Hans Willenegger – författare

In the early 1950s, the pioneering work of Robert Danis on operative treatment of fractures was in danger of falling into oblivion. Maurice E. Muller, impressed and intrigued by his contacts with Danis, first critically applied internal fixation and immediate mobilization to some 80 patients and found the basic concept confirmed, but in need of further develop- ment with regard to technology, clinical application, and scientific analysis. In 1958 he assembled a group of friends, general and orthopedic surgeons, willing to invest time and effort in helping to create the necessary armamentarium and to form a study group for clinical trials. This group was set up in the same year under the name Arbeitsgemein- schaft fiir Osteosynthesefragen (AO), later on to be known in English-speaking countries as the Association for the Study of Internal Fixation (ASIF). The first report on operative treatment of fractures by Muller, Allgower, and Willeneg- ger, published in 1963, stressed the advantages of early open reduction and internal fixa- tion. This book, first published in German, amusingly lost an important part when trans- lated into English.At the suggestion of worried American and English partp. ers, a picture series showing the healing pattern of 188 tibial fractures operated on in Chur between December 20, 1961 and April26, 1962 was left out.

The first part of this manual deals with the experimental and scientific basis and the principles of the AOjASIF method of stable internal fixation. It deals with the function and main use of the different AO implants, the use of the different AO instruments, and with the essentials of the operative technique and of postoperative care. It also discusses the handling of the most important postoperative complications. The second part deals at length with the AO recommendations for the operative treatment of the most common closed fractures in the adult. This has been organized in anatomical sequence. The discussion of the closed fractures is followed by a discus­ sion of open fractures in the adult, then by fractures in children and finally by pathological fractures. The third part presents, in a condensed fashion, the application of stable internal fixation to reconstructive bone surgery. 1 GENERAL CONSIDERATIONS 1 Aims and Fundamental Principles of the AO Method The Chief Aim of Fracture Treatment is the Full Recovery of the Injured Limb In every fracture there is a combination of damage to both the soft tissues and to bone. Immediately after the fracture and during the phase of repair, we see certain local circulatory disturbances, certain manifestations of local inflammation, as well as pain and reflex splinting. These three factors, that is, circulatory disturbances, inflammation and pain, when combined with the defunctioning of bone, joints and muscle, result in the so-called jl''acture disease.

The first part of this manual deals with the experimental and scientific basis and the principles of the AOjASIF method of stable internal fixation. It deals with the function and main use of the different AO implants, the use of the different AO instruments, and with the essentials of the operative technique and of postoperative care. It also discusses the handling of the most important postoperative complications. The second part deals at length with the AO recommendations for the operative treatment of the most common closed fractures in the adult. This has been organized in anatomical sequence. The discussion of the closed fractures is followed by a discus­ sion of open fractures in the adult, then by fractures in children and finally by pathological fractures. The third part presents, in a condensed fashion, the application of stable internal fixation to reconstructive bone surgery. 1 GENERAL CONSIDERATIONS 1 Aims and Fundamental Principles of the AO Method The Chief Aim of Fracture Treatment is the Full Recovery of the Injured Limb In every fracture there is a combination of damage to both the soft tissues and to bone. Immediately after the fracture and during the phase of repair, we see certain local circulatory disturbances, certain manifestations of local inflammation, as well as pain and reflex splinting. These three factors, that is, circulatory disturbances, inflammation and pain, when combined with the defunctioning of bone, joints and muscle, result in the so-called jl'acture disease.

Es ist ein hohes und bleibendes Verdienst von LORENZ BÖHLER und seiner Schule, in den vergangenen Jahrzehnten die konservativen Behandlungsverfahren bei Knochen­ brüchen in umfassender Weise ausgearbeitet und dargestellt zu haben. Trotzdem hat es nie an Stimmen auch aus dieser Schule gefehlt, die dem operativen Vorgehen einen mehr oder weniger breiten Platz zuwiesen. Die Nachkriegszeit mit ihren bedeutenden Fort­ schritten für die allgemeine Chirurgie hat folgerichtig auch diesem Teil der Traumatologie neue Impulse gegeben, zumal durch die Zunahme und Kompliziertheit der Knochen­ verletzungen eine nur einseitige Einstellung den Aufgaben der Behandlung nicht mehr gerecht werden kann. Der Gedanke einer operativen Osteosynthese ist nicht neu Die ernsthafte Kritik, die an ihr geübt wurde, hat auch heute im Grunde noch ihre Bedeutung. Die erreichten Fort­ schritte auf dem Gebiet der Asepsis, der Verhütung von Infektionen, der Schaffung ein­ wandfreier metallischer Implantate, in der operativen Erfahrung und in der sachgemäßen Nachbehandlung haben zwar die Gefahren wesentlich vermindert, nicht aber die Verant­ wortung! Die Arbeitsgemeinschaft für Osteosynthesefragen hat sich nun in einer mehrjährigen Zusammenarbeit der Aufgabe gewidmet, durch ausgedehnte klinische und wissenschaft­ liche Prüfung die Grundlagen und die besten Methoden einer 0 per a t i v e Frakturbehand­ n lung herauszuarbeiten, um für den Einzelfall das erfolgversprechendste Verfahren wählen zu können. Hierzu wurde gleichzeitig ein wohldurchdachtes und erprobtes Instrumenta­ rium mit genauen Angaben zum technischen Vorgehen geschaffen. Dabei sind die, bei der stabilen Osteosynthese gewonnenen neuen, wissenschaftlichen Erkenntnisse über die "primäre Knochenbruchheilung" ebensointeressant, wie die vorteilhaften Aspekte für die funktionelle Nachbehandlung.