AO Principles of Fracture Management

For the last half century, the AO Foundation has been a pioneer in developing principles and techniques of fracture fixation. Wide-spread acceptance of its philosophy has been supported by a well-developed educational programme including instructional meetings and technical manuals. The original AO manuals of internal fixation expounding the principles of anatomical reduction and rigid internal fixation were compulsory reading for orthopaedic trauma surgeons. This book builds on the first edition published in 2000. Like its award-winning predecessor, this second edition aims to provide trainee and senior surgeons with up-to-date knowledge for correctly applying AO philosophy and principles as they apply to the management of fractures. I feel these aims have been largely met. Rapid advances in trauma knowledge during the 7 years since the first edition are recognised by the inclusion of new chapters on minimally invasive surgery, soft-tissue handling, osteoporosis and an introduction to biotechnology. All other chapters have been updated with particular reference to the increasing popularity of bridge plating/locking plates. The book consists of two volumes. Volume 1, ‘Principles’, contains sections covering basic sciences, fracture classification, decision-making, surgical principles, general topics and complications. Volume 2, ‘Specific fractures’, contains 21 chapters covering most fractures including long bones, pelvis and acetabulum, and spine. This results in some inevitable repetition with general principles covered in volume 1 being repeated in the individual chapters in volume 2. This does, however, enable each chapter to stand alone for one-off reading. For a multi-author production, the style is generally consistent between chapters. Each chapter provides an overview of relevant anatomy, surgical approaches, basic science, fracture classification (largely confined to the AO system), decision-making, surgical techniques and pitfalls. The writing style is clear and concise, making for easy reading. The illustrations and diagrams supported by short videos in the accompanying DVD are of excellent quality. Most chapters provide a clear, concise overview of their subject. Particularly strong chapters are those on fracture classification, intra-articular fractures, intramedullary nails, polytrauma (including a good description of the concept of damage control surgery), proximal humeral, pelvic and acetabular fractures. Some chapters, for example external fixator, distal radius and wrist, suffer due to restricting fixation devices described to those produced by AO. The proximal femur chapter is also too brief and lacking in operative tips for such a common subject. The spine chapter has less detail than the others, though this is probably understandable for such a large topic. Overall, there is a good number of relevant references for each subject. The arguments made in favour of the AO philosophy are generally sound. At times, it seems there is poor evidence offered to support the principles recommended, though this reflects the relative lack of randomised controlled trials in trauma surgery rather than being a criticism of this book. This book is released into a market where there is fierce competition ranging from established major reference works through other AO publications to a variety of regional or single fracture texts. Against this background, it has to be asked at whom this book is aimed. I feel it can be recommended as worthy of consideration for higher surgical trainees requiring a basic grounding in the principles of operative fracture care. Nevertheless, in an era of increasing subspecialisation in trauma care, it does not provide sufficient detail for subspecialty expertise but I feel it can be recommended for consultants providing a general trauma service outside their field of subspecialty interest.