This book is the result of an international symposium on bone transplantation, the first of its kind, held in Berne, Switzerland, on May 14-16, 1987. This symposium brought together some of the most outstanding experts - from all over the world, principally from North America and Europe -in the clinical bone transplantation and in basic research. It was an unique opportunity to summarize in a few days the state of the art in this field and to bring clinicians who carry out some research related to their work together with basic scientists. The clinician can on the one hand profit from the basis researcher's knowledge and on the other stimulate the researcher to share the orthopedic surgeon's interest in osteo articular allografts. The book, like the symposium, contains two types of contributions: 1. Papers from invited experts who have often dedicated a significant part of their professional life to the subject of bone transplantation. Knowledge which would otherwise be scattered among original papers from many different sources, some of it less firmly established and therefore less well known, is thus collected together in one volume, so that the reader does not have to weed out a mass ofless important material. These chapters may for a certain time act as a textbook on bone transplantation, but inevitably will eventually be superseded by new findings. 2. Descriptions of current research in all the main subjects covered in the state of-the-art papers."

The need for greater international collaboration is becoming increas. ingly clear. Practically every nation or people has, in addition to its own characteristics and history, its own medical tradition. Methods and ways of thinking that are successfully established in one place may not be accepted in another for some time. The medical tradition and training in different countries can take quite different forms. What would our present knowledge be - Without the creative, spontaneous ideas and contributions from the romance countries? - Without the opportunity of research, as it is practised on a large scale in the USA, where so many young Europeans took their first steps in experimental science? - Without the conscientious clinical work done in Central Europe and the valuable experience gained there? - Without, finally, the sober and critical scientific approach, as fostered in the cool heads of Northern Europe for generations? None of these qualities is sufficient without the others, but together they are a source of strength. Ultimately, we hope, through sensible con centration of efforts (while maintaining variety), to overcome the lack of an integrated approach in experimental science and to prevent repetition of painful mistakes. In this regard, the first two ESKA congresses have brought us great advances."

External fixation is now being used widely to maintain fractures, osteo tomies, and arthrodeses in a desired position during consolidation. Whereas external fixation has been readily accepted in European countries, its use has weathered a rather stormy course in North America, especially in the treatment of fractures. Only recently has external fixation found its rightful place on this continent as well. Many different models are on the market today, and the practitioner is faced with a difficult decision in selecting a model. Should he buy a system where the fracture has to be reduced first, or should he work with a device permitting a reduction after insertion of the pins? To enable surgeons to study the different systems, to discuss their advantages and disadvantages, and to permit them to put their hands on these devices and inspect them personally, the Division of Orthopedic Surgery, University of Ottawa organized an applied basic science course in May 1981, External Fixation of Fractures. During this course, all major systems were pre sented to the participants. As happened during the course "Internal Fixation of Fractures" held two years ago, the rigidity of internal fixation was frequently and intensively debated. Whereas the rigidity of internal fixation cannot be altered during the course of healing, the rigidity of external fixation can be changed. In fact, with progression of union, rods of increasing elasticity can be used."

From the 12th to the 15th September 1985 the International Symposium on Methods of Presurgical Evaluation of Epileptic Patients: Basics, Techniques, and Implications for Epileptology and Surgical Epilepsy Therapy was held in Zurich. This symposium was a consequence of the increasing recognition by Europeans, especially from Ger man-speaking countries, of a growing need for surgical therapy of epileptics. The main aim was to provide a venue for critical review and lively discussion of presurgical eval uation protocols, with special emphasis on the electrophysiological aspects, including in vasive techniques. To provide a necessary background, some basic aspects along with postsurgical results had to be dealt with by leading experts in the different fields of ex perimental and clinical epileptology and neurosurgery. It was intended to be an inter national but moderately scaled meeting. Finally, however, in addition to the European contingent, there were participants from Australia, Brazil, Canada, Israel, Japan, Korea, and the United States of America, including pioneers from the surgically active centers. This international discussion was surely facilitated by the close temporal relation ship to the International Congresses (XIIIth World Congress of Neurology and XVIth Epilepsy International Congress) which took place in Hamburg. And, probably most important, is the fact that the Zurich symposium was dedicated to Prof. Rudolf Hess and his lifelong devotion to epilepsy diagnosis and treatment in Switzerland, as out lined in the Honorary Address by his eminent colleague and personal friend, Prof. Henri Gastaut.

This supplement of Acta Neurochirurgica contains the proceedings of the Ninth Convention of the Academia Eurasiana Neurochirurgica held in Chateau St. Gerlach, Houthem, The Netherlands, 29 July - 1 August 1998. During this convention a three-day symposium on Neurosurgery and Medical Ethics was held. In this time of tremendous technical advancement in medicine in general and neurosurgery in particular, we are liable to lose sight of the sick patient as a human being, and the odds are that he will be the object rather than the subject of our action in the near future. It is a purpose and a task of the Academia Eurasiana Neurochirurgica to recognize this thread and to pay attention to tradition, morality and ethics in neurological surgery. The theme of this convention and the subject of the symposium met this purpose as no other. In the scientific sessions during the first day, the moral backgrounds of medical ethics in the most important cultures and religions in east and west were elucidated by invited experts in this field. A mutual respectful understanding of each other's conception of and belief in ethical principles is a growing necessity in our multicultural societies in both continents. On the second day, the ethical aspects of different fields of neurological surgery were discussed by members of the Academia. In this context, also the internationally much-discussed and much-criticized regulations on euthanasia in The Netherlands were explained.

The AOjASIF* dynamic hip screw (DRS) has been designed primarily to stabilize trochanteric fractures of the hip. Selected fractures of the femoral neck and some subtrochanteric fractures are further indications for the DRS [40, 46]. The dynam ic condylar screw (DCS) has been developed for fractures of the distal femur and is now being tested clinically. The DRS and DCS are carefully coordinated with the preexisting ASIF standard sets of equipment for internal fixation of fractures. The concept of a sliding screw for trochanteric fractures is not new. The first author describing such an implant was Schumpelick [44]; he gives credit to Pohl [22], who was primarily a manufacturer working for Gerhardt Kiinscher. Re described the possibility of impaction at the fracture site with a sliding device. In the United States Clawson [7, 8] introduced the hip screw and found it to be extremely beneficial in trochanteric fractures. At approximately the same time, Massie [31, 32] and Pugh [39] designed the sliding-type flange nails, which offer similar intramedullary splinting with the possibility of fracture impaction. The following chapters describe the concept and design features of the DRS, as well as the details of the surgical technique. The application of the DRS for different types of fractures is illustrated with clinical examples. The results of 268 cases of trochanteric fractures treated with the DRS are presented and compared with results using the angled blade plate and Ender's nails. Finally, some laboratory tests are described.

The past 25 years have seen a progressive improvement in external fixation techniques in terms of patient acceptability, ease of appli- cation and apparatus stability. The recent awareness in Europe of the method, application and excellent results of the technique pio- neered by G. A. I1izarov has caused a rapid increase here in the number of surgeons who have become "banderilleros". In particu- lar, external fixators can be used in the treatment of difficult clini- cal conditions, such as severe fractures and their sequelae, as well as for the correction of congenital deformities of the peripheral skeleton. As one of the first in France to use the lIizarov method, I became increasingly aware that we needed an updating of anatomical knowledge oriented towards this technique, which uses multiple fixation pins. Without this anatomical infonnation, there is real danger of damaging neuro-vascular structures or entering ajoint in the course of assembling the fixator. Traditional anatomical cross- sections are often inadequate or too schematic to serve as a safe guide for the surgeon using this particular technique. This is the reason why my colleagues Claude Faure and Philippe Merloz have produced and analysed a series of anatomical cross-sections of the limbs to serve this particular need.

This book is a record of the papers read at the first meeting of the European Society of Knee Surgery and Arthroscopy (ESKA). This was held in the magnificent International Congress Centre (ICC) in West Berlin. Planning for the inaugural meeting of a proposed large society is inevitably fraught with problems and doubts. However, thanks to the tremendous assistance given by the ICC organization and to the participation of so many orthopaedic surgeons from Europe and all over the world the society had a very successful meeting, and it is fitting that the papers are collected together in this book as a permanent record. Various factors combined to delay the appearance of the book until now, shortly before the second ESKA meeting (1986) in Basle. We should like to take this opportunity of thanking Springer-Verlag for all the hard work involved in ensuring that the book was finished before this occasion and while the subject matter is still so topical.

In thc space of ooly a few years, reconstructive surgery of the skeleton of the hand has become a foeus of attention. Thc reason for this has been the advent of principles and techniques of stable internal fixation, tbc unparaJleled advantages of which are particularly evident in the treatment of the complex, multi- structural lesions so typical of injuries of the hand, and also in procedures such as replantation or revascularisatioss. What a striking contrast on the other hand is to be seen in the slow and painful progress made in Dur understanding of the biomechanics of the radiocarpal joint! This is most elo- quently ilIustrated by the embryonie state of prosthetic surgery of the wrist, compared with the sophisticatcd advances made in hip and knee surgery. Yet it is undeniable that painful condi- tions involving dysfunctions of the wrist are increasing in number and affect young people in particular; this should spur us on to seek more effective therapeutic solutions.

The reconstructive surgery of posttraumatic deformities has made significant advances in recent years. Reports on technical progress and clinical results are encouraging, even though they have often raised patient expectations to an unrealistic level. The operative methods available to us today enable corrective osteotomies to be performed with a high degree of accuracy and success. Precisely because the sequelae of trauma are so difficult to schematize, every case must be evaluated individually based on a critical assessment of subjective complaints, diagnosis and prognosis before a decision can be made. The planning and execution of corrective procedures are carried out with the same meticulous care as for idiopathic limb deformities. However, the occurrence of a traumatizing event with its immediate and long-term complications calls for special insight in the setting of therapeutic goals. It is essential that the patient be appraised of the results that can reasonably be expected and of the risks that are involved. Success in therapeutic procedures requires detailed theoretical knowledge, thorough operative training, and a strong commitment on the part of the surgeon. It is these aspects of the corrective surgery of posttraumatic deformities with which the editors are principally concerned.

"Knee replacement is bound to fail-providing the patient lives long enough." There is some truth in this hoary cliche, so why write books on the subject? I think the answer is that knee replacement has at last become established and even respectable. The more absurd surgical extravaganzas have been recognised and discarded; today a patient can expect to rely on his new knee to serve him with comfort for a fair number of years. Of course even the early knee replacements often made the patient comfortable; the trouble was they just did not last. All too often the innovator's enthusiasm was overtaken by the patient's disillusionment. Indeed, the operation might well have been abandoned had it not been for the hope that one day the dazzling results at the hip might be matched at the knee. These pioneer prostheses were designed as though the knee were biomechanically as straightforward as the hip. Alas, numerous complexities soon became apparent; in response the models multiplied-and multiplied-until the ordinary orthopaedic practitioner became hopelessly bewildered. He found himself subjected to high pressure propaganda; from the surgeon offering a miracle cure, from the engineer seeking fame and from the manufacturer expecting fortune. Visiting his unit as a team, this trio was well-nigh irresistible.

La pathologie vasculaire a ete tres marquee par les progres biologiques de ces vingt demieres annees. Le systeme arteriel est main tenant considere comme un organe a part entiere. Modelee au cours de l'organogenese par les facteurs hemodynamiques, Ie paroi arterielle maintient une structure hautement organisee et des proprietes mecaniques qui dependent directement des conditions de pression et de debit. La monocouche endotheliale developpe 2 une surface de plusieurs centaines de m a l'interface sang-tissu; elle est a la fois un organe endocrine complexe synthetisant de nombreuses proteines qui participent a l'hemostase, une surface thromboresistante et hemocompatible, une barriere de permeabilite contr6lant les echanges sang-tissus. Les cellules musculaires lisses constituent un tissu multifonctionnel, contractile, assurant la synthese des composants structuraux responsables des proprietes mecaniques de la paroi arterielle, la transmission de la force contractile, et une etonnante activite reparatrice en reponse aux agressions. Tout ceci est soumis a un ensemble complexe de communications cellulaires qui font de l'endothelium un veritable systeme recepteur pour la paroi vasculaire. Parallelement, ou a la suite de ces progres, l'angeiologie s'est progressivement affirmee comme une specialite clinique. Debordant Ie cadre de la chirurgie vasculaire, elle integre les concepts physiopathologiques au diagnostic et au traitement des maladies arterielles. De cet effort d'integration est ne cet ouvrage, cherchant a concilier les connaissances fondamentales es plus recentes et la demarche clinique.

The management of ankle injuries has long been a stumbling block for orthopae dists in training. As a first year resident, I was fortunate to encounter the series of articles by N. Lauge-Hansen and T. Baek Kristensen that classified ankle injuries according to their mechanism. I found this information quite helpful throughout my residency and early years of practice. Several years ago, an attempt was made to summarize this material for the benefit of the orthopaedic house staff of Thomas Jefferson University. It quickly become obvious that such a "manual" would require a great deal of professional illustration and editorial assistance in order to be effective. Almost simulta neously, a fortuitous encounter with Ms. Marie Low (at that time Medical Editor of Springer-Verlag New York Incorporated) provided both the stimulus and the means to present this information in the manner and detail which it deserved. Contributors were carefully selected for their knowledge and experience in particular areas and for their willingness to cooperate in providing a smooth flowing manuscript. This text contains little new material. Rather, it represents an attempt to bring together, under one cover, the wealth of extant information on this subject. Wherever a consensus could not be perceived, conflicting views have been sum marized as objectively as possible. Unfortunately, there are still many aspects of ankle injury for which we have more questions than answers."

This volume contains the proceedings of the Symposion on Shoulder Joint Replace ment held at the Kieler Yacht Club in conjunction with the 35th Annual Meeting of the Northwest German Orthopaedic Surgeons at Kiel in 1985. Since the advent of suitable implant materials hemiarthroplasty of the shoulder was explored in the 1950s; total shoulder joint replacement was first reported in 1971. As interest in solutions to problems of the shoulder is growing, it appeared timely to present to interested clinicians the possibilities and limitations of a proce dure as seen after nearly two decades of trials and experience. This volume is meant to give a comprehensive overview of the bases, the development, the alternatives, the state ofthe art and, an outlook on some future trends. The number of patients with problems warranting shoulder arthroplasty is rela tively small. We consider this a blessing. This may be the reason why the number of surgeons who ventured in this field has remained small, even after implants became available - testimony of an awareness, that shoulder surgery is difficult. The editors consider themselves fortunate to have been able to call on a number of those individuals, who were involved in first trials and in their evaluation. The editors are especially indebted to those from overseas who took it upon themselves to come, share their experience and join in the discussion."

Trauma to the abdomen, both accidental and willful, has become increasingly common in this era of increasing violence. Large numbers of patients all over the country are admitted to emergency rooms because of abdominal trauma of varying degrees of severity. All too often the correct diagnosis is suspected belatedly or not at all, so that proper treatment is not initiated in sufficient time to be lifesaving. Not infre quently, the injured patient is examined by an intern or an insufficiently experienced resident physician. Even in instances where more senior internists and surgeons are available, detailed knowledge about the necessary methodology to establish the correct diagnosis and institute the appropriate treatment is lacking. This monograph, representing the felicitous collaboration of a surgeon and a radiolo gist together with several other contributors, is timely and important. The authors (and their contributors) have approached their subject with a wealth of clinical experi ence obtained in several very active acute-care municipal hospitals in the largest city in this country. They have observed and treated a very large number of patients with a multitude of traumatic causes, including firearm injuries, stab wounds, vehicular accidents, falls, and assaults. The authors have divided this work into four main sections: General Perspectives on Abdominal Injury, Types of Abdominal Injuries, Specific Diagnostic Techniques, and Specific Organ or Supporting-Structure Injury."

The first edition of Surgery of the Hip Joint has had certain measures of success. Its cover won the Outstanding A ward for art at a publishers trade show. A year later it was translated into Spanish for exposure to the vast world of the Spanish speaking peoples. As I traveled through Europe, it was repeatedly a pleasant surprise to have the book recognized as an authoritative reference. This was a great tribute to the experts whose diligent efforts made it all possible. Apparently the book has stood the test of time to judge from the many inquiries and constructive comments made toward urging us on to write a second edition. It was not an easy task to gather another cadre of authorities to update our knowledge of the hip joint. People who have earned respected positions in their field are unavoidably burdened with a busy schedule, so a chapter in this text must be appreciated as coming from someone devoted to giving up some of his precious time for the sake of sharing his knowledge with peers and students. As we struggled along, it became obvious that the book should be divided into three volumes, because outdated concepts had to be scrapped if an up-to-date text were to be offered. Time passed so rapidly that total hip arthroplasties would not become stabilized because of a never-ending parade of implant designs with increasing bioengineering considerations.

During the past 30 years, the Study Group for the Problems of Osteosyn thesis (AO) has made decisive contributions to the development of osteo synthesis as a surgical method. Through close cooperation among special ists in the fields of orthopedic and general surgery, basis research, metallurgy, and technical engineering, with consistently thorough follow up, it was possible to establish a solid scientific background for osteosyn thesis and to standardize this operative method, not only for the more ob vious applications in fracture treatment, but also in selective orthopedics where hardly any problems relating to bone, such as those with osteoto mies can be solved without surgical stabilization. Besides the objective aim, the AO was additionally stimulated by a spirit of open-minded friendship; each member of the group was recruited according to his pro fessional background and position, his skills, and his talent for improvisa tion. Against this backdrop without even mentioning the schooling program well known throughout the world I should like to add some personal and general comments. This book is written for clinicians, instructing them how to perform osteo synthesis with special reference to plating in all its varieties and in strict accordance with the biomechanical and biological aspects and facts. From this point of view, the chapter on preoperative planning merits par ticular emphasis. Not only is it conductive to optimal surgery, it will also contribute to self-education and may found a school."

On April 23, 1906, Alexis Carrel presented his manuscript entitled "The Surgery of Blood Vessels" to the Johns Hopkins Medical Society. His work on the tech nique of small vessel anastomosis and the transplantation of visceral organs earned him the Nobel Prize in 1912. The use of magnification in operative surgery began in 1921 with the work of Nylen, who first employed the microscope for reconstructive procedures in the middle ear. Jacobson and Suarez published their initial observa tions on the use of microsurgery for the anastomosis of small vessels in 1960, and two years later, Malt reported the historic replantation of an upper extremity. To surgeons involved in reconstruction of the extremities, the evolution of micro surgery has provided the most significant advances of the past three decades. The dramatic clinical successes of replantation surgery and free tissue transfer have substantially improved functional and cosmetic results in addition to decreas ing morbidity in patients who present with complex reconstructive problems. Mi crosurgical Reconstruction of the Extremities crosses the traditional surgical discip lines and will be invaluable to orthopaedic surgeons, plastic surgeons, hand sur geons, and general surgeons, as well as to residents and fellows.

This volume is the work product of an international group of authors who are experienced in the field of musculoskeletal allografts. The chapters are written by experts in many differing areas of allografting and represents the current knowledge in this rapidly changing dynamic field. The reconstructive community and their patients owe a significant debt of gratitude to Doctors Czitrom and Winkler for this volume. William F. Enneking, M. D. Preface What follows is the result of a timely project bringing together the newest ideas of top experts worldwide in a rapidly growing technology: Orthopaedic Allograft Surgery. The title of the book reflects a method rather than a speciality. It transgresses well established subspecialities of orthopaedic surgery such as joint replacement, oncology, spine, trauma and sports medicine. The technology encompasses knowledge of tissue banking, biology and biomechanics, both in a research and clinical sense. The common denominator for those interested is the need and ability to provide or use allogeneic tissues in orthopaedic applications. Inherent to a multiauthored text based on chapters written by authors from many parts of the world is a variety in format and style. While we tried to some extent reducing large discrepancies, there was no attempt made to eliminate dissimilar ities. We did not aim for a homogeneous textbook. Rather, we asked for originality, novelty, individuality in the presentation of data and concepts. Consequently, chapters vary in format from that seen in a scientific article to that of a descriptive essay."

The varus knee has a group of bone and ligament abnormalities that must be addressed to correct the deformity. The mechanical axis of the femur is tilted medially relative to the long axis of the tibia. The distal femoral surface usually remains in valgus alignment to the long axis of the femur. Most of the varus deformity is caused by deficiency in the medial tibial plateau. The deep and superficial medial collateral ligaments are contracted and deformed by osteophytes.

Substantialfundamental workhas been undertaken inthe different aspects of impact biomechanics over the past three decades. Much of this has been motivated and undertaken bythe automotive industry intheirefforts to improve transport safety. More recently, however, it has become app- ent that themultidisciplinary synergies which are realisedby interactions between engineers, scientists and clinical practitioners will ultimately lead to a greater understanding of the complex interacting phenomena withinthe human bodyafter it has sustained an impact. In turn, this greater depth of knowledge will provide more fundamentalinsights into the analysis, d- gnosis, treatment and prevention ofimpact injuries across a broader sp- trum of accident environments. Thescienti?c focus of this IUTAM symposium istoaddress those t- ics that are centrally important to the biomechanics ofimpact. These can be groupedinto those that are concerned with the different causes of - cidents (e. g. , transport, occupational and sports injuries), themechanics - volvedinaccident analysis (e. g. , accident investigation, computational m- elling techniques), the different types of resulting traumatic injuries (incl- ing musculoskeletal, organ, spinal and head injuries), methods of asse- ing the extent of injury (e. g. , injury assessment, injury criteria, constitutive laws for human tissue), and providing protection during an impact (e. g. , injury prevention, energy absorption materials, and safety devices).

In preparation for the quadrennial international IPRAS conference, leading plastic surgeons worldwide have been asked by the International Confederation for Plastic, Reconstructive and Aesthetic Surgery to contribute their most up-to-date findings, research results, and experiences in their area of expertise. The book is structured according to the major fields of plastic surgery, and the reader is thus offered insight into the most significant contributions to the international community, as well as into new developments, tricks, and refinements in the field.

This book is about visions and pioneers in the field share their innovations with the reader.

Innovations in Plastic and Aesthetic Surgery will not only give plastic surgeons up-to-date knowledge of new developments, but will inspire with its innovations, many of which have not been published before."

Edited by two leading orthopedic surgeons who are specialists in the treatment of hemophilia, Orthopedic Surgery in Patients with Hemophilia shows all the surgical techniques needed for surgical treatment of musculoskeletal complications of hemophilia. A practical guide, designed for use on the ward or in the office, this book draws on the experience of numerous specialists worldwide, from developed and developing countries. As well as orthopedic surgery, it also covers research, hematology, and rehabilitation. Although of primary interest to the orthopedic surgeon, rheumatologist, and physiotherapist, this book will also be relevant to the hematologist responsible for the care of the hemophiliac patient.

This book provides detailed guidelines to any physician treating patients with emergency vascular disorders. These might include ruptured abdominal aortic aneurysms, acute limb ischemia, vascular trauma, iatrogenic vascular injuries and complications to vascular surgery. The book provides an introduction to vascular surgical operations and focuses on how to manage patients. Numerous figures illustrate the particular points in vascular techniques and diagnostic problems in the emergency situation. This is an indispensable guide for all surgeons dealing with vascular emergencies.

This book offers a comprehensive review on the last development in the management and the treatment of acute and life-threatening conditions. Written by leading experts in the field, this book will help the clinician to understand the clinical problems and to select the methodological and technical options that will ensure prompt and effective response and correct interpretation of the clinical findings. This book is richly illustrated and will serve as unique source of information for radiologists and other specialists including neuroradiologists, surgeons, cardiologists, angiologists and gastroenteologists.