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Campbell’s Operative Orthopaedics, 14th ed.
List of Techniques
VOLUME I 1.56 Direct Posterolateral Approach to the Knee (Minkoff, Jaffe, and
Menendez), 62
Surgical Techniques 1.57 Anterolateral Approach to the Femur (Thompson), 62
1.1 Fixation of Tendon to Bone, 14 1.58 Lateral Approach to the Femoral Shaft, 63
1.2 Tendon Fixation Into the Intramedullary Canal, 15 1.59 Posterolateral Approach to the Femoral Shaft, 64
1.3 Tendon to Bone Fixation Using Locking Loop Suture, 16 1.60 Posterior Approach to the Femur (Bosworth), 64
1.4 Tendon to Bone Fixation Using Wire Suture, 16 1.61 Medial Approach to the Posterior Surface of the Femur in the
1.5 Fixation of Osseous Attachment of Tendon to Bone, 17 Popliteal Space (Henry), 67
1.6 Removal of a Tibial Graft, 22 1.62 Lateral Approach to the Posterior Surface of the Femur in the
1.7 Removal of Fibular Grafts, 23 Popliteal Space (Henry), 67
1.8 Removal of an Iliac Bone Graft, 26 1.63 Lateral Approach to the Proximal Shaft and the Trochanteric
1.9 Approach to the Interphalangeal Joints, 28 Region, 68
1.10 Medial Approach to the Great Toe Metatarsophalangeal Joint, 28 1.64 Anterior Iliofemoral Approach to the Hip (Smith-Petersen), 70
1.11 Dorsomedial Approach to Great Toe Metatarsophalangeal Joint, 29 1.65 Anterior Approach to the Hip Using a Transverse Incision
1.12 Approach to the Lesser Toe Metatarsophalangeal Joints, 29 (Somerville), 71
1.13 Medial Approach to the Calcaneus, 29 1.66 Modified Anterolateral Iliofemoral Approach to the Hip
1.14 Lateral Approach to the Calcaneus, 29 (Smith–Petersen), 71
1.15 Extended Lateral Approach to the Calcaneus, 29 1.67 Lateral Approach to the Hip (Watson-Jones), 73
1.16 Sinus Tarsi Approach, 31 1.68 Lateral Approach for Extensive Exposure of the Hip (Harris), 73
1.17 U–Shaped Approach to the Calcaneus, 31 1.69 Lateral Approach to the Hip Preserving the Gluteus Medius
1.18 Kocher Approach (Curved L) to the Calcaneus, 32 (McFarland and Osborne), 75
1.19 Anterolateral Approach to Chopart Joint, 33 1.70 Lateral Transgluteal Approach to the Hip (Hardinge), 77
1.20 Anterior Approach to Expose the Ankle Joint and Both Malleoli, 33 1.71 Lateral Transgluteal Approach to the Hip (Hay as Described by
1.21 Kocher Lateral Approach to the Tarsus and Ankle, 34 McLauchlan), 77
1.22 Ollier Approach to the Tarsus, 34 1.72 Posterolateral Approach (Gibson), 78
1.23 Single-Incision Posterolateral Approach to the Lateral and Posterior 1.73 Posterior Approach to the Hip (Osborne), 80
Malleoli, 35 1.74 Posterior Approach to the Hip (Moore), 82
1.24 Posterolateral Approach to the Ankle (Gatellier and Chastang), 35 1.75 Medial Approach to the Hip (Ferguson; Hoppenfeld and DeBoer), 84
1.25 Anterolateral Approach to the Lateral Dome of the Talus (Tochigi, 1.76 Stoppa Approach (AO Foundation), 85
Amendola, Muir, and Saltzman), 35 1.77 Ilioinguinal Approach to the Acetabulum (Letournel and Judet, as
1.26 Posterior Approach to the Ankle, 36 Described by Matta), 87
1.27 Medial Approach to the Tarsus (Knupp et al.), 37 1.78 Iliofemoral Approach to the Acetabulum (Letournel and Judet), 90
1.28 Medial Approach to the Ankle (Koenig and Schaefer), 37 1.79 Kocher-Langenbeck Approach (Kocher-Langenbeck; Letournel and
1.29 Medial Approach to the Posterior Lip of the Tibia (Colonna and Judet), 91
Ralston), 38 1.80 Modified Gibson Approach (Modified Gibson Approach, Moed), 93
1.30 Anterolateral Approach to the Tibia, 39 1.81 Extensile Iliofemoral Approach (Letournel and Judet), 94
1.31 Medial Approach to the Tibia (Phemister), 39 1.82 Extensile Iliofemoral Approach (Reinert et al.), 94
1.32 Posterolateral Approach to the Tibial Shaft (Harmon, Modified), 39 1.83 Triradiate Extensile Approach to the Acetabulum (Mears and
1.33 Anterolateral Approach to the Lateral Tibial Plateau (Kandemir and Rubash), 97
MacLean), 39 1.84 Extensile Approach to the Acetabulum (Carnesale), 99
1.34 Medial Approach to the Medial Tibial Plateau, 41 1.85 Approach to the Ilium, 99
1.35 Posteromedial Approach to the Medial Tibial Plateau (Supine), 41 1.86 Approach to the Symphysis Pubis (Pfannenstiel), 100
1.36 Posteromedial Approach (Prone) to the Superomedial Tibia (Banks 1.87 Posterior Approach to the Sacroiliac Joint, 102
and Laufman), 42 1.88 Anterior Approach to the Sacroiliac Joint (Avila), 102
1.37 Posterolateral Approach to the Tibial Plateau (Solomon et al.), 43 1.89 Approach to Both Sacroiliac Joints or Sacrum (Modified from Mears
1.38 Posterolateral Approach to the Tibial Plateau Without Fibular and Rubash), 103
Osteotomy (Frosch et al.), 44 1.90 Approach to the Sternoclavicular Joint, 104
1.39 Tscherne-Johnson Extensile Approach to the Lateral Tibial Plateau 1.91 Approach to the Acromioclavicular Joint and Coracoid Process
(Johnson et al.), 44 (Roberts), 104
1.40 Anterolateral Approach for Access to Posterolateral Corner 1.92 Anteromedial Approach to the Shoulder (Thompson; Henry), 105
(Sun et al.), 45 1.93 Anteromedial/Posteromedial Approach to the Shoulder (Cubbins,
1.41 Posterolateral Approach to the Fibula (Henry), 46 Callahan, and Scuderi), 106
1.42 Anteromedial Parapatellar Approach (von Langenbeck), 47 1.94 Anterior Axillary Approach to the Shoulder (Leslie and Ryan), 106
1.43 Subvastus (Southern) Anteromedial Approach to the Knee (Erkes, as 1.95 Anterolateral Limited Deltoid-Splitting Approach to the Shoulder, 106
Described by Hofmann, Plaster, and Murdock), 47 1.96 Extensile Anterolateral Approach to the Shoulder
1.44 Anterolateral Approach to the Knee (Kocher), 48 (Gardner et al.), 109
1.45 Posterolateral Approach to the Knee (Henderson), 49 1.97 Transacromial Approach to the Shoulder (Darrach; McLaughlin), 109
1.46 Posteromedial Approach to the Knee (Henderson), 51 1.98 Posterior Deltoid-Splitting Approach to the Shoulder
1.47 Medial Approach to the Knee (Cave), 52 (Wirth et al.), 110
1.48 Medial Approach to the Knee (Hoppenfeld and deBoer), 53 1.99 Posterior Approach to the Shoulder (Modified Judet), 111
1.49 Transverse Approach to the Meniscus, 53 1.100 Simplified Posterior Approach to the Shoulder (King, as Described
1.50 Lateral Approach to the Knee (Bruser), 55 by Brodsky et al.), 111
1.51 Lateral Approach to the Knee (Brown et al.), 56 1.101 Posterior Inverted-U Approach to the Shoulder (Abbott and Lucas), 113
1.52 Lateral Approach to the Knee (Hoppenfeld and deBoer), 57 1.102 Anterolateral Approach to the Shaft of the Humerus (Thompson;
1.53 Extensile Approach to the Knee (Fernandez), 58 Henry), 114
1.54 Direct Posterior Approach to the Knee (Brackett and Osgood; Putti; 1.103 Subbrachial Approach to the Humerus (Boschi et al.), 116
Abbott and Carpenter), 58 1.104 Posterior Approach to the Proximal Humerus (Berger and
1.55 Direct Posteromedial Approach to the Knee for Tibial Plateau Buckwalter), 117
Fracture (Galla and Lobenhoffer as Described by Fakler et al.), 61
1.105 Posterolateral Approach to the Distal Humeral Shaft (Moran), 118 3.32 Management of Proximal Femoral Bone Loss with Modular Tapered
1.106 Posterolateral Extensile (Cold) Approach to the Distal Humerus Fluted Stem (Kwong et al.), 317
(Lewicky, Sheppard, and Ruth), 120 3.33 Management of Proximal Femoral Deficiencies with Impaction Bone
1.107 Posterolateral Approach to the Elbow (Campbell), 121 Grafting and Cemented Revision Stem (Gie, Modified), 317
1.108 Extensile Posterolateral Approach to the Elbow (Wadsworth), 121 3.34 Management of Massive Deficits with Proximal Femoral Allograft-
1.109 Posterior Approach to the Elbow by Olecranon Osteotomy Prosthesis Composite, 319
(MacAusland and Müller), 123 3.35 Management of Massive Deficits with Modular Megaprosthesis
1.110 Extensile Posterior Approach to the Elbow (Bryan and Morrey), 123 (Klein et al.), 321
1.111 Lateral Approach to the Elbow, 124 Surface Replacement Hip Arthroplasty
1.112 Lateral J–Shaped Approach to the Elbow (Kocher), 126 4.1 Hip Resurfacing Technique—Birmingham Hip Replacement, 336
1.113 Medial Approach with Osteotomy of the Medial Epicondyle
(Molesworth; Campbell), 127 Arthrodesis of the Hip
1.114 Medial and Lateral Approach to the Elbow, 127 5.1 Arthrodesis with Cancellous Screw Fixation (Benaroch et al.), 349
1.115 Global Approach to the Elbow (Patterson, Bain, and Mehta), 127 5.2 Arthrodesis with Anterior Fixation (Matta et al.), 349
1.116 Posterolateral Approach to the Radial Head and Neck, 130 5.3 Arthrodesis with Double-Plate Fixation (Müller et al.), 350
1.117 Approach to the Proximal and Middle Thirds of the Posterior Surface 5.4 Arthrodesis with Cobra Plate Fixation (Murrell and Fitch), 351
of the Radius (Thompson), 131 5.5 Arthrodesis with Hip Compression Screw Fixation (Pagnano and
1.118 Anterolateral Approach to the Proximal Shaft and Elbow Joint Cabanela), 353
(Henry), 132 5.6 Arthrodesis in the Absence of the Femoral Head (Abbott, Fischer,
1.119 Anterior Approach to the Distal Half of the Radius (Henry), 132 and Lucas), 353
1.120 Anterior Approach to the Coronoid Process of the Proximal Ulna Hip Pain in the Young Adult and Hip Preservation Surgery
(Yang et al.), 134 6.1 Surgical Dislocation of the Hip (Ganz et al.), 367
1.121 Approach to the Proximal Third of the Ulna and the Proximal Fourth of 6.2 Combined Hip Arthroscopy and Limited Open Osteochondroplasty
the Radius (Boyd), 135 (Clohisy and McClure), 371
1.122 Dorsal Approach to the Wrist, 137 6.3 Mini-Open Direct Anterior Approach (Ribas et al.), 373
1.123 Dorsal Approach to the Wrist, 137 6.4 Bernese Periacetabular Osteotomy (Matheney et al.), 381
1.124 Volar Approach to the Wrist, 137 6.5 Rectus-Sparing Modification of Bernese Osteotomy (Novais et al.), 385
1.125 Lateral Approach to the Wrist, 138 6.6 Step-Cut Lengthening of the Iliotibial Band (White et al.), 388
1.126 Medial Approach to the Wrist, 138 6.7 Core Decompression (Hungerford), 393
Arthroplasty of the Hip 6.8 Core Decompression—Percutaneous Technique (Mont et al.), 394
3.1 Preoperative Templating for Total Hip Arthroplasty (Capello), 203 Arthroplasty of the Knee
3.2 Posterolateral Approach with Posterior Dislocation of the Hip, 207 7.1 Surgical Approach for Primary Total Knee Arthroplasty, 436
3.3 Implantation of Cementless Acetabular Component, 210 7.2 Bone Preparation for Primary Total Knee Arthroplasty, 439
3.4 Implantation of Cemented Acetabular Component, 212 7.3 Pie-Crusting, 444
3.5 Implantation of Cementless Femoral Component, 214 7.4 Posterior Stabilized Total Knee Arthroplasty In A Varus Knee, 445
3.6 Implantation of Cemented Femoral Component, 218 7.5 Posterior Cruciate–Retaining Total Knee Arthroplasty of a Varus
3.7 Direct Anterior Approach with Anterior Dislocation of the Hip, 222 Knee, 445
3.8 Gluteus Maximus and Tensor Fascia Lata Transfer for Primary 7.6 Valgus Deformity Correction, 446
Deficiency of the Abductors of the Hip, 269 7.7 Flexion Contracture Correction, 447
3.9 Revision After Adverse Local Tissue Reaction, 285 7.8 Recurvatum Correction, 448
3.10 Transtrochanteric Approach for Revision Total Hip Arthroplasty, 289 7.9 Posterior Cruciate Ligament Balancing, 448
3.11 Removal of Cemented Femoral Component, 289 7.10 Bone Grafting of Peripheral Tibial Defects (Windsor, Insall, and
3.12 Removal of Cementless Femoral Component, 290 Sculco), 450
3.13 Removal of Implants with Extensive Distal Bone Ingrowth 7.11 Component Implantation, 453
(Glassman and Engh), 291 7.12 Unicondylar Knee Arthroplasty, 455
3.14 Extended Trochanteric Osteotomy (Younger et al.), 292 7.13 Patellofemoral Arthroplasty, 456
3.15 Removal of a Broken Stem—Proximal Window (Moreland, Marder, 7.14 Arthrodesis with an Intramedullary Nail for an Infected Total Knee
and Anspach), 294 Arthroplasty, 463
3.16 Removal of a Broken Stem—Distal Window, 295 Arthrodesis of the Knee
3.17 Removal of Femoral Cement, 295 8.1 Compression Arthrodesis Using External Fixation, 486
3.18 Removal of Distal Cement with a High-Speed Burr 8.2 Arthrodesis Using Intramedullary Nail Fixation, 487
(Turner et al.), 296 8.3 Knee Arthrodesis with Locked Intramedullary Nail After Failed Total
3.19 Removal of Distal Cement with a High-Speed Burr and Cortical Knee Arthroplasty, 489
Window (Mallory), 298 8.4 Arthrodesis Using Plate Fixation, 490
3.20 Removal of a Loose All-Polyethylene Cup, 299
3.21 Removal of a Metal-Backed, Cemented Acetabular Component, 299 Soft-Tissue Procedures and Osteotomies About the Knee
3.22 Cementless Acetabular Component (Mitchell), 301 9.1 Proximal Release of Quadriceps (Sengupta), 494
3.23 Management of Acetabular Cavitary Deficits, 302 9.2 Quadricepsplasty for Posttraumatic Contracture of the Knee
3.24 Management of Segmental Acetabular Deficit with Femoral Head (Modified Thompson, Described by Hahn et al.), 494
Allograft, 307 9.3 Drainage of Bursa, 499
3.25 Management of Segmental Acetabular Deficit with Metal Augment 9.4 Excision of Bursa, 499
(Jenkins et al., Modified), 307 9.5 Popliteal Cyst Excision (Hughston, Baker, and Mello), 501
3.26 Management of Combined Deficits with Structural Grafting (Sporer 9.6 Medial Gastrocnemius Bursa Excision (Meyerding and
et al.), 308 Van Demark), 502
3.27 Acetabular Distraction for Management of Pelvic Discontinuity 9.7 Semimembranosus Bursa Excision, 503
(Sheth et al.), 310 9.8 Semitendinosus Tendon Transfer (Ray, Clancy, and Lemon), 503
3.28 Cup-Cage Technique for Management of Pelvic Discontinuity (Abdel 9.9 Lateral Closing Wedge Osteotomy (Modified Coventry; Hofmann,
et al., Modified), 311 Wyatt, and Beck), 513
3.29 Management of Pelvic Discontinuity with Allografting and Custom 9.10 Opening Wedge Hemicallotasis (Turi et al.), 518
Component (DeBoer et al.), 311 9.11 Varus Distal Femoral Osteotomy (Coventry), 522
3.30 Management of Femoral Deficit with Modular Femoral Component Total Ankle Arthroplasty
(Cameron), 316 10.1 Total Ankle Arthroplasty, 533
3.31 Revision with Extensively Porous-Coated Femoral Stem (Mallory 10.2 Dome Osteotomy for Correction of Varus Deformity Above the
and Head), 316 Ankle Deformity (Tan and Myerson), 536
10.3 Medial Tibial Plafondplasty for Varus Deformity at the Ankle Joint Amputations of the Lower Extremity
(Tan and Myerson), 537 16.1 Transtibial Amputation, 722
10.4 Reconstruction of Lateral Ankle Ligaments for Chronic Instability as 16.2 Transtibial Amputation (Modified Ertl; Taylor and Poka), 723
an Adjunct to Total Ankle Arthroplasty (Coetzee), 538 16.3 Transtibial Amputation Using Long Posterior Skin Flap
10.5 Tibiotalar Arthrodesis Conversion to Total Ankle Arthroplasty (Burgess), 725
(Pellegrini et al.), 540 16.4 Knee Disarticulation (Batch, Spittler, and McFaddin), 726
10.6 Revision Total Ankle Arthroplasty (Meeker et al.), 555 16.5 Knee Disarticulation (Mazet and Hennessy), 728
Ankle Arthrodesis 16.6 Knee Disarticulation (Kjøble), 728
11.1 Opening Wedge Osteotomy of the Tibia For Varus Deformity and 16.7 Transfemoral (Above-Knee) Amputation of Nonischemic Limbs, 730
Medial Joint Arthrosis, 564 16.8 Transfemoral (Above-Knee) Amputation of Nonischemic Limbs
11.2 Intraarticular Opening Medial Wedge Osteotomy (Plafondplasty) (Gottschalk), 731
of the Tibia for Intraarticular Varus Arthritis and Instability (Mann, Amputations of the Hip and Pelvis
Filippi, and Myerson), 566 17.1 Anatomic Hip Disarticulation (Boyd), 733
11.3 Distraction Arthroplasty of the Ankle, 568 17.2 Posterior Flap (Slocum), 735
11.4 Mini-Incision Technique, 575 17.3 Standard Hemipelvectomy, 736
11.5 Transfibular (Transmalleolar) Arthrodesis with Fibular Strut 17.4 Anterior Flap Hemipelvectomy, 736
Graft, 576 17.5 Conservative Hemipelvectomy, 739
11.6 Anterior Approach with Plate Fixation, 580 Major Amputations of the Upper Extremity
11.7 Lateral Approach with Fibular Sparing (Smith, Chiodo, Singh, 18.1 Amputation at the Wrist, 743
Wilson), 580 18.2 Disarticulation of the Wrist, 743
11.8 Tibiotalocalcaneal Arthrodesis, 581 18.3 Distal Forearm (Distal Transradial) Amputation, 744
11.9 Posterior Approach for Arthrodesis of Ankle and Subtalar Joints 18.4 Proximal Third of Forearm (Proximal Transradial) Amputation, 745
(Campbell), 584 18.5 Disarticulation of the Elbow, 745
11.10 Arthrodesis with a Thin-Wire External Fixation, 584 18.6 Supracondylar Area, 746
11.11 Tibiotalar Arthrodesis with a Sliding Bone Graft (Blair; 18.7 Amputation Proximal to the Supracondylar Area, 748
Morris et al.), 590 18.8 Amputation Through the Surgical Neck of the Humerus, 748
11.12 Tibiotalar or Tibiotalocalcaneal Fusion with Structural Allograft 18.9 Disarticulation of the Shoulder, 750
and Internal Fixation for Salvage of Failed Total Ankle Arthroplasty 18.10 Anterior Approach (Berger), 752
(Berkowitz et al.), 591 18.11 Posterior Approach (Littlewood), 753
11.13 Bone Graft Harvest from the Proximal Tibia 18.12 Targeted Muscle Reinnervation After Transhumeral Amputation
(Whitehouse et al.), 593 (O’Shaughnessy et al.), 756
Shoulder and Elbow Arthroplasty Amputations of the Hand
12.1 Hemiarthroplasty, 608 19.1 Kutler V-Y or Atasoy Triangular Advancement Flaps (Kutler;
12.2 Total Shoulder Arthroplasty, 612 Fisher), 764
12.3 Reverse Total Shoulder Arthroplasty, 617 19.2 Atasoy Triangular Advancement Flaps (Atasoy et al.), 766
12.4 Debridement Arthroplasty (Wada et al.), 633 19.3 Bipedicle Dorsal Flaps, 767
12.5 Interposition Arthroplasty, 637 19.4 Adipofascial Turnover Flap, 768
12.6 Radial Head Arthroplasty, 639 19.5 Thenar Flap, 768
12.7 Coonrad-Morrey Prosthesis, 642 19.6 Local Neurovascular Island Flap, 769
12.8 Elbow Resection Arthroplasty (Campbell), 648 19.7 Island Pedicle Flap, 769
Salvage Operations for the Shoulder and Elbow 19.8 Retrograde Island Pedicle Flap, 771
13.1 External Fixation (Charnley and Houston), 660 19.9 Ulnar Hypothenar Flap, 771
13.2 Plate Fixation (AO Group), 660 19.10 Index Ray Amputation, 771
13.3 Pelvic Reconstruction Plate (Modification of Richards et al.), 661 19.11 Transposing the Index Ray (Peacock), 774
13.4 Shoulder Arthrodesis After Failed Prosthetic Shoulder Arthroplasty 19.12 Advancement Pedicle Flap for Thumb Injuries, 776
(Scalise and Iannotti), 662 19.13 Phalangization of Fifth Metacarpal, 778
13.5 Arthroscopic Shoulder Arthrodesis for Brachial Plexus Injury 19.14 Krukenberg Reconstruction (Krukenberg; Swanson), 779
(lenoir), 664 19.15 Lengthening of the Metacarpal and Transfer of Local Flap (Gillies
13.6 Elbow Arthrodesis (Staples), 665 and Millard, Modified), 781
13.7 Elbow Arthrodesis (Müller et al.), 666 19.16 Osteoplastic Reconstruction and Transfer of Neurovascular Island
13.8 Elbow Arthrodesis (Spier), 666 Graft (Verdan), 782
13.9 Latissimus Dorsi Transfer, Open Technique (Gerber et al.), 668 19.17 Riordan Pollicization (Riordan), 784
13.10 Latissimus Dorsi Transfer, Arthroscopically Assisted Technique 19.18 Buck-Gramcko Pollicization (Buck-Gramcko), 785
(Castricini et al.), 669 19.19 Foucher Pollicization, 787
13.11 Lower Trapezius Transfer, Open Technique (Elhassan et al.), 671 Osteomyelitis
13.12 Lower Trapezius Transfer, Arthroscopically Assisted Technique 21.1 Drainage of Acute Hematogenous Osteomyelitis, 821
(Elhassan et al.), 672 21.2 Sequestrectomy and Curettage for Chronic Osteomyelitis, 827
13.13 Pectoralis Major Transfer (Modification of Resch et al.,), 673 21.3 Open Bone Grafting (Papineau et al.; Archdeacon and
13.14 Latissimus Dorsi Tendon Transfer (Mun et al.), 675 Messerschmitt), 828
Amputations of the Foot 21.4 Antibiotic Bead Pouch (Henry, Ostermann, and Seligson), 829
15.1 Terminal Syme Amputation, 700 21.5 Intramedullary Antibiotic Cement Nail, 829
15.2 Amputation at the Base of the Proximal Phalanx, 700 21.6 Split-Heel Incision (Gaenslen), 834
15.3 Metatarsophalangeal Joint Disarticulation, 703 21.7 Distal Third of the Femur, 835
15.4 Metatarsophalangeal Joint Disarticulation, 703 21.8 Drainage, 835
15.5 First or Fifth Ray Amputation (Border Ray Amputation), 703 21.9 Resection of the Metatarsals, 836
15.6 Central Ray Amputation, 704 21.10 Partial Calcanectomy, 837
15.7 Transmetatarsal Amputation, 707 21.11 Resection of the Fibula, 837
15.8 Chopart Amputation, 711 21.12 Resection of the Iliac Wing (Badgley), 838
15.9 Syme Amputation, 713 Infectious Arthritis
15.10 Two-Stage Syme Amputation (Wyss et al.; Malone et al.; 22.1 Surgical Drainage of the Tarsal Joint, 846
Wagner), 717 22.2 Anterolateral Drainage of the Ankle, 847
15.11 Boyd Amputation, 717
22.3 Posterolateral Drainage of the Ankle, 847 23.4 Excision of Navicular, 875
22.4 Anteromedial Drainage of the Ankle, 847 23.5 Excision of Cuboid, 875
22.5 Posteromedial Drainage of the Ankle, 847 23.6 Excision of Calcaneus, 875
22.6 Arthroscopic Drainage of the Knee, 848 23.7 Excision of Talus, 876
22.7 Anterior Drainage of the Knee, 849 23.8 Partial Synovectomy and Curettage (Wilkinson), 877
22.8 Posterolateral and Posteromedial Drainage of the Knee 23.9 Lesions above Acetabulum, 878
(Henderson), 849 23.10 Lesions of the Femoral Neck, 878
22.9 Posteromedial Drainage of the Knee (Klein), 850 23.11 Lesions of the Trochanteric Area (Ahern), 878
22.10 Posteromedial and Posterolateral Drainage of the Knee 23.12 Excision of the Hip Joint, 879
(Kelikian), 850 23.13 Excision of Elbow Joint, 880
22.11 Lateral Aspiration of the Hip, 851 23.14 Excision of Wrist Joint, 880
22.12 Anterior Aspiration of the Hip, 851 General Principles of Tumors
22.13 Medial Aspiration of the Hip, 851 24.1 Resection of the Shoulder Girdle (Marcove, Lewis, and Huvos), 909
22.14 Posterior Drainage of the Hip (Ober), 852 24.2 Resection of the Scapula (Das Gupta), 913
22.15 Anterior Drainage of the Hip, 852 24.3 Resection of the Proximal Humerus, 916
22.16 Lateral Drainage of the Hip, 852 24.4 Intercalary Resection of the Humeral Shaft (Lewis), 920
22.17 Medial Drainage of the Hip (Ludloff), 853 24.5 Resection of the Distal Humerus, 920
22.18 Arthroscopic Debridement and Partial Synovectomy of the Hip in 24.6 Resection of the Proximal Radius, 920
an Adult, 853 24.7 Resection of the Proximal Ulna, 921
22.19 Resection of the Hip (Girdlestone), 854 24.8 Resection of the Distal Radius, 921
22.20 Anterior Drainage of the Shoulder, 856 24.9 Resection of the Pubis and Ischium (Radley, Liebig, and Brown), 928
22.21 Posterior Drainage of the Shoulder, 856 24.10 Resection of the Acetabulum, 932
22.22 Medial Drainage of the Elbow, 857 24.11 Resection of the Innominate Bone (Internal Hemipelvectomy)
22.23 Lateral Drainage of the Elbow, 857 (Karakousis and Vezeridis), 934
22.24 Posterior Drainage of the Elbow, 858 24.12 Resection of the Sacroiliac Joint, 934
22.25 Lateral Drainage of the Wrist, 858 24.13 Resection of the Sacrum (Stener and Gunterberg), 936
22.26 Medial Drainage of the Wrist, 859 24.14 Resection of the Sacrum (Localio, Francis, and Rossano), 937
22.27 Dorsal Drainage of the Wrist, 859 24.15 Resection of the Sacrum Through Posterior Approach (MacCarty
22.28 Osteotomy of the Ankle, 859 et al.), 937
22.29 Transverse Supracondylar Osteotomy of the Femur, 859 24.16 Resection of the Proximal Femur (Lewis and Chekofsky), 938
22.30 V-Osteotomy of the Femur (Thompson), 860 24.17 Resection of Entire Femur (Lewis), 938
22.31 Supracondylar Cuneiform Osteotomy of the Femur, 860 24.18 Intraarticular Resection of the Distal Femur with Endoprosthetic
22.32 Supracondylar Controlled Rotational Osteotomy of the Femur, 861 Reconstruction, 943
22.33 Intraarticular Osteotomy, 861 24.19 Resection of the Proximal Tibia (Malawer), 944
22.34 Reconstruction After Hip Sepsis (Harmon), 864 24.20 Resection of the Proximal Fibula (Malawer), 945
22.35 Transverse Opening Wedge Osteotomy of the Hip, 864 24.21 Resection of the Distal Third of the Fibula, 945
22.36 Transverse Closing Wedge Osteotomy of the Hip, 865 24.22 Rotationplasty for a Lesion in the Distal Femur (Kotz and
22.37 Brackett Osteotomy of the Hip (Brackett), 865 Salzer), 950
Tuberculosis and Other Unusual Infections 24.23 Rotationplasty for a Lesion of the Proximal Femur Without
23.1 Curettage for Tuberculous Lesions in the Foot, 874 Involvement of the Hip Joint (Winkelmann), 950
23.2 Excision of Metatarsal, 874 24.24 Rotationplasty for a Lesion of the Proximal Femur Involving the Hip
23.3 Excision of Cuneiform Bones, 874 Joint (Winkelmann), 952
Campbell’s Operative Orthopaedics, 14th ed.
List of Techniques
VOLUME II
Congenital Anomalies of the Lower Extremity 29.48 Femoral Lengthening (DeBastiani et al.), 1175
29.1 Amputation of an Extra Toe (Simple Postaxial Polydactyly), 1081 29.49 Femoral Lengthening (Ilizarov, Modified), 1175
29.2 Tsuge Ray Reduction (Tsuge), 1082 29.50 Femoral Lengthening Over Intramedullary Nail (PRECICE);
29.3 Ray Reduction, 1083 (Standard, Herzenberg, and Green), 1179
29.4 Ray Amputation, 1083 Congenital and Developmental Abnormalities of the Hip and Pelvis
29.5 Simplified Cleft Closure (Wood, Peppers, and Shook), 1087 30.1 Arthrography of the Hip in DDH, 1193
29.6 Correction of Angulated Toe, 1088 30.2 Application of a Hip Spica Cast (Kumar), 1195
29.7 Arthroplasty of the Fifth Metatarsophalangeal Joint (Butler), 1088 30.3 Anterior Approach (Beaty; After Somerville), 1197
29.8 Creation of Syndactyly of the Great Toe and Second Toe for Hallux 30.4 Medial Approach (Ludloff), 1199
Varus (Farmer), 1090 30.5 Trochanteric Advancement (Lloyd-Roberts and Swann), 1202
29.9 Dome-Shaped Osteotomies of Metatarsal Bases (Berman and 30.6 Varus Derotational Osteotomy of the Femur In Hip Dysplasia, with
Gartland), 1092 Pediatric Hip Screw Fixation, 1203
29.10 Cuneiform and Cuboid Osteotomies (McHale and Lenhart), 1095 30.7 Primary Femoral Shortening, 1206
29.11 Anterior Tibial Tendon Transfer, 1100 30.8 Innominate Osteotomy Including Open Reduction (Salter), 1209
29.12 Transverse Circumferential (Cincinnati) Incision (Crawford, 30.9 Pericapsular Osteotomy of the Ilium (Pemberton), 1211
Marxen, and Osterfeld), 1102 30.10 Triple Innominate Osteotomy (Steel), 1214
29.13 Extensile Posteromedial and Posterolateral Release (McKay, Modi- 30.11 Transiliac (Dega) Osteotomy (Grudziak and Ward), 1216
fied), 1103 30.12 Slotted Acetabular Augmentation (Staheli), 1219
29.14 Achilles Tendon Lengthening and Posterior Capsulotomy (Selective 30.13 Chiari Osteotomy, 1222
Approach), 1106 30.14 Valgus Osteotomy for Developmental Coxa Vara, 1225
29.15 First Metatarsal Osteotomy and Tendon Transfer for Dorsal Bunion, 1108 30.15 Bilateral Anterior Iliac Osteotomies (Sponseller, Gearhart, and Jeffs),
29.16 Osteotomy of the Calcaneus for Persistent Varus Deformity of the 1227
Heel (Dwyer, Modified), 1109
Congenital Anomalies of the Trunk and Upper Extremity
29.17 Medial Release with Osteotomy of the Distal Calcaneus (Lichtblau),
31.1 Woodward Operation, 1232
1109
31.2 Morcellation of the Clavicle, 1233
29.18 Selective Joint-Sparing Osteotomies for Residual Cavovarus Deform-
31.3 Unipolar Release, 1236
ity (Mubrak and Van Valin), 1110
31.4 Bipolar Release (Ferkel et al.), 1237
29.19 Triple Arthrodesis, 1112
31.5 Open Reduction and Iliac Bone Grafting for Congenital
29.20 Talectomy (Trumble et al.), 1112
Pseudarthrosis of the Clavicle, 1239
29.21 Open Reduction and Realignment of Talonavicular and Subtalar
31.6 Radial and Ulnar Osteotomies for Correction of Congenital
Joints (Kumar, Cowell, and Ramsey), 1115
Radioulnar Synostosis (Two-Stage) (Lin et al.), 1243
29.22 Open Reduction and Extraarticular Subtalar Fusion (Grice- Green),
1116 Osteochondrosis or Epiphysitis and Other Miscellaneous Affections
29.23 Tibiofibular Synostosis (Langenskiöld), 1120 32.1 Innominate Osteotomy for Legg-Calvé-Perthes Disease (Canale
29.24 Insertion of Williams Intramedullary Rod and Bone Grafting et al.), 1250
(Anderson et al.), 1123 32.2 Lateral Shelf Procedure (Labral Support) for Legg-Calvé-Perthes
29.25 One-Stage or Two-Stage Release of Circumferential Constricting Disease (Willett et al.), 1252
Band (Greene), 1126 32.3 Varus Derotational Osteotomy of the Proximal Femur for
29.26 Capsular Release and Quadriceps Lengthening for Correction of Legg-Calvé-Perthes Disease (Stricker), 1253
Congenital Knee Dislocation (Curtis and Fisher), 1127 32.4 Reversed or Closing Wedge Technique for Legg-Calvé-Perthes
29.27 Lateral Release and Medial Plication (Beaty; Modified from Gao et al. Disease, 1256
and Langenskiöld), 1129 32.5 Arthrodiastasis for Legg-Calvé-Perthes Disease (Segev et al.), 1257
29.28 Distal Fibulotalar Arthrodesis, 1136 32.6 Osteochondroplasty Surgical Dislocation of the Hip (Ganz), 1258
29.29 Proximal Tibiofibular Synostosis, 1137 32.7 Trochanteric Advancement for Trochanteric Overgrowth (Wagner),
29.30 Varus Supramalleolar Osteotomy of the Ankle (Wiltse), 1139 1261
29.31 Knee Fusion for Proximal Femoral Focal Deficiency (King), 1145 32.8 Trochanteric Advancement for Trochanteric Overgrowth (MacNicol
29.32 Rotationplasty (Van Nes), 1148 and Makris), 1262
29.33 Syme Amputation, 1150 32.9 Greater Trochanteric Epiphysiodesis for Trochanteric Overgrowth,
29.34 Boyd Amputation, 1152 1263
29.35 Physeal Exposure Around the Knee (Abbott and Gill, Modified), 32.10 Tibial Tuberosity and Ossicle Excision (Pihlajamäki et al.), 1267
1160 32.11 Excision of Ununited Tibial Tuberosity for Osgood-Schlatter Disease
29.36 Percutaneous Epiphysiodesis (Canale et al.), 1161 (Ferciot and Thomson), 1268
29.37 Percutaneous Transepiphyseal Screw Epiphysiodesis (Métaizeau 32.12 Arthroscopic Ossicle and Tibial Tuberosity Debridement for
et al.), 1162 Osgood-Schlatter Disease, 1269
29.38 Tension Plate Epiphysiodesis, 1164 32.13 Extraarticular Drilling for Stable Osteochondritis Dissecans of the
29.39 Proximal Femoral Metaphyseal Shortening (Wagner), 1165 Knee (Donaldson and Wojtys), 1270
29.40 Distal Femoral Metaphyseal Shortening (Wagner), 1165 32.14 Reconstruction of the Articular Surface with Osteochondral Plug
29.41 Proximal Tibial Metaphyseal Shortening (Wagner), 1166 Grafts for Osteochondrosis of the Capitellum (Takahara et al.), 1276
29.42 Tibial Diaphyseal Shortening (Broughton, Olney, and Menelaus), 1166 32.15 Metaphyseal Osteotomy for Tibia Vara (Rab), 1281
29.43 Closed Femoral Diaphyseal Shortening (Winquist, Hansen, and 32.16 Chevron Osteotomy for Tibia Vara (Greene), 1282
Pearson), 1166 32.17 Epiphyseal and Metaphyseal Osteotomy for Tibia Vara (Ingram,
29.44 Transiliac Lengthening (Millis and Hall), 1168 Canale, Beaty), 1283
29.45 Tibial Lengthening (DeBastiani et al.), 1170 32.18 Intraepiphyseal Osteotomy for Tibia Vara (Siffert, Støren, Johnson
29.46 Tibial Lengthening (Ilizarov, Modified), 1171 et al.), 1285
29.47 Tibial Lengthening Over Intramedullary Nail (PRECICE 32.19 Hemielevation of the Epiphysis Osteotomy with Leg Lengthening
Intramedullary Lengthening System, Ellipse Technologies, Irvine, Using an Ilizarov Frame for Tibia Vara (Jones et al., Hefny et al.), 1285
CA); (Herzenberg, Standard, Green), 1174 32.20 Synovectomy of the Knee In Hemophilia, 1293
32.21 Synoviorthesis for Treatment of Hemophilic Arthropathy, 1293 34.25 Flexorplasty (Bunnell), 1404
32.22 Open Ankle Synovectomy in Hemophilia (Greene), 1293 34.26 Anterior Transfer of the Triceps (Bunnell), 1405
32.23 Fassier-Duval Telescoping Rod, Femur (Open Osteotomy), 1297 34.27 Transfer of the Pectoralis Major Tendon (Brooks and Seddon), 1405
32.24 Tibial Lengthening Over an Intramedullary Nail with External 34.28 Transfer of the Latissimus Dorsi Muscle (Hovnanian), 1406
Fixation in Dwarfism (Park et al.), 1305 34.29 Rerouting of Biceps Tendon for Supination Deformities of Forearm
32.25 Bony Bridge Resection for Physeal Arrest (Langenskiöld), 1306 (Zancolli), 1408
32.26 Bony Bridge Resection and Angulation Osteotomy for Physeal Arrest 34.30 V-O Procedure, 1416
(Ingram), 1306 34.31 Anterolateral Release, 1418
32.27 Peripheral and Linear Physeal Bar Resection for Physeal Arrest 34.32 Transfer of the Anterior Tibial Tendon to the Calcaneus, 1418
(Birch et al.), 1308 34.33 Screw Epiphysiodesis, 1422
32.28 Central Physeal Bar Resection for Physeal Arrest (Peterson), 1308 34.34 Supramalleolar Varus Derotation Osteotomy, 1422
Cerebral Palsy 34.35 Radical Flexor Release, 1424
33.1 Adductor Tenotomy and Release, 1328 34.36 Anterior Hip Release, 1426
33.2 Iliopsoas Recession, 1329 34.37 Fascial Release, 1427
33.3 Iliopsoas Release at the Lesser Trochanter, 1329 34.38 Adductor Release, 1427
33.4 Combined One-Stage Correction of Spastic Dislocated Hip, 1333 34.39 Transfer of Adductors, External Oblique, and Tensor Fasciae Latae
33.5 Proximal Femoral Resection, 1336 (Phillips and Lindseth), 1428
33.6 Redirectional Osteotomy (McHale Procedure for Neglected Hip 34.40 Proximal Femoral Resection and Interposition Arthroplasty (Baxter
Dislocation), (McHale et al.), 1337 and D’Astous), 1429
33.7 Hip Arthrodesis, 1337 34.41 Pelvic Osteotomy (Lindseth), 1430
33.8 Fractional Lengthening of Hamstring Tendons, 1339 34.42 Correction of Knee Flexion Contracture with Circular-Frame
33.9 Distal Femoral Extension Osteotomy and Patellar Tendon External Fixation (Van Bosse et al.), 1436
Advancement (Stout et al.), 1341 34.43 Correction of Knee Flexion Contracture with Anterior Stapling
33.10 Rectus Femoris Transfer (Gage et al.), 1343 (Palocaren et al.), 1438
33.11 Z-Plasty Lengthening of the Achilles Tendon, 1346 34.44 Reorientational Proximal Femoral Osteotomy for Hip Contractures
33.12 Percutaneous Lengthening of the Achilles Tendon, 1347 in Arthrogryposis (Van Bosse), 1439
33.13 Gastrocnemius-Soleus Lengthening, 1348 34.45 Posterior Elbow Capsulotomy with Triceps Lengthening for Elbow
33.14 Musculotendinous Recession of the Posterior Tibial Tendon, 1349 Extension Contracture (Van Heest et al.), 1442
33.15 Split Posterior Tibial Tendon Transfer, 1350 34.46 Posterior Release of Elbow Extension Contracture and Triceps
33.16 Split Anterior Tibial Tendon Transfer (Hoffer et al.), 1351 Tendon Transfer (Tachdjian), 1442
33.17 Lateral Closing-Wedge Calcaneal Osteotomy (Dwyer), 1353 34.47 Dorsal Closing Wedge Osteotomy of the Wrist (Van Heest and
33.18 Medial Displacement Calcaneal Osteotomy, 1354 Rodriguez, Ezaki, and Carter), 1443
33.19 Hindfoot Arthrodesis, 1355 34.48 Anterior Shoulder Release (Fairbank, Sever), 1449
33.20 Release of Elbow Flexion Contracture, 1359 34.49 Rotational Osteotomy of the Humerus (Rogers), 1449
33.21 Correction of Talipes Equinovarus, 1362 34.50 Derotational Osteotomy with Plate and Screw Fixation (Abzug et al.),
33.22 Release of Internal Rotation Contracture of the Shoulder, 1363 1450
33.23 Fractional Lengthening of Pectoralis Major, Latissimus Dorsi, Teres 34.51 Glenoid Anteversion Osteotomy and Tendon Transfer (Dodwell
Major, 1364 et al.), 1450
34.52 Release of the Internal Rotation Contracture and Transfer of the
Paralytic Disorders Latissimus Dorsi and Teres Major (Sever-L’Episcopo, Green), 1451
34.1 Posterior Transfer of Anterior Tibial Tendon (Drennan), 1374 34.53 Arthroscopic Release and Transfer of the Latissimus Dorsi (Pearl
34.2 Subtalar Arthrodesis (Grice and Green), 1376 et al.), 1455
34.3 Subtalar Arthrodesis (Dennyson and Fulford), 1377
34.4 Triple Arthrodesis, 1378 Neuromuscular Disorders
34.5 Correction of Cavus Deformity, 1380 35.1 Open Muscle Biopsy, 1463
34.6 Lambrinudi Arthrodesis (Lambrinudi), 1380 35.2 Percutaneous Muscle Biopsy (Mubarak, Chambers, and Wenger), 1463
34.7 Anterior Transfer of Posterior Tibial Tendon (Barr), 1382 35.3 Percutaneous Release of Hip Flexion and Abduction Contractures
34.8 Anterior Transfer of Posterior Tibial Tendon (Ober), 1382 and Achilles Tendon Contracture (Green), 1467
34.9 Split Transfer of Anterior Tibial Tendon, 1383 35.4 Transfer of the Posterior Tibial Tendon to the Dorsum of the Foot
34.10 Peroneal Tendon Transfer, 1384 (Greene), 1467
34.11 Peroneus Longus, Flexor Digitorum Longus, or Flexor or Extensor 35.5 Transfer of the Posterior Tibial Tendon to the Dorsum of the Base of
Hallucis Longus Tendon Transfer (Fried and Hendel), 1385 the Second Metatarsal (Mubarak), 1469
34.12 Tenodesis of the Achilles Tendon (Westin), 1386 35.6 Scapulothoracic Fusion (Diab et al.), 1472
34.13 Posterior Transfer of Peroneus Longus, Peroneus Brevis, and 35.7 Plantar Fasciotomy, Osteotomies, and Arthrodesis for Charcot-
Posterior Tibial Tendons, 1387 Marie-Tooth Disease (Faldini et al.), 1477
34.14 Posterior Transfer of Posterior Tibial, Peroneus Longus, and Flexor 35.8 Radical Plantar-Medial Release and Dorsal Closing Wedge
Hallucis Longus Tendons (Green and Grice), 1388 Osteotomy (Coleman), 1481
34.15 Transfer of Biceps Femoris and Semitendinosus Tendons, 1389 35.9 Transfer of the Extensor Hallucis Longus Tendon for Claw Toe
34.16 Osteotomy of the Tibia for Genu Recurvatum (Irwin), 1391 Deformity (Jones), 1481
34.17 Triple Tenodesis for Genu Recurvatum (Perry, O’Brien, and 35.10 Transfer of the Extensor Tendons to the Middle Cuneiform (Hibbs),
Hodgson), 1392 1482
34.18 Complete Release of Hip Flexion, Abduction, and External Rotation 35.11 Stepwise Joint-Sparing Foot Osteotomies (Mubarak and Van Valin),
Contracture (Ober; Yount), 1394 1482
34.19 Complete Release of Muscles from Iliac Wing and Transfer of Crest Fractures and Dislocations in Children
of Ilium (Campbell), 1395 36.1 Closed Reduction and Percutaneous Pinning (or Screw Fixation) of
34.20 Posterior Transfer of the Iliopsoas for Paralysis of the Gluteus Medius Proximal Humerus, 1501
and Maximus Muscles (Sharrard), 1396 36.2 Closed Reduction and Intramedullary Nailing of Proximal Humerus,
34.21 Trapezius Transfer for Paralysis of Deltoid (Bateman), 1401 1501
34.22 Trapezius Transfer for Paralysis of Deltoid (Saha), 1402 36.3 Closed/Open Reduction and Intramedullary Nailing of Humeral
34.23 Transfer of Deltoid Origin for Partial Paralysis (Harmon), 1402 Shaft, 1502
34.24 Transfer of Latissimus Dorsi or Teres Major or Both for Paralysis of 36.4 Closed Reduction and Percutaneous Pinning of Supracondylar
Subscapularis or Infraspinatus (Saha), 1403 Fractures (Two Lateral Pins), 1504
36.5 Anterior Approach, 1507 37.10 Modified Anterior Approach to Cervicothoracic Junction (Darling
36.6 Lateral Closing Wedge Osteotomy for Cubitus Varus, 1509 et al.), 1658
36.7 Open Reduction and Internal Fixation of Lateral Condylar Fracture, 37.11 Anterior Approach to the Cervicothoracic Junction Without
1512 Sternotomy (Pointillart et al.), 1659
36.8 Osteotomy for Established Cubitus Valgus Secondary to Nonunion 37.12 Anterior Approach to the Thoracic Spine, 1661
or Growth Arrest, 1513 37.13 Video-Assisted Thoracic Surgery (Mack et al.), 1661
36.9 Open Reduction and Internal Fixation of Medial Condylar Fracture, 37.14 Anterior Approach to the Thoracolumbar Junction, 1663
1515 37.15 Minimally Invasive Approach to the Thoracolumbar Junction, 1663
36.10 Open Reduction and Internal Fixation for Displaced or Entrapped 37.16 Anterior Retroperitoneal Approach, L1 to L5, 1664
Medial Epicondyle, 1518 37.17 Percutaneous Lateral Approach, L1 to L4-5 (Ozgur et al.), 1667
36.11 Closed and Open Reduction of Radial Neck Fractures, 1526 37.18 Anterior Transperitoneal Approach, L5 to S1, 1669
36.12 Percutaneous Reduction and Pinning, 1527 37.19 Oblique Approach for Lumbar Interbody Fusion, L1-L5 and L5-S1
36.13 Closed Intramedullary Nailing, 1527 (Mehren et al.), 1670
36.14 Overcorrection Osteotomy and Ligamentous Repair or 37.20 Video-Assisted Lumbar Surgery (Onimus et al.), 1673
Reconstruction (Shah and Waters), 1535 37.21 Posterior Approach to the Cervical Spine, Occiput to C2, 1673
36.15 Intramedullary Forearm Nailing, 1538 37.22 Posterior Approach to the Cervical Spine, C3 to C7, 1674
36.16 Closed Reduction and Percutaneous Pinning of Fractures of the 37.23 Posterior Approach to the Thoracic Spine, T1 to T12, 1675
Distal Radius, 1540 37.24 Costotransversectomy, 1676
36.17 Open Reduction and Internal Fixation of Physeal Fractures of 37.25 Posterior Approach to the Lumbar Spine, L1 to L5, 1677
Phalanges and Metacarpals, 1543 37.26 Paraspinal Approach to Lumbar Spine (Wiltse and Spencer), 1677
36.18 Closed Reduction and Internal Fixation, 1561 37.27 Posterior Approach to the Lumbosacral Spine, L1 to Sacrum
36.19 Open Reduction and Internal Fixation (Weber et al.; Boitzy), 1561 (Wagoner), 1677
36.20 Valgus Subtrochanteric Osteotomy for Acquired Coxa Vara or 37.28 Posterior Approach to the Sacrum and Sacroiliac Joint (Ebraheim
Nonunion, 1561 et al.), 1679
36.21 Modified Pauwels Intertrochanteric Osteotomy for Acquired Coxa Degenerative Disorders of the Cervical Spine
Vara or Nonunion (Magu et al.), 1564 38.1 Interlaminar Cervical Epidural Injection, 1688
36.22 Determining the Entry Point for Cannulated Screw Fixation of a 38.2 Cervical Medial Branch Block Injection, 1689
Slipped Epiphysis (Canale et al.), 1569 38.3 Cervical Discography (Falco), 1690
36.23 Determining the Entry Point for Cannulated Screw Fixation of a 38.4 Removal of Posterolateral Herniations by Posterior Approach
Slipped Epiphysis (Morrissy), 1570 (Posterior Cervical Foraminotomy), 1695
36.24 Positional Reduction and Fixation for SCFE (Chen, Schoenecker, 38.5 Minimally Invasive Posterior Cervical Foraminotomy with Tubular
Dobbs, et al.), 1572 Distractors (Gala, O’Toole, Voyadzis, and Fessler), 1697
36.25 Subcapital Realignment of the Epiphysis (Modified Dunn) for SCFE 38.6 Full-Endoscopic Posterior Cervical Foraminotomy (Ruetten et al.),
(Leunig, Slongo, and Ganz), 1573 1697
36.26 Compensatory Basilar Osteotomy of the Femoral Neck (Kramer 38.7 Tissue-Sparing Posterior Cervical Fusion (Mccormack and Dhawan),
et al.), 1575 1699
36.27 Extracapsular Base-of-Neck Osteotomy (Abraham et al.), 1576 38.8 Smith-Robinson Anterior Cervical Fusion (Smith-Robinson et al.),
36.28 Intertrochanteric Osteotomy (Imhäuser), 1578 1703
36.29 Spica Cast Application, 1586 38.9 Anterior Occipitocervical Arthrodesis by Extrapharyngeal Exposure
36.30 Flexible Intramedullary Nail Fixation, 1589 (De Andrade and MacNab), 1705
36.31 Closed or Open Reduction, 1595 38.10 Fibular Strut Graft in Cervical Spine Arthrodesis with Corpectomy
36.32 Reconstruction of the Patellofemoral and Patellotibial Ligaments (Whitecloud and Larocca), 1705
with a Semitendinosus Tendon Graft (Nietosvaara et al.), 1598
36.33 3-In-1 Procedure for Recurrent Dislocation of the Patella: Lateral Degenerative Disorders of the Thoracic and Lumbar Spine
Release, Vastus Medialis Obliquus Muscle Advancement, and 39.1 Myelography, 1724
Transfer of the Medial Third of the Patellar Tendon to the Medial 39.2 Interlaminar Thoracic Epidural Injection, 1728
Collateral Ligament (Oliva et al.), 1599 39.3 Interlaminar Lumbar Epidural Injection, 1729
36.34 Open Reduction and Internal Fixation of Sleeve Fracture (Houghton 39.4 Transforaminal Lumbar and Sacral Epidural Injection, 1730
and Ackroyd), 1600 39.5 Caudal Sacral Epidural Injection, 1730
36.35 Open Reduction and Internal Fixation of Tibial Eminence Fracture, 39.6 Lumbar Intraarticular Injection, 1732
1602 39.7 Lumbar Medial Branch Block Injection, 1732
36.36 Arthroscopic Reduction of Tibial Eminence Fracture and Internal 39.8 Sacroiliac Joint Injection, 1734
Fixation with Bioabsorbable Nails (Liljeros et al.), 1603 39.9 Lumbar Discography (Falco), 1735
36.37 Open Reduction and Internal Fixation, 1606 39.10 Thoracic Discography (Falco), 1736
36.38 Open Reduction and Removal of Interposed Tissue (Weber et al.), 1611 39.11 Thoracic Costotransversectomy, 1738
36.39 Elastic Stable Intramedullary Nailing of Tibial Fracture (O’Brien 39.12 Thoracic Discectomy—Anterior Approach, 1738
et al.), 1614 39.13 Thorascopic Thoracic Discectomy (Rosenthal et al.), 1740
36.40 Open Reduction and Internal Fixation, 1617 39.14 Minimally Invasive Thoracic Discectomy, 1740
36.41 Open Reduction and Internal Fixation, 1618 39.15 Transforaminal Endoscopic Thoracic Discectomy, 1741
36.42 Excision of Osteochondral Fragment of the Talus, 1625 39.16 Microscopic Lumbar Discectomy, 1747
36.43 Open Reduction and Internal Fixation of Cuboid Compression 39.17 Transforaminal Endoscopic Lumbar Discectomy, 1750
(Nutcracker) Fracture (Ceroni et al.), 1629 39.18 Interlaminar Endoscopic Lumbar Discectomy, 1750
39.19 Dural Repair Augmented with Fibrin Glue, 1754
Anatomic Approaches to the Spine 39.20 Repeat Lumbar Disc Excision, 1755
37.1 Anterior Transoral Approach (Spetzler), 1648 39.21 Transthoracic Approach to the Thoracic Spine, 1756
37.2 Anterior Retropharyngeal Approach (McAfee et al.), 1649 39.22 Anterior Interbody Fusion of the Lumbar Spine (Goldner et al.), 1757
37.3 Subtotal Maxillectomy (Cocke et al.), 1651 39.23 Percutaneous Anterior Lumbar Arthrodesis—Lateral Approach to L1
37.4 Extended Maxillotomy, 1652 to L4-5, 1758
37.5 Anterior Approach, C3 to C7 (Southwick and Robinson), 1653 39.24 Hibbs Fusion (Hibbs, as Described by Howarth), 1759
37.6 Anterolateral Approach, C2 to C7 (Bruneau et al., Chibbaro et al.), 39.25 Posterolateral Lumbar Fusion (Watkins), 1760
1655 39.26 Intertransverse Lumbar Fusion (Adkins), 1761
37.7 Low Anterior Cervical Approach, 1657 39.27 Minimally Invasive Transforaminal Lumbar Interbody Fusion
37.8 High Transthoracic Approach, 1657 (Gardock), 1762
37.9 Transsternal Approach, 1657
39.28 Pseudarthrosis Repair (Ralston and Thompson), 1764 43.8 Occipitocervical Fusion Using Contoured Rod and Segmental Rod
39.29 Midline Decompression (Neural Arch Resection), 1780 Fixation, 1969
39.30 Spinous Process Osteotomy (Decompression) (Weiner et al.), 1781 43.9 Occipitocervical Fusion Using a Contoured Occipital Plate, Screw,
39.31 Microdecompression (McCulloch), 1782 and Rod Fixation, 1970
39.32 Pedicle Subtraction Osteotomy (Bridwell et al.), 1792 43.10 Transoral Approach (Fang and Ong), 1970
39.33 Coccygeal Injection, 1795 43.11 Transoral Mandible-Splitting and Tongue-Splitting Approach (Hall,
Spondylolisthesis Denis, and Murray), 1971
40.1 Repair of Pars Interarticularis Defect with V-Rod Technique (Gillet 43.12 Lateral Retropharyngeal Approach (Whitesides and Kelly), 1972
and Petit), 1810 43.13 Anterior Retropharyngeal Approach (McAfee et al.), 1974
40.2 In Situ Posterolateral Instrumented Fusion: Wiltse and Spencer 43.14 Application of Halo Device (Mubarak et al.), 1976
Approach, 1815 43.15 Posterior Fusion of C3-7, 1985
40.3 Posterior Instrumented Fusion with Interbody Fusion (PLIF and 43.16 Posterior Fusion of C3 to C7 Using 16-Gauge Wire and Threaded
TLIF), 1815 Kirschner Wires (Hall), 1985
40.4 L5-S1 Anterior Lumbar Interbody Fusion, 1818 43.17 Posterior Fusion with Lateral Mass Screw Fixation (Roy- Camille),
40.5 Lumbar Decompression, 1823 1986
40.6 Lumbar Decompression and Posterolateral Fusion with or without 43.18 Posterior Fusion with Lateral Mass Screw and Rod Fixation, 1986
Instrumentation, 1824 43.19 Rib Resection (Bonola), 1987
40.7 Lumbar Decompression and Combined Posterolateral and Interbody 43.20 Posterior Spinal Fusion for Cervical Kyphosis Through a Lateral
Fusion (TLIF or PLIF), 1825 Approach (Sakaura et al.), 1992
43.21 Sternal-Splitting Approach to the Cervicothoracic Junction (Mulpuri
Fractures, Dislocations, and Fracture-Dislocations of the Spine et al.), 1994
41.1 Stretch Test, 1838
41.2 Application of Gardner-Wells Tongs, 1843 Scoliosis and Kyphosis
41.3 Closed Reduction of the Cervical Spine, 1843 44.1 Casting for Idiopathic Scoliosis, 2002
41.4 Halo Vest Application, 1848 44.2 Dual Growing Rod Instrumentation Without Fusion, 2007
41.5 Occipitocervical Fusion Using Modular Plate and Rod Construct, 44.3 Shilla Guided Growth System (McCarthy et al.), 2008
Segmental Fixation with Occipital Plating, C1 Lateral Mass Screw, C2 44.4 Growing Rod Attachment Using Rib Anchors (Sankar and Skaggs),
Isthmic (Pars) Screws, and Lateral Mass Fixation, 1851 2010
41.6 Occipitocervical Fusion Using Wires and Bone Graft (Wertheim and 44.5 Anterior Vertebral Tethering, 2012
Bohlman), 1853 44.6 Posterior Surgeries for Idiopathic Scoliosis, 2025
41.7 Posterior Primary Osteosynthesis of C1 (Shatsky et al.), 1856 44.7 Facet Fusion (Moe), 2027
41.8 Anterior Odontoid Screw Fixation (Etter), 1858 44.8 Facet Fusion (Hall), 2027
41.9 Posterior C1-C2 Fusion Using Rod and Screw Construct with C1 44.9 Autogenous Iliac Crest Bone Graft, 2028
Lateral Mass Screws (Harms), 1859 44.10 Thoracic Pedicle Screw Insertion Techniques, 2035
41.10 Posterior C1-C2 Fusion with C2 Translaminar Screws (Wright), 1862 44.11 Pedicle Hook Implantation, 2039
41.11 Posterior C1-C2 Transarticular Screws (Magerl and Seemann), 1863 44.12 Transverse Process Hook Implantation, 2040
41.12 Posterior C1-C2 Fusion Using the Modified Gallie Posterior Wiring 44.13 Laminar Hook Implantation, 2040
Technique (Gallie, Modified), 1863 44.14 Sublaminar Wires, 2040
41.13 Posterior C1-C2 Wiring (Brooks and Jenkins), 1864 44.15 Instrumentation Sequence in Typical Lenke 1A Curve, 2043
41.14 Anterior Cervical Discectomy and Fusion with Plating, 1873 44.16 Deformity Correction by Direct Vertebral Rotation, 2044
41.15 Cervical Corpectomy and Reconstruction with Plating, 1875 44.17 Halo-Gravity Traction (Sponseller and Takenaga), 2046
41.16 Lateral Mass Screw and Rod Fixation (Magerl), 1877 44.18 Temporary Distraction Rod (Buchowski et al.), 2048
41.17 Thoracic and Lumbar Segmental Fixation with Pedicle Screws, 1888 44.19 Anterior Release (Letko et al.), 2050
41.18 Anterior Plating, 1891 44.20 Osteotomy in Complex Spinal Deformity (Ponte Osteotomy), 2050
41.19 Lumbopelvic Fixation (Triangular Osteosynthesis) (Shildhauer), 1895 44.21 Posterior Thoracic Vertebral Column Resection (Powers et al.),
2051
Infections and Tumors of the Spine 44.22 Osteotomy of the Ribs (Mann et al.), 2058
42.1 Drainage of Retropharyngeal Abscess Through Posterior Triangle of 44.23 Thoracoabdominal Approach, 2059
the Neck, 1934 44.24 Lumbar Extraperitoneal Approach, 2059
42.2 Anterior Cervical Approach to Drainage of Retropharyngeal Abscess, 44.25 Disc Excision, 2060
1934 44.26 Anterior Instrumentation of a Thoracolumbar Curve, 2060
42.3 Costotransversectomy for Drainage of Dorsal Spine Abscess, 1935 44.27 Video-Assisted Thoracoscopic Discectomy (Crawford), 2065
42.4 Drainage of Paravertebral Abscess, 1935 44.28 Thoracoscopic Vertebral Body Instrumentation for Vertebral Body
42.5 Drainage Through the Petit Triangle, 1936 Tether (Picetti), 2067
42.6 Drainage by Lateral Incision, 1936 44.29 Luque Rod Instrumentation and Sublaminar Wires Without Pelvic
42.7 Drainage by Anterior Incision, 1937 Fixation, 2074
42.8 Coccygectomy for Drainage of a Pelvic Abscess (Lougheed and 44.30 Sacropelvic Fixation (McCarthy), 2075
White), 1937 44.31 Galveston Sacropelvic Fixation (Allen and Ferguson), 2076
42.9 Radical Debridement and Arthrodesis (Roaf et al.), 1937 44.32 Unit Rod Instrumentation with Pelvic Fixation, 2078
42.10 Anterior Excision of Spinal Tumor, 1949 44.33 Iliac Fixation with Iliac Screws, 2079
42.11 Costotransversectomy for Intralesional Excision of Spinal Tumor, 44.34 Iliac and Lumbosacral Fixation with Sacral-Alar-Iliac Screws, 2081
1950 44.35 Transpedicular Convex Anterior Hemiepiphysiodesis and Posterior
42.12 Transpedicular Intralesional Excision for Tumor of the Spine, 1950 Arthrodesis (King), 2098
Pediatric Cervical Spine 44.36 Convex Anterior and Posterior Hemiepiphysiodeses and Fusion
43.1 Posterior Atlantoaxial Fusion (Gallie), 1961 (Winter), 2099
43.2 Posterior Atlantoaxial Fusion Using Laminar Wiring (Brooks and 44.37 Hemivertebra Excision: Anteroposterior Approach (Hedequist and
Jenkins), 1963 Emans), 2102
43.3 Translaminar Screw Fixation of C2, 1963 44.38 Hemivertebra Excision: Lateral-Posterior Approach (Li et al.), 2105
43.4 Occipitocervical Fusion, 1964 44.39 Hemivertebra Excision: Posterior Approach (Hedequist, Emans,
43.5 Occipitocervical Fusion Passing Wires Through Table of Skull Proctor), 2105
(Wertheim and Bohlman), 1966 44.40 Transpedicular Eggshell Osteotomies with Frameless Stereotactic
43.6 Occipitocervical Fusion Without Internal Fixation (Koop et al.), 1966 Guidance (Mikles et al.), 2107
43.7 Occipitocervical Fusion Using Crossed Wiring (Dormans et al.), 44.41 Expansion Thoracoplasty (Campbell), 2110
1967 44.42 Anterior Release and Fusion, 2120
44.43 Posterior Multiple Hook and Screw Segmental Instrumentation 44.53 Spondylolysis Repair with U-Rod or V-Rod (Sumita et al.), 2144
(Crandall), 2120 44.54 Posterolateral Fusion and Pedicle Screw Fixation (Lenke and
44.44 Posterior Column Shortening Procedure for Scheuermann Kyphosis Bridwell), 2147
(Ponte et al.), 2122 44.55 Instrumented Reduction (Crandall), 2147
44.45 Anterior Osteotomy and Fusion (Winter et al.), 2129 44.56 Reduction and Interbody Fusion (Smith et al.), 2150
44.46 Anterior Cord Decompression and Fusion (Winter and Lonstein), 44.57 One-Stage Decompression and Posterolateral Interbody Fusion
2129 (Bohlman and Cook), 2153
44.47 Anterior Vascular Rib Bone Grafting (Bradford), 2130 44.58 Uninstrumented Circumferential In Situ Fusion (Helenius et al.),
44.48 Circumferential Decompression and Cantilever Bending (Chang 2154
et al.), 2132 44.59 L5 Vertebrectomy (Gaines), 2156
44.49 Posterior Hemivertebra Resection with Transpedicular Instrumenta- 44.60 Posterior Instrumentation and Fusion, 2160
tion (Ruf and Harms), 2133 44.61 Vertebral Excision and Reduction of Kyphosis (Lindseth and Selzer),
44.50 Spondylolysis Repair (Kakiuchi), 2142 2163
44.51 Modified Scott Repair Technique (Van Dam), 2143 44.62 Open Biopsy of Thoracic Vertebra (Michele and Krueger), 2173
44.52 Intralaminar Screw Fixation of Pars Defect (Buck Screw Technique),
2144
Campbell’s Operative Orthopaedics, 14th ed.
List of Techniques
Frederick M. Azar, MD
Professor
Department of Orthopaedic Surgery and Biomedical Engineering
University of Tennessee–Campbell Clinic
Chief of Staff, Campbell Clinic
Memphis, Tennessee
James H. Beaty, MD
Harold B. Boyd Professor and Chair
Department of Orthopaedic Surgery and Biomedical Engineering
University of Tennessee–Campbell Clinic
Memphis, Tennessee
Editorial Assistance
Kay Daugherty and Linda Jones
Elsevier
1600 John F. Kennedy Blvd.
Ste. 1600
Philadelphia, PA 19103-2899
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Notices
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S. Terry Canale, MD
It is with humble appreciation and admiration that we dedicate this edition
of Campbell’s Operative Orthopaedics to Dr. S. Terry Canale, who served
as editor or co-editor of five editions. He took great pride in this position
and worked tirelessly to continue to improve “The Book.” As noted by one
of his co-editors, “Terry is probably the only person in the world who has
read every word of multiple editions of Campbell’s Operative Orthopae-
dics.” He considered Campbell’s Operative Orthopaedics an opportunity for
worldwide orthopaedic education and made it a priority to ensure that each
edition provided valuable and up-to-date information. His commitment to
and enthusiasm for this work will continue to influence and inspire every
future edition.
Kay C. Daugherty
It is with equal appreciation and regard that we dedicate this edition to Kay
C. Daugherty, the managing editor of the last nine editions Campbell’s Oper-
ative Orthopaedics. Over the last 40 years, she has faithfully and tirelessly
edited, reshaped, and overseen all aspects of publication from manuscript
preparation to proofing. She has a profound talent to put ideas and disjointed
words into comprehensible text, ensuring that each revision maintains the
gold standard in readability. Each edition is a testament to her dedication
to excellence in writing and education. A favorite quote of Mrs. Daugherty
to one of our late authors was, “I’ll make a deal. I won’t operate if you won’t
punctuate.” We are grateful for her many years of continual service to the
Campbell Foundation and for the publications yet to come.
CONTRIBUTORS
ix
CHAPTER 1
SURGICAL TECHNIQUES
Andrew H. Crenshaw Jr.
2
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CHAPTER 1 SURGICAL TECHNIQUES 3
that must be used with proper knowledge and care. In some tourniquet is inflated. The conical, obese, or muscular lower
procedures, a tourniquet is a luxury, whereas in others, such extremity presents a special challenge. If a curved tourniquet
as delicate operations on the hand, it is a necessity. A pneu- is not available, a straight tourniquet may be used but is dif-
matic tourniquet is safer than an Esmarch tourniquet or a ficult to hold in place because it tends to slide distally dur-
Martin sheet rubber bandage. ing skin preparation. Application of adhesive drapes, extra
A pneumatic tourniquet with a hand pump and an accu- cast padding, and pulling the fat tissue distally before apply-
rate pressure gauge probably is the safest, but a constantly ing the tourniquet generally works. A simple method has
regulated pressure tourniquet is satisfactory if it is properly been described to keep a tourniquet in place on a large thigh.
maintained and checked. A tourniquet should be applied by Surgical lubricating jelly is applied circumferentially to the
an individual experienced in its use. thigh, and several layers of 6-inch cast padding are applied
Several sizes of pneumatic tourniquets are available for over the jelly. The tourniquet is then applied. The cast pad-
the upper and lower extremities. The upper arm or the thigh ding adheres to the lubricating jelly-covered skin and reduces
is wrapped with several thicknesses of smoothly applied cast the tendency of the tourniquet to slide.
padding. Rajpura et al. showed that application of more than If surgery is significantly delayed, both lower extremities
two layers of padding resulted in a significant reduction in should be studied with Doppler ultrasonography for the pres-
the actual transmitted pressure. When applying a tourniquet ence of deep venous thrombi. If present, the patient should
on an obese patient, an assistant manually grasps the flesh receive full anticoagulation treatment and the procedure
of the extremity just distal to the level of tourniquet applica- delayed. If the procedure is emergent, insertion of an inferior
tion and firmly pulls this loose tissue distally before the cast vena cava filter should be considered. There have been case
padding is placed. Traction on the soft tissue is maintained reports describing fatal or near fatal pulmonary emboli after
while the padding and tourniquet are applied, and the latter is exsanguination of a leg.
secured. The assistant’s grasp is released, resulting in a greater The exact pressure to which the tourniquet should be
proportion of the subcutaneous tissue remaining distal to the inflated has not been determined (Table 1.1). The correct
tourniquet. This bulky tissue tends to support the tourniquet pressure depends on the age of the patient, the blood pres-
and push it into an even more proximal position. All air is sure, and the size of the extremity. Reid et al. used pneumatic
expressed from the sphygmomanometer or pneumatic tour- tourniquet pressures determined by the pressure required
niquet before application. When a sphygmomanometer cuff to obliterate the peripheral pulse (limb occlusion pressure)
is used, it should be wrapped with a gauze bandage to prevent using a Doppler stethoscope; they then added 50 to 75 mm
its slipping during inflation. The extremity is elevated for 2 Hg to allow for collateral circulation and blood pressure
minutes, or the blood is expressed by a sterile sheet rubber changes. Tourniquet pressures of 135 to 255 mm Hg for the
bandage or a cotton elastic bandage. Beginning at the finger- upper extremity and 175 to 305 mm Hg for the lower extrem-
tips or toes, the extremity is wrapped proximally to within ity were satisfactory for maintaining hemostasis.
2.5 to 5 cm of the tourniquet. If a Martin sheet rubber ban- Wide tourniquet cuffs are more effective at lower infla-
dage or an elastic bandage is applied up to the level of the tion pressures than are narrow ones. Curved tourniquets
tourniquet, the latter tends to slip distally at the time of infla- on conical extremities require significantly lower arterial
tion. The tourniquet should be inflated quickly to prevent fill- occlusion pressures than straight (rectangular) tourniquets
ing of the superficial veins before the arterial blood flow has (Fig. 1.1). The use of straight tourniquets on conical thighs
been occluded. Every effort is made to decrease tourniquet should be avoided, especially in extremely muscular or obese
time; the extremity often is prepared and ready before the individuals.
TABLE 1.1
Published Recommendations on Tourniquet Use
ORGANIZATION/STUDY PRESSURE DURATION (MIN) REPERFUSION INTERVAL
Association of Surgical Upper extremity, 50 mm Hg above SBP; Upper extremity, 60; 15 min
Technologists lower extremity, 100 mm Hg above SBP lower extremity, 90
Association of 40 mm Hg above LOP for LOP <130 mm Upper extremity, 60; 15 min deflation after
Perioperative Registered Hg; 60 mm Hg above LOP for LOP <131- lower extremity, 90 every 1 h of tourniquet
Nurses 190 mm Hg; 80 mm Hg above LOP for time
LOP >190 mm Hg
Wakai et al. General recommendation, 50-75 mm Hg 120 30 min at 2-h point in
above LOP; upper extremity, 50-75 mm surgery lasting >3 h
Hg above SBP; lower extremity, 90-150
mm Hg above SBP
Kam et al. 50-150 mm Hg above SBP, using the 120 10 min at the 2-h point
lower end of the range for the upper for surgery lasting <2 h
extremity and the higher end for the
lower extremity
Noordin et al. Use LOP. No margin specified 120 NR
LOP, Limb occlusion pressure; NR, no recommendation; SBP, systolic blood pressure.
From Fitzgibbons PG, DiGiovanni C, Hares S, Akelman E: Safe tourniquet use: a review of the literature, J Am Acad Orthop Surg 20:310, 2012.
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4 PART I GENERAL PRINCIPLES
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CHAPTER 1 SURGICAL TECHNIQUES 5
TABLE 1.2
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6 PART I GENERAL PRINCIPLES
A C D
FIGURE 1.3 A, The ForgetMeNot tourniquet as supplied. B, Form two loops. C, Place the digit
in the space between the two loops and pull proximally to exsanguinate the digit. D, Tourniquet
in place. (Modified from Diaz HJJ, et al: The new digit tourniquet ForgetMeNot, Orthop Traumatol Surg
Res 104:133, 2018.)
radiographs are made to avoid possible contamination from the C-arm should be avoided to prevent excessive radiation
the machine as it is moved into position. exposure.
Portable C-arm image intensifier television fluoros-
copy allows instantaneous evaluation of the position of frac-
ture fragments and internal fixation devices. Many of these PREVENTING MISTAKES
machines have the ability to make permanent radiographs. Before entering the operating room, the surgeon and the
When used near the sterile field, the C-arm portion of the awake, alert patient should agree on the planned procedure
machine must be draped in a sterile fashion (Fig. 1.4A). Every and the surgical site. The surgeon should mark this clearly
time the C-arm is brought to the lateral position (Fig. 1.4B), with his or her initials to prevent a “wrong-site” error. Once
a fresh or sterile, disposable drape should be applied over the the patient is under anesthesia, a designated member of the
end of the C-arm and dropped off the field when complete. team should state the name of the patient, the procedure, and
This prevents the potentially contaminated lower half of the the correct site. All members of the team should be in agree-
drape from getting near the patient and operating surgeon. ment. This statement should be clear, concise, and not contain
As with any electronic device, failure of an image inten- unnecessary information. A short statement is more likely to
sifier can occur. In this event, backup plain radiographs are be closely heard. This statement should be preferably made
necessary. Two-plane radiographs can be made, even of the after draping.
hip when necessary, using portable equipment (Fig. 1.4C, D).
Closed intramedullary nailing or percutaneous fracture fixa-
tion techniques may need to be abandoned for an open tech- POSITIONING OF THE PATIENT
nique if the image intensifier fails. The position of a patient on the operating table should be
All operating room personnel should avoid exposure to adjusted to afford maximal safety to the patient and conve-
radiation. Proper lead-lined aprons should be worn beneath nience for the surgeon. A free airway must be maintained at
sterile operating gowns. Thyroid shields, lead-impregnated all times, and unnecessary pressure on the chest or abdomen
eyeglasses, and rubber gloves are available to decrease expo- should be avoided. This is of particular importance when the
sure. C-arm imaging should be used as a 1- to 2-second pulse patient is prone; in this position, sandbags are placed beneath
to produce a still image for viewing. Active fluoroscopy with the shoulders, and a thin pillow is placed beneath the symphysis
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CHAPTER 1 SURGICAL TECHNIQUES 7
A B
C D
FIGURE 1.4 A and B, Portable C-arm image intensifier television fluoroscopy setup for
fracture repair. C-arm rotates 90 degrees to obtain lateral view. C and D, Technique for two-plane
radiographs during hip surgery with a portable machine for anteroposterior and lateral views.
Film cassette for lateral view is positioned over superolateral aspect of hip.
pubis and hips to minimize pressure on the abdomen and where a nerve may be pressed against the bone (i.e., the radial
chest. Large, moderately firm chest rolls extending from the nerve in the arm, the ulnar nerve at the elbow, and the pero-
iliac crests to the clavicular areas may serve the same purpose. neal nerve at the neck of the fibula).
When the patient is supine, the sacrum must be well
padded; and when the patient is lying on his or her side, the
greater trochanter and the fibular neck should be similarly
protected. When a muscle relaxant drug is used, the danger
LOCAL PREPARATION OF
of stretching a nerve or a group of nerves is increased. Figure THE PATIENT
1.5 shows traction on the brachial plexus from improper Superficial oil and skin debris are removed with a thor-
positioning of the arm. The brachial plexus can be stretched ough 10-minute soap-and-water scrub. We prefer a skin
when the arm is on an arm board, particularly if it is hyper- cleanser containing 7.5% povidone-iodine solution that is
abducted to make room for the surgeon or an assistant or for diluted approximately 50% with sterile saline solution or
administration of intravenous therapy. The arm should not be Hexachlorophene-containing skin cleanser when allergy to
tied above the head in abduction and external rotation while shellfish or iodine is present or suspected. After scrubbing,
a body cast is applied because this position may cause a bra- the skin is blotted dry with sterile towels.
chial plexus paralysis. Rather, the arm should be suspended in After a tourniquet has been fitted, if one is required, the
flexion from an overhead frame, and the position should be sterile sheets applied during the earlier preparation should be
changed frequently. Figure 1.6 shows the position of the arm removed. Care should be taken that the operative field does
on the operating table that may cause pressure on the ulnar not become contaminated because the effectiveness of the
nerve, particularly if someone on the operating team leans preparation would be partially lost. With the patient in the
against the arm. The arm must never be allowed to hang over proper position, the solutions are applied, each with a sepa-
the edge of the table. Padding should be placed over the area rate sterile sponge stick, beginning in the central area of the
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8 PART I GENERAL PRINCIPLES
Scalenus medius
muscle
Scalenus anterior
Brachial plexus muscle
Clavicle
1st rib
Humerus
Axillary artery
FIGURE 1.5 Anatomic relationships of brachial plexus when limb is hyperabducted. Inset,
With patient in Trendelenburg position, brace at shoulder is in poor position because limb has
been abducted and placed on arm board.
Humerus
Median
nerve
Radial
nerve
Ulnar nerve
Medial epicondyle
FIGURE 1.6 Points at which nerves of arm may be damaged by pressure (dashed lines). Inset,
Pressure is applied to medial side of arm because patient is poorly positioned on operating table.
site of the incision and proceeding peripherally. Once painted underneath a tourniquet. Pooled alcohol-based solutions
on, it is allowed to dry and then is taken off with plain alcohol. should be removed from the field because they can be ignited
Some surgeons routinely use povidone-iodine solution, espe- by a spark from a cautery unit.
cially when the risk of a chemical burn from tincture of iodine When traumatic wounds are present, tincture of iodine
is significant. The immediate operative field is prepared first; and other alcohol-containing solutions should not be used for
the area is enlarged to include ample surrounding skin. The antiseptic wound preparation. Povidone-iodine or hexachlo-
sponges used to prepare the lumbar spine are carried toward rophene solutions without alcohol should be used instead to
the gluteal cleft and anus rather than in the opposite direction. avoid tissue death.
Sponges should not be saturated because the solution would In operations around the upper third of the thigh, the pel-
extend beyond the operative field and must be removed. If vis, or the lower lumbar spine in male patients, the genitalia
the linen on the table or the sterile drape becomes saturated should be displaced and held away from the operative field with
with strong antiseptic solutions, they should be replaced by adhesive tape. A long, wide strip of tape similarly helps cover
fresh linen or drapes. Solutions should not be allowed to flow the gluteal cleft, from which there is the potential of infection.
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CHAPTER 1 SURGICAL TECHNIQUES 9
In female patients, the genital area and gluteal cleft also are
covered longitudinally by strips of adhesive tape. Adherent,
sterile, plastic drapes can be used for these purposes.
Before the operative field in the region of the lower lum-
bar spine, sacroiliac joints, or buttocks is prepared, the gluteal
cleft is sponged with alcohol and sterile dry gauze is inserted
around the anus so that iodine or other solutions are pre-
vented from running down to this region, causing dermatitis.
Brown et al. and others recommended that before total joint
arthroplasty, the extremity should be held by a scrubbed and
gowned assistant because this reduces bacterial air counts by
almost half. They also recommended that instrument packs not
be opened until skin preparation and draping are completed.
When these preparations are done in haste, the gown or
gloves of the sterile assistant preparing the area may become
contaminated without the assistant’s knowledge. To prevent
this, a nurse or anesthetist should be appointed to watch this
stage of preparation. FIGURE 1.7 Disposable drape package for knee surgery.
DRAPING
Draping is an important step in any surgical procedure
and should not be assigned to an inexperienced assistant. FIGURE 1.8 Disposable drape package for hip surgery.
Haphazard draping that results in exposure of unprepared
areas of skin in the middle of an operation can be cata-
strophic. Considerable experience is required in placing the
drapes, not only to prevent them from becoming disarranged DRAPING THE EDGES OF THE INCISION
during the operation but also to avoid contamination of the The gloved hand should not come in contact with the skin
surgeon and the drapes. If there is the least doubt as to the ste- before the incision is made. For the extremities, a section
rility of the drapes or the surgeon when draping is complete, of sterile stockinette is drawn proximally over the operative
the entire process should be repeated. Unless assistants are field. The stockinette is grasped proximally and distally and
well trained, the surgeon should drape the patient. cut with scissors to uncover the area of the proposed inci-
In the foundation layer of drapes, towel clips or skin sta- sion. Its cut edges are pulled apart, and the area is covered
ples are placed not only through the drapes but also through by a transparent adhesive-coated material (Fig. 1.9). A large
the skin to prevent slipping of the drapes and exposure of transparent plastic adhesive drape may be wrapped entirely
the contaminated skin. In every case, the foundation drapes around the extremity or over the entire operative field so that
should be placed to overlap the prepared area of skin at least 3 the stockinette is not needed. The incision is made through
inches (7.5 cm). During draping, the gloved hands should not the material and the skin at the same time. The edges of the
come in contact with the prepared skin. incision are neatly draped, and the operative field is virtu-
Cloth drapes are being replaced with disposable paper ally waterproof; this prevents the drapes in some areas from
and plastic drape packages specifically designed for the area becoming soaked with blood, which can be a source of con-
to be draped (Figs. 1.7 and 1.8). A disposable drape pack- tamination. The plastic adhesive drape minimizes the need
age should have at least one layer made of waterproof plastic for towel clips or staples around the wound edge and allows
to prevent fluids from soaking through to unprepared areas the entire undraped field to be seen easily. Visibility is espe-
of the body. Drape packages for bilateral knee and foot sur- cially important when there are scars from previous injuries
gery also are available. Paper drapes shed lint that collects on or surgery that must be accommodated by a new incision. Old
exposed horizontal surfaces in the operating room if those incisions should be traced with a sterile marking pen before
surfaces are not cleaned daily. application of plastic adhesive drape material.
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10 PART I GENERAL PRINCIPLES
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CHAPTER 1 SURGICAL TECHNIQUES 11
TABLE 1.3
Anticoagulant Reversal
ANTITHROMBOTIC REVERSAL AGENT(S) COMMENTS
DIRECT THROMBIN Idarucizumab (Praxbind)—only used for reversal of dabigatran Use of PCC
INHIBITORS (DTIs) (Pradaxa) Idarucizumab:
PO: Restrictions: patients confirmed to have recent dabigatran use n REQUIRES ATTENDING
(May be considered for dabigatran reversal if idarucizumab not (TT) rules out clinically
available) relevant dabigatran effect
Dose*: 1500 units × 1 (optional rescue dose of 1500 units avail- n Do not use INR
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12 PART I GENERAL PRINCIPLES
TABLE 1.3
Anticoagulant Reversal—cont’d
ANTITHROMBOTIC REVERSAL AGENT(S) COMMENTS
IV: IV DTIs:
n Argatroban n Short half-life and discontinuation of IV DTIs are primary means
mal renal function administer via IV push over 5 min in the order comments
n Rivaroxaban (Xarelto) Use within 4 hr of reconstitution
n Additional options:
Half-life 5-9 hr Onset: <30 min n If rivaroxaban, apixaban, or
penia (HIT). In this instance, please contact pharmacy to discuss Laboratory measurement:
possible use of the alternative procoagulant FEIBA for reversal. n A normal anti-Factor Xa
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CHAPTER 1 SURGICAL TECHNIQUES 13
TABLE 1.3
Anticoagulant Reversal—cont’d
ANTITHROMBOTIC REVERSAL AGENT(S) COMMENTS
WARFARIN SUPRATHERAPEUTIC INR Phytonadione (Vitamin K) Use of Kcentra:
Half-life 36 hr (5 days for n INR 5-9: Omit 1-2 warfarin doses Dose: See box on left n REQUIRES ATTENDING
n Hold warfarin and give Vit K Caution: IV—may be associ- END OF Kcentra/FFP
5-10 mg IV (may repeat q 12 h ated with very small risk INFUSION
based on repeat INR) of anaphylaxis
MAJOR OR LIFE-THREATENING FFP
BLEED: Dose: See box on left
n Hold warfarin and give Vit K 10 Administration: At least 10
mg IV (may repeat q 12 h based mL/min
on repeat INR) Onset: 2-6 hr
PLUS either Kcentra (preferred) Caution: Carries risk of infec-
or FFP tion, must be thawed and
n Kcentra 1500 units × 1 OR a large volume is required
n FFP 10-30 mL/kg (often >1 L)
SURGERY REVERSAL Kcentra
n INR >1.5-2.5 Dose: 1500 units × 1
Surgery <24 hr: (optional rescue dose
0.5-1 mg IV Vit K × 1; ±5-8
n of 1500 units available
mL/kg FFP if hemostasis or desired
Surgery 24-96 hr: target INR not achieved)
0.5-1 mg PO Vit K ×1; moni-
n Administration: Send
tor INR q12-24hr Kcentra Kit for bedside
n INR >2.5-5 reconstitution and admin-
Surgery <24 hr: ister via IV push over 5 min
1-2.5 mg IV Vit K × 1; ±5-8
n n Use within 4 hr of
mL/kg FFP reconstitution
Surgery 24-96 hr: Onset: <30 min
1-2.5 mg PO Vit K × 1;
n Caution: thrombotic risk
monitor INR q12-24hr Kcentra contains trace
amounts of heparin (to
mitigate thrombotic poten-
tial) and should not be
used in bleeding patients
with active or recent (last
100 days) heparin-induced
thrombocytopenia (HIT). In
this instance, please contact
pharmacy to discuss possible
use of the alternative proco-
agulant FEIBA for reversal.
*Doses are NOT based on high-quality evidence and are intended as suggestions only.
DDAVP, Desmopressin; FFP, fresh frozen plasma; INR, International Normalized Ratio; IV, intravenous; LMWH, low-molecular-weight heparin; PCC, prothrombin
complex concentrates (Kcentra); rVIIa, recombinant active factor VIIa (NovoSeven); SIVP, slow intravenous push; UFH, unfractionated heparin.
Consider the following agents if patient refractory to standard therapies:
DDAVP:
Mechanism: increases release of vWF and enhances platelet adhesion and aggregation
Dose: 0.3 mcg/kg in 50 mL NS IV over 15 min
Caution: Serial doses associated with tachyphylaxis, hyponatremia, and seizures
Aminocaproic acid:
Mechanism: antifibrinolytic
Dose: 4-5 g loading dose in 250 mL NS over 15 min followed by infusion of 1 g/hr infusion until bleeding subsides (max 30 g/day)
Caution: May require renal adjustment.
Tranexamic acid:
Mechanism: antifibrinolytic
Dose: 1 g loading dose in 50 mL NS IV over 10 min followed by 1 g in 250 mL NS infused over the next 8 hr
Caution: May require renal adjustment
From Dilworth T, Burnett A, Tawil I, Garcia D, Fletcher: Guideline for antithrombotic reversal. UNM Health System. Anticoagulation Subcommittee, UNMH P&T
Committee. Updated October 2016. PDF downloads from here: https://hospitals.health.unm.edu/intranet7/apps/doc_management/index.cfm?document_id=198547.
booksmedicos.org
14 PART I GENERAL PRINCIPLES
TABLE 1.4
Antiplatelet Reversal
HALF-LIFE REVERSAL AGENT COMMENTS
ASPIRIN 15-30 min DDVAP n Short half-life and discontinu-
5-10 days for platelet Dose: 0.3 mcg/kg IV × 1 ation of GP IIb-IIIa are primary
recovery Administration: over 15 min means of attenuating bleed
Onset: Immediate n May consider transfusion
fixation and bone grafting are discussed here. The methods of techniques described in Chapter 71. With this suture, pull
tendon suture are discussed in Chapter 66. the tendon distally, removing all slack, and determine the
point of attachment.
Drill a hole transversely into the bone just distal to this
n
and tendons are discussed; and under the discussion of ten- hole in the bone and suture the tendon to itself (Fig.
don transfers in Chapter 71. The following discussion deals 1.10B). If passing the tendon or piece of fascia through
only with the methods of attaching a tendon to bone. the hole drilled in bone is difficult, construct a homemade
Attaching tendon to bone can be a fairly easy task. Healing Chinese finger trap from two pieces of suture woven
of tendon to bone with something close to biologically normal around the tendon (Fig. 1.11).
tissue is the challenge. Multiple modalities such as osteoinduc- If a distally based strip of iliotibial band is to be inserted
n
tive growth factors, periosteal grafts, osteoconductive factors, into bone, roll the part of the band that is to be insert-
platelet-rich plasma, biodegradable scaffolds, ultrasound, and ed into a cylindrical shape and wrap a suitable length
extracorporeal shockwave therapy are being studied.
booksmedicos.org
CHAPTER 1 SURGICAL TECHNIQUES 15
A B C
FIGURE 1.10 A-C, Fixation of tendon to bone. SEE TECHNIQUES
B
1.1 AND 1.5.
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Another random document with
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artist, the decorator, the paper mills’ agent, and, last of all, the printer and the
binder. This was not the way the old-time printers had planned their books.
With all their mechanical limitations, they had followed architectural lines kept
consistent and harmonious because controlled by a single mind, while the
finished volume of the eighteen-nineties was a composite production of many
minds, with no architectural plan. No wonder that the volumes manufactured,
even in the most famous Presses, failed to compare with those produced in
Venice by Jenson and Aldus four centuries earlier!
When I succeeded John Wilson as head of the University Press in 1895, I
determined to carry out the resolution I had formed four years earlier, while
sitting in on the Eugene Field conference, of following the example of the
early master-printers so far as this could be done amidst modern conditions.
Some of my publisher friends were partially convinced by my contention that
if the printer properly fulfilled his function he must know how to express his
clients’ mental conception of the physical attributes of prospective volumes in
terms of type, paper, presswork, and binding better than they could do it
themselves. The Kelmscott publications, which appeared at this time, were of
great value in emphasizing my contention, for William Morris placed printing
back among the fine arts after it had lapsed into a trade.
I had no idea, when I presented my plan, of persuading my friends to
produce typographical monuments. No demand has ever existed for volumes
of this type adequate to the excessive cost involved by the perfection of
materials, the accuracy of editorial detail, the supreme excellence of
typography and presswork, and the glory of the binding. Sweynheim and
Pannartz, Gutenberg’s successors, were ruined by their experiments in Greek;
the Aldine Press in Venice was saved only by the intervention of Jean Grolier;
Henri Étienne was ruined by his famous Thesaurus, and Christophe Plantin
would have been bankrupted by his Polyglot Bible had he not retrieved his
fortunes by later and meaner publications. Nor was I unmindful of similar
examples that might have been cited from more modern efforts, made by
ambitious publishers and printers.
What I wanted to do was to build low-cost volumes upon the same
principles as de luxe editions, eliminating the expensive materials but retaining
the harmony and consistency that come from designing the book from an
architectural standpoint. It adds little to the expense to select a type that
properly expresses the thought which the author wishes to convey; or to have
the presses touch the letters into the paper in such a way as to become a part
of it, without that heavy impression which makes the reverse side appear like
an example of Braille; or to find a paper (even made by machine!) soft to the
feel and grateful to the eye, on which the page is placed with well-considered
margins; or to use illustrations or decorations, if warranted at all, in such a way
as to assist the imagination of the reader rather than to divert him from the
text; to plan a title page which, like the door to a house, invites the reader to
open it and proceed, its type lines carefully balanced with the blank; or to bind
(even in cloth!) with trig squares and with design or lettering in keeping with
the printing inside.
By degrees the publishers began to realize that this could be done, and
when once established, the idea of treating the making of books as a
manufacturing problem instead of as a series of contracts with different
concerns, no one of which knew what the others were doing, found favor. The
authors also preferred it, for their literary children now went forth to the
world in more becoming dress. Thus serving in the capacity of book architect
and typographical advisor, instead of merely as a contrasting printer, these
years have been lived in a veritable Kingdom of Books, in company with
interesting people,—authors and artists as well as publishers,—in a delightfully
intimate way because I have been permitted to be a part of the great
adventure.
During these years I have seen dramatic changes. Wages were somewhat
advanced between 1891 and the outbreak of the World War, but even at this
latter date the cost of manufacturing books was less than half of what it is now.
This is the great problem which publishers have to face today. When the cost
of everything doubled after the World War, the public accepted the necessity
of paying twice the price for a theater ticket as a matter of course; but when
the retail price of books was advanced in proportion to the cost of
manufacture, there was a great outcry among buyers that authors, publishers,
and booksellers were opportunists, demanding an unwarranted profit. As a
matter of fact, the novel which used to sell at $1.35 per copy should now sell
at $2.50 if the increased costs were properly apportioned. The publisher today
is forced to decline many promising first novels because the small margin of
profit demands a comparatively large first edition.
Unless a publisher can sell 5,000 copies as a minimum it is impossible for
him to make any profit upon a novel. Taking this as a basis, and a novel as
containing 320 pages, suppose we see how the $2.00 retail price distributes
itself. The cost of manufacture, including the typesetting, electrotype plates,
cover design, jacket, brass dies, presswork, paper, and binding, amounts to 42
cents per copy (in England, about 37 cents). The publisher’s cost of running
his office, which he calls “overhead,” is 36 cents per copy. The minimum
royalty received by an author is 10 per cent. of the retail price, which would
give him 20 cents. This makes a total cost of 98 cents a copy, without
advertising. But a book must be advertised.
Every fifty dollars spent in advertising on a five thousand edition adds a
cent to the publisher’s cost. The free copies distributed for press reviews
represent no trifling item. A thousand dollars is not a large amount to be spent
for advertising, and this means 20 cents a copy on a 5000 edition, making a
total cost of $1.18 per copy and reducing the publisher’s profit to 2 cents, since
he sells a two-dollar book to the retail bookseller for $1.20. The bookseller
figures that his cost of doing business is one-third the amount of his sales, or,
on a two-dollar book, 67 cents. This then shows a net profit to the retail
bookseller of 13 cents, to the publisher of 2 cents, and to the author of 20
cents a copy.
Beyond this, there is an additional expense to both bookseller and
publisher which the buyer of books is likely to overlook. It is impossible to
know just when the demand for a book will cease, and this means that the
publisher and the bookseller are frequently left with copies on hand which
have to be disposed of at a price below cost. This is an expense that has to be
included in the book business just as much as in handling fruit, flowers, or
other perishable goods.
When a publisher is able to figure on a large demand for the first edition,
he can cut down the cost of manufacture materially; but, on the other hand,
this is at least partially offset by the fact that authors whose books warrant
large first editions demand considerably more than 10 per cent. royalty, and
the advertising item on a big seller runs into large figures.
I wish I might say that I had seen a dramatic change in the methods
employed in the retail bookstores! There still exists, with a few notable
exceptions, the same lack of realization that familiarity with the goods one has
to sell is as necessary in merchandizing books as with any other commodity.
Salesmen in many otherwise well-organized retail bookstores are still painfully
ignorant of their proper functions and indifferent to the legitimate
requirements of their prospective customers.
Some years ago, when one of my novels was having its run, I happened to
be in New York at a time when a friend was sailing for Europe. He had
announced his intention of purchasing a copy of my book to read on the
steamer, and I asked him to permit me to send it to him with the author’s
compliments. Lest any reader be astonished to learn that an author ever buys a
copy of his own book, let me record the fact that except for the twelve which
form a part of his contract with the publisher, he pays cash for every copy he
gives away. Mark Twain dedicated the first edition of The Jumping Frog to “John
Smith.” In the second edition he omitted the dedication, explaining that in
dedicating the volume as he did, he had felt sure that at least all the John
Smiths would buy books. To his consternation he found that they all expected
complimentary copies, and he was hoist by his own petard!
With the idea of carrying out my promise to my friend, I stepped into one
of the largest bookstores in New York, and approached a clerk, asking him for
the book by title. My pride was somewhat hurt to find that even the name was
entirely unfamiliar to him. He ran over various volumes upon the counter, and
then turned to me, saying, “We don’t carry that book, but we have several
others here which I am sure you would like better.”
“Undoubtedly you have,” I agreed with him; “but that is beside the point. I
am the author of the book I asked for, and I wish to secure a copy to give to a
friend. I am surprised that a store like this does not carry it.”
Leaning nonchalantly on a large, circular pile of books near him, the clerk
took upon himself the education of the author.
“It would require a store much larger than this to carry every book that is
published, wouldn’t it?” he asked cheerfully. “Of course each author naturally
thinks his book should have the place of honor on the bookstalls, but we have
to be governed by the demand.”
It was humiliating to learn the real reason why this house failed to carry
my book. I had to say something to explain my presumption even in assuming
that I might find it there, so in my confusion I stammered,
“But I understood from the publishers that the book was selling very
well.”
“Oh, yes,” the clerk replied indulgently; “they have to say that to their
authors to keep them satisfied!”
With the matter thus definitely settled, nothing remained but to make my
escape as gracefully as circumstances would permit. As I started to leave, the
clerk resumed his standing position, and my eye happened to rest on the pile
of perhaps two hundred books upon which he had been half-reclining. The
jacket was strikingly familiar. Turning to the clerk I said severely,
“Would you mind glancing at that pile of books from which you have just
risen?”
“Oh!” he exclaimed, smiling and handing me a copy, “that is the very book
we were looking for, isn’t it?”
It seemed my opportunity to become the educator, and I seized it.
“Young man,” I said, “if you would discontinue the practice of letting my
books support you, and sell a few copies so that they might support me, it
would be a whole lot better for both of us.”
“Ha, ha!” he laughed, graciously pleased with my sally; “that’s a good line,
isn’t it? I really must read your book!”
The old-time publisher is passing, and the author is largely to blame. I have
seen the close association—in many cases the profound friendship—between
author and publisher broken by the commercialism fostered by some literary
agents and completed by competitive bids made by one publishing house to
beguile a popular author away from another. There was a time when a writer
was proud to be classified as a “Macmillan,” or a “Harper” author. He felt
himself a part of the publisher’s organization, and had no hesitation in taking
his literary problems to the editorial advisor of the house whose imprint
appeared upon the title pages of his volumes. A celebrated Boston authoress
once found herself absolutely at a standstill on a partially completed novel. She
confided her dilemma to her publisher, who immediately sent one of his
editorial staff to the rescue. They spent two weeks working together over the
manuscript, solved the problems, and the novel, when published, was the most
successful of the season.
Several publishers have acknowledged to me that in offering unusually
high royalties to authors they have no expectation of breaking even, but that to
have a popular title upon their list increases the sales of their entire line. The
publisher from whom the popular writer is filched has usually done his share
in helping him attain his popularity. The royalty he pays is a fair division of the
profits. He cannot, in justice to his other authors, pay him a further premium.
Ethics, perhaps, has no place in business, but the relation between author
and publisher seems to me to be beyond a business covenant. A publisher may
deliberately add an author to his list at a loss in order to accomplish a specific
purpose, but this practice cannot be continued indefinitely. A far-sighted
author will consider the matter seriously before he becomes an opportunist.
During the years that followed I served as his typographic mentor. He was
eager to try weird and ingenious experiments to bring out the various points of
his theories through unique typographical arrangement (see opp. page). It
required all my skill and diplomacy to convince him that type possessed rigid
limitations, and that to gain his emphasis he must adopt less complicated
methods. From this association we became the closest of friends, and
presuming upon this relation I used to banter him upon being so casual. His
copy was never ready when the compositors needed it; he was always late in
returning his proofs. The manufacture of a Fletcher book was a hectic
experience, yet no one ever seemed to take exceptions. This was characteristic
of the man. He moved and acted upon suddenly formed impulses, never
planning ahead yet always securing exactly what he wanted, and those
inconvenienced the most always seemed to enjoy it.
“I believe,” he used to say, “in hitching one’s wagon to a star, but I always
keep my bag packed and close at hand ready to change stars at a moment’s
notice. It is only by doing this that you can give things a chance to happen to
you.”
Among the volumes Fletcher had with him on board ship was one he had
purchased in Italy, printed in a type I did not recognize but which greatly
attracted me by its beauty. The book bore the imprint: Parma: Co’tipi Bodoniani.
Some weeks later, in a small, second-hand bookstore in Florence, I happened
upon a volume printed in the same type, which I purchased and took at once
to my friend, Doctor Guido Biagi, at the Laurenziana Library.
“The work of Giambattista Bodoni is not familiar to you?” he inquired in
surprise. “It is he who revived in Italy the glory of the Aldi. He and Firmin
Didot in Paris were the fathers of modern type design at the beginning of the
nineteenth century.”
“Is this type still in use?” I inquired.
“No,” Biagi answered. “When Bodoni died there was no one worthy to
continue its use, so his matrices and punches are kept intact, exactly as he left
them. They are on exhibition in the library at Parma, just as the old Plantin
relics are preserved in the museum at Antwerp.”
GIAMBATTISTA BODONI, 1740–1813
From Engraving at the Bibliothèque Nationale, Paris