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The AO group has developed a comprehensive classification of fractures. The classification is arranged in order of increasing severity according to the complexities of the fracture, difficulty of treatment and worsening prognosis.

More detailed information about the classification can be obtained from AO Foundation

• AO Classification – General Principles
• 11 – Proximal Humerus
• 12 – Humeral Diaphysis
• 13 – Distal Humerus
• 21 – Radius/Ulna Proximal
• 22 – Radius/Ulna Diaphysis
• 23 – Radius/Ulna Distal
• 31 – Femur Proximal
• 32 – Femur Diaphysis
• 33 – Femur Distal
• 41 – Tibia/Fibula Proximal
• 42 – Tibia/Fibula Diaphysis
• 43 – Tibia/Fibula Distal
• 43 – Tibia/Fibula Malleoli

Adamantinoma

– 1o bone tumor with predilection for tibial diaphysis presenting during early adulthood

Signs & Symptoms:
– painful masses with variable symptom duration ranging from few months to few years

Xrays:
– well-circumscribed, eccentric, lytic lesions of tibial diaphysis
– may be multicystic lesion with surrounding sclerosis
– expansion of bone +/- intact cortex but no periosteal reaction

Histology:
– wide variety of histologic appearances
– basaloid pattern composed of groups of cells which peripherally have palisading epithelial cells
– hypocellular, poorly organized, fibrous connective tissue between islands of epithelial cells

Treatment:
– wide excision (limb salvage vs amputation)
– 20-25% metastasize to lungs

Hip – posterior approach
Moore/southern

* position – lateral decubitus

* incision – 15cm curved incision centered on post. edge of GT
– curve towards PSIS or @ 30 deg. angle

* no internervous plane

* dissection
– incise fascia latae to expose vastus lateralis
– split fibers of GMax in line with fibers
– retract fibers of spit GMax
– ID short ER
– ID sciatic nerve
– IR hip to put short ER on stretch & pull operative field farther from sciatic n.
– stay sutures in piriformis & obturator internus tendons
– detach short ER from femur (piriformis, sup. gem., obt. int., inf. gem)
– may need to detach sup. border of quad. fem.
– reflect muscles backward to protect sciatic n.
– incise capsule
– dislocate hip

* dangers
– sciatic n. – always ID & protect

– IGA – leaves pelvis beneath piriformis & heads cephalad to supply deep surface of GMax
– branches cut with splitting of GMax

– cruciate anastomosis
> at lower border of QF
> anastomosis of ascending branch of 1st perforator, descending branch of inf. epigastric art., med. & lat. fem. circumflex art.

Thoracic spine – anterior approach

* position – lat. with bean bag

* incision
– usu R sided approach
– 1/2way btw spine & scapula –> ant. axillary line
– 2 ribs above level wanting to be accessed

* dissection
– divide lat. dorsi in line with skin
– divide serratus ant. in line with skin down to rib
– expose rib subperiosteally
– resect rib as far post. as possible
– nick pleura with knife
– enter pleura bluntly
– deflate lung & retract ant.
– identify esphagus
– incise pleura over lat. sid of esophagus & retract
– tie off intercostal vessels (avoid if possible due to blood supply to SC)

* dangers
– intercostal vessels
> during rib resection
> during exposure of vert. body
– lung