Kenneth Egol MD - Handbook of Fractures

FOURTH EDITION

Handbook of
Fractures

FOURTH EDITION

Handbook of
Fractures

Kenneth A. Egol, MD

Professor and Vice Chairman
Department of Orthopaedic Surgery
NYU Hospital for Joint Diseases New York University Medical Center
New York, New York

Kenneth J. Koval, MD

Professor
Department of Orthopaedics
Dartmouth Hitchcock Medical Center
Lebanon, New Hampshire

Joseph D. Zuckerman, MD

Professor and Chairman
Department of Orthopaedic Surgery
NYU Hospital for Joint Diseases
New York University Medical Center
New York, New York

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All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright.

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Library of Congress Cataloging-in-Publication Data
Egol, Kenneth A., 1967-

Handbook of fractures/Kenneth A. Egol, Kenneth J. Koval, Joseph D. Zuckerman.

4th ed.

p. ; cm.

Rev. ed. of: Handbook of fractures/Kenneth J. Koval, Joseph D. Zuckerman.

Abridgement of Rockwood and Greens fractures in adults. 7th ed. c2010.

Includes bibliographical references and index.

ISBN 978-1-60547-760-2 (alk. paper)

1. Fractures--Handbooks, manuals, etc. 2. Dislocations--Handbooks, manuals, etc.

I. Koval, Kenneth J. II. Zuckerman, Joseph D. (Joseph David), 1952-

III. Koval, Kenneth J. Handbook of fractures. IV. Rockwood & Greens fractures in adults. V. Title.

[DNLM: 1. Fractures, BoneHandbooks. 2. DislocationsHandbooks.

WE 39 E31h 2010]

RD101.K685 2010

617.1'5dc22

2009051161

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner.

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Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.

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10 9 8 7 6 5 4 3 2 1

To my family, Lori, Alexander, Jonathan,
and Gabrielle, and to my mentors
KJK, JDZ, and MJB.
Kenneth A. Egol

To all those people who have believed in me
and stood by me during adversity.
Kenneth J. Koval

To the residents and faculty of the
NYU Hospital for Joint Diseases for all
their support in the past 25 years.
Joseph D. Zuckerman

This book represents the work of many physicians who trained at the Hospital for Joint Diseases. Starting in the 1980s, the Department of Orthopaedic Surgery initiated a weekly, didactic topic-related fracture case conference. This conference consisted of a short lecture presented by a senior resident on pertinent anatomy, fracture mechanism, radiographic and clinical evaluation, and classification and treatment options, followed by a series of cases that were used to further clarify the options for fracture care. The senior resident was also responsible for preparing a handout on the fracture topic, which was distributed prior to the lecture.

Over time, it became apparent that these topic-related fracture handouts were very useful as a reference for later study and were utilized by incoming residents as an aid in the Emergency Department. This resulted in the original compilation of the Hospital for Joint Diseases Fracture Manual, which was organized and prepared for publication in-house, by ourselves, two senior residents Scott Alpert and Ari Ben-Yishay, and our editorial associate William Green. The Fracture Manual became very popular, very quickly. Its popularity led to the preparation and publication of the second edition. The third edition was designed, in part, to accompany Rockwood and Greens textbook Fractures in Adults.

This fourth edition is a complete update of the Fracture Manual. We have tried to keep it pocket-size despite the ever increasing expanse of material. Most importantly, we have tried to keep the Fracture Manual true to its roots as a comprehensive, useful guide for the management of patients with fractures and associated injuries. We hope that the users of this Fracture Manual find it helpful in their daily practice of fracture care.

Kenneth A. Egol , MD

Kenneth J. Koval , MD

Joseph D. Zuckerman , MD

We would like to acknowledge the following people: James Slover, MD, Timothy Rapp, MD, Ronald Moskovich, MD, Alan Strongwater, MD, and Gail Chorney, MD, for their help in preparation of this book. In addition we would like to acknowledge all of the residents and fellows, past, present, and future, at the NYU Hospital for Joint Diseases whose inquisitiveness compel us to continually update this text.

PART I

Closed Reduction, Casting, and Traction

PRINCIPLES OF CLOSED REDUCTION

Displaced fractures, including those that will undergo internal fixation, should be reduced to minimize soft tissue trauma and provide patient comfort.

Splints should respect the soft tissues.

Pad all bony prominences.

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