B. G. Weber – författare

It is to the great and lasting credit of LORENZ BOHLER and his school that they have in the last decade developed and demonstrated so thoroughly the techniques for the conservative management of fractures. Nevertheless there have always been many, including some from BOHLER''S school, who have found considerable place for surgical management, and with the significant progress in general surgery seen in postwar years, a new stimulus has been given to this part of traumatic surgery, especially since bone injuries have become more complex and frequent. The concept of internal fixation is not new. The serious criticisms that have been levelled at it retain today their basic significance. Progress in the fields of asepsis, corrosion-free metal implants, operative experience and postoperative care has diminished the dangers but has not relieved the surgeon of responsibility. The Association for the Study of the Problems of Internal Fixation (AO) has devoted itself over a number of years to the basic principles and best methods of open treatment of fractures by means of extended clinical and scientific studies in order to determine in each individual case the most promising line of treatment. At the same time a well designed and tested instrument set has been developed with precise instructions for the appropriate techniques. As a result, the new observations about primary bone healing which have emerged from the practice of rigid internal fixation are as interesting as the uses to which they can be put in allowing early mobilization.

It is to the great and lasting credit of LORENZ BOHLER and his school that they have in the last decade developed and demonstrated so thoroughly the techniques for the conservative management of fractures. Nevertheless there have always been many, including some from BOHLER'S school, who have found considerable place for surgical management, and with the significant progress in general surgery seen in postwar years, a new stimulus has been given to this part of traumatic surgery, especially since bone injuries have become more complex and frequent. The concept of internal fixation is not new. The serious criticisms that have been levelled at it retain today their basic significance. Progress in the fields of asepsis, corrosion-free metal implants, operative experience and postoperative care has diminished the dangers but has not relieved the surgeon of responsibility. The Association for the Study of the Problems of Internal Fixation (AO) has devoted itself over a number of years to the basic principles and best methods of open treatment of fractures by means of extended clinical and scientific studies in order to determine in each individual case the most promising line of treatment. At the same time a well designed and tested instrument set has been developed with precise instructions for the appropriate techniques. As a result, the new observations about primary bone healing which have emerged from the practice of rigid internal fixation are as interesting as the uses to which they can be put in allowing early mobilization.

and refinement that exists within the necessarily strict rules of the internal fixation method. In this way we seek to contribute to as weIl as to stimulate the search for rational solutions to surgical problems. It is assumed throughout that the reader is fa miliar with the technical fundamentals of internal fixation, and so these details are omitted. Instead, special indications and technical refinements are presented on the basis of case examples. Because an endless variety of situations can arise in orthopedic surgery (a circumstance that is attracting more and more surgeons to the field), we have taken ca re that our examples can readily be applied to novel situations. We now credit, in alphabetic order, those who contributed most to the techniques presented: R. BLATTER, A. BOITZY, C. BRUNNER, O. CECH, A. DEBRUNNER, F. MAGERL, G. SEGMÜLLER, G. STÜHMER, and B.G. WEBER. We thus express thanks to those colleagues in our clinic who agreed to having their ideas published. But we are also grateful to our illustrators, H. and K. SCHUMACHER, our photographer, M. SCHAFFNER, and our chief secretary, U. OETLIKER, who contributed so much to the preparation of the manuscript. Finally, we thank Springer-Verlag for their patience with us and especiaUy for their efficient work in bringing the book to press. St. GaU, Fall 1981 CH.F. BRUNNER B.G. WEBER Contents Lag Screws ............. .

and refinement that exists within the necessarily strict rules of the internal fixation method. In this way we seek to contribute to as weIl as to stimulate the search for rational solutions to surgical problems. It is assumed throughout that the reader is fa miliar with the technical fundamentals of internal fixation, and so these details are omitted. Instead, special indications and technical refinements are presented on the basis of case examples. Because an endless variety of situations can arise in orthopedic surgery (a circumstance that is attracting more and more surgeons to the field), we have taken ca re that our examples can readily be applied to novel situations. We now credit, in alphabetic order, those who contributed most to the techniques presented: R. BLATTER, A. BOITZY, C. BRUNNER, O. CECH, A. DEBRUNNER, F. MAGERL, G. SEGMÜLLER, G. STÜHMER, and B.G. WEBER. We thus express thanks to those colleagues in our clinic who agreed to having their ideas published. But we are also grateful to our illustrators, H. and K. SCHUMACHER, our photographer, M. SCHAFFNER, and our chief secretary, U. OETLIKER, who contributed so much to the preparation of the manuscript. Finally, we thank Springer-Verlag for their patience with us and especiaUy for their efficient work in bringing the book to press. St. GaU, Fall 1981 CH.F. BRUNNER B.G. WEBER Contents Lag Screws ............. .

Die Stabilisierung von Knochenfragmenten mit Hilfe eines Fixateur externe geht wa- scheinlich auf LAMBOTTE (1902) zurück. Der Fixateur externe ist jedoch noch nicht im gleichen Maße zum Durchbruch gekommen, wie die geschlossene Frakturenbehandlung nach BöHLER, W ATSON-JONES, SARMIENTO und die stabilen Osteosynthesen. Aber auch die operative Frakturbehandlung hat erst 1958 durch die Schweizerische Arbeitsgemeinschaft für Osteosynthesefragen AO weltweite Verbreitung gefunden. Dabei ist die AO-Technik von deren Autoren MüLLER, ALLGÖWER und WILLENEGGER zu keiner Zeit etwa als allein richtige Methode verstanden worden, und in ihrem Buch "Technik der operativen Frakturenbehandlung", Springer-Verlag 1963, steht im Vorwort: "Wir können nicht genug warnen vor Osteosynthesen, die ohne entsprechende Schulung des Chirurgen und ohne notwendige technische Voraussetzungen bezüglich Instrumentarium und Asepsis im Operationsbetrieb durchgeführt werden ... ". Die Gefahren der direkten Osteosynthese haben die konservative Behandlung in modifizierter Form reaktiviert, so daß heute das "functional bracing" nach SARMIENTO vielerorts genauso oft Anw- dung findet, wie die AO-Technik.