Description
Orthopaedic surgery today is undergoing a phase of vara, pseudarthrosis of the neck of the femur, and osteo turbulent development. Once the essential aim of treatment arthritis, even in cases which up to now would usually have been considered incurable. consisted in restitution of anatomy by surgery in order to This atlas not only shows convincing results of such restore function. Various forms of alloplasty have recently become fashionable for the treatment of joint diseases. treatment. Above all, it gives interested clinicians a line to The main reason for this vogue is that restoration of follow and sets out precise indications for the practical normal anatomy improves function and alleviates pain steps of the operations. only in certain special instances. I am especially grateful to Professor B. Kummer who, as Alternatively, the implantation of artificial joints of an anatomist, acted as the devil's advocate, and subjected different types has been presented as the method of the new concepts in functional anatomy and biomechanics choice because the immediate results are often spectacular shown in the atlas to critical analysis. I. Theoretical Foundation.- 1. Loading and Stressing.- 2. Effect of Mechanical Stress on the Skeleton.- a) Influence of Mechanical Stress on Mature Bone.- b) Influence of Type of Mechanical Stress on the Differentiation of Supporting Tissue.- 3. Physiological Load on the Upper Extremity of the Femur.- 4. Survey of the Types of Stress That Occur.- 5. Influence of the Area of the Loaded Surface on the Magnitude of Stressing.- 6. Fundamental Stressing of a Long Bone.- 7. Physiological Stress at the Upper End of the Femur.- 8. The Functional Architecture of the Upper End of the Femur.- 9. The Consequence of a Disturbance of the Equilibrium between Tissue Resistance and Mechanical Stressing.- 10. Basic Treatment of the Three Conditions Mentioned: Congenital Coxa Vara, Osteoarthritis, and Pseudarthrosis of the Neck of the Femur.- 11. The Influence of the Neck/Shaft Angle on the Load and Stressing of the Upper End of the Femur.- a) Influence of the Neck/Shaft (CCD) Angle on the Loading of the Upper End of the Femur.- b) Influence of the Neck/Shaft Angle on the Stressing of the Upper End of the Femur.- 12. The Trajectorial Structure of Cancellous Bone as a Proof of the Stressing of the Femoral Neck.- II. Biomechanical Analysis and Basic Treatment of Congenital Coxa Vara, Pseudarthrosis of the Femoral Neck, and Osteoarthritis of the Hip.- A. Congenital Coxa Vara.- 1. Pathology and Biomechanics.- 2. Principles of Treatment of Congenital Coxa Vara during the Growth Period.- a) Recurrences after the Neck/Shaft Angle Has Been Restored to Normal.- b) Lasting Results Obtained by Adaptation of the Mechanical Stress to Defective Tissue.- 3. The Y Osteotomy as Basic Treatment.- a) Definition and Consequences.- b) Planning and Execution of the Operation.- c) Results of the Y Osteotomy.- B. Pseudarthrosis of the Neck of the Femur.- 1. Influence of the Type of Mechanical Stress on the Healing of a Fracture.- 2. Classification of Fractures of the Femoral Neck from the Biomechanical Standpoint.- 3. The Special Case of the Abduction Fracture.- 4. Basic Treatment of Pseudarthrosis of the Neck of the Femur by Alteration of the Type of Mechanical Stress.- a) Reorientation of the Fracture Surfaces by Intertrochanteric Wedge Osteotomy.- b) Planning and Technique of the Reorientation Osteotomy.- c) Reorientation by Y Osteotomy.- d) Planning and Procedure of Reorientation by Y Osteotomy.- e) Results of Y Reorientation Osteotomy.- f) Reorientation of the Pseudarthrosis with Reshaping of the Bone by Wedge Resection.- g) Treatment of Necrosis of the Femoral Head.- 5. Reconstruction of the Femoral Neck by Bone Grafting.- 6. Influence of the Position of a Graft in Contact with Bone on the Magnitude of the Mechanical Stress.- C. Osteoarthritis.- 1. The Pathological Entity and Its Relation to Mechanics.- a) Disturbance of the Biomechanical Equilibrium.- b) The Influence of Articular Cartilage on the Magnitude and Distribution of Joint Pressure.- c) The Outline of the Bony Condensation in the Acetabular Roof (Sourcil) as a Representation of the Diagram of the Compressive Stresses.- d) The Effect on the Hip Joint of Relatively Excessive Pressure.- 2. The Task of Basic Treatment.- 3. The Diminution of Articular Pressure by Reduction of the Load When the Articular Surfaces Are Congruent (Voss, McMurray).- 4. The Reduction of Joint Pressure by Increasing the Weight-Bearing Area Where There Is Incongruence of the Joint Contours.- a) The Adduction-Varus Osteotomy (PI) and the Abduction-Valgus Osteotomy (PH).- b) The Indications and Planning for the Varus (Adduction) Osteotomy (PI) and for the Valgus (Abduction) Osteotomy (PH).- c) Results of the Varus (Adduction) Osteotomy (PI) in the Incipient Stages of Osteoarthritis.- d) Results of the Varus (Adduction) Osteotomy (PI) in Advanced Cases of Osteoarthritis of the Hip.- e) Results of the Abduction (Valgus) Osteotomy (PH).- f) Results of the Abduction (Valgus) Osteotomy (PH) in Cases of Extreme Subluxation of the Femoral H
