet Fragments Local Toxicity Systemic Lead Toxicity Bullet Migration Outcomes Summary of Penetrating Spinal Injuries Management of Expected Adverse Outcomes and Unexpected Complications Related to Thoracolumbar Fractures and Dislocations Thoracolumbar Fractures and Dislocations: Common Adverse Outcomes and Complications Infection Neurologic Deterioration Cerebrospinal Fluid Leakage Concomitant Injuries Spinal Deformity Complications of Cement Augmentation Annotated References References RELATED CONTENT Textbook Video 49: Pelvic Ring Injuries Introduction to Pelvic Ring Injuries Assessment of Pelvic Ring Injuries Mechanism of Injury for Pelvic Ring Injuries Injuries Associated with Pelvic Ring Injuries Genitourinary Tract Injuries Open Pelvic Ring Injuries and Gastrointestinal Injuries Signs and Symptoms of Pelvic Ring Injuries Physical Examination Imaging and Other Diagnostic Studies for Pelvic Ring Injuries Plain Radiography Computed Tomography Fluoroscopic Stress Examinations Magnetic Resonance Imaging Classification of Pelvic Ring Injuries Tile Classification Tile Classification of Pelvic Ring Injuries Young and Burgess Classification Young and Burgess Classification of Pelvic Ring Injuries OTA/AO Classification Fragility Fractures of the Pelvic Ring Comparison of Classifications Classification of Sacral Fractures Denis Classification Modified Roy-Camille (Strange-Vognsen) Classification Outcome Measures for Pelvic Ring Injuries Pathoanatomy and Applied Anatomy Relating to Pelvic Ring Injuries Treatment Options for Pelvic Ring Injuries Initial Management of Pelvic Ring Injuries Pelvic Bleeding Transfusion Requirements Binders/MAST Emergent External Fixation Angiography Pelvic Packing Future Trends in Hemorrhage Control Nonoperative Treatment of Pelvic Ring Injuries Indications/Contraindications Nonoperative Treatment of Pelvic Ring Injuries: Indications and Contraindications Techniques Outcomes Operative Treatment of Pelvic Ring Injuries Indications Pelvic Ring and Sacral Fracture Stabilization: Indications Surgical Approaches Anterior External Fixation of Pelvic Ring Injuries Technique Iliac Crest Frame Iliac Crest Frame for Anterior External Fixation of Pelvic Ring Injuries: Key Surgical Steps Hannover Technique Hannover Technique for Anterior External Fixation of Pelvic Ring Injuries: Key Surgical Steps Distraction External Fixation Postoperative Care Potential Pitfalls and Preventive Measures Anterior External Fixation of Pelvic Ring Injuries: Surgical Pitfalls and Preventions Iliac Crest Frame Hannover Technique Outcomes Internal External Fixator Technique1 Internal External Fixation of Pelvic Ring Injuries: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Internal External Fixation of Pelvic Ring Injuries: Surgical Pitfalls and Preventions Outcomes Stabilization of the Anterior Pelvic Ring Preoperative Planning Stabilization of the Anterior Pelvic Ring: Preoperative Planning Checklist Patient Positioning Surgical Approach ORIF of Symphysis Diastasis Technique ORIF of Symphysis Pubis: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures ORIF of Symphysis Pubis: Surgical Pitfalls and Preventions Outcomes Stabilization of Ramus Fractures Technique Open Reduction and Internal Fixation ORIF of Ramus Fracture: Key Surgical Steps Antegrade Percutaneous Screw Fixation Antegrade Percutaneous Screw Fixation of Ramus Fracture: Key Surgical Steps Retrograde Percutaneous Screw Fixation Retrograde Percutaneous Screw Fixation of Ramus Fracture: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Stabilization of Ramus Fractures: Surgical Pitfalls and Preventions Outcomes Posterior Approach for Posterior Pelvic Ring Injuries Preoperative Planning and Patient Positioning Posterior Approach for Posterior Pelvic Ring Injuries: Preoperative Planning Checklist Posterior Surgical Approach for Sacroiliac Joint Dislocation Posterior Surgical Approach for Sacral Fractures Posterior Surgical Approach for Crescent and Iliac Wing Fractures Anterior Approaches to Posterior Pelvic Ring Injuries Preoperative Planning and Patient Positioning Anterior Approaches for Posterior Pelvic Ring Injuries: Preoperative Planning Checklist Surgical Approach ORIF of Iliac Wing Fractures Technique ORIF of Iliac Wing Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures ORIF of Iliac Wing Fractures: Surgical Pitfalls and Preventions Outcomes Fixation of Crescent Fractures (Fracture–Dislocations) Technique Open Reduction and Internal Fixation of Crescent Fractures ORIF of Crescent Fractures: Key Surgical Steps Closed Reduction and Percutaneous Fixation of Crescent Fractures Closed Reduction and Percutaneous Fixation of Crescent Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Fixation of Crescent Fractures: Surgical Pitfalls and Preventions Outcomes Iliosacral Screw Fixation for Sacroiliac Joint Dislocation Preoperative Planning and Patient Positioning Iliosacral Screw Fixation for Sacroiliac Joint Dislocation: Preoperative Planning Checklist Technique Iliosacral Screw Fixation for Sacroiliac Joint Dislocation: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Iliosacral Screw Fixation for Sacroiliac Joint Dislocation: Surgical Pitfalls and Preventions Open Reduction and Internal Fixation for Sacroiliac Joint Dislocation Technique Anterior Approach ORIF for Sacroiliac Joint Dislocation From Anterior Approach: Key Surgical Steps Posterior Approach ORIF for Sacroiliac Joint Dislocation From Posterior Approach: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures ORIF for Sacroiliac Joint Dislocation: Surgical Pitfalls and Preventions Outcomes Repair of Sacral Fractures Percutaneous Iliosacral Screw Fixation Preoperative Planning Percutaneous Iliosacral Screw Fixation: Preoperative Planning Checklist Positioning Surgical Approaches Technique Percutaneous Iliosacral Screw Fixation: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Percutaneous Iliosacral Screw Fixation: Surgical Pitfalls and Preventions Open Reduction and Internal Fixation of Vertical Shear Fractures Preoperative Planning ORIF of Vertical Shear Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Vertical Shear Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures ORIF of Vertical Shear Fractures: Surgical Pitfalls and Preventions Outcomes Lumbopelvic Fixation for Spinopelvic Disassociation Preoperative Planning Lumbopelvic Fixation for Spinopelvic Disassociation: Preoperative Planning Checklist Positioning Surgical Approach Technique Lumbopelvic Fixation for Spinopelvic Disassociation: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Lumbopelvic Fixation for Spinopelvic Disassociation: Surgical Pitfalls and Preventions Outcomes Author's Preferred Treatment for Pelvic Ring Injuries Postoperative Care Drains and Soft Tissues Mobilization and Weight bearing Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Pelvic Ring Injuries: Common Adverse Outcomes and Complications Intraoperative Hemorrhage Inability to Achieve Adequate Fixation Loss of Fixation and Reduction Postoperative Wound Infection and Dehiscence Newly Recognized Postoperative Neurologic Deficits Pin-Tract Infections Deep Venous Thrombosis/Pulmonary Embolism Prophylaxis Controversies and Future Directions Related to Pelvic Ring Injuries Annotated References References 50: Acetabulum Fractures Introduction to Acetabulum Fractures Assessment of Acetabulum Fractures Mechanisms of Injury for Acetabulum Fractures Injuries Associated with Acetabular Fractures Signs and Symptoms of Acetabular Fractures Imaging and Other Diagnostic Studies for Acetabular Fractures Classification of Acetabular Fractures Elementary Types of Acetabulum Fractures Posterior Wall Fractures Posterior Column Fractures Anterior Wall Fractures Anterior Column Fractures Transverse Fractures Associated Fracture Patterns Posterior Column and Posterior Wall Fractures Transverse and Posterior Wall Fractures Anterior Column (or Wall) and Posterior Hemitransverse Fractures T-Shaped Fractures Both-Column Fractures Outcome Measures for Acetabular Fractures Pathoanatomy and Applied Anatomy Related to Acetabular Fractures Treatment Options for Acetabular Fractures Nonoperative Treatment of Acetabular Fractures Indications/Contraindications Nonoperative Treatment of Acetabular Fractures: Indications Geriatric Patients Techniques Outcomes Operative Treatment of Acetabular Fractures Indications/Contraindications Preoperative Planning Fracture Classification Timing of Surgery Patient Positioning Fracture Reduction and Fixation of Acetabular Fractures General Instrumentation and Implants Surgical Approaches Standard Approaches Kocher–Langenbeck Approach Ilioinguinal Approach Iliofemoral Approach Extended Iliofemoral Approach Alternative Surgical Approaches Trochanteric Flip Osteotomy Modified Gibson Approach Modified Stoppa Intrapelvic Approach Combined Anterior and Posterior Approaches Operative Treatment of Elementary Acetabular Fracture Types Open Reduction and Internal Fixation of Posterior Wall Fractures Preoperative Planning ORIF of Posterior Wall Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Posterior Wall Fractures: Key Surgical Steps Potential Pitfalls and Preventive Measures ORIF of Posterior Wall Fractures: Potential Pitfalls and Preventions Open Reduction and Internal Fixation of Posterior Column Fractures Preoperative Planning ORIF of Posterior Column Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Posterior Column Fractures: Key Surgical Steps Potential Pitfalls and Preventive Measures ORIF of Posterior Column Fractures: Potential Pitfalls and Preventions Open Reduction and Internal Fixation of Anterior Column Fractures and Anterior Wall Fractures Preoperative Planning ORIF of Anterior Wall and Column Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Anterior Column and Wall Fractures: Key Surgical Steps Potential Pitfalls and Preventive Measures ORIF of Anterior Column and Wall Fractures: Potential Pitfalls and Preventions Open Reduction and Internal Fixation of Transverse Fractures Preoperative Planning ORIF of Transverse Fractures: Preoperative Planning Checklist Positioning and Surgical Approach Technique ORIF of Transverse Acetabulum Fractures: Key Surgical Steps Potential Pitfalls and Preventive Measures Operative Treatment of Associated Acetabular Fracture Types Open Reduction and Internal Fixation of Posterior Column and Posterior Wall Fractures Preoperative Planning Positioning and Surgical Approach Technique ORIF of Posterior Column and Wall Fractures: Key Surgical Steps Potential Pitfalls and Preventive Measures Open Reduction and Internal Fixation of Transverse and Posterior Wall Fractures Preoperative Planning Positioning and Surgical Approach Technique ORIF of Transverse and Posterior Wall Fractures: Key Surgical Steps Potential Pitfalls and Preventive Measures Open Reduction and Internal Fixation of Anterior Column (or Wall) and Posterior Hemitransverse Fractures Preoperative Planning Position and Surgical Approach Technique ORIF of Anterior Column/Wall and Posterior Hemitransverse Fractures: Key Surgical Steps Potential Pitfalls and Preventive Measures Open Reduction and Internal Fixation of T-Shaped Fractures Preoperative Planning Position and Surgical Approach Technique ORIF of T-Shaped Fractures via the Posterior Approach: Key Surgical Steps Potential Pitfalls and Preventive Measures ORIF of T-Shaped Fractures: Potential Pitfalls and Preventions Open Reduction and Internal Fixation of Both-Column Fractures Preoperative Planning Position and Surgical Approach Technique ORIF of the Both-Column Fracture via the Ilioinguinal Approach: Key Surgical Steps Potential Pitfalls and Preventive Measures Percutaneous Fixation of Acetabular Fractures Preoperative Planning Percutaneous Fixation of Acetabular Fractures: Preoperative Planning Checklist Technique Percutaneous Fixation of Acetabular Fractures: Key Surgical Steps Potential Pitfalls and Preventive Measures Operative Treatment of Acetabular Fractures in Geriatric Patients Fracture Reduction and Internal Fixation Total Hip Arthroplasty Authors' Preferred Treatment for Acetabulum Fractures (Algorithm 50-1) Perioperative Care Outcomes ORIF of Acetabular Fractures Clinical Results Functional Outcomes Percutaneous Treatment of Acetabular Fractures Clinical Results Functional Outcomes Management of Expected Adverse Outcomes and Unexpected Complications in Acetabulum Fractures Acetabular Fractures: Common Adverse Outcomes and Complications Posttraumatic Arthritis and Osteonecrosis of the Femoral Head Infection Iatrogenic Nerve Injury Venous Thromboembolism Intra-articular Hardware Heterotopic Ossification Summary, Controversies, and Future Directions Relating to Acetabulum Fractures Annotated References References RELATED CONTENT Textbook Video 51: Hip Dislocations and Femoral Head Fractures Introduction to Hip Dislocations and Femoral Head Fractures Assessment of Hip Dislocations Mechanisms of Injury for Hip Dislocations Injuries Associated with Hip Dislocations Signs and Symptoms of Hip Dislocations Imaging and Other Diagnostic Studies for Hip Dislocations Classification of Hip Dislocations Thompson and Epstein Classification of Posterior Hip Dislocation Stewart and Milford Classification of Posterior Hip Dislocation Pipkin Classification of Posterior Hip Dislocation Brumback Classification of Femoral Head Fractures Outcome Measures for Hip Dislocations Pathoanatomy and Applied Anatomy Relating to Hip Dislocations Biomechanics Surgical and Applied Anatomy Ligamentous Anatomy Neurovascular Anatomy Treatment Options for hip Dislocations and Femoral Head Fractures Nonoperative Treatment of Hip Dislocations and Femoral Head Fractures Indications/Contraindications Nonoperative Treatment of Hip Dislocations and Femoral Head Fractures: Indications and Contraindications Techniques for Closed Reduction of Hip Dislocations Posterior Dislocation: Allis Maneuver Anterior Dislocation: Walker Modification of Allis Maneuver Fluoroscopic Evaluation of the Hip Following Closed Reduction Outcomes Operative Treatment of Hip Dislocations and Femoral Head Fractures Indications/Contraindications Open Reduction with or without Debridement Open Reduction and Internal Fixation Surgical Procedure and Approach Arthroscopic Debridement of the Dislocated Hip Preoperative Planning Arthroscopic Debridement of the Dislocated Hip: Preoperative Planning Checklist Positioning Surgical Approach Technique Arthroscopic Debridement of the Dislocated Hip: Key Surgical Steps Open Reduction, Debridement, and Fixation of the Dislocated Hip Through an Anterior Approach Preoperative Planning Open Reduction, Debridement, and Fixation of the Dislocated Hip Through an Anterior Approach: Preoperative Planning Checklist Positioning Surgical Approach and Technique Direct Anterior (Smith-Petersen or Hueter Interval) Approach Direct Anterior (Smith-Petersen or Heuter Interval) Approach to the Hip: Key Surgical Steps Anterolateral (Watson-Jones) Approach Through a Posterior (Kocher–Langenbeck) Approach Preoperative Planning Open Reduction, Debridement, and Fixation of the Dislocated Hip Through a Posterior (Kocher–Langenbeck) Approach: Preoperative Planning Checklist Positioning Surgical Approach and Technique Open Reduction, Debridement, and Fixation of the Hip Through a Posterior (Kocher–Langenbeck) Approach: Key Surgical Steps Surgical Hip Dislocation or Transtrochanteric Approach to the Hip Preoperative Planning Surgical Dislocation of the Hip: Preoperative Planning Checklist Positioning Surgical Approach and Technique Surgical Dislocation of the Hip: Key Surgical Steps Authors' Preferred Treatment for Hip Dislocations and Femoral Head Fractures (Algorithm 51-1) Postoperative Care Arthroscopic Debridement Open Surgical Treatment Potential Pitfalls and Preventive Measures Surgical Treatment of the Dislocated Hip: Surgical Pitfalls and Preventions Arthroscopic Debridement Open Approaches Anterior Approaches Posterior Approach Surgical Dislocation Outcomes Arthroscopic Debridement Open Approaches Management of Expected Adverse Outcomes and Unexpected Complications Related to hip Dislocations and Femoral Head Fractures Open Surgical Treatment of Hip Dislocation and Femoral Head Fractures: Common Adverse Outcomes and Complications Prereduction Considerations Postreduction Considerations Avascular Necrosis Arthritis Heterotopic Ossification Malunion Sciatic Nerve Dysfunction Summary, Controversies, and Future Directions Related to hip Dislocations and Femoral Head Fractures Annotated References References RELATED CONTENT Video 52: Femoral Neck Fractures Introduction to Femoral Neck Fractures Epidemiology of Femoral Neck Fractures Assessment of Femoral Neck Fractures Mechanisms of Injury for Femoral Neck Fractures Injuries Associated with Femoral Neck Fractures Signs and Symptoms of Femoral Neck Fractures Imaging and Other Diagnostic Studies for Femoral Neck Fractures Preoperative Traction Medication Classification of Intracapsular Hip Fractures Garden Classification Pauwels Classification AO/OTA Classification Outcome Measures for Femoral Neck Fractures Pathoanatomy and Applied Anatomy Relating to Femoral Neck Fractures Skeletal Anatomy Blood Supply Ligaments Sensory Supply Muscles Treatment Options for Femoral Neck FRACTURES Nonoperative Treatment of Femoral Neck Fractures Outcomes Operative Treatment of Femoral Neck Fractures Common Surgical Approaches Anterior Smith-Petersen Approach Anterior Hueter Approach Anterolateral Watson-Jones Exposure Direct Lateral Hardinge Approach Posterior Approach Internal Fixation of Undisplaced Intracapsular Femoral Neck Fractures Positioning Technique Internal Fixation of Undisplaced Intracapsular Femoral Neck Fractures: Key Surgical Steps Outcomes Arthroplasty for Undisplaced Femoral Neck Fractures Reduction and Fixation of Displaced Femoral Neck Fractures Positioning Technique Reduction and Fixation of Displaced Femoral Neck Fractures: Key Surgical Steps Postoperative Care Outcomes Ancillary Techniques Secondary Arthroplasty Hemiarthroplasty Unipolar Hemiarthroplasty Technique Unipolar Hemiarthroplasty: Key Surgical Steps Outcomes Bipolar Hemiarthroplasty Technique Bipolar Hemiarthroplasty: Key Surgical Steps Outcomes Cement Versus Cementless Total Hip Replacement Indications Technique Total Hip Replacement: Key Surgical Steps Outcomes Comparison of Treatment Modalities for Displaced Femoral Neck Fractures Hemiarthroplasty Versus Internal Fixation THR Versus Internal Fixation THR Versus Hemiarthroplasty Three-Way Comparisons Summary Special Situations of Femoral Neck Fractures Displaced Femoral Neck Fractures in Young Adults Ipsilateral Femoral Neck and Shaft Fractures Femoral Neck Fractures in Rheumatoid Arthritis Stress Fractures Femoral Neck Fractures in Paget's Disease Metastatic Femoral Neck Fractures Femoral Neck Fractures in Cerebral Palsy and Other Conditions with Muscle Spasticity Author's Preferred Treatment for Femoral Neck Fractures (Algorithm 52-1) Outcomes of Femoral Neck Fractures Pain Mobility Economic Outcome Mortality Management of Expected Adverse Outcomes and Unexpected Complications Related to Femoral Neck Fractures Delay to Surgery Infection Fixation Failure and Nonunion Nonunion in Young Patients Meyer's Bone Graft Fibular Bone Graft Proximal Femoral Valgus Osteotomy Avascular Necrosis Prosthesis Dislocation Prosthetic Loosening General Complications Deep Venous Thrombosis and Pulmonary Embolism Summary, Controversies, and Future Directions Related to Femoral Neck Fractures Annotated References References RELATED CONTENT Video 53: Trochanteric Hip Fractures Introduction to Trochanteric HIP Fractures Assessment of Trochanteric HIP Fractures Terminology and Classification for Trochanteric Hip Fractures Etiology of Trochanteric Hip Fracture Injuries Associated with Trochanteric Hip Fracture Diagnosis of Trochanteric Hip Fractures Pathoanatomy and Applied Anatomy Relating to Trochanteric HIP Fractures Isolated Fractures of the Lesser and Greater Trochanter Treatment Options for Trochanteric HIP Fractures Nonoperative Treatment of Trochanteric Hip Fractures Isolated Fractures of the Lesser and Greater Trochanter Operative Treatment of Trochanteric Hip Fractures Indications/Contraindications Preoperative Planning Choice of Implant Fixed Nail Plates Blade Plates or 95-Degree Condylar Screw Plates Proximal Femoral Locking Plates Sliding Hip Screw Medoff Plate Lateral Trochanteric Stabilizing Plate Percutaneous Compression Plate Proximally Inserting (Cephalomedullary) Intramedullary Nails External Fixator Arthroplasty Trochanteric Fractures with Loss of Lateral Support Advice From Register-Based Studies on Choice of Implant Advice From Clinical Guidelines on the Choice of Implant Summary of Choice of Implant Internal Fixation of Trochanteric Hip Fracture Preoperative Planning Internal Fixation of Trochanteric Hip Fracture: Preoperative Planning Checklist Patient Positioning Fracture Reduction Positioning of the Lag Screw Design of the Lag Screw Technique Sliding Hip Screw Sliding Hip Screw: Key Surgical Steps Cephalomedullary Nail Fixation Cephalomedullary Nail Fixation: Key Surgical Steps Subtrochanteric Extension and Cerclage Wiring Wound Closure and Care Author's Preferred Treatment for Trochanteric Hip Fractures (Algorithm 53-1) Postoperative Care Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Trochanteric Hip Fractures Trochanter Fractures: Common Adverse Outcomes and Complications Wound Sepsis Implant Cut-Out Detachment of the Plate From the Femur Refracture Around the Implant Breakage of the Implant Fracture Nonunion Femoral Head Avascular Necrosis Vascular Damage Malunion Limb Shortening Summary, Controversies, and Future Directions Related to Trochanteric Hip Fractures Annotated References References RELATED CONTENT Video 54: Subtrochanteric Femur Fractures Introduction to Subtrochanteric Femur Fractures Assessment of Subtrochanteric Femur Fractures Mechanisms of Injury for Subtrochanteric Femur Fractures Injuries Associated with Subtrochanteric Femur Fractures Signs and Symptoms of Subtrochanteric Femur Fractures Imaging and Other Diagnostic Studies for Subtrochanteric Femur Fractures Classification of Subtrochanteric Femur Fractures Outcome Measures for Subtrochanteric Femur Fractures Pathoanatomy and Applied Anatomy Relating to Subtrochanteric Femur Fractures Subtrochanteric Femur Fracture Treatment Options Nonoperative Treatment of Subtrochanteric Femur Fractures Indications/Contraindications Nonoperative Treatment of Subtrochanteric Femur Fractures: Indications Techniques Outcomes Operative Treatment of Subtrochanteric Femur Fractures Indications/Contraindications Open Reduction and Internal Fixation with Intramedullary Nailing: Preoperative Planning ORIF of Subtrochanteric Femur Fractures with Intramedullary Nailing: Preoperative Planning Checklist Positioning Technique ORIF of Subtrochanteric Femur Fractures with Intramedullary Nailing: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Subtrochanteric Femur Fractures: Potential Pitfalls and Preventions Plating Preoperative Planning Positioning Technique Plating of Subtrochanteric Femur Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Authors' Preferred Treatment for Subtrochanteric Femur Fractures (Algorithm 54-1) Management of Expected Adverse Outcomes and Unexpected Complications in Subtrochanteric Femur Fractures Subtrochanteric Femur Fractures: Common Adverse Outcomes and Complications Malunion Nonunion Infection Summary, Controversies, and Future Directions Related to Subtrochanteric Femur Fractures Annotated References References RELATED CONTENT Video 55: Atypical Femur Fractures Introduction to Atypical Femur Fractures Epidemiology Atypical Femur Fractures and Bisphosphonate Therapy Assessment of Atypical Femur Fractures Mechanisms of Injury for Atypical Femur Fractures Injuries Associated with Atypical Femur Fractures Signs and Symptoms of Atypical Femur Fractures Imaging and Other Diagnostic Studies for Atypical Femur Fractures Classification of Atypical Femur Fractures Pathoanatomy and Applied Anatomy of Atypical Femur Fractures Treatment Options for Atypical Femur Fractures Nonoperative Treatment of Atypical Femur Fractures Indications/Contraindications Technique Outcomes Operative Treatment of Atypical Femur Fractures Indications/Contraindications Cephalomedullary Nailing Preoperative Planning Cephalomedullary Nailing of Atypical Femur Fracture: Preoperative Planning Checklist Positioning Surgical Approaches Technique Cephalomedullary Nailing of Atypical Femur Fracture: Key Surgical Steps Open Reduction and Internal Fixation Preoperative Planning Open Reduction Internal Fixation of Atypical Femur Fracture: Preoperative Planning Checklist Technique Open Reduction Internal Fixation of Atypical Femur Fracture: Key Surgical Steps Author's Preferred Treatment for Atypical Femur Fractures (Algorithm 55-1) Postoperative Care Potential Pitfalls and Preventive Measures Cephalomedullary Nailing of Atypical Femur Fracture: Surgical Pitfalls and Preventions Outcomes Management of Expected Adverse Outcomes and Unexpected Complications Related to Atypical Femur Fractures Atypical Femur Fractures: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Atypical Femur Fractures Annotated References References RELATED CONTENT Video 56: Femoral Shaft Fractures Assessment of Femoral Shaft Fractures Mechanism of Injury for Femoral Shaft Fractures Injuries Associated with Femoral Shaft Fractures Signs and Symptoms of Femoral Shaft Fractures Imaging and Other Diagnostic Studies for Femoral Shaft Fractures Classification of Femoral Shaft Fractures Winquist and Hansen Classification of Fracture Comminution Biomechanics and Nailing in Femoral Shaft Fractures Outcome Measures for Femoral Shaft Fractures Pathoanatomy and Applied Anatomy Relating to Femoral Shaft Fractures Treatment Options for Femoral Shaft Fracture Nonoperative Treatment of Femoral Shaft Fractures Indications/Contraindications Nonoperative Treatment of Femoral Shaft Fractures: Indications Traction Cast Bracing Outcomes Operative Treatment of Femoral Shaft Fractures External Fixation of Femoral Shaft Fractures Indications/Contraindications External Fixation of Femur Fractures: Indications and Contraindications Preoperative Planning External Fixation of Femur Fracture: Preoperative Planning Checklist Technique External Fixation of Femur Fractures: Key Surgical Steps Plate Fixation Indications/Contraindications Plate Fixation of Femoral Shaft Fractures: Indications and Contraindications Preoperative Planning Plate Fixation of Femoral Shaft Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Plate Fixation of Femoral Shaft Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Plate Fixation of Femoral Shaft Fractures: Surgical Pitfalls and Preventions Antegrade Intramedullary Nailing Indications/Contraindications Antegrade Intramedullary Nailing of Femoral Shaft Fractures: Indications and Contraindications Preoperative Planning Antegrade Intramedullary Nailing of Femoral Shaft Fractures: Preoperative Planning Checklist Patient Positioning Technique Antegrade Intramedullary Nailing of Femoral Shaft Fractures: Key Surgical Steps Entry Point for Antegrade Intramedullary Nailing Piriformis Entry Nail Technique Postoperative Care Potential Pitfalls and Preventive Measures Antegrade Intramedullary Nailing of Femoral Shaft Fractures: Surgical Pitfalls and Preventions Antegrade Intramedullary Nailing with Trochanteric Entry Indications/Contraindications Preoperative Planning Patient Positioning Technique Postoperative Care Potential Pitfalls and Preventive Measures Retrograde Intramedullary Nailing of Femoral Shaft Fractures Indications/Contraindications Retrograde Intramedullary Nailing of Femoral Shaft Fractures: Indications and Contraindications Preoperative Planning Retrograde Intramedullary Nailing of Femoral Shaft Fractures: Preoperative Planning Checklist Positioning Technique Retrograde Intramedullary Nailing of Femoral Shaft Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Retrograde Intramedullary Nailing of Femoral Shaft Fractures: Surgical Pitfalls and Preventions Authors' Preferred Treatment for Femoral Shaft Fractures (Algorithm 56-1) Outcomes External Fixation Plating Antegrade Nailing Reamed Versus Unreamed Antegrade Femoral Intramedullary Nailing Trochanteric Entry Point Retrograde Intramedullary Nailing Operative Treatment of Special Fracture Patterns and Associated Injuries in Femoral Shaft Fractures Intramedullary Nailing in the Multiply Injured Patient Open Fractures Femur Fractures Secondary to Gunshots Associated Vascular Injury Associated Head Injury Ipsilateral Neck and Shaft Fractures Comminution and Associated Fracture Patterns Bilateral Fractures Intramedullary Nailing in Obese Patients Fractures in the Elderly Management of Expected Adverse Outcomes and Unexpected Complications in Femoral Shaft Fractures Femoral Shaft Fractures: Common Adverse Outcomes and Complications Nerve Injury Muscle Weakness Angular Malalignment Rotational Deformity Knee Stiffness, Knee Pain, and Hip Pain Heterotopic Ossification Compartment Syndrome Refracture Delayed Union or Nonunion Infection and Infected Nonunions Femoral Nail Removal Implant Complications: Broken Nails, Broken Interlocking Screws, and Bent Nails Summary, Controversies, and Future Directions Related to Femoral Shaft Fractures Annotated References References 57: Distal Femur Fractures Introduction to Distal Femur Fractures Assessment of Distal Femur Fractures Mechanisms of Injury for Distal Femur Fractures Injuries Associated with Distal Femur Fractures Open Distal Femur Fractures Vascular Injuries Concomitant Ligament Injuries Periprosthetic Distal Femur Fractures Signs and Symptoms of Distal Femur Fractures Imaging and Other Diagnostic Studies for Distal Femur Fractures Classification of Distal Femur Fractures Outcome Measures for Distal Femur Fractures Pathoanatomy and Applied Anatomy Relating to Distal Femur Fractures Applied Anatomy of the Distal Femur Bone Knee Joint Soft Tissues About the Distal Femur Distal Femur Fracture Treatment Options Nonoperative Treatment of Distal Femur Fractures Indications/Contraindications Nonoperative Treatment of Distal Femur Fractures: Indications and Contraindications Techniques Outcomes Operative Treatment of Distal Femur Fractures Indications Open Reduction and Internal Fixation with Plates and Screws Preoperative Planning ORIF of Distal Femur Fractures: Preoperative Planning Checklist Positioning Surgical Approaches Lateral Approach: Standard Open Technique Lateral Approach: Minimally Invasive Technique Medial Approach Technique ORIF of OTA Type A and C Distal Femur Fractures: Key Surgical Steps ORIF of OTA Type A Distal Femur Fractures ORIF of OTA Type B Distal Femur Fractures ORIF of OTA Type C Distal Femur Fractures Postoperative Care Potential Pitfalls and Preventive Measures After ORIF of Distal Femur Fractures ORIF of Distal Femur Fractures: Potential Pitfalls and Preventions Outcomes Retrograde Femoral Nailing of Distal Femur Fractures Indications Preoperative Planning Retrograde Nailing of Distal Femur Fractures: Preoperative Planning Checklist Positioning Approaches Technique Retrograde Nailing of Distal Femur Fractures (A- and C-Types): Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Retrograde Nailing of Distal Femur Fractures: Potential Pitfalls and Preventions Outcomes Intramedullary Nailing of Distal Femur Fractures with Flexible and Semirigid Nails Indications Outcomes External Fixation of Distal Femur Fractures Indications Outcomes Authors' Preferred Treatment for Distal Femur Fractures (Algorithm 57-1) Comparative Outcomes of Distal Femur Fracture Treatments Level 1 Evidence Level 2 Evidence Level 4 Evidence Management of Expected Adverse Outcomes and Unexpected Complications of Distal Femur Fractures Distal Femur Fractures: Common Adverse Outcomes and Complications Malalignment/Malunion Nonunion Infection Knee Stiffness Implant-Related Problems Posttraumatic Arthritis Summary, Controversies, and Future Directions for Treatment of Distal Femur Fractures Annotated References References RELATED CONTENT Video 58: Lower Extremity Periprosthetic Fractures Introduction to Lower Extremity Periprosthetic Fractures Assessment of Lower Extremity Periprosthetic Fractures Mechanisms of Injury for Lower Extremity Periprosthetic Fracture Injuries Associated with Periprosthetic Fractures Signs and Symptoms of Lower Extremity Periprosthetic Fractures Imaging and Other Diagnostic Studies for Lower Extremity Periprosthetic Fractures Outcome Measures for Lower Extremity Periprosthetic Fractures Periprosthetic Acetabular Fractures Classification of Periprosthetic Acetabular Fractures Incidence of and Risk Factors for Periprosthetic Acetabular Fractures Treatment Options for Periprosthetic Acetabular Fractures Nonoperative Treatment of Periprosthetic Acetabular Fractures Operative Treatment of Periprosthetic Acetabular Fractures Intraoperative Periprosthetic Acetabular Fractures Postoperative Periprosthetic Acetabular Fractures Open Reduction and Internal Fixation Preoperative Planning ORIF of Periprosthetic Acetabular Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Periprosthetic Acetabular Fractures with a Stable Cup: Key Surgical Steps ORIF of Periprosthetic Acetabular Fractures with an Unstable Cup: Key Surgical Steps Potential Pitfalls and Preventive Measures ORIF of Periprosthetic Acetabular Fractures: Surgical Pitfalls and Preventions Outcomes Author's Preferred Treatment of Periprosthetic Acetabular Fractures (Algorithm 58-1) Periprosthetic Fractures About Femoral Resurfacing Prostheses Classification of Periprosthetic Femur Fractures After Hip Resurfacing Nonoperative Treatment of Fractures About Femoral Resurfacing Prostheses Outcomes Periprosthetic Femur Fractures About Hip Arthroplasty Prostheses Classification of Periprosthetic Femur Fractures About Hip Arthroplasty Prostheses Incidence of and Risk Factors for Periprosthetic Femur Fractures Vancouver Type A Periprosthetic Femur Fractures Vancouver B and C Periprosthetic Femur Fractures Treatment of Periprosthetic Femur Fractures About Hip Arthroplasty Prostheses Vancouver Type A Fracture Treatment Principles Vancouver Type B Fracture Treatment Principles Vancouver Type C Fracture Treatment Principles Nonoperative Treatment of Periprosthetic Femur Fractures About Hip Arthroplasty Prostheses Indications/Contraindications Nonoperative Treatment of Periprosthetic Femur Fractures About Hip Arthroplasty Prostheses: Indications and Contraindications Operative Treatment of Periprosthetic Femur Fractures About Hip Arthroplasty Prostheses Open Reduction and Internal Fixation Preoperative Planning ORIF of Periprosthetic Femoral Fractures About Hip Arthroplasty Prostheses: Preoperative Planning Checklist Surgical Approach Positioning Technique ORIF of Simple Periprosthetic Femoral Shaft Fractures About Hip Arthroplasty Prostheses (Vancouver Types B and C): Key Surgical Steps ORIF and Bridge Plating of Comminuted Periprosthetic Femoral Shaft Fractures About Hip Arthroplasty Stems (Vancouver Types B and C): Key Surgical Steps ORIF for Vancouver Type A Fractures ORIF for Vancouver Type B and C Fractures Postoperative Care Potential Pitfalls and Preventive Measures ORIF of Periprosthetic Femur Fractures About Hip Arthroplasty Prostheses: Surgical Pitfalls and Preventions Revision Arthroplasty of Periprosthetic Femur Fractures Preoperative Planning Revision Hip Arthroplasty for Periprosthetic Femur Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Revision Arthroplasty for Periprosthetic Femoral Shaft Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Revision Arthroplasty for Periprosthetic Femoral Shaft Fractures: Surgical Pitfalls and Preventions Outcomes Vancouver Type A Periprosthetic Femur Fractures Vancouver Type B and C Periprosthetic Femur Fractures ORIF Revision Arthroplasty Author's Preferred Treatment of Periprosthetic Femur Fractures About Hip Arthroplasty Prostheses (Algorithm 58-2) Periprosthetic Distal Femur Fractures About Total Knee Arthroplasty Classification of Periprosthetic Distal Femur Fractures Incidence of and Risk Factors for Periprosthetic Distal Femur Fractures Treatment Options for Periprosthetic Distal Femur Fractures Nonoperative Treatment of Periprosthetic Distal Femur Fractures Indications/Contraindications Nonoperative Treatment of Periprosthetic Distal Femur Fractures: Indications and Contraindications Techniques Outcomes Operative Treatment of Periprosthetic Distal Femur Fractures Open Reduction and Internal Fixation Preoperative Planning ORIF of Periprosthetic Distal Femur Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Periprosthetic Distal Femur Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures ORIF of Periprosthetic Distal Femur Fractures: Surgical Pitfalls and Preventions Outcomes Intramedullary Nailing Preoperative Planning Intramedullary Nailing of Periprosthetic Distal Femur Fractures: Preoperative Planning Checklist Positioning and Surgical Approach Technique Intramedullary Nailing of Periprosthetic Distal Femur Fractures: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures IM Nailing of Periprosthetic Distal Femur Fractures: Surgical Pitfalls and Preventions Outcomes Revision Total Knee Arthroplasty Preoperative Planning Revision Total Knee Arthroplasty for Periprosthetic Distal Femur Fractures: Preoperative Planning Checklist Technique Revision Total Knee Arthroplasty for Periprosthetic Fractures About the Knee: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Revision Total Knee Arthroplasty for Periprosthetic Distal Femur Fractures: Surgical Pitfalls and Preventions Outcomes Author's Preferred Treatment of Periprosthetic Distal Femur Fractures (Algorithm 58-3) Periprosthetic Patella Fractures Classification of Periprosthetic Patella Fractures Ortiguera and Berry Classification for Periprosthetic Patella Fractures222 Incidence of and Risk Factors for Periprosthetic Patella Fractures Treatment of Periprosthetic Patella Fractures Potential Pitfalls and Preventive Measures Outcomes Author's Preferred Treatment of Periprosthetic Patella Fractures (Algorithm 58-4) Periprosthetic Proximal Tibia Fractures Classification of Periprosthetic Proximal Tibia Fractures Classification of Periprosthetic Proximal Tibia Fractures Incidence of and Risk Factors for Periprosthetic Proximal Tibia Fractures Tibia Fractures About Total Knee Components Tibia Fractures About Unicompartmental Components Treatment of Periprosthetic Proximal Tibia Fractures Tibia Fractures About Total Knee Components Tibia Fractures About Unicompartmental Components Potential Pitfalls and Preventive Measures Periprosthetic Proximal Tibia Fractures: Surgical Pitfalls and Preventions Outcomes Author's Preferred Treatment for Periprosthetic Tibia Fractures (Algorithm 58-5) Periprosthetic Fractures About Ankle Arthroplasty Treatment of Periprosthetic Fractures About Ankle Arthroplasty Author's Preferred Treatment of Periprosthetic Fractures About Ankle Arthroplasty (Algorithm 58-6) Annotated References References RELATED CONTENT Textbook Video 59: Patellar Fractures and Dislocations and Extensor Mechanism Injuries Patellar Fractures Introduction to Patellar Fractures Assessment of Patellar Fractures Mechanisms of Injury for Patellar Fractures Injuries Associated with Patellar Fractures Signs and Symptoms of Patellar Fractures Imaging and Other Diagnostic Studies for Patellar Fractures Plain Radiographs Computed Tomography Magnetic Resonance Imaging Classification of Patellar Fractures Nondisplaced Fractures Transverse Fractures Stellate Fractures Vertical Fractures Displaced Fractures Transverse Fractures Stellate Fractures Pole Fractures Osteochondral Fractures Fractures After Bone–Tendon–Bone Harvest Masqueraders Outcome Measures for Patellar Fracture and Extensor Mechanism Injuries Pathoanatomy and Applied Anatomy Relating to Patella Fractures Osseous Anatomy Arterial Blood Supply Soft Tissue Anatomy Biomechanics of the Extensor Mechanism Treatment Options for Patellar Fracture Nonoperative Treatment of Patellar Fractures Indications/Contraindications Nonoperative Treatment of Patellar Fractures: Indications and Contraindications Techniques Outcomes Operative Treatment of Patellar Fractures Indications Internal Fixation of Patellar Fractures Preoperative Planning Internal Fixation of Patellar Fractures: Preoperative Planning Checklist Positioning Surgical Approaches Techniques Modified Anterior Tension Band: Key Surgical Steps Cannulated Screw Tension Band: Key Surgical Steps Longitudinal Anterior Banding and Cerclage Wiring: Key Surgical Steps Plate Fixation: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Internal Fixation of Patellar Fractures: Potential Pitfalls and Preventions Outcomes Minimally Invasive and Arthroscopic-Assisted Fixation Partial Patellectomy Indications/Contraindications Preoperative Planning Surgical Approach Technique Partial Patellectomy: Key Surgical Steps Postoperative Care Distal Pole Osteosynthesis: Basket Plate Outcomes Total Patellectomy Indications/Contraindications Total Patellectomy: Indications and Contraindications Preoperative Planning, Positioning, and Surgical Approach Technique Total Patellectomy: Key Surgical Steps Potential Pitfalls and Preventive Measures Outcomes Open Fractures Periprosthetic Fractures Authors' Preferred Method of Treatment for Patellar Fractures (Algorithm 59-1) Acute Patellar Dislocations Authors' Preferred Treatment for Acute Patellar Dislocations Extensor Mechanism Injuries Introduction to Extensor Mechanism Injuries Assessment of Extensor Mechanism Injuries Mechanisms of Extensor Mechanism Injuries Injuries Associated with Extensor Mechanism Injuries Signs and Symptoms of Extensor Mechanism Injuries Pathoanatomy and Applied Anatomy Related to Extensor Mechanism Injuries Imaging and Other Diagnostic Studies for Extensor Mechanism Injuries Treatment Options for Extensor Mechanism Injuries Nonoperative Treatment of Extensor Mechanism Rupture Indications/Contraindications Nonoperative Treatment of Extensor Tendon Rupture: Indications and Contraindications Technique Operative Treatment of Extensor Mechanism Injuries Indications/Contraindications Extensor Tendon Repair Preoperative Planning Extensor Tendon Repair: Preoperative Planning Checklist Patient Positioning Surgical Approach Technique Repair of Acute Extensor Tendon Rupture: Key Surgical Steps Postoperative Care Potential Pitfalls and Preventive Measures Extensor Tendon Repair: Potential Pitfalls and Preventions Outcomes Authors' Preferred Techniques for Extensor Mechanism Injuries (Algorithm 59-2) Management of Expected Adverse Outcomes and Unexpected Complications in Patellar Fractures and Dislocations and Extensor Mechanism Injuries Patellar Fractures and Dislocations and Extensor Mechanism Injuries: Common Adverse Outcomes and Complications Loss of Knee Motion Extensor Mechanism Weakness Symptomatic Retained Hardware Infection and Wound Complications Loss of Fixation, Refracture, or Rerupture Delayed Union and Nonunion Posttraumatic Arthritis or Pain Summary, Controversies, and Future Directions Related to Patella Fractures and Dislocations and Extensor Mechanism Injuries Annotated References References RELATED CONTENT Textbook Video 60: Knee Dislocations Introduction to Knee Dislocations Assessment of Knee Dislocations Mechanisms of Injury for Knee Dislocations Injuries Associated with Knee Dislocations Signs and Symptoms of Knee Dislocations Imaging and Other Diagnostic Studies for Knee Dislocations Radiography Magnetic Resonance Imaging Stress Radiography Vascular Assessment Classification of Knee Dislocations Outcome Measures for Knee Dislocations Pathoanatomy and Applied Anatomy Related to Knee Dislocations Medial-Side Knee Anatomy Medial-Side Function and Biomechanics Medial Injury Patterns Considerations in Repair and Reconstruction of Medial Knee Injury Lateral-Side Knee Anatomy Lateral Function and Biomechanics Lateral Injury Patterns Considerations in Repair and Reconstruction of Lateral Knee Injury Posterior Knee Anatomy Posterior Function and Biomechanics Posterior Injury Patterns Considerations in Repair and Reconstruction of PCL Injury Anterior Cruciate Ligament Anatomy ACL Function and Biomechanics ACL Injury Patterns Treatment Options in Knee Dislocations Nonoperative Treatment of Knee Dislocations Indications/Contraindications Nonoperative Treatment of Knee Dislocations: Indications and Contraindications Techniques for Nonoperative Treatment Immobilization External Fixation Operative Treatment of Knee Dislocations Emergent Treatment Preoperative Planning Technique Postoperative Care Potential Pitfalls and Preventive Measures Emergent Intervention for Knee Dislocations: Surgical Pitfalls and Preventions Outcomes Nonemergent Intervention Indications/Contraindications Early Repair Early Reconstruction (with or without Repair) Staged Approaches Delayed Reconstruction Preoperative Planning Nonemergent Intervention for Knee Dislocation: Preoperative Planning Checklist Positioning Technique Diagnostic Arthroscopy Diagnostic Arthroscopy: Key Surgical Steps FCL/PLC Repair FCL/PLC Repair: Key Surgical Steps MCL/PMC Repair MCL/PMC Repair: Key Surgical Steps ACL Reconstruction ACL Reconstruction: Key Surgical Steps PCL Reconstruction PCL Reconstruction: Key Surgical Steps FCL/PLC Reconstruction FCL/PCL Reconstruction: Key Surgical Steps MCL/PMC Reconstruction MCL/PMC Reconstruction: Key Surgical Steps Authors' Preferred Treatment for Knee Dislocations (Algorithm 60-1) Postoperative Care Potential Pitfalls and Preventive Measures Ligament Repair or Reconstruction for Knee Dislocations: Surgical Pitfalls and Preventions Management of Adverse Outcomes and Unexpected Complications in Knee Dislocations Knee Dislocations: Common Adverse Outcomes and Complications Summary, Controversies, and Future Directions Related to Knee Dislocations Operative Versus Nonoperative Management for Knee Dislocations Early Versus Delayed Surgical Management for Knee Dislocations Repair Versus Reconstruction for Knee Dislocations Autograft Versus Allograft Reconstruction for Knee Dislocations Postoperative Rehabilitation for Knee Dislocations Acknowledgment Annotated References References RELATED CONTENT Video 61: Tibial Plateau Fractures Introduction to Tibial Plateau Fractures Epidemiology Assessment of Tibial Plateau Fractures Mechanisms of Injury for Tibial Plateau Fractures Types of Accidents Forces Causing Injury Injuries Associated with Tibial Plateau Fractures Signs and Symptoms of Tibial Plateau Fractures Imaging and Other Diagnostic Studies for Tibial Plateau Fractures Radiographs Computed Tomography Magnetic Resonance Imaging Classification of Tibial Plateau Fractures Classification by Word Description Schatzker Classification Type I: Pure Cleavage Pattern Type II: Cleavage Combined with Articular Depression Type III: Pure Depression Pattern Type IV: Fracture of the Medial Condyle Type V: Bicondylar Tibial Plateau Fracture Type VI: Fracture of the Tibial Plateau with Dissociation of Metaphysis and Diaphysis Limitations OTA/AO Classification OTA/AO Classification of Tibial Plateau Fractures Luo Three-Column Classification Fracture-Dislocation Classification of Hohl and Moore Type I: Coronal Split Fractures Type II: Fracture of the Entire Condyle Type III: Rim Avulsion Fracture Type IV: Rim Compression Fractures Type V: Four-Part Fracture Reliability of Tibial Plateau Fracture Classification Outcome Measures for Tibial Plateau Fractures Outcome Assessment Metrics Pathoanatomy and Applied Anatomy Related to Tibial Plateau Fractures Surgical and Applied Anatomy for Tibial Plateau Fractures Treatment Options for Tibial Plateau Fractures Nonoperative Treatment of Tibial Plateau Fractures Indications/Contraindications Nonoperative Treatment of Tibial Plateau Fractures: Indications and Contraindications Techniques Bracing Weight-Bearing Guidelines Outcomes Operative Treatment of Tibial Plateau Fractures Indications/Contraindications Preoperative Planning Fracture Classification and Pattern Dictate the Approach Technique Overview Techniques to Visualize the Articular Reduction Treatment of Soft Tissue Injuries Associated with Tibial Plateau Fractures Ligament and Meniscal Injuries Injuries to the Soft Tissue Envelope Principles of Fixation Technique for Tibial Plateau Fractures Principles of Plates and Screw Fixation Principles of External Fixation Early Total Care Principles of Void Filling Principles of Postoperative Care Minimally Invasive Limited Fixation Techniques for Fixation of Simple Fractures (Schatzker Type I or OTA/AO B1) Preoperative Planning Minimally Invasive Limited Fixation of Simple Tibial Plateau Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Minimally Invasive Limited Fixation of Simple Tibial Plateau Fractures: Key Surgical Steps Postoperative Care Reduction, Buttress Plate Fixation and Void Filling for Displaced Tibial Plateau Fractures (OTA/AO B2 or B3 or Schatzker Type II—Split Depression Fractures of the Lateral Plateau) Preoperative Planning Reduction and Buttress Plate Fixation and Void Filling for Displaced Tibial Plateau Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Reduction and Buttress Plate Fixation and Void Filling for Displaced Tibial Plateau Fractures: Key Surgical Steps Postoperative Care Limited Approach Techniques with Arthroscopic or Fluoroscopic Assessment of Reduction and Screw or Plate Fixation and Void Filling of Depressed Lateral Side Fractures (Schatzker Type III—Local Compression Fractures) Preoperative Planning Limited Approach Techniques with Arthroscopic or Fluoroscopic Assessment of Reduction and Screw or Plate Fixation and Void Filling of Depressed Lateral-Side Fractures: Preoperative Planning Checklist Positioning Surgical Technique Limited Approach Techniques with Arthroscopic or Fluoroscopic Assessment of Reduction and Screw or Plate Fixation and Void Filling of Depressed Lateral-Side Fractures: Key Surgical Steps Postoperative Care Medial Antiglide Plating via a Posteromedial Surgical Approach for Isolated Medial-Side Fractures (OTA/AO B1, B2, or B3, or Schatzker Type IV) Preoperative Planning Medial Antiglide Plating via a Posteromedial Surgical Approach for Isolated Medial-Side Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Medial Antiglide Plating via a Posteromedial Surgical Approach for Isolated Medial-Side Fractures: Key Surgical Steps Postoperative Care Techniques for Bicondylar or Metaphyseal–Diaphyseal Dissociation Fractures (OTA/AO 41 C or Schatzker Types V and VI) Dual Plating for Bicondylar or Metaphyseal–Diaphyseal Dissociation Tibial Plateau Fractures Preoperative Planning Dual Plating for Bicondylar or Metaphyseal–Diaphyseal Dissociation Tibial Plateau Fractures: Preoperative Planning Checklist Positioning Surgical Approach Anterolateral Approach Posteromedial Approach Combined Anterior and Posteromedial Approaches Anteromedial Approach Posterior Approaches Technique Dual Plating for Bicondylar or Metaphyseal–Diaphyseal Dissociation Tibial Plateau Fractures: Key Surgical Steps Postoperative Care Lateral Locked Plating for Bicondylar or Metaphyseal–Diaphyseal Dissociation Tibial Plateau Fractures Preoperative Planning Lateral Locked Plating for Bicondylar or Metaphyseal–Diaphyseal Dissociation Tibial Plateau Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Lateral Locked Plating for Bicondylar or Metaphyseal–Diaphyseal Dissociation Tibial Plateau Fractures: Key Surgical Steps Postoperative Care External Fixation of Bicondylar or Metaphyseal–Diaphyseal Dissociation Tibial Plateau Fractures Preoperative Planning External Fixation of Bicondylar or Metaphyseal–Diaphyseal Dissociation Tibial Plateau Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique External Fixation of Bicondylar or Metaphyseal–Diaphyseal Dissociation Tibial Plateau Fractures: Key Surgical Steps Postoperative Care Authors' Preferred Treatment for Tibial Plateau Fractures (Algorithm 61-1) Potential Pitfalls and Preventative Measures Operative Treatment of Tibial Plateau Fractures: Surgical Pitfalls and Preventions Outcomes Minimally Invasive Limited Fixation Reduction and Buttress Plate Fixation and Void Filling Limited Approach with Arthroscopic or Fluoroscopic Assessment of Reduction and Screw or Plate Fixation and Void Filling Medial Antiglide Plating Dual Plating Lateral Locked Plating External Fixation Management of Expected Adverse Outcomes and Unexpected Complications Related to Tibial Plateau Fractures Tibial Plateau Fractures: Common Adverse Outcomes and Complications Loss of Reduction Wound Breakdown and Infection Septic Arthritis Knee Stiffness Prominent or Painful Hardware Nonunion Malunion Posttraumatic Arthritis Compartment Syndrome Summary, Controversies, and Future Directions Related to Tibial Plateau Fractures Recent Trends Future Trends Annotated References References RELATED CONTENT Video 62: Tibia and Fibula Shaft Fractures Introduction to Tibia and Fibula Shaft Fractures Assessment of Tibia Shaft Fractures Mechanisms of Injury for Tibia and Fibula Shaft Fractures Injuries Associated with Tibia Shaft Fractures Compartment Syndrome Ankle Injuries Floating Knee Injuries Fracture Extension Into Tibia Plateau Knee Ligamentous Injury Proximal Tibiofibular Joint Dislocation Signs and Symptoms of Tibia Shaft Fractures Compromised Skin Wounds Vascular Motor Function Sensory Symptoms Compartment Syndrome Imaging and Other Diagnostic Studies for Tibia Shaft Fractures Classification of Tibia and Fibula Shaft Fractures AO/OTA Classification of Tibia Shaft Fractures Gustilo Classification of Open Fractures Outcome Measures for Tibia and Fibula Shaft Fractures Lower Extremity Trauma Scores General Functional Outcome Instruments PROMIS SF-36, SF-12, VR-12 SMFA SIP Knee and Ankle Functional Outcome Instruments WOMAC Lysholm Cincinnati AOFAS Foot Function Index Pathoanatomy and Applied Anatomy for Tibia and Fibula Shaft Fractures Osteology Vascularity Compartments and Musculature Tibia Shaft Fractures Treatment Options for Tibia SHAFT Fractures Nonoperative Treatment of Tibia SHAFT Fractures Indications/Contraindications Nonoperative Treatment of Tibia Shaft Fractures: Indications and Contraindications Techniques Outcomes Operative Treatment of Tibia SHAFT Fractures Indications/Contraindications Open Fractures of the Tibia Diaphysis Intramedullary Nailing of Open Tibia Shaft Fractures Preoperative Planning Intramedullary Nailing of Open Tibia Shaft Fractures: Preoperative Planning Checklist Positioning Surgical Approaches Technique Intramedullary Nailing of Open Tibia Shaft Fractures: Key Surgical Steps Postoperative Care Plate Fixation of Extra-Articular Tibia Fractures Open Extra-Articular Tibia Fractures Preoperative Planning Plate Fixation of Extra-Articular Tibia Fractures: Preoperative Planning Checklist Positioning Surgical Approaches Technique Plate Fixation of Extra-Articular Tibia Fractures: Key Surgical Steps Postoperative Care External Fixation of Tibia Shaft Fractures Open Tibia Fractures Preoperative Planning External Fixation of Tibia Shaft Fractures: Preoperative Planning Checklist Positioning Surgical Approaches Technique External Fixation of Tibia Shaft Fractures: Key Surgical Steps Postoperative Care Amputation for Tibia Shaft Fractures Technique Postoperative Care Authors' Preferred Method of Treatment for Tibia and Fibula Shaft Fractures (Algorithm 62-1) Potential Pitfalls and Preventive Measures Intramedullary Nailing of Tibia Shaft Fractures Plate Fixation of Extra-Articular Tibia Fractures External Fixation of Tibia Shaft Fractures Outcomes Intramedullary Nailing of Tibia Shaft Fractures Plate Fixation of Extra-Articular Tibia Fractures External Fixation of Tibia Shaft Fractures Amputation Long-Term Outcomes Open Tibia Fracture Outcomes Management of Complications Tibia Shaft Fractures: Common Adverse Outcomes and Complications Compartment Syndrome Anterior Knee Pain Symptomatic Hardware Malunion Nonunion Deep Infection Isolated Fibula Shaft Fractures Epidemiology of Isolated fibula shaft Fractures Assessment of Isolated fibula shaft Fractures Treatment Options for Isolated fibula shaft Fractures Nonoperative Treatment of Isolated fibula shaft Fractures Acknowledgment Annotated References References RELATED CONTENT Textbook Video 63: Tibial Pilon Fractures Introduction to Tibial Pilon Fractures Assessment of Tibial Pilon Fractures Mechanisms of Injury for Tibial Pilon Fractures Injuries Associated with Tibial Pilon Fractures Signs and Symptoms of Tibial Pilon Fractures Imaging and Other Diagnostic Studies for Tibial Pilon Fractures Classification of Tibial Pilon Fractures Fracture Classification Soft Tissue Injury Classification Outcome Measures for Tibial Pilon Fractures Pathoanatomy and Applied Anatomy Relating to Tibial Pilon Fractures Tibial Pilon Fracture Surgical Anatomy Tibial Pilon Osseous and Ligamentous Anatomy Tibial Pilon Fracture Anatomy Treatment Options for Tibial Pilon Fracture Nonoperative Treatment of Tibial Pilon Fractures Indications/Contraindications Nonoperative Treatment of Tibial Pilon Fractures: Indications and Contraindications Nonoperative Treatment of Fibula Fractures Techniques Outcomes Operative Treatment of Tibial Pilon Fractures Indications/Contraindications Definitive External Fixation of Tibial Pilon Fractures Tibiotalar-Sparing External Fixation Transarticular Spanning External Fixation Articular Reduction and External Fixation Management of Concomitant Fibula Fractures with Definitive External Fixation Open Reduction and Internal Fixation Immediate (Acute) Open Reduction and Internal Fixation Staged Open Reduction and Internal Fixation Stage I: Fibular Open Reduction and Internal Fixation and Tibiotalar Spanning External Fixation Preoperative Planning Stage I: Fibular ORIF and Tibiotalar Spanning External Fixation: Preoperative Planning Checklist Positioning Surgical Approach Technique Fibular ORIF: Key Surgical Steps Tibiotalar Spanning External Fixation: Key Surgical Steps Postoperative Care Stage II: Definitive Tibial Pilon Fracture Open Reduction and Internal Fixation Preoperative Planning Stage II: Definitive Tibial Pilon ORIF: Preoperative Planning Checklist Positioning Surgical Approaches Technique Definitive Tibial Pilon ORIF: Key Surgical Steps Postoperative Care Author's Preferred Treatment for Tibial Pilon Fractures (Algorithms 63-1 and 63-2) Potential Pitfalls and Preventive Measures Outcomes Importance of Articular Reduction Comparative Studies Management of Expected Adverse Outcomes and Unexpected Complications After Tibial Pilon Fractures Tibial Pilon Fractures: Common Adverse Outcomes and Complications Superficial Wound Complications Deep Wound Complications Osteomyelitis Nonunion Posttraumatic Arthritis Summary, Controversies, and Future Directions for Tibial Pilon Fractures Annotated References References RELATED CONTENT Video 64: Ankle Fractures Introduction to Ankle Fractures Pathoanatomy, Applied Anatomy, and Biomechanics Relating to Ankle Fractures Surgical Approaches for Ankle Fractures Medial Approach Posteromedial Approach Lateral Approach Posterolateral Approach Assessment of Ankle Fractures Classification of Ankle Fractures Pott Classification Danis–Weber and AO Classifications Lauge–Hansen Classification Supination External Rotation Fractures Supination Adduction Fractures Pronation Abduction Fractures Pronation External Rotation Fractures Eponymous Terms Clinical Assessment of Ankle Fractures Imaging and Other Diagnostic Studies for Ankle Fractures Radiography Axial Imaging Treatment Options for Ankle Fractures Evidence-Based Management of Ankle Fractures Isolated Lateral Malleolar Fractures Lateral Malleolar Fractures Associated with Clear Instability Lateral Malleolar Fracture with Occult Ankle Instability Isolated Medial Malleolar Fractures Bimalleolar Fractures Conservative Treatment Fixation of Medial Malleolus Only Fixation of Medial and Lateral Malleoli Posterior Malleolar Fractures Syndesmotic Injuries Operative Treatment of Ankle Fractures Open Reduction and Plating Preoperative Planning Open Reduction and Plating of Ankle Fractures: Preoperative Planning Checklist Technique Open Reduction and Plating of Ankle Fractures: Key Surgical Steps Fibular Intramedullary Nailing Preoperative Planning Fibular Intramedullary Nailing of Ankle Fractures: Preoperative Planning Checklist Technique Fibular Intramedullary Nailing of Ankle Fractures: Key Surgical Steps Other Fixation Techniques Potential Pitfalls and Preventive Measures Management of Lateral Malleolar Fractures: Potential Pitfalls and Preventsions Medial Malleolar Fixation Preoperative Planning Medial Malleolar Fixation: Preoperative Planning Checklist Technique Medial Malleolar Fixation: Key Surgical Steps Potential Pitfalls and Preventive Measures Treatment of Medial Malleolar Fractures: Potential Pitfalls and Preventions Posterior Malleolar Fixation Treatment of Posterior Malleolar Fractures: Indications Preoperative Planning Posterior Malleolar Fixation with AP Screws: Preoperative Planning Checklist Technique Posterior Malleolar Fixation with AP Screws: Key Surgical Steps Posterior Malleolar Fixation with Posterior Plate: Preoperative Planning Checklist Posterior Malleolar Fixation with Posterior Plate: Key Surgical Steps Syndesmotic Stabilization Preoperative Planning Syndesmotic Stabilization: Preoperative Planning Checklist Technique Syndesmotic Stabilization: Key Surgical Steps Author's Preferred Treatment of Ankle Fractures (Algorithms 64-1 and 64-2) Perioperative Management Considerations Timing of Surgery Tourniquet Use Thromboprophylaxis Postoperative Care Immobilization Driving Complicated Patient Groups Diabetics Obesity Elderly Smoking and Alcohol Outcomes of Ankle Fractures Management of Adverse Outcomes and Unexpected Complications in Ankle Fractures Common Adverse Outcomes and Complications Annotated References References RELATED CONTENT Textbook Video 65: Fractures and Dislocations of the Talus Fractures of the Talus Introduction to Fractures of the Talus Assessment of Fractures of the Talus Mechanisms of Injury for Fractures of the Talus Talar Neck Fractures Talar Body Fractures Talar Head Fractures Talar Process Fractures Injuries Associated with Fractures of the Talus Signs and Symptoms of Fractures of the Talus Imaging and Other Diagnostic Studies for Fractures of the Talus Computed Tomography and Magnetic Resonance Imaging Classification of Fractures of the Talus Pathoanatomy and Applied Anatomy Related to Fractures of the Talus Blood Supply Treatment Options for Fractures of the Talus Nonoperative Treatment of Fractures of the Talus Indications/Contraindications Indications/Contraindications Nonoperative Treatment of Fractures of the Talus: Indications and Contraindications Closed Reduction Operative Treatment of Fractures of the Talus Talar Neck Fractures Indications/Contraindications Open Reduction and Internal Fixation Preoperative Planning ORIF of Talar Neck Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of Talar Neck Fractures: Key Surgical Steps Authors' Preferred Treatment for Talar Neck Fractures (Algorithm 65-1) Talar Body Fractures Indications/Contraindications Open Reduction Internal Fixation of Talar Body Fractures Preoperative Planning Open Reduction Internal Fixation of Talar Body Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Reduction Internal Fixation of Talar Body Fractures: Key Surgical Steps Authors' Preferred Treatment for Talar Body Fractures (Algorithm 65-2) Talar Head Fractures Indications/Contraindications Open Reduction Internal Fixation of Talar Head Fractures Preoperative Planning Open Reduction Internal Fixation of Talar Head Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Reduction Internal Fixation of Talar Head Fractures: Key Surgical Steps Posterior Talar Process Fractures Indications/Contraindications Open Reduction Internal Fixation of Posterior Talar Process Fractures Preoperative Planning Open Reduction Internal Fixation of Posterior Talar Process Fractures: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Reduction Internal Fixation of Posterior Talar Process Fractures: Key Surgical Steps Lateral Talar Process Fractures Indications/Contraindications Open Reduction Internal Fixation of Lateral Talar Process Fractures Preoperative Planning Open Reduction Internal Fixation of Lateral Talar Process Fractures: Planning Checklist Positioning Surgical Approach Technique Open Reduction Internal Fixation of Lateral Talar Process Fractures: Key Surgical Steps Extruded Talus Postoperative Care Potential Pitfalls and Preventive Measures Fractures of the Talus: Surgical Pitfalls and Preventions Outcomes Talar Neck Fractures Talar Body Fractures Talar Head Fractures Posterior Talar Process Fractures Lateral Talar Process Fractures Management of Expected Adverse Outcomes and Unexpected Complications Related to Fractures of the Talus Fractures of the Talus: Common Adverse Outcomes and Complications Delayed Wound Healing and Infection Osteomyelitis Avascular Necrosis Delayed Union and Nonunion of Talar Neck Malunion of the Talar Neck Posttraumatic Arthritis Dislocations of and Around the Talus Introduction to Dislocations of and Around the Talus Assessment of Dislocations of and Around the Talus Mechanisms of Injury of Dislocations of and Around the Talus Signs and Symptoms of Dislocations of and Around the Talus Imaging and Other Diagnostic Studies for Dislocations of and Around the Talus Treatment Options for Dislocations of and Around the Talus Nonoperative Treatment of Dislocations of and Around the Talus Operative Treatment of Dislocations of and Around the Talus Outcomes Summary, Controversies, and Future Directions Related to Fractures and Dislocations of the Talus Annotated References References RELATED CONTENT Textbook Video 66: Calcaneus Fractures Introduction to Calcaneus Fractures Calcaneus Anatomy Assessment of Calcaneus Fractures Mechanisms of Injury for Calcaneus Fractures Injuries Associated with Calcaneus Fractures Signs and Symptoms of Calcaneus Fractures Imaging and Other Diagnostic Studies for Calcaneus fractures Plain Radiographs Computed Tomography Classification of Calcaneus Fractures Sanders Classification Outcome Measures for Calcaneus Fractures Pathoanatomy Related to Calcaneus Fracture Main Fracture Fragments Anterior Process Fractures Tuberosity Fractures Fracture-Dislocation of the Calcaneus Treatment Options for Calcaneus Fractures Nonoperative Treatment of Calcaneus Fractures Indications/Contraindications Nonoperative Treatment of Calcaneus Fractures: Indications Techniques Outcomes Operative Treatment of Calcaneus Fractures Extra-Articular Calcaneus Fractures Indications Percutaneous or Minimally Invasive Fixation of Displaced Tongue-Type, Calcaneal Tuberosity, or Beak Fractures Preoperative Planning Percutaneous or Minimally Invasive Fixation: Preoperative Planning Checklist Positioning Surgical Approach Technique Percutaneous or Minimally Invasive Fixation: Key Surgical Steps Open Reduction and Internal Fixation of Anterior Process Fractures Technique ORIF of Anterior Process Fractures: Key Surgical Steps Intra-articular Calcaneus Fractures Open Reduction and Internal Fixation via the Sinus Tarsi Approach Preoperative Planning Open Reduction and Internal Fixation via the Sinus Tarsi Approach: Preoperative Planning Checklist Positioning Technique Open Reduction and Internal Fixation via the Sinus Tarsi Approach: Key Surgical Steps Open Reduction and Internal Fixation via the Percutaneous Approach Preoperative Planning Open Reduction and Internal Fixation via the Percutaneous Approach: Preoperative Planning Checklist Technique Open Reduction and Internal Fixation via the Percutaneous Approach: Key Surgical Steps Balloon Kyphoplasty Arthroscopic-Assisted Reduction Open Reduction and Internal Fixation via the Medial Approach Preoperative Planning Open Reduction and Internal Fixation via the Medial Approach: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Reduction and Internal Fixation via the Medial Approach: Key Surgical Steps Open Reduction and Internal Fixation via the Extensile Lateral Approach Preoperative Planning Open Reduction and Internal Fixation via the Extensile Lateral Approach: Preoperative Planning Checklist Positioning Surgical Approach Technique Open Reduction and Internal Fixation via the Extensile Lateral Approach: Key Surgical Steps Open Reduction Combined with Subtalar Fusion Technique Open Reduction Combined with Subtalar Fusion: Key Surgical Steps Authors' Preferred Treatment for Calcaneus Fractures (Algorithm 66-1) Potential Pitfalls and Preventive Measures Calcaneus Fractures: Surgical Pitfalls and Preventions Outcomes Sinus Tarsi Approach Percutaneous Treatment Extensile Lateral Approach Primary Subtalar Fusion Management of Expected Adverse Outcomes and Unexpected Complications Related to Calcaneus Fractures Calcaneus Fractures: Common Adverse Outcomes and Complications Posttraumatic Subtalar Arthritis Posttraumatic Calcaneocuboid Arthritis Annotated References References RELATED CONTENT Video 67: Fractures and Dislocations of the Midfoot and Forefoot Introduction Injuries of the Midfoot Tarsal Navicular Fractures Introduction to Tarsal Navicular Fractures Assessment of Tarsal Navicular Fractures Mechanisms of Injury of Tarsal Navicular Fractures Signs and Symptoms and Imaging of Tarsal Navicular Fractures Classification of Tarsal Navicular Fractures Tarsal Navicular Fractures: Classification Pathoanatomy and Applied Anatomy Relating to Tarsal Navicular Fractures Treatment Options for Tarsal Navicular Fractures Nonoperative Treatment of Tarsal Navicular Fractures Indications/Contraindications Nonoperative Treatment of Tarsal Navicular Fractures: Indications/Contraindications Techniques Outcomes Operative Treatment of Tarsal Navicular Fractures Indications/Contraindications Reduction and Fixation of Tarsal Navicular Fractures Preoperative Planning Reduction and Fixation of Tarsal Navicular Fractures: Preoperative Planning Checklist Positioning Surgical Approach Techniques Closed Reduction and Fixation of Tarsal Navicular Fractures: Key Surgical Steps Open Reduction and Fixation of Tarsal Navicular Fractures: Key Surgical Steps Adjunct Internal Spanning Fixation of Tarsal Navicular Fractures: Key Surgical Steps Authors' Preferred Treatment for Tarsal Navicular Fractures (Algorithm 67-1) Postoperative Care Management of Adverse Outcomes and Unexpected Complications Related to Tarsal Navicular Fractures Tarsal Navicular Fractures: Common Adverse Outcomes and Complications Cuboid Fractures Introduction to Cuboid Fractures Pathoanatomy and Applied Anatomy, Mechanisms of Injury, and Associated Injuries Relating to Cuboid Fractures Assessment of Cuboid Fractures Signs and Symptoms and Imaging of Cuboid Fractures Classification of Cuboid Fractures Treatment Options for Cuboid Fractures Nonoperative Treatment of Cuboid Fractures Indications/Contraindications Nonoperative Treatment of Cuboid Fractures: Indications/Contraindications Techniques Outcomes Operative Treatment of Cuboid Fractures Indications/Contraindications Surgical Treatment of Cuboid Fractures: Indications and Contraindications Reduction and Fixation of Tarsal Cuboid Fractures Preoperative Planning Reduction and Fixation of Cuboid Fractures: Preoperative Planning Checklist Surgical Approach Techniques Closed Reduction and Fixation of Tarsal Cuboid Fractures: Key Surgical Steps Open Reduction and Fixation of Tarsal Cuboid Fractures: Key Surgical Steps Adjunct Internal Spanning Fixation of Cuboid Fractures: Key Surgical Steps Authors' Preferred Treatment of Cuboid Fractures (Algorithm 67-2) Postoperative Care Outcomes Management of Adverse Outcomes and Unexpected Complications Related to Cuboid Fractures Cuboid Fractures: Common Adverse Outcomes and Complications Cuneiform Injuries Introduction to Cuneiform Injuries Pathoanatomy and Applied Anatomy Related to Cuneiform Injuries Assessment of Cuneiform Injuries Mechanisms of Injury of Cuneiform Injuries Signs and Symptoms and Imaging of Cuneiform Fractures Classification of Cuneiform Injuries Treatment Options for Cuneiform Injuries Nonoperative Treatment of Cuneiform Injuries Indications/Contraindications Nonoperative Treatment of Cuneiform Injuries: Indications and Contraindications Operative Treatment of Cuneiform Injuries Reduction and Fixation of Cuneiform Injuries Technique Postoperative Care Authors' Preferred Treatment for Cuneiform Injuries (Algorithm 67-3) Management of Adverse Outcomes and Unexpected Complications of Cuneiform Injuries Cuneiform Injuries: Common Adverse Outcomes and Complications Tarsometatarsal (Lisfranc) Joint Injuries Introduction to Tarsometatarsal Joint Injuries Pathoanatomy and Applied Anatomy Related to Tarsometatarsal Joint Injuries Assessment of Tarsometatarsal Joint Injuries Mechanisms of Injury Related to Tarsometatarsal Joint Injuries Signs and Symptoms and Imaging of Tarsometatarsal Joint Injuries Classification of Tarsometatarsal Injuries Treatment Options for Tarsometatarsal Injuries Nonoperative Treatment of Tarsometatarsal Injuries Indications/Contraindications Nonoperative Treatment of Tarsometatarsal Injuries: Indications/Contraindications Techniques Operative Treatment of Tarsometatarsal Injuries Indications/Contraindications Operative Treatment of Tarsometatarsal Injuries: Indications and Contraindications Surgical Treatment of Tarsometatarsal Injuries Preoperative Planning Surgical Treatment of Tarsometatarsal Injuries: Preoperative Planning Checklist Positioning Surgical Approach Technique Closed Reduction and Internal Fixation of Tarsometatarsal Injuries: Key Surgical Steps Open Reduction and Internal Fixation of Tarsometatarsal Injuries: Key Surgical Steps Primary Arthrodesis of Tarsometatarsal Injuries: Key Surgical Steps Authors' Preferred Treatment for Tarsometatarsal Injuries (Algorithm 67-4) Postoperative Care Outcomes Management of Adverse Outcomes and Unexpected Complications Related to Tarsometatarsal Injuries Tarsometatarsal Injuries: Common Adverse Outcomes and Complications Forefoot Injuries Metatarsal Fractures Introduction to Metatarsal Fractures First Metatarsal Fractures Pathoanatomy and Applied Anatomy Related to First Metatarsal Fractures Assessment of First Metatarsal Fractures Mechanisms of Injury for First Metatarsal Fractures Signs and Symptoms and Imaging of First Metatarsal Fractures Classification of First Metatarsal Fractures Treatment Options for First Metatarsal Injuries Nonoperative Treatment of First Metatarsal Injuries Indications/Contraindications Nonoperative Treatment of First Metatarsal Fractures: Indications and Contraindications Techniques Operative Treatment of First Metatarsal Injuries Indications/Contraindications Open Reduction and Internal Fixation Preoperative Planning ORIF of First Metatarsal Injuries: Preoperative Planning Checklist Positioning Surgical Approach Technique ORIF of First Metatarsal Fractures: Key Surgical Steps Authors' Preferred Treatment of First Metatarsal Fractures (Algorithm 67-5) Postoperative Care Potential Pitfalls and Preventive Measures ORIF of First Metatarsal Fractures: Surgical Pitfalls and Preventions Management of Adverse Outcomes and Unexpected Complications Related to First Metatarsal Fractures First Metatarsal Fractures: Common Adverse Outcomes and Complications Central Metatarsal Fractures Introduction to Central Metatarsal Fractures Assessment of Central Metatarsal Fractures Mechanisms of Injury for Central Metatarsal Fractures Signs and Symptoms and Imaging of Central Metatarsal Fractures Classification of Central Metatarsal Fractures Pathoanatomy and Applied Anatomy Related to Central Metatarsal Fractures Treatment Options for Central Metatarsal Fractures Nonoperative Treatment of Central Metatarsal Fractures Indications/Contraindications Nonoperative Treatment of Central Metatarsal Fractures Techniques Operative Treatment of Central Metatarsal Fractures Open Reduction and Internal Fixation of Central Metatarsal Fractures Indications/Contraindications Preoperative Planning ORIF of Central Metatarsal Fractures: Preoperative Planning Checklist Positioning and Surgical Approach Technique ORIF of Central Metatarsal Fractures: Key Surgical Steps Authors' Preferred Treatment of Central Metatarsal Fractures (Algorithm 67-6) Postoperative Care Potential Pitfalls and Preventive Measures Management of Adverse Outcomes and Unexpected Complications of Central Metatarsal Fractures Central Metatarsal Fractures: Common Adverse Outcomes and Complications Fifth Metatarsal Fractures Pathoanatomy and Applied Anatomy Related to Fifth Metatarsal Fractures Assessment of Fifth Metatarsal Fractures Mechanisms of Injury for Fifth Metatarsal Fractures Signs and Symptoms and Imaging of Fifth Metatarsal Fractures Classification of Fifth Metatarsal Fractures Treatment Options for Fifth Metatarsal Fractures Nonoperative Treatment of Fifth Metatarsal Fractures Indications/Contraindications Nonoperative Treatment of Fifth Metatarsal Fractures: Indications and Contraindications Techniques Operative Treatment of Fifth Metatarsal Fractures Indications/Contraindications Open Reduction and Internal Fixation of Fifth Metatarsal Fractures Preoperative Planning ORIF of Fifth Metatarsal Fractures: Preoperative Planning Checklist Positioning and Surgical Approach Technique ORIF of Fifth Metatarsal Fractures: Key Surgical Steps Authors' Preferred Treatment of Fifth Metatarsal Fractures (Algorithm 67-7) Postoperative Care Potential Pitfalls and Preventive Measures Management of Adverse Outcomes and Unexpected Complications of Fifth Metatarsal Fractures Fifth Metatarsal Fractures: Common Adverse Outcomes and Complications Sesamoid Fractures Introduction to Sesamoid Fractures Assessment of Sesamoid Fractures Mechanisms of Injury of Sesamoid Fractures Signs and Symptoms and Imaging of Sesamoid Fractures Classification of Sesamoid Fractures Pathoanatomy and Applied Anatomy Related to Sesamoid Fractures Treatment Options for Sesamoid Fractures Nonoperative Treatment of Sesamoid Fractures Operative Treatment of Sesamoid Fractures Indications Preoperative Planning Operative Treatment of Sesamoid Fractures: Preoperative Planning Checklist Percutaneous Screw Fixation of Sesamoid Fractures Positioning Technique Percutaneous Screw Fixation of Sesamoid Fractures: Key Surgical Steps Sesamoidectomy Positioning and Surgical Approach Technique Sesamoidectomy for Hallucal Sesamoid Fractures: Key Surgical Steps Authors' Preferred Treatment for Sesamoid Fractures (Algorithm 67-8) Postoperative Care Outcomes Management of Adverse Outcomes and Unexpected Complications Related to Sesamoid Fractures Sesamoid Fractures: Common Adverse Outcomes and Complications Phalangeal Fractures Introduction to Phalangeal Fractures Assessment of Phalangeal Fractures Mechanisms of Injury for Phalangeal Fractures Signs and Symptoms and Imaging of Phalangeal Fractures Classification of Phalangeal Fractures Treatment Options for Phalangeal Fractures Nonoperative Treatment of Phalangeal Fractures Operative Treatment of Phalangeal Fractures Authors' Preferred Treatment for Phalangeal Fractures (Algorithm 67-9) Potential Pitfalls and Preventive Measures High-Energy Injuries: The Multiple Injured Foot Introduction to High-Energy Injuries of the Foot Assessment of High-Energy Injuries of the Foot Imaging of High-Energy Injuries of the Foot Classification of High-Energy Injuries of the Foot Treatment Options for High-Energy Injuries of the Foot Operative Treatment of High-Energy Injuries of the Foot Preoperative Planning Operative Treatment of High-Energy Injuries of the Foot: Preoperative Planning Checklist Techniques Reduction and Provisional Osseous Stabilization Soft Tissue Reconstruction Compartment Syndrome of the Foot Introduction to Compartment Syndrome of the Foot Pathoanatomy and Applied Anatomy Related to Compartment Syndrome of the Foot Assessment of Compartment Syndrome of the Foot Mechanisms of Injury for Compartment Syndrome of the Foot Signs and Symptoms and Imaging of Compartment Syndrome of the Foot Treatment Options for Compartment Syndrome of the Foot Nonoperative Treatment of Compartment Syndrome of the Foot Operative Treatment of Compartment Syndrome of the Foot Indications Operative Treatment of Compartment Syndrome of the Foot: Indications Fasciotomy Preoperative Planning Fasciotomy for Compartment Syndrome of the Foot: Preoperative Planning Checklist Technique Fasciotomy for Compartment Syndrome of the Foot: Key Surgical Steps Management of Adverse Outcomes and Unexpected Complications Related to Compartment Syndrome of the Foot Compartment Syndrome of the Foot: Common Adverse Outcomes and Complications Acknowledgments Annotated References References RELATED CONTENT Textbook Video