M.E. Müller

Bis vor zehn Jahren galt die operative Hiiftversteifung bei der Behandlung der schmerzhaften einseitig teilversteiften oder stark inkongruenten Hiifte als Therapie der Wahl. Bei richtiger Indikation und Operationstechnik erzielte man damit ein standfestes, schmerzfreies Hiiftgelenk, mit dem die meisten Patienten sehr zufrieden waren. Heute glaubt nahezu jeder Hiiftpatient und leider auch mancher orthopadi- sche Chirurg, daB Totalprothesen bedenkenlos bei noch verhaltnismaBig jungen Patienten implantiert werden diirfen. Enttauschungen werden aber nicht lange auf sich warten lassen, denn Patienten unter fiinfzig Jahren werden ihre einstweilen schmerzfreien kiinstlichen Hiiftgelenke trotz allen arztlichen Mahnungen so sehr strapazieren, daB sich schon nach wenigen Jahren manche einzementierte Gelenkkorper lockem werden. Wohl kann eine Prothese ein- oder gar zweimal ausgewechselt werden, was aber dann? 1m Jahre 1970 wurden in einer Kollektivarbeit der neun groBten orthopadi- schen Kliniken der Schweiz die Ergebnisse der intertrochanteren Osteotomie in bezug auf Schmerzen, Gehfahigkeit, Beweglichkeit und Arbeitsfahigkeit kritisch analysiert. Es wurden Richtlinien fUr die Indikationsstellung, Wahl des Verfahrens und Operationstechnik ausgearbeitet. Eine Kollektivarbeit der Schweiz. Gesellschaft fUr Orthopadie solI demnachst die Spatergebnisse der Totalprothese fUr das dritte bis zehnte Jahr nach dem Eingriff zusammenstellen und nach ahnlichen Kriterien auswerten. 1m Laufe der letzten fUnfzehn Jahre hat sich die Technik der Arthrodese grundlegend geandert. Wahrend im Jahre 1958 noch niemand geglaubt hatte, daB eine Hiiftarthrodese ohne Gipsverband fest werden konne, wurden an verschiedenen Kliniken schon sechs Jahre spater die meisten Hiiftarthrodesen mit der Doppelplatte oder der Kreuzplatte versorgt und sofort funktionell nachbehandelt.

The original AO/ASIF Instrumentation manual presented a concise and complete description of the AO instruments. Thoughtfully developed by Fridolin Sequin and Rigmor Tex­ hammar, the manual discussed in a clear fashion the purpose and care of the various AO instruments that are handled by the operating room staff. One important feature of the first edition was a detailed checklist of the instruments required for the more common operative procedures for treating fractures. Fridolin Sequin was well-suited to author the first edition: his 15 years of experience as a technical engineer for the AO gave him in-depth knowledge of AO instruments, and he drew on the clinical knowledge of Rigmor Texhammar, a consultant and di­ rector of the AO courses for nurses. Its original feature of com­ bining a column of text with a column of illustrations meant the manual quickly became accepted as a standard. By 1981, trans­ lations could be found in English, French, Spanish, and Italian. Not surprisingly, the manual was very popular.

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.

Mit einem Geleitwort von Müller, M. E.

The German edition of our book entitled "Operative Frakturen­ behandlung" by M. E. MÜLLER, M. ALLGÖWER and H. WILLENEGGER (Springer, Berlin . Göttingen . Heidelberg, 1963) has been out of print now for more than three years. We are planning a new edition which will deal with the collective experience of 14,000 new cases, all treated by internal fixation, and will include the newest developments in the field of internal fixa­ tion. However, it will be some time before this new edition can be published. Increasing demands for a description of the AO technique of internal fixation has stimulated us to publish this manual. In it we shall describe in a comprehensive but somewhat apodictic mann er the principles and techniques of the AO methods of fracture treatment and reconstructive surgery, which in our hands, have stood the test of time. The book is written in a somewhat abbreviated style. It cor­ responds in subject matter to the teaching given at the AO courses in Davos, but deals with each subject more thoroughly. We have dispensed with pictures of the instruments, as these may be found in the Synthes Catalogue *. This manual should be regarded as the product of collective experiencc, containing new thoughts and new discoveries from basic research. In considering the risks of mistakes and dangers, we can only reiterate what we have already stated in "Technique of Internal Fixation of Fractures": "Open treatment of fractures is a valuable but difficult method which involves much responsibility.

Vor dem Hintergrund einer uber 30jahrigen Erfahrung zeigt dieses Werk den aktuellen Wissensstand der Endoprothetik. Es ist Dr.med.h.c. Otto Frey-Zund gewidmet, der in gemeinsamer Pionierarbeit mit orthopadischen Chirurgen, Wissenschaftlern und Ingenieuren aus ganz Europa Kunstgelenke fur Huft-, Knie-, Ellenbogen- und Handgelenke entwickelt hat.

Modern endoprosthetics requires the examination of basic principles such as metallurgy, tribology, gait analysis, model and system development, methods of implant fixation, design, surface problems, material characteristics, stability behaviour, and operating techniques. With a background of more than 30 years of experience, this work presents a summary of these fields, providing the reader with the current state of knowledge. It is dedicated to Dr. med. h.c. Otto Frey-Zünd who, in conjunction with orthopaedic surgeons, scientists and engineers from all over Europe, developed artificial joints for hips, knees, elbows and wrists in over 30 years of pioneering work.