Internal Fixators: Concepts and Cases using LCP and LISS

Abstract

This is the latest offering from the superb AO Publishing series, which has been educating and guiding orthopaedic surgeons and traumatologists for four decades. It builds on the original AO internal fixation philosophies and details the evolution of fixation methods and techniques, which have continued to develop in response to scientific investigations and clinical observations. The manual consists of 868 pages, 800 clear illustrations, 2280 pictures and X-rays, with an accompanying DVD-ROM (which is compatible with both PC and Mac). It is well referenced and has a comprehensive list of contributors, each of whom is internationally recognised in his or her own right. It is also apt that the two editors, Wagner and Frigg, are in fact the designers and developers of the ‘combination hole’, the screw hole that accommodates both standard dynamic compression cortical screws and locking head screws and which has led to the versatility of the locking compression plate (LCP) systems, providing new hope in the treatment of articular and osteoporotic fractures. The ‘Concepts’ section, divided into four subsections, deals with the background of internal fixation, surgical reduction techniques, the techniques of the less invasive stabilisation system (LISS) and LCP together with pitfalls and complications of surgery. The chapters on methodological principles and surgical reduction techniques are particularly useful for the novice surgeon. I feel that the LISS and LCP techniques and procedures sections should be mandatory reading before embarking on the use of these fixation systems. The ‘Cases’ section is divided into body regions and gives 117 step-by-step orthopaedic case descriptions, including in most cases the surgical indications, approaches, reduction and fixation as well as rehabilitation regimes. There is also a pitfalls and pearls table for each clinical case. The technical descriptions are good, with very useful concise preoperative planning guides together with information on patient positioning, C-arm placement and equipment requirements. This makes an ideal operating theatre and examination reference guide. The DVD-ROM is also an excellent resource, with a lot of the screen texts benefiting from animations. In addition, there is a multitude of good technical videos to complement the text in the manual although these are performed on plastic bones. I would have far preferred that those same 117 cases be recorded on the DVD. An interesting additional feature on the DVD is the ability to have one's own ‘personal favourites’ basket, where videos and text can be stored for repeated easy and quick access. My criticism of the DVD lies with non-user-friendly menus, which are slow to scroll and, irritatingly, one has to return to each title heading when attempting to change sections. Also, on first use, the DVD would not automatically load up with Windows Vista and the QuickTime application had to be downloaded separately from the internet. These small factors aside this publication certainly does not disappoint. I believe that it is essential reading for both the new orthopaedic trainee, trainees preparing for supervised surgery and those surgeons already involved in trauma surgery needing to refresh their practice. Despite the high price tag I would not hesitate to purchase a copy.